Man walks after removing wheat

9. May 2010 William Davis (27)
No, this isn't some National Enquirer headline like "Woman delivers alien baby."

Tom is a 26-year old man with a complex medical condition, a malformation he was born with and has had reconstructed. Aside from this, he leads a normal life: works, is married, and is, in fact, quite intelligent.

He came to me for an opinion regarding his overall health. Tom was worried that his congenital condition would impair his long-term health and longevity prospects, so he wanted to optimize all other aspects of his health.

But, when I examined Tom, he could barely get himself up on the exam table without wincing in pain. When I asked him to walk, he hobbled a few steps, again clearly in pain. When I asked him what hurt, he said "everything." He said that all his joints hurt just to move.

He told me that his several doctors over the years didn't know why he was in such pain: It wasn't rheumatoid arthritis, gout, pseudogout, or any of the other inflammatory joint diseases that might account for virtually incapacitating this 26-year old man. Even the rheumatologists were stumped. It was also unrelated to his repaired congenital condition. So Tom went on with his life, barely able to even go for a walk with his wife without pain, slowing him down to the pace of an 80-year old.

So I suggested that he eliminate all wheat products. "I don't know for a fact whether it will work, Tom. But the only way to find out is to give it a try. Why not try a 4-week period of meticulously avoiding wheat? Nothing bad will come of it."

He and his wife look perplexed, but were so desperate for a solution that they agreed to give it a try.

Tom returned 6 weeks later. He walked into the room briskly, then bounded up on the exam table. He told me that, within days, all his joint pains had completely disappeared. He could walk, stretch, do all the normal physical things with none of the pain he had suffered previously.

Tom told me, "I didn't think it could be true. I thought it was just a coincidence. So I had a sandwich about 2 weeks into it. In about 5 minutes, I got about half my pains back."

Tom now remains wheat-free and pain-free, thankfully with no discernible joint impairment.

So, yes, Tom walked freely and without pain simply by eliminating wheat from his life.

Is it an immune phenomenon? Does wheat gluten trigger some inflammatory reaction in some people? There is surely something like this underlying experiences like Tom.

Wheat contains far more than gluten. Modern wheat is a collection of hundreds of different proteins, though gluten is the most plentiful, the one that confers the "viscoelasticity" of dough. But there's plenty more to wheat than gluten or celiac disease.

AGEing gracefully

5. May 2010 William Davis (32)
Advanced Glycation End-products, or AGEs, have the potential to change our entire conversation about diet.

AGEs come from two principal sources:

1) Endogenous--Glucose-protein interactions that arise from high blood glucose levels

2) Exogenous--From diet

The first is sensitive to glucose levels: the higher the glucose level, the greater the AGE formation. The second depends on the quantity of AGE in the food consumed.

A compelling body of evidence points towards AGEs as an agent of aging, as well as kidney dysfunction, dementia, and atherosclerosis. Some of the observations made include:

--If AGEs are infused into an experimental animal, it develops atherosclerosis, kidney disease, and other "diseases of senescence" within weeks to months.

--In endothelial cells (cells lining arteries), AGE induces expression of adhesion molecules and inflammatory signals. In fibroblasts, AGE provokes collagen production. In smooth muscle cells, AGE triggers migration and proliferation. In monocytes and macrophages, AGEs induce chemotaxis and release of inflammation mediators. In short, AGEs have been implicated in just about every step leading to atherosclerosis.

--In humans, greater quantities of AGEs are present in diabetics, pre-diabetics and people with insulin resistance. We all know that these people develop atherosclerosis, kidney disease, cataracts, and other conditions at an accelerated rate.

--Foods containing greater quantities of AGEs cause endothelial dysfunction, i.e., artery constriction via blockade of nitric oxide and other mechanisms.

Short of taking agents that block AGE activity, how can you minimize the absorption or production of AGEs? There are two general strategies:

1) Keep blood glucose low--The Whitehall study demonstrated increased cardiovascular mortality with a postprandial (actually 2-hour post- 50-gram glucose challenge) blood sugar of 83 mg/dl. Lower blood glucose, less glycation. Less carbohydrates in the diet, the lower the blood sugar, the less the glycation. Studies like Whitehall demonstrate that glycation begins with glucose values within the normal range. Thus, aging occurs even with normal glucose levels. It occurs faster with higher glucose levels.

2) Choose and prepare foods with lower AGE content. Food content of AGEs is a major determinant of blood AGE levels. Fats and meats are the primary dietary source of AGEs, particularly if cooked at high temperature (broiling, frying). While this does not mean that meats and fats need to be avoided, it can mean that limiting serving size of meats and fats, while being selective in how they are prepared, are important. This can mean cutting your meats in thinner slices or smaller pieces to permit faster cooking, eating rare when possible (not poultry, of course), avoiding cooking with sauces that contain sugar (which enhances AGE formation). Is this an argument in favor of sashimi?

Minimizing exposure to AGEs, endogenous or exogenous, has the potential to slow the aging process, or at least to lessen the likelihood of many of the phenomena of aging.

More on this to come.

Small LDL: Simple vs. complex carbohydrates

4. May 2010 William Davis (17)
Joseph is a whip-smart corporate attorney, but one who accepts advice at his own pace. He likes to explore and consider each step of the advice I give him.

