In a quick Q&A, a CNN.com doc answers a question about resolution of diabetes with weight loss surgery:
Does roux-en-Y gastric bypass cure diabetes?
Asked by Rick Shetron, Troy, New York
“60 Minutes” had a story several months ago about a type of weight-loss surgery that seemed to also cure type 2 diabetes in many people. Has more research been done on this? Do you need the full bypass of about one-third of the small intestine or just the duodenum and jejunum? My weight problem came about with/after diabetes, not before.
Hi, Rick. I’m not a surgeon, so to answer your question more thoroughly, I consulted with a very well-respected bariatric surgeon in San Francisco, John Rabkin, M.D. He explained that the roux-en-Y gastric bypass (RGB) improves type 2 diabetes via at least three different mechanisms:
1. The surgery decreases caloric intake immediately after the procedure because food intake is restricted by the small volume of the created stomach pouch, which holds only 1 ounce. The decrease in food intake, particularly refined carbohydrates, which are not well-tolerated after this procedure, can help stabilize blood sugar levels and immediately improves control of diabetes.
2. The significant amount of weight loss that results from the surgery improves insulin resistance over time.
3. There are changes in hormones and caloric processing because the food ingested bypasses the segment of the small intestine closest to where it attaches to the stomach (the duodenum and proximal jejunum), but not quite as much as you mentioned (not one-third of the small intestine). Because of the anatomical changes resulting from the surgery, it appears that these hormonal changes are greater than would be seen with weight loss via diet and exercise, but no research has yet to compare the two directly and evaluate hormonal changes.
The overall outcome is complete resolution of type 2 diabetes in greater than 70 percent of patients with diabetes before the procedure.
Unfortunately, as many RGB patients regain weight over time, the durability of the cure isn’t as high as with a newer procedure called the duodenal switch.
In this procedure, there is a much larger pouch created (4 to 5 ounces), and the complete stomach anatomy is preserved, which helps preserve more normal stomach function. In this procedure, the rearrangement of the intestines leads not only to some restriction of food, but also causes your body to absorb significantly fewer calories, which has a more lasting effect.
Rabkin, a leader in this procedure, reports that he has had a 96 percent cure of type 2 diabetes at one year after surgery, which has persisted for five and 10 years post -op and seems to be similarly durable out past 15 years post-op.
Hope this helps. I strongly recommend spending a considerable amount of time with your surgeon if you are considering either of these procedures, as both have important lifestyle-related issues that should be discussed to determine the best procedure for you for the long term.
Answered by Dr. Melina Jampolis Physician Nutrition Specialist
Bout time this is really hitting the mainstream. I would take some exception with the assumption that all RNY’ers regain their weight, but many do. I get that. I only wish they had qualified this a bit better, but glad the DS got some mainstream attention.
Disclaimer – I got this from the OH Atlanta convention. Theresa from Bariatric Eating was handing these out, along with the Calcet creamy bites (which might be where I got mine, I’m not certain..) BE doesn’t know I’m doing this review — in fact, I’m not certain Theresa knows who I am, and she certainly didn’t know I was going to be blogging about the product when she handed it to me. Actually, neither did I. It took Beth several conversations over the course of the weekend to convince me to do so. So basically, again, no product endorsement was asked for, implied, or anything else.
Italian Cappuccino, is a Splenda-sweetened espresso latte, with 20 grams of protein, a blast of natural energy and a hint of caramel goodness.
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So I’ll be honest — I opened this expecting it to be exactly like the Buxx drinks in the same containers. I’m not certain why, given that this is good for me and those, well, aren’t. But my mind saw the bottle, the packaging and thought “mmm.. creamy coffee goodness..”
Well, not quite.
It’s thinner, much much thinner. It’s sweeter, to me, than the Buxx drinks, and this comes from an admitted Splenda whore. To me, it leaves an aftertaste — kind of a gritty aftertaste on my tongue, like a dry taste, but not horrible. This might just be me because I handed it to the hubs, who does not like diet anything and he said it tasted much like the Buxx drinks to him. So maybe my tongue may be broken, or overly-sensitive, or something else. It is nowhere near as strong as Click is, so if Click is too much for you but you like your coffee, then this might be a good alternative to try.
