Lp(a): Be patient with fish oil

High-dose omega-3 fatty acids from fish oil has become the number one strategy for reduction of lipoprotein(a), Lp(a), in the Track Your Plaque program for gaining control over coronary plaque and heart disease risk.

The original observations made in Tanzanian Bantus in the Lugalawa Study by Marcovina et al first suggested that higher dietary exposure to fish and perhaps omega-3 fatty acids from fish were associated with 40% lower levels of Lp(a). Interestingly, higher omega-3 exposure was also associated with having the longer apo(a) "tails" on Lp(a) molecules, a characteristic associated with more benign, less aggressive plaque-causing behavior.

Of course, the 600+ fish- consuming Bantus in the study consumed fish over a lifetime, from infancy on up through adulthood. So what is the time course of response if us non-Bantus take higher doses of fish oil to reduce Lp(a)?

We have been applying this approach in the Track Your Plaque program and in my office practice for the past few years. To my surprise, the majority of people taking 6000 mg per day of omega-3 fatty acids, EPA and DHA, will drop Lp(a) after one year.  Some have required two years.  Therefore checking Lp(a) after, say, 3 or 6 months, is nearly useless. (An early response does, however, appear to predict a very vigorous 1-2 year response.)

I'm sure that there is an insightful lesson to be learned from the incredibly slow response, but I don't currently know what it is.  But this strategy has become so powerful, despite its slow nature, that it has allowed many people to back down on niacin.

Comments (35) -

  • aerobic1

    7/8/2011 5:50:17 PM |

    Strange stuff that Lp(a).  The TYP protocol worked well for me a dropped my Lp(a) from 21 to 3.  But, was the reduction due to fish oil alone or the combination of fish oil and other TYP strategies?  If you had to rank each of the following strategies in order of effectiveness (from 1 to 10) for reducing Lp(a) what would they be?  5,000 MG EPA + DHA, 5,000 IU D3, 1,000 MG Slo-Niacin, low carb/high fat/high protein diet, elimination of grain, sugar and starches?

  • Jack Christoher

    7/8/2011 9:02:29 PM |

    Maybe PUFA's 2yr/life?

  • Might-o'chondri-AL

    7/9/2011 12:40:54 AM |

    Post got lost again, said "error" ....
    11 humans (rheumatoid arthritics) blocked their interleukin 6 (Il-6) signalling by regularly saturating the alpha chain of Il-6 receptors with  Tocilizumab reduced their Lp(a) as a side benefit;  relevant data:
    * starting Lp(a) = 34.5 (+/- 12.8) mg/dL
    * 1 month Lp(a) = 24.3 (+/- 7.6) mg/dL
    * 3 month Lp(a) = 19.9 (+/- 6.3) mg/dL
    EPA/DHA from anti-inflammatory fish oil also blocks Il-6;  so this may be operating mechanism where it too can lower Lp(a).

  • easybleeder

    7/9/2011 1:05:14 AM |

    my cardiologist believes in many of your protocols, but forbids me to take large dose of omega 3 epa/dha. i am on plavix/aspirin since stents in two arteries one year ago. i have thrombocytopenia, lower than threshold platelet count and lower rbc and hgb levels. his thoughts are this addition could cause bleeding episodes that could cause even more trouble. i understand and agree with him. my supplement intake has been limited, even ubiquinol because of my situation. no chance of ending plavix because of recently diagnosed mitral valve regurgitation during echo. any thoughts on your part or the community thoughts. i feel as if i am losing control of my health as i hold distrust for most traditional medical community.

  • cancerclasses

    7/9/2011 1:41:09 AM |

    My research of lipids & Essential Fatty Acids has taught me that the "insightful lesson to be learned from the incredibly slow response" of fish oil in the treatment of CAD & CVD is that fish oil is:  1.) the wrong substance (there are BETTER ones!) and dosage levels,  and 2.) largely ineffective in the face of continued intake of high carb & TRANS fat containing processed junk, fast & restaurant "foods" and grocery store vegetable oils.   Failure to make changes to correct bad dietary habits and failure to stop the intake of TRANS fats is the single cause of re-stenosis in CVD patients, which guarantees further atherosclerosis, thrombosis, strokes & heart attacks.

    Dr. Robert Rowen recently wrote about his re think of the whole fish oil thing in his June Second Opinion newsletter that somebody (not me) posted here: http://goo.gl/rPvRx  
    which he based on this:  http://goo.gl/uAiv2  
    and this:  http://goo.gl/j9MgY    
    and mostly this:  http://goo.gl/ZdORy  

    In regard to the drop in Lp(a) comment it should be noted that LDL, VLDL & their  fractions will correct in response to reducing carb intake alone, even without further dietary correction or supplementation.  There is also a nutritional supplement protocol known as the Linus Pauling therapy that is reported to lower Lp(a) by using vitamin C, L-lysine, and L-proline, but Joe Mercola advises the regimen "is ONLY for people with established CVD and/or elevated Lp(a) levels."

  • aerobic1

    7/9/2011 1:45:24 AM |

    easybleeder:  Check with your doctor to see if you may be a candidate for the newer antiplatelet meds  Prasugrel or  Ticagrelor.  Both have been reported to have a lower risk profile and mortality rate than Clopidogrel.  Prasugrel is reported to be useful for those with high thrombotic risk.  Go to: http://www.escardio.org/communities/councils/ccp/e-journal/volume8/Pages/antiplatelet-agents-alegria-barrero.aspx

  • cancerclasses

    7/9/2011 1:46:39 AM |

    Oops, I posted the search for Rowen's article, it's the top hit, but here's the real link:  http://goo.gl/DDp8P

  • Tyson

    7/9/2011 6:25:51 AM |

    Atherosclerosis is a slow process, so I am not surprised that strategies to halt or reverse it are also slow (but powerful).

  • majkinetor

    7/9/2011 12:05:32 PM |

    From "Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases"

    There have been a number of clinical trials assessing the benefits of dietary supplementation with fish oils in several inflammatory and autoimmune diseases in humans, including rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, lupus erythematosus, multiple sclerosis and migraine headaches. Many of the placebo-controlled trials of fish oil in chronic inflammatory diseases reveal significant benefit, including decreased disease activity and a lowered use of anti-inflammatory drugs.

  • majkinetor

    7/9/2011 12:09:32 PM |

    I wonder, what is exact reason that some doctors don't recommend large doses of fish oil (and 5g EPA/DHA is large dose, its around 25-50 ml of liquid fish oil equals 2 - 4 tbsps), because that is what I heard as doctors response from several people with cvd problems. I always thought its because of rancidity. I put extra 200 IU of mixed tocopherol in my 100 ml liquid fish oil and keep it in fridge just to be sure.

  • Anne

    7/9/2011 2:32:05 PM |

    Thrombocytopenia and anemia - have you looked into a possible connection to gluten. Anemia is a very common problem in those with any kind of gluten sensitivity. If you do a PubMed search for "thrombocytopenia" and "gluten" you will bring up some references. There are also some references in The Gluten File - just scroll down to the bottom of this page

    Have you stopped eating wheat as recommended by Dr. Davis. It may be important for you to go 100% gluten free. Gluten can damage any and all organs and systems and you don't have to have celiac disease for this to happen.

  • Dr. William Davis

    7/9/2011 2:45:00 PM |

    HI, Might-o--

    As always, a fascinating suggestion. Sadly, there are no investigations that shed any light on precisely why. An anti-inflammatory mechanism is a very good possibility. I also wonder if there is an effect at the transcription level, given the modification of apo(a) tail length.

  • Dr. William Davis

    7/9/2011 2:47:04 PM |

    Hi, Easy--

    It sounds like you need an explanation for your thrombocytopenia.

    Putting the question of thrombocytopenia aside, I have never seen any excess bleeding when adding fish oil at any dose to aspirin and Plavix.

  • easybleeder

    7/9/2011 4:54:01 PM |

    prasugrel, while having a better cvd profile, in studies, i believe, has  a worse profile in bleeding episodes. it is usually given to those who are non-responders to plavix as determined by genetic profile (ususally done at time of angioplasty and afterwards). ticagrelor, unfortuneatly, has yet to gain FDA approval. maybe soon though. drs. will be slow to adopt to a new drug.

  • Might-o'chondri-AL

    7/9/2011 5:58:55 PM |

    Hi c-classes,
    That tweaked edible oil is a  formulation from Brian Peskin not the link's Rowen, M.D. remarking on Peskin's product inducing  better elasticity of blood vessels in comparison to fish oil.  There are other effects of fish oil's  EPA/DHA that  are not related to vascular elasticity;  such as the benefit of reducing Lp(a) that Doc Davis reports.  If you have decided to personally set a limit on fish oil intake it would be interesting to hear your experience.

