Vitamin Information Center

A flurry of recent reports trumpeting the health benefits of vitamin D have vaulted the supplement to a starring role on the merchandise shelves at Burns Drugs in La Jolla.

Pharmacist Wayne Woods, who owns the store, said he’s seeing a growing number of customers asking for bottles of high-dosage vitamin D.

“We barely carried it before, but physicians are recommending it as a normal supplement on a daily basis in addition to taking your multivitamin,” Woods said.

Vitamin D’s role in bone health has long been known – think rickets in malnourished children and osteoporosis in older people. But research tying vitamin D deficiency to cancers, heart disease, diabetes and other illnesses has transformed the nutrient into a potential miracle cure. A global network of influential scientists said daily intake should be up to 10 times higher than the U.S. government’s current recommendations.

Yesterday, more than 100 physicians, nutritionists, acupuncturists, massage therapists and others gathered at the University of California San Diego for a daylong conference extolling vitamin D.

But not everyone is as enthusiastic, especially after a succession of reports dimmed the spotlight on vitamin supplements. Last month, two major clinical trials debunked vitamin B as a treatment for Alzheimer’s disease and vitamins E and C as protectors against cancer.

The scientific uncertainty has generated debate over the virtues and dangers of vitamin D. One big reason for the researchers’ disagreements: The most promising studies suggest a relationship between low vitamin D intake and many diseases, but they have failed to show a direct cause and effect.

Skeptics of dramatically boosting vitamin D supplements point to the lack of large-scale, random and “double blind” clinical studies comparing the nutrient to placebos. Dermatologists also have bristled at suggestions that people spend more time in the sun to increase the natural production of vitamin D.

Those concerns didn’t deter several longtime advocates of vitamin D supplements at yesterday’s meeting, including Dr. Robert Heaney, a professor at Creighton University in Omaha, Neb.

Heaney said studies conducted in North America and Europe found low vitamin D levels in as many as 95 percent of participants. “I think we can take it as a given that the vast majority of patients in the U.S. are vitamin D deficient,” he said.

People get most of their vitamin D from exposure to sunlight, according to the National Institutes of Health. Spending 10 to 15 minutes outdoors two to three times each week is typically enough.

The best food sources of the nutrient are oil-rich fish such as salmon, tuna and mackerel. Milk and some cereals also are fortified with the vitamin.

Another speaker at the conference, Dr. Cedric Garland, said vitamin D might prevent certain cancers partly because it helps to form the glue that binds cells to each other. Without that glue, cells can become malignant and spread to other parts of the body.

Despite the academic nature of the presentations, the gathering at times felt more like a pep rally for campaign partisans.

Carole Baggerly of Encinitas opened the conference by leading the crowd in singing “You Are My Sunshine.”

She is a former computer sales and marketing executive who founded the conference’s sponsor organization, GrassrootsHealth, after surviving breast cancer.

Baggerly called on conference attendees to become part of her organization’s D*action campaign, a “grand mission” to promote testing for vitamin D deficiency.

“There is no need for a vitamin deficiency epidemic to go on and on and on,” she said.

GrassrootsHealth and some of the conference speakers want federal health officials to increase the daily recommended intake of vitamin D to as much as 2,000 international units.

Current U.S. nutritional guidelines call for 200 international units per day for children and adults up to age 50, 400 international units for people up to 70, and 600 international units for those 71 and older.

The American Medical Association and the American Academy of Pediatrics also have called on the government to raise its vitamin D benchmarks.

But the effort is opposed by the American Academy of Dermatology, which last month advised against too much sun exposure because of the heightened risk of developing skin cancer.

While there is a growing body of “exciting” discoveries pointing to the benefits of vitamin D, more research is needed before health officials adjust supplement standards, said Patsy Brannon, a professor of nutritional science at Cornell University in Ithaca, N.Y.

“The evidence on safety and efficacy is not as strong as what we would like it to be,” she said.

At least two studies meeting the rigorous criteria of large-scale clinical trials have offered reasons for caution.