Starting (NMR) lipoprotein panel on no treatment or diet change:

LDL particle number 2620 nmol/L (which I would equate to 262 mg/dl LDL cholesterol)
Small LDL 2331 nmol/L--representing 89% of LDL particle number, a severe dominance of small LDL

I advised him to eliminate wheat, cornstarch, and sugars, while limiting other carbohydrate sources, as well. Joseph didn't like this idea very much, concerned that it would be impractical, given his busy schedule. He also did a lot of reading of the sort that suggested that replacing white flour with whole grains provided health advantages. So that's what he did: Replaced all sugar and refined flour products with whole grains, but did not restrict his intake of grains.

Next lipoprotein panel with whole grains replacing white refined flour:

LDL particle number 2451 nmol/L
Small LDL 1998 nmol/L--representing 81.5% of LDL particle number.

In other words, replacing white flour products with whole grain products reduced small LDL by 14%--a modest improvement, but hardly great.

I explained to Joseph that any grain, complex, refined, or simple--will, just like other sugars and carbohydrates, still provoke small LDL. Given the severity of his patterns, I suggested trying again, this time with full elimination of grains.

Next lipoprotein panel with elimination of whole grains:

LDL particle number 1320 nmol/L
Small LDL 646 nmol/L--48.9% of total LDL particle number, but a much lower absolute number, a reduction of 67.6%.

This is typical of the LDL responses I see with elimination of wheat products on the background of an overall carbohydrate restriction: Big drops in precisely measured LDL as LDL particle number (i.e., an actual count of LDL particles, not LDL cholesterol) and big drops in the number of small LDL particles.

You might say that wheat elimination and limitation of carbohydrate intake can yield statin-like values . . . without the statin.

Is Cocoa Puffs no longer heart healthy?

29. April 2010 William Davis (17)
Until recently, Cocoa Puffs enjoyed the endorsement of the American Heart Association (AHA) as a heart-healthy food.

For a price, the AHA will allow food manufacturers to affix a heart "check mark" signifying endorsement by the AHA as conforming to some basic "heart healthy" requirements.

Odd thing: The list of breakfast cereals on the check mark program has shrunk dramatically. When I last posted about this, there were around 50-some breakfast cereals, from Cocoa Puffs to Frosted Mini Wheats. Now, the list has been trimmed down to 17:

Berry Burst Cheerios-Triple Berry
Cheerios
Cheerios Crunch
Honey Nut Cheerios
Kashi Heart to Heart Honey Toasted Oat Cereal
Kashi Heart to Heart Oat Flakes & Wild Blueberry Clusters
Kashi Heart to Heart Warm Cinnamon Oat Cereal
Multi Grain Cheerios
Oatmeal Crisp Crunchy Almond
Oatmeal Crisp Hearty Raisin
Quaker Cinnamon Life
Quaker Heart Health
Quaker Life
Quaker Life Maple & Brown Sugar
Quaker Oat Bran
Quaker Oatmeal Squares - Brown Sugar
Quaker Oatmeal Squares - Cinnamon


According to sales material targeted to food manufacturers, the American Heart Association boasts that "The American Heart Association’s heart-check mark is the most recognized and trusted food icon today . . . Eighty-three percent of consumers are aware of the heart-check mark. Sixty-six percent of primary grocery shoppers say the heart-check mark has a strong/moderate influence on their choices when shopping."

So, is Cocoa Puffs no longer heart healthy?

I suspect that agencies like the AHA, the USDA, the American Diabetes Association as starting to understand that they have blundered big time by pushing low-fat, having contributed to the nationwide epidemic of obesity and diabetes, and that it is time to quietly start backpedaling.

While it's a step in the right direction, judging from the above list of breakfast cereal "survivors" of the check mark program, the criteria may have been tightened . . . but not that much.

Fractures and vitamin D

27. April 2010 William Davis (25)
This is a bit off topic, but it's such an interesting observation that I'd like to pass it on.

Over the past several years, there have been inevitable bone fractures: People slip on ice, for instance, and fracture a wrist or elbow. Or miss a step and fracture a foot, fall off a ladder and fracture a leg.

People will come to my office and tell me that their orthopedist commented that they healed faster than usual, often faster than anyone else they've seen before. My son was told this after he shattered his hand getting slammed against the boards in hockey; his orthopedist took the screws and cast off much sooner than usual since he judged that healing had occured early. (My son was taking 8000 units vitamin D in gelcap form; I also had him take 20,000 units for several days early after his injury to be absolutely sure he had sufficient levels.)

My suspicion is that people taking vitamin D sufficient to enjoy desirable blood levels (I aim for a 25-hydroxy vitamin D level of 60-70 ng/ml) heal fractures much faster, abbreviating healing time (crudely estimated) by at least 30%.

For any interested orthopedist, it would be an easy clinical study: Enroll people with traumatic fractures, randomize to vitamin D at, say, 10,000 units per day vs. placebo, watch who heals faster gauged by, for instance, x-ray. My prediction: Vitamin D will win hands down with faster healing and perhaps more assured fusion of the fracture site.

T3 for accelerating weight loss

25. April 2010 William Davis (57)
Supplementation of the thyroid hormone, T3, is an underappreciated means to lose weight.