  • cancerclasses

    7/9/2011 10:08:38 PM |

    Hi Might-o,
    Yeah,  that oops comment is a correction to a comment I submitted which has not yet passed the moderation.  You can find my original comment here:  http://goo.gl/fyVfH   and a related comment here: http://goo.gl/WrQKK

    As I note in the related comment I started taking fish oils around 2002 for shoulder pain due to 30 years of heavy construction work.  They were effective, but after researching Peskin's & MANY others work re lipids I found something better & stopped taking the fish oils, moved higher up the metabolic pathway and now follow Peskin's protocol & take around 2 or 3 grams of organic O-6 in either evening primrose, sunflower, safflower or hemp seed oils & 1 gram of O-3 organic flax to maintain his recommended 2.5 or 3 to 1 O-6 to O-3 ratio.  

    Haven't had a workup since my 45th b'day 9 years ago, but I have no health issues at all that I am aware of.   I occasionally check my bp with the free machine in drug stores, it's always within normal range between 117/77 to 121/81-82, no palpitations, angina or other symptoms at all.

    Only problem I've noted since starting that regimen is I seem to always be clipping my hair & nails, growth seems to have accelerated.

  • Mary A

    7/10/2011 1:16:23 AM |

    Is it safe to presume that adding  Dr.Peskin's edible oil formulation to my intake along with 2.5 Gm of fish oil would be beneficial?  Does fish oil not affect the vascular elasticity as well?  BTW, what is the recommended amount of fish oil   one should take daily?  I too am afraid of the potential of oxidation.  Is there any way to measure the level of oxidative stress related to taking too much fish oil?

  • Might-o'chondri-AL

    7/10/2011 5:10:42 AM |

    "Server Error" keeps eating my comments ... anybody else?

  • Might-o'chondri-AL

    7/10/2011 5:25:22 AM |

    Hi Mary A,
    Peskin is not a medical doctor, although some medical doctors use his protocols and products; Peskin thinks "parent"  omega 6 & omega 3 fatty acids are all that is needed for anybody to make enough "derivative" omega 6s & 3s (inc. EPA/DHA). His theory is taking fish oil is giving us the incomplete benefit of a "derivative" and incurs an excessive level over-loading in un-natural way  ;   claiming risks potential lower natural tumor cell killing, increased bacterial infection, worse  insulin resistance, less glucose tolerance, "resting" blood sugar rises, brain damage and discounts lower triglycerides as "irrelevant".  Doc Davis probably has heard of Peskin and still finds fish oil useful.

  • Denton Holland

    7/10/2011 9:00:12 AM |

    Does fish oil (or Borage oil)  to a regimen of Crestor (currently prescribed 20 mg/d) & Niancin ER (1g/d) make sense?   ...Have read that high doses of oils & statins taken together effectively cancel benefits of both.

  • cancerclasses

    7/10/2011 8:27:18 PM |

    Peskin did not invent the theory of the dangers of taking pharmacological overdose levels of omega 3 derivatives, it is a well known biochemical fact that has been thoroughly researched by many other groups.  Check any of his writings & you'll see he always cites the sources of his findings.  

    Peskin himself has only been led to his conclusions by simply analyzing ALL the available literature from many research groups, separating the true wheat from the false chaff, then he simply republishes the results of his analysis of the literature to make it understandable to all, some of which has been known & available for decades but has been either suppressed, discredited, discounted, sidestepped, ignored or just not talked about or publicized by the mainstream media because it's contrary to the financial interests of the medical & pharmaceutical "sick care" industries.

    A perfect example of that is M.D., Ph.D. biochemist Otto Warburg who was awarded the 1931 Nobel Prize for his work in defining the prime cause of cancer.  But who has ever heard of him & the prime cause?  It's staggering how few M.D.'s & oncologists have ever heard of him, or have ever been taught about Warburg in med school. And if the medical profession doesn't teach their students, it's a slam dunk guarantee that people will never hear about Warburg & the prime cause of cancer from their doctors.   I'm 53 years old & I had never heard of him or his work, & if I hadn't stumbled across Peskin I most likely would have lived my entire life, contracted some kind of cancer along the way, most likely prostate, then later would have died & STILL would never have known about Warburg.

    Anyone that wants to do more in life than just parrot the opinions published in the popular & "peer reviewed" press can find the true facts.  I find it quite ironic that at our point in human history, when we have even freely available to us the most powerful information & truth gathering tool ever devised by man, science is DEvolving into the realm of belief, tradition & superstition, and people are being polarized into affinity groups based on those beliefs, traditions & superstitions instead of gathering together to honor real scientific truths.

  • Might-o'chondri-AL

    7/11/2011 6:20:27 AM |

    Hi c-classes,
    Warburg is famous enough for describing cancer cells proclivity for performing aerobic glycolysis as an edge to thrive; I think this is best described as a modality of function and modern research is showing the causes  of cancer are complex. You may be interested in this weeks published details of the molecular development promoting cancer  cells replication; see journal Molecular Cell, vol. 43, issue 1, 122-131 "Failure of Origin Adaptation in Response to FORK Stalling Leads to Chromosomal Instability at Fragile Site".

    A synopsis : Kerem, et.all.,  give 1st details of how fragile sites of a single DNA molecule breaks in early cancer due to "perturbed" DNA replication; normally DNA copying slows and sometimes stalls at fragile sites so that the cell sometimes has to shift to use stress mechanisms in order to finish single molecules DNA copy. But, in the case of an incipient cancer cell which has already utilized the stress mechanics  that cell has no more stress mechanisms to call on that can do enough at a fragile site to keep proper replication going; then the DNA molecule actually breaks whereby normal protein expression suffers, functional changes occur and cancer defects particular to that type of cancer replicates.

  • Mary A

    7/11/2011 2:44:18 PM |

    I guess my question still remains does the edible oil formulations of Dr. Peskin hold any health benefits for a person and if so, then how much would a person take and with or without fish oil?  Are there any other blogs or websites that are dedicated  to his research?   BTW, great info Might-o'chondrl-AL and cancerclasses.

  • Mary A

    7/11/2011 4:20:08 PM |

    Forgive me for asking the previous question before I read Dr. Peskin's  website. I am not a scientist but the research he identifies seems to support his conclusions.  Cancerclasses, you seem to be a supporter of his.  Are you following his protocol and, if so, what have you experienced?  I would appreciate others opinions regarding Dr. Peskin and his protocol.  I think this is a very important area especially since many physicians and PhDs (i.e. Dr. Sears et al) encourage the use of fish oil in the dietary regime.

  • cancerclasses

    7/11/2011 9:39:09 PM |

    Hi Mary A:
    I have submitted several replies to this article that have not passed moderation and have not been posted here, just click on my name at the top of my comments & it will take you to my Twitter channel where I have posted my comments. Click on the link at the comment that starts with "My study & research of..."  then also click on the one 2 posts down about  bursitis & arthritis.  You may also scan my posts for anything else that interests you, as I post info there from a wide variety of subjects & sources I find interesting & relevant while conducting my own research.

  • Might-o'chomdri-AL

    7/11/2011 9:42:28 PM |

    Hi Mary,
    Peskin refers to 1988-1992 rodent studies showing brain "damage" from  extra EPA/DHA; maybe elsewhere he cites newer brain damage indications. The extrapolation to humans is not certain ; since we have +/- 1,100 million synapses per cubic mm. , while rodents have 1,397 million synapses per cubic mm.  Humans gain not only from having astrocytes 2.5 times wider than rodents, but also we function with 1 astrocyte for each 270,000 to 2,000,000 synapses in a neurological domain; while rodents must use 1 astrocyte for each 20,000 to 120,000 synapses in a neurological domain.

    As for Peskin's assertion that lowering triglycerides is "irrelevant" Doc Davis elaborated for us why they are worth controlling; when more trigs going into circulation hitched to VLD Lipid  this morphs into trig rich LDL and small LDL particles increase in numbers. The same trig laden VLDL  contributes to formation of some HDL,  but the result is rapid degradation of that HDL; so the HDL circulating is small HDL particles and the net amount of HDL is also reduced.  Doc Davis has been seeing human clinical success using fish oil (EPA/DHA) to lower the VLDL and co-administering niacin to act on reducing the number of small LDL particles (to ideally maximum 10% of total LDL number of particles);  while the fish oil & niacin combination work synergisticly to keep down circulating  triglycerides  (to ideally 60 mg/dL). This is a synopsis of what I l learned here.

