I Love Vitamin D, but watch out for Vitamin A in your multivitamins
Robert G Carlson, MD, FACS
No other nutrient, hormone or even drug has gained so much scientifically supported credibility than Vitamin D, demonstrating reductions in cancer, heart disease, blood pressure, chronic inflammation, diabetes, viral infections and the autoimmune diseases( arthritis, Lupus, Hashimoto’s thyroiditis). Even though Vitamin D has been shown to be so incredibly beneficial , it is often in very low doses in standard multivitamins, and often side by side with high doses of Vitamin A. Unfortunately some forms of Vitamin A actually BLOCK the benefit of Vitamin D. So grab your multivitamin bottle and look at how much vitamin D and Vitamin A is in it. Most multivitamins have woeful amounts of vitamin D , often ranging from 200 units to 1000, but we should be taking at least 5000 units a day and now more studies show absolutely no toxicity at 10,000 units(should consider this dose in the fall/winter months) and incredible benefits. So what about Vitamin A? The preformed Vitamin A (retinols) are often excessive in multivitamins and having Vitamin A in the beta-carotene form is the form you want. “Preformed” vitamin A comes only from animal products, fortified foods, and supplements. It is most commonly measured in International Units (IU). The Recommended Dietary Allowance (RDA) for vitamin A is 2,310 IU daily for women, 3,000 IU for men, although some food products identify the recommended dose as 5000 IU. Watch out because preformed Vitamin A is not your friend. Studies have proven that too much preformed Vitamin A results in a two fold increase in hip fractures, and a 16 % increase in total mortality, undoubtedly because it blocks all the amazing benefits of Vitamin D. Keep that form of Vitamin A no higher than 1000 IU. Now if the Vitamin A is in the beta-carotene form, there are fewer issues because it is found in plant foods, especially dark green and highly colored vegetables and fruits. It is converted to vitamin A only as our body needs it. Therefore one can’t get dangerous levels of vitamin A by consuming too much beta carotene. By the way that foul tasting modern day Cod Liver oil has up to 10,000 units of preformed Vitamin A….so don’t drink that stuff!
Showing posts with label prostate cancer. Show all posts
Showing posts with label prostate cancer. Show all posts
Sunday, September 19, 2010
Friday, September 3, 2010
Progesterone and Men- GETTING RID OF BELLY FAT Robert Carlson, MD
Is It Hot In Here?
We joke gingerly about women having a “personal summer” or “power surges” but for those going through it it’s no joke. And men who have low progesterone and excess adipose (brown) fat around the belly that actually produces estrogen can experience a form of male menopause called andropause. Progesterone helps reduce hot flashes in women; but men with low levels of progesterone and testosterone along with higher levels of estrogen will get hot flashes too. For both men and women, progesterone can help calm the fire.
Men can even fall victim to breast cancer thanks to hormonal imbalances! Progesterone can protect men breast tumors. Progesterone insufficiency causes norepinephrine and epinephrine levels to go up which increases your anxiety levels. Your aldosterone levels will also go up which results in swelling. Progesterone stimulates the parasympathetic system which helps to calm you. However if your levels are low you’ll get stressed, anxious and find yourself constantly worrying. And if that weren’t enough problems because of low progesterone, if you have elevated estrogen levels you’ll have problems with constipation too.
Let Me See Your Guy Card
One of the more surprising things I’ve been seeing in my patients’ lab work lately is men with estrogen levels that are off the charts! Estrogen dominance in men is a recipe for disaster. When you have a progesterone deficiency and elevated estrogen levels, you will have difficulty voiding because estrogen causes an increase in the size of your prostate. Men with progesterone deficiency have an enlarged hard fibrous prostate. Estrogen also promotes the development of fibrous tissue within the prostate. The urethra which carries urine from the bladder, passes through this enlarged fibrous tissue and gets narrowed and subsequently blocked by the enlarged prostate. Numerous studies have identified the effects of elevated estrogen levels and an enlarged prostate. Sadly, most of the studies are missing the point! Researchers aren’t measuring progesterone levels. You can easily combat the problem and reduce estradiol levels up to 30% with the addition of 100 mg of progesterone at bedtime. Progesterone will reduce prostatic volume, weight, and the DNA content.
I am deeply concerned not just about progesterone deficiency, but also about the estrogen mimics and interrupters men are flooding their bodies with. Our rabid fascination with soy is dangerous. Soy is a phytoestrogen. Chemicals in our shampoos (dandruff shampoos are the worst), skincare products and *** are fooling our endocrine systems and creating sky-high levels of estrogen in men.
We need to balance our bodies and replenish our depleted levels of progesterone. Progesterone helps men and women fall asleep, stay asleep and wake up rested, while getting rid of their sleeping pills and the nasty brain fog side effects. Do you find yourself feeling grouchy? Men can be very irritable and tense in the face of low progesterone levels. By just correcting progesterone levels we can restore calmness and help you get a better night’s sleep. It protects you from the accumulation of fat within the abdomen – the dangerous fat doctors call visceral fat.
Is Your Health a House of Cards?
Everywhere I look I see the effects of excess estrogen and low progesterone in men. Metabolic syndrome with its high blood pressure, dyslipidemias, elevated insulin levels, and increased abdominal fat can be turned around with progesterone. Belly fat can begin to melt off with progesterone. Prostate enlargement can be shrunk with progesterone. And male pattern baldness can be reduced just by using progesterone.
Without enough progesterone over a prolonged period of time, you’ll start to see major problems domino out of control in all the systems of the body. Progesterone is foundation for health, youth, and vitality.
It’s time to work with your doctor to assess your hormone levels in a full blood panel screening. So when was the last time you had your progesterone checked? Consider using bio-identical (not synthetic!) hormone therapy to restore your body’s progesterone levels. If your doctor poo-poo’s your request, find another doctor who will listen to your concerns. Remember, if your lab results are “normal” but you still don’t feel up to par, you need a doctor who will help you get to the bottom of the problem and put your health back on top.
