Cytokine Storm & Vitamin D relationship?

[the doctor]

Re: Cytokine Storm & Vitamin D relationship?

cartski asked:

If D is synthesized when a person is exposed to sunlight, could not dosage + sunlight could produce a whopping amount"?

Yes it could but this is not usually something we see clinically.

Dr. Robert Heaney and colleagues at Creighton University in Iowa did an interesting study of 25 OH vit D3 levels (personal communication at a meeting but this was years ago and was probably been published back then). They opined that roofers who worked in the summer with their shirts off would have higher than common vitamin D levels. What they found was that these people had 25 OH vit D3 levels in the 150ng range with no signs if high calcium levels or of any toxicity.

He also described vitamin D2 dosing studies where very high daily doses (up to 50,000iu/day) of vitamin D2 were given to volunteers for various lengths of time.

One finding that was of interest to me was those treated at even the highest level of vitamin D2 rarely displayed 25 OH vit D3 levels much higher than 100ngs.

These are interesting observations and are consistent with my anecdotal experience with giving high doses of vitamin D2 to patients suspected of having low grade prostate cancer. I could never get their serum 25 OH vit D3 level much above 100ng even when they took 50,000iu daily for several months.

Grattan Woodson, MD

[the doctor]

Re: Cytokine Storm & Vitamin D relationship?

For whatever its worth, here are some interesting comments from Dr. Mercola on Vitamin D. (I don't give him much credence either way, but I'm inclined to think he has a point regarding Vitamin D3):

Vitamin D3 Supplemental vitamin D comes in two forms: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3).

They have generally been regarded as equivalent and interchangeable, but that notion is based on studies of rickets prevention in infants conducted seven decades ago.

Recent studies have shown that vitamin D3 is a more potent form of vitamin D. Vitamin D2 has a shorter shelf life, and its metabolites bind with protein poorly, making it less effective. One unit of cod liver oil (containing vitamin D3) has been shown to be as effective as four units of Viosterol (a medicinal preparation of vitamin D2).

However, the form of vitamin D used in prescriptions in North America is almost invariably vitamin D2.

Sources: American Journal of Clinical Nutrition October 2006; 84(4): 694-697


Dr. Mercola''s Comments

Basically there are two types of oral vitamin D supplements. The natural ones are D3, and they contain the same vitamin D your body makes when exposed to sunshine. The synthetic ones are vitamin D2, which are sometimes called ergocalciferol.

Once either form of the vitamin is in your body, it needs to be converted to a more active form. Vitamin D3 is converted 500 percent faster than vitamin D2. Interestingly, it was previously thought that the kidney exclusively performed this function, as least that is what I was taught in med school.

However, in 1998 Dr. Michael Hollick, the person who discovered activated vitamin D, showed that many other cells in your body can make this conversion, but they use it themselves, and it is only the kidney that makes enough to distribute to the rest of your body.

While there have been no clinical trials to date demonstrating conclusively that D2 prevents fractures, every clinical trial of D3 has shown it does.

However, nearly all the prescription-based supplements contain synthetic vitamin D2, which was first produced in the 1920s through ultraviolet exposure of foods. The process was patented and licensed to drug companies for use in prescription vitamins. In case you didn't know, the vitamin D that is added to milk is NOT D3 but the highly inferior vitamin D2.

The study linked above concluded that "vitamin D2 should no longer be regarded as a nutrient appropriate for supplementation or fortification of foods."

That being said, optimizing your sun exposure and levels of vitamin D3 may, indeed, be one of the most important physical steps you can take in support of your long-term health. Conventional medicine is finally beginning to get on board the vitamin-D3 bandwagon, using the natural power of sunshine to treat type 2 diabetes, osteoporosis during a woman's pregnancy and even tuberculosis.

It is important to understand that the ideal and STRONGLY preferred method of increasing your vitamin D3 level is through appropriate sun exposure. I really do not advise oral supplements, not even cod liver oil now, UNLESS you can have your blood levels regularly monitored.

It just is too risky. I have seen too many potentially dangerous elevations of vitamin D levels, including my own, from those that are taking oral supplements.

But when you get your vitamin D from appropriate sun exposure your body can indeed self-regulate and greatly reduce vitamin D production if you don't need it, which makes it very difficult to overdose on vitamin D from sun exposure.

