In a report issued late last year by the Institute of Medicine, a committee of physicians and researchers cautioned against taking large amounts of supplemental vitamin D and calcium because they are unnecessary and potentially harmful. However, the committee did recommend slight increases in the Recommended Daily Allowances (RDAs) for calcium (1,000 to 1,300 mg/d) and vitamin D (600 IU/d).

If you follow the advice of the Institute of Medicine, you’ll increase your long-term risk of disease.

It’s always safer for researchers and physicians to take the more conservative approach when recommending supplements—except that it reveals a naiveté about clinical nutrition and can lead to chronic nutritional deficiencies and harm to patients. That is the case with this cautious increase in the RDA for vitamin D, combined with a warning about high-dose vitamin D supplementation. Maintaining the status quo by saying “no” to higher dose supplements carries relatively little risk, at least for doctors. It’s a very different story for the average person, though.

The truth is that three of every four Americans are deficient or marginally deficient in vitamin D, a number that most likely gets even worse during the winter months when people huddle indoors. (Ginde AA. Arch Intern Med, 2009;169:626-632.) By refusing to acknowledge the scale of vitamin D deficiency, and the easy and inexpensive means of treating it, the committee from the National Institute of Medicine is guilty of malpractice. The committee members have reversed the Hippocratic Oath, from “first do no harm” to “first do harm.” Their action, or lack of action, is simply unconscionable.

The situation was made even worse by incredibly sloppy reporting in newspapers, particularly by Gina Kolata of the New York Times. In her article in the NYT after the report came out, she simply related a summary of the Institute of Medicine’s report without critical comment by any expert on vitamin D, such as Michael Holick, M.D., Reinhold Veith, Ph.D., or Robert Heaney, M.D. No mainstream reporter would be so uncritical in echoing a self-serving news release from politicians or corporations. But then, the committee did not even include a recognized expert on vitamin D, so the cautious nature of report may have reflected the fact that the committee members were out of their depth.

The cost of ongoing vitamin D deficiencies will mount with susceptibility to infectious diseases and a greater risk of cancer, heart disease, and depression. But then, there is much more money to be made on treating these diseases than on preventing them.

The Recommended Dietary Allowance or RDA (sometimes referred to as Recommended Daily Allowance) is defined as “the average daily dietary intake level that is sufficient to meet the nutrient requirements of nearly all (approximately 98 percent) healthy individuals”.

Most physicians (who practice Nutrition) and researchers consider the RDA an overly conservative and antiquated dietary standard. The RDA was designed by the federal government as a guideline for “practically all healthy persons,” but it’s easy to question whether Americans can be considered healthy-
In fact, the very concept of an RDA may be flawed. Forty years ago, Roger Williams, Ph.D., who discovered the B-vitamin pantothenic acid, developed the concept of “biochemical individuality.” Williams contended that people need the same nutrients-but that they are highly individualistic in the amounts they need. For one person, 100 milligrams daily of vitamin C might be sufficient for health; for another, 3,000 milligrams. In other words as we are all so different, so biochemically unique, our nutrient needs differ. As much as 10 fold for different people. And for optimal functioning, most people will need extra nutrients.

What’s a better way to assess a person’s nutritional needs?

Instead of minimum or recommended levels of nutrients, the late Nobel laureate Linus Pauling, Ph.D., emphasized the concept of optimal nutrition-that is, providing the body’s cells with levels of vitamins and minerals that help them function at their best. It is like putting premium gas instead of regular fuel into your body.

Determining your optimal intake requires a little experimentation as everyone is a little different. My experience has shown me that almost everyone in this day and age needs a good multi that has way more than the recommended RDA’s. For example, Pauling often recommended that people take anywhere from 100 to 300 times the RDA level of vitamin C for optimal health. Determining your optimal intake requires a little experimentation-everyone is a little different.

First, you need to set some clear objectives that you want to achieve with supplements. Second, you need to assess whether specific supplements help you feel better.

For example, if you’re in your 20s, eat well, and are in good health, your objective might be “dietary insurance.” You may not need much more than a multivitamin supplement and a little extra vitamin C.
On the other hand, if you’re in your 30s and face a lot of stress at home or at work, “stress management” might be an objective. In this case, you might do well taking a high-potency B-complex supplement. The B-complex has long been considered the anti-stress supplement.

My basic recommendations for supplements to sustain wellness are a good multivitamin with good amounts of the B vitamins, at least 2,000 IU of vit D, a good fish oil and a probiotic.

With the fanfare of a holiday parade, drug companies a few years ago unveiled two new Cox-2 inhibitor drugs-Celebrex and Vioxx-to treat arthritis, inflammation, premenstrual syndrome, and potentially even cancer. All the hoopla paid off. Since then, doctors have written more than seven million prescriptions for these “super aspirin” drugs, earning hundreds of million dollars for their makers.