We joke gingerly about women having a “personal summer” or “power surges” but for those going through it it’s no joke. And men who have low progesterone and excess adipose (brown) fat around the belly that actually produces estrogen can experience a form of male menopause called andropause. Progesterone helps reduce hot flashes in women; but men with low levels of progesterone and testosterone along with higher levels of estrogen will get hot flashes too. For both men and women, progesterone can help calm the fire.
Men can even fall victim to breast cancer thanks to hormonal imbalances! Progesterone can protect men breast tumors. Progesterone insufficiency causes norepinephrine and epinephrine levels to go up which increases your anxiety levels. Your aldosterone levels will also go up which results in swelling. Progesterone stimulates the parasympathetic system which helps to calm you. However if your levels are low you’ll get stressed, anxious and find yourself constantly worrying. And if that weren’t enough problems because of low progesterone, if you have elevated estrogen levels you’ll have problems with constipation too.
Let Me See Your Guy Card
One of the more surprising things I’ve been seeing in my patients’ lab work lately is men with estrogen levels that are off the charts! Estrogen dominance in men is a recipe for disaster. When you have a progesterone deficiency and elevated estrogen levels, you will have difficulty voiding because estrogen causes an increase in the size of your prostate. Men with progesterone deficiency have an enlarged hard fibrous prostate. Estrogen also promotes the development of fibrous tissue within the prostate. The urethra which carries urine from the bladder, passes through this enlarged fibrous tissue and gets narrowed and subsequently blocked by the enlarged prostate. Numerous studies have identified the effects of elevated estrogen levels and an enlarged prostate. Sadly, most of the studies are missing the point! Researchers aren’t measuring progesterone levels. You can easily combat the problem and reduce estradiol levels up to 30% with the addition of 100 mg of progesterone at bedtime. Progesterone will reduce prostatic volume, weight, and the DNA content.
I am deeply concerned not just about progesterone deficiency, but also about the estrogen mimics and interrupters men are flooding their bodies with. Our rabid fascination with soy is dangerous. Soy is a phytoestrogen. Chemicals in our shampoos (dandruff shampoos are the worst), skincare products and *** are fooling our endocrine systems and creating sky-high levels of estrogen in men.
We need to balance our bodies and replenish our depleted levels of progesterone. Progesterone helps men and women fall asleep, stay asleep and wake up rested, while getting rid of their sleeping pills and the nasty brain fog side effects. Do you find yourself feeling grouchy? Men can be very irritable and tense in the face of low progesterone levels. By just correcting progesterone levels we can restore calmness and help you get a better night’s sleep. It protects you from the accumulation of fat within the abdomen – the dangerous fat doctors call visceral fat.
Is Your Health a House of Cards?
Everywhere I look I see the effects of excess estrogen and low progesterone in men. Metabolic syndrome with its high blood pressure, dyslipidemias, elevated insulin levels, and increased abdominal fat can be turned around with progesterone. Belly fat can begin to melt off with progesterone. Prostate enlargement can be shrunk with progesterone. And male pattern baldness can be reduced just by using progesterone.
Without enough progesterone over a prolonged period of time, you’ll start to see major problems domino out of control in all the systems of the body. Progesterone is foundation for health, youth, and vitality.
It’s time to work with your doctor to assess your hormone levels in a full blood panel screening. So when was the last time you had your progesterone checked? Consider using bio-identical (not synthetic!) hormone therapy to restore your body’s progesterone levels. If your doctor poo-poo’s your request, find another doctor who will listen to your concerns. Remember, if your lab results are “normal” but you still don’t feel up to par, you need a doctor who will help you get to the bottom of the problem and put your health back on top.
Progesterone and Men-Optimizing the Aging Male's Health
Progesterone and Men-Optimizing the Aging Male's Health
Dr Robert G Carlson, MD, FACS
Progesterone – It’s Not Just for Girls!
Every day we see a new article dedicated to explaining how important progesterone is for women in the array of hormones that are key to good health and healthy aging. But what about men? Most men and women along with many doctors would be surprised to find that progesterone is very important to a man’s health!
So Men Produce Progesterone?!
Most men have about seven times lower levels of progesterone than testosterone; but it is actually more abundant than DHT, the primary metabolite of testosterone that makes a man look like a man. Hormones give us our secondary sex characteristics –
curves for a woman, a lower voice etc. for a man. Even though some hormones are more prevalent in men or women, both sexes have all the same hormones just in different levels. Healthy men have more progesterone than the other “female hormones” like estradiol or estrone, 10 times more of it than melatonin, and much more of it than thyroid hormones like free T4 or thyroxin. Progesterone is actually just as important to a man’s health as a woman’s!
We’re Wired for Equality…Most of the Time!
For a short time every month, men and women are equal…in progesterone! The levels of progesterone that men have is equivalent to what women have during the follicular phase each month; this is the first phase of a women’s cycle when progesterone is low, just like a man’s progesterone level.
The reason that men and women will have equal levels of progesterone is because a man creates progesterone in his adrenal glands and the primary source of progesterone for a woman during the first 2 weeks after the onset of the menstrual cycle is from the adrenals as well. In fact, for both men and women the adrenal glands make 1 ½ - 3 mg a day of progesterone.
A woman will have a much higher level of progesterone over the course of each month though because during the second phase of her cycle her ovaries will also produce it. So for two-thirds of every month, men and women will have the same level of progesterone!
Progesterone can also be a precursor of testosterone, aldosterone, and even cortisol. Progesterone is also very important as a base of hormone production; it joins with cholesterol to create””. Progesterone is also a bellweather of how your body is handling stress. During stressful crisis situations, you may have higher levels of progesterone and your body may react by making lots of cortisol (and creating that dreaded spare tire around your waist!) If you are under chronic stressful situations, you can suffer from adrenal fatigue and your body will no longer produce adequate amounts of cortisol.
