Saturday, October 16, 2010

Vitamin D from Sunshine: How Much is Enough? and Interactions with Vitamins C, Thiamin, and Niacin

Throughout the ages fresh air and sunshine has been associated with good health. Millions of our forbears spent their lives under conditions that ordinary folk today would consider extreme exposure to sunshine. A tiny minority of people today (e.g. roofers) spend an extreme amount of time out in the sun. OSHA has not passed any rules requiring limits to sun exposure. Even extreme sun exposure does no obvious harm. Even the impact of extreme sun exposure on the skin is controversial. Defenders of the sun claim that accelerated skin aging and higher rates of skin cancer are caused by sunburns. Common sense suggests that extreme sun exposure accelerates skin aging - we've all seen the consequences with our own eyes. No more science is needed. No one has to run a study. Again - the facts are the facts. Extreme sun exposure does what it does to the skin. OSHA (and everyone else) has reviewed the facts and exposure to sun in the workplace is not subject to any rules.

Study after study has associated increased exposure to the sun with improved average health. Increasing exposure to the sun increases the daily dose of vitamin D. So - we know with certainty that there is a dose-response realtionship between sunshine-derived vitamin D and health. Higher doses result in better average health. The relationship between vitamin D dose and health is non-linear. Complete deprivation of vitamin D causes death within less than a year. Just the tinest amount of vitamin D from the sun or food prevents death, and a tiny amount enables a normal life expectancy.

I was asked to comment on this article.

My differences from this author are in the details. A general problem I have is with the unspoken paradigm that there is an optimum daily dose. There isn't. Needs for vitamins, A, B1, B3, C, and D fluctuate with age and state of health. Vitamin D is no exception. I use vitamin D to fight off respiratory infections. When I feel I'm coming down with a cold, I take extra vitamins A, B1, B3, and C by mouth, and get extra sunshine. I've found the extra sunshine to be so obviously beneficial that I bought a sunlamp so that I can get the UVB I need at any time. When fighting off a cold, I want more sun exposure. This is just my story.

As I get more and more vitamin D from the sun, I have found myself remarkably intolerant to vitamin D supplements. In fact, I've been reacting badly even to eating large servings of salmon. One reason is that, contrary to my expectations, I am not very tan. When I have a cold, I get in the sun for about 3 minutes once an hour every hour between 10 and 2 and then use the sunlamp before bed. My perception is that I'm making more vitamin D every time I'm in the sun. The reality is that all this extra sun is not making me significantly more tan.

I simply don't understand the view that the winter sun in CT doesn't make vitamin D. A UVB meter placed in direct sunshine at noon in CT will register UVB. The more obvious trouble is the cold weather. No one wants to get into underwear equivalent clothing and get into the sun when it is so cold. This problem is straightforward to overcome. The Romans built solariums. We just don't think it is important enough. Sunlamps can also solve this problem, but I won't recommend them until more research is done about the safety of sun lamps.

I don't like vitamin D blood testing. It is a very difficult measurement and I don't trust the numbers. There is very little data and it is, in my opinion, being over interpreted. I don't understand how studies of tiny numbers of people can distract commentators from the big picture. Sunshine is essential for health and there is an obvious dose response relationship. Higher doses of sunshine result in better average health. Extreme doses of sunshine do no obvious harm. To me, the obvious conclusion is to recommend getting as much sunshine as can be practically managed. I'm also pointing out that alot of sunshine is practical, although socially unacceptable. Setting aside just one sunny day a month for sun therapy may pump up vitamin D levels alot higher than you might think - especially if you are light skinned. Even on these sun therapy days, I think just 5 minutes in underwear equivalent clothing per hour for every hour between 10 am and 2 pm will achieve a maximum daily dose of sunshine-derived vitamin D.

