Mesmerized by Epimerization

Franz Mesmer was a German born physician that had interest related to human and animal behavior.  He contended that through ‘animal magnetism’, significant physical results could be realized.  His name is the basis for the word Mesmerized.  It has been an unfortunate occurrence in vitamin D science that the medical professionals and the general population have been hypnotized like chickens with a line drawn in the dirt. (We did this as kids – check it out Chicken Hypnotized) We all need a nudge to wake up from this surreal dream.  The following is not for the faint of heart or for those that do not have the curiosity to pursue a deeper understanding.  If not curious, then just watch the chicken video and have a good day.

Epimerization is simply the difference in the positioning or bond angle of the OH group in the Carbon 3 position of the vitamin D compound.  What do we know about how much difference a bond angle will make?  It seems that this bond angle is of significance in genetic expression, so let’s explore.  Check out this example for the sugar glucose: Epimers

It came to my attention several years ago that one of the local hospitals that was attached to a state university was doing vitamin D testing only on D2 and its metabolites.  The reasoning was that the clinicians wanted only to know the level of the drug, vitamin D2, because this is what had been prescribed.  The logic was that the level of the hormonal metabolites of natural vitamin D3 were so low that it was of no consequence.  After all, there had been a great job done for the last fifty years of scaring people out of the sun.  Or maybe, this was not exactly the logic, but I am sure this is close.  So the mixture of treating D3 and D2 as equals and ignoring the total effect of the metabolites of these pre-hormones has done the practice of medicine and the population as a whole a great disservice.  It is only through the separation of these two compounds and not allowing peer reviewed papers to be published without designating what is being used that we can achieve our goal of being reconnected to the sun.

I had always thought that the complications of not having accurate serum vitamin D levels or 25(OH)D was a matter of the different test methods not giving either totals of the two or only values for one or the other  –  25(OH)D2 or 25(OH)D3.  In the later case I was right as is suggested by what was being done at one of our university hospitals.  But it turns out that it is a lot more complicated.  Consider the recent release by the American Chemical Society – “New Standard for vitamin D testing to assure accurate test results”, January 25, 2012.  The paper describes the storage metabolites of vitamin D:  “The researchers developed four versions of the standard, with different levels of the vitamin D metabolites 25(OH)D2 and 25(OH)D3 in human serum. They also determined the levels of 3-epi-25(OH)D in the adult human serum samples. Surprisingly, they found that this metabolite — previously thought to only exist in the blood of infants — was present in adult serum. “This reference material provides a mechanism to ensure measurement accuracy and comparability and represents a first step toward standardization of 25(OH)D measurements,” say the researchers.”  It seems that these epi-metabolites have a less effect on calcium.  In order of effect on increasing hypercalcemia, it is 3-epi-25(OH)D3, 25(OH)D3, 3-epi-25(OH)D2, and 25(OH)D2 (and don’t forget the toxisterols that can be made during manufacture of D2 from over irradiation of fungus).  It also seems that the epi-compounds are just as effective as the original.  Did I get this correct?  Here is a starting place for you to begin your consideration. 1α,25(OH)2-3-Epi-Vitamin D3, a Natural Physiological Metabolite of Vitamin D3: Its Synthesis, Biological Activity and Crystal Structure with Its Receptor  This is an open access to the full paper.  Do you begin to see the need for the separation of D2 and D3 and metabolites?

Now does this really get us to a better place in the understanding of our natural hormone D?  Consider the recent attention on cholesterol sulfate and the resulting compounds of hormones that are made from cholesterol sulfate, in particular vitamin D3 sulfate.  So now are we looking at eight storage metabolites instead of four?  How confusing can it get?  Consider what the writers of this paper:  HPLC Method for 25-Hydroxyvitamin D Measurement: Comparison with Contemporary Assays, March 2006, had to say: “According to Shimada et al., nearly equal amounts of 25(OH)D3 sulfate and 25(OH)D3 are usually present in patient sera.”  The Shimada paper: Shimada K, Mitamura K, Higashi T. Determination of vitamin D3 metabolites using high-performance liquid chromatography or immunoaffinity chromatography. J Chin Chem Soc 2000;47:285-228.  

Only after the clinical outcomes related to the levels of the eight compounds, 3-epi-25(OH)D3, 25(OH)D3, 3-epi-25(OH)D2, 25(OH)D2, 3-epi-25(OH)D3 sulfate, 25(OH)D3 sulfate, 3-epi-25(OH)D2 sulfate, and 25(OH)D2 sulfate are determined will we be able to accurately assess the health benefits  of vitamin D. 