Our bodies are designed to respond to stress as a self-protective reflex – we either fight, flee or freeze. Crisis triggers cortisol production to help the body manage stress. Cortisol is so important to the body during stress that it becomes the body’s primary focus and the cortisol “sink” is where most of the substrate for other hormone production is often shunted to fortify the body’s arsenal of protection. Remember, we developed in a very unsafe world where we were under constant threat so our bodies are hard-wired for self-preservation by using hormones to respond to stress and keep us alive.
How Much Stress Can You Handle?
Our bodies are designed for a quick, reflexive, self-preservation response to stress but our lives today are one crisis after another. At some point we do “accommodate” to stress, we become more capable of bearing the stress load. But is it healthy? Some stress is good, but too much stress is a killer. One of the key hormones we need for health and longevity – progesterone – falls by the wayside when we are stressed. Everything becomes focused on cortisol production. If you have the typical, chronic stress levels of American daily life, you probably are deficient in progesterone. If you are walking through a crisis event, you may be producing far too much progesterone. In either scenario, you need to support your body’s hormone levels. So, high progesterone levels maybe an indicator of stress, whereas very low levels indicate a serious adrenal fatigue condition.
“You Are Getting Older!” – Bite Me!
Progesterone levels decline with age just like all the adrenal hormones and this affects most of your major organ systems. There are progesterone receptors in your heart an in your major blood vessels such as your arteries and veins. Progesterone is the hormone of calmness. It is nature’s valium, the Feng Sui of hormones. When you have low progesterone levels, some of your organ systems may demonstrate more tenseness or nervousness. The gall bladder has progesterone receptors and a stressed gallbladder with low progesterone may lead to a danger situation like acalculous cholecystitis, which we see in very stressed patients in the ICU. In the prostate, epididymis, and the testicles, there are also progesterone receptors, and there must be a purpose for that? Sperm also has progesterone receptors as well.
Progesterone – What Have You Done for Me Lately?
Progesterone is the peacekeeper hormone that keeps the levels of other hormones in balance and it helps maintain the hormonal symphony resonating in through your body. For instance, estradiol in men is not a good thing; it results in higher stroke rates, increased heart attack rates, and increased prostate cancer. Progesterone keeps your estradiol levels in control.
Progesterone also keeps the levels of Dihydrotestosterone(DHT) in balance. Too much DHT leads to hair loss and increased prostate cancer risks. Progesterone will also keep your aldosterone in balance. You can also blame progesterone if your wife or girlfriend complains that you fall asleep right after sex. Progesterone levels spiral during intercourse and peak after an orgasm; it’s progesterone that creates a calmer, more relaxed state after an orgasm. Many of my male patients like taking progesterone in the evening because it does make everything so much more relaxed and some of them tell me it also increases their deep breathing almost like yoga.
You Gotta Have Heart!
Progesterone has a role to play with regard to cardiovascular disease. Not only are there progesterone receptors in the heart and all the major blood vessels, but it’s also been shown to reduce lipids in the blood. It also helps protect against damage to the arterial system from elevated insulin levels. Too much insulin floating around in your blood can prematurely break down and age the walls of the arteries. Progesterone protects the blood vessels from the effects of insulin.
For people who are progressing into atherosclerosis, there is an overgrowth of smooth muscle cells within the lining of the blood vessels. Progesterone has been shown to stop this out of control growth. And those coronary arteries? The major cause of death from heart disease is the decreasing blood flow to regions of the heart that need it. We call these “ischemic changes” which is the technical term for lack of blood flow. Most doctors have been trained to provide medications that improve blood flow through the coronary arteries like nitroglycerin. But who wants to swallow the poisonous basis of explosives? There are numerous natural compounds throughout the body that do the same thing, including progesterone and testosterone; and they may even help reduce hypertension by helping to relax the muscular walls of arteries and reduce water retention/edema by helping the body excrete sodium.
More to come....
Dr Robert G Carlson, MD, FACS
Progesterone – It’s Not Just for Girls!
Every day we see a new article dedicated to explaining how important progesterone is for women in the array of hormones that are key to good health and healthy aging. But what about men? Most men and women along with many doctors would be surprised to find that progesterone is very important to a man’s health!
So Men Produce Progesterone?!
Most men have about seven times lower levels of progesterone than testosterone; but it is actually more abundant than DHT, the primary metabolite of testosterone that makes a man look like a man. Hormones give us our secondary sex characteristics –
curves for a woman, a lower voice etc. for a man. Even though some hormones are more prevalent in men or women, both sexes have all the same hormones just in different levels. Healthy men have more progesterone than the other “female hormones” like estradiol or estrone, 10 times more of it than melatonin, and much more of it than thyroid hormones like free T4 or thyroxin. Progesterone is actually just as important to a man’s health as a woman’s!
We’re Wired for Equality…Most of the Time!
For a short time every month, men and women are equal…in progesterone! The levels of progesterone that men have is equivalent to what women have during the follicular phase each month; this is the first phase of a women’s cycle when progesterone is low, just like a man’s progesterone level.
The reason that men and women will have equal levels of progesterone is because a man creates progesterone in his adrenal glands and the primary source of progesterone for a woman during the first 2 weeks after the onset of the menstrual cycle is from the adrenals as well. In fact, for both men and women the adrenal glands make 1 ½ - 3 mg a day of progesterone.
A woman will have a much higher level of progesterone over the course of each month though because during the second phase of her cycle her ovaries will also produce it. So for two-thirds of every month, men and women will have the same level of progesterone!
