Below is a recent newsletter from Dr. Cannell of the Vitamin D Council for a Q&A on international issues with vitamin D. I found the letter on acne, accutane, and the interaction to be of particular interest. It is amazing to think how we have ignored the science since 1938. Check out the letter from Eric, Scotland and the response to read the 1938 paper on acne.
International Questions and Answers
||John Cannell, M.D.
||Fri 5/14/10 2:05 AM
The Vitamin D Newsletter May 14, 2010 International Questions and Answers This is a periodic newsletter from the Vitamin D Council, a non-profit trying to end the epidemic of vitamin D deficiency. If you want to unsubscribe, go to the end of this newsletter. If you have not subscribed, you can do so on the Vitamin D Council’s website.
Dear Dr. Cannell: As a nutritionist, I am preparing my own website to spread the word about vitamin D to the German speaking parts of Europe. Germans are not allowed to import pharmaceuticals into Europe on our own. Higher dose supplements are declared medication by customs. Customs has the right to search every parcel from foreign countries and if products are found inside that are deemed medication they might be destroyed without further notice to the recipient. That means that a European government agency decided which vitamins and minerals in which forms and doses are necessary for the European people and may be used as supplements. Thank you for your good work! Hans, Germany
Dear Hans: What you describe may be coming to the USA. For now, sunshine during the German summers, safe and sensible use of sun-tanning booths in the winter, or taking 12 of the 400 IU tablets/day of the vitamin D that is available in Germany may be the only legal way to obtain enough vitamin D in Germany. However, I believe Bio Tech Pharmacal ships overseas. E-mail their customer service at email@example.com. Remember, if you use sun-tanning beds; ask for either the full-spectrum or the older type of low-pressure beds; do not use the high-pressure UVA beds. John Cannell
Dear Dr. Cannell: My father and I have had our 25 OH Vitamin D tests in Canada, but have received the results in nmol/L. I am stunned that your website does not appear to address how to convert these units to the units you use, ng/ml. I found a web blog that claimed that to convert you divide nmol/L by 2.5 to get ng/ml, but I would greatly appreciate a confirmation of this, and I strongly suggest this tidbit needs to be added to your web site. Thank you, Seth, Vancouver
Dear Seth: Yes, divide nmol/L by 2.5 to get ng/ml. In the USA, all labs report 25(OH)D levels as ng/ml so no division is needed. As far as our website goes, the conversion is now on it, thank you. The English company Minervation is well into a two-year project of greatly improving our website. Dr. William Grant, a member of our Board, is working closely with Minervation to get the science right. The current website began in 2003 when I spent several months writing it and my son then published it on the internet, so it is far from perfect. John Cannell
Dear Dr. Cannell: This is so impressive what this kid is doing, it would be neat if there were some way the Council could endorse him: http://www.shineonscotland.org.uk/ Mary, Scotland
Dear Mary: Thanks for the link. Quite a kid. We will take steps to endorse and encourage him. John Cannell
Dear Dr Cannell: I have been reading your newsletter with great interest for a few years. I am a French doctor, specialist in Rehabilitation Medicine, and am very much aware of the crucial role of vitamin D.
Having followed your action to promote vitamin D, I have written a book on this subject called “Soleil, Mensonge et Propagande,” which means “Sun, Lies and Propaganda.”
It gives the same message as yours, to the French public. Again “bravo” for the Vitamin D Council!