The statistics are really good for the drink:
So would I drink this again? Yes. In fact, since I have one in my fridge, I will be drinking it again. It’s not as strong as the Click, which might be great for people who aren’t into the massive espresso need like I am. It’s definately something I would drink, and would consider buying again. And let’s face it, the stats are super.
It may be on it’s way…
Scientists are starting to test a kind of sensor that changes color with rising blood sugar levels. The high-tech tattoo, which is about the size of the clicker on the end of a ballpoint pen, is made up of tiny spheres that are injected into the outermost layer of skin. These nanospheres contain a special kind of ink that reacts with glucose, explains the tattoo’s inventor, Heather Clark, a biomedical engineer at Draper Laboratory in Cambridge, Mass.
What would be cool is if this could be used for those of us that are severely hypoglycemic rather than diabetic. Some of us don’t even begin to get symptomatic until comatose levels — quite recently, I remember a reading of 28 on my glucometer — a number that would have many people unconscious and drooling on the floor. If I had this implantable mood ring of sorts, I could save myself some of the misery that I encounter at such low numbers and try to head off the hours it takes to gradually get those numbers normal without doing a massive yo-yo of reactive-ness (yes, I am now making up my own words).
A girl can dream, right?
FTC disclaimer — Yeah, they don’t know I’m reviewing their product. I didn’t get this free — unless you count stealing it from Sam’s cabinet. Okay, so yeah, I got it free. But not from the company. And only because they are so very yummy.
Melting Mama had done a review on these suckers. She talked about how they were like little orgasms in tiny plastic containers. Okay, so I thought maybe they were good. I like Beth. I think she’s the best thing since Prime Rib (hey, I got fat for a reason — I lurve me a good Prime Rib — medium rare, please). But calcium? Really? It can’t be that good. There had to be a catch — something like the Upcal-D fiasco way-back when they were substituting some of the calcium with sugar to make it taste good and sweet-talking the labeling to make it look better than it was. So sure.. there had to be a catch. There was no way these were going to be that good and be that wonderful for us.
So at OH Atlanta, there were a number of tables that had these out. I think three or four. I don’t remember where I grabbed mine from, to be honest, but I grabbed one for me, and one for Sam — who does not do mornings and was still in bed. Stacy also had grabbed one and we sat down for the opening ceremonies with Bo. Together, we started to pry the packaging open.. and yes, it’s difficult. I wouldn’t go as far as to say that we needed scissors, or a flame-thrower to get it open.. perhaps a knife would have been handy. But we got them open and popped that little bite into our mouths.
The flavor was wonderful. The texture was creamy. It was pure bliss in a tiny little flavorful package. And! And! And! it was calcium?! Really? This is good for us?
So Sam comes down and I plop this in front of her. She immediately thinks I’m trying to kill her (which is a normal occurrance), and after multiple assurances from others around her that it is not poison, she also tries it, and immediately buys two boxes (of which the pictured bite came from — so see FTC, I’m legal).
The taste is creamy.. I don’t get the gritty taste that I do with many of the other calciums out on the market (later, folks — I couldn’t help myself.. these had to come first). These have a smooth taste, a light lemony flavor without having an overtone of Pledge. And I saw that there is a chocolate flavor promised soon. I’m hopeful, of course, that the chocolate won’t suck. But regardless, I could totally do my entire 2000mg of calcium from these alone if they weren’t quite so pricey. At most places, they work out about 40 cents each, plus some shipping. But a treat, if you can limit yourself to just one — and yes they really are that good — would be worth it to me, and will be worth it. I have a list of things to buy when I get my credit card out and actually decide to do it. Probably next week. If I think I could leave them alone and only do 2000mg of calcium a day. Or do them 2 hours apart. Which actually might be difficult.