Progesterone can also be a precursor of testosterone, aldosterone, and even cortisol. Progesterone is also very important as a base of hormone production; it joins with cholesterol to create””. Progesterone is also a bellweather of how your body is handling stress. During stressful crisis situations, you may have higher levels of progesterone and your body may react by making lots of cortisol (and creating that dreaded spare tire around your waist!) If you are under chronic stressful situations, you can suffer from adrenal fatigue and your body will no longer produce adequate amounts of cortisol.
Our bodies are designed to respond to stress as a self-protective reflex – we either fight, flee or freeze. Crisis triggers cortisol production to help the body manage stress. Cortisol is so important to the body during stress that it becomes the body’s primary focus and the cortisol “sink” is where most of the substrate for other hormone production is often shunted to fortify the body’s arsenal of protection. Remember, we developed in a very unsafe world where we were under constant threat so our bodies are hard-wired for self-preservation by using hormones to respond to stress and keep us alive.
How Much Stress Can You Handle?
Our bodies are designed for a quick, reflexive, self-preservation response to stress but our lives today are one crisis after another. At some point we do “accommodate” to stress, we become more capable of bearing the stress load. But is it healthy? Some stress is good, but too much stress is a killer. One of the key hormones we need for health and longevity – progesterone – falls by the wayside when we are stressed. Everything becomes focused on cortisol production. If you have the typical, chronic stress levels of American daily life, you probably are deficient in progesterone. If you are walking through a crisis event, you may be producing far too much progesterone. In either scenario, you need to support your body’s hormone levels. So, high progesterone levels maybe an indicator of stress, whereas very low levels indicate a serious adrenal fatigue condition.
“You Are Getting Older!” – Bite Me!
Progesterone levels decline with age just like all the adrenal hormones and this affects most of your major organ systems. There are progesterone receptors in your heart an in your major blood vessels such as your arteries and veins. Progesterone is the hormone of calmness. It is nature’s valium, the Feng Sui of hormones. When you have low progesterone levels, some of your organ systems may demonstrate more tenseness or nervousness. The gall bladder has progesterone receptors and a stressed gallbladder with low progesterone may lead to a danger situation like acalculous cholecystitis, which we see in very stressed patients in the ICU. In the prostate, epididymis, and the testicles, there are also progesterone receptors, and there must be a purpose for that? Sperm also has progesterone receptors as well.
Progesterone – What Have You Done for Me Lately?
Progesterone is the peacekeeper hormone that keeps the levels of other hormones in balance and it helps maintain the hormonal symphony resonating in through your body. For instance, estradiol in men is not a good thing; it results in higher stroke rates, increased heart attack rates, and increased prostate cancer. Progesterone keeps your estradiol levels in control.
Progesterone also keeps the levels of Dihydrotestosterone(DHT) in balance. Too much DHT leads to hair loss and increased prostate cancer risks. Progesterone will also keep your aldosterone in balance. You can also blame progesterone if your wife or girlfriend complains that you fall asleep right after sex. Progesterone levels spiral during intercourse and peak after an orgasm; it’s progesterone that creates a calmer, more relaxed state after an orgasm. Many of my male patients like taking progesterone in the evening because it does make everything so much more relaxed and some of them tell me it also increases their deep breathing almost like yoga.
You Gotta Have Heart!
Progesterone has a role to play with regard to cardiovascular disease. Not only are there progesterone receptors in the heart and all the major blood vessels, but it’s also been shown to reduce lipids in the blood. It also helps protect against damage to the arterial system from elevated insulin levels. Too much insulin floating around in your blood can prematurely break down and age the walls of the arteries. Progesterone protects the blood vessels from the effects of insulin.
For people who are progressing into atherosclerosis, there is an overgrowth of smooth muscle cells within the lining of the blood vessels. Progesterone has been shown to stop this out of control growth. And those coronary arteries? The major cause of death from heart disease is the decreasing blood flow to regions of the heart that need it. We call these “ischemic changes” which is the technical term for lack of blood flow. Most doctors have been trained to provide medications that improve blood flow through the coronary arteries like nitroglycerin. But who wants to swallow the poisonous basis of explosives? There are numerous natural compounds throughout the body that do the same thing, including progesterone and testosterone; and they may even help reduce hypertension by helping to relax the muscular walls of arteries and reduce water retention/edema by helping the body excrete sodium.
More to come....
Saturday, August 28, 2010
THE AMAZING VITAMIN D...JUST THE FACTS
Please check out all the amazing benefits of Vitamin D in this linked video. Even in Florida we don't get enough because we wear sunscreen all the time, that blocks all of the Vitamin D production. In the winter we did a study on women 30-65 years of age and 92 % of the women were below the lowest normal range of vitamin D, essentially Vitamin D deficient. When Vitamin D protects from Cancer, Heart Disease, Diabetes,Autoimmune diseases like Rheumatoid arthritis,the common cold as well as upper respiratory infections so prevalent in the winter months, we would be better off if we kept our Vitamin D levels. Doesn't that make sense? And it is so inexpensive...not cheap!
check this you tube video out....
http://www.youtube.com/watch?v=wQbVTEesb3I
check this you tube video out....
http://www.youtube.com/watch?v=wQbVTEesb3I
Monday, June 21, 2010
Vitamin D myths and management-Robert Carlson,MD
THE MANY VITAMIN D MYTHS
Patient EB is a 50-year-old female with a family history of colon cancer and breast cancer as well as a history of arthritis with probable autoimmune etiology. She takes a daily multivitamin which includes 10,000 units of Vitamin A as well as a separate 1000 IU of Vitamin D3 and her 25-(OH) Vitamin D3 level is 36 ng/mL (reference range 33-100 ng/mL). Should EB increase her dose of Vitamin D3? Should she continue her multi-vitamin?