    Peskin's PEO, "parent essential oils", are touted as offering measurably better vascular membrane flexibility in comparison to fish oil; this may not  (may be, I don't know) necessarily translate to reduction &/or protection from the circulating small LDL molecules that oxidize and foster plaque.  He quotes USDA that only 0.05 % of alpha linolenic acid we ingest is made into DHA and 0.20% made into EPA; extrapolating from there that supplementing EPA/DHA radically exceeds what we are designed to need.  The fact that age remodels many of our functions to me suggests that  taking extra EPA/DHA is akin to dosing one for  therapeutic purposes (ie:  reduce VLDL, trigs &  Lpa the theme of this thread) that are more critical to survival  from sudden death than vascular flexibility alone is.   If someone on Peskin's PEO protocol has before and after Lp(a) & NMR lipid profile data that would be interesting to see.

    Peskin exclaims fish oil raises blood sugar and insulin resistance; my own experiment 4 months after adding large dose of EPA/DHA  (also started niacin) laboratory data show I did  elevate my fasting serum blood sugar an extra 5mg/dL,  with HbA1c going up 0.3; yet had fasting insulin measuring only 4.1.  Personally I was happy to trade that  blip in  glucose tolerance for the drop in number of small LDL particles from 1,021 nmol/L (out of  1,676 nmol/L total) down to small LDL particles numbering 96 nmol/L ; and triglycerides dropping from 90 mg/dL down to 42 mg/dL.  Blood sugar control seems ammenable to more dietary interventions to compensate  against  and  I'm relieved to see Doc Davis'  advice worked for my unruly small LDL.

  • Mary A

    7/12/2011 4:58:59 PM |

    Thank you Cclasses and Might-o for your responses.  Could something so simple be so valuable as PEO.
    I did read Prof Peskin's Iowa study along with a couple of posted letters from physicians supporting the benefits of PEO found in their patients along with the results of an actual scan taken of Brian Peskin's heart  which showed NO plaque at all--.  Correct me if I am wrong but it is my understanding that if the intimal lining is healthy there is less /no inflammation. A healthy intimal lining prevents the events that cause a thrombus from occurring thereby preventing plaque build up and the adverse sequelae from developing. I know this is a simplistic understanding but, like I said, I'm no scientist.  It seems like it would be worth a good controlled study since Prof Peskin says positive results can be seen in as little as three months.   Hopefully, any study would include looking at various inflammatory markers as well as the total cholesterol profile.
    Might-O..I have been reading lately about the effectiveness of delta and gamma tocotrienols in reducing LDL, Lpa as well as increasing insulin sensitivity.  There is some research to support this.  I don't know if Dr. Davis utilizes this in his Tx protocols.

  • cancerclasses

    7/12/2011 7:39:41 PM |

    Yes, fats ARE simple, but you don't have to be a scientist to know that fats are crucially important to have as a regular part of our diets.  I find most people are seriously deficient in knowledge (which is intentional & by design) of the critical physiological & biochemical importance of regular dietary intake of essential fatty acids & good saturated animal fats, and thus are seriously deficient in those EFA's & natural saturated animal fats.  

    The medical & pharmaceutical "sick care" industries both perpetuate & exploit the public's fear of fats, cholesterols, protein, salt, etc, the very same substances that every one of our 100 trillion cells are made of, and this is why the average American is chronically sick & tired, diabetic, dehydrated, cancerous & cardiovascularly compromised.  As even you have learned & now know, there is NO omega 3 or derivatives in arterial intima & media, or even in human skin, it' all omega 6.  Yes it's true that a healthy arterial intima indicates less inflammation & vice versa, but EFA's & PEO's only facilitate healing & proper structural conformity, they won't PREVENT arterial damage if a person continues the high carb & TRANS fat intake that leads to the elevated serum glucose & LDL & VLDL levels that damage & alter the structure of endothelial cells & cholesterol.

    The studies you would like to see have been done, they are out there, Peskin writes about & references them all the time.  His book The Hidden Story Of Cancer and his website are not just about cancer, he includes a large amount of information about heart disease, statins, nutrition & related issues. Go to brianpeskin dot com & see Reports & Publications, and in particular go to Reports - Medical Reports - New Look LDL

  • Mary A

    7/13/2011 4:45:56 PM |

    Thanks CClasses for your help.  You are so right....the public at large have been taught to be afraid of so many things regarding their health.  Some try to seek out valuable information and others don't.  Many people look to their physicians to tell them all they need to know and that is a mistake.  Maybe with this new crisis going on in health care, people will begin to take an even more active role in their health.

  • cancerclasses

    7/14/2011 9:31:09 PM |

    @ easybleeder:
    Plavix CAUSES Thrombotic thrombocytopenic purpura (TTP).   From Wikipedia search Plavix,
    "Clopidogrel is an oral, thienopyridine class antiplatelet agent used to inhibit blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease. It is marketed by Bristol-Myers Squibb and Sanofi-Aventis under the trade name Plavix. The drug works by irreversibly inhibiting a receptor called P2Y12, an adenosine diphosphate ADP chemoreceptor. Adverse effects include hemorrhage, severe neutropenia, and thrombotic thrombocytopenic purpura (TTP).

    Also Google Brian Peskin, aspirin.   From the cover of his article "Aspirin Is Awful":   “...Low-dose aspirin, which enhances platelet adhesivity, increases thrombosis (clotting) when platelet adhesion dominates as the response to injury.” Buchanan, MR and Jejana, E, Journal of Clinical Investigation, 67503-508

    So your doctor has you on Plavix which ostensibly prevents thrombosis, but also causes thrombosis, and also has you on aspirin which causes thrombosis?!?!  His theory must be that the effects of the two drugs cancel each other out, so theoretically you should be perfectly healthy.  No wonder you feel so out of control.

  • cancerclasses

    7/14/2011 9:40:17 PM |

    Hi Might-o,
    Yeah, that oops comment is a correction to a comment I submitted which has not yet passed the moderation. You can find my original comment by clicking on my name at the top of my comment.

    I started taking fish oils around 2002 for shoulder pain due to 30 years of heavy construction work. They were effective, but after researching Peskin’s & MANY others work re lipids I found something better & stopped taking the fish oils, moved higher up the metabolic pathway and now follow Peskin’s protocol & take around 2 or 3 grams of organic O-6 in either evening primrose, sunflower, safflower or hemp seed oils & 1 gram of O-3 organic flax to maintain the biochemically optimum recommended 2.5 or 3 to 1 O-6 to O-3 ratio.

    Haven’t had a workup since my 45th b’day 9 years ago, but I have no health issues at all that I am aware of. I occasionally check my bp with the free machine in drug stores, it’s always within normal range between 117/77 to 121/81-82, no palpitations, angina or other symptoms at all.

    Only problem I’ve noted since starting that regimen is I seem to always be clipping my hair & nails, growth seems to have accelerated.

  • cancerclasses

    7/14/2011 10:17:21 PM |

    Mary A:  Sorry I didn't reply to this sooner.  Taking fish oils along with Omega-6 & Omega 3 would be redundant & that much Omega-3's would negate the effect & benefit of the O-6 by dominating the desaturase & elongase enzymes the body uses to produce the derivative forms of the fats that are further down the metabolic pathway, as PhD lipid researcher Mary Enig explains in her article "Tripping Lightly Down the Prostaglandin Pathways."  Just google the title of the article & also study the metabolic pathway chart there, I can't include the links here or this comment won't pass moderation.

    If you take a look at the O-6 & O-3 metabolic pathway chart in that article, it becomes readily apparent that by taking any single derivative form of O-6 or O-3 you are jumping into the pathway at the point of that particular derivative, creating an oversupply & IM-balance of that derivative, and you are also cheating your body & yourself out of ALL the other derivative forms your body needs & would otherwise use for the formation of the critical BALANCE of prostanoids, leukotrenes, lipoxins & thromboxins you'd have if you instead just took the parent base substrate Omega-6 & Omega-3 at the top of the pathway. People just don't understand the importance of supplying your body ALL and complete, natural organic forms of the materials it needs for ALL it's metabolic processes, and that's why people are sick & diseased.  

    To be completely truthful, there is a list of diseases & conditions that deactivate the desat & elongase enzymes necessary for the breakdown & utilization of the base substrate oils, so some  persons with those conditions require & will only benefit by taking the derivative forms.  However, in analyzing that list of diseases it's also easy to deduce that many of them only exist because of a primary & earlier deficiency of essential fatty acids.

  • Cholesterol and Heart Disease

    8/2/2011 6:23:02 PM |

    Hi,

    DR Davis recommends taking fish oil for curing heart disease, but I also read somewhere that fish oil is also anti-inflammatory and inflammation is the real cause of heart disease, not high cholesterol.

    What you think of that? Is inflammation more dangerous than high cholesterol?
    Thank you!

  • mgts24

    5/4/2012 8:49:06 AM |

    I'm new to the site, and I just wanted to say how much I'm appreciating it.  I began taking krill oil capsules a month ago, and haven't had a single heart palpitation since.  In fact they stopped after only two days of taking it.

