Vitamin D2 belongs in the garbage

It happened yet again.

Mel came to the office. CT heart scan score: 799--quite high, enough to pose a real threat very soon. Thus, no time to lose in instituting an effective prevention program.

We do the usual--identify the six causes of coronary plaque; begin fish oil, show him how to correct his plaque causes. You've heard it before.

Vitamin D blood level in March: 17 ng/ml--severe deficiency.

Vitamin D replacement needs to be a part of his coronary plaque control program. So I suggested 6000 units per day of an oil-based preparation of vitamin D3 (cholecalciferol). Conveniently, there is a Vitamin Shoppe outlet across the street from my office. I just point and tell people to go across the street.

Mel did just that. However, he also informed his primary care physician about his vitamin D deficiency. His primary physician promptly told him he needed to take a prescription form of vitamin D and not to bother with just a supplement.

So Mel stopped his vitamin D capsules and started taking vitamin D prescription "medication." Mel figured, naturally, that if it requires a prescription, it must be better. Unfortunately, Mel and his doctor failed to pass the change in strategy onto us.

So, four months later, Mel got repeat vitamin D blood level: 19 ng/ml.

I've seen this too many times. The prescription form of vitamin D is nonsense. There's hardly any effect on blood levels of vitamin D3 at all. The body's conversion of this non-human form of D is extremely inefficient and therefore virtually useless. While it raises the blood level of vitamin D2 (ergocalciferol) and thereby total D (D3 + D2), there is negligible effect on the real human and active form, D3.

How and why this preparation got through the FDA process to obtain approval as a drug is beyond me, though I am not a defender of FDA practices and politics.

This notion that "if it's a prescription, it must be better" is a fiction perpetuated by the drug industry. The same principle gets tossed around with fish oil, hormones like estrogens and testosterone, and others. Often, the principal difference between prescription and non-prescription is patent protection. Patent protection provides profit protection. Selling a product without patent protection can be risky business. It's certainly less profitable.

As always, getting at the truth is sometimes the most difficult job of all. Prescription vitamin D belongs in the garbage. Vitamin D capsules (gelcaps) do the job and do it well, over and over, with reliable, consistent and substantial rises in blood levels of 25-OH-vitamin D3. I take 6000 units per day (3 2000 unit capsules) that cost me $5.99 for a bottle of 120 capsules, or about $4.50 a month.

And nobody--nobody--pays me to say this. I say it because I believe it's true.

Comments (15) -

  • TedHutchinson

    8/8/2007 5:39:00 PM |

    The situation is the same in the UK.
    An "official" answer from the NHS National Library for Health explains "What is the most appropriate way to supplement vitamin D in a patient with low vitamin d which does not appear to be due to malabsorption , and who has a normal calcium and alkaline phosphatase" can be found here.

    Now who here thinks that if your outgoings are $4000 daily and your overdraft is at it's limit,in-payments of $800 daily will clear the overdraft and build up your savings?

    It appears from the GPnotebook that "there are no suitable preparations available on the NHS for situations where stand-alone vitamin D supplementation would be preferable, as in pregnancy"

    It seems to me utterly absurd that when our major high street chemists have on their supplement shelves 1000iu Cholecalciferol Vitamin D3, our Health Professionals appear unaware this is available (and at less then the cost of the normal prescription charge).

    The case against ergocalciferol (vitamin D2) as a vitamin supplement by Lisa A Houghton and Reinhold Vieth explains the science supporting Dr. Davis for those who are have any doubts about his opinions.

  • Ortcloud

    8/8/2007 5:39:00 PM |

    maybe this is why you see some doctors or studies using outrageous amounts like 50,000 iu's. The problem is that some people see these studies or amounts and take this amount in d3, which would be dangerous.

  • TedHutchinson

    8/8/2007 5:41:00 PM |

    The case against ergocalciferol (vitamin D2) as a vitamin supplement by Lisa A Houghton and Reinhold Vieth provides the science for those who doubt Dr Davis.

  • TedHutchinson

    8/8/2007 5:52:00 PM |

    In the UK "official" medical policy can be seen in this "official" answer from our NHS National Library of Health.
    What is the most appropriate way to supplement vitamin D in a patient with low vitamin d which does not appear to be due to malabsorption , and who has a normal calcium and alkaline phosphatase?