Oh, stats? These have them:
It’s important to note these have some sugar and milk in them — so if you are seriously sensitive to sugar (3g) or milk, then be cautious when trying these (or buy them and send me any extras if they don’t work for you). Yeah, yeah, yeah.. these have 40 calories in them — shock! But being 5 years out, calories are not evil for me. I know that my resting metabolic rate is somewhere around 1800 calories on a normal day.. 1500 if I sit on my butt on the internet all day. Even if I did eat 4 of these a day, I’m not going to kill myself with calcium. A box-worth? Mebbe.. but 4 a day.. no. If you’re new postop, 4 might be hitting your caloric threshold, but not for me.
Final result? Yes, Andrea likes these. The problem is whether or not Andrea will leave them alone if they are in the house — they are very much like candy! Hey, at least I know my triggers.
I bring this up because RNY and DS’ers are more likely to become D deficient.. but the US as a whole is popping up deficient. Hubby, my skinny ass, non-rerouted gutted husband who drinks Mt. Dew all day husband, is D deficient. Point is — this is something we need to be adding to prenatal blood workups, postop or not. While many of my readers may not be currently pregnant, it can (and has) happened and should be noted as important. I mean, I’m living proof as I sit here watching my two little vikings color.
Pregnancy and Gestational Vitamin D Deficiency
In the last 3 years, an increasing amount of research suggests that some of the damage done by Vitamin D deficiency is done in-utero, while the fetus is developing. Much of that damage may be permanent, that is, it can not be fully reversed by taking Vitamin D after birth. This research indicates Vitamin D deficiency during pregnancy endangers the mother’s life and health, and is the origin for a host of future perils for the child, especially for the child’s brain and immune system. Some of the damage done by maternal Vitamin D deficiency may not show up for 30 years. Let’s start with the mother.
Incidence of Gestational Vitamin D Deficiency
Dr. Joyce Lee and her colleagues at the University of Michigan studied 40 pregnant women, the majority taking prenatal vitamins. Only two had blood levels >50 ng/mL and only three had levels >40 ng/mL. That is, 37 of 40 pregnant women had levels below 40 ng/mL, and the majority had levels below 20 ng/mL. More than 25% had levels below 10 ng/mL. Lee JM, Smith JR, Philipp BL, Chen TC, Mathieu J, Holick MF. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila). 2007 Jan;46(1):42–4.
Dr. Lisa Bodnar, a prolific Vitamin D researcher, and her colleagues at the University of Pittsburg studied 400 pregnant Pennsylvania women; 63% had levels below 30 ng/mL and 44% of the black women in the study had levels below 15 ng/mL. Prenatal vitamins had little effect on the incidence of deficiency. Bodnar LM, Simhan HN, Powers RW, Frank MP, Cooperstein E, Roberts JM. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr. 2007 Feb;137(2):447–52.
Dr. Dijkstra and colleagues studied 70 pregnant women in the Netherlands, none had levels above 40 ng/mL and 50% had levels below 10 ng/mL. Again, prenatal vitamins appeared to have little effect on 25(OH)D levels, as you might expect since prenatal vitamins only contain 400 IU of Vitamin D. Dijkstra SH, van Beek A, Janssen JW, de Vleeschouwer LH, Huysman WA, van den Akker EL. High prevalence of vitamin D deficiency in newborns of high-risk mothers. Arch Dis Child Fetal Neonatal Ed. 2007 Apr 25.
Thus, more than 95% of pregnant women have 25(OH)D levels below 50 ng/mL, the level that may indicate chronic substrate starvation. That is, they are using up any Vitamin D they have very quickly and do not have enough to store for future use. Pretty scary.
Effects on the Mother
The rate of Caesarean section in American women has increased from 5% in 1970 to 30% today. Dr. Anne Merewood and her colleagues at Boston University School of Medicine found women with levels below 15 ng/mL were four times more likely to have a Cesarean section than were women with higher levels. Among the few women with levels above 50 ng/mL, the Caesarean section rate was the same as it was in 1970, about 5%. Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab. 2009 Mar;94(3):940–5.
Preeclampsia is a common obstetrical condition in which hypertension is combined with excess protein in the urine. It greatly increases the risk of the mother developing eclampsia and then dying from a stroke. Dr. Lisa Bodnar and her colleagues found women with 25(OH)D levels less than 15 ng/mL had a five-fold (5 fold) increase in the risk of preeclampsia. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007 Sep;92(9):3517–22.
