Vitamin D3-5

The Vitamin D Newsletter
More Vitamin D Studies of Interest
March 14, 2010

The mainstream American press is ignoring much of the recent Vitamin D
scientific literature. I suspect newspaper editors have decided that too
many favorable Vitamin D stories run the risk of repeating the folic acid,
beta-carotene and vitamin E affairs, when early epidemiological research was
not routinely substantiated by later randomized controlled trials. If the
press has made that decision, then this newsletter is your best source of
information on new Vitamin D science.

*Genetics, as well as dose, determine response to vitamin D supplements.*

Your vitamin D blood level depends entirely on how much you take or how
often you sunbathe, right? Wrong. Prior studies of identical twins show that
about 25 -50% of the variation of Vitamin D levels depends on genetics. In
July, researchers at the University of Toronto discovered the heritability
of 25(OH)D is probably mediated through the Vitamin D binding protein

Fu L, Yun F, Oczak M, Wong BY, Vieth R, Cole DE. Common genetic variants of
the vitamin D binding protein (DBP) predict differences in response of serum
25-hydroxyvitamin D [25(OH)D] to vitamin D supplementation. Clin Biochem.
2009 Jul;42(10-11):1174-7.<>

One of the common emails I get (and I’m sorry I can’t answer individual
emails) is “I am taking 5,000 IU per day but my blood level is only 35
ng/ml.” What should I do? This study helps answer such questions. You
probably inherited a tendency to not respond to higher doses of Vitamin D.
Simply take a little more and get your blood tested again in 3-4 months.

Also, don’t forget your weight. Does it make sense that if you weigh 300
pounds, you need more vitamin D than a 3 pound baby? If that makes sense to
you, congratulations, it has not made sense to any of the five Food and
Nutrition Boards (FNB) that have convened and issued recommendations to
Americans over the last 60 years; they have all recommended the same 200
IU/day dose for infants and young adults, no matter how much the adults

*More researchers actually recommend that people take Vitamin D and not just
give more money to scientists.*

Researchers from Austria concluded their review paper on vitamin D and high
blood pressure by stating: “In view of the multiple health benefits of
vitamin D and the high prevalence of vitamin D deficiency, as well as the
easy, safe, and inexpensive ways in which vitamin D can be supplemented, we
believe that the implementation of public health strategies for maintaining
a sufficient vitamin D status of the general population is warranted.”

Pilz S, Tomaschitz A, Ritz E, Pieber TR; Medscape. Vitamin D status and
arterial hypertension: a systematic review. Nat Rev Cardiol. 2009

Good for Austria! By the way, while vitamin D may improve hypertension, it
is not the be all and end all of hypertensive disease. If your doctor can
stop your high blood pressure medication after you start taking vitamin D,
great, but I doubt that will happen. Most people will have to continue
taking their antihypertensive medication even after adequate vitamin D
supplementation, albeit sometimes at a lower dose.

While I am on the subject, remember, that vitamin D will not prevent all
cancer or heart disease or respiratory infections. True, evidence is
accumulating that it will help, but you can still develop cancer, heart
disease and respiratory infections with adequate blood levels of vitamin D.
That’s why I believe in complimentary, not alternative, medicine.

*Professor Michael Holick keeps increasing the amount of vitamin D he

As readers know, Professor Holick is one of the world’s foremost authorities
on vitamin D. However, after being on the 1997 Food and Nutrition Board
(FNB), he stuck with the FNB’s 200 IU/day recommendation well into the next
century. Then he slowly went to 400 IU, then 800 IU, then 1,000 IU and now
he is at 2,000 IU/day. Professor Holick is going in the right direction and
is almost there.

Cynthia K. Buccini Sunny Dispositions vitamin D deficiency may be the most
common medical problem in the world. BU Today, March 8,

*Professor Robert Heaney of Creighton University just discovered that if you
take 2,200 IU of vitamin D every day, you only have about 12 days supply of
vitamin D in your body.*

I love Robert Heaney’s papers. In a previous paper, Dr. Heaney discovered
that at blood levels of 35 ng/ml, 50% of people are using up their vitamin D
as quickly as they take it, that is, they are not storing any for future use
and suffer from chronic substrate starvation. Obviously, one wants to take
enough so the body has all it can use, which is why I recommend 25(OH)D
levels of at least 50 ng/ml. At that level, no one should have chronic
substrate starvation.