  • heart disease in apes

    5/11/2013 1:43:29 AM |

    Hello there! This is my first visit to your blog!
    We are a team of volunteers and starting a new initiative in a community
    in the same niche. Your blog provided us beneficial information to work on.
    You have done a wonderful job!

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Low HDL makes Dr. Friedewald a liar

There's a $22 billion industry based on treating LDL cholesterol, a fictitious number.

LDL cholesterol is calculated from the following equation:

LDL cholesterol = Total cholesterol - HDL cholesterol - triglycerides/5

So when your doctor tells you that your LDL cholesterol is X, 99% of the time it has been calculated. This is based on the empiric calculation developed by Dr. Friedwald in the 1960s. Back then, it was a reasonable solution, just like bacon and eggs was a reasonable breakfast and a '62 Rambler was a reasonable automobile.

One of the problems with Dr. Friedewald's calculation is that the lower HDL cholesterol, the less accurate LDL cholesterol becomes. If it were just a few points, so what? But what if it were commonly 50 to 100 mg/dl inaccurate? In other words, your doctor tells you that your LDL is 120 mg/dl, but the real number is somewhere between 170 and 220 mg/dl. Does this happen?

You bet it does. In my experience, it is an everyday event. In fact, I'm actually surprised when the Friedewald calculated LDL closely approximates true LDL--it's the exception.

Dr. Friedewald would likely have explained that, when applied to a large population of, say, 10,000 people, calculated LDL is a good representation of true LDL. However, just like saying that the average weight for an American woman is 176 lbs (that's true, by the way), does that mean if you weigh 125 lbs that you are "off" by 41 lbs? No, but it shows how you cannot apply the statistical observations made in large populations to a single individual.

The lower HDL goes, the more inaccurate LDL becomes. This would be acceptable if most HDLs still permitted reasonable estimation of LDL--but it does not. LDL begins to become significantly inaccurate with HDL below 60 mg/dl.

How to get around this antiquated formula? In order of most accurate to least accurate:

--LDL particle number (NMR)--the most accurate by far.

--Apoprotein B--available in most laboratories.

--"Direct" LDL

--Non-HDL--i.e., the calculation of total cholesterol minus HDL. But it's still a calculated with built-in flaws.

--LDL by Friedewald calculation.

My personal view: you need to get an NMR if you want to know what your LDL truly is. A month of Lipitor costs around $80-120. A basic NMR costs less than $90. It's a relative bargain.

Menopause unleashes lipoprotein(a)

Faye was clearly frustrated.

At age 52, she was having chest pains every day. A CT heart scan showed a score of zero. A CT coronary angiogram showed no plaque whatsoever.

"Everything went downhill when my menopause started. I gained weight, I started to have chest pains, my blood pressure went up, my cholesterol shot up."

She saw three physicians, none of whom shed much light on the situation. They ran through the predictable sequence of (horse, not human) estrogens, anti-depressants, suggestions for psychological counseling.

But we checked Faye for lipoprotein(a), which she proved to have at a high level of 182 nmol/l. This explained a lot.

A curious and predictable set of phenomenon occur to females with Lp(a) proceeding through the menopause. As estrogen recedes:

--Lp(a) levels rise dramatically.

--Blood pressure goes up, sometimes creating severe hypertension by mid- to late-50s.

--Chest pain can develop, presumably due to "endothelial dysfunction" or "microvascular angina", both representing abnormal coronary artery constriction facilitated by worsening expression of Lp(a).

All too often, these phenomena get dismissed as simply part of the menopausal package, when they are, in fact, important facets of this very important genetic pattern that confers high risk for heart disease.

If any of this rings familiar for you or a loved one, think Lp(a). Though Faye hadn't yet developed any measurable coronary plaque by her CT heart scan score, it was likely on its way, given the surge in Lp(a) expression as menopause unfolded--unless its recognized and appropriate preventive action taken.

Vitamin D must be oil-based

I've talked about this before, but I need to periodically remind everybody:
Vitamin D must be an oil-based capsule, a gel-cap, not a tablet.

Lisa is one of early success stories: a heart scan score of 447 in her early 40's, modest reduction of CT heart scan score three years ago.

However, Lisa had a difficult time locating oil-based vitamin D. There has, in fact, been a national run on vitamin D and I'm told that even manufacturers are scrambling to keep up with the booming demand. So, she bought tablets instead and was taking 3000 units per day.

She came in for a routine check. Lisa's 25-OH-vitamin D3: 17 ng/ml, signifying severe deficiency, the same as if she were taking nothing at all. (Recall that we aim for 50 ng/ml.)

In other words, vitamin D tablets do not work. It is shameful. I see numerous women taking calcium tablets with D--the vitamin D does not work. I've actually seen blood levels of zero on these preparations.

You may have to look, but if you want to enjoy the extraordinary benefits of vitamin D replacement, it must be an oil-based capsule. Carlson's and Vitamin Shoppe have excellent prepartions. They raise blood levels substantially and consistently, and they're inexpensive. We pay $5.99 for a bottle of 120 capsules.

Vitamin D for $200?

What if vitamin D cost $200 rather than $2?

In other words, what if cholecalciferol, or vitamin D3, was a patent-protectable agent that would sell for an extravagant price, just like a drug?

Vitamin D would be the hot topic. There would be TV ads run during Oprah, slick magazine two-page spreads with experts touting its outsized benefits, insurance companies would battle over how much your copay should be.

The manufacturer would host large fancy symposia to educate physicians on how wonderful vitamin D is for treatment of numerous conditions, complete with dinner, a show, and gifts. They would hire expert speakers to speak, scientists to have articles ghost-written, give out knick knacks with the brand label inscribed--just like Lipitor, Actos, Vytorin, ReoPro, Plavix . . .

After all, what other "drug" substantially increases bone density (up to 20% in adult females), enhances insulin responses 30% (equivalent to the TZD drugs, Actos and Avandia), and slashes colon cancer risk?

But it's not a drug. That is both vitamin D's strength and its weakness. It's a strong point because it's natural, phenomenally helpful across a variety of conditions, and inexpensive. It is also a weakness because, at $2 a month, no one is raking in the $12 billion annually that Pfizer makes for Lipitor that allows it to fund an enormous marketing campaign.

Vitamin D is a "discovery" of huge importance for health, including making reductions of CT heart scan scores far more likely for more people. And it comes without a prescription.

What's up with garlic?


Fanatic Cook has posted an excellent summary on the recent negative attention cast on garlic preparations, at least for LDL cholesterol reduction.

Go to http://fanaticcook.blogspot.com to view.

I think Fanatic Cook is right--despite the lack of LDL reducing effects, it doesn't necessarily mean no benefit whatsoever. Anti-coagulation and anti-inflammatory effects, in particular, are well proven.

I do think, however, that it argues more in favor of sticking to whole cloves, rather than supplements. The benefits are also likely small. I would view garlic as a soft advantage for your plaque control program. You can do fine without it. You might do slightly better with it.

Drop the pretense

Most hospitals maintain the "Saint _____" in their names, despite many having little or nothing to do with the church.

Out of 15 hospitals in my area, 13 are named after saints.

In my view, a more honest name would be something like "ABC Medical Enterprises, Inc." The profit motive, aggressive marketing tactics, and high CEO salaries would make better sense then. The trend to convert practicing physicians from professionals acting on behalf of patient welfare into paid employees would also be clearer.

Imagine Walmart were to change its name to "St. Mary's Emporium" Would it modify your perception of their business? I think it would. It would cause many people to believe that maybe their work was, at least in part, charitable and being done for the public welfare. But Walmart makes such pretense--they are in business for profit, just like all businesses.

It's time for the pretense to be dropped. Hospitals are cut-throat profit-seeking operations, operating under the guise of charitable, tax-free institutions. It's the farthest thing from the truth.

John Cannell on Vitamin D

You can always count on Dr. John Cannell for unique perspectives on vitamin D. I reprint here his unfailingly entertaining and informative Vitamin D Newsletter on whether vitamin D replacement enhances physical performance.

The whole vitamin D "discovery" sometimes worries me. Vitamin D has proven to be an unbelievable, remarkable, dramatic boon to health, including facilitation in dropping CT heart scan scores. Yet the answer was always right in front of us. It worries me that you and I might have the answer to important questions right within our grasp all along--but don't know it. What if the same were true, say, for cancer? That is, a profound answer is right there, but our eyes just pass right over it.

Anyway, we should all keep our eyes open and perhaps you and I will continue to identify the most powerful tools available that return control over heart disease to us and take it away from the perverse, procedural hospital formula that still reigns.

If you haven't done so already, be sure to visit Dr. Cannell's website, www.vitamindcouncil.com.