Diabetes during pregnancy affects about 5% of all pregnant women, is increasing in incidence, and may have deleterious effects on the fetus. Dr. Cuilin Zhang and colleagues at the NIH found women with low 25(OH)D levels were almost 3 times more likely to develop diabetes during pregnancy. Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, Williams MA. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS ONE. 2008;3(11):e3753.
Dr. Lisa Bodnar and her colleagues found pregnant women with the lowest 25(OH)D level are almost twice as likely to get a bacterial vaginal infection during their pregnancy. Bodnar LM, Krohn MA, Simhan HN. Maternal Vitamin D Deficiency Is Associated with Bacterial Vaginosis in the First Trimester of Pregnancy. J Nutr. 2009 Apr 8.
Effects on the child
Seventeen experts—many of them world-class experts—recently recommended:
“Until we have better information on doses of vitamin D that will reliably provide adequate blood levels of 25(OH)D without toxicity, treatment of vitamin D deficiency in otherwise healthy children should be individualized according to the numerous factors that affect 25(OH)D levels, such as body weight, percent body fat, skin melanin, latitude, season of the year, and sun exposure. The doses of sunshine or oral vitamin D3 used in healthy children should be designed to maintain 25(OH)D levels above 50 ng/mL. As a rule, in the absence of significant sun exposure, we believe that most healthy children need about 1,000 IU of vitamin D3 daily per 11 kg (25 lb) of body weight to obtain levels greater than 50 ng/mL. Some will need more, and others less. In our opinion, children with chronic illnesses such as autism, diabetes, and/or frequent infections should be supplemented with higher doses of sunshine or vitamin D3, doses adequate to maintain their 25(OH)D levels in the mid-normal of the reference range (65 ng/mL) — and should be so supplemented year-round (p. 868).” Cannell JJ, Vieth R, Willett W, Zasloff M, Hathcock JN, White JH, Tanumihardjo SA, Larson-Meyer DE, Bischoff-Ferrari HA, Lamberg-Allardt CJ, Lappe JM, Norman AW, Zittermann A, Whiting SJ, Grant WB, Hollis BW, Giovannucci E. Cod liver oil, vitamin A toxicity, frequent respiratory infections, and the vitamin D deficiency epidemic. Ann Otol Rhinol Laryngol. 2008 Nov;117(11):864–70.
That’s right. Healthy children need about 1,000 IU per 25 pounds of body weight and their 25(OH)D levels should be >50 ng/mL, year-round.
Eight years before the above recommendations, Professor John McGrath of the Queensland Centre for Mental Health Research theorized that maternal Vitamin D deficiency adversely “imprinted” the fetus, making infants more liable for a host of adult disorders. Research since that time has supported McGrath’s theory. Consider, for a minute, what it must be like for John McGrath, to know that maternal Vitamin D deficiency is causing such widespread devastation, to know it could be so easily treated, but to also know he must wait the decades that will be required to deal with the problem. McGrath J. Does ‘imprinting’ with low prenatal vitamin D contribute to the risk of various adult disorders? Med Hypotheses. 2001 Mar;56(3):367–71.
Dr. Dennis Kinney and his colleagues at Harvard published a fascinating paper last month on the role of maternal Vitamin D deficiency in the development of schizophrenia, in support of Dr. McGrath’s theory. As they point out, the role of inadequate Vitamin D during brain development appears to “overwhelm” other effects, explaining why schizophrenia has so many of the footprints of a maternal Vitamin D deficiency disorder, such as strong latitudinal variation, excess winter births, and skin color. Kinney DK, Teixeira P, Hsu D, Napoleon SC, Crowley DJ, Miller A, Hyman W, Huang E. Relation of schizophrenia prevalence to latitude, climate, fish consumption, infant mortality, and skin color: a role for prenatal vitamin d deficiency and infections? Schizophr Bull. 2009 May;35(3):582–95.
I will say not more, other than to point out that Scientific American ran a lengthy article last month on my autism theory but the editors insisted that the author not cite me, nor my paper, because I am “not a scientist.” Gabrielle Glaser. What If Vitamin D Deficiency Is a Cause of Autism? 2009 April 24. Scientific American.
