Monday, March 29, 2010

Why Vitamin D Levels Won't Rise Despite Supplementation

It’s estimated that nearly one billion people around the world are deficient in vitamin D and need to be supplemented. We’ve discussed the important functions that vitamin D performs in earlier posts (see post of May 4, 2008) but let’s summate the highlights of its function.

Benefits of Vitamin D:
1. It strengthens your immune system, reducing your risk of cancer as well as colds and flu.

2. It affects the development and maintenance of bone health. In people who are vitamin D deficient, you will see a wide variety of bone disorders, such as osteoporosis, osteopenia and osteomalacia - the inability to mineralize bone, causing pain and weakness.

3. It has been shown to improve hypertension and drastically reduce the risk of heart disease.

4. It can help with diabetes, psoriasis and there are even some studies that link Alzheimer's disease, depression and multiple sclerosis to low vitamin D levels.

5. Deficiency is associated with musculoskeletal pain and fibromyalgia.

6. It is commonly malabsorbed in patients with celiac disease and gluten intolerance. Note: vitamin D deficiency subsequent to celiac disease and intestinal damage has been discussed previously and is not the focus of this post.

All too often patients are supplemented with vitamin D only to find in subsequent testing that they are still deficient. Knowing the importance of normalizing these levels for optimal health, the patient is left frustrated as they have followed their clinician’s instructions accurately.

What is the reason? There appear to be two major reasons vitamin D supplementation does not work adequately. The good news is that there IS a solution.

1. It has been a protocol for some time to use vitamin D2 as a supplement when D levels are found to be very low. Prescribing 50,000 IU for several weeks to a patient very deficient in vitamin D has been a standard accepted protocol.

Research reveals flaws in this protocol. The vitamin D2 potency is less than one third that of vitamin D3. Vitamin D2 has a shorter half-life in the blood and a lower affinity for the vitamin D binding protein. What this means is that according to a recent study in the French Internal Medicine Review, “vitamin D2 should not be regarded anymore as suitable for supplementation or fortification.”

So if you’ve been supplementing with vitamin D2 switch to D3 and recheck your levels in a few months. You should also feel much better with this preferred form.

2. Very recent research brings another very important issue to light. Retinol, a form of vitamin A, competes with vitamin D (even the preferred vitamin D3) and prevents its absorption. When you supplement vitamin A you can do it in two forms. Beta carotene, or pre-vitamin A derived from vegetables (or a supplement) which, in your intestines, is converted into the correct amount of retinol needed by your body. Your body will not convert beta carotene into excessive levels of vitamin A. Retinol, the other means of supplementing vitamin A, when given directly as a supplement, bypasses the natural controls of the body as seen above when beta carotene is the source. One could, therefore, get too much vitamin A in the form of retinol.

In an ideal world, all the vitamin A you require would come from vegetables you ate and all the vitamin D you need would come from sunlight. Unfortunately, we don’t live in such a place and many of us are deficient. And as discussed previously, we are not a culture that excels in consuming adequate quantities of vegetables.

Cancer, heart disease and diabetes are leading killers of Americans. As an example, a study by Dr. William Grant, Ph.D., a research scientist, found that about 30 percent of cancer deaths could be prevented each year with higher levels of vitamin D. That’s truly fantastic!

Since proper vitamin D status is known to lessen the incidence of these diseases, it is critical that you maintain an optimal status.

But what if another supplement interfered?

In the recent British Medical Journal 2010; 340:b5500, an article entitled:
“Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: a nested case-control study” was published. In this article the researchers confirmed that low vitamin D levels are a risk for colon cancer and those with the highest levels are half as likely to develop the disease as compared to those with the lowest levels.

However, what they almost missed was that vitamin D levels are almost entirely negated in those with the highest vitamin A intake. Ingesting vitamin A, in the form of retinol could negate the effect of supplementing with vitamin D, even with levels as low as 3,000 IU/day. That is not a high dose.

Many people are completely losing the benefits they could receive from adequate vitamin D due to taking vitamin A (retinol), either in the form of multi-vitamins or cod liver oil.

Many people take cod liver oil based on the fact that it DOES contain vitamin D, A and omega-3 fatty acids. Now it appears that it should be avoided. Vitamin A and D do work together but the form of vitamin A (beta carotene vs retinol) and the ratio between the two must be balanced. On the other side of the coin consider this: being deficient in vitamin A precludes the proper function of vitamin D.