Just think of the confusion of test methods to determine the amounts of the various vitamin D compounds and correlating clinical outcomes with one thing that we call 25(OH)D.  Researchers and reviewers, it is really up to you.  If you fail in allowing papers to be published without making the necessary distinctions, then, the population will continue to suffer at your ineptness. Kathleen Sebelius, Secretary HHS   –  Carolyn M. Clancy, M.D., Director Agency for Healthcare Research and Quality, are you listening?  Okay, all you chickens, GET UP!

If you really were not curious and you made it this far anyway, then may God bless you and go spend some time in the sun.  – Pandemic Survivor

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Downward Trend for the Flu

A quick review of the influenza-like illness in the US for the week ending January 21, shows the flu is staying low.  The really interesting thing is that the trend is downward.  There are lower highs of the incidence of patients seeking aid and lower lowers.  This type of pattern in random events like the incidence of flu or a stock market is called a flag pattern.  The pattern usually allows for a consolidation of events toward the convergence and then trends in the direction that formed the flag or downward in our case.  If the incidence does not go above the baseline this year then something significant is happening.  From the CDC:

What is that something that is really significant?  Either we are doing a great job of vaccination or people are taking a significant amount of vitamin D which means the population is acting like it is summertime all year.  If you note the spike in 2008 which was a mild year for the flu; it occurred about the first week of March.  If we make it until the first of March without a significant spike then I say Waa Hoo! You can bet that a multi-national like P&G and their NyQuil sales are fully aware of what is happening with cold and flu trends.

Have you had a cold or the flu this year with a serum level of 25(OH)D above 50 ng/ml, let me know.  – Pandemic Survivor

Vitamin D Awareness in Decline

It is apparent from the number of newly reported cases of rickets that the UK has a severe problem with vitamin D deficiency.  The Guardian reports: “England’s chief medical officer, Dame Sally Davies, is concerned that young children and some adults are not getting enough vitamin D.”  It appears that since the free give away of supplements has stopped at clinics that the population is using less vitamin D.  I suspect this problem is more than just an awareness problem as it has been pushed by the medical profession for more than five decades that sun exposure is bad for you.  The problem in the UK now, as the Guardian reports, is “the hard bit – ideas on how to get more of us to get more vitamin D.”  The encouraging news is that he chief medical officer in the UK is aware and feels that new initiatives should take place.

The practice of giving away cod liver oil was stopped in the fifties because it was felt that it was not really needed.  How could such an incompetent decision be made?  The question now is will there be a new emphasis placed on the deficiency issue here in the US.  It seems that the Institute of Medicines decision that a serum level of 20 ng/ml has thrown a real monkey wrench into the works.  A level of twenty may prevent the worse cases of rickets, but how do you explain the continued issue of osteoporosis that is ongoing in the US if that is high enough level.  At least the committee said that there was no issue with using up to 4000 IU of vitamin D3 per day in children over nine.  The real issue is the statements made that a serum level of over 20 ng/ml could be detrimental to your health.  Again, this is the confusion over vitamin D2 versus vitamin D3.  Vitamin D2 is good for rats because they are nocturnal animals.  Vitamin D3 is good for humans because this is what our body makes when exposed to UVB from the sun.  Normal levels for sun exposed populations range for 54 ng/ml to 90 ng/ml.  This is the level required for health.  Vitamin D2 and vitamin D3 are not equivalent!

The question now:  Secretary Kathleen Sebelius, will you come to the same level of awareness as Dame Sally Davis?  How many more cases of vitamin D deficient children with rickets will be taken from their parents because it is mistaken for child abuse?  This sad problem falls directly in the lap of dermatologist that have been used by the medical institutions seeking to garner profits from a sick population.  Of course the dermatologists plead complete unawareness because the cases of skin cancer have increased.  Skin cancer has increased from the use of sunscreen in a real catch 22 that has been played out on the people served by our health institutions.  Normally in a situation like this, the Surgeon General of the US issues a statement giving the population the latest health information.  This happened with tobacco use in the 1960’s, even though it was ignored by most of the population.  So Surgeon General, Vice Admiral Regina M. Benjamin,  what are you going to do?  I think that you should have a conversation with Dame Sally Davies and start a vitamin D initiative in conjunction with Canada.  The US, UK, and Canada taking such an action would bring the rest of the world along.