Thyroid health, in general, is extremely important for weight control, since even subtle low thyroid hormone levels can result in weight gain. The first step in achieving thyroid health is to be sure you are obtaining sufficient iodine. (See Iodine deficiency is real and Healthy people are the most iodine deficient) But, after iodine replacement has been undertaken, the next step is to consider your T3 status.

I've seen T3 ignite weight loss or boost someone out of a weight loss "plateau" many times.

Endocrinologists cringe at this notion of using T3. They claim that you will develop atrial fibrillation (an abnormal heart rhythm) and osteoporosis by doing this. I have yet to see this happen.

Adding T3 revs up metabolic rate at low doses. The idea is to push free T3 hormone levels to the upper limit of normal, but not to the hyperthyroid range. While an occasional person feels a little "hyper" like they've had a pot of coffee, most people just feel energized, clear-headed, and happier. And weight trends down much more readily.

Taking T3 by itself with no effort at weight loss generally yields only a modest weight reduction. However, T3 added to other weight reducing efforts, such as wheat elimination and exercise, accelerates the weight loss effect considerably. 5 lbs lost will likely be more like 8 to 10 lbs lost; 10 lbs lost will likely be more like 15 to 20 lbs, etc.

It's also my suspicion that more and more people are developing a selective impairment of T3, making it all the more important. I believe that you and I are being exposed to something (perchlorates, bisphenol A, perflurooctanoic acid, and others?) that may be impairing the 5'-deiodinase enzyme that converts the T4 thyroid hormone to the active T3. Relative lack of T3 leads to slowed metabolism, weight gain, and depressed mood. While avoiding or removing the toxin impairing 5'-deiodinase would be ideal, until we find out how to do this, taking T3 is a second best.

The tough part: Finding a prescriber for your T3.

The world according to the Wheat Foods Council and the Whole Grains Council

23. April 2010 William Davis (26)

You might get a kick out of what the Wheat Foods Council and the Whole Grains Council recommend for a sample meal plan:

Breakfast: Whole grain raisin toast
Lunch: Sandwich on whole grain
Snack: Rye bread crackers
Dinner: Whole grain pasta with your favorite sauce

Breakfast: Whole grain waffles 
Lunch: Hamburger on whole grain bun
Snack: Graham crackers
Dinner: Whole grain homemade pizza on whole grain pita crust

Remember Morgon Spurlock's documentary movie, Super Size Me? (If you haven't already seen it, Super Size Me is viewable for free on Hulu.) Spurlock conducts a self-inflicted 30-day experiment of eating at McDonald's fast food restaurants every day. In short, the results on Spurlock's weight and health are disastrous. 

How about Wheat Belly: The Movie? We would chronicle our star through a 30-day course of meals served up by the Wheat Foods and Whole Grains Councils, all featuring wonderful wheat products in every meal. We could measure blood sugar, triglycerides, LDL, small LDL, weight, etc.


Any predictions?

Why bananas increase cholesterol

21. April 2010 William Davis (0)
Anything that increases postprandial (after-eating) blood sugar will increase the number of LDL particles in the blood.

An increase in LDL particles is an important factor in causing heart disease: The greater the number of LDL particles, the more opportunity they have to interact with the walls of arteries, contributing to atherosclerosis.

Carbohydrates increase small LDL, especially if postprandial sugar is increased. Here's another way carbohydrates increase LDL particles: The duration of time LDL particles hang around in the blood stream is doubled.

When blood sugar increases, such as after the 30 grams carbohydrates in a medium-sized banana, glycation of LDL particles occurs. This means that a gglucose (sugar) molecule reacts with a lysine residue in the apoprotein B of the LDL particle. This induces a change in conformation that makes it less readily recognized by the LDL receptor. Thus, the glycated LDL particle persists for a longer period of time in the blood stream.

LDL particles are therefore cleared less efficiently, numbers of LDL particles increase.

Plant-based or animal-based?

19. April 2010 William Davis (78)
The ideal diet for heart and overall health restricts carbohydrate intake. I say this because carbohydrates:

Make you fat--Carbohydrates increase visceral fat, in particular.
Increase triglycerides
Reduce HDL
Increase small LDL particles
Increase glycation of LDL
Increase blood pressure
Increase c-reactive protein

Reducing carbohydrates reverses all the above.

But here's a common mistake many people make when following a low-carbohydrate diet: Converting to a low-carb, high-animal product diet.

It accounts for a breakfast of a 3-egg omelette with cheese and butter, 4 strips of bacon, 2 sausages, cream in coffee. Low-carb? It certainly is. But it is a purely high-animal product, no-plant-based meal.

I believe a strong argument can be made that a low-carbohydrate but plant-based diet with animal products as the side dish is a better way to go.

Consider that:

1) Animal products have little to no fiber, while plant-based products like spinach, avocado, and walnuts and other raw nuts have substantial quantities.

2) Plant products are a source of polyphenols and flavonoids--This encompasses a large universe of nutrients, from epigallocatechins in tea, polymeric procyanidins from cocoa, to hydroxytyrosol from olives, and anthocyanins from red wine and eggplant. The inflow of these beneficial compounds needs to be frequent and generous, not piddly amounts taken infrequently.

3) Vitamin C--While it's easy to obtain, the fact that you and I need to obtain vitamin C from frequent ingestion of plant sources suggests that humans were meant to eat lots of plants. While it may require a few months of deficiency before your teeth fall out, imagine what low-grade deficiency can do over a long period.

