Skin necrosis after warfarin administration suggests an inheritable cause of thrombosis.
A new article in the American Journal of Clical Nutrition (2006:84:18-28) reviews the evidence on how much vitamin D we need. The authors recommend that the USRDA be changed.
Taking 1,000 units a day only gets adequate vitamin D levels in something over 50 percent of the population. So probably, if you want to be safe, you need to take more. As I have indicated elsewhere, there is absolutely no evidence that 2,000 units a day will hurt you, even with the unscientific and paranoid methods used to calculate the current USRDA of 400 to 600 units.
I am not a nutritional zealot. I'm not pushing a bunch of supplements at you from all sides. In fact, based on the current nutritional and natural foods marketplace, I'm hesitant about advocating on any nutritional topic. In the marketplace, there are too many claims of dubious value, and I don't want to be associated with them.
Even before medical school, I have always had a sense that there was something wrong with human health, in a deep way. It didn't make sense that so many people would have so many odd diseases, or malaise, or general weakness. Over time I began to see life itself not so much as an "on-off" condition, not as a binary state, but as a quantity. Some people are more full of life than other people. Some situations make people more full of life than other situations. And this "life" that people have in them, it is not imaginary. It is a real thing, though you can't touch it, or measure it. Still, you can sense its relative presence or absence.
Looking back on my education, I see now that I have been watching for something in the human body that would explain this variation in quantity of life, and the relative absence of life in some people that leads to sickness, malase, and weakness. I have considered every organ system, every physiologic process, and every mental state looking for this answer.
What I have found, and what seems to be the problem, is widespread vitamin D deficiency.
A trial published in the New England Journal of Medicine finds little benefit to taking calcium plus vitamin D - basically no fewer fractures in the women taking the medication. I don't find this too surprising in that the dose of vitamin D was low - 400 units a day. It has been shown that it probably takes something like 2,000 units a day just to keep your level from going down. Furthermore, unless the subjects were getting a new bottle of the vitamin D supplement once a month or so, it is likely that it was decaying through oxidation, and not much was left in the bottles after a few weeks.
There was a higher incidence of kidney stones in the treatment arm of the study, so this is something to watch.
A new study by vitamin D researcher Michael Holick shows that about half of elderly women receiving prescription medications for osteoporosis don't have enough vitamin D. This is bad because inadequate vitamin D causes osteoporosis. Conversely, if you get enough, you have fewer fractures and more muscle strength.
It makes sense that if we're going to spend the energy to diagnose and treat osteoporosis, we should probably spend the effort to treat what might be causing it. It's ridiculous that we don't. It's like treating kids for lead poisoning with chelating agents without checking out the paint in the house. Or it's like treating diabetes without adjusting the diet.
Prostate cancer is much more common among black men than white men in America. This may be due to vitamin D. It is clear to me, by the way, that much of the health disparity between the races in the USA is related to the fact that people with darker skin make vitamin D more slowly when exposed to the ultraviolet radiation of sunlight. This is by no means a fringe theory or any crazy racist postulate: I got the idea from a combination of journal articles I've read over the years, and in particular one from the Journal of Human Evolution in 2000 (Jablonski, Nina G., and George Chaplin. “The Evolution of Human Skin Coloration.” Journal of Human Evolution 39, no. 1, July (2000): 57-106.).
Here's an abstract on how ultraviolet light exposure, and so probably vitamin D, is probably related to prostate cancer in the same way rickets is.
Why am I talking about this? Because I'm tired of watching black people in Buffalo die at age 45 or 55. To me, the degree to which this is a factor of poverty is overestimated.
Here's a nice new study from Russia. Only the translated abstract is available to me. Basically it's a randomized controlled trial of a tailored multi-ingredient supplement for prevention of osteoporosis in postmenopausal women. There are about 100 women in each of three arms of the trial: 125 getting the supplement, 111 getting only a calcium supplement, and 96 getting nothing. The supplement, called vitrum osteomag - some sort of proprietary formulation I'm sure - contains "600 mg calcium (1500 mg calcium carbonate), 200 IU of cholecalcepherol, 40 mg of magnesium, zinc (7.5 mg), copper (1 mg), manganese (1.8 mg) and boron (250 mcg)." Women taking this stuff did quite well, with an increase in bone mineral density of 1.5% after 12 months. That's really remarkable, in my opinion. Bisphosphonate drugs like Fosamax increase bone mineral density on the same order, a few percentage points. And this supplement probably isn't likely to rip apart your esophagus like Fosamax can. What we're probably looking at is the restoring of subclinical deficiencies of at least some these nutrients. Certainly it's a fact that most people are vitamin D deficient anyway.
Now I'm not saying people shouldn't take, or should stop taking Fosamax. Despite its documented toxicities, it's usually worth it to take it, when one considers the toxicity of death by hip fracture, which probably scores pretty high when one thinks of toxicity in general.
Merck, the manufacturer of Fosamax, in fact has perceived at least some of this reality, and has started including vitamin D along with some preparations of the drug.
More power to them. [Clap clap clap.]
In my opinion, once you open a bottle of vitamin D, you probably only have about a week or two of useful shelf-life.
When it is synthesized in a lab, vitamin D as a powder is unstable, and oxidizes rapidly, even in cool, dry air. Manufacturers package vitamin D in an inert gas, like nitrogen, without oxygen for storage and transport. When you open the bottle, oxygen gets in and can begin the decay process of the vitamin D into inactive metabolites. This is a known phenomenon, and that's one line of evidence.
Another is multiple anecdotal stories I have heard indicating that people get a benefit after they take the first one or two doses of prescription-strength vitamin D, and then the benefit wears off. For example, if they notice a reduction in body-wide pain or muscle aches, the effect is greatest during the first few weeks. Of if they notice an increase in wintertime energy, again, the effect dissipates after a few weeks. And I have noticed this myself.
Certainly there are other explanations for these reports. There may be a brief energy surge or reduction in pain from a rapid correction of a low vitamin D level, and then after the quick change the baseline metabolic processes take over again. But this is thought provoking. And the trend is such that in my opinion, it is likely that there is some decay of the vitamin.
There are a few potential answers to this problem. One is to buy a new bottle of vitamin D every few weeks. An over the counter bottle, if you find the right store and manufacturer, can cost you about $4.00, and this is a low price every few weeks for the potential benefit that the supplement can give you. Another option might be to devise some sort of inert-gas storage system, such as used to preserve wines. I haven't tried this yet.