There are so many myths surrounding Vitamin D. First and foremost, is the myth that Vitamin D is
a Vitamin. Vitamin D is not a Vitamin, it is actually a steroid hormone. Vitamin D is produced in one part of the body (the skin), and then travels to a remote site, where it exerts an endocrine effect. Thus, it fulfills the definition of a hormone. Another Vitamin D myth is that its only function is calcium regulation. That idea has been well and truly debunked in recent years. Then there is the idea that 1000 IUs a day is more than enough, which is simply not true. Also many believe that taking over 2000 units a day might cause toxicities. I hear this from numerous health professionals and even from pharmacists who should know better. The literature is very clear…..evidence from clinical trials shows that a prolonged intake of 10,000 units of Vitamin D per day poses no risk of adverse effects for adults 1 ……therefore one can take 10,000 units a day and have no risk for toxicity.
Other myths of interest include:
1) Most people living in the US get adequate amounts of Vitamin D – not true (see below).
2) Extreme care must be taken to avoid toxicity – not true! There have been numerous
studies on Vitamin D toxicity and no toxicity has been seen in doses lower than 30,000
IU/day (200 ng/mL). An excess of Vitamin D causes hypercalcemia, however all known
cases of Vitamin D toxicity with hypercalcemia have involved intakes of 40,000 IU or more
per day.2
3) Spending 15 minutes in the sun each day enables the body to produce ample amounts of
Vitamin D – that may be true if you are sitting on a beach in Hawaii at noon wearing
nothing but a bikini, but for the vast majority of us that is a myth. Unfortunately, once sunscreen is applied the Vitamin D production drops to nothing. If you live above 35 degrees latitude, the body is unable to produce adequate amounts of Vitamin D from the winter sun. In fact the only adequate amount of sunshine in Boston occurs, between May and Sept, otherwise there is inadequate sunlight for Vitamin D metabolism.
4) Eating a balanced diet will provide adequate amounts of Vitamin D – not true! Vitamin D is present, in small amounts, in only a handful of foods – oily fish, eggs, and fortified
foods. Vitamin D fortified Milk and Orange Juice only contain 50 Units of Vitamin D2, not Vitamin D3. Thus it is very unlikely that adequate amounts could be obtained from the diet.
• Vitamin D does not prevent cancer – it does , in fact one study showed the reduction in all cancers by 77 % over a four year period in a well designed study.(see below).
• Vitamin D does not prevent autoimmune disease – it does , reducing Systemic Lupus ,Rheumatoid Arthritis and Childhood onset diabetes(see below).
• Vitamin D does not prevent acute MI and heart disease – it does (see below).
As mentioned above, the notion that most people living in the US get adequate amounts of
Vitamin D is far from true. Research has shown that Vitamin D deficiency is present among all age groups of US citizens from children to the elderly, and especially in African-Americans.3 Studies have shown that the prevalence of low 25-(OH) D levels (<20 ng/mL) is approximately 36% in young adults aged 18-294 ,42% of African-American women aged 15-495 ,41% of outpatients aged 49-83,6 and 57% of inpatients.7
In Europe, it is believed that between 28 and 100% of healthy adults and 70-100% of hospitalized adults have low 25-(OH) D levels (<20 ng/mL).8,9,10
A study we completed examining women age 35-65 in Tampa, Florida in December, demonstrated that 92 % of the women had 25-(OH) D levels less than the low normal range of 32. Can you imagine what the Vitamin D levels are in the same group of women in Minneapolis, Minnesota in December?
Research has shown that the incidence of many diseases could be dramatically reduced by
increasing serum 25-(OH) D levels, and by looking at the list below, it is easy to see why Vitamin D has become a very hot topic in recent years:
1) Increasing serum 25-(OH) D levels to 35 ng/mL could prevent 30% of MI in men11 and
reduce the risk of fracture in elderly people by 50%.12
2) Increasing serum 25-(OH) D levels to approximately 40 ng/mL could reduce the risk of
cancer in postmenopausal women by 35%13 and reduce the risk of falls in elderly people
by 50%. 14
3) Increasing serum 25-(OH) D levels to 50 ng/mL could reduce the incidence of breast
cancer by as much as 80%,15 multiple sclerosis by as much as 60%,16 and type I
diabetes by up to 50%.17
Why is Vitamin D so beneficial? There is no clear answer at present. However, anything that has
such wide-ranging benefits has to possess the ability to modulate inflammation. Indeed, studies have shown that Vitamin D inhibits nuclear factor-κβ (NF-κβ) 18 – a protein that plays a key role in the inflammatory response and in the proliferation of cancer cells. It has also been shown to lower levels of the inflammatory marker CRP.19 Thus, it is vital that we ensure our patients are getting plenty of Vitamin D.
What about Patient EB, does she need to increase her daily dose of Vitamin D3? Yes. The
reference range for 25-(OH) D is 32-100 ng/mL Given the evidence published in the medical literature over the last few years, it is advisable to try and keep patients at the top end of the reference range – so, we should be aiming for 75-100 ng/mL The optimal dose for an average person is 5000-15,000 IU/day; however this should be lowered for people who get a lot of sun exposure. Ideally check Vitamin D leveIs and regularly check serum calcium in patients who take supplementary Vitamin D, just to ensure there is no risk of hypercalcemia.
So what about her multi-Vitamin choice? Some multi-Vitamins may be doing more harm than good. I recommend avoiding excessive amount of pre-formed Vitamin A in the retinol form, as opposed to the beta-carotene form that converts to Vitamin A in your body. The presence of excessive pre-formed actually will neutralize all the amazing benefits of Vitamin D3.20 Unfortunately, multi-vitamins often continue a lot of Vitamin A(average 4400 units) as retinol and very low levels of D3( average 400). Vitamin A and Vitamin D receptors are very close to each other and excess Vitamin A will block the beneficial effects of Vitamin D. Women who took the highest intake of pre-formed Vitamin A actually had twice as many hip fractures. 21 So keep the non- beta carotene Vitamin A supplements to less than 1000 units, and this will allow all the amazing benefits of Vitamin D3.