4) Vitamin K1--Rich in green vegetables, vitamin K1 is virtually absent in animal products.

5) Tocotrienols--I've been watching the data on this fascinating family of powerful oil-soluble antioxidants unfold for 20 years. Tocotrienols come only from plants. (I recently had an extended conversation with the brilliant biochemist, Dr. Barrie Tan, who is incredibly knowledgeable about tocotrienols, having developed several methods of extraction from plants, including his discovery of the highly concentrated source, annatto. Be sure to watch for future conversations about tocotrienols.)

6) Meats and dairy yield a net acid load--While plant foods are net basic. At the very least, this yields risk for osteoporosis, since acids are ultimately buffered by basic calcium salts from the bones. Tissue and blood pH is a tightly regulated system; veering off just a teensy-weensy bit from the normal pH of 7.4 to an acidic pH of, say, 7.2, leads to . . . death. In short, pH control is very important. A net acid challenge from animal products is a lot like drinking carbonated soda, a huge acid challenge that leads to osteoporosis and other health issues.

Conversely, a pure plant-based diet has its own set of problems. Eating a pure plant-based diet can lead to deficiencies of vitamin B12, omega-3 fatty acids (no, linolenic acid from flaxseed will NOT cut it), vitamin K2, carnitine, and coenzyme Q10.

So, rather than a breakfast of 3-egg omelet with bacon, sausage, cream, and cheese, how about a handful of pecans, some blueberries, and a 2-egg omelet made with basil-olive oil pesto? Or a spinach salad with walnuts, feta cheese, and lots of olive oil?

Fat is not the demon

16. April 2010 William Davis (36)
So my patient, Dane, generously volunteered to be on the Dr. Oz show, as I discussed previously.

What we didn't know, nor did the producer who contacted us mention, that Dane would be counseled by low-fat guru Dr. Dean Ornish on a strict low-fat diet. The teaser introduction essentially tells the entire story.

Ironically, that is the exact opposite of the dietary program that I advocate. I rejected the 10% fat diet long ago after I became a type II diabetic, gained 30 lbs, and suffered miserable deterioration of my cholesterol values on this diet. I also witnessed similar results in many hundreds of people, all following a strict low-fat diet. In fact, elimination of wheat--whole, white, or otherwise--along with limitation or elimination of all other grains has been among the most powerful health strategies I have ever witnessed.

I now regret having subjected my patient to this theatrical misinformation. Dane is a smart cookie--That's probably why he was not allowed more than a "yes" or "no" during Dr. Oz's monologue, else Dane might have pitched in about some ideas that would have tripped Oz and Ornish up.

In their defense, if we took 100 Americans all following a typical 21st century diet of fast food, white bread buns, Coca Cola and other soft drinks, chips, barbecue sauce, and French fries, converting to a plant-based, high-carbohydrate, grain-rich diet is indeed an improvement. People will, at first, lose weight and enjoy an initial response. (The occasional person with the Apo E4 genetic pattern, heterozygote or homozygote, may even enjoy long-term benefits, a topic for another day.)

But the majority of people, in my experience, after an initial positive response to an Ornish-like low-fat, high-carbohydrate diet will either plateau (stay overweight, have low HDL, high triglycerides, plenty of small LDL, and high blood sugars) or deteriorate, much as I did.

Thankfully, Dane has been a good sport about this, understanding that this is essentially show business. I believe he understands that the information was all well-intended and, after all, we are all working towards the same goal: reduction of heart disease risk.

By the way, regardless of which diet you follow, it is, in my view, absurd to believe that diet alone will do it. What about vitamin D normalization, thyroid normalization (thyroid disease is incredibly common), omega-3 fatty acids from fish oil, identification of hidden sources of risk (something that is unlikely in Ornish, since small LDL particles skyrocket on a low-fat diet), postprandial glucoses, etc., all the pieces we focus on to gain control over coronary plaque? Eating green peppers and barley soup alone is not going to do it.
Prescription vitamin D

Prescription vitamin D

23. June 2007 William Davis (32)
Niacin:

Over-the-counter: $2-5 per month
Prescription: $120 per month


Fish oil:

Over-the-counter: $3-6 per month
Prescription: $120 per month


Vitamin D:

Over-the-counter: $2 per month
Prescription: $70 per month



With vitamin D in particular, the prescription form is vastly inferior to the over-the-counter preparation. This is because the prescription form is ergocalciferol, or vitamin D2, not the effective human form, vitamin D3 or cholecalciferol.

When you're exposed to sun, what form of vitamin D is activated in the skin? It's all vitamin D3, no vitamin D2 whatsoever. Vitamin D3 is also far more effective than D2. People taking D3 (as long as it's oil-based) easily obtain healthy levels of vitamin D in the blood. People taking 50,000 units per day of D2 (the recommended quantity) remain miserably deficient, with minor increases in vitamin D blood levels. In short, D2 barely works at all. D3 works easily and effectively.

Moreover, D2 is the plant-based form. It is a form not found naturally in humans. D3 is the mammalian form, the same found in humans that exerts all its biologic benefits.

Then why is the prescription form of vitamin D2 (brand names Driscol and Calciferol) more expensive?