    It appears officially there are no suitable preparations available on the NHS for situations where stand-alone vitamin D supplementation would be preferable, as in pregnancy yet every high street has chemists selling 1000iu Cholecalciferol Vitamin D3.

  • TedHutchinson

    8/8/2007 7:36:00 PM |

    In reply to Ortcloud

    But we do not say because five times the safe limit daily recommendations for water (8 glasses) may cause adverse events (water intoxication) if people are stupid enough to consume 40 glasses a day that Water should have warning labels and/or a restricted supply.

    Our bodies use between 3000 & 5000iu Vitamin D daily. Ten times this amount will, over time, cause adverse events (hypercalcemia) but that is 10 times the most anyone (who hasn't access to sunlight) may need.
    Risk assessment for vitamin D
    John N Hathcock, Andrew Shao, Reinhold Vieth and Robert Heaney
    explains the safety of Vitamin D3 in more detail than I can here.
    If you find it difficult to follow you can listen to Vieth giving a presentation at
    Contemporary Diagnosis and Treatment of Vitamin D-Related Disorders
    Session 4: Vitamin D and Population Health use the arrows by the slide preview to fast forward to Vieth session (though the others are worth listening to if you have the time.

    If anyone is wondering; You cannot become Vitamin D intoxicated from sunshine, it is a self limiting process and if you continue to apply UVB heat the Vit d is turned into supra sterols that the body doesn't use. The animated diagrams here show it in action. but it explains why regular SHORT sun exposure sessions are far more effective than longer sessions that may lead to dangerous sunburn.

  • Anonymous

    8/11/2007 2:16:00 AM |

    I asked the clerk in my doctor's office to add a vitamin D3 test to my blood test requisition form. She put down vitamin D 25-hydroxy. The blood test result states that this assay quantifies the sum of vitamin D3, 25-hydroxy and vitamin D2, 25-hydroxy. Is it normal to report the sum rather than D3 and D2 separately?

  • Dr. Davis

    8/11/2007 2:20:00 AM |

    Most of the time, the sum of D3 + D2 is reported along with the individual components, D3 and D2 individually. D2 is usually reported as a means of measuring "compliance"--are you taking your "drug" or not? If the individual components are not reported, then a different lab should be used in my view.

  • Anonymous

    8/11/2007 2:37:00 AM |

    Thanks, Dr Davis
    The vitamin D test was performed by ARUP Laboratories in Salt Lake City, Utah, and my blood sample was collected in New York City. I did not take any vitamin D or related drug at the time. The report shows that my D3 + D2 level is normal low at 24. Now I take over-the-counter vitamin D3 2000 IU softgel supplement.

  • Dr. Davis

    8/11/2007 1:16:00 PM |

    That's great. However, in our patients we usually use at least 4000 units per day for a level this low. Or, you can be guided by your level on whatever dose you and your doctor choose.

  • w

    3/25/2008 8:24:00 PM |

    To make a long story short I began getting sinusitis back in Aug. '07. Never had it before. Battled that and a couple of small colds. The in December things went wacky. Weakness in arms. Stomach ulcer (which finally has pretty much gone away). Weak legs. Extreme exhaustion at times. Once I started Augmentin for the sinus infection in Dec. I was introduced to muscle pain as well. Got my Vit D tested by chance and found out it was <7ng/ml (yikes).

    The doc didn't know how to treat it so he had me on 400IUs daily (yeah right). So I did some research and started taking 2000IU D3 daily and tanning 15 minutes a week for a month. Within a couple of weeks I felt some improvement but still nowhere near 100% normal. Finally another doc prescribed 50,000IUs of Drisdol (D2) daily for 6 weeks. By that time I had already raised my D up to 32ng/ml in about 6 weeks using D3. 3 days on Drisdol and my knee pain subsided a bit...but 10 days on it I had a severe migraine and stopped taking it. Got another vit D test and I had skyrocketed to 76ng/ml...but still felt bad. I have to admit that some of the pain has lifted since being on the Drisdol but I'm nowhere near "normal" feeling.

    Since most of my "tank" is 2/3 full of D2 could this be why I'm still feeling yucky even though my total level is 76ng/ml? What can I do to slowly introduce D3 back into the mix without overdosing?

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Appetite stimulants

Appetite stimulants

Ever have days when you just can't seem to get enough to eat, your stomach gnawing just a hour after a meal? We all get them, some more than others. Other days, you can be content with a few simple foods and hunger is subdued, temptation easy to control.