In the paper below, Dr. Heaney collaborated with two other Creighton
scientists, Dr. Diane Cullen and Dr. Laura Armas, as well as one of the
premier experts in measuring vitamin D in the world, Dr. Ron Horst of
Heartland Assays. Ron runs tens of thousands of vitamin D samples a year as
Heartland Assays performs vitamin D testing for most of the big studies and
Dr. Horst is one of the few people in the world who can accurately measure
cholecalciferol, and not just 25(OH)D.

Heaney RP, Horst RL, Cullen DM, Armas LA. Vitamin D3 distribution and status
in the body. J Am Coll Nutr. 2009

Anyway, in his latest paper, Dr. Heaney found that if you regularly take
2,200 IU per day, you have about 12 days supply of vitamin D in your body.
He explained, “What this indicates is that fat reserves of the vitamin are
essentially running on empty and that . . . additional vitamin D inputs are
[converted to 25(OH)D] almost immediately.” . . “The currently recommended
intake of vitamin D needs to be revised upward by at least an order of

What is not known, at least by me, is what happens when cholecalciferol
intake far exceeds the body’s requirement. We know it is stored in the body,
mainly in fat and muscle, but what does the body do to control excess
cholecalciferol from building up in the body? Professor Reinhold Vieth has
written that much of it will simply be excreted unchanged in the bile, but
how does that system work exactly, to get rid of excess cholecalciferol? We
know it works because the few patients with vitamin D toxicity reported in
the literature – almost always due to industrial errors – reduce their
vitamin D levels rather quickly by simply stopping the vitamin D and staying
out of the sun.

*Zocor has no effect on vitamin D levels.*

I know several studies have found statins raise vitamin D levels but
different scientists report different findings. This paper found Zocor had
no effect of vitamin D levels while a previous paper found Crestor almost
tripled vitamin D levels. What’s the truth? I don’t know. The above study
did find that higher vitamin D levels were strongly associated with better
triglycerides and weakly associated with higher HDL (the good cholesterol)

Rejnmark L, Vestergaard P, Heickendorff L, Mosekilde L. Simvastatin does not
affect vitamin d status, but low vitamin d levels are associated with
dyslipidemia: results from a randomised, controlled trial. Int J Endocrinol.

*Vitamin D lowers statin blood levels*

This study makes the point that things are often more complex than they
first appear. Almost nothing is known of vitamin D’s drug-drug interactions.
That is, how does vitamin D affect the blood level of other drugs? The below
study measured the effects of vitamin D on Lipitor levels and cholesterol
levels hours after Lipitor was given to patients taking vitamin D. The
authors were looking for drug-drug interactions and found them.

Schwartz JB. Effects of vitamin D supplementation in atorvastatin-treated
patients: a new drug interaction with an unexpected consequence. Clin
Pharmacol Ther. 2009

The above study found vitamin D not only lowered Lipitor levels, but vitamin
D lowered bad cholesterol levels as well. That is, the lowest bad
cholesterol levels were found in patients on vitamin D with the lowest
Lipitor levels, just the opposite of what one would think. I mean, wouldn’t
higher Lipitor levels result in lower cholesterol levels? Not when vitamin D
was taken into account. If you think my explanation of this study is
confusing, you should read the study.

*Intensive treatment with vitamin D, statins, and omega-3 fish oil reverses
coronary calcium scores.*

The below open study by Dr. William Davis and colleagues studied 45 adults
with evidence of calcified coronary arteries, treating them with high dose
statins, niacin, fish oil (not cod liver oil) capsules, and enough vitamin D
(average of about 4,000 IU/day) to obtain 25(OH)D levels of 50 ng/ml. They
found that regimen reduced coronary calcium scores in 20 patients and slowed
progression in 22 additional patients. That is, it reversed the coronary
calcification process in about half of patients and slowed its progression
in most of the rest.

