Dietary Disorder

I recently read an article written by a vegan (no animal products whatsoever) dietician who mentioned vitamin D supplementation. Unfortunately for herself and her readers, the information she gave them was inaccurate, even potentially harmful. She stated that vegans should not use vitamin D3/cholecalciferol since it came from animal sources. Instead, they should use vitamin D2/ergocalciferol which is from plant sources.

The idea that ergocalciferol (D2) is equivalent to cholecalciferol (D3) has been shown to be based on archaic, erroneous data as shown by the quote below.

“The case that vitamin D2 should no longer be considered equivalent to vitamin D3 is based on differences in their efficacy at raising serum 25-hydroxyvitamin D, diminished binding of vitamin D2 metabolites to vitamin D binding protein in plasma, and a nonphysiologic metabolism and shorter shelf life of vitamin D2. Vitamin D2, or ergocalciferol, should not be regarded as a nutrient suitable for supplementation or fortification.”

Check out this link for the full article as published in the American Journal of Clinical Nutrition.
http://www.ajcn.org/cgi/content/full/84/4/694

It is impossible to get enough vitamin D from one’s diet to achieve the optimal level of 50 – 60 ng/mL of 25 OHD even if one were to properly eat foods with D3 such as sardines. Therefore, if one is going to avoid UVB exposure, then one must take vitamin D3 supplements with 1000 IU/day as a minimum dosage. More is probably necessary to optimize 25 OHD.

The article allowed for comments, so I commented on it as above. My comment was up for about two hours and then disappeared. The vegan dietician has both MPH (Masters of Public Health) and RD (Registered Dietician) degrees, so one would assume that she was trained in critical thinking and the scientific method. However, removing my comment does not support that supposition.

By removing my comment, she is denying her readers the opportunity to judge the validity of her own comments. She evidently also denies the validity of research published in one of the major journals in her own field.

Vitamin D3/cholecalciferol is absolutely necessary for optimal health. Using the plant-based form will not cut it. Hiding that information from one's readers does not alter the facts, but it does alter one's perceptions of the one doing the hiding.

Vegging Out

The July, 2009 issue of the Journal of the American Dietetic Association has a position statement on vegetarian and vegan diets. Their position states that, “Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.” This is disturbing advice, especially since the ADA defines a vegetarian diet, “… as one that does not include meat (including fowl) or seafood, or products containing those foods.”

Brain growth is very rapid during infancy and childhood. Brain growth requires the fatty acids arachidonic acid (AA) and docosahexaenoic acid (DHA). A healthy, well-fed mother provides these fatty acids in her breast milk. Infant formulas need to be supplemented with these fatty acids; not all of them are. Research has shown that breastfed infants have, on average, higher IQs than do formula-fed infants. Here’s the takeaway message: brain growth requires animal-based fatty acids, not plant-based ones.

Monkey species like capuchins that eat meat are smarter than ones that do not like howlers. Chimps and orangutans show more complex behaviors in the wild than do the vegan gorillas.

Among the best sources of the brain growth fatty acids are fish and shellfish. There is evidence that brain growth was spurred in our hominid ancestors when they began including fish and shellfish in their diets. If not for that dietary change, we would probably still be small-brained hominids dodging cheetahs on the savannas.

The fatty acids AA and DHA are also needed to maintain brain health throughout one’s life. Lack of these fatty acids leads to neurological disorders, even dementia.

Vegging out means sitting around passively doing little thinking, i.e. a couch potato (a relatively useless vegetable). If you don’t eat fish and shellfish your brain will veg out. If you want to do that to yourself, well… However, deliberately stunting your infant or child’s chances for healthy brain development…? How can the ADA really believe that vegging out is a good option for anyone?

Dermatological Purdah

Once again, The American Academy of Dermatology Issues (AAD) has published a statement that, “The Academy continues to recommend that individuals protect themselves from UV exposure when outdoors, such as seeking shade whenever possible, wearing sunscreen and covering up with a wide-brimmed hat, long sleeves, pants and sunglasses.” This amounts to Dermatological Purdah: do not allow any skin exposure to the sun!

Evidently, the AAD would be thrilled if we returned to the fashions of the Edwardian era. Note the stylish summer wear of these two women. No sunglasses, but even better for concerned dermatologists, they are wearing gloves and carrying a parasol. What could be better for the AAD?! Let’s return fashion to the days of Fin de Siècle. No more worries: Skin will be smooth and untanned. Why live in the 21st century when the 19th will do so much better?