The only evidence that Vitamin D deficiency is a common cause of mental retardation is from researchers at the CDC who found mild mental retardation is twice as common among African Americans as whites, and that the politically correct explanation—socioeconomic factors—cannot explain it. If latitudinal studies of mild mental retardation exist, I am unable to locate them. Yeargin-Allsopp M, Drews CD, Decoufle P, Murphy CC. Mild mental retardation in black and white children in metropolitan Atlanta: a case-control study. Am J Public Health 1995;85(3):324–8. Drews CD, Yeargin-Allsopp M, Decoufle P, Murphy CC. Variation in the influence of selected sociodemographic risk factors for mental retardation. Am J Public Health 1995;85(3):329–34.
Of course, it is claimed you are a racist if you believe these studies. In fact, a number of writers have told me their editors will not allow writers to discuss these studies in their stories. I am glad these studies were conducted by researchers at the CDC. Although, I worry about their political longevity at the CDC after reporting such findings.
I will mention one other fact (at my peril) and that is the fact that a very smart man, President Barack Obama, was born in the late summer (August) and has a brain that developed in a womb covered in white skin, during the spring and summer, in the subtropics (Latitude 21 degrees North), during an age before sun-avoidance was the mantra (1961). Make what you want to of that fact. My point is that whites living at temperate latitudes may have a huge developmental advantage over blacks, an advantage that begins immediately after conception, an advantage that has nothing to do with innate genetic ability and everything to do with environment.
Newborn Lower Respiratory Tract Infection
Newborn babies are vulnerable to infections in their lungs and women with the lowest 25(OH)D level during pregnancy were much more likely to have their newborn in the ICU being treated for lower respiratory tract infections. Drs. Walker and Modlin at UCLA recently presented reasons why viral pneumonia is probably only one of many pediatric Vitamin D deficient infections. Karatekin G, Kaya A, Salihoğlu O, Balci H, Nuhoğlu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr. 2009 Apr;63(4):473–7. Walker VP, Modlin RL. The Vitamin D Connection to Pediatric Infections and Immune Function. Pediatr Res. 2009 Jan 28.
While conflicting results exist on the effects of maternal Vitamin D deficiency and birth weight, the majority of the studies find an effect. Furthermore, the studies are comparing women who have virtually no intake to women who have minuscule intakes. For example, women who ingested around 600 IU per day were more likely to have normal weight babies compared to women whose intake was less than 300 IU per day. One can only wonder what would happen if pregnant women had adequate intakes? Drs. Scholl and Chen, at the Department of Obstetrics at the University of Medicine and Dentistry of New Jersey, concluded pregnant women need 6,000 IU per day, not the 400 IU/day contained in prenatal vitamins. Scholl TO, Chen X. Vitamin D intake during pregnancy: association with maternal characteristics and infant birth weight. Early Hum Dev. 2009 Apr;85(4):231–4.
My old nemesis, cod liver oil, when given during pregnancy resulted in children who were three times less likely to develop juvenile diabetes before the age of 15. Of course, this was back when cod liver oil had meaningful amounts of Vitamin D (these Norwegian mothers were taking cod liver oil in the 1980s). Stene LC, Ulriksen J, Magnus P, Joner G. Use of cod liver oil during pregnancy associated with lower risk of Type I diabetes in the offspring. Diabetologia. 2000 Sep;43(9):1093–8.
Newborns frequently have seizures and those seizures are almost always due to low blood calcium. This problem is so common that many newborns are given a prophylactic injection of calcium. In 1978, researchers found such hypocalcemia can easily be prevented by giving Vitamin D. Sadly, standard treatment remains—not Vitamin D, but calcium and an analogue of activated Vitamin D. Such analogues do not correct Vitamin D deficiency. The fact that this was known in 1978 and has been routinely ignored by obstetricians since then should give you pause. Do not think science will solve the Vitamin D problem. Science simply points the way, activists must change the practice. Fleischman AR, Rosen JF, Nathenson G. 25-Hydroxycholecalciferol for early neonatal hypocalcemia. Occurrence in premature newborns. Am J Dis Child. 1978 Oct;132(10):973–7.