Cox-2 is short for cyclooxygenase-2, one of the key enzymes that helps the body produce inflammatory hormone-like compounds called prostaglandins and cytokines. Cox-2 is essential-without it, we wouldn’t be able to fight infections or heal injuries. But when the body overproduces Cox-2, the result is chronic inflammation and pain.

The intensive marketing and advertising of Cox-2 inhibitors obscured why many people overproduce the enzyme. Too much Cox-2 appears to result from imbalances and deficiencies of certain nutrients. Rather than correct these underlying dietary problems, pharmaceutical Cox-2 inhibitors only mask the most visible symptoms. Relatively minor dietary changes, plus some vitamin and herbal supplements, correct the underlying problems.

Problems with Cox-2 Inhibitor Drugs

For years, people have used nonsteroidal antiinflammatory drugs (NSAIDS), such as ibuprofen, to treat the inflammation and pain associated with rheumatoid arthritis and osteoarthritis. NSAIDS ease inflammation by inhibiting the activity of both Cox-2 and Cox-1, the latter an enzyme that helps maintain homeostasis (biological equilibrium) protect the stomach lining. Because stomach ulcers occur in about 25 percent of NSAID users, pharmaceutical companies worked to develop NSAIDS that blocked only the activity of Cox-2. The idea was that a selective Cox-2 inhibitor would reduce inflammation but not irritate the stomach.

The motivation was profiting from a potentially huge market. An estimated 40 million Americans suffer from some form of arthritis. In a typical year, physicians write about 60 million prescriptions for NSAIDS-to say nothing of their over-the-counter sales. However, each year some half-million people develop complications from NSAIDS, with an estimated 80,000 people requiring hospitalization and 8,000 dying.

Though touted for their relative safety, Cox-2 inhibitors may be far more hazardous than originally believed. While gastrointestinal problems with Cox-2 inhibitors occur less frequently, they can be severe. Just four months after the FDA approved Celebrex, 10 deaths from the drug were reported. One study has even suggested that Cox-2 is important to the gut and healing ulcers, suggesting that pharmaceutical tampering with the enzyme may not be wise.

The Double-Edged Sword of Inflammation

Nutrients supply the most basic building blocks of the body’s powerful inflammatory compounds. The “parent” nutrient is linoleic acid, found in many foods but especially concentrated in vegetable oils (e.g., corn, soy, and safflower oils). The body converts linoleic acid to the omega-6 family of fatty acids, including arachidonic acid. Cox-2 plays a critical role in converting arachidonic acid to the hormone-like prostaglandin E2 (PGE2) and to the cytokines interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFa), all of which promote inflammation.

According to Robert F. Grimble, Ph.D., of the University of Southampton, England, once an infection or injury stimulates production of IL-1 and TNFa, these two proinflammatory compounds can further stimulate each other, as well as IL-6. In addition, IL-1 and TNF a trigger the production of free radicals, which encourage the production of more proinflammatory cytokines. The proinflammatory reaction essentially feeds on itself, setting the stage for chronic inflammation.

Ideally, the body balances these compounds with a group of antiinflammatory compounds that originate with alpha-linolenic acid, found in cold-water fish, leafy green vegetables, and flaxseed. The body converts alpha-linolenic acid to the omega-3 family of fatty acids, which include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Preformed EPA and DHA are also found in cold-water fish.

Much of the problem with inflammatory disorders actually stems from a lopsided imbalance in dietary intake of the omega-6 and omega-3 fatty acids-and the consequential cascade in proinflammatory activity. Artemis Simopolous, M.D., director of the Center for Genetics, Nutrition and Health in Washington, D.C., has shown that people historically consumed roughly equal amounts of the proinflammatory omega-6 fatty acids and the antiinflammatory omega-3 fatty acids.

However, over the past 30 years or so, Americans have replaced much of their dietary saturated fat (a bystander, so far as inflammation is concerned) with omega-6 fatty acids. Simopoulos estimates that people are now eating 20 times more omega-6s than omega-3s. From a biochemical standpoint, this sets the stage for powerful and chronic proinflammatory reactions.

Indeed, inflammation plays a role in many diseases, including arthritis, gingivitis and most of “-itis” diseases. Recent research has pointed to the role of inflammation in heart disease, stroke, and even Alzheimer’s disease. In addition, Bruce N. Ames, Ph.D., of the University of California, Berkeley, has estimated that chronic inflammation and infection cause about one-third of all cancers.