Dr Brigitte Houssin, MD, France
Dear Dr. Houssin: Congratulations on your book. Readers who want to buy your book in French should just Google the French title and buy it on Amazon. John Cannell
Dear Dr. Cannell: I am mother of 7 year-old boy with autism, I am medical doctor, we live in Rome Italy, I have read most of your papers, and I was happy to read your theory regarding autism and low vitamin D. I am originally from Somalia, and as you know already the research done in Minneapolis and Sweden documented high incidence in Somali emigrants, probably due to low level of Vitamin D. The Somali people usually are not fish consumers, even though the most important thing to add is about Somali women/mothers, most of these women cover themselves in Muslim tradition more in Europe than in Somalia, and some of them even use lightening creams that makes there skin more light and most of women that use these creams avoid the sun, because it can cause skin discoloration. Actually, I have been treating my autistic son with Vitamin D for 11 months, local product that contains 5 mcg per 1 drop of Calcifediolo. He takes 10 drops a day and I see his language more fluent, and he is really happier and more social. Do you think this dose is enough? My son is suspected to have mitochondrial disorder, his muscle enzymes are alliterated, so he is seeing mitochondrial expert to decide soon if we should do muscle biopsy? Do you think there could be any correlation about mitochondrial issue and Vitamin D?? Sincerely, Dr. Awolla Fur, Italy
Dear Dr. Fur: Calcifediolo is 25(OH)D, not vitamin D 3, and is no longer available for prescription in the USA. The dose of 25(OH)D is considerably less than the dose of vitamin D3. Your son appears to be on 50 mcg (2,000 IU) of 25(OH)D, which is too much, reduce the dose by half and obtain frequent 25(OH)D levels and then titrate the dose up until his 25(OH)D is between 100 and 150 ng/ml (250 – 375 nmol/L). So-called “mitochondrial disorders” are common in autism; I suspect – but do not know – that they will improve with chronic vitamin D treatment. I doubt a muscle biopsy will add any useful information to his treatment. John Cannell
Dear Dr. Cannell: I am the Somali medical doctor from Italy. My son was responding well with Calcifediolo treatment, no Candida, no regression, just doing fine, I got your email and got him a 25(OH)D test. The result was more than 150ng/ml (in our laboratory normal value is 8.6-54.8ng/Ml). We stopped the Calcifediolo and repeated the testing 6 weeks later and his 25(OH)D was 80ng/ml and other vitamin D was 101. After stopping the Calcifediolo he started to regress, he was not at all improving, he started to have hyperactivity, and started to have new symptom, which is chewing his shirt, so we decided recently to introduce 4,000 IU of Ddrops D3 Carlson ( 2 drops a day), for 20 days, and we have seen really good improvement. He is more connected, talking much more, and responding more quickly the questions that are asked. At the moment he is taking only 1 drop a day with only 2.0000 IU Carlson, I will appreciate if you can give me any support how we proceed from now, and what doses we can use? And for how long? Thank you again. God bless you Dr. Awolla A.Fur, Italy
Dear Dr. Fur: I am glad he is now on Ddrops, which is vitamin D3. As he has already demonstrated a treatment response, I suspect his autism will steadily improve on vitamin D. Autistic children need between 2,000 and 5,000 IU per every 25 pounds of body weight of vitamin D3, per day. I suspect the other vitamin D you wrote about was 1,25(OH)2D. Only obtain a 25(OH)D blood test as a 1,25(OH)2D will add nothing to his treatment. Once you find a vitamin D3 dose that stabilizes his 25(OH)D between 100 and 150 ng/ml, keep that dose indefinitely with frequent checks of his 25(OH)D levels. In spite of his dark skin, his 25(OH)D levels may increase some in the summer if he is outside, so the apparent 25(OH)D response to vitamin D3 may appear to be more robust in the spring/summer than the fall/winter. I suspect, but do not know, that after several years of levels between 100 and 150 ng/ml, you can begin to slowly lower the dose without an exacerbation of symptoms. Avoid rapid changes in dose, once he is in the range of 100 to 150 ng/ml. John Cannell
Dear Dr. Cannell: I have a four-month-old infant and I am worried because I only took a prenatal vitamin during my pregnancy but no extra vitamin D. I am breastfeeding but I give him formula as well as breast milk. Do I need to give him extra vitamin D? Jeanne, England