My final word on this is that despite an association with health, sunshine remains controversial. The body is highly sensitive to sun exposure. You can literally feel the sun - even a faint morning sun. If you stand in the sun, how you feel about it changes. Sometimes you get more comfortable - sometimes less. People "decide" how much sun they want and/or need and then it's very difficult to change their views. People "decide" they want to stay out of the sun. It's very hard to change how people feel about the sun with logic. It was proven beyond doubt and published in the early 1800s that sunshine prevent rickets. Despite this, in the 1870's there was a major rickets epidemic in northern Europe and the U.S. There was a medical industry even back in the 1870's. Their children suffered from rickets along with everyone else. It is what it is. Time and again communities of people have found it difficult to use sunshine to improve health.

11 Comments:

At 10:36 AM, Anonymous moises said...

I started taking niacin 100 mg/day 6 months ago. Three months ago I increased my dosage to 100 mg twice a day.

This week I changed brands and experienced my first ever "niacin flush." Since I had been taking niacin for so long, it took me about an hour to figure out what was happening.

The old niacin was from a chain drugstore. The new niacin was from a reputable vitamin company.

I am assuming that the old niacin did not have the labeled amount, if it had any. And niacin is ridiculously cheap.

The lesson I learned is to purchase supplements only with reputable brands.

 
At 8:46 PM, Blogger Steve said...

Moises,

Don't jump to conclusions. You first need to check to make sure that the niacin you used first was really niacin and not niacinamide or any of the niacin esters or a time release preparation.

Odds are you did check this and it is just regular niacin. Even then, flushing is highly responsive to how the tablets are formulated. The faster the tablets dissolve, the more likely they are to cause a flush. When it comes to niacin pills, tablets that dissolve slowly have benefits (less flushing).

As you pointed out, niacin is rediculously cheap - and chain drugstores do value their reputations. My feeling was that straight-release niacin is a safer and more effective product than time-release. It had never occurred to me before you wrote that each straight-release brand will actually release at a different rate. So - before giving up on straight-release niacin because of the flushing - it's also a good idea to try out a few different brands to find one that releases more slowly.

I don't know how to respond to the possibility that businesses would sell a product without the labeled amount of a vitamin actually being in the pill. Is anyone watching? Maybe I'll look into that question.

Thanks for another great comment,

Steve

 
At 9:23 PM, Anonymous moises said...

Steve,

Thanks for your explanation. Both brands give no more than "niacin." But it seems as if it were niacinamide it would have been labeled as "no-flush" or something similar.

It hadn't occurred to me that my previous brand had different effects because of excipients, binders, etc. And what I've found with my new brand, after my initial experience, is that I get no flush at all on most days. And the days that I do get a flush, now that I know what it is, are quite tolerable.

Thanks for pointing out that I might have too hastily jumped to the wrong conclusion.

 
At 7:25 PM, Blogger Steve said...

Moises,

You're most welcome.

Steve

 
At 6:03 AM, Blogger Elaine Locke said...

Steve -- Hi, and thanks for such a helpful blog. I hope this question about vitamin D isn't too off topic. I have MS. I was reading some articles by Dr. Cannell and other sources of MS/low vitamin D levels, and long story short and stupid, I started 5000 IU vitamin D per day. I've taken this dose for 12 days (total dose 60,000 IU plus incidentals from about 16 oz milk per day) and yesterday started feeling very nauseated and with rapid heart beat. I believe I am exhibiting symptoms of vitamin D toxicity, and as of today will stop supplementation, eliminate sources of calcium and vitamin D, and drink enough water to eliminate excess calcium without developing kidney stones. My questions: are these actions sufficient or might I need further intervention and/or professional intervention? Should I take an alkaline agent and/or push fruits and vegetables in my diet, for example? What about phosphorus? What might be a "safe" wait period before starting calcium again? Although I've probably demineralized my bones from this, I would like to keep them as strong as possible. Does exercise have any adverse effects, since Vitamin D might be mobilized if fat is metabolized? I understand that your answers are just your opinion and not to be taken on a medical/professional level, but I don't know who else I might ask. I'm really mad at myself because I know better than to self-medicate, but gee I was hopeful. Thank you!

 
At 6:11 PM, Blogger Steve said...

Elaine,

Thanks for writing. I don't think you did anything stupid. After reading Dr. Cannell's website and others I chose to start vitamin D at 4000 IU/day - almost the exact choice you made. I fully expected side effects to occur. Unlike you, I had to wait 3 months.