Davis W, Rockway S, Kwasny M. Effect of a combined therapeutic approach of
intensive lipid management, omega-3 fatty acid supplementation, and
increased serum 25 (OH) vitamin D on coronary calcium scores in asymptomatic
adults. Am J Ther. 2009

Most studies have shown high dose statins on their own do not reverse
coronary arthrosclerosis, so we know it was not the statins alone. What
would vitamin D levels of 70 ng/ml do? So, if you have coronary artery
disease: ask your cardiologist about statins and niacin, take 5-10 fish oil
capsules per day, and at least 5,000 IU of vitamin D3 per day.

A word about fish oil is in order. Fish oil means fish body oil, not fish
liver oil. And, four or five capsules of omega-3 fish oil a day will do very
little if you do not limit your intake of omega-6 oils. Your ratio of
omega-6 to omega-3 is the crucial number, your want that ratio at 2 or
below, which means no chips, no French fries and no processed foods, a
difficult diet. Omega-6 oils are vegetable oils such as corn oil, safflower
oil, soybean oil, sunflower oil and cottonseed oil. Read the packages to see
what is in them and if they contain the above oils do not eat them. In
additions to taking fish oil capsules, try to eat wild-caught salmon three
times a week.

*Our group’s second paper on influenza is now the most accessed paper in the
history of Virology Journal.*

I was asked to write the paper by the editor of another journal, who then
refused it! I almost decided to scrap the paper but, in the end, submitted
it to Virology Journal. I’m glad I did.

Virology Journal: Top 20 most accessed articles for all

I was glad to see that six other experts recently recommended that the
diagnosis and treatment of vitamin D deficiency be part of our national
preparedness for the H1N1 pandemic.

Edlich RF, Mason SS, Dahlstrom JJ, Swainston E, Long WB 3rd, Gubler
K. Pandemic preparedness for swine flu influenza in the United States. J
Environ Pathol Toxicol Oncol.

In addition, I hear through the grapevine that the CDC has discovered that,
of the 329 American children who have died so far from H1N1, vitamin D
levels in the dead children were lower than in children who survived the
swine flu. Maybe something can be done to save our children by next winter?
Not to mention the 16,000 adult Americans the CDC thinks died from H1N1.

Reuters. Up to 80-million Americans have been infected with H1N1.

*Low vitamin D levels mean higher death rates in patients with kidney

The below study is the first of its kind; Dr. Rajnish Mehrota and his eight
colleagues studied 3,000 of the 28 million U.S. adults who have chronic
kidney disease, finding those with vitamin D levels below 15 ng/ml had a 50%
increased risk of death compared to those with levels above 30 ng/ml over
the nine years of the study. These researchers from UCLA, Harvard, the Los
Angeles Biomedical Research Institute, and other institutions concluded:
“The broad public health implications of our findings cannot be
overemphasized given the high prevalence of vitamin D deficiency among
individuals with chronic kidney disease, and the ease, safety, and low cost
of maintaining replete vitamin D levels.”

Mehrotra R Mehrotra R, Kermah DA, Salusky IB, Wolf MS, Thadhani RI, Chiu YW,
Martins D, Adler SG, Norris KC.. Chronic kidney disease, hypovitaminosis D,
and mortality in the United States. Kidney Int. 2009

These words are music to my ears; these words are strong words, urgent
words, and, better yet, they are not my words. This is the first large study
looking at a representative group of Americans with kidney disease, before
dialysis, finding about 1/3 of them died over the 9 years of the study.
Those with low vitamin D levels were more likely to die; in fact, they were
more likely to have about every chronic disease you can think of before they
died. The average age of those with kidney disease was only 55. This is a
very important study, well written and well-conducted.

However, there is a scandal in medicine, a scandal not openly discussed in
scientific papers, one not yet reported by the mainstream press. The scandal
is this: if you are on dialysis, the chances are very high that your kidney
doctor thinks he is giving you vitamin D when he is doing no such thing and
some drug companies encourage such ignorance.