This relationship between diet, inflammation, and cancer was recently demonstrated by researchers at the American Health Foundation, Valhalla, New York. In animal experiments, they noted that corn oil (rich in omega-6) increased Cox-2 activity, whereas fish oil (rich in omega-3) blunted Cox-2 activity. The researchers also showed that the omega-6 fatty acids could promote the growth of colon cancer, whereas the omega-3 fatty acids prevented cancer.

In addition to a diet containing too many omega-6 fatty acids, a shortage of nutritional antioxidants, such as vitamin E, also contributes to chronic inflammation. The proinflammatory cytokines, IL-1 and TNFa, trigger the release of free radicals. A diet rich in antioxidants-found chiefly in vegetables and fruit-can help neutralize these free radicals. But relatively few people-9 to 34 percent, according to different researchers-eat the recommended five daily servings of vegetables and fruit. Between an excess omega-6 fatty acids and a lack of omega-3 fatty acids, and inadequate intake of antioxidants, the body’s proinflammatory reaction goes out of control, leading to chronic inflammation and pain.

Quenching the Fires of Inflammation

The simplest and most biochemically sound way of turning down the body’s proinflammatory prostaglandins and cytokines is by restoring a balance between pro- and antiinflammatory foods. From a dietary standpoint, this means switching from vegetable oils to extra-virgin olive oil (high in antiinflammatory omega-9 fatty acids). It also means avoiding most processed (boxed, canned, or frozen) foods, because their makers frequently add omega-6 fatty acids. By eating simple unprocessed foods-such as baked chicken, a salad, and steamed vegetables-it becomes easier to consume a more balanced ratio of omega-6 and omega-3 fatty acids.

However, if you’re like most people, you’ve been eating a diet high in omega-6 fatty acids and low in antioxidants for years. Simply restoring a balance is not enough to quickly offset accumulated damage, because the fatty acid composition of the body’s cells reflects their dietary ratios. It’s imperative to increase consumption of antiinflammatory fatty acids and antioxidants.

These are the supplements to emphasize:

• Omega-3 essential fatty acids

Found in fish oils, EPA and DHA are essential building blocks for the body’s antiinflammatory prostaglandins (e.g., prostaglandin E1) and for turning off Cox-2 and the body’s proinflammatory cytokines (IL-1, IL-6, and TNFa). In addition, omega-3 fatty acids block the activity of an enzyme that breaks down joint cartilage. Daily dosage: 3 or more grams.


• Vitamin E

Although Cox-2 and prostaglandin E2 levels rise with age, animal studies have shown that vitamin E supplements reverse the increase in Cox-2 and prostaglandin E2. Vitamin E also turns off nuclear factor-kB (NF-kB) and activator protein-1 (AP-1), compounds that turn on inflammatory genes. One recent study found that arthritics taking supplements of natural vitamin E (600 mg twice daily) for 12 weeks had their pain reduced by about half. Daily dosage: 400-800 IU.


• Polyphenols and Flavonoids

Researchers at Case Western Reserve University, Cleveland, recently reported that the antioxidant polyphenols in green tea had antiinflammatory properties by inhibiting Cox-2 and TNFa. Genistein inhibits prostaglandin E2 and Cox-2, and quercetin inhibits the activity of inflammation-promoting “adhesion” molecules. It’s likely that Pycnogenol, grape seed extract, and other flavonoids work through similar mechanisms. Daily dosage: 25-500 mg.


• Silymarin

A cell-culture study found that silymarin, the antioxidant extract of milk thistle, inhibited Cox-2 formation. This role of silymarin may partly explain why earlier cell-culture studies found it to inhibit the growth of prostate, breast, and skin cancers. Daily dosage: 100-200 mg.


• Rosemary

This common kitchen herb is rich in ursolic acid and many of its derivatives. In laboratory experiments, Swedish researchers found that the ursolic acid extract of rosemary was a potent inhibitor of Cox-2 activity. Daily dosage: 100 mg.


• Cat’s Claw

Known as una de gato and Uncaria tomentosa, this Peruvian herb has a long history as a remedy for inflammatory arthritis. Recent cell-culture and animal experiments at the Albany Medical College, New York, found that cat’s claw inhibited inflammation by blocking the activity of NF-kB. Daily dosage: Because products vary, follow label directions.

The take home message in all this is relatively simple: pharmaceutical drugs, while providing rapid relief of symptoms, do not correct the underlying cause of chronic inflammation. The cause is frequently a diet that’s either unbalanced or lacking in key nutrients. No drug can correct a nutritional deficiency or imbalance. Only nutrients can do that.