The federal Women’s Health Initiative found that women taking 400 international units of vitamin D plus 1,000 milligrams of calcium daily had a 17 percent higher risk of developing kidney stones over seven years. Their risk of developing colorectal cancers was no different than that of women who took a placebo.

In Finland, male smokers who took high doses of vitamin D supplements had a significantly greater risk of developing pancreatic cancer.

Last week, an international group of cancer researchers warned that changes to vitamin D recommendations could end up harming people if higher doses are eventually found to elevate the risk for some diseases.

“There is insufficient evidence (to prove) a lack of harm due to long-term, higher levels of vitamin D,” the scientists wrote in a report prepared for the World Health Organization’s International Agency for Research on Cancer.

The bottom line is “controversy and conflicting evidence,” Brannon said, “so there is no consensus.”

For now, people concerned about their vitamin D levels should make sure they are following the government’s guidelines by tracking their daily intake through food and supplement labels, she said.

Elderly people at risk of developing brittle bones should consult their physicians before taking supplements.

Keith Darce: (619) 293-1020; keith.darce@uniontrib.com

(Best Syndication News) Although Vitamin D is important for bone and muscle health, researchers are now saying that it is very important for the heart as well. Linus C Pauling (February 28, 1901 – August 19, 1994) illustrated the importance of vitamin C for health while new researchers at the Mid American Heart Institute in Kansas are recognizing that vitamin D plays a very important role in our wellbeing.

“Vitamin D deficiency is an unrecognized, emerging cardiovascular risk factor, which should be screened for and treated,” said James H. O’Keefe, M.D., cardiologist and director of Preventive Cardiology at the Mid America Heart Institute, Kansas City, MO. O’Keefe says that a deficiency of the vitamin increases the risk of cardiovascular disease (CVD).

“Vitamin D is easy to assess, and supplementation is simple, safe and inexpensive,” O’Keefe added. Viactiv, the common calcium supplement recently doubled the vitamin d in their chews.

Half of all adults and 30 percent of the children and teenagers in the United States have a vitamin D deficiency. Data from the Framingham Heart Study suggested that participants below 15 ng/ml were twice as likely to experience a heart attack, stroke or other CV event within the next five years when compared to those with higher levels.

“Restoring vitamin D levels to normal is important in maintaining good musculoskeletal health, and it may also improve heart health and prognosis,” said Dr. O’Keefe. “We need large randomized controlled trials to determine whether or not vitamin D supplementation can actually reduce future heart disease and deaths.”

From the report:

In the absence of clinical guidelines, the authors outline specific recommendations for restoring and maintaining optimal vitamin D levels in CV patients. These patients should initially be treated with 50,000 IU of vitamin D2 or D3 once weekly for 8 to 12 weeks. Maintenance therapy should be continued using one of the following strategies:

1) 50,000 IU vitamin D2 or D3every 2 weeks;

2) 1,000 to 2,000 IU vitamin D3 daily;

3) Sunlight exposure for 10 minutes for Caucasian patients (longer for people with increased skin pigmentation) between the hours of 10 a.m. to 3 p.m.

Vitamin D supplements appear to be safe. In rare cases, vitamin D toxicity (causing high calcium levels and kidney stones) is possible, but only when taking in excess of 20,000 units a day.

The research and recommendations are published in the December, 9, 2008, issue of the Journal of the American College of Cardiology (JACC)

By Jeffrey Workmman
Beest Syndication News Health Writer

EAGLE COUNTY, Colorado — Vitamin D deficiency is now recognized as an epidemic throughout the United States. And as the dark winter clouds descend upon the Vail Valley to obscure the warm Colorado sunshine, things will only get worse.

A growing body of research has begun to demonstrate the importance of vitamin D, known as the “sunshine” vitamin. Historically vitamin D has been associated with skeletal growth and strong bones. This association arose early in the 20th century when it was shown that rickets, a childhood disease characterized by improper development of bones, could be prevented by a fat-soluble “factor D” in the diet or body exposure to ultraviolet light. Therefore, any compound with curative action on rickets was designated as vitamin D.

