Vitamin D

Vitamin D helps fibromyalgia

There's tremendous overlap between the symptoms of fibromyalgia and some of the symptoms of vitamin D deficiency. In some people, low vitamin D causes a body-wide pain and a hypersensitivity to touch, along with fatigue and depression - very similar to fibromyalgia. There are differences, though. For example, fibromyalgia classically involves trigger points. 

Now a small study shows that vitamin D helps fibromyalgia patients. This was a randomized, blinded, controlled study, which is pretty high quality design. The numbers were low - 30 patients - but the study reached statistical significance despite that, which argues that the effect of vitamin D was strong. 

So anyway, they took 30 patients with fibromyalgia, randomized them, and used supplementation to increase vitamin D levels from the 20's to around 50 ng/ml. After a few weeks, the group getting vitamin D had lower pain and higher levels of physical function. 

Not bad for a stupid vitamin. Of course, as I have noted previously, vitamin D appears to lower death rates, so we know something's going on here. I never said this stuff was a miracle cure for everybody - but it appears to be doing some good for at least some people.

Vitamin D makes ballerinas stronger

One of the classic manifestations of vitamin D deficiency is reduced muscle strength, and if you want to be as strong as possible, you must avoid deficiency. Deficiency of course is relatively common, and supplementation is cheap and safe. 

Professional ballerinas train indoors for up to 8 hours a day, with little exposure to sunlight. They tend to have low vitamin D levels in the wintertime. They are prone to injuries. At the Birmingham (UK) Royal Ballet, a study in 2012 demonstrated low vitamin D levels.

In this study, 24 volunteers were enrolled in a randomized trial. Seventeen received a 2,000 units of vitamin D a day for 4 months. Seven were controls.

 

The ballerinas taking the vitamin D had 19% higher quadriceps strength. They also could jump 3 cm higher, and had fewer injuries during the four months. 

How does the increase in strength happen? It's not clear, but correcting vitamin D deficiency increases muscle protein synthesis, and increases muscle concentrations of ATP. (For non-healthcare-types, think of ATP as a bunch of little tiny batteries flying around in the body, giving energy where it is required.) 

The ballerina study was not blinded, and not randomized, which makes it weaker. Nontheless the results are thought-provoking. How many injuries could be prevented with this simple intervention? How many athletic careers are cut short for lack of the few percentage points of performance vitamin D could provide? 

And of course, in my fair city of Buffalo, how many Superbowls could have been won?

 

 

A problem with all the vitamin D data: the stuff decays rapidly

The older I get, the more experience I have with vitamin D, the more I realize that this stuff starts to decay as soon as you open the bottle. I think it's gone within 6 weeks.

If this is true, it creates a tremendous confounder for all the published vitamin D literature that measures the effects of supplements. All the research, in other words, might have a significant problem. What a pain, if one is  trying to be scientific about all this. 

What evidence do I have of this? First, according to this chemical database from the NIH, vitamin D3 (cholecalciferol) is "oxidized and inactivated by moist air within a few days."

Second, I have direct observation. When I was working at the Buffalo Psychiatric Center in the early 2000s, I found many patients with vitamin D deficiency. I started supplementing them with what was standard at the time: ergocalciferol (vitamin D2) 50,000 units a week. At first this worked well, but after a few months I found that I couldn't get the vitamin D levels up despite this large-dose supplementation. Could all my patients have malabsorption? I doubted it. So, after seeing the information above about vitamin D degradation, I went down to the pharmacy and asked them how they store it. They had opened a bottle about six months previously and individually packed the pills into blister packs. So essentially the vitamin D had been sitting in air for the past six months. 

The makers of Replesta apparently have figured this out. (I have no relationship with the company.) They individually wrap their high-dose vitamin D in little foil packets. I have started using this stuff in my office, the vitamin D levels go up very rapidly, to the point that I have to change my practice patterns. I rarely give 50,000 units a week any more; that turns out to be too much. Now it's 14,000 a week for almost everybody. 

So based on this perspective, and considering that I have never seen a research study indicate how vitamin D is stored after it is dispensed to the research subjects, I am being careful about interpreting clinical trials of vitamin D. They may underestimate the true effect of this steroid hormone. 

 

Vitamin D reduces death rates in the elderly

I'm looking at the systematic review by Autier from Lancet Diabetes and Endocrinology. It finds basically zero effect of vitamin D supplementation for any health outcome. Except overall mortality. Vitamin D supplementations trials have consistently shown a reduction in death rate  by about 7 percent. Autier believes this is mostly due to supplementation in elderly people who are debilitiated. 

I've got to say, in clinical practice, what I see largely mirrors what Autier has found, in terms of vitamin D's effects on diseases. There are no real miracles here - except in the cases where the vitamin D level is profound, and supplementing it helps musculoskeletal weakness and pain. For example, there's the 2000 case series by Dandona's folks, reporting people who got up out of wheelchairs after being given vitamin D supplementation. Only a case series, but a compelling story.

But the real news is the decrease in mortality. This showed up in a meta-analysis I read years ago, and it struck me that if this was an outcome for a patentable drug, this news would be widely marketed and every elderly American would be on this drug. The news take on this story is that "vitamin D supplementation is irrational," but I think it should be, "vitamin D supplementation reduces mortality by a mechanism we don't understand."