CONCLUDING REMARKS
There are many myths surrounding hormone replacement therapies, however from the evidence
presented above, we can see that not one of them is true. Hormone optimization provides us with an extremely powerful anti-aging tool to maximize quality of life.
REFERENCES
1. Vieth R. Vitamin D and Cancer Mini-Symposium: the risk of additional Vitamin D. Ann Epidemiol. 2009; 19(7):441-5.
2. Vieth R. Vitamin D supplementation, 25-hydroxyVitamin D concentration, and safety. Am J Clin Nutr. 1999;69:842-56.
3. Holick MF. High prevalence of Vitamin D inadequacy and implications for health. Mayo Clin Proc.
2006;81:353-373.
4. Tangpricha V, Pearce EN, Chen TC, Holick MF. Vitamin D insufficiency among free-living healthy young
adults. Am J Med. 2002;112:659-662.
5. Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C,
Gunter EW, Bowman BA. HypoVitaminosis D prevalence and determinants among African American and
336 white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994. Am
J Clin Nutr. 2002;76:187-192.
6. Malabanan A, Veronikis IE, Holick MF. Redefining Vitamin D insufficiency [letter]. Lancet. 1998;351:805-
806.
7. Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM,
Prince RL, Finkelstein JS. HypoVitaminosis D in medical inpatients. N Engl J Med. 1998;338:777-783.
8 . McKenna MJ. Differences in Vitamin D status between countries in young adults and the elderly. Am J
Med. 1992;93:69-77.
9. Isaia G, Giorgino R, Rini GB, Bevilacqua M, Maugeri D, Adami S. Prevalence of hypoVitaminosis D in
elderly women in Italy: clinical consequences and risk factors. Osteoporos Int. 2003;14:577-582.
10. Passeri G, Pini G, Troiano L, Vescovini R, Sansoni P, Passeri M, Gueresi P, Delsignore R, Pedrazzoni M,
Franceschi C. Low Vitamin D status, high bone turnover, and bone fractures in centenarians. J Clin
Endocrinol Metab. 2003;88:5109-5115.
11. Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-hydroxyVitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168:1174-80.
12. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture
prevention with Vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA.
2005;293:2257-2264.
13. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium
supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;85:1586-1591.
14. Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP. A higher dose of Vitamin d
reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc.
2007;55:234-239.
15. Garland CF, Gorham ED, Mohr SB, Grant WB, Garland FC. Breast cancer risk according to serum s5-
hydroxyVitamin D: Meta-analysis of dose-response. Presented at: American Association for Cancer
Research Annual Meeting; April 12-16, 2008; San Diego, California.
16. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyVitamin D levels and risk of
multiple sclerosis. JAMA. 2006;296:2832-2838.
17. Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of Vitamin D and risk of type 1
diabetes: a birth-cohort study. Lancet. 2001;358:1500-1503.
18. Szeto FL, Sun J, Kong J, Duan Y, Liao A, Madara JL, Li YC. Involvement of the Vitamin D receptor in the
regulation of NF-kappaB activity in fibroblasts. J Steroid Biochem Mol Biol. 2007;103:563-566.
19. Boxer RS, Dauser DA, Walsh SJ, Hager WD, Kenny AM. The association between Vitamin D and
inflammation with the 6-minute walk and frailty in patients with heart failure. J Am Geriatr Soc.
2008;56:454-461.
20. Melhus H, Michaëlsson K, Kindmark A, Bergström R,. Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk for hip fracture. Annals of Internal Medicine, 1998;129(10):770-8.
21. Johansson S, Melhus H. Vitamin A antagonizes calcium response to vitamin D in man. J Bone Mineral Res. 2001;16(10):1899-905.
Robert G Carlson, MD, FACS
Patient EB is a 50-year-old female with a family history of colon cancer and breast cancer as well as a history of arthritis with probable autoimmune etiology. She takes a daily multivitamin which includes 10,000 units of Vitamin A as well as a separate 1000 IU of Vitamin D3 and her 25-(OH) Vitamin D3 level is 36 ng/mL (reference range 33-100 ng/mL). Should EB increase her dose of Vitamin D3? Should she continue her multi-vitamin?
There are so many myths surrounding Vitamin D. First and foremost, is the myth that Vitamin D is
a Vitamin. Vitamin D is not a Vitamin, it is actually a steroid hormone. Vitamin D is produced in one part of the body (the skin), and then travels to a remote site, where it exerts an endocrine effect. Thus, it fulfills the definition of a hormone. Another Vitamin D myth is that its only function is calcium regulation. That idea has been well and truly debunked in recent years. Then there is the idea that 1000 IUs a day is more than enough, which is simply not true. Also many believe that taking over 2000 units a day might cause toxicities. I hear this from numerous health professionals and even from pharmacists who should know better. The literature is very clear…..evidence from clinical trials shows that a prolonged intake of 10,000 units of Vitamin D per day poses no risk of adverse effects for adults 1 ……therefore one can take 10,000 units a day and have no risk for toxicity.
Other myths of interest include:
1) Most people living in the US get adequate amounts of Vitamin D – not true (see below).
2) Extreme care must be taken to avoid toxicity – not true! There have been numerous
studies on Vitamin D toxicity and no toxicity has been seen in doses lower than 30,000
IU/day (200 ng/mL). An excess of Vitamin D causes hypercalcemia, however all known
cases of Vitamin D toxicity with hypercalcemia have involved intakes of 40,000 IU or more
per day.2
3) Spending 15 minutes in the sun each day enables the body to produce ample amounts of
Vitamin D – that may be true if you are sitting on a beach in Hawaii at noon wearing
nothing but a bikini, but for the vast majority of us that is a myth. Unfortunately, once sunscreen is applied the Vitamin D production drops to nothing. If you live above 35 degrees latitude, the body is unable to produce adequate amounts of Vitamin D from the winter sun. In fact the only adequate amount of sunshine in Boston occurs, between May and Sept, otherwise there is inadequate sunlight for Vitamin D metabolism.