Why such contrasts on different days?

A major part of the reason can be the presence of appetite stimulants, factors that trigger appetite beyond rational control. The list of common appetite stimulants includes:

--Sleep deprivation--A very important factor. Lack of sleep drives tremendous appetite, and often for the wrong foods (processed carbohydrates). I personally have experienced my most shamefully indulgent days when sleep-deprived. The solution is obvious: Sleep. Another factor that is based purely on personal observation is that of waking mid-phase. In other words, waking up while you're still enjoying the deeper phases of sleep (e.g., phase 3,4, or REM). This can oddly disrupt your day and your impulse control. I usually try and time sleep to increments of 90 minutes to coincide with the average duration of the full cycle of sleep. For example, 7 1/2 hours is better than 8 hours, since the extra half hour puts your square into a deeper sleep cycle.

--Excessive caffeine--Caffeine stimulates stomach acid. This triggers the impulse to eat . . . and eat and eat.

Image courtesy Wikipedia

--Aspirin and other anti-inflammatory agents--If you take aspirin (as many of our Track Your Plaquers do), then beware of the gastritis that can develop. Like excessive caffeine, it also triggers the impulse to eat, likely a protective mechanism, since food sops up excess acid. I ask patients to take periodic breaks from aspirin, e.g., a week off every two or three months, to allow the stomach to heal. Alternatively, an occasional dose of acid-suppressing medication is a safe practice, e.g., Pepcid AC 10-20 mg; Prilosec 10-20 mg.

--Wheat-containing foods--Followers of The Heart Scan Blog know my feelings on this. Wheat is a potent appetite stimulant: Eat something containing wheat like a pretzel or whole wheat bagel, and you want more. You may want more immediately, or a little later when your blood sugar plunges after the wheat-driven insulin surge. Solution: Dump the wheat, one of the most unhealthy food groups around.

--Alcohol--Though perhaps not a direct appetite-stimulating effect, the loss of impulse-control with alcoholic drinks can lead to overindulgence, often in the worst foods. Just beware.

--Hanging around with heavy people. Remember peer pressure? It can be subliminal. People with poor eating habits provide the silent message that it's okay to yield to impulse, overeat, overindulge, and choose the wrong foods.

--Stress--Whether through cortisol stimulation or other means, stress triggers appetite in some people. If you experience this and must give in, reach for raw nuts or nuts, rather than wheat snacks or chips. The effect will be minimal, perhaps even beneficial, rather than the bloating, appetite-stimulating, fattening effect of crackers, chips, or pretzels. This may be the same phenomenon as taking prescription steroids like prednisone.

--Short dark days, long nights--In other words, winter. Though just an anecdotal observation, I am convinced that vitamin D supplementation is an effective antidote to this effect. The short, dark days just don't bother you as much, perhaps not at all, and there's no impulse for comfort foods.

How about appetite suppressants? In this list I would include 1) raw nuts--especially almonds, walnuts, pecans, and pistachios, the sort with a fibrous covering and rich in monounsaturates, 2) other sources of plentiful healthy oils, e.g, use more olive oil in your salad or add it to hummus for your veggie dip, 3) space-occupying fibers such as glucomannan, inulin (such as in Fiber Choice), and psyllium seed products. Counteracting the above appetite stimulants like sleep deprivation is, of course, important.

The coming wheat frenzy, otherwise known as the holidays, is an especially important time to be aware of these effects. Eat, drink, and be merry--but with rational impulse control not driven by subconscious appetite stimulants.

Comments (17) -

  • Nancy M.

    12/20/2007 4:16:00 PM |

    You didn't mention one of the biggest appetite stimulants ever.... insulin. They used to inject it directly into anorexics to get them to eat.  That pre-meal release of insulin where you get very, very hungry as you're about to sit down to your dinner.

    Actually, it probably isn't the insulin per se, but what the insulin does, drops your blood sugar.  This is why a low carb diet works so well on moderating appetite, insulin and blood sugar drops are much quieter.