Idiopathic infant heart failure is often fatal. Of course, idiopathic to whom? The uninformed cardiologists who do not recognize severe infantile Vitamin D deficiency? Luckily, for 16 infants, Dr. Maiya, Dr. Burch, and colleagues at the Great Ormand Street Hospital for Children are not among them. Maiya S, Sullivan I, Allgrove J, Yates R, Malone M, Brain C, Archer N, Mok Q, Daubeney P, Tulloh R, Burch M. Hypocalcaemia and vitamin D deficiency: an important, but preventable, cause of life-threatening infant heart failure. Heart. 2008 May;94(5):581–4.
Dr. Muhammad Javaid and colleagues at the University of Southampton found that children of Vitamin D deficient mothers were much more likely to have weak bones 9 years later. Dr. Adrian Sayers and Jonathan Tobias of the University of Bristol recently found the same thing when they looked at maternal sun-exposure. Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ, Arden NK, Godfrey KM, Cooper C; Princess Anne Hospital Study Group. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet. 2006 Jan 7;367(9504):36–43. Sayers A, Tobias JH. Estimated maternal ultraviolet B exposure levels in pregnancy influence skeletal development of the child. J Clin Endocrinol Metab. 2009 Mar;94(3):765–71.
John McGrath’s group discovered that children with astrocytomas and ependymomas (brain tumors you do not want your child to have) were more likely to be born in the winter. Ko P, Eyles D, Burne T, Mackay-Sim A, McGrath JJ. Season of birth and risk of brain tumors in adults. Neurology. 2005 Apr 12;64(7):1317.
Three studies have found that epileptic patients are much more likely to be born in the winter. Dr. Marco Procopio of the Priory Hospital Hove in Sussex has written all three. Procopio M, Marriott PK, Davies RJ. Seasonality of birth in epilepsy: a Southern Hemisphere study. Seizure. 2006 Jan;15(1):17–21.
Craniotabes is softening of the skull bones that occurs in 1/3 of “normal” newborns. Recent evidence indicates it is yet another sign and sequela of maternal vitamin D deficiency. Yorifuji J, Yorifuji T, Tachibana K, Nagai S, Kawai M, Momoi T, Nagasaka H, Hatayama H, Nakahata T. Craniotabes in normal newborns: the earliest sign of subclinical vitamin D deficiency. J Clin Endocrinol Metab. 2008 May;93(5):1784–8.
Dr. Robert Schroth from the University of Manitoba reported that mothers of children who developed cavities at an early age had significantly lower vitamin D levels during pregnancy than those whose children were cavity-free. Megan Rauscher. Prenatal vitamin D linked to kids’ dental health. 2009. Reuters.
The extant data here is conflicting. Two studies have found higher Vitamin D intakes during pregnancy decrease the risk of asthma in later childhood and one has found the opposite. The best review of the issue is by Drs. Augusto Litonjua and Scott Weiss, at Harvard, who conclude that the current epidemic of asthma among our children is related to both gestational and ongoing childhood vitamin D deficiency. Litonjua AA, Weiss ST. Is vitamin D deficiency to blame for the asthma epidemic? J Allergy Clin Immunol. 2007 Nov;120(5):1031–5.
Furthermore, a very recent study by Dr. John Brehm and the same Harvard group found low Vitamin D levels in asthmatic children were associated with hospitalization, medication use, and disease severity. Brehm JM, Celedón JC, Soto-Quiros ME, Avila L, Hunninghake GM, Forno E, Laskey D, Sylvia JS, Hollis BW, Weiss ST, Litonjua AA. Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Am J Respir Crit Care Med. 2009 May 1;179(9):765–71.
In case you are wondering, black children are four times more likely than white children to be hospitalized or die from asthma. Akinbami LJ, Schoendorf KC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics. 2002 Aug;110(2 Pt 1):315–22.