More on vitamin D and exercise

At this point, it's obvious to me that vitamin D helps athletic performance.

Vitamin D deficiency is known to occur among athletes, even in sunny countries (where people tend to have more ultraviolet-deflecting melanin, and where they make serious attempts to stay out of the sun). Vitamin D deficiency causes muscle weakness, slower reaction times, and is associated with a lower VO2 max.

Ultraviolet radiation (which makes vitamin D in the skin) was known in the early 20th century to help athletes. However, this has been forgotten by the medical field, or perhaps ignored because of the skin cancer risks. In a 1938 Russian study, athletes subjected to UV irradiation improved 100-meter sprint times by 7.4 percent, while controls undergoing the same training improved by 1.7 percent. In Germany in 1944, medical students getting UV irradiation improved their work on a bicycle ergometer by 13%. In 1952, German schoolchildren irridadiated in their classrooms for months increased their physical fitness scores by 56%. The researchers were able to duplicate this effect by giving other children a single dose of 250,000 units of vitamin D, basically confirming that the UV light was having its effect through vitamin D. (Please don't take 250,000 units of vitamin D.)

Vitamin D may protect against overtraining. The evidence is only circumstantial, but it's suggestive. Researchers at the University of Wyoming have found that in long-distance runners, levels of TNF-alpha, a pro-inflammatory hormone, are higher when they don't get enough vitamin D. TNF-alpha is one of the hormones elevated in overtraining syndrome. And vitamin D is known to reduce inflammation in general.

Manchester United

Hey - Manchester United uses UV lights to increase their vitamin D levels. I don't know much about "football," but they're pretty good, right? 

(Hey Bills, check it out.)

http://www.telegraph.co.uk/sport/football/teams/manchester-united/8275326/Manchester-Uniteds-Ryan-Giggs-and-Rio-Ferdinand-buy-into-cutting-edge-methods-at-Carrington.html

Vitamin D and exercise

Dave at Crossfit Buffalo asked me to post something on vitamin D's benefits for exercise. 

Scientifically speaking, Vitamin D supplementation might increase your exercise performance. Practically speaking, it's a good bet that it will if your levels are low.

It's a textbook phenomenon that a low level of vitamin D (vitamin D deficiency) decreases muscle strength. Most research that I've seen over the past 10 years or so bears this out. I've personally seen extreme cases of it - like a patient being able to stand up from a wheelchair after vitamin D status is normalized.

Furthermore, a great many people have vitamin D deficiency. I'd estimate that around 30 to 40 percent of people in my city who are not taking supplements have it.

So if we put two and two together, you reading this are somewhat likely to have vitamin D deficiency, and vitamin D deficiency leads (at least in extreme cases) to lower muscle strength, so taking vitamin D might improve your exercise performance.

There isn't much direct evidence that I've seen in the literature that vitamin D supplementation in young, healthy athletes helps athletic performance. However, there's a chance. And vitamin D is safe up to 4000 units per day for adults.

Personally, I think this is one reason why the Buffalo Bills are always losing.

UPDATE: more on vitamin D and exercise. 

 

 

 

tanning beds

I'm overall skeptical of industrial tanning. Anything that damages the skin - which is what you're doing with tanning, little by little - puts you at risk for skin cancer.

However ...

Yesterday I went tanning for the first time. The store advertised their bulbs as providing vitamin D - because they included Ultraviolet B (UVB) radiation. 

Afterwards, I had a huge burst of energy. I cleaned my kitchen in 12 minutes. The only biochemical explanation I know for this is the production of vitamin D - basically, the reversal of a vitamin-deficient state. (Actually, a steroid deficiency - because vitamin D is a steroid hormone, not really a "vitamin.")

It made me think of a several-hundred year old trend in English thought - that the sun makes you "mad." Certainly I had enough energy to make me look a bit crazy. 

But then again there appear to be multiple positive effects of vitamin D on health. 

I think I'm going back. 

vitamin D and alopecia

I recently heard of a case of unexplained alopecia in a 5 year old child. The child was given vitamin D supplementation (I'm not sure if it was 1,000 or 2,000 units per day), on the assumption that like every other child in the northeast USA, the child was at risk of vitamin D deficiency. The alopecia disappeared in 3 months.

A quick review of the literature shows me no link between vitamin D deficiency per se and alopecia. However there is a syndrome of rickets with alopecia that occurs when people have a receptor mutation that makes them resistant to vitamin D. So there is some indirect evidence that low vitamin D states could cause alopecia.

colon cancer

There's more evidence of a link between vitamin D and cancer, and you can probably reduce your cancer risk over time by taking this supplement.
In  a study in the American Journal of Preventive Medicine (link below), researchers analyzed data from five studies on vitamin D and colon cancer and found that people with higher levels had a 50 percent lower risk of colon cancer over the years.
Vitamin D is made when sunlight strikes skin, but can be taken as a pill also. In low areas like Buffalo, this is just about the only option for getting vitamin D for most of the year.  1,000 to 2,000 units a day is absolutely safe, and is enough to lower your cancer risk.
Vitamin D levels may explain why many cancers are less frequent in the southeastern US, and more frequent in the Northeast.