4) Eating a balanced diet will provide adequate amounts of Vitamin D – not true! Vitamin D is present, in small amounts, in only a handful of foods – oily fish, eggs, and fortified
foods. Vitamin D fortified Milk and Orange Juice only contain 50 Units of Vitamin D2, not Vitamin D3. Thus it is very unlikely that adequate amounts could be obtained from the diet.
• Vitamin D does not prevent cancer – it does , in fact one study showed the reduction in all cancers by 77 % over a four year period in a well designed study.(see below).
• Vitamin D does not prevent autoimmune disease – it does , reducing Systemic Lupus ,Rheumatoid Arthritis and Childhood onset diabetes(see below).
• Vitamin D does not prevent acute MI and heart disease – it does (see below).
As mentioned above, the notion that most people living in the US get adequate amounts of
Vitamin D is far from true. Research has shown that Vitamin D deficiency is present among all age groups of US citizens from children to the elderly, and especially in African-Americans.3 Studies have shown that the prevalence of low 25-(OH) D levels (<20 ng/mL) is approximately 36% in young adults aged 18-294 ,42% of African-American women aged 15-495 ,41% of outpatients aged 49-83,6 and 57% of inpatients.7
In Europe, it is believed that between 28 and 100% of healthy adults and 70-100% of hospitalized adults have low 25-(OH) D levels (<20 ng/mL).8,9,10
A study we completed examining women age 35-65 in Tampa, Florida in December, demonstrated that 92 % of the women had 25-(OH) D levels less than the low normal range of 32. Can you imagine what the Vitamin D levels are in the same group of women in Minneapolis, Minnesota in December?
Research has shown that the incidence of many diseases could be dramatically reduced by
increasing serum 25-(OH) D levels, and by looking at the list below, it is easy to see why Vitamin D has become a very hot topic in recent years:
1) Increasing serum 25-(OH) D levels to 35 ng/mL could prevent 30% of MI in men11 and
reduce the risk of fracture in elderly people by 50%.12
2) Increasing serum 25-(OH) D levels to approximately 40 ng/mL could reduce the risk of
cancer in postmenopausal women by 35%13 and reduce the risk of falls in elderly people
by 50%. 14
3) Increasing serum 25-(OH) D levels to 50 ng/mL could reduce the incidence of breast
cancer by as much as 80%,15 multiple sclerosis by as much as 60%,16 and type I
diabetes by up to 50%.17
Why is Vitamin D so beneficial? There is no clear answer at present. However, anything that has
such wide-ranging benefits has to possess the ability to modulate inflammation. Indeed, studies have shown that Vitamin D inhibits nuclear factor-κβ (NF-κβ) 18 – a protein that plays a key role in the inflammatory response and in the proliferation of cancer cells. It has also been shown to lower levels of the inflammatory marker CRP.19 Thus, it is vital that we ensure our patients are getting plenty of Vitamin D.
What about Patient EB, does she need to increase her daily dose of Vitamin D3? Yes. The
reference range for 25-(OH) D is 32-100 ng/mL Given the evidence published in the medical literature over the last few years, it is advisable to try and keep patients at the top end of the reference range – so, we should be aiming for 75-100 ng/mL The optimal dose for an average person is 5000-15,000 IU/day; however this should be lowered for people who get a lot of sun exposure. Ideally check Vitamin D leveIs and regularly check serum calcium in patients who take supplementary Vitamin D, just to ensure there is no risk of hypercalcemia.
So what about her multi-Vitamin choice? Some multi-Vitamins may be doing more harm than good. I recommend avoiding excessive amount of pre-formed Vitamin A in the retinol form, as opposed to the beta-carotene form that converts to Vitamin A in your body. The presence of excessive pre-formed actually will neutralize all the amazing benefits of Vitamin D3.20 Unfortunately, multi-vitamins often continue a lot of Vitamin A(average 4400 units) as retinol and very low levels of D3( average 400). Vitamin A and Vitamin D receptors are very close to each other and excess Vitamin A will block the beneficial effects of Vitamin D. Women who took the highest intake of pre-formed Vitamin A actually had twice as many hip fractures. 21 So keep the non- beta carotene Vitamin A supplements to less than 1000 units, and this will allow all the amazing benefits of Vitamin D3.
CONCLUDING REMARKS
There are many myths surrounding hormone replacement therapies, however from the evidence
presented above, we can see that not one of them is true. Hormone optimization provides us with an extremely powerful anti-aging tool to maximize quality of life.
REFERENCES
1. Vieth R. Vitamin D and Cancer Mini-Symposium: the risk of additional Vitamin D. Ann Epidemiol. 2009; 19(7):441-5.
2. Vieth R. Vitamin D supplementation, 25-hydroxyVitamin D concentration, and safety. Am J Clin Nutr. 1999;69:842-56.
3. Holick MF. High prevalence of Vitamin D inadequacy and implications for health. Mayo Clin Proc.
2006;81:353-373.
4. Tangpricha V, Pearce EN, Chen TC, Holick MF. Vitamin D insufficiency among free-living healthy young
adults. Am J Med. 2002;112:659-662.
5. Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C,
Gunter EW, Bowman BA. HypoVitaminosis D prevalence and determinants among African American and
336 white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994. Am
J Clin Nutr. 2002;76:187-192.
6. Malabanan A, Veronikis IE, Holick MF. Redefining Vitamin D insufficiency [letter]. Lancet. 1998;351:805-
806.
7. Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM,
Prince RL, Finkelstein JS. HypoVitaminosis D in medical inpatients. N Engl J Med. 1998;338:777-783.