Drug companies market very lucrative activated vitamin D drugs to
nephrologists as “vitamin D.” The kidney doctors, in turn, think they are
giving vitamin D to their dialysis patients when they are doing no such
thing. If anything, the activated vitamin D analogs nephrologists use in
kidney disease will lower 25(OH)D levels by turning on the enzyme that gets
rid of vitamin D.

The ugly secret is that plain old dirt-cheap vitamin D would lower the
amount of activated vitamin D analogs needed to treat kidney disease. We
used to think it was all or none, the kidneys would either make activated
vitamin D to maintain blood calcium or the kidneys would not, as in renal
failure. However, it is not all or none; the more vitamin D building blocks
available to the diseased kidneys, the more activated vitamin D diseased
kidneys can make. And, tissues other than the kidney, such as the skin,
pancreas, adrenal medulla, and certain white blood cells, can contribute to
serum activated vitamin D levels, and probably would if they had enough of
the building block (plain old, dirt-cheap old, regular old, vitamin D).

*Just out: Vitamin D administration (plain old vitamin D) to renal dialysis
patients reduces the need for expensive vitamin D analogues, reduces
inflammation, reduces the need for medication that increases red blood
count, and improves cardiac function.*

As I was about to finish this tirade about vitamin D and kidney failure, the
below open study was published on March 4, 2010 and I ordered it. (By the
way, the Council has to pay $11.00 for every paper I get and only one paper
in ten is worth reporting on). The study below confirms what the above
authors predicted; plain old cheap vitamin D helps patients with kidney

Matias PJ, Jorge C, Ferreira C, Borges M, Aires I, Amaral T, Gil C, Cortez
J, Ferreira A. Cholecalciferol Supplementation in Hemodialysis Patients:
Effects on Mineral Metabolism, Inflammation, and Cardiac Dimension
Parameters. Clin J Am Soc Nephrol. 2010 Mar

Dr. Patricia Matias and colleagues in Portugal gave vitamin D3 to 158
patients on renal dialysis, using a sliding scale of vitamin D3
administration dependent on baseline 25(OH)D levels. Some patients got
50,000 IU per week, some got 10,000 IU per week, etc. Their dosing regimen
increased 25(OH)D levels from a mean of 22 ng/ml at the beginning of the
study to a mean of 42 ng/ml during treatment, indicating half of patients
still had levels lower than 42 ng/ml after treatment. Interestingly, most of
the patients who did not increase their 25(OH)D very much had diabetes,
suggesting the metabolic clearance (how quickly it is used up) of vitamin D
is increased in diabetes. By the way, we know the patients took the vitamin
D; the doctors gave it to them when they came in for dialysis.

The results of this study were amazing. After vitamin D administration,
parathyroid hormone, albumin, CRP (a measure of inflammation), brain
natriuretic peptide (a measure of heart failure), and left ventricular mass
index (a measure of heart function) all improved significantly. The dose of
activated vitamin D (Zemplar in this case) was reduced, and some patients
were able to stop it all together. Also, the dose of two other drugs used in
kidney failure, one to bind phosphorus and the other to raise hemoglobin,
was reduced.

It is a tragedy that drug companies sell more expensive vitamin D analogs by
having their drug salesman assure kidney doctors that the expensive vitamin
D analogues are vitamin D, even if it kills their clients. But, with the
brand new knowledge that kidney failure patients live much longer on vitamin
D, the drug companies might want to do some simple math. They might make
even more money if they kept their patients alive longer. True, they will
need less vitamin D analogues and other expensive kidney drugs every day,
but the patients may live many more days.

John Cannell, MD

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The Vitamin D Newsletter

More Vitamin D Studies of Interest

December 3, 2009.

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 are not subscribed, you can do so on the Vitamin D Council’s website.

This newsletter may be reproduced as long as you properly and prominently attribute it source. Please reproduce it, post it on Internet sites, and forward it to your friends.