Thanks St. Michael for this contribution.

I am framiliar with Dr. Mecola and have read his book concerning the pandemic hoax.

There is a lot to say about the contents above. First the observation that vitamin D3 is rather rapidly converted to 25 OH vit D3 is of interest and probably explains why it has such a short serum half-life.

I wonder, if someone like a roofer as described by Dr. Heaney above has very high vitamin D3 production from the sun, would the excess be stored in the tissue (fat or somewhere else like muscle) or would there be an obligate conversion of excess vitamin D3 to 25 OH vit D3 irrespective of needs?

Grattan Woodson, MD

[gsgs]

Re: Cytokine Storm & Vitamin D relationship?

http://www.ncbi.nlm.nih.gov/pubmed/19491064?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

...further research needed...

doesn't sound encouraging. Why can't they prove it ?

[the doctor]

Re: Cytokine Storm & Vitamin D relationship?

While it is possible to make plenty of vitamin D3 with enough sun exposure, there is a cost to taking this approach. Prolonged sun exposure damages the skin and increases risk for skin cancers and melenoma, especially in fair skinned people.

I would prefer to fill my tank with synthetic oral vitamin D2 and skip the excessive sun exposure.

This does not mean that I do not agree that vitamin D3 is converted much faster to activated 25 OH vit D3 than is vitamin D2. It certainly is but what I wonder; is it necessary to take vitamin D3 as the supplement or via UV exposure or is it simply good enough or perhaps even better to get your vitamin D as the storage form, vitamin D2.

I think that as long as your vitamin D storage tank is adequately filled, when there is a need for more active vitamin D, the stored D2 is released, converted to D3 and then rapidly transformed into activated 25 vit D3 along with all those fascinating other forms of activated vitamin D that target the immune system rather than bone and calcium metabolism, i.e; "the useless brethren of 25 OH vit D3 produced by the liver.

Grattan Woodson, MD

[gsgs]

Re: Cytokine Storm & Vitamin D relationship?

how long does it take to fill your tank ?

correlate flu in cities with #sunny days, the data is available

[wbgrant]

Re: Cytokine Storm & Vitamin D relationship?

Hi,
Interesting discussion. Here are a few additional comments.

1 - The half life of vitamin D and 25(OH)D in the body is about 4-6 weeks. Thus, vitamin D made in summer can last into the fall, but not winter.

2 - UVB produces vitamin D but UVB and UVA out to 330 nm also destroys some of the vitamin D metabolites. This is why the maximum amount of vitamin D that can be produced per day with whole body exposure is about 10,000 IU. That much can be made in a few minutes by a young person with pale skin on a bright summer's day.

3 - There is good evidence that vitamin D, through production of human cathelicidin, LL-37, reduces the risk of several viruses including seasonal influenza, the common cold, Epstein-Barr virus, and others, and bacteria such as TB, vaginal bacteria, bacteria involved in septicemia, pneumonia bacteria, etc. What has not been shown is that vitamin D and LL-37 had any impact on the A/H1N1 pandemic virus of 1918-19. On the other hand, A/H1N1 in recent times has been seasonal, implying that vitamin D/LL-37 probably played an important role in combating it.

4 - Cold temperature can also play a role in susceptibility to respiratory viral infections. Respiratory syncytical virus, often the cause of bronchitis, is more related to cold air than vitamin D. Cold temperature shuts down the capillaries in the respiratory system, so white blood cells, etc., can't get to the surface to attack the virus. This may play a role in influenza as well.

[the doctor]

Re: Cytokine Storm & Vitamin D relationship?

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
...further research needed...

doesn't sound encouraging. Why can't they prove it ?