It's the same old pharmaceutical industry scam: Look for something patent protectable, regardless of whether it's superior to the non-patent protectable product, then sell it for exagerated profits. Though it is inferior and the science and clinical experience prove that it's inferior, you can still fool lots of people, including prescribing physicians. So what if you only make $50 or $100 million?

Don't fall for it. Prescription doesn't necessarily mean superior. In fact, the prescription form may be significantly inferior, as with vitamin D2. But the pharmaceutical industry carries such power and persuasion, who's going to know?
Tags :

Comments (32) -

  • Anonymous

    6/23/2007 12:10:00 PM |

    I guess it could be said that a flaw some have is a willingness to take advantage of the uneducated.  

    On the niacin, my guess is that the over the counter Slo Niacin is manufactured by the same company in the same facility as the prescription form.  The machines used would be different as the FDA wants this, but the manufacturing procedures and source product would be the same.  I don't know this for a fact, but it would not surprise me if it were true.  

    For fish oil, there are only a couple facilities in the world that manufacture fish oil.  The products these facilities sell are pretty much all the same in quality.  Everyone buys from the same places.  The facilities that encapsulate pharmaceuticals often times also manufacture health foods in the same plant.  The exact machines used for encapsulating pharmaceutical fish oil and store shelf fish oil will need to be different for government purposes but basic manufacturing practices followed will be about the same.

    I was in a unique situation to witness a Germany company sell a product as a health food - and at the same time was going through the FDA drug approval process with the same exact patent protected product.  The product never did make it through testing in the end.  Phase 3 (I think that is what it is called) human studies at the Cleveland Clinic were a bust as too many people stopped taking the product. (Reportedly the product worked so well that people stopped taking it as they felt healed.)  I remember the German company planned to make “large” amounts of money off of their product if it passed testing as they would be able to charge a premium.  After testing fell through they decided to not try again.  A large American firm took on their product and placed it into every store in America, - and that was good enough for them.

  • Edward Hutchinson

    6/23/2007 1:49:00 PM |

    http://www.ajcn.org/cgi/content/abstract/84/4/694
    The case against ergocalciferol (vitamin D2) as a vitamin supplement provides more information which may interest some.
    http://www.ajcn.org/cgi/content/full/85/1/6
    Risk Assessment for Vitamin D shows that up to 10,000iu daily produces no observable adverse events but readers should note that actual harm occurs is 40,000iu are consumed daily.
    However as you body uses only 4000iu daily http://www.ajcn.org/cgi/content/full/77/1/204 there has to be good reason to take more than 4000iu daily.

  • BarbaraW

    6/23/2007 2:06:00 PM |

    Dear Dr. Davis,

    I've been reading your blog for sometime, since I found the link on Regina Wilshire's blog. I've learned a lot and want to thank you for sharing your insights and expertise with everyone. I imagine (and hope) that there are many, many more people reading it than are posting. I think what you and your colleagues are doing with Track Your Plaque is phenomenal. Interesting that there seem to be none of these services in New England, that bastion of tradition.

    I've been fascinated by your articles on Vitamin D.  In looking around at Vitamin D3 (cholecalciferol) to purchase online (I can't find gelcaps locally), I came across the "Wilderness Family Naturals" web site.  In their article on cod liver oil ( http://www.wildernessfamilynaturals.com/cod-liver-oil-health-benefits.htm ), they state:
    "Cholecalciferol is the form found in vitamin supplements and fortified dairy products and not the hormonal form of vitamin D, namely 1,25-dihydroxycholecalciferol."
    The also state: "The form of vitamin D that we get from supplements is not fully active."

    Can you talk about this for us?

    In any case, my question is: can't I just take my cod liver oil to get my Vitamin D? Do I need the gelcaps of D3 in addition?

    Thanks again,
    Barbara

  • Dr. Davis

    6/23/2007 10:04:00 PM |

    Wow! Thanks for the helpful commentary.

  • Dr. Davis

    6/23/2007 10:09:00 PM |

    Barbara-
    It's really very simple once you start checking blood levels on everybody--you quickly begin to learn what works and what doesn't.

    Vitamin D3 (cholecalciferol) is what you need. Don't be confused by the comment about the "real" form, 1,25-diOH-vitamin D3. This is a kidney metabolite. We all still need vitamin D3.

    It's best to find D3, not cod liver oil. I remain skeptical about the safety of cod liver oil due to some reports of preparations with excessive pesticide residues.

    Try www.vitaminshoppe.com or look for Carlson's preparation, both 2000 unit gelcaps of D3.

  • Cindy

    6/24/2007 9:06:00 PM |

    I take D3 and have been for at least 3 months. I've been taking 3000iu/day and just had a blood test that indicates my blood level is only 33 (22 - 67 is the reference level).

    I'm out in the sun at least 15 min a day, not including driving, walking to and from, etc.

    So...how much Vit D should I be taking? I believe you recommend a level of 50-60?

  • Dr. Davis

    6/24/2007 11:24:00 PM |

    Cindy--
    We commonly use 5000-6000 when situations like this arise and generate desirable levels. Also, the values of "normal" in the reference range you provide suggests that your laboratory also runs an outdated method of measurement. (The newer methods tend to show "references ranges" of 20-100, or something close to that range.)

  • Cindy

    6/25/2007 4:22:00 AM |

    Thanks!! I've made several changes recently thanks to your posts!!

