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An interview with Dr. John Cannell: The Importance of Vitamin D
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Vitamin D, previously regarded (ignored) as only a risk for childhood rickets, is now being increasingly recognized as a crucial modulator of numerous body processes. Low vitamin D levels are epidemic and a major contributor to hypertension, diabetes, cancer (esp. prostate and colon), and heart disease.

Dr. John Cannell is founder of the non-profit Vitamin D Council and, both established to alert the public and physicians to this terribly underappreciated issue. Here are Dr. Cannell’s insights into the exciting possibilities in vitamin D replacement.

The first section is comprised of a number of questions we posed to Dr. Cannell, followed by a reprint of his most recent newsletter on vitamin D. The newsletter, entitled “Paradigms and Paradoxes”, is a wonderfully unique and concise summary of Dr. Cannell’s perspectives on vitamin D.

TYP: You've become a real crusader publicizing the serious deficiency of vitamin D in Americans. How did you personally first become interested in the vitamin D issue?

Dr. Cannell: I have a history of crusading for public causes, going back to my days as an antiwar activist. I was deeply involved in working against the Vietnam War. I played a part in organizing the “March on Washington” while at the University of Maryland and demonstrated against the war at the 1968 Chicago Democratic Convention. In 1969, I joined the government’s Volunteers in Service to America (VISTA) program.

After my first year of medical school at the University of North Carolina, I spent the summer in southern Iran, conducting research on vitamin D and calcium balance. I remember being besieged by villagers because they thought I was an American doctor. As only a first year student, I knew nothing of clinical medicine and didn’t have any medication. Regardless of whether the illness was hypertension, diabetes, heart disease, cancer, rickets, osteoporosis or tuberculosis, all I could advise the villagers to do was to sit in the sun to get vitamin D. I still remember walking around the village of Amadabad and seeing sick people sunning themselves because I told them to!

My fascination with vitamin D continued on my return to the states but was put on hold for many of my other interests. However, when I moved to Atascadero, California, in the late 1990s, I rekindled my interest. I realized that the government sanctioned Food and Nutrition Board (FNB) of the Institute of Medicine (IOM) was placing many Americans at risk. At that time [1997], the National Institute of Medicine’s Food and Nutrition Board (FNB) recommended adequate intake (AI) for vitamin D was 200, 400 or 600 IU a day, depending on the person’s age.

Professor Heaney and colleagues at Creighton University, writing in the American Journal of Clinical Nutrition in 2003 said,

“The recommendations of the Food and Nutrition Board with respect to oral vitamin D input fall into a curious zone between irrelevance and inadequacy. For those persons with extensive solar exposure, the recommended inputs add little to their usual daily production, and for those with no exposure, the recommended doses are insufficient to ensure desired 25(OH)D concentration.”

I came to believe that the physiological human requirements (from all sources) for vitamin D are approximately ten times higher than the current AI listed by the FNB. How is that for unintended consequences of a well-intentioned government program?

The main problem with the FNB’s recommendation is that most people greatly exceed the AI of vitamin D by simply spending a few minutes outside in the summer sun while wearing their bathing suits. In 1995, Professor Holick of Boston University demonstrated that a brief full-body dose of noonday summer sun is comparable to taking between 10,000 and 25,000 IU of vitamin D. Four earlier papers all found similar rates of natural vitamin D production. Dr. Adams and colleagues at the University of Southern California found that up to 50,000 IU/day of vitamin D/day is released into the circulation of Caucasians after 30 minutes of sun noonday summer sun. Three additional studies support the fact that even older humans make at least 8,000 and 10,000 IU/day after brief exposure to sunlight. The high rate of natural production of vitamin D in the skin is the single most important fact every person should know about vitamin D because it has such profound implications for the natural human condition.

I was left wondering whom I should believe, nature or another well-intentioned government program such as the FNB? That’s why in 2003 I recruited professional colleagues, friends and family for a board of directors and took the steps necessary to incorporate The Vitamin D Council as a tax exempt, nonprofit, 501(c) (e) corporation.

TYP: What measure(s) do you advocate to establish vitamin D adequacy--25-OH-vitamin D3, 1,25-OH-D3, PTH, bone density, CRP, etc.?

Dr. Cannell: The only test that can and should be used to determine vitamin D adequacy is a 25-hydroxy-vitamin D level [25(OH)D]. Levels should be maintained around 50 ng/ml. 1,25-dihydroxy-vitamin D [an alternative blood test commonly performed] levels can be low, normal or elevated in vitamin D deficiency.

Testing for vitamin D toxicity, which is rare, requires a 25(OH)D and an ionized serum calcium. If both are elevated, then vitamin D toxicity is possible, although 25(OH)D levels must exceed 100 ng/ml for such a diagnosis to be likely.

Vitamin D hypersensitivity, which is different from vitamin D toxicity, occurs when aberrant tissue in the body activates vitamin D in an uncontrolled manner. Primary hyperparathyroidism is a common cause. Sarcoidosis is another common such disease, but any of the granulomatous diseases can do it, as well as some cancers, especially non-Hodgkin's lymphoma. In these cases, hypercalcemia can occur with normal, or even low 25(OH)D levels. The diagnosis is confirmed when 25(OH)D levels are normal or low, 1,25(OH)D levels are elevated, and ionized serum calcium is elevated. If PTH is also elevated, then primary hyperparathyroidism is the most likely diagnosis.

TYP: What is the single most important fact about vitamin D?

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