Like most things in nutrition (and life), neither too much nor too little is beneficial.

While it’s unclear what the exact correct ratio is, we do know this: vitamin A should be ingested in the beta carotene form, not retinol. Based on this research it seems unlikely that the amount of beta carotene gotten in a multiple vitamin would create any imbalance to vitamin D absorption.

Help me spread the word about this. In our clinic we see an abundance of patients deficient in vitamin D. Optimizing those levels create wonderful health benefits.

Please let me know if I can be of any assistance. If you would like to improve your health consider calling us for a free health analysis - call 408-733-0400. We are a destination clinic and we treat patients from across the country and internationally. You don't need to live locally to receive help.

To your good health,

Dr Vikki Petersen
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect

Wednesday, March 03, 2010

Steps to Deal with a Gluten Intolerance

If you’ve recently been diagnosed with celiac disease or gluten sensitivity you’re probably feeling a bit disoriented and confused. It’s not easy to discover that a mainstay in your diet has been creating major health problems. It’s also not easy to change your diet overnight. I’ve been helping patients in this arena for 20 years and I’ve laid out a stepwise program that I hope will assist you to feel less overwhelmed and start feeling better as quickly as possible.

1. Go through your home and eliminate all gluten-containing foods. If you live with others who are not gluten-free then simply give yourself a generous section of the kitchen’s real estate, both in the pantry and the refrigerator, that all family members understand is a gluten-free zone.

2. If you like to use a toaster either buy yourself one that’s exclusively yours or purchase bags that you can place your gluten-free bread in that are toaster and contamination safe, reusable, and will allow you to utilize the family toaster. I don’t have the exact source but these bags work well – you should be able to find them online. You can also get yourself your own cutting board if sandwich preparation is a frequent activity in your home.

3. Go on-line and acquaint yourself with the list of grains you can consume, sources of “hidden” gluten (much less than it’s ever been due to improved labeling laws) and manufacturers that cater to the gluten-free lifestyle. I have written several blogs on this topic and my website: is also a good resource that is updated often.

4. Realize that your small intestine needs to heal itself and that takes time. Don’t expect your symptoms to resolve overnight. Patience is key.

5. While successfully eliminating all gluten from your diet I would also strongly encourage you to eliminate all dairy products as well. I’ve spoken about why before but suffice to say that dairy is a source of irritation to the intestine and anything creating inflammation will hinder the healing process. (Organic butter is fine to eat – it is virtually free of the problematic milk proteins as it is a fat predominantly.)

6. Ensure that your diet consists of a good number of servings (5 is ideal) of organic vegetables and fruits. These are very healing and anti-inflammatory. Also work at staying well hydrated (8-10 glasses of purified water/day) as it will assist your body in detoxifying.

7. Exercise several times per week at a level of intensity that you can tolerate. What I mean by that is that you should feel energized by the exercise and not “wiped out” the following day. Exercising earlier in the day is also beneficial vs. at night to allow a more regenerative sleep.

8. Try to get a blood test as soon as possible to evaluate some frequently compromised vitamins and minerals associated with the malabsorption secondary to gluten intolerance. Vitamin D, vitamin K, calcium, magnesium, folic acid, zinc, essential fatty acids and iron are nutrients that should be checked. If found to be deficient ensure that you supplement with a high quality product and retest to ensure that your levels are normalizing.

9. Elimination of any inhospitable organisms from your gut is also critical to healing. Performing a stool test that evaluates for the presence of any bacteria, parasites, amoeba, yeast as well as one that looks at the balance of the good bacteria, or probiotics, is essential. Receive treatment for any pathogenic organisms and then recolonize with healthy bacteria. Taking 1 capsule per day of probiotics is likely something you should consider doing for life.

10. Get a hormone balance test that evaluates the sex hormones (estrogen, progesterone and DHEA – testosterone for men) as well as the adrenal hormone cortisol. The adrenal function is best tested through saliva and the hormones are best measured through blood. Menstruating women should take this test approximately 1week before their period for the best accuracy. You will need to find a practitioner excelling in this area but it is important for regaining your energy, metabolism and optimal brain function.

Please let me know if I can be of any assistance in this area of if you have any questions.

To your good health,

Dr Vikki Petersen
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect