(reprint from Flu Trackers)
Dear FT members,
Some of you know me from my posts here and elsewhere but most of you don't. For those who don't know me, I am both a primary care physician and researcher for the pharmaceutical industry. I became concerned about the possibility of pandemic influenza in 2004 when upon review of the medical literature discovered that H5N1 had reemerged within Southeast Asia. This discover lead to one event after another for me including being active in flubloggia and the author of 3 books about the coming pandemic.The information below is of significant importance to those of you interested in having the best chance of surviving infection by the pandemic strain.
What's more it will also be of importance to your children, parents, and siblings.Of all the ways I have evaluated that have the potential to be of benefit during the current pandemic and possibly beyond, having an optimal serum level of 25 OH vitamin D3 level may well be one of the best. This is why I have decided to post this information again. I urge you to copy and print out this initial thread as it could become critically important for the survival of your family and friends in the time to come.
Currently, what I recommend is that we all take 2000iu of vitamin D3 as a supplement each day. There are a few for whom this suggestion is not a good idea and they are referenced below. Otherwise, following this approach is both safe and potentially of great benefit.
Best regards,
Grattan Woodson, MD
A considerable quantity of research data published in the peer reviewed medical literature over that past 2 decades has shown that many people within the developed and underdeveloped world are vitamin D deficient. There are a variety of reasons for this finding including diet, lifestyle and use of inadequate levels of vitamin D supplements.
With regard to risk for pandemic influenza, the most important thing this data suggest for those deficient in this key vitamin is that they are much more likely to contract influenza than the vitamin D replete and are at higher risk of experiencing severe complication from this infection including cytokine storm, post influenza pneumonia and death.
The data suggests that cytokine storm seen in young victims of the current and past pandemic is due to an immune system dysregulation. It is clear that vitamin D plays an important role in immune health and being deficient in this critical substance maybe playing a causal role in this fatal complication of pandemic influenza.
The vitamin D story is quite interesting and has a long history and is not limited to influenza mitigation. What we understand today is that vitamin D is converted into a hormone by the body that has many important roles. While most think of vitamin D in relation to its role in bone and calcium metabolism what has become apparent is that this substance plays a critical role within the immune system too. People that are deficient in vitamin D are at much higher risk for a variety of common human diseases including infections, autoimmune disease and cancer due to the fact that their immune system is impaired by this condition.
Vitamin D is widely available, inexpensive, and easy to obtain both in the drug or health food store without a prescription or by simply exposing yourself to the sun on a regular basis while attired in a short sleeved shirt and sorts for 15 minutes daily.
The early adopter expert consensus is people need between 5000iu and 10,000iu of vitamin D3 daily for optimal health. This provides one who follows this recommendation after a few months with an optimal serum level of 25 OH vitamin D3 of between 50 ng/ml and 80 ng/ml. What’s more, despite the fact that this dose is between 12 and 24 times greater than the US RDA, the data show the supplementing with vitamin D3 at this level has almost no risk of toxicity.
The US RDA for vitamin D of 400iu is clearly too low to provide immunological benefits but is enough to prevent rickets in children. The US RDA is focused entirely upon rickets prevention since it was established many years ago when it was first understood that vitamin D deficiency caused rickets and that by adding 400iu to the daily diet prevented this bone disease. What we understand today is that while one might be able to avoid rickets with this very low dose of vitamin D, there are many other things vitamin D does that are not prevented by this very small daily dose. Many people who obtain a dose of 400iu vitamin D daily remain deficient in this key vitamin, as we now understand what having an adequate serum level of this substance means.
Current studies show that people need much more vitamin D each day for optimal health than 400iu per day. At a minimum what research scientists whose work is focused on this vitamin recommend is that people have at least 5,000iu of vitamin D3 each day. It is remarkable and frankly surprising that these dose suggestions are between 12 and 24 times higher than the US RDA and there is some older data to suggest that people taking supplements in this range could be placing themselves at risk for harm. However most recent studies show that this is not the case. Rather these data show that it is very rare for anyone to suffer vitamin D excess until they obtain more than 30,000iu on a daily basis from all sources for at least two months.
It requires about 2000iu of vitamin D3 daily to obtain a level of 32ng/ml of 25OH vit D3, the minimum needed for bone health. To approach optimum health with vitamin D, meaning a level that encompasses both bone and immune health requires having a serum 25 OH vit D3 level between 50ng/ml and 80ng/ml. To achieve this serum level of 25 OH vit D require a daily intake of between 5,000iu and 10,000iu.
What is meant by optimal health? This means having enough vitamin D to prevent common disorders including infections like flu and solid tumors including breast and colon cancer. There are other cancers that can be prevented by having optimum levels of this vitamin including prostate, uterine, ovarian and non-melenoma skin cancer. This is a very exciting new field of medical research and the answers regarding these purported benefits have not yet been proven but what is clear is there are a considerable body of evidence being accumulated at a rapid clip that support both the efficacy and safety of vitamin D used for these purposes.
With respect to flu as well as these other serious common chronic diseases, having a serum 25 OH vit D3 level of between 50ng and 80 ng/ml is regarded as optimum. IMO, those who obtain the goal are those who are most likely to be able to experience an asymptomatic case of flu during this pandemic and if they become symptomatic are much more likely to have a benign course. Of course there are no guarantees in life and while having optimum levels of vitamin D has many potential benefits it is clear that it is no panacea. There are many reasons people die as a result of becoming infected with pandemic influenza with one of them probably being vitamin D deficient. What is important is to recognize this fact before being exposed to the virus and taking action now to obtain optimum serum levels of the vitamin. By doing so at a minimum you remove this source of risk from infection with the pandemic strain.
Getting your vitamin D3 from the sunWhat is remarkable is light skinned people can obtain 15,000iu of Vitamin D3 by getting a MED (minimal erythema dose) meaning in the buff with 7.5 min on the front and back sides at high noon in the summer below 45 degrees latitude on a clear day. MED means not getting sunburned but just before it.
It is of interest that people of color need more sun expose than pale skinned people. A dark African American needs as much as 4 times this exposure to get the same benefit. So, what is needed is to time your exposure according to your skin tone.
An interesting thing about getting your vitamin D3 from the sun is that you cannot get too much! Why, because for the white person who gets their MED and 15,000iu of D3 in 15 minutes, if they stay out longer, while new D3 is being made, the UV light is destroying the D3 made earlier. This is apparently nature's way of preventing us from becoming vitamin D toxic from sun exposure. This means that there is no added benefit to exposing yourself for more than the MED.
Now, if you don't have a good place to obtain your MED in the nude, then you can do it in shorts and a short-sleeved shirt or bathing suit. This obviously reduces your exposed skin by up to 40% depending on the style of clothes, so in this instance for the white person, they will get about 6000iu of D3 with 15 minutes of full sun expose, an excellent dose. But remember, if you stay out longer, all you do is burn and damage your skin with no added vitamin D3 production so either go inside or put on sunscreen from that point on.
Sunscreen completely blocks the skins ability to make vitamin D3 so use it but not until after you have gotten your MED. Yes, tanned white folks will need to spend more time in the sun to get the full benefit.
The older you get the less efficient the skin becomes converting sunshine into vitamin D3. I think people in their 50s and 60s are able to convert much of the sun they receive into vitamin D3 but once you get into the 70s, then skin production gets pretty low. The best bet for older folks is to take at least 5,000iu of vitamin D3 daily.
Who should avoid vitamin D supplementation? There are some medical conditions where vitamin D3 supplementation should be avoided or at least delayed until the condition is treated or cured.
Primary Hyperparathyroidism: this disorder is associated with high blood calcium levels, high vitamin D levels, kidney stones and osteoporosis. It is usually due to a benign tumor of one of the 4 parathyroid glands in the neck. Until the tumor has been removed, vitamin D3 supplementation is not recommended because it could make the consequences of this disease worse.
Sarcoidosis: this is a disease of unknown cause that is associated with abnormal production of activated vitamin D. Hypercalcemia is commonly seen with this condition especially in those who take vitamin D3 supplements. In this case, vitamin D supplementation should only be undertaken under your physician's guidance. Kidney Stones: Most kidney stones contain calcium but not all kidney stones are due to calcium. If you have had kidney stones, vitamin D supplementation is not recommended until after the cause for the stones has been determined and treated and then only under the supervision of your physician.
Unexplained Hypercalcemia: If your blood calcium level has been elevated in the past or is presently, then vitamin D supplementation is not recommended until the cause of this is determined and an appropriate treatment has been applied. Afterward depending on the cause of the elevated calcium level and only with your doctors supervision can vitamin D supplementation be considered.
Renal insufficiency or failure: Chronic kidney disease that leads to reduced function is a complex medical disorder that affects vitamin D levels and metabolism. Patients with this problem should not supplement on their own rather they should only do so with their physician's guidance which might include forms of vitamin D available only by prescription.