Our current understanding of the vitamin is now much more far-reaching, but still far from complete. We know that almost every cell in the human body has a receptor for vitamin D. Thousands of studies have confirmed that vitamin D can improve mood, prevent colds and flu’s, prevent autoimmune disease, build bone mass, increase strength in the elderly, significantly reduce risk of cancer, decrease chronic pain and systemic inflammation and the incidence of heart disease, and much more. With such broad effects on health, scientists are saying that vitamin D might be the most important hormone in the body.

We know that vitamin D is found in small quantities in milk, milk products, fatty fish, sun-dried shiitaki mushrooms, fortified cereals, and a good multivitamin. But the best and most reliable source is sunlight exposure. Every inch of your skin is covered with a cholesterol derivative called 7-dehydrocholesterol, which is converted to vitamin D when exposed to sunlight (or more specifically, the invisible form of sunlight that causes sunburn known as ultraviolet-B). Interestingly, sunscreen with an SPF of 8 will decrease vitamin D synthesis by 92.5 percent, and an SPF of 15 will decrease it by 99 percent. In light of this fact, most naturopathic doctors are beginning to recommend sensible exposure to sunshine. Fifteen to 20 minutes of exposure to midday summer sun on the forearms and face is usually sufficient to raise vitamin D in the blood to healthy levels. And because most tanning beds emit 2 to 6 percent UVB radiation, some docs are even recommending tanning beds for the treatment and prevention of vitamin D deficiency during the wintertime — in moderation of course and for 30 to 50 percent of the time recommended for tanning.

Many doctors once scoffed at vitamin D deficiency, but testing has become more routine and is now covered by most health insurance plans. In Seattle, which is infamous for dark and excruciating long winters, most hospitals and clinics are routinely checking 25-hydroxy vitamin D levels on patients. In my experience, after living and working in Seattle for the past seven years, approximately 80 to 90 percent of Seattleites are proving to be deficient in this essential nutrient!

Even in sunny Colorado it seems that vitamin D deficiency may be the rule rather than the exception. This is especially true during the winter months, when Colorado is furthest from the sun and located at such an angle to the sun’s radiation that makes it impossible to allow for adequate vitamin D production in the skin. You can literally stand outside naked for eight hours a day during the winter and still not increase your vitamin D levels. This naked truth — in conjunction with widespread sunscreen use in the summertime, the rise in obesity (which causes the body to sequester the vitamin in fat cells), the high prevalence of various malabsorption syndromes (including wheat and dairy sensitivities), and the use of certain medications (that destroy or block the absorption of vitamin D into the bloodstream) — suggests that many of us are unknowingly deficient in this important nutriment.

Most experts believe that without adequate sun exposure, children and adults require 1,000 to 2,000 IU of vitamin D3 per day. In cases of frank deficiency, much larger doses are often required to reestablish healthy levels. But be mindful that it is possible to go overboard with supplements. Because vitamin D is fat soluble and can build up in the body, it does have the potential to trigger dangerous calcium deposits in the kidneys and blood vessels. Therefore, it is advised to work closely with a doctor to promptly diagnose and effectively treat vitamin D deficiency. Your heath just might depend on it.

Nick Bitz is a naturopathic doctor at the Riverwalk Natural Health Clinic in Edwards. To reach the clinic, call 970-926-7606. E-mail comments about this column to cschnell@vaildaily.com.

Low serum vitamin D levels in older men are associated with a higher risk of cardiovascular mortality, noncancer mortality, and noncancer, noncardiovascular mortality, according to research presented here at the American Society for Bone and Mineral Research (ASBMR) 30th Annual Meeting.

Although low 25-hydroxy vitamin D (25-OH vitamin D) levels have previously been associated with an increased risk of fractures and some diseases in older men, few studies of all-cause and cause-specific mortality have previously been conducted in elderly males, said Peggy Cawthon, California Pacific Medical Center Research Institute, San Francisco, California, who presented results from the prospective study here on September 12.