Five million dollar randomized controlled trial sponsored by Thrasher Research Fund and NIH

Scientists around the world presented their work at the recent Vitamin D conference in Brugge, Belgium. Many, but not all, of the scientists opined that we have to wait for randomized controlled trials (RCT) before recommending Vitamin D. In a future newsletter, I will review many of these presentations.
However, one was extraordinary. Professor Bruce Hollis presented findings from his and Carol Wagner’s five million dollar Thrasher Research Fund and NIH sponsored randomized controlled trials of about 500 pregnant women. Bruce and Carol’s discoveries are vital for every pregnant woman. Their studies had three arms: 400, 2,000, and 4,000 IU/day.
1. 4,000 IU/day during pregnancy was safe (not a single adverse event) but only resulted in a mean Vitamin D blood level of 27 ng/ml in the newborn infants, indicating to me that 4,000 IU per day during pregnancy is not enough.
2. During pregnancy, 25(OH)D (Vitamin D) levels had a direct influence on activated Vitamin D levels in the mother’s blood, with a minimum Vitamin D level of 40 ng/ml needed for mothers to obtain maximum activated vitamin D levels. (As most pregnant women have Vitamin D levels less than 40 ng/ml, this implies most pregnant women suffer from chronic substrate starvation and cannot make as much activated Vitamin D as their placenta wants to make.)
3. Complications of pregnancy, such as preterm labor, preterm birth, and infection were lowest in women taking 4,000 IU/day, Women taking 2,000 IU per day had more infections than women taking 4,000 IU/day. Women taking 400 IU/day, as exists in prenatal vitamins, had double the pregnancy complications of the women taking 4,000 IU/day.
What does this huge randomized controlled trial mean?
We have long known that blood levels of activated Vitamin D usually rise during very early pregnancy, and some of it crosses the placenta to bathe the fetus, especially the developing fetal brain, in activated vitamin D, before the fetus can make its own. However, we have never known why some pregnant women have much higher activated Vitamin D levels than other women. Now we know; many, in fact most, pregnant women just don’t have enough substrate, the 25(OH)D building block, to make all the activated Vitamin D that their placenta wants to make.
Of course fetal tissues, at some time in their development, acquire the ability to make and regulate their own activated Vitamin D. However, mom’s activated Vitamin D goes up very quickly after conception and supplies it to baby, during that critical window when fetal development is occurring but the baby has yet to acquire the metabolic machinery needed to make its own activated Vitamin D.
The other possibility, that this is too much activated Vitamin D for pregnancy, cannot stand careful scrutiny. First, the amount of activated vitamin D made during pregnancy does not rise after the mother’s 25(OH)D reaches a mean of 40 ng/ml, so the metabolism is controlled. Second, levels above 40 ng/ml are natural, routinely obtained by mothers only a few short decades ago, such as President Barack Obama’s mom probably did, before the sun scare. (President Obama was born in Hawaii in late August before the sun-scare to a mother with little melanin in her skin) Third, higher blood levels of Vitamin D during pregnancy reduce risk of infection and other pregnancy complications, the opposite may be expected if 25(OH)D levels above 40 ng/ml constituted harm.
It is heartening to see the Thrasher Research Fund and NIH support such a large randomized controlled trial. In fact the Thrasher Research Fund has already funded a three year follow up and the NIH request for a follow up grant is pending. Nevertheless, a large number of medical scientists keep saying, “We need even more science before recommending Vitamin D.” What are they really saying?
First they said we need randomized controlled trials (RCT) before we do anything. Well here is a big one. Then they say, as they did in Brugge, “We don’t believe this RCT, we need more money for more RCTs.” If you think about it, they are saying pregnant women should remain Vitamin D deficient until scientists get all the money for all the RCTs they want, which may take another ten years. How many children will be forever damaged in that ten years?