Most people recover from mild vitamin D overdose with no harm done. Don't overly worry about having demineralized your bones.

I think the actions you have taken are sensible, and that moderate exercise will also help get you feeling better sooner.

The linkage between vitamin D and MS is strong. Vitamin D is also clearly linked to the immune system. As a person with MS, your interest in vitamin D is fully justified. I recommend that you consider getting plenty of sunshine. I'm out in the sun every day. As a result, knock on wood, I've greatly improved my immunity to the cold virus. I'm having my best fall ever.

In addition to sunshine, I recommend vitamin A, vitamin C, niacin and thiamine. These are the only vitamins that prevent pandemic vitamin deficiency diseases. If you're having any trouble finding my blog with recommended starting doses, just let me know. Please discuss your situation with a physician. I find my way around my blog with Google. Try typing cforyourself recommended doses.

 
At 3:37 PM, Blogger Elaine Locke said...

Steve, thanks for your comments. I had a flare a few years ago and it was frightening, and I'm always afraid something else might further throw my functioning off balance. I'll definitely check out the specific blogs you mention. I have some medical background and am aware I need to better balance vitamin intake, esp. vitamin D, but practically speaking haven't done as much as I should. My doc isn't familiar with this aspect of therapy. Thank you for your thoughts with this. Your blog seems well-balanced, and I'm grateful!

 
At 4:49 PM, Blogger Steve said...

Elaine,

Thanks. Please don't hesitate to ask more questions.

I'll keep you in my thoughts.

Steve

 
At 2:10 PM, Anonymous Anonymous said...

I know this is a relatively old post but I wanted to share my experience with you anyways. Without going into detail, 2010 was probably the worst year for me healthwise that I can remember. March 2010 I was diagnosed with prostatitis, I was treated with antibiotics. Residual symptoms waxed and waned over the following months. From late March 2010 to now January 2011 I've experience lower abdominal pain, urinary pain, perineal pain and most recently lower back(tailbone) pain that radiates into the buttocks and rectal region.

Now it may seem obvious that these are symptoms of chronic prostatitis but in my opinion a lot of them were muscular in nature because I never experienced them in the middle of the night or in the mornings when I was more relaxed. As the day would go on the symptoms would gradually start to re-appear.

I was trying to figure out how, out of nowhere it seems, I went from being in perfect health to having one of the worst years of my life. The ONLY change in lifestyle I had made was in LATE 2009 I started taking on average 3000 to 5000 iu's of Vitamin D3 per day. On some occassions when I felt a cold coming on, I would megadose 50,000 iu's.

So, last week I decided to stop taking it altogether just to see what would happen. I kid you not, I'm on day 8 of NO supplemental D3 and my symptoms are almost gone.

I'm not discounting D3's part in a healthy lifestyle but it just seems like WAY TOO MUCH of a coincidence.

Mike

 
At 5:00 PM, Anonymous Anonymous said...

I forgot to add in my previous post, but I'm 31 years old, currently living in Canada so getting Vitamin D through sun exposure is next to impossible during the fall and winter months.

I may spring for one of those Vitamin D lamps instead.

What people don't realize is that the studies show correlations between lower incidences of a bunch of different diseases in people who have higher 25(OH)D3 levels. Michael Holick has said before that there's no real way to tell yet whether or not it's D3 that's good for you, OR if it's the hundreds/thousands of other photo by-products the body produces during sun exposure. Or perhaps a combination of both.

One thing's for sure, I will make a concious effort to get more sun this spring and summer as it seems I DO NOT react well to supplements.

Mike

 
At 8:56 PM, Blogger Steve said...

Mike,

Awesome comment. I can't believe it took me so long to find it. I wish I knew how to use this blog better so I'd see every time someone left a comment.

Is anyone out there listening? Vitamin D supplements are toxic. Watch out if you are taking them. If you get side effects, don't give up on the vitamin D - switch to sunshine instead (and a sunlamp if you really can't manage the sunshine).

Steve

 

Post a Comment

<< Home