If not now, when?  – Pandemic Survivor

Negative Findings for Vitamin D?

There have been two reports this month that vitamin D had less than a positive effect on health.  It seems that a study on C-reactive protein as a marker for inflammation did not significantly reduce at higher levels of vitamin D.  A second was that vitamin D did not reduce the number of exacerbations in patients with COPD at higher levels of vitamin D.  Relation between serum 25-hydroxyvitamin d and C-reactive protein in asymptomatic adults (from the continuous national health and nutrition examination survey 2001 to 2006).  and   High doses of vitamin d to reduce exacerbations in chronic obstructive pulmonary disease: a randomized trial. 

The really interesting thing about both of these studies was that vitamin D did appear to help significantly until 25(OH)D reached about 20 ng/ml.  At levels higher than this there did not seem to be a significant improvement and even an increase in inflammation as assumed by C-reactive protein.  There are two things that come to mind when reading these reports.  First, I know from my own experience with vitamin D that inflammation does not significantly reduce until my 25(OH)D level is above 60 ng/ml for extended periods of time.  Second, there was no indication for controls on cofactors of vitamin D like magnesium, vitamin A, and age control for L-arginine levels.  Yes I know that most of you think that vitamin A is not a cofactor for vitamin D, but an antagonist.  The clearing of the liver from an overload of vitamin A with vitamin D deficiency is significant as the vitamin D level is increased.  However, if an adequate intake of vitamin A is not maintained, then the combination of vitamin A and vitamin D for genetic expression or cellular differentiation is lost.  The worry over two much vitamin A seems to be a reduction in the level of vitamin D.  The combination of action of these two cofactors needs to be maintained.  This is a similar case for magnesium and L-arginine.

The common headlines for these two reports were disturbing.  Such as, “Too Much Vitamin D Linked to Heart Risk” –eMaxHealth, and “Vitamin D want help most COPD patients” USA Today.  On the face of the headline, it is correct.  But what the reports actually say and what the headlines say for the casual reader are two different things.  Again, in both studies, there were positive effects found for levels improving to 20ng/ml.  In the COPD study, there were 30 patients out of a total of 182 studied that had fewer exacerbations.

In the study for c-reactive protein, it was found that there was some increase with vitamin D levels higher than 20 ng/ml.  It has been accepted that at higher levels of c-reactive protein that there is a stiffening of the artery walls and it has been assumed this was from inflammation.  A lot of assumption – What has been discovered in the last fifteen years is that nitric oxide has a significant relaxing effect on arterial walls.  There has even been a Nobel Prize awarded for this understandingDr. Joseph Prendergrast  (not the Nobel Prize recipient, but in his words – “an uncommon doctor’) has shown in treating thousands of diabetics for heart disease that L-arginine is extremely important in combination with vitamin D.  Typically a person will make about three to six grams of L-arginine per day.  As we age this number is significantly reduced.  Once the amount of nitric oxide is reduced because of reduced L-arginine, then the communication for the relaxation of arterial walls is also lost.  Was there a control for age and L-arginine production or nitric oxide levels?  Magnesium is also extremely important to heart health.  Heart arrhythmia can be linked directly to  low intakes of magnesium.  Were there any controls for magnesium?  This is a very serious issue for heart health as there is not even a standardize test that gives the clinician results to act on for magnesium.

Our medical researchers owe us better studies than what we are getting.  The human body does not turn on one nutrient or another.  It is always the combination that is important.  Increasing any one thing without consideration for what is happening to the levels of other needs in the body is just dumb.  Incompetence is only measured by the amount of money that can be generated or lost from a trusting mass market.  – Pandemic Survivor

Magic Bullet for the Flu – Summertime all Year

I have not had the flu or a cold since 2004, the year that I begin to take vitamin D.  Is it just possible that the entire population could protect itself from the flu by just maintaining a summertime level of vitamin D year round?  I do believe the answer to this question is yes.

In just checking the CDC flu information, I found a significant variation below what is expected this time of year for the flu.  There are several possibilities as to why this is the case.  Of course the government is going to say it is the effectiveness of their programs of prevention that includes trying to get everyone vaccinated with the flu shot.  It is just normal statistical variation.  There are more people taking vitamin D and this has helped to reduce the total number of flu cases.  Here is the info for mortality and people seeking medical attention for flu symptoms:

Did you notice the dip on the last week of people seeking help for flu symptoms?  You would normally start to expect an ‘up-tick’ this time of year.  It is also significant to note that the death rate is below the normal control limits for this time of year.  This definitely means that something unusual is happening.