Amazing study just presented at American Heart Association meeting
Dr. Tami Bair and Dr. Heidi May, of the Intermountain Medical Center in Utah, report yet another study showing that your risk of heart attack, stroke, congestive heart failure and death are dramatically increased by Vitamin D deficiency. In a presentation at the American heart Association meeting, they found that people with low levels (< 15 ng/ml) had a 45% increased risk for cardiovascular disease, 78% greater risk of stroke and double the risk for congestive heart failure, not to mention a 77% increased risk of death, compared to people with Vitamin D levels > 30 ng/ml. All that disease and death occurred in only 13 months of follow up for the 27,000 people in the study.
So how many Americans died this last year from Vitamin D deficiency? Ten thousand? A hundred thousand? More? How many will die next year? Someone is responsible. Medical scientists who want more money before recommending that Vitamin D deficiency be treated have to assume responsibility. I am all for more studies but we have to act now, like we did with cigarettes. Remember, no human randomized controlled trials exist showing cigarettes are dangerous, so we have much more and better science than we did when we warned about smoking. If we fail to act on the dangers of Vitamin D deficiency, someone will end up with blood on their hands.

The Great Disappearing Act
We are currently witnessing one of the great mysteries of the natural world. The H1N1 outbreak is rapidly disappearing, despite a wealth of potential victims without antibodies to the virus, and yes, in spite of plummeting Vitamin D levels. In several weeks, the CDC will announce that perhaps one-third of Americans were infected in the last nine months and now have Swine flu antibodies, leaving the majority of the population still susceptible.
But this H1N1 virus is rapidly refusing the invitation to infect the two-third of Americans who are mostly immunological virgins and will soon recede until the next widespread outbreak, which may come this spring or next fall and winter. When H1N1 returns again, I predict it will cause more illness and death than it did this fall despite the fact it will attack a population with more H1N1 specific antibodies. Measles, another virus thought to transmit via respiratory secretions, would never forego the opportunity to infect so many virgins.
Influenzologists have no idea why this Disappearing Act happens. Dr. Edgar Hope-Simpson believed the reason lay in the mode of transmission; the current outbreak is ending despite a wealth of potential victims because the people transmitting the flu are suddenly no longer contagious. I recommend Hope-Simpson’s book:
I also believe that only a small population was transmitting, not all those infected. If these good transmitters – and not all the sick – usually spread the virus, and their transmission period is limited, the epidemic would end shortly after the good transmitters lose their infectivity. Why they lose their infectivity is yet another mystery, but a mystery that fits the epidemiology of influenza.
Another incredible Disappearing Act, one that usually follows the introduction of a pandemic virus, is the rapid and usually complete replacement of seasonal flu with the pandemic one. It is as if the pandemic virus murders the seasonal flu. We will have to wait to see if that happens worldwide with this pandemic, but in the USA it has already happened. Last week the CDC reported that more than 99% of all influenza viruses identified in the USA were Swine flu. Only 1 of 1,874 influenza A viruses identified last week was seasonal flu. Where did the seasonal flu virus go?

Thanks to those who volunteered!
If your email address begins with A through E, you may have gotten my email asking for volunteers to help give feedback on our new website. We were overwhelmed with the response, ten times more than we needed. Thank you.
The reason for the request is that the Vitamin D Council has contracted with Minervation Ltd for $40,000 to build a new website over the next several years. We can only afford $1,000 per month so it take three and a half years to pay them, however; the first version of the new site is scheduled to go up in the late fall of 2010.
We decided to make our site more accessible, so if you only want to know about Vitamin D and pregnancy, you will be able to pull up the information quickly. Our new website will also update Vitamin D articles in the press and scientific studies from the National Library of Medicine automatically every day.
We also want to clearly separate fact from opinion, so readers can easily see what the science is and what our opinion is. Finally, as you know, the Vitamin D Council unfortunately has to market products, like the in-home Vitamin D blood test, to stay in business. The new website will prominently display all of our potential conflicts so readers will know them up front.
If you want our new website up and running sooner than 12 months, consider making a dedicated donation, either by using the snail mail address below or via PayPal on our website. We are now going on our seventh year of operation and plan on 20 more years, in spite of the fact that all 15 of our requests for grants were recently turned down.
Did you know that when you Google “Vitamin D,” you will get more than 12 million hits? Our current website is usually ranked either number 1 or 2 of those 12 million, beating out the NIH, Mayo Clinic and Wikipedia on most days? This is almost entirely due to our webmaster Dana Clark. However, we believe we can dramatically improve our website, with your help.