  • Stan

    12/20/2007 6:28:00 PM |

    It is not surprising that you have listed nuts and seeds as appetite supressants.  In my experience the most powerful apetite controller (suppressants if you have eaten enough) are fats!   All fats work like that, especially butter, lard, egg yolks etc.  Typically, our digestive system produces a satiety feedback within 10-20 minutes from eating a meal containing a reasonable amount of fat (for me personally, "reasonable" means 60-80%).  It does not work for low fat high carb meals - then the only restraint is the bulk volume.

    Stan (Heretic)

  • HeartCipher

    12/20/2007 8:15:00 PM |

    Maybe I'm just imagining it but I could swear that I'm less hungry if I drink two large glasses of water as soon as I get up in the morning and then eat 2 or 3 hard boiled eggs for breakfast.

    That keeps me going through lunch as I also snack on almonds during the morning (while doing my 2 month "almond eating personal trial".

    If I manage to have a couple of more eggs for lunch then I'm good until dinner.

    Anyone else had this experience with eggs?

  • Anonymous

    12/20/2007 9:29:00 PM |

    Here's an odd one, but true: diet sodas cause tremendous hunger.  And they especially cause ravenous carb cravings before bedtime on any day a diet soda has been consumed.

  • Dr. Davis

    12/21/2007 2:41:00 AM |

    I have. The combined protein in the white and fat in the yolk are very filling.

  • Dr. Davis

    12/21/2007 2:42:00 AM |

    What an interesting observation!

    This would also be consistent with the recent study suggesting that diet sodas are no different than sugared sodas on long-term impact on weight.

  • chickadeenorth

    12/21/2007 7:09:00 AM |

    Yes I notice eggs can hold me till late aft and ground flaxseed only holds me for 2 or 3 hrs.

  • Anonymous

    12/21/2007 11:02:00 AM |

    It really is remarkable how a heart healthy diet has cut down on my appetite.  Going into it, I never thought this would happen.  I figured I'd have a feeling of starving all the time.  

    A little different question, but a topic that came up over dinner last night, some friends and I have been on a low carb diet for a few months, and have noticed that our hair that was formerly thinning has become thicker.  Have you noticed this yourself, or patients mention this before?

  • Dr. Davis

    12/21/2007 12:21:00 PM |

    Curious. No, I've never seen this effect before. I'll have to watch for it.

  • g

    12/22/2007 3:37:00 PM |

    Yes, I had a pt in his 60s (his 25(OH)D was already 60ng/ml in Nov naturally because he lives in Arizona) and after ONE-WEEK on the TYP meal plan, he reported more hair. a-m-a-z-i-n-g!
    he even smokes still 1/2-ppd.
    I think that TYP somehow magically synergizes things in the body. I wonder why? DR. Davis, you are truly like other talented artists like Emeril... you put things all in a pot *POW*  *BAM* and make them A-L-L.... HAPPY!

    BTW an interesting observation, I've been on Vit D and TYP now for 2mos and I'm getting hit on more than ever... and it aint the Victoria S Superbra *ha ha* ;)
    Keep trackin' and REVERSE-PLAQUIN,

  • MAC

    12/22/2007 10:45:00 PM |

    Re: hair growth and low carb.

    There is a statement in the "Life w/o Bread" book by Christian Allan that too much insulin interferes with human growth hormone levels. Fingernails grow faster and hair growth increases on a low carb diet. This book is about Dr. Lutz who prescribed a low carb diet to his patients for 40+ years in Austria and Germany. The low carb diet puts the body back in balance between anabolic and catabolic processes.

  • Dr. Davis

    12/23/2007 12:39:00 AM |

    Hi, MAC--
    I wasn't aware of that. Thanks.

  • chickadeenorth

    12/23/2007 9:04:00 AM |

    Yes my nails grow like crazy as does my hair and lots on Atkins board said their hair grew and thickened.

  • Anonymous

    12/25/2007 9:57:00 AM |

    Hey g,

    Vitamin D must be an elixer huh?

    Very funny!

  • Anonymous

    1/18/2010 4:33:41 PM |

    Hanging around with heavy people can be bad for your health...?

    Comments like that are very hurtful and feed into the pressures in this country to be the perfect size 2.  Also, it assumes that only fat people eat a lot.  Thanks for that.  Appreciate it.

  • buy jeans

    11/2/2010 7:41:47 PM |

    --Hanging around with heavy people. Remember peer pressure? It can be subliminal. People with poor eating habits provide the silent message that it's okay to yield to impulse, overeat, overindulge, and choose the wrong foods.

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