“There’s been a lot of interest in vitamin D levels and various health conditions in older adults, and some recent observational studies have suggested there is an association between higher vitamin D and protection for mortality, so the more vitamin D you have, the less likely you are to die,” Cawthon explained.

To test the hypothesis that low serum levels of vitamin D are associated with an increased risk of mortality in older men, the researchers looked at 5,995 men aged 65 years and up at 6 clinics in the United States. All subjects were participating in the Osteoporosis Fractures in Men study. An analysis sample of 1,608 men was randomly selected, and the subjects were followed for 6.1 years.

Proportional hazards models were used to test associations between low vitamin D levels and overall mortality, noncancer mortality, and cancer mortality as well as cardiovascular death. Adjustments were made for factors such as age, clinical centre, and season of the blood draw.

The study found that men with vitamin D deficiency (≤15 ng/mL) had a 2.2-fold increased risk of death due to causes besides cancer, with no significantly increased mortality for those with levels of 15 to 30 ng/mL (P = .008).

The researchers also found, however, that there was no significant association between 25-OH vitamin D deficiency and death due to all types of cancer combined (relative hazard = 0.6; confidence interval, 0.2-1.4), with results for vitamin D deficiency similar to results in the lowest quartile of 25-OH vitamin D levels (≤20 ng/mL) compared to those in men in the highest quartile (≥30 ng/mL) (P = .12).

“We saw the opposite of what we expected,” Cawthon noted. “There’s not any other information in the literature that would suggest that association, and we’re not really sure why that is.”

Potential harmful effects of higher vitamin D levels should be investigated further in larger studies with better power, the investigators concluded. “We’d like to look at this in [the setting of] a randomised, controlled trial,” Cawthon said.

A national campaign to persuade every Scot to take daily supplements of vitamin D is needed if the country’s appalling health record is to be reversed, leading scientists believe.

A report, published this week, links poor weather to the lack of the “sunshine vitamin” in Scotland, and urges the Scottish government to launch a nationwide vitamin D programme to lower the incidence of devastating illnesses, such as heart disease, cancer and multiple sclerosis.

The research points to the country’s damp, cloudy climate as a significant contributor to its bleak record of ill health and disease.

Vitamin D deficiency – caused by lack of exposure to sunshine – is twice as common among the Scots as it is among the English. The average Scot has a vitamin D level four times lower than their neighbour south of the Border.
A five-year research project by Oliver Gillie, a scientist and writer, demonstrates extensive and remarkable parallels between Scotland’s dull weather and indices of disease.

It suggests that the “Scottish effect”, the country’s hitherto unexplained high mortality rate compared with other industrial countries, is in large part down to lack of sun. Crucially, a shortage of the “sunshine vitamin” is established as a factor in higher rates of multiple sclerosis (MS), diabetes, hypertension, arthritis, several types of cancer, cardiovascular disease and other ailments that together give Scotland one of the worst health records and highest premature mortality rates in Western Europe.

Dr Gillie’s study – Scotland’s Health Deficit: An Explanation and a Plan – echoes world-wide research on vitamin D deficiency but goes further, showing how the higher rates of disease in Scotland mirror closely the lower amount of available sunlight.

A lack of sunshine in Glasgow and the West of Scotland reflects levels of chronic illness that which cannot be explained by deprivation alone. A lack of sunshine on Orkney and Shetland – only 24 per cent of the maximum number of hours possible – corresponds to the highest prevalence of MS in the world.

By contrast, the South Coast of England, where such diseases are much less common, receives 400 more hours of sunshine a year than Scotland.

Dr Gillie says that successive reports on the state of Scotland’s health have failed to recognise that insufficient sunlight and vitamin D are important risk factors, and calls for firm action from the Scottish government on supplementation and the fortification of food.