  • Mike

    6/26/2007 6:25:00 AM |

    Hi Dr. Davis,
    I see both Vitamin D and Vitamin D3 supplements being sold:

    Vitamin D

    Do I need to assume that supplements labeled as simply Vitamin D are, in fact, D2?  Are there other forms that it could be?
    Thanks,
    Mike

  • Dr. Davis

    6/26/2007 12:33:00 PM |

    Mike-
    No, you can not assume D is D3.

    Always look for:
    1) gelcaps, not tablets
    2) D3 or cholecalciferol
    3) Never D2 or ergocalciferol.

    Those little attentions to detail will help a bunch and ensure you get the right stuff.

  • Mike

    6/26/2007 6:19:00 PM |

    Thanks!

  • Anonymous

    7/25/2007 8:32:00 AM |

    I was diagnosed with a defiency in vitamin D in january . My total level was 12ng/mL . I started taking supplementation, 800 IU daily of Vitamin D3 (cholcalciferul), and a Centrum multi-vitamin which has another 400 IU . I took that for over 6 months. I just had my level checked again . It is only 15ng/mL still !
    How much D3 should I be taking ?
    And what would be a good target for a 31 year old male ?

  • Dr. Davis

    7/25/2007 12:04:00 PM |

    There's no "one-size"fits-all" in dose for vitamin D. However:

    1) The vitamin D in multivitamins doesn't work at all.

    2) You're therefore taking 800 units per day, the dose for a small child.

    3) Most adults require 2000-6000 units per day. The D must be in capsule form, not tablet.

    4) In the Track Your Plaque program, we aim for a blood level of 50 ng/ml.

  • Anonymous

    7/26/2007 5:43:00 AM |

    Thanks, Dr.

    1) Can you expand on why that is re. multi-vitamins inefficacy of vitamin D ? Does this apply only to the vitamin D in them ?
    Are the liquid forms of multi-vitamins any better than the tablets (eg. centrum liquid) ?

    2-3) I thought according to the FDA, the recommended daily dose was 400 IU for an adult and the safe dose was 2000 IU. How did you come up with your numbers ?

    3) You guessed it - I had been taking Vitamin D in tablet form only. I can certainly believe that they were not effective given my test results. But can you explain why the tablet forms don't work ?

    Tonight I looked for vitamin D in liquid form . I had to go to 4 places - Costco, my Kaiser pharmacy, Longs, and finally Walgreen's, which had some softgels from fish oil. I bought 100 softgels of 1000 IU each for $7.99.

    The tablets I have are Nature made brand. I have about 300 left. As far as tablets go, how do you rate them ? Would you just throw them away and just take the gels ? Or take some gels and tabs ? I hate to just waste the tabs.

    4) Thanks !

  • Dr. Davis

    7/26/2007 12:30:00 PM |

    Please refer to the several previous posts under "Vitamin D" or our extensive discussion on the www.trackyourplaque.com website.

  • Dr. Davis

    7/28/2007 2:50:00 PM |

    Vitamin D should always be either "D3" or cholecalciferol, NEVER "D2" or ergocalciferol, since D2 exerts negligible benefits.

    If your preparation fails to specify which form, look for another that does.

  • Ava

    10/10/2007 8:12:00 PM |

    Hello I'm a vegan from Germany and like to respond to the argument that is circling through the web relating to D2. Since I'm vegan don't use D3 since that is produced by irridating butchers-wool with UV-light, an information that is often left out when touting this version of vitamin D as the "natural" one. Because of all the negative rap D2 has gotten, it has now in fact disappeared as a supplement in the EU, effectively starving vegans and other vegetarians of vitamin D. I was thus forced to look for alternatives to have my winter supply of vitamin D. What I do is grow my own delicatessen mushrooms right here at home and either dry them in the sun or irridate them with the Utra Vitalux 300 Watt UVB - Lightbulb after harvest which makes them a very rich source for vitamin D2.  Now here comes the interesting part. My previously utter deficient 25(OH)D below detection level, measured at the end of summer -I'm not the outside type and almost never get enough UV-exposure from sunlight- has after a year gone up to 105 nmol/L. Given that I have nowhere near enough sun exposure, and as a vegan no other dietary source of vitamin D, it is clear to me that the vitamin D2 from my sun-dried or irridated mushrooms is responsible for my recovery from hypovitaminosis D.

    Now I don't know if there's a difference of vitamin D2 in mushrooms or the pharmacological D2 in pills, all I know is that Vitamin D2 is *my* primary source of vitamin D and it's giving me excellent levels of 25(OH)D.

    What I find highly irritating is the meme like argument flying around that vitamin D3 is the one "naturally appearing in the body". Duh. Vitamin D2 is also converted into vitamin D3 so the fact that D2 is not "naturally in the human body" should be as relevant that Vitamin C is not "naturally in the human body" and has to by sourced from diet. There are many nutrients that are "not natural" in the human body and which we need to source from diet, for example the essential amino acid. Besides, since when does "natural" equate to being good? If a Uranium miner has "natural" radioactivity in his body because he is exposed to it during work, is that good? I don't think so.

    The reason I'm irritated is because the information about vitamin D2 being bad (when that is, at least in my case *not* true) has real implications and discriminatory effect on vegans and other vegetarians because not everybody of us has the patience and curiousity to produce their own Vitamin D at home, and perhaps some people don't enjoy eating mushrooms.