Dear Jeanne: Yes, you do. In fact, CDC researchers just announced that less than 25% of U.S. infants are getting the outdated recommended amount of vitamin D (400 IU/day). I suspect the situation is worse in England. Dr. Cria Perrine and her colleagues at the CDC analyzed questionnaires sent to over 15,000 mothers with infants ranging in age from 1-10 months. Perrine CG et al.Adherence to Vitamin D Recommendations Among US Infants. Pediatrics. 2010 Mar 22. [Epub ahead of print] The breast milk of vitamin D deficient mothers contains little vitamin D and virtually all mothers are deficient, thus breast milk usually has little vitamin D. Dr. Perrine found that only about 10% of breast-feeding infants are supplemented to meet the 400 IU/day recommendation; more surprising, only about 30% of formula-fed infants were getting 300 IU/day, mainly because few infants consume the one liter of formula needed to do so. One bad sign, Dr. Perrine reiterated the 1999 American Academy of Pediatrics sunshine warning, which amounts to child abuse, stating, “children under the age of 6 months should be kept out of the sun altogether and that those aged 6 months or older should wear protective clothing and sunscreen to minimize sun exposure.” One good sign, WebMD mentioned that adequate amounts of vitamin D might prevent respiratory infections in infants. Boyles S. CDC: Babies Don’t Get Enough Vitamin D. WebMD, March 22, 2010 The vitamin D Council recommends that breastfeeding infants under one year of age take 1,000 IU/day unless the mother takes 5,000 IU/day, in which case the infants will get all they need from breast milk. Formula fed infants need an extra 600 IU/day. Carlson Ddrops, either 400, 1,000 or 2,000 IU/drop are available at most health food stores and on the internet; they are an easy way to keep your infant vitamin D sufficient. I understand that similar dropper products are available in England’s health food stores. By the way, Dr. Carol Wagner and Bruce Hollis have just presented their data about pregnant women and vitamin D. Boyles S. High Doses of Vitamin D May Cut Pregnancy Risks: Study Shows 4,000 IU a Day of Vitamin D May Reduce Preterm Birth and Other Risks. WebMd, May 4, 2010. Their study had two treatment arms; pregnant women took either 2,000 IU/day and 4,000 IU/day. In Belgium, Dr. Hollis reported their findings forced them to discontinue the 2,000 IU/day treatment arm for ethical reasons: it was associated with more obstetrical complications than the 4,000 IU/day treatment arm. John Cannell
Dear Dr. Cannell: Is there anything out there about vitamin D and libido? I am asking because I have noticed an increase in my libido (I am a 48-year-old male who has been getting 5,000 IU/day shipped to me in France from Bio Tech Pharmacal for about a year.) Philippe, France
Dear Philippe: I know of no studies measuring male libido and vitamin D but Dr. Wehr and colleagues, at the Medical University of Graz in Austria, just published a surprising study showing that testosterone levels are directly associated with vitamin D levels (measured with the DiaSorin technique) and testosterone levels vary with the seasons, in concert with vitamin D levels. Furthermore, the men with very low testosterone levels had very low vitamin D levels. This study does not prove, like any association study, that vitamin D increases testosterone levels. It may be that sun-exposure in the summer is responsible for both higher vitamin D levels and higher testosterone levels. Wehr E et al. Association of vitamin D status with serum androgen levels in men. Clin Endocrinol (Oxf). 2009 Dec 29. [Epub ahead of print] By the way, the New York Daily News got it wrong, nothing in the Wehr study talks about vitamin D increasing male libido. Dominguez R. Suntanning, and the doses of vitamin D it provides, found to boost male sex drive: study. February 2nd 2010 John Cannell
Dear Dr. Cannell: Thanks for all your work on Vitamin D, I have been supplementing with vitamin D and also found a doctor who will test get my blood levels regularly. I am wondering, does the vitamin A drug, Isotretinoin, compete similarly to vitamin A with vitamin D receptors?
Isotretinoin is often prescribed for inflammatory skin conditions; it is supposed to shrink the sebaceous glands and act as an anti-inflammatory, therefore helping acne and rosacea. Do you think it can have similar negative effects as retinol on Vitamin D usefulness? I am quite concerned after reading your February Newsletter: “Vitamin D, Vitamin A, and Cancer”
Many people might be taking or have taken Isotretinoin for acne and I would greatly appreciate your insights on the effects of Accutane (even low doses like 2.5mg/day) on Vitamin D.