The Vitamin D Newsletter
March, 2007

Peak Athletic Performance and Vitamin D

"No way doc." I had just finished telling my patient about the benefits of vitamin D, telling him he should take 4,000 IU per day, using all the techniques I had learned in 30 years of medical practice to convince someone proper treatment is important. But, he knew the U.S. government said he only needed 200 IU per day, not 4,000. He also knew the official Upper Limit was 2,000 IU a day. "What are you trying to do doc, kill me?" I told him his 25(OH)-vitamin D blood test was low, only 13 ng/ml. He had read about that too, in a medical textbook, where it said normal levels are between 10 and 40 ng/ml. "I'm fine doc;" adding "Are you in the vitamin business?" I explained I was not; that the government used outdated values; that recent studies indicate ideal 25(OH)D levels are about 50 ng/ml; and that they indicated that he needed about 4,000 IU per day to get his level up to 50. "No thanks doc, I'm fine."

So I tried a different tact. I brought him copies of recent press articles. "Look," I said, "look at these." Science News called vitamin D the Antibiotic Vitamin. The Independent in England says vitamin D explains why people die from influenza in the winter, and not the summer. U.S. News and World Report says almost everyone needs more. Newsweek says it prevents cancer and helps fight infection. In four different recent reports, United Press International says that: it reduces falls in the elderly, many pregnant women are deficient , it reduces stress fractures, and that it helps heals wounds.

He glanced at the articles, showing a little interest in stress fractures. Then he told me what he was really thinking. "Look doc, all this stuff may be important to old guys like you. I'm 22. All I care about are girls and sports. When I get older, maybe I'll think about it. I'm too young to worry about it. I'm in great condition." I couldn't argue. He was in good health and a very good basketball player, playing several hours every day, always on indoor courts.

What could I do to open his eyes? As an African American, his risk of early death was very high, although the risk for blacks doesn't start to dramatically increase until their 40's and 50's. Like all young people, he saw himself as forever young. The U.S. government was no help, relying on a ten-year-old report from the Institute of Medicine that is full of misinformation.

I tired to tell him that the 200 IU per day the U.S. government recommends for 20-year-olds is to prevent bone disease, not to treat low vitamin D levels like his. I pointed out the U.S. government's official current Upper Limit of 2,000 IU/day is the same for a 300 pound adult as it is for a 25 pound toddler. That is, the government says it's safe for a one-year-old, 25-pound, child to take 2,000 IU per day but it's not safe for a 30-year old, 300-pound, adult to take 2,000 and one IU a day. I mean, whoever thought up these Upper Limits must have left their thinking caps at home. Nevertheless, nothing worked. My vitamin D deficient patient was not interested in taking any vitamin D.

What are young men interested in? I remembered that he had told me: "Sex and sports." Two years ago I had researched the medical literature looking for any evidence vitamin D enhanced sexual performance. Absolutely nothing. That would have been nice. Can you imagine the interest?

Then I remembered that several readers had written to ask me if vitamin D could possibly improve their athletic performance? They told me that after taking 2,000 to 5,000 IU per day for several months, they seemed just a little faster, a little stronger, maybe had a little better balance and timing. A pianist had written to tell me she even played a better piano, her fingers moved over the keys more effortlessly! Was vitamin D responsible for these subtle changes or was it a placebo effect? That is, did readers just think their athletic performance improved because they knew vitamin D was a steroid hormone precursor (hormone, from the Greek, meaning "to set in motion")?

The active form of vitamin D is a steroid (actually a seco-steroid) in the same way that testosterone is a steroid and vitamin D is a hormone in the same way that growth hormone is a hormone. Steroid hormones are substances made from cholesterol, which circulate in the body, and work at distant sites by "setting in motion" genetic protein transcription. That is, both vitamin D and testosterone regulate your genome, the stuff of life. While testosterone is a sex steroid hormone, vitamin D is a pleomorphic (multiple function) steroid hormone.

All of a sudden, it didn't seem so silly. Certainly steroids can improve athletic performance although they can be quite dangerous. In addition, few people are deficient in growth hormone or testosterone, so when athletes take sex steroids or growth hormone they are cheating, or doping. The case with vitamin D is quite different because natural vitamin D levels are about 50 ng/ml and, since almost no one has such levels, extra vitamin D is not doping, it's just good treatment. I decided to exhaustively research the medical literature on vitamin D and athletic performance. It took me over a year.

To my surprise, I discovered that there are five totally independent bodies of research that all converge on an inescapable conclusion: vitamin D will improve athletic performance in vitamin D deficient people (and that includes most people). Even more interesting is who published this literature, and when. Are you old enough to remember when the Germans and Russians won every Olympics in the 60's and 70's? Well, it turns out that the most convincing evidence that vitamin D improves athletic performance was published in old German and Russian medical literature.

With the help of my wife and mother-in-law, both of whom are Russian, and with the help of Marc Sorenson, whose book Solar Power is a must read, I finally was able to look at translations of much of the old Russian and German literature. When one combines that old literature with the modern English language literature on neuromuscular performance, the conclusion is inescapable. The readers who wrote me are right.

If you are vitamin D deficient, the medical literature indicates that the right amount of vitamin D will make you faster, stronger, improve your balance and timing, etc. How much it will improve your athletic ability depends on how deficient you are to begin with. How good an athlete you will be depends on your innate ability, training, and dedication. However, peak athletic performance also depends upon the neuromuscular cells in your body and brain having unfettered access to the steroid hormone, activated vitamin D. In addition, how much activated vitamin D is available to your brain, muscle, and nerves depends on having ideal levels of vitamin D in your blood - about 50 ng/ml, to be precise.

Why would I write about such a frivolous topic like peak athletic performance when cancer patients all across this land are dying vitamin D deficient? Like many vitamin D advocates, I have been disappointed that the medical profession and the public don't seem to care about vitamin D. Maybe people, like my young basketball player, will care if it makes better athletes. So, Hey! You jocks! Listen up! I'm talking speed, balance, choice reaction time, muscle mass, muscle strength, squats, reps, etc. Important stuff. Here's the Vitamin D Council's first ever sports quiz.


1. Vitamin D-producing UVB radiation improves athletic performance and may have been widely practiced by German and Russian Olympic athletes in the 1960's and 70's.


True. I found tantalizing evidence the Russians and especially the Germans were on to this during the 60's and 70's when those two nations took turns placing number one and number two in the Olympics every year?


For example, in 1938, Russian researchers reported that a course of ultraviolet irradiations improved speed in the 100-meter dash in college students compared to matched controls, both groups undergoing daily training. Average 100-meter dash times decreased from 13.51 seconds to 13.28 seconds in the non-irradiated controls, but from 13.63 seconds to 12.62 seconds in the irradiated students. Here we see training improved times but training and irradiation improved times much more. Obviously, irradiation or vitamin D would not render the same magnitude of improvements in world-class sprinters, but they would be happy with a few milliseconds.


Gorkin Z, Gorkin MJ, Teslenko NE. [The effect of ultraviolet irradiation upon training for 100m sprint.] The Journal of Physiology of the USSR [Fiziol, z. (RSSR)] 1938; 25: 695-701. (In Russian)



If you want to know what early German thinking was on this, read this summation of the German literature:

"It is a well-known fact that physical performance can be increased through ultra-violet irradiation. In 1927, a heated argument arose after the decision by the German Swimmers' Association to use the sunlamp as an artificial aid, constituting an athletic unfairness, doping, so to speak. In 1926, Rancken had already reported the improving effect of sunlamp irradiation on muscle work with the hand-dynamo-graph. Heib observed an improvement in swimming times after repeated irradiations. In thorough experiments, Backmund showed that a substantial increase in muscle activity happens after radiation of larger portions of the body with an artificial sunlamp; that this performance increase is not caused through local - direct or indirect - effects on the musculature, but through a general effect. This general effect, triggered by ultra-violet irradiation, is caused by a systemic effect on the nervous system." (p. 17)


Parade GW, Otto H. Die beeinflussung der leistungsfahigkeit durch Hohensonnenbestrahlung. Zeitschrift fur Klinische Medizin (Z Klin Med),1940;137:17-21 [In German]


In 1945, two Americans measured the cardiovascular fitness and muscular endurance of 11 male Illinois subjects undergoing training in an indoor physical education class, comparing them to 10 matched controls. Both groups underwent similar physical training. Treatment consisted of ultraviolet irradiation, given in the nude, up to two minutes per session, three times per week, for ten weeks in the late fall and winter. After ten weeks, the treatment group had a 19% standard score gain in cardiovascular fitness compare to a 2% improvement in the control students. To regular readers of this newsletter, it should come as no surprise that the un-irradiated control group reported twice as many viral respiratory infections as the treatment group.


Allen R, Cureton T. Effects of Ultraviolet Radiation on Physical Fitness. Arch Phys Med 1945: 10: 641-44.