John Cannell, MD
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When you talk about Vitamin D, there are a number of things you can say about it.

Protects your bones from osteoarthritis and osteoporosis?   Duh?
Helps fight against 17 different forms of cancer?  Yup!
Wards against auto-immune disease, stroke, diabetes, depression, and hypertension?  Sure!
Keeps you from getting Piggy Flu?  Yes.. wait.. what?

The experts over at the Vitamin D Council — those guys that actually know what the heck they are talking about when it comes to this stuff — have gotten two emails concerning the efficacy of Vitamin D protecting against H1N1:

Dr. Cannell: Your recent newsletters and video about Swine flu (H1N1) prompted me to convey our recent experience with an H1N1 outbreak at Central Wisconsin Center (CWC). Unfortunately, the state epidemiologist was not interested in studying it further so I pass it on to you since I think it is noteworthy.

CWC is a long-term care facility for people with developmental disabilities, home for approx. 275 people with approx. 800 staff. Serum 25-OHD has been monitored in virtually all residents for several years and patients supplemented with vitamin D.

In June, 2009, at the time of the well-publicized Wisconsin spike in H1N1 cases, two residents developed influenza-like illness (ILI) and had positive tests for H1N1: one was a long-term resident; the other, a child, was transferred to us with what was later proven to be H1N1.

On the other hand, 60 staff members developed ILI or were documented to have H1N1: of 17 tested for ILI, eight were positive. An additional 43 staff members called in sick with ILI. (Approx. 11–12 staff developed ILI after working on the unit where the child was given care, several of whom had positive H1N1 tests.)

So, it is rather remarkable that only two residents of 275 developed ILI, one of which did not develop it here, while 103 of 800 staff members had ILI. It appears that the spread of H1N1 was not from staff-to-resident but from resident-to-staff (most obvious in the imported case) and between staff, implying that staff were susceptible and our residents protected. Sincerely, Norris Glick, MD Central Wisconsin Center Madison, WI

This is the first hard data that I am aware of concerning H1N1 and vitamin D. It appears vitamin D is incredibly protective against H1N1. Dr. Carlos Camargo at Mass General ran the numbers in an email to me. Even if one excludes 43 staff members who called in sick with influenza, 0.73% of residents were affected, as compared to 7.5% of staff. This 10-fold difference was statistically significant (P<0.001). That is, the chance that this was a chance occurrence is one less than one in a thousand.

Dr. Cannell: Thanks for your update about the hospital in Wisconsin. I have had similar anecdotal evidence from my medical practice here in Georgia. We are one of the 5 states with widespread H1N1 outbreaks.

I share an office with another family physician. I aggressively measure and replete vitamin D. He does not. He is seeing one to 10 cases per week of influenza-like illness.

In my practice— I have had zero cases. My patients are universally on 2000–5000 IU to maintain serum levels 50–80 ng/ml. Ellie Campbell, DO Campbell Family Medicine 3925 Johns Creek Court Ste A Suwannee GA 30024

Critics say we should not recommend vitamin D to prevent influenza until it is proven to do so (It has not been).

The critics are thus saying, although they seem not to know it, you should be vitamin D deficient this winter until science proves being vitamin D sufficient is better than being Vitamin D deficient. Such advice is clearly unethical and has never ever been the standard of care.

This is not rocket science. If I am wrong, and Vitamin D does not prevent influenza, what is lost? A few dollars. If they are wrong, and it does prevent influenza, what is lost? So far, the CDC says 41 kids are dead from H1N1, and the flu season has not yet started.

I read this, called in DH from his gaming adventures, and gave him 5k of dry D3.  I agree with Dr. Cannell — if it’s just a coincidence, then he’s taking a pill that might make him a bit happier, lower his chances of stroke, cancer, hypertension, and diabetes (and given the amount of Mt. Dew he drinks, he needs all the help he can get in that department).  But hey, given how miraculous Vitamin D seems to be?  Yeah, he’s taking the damned little capsule anyway.