Dear Eric: Isotretinoin or 13-cis-Retinoic Acid (Accutane in the USA) is a retinoid used in severe acne and rosacea as well as in cancer chemotherapy. It may have the same effects on the vitamin D receptor as other retinols. It certainly interferes with vitamin D metabolism. Rødland O, et al. Serum levels of vitamin D metabolites in isotretinoin-treated acne patients. Acta Derm Venereol. 1992;72(3):217-9. For those taking Isotretinoin for cancer, continue doing what your oncologist says to do, but also get your 25(OH)D to at least 100 ng/ml. If you are taking Isotretinoin for acne, my advice is to stop the Isotretinoin and take adequate doses of vitamin D. In 1938, Dr. Merlin Maynard showed vitamin D helped acne more than one of the most effective treatments of all time, x-ray treatment. You can download his entire paper for free. Maynard MT. Vitamin D in acne, a comparison with x-ray treatment. California and Western Medicine: 49 (2);127-132 Dr. Maynard wrote beautifully: There is probably no skin disease of greater importance to the human race than acne. It is undoubtedly our commonest skin disease, and it is rare that any individual reaches maturity without having had it in one of its phases. It is a disease of considerable economic importance, as the disfiguring scars of a severe case are never completely obliterated. It is also a disease of youth. It attains its most noxious form at the time the individual first has to earn his own living. It is undoubtedly responsible for many failures in getting business positions. It is also the basis for inferiority complexes and discouragement in young people. Dr. Maynard published a long case series. In his earlier days, he used x-ray treatment for acne, but when he started using viosterol (vitamin D2) he stopped using x-ray treatment. In reviewing his cases, he found x-ray treatment led to favorable results 48% of the time but vitamin D did so 76% of the time; he used between 5,000 and 14,000 IU per day. Vitamin D3 may work even better than D2, if acne patients take adequate doses, like 10,000 IU/day with frequent 25(OH)D levels. In summary, he said: I believe I may say that at no time in my dermatological experience have I felt such complete satisfaction with a treatment as I have with the cases of this series. I know that vitamin D is an imperfect weapon to slay this disfiguring disease, but it undoubtedly gives one a feeling of being well defended. From the patients’ viewpoint, it has left little to be desired, as they find themselves improving, both in appearance and in general well-being. Many have expressed the sentiment, ‘Never felt better.’ In 2008, the mechanism of action of vitamin D in the skin was the subject of a lengthy review: Schauber J, Gallo RL. The vitamin D pathway: a new target for control of the skin’s immune response? Exp Dermatol. 2008 Aug;17(8):633-9. Theoretically, rosacea should not respond to vitamin D, just the opposite, but readers have told me it does. However, if you have been on Isotretinoin, it may take months or years for the excessive vitamin A to get out of your system. The excess vitamin A may continue to compete for the vitamin D’s receptors attention and, until the vitamin A is gone, one may not see the full effects of vitamin D. By the way, just ask any acne patient if their acne gets better after a week of sunning at the beach. John Cannell
Dear Dr. Cannell: Why are you against vitamin A? People need to take all vitamins for good health. Susan, Australia
Dear Susan: The body needs all vitamins for good health but this hardly means one has to take all vitamins as supplements for good health. A balanced diet with varied food consumption, including vegetables, seeds and nuts, cold water fatty fish, dairy, red meat, and fruit, will supply almost all needed vitamins with the absolute exception of vitamin D, and possible exception of magnesium, zinc, potassium, and vitamin K2. Remember, nature never intended you to put vitamin D in your mouth; nature intended you to make it in your skin. As far a vitamin A, the question is, do we get enough in our diet. The answer appears to be that we do, maybe way too much due to widespread food fortification and the use of vitamin A supplements, vitamin A in multivitamins, and cod liver oil. Beta-carotene is fine but if your multivitamin says retinyl acetate or retinyl palmitate, 5,000 IU, do not take it. The problem of widespread vitamin A toxicity is so perverse; it includes the monkeys and apes we use in experiments, perhaps those we keep in our zoos. Drs. Joseph Dever and Sherry Tanumihardjo, of the University of Wisconsin, reported that liver biopsies of such primates show evidence of liver damage from the vitamin A. The reason is that way too much vitamin A is added to primate chow. Dever JT, Tanumihardjo SA. Hypervitaminosis A in experimental nonhuman primates: evidence, causes, and the road to recovery. Am J Primatol. 