In 1952, the German sports medicine researcher, Spellerberg, reported on the effects of wholesale irradiation of athletes studying and training at the Sports College of Cologne - including many elite athletes - with a "central sun lamp." He irradiated the athletes in their bathing suits, on both sides of their bodies, for up to ten minutes, twice a week, for 6 weeks. He reported a "convincing effect" on athletic performance and a 50% reduction in sports injuries. Results were particularly impressive for swimmers, soccer, handball, hockey, and tennis players, as well as for boxers and most track and field athletes. He reported that irradiation leading to burns, further irradiation of athletes having achieved peak performance, and irradiation within 24 hours of competition, all impaired athletic performance. Their results were so convincing, the Sports College of Cologne officially notified the "national German and International Olympic committee." (p. 570)


Spellerberg AE. [Increase of athletic effectiveness by systematic ultraviolet irradiation.] Strahlentherapie 1952; 88: 567-70. [In German]


In 1952, Ronge exposed 120 German schoolchildren to UV lights installed in classrooms and compared them to 120 un-irradiated control children. Over a two-year period - excluding summer vacations - he tested both groups with a series of six cardiovascular fitness tests using a bike ergometer. Un-irradiated children showed a distinct seasonality in fitness, with the highest values right after summer break and the lowest values in the spring. Treated children showed no seasonal differences in physical performance. Differences in work performance between the irradiated and un-irradiated children were most conspicuous in the spring with 56% difference between the two groups. In a final experiment, he gave 30 children in the control classrooms 6.25 mg (250,000 IU) of vitamin D as a single dose in February and found their performance had "increased considerably," one month later but did not report the actual numbers. He concluded that vitamin D, either as a supplement or induced via UV irradiation, improved physical performance.


Ronge HE. [Increase of physical effectiveness by systematic ultraviolet irradiation.] Strahlentherapie 1952; 88: 563-6. [In German]

In 1954, another researcher, at the Max-Planck Institute for Industrial Physiology in Dortmund, Germany, administered three different wavelengths of UV light over 8 weeks to university students. He found that ultraviolet light in the vitamin D-producing UVB range was consistently effective in reducing resting pulse, lowering the basal metabolic rate, and increasing athletic performance. UVA had no effect; interestingly, artificial UVC irradiation (the atmosphere normally completely filters out UVC radiation and thus it's not naturally present on earth) also gave some positive results.


Lehmann G. [Significance of certain wave lengths for increased efficacy of ultraviolet irradiation.] Strahlentherapie. 1954 Nov;95(3):447-53. [In German]


In 1956, Hettinger and Seidel irradiated seven subjects in two different experiments: athletic performance on bike-ergometers and forearm muscle strength. They found that UV radiation induced a significant improvement in both muscle strength and athletic performance.



Hettinger T, Seidl E. [Ultraviolet irradiation and trainability of musculature.] Internationale Zeitschrift für angewandte Physiologie, einschliesslich Arbeitsphysiologie 1956; 16: 177-83. [In German]


Another German researcher, at the Institute for Medical Physics and Biophysics at the University of Gottiingen, studied reaction times (the time needed to recognize a light and switch it off) during October and November in a series of controlled experiments on 16 children and an unspecified number of adults. He first controlled for practice effects (getting better by practicing) and then administered nine full-body UV radiation treatments over three weeks to the two treatment groups, using placebo radiation in the two control groups. UV radiation improved choice reaction time by 25% in children and 20% in adults while reaction time worsened in controls. The improvements in the irradiated groups peaked at the end of the three weeks of UV treatments and reverted to baseline levels three weeks later. In the two control groups, he found distinctly improved reaction times in the sunnier months.


Sigmund R. [Effect of ultraviolet rays on reaction time in man.] Strahlentherapie. 1956; 101: 623-9. [In German]


The next study threw me because it was very well conducted, meticulously designed, and completely negative. In 1963, Berven reported on the effects of ultraviolet irradiation and vitamin D supplementation in a group of 30 Stockholm schoolchildren, aged 10 -11, comparing them to appropriate controls. He found no seasonality of fitness in the control group and no effect from either irradiation or two different vitamin D supplementation protocols (1500 IU of cholecalciferol daily for two months and a single dose of 400,000 IU of ergocalciferol) on performance on a bike ergometer.


Berven H. The physical working capacity of healthy children; seasonal variations and effect of ultraviolet irradiation and vitamin-D supply. Acta paediatrica. Supplementum 1963; 148: 1-22.


However, two things were not right and got me thinking. One, Berven found no seasonality of physical fitness and was the only author who found no such seasonal variations in athletic performance. Second, he found no effect from irradiation, again, the only author. Then I realized he was working with Swedish children in the late 1950's. Supplementation of children with high doses of vitamin D - often as cod liver oil - was routine in Scandinavia in the past, particularly in children. For example, in neighboring Finland, the official recommended daily dose of vitamin D for children - including infants - was 4,000 IU per day until 1964, when authorities reduced it to 2,000 IU/day. (That's right, you read that correctly, 4,000 IU per day for infants, which is too much by the way.)



In 1975, Finnish authorities reduced it to 1,000 IU per day, and, in 1992, to 400 IU per day. I emailed Professor Elina Hypponen who confirmed that the Swedish recommendations were similar to the Finnish ones. Therefore, it seems highly unlikely that many of Berven's Swedish children, studied in 1958 and 1959, all from "families with a good standard of living," were vitamin D deficient. Therefore, this study showed that vitamin D will not improve athletic ability in vitamin D replete people. That's very important because it indicates more is not necessarily better. More is only better if you are not taking enough.

Hypponen E, et al. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001 Nov 3;358(9292):1500-3.

In the 1960's, three American researchers conducted experiments with university students. Rosentswieg studied the effects of a single six-minute dose of UV light on each side of the trunk in 23 college women, recording changes in various tests of muscle strength at one and five hours. He found a trend towards significance after five hours in white but not African American students. In 1968, Cheatum found that a six-minute administration of UV light, on each side of the trunk, increased the speed of 15 college women in the 30-yard dash. In 1969, Rosentswieg found a six-minute dose of UV light, on each side of the trunk, finding improved performance on a bicycle ergometer in college women. However, unlike the Germans and Russians, I could find no evidence that any of these American findings interested any American professionals involved in the care or training of athletes.


Rosentsweig J. The effect of a single suberythemic biodose of ultraviolet radiation upon the strength of college women. J Assoc Phys Ment Rehabil. 1967 Jul-Aug;21(4):131-3.

Cheatum BA. Effects of a single biodose of ultraviolet radiation upon the speed of college women. Res Q. 1968 Oct;39(3):482-5.

Rosentswieg J. The effect of a single suberythemic biodose of ultraviolet radiation upon the endurance of college women. J Sports Med Phys Fitness. 1969 Jun;9(2):104-6.


2. Athletic performance peaks in the summer when vitamin D levels peak, and is at its lowest in the winter when vitamin D levels are at their lowest.

A. True
B. False


True. The studies below - all I could find in the literature - show tests of physical performance peak in the summer, when vitamin D levels peak, start to decline in early autumn, as vitamin D levels decline, and athletic performance reaches its lowest point in late winter, when vitamin D levels bottom out. However, it is reasonable to assume that any associations between athletic performance and summer season may be due to "reverse causation." That is, improved athletic performance in the summer might be secondary to increased outdoor physical and recreational activity in the warmer weather with an indoor sedentary lifestyle during the colder months. Maybe people have better athletic ability in the summer because they exercise more. If that is true - and using the same logic - athletic performance should not begin to decline until late autumn, because at most temperate latitudes early fall weather is ideal for outdoor physical activities.


However, some of the studies below controlled for seasonal variations in time spent exercising. Furthermore, besides a consistent positive association of summer season with improved athletic performance, the below studies found an abrupt - and unexplained - reduction in athletic performance beginning in the early fall - when vitamin D levels decline - but when the weather is ideal for outdoor activities.


For example, in 1956, German researchers found a distinct seasonal variation in the trainability of musculature, studying wrist flexor strength in 21 German subjects undergoing daily training. They found highly significant seasonal differences with peak performance during the later part of the summer, nadirs in the winter, and an unexplained sharp autumn decline beginning in October.


Hettinger T, Muller EA. Seasonal course of trainability of musculature. Int Z Angew Physiol. 1956;16(2):90-4.

A study of Polish pilots and crew found physical fitness and tolerance to hypoxia were highest in the late summer with an unexplained sharp decline starting in September. The authors hypothesized that seasonal variations in an unidentified hormone best explained their results.


Kwarecki K, Golec L, Klossowski M, Zuzewicz K. Circannual rhythms of physical fitness and tolerance of hypoxic hypoxia. Acta Physiol Pol. 1981 Nov-Dec;32(6):629-36.


Cumulative work ability among 1,835 mainly sedentary Norwegian men during bicycle exercise tests showed an August peak, a sharp decline starting in the autumn, and a wintertime nadir. There were no seasonal changes in body weights, as might be expected if more caloric-demanding recreational activity during the sunnier months explained their results.