The bird flu of 2006 and the swine flu of 2009 turned out to be nothing but just over concern by the agencies that are involved in monitoring disease.  There were two op-eds that also caught my attention.  “Fear Gone Viral” by Wendy Orent in the LA Times reports that the US government has requested two studies not be published with methods for making the flu more transmittable in populations.  This has got the world health organizations in an uproar over how one country is able to control science.  Why are we studying how to make the flu more easily transmittable?

The other interesting story was about the ineffectiveness of Tamiflu and how the studies that were published on the use were falsified.  It does not surprise me in that we spent a billion dollars in 2006 to make this drug readily available.  It seems that there were fourteen unreported side effects.  The cure seems to have been more dangerous than the flu.  “No Magic Bullet on the Flu”  David Finkelstein LA Times

Magic Bullet for the Flu – Vitamin D!  – Pandemic Survivor

Knowing When to Eliminate the CPAP

It really gives me a chuckle when I read or hear a description of the three types of sleep apnea.  Obstructive sleep apnea – doctors do not have a clue as to what this means other than in their minds they think their patient is just a fatty and all its associations.  If you have sleep apnea the central nervous system has to be involved.  Certainly being obese will make the problem worse, but the origin of breath is from our automatic response to live as controlled by the nervous systems.  Apnea during sleep means that you stop breathing long enough to cause a drop in the amount of oxygen in your blood to a level that is too low to sustain the body functions.

When you sleep, the body functions slow down.  By design, carbon dioxide builds up in your blood.  Yes, that is the same stuff that your government wants to regulate to prevent ‘global warming’.  Stop breathing, you are heating the planet up – you dirty polluter.  Sorry, did not mean to get side tracked.  As your body relaxes, breath rate slows and the amount of blood oxygen saturation drops.  This saturation is measured from complete saturation of one hundred percent.  When awake this level of saturation is typically above ninety eight percent.  When you sleep, it is normal for the saturation to drop into the low nineties or ninety-one to ninety-three percent.  When the level drops below seventy percent, organ death begins to occur.

During an apnea event, the body begins to arouse because of the need for more oxygen.  It automatically causes your heart to start beating faster because the demand for oxygen has increased throughout the body.  This event is very similar to when you exert yourself and the demand from oxygen causes your heart rate to increase.  You may awake to find yourself gasping for breath and your heart is racing.  The body’s oxygen requirement gets satisfied and you relax again.

So how do you know if you have sleep apnea or if it has gotten better?  There are many levels of sleep disturbance.  Apnea is distinguished from the rest of the disorders by this drop in oxygen.  Do not get me wrong as I am not diminishing other sleep disorders.  Restful sleep is extremely important to allow our bodies to repair.  To determine if you have a disorder that includes apnea, a polysomnogram or sleep study is required.  This is when you are connected to monitoring that includes the various metrics of your body.

You have sleep apnea and are using a CPAP to control the amount of oxygen intake.  You increase your vitamin D and magnesium to allow your body to heal.  A simple method to determine if you are healing or if your blood has enough oxygen is a device called a pulse oximeter.  This device fits onto your hand or arm and measures both the heart rate and oxygen saturation.  Sometimes, you are asked to wear this device at home before or instead of a sleep test.  It is also a good device to help you decide if you can stop wearing your CPAP.

That is exactly what I did to determine if my sleep apnea had reversed itself.  I felt like I did not need the CPAP any longer, but my doctor insisted that if I stopped wearing it the issues would return.  I did not want the expense or nuisance of doing a sleep study.  I found a pulse oximeter and used it for three months while not wearing the CPAP.  I set the alarms to wake me when my oxygen rate dropped below eighty five percent or my heart rate got above 90 or below 50.  The use of this device at home should be discussed with your doctor.

In a recent review on availability, I was amazed at how easy these pulse oximeters are to obtain.  Six years ago, I had to order from a medical supply and the cost was over three hundred dollars.  Now these devices are available at drugs stores.  They range in price from about fifty dollars to two hundred fifty.  I noticed one popular brand and model was about eighty dollars at CVS to one hundred fifteen at Walmart.  It had enough memory to store events for up to seventy two hours with software and cable so that the data could be transferred to a computer.