Numerous surveys over the past 150 plus years have confirmed that people who seek homeopathic treatment tend to be considerably more educated than those who don’t (1). What is not as well known is the fact that homeopathic medicine is the leading “alternative” treatment used by physicians in Europe…and growing numbers of the citizenry.
And despite homeopathy’s impressive popularity in Europe, it is actually even more popular in India where over 100 million people depend solely on this form of medical care (2). Further, according to an A.C. Neilsen survey in India, 62 percent of current homeopathy users have never tried conventional medicines and 82 percent of homeopathy users would not switch to conventional treatments (3).

Skeptics of homeopathy insist that homeopathic medicines do not work, but have difficulty explaining how so many people use and rely upon this system of medicine to treat themselves for so many acute and chronic diseases; and a very large number of these people do not have to use anything else. A previous article that I wrote at this site presented a strong case for the scientific and historical evidence for homeopathy. Further, other articles here have provided additional scientific evidence for the use of homeopathic medicines in respiratory allergies and in pediatrics. Although a small and vocal group of skeptics of homeopathy continue to deny its viability, homeopathy’s growing popularity throughout the world amongst physicians, other health professionals, and educated populations continue to prove that skeptics are really simply medical fundamentalists.

The entire field of “alternative and complementary medicine” was so hot in the 1980s that, according to a respected market survey, the field of alternative and complementary medicine in Europe was second only to the computer industry for growth during this decade (4). This explosion of interest in natural medicine has continued in the 21st century.
In 1998, homeopathy was the most frequently used CAM therapy in five out of 14 surveyed countries in Europe and among the three most frequently used CAM therapies in 11 out of 14 surveyed countries (5). Three out of the four Europeans know about homeopathy and of these people 29 percent use it for their own health care. In other words, approximately 100 million Europeans use homeopathic medicines (6).

The sales of homeopathic and anthroposophical medicines grew by 60 percent between 1995 and 2005, from 590 million Euros in 1995 to 775 million Euros in 2001 and to $930 million Euros in 2005 (7). Because of homeopathy’s impressive and growing popularity in Europe, this alternative treatment poses a significant threat to conventional medicine, which may explain why there are ongoing efforts to attack it (and homeopaths) using devious and questionably ethical means.

France

Homeopathy is particularly popular in France, where it is the leading alternative therapy. In 1982, 16 percent of the population used homeopathic medicine, rising to 29 percent in 1987, and to 36 percent in 1992 (8). In 2004, 62 percent of French mothers used homeopathic medicines in the previous 12 months (9). A survey of French pharmacists was conducted in 2004 and found that an astounding 94.5 percent reported advising pregnant women to use homeopathic medicines (10).

Homeopathy is popular not only among the French public but also among the French medical community. As many as 70 percent of physicians are receptive to homeopathy and consider it effective, at least 25,000 physicians prescribe homeopathic medicines for their patients. Homeopathy is taught in at least seven medical schools: Besancon, Bordeaux, Lille, Limoges, Marseille, Paris-Nord, and Poitiers, and there are numerous postgraduate training programs. Courses in homeopathy are taught in 21 of France’s 24 schools of pharmacy, and also taught in two dental schools, two veterinary medical schools, and three schools of midwivery.

United Kingdom

England’s Royal Family has been homeopathy’s strongest advocates, thereby confirming that this system of natural medicine is not some “new age” therapy. There are five homeopathic hospitals working within the National Health Service, some of them with a two-year waiting list for non-emergency visits to a homeopath.
According to a House of Lords report (2000), 17 percent of the British population use homeopathic medicines (11). The respect accorded homeopathy and homeopathic practice by British physicians is evidenced by a 1986 survey in the British Medical Journal that showed that 42 percent of physicians referred patients to homeopathic doctors (12). Other evidence of support from health professionals was a 1990 survey of British pharmacists that found 55 percent considered homeopathic medicines “useful,” while only 14 percent considered them “useless” (13). The normally conservative British Pharmaceutical Association held a debate in 1992 to decide whether pharmacists should promote homeopathic medicines (14). They concluded by a large majority that they should. The field of complementary medicine has gained much support in the 1990s. In 1993 the British Medical Association published a book entitled, Complementary Medicine: New Approaches to Good Practice (15). Britain’s health minister (in 1994), Dr. Brian Mawhinney, stated, “Complementary medicine has generally proved popular with patients, and a recent survey found that 81 percent of patients are satisfied with the treatment they received” (16). Another health minister stated that 80 percent of general practitioners want training in complementary therapies; 75 percent now refer patients to complementary therapists.

Despite the use and acceptance of homeopathy throughout the U.K., there is a very active group of skeptics, with significant Big Pharma funding, who work vigorously to attack this system of natural medicine. Even though there is a wide variety of serious and significant pressing issues in British medicine and science today, an active group of skeptics of homeopathy successfully resurrected in October, 2009, a House of Commons committee, called the