Diseases: A Systematic Review of Randomized Controlled Trials.
Abstract

Yamshchikov AV, Desai NS, Blumberg HM, Ziegler TR, Tangpricha V.
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA 30303.
Objective Vitamin D is the precursor to a steroid hormone primarily known for its role in regulating calcium homeostasis and skeletal health. Vitamin D also has non-skeletal functions that may play a role in susceptibility to various infectious and autoimmune conditions. Despite recent advances in understanding of the non-classical functions of vitamin D, little information is available regarding their clinical relevance for patient care. We review the existing human controlled intervention studies of vitamin D as adjunctive therapy in settings of infection, and provide recommendations for design and implementation of future studies in this field based on the evidence reviewed.Methods We conducted a systematic review of randomized controlled clinical trials that studied vitamin D therapy for treatment or prevention of infectious diseases in humans. Studies from 1948-2009 were identified through search terms in PubMed and Ovid.Results Thirteen controlled trials were identified by our search criteria. Ten trials were placebo controlled, and nine of the ten were conducted in a rigorous double-blind design. The selected clinical trials demonstrated significant heterogeneity in terms of baseline patient demographics, sample size, and vitamin D intervention strategies. Serious adverse events attributable to vitamin D supplementation were rare across all studies. Based on studies reviewed to date, the strongest evidence supports further research into adjunctive vitamin D therapy for tuberculosis, influenza, and viral upper respiratory illnesses. Aspects of study design are highlighted for the selected studies to help guide future clinical research in the field.Conclusions More rigorously designed clinical trials are need to further evaluate the relationship between vitamin D status and the immune response to infection, and to delineate necessary changes in clinical practice and medical care of patients with vitamin D deficiency in infectious disease settings.


I need to read the whole article not just the abstract to understand this communication.

Given that I do not know what these authors have presented or proposed, I will venture to make a few comments. While academically risky, I have moved beyond those concerns so here goes.

If vitamin D2 was used therapeutically in very ill people as a rescue treatment then it might not have been able to be converted to vitamin D3 fast enough to make a difference.

If there was a consensus that vitamin D3 was rapidly converted to 25 OH vit D3 and its immune stimulating brethren, then if I were considering use of vitamin D as a rescue therapy of someone with severe influenza for instance, then giving them vitamin D3 instead of vitamin D2 would be more likely, IMO to result in a higher level of the desired immune potent activated forms of vitamin D produced by the liver.

It is unlikely that those acutely ill with an infectious disease would benefit if treated acutely with previously activated forms of vitamin D including 25 OH vit D3 or 1,25 OH2 vit D3 since both are products destined for a role in calcium metabolism. It is the activated vitamin D products produced by the liver other than 25 OH vit D3 that play the greatest immune system role IMO and it is those therefore that would be likely to have the greatest immediate benefit in the acutely ill patient.

While there have been comments above about the non-renal intercellular conversion of 25 OH vit D3 to 1,25 vit D3 and the activity of this terminal hormone, IMO what is likely is that it plays different roles in different tissues.

The immune competent vitamin D products are not the ones we measure routinely in the clinic with assays commercially available from Quest or Lab Corp. They can only be measured today in research labs who have developed specific techniques to do so. The methods to do this are well established in the bone literature and probably elsewhere by now given our new found interest in these compounds.

So, when I find this article in its complete form, these concerns will be foremost in my mind. If they are not considered, then it may be that I will discount this work as definitive but not necessarily as informative. All work done in an objective fashion have value. The author's interpretation of the results are not always the key point of the work.

GW

[gsgs]

Re: Cytokine Storm & Vitamin D relationship?

it should be possible to show connection with weather

first show a connection of weather in the last 4-6 weeks and
how full the D-Tank is (assuming Vitamin-D level in a person
can be easily measured ?)

then compare with seasonal ILI-data

[the doctor]

Re: Cytokine Storm & Vitamin D relationship?

Hi,
Interesting discussion. Here are a few additional comments.

1 - The half life of vitamin D and 25(OH)D in the body is about 4-6 weeks. Thus, vitamin D made in summer can last into the fall, but not winter.

2 - UVB produces vitamin D but UVB and UVA out to 330 nm also destroys some of the vitamin D metabolites. This is why the maximum amount of vitamin D that can be produced per day with whole body exposure is about 10,000 IU. That much can be made in a few minutes by a young person with pale skin on a bright summer's day.

3 - There is good evidence that vitamin D, through production of human cathelicidin, LL-37, reduces the risk of several viruses including seasonal influenza, the common cold, Epstein-Barr virus, and others, and bacteria such as TB, vaginal bacteria, bacteria involved in septicemia, pneumonia bacteria, etc. What has not been shown is that vitamin D and LL-37 had any impact on the A/H1N1 pandemic virus of 1918-19. On the other hand, A/H1N1 in recent times has been seasonal, implying that vitamin D/LL-37 probably played an important role in combating it.