8 . McKenna MJ. Differences in Vitamin D status between countries in young adults and the elderly. Am J
Med. 1992;93:69-77.
9. Isaia G, Giorgino R, Rini GB, Bevilacqua M, Maugeri D, Adami S. Prevalence of hypoVitaminosis D in
elderly women in Italy: clinical consequences and risk factors. Osteoporos Int. 2003;14:577-582.
10. Passeri G, Pini G, Troiano L, Vescovini R, Sansoni P, Passeri M, Gueresi P, Delsignore R, Pedrazzoni M,
Franceschi C. Low Vitamin D status, high bone turnover, and bone fractures in centenarians. J Clin
Endocrinol Metab. 2003;88:5109-5115.
11. Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-hydroxyVitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168:1174-80.
12. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture
prevention with Vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA.
2005;293:2257-2264.
13. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium
supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;85:1586-1591.
14. Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP. A higher dose of Vitamin d
reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc.
2007;55:234-239.
15. Garland CF, Gorham ED, Mohr SB, Grant WB, Garland FC. Breast cancer risk according to serum s5-
hydroxyVitamin D: Meta-analysis of dose-response. Presented at: American Association for Cancer
Research Annual Meeting; April 12-16, 2008; San Diego, California.
16. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyVitamin D levels and risk of
multiple sclerosis. JAMA. 2006;296:2832-2838.
17. Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of Vitamin D and risk of type 1
diabetes: a birth-cohort study. Lancet. 2001;358:1500-1503.
18. Szeto FL, Sun J, Kong J, Duan Y, Liao A, Madara JL, Li YC. Involvement of the Vitamin D receptor in the
regulation of NF-kappaB activity in fibroblasts. J Steroid Biochem Mol Biol. 2007;103:563-566.
19. Boxer RS, Dauser DA, Walsh SJ, Hager WD, Kenny AM. The association between Vitamin D and
inflammation with the 6-minute walk and frailty in patients with heart failure. J Am Geriatr Soc.
2008;56:454-461.
20. Melhus H, Michaëlsson K, Kindmark A, Bergström R,. Excessive dietary intake of vitamin A is associated with reduced bone mineral density and increased risk for hip fracture. Annals of Internal Medicine, 1998;129(10):770-8.
21. Johansson S, Melhus H. Vitamin A antagonizes calcium response to vitamin D in man. J Bone Mineral Res. 2001;16(10):1899-905.
Robert G Carlson, MD, FACS
Prostate Cancer and Men Robert G Carlson, MD
Prostate Cancer Myth:
Testosterone therapy causes prostate cancer
Absolutely not, in fact lower testosterone levels are associated with an increased incidence of Prostate cancer.
For over 60 years there has been an overwhelming fear that testosterone therapy for low testosterone levels will cause new cancers or hidden ones to grow. There is very little scientific data to support that philosophy but even in the face of numerous recent studies saying there is NO association, doctors are still telling their patients that testosterone therapy causes prostate cancer. Instead the opposite is true. Low blood levels of testosterone don’t protect against prostate cancer, but in fact lower testosterone levels are associated with increased incidence of prostate cancer.
A Journal of National Cancer Institute article in 2008, pooled 18 separate studies looking at the effect of testosterone therapy and prostate cancer. In over 9000 men studied, there was no relationship between testosterone therapy and Prostate cancer. NONE. The authors pleaded with the medical community to move past the long-believed, but unsupported view that testosterone therapy causes prostate cancer. IT DOES NOT CAUSE PROSTATE CANCER.
To summarize:
1) Low testosterone levels do not protect against prostate cancer, and in fact are associated with a higher incidence of prostate cancer.
2) High testosterone levels in men are not associated with an increased incidence of prostate cancer.
3) Treatment with testosterone therapy does not increase the incidence of prostate cancer, even in the men who are presumably at a higher risk.
4) If a man has metastatic prostate cancer (spread all over) and has been aggressively treated to lower testosterone levels, then careful management with testosterone therapy is recommended.
5) By restoring Testosterone levels to healthy levels, aging men should expect higher energy levels, memory improvement, improvement of depression, reduction of osteoporosis, and improvement in erectile dysfunction.
Robert G Carlson, MD, FACS
Testosterone therapy causes prostate cancer
Absolutely not, in fact lower testosterone levels are associated with an increased incidence of Prostate cancer.
For over 60 years there has been an overwhelming fear that testosterone therapy for low testosterone levels will cause new cancers or hidden ones to grow. There is very little scientific data to support that philosophy but even in the face of numerous recent studies saying there is NO association, doctors are still telling their patients that testosterone therapy causes prostate cancer. Instead the opposite is true. Low blood levels of testosterone don’t protect against prostate cancer, but in fact lower testosterone levels are associated with increased incidence of prostate cancer.
A Journal of National Cancer Institute article in 2008, pooled 18 separate studies looking at the effect of testosterone therapy and prostate cancer. In over 9000 men studied, there was no relationship between testosterone therapy and Prostate cancer. NONE. The authors pleaded with the medical community to move past the long-believed, but unsupported view that testosterone therapy causes prostate cancer. IT DOES NOT CAUSE PROSTATE CANCER.
To summarize:
1) Low testosterone levels do not protect against prostate cancer, and in fact are associated with a higher incidence of prostate cancer.
2) High testosterone levels in men are not associated with an increased incidence of prostate cancer.
3) Treatment with testosterone therapy does not increase the incidence of prostate cancer, even in the men who are presumably at a higher risk.
4) If a man has metastatic prostate cancer (spread all over) and has been aggressively treated to lower testosterone levels, then careful management with testosterone therapy is recommended.
5) By restoring Testosterone levels to healthy levels, aging men should expect higher energy levels, memory improvement, improvement of depression, reduction of osteoporosis, and improvement in erectile dysfunction.
Robert G Carlson, MD, FACS
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