Last week The Times convened a panel of experts who studied the report and endorsed unanimously the importance of vitamin D as an important ingredient in creating a healthy Scottish population.

Dr Harry Burns, the Chief Medical Officer for Scotland, said: “It is important that attempts to improve health in Scotland remain focused on action on the social, economic, behavioural and psychological determinants of health. If vitamin D supplements can be shown to contribute to that agenda then we will make the appropriate recommendations.”

Dr Adrian Martineau from Queen Mary’s School of Medicine, London, who is working on evidence that vitamin D can reduce cold and flu symptoms, said: “This is a very important initiative. What [Dr Gillie] has highlighted is that 85 per cent of us have lower Vitamin D levels than we should have and 85 per cent of our cells need vitamin D to function properly. It’s highly plausible that supplementation would be of great benefit.”

Eric Madrid, MD
Physicians and scientists are starting to realize the numerous health benefits of sunshine exposure and vitamin D supplementation. Most doctors know severe vitamin D deficiency causes rickets. Since rickets is rarely seen today, it is incorrectly assumed that vitamin D deficiency is nonexistent.

Fallbrook and Temecula medical providers have diagnosed hundreds of patients with vitamin D deficiency, or about 90 percent of all patients tested. Nine out of 10 people reading this story likely suffer from vitamin D deficiency.

Why should you have your vitamin D level checked? Studies have shown that those with lower levels of vitamin D in their blood have a higher risk of developing breast cancer, ovarian cancer, colon cancer, prostate cancer, type 1 diabetes, multiple sclerosis and heart disease. One study showed greater than a 60-percent reduction in breast cancer in those with the highest levels of vitamin D in their blood.

In addition, senior citizens who have lower levels of vitamin D in their blood are at higher risk of falls, osteoporosis and bone fractures. Those who suffer from chronic pain and fibromyalgia also have lower levels of vitamin D.

Vitamin D levels are checked by a simple blood test. Treatment usually requires supplementation with vitamin D3 as opposed to the more commonly sold over the counter vitamin D.

Vitamin D is also made from moderate daily sun exposure to the arms and legs. Caution must be taken to prevent sun burning. Many sunscreens will block out UVB, which is the type of sunlight needed for skin to make vitamin D. Those with darker pigment are higher risk of deficiency, which may explain the higher incidence of diseases in certain ethnic populations.

To check your vitamin D level, contact your physician or call (951) 676-4193 for an appointment.

Eric Madrid MD is a family physician with Rancho Family Medical Group, which has offices in Fallbrook and Temecula. See www.ranchofamilymed.com.

It is a well known fact that ‘we are what we eat’. Food not only affects us physically, but psychologically as well. However, researchers are now looking into the effects of food on chronic ailments like osteoarthritis, only to find that food plays a vital role in dealing with this ailment. Here’s more on this newly developing field of study.

Osteoarthritis or Degenerative Joint Disease (DJD) is the wear and tear of our joints caused by the breakdown of cartilage in them. Cartilage, which is a hard but slippery tissue between joints, is more of a cushion for the bones which form the joints. It not only avoids direct friction between the bones but, also helps to absorb shock, allowing them to move smoothly over each other, as it is composed of 65-80% water, collagen, proteoglycans and chondrocytes.

This is what happens when you suffer from osteoarthritis –
• Cartilage loss is there.
• Joints begin to deteriorate due to constant rubbing of bones with each other.
• Fluid accumulates in the joints.
• Structural changes and bony overgrowths can be seen around the joint.
• Patient suffers chronic pain.
• Problem can affect the joints of fingers, hips, knees, feet and spine too.
• Severe symptoms might lead to loss of mobility in the patient or disability.

With over 21 million Americans living with the disease, commonly seen in elderly people above the age of 65 years, researchers are now delving into different ways of tackling the problem to gain more control over it, the most recent one being dietary changes for osteoarthritis.

There are various factors which pave way for a person to develop osteoarthritis, like – obesity, vitamin C deficiency, low bone mineral density and vitamin D deficiency. Thus keeping these in mind dieticians suggest some additions and subtractions in your diet to avoid and also keep under control this ailment.