The fear of not wearing the CPAP was gone.  I did not have to worry about whether my blood oxygen was dropping low enough to damage my organs.  That was great relief.  It was amazing as I went from dying with blood oxygen below seventy percent to no events without a CPAP.  My weight had not changed, my nervous system had healed.  I don’t need to know the mechanism of healing, just that I could sleep again without the CPAP.  Obstructive sleep apnea – indeed!  I love the sun!   -Pandemic Survivor

How to Heal Sleep Apnea – Eliminate the CPAP

As you have read from my recent post, sleep apnea is a very serious disease.  There seems to currently be an increase with sleep apnea like many other chronic diseases.  All of these diseases follow very closely the reduction of the amount of vitamin D that is produced in the population from sun avoidance as promoted by our medical professionals for the last fifty years.  In addition, air conditioning and electronic ‘toys’ keep us trapped when we would otherwise be outside soaking up the sun.

Symptoms of sleep apnea include:

Daytime sleepiness
Memory Issues
Headaches
Body pains
Tiredness
Obesity
High blood pressure
Stroke
Heart disease which includes arrhythmia and heat attack

Would you like to get rid of that CPAP?  There is hope.  It is possible!  It took me two years because my sleep apnea was so severe.  I had sixty events per hour or an AHI of 60.  That is I would hold my breath for thirty seconds; and then, breathe for thirty seconds for the full sixty minutes in an hour.  This would drive my blood oxygen saturation to extremely low levels to say nothing of the lost sleep.  My health was bad as I was nearing death.

After my polysomnagrapy, the neurologist described what he felt was nothing more than obstructive sleep apnea.  That is I was so fat at a BMI of 32 that my ‘fat was closing my airway when I slept.’  I suggested that perhaps some of it could be coming from all of the spinal cord issues that I had with degenerative disc disease.  He simply shook his head and said that he did not see anything to suggest that it was central sleep apnea or coming from my central nervous system.  On a later MRI by my neurosurgeon, it was discovered that I had severe stenosis at C3-C4 cervical disc.  This location is the origin for the nerve root that supports lung function.  This diagnosis also explained why I sometimes would just stop breathing during my awake time.  I had another professional tell me it was just stress.

The CPAP was a blessing because it cleared up a lot of the symptoms.  However, it is a real ‘evil’ device when you have to use it even to take naps.  I know that if you have used this device that you recognize the truth of what I have just said.  Enough oxygen and enough sleep is always a necessity to life.  A breathing mask on your face or a nasal cannula stuck up your nose, supported by a band wrapped around your head, and tied by a hose to a mechanical air pump is well, just ‘evil.’  This device belongs in the twentieth century and not the twenty-first.

There is now at least one neurologist that finally is practicing medicine and not the politically correct NIH guidelines.  Dr. Stasha Gominak, Tyler Texas, discovered vitamin D and its effects on sleep in 2009.  I first discovered her work through Henry LeHore at www.vitamindwiki.com.  She has now been treating patients for two years with vitamin D and magnesium with great success including the elimination of the CPAP device.  If you have sleep apnea, I would suggest that you review her website closely so that you will know how to talk with your neurologist about this treatment.  In a recent email I described all sleep apnea as being related to the central nervous system except for extreme obesity and her response was “You’re right, it’s all central, if you can breathe through your neck when you’re awake you can breathe through it while sleeping, until your paralysis in sleep kicks in.  — explanation of how the CNS works in sleep———- Be careful to follow your levels [25(OH)D], the sleep disorder comes right back when you go over 80. Keep it 60-80 and you’ll do great. Once you get the vitamin D connection the morbid obesity is explained by the D deficiency as well, so it’s not obesity causes sleep apnea, it’s that obesity and sleep disorders of many kinds both arise from D deficiency.”

We applaud your efforts Dr. Gominak and thank you for your work in helping the sufferers of the many chronic diseases that are a result of vitamin D deficiency!

Dr. Gominak’s info:

Vitamin D Hormone http://drgominak.com/vitamin-d ‘I have left the link visible to be sure you can connect.’

Video Lecture on Sleep and Vitamin D and Magnesium:  5 part series http://drgominak.com/lecture   First video is middle of left hand column.

I know that you may be restless and tired, but get excited, go to this website or have your neurologist go there and then do the treatment.  Dr. Gominak does a great job in an entertaining lecture on how we got to where we are in the treatment of sleep disorders and what to do about it as well as her journey of discovery.

I have been without a CPAP and healed of sleep apnea since 2008.  Be well, sleep well, and go into the sun!  Pandemic Survivor