My experience, both at the hospital and via my readers, is that asthma improves—albeit sometimes slowly—when adequate doses of Vitamin D are taken. However, Vitamin D does not appear to be a cure, like it is in some other conditions. I suspect children with asthma have suffered both gestational and ongoing childhood Vitamin D deficiency that probably altered, perhaps permanently, their immune system.
The Vitamin D Council’s Effort
We recently ran a ¼ page announcement in OB/GYN News and the American Journal of Obstetrics and Gynecology (AJOG). Unfortunately, the editor of AJOG censored our announcement after its first month, but we were able to get the full, three-month run in OB/GYN News. We also sent a very similar email to 18,000 obstetricians in the United States. The total cost to the Vitamin D Council for this campaign was about $12,000.00.
The announcement simply pointed out that the American Academy of Pediatrics (AAP) recently recommended that all pregnant women have a 25(OH)D blood test because Vitamin D is important for normal fetal development (p. 1145):
“Given the growing evidence that adequate maternal vitamin D status is essential during pregnancy, not only for maternal well-being but also for fetal development, health care professionals who provide obstetric care should consider assessing maternal vitamin D status by measuring the 25-OH-D concentrations of pregnant women. On an individual basis, a mother should be supplemented with adequate amounts of vitamin D3 to ensure that her 25-OH-D levels are in a sufficient range (>32 ng/mL). The knowledge that prenatal vitamins containing 400 IU of vitamin D3 have little effect on circulating maternal 25-OH-D concentrations, especially during the winter months, should be imparted to all health care professionals.” Wagner CL, Greer FR; American Academy of Pediatrics Section on breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008 Nov;122(5):1142–52.
As the AAP recommendation came from an official medical body, to medical malpractice attorneys it represents evidence of a “standard of care” for future lawsuits. We also reminded obstetricians that the statute of limitations on malpractice suits does not toll (begin) until the injured party recognizes the injury. That is, the parents of a 5-year-old child diagnosed with autism five years in the future may bring suit against that obstetrician for how the child was treated during his time in the uterus, citing the 2008 AAP‘s recommendation as a standard of care. Obstetricians are already burdened with lawsuits, but they could decrease the number of suits significantly if they would just take the time to learn about Vitamin D.
Finally, we used our last $12,000 to produce and run a television announcement in the Washington, D.C. TV market, entitled Pregnancy and Vitamin D.
What can you do?
Most people want to do good—at least some good—in their lives. The endless pursuit of the God-almighty dollar, better clothes, better houses and better vacations than your neighbors eventually leaves a hole in your soul. Here is an opportunity to fill it.
If you don’t feel that soul hole, try a meditation I learned at Esalen Institute in the 1980s and have practiced ever since. Lie on the floor and pretend you are dead in your grave. Feel the worms, smell the rot, sense the finality. Then, when you really feel dead, visualize your gravestone above. What does it say? “Here lies Robert; he had a big fancy house.” “Here lies Vanessa; she wore beautiful clothes and had four face lifts.” Here lies Michael; he made a billion dollars.” Through this meditation, I realized I want my gravestone to say, “Here lies John, he did something good.”
One good thing you can do is simply tell every pregnant woman and women thinking of getting pregnant that she needs to take more Vitamin D, a lot more. Pregnant women need a minimum of 5,000 IU per day and even that dose will not achieve 25(OH)D levels of >50 ng/mL in all women. Why not buy a few bottles of 5,000 IU capsules and hand out the bottles to your pregnant friends? You can get 250 vitamin D capsules for 15 bucks. Or, forward this email to them. Show them our Pregnancy and Vitamin D public service announcement.
If you want to do more, why not get a copy of our Pregnancy and Vitamin D public service announcement by emailing our webmaster at email@example.com (the ad is not copyrighted) and then pay to run it on a TV station in your hometown? You can easily add a caption at the bottom saying this public service announcement is being sponsored by your company, combining a good deed with good business.
Alas, no glory will be yours, at least in this life. No woman will ever thank you for the schizophrenic child she never had, for the trips to the emergency room with a breathless child that she never made, for the repetitive moaning of the autistic child she never endured. Although, she may wonder why her pregnancy was so easy and why her infant is so healthy, alert, active, and smart.
John Jacob Cannell MD Executive Director