Some dietary changes to keep osteoarthritis at bay -

Foods to avoid -

• Reduce the consumption of fatty foods in your daily intake as the more weight your body has to carry, greater is the burden on the joints and greater the risk.
• Identify the inflammatory elements of your diet by eliminating all short listed ones from the food you consume. Reintroduce them one by one, noting your body’s reactions to them. This would help you identify the culprit food items, which you need to remove at the earliest.
• Common inflammatory foods are – wheat, potato, pepper, egg plant, tobacco, tomatoes etc. you need to stay away from them for about a month and then start reintroducing.
• Elimination of dairy products and animal food has proven to help many. Thus staying on a vegetarian diet would be best for high risk patients.
• Research has shown that periodic fasting has helped show improvement for arthritis patients. It helps to cleanse and restore the digestive system and kidneys, relaxes the mind and nervous system and is good for the well being of the body as whole.
• Lifestyle changes involving elimination of alcohol, smoking, tobacco, coffee, fats, sugar and excessive salt, are now known as ways to overcome the problem at best.

Foods to add -
• Vitamin C is known to develop cartilage, thus foods rich in the vitamin should be deliberately had on a regular basis, in addition to tablets. Some foods are citrus fruits etc.
• Vitamin D helps to decrease the narrowing of joint spacing, thus a daily supplement of the Vit-D tablet is a must for osteoarthritis patients.
• Osteoarthritis symptoms are said to show a slowdown with foods rich in glucosamine and chondroitin.
• In general eating green leafy vegetables, carrots, avocado, sea weeds, fish, soy products, sprouts, oats, barley, rice, millet, and fish like salmons, tuna, sardines etc, help patients suffering from the disease and also help to overcome the above mentioned deficiencies.
• Regular intake of calcium supplements is a must.
• Lifestyle changes like weight reduction, exercising and diet control, not only help reduce weight, they also help people with low bone mineral density.

So eat healthy and live healthy!

Vitamin D is known as the “sunshine vitamin” because the human body naturally produces vitamin D when exposed to sunlight. A report in the Archives of General Psychiatry gives new meaning to the term. New research has shown that your risk for depression could be high if your blood is low in vitamin D and high in serum parathyroid hormones, says a report in . (Arch Gen Psychiatry. 2008;65[5]:508-512.)

More specifically, poor vitamin D consumption can cause an increase in serum parathyroid levels, which are frequently accompanied by symptoms of depression. And considering that nearly 15% of older individuals suffer from the blues this could be the relief that they’ve been seeking.

The findings may be important to patients because both low blood vitamin D levels and high parathyroid hormone levels can be treated with higher dietary intake of vitamin D or calcium and increased sunlight exposure. “Moreover, the clinical relevance of the present study is underscored by our finding that 38.8% of men and 56.9% of women in our community-based cohort had an insufficient vitamin D status,” researchers conclude. Additional studies are needed to determine whether changes in levels of vitamin D and parathyroid hormone precede depression or follow it.

The Anti-Aging Bottom Line: Almost 15% of older Americans suffer from depression, which can substantially decrease your quality of life. if you feel like you may be depressed, get your vitamin D levels checked. Recent research has found that vitamin D deficiency is much more common that was previously thought, and that most people need higher amounts of D than the current government mandated recommendations. Vitamin D supplementation has been proven very effective at correcting deficiency. Make sure you are getting at least 1,000 IU of supplemental vitamin D daily.

Exclusive breastfeeding can increase a child’s risk of developing rickets because breast milk alone does not provide adequate levels of vitamin D, a critical ingredient that helps to absorb calcium and build strong bones, the New York Times reports. Rickets develops when a child’s vitamin D levels are too low and is characterized by the curving of a child’s legs and the softening of other bones. Some children are asymptomatic.