4 - Cold temperature can also play a role in susceptibility to respiratory viral infections. Respiratory syncytical virus, often the cause of bronchitis, is more related to cold air than vitamin D. Cold temperature shuts down the capillaries in the respiratory system, so white blood cells, etc., can't get to the surface to attack the virus. This may play a role in influenza as well.

Thanks Dr. Grant. These comments make a lot of sense.

We often see patients with osteoporosis who have adequate levels of 25 OH D3 in the summer but who become deficient in the winter.

If these people were provided with adequate supplements of vitamin D2 (both in respect to "filling their tank" and in an ongoing basis perhaps at the level of 10,000iu dosage per day, do you care to speculate on what the effect of this approach might have on both the circulating levels of 25 OH vit D3 as well as those of the immune competent forms of activated vitamin D produced by the liver?

GW

[cartski]

Re: Cytokine Storm & Vitamin D relationship?

I need to read this thread more carefully. However, here's a nice review of the literature, I believe:

http://www.cfp.ca/cgi/reprint/53/5/841

J.

[cartski]

Re: Cytokine Storm & Vitamin D relationship?

Sun exposure levels:

http://www.sciencedaily.com/releases/2007/02/070206100608.htm

(very good article about how Vitamin D prevents many illnesses)

Sun levels assume you're NOT in the northern latitudes. Here in Alaska, we're told that after mid-August, the sun is too low to get sufficient Vitamin D from the sun. So we only have 4 months/year where sun exposure is sufficient.

.

I don't get that. We hear the same in Winnipeg, but I've often had a burnt face after spending a day skiing outside. What's the difference how high the sun is in the sky, except for the fact that there's more shade? Planetary physics??

J.

[Shannon Bennett]

Re: Cytokine Storm & Vitamin D relationship?

Cartski, it has more to do with how much air the rays travel through not planetary alignment. The more air the more absorption of the suns rays before it reaches you. As the planet tilts the angle of the suns rays lowers making those rays pass through more atmosphere thus reducing the actual amount of UV reaching you. The reason you get burned while out skiing is the light hits your face both directly from the suns rays, as well as the rays bouncing of the white snow. In essence you are getting double the amount you would without the snow.

[cartski]

Re: Cytokine Storm & Vitamin D relationship?

Cartski, it has more to do with how much air the rays travel through not planetary alignment. The more air the more absorption of the suns rays before it reaches you. As the planet tilts the angle of the suns rays lowers making those rays pass through more atmosphere thus reducing the actual amount of UV reaching you. The reason you get burned while out skiing is the light hits your face both directly from the suns rays, as well as the rays bouncing of the white snow. In essence you are getting double the amount you would without the snow.

Duhhh, oh. Thank you. )

So, to be facetious, a hole in the ozone may be a good thing to combat D insufficiency?

More seriously, can the prevalence of D insufficiency explain, in part, the geographical development of SOIV?

In other words, do we have reason to beleive that persons in slum neighbourhoods in Mexico are D insufficient? Similarly, with the Aboriginal people in mid-northern communities?

Perhaps there is a disease or condition, also prevalent in these peoples, that could be seen as a proxy for D insufficiency?

Could it be that the modern diet, which has replaced the traditional, cultural diets for these peoples, has created a substantial D insufficiency?

Can we assume that there was a high sun exposure in Mexico in March and a very low sun exposure in Manitoba due to the late spring?

J.

ps. As well, many, many thanks to the expert responders! This is exactly why FT was created!

[gsgs]

Re: Cytokine Storm & Vitamin D relationship?

what's the concusion of that paper from CDC ?
I hate how they talk around the issue, don't want
to read the whole paper.

give me a 1-bit summary:
vitamin D reduces flu, yes or no ?

[The Mountains Voice]

Re: Cytokine Storm & Vitamin D relationship?

http://www.cfp.ca/cgi/reprint/53/5/841

Excerpt from one study listed.....

Obesity
Irreversible sequestration of VTD in the fat pool, especially if body mass index is >30 and person does little outdoor activity.

Could the above also be relevant to the large numbers of overweight people developing more severe symptoms? Or would it go against that argument? Not sure how they are using the term "irreversible sequestration".

Thoughts on Vitamin D & Obesity correlation?