Erikssen J, Rodahl K. Seasonal variation in work performance and heart rate response to exercise. A study of 1,835 middle-aged men. Eur J Appl Physiol Occup Physiol. 1979 Oct;42(2):133-40.


Koch and Raschka reviewed the mostly German literature on the seasonality of physical performance, discussing studies indicating that muscle strength and stamina peak in the late summer. The authors then attempted to control for seasonal variations in the time spent exercising by instituting a controlled yearlong training regimen, beginning in December. The training regimen consisted of at least 20 push-ups per day and 2 or 3 long-distances races per week for the entire year. They found the both the number of push-ups and muscle strength peaked in late summer followed by a rapid decline in the fall, and a nadir in the winter, despite continued training. They concluded that seasonal variations in an unidentified hormone best explained their results. In addition, by now we all know that vitamin D is a seasonal hormone, and a steroid hormone precursor to boot.


Koch H, Raschka C. Circannual period of physical performance analysed by means of standard cosinor analysis: a case report. Rom J Physiol. 2000 Jan-Dec;37(1-4):51-8.

3. Vitamin D has direct muscle-building (anabolic) effects.


A. True
B. False

True, but only in vitamin D deficient subjects. Both animal and human studies have found that vitamin D directly affects muscle. That is, vitamin D increases muscle mass.



For example, Birge and Haddad found that vitamin D caused new protein synthesis in rat muscle.


Birge SJ, Haddad JG. 25-hydroxycholecalciferol stimulation of muscle metabolism. J Clin Invest. 1975 Nov;56(5):1100-7.


What about humans? In 1981, Young performed muscle biopsies on 12 severely vitamin D deficient patients before and after vitamin D treatment. They found type-II (fast-twitch) muscle fibers were small before treatment and significantly enlarged after treatment. Sorensen performed muscle biopsies on eleven older patients with osteoporosis before and after treatment with vitamin D. The percentage and area of fast twitch fibers increased significantly after treatment, despite the lack of any physical training.


Young A, Edwards R, Jones D, Brenton D. Quadriceps muscle strength and fibre size during treatment of osteomalacia. In: Stokes IAF (ed) Mechanical factors and the skeleton. 1981. pp 137-145.

Sorensen OH, Lund B, Saltin B, Lund B, Andersen RB, Hjorth L, Melsen F, Mosekilde L. Myopathy in bone loss of ageing: improvement by treatment with 1 alpha-hydroxycholecalciferol and calcium. Clin Sci (Lond). 1979 Feb;56(2):157-61.


Sato reported that two years of treatment with 1,000 IU of vitamin D per day significantly increased muscle strength, doubled the mean diameter, and tripled the percentage of fast-twitch muscle fibers, in the functional limbs of 48 severely vitamin D deficient elderly stroke patients. The placebo control group suffered declines in muscle strength, and in the size and percentage of fast-twitch muscle fibers.


Sato Y, Iwamoto J, Kanoko T, Satoh K. Low-Dose Vitamin D Prevents Muscular Atrophy and Reduces Falls and Hip Fractures in Women after Stroke: A Randomized Controlled Trial. Cerebrovasc Dis. 2005 Jul 27;20(3):187-192 [Epub ahead of print]

These studies clearly show that vitamin D when administered to vitamin D deficient people stimulates the growth and number of those muscle fibers critical to athletic ability, type-2, or "fast twitch," muscle fibers.

4. Many studies have found direct associations between physical performance and vitamin D levels. That is, the higher your vitamin D level, the better your athletic performance.

A. True
B. False

True. I found 13 positive studies of associations between vitamin D levels and various parameters of neuromuscular performance. However, they were all in old people. Of course, old people can be athletes too. Furthermore, age differences in physiology and pharmacology are quantitative, not qualitative. That is, what is true in old people will be true in young people, although the magnitude might be different. Higher vitamin D levels are associated with a wide variety of athletic performance but appear to have the strongest associations with balance, timing, and timed tests of physical performance.

The three largest studies had more than 7,000 elderly subjects. All found evidence of a vitamin D threshold of between 30 - 50 ng/ml, above which further improvements in athletic performance were not seen. Wicherts and her colleagues found a linear correlation between vitamin D and neuromuscular performance; scores were 78% better for those with vitamin D levels greater than 30 ng/ml compared to those with levels less than10 ng/ml.


Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW, Dawson-Hughes B. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. Am J Clin Nutr. 2004 Sep;80(3):752-8.

Gerdhem P, Ringsberg KA, Obrant KJ, Akesson K. Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int. 2005 Nov;16(11):1425-31.


Wicherts IS, et al. Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab. 2007 Mar 6; [Epub ahead of print]

Professor Heike Bischoff-Ferrari, now in Switzerland, did the largest study. She and her colleagues found a strong positive correlation and suggestion of a U-shaped curve with athletic performance on one test peaking with vitamin D levels of 50 ng/ml but deteriorating at higher levels. It is interesting to speculate that levels around 50 ng/ml may be optimal for athletic performance as such levels are common in humans living in a "natural" state of sun-exposure, such as lifeguards or tropical farmers.


Bischoff HA, Stahelin HB, Urscheler N, Ehrsam R, Vonthein R, Perrig-Chiello P, Tyndall A, Theiler R. Muscle strength in the elderly: its relation to vitamin D metabolites. Arch Phys Med Rehabil. 1999 Jan;80(1):54-8.


Interestingly, all three studies that looked for an association between mental abilities and vitamin D levels found one. A fourth study, unrelated to athletic function, also found an association. The obvious explanation for these findings is that cognitively impaired patients do not go outdoors as often as higher functioning patients and thus have lower vitamin D levels. However, Dhesi found the association after excluding all but mildly demented patients, making such an explanation more difficult. Flicker and - more recently - Przybelski and Binkley, found the association after controlling for outdoor activities, raising the possibility that the association of vitamin D levels with cognitive abilities is casual. Both the vitamin D receptor and the enzyme necessary to activate vitamin D are present in a wide-variety of human brain tissue. If vitamin D deficiency impairs cognitive abilities, it is likely that such deficiencies will also impair the brain's ability to process the complex circuits needed for peak athletic performance.


Dhesi JK, Bearne LM, Moniz C, Hurley MV, Jackson SH, Swift CG, Allain TJ. Neuromuscular and psychomotor function in elderly subjects who fall and the relationship with vitamin D status. J Bone Miner Res. 2002 May;17(5):891-7.

Kenny AM, Biskup B, Robbins B, Marcella G, Burleson JA. Effects of vitamin D supplementation on strength, physical function, and health perception in older, community-dwelling men. J Am Geriatr Soc. 2003 Dec;51(12):1762-7.

Flicker L, Mead K, MacInnis RJ, Nowson C, Scherer S, Stein MS, Thomasx J, Hopper JL, Wark JD. Serum vitamin D and falls in older women in residential care in Australia. J Am Geriatr Soc. 2003 Nov;51(11):1533-8.

Przybelski RJ, Binkley NC. Is vitamin D important for preserving cognition? A positive correlation of serum 25-hydroxyvitamin D concentration with cognitive function. Arch Biochem Biophys. 2007 Jan 8;

There can be no doubt that higher vitamin D levels are associated with improved athletic performance in the elderly. From what we know of physiology and pharmacology, the same associations should hold true in young people, including young athletes.

5. Numerous studies have found that vitamin D improves physical performance.

A. True
B. False.

True, but, again, most all the studies are in old persons, not young ones, and none of the studies are in world-class athletes. However, there is no medical reason why vitamin D would improve the athletic performance of vitamin D deficient old people but not vitamin D deficient young ones. Eleven studies found vitamin D improved physical performance, mainly on measures of balance and reaction time. The one study of younger subjects showed dramatic physical performance effects in 55 severely vitamin D deficient women.


Sorensen OH, Lund B, Saltin B, Lund B, Andersen RB, Hjorth L, Melsen F, Mosekilde L. Myopathy in bone loss of ageing: improvement by treatment with 1 alpha-hydroxycholecalciferol and calcium. Clin Sci (Lond). 1979 Feb;56(2):157-61.

Gloth FM 3rd, Smith CE, Hollis BW, Tobin JD. Functional improvement with vitamin D replenishment in a cohort of frail, vitamin D-deficient older people. J Am Geriatr Soc. 1995 Nov;43(11):1269-71.

Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Andersen H, Charles P, Eriksen EF. Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int. 2000 Jun;66(6):419-24.

Prabhala A, Garg R, Dandona P. Severe myopathy associated with vitamin D deficiency in western New York. Arch Intern Med. 2000 Apr 24;160(8):1199-203.

Verhaar HJ, Samson MM, Jansen PA, de Vreede PL, Manten JW, Duursma SA. Muscle strength, functional mobility and vitamin D in older women. Aging (Milano). 2000 Dec;12(6):455-60.