2009 Oct;71(10):813-6. This is an excellent paper for other reasons. Dr. Dever reminds us that blood retinol levels are useless to detect either vitamin A deficiency or vitamin A toxicity, and that the rate limiting step (how the body controls vitamin A levels) occurs with an enzyme in the intestine (carotenoid monooxygenase). The body simply makes the amount of retinol needed from orange-colored vegetables and fruit, but does not make retinol if you do not need it. That is why you can turn yourself yellow by drinking large amounts of carrot juice but you apparently cannot make yourself vitamin A toxic by doing so. When you take retinyl acetate or retinyl palmitate, or cod liver oil, you bypass this intestinal regulatory system and dump preformed retinol into a closed system that has no good way of getting rid of it. This also explains why many studies from developed countries (where vitamin A toxicity is common) show one does not make much retinol from carotenoids, while studies from underdeveloped countries (where vitamin A deficiency is the rule) show that one does make it. In 2008, Dr. Anthony Mawson, of the University of Mississippi, discussed evidence that taking vitamin A, especially during pregnancy, may account for some of the aggressive disorders (like ADHD, irritability, and conduct disorders). In fact, he discusses the numerous case reports associating vitamin A, including Accutane, with aggression. Mawson AR. On the association between low resting heart rate and chronic aggression: retinoid toxicity hypothesis. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Mar 17;33(2):205-13. I am no friend of the “lots of all vitamins” crowd. Take what you need and leave the rest, and the only way to know what you need is to do an accurate dietary evaluation of what you are eating. John Cannell
Dear Dr. Cannell: I am a naturopath in Montréal, Canada. I work primarily in mental health. I did a search on MDConsult recently for “Differential diagnosis of psychosis.” One of the differential diagnoses in the list was vitamin D deficiency. I am unable to find any research that supports that, and that list had no citations. Do you know anything about it? I have a patient who recently experienced some of the most extreme psychosis of his life. During that time, I measured his Vitamin D. It was too low to be detected! I started him on 5,000 IU per day and had measured it a few months later, when he was doing much better, and it was 22 ng/ml. I thought there was a relationship between the deficiency and the psychosis, but could not find anything on PubMed or anywhere else about the connection. Any thoughts on that? Melissa, Canada
Dear Melissa: This is good news; however, I am not aware of any papers on the treatment of psychosis with vitamin D. At my hospital, which now has a policy to test all new patients for vitamin D deficiency, several of us have noticed that a few psychotic patients seem to get remarkably better on vitamin D, and others can reduce the dose of their meds, once their vitamin D deficiency is treated. However, the vast majority of patients must stay on meds or they relapse. However, no one, to my knowledge, has treated psychotic patients with pharmaceutical doses, like 20,000 IU per day. It would not surprise me at all if researchers found that dose to be effective treatment in some cases of psychosis. The scientific community has never researched the issue of using vitamin D as a drug, that is, as a pharmaceutical. If one was free to use pharmaceutical doses, as psychiatrists in private practice are free to do, they could rapidly lend some light to the subject by treating psychotic patients with both antipsychotic meds and with 20,000 IU per day and carefully follow 25(OH)D, calcium, and clinical course. I suspect they would find a vitamin D treatment effect. If they did such a case series, I would publish their reports in this newsletter, be they negative or positive. John Cannell
Dear Dr. Cannell: I work with the Somali immigrant community in Ottawa. If you see how healthy these immigrants are when they come here and how terrible their health is after a few years it is hard to see how it could be anything but vitamin D. Why do the health officials in Canada do nothing? Gail, Ottawa
Dear Gail: What is going on in Ottawa is a crime against people of color, just as what is going on against African Americans in the USA is a crime. It is not just autism, but schizophrenia, depression, heart attack, stroke, diabetes, and hypertension, are all diseases associated with vitamin D deficiency and also associated with dark skin in temperate latitudes. Starved for Sunlight Immigrants struggle with declining health. CBC News, 2/17/2010 African Americans die almost eight years younger than Whites do, due to the diseases of vitamin D deficiency. I hoped the Obama administration might do something, but so far nothing. Perhaps we should file our civil rights complaint again, like the one we filed in 2005, which then Attorney General Alberto Gonzales summarily dismissed: http://www.vitamindcouncil.org/PDFs/2005pr-doj-civil-rights-complaint.pdf John Cannell, MD Executive Director Vitamin D Council You may reproduce this newsletter as long as you properly and prominently attribute it source. Please reproduce it, post it on Internet sites, and forward it to your friends. Remember, we are a non-profit and rely on your donations to publish our newsletter, maintain our website, and pursue our objectives. Send your tax-deductible contributions to: The Vitamin D Council 1241 Johnson Ave., #134 San Luis Obispo, CA 93401