Darker-skinned children have a greater risk of vitamin D deficiency than other children because they do not absorb vitamin D as easily through the skin. Sunlight enables the skin to synthesize vitamin D.

Cases of nutritional rickets among infants and young children in the U.S. have been “accumulating over the last decade or so,” and children with the condition are more likely to be black or dark-skinned and have been breastfed exclusively for an extended period of time without vitamin supplementation, according to the Times. Some experts say that an increase in infants being exclusively breastfed, more children drinking soda or juice and less milk, and children spending less time in the sun could contribute to rickets re-emerging as a public health problem, the Times reports.

According to the Times, while physicians have known for years that exclusive breastfeeding is associated with vitamin D deficiency in infants and rickets, many are “reluctant to say anything that might discourage breastfeeding.” The American Academy of Pediatrics in 2003 recommended that infants who are exclusively breastfed receive vitamin D drops daily.

According to one study on rickets and vitamin D that included mostly black and Hispanic infants and toddlers, 40% of the participants had low levels of vitamin D, 12% were vitamin D deficient, 13 children showed evidence of bone loss and three children had signs of rickets. The study, published in the June issue Archives of Pediatrics & Adolescent Medicine, also found that breastfeeding without vitamin supplementation was a significant risk factor for rickets.

Study author Catherine Gordon, director of Children’s Hospital Boston’s bone health program, said, “I completely support breastfeeding, and I think breast milk is the perfect food, and the healthiest way to nourish an infant. However, we’re finding so many mothers are vitamin D deficient themselves that the milk is therefore deficient, so many babies can’t keep their levels up.” She added, “They may start their lives vitamin D deficient, and then all they’re getting is vitamin D deficient breast milk” (Rabin, New York Times, 8/26).

Vitamin D is the key to preventing rickets and osteoporosis, but Rockefeller University scientists suspect it may also play a role in heading off atherosclerosis in people with chronic kidney disease. In a new clinical study, investigators at The Rockefeller University Hospital are examining patients with moderately reduced kidney function to investigate the effect of vitamin D therapy on endotoxemia, a condition that is common among those with renal disease and is widely viewed as a contributor to heart disease. The study, led by Instructor in Clinical Investigation Manish Ponda, is partially funded by a $25,000 grant from the Center for Clinical and Translational Science.

The high rate of atherosclerosis among patients with kidney disease is well documented but little understood by medical experts. Endotoxins, products of the natural breakdown process of bacteria, are a hot topic of clinical investigation with regard to both heart and kidney disease. “The number one killer among people with kidney disease is heart disease, just like in the rest of the population, except that in people with kidney disease, the heart disease exhibits an accelerated course,” says Ponda, a member of Jan Breslow’s Laboratory of Biochemical Genetics and Metabolism at Rockefeller. The research is an extension of earlier clinical work by Ponda that showed a high incidence of vitamin D deficiency among early-stage kidney disease patients.

Study participants — males and postmenopausal females between ages 50 and 80 with stage three chronic kidney disease and vitamin D deficiency — will be provided with thrice-weekly doses of vitamin D3, also known as cholecalciferol, the form of vitamin D produced by the body in response to sunlight. Participants will make three outpatient visits at intervals of four weeks each to The Rockefeller University Hospital, where investigators test for levels of endotoxins in response to vitamin D repletion.

The dose of vitamin D prescribed for the study — 30,000 international units per week — equals more than 20 times the intake recommended by the United States Department of Agriculture and approximately 10 times the amount in an average multivitamin supplement. The dosage is designated to safely reverse vitamin D deficiency.

If Ponda’s hypothesis — that vitamin D repletion will be accompanied by decreases in blood endotoxin levels — holds true, a larger, more-extensive, “progression” study will follow, to chart the connection over longer periods of treatment and in later stages of renal disease. “Kidney disease puts a person at significantly higher risk for cardiovascular disease, but it is often asymptomatic even as late as stage three,” says Ponda. “The more definitively we can characterize renal disease, the closer we are to effectively treating both it and its comorbid conditions.”