The AAD does admit that following their fashion purdah restrictions will mean that vitamin D supplementation will probably be necessary. However, they think that 1000 IU/day will be adequate. Adequate? Unlikely. It is estimated that at least 80% of the US population has inadequate levels of serum vitamin D. And the vast majority isn’t following purdah restrictions. 1000 IU/day is better than nothing, of course, but if you are already at inadequate levels (and the odds are that you are), and then you follow the AAD’s advice, 1000 IU/day will be nowhere near enough to optimize your vitamin D levels. Before deciding to undertake dermatological purdah, get you 25 OHD levels checked. Anything under 50 ng/mL means that you need to take a supplement. Vitamin D3 now comes in 2000 IU/day pills.

Think it isn’t that serious? Muslim women who practice purdah in Saudi Arabia (pretty darn sunny there) have dangerously low, even undetectable, levels of serum vitamin D. Edwardian women who practiced dermatological purdah had such high rates of flattened pelvic inlets that obstetricians thought that was what a normal pelvis looked like. Childbirth is hard enough with a normal pelvic inlet. Can you imagine what it was like in Edwardian times? Do you want to return to that era? I don’t.

Sure, you need to make sure that you don’t overdo sun exposure. But get real AAD, dermatological purdah is not the answer either.

It's About Time!!

Way back in 1992, I began doing research on vitamin D deprivation. At that time, there were only a few other researchers looking at this topic. If anyone else thought of vitamin D at all, they figured it was a very minor problem resolved by drinking milk; and that it only affected bones. My research pointed to vitamin D deprivation being a widespread problem that affected multiple regions in the body beyond bones. But trying to get most of my colleagues to take this seriously was an arduous, disappointing process.

Between 1999 and 2001, I submitted grants to NIH trying to get funding to do a major research study on vitamin D deprivation among heavily-pigmented women. There was no interest in such research at that time. I wrote articles on vitamin D deprivation that have been widely cited, but still the issue wasn’t considered important enough for the NIH.

Part of the reason for this is the massive public relations campaign against sun exposure launched and carried out by dermatologists and their media friends. Yes, too much UVB exposure can be a problem; but not enough exposure is a much bigger problem. Only in the past year or so has the media finally, finally realized this. Now we are seeing articles on vitamin D deprivation and the importance of maintaining optimal levels of vitamin D if one wishes to avoid multiple health problems such as heart disease, cancer, auto-immune conditions, and, of course, keeping the skeletal system strong.

And FINALLY the NIH is going to fund a major study on vitamin D deprivation. It’s only taken almost two decades, but better late than never. This study will enroll 20,000 participants from throughout the nation. However, the group is limited to women who are 65 or older, or men who are 60 or older. Also, they need to be free of any major health problems. The study will be double blind in that participants and researchers will not know whether the participant is receiving actual vitamin D3 (2000 IU/day) or a dummy pill. The vitamin D dosage is also large enough that effects should be noticeable, unlike other recent studies where the dosage was much lower.

The study begins in January 2010 and will run for five years, so we cannot expect to read about results any time soon. However, It’s About Time! Maybe we will now see many other major research projects done on this important topic.

Just today a large cancer research study [ http://www.washingtonpost.com/wp-dyn/content/article/2009/07/07/AR2009070702252.html ] found that even after controlling for a variety of factors, African Americans had higher rates of adverse outcomes for breast, colon, and ovarian cancers than was true of European Americans. This study evidently did not look at vitamin D levels, but, as I pointed out in one of my articles (Health Disparities: Reframing the Problem. Medical Science Monitor 2003; 9 (3): SR9-15), vitamin D deprivation is the probable factor involved in this disparity [ http://journals.indexcopernicus.com/fulltxt.php?ICID=4712 ]

Meanwhile, there is no evidence that taking 2000 IU of vitamin D3/day causes problems; and there are many studies that indicate there are important benefits. So, take your vitamin D every day and you will be ahead of the curve when the NIH study is finally analyzed and published.

Culture of Success

I just finished reading Outliers: The Story of Success by Malcolm Gladwell (author of The Tipping Point and Blink). This is a must-read book. You probably think you know why some individuals are successful and others are not, but you are probably wrong, at least according to Gladwell.

Why are the vast majority of successful Canadian hockey players born in January, February, and March? How do rice paddies and the way in which numbers are encoded in language relate to success in math for many East Asians? Why does the year in which someone is born lead to or inhibit that person’s chances for success? What is the 10,000 hour rule? How can deference to superiors lead to air disasters? Why would a culture of honor created hundreds of years ago and thousands of miles away still have an impact in the 21st century? Can the differences in academic achievement between rich and poor be as simple as the difference between summer vacations and year-round schooling?

These are some of the questions Gladwell raises and answers in his extremely entertaining and enlightening book. This is a book that so intrigued me that I didn’t want to put it down. I do not want to provide more detail about the book at this point because I strongly encourage everyone to read it for themselves. However, I would like to have a conversation on this blog with anyone who has read the book and wishes to discuss Gladwell’s insights further.