    There is one more point and then I'll end my rant. Every time us vegans were informed that a particular plant based nutrient like vitamin A (beta-carot.) or iron was inferior because it has a lower bio-availability, later research discovered that that lower bio-availability has actually real benefits. I wouldn't be surprised if the same appears to be true for vitamin D2. I have already come across research which noted one of the D2 metabolites to have anti cancer properties, although this study is based on non-human animals meaning it has little to no relevance to humans and is based on the exploitation and death of rats.

    For those who (despite reading this on an electronic network of computers) lay any importance on _naturality_ regarding nutrients, you may want to consider my method of just drying mushrooms in the sun. That's certainly more natural than killing sheep, stripping the hair grease of their wool and irridating that with UV-B light, which is the standard method of how vitamin D3 is produced - a byproduct of butchers waste.

  • Dr. Davis

    10/10/2007 9:40:00 PM |

    Fascinating solution!

    However, I stick by my claim that, for most people, vitamin D2 supplementation does not work. I have seen many people on as much as 50,000 units of D2 per day with zero or near zero levels of conversion to the active D3, all proven by blood levels.

    However, for a vegan, I do not have any useful non-animal solutions beyond getting sun.

  • Anonymous

    2/14/2008 8:14:00 PM |

    My Vitamin D levels, when first tested, were 12.  I have been using a Vitamin D lamp to try to raise the levels, which are now 32-33.  Initially, I took Puritan's Pride Vitamin D, which made me feel like a new person, but I quickly learned that it interfered with the efficacy of Cytomel, which I take because Synthroid interferes with yet a different medication.  Do you know of any form of Vitamin D that might not interfere with Cytomel?  

    Thank you.

  • Anonymous

    4/4/2008 5:47:00 PM |

    I just found out my vitamin D level is abysmally low from a blood test. My endocrinologist gave me a prescription for 50,000 units of vitamin D.  After reading about the subject here, I don't know whether to fill the prescription or go the the health food store and get a bottle of vitamin D3 capsules and disobey doctor's orders. We are investigating whether I have disturbances in my cortisol levels.  So far, testing has shown very low morning cortisol levels.

  • Anonymous

    5/6/2008 8:00:00 PM |

    I went from sickly to healthy from taking 50,000IU (once a week) of Calciferol, proven by my recent bloodwork.  My D level was 18 in November,  and 4 months later it was 38!!!  Taking D2 has changed my life and I continue to take it without hesitation or reservation.

    I have read that I should be taking a cal/mag supplement to increase absorbtion but I have not done so . . . your thoughts please.

  • Anonymous

    7/25/2008 6:43:00 AM |

    Maybe the lab you use for blood tests isn't DEQAS certified, and isn't accurate.  I don't know how else to explain why a recent study contradicts what you're saying about D2:

    http://jcem.endojournals.org/cgi/rapidpdf/jc.2007-2308v1.pdf

  • Anonymous

    8/5/2008 11:38:00 AM |

    Hello, can you tell me what form of D3 is best and why.

  • Anonymous

    11/7/2008 2:11:00 PM |

    Ergocalciferol (D2) has a kenetic half life of 10 days.  Calcitriol (D3) has a half life of 3 days. I am surgically hypoparathyroid and replaced 100% of that function with calcitriol or ergocalciferol for 30+ years. I find the D3 form is smoother on my body, until I forget to take my dose on any particular day. Then my mood, energy, stamina, sense of well being etc noticably deteriorate. I lived quite easily on D2 for nearly 28 years until medicare decided this life essential medication was a non life essential vitamin and forced a change to the more expensive calcitriol they would pay for. So now I painfully die in 10 days without D3 instead of 30 days if taking D2. This is germane when the price of ergocalciferol in 1991 was $1.99/100 50000IUs dose. After several years of repeated "offshore supply problems" the price is now $125/100 forn teh identical medication. Sometimes I'd drive 75 miles to another pharmacy (dealer - lol) to refill the D2 when the supply dried up. On correct fo the supply problem the price would double or triple (WTF???). Oh well - rather that a "DNR" I insist on a "JSM" (just shoot me).

  • Carminal

    11/8/2008 12:23:00 AM |

    Hi everyone,

    Firstly, I must say I agree with ava reactions being irritated above, even if not being vegan myself, but vegetarian.

    I would like also to point out that health is definitly not numbers on a paper coming from tests but is how we can feel and act.

    Good health is about feeling balanced and in a state that allows personal accomplishment. It is not, not at all, about obtaining or aiming a level of that molecule or this other one in a blood test.
    You can take two people with same amount of that molecule, or with similar tests results and having one feeling very healthy and being really so and the other one being and feeling desperetly ill. Blood tests reflect only very poorly what is really happening in the vast universe of our cells and tissues. It does not indicate at all how plenty of important biological reactions are going in us.

    It makes me smile when I read 50,000 IU of D2 did not increase D3 levels. When you place carrots in your dish, you do not have sprouts !! The purpose of taking D2 is not about raising D3 and D3 metabolites levels but D2 and D2 metabolites ones. D2 and D3 molecules react in same biological fields, and D2 is beeing used with success for decades. It is not honnest to omit that and to pretend D2 is worthless because D3 levels do not raise : it is a false demonstration.