Pfeifer M, Begerow B, Minne HW, Abrams C, Nachtigall D, Hansen C. Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res. 2000 Jun;15(6):1113-8.

Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, Nebiker M, Theiler R, Pfeifer M, Begerow B, Lew RA, Conzelmann M. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res. 2003 Feb;18(2):343-51.

Dhesi JK, Jackson SH, Bearne LM, Moniz C, Hurley MV, Swift CG, Allain TJ. Vitamin D supplementation improves neuromuscular function in older people who fall. Age Ageing. 2004 Nov;33(6):589-95.

Sato Y, Iwamoto J, Kanoko T, Satoh K. Low-Dose Vitamin D Prevents Muscular Atrophy and Reduces Falls and Hip Fractures in Women after Stroke: A Randomized Controlled Trial. Cerebrovasc Dis. 2005 Jul 27;20(3):187-192 [Epub ahead of print]



In summary, five converging - but totally separate - lines of scientific evidence leave little doubt that vitamin D improves athletic performance. (I actually left out a sixth line of evidence, something a little more complicated, studies of muscle strength and vitamin D receptor polymorphisms; the two studies I could find were both positive.) Anyway, the scientific evidence that UVB radiation, either from the sun or from sunbeds, will improve athletic performance is overwhelming and the mechanism is almost certainly vitamin D production. Peak athletic performance will probably occur with 25(OH)D levels of about 50 ng/ml, whether from sun, sunbeds, or supplements.


All that is missing is a big-time professional or college team identifying and then treating their elite athletes who are vitamin D deficient. Can you imagine what such performance-enhancing effects would do for basketball players, most of who are African American and who practice and play indoors all winter? Or gymnasts? Or weight lifters?


However, a word of caution. The above studies suggest that taking too much vitamin D (more than 5,000 IU per day) may actually worsen athletic performance. Take the right amount, not all you can swallow. Take enough to keep your 25(OH)D levels around 50 ng/ml, year round. Easier yet, regularly use the sun in the summer and sunbeds in the winter - with care not to burn. Once a week should be about right.


When you think about it, none of this should surprise anyone. Every body builder knows that steroid hormones can improve athletic performance, certainly increase muscle mass. Barry Bonds knows they increase timing and power. Moreover, activated vitamin D is as potent a steroid hormone as exists in the human body. However, unlike other steroids, levels of activated vitamin D in muscle and nerve tissue are primarily regulated by sun exposure. That's right, the rate-limiting step for the cellular function (autocrine) of activated vitamin D is under your control. It depends on how much you put in your both or go into the sun. It's ironic that many athletes now avoid the sun, organized baseball is even promoting sun avoidance and sunblocks. The ancient Greeks knew better; they had there elite athletes train on the beach and in the nude.



The medical literature indicates vitamin D levels of about 50 ng/ml are associated with peak athletic performance. Of course, recent studies show such levels are ideal for preventing cancer, diabetes, hypertension, influenza, multiple sclerosis, major depression, cognitive impairments, etc. But who cares about all that disease stuff old people get, we're talking about something really important: speed, balance, reaction time, muscle mass, muscle strength, squats, reps, etc. And guess who's now taking 4,000 IU/day? Yes he is, and he tells me his timing is better, he can jump a little higher, run a little faster, and the ball feels "sweeter," whatever that means.

John Cannell, MD

This is a periodic newsletter from the Vitamin D Council, a non-profit trying to end the epidemic of vitamin D deficiency. If you don't want to get the newsletter, please hit reply and let us know. We don't copyright this newsletter. Please feel free to reproduce it and post it on Internet sites and blogs. Remember, we are a non-profit educational organization. Our pathetic finances are available for public inspection. We rely on donations to publish our newsletter and maintain our website. Send your tax-deductible contributions to:


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Watch your groin

The reason why I've been blogging lightly these past few days is because, as a favor, I'm covering the practice for some colleagues who I'm (very) loosely affiliated with. The time demands have been great.

Nonetheless, it is a good reminder to me just how far wrong conventional cardiology remains. Judging by what I see around me, there is a startling lack of restraint in proceeding to the catheterization laboratory. Curiously, the internists and family practitioners have been brainwashed into accepting this path. I suppose that all it takes is an occasional real "save" for these physicians to develop a fear of ever missing real disease.

What I'm seeing is just how many people presenting with chest pain or similar symptoms end up going to the cath lab. I would crudely estimate 80%. That is, once you make it past the emergency room, there's a four out of five chance that you'll end up with a heart catheterization to "be sure your heart is okay", "make certain you're not going to die of heart disease", "see if there's a ticking time bomb in your chest". You've heard all the clever, scary phrases that get tossed around to scare the pants off you and justify putting catheters in your groin.

Despite the fact that tools for heart disease prevention have improved dramatically, the volume of heart catheterizations continues to grow nationwide.

I find it shocking and unacceptable. We're currently working behind the scenes to help change this situation through education of the public. Persuade a $1 million a year cardiologist that he is overdoing procedures? Unlikely in my experience. Educate the public about the shocking over-reliance on high-revenue procedures? Perhaps more practical.

Garlic and cholesterol--Does everyone now need Lipitor?

Garlic May Not Lower Cholesterol
Study Shows No Improvement in Cholesterol Levels From Raw Garlic or Garlic Supplements

Lots of reports continue to hit the press about a small study that hoped to determine whether garlic as whole cloves (4 to 6), an aqueous extract of garlic called Kyolic, or an oil extract called Garlicin (high in allicin), or placebo. No differences in lipid numbers including LDL cholesterol were observed.

(Full text at WebMD at http://www.webmd.com/cholesterol-management/news/20070226/garlic-may-not-lower-cholesterol?ecd=wnl_chl_030507. You may be required to log in or register.)

I believe that the researchers were sincere in their effort to follow an honest, scientfically sound clinical trial design. I'm personally not that surprised. The effect in prior studies has been modest, sometimes none. Does that mean that we should ignore the other studies that suggest there may be modest blood-thinning, anti-inflammatory, blood pressure-reducing, and cancer-preventing properties? No, it does not. Dr. Matt Budoff at UCLA even published a very small study in about 20 people that suggested a slowing of plaque growth by using Kyolic in persons tracked by CT heart scans.

Nonetheless, garlic is, at best, probably no more than a source of small benefits. The biggest fallout from this kind of report, however, is not the neutral results from garlic, but from the open door the drug companies sense when this happens.

If you read the WebMD report, you'll notice all sorts of advertisements from drug companies for statin cholesterol drugs ("Cholesterol health center"; "Understanding Cholesterol Numbers"; "There are two sources of cholesterol: food and family"), Niaspan (which I used to support but have been discouraged by the Kos companies excessively profiteering methods and recent big Wall Street sellout).

It doesn't follow. The failure of one nutritional strategy to reduce LDL does nothave to trigger a run to the drugs. Don't fall for it. Drugs have their place. So do supplements and food choices, which can be very powerful. Drug manufacturers and their marketing people salivate when something like this comes along, an open invitation to say, "If garlic doesn't work, _____ sure does."

Diet Coke saves father's life

Jason came to the office because of chest pain. At 34 years old, he works as manager of a (non-fast food) restaurant, but indulges in lots of the odds and ends. Among his indulgences: Diet Coke. Every time he'd have a diet Coke, he'd have chest pain. Not drinking diet Coke--no chest pain. If Jason drank coffee, no chest pain. Other foods, no chest pain. Anyway, just eliminating the diet Coke seemed to do the trick. (Aspartame?)

Anyway, that's not why I tell you Jason's story. In the midst of his evaluation, an echocardiogram showed a mildly enlarged aorta, measuring 4.0 cm in diameter. So we obtained lipoproteins. Jason showed lipoprotein(a) and small LDL particles, the dreaded duo. We talked about how to correct this pattern. Among the strategies we discussed was niacin.

But what bothered me was that neither of Jason's parents had a diagnosis of heart disease. Jason had to have gotten Lp(a) from either his mother or father, since you obtain the gene from one or the other parent. You cannot acquire Lp(a). So one of Jason's parents was sitting on a genetic time bomb of unrecognized Lp(a) and hidden heart disease.

Because Jason's paternal grandfather had a heart attack at age 62, only Jason's Dad had the heart scan (though I urged both to get one). Score: 1483. Recall that heart scan scores >1000 carry a risk of death or heart attack of 25% per year if no preventive action is taken. Now, of course, we have to persuade Jason's Dad that a program of prevention--intensive prevention is in order, including a measure of Lp(a).

So that's the curious story of how Diet Coke probably saved Jason's Dad's life. The lesson is that if you or someone you know has Lp(a), think about their children as well as their parents, each of whom carry a 50% chance of having the pattern.