Children: While children need vitamin D just as adults do, the safe dose for use in them is not certain. It is probably true that the recommended RDA for children is much too low as is the case for adults. The optimal 25 OH vit D3 range in children is the same as it is for adults but the adult dose is probably too high for kids. For kinds then, one should not give them more than 2000 iu per day in the form of a supplement. Parents are advised to depend more of the sun as a source of vitamin D for their kids as it is impossible to get too much vitamin D from the sun although as in adults, in no case should you allow your child to remain in the sun long enough to obtain a sunburn. After 15 minutes of exposure, apply sunscreen to prevent this.
Children and adults living in the far northern or southern latitudes must use supplements to obtain vitamin D since sun exposure is inadequate. In this case, a starting dose of 2,000iu per day of vitamin D3 would be reasonable for kids and 5,000iu for adults. Monitoring blood levels of 25 OH vit D3 is recommended on the same schedule as for kids and adults. Working to obtain the optimal serum 25 OH vit D3 range with a "vitamin D friendly pediatrician or family physician" is the best strategy.
Interpretation of Serum Vitamin D Results
First rule, ignore the normal range provide by the lab as these have not kept pace with the research.
25 OH vit D3 level <> 32ng/ml is adequate for bone health
25 OH vit D3 level > 50ng/ml is adequate for bone and immune health
25 OH vit D3 level > 80ng/ml is the highest recommended level
25 OH vit D3 level > 120ng/ml can cause toxic hypercalcemia and is potentially dangerous
The goal for optimal health is to maintain a 25 OH vit D3 level between 50ng/ml and 80ng/ml
You can buy vitamin D3 in health food stores and online in much higher doses than 400iu I have seen doses as high as 5000iu but this is rare. More commonly, you will find doses of 1000iu and 2000iu of vitamin D3. Vitamin D2 is also sold but the experts recommend D3 over D2.
Recommended vitamin D3 dosing for optimal health To obtain a serum 25 OH vit D3 level of >50ng/ml but <80ng/ml,>80ng/ml decrease your supplement. In the event that you are either above or below the goal range, it is necessary to recheck you level again after 2 months on the new regimen.
Once within the goal range, check your level annually to ensure that your regimen remains adequate.
Everyone should have their vitamin D level checked This is a simple test to have and while it is not cheap, it might be covered by insurance if you have it. If not, while the test cost varies, on average it is about $75 or so. The test to have is a 25 hydroxyvitamin D3 level (25 OH vit D3).
Interpretation of Serum Vitamin D Results
First rule, ignore the normal range provide by the lab as these have not kept pace with the research.
25 OH vit D3 level <> 32ng/ml is adequate for bone health
25 OH vit D3 level > 50ng/ml is adequate for bone and immune health 25 OH vit D3 level > 80ng/ml is the highest recommended level
25 OH vit D3 level > 120ng/ml can cause toxic hypercalcemia and is potentially dangerous
The goal for optimal health is to maintain a 25 OH vit D3 level between 50ng/ml and 80ng/ml
You can buy vitamin D3 in health food stores and online in much higher doses than 400iu I have seen doses as high as 5000iu but this is rare. More commonly, you will find doses of 1000iu and 2000iu of vitamin D3. Vitamin D2 is also sold but the experts recommend D3 over D2.
Conclusion
It is true that these recommendations sound radical because they are so much higher than the standard recommendation. I thought the same when I first encountered them but have come to be a supporter of them over the last few years but especially of late. Education is a powerful tool. Don’t take my word for this. You can use the Internet to investigate this for yourself and this is what I recommend. Go on Google scholar and search vitamin D and immunity or vitamin D and infectious disease or vitamin D and dose and toxicity.
You will find a lot of very interesting articles that reflect the ebb and flow of this debate that has now become pretty clearly resolved in favor of people needing between 5000iu and 10,000iu of D3 for optimal health, not just rickets prevention.
Nevertheless, the vitamin D nay Sayers remain a potent force and have not capitulated. It will be some time before the conservative keepers of the RDA increase the recommendation for the general public. IMO, the argument has been won and resoundingly in favor of taking a lot more vitamin D than the RDA but this is something that you can investigate for yourself and decide this on the merits as I have. Grattan Woodson, MD
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If you prefer to ignore current research and view a paper from 1918 I would suggest this paper;
THE OPEN AIR TREATMENT OF INFLUENZA. (circa 1918)
WILLIAM A. BROOKS,
Surgeon-General, Massachusetts State Guard.
http://www.ajph.org/cgi/reprint/8/10/746.pdf.
It took me a while to figure this out. But as we say in Massachusetts “Light dawns on Marblehead”. This type diet faces many problems for the foods we find in the supermarket vary in composition from those found in the equatorial jungle. Supermarket, higher latitude crops and selections are geared to D deficient people. Even the accepted food pyramid is based on D deficient people and the changes D deficiency produces in the human digestive process.