    In my view solar exposition is the most important factor for everyone, but when not getting enough D from sun, the plant-form D (D2) is perfectly suiting. I have never read any animal study that tends to show D3 supplementation is preferable to D2; on the contrary toxicity is shown to be a lot greater with D3 hypervitaminosis than with D2 hypervitaminosis (a lot more calcifications with D3 than with D2). Plants represent the reference in food because everything we need, even B12 for example, can be found in the plant kingdom; that is not the case if the animal kingdom is taken as food. Then ask your intuition about D2 and D3 being the most desirable form of Vit. D when not receiving enough sun...

    Readers should remind that there is two different 25(OH)D : the one with D2 and the one with D3, and also two 1,25(OH)2D. Measuring the D3 forms (most commonly measured in blood tests) is meaningless if you take D2 supplements. It is NATURAL having in the blood less 25(OH)D in its D3 form during winter than during summer because at that time there is less sun activity. Correcting lowering Vitamine D activity during winter with D3 supplementation rather than with D2 is illogical and unatural.

    R. Jehl
    Naturotherapist in France

  • Anonymous

    11/30/2008 10:58:00 PM |

    Individualized Vit D supplementation is necessary. The arguments regardind D2, D3, single Hydroxy and double hydroxy depend on your body and its current disease status. For example, giving a D2 or D3 to a patient without kidney function is useless because they cannot convert it to the ACTIVE form of 1,25(0H)2D3. Kidney patients must take activated or the final form of vitamin D 1,25(0H)2D3. Liver dysfunction patients cannot convert the D3 to the single hydroxylated form, which the kidney needs in order for its metabolism. So, really, blank statements as given by the French provider indicating D2 for all is FALSE. Look up the metabolic pathway. If you are stone cold normal and only have low Vit D, then you can take either form of regular D2 or D3. If you have a disease, GI malabsorption, liver or kidney disease, granulomatous disease etc you should consult a professional to guide your dosage for proper results. I do like combining some fast acting forms with some slower acting forms to help folks feel better faster and then long term treating with slower forms if they can metabolize them. Everyone is unique and sometimes trial and error are required.

  • Anonymous

    12/22/2008 6:32:00 PM |

    I have read through these posts with interest. I am new to this site, looking for a solution to my 'no beef' diet and insufficiencies in Vitamin D (3 mostly). I am on synthroid, but never knew of the Vitamin D correlation.

    I find that in the US there appears to be NO 50,000 Vitamin D without bovine capsules. I cannot find a veggie tab surrounding even the D2.

    Can anyone advise where I might 50,000 units of Vitamin D3 with no 'cow' gelatin coating?

  • Anonymous

    2/4/2009 1:33:00 PM |

    Do you have any recommendations for those who are vitamin D deficient but cannot tolerate oil based capsules but have no problem with fortified foods?  Is the UV lamp a safe alternative?  Is there a powder form of D that is effective?

  • Anonymous

    2/6/2009 8:52:00 PM |

    I've read this discussion with a great deal of interest.  I've been supplementing with Vital Nutrients capsules which are vegetarian.  They make 2000iu capsules and 5000iu capsules. http://www.vitalnutrients.net/vnestore/detail.asp?product_id=VNVD2

  • Ava

    12/26/2009 1:17:19 AM |

    Hello this is Ava again from Germany, I posted a long rant into this thread some while ago.

    I'd just like update that I've switched from irradiated mushrooms to a vitamin D2 supplement as drops ( Sterogyl 2,000,000 ergocalciferol ) and my 25(OH)D levels are really nice in winter at 156 nmol/L or 62 ng/ml! In France it's availalbe without perscription and we've been able to get it Germany too. It's very cheap around 2 Euro for 400,000 IUs despite the name. I started out with 13 drops / 5200 IU for 14 days, then I took a single mega dose of 300,000 IUs. Since that I've been taking 70.000 IUs once a week. I'm very tall at 6' flat and this is the dose my body needs to achieve good levels.

    It's also possible to just keep on taking 3500 to 5000 every day, however it then takes much longer to reach desired serum levels.

    If you have access to this cheap product and take 5200 every day, the 2.50 Euro or so will still last you almost 3 months.

  • josephmoss

    7/24/2010 7:37:50 AM |

    Vitamin D3 Iu:

    NOW Vitamin D softgels supply this key vitamin in a highly-absorbable liquid softgel form. Vitamin D is normally obtained from the diet or produced by the skin from the ultraviolet energy of the sun. However, it is not abundant in food. As more people avoid sun exposure, Vitamin D supplementation becomes even more necessary to ensure that your body receives an adequate supply. Vitamin D3 Iu on discount at NutroVita.com.

    For more details please visit:
    http://www.nutrovita.com/32760/now-foods/vitamin-d-3-2-000-iu.htm

  • buy jeans

    11/2/2010 7:55:30 PM |

    When you're exposed to sun, what form of vitamin D is activated in the skin? It's all vitamin D3, no vitamin D2 whatsoever. Vitamin D3 is also far more effective than D2. People taking D3 (as long as it's oil-based) easily obtain healthy levels of vitamin D in the blood. People taking 50,000 units per day of D2 (the recommended quantity) remain miserably deficient, with minor increases in vitamin D blood levels. In short, D2 barely works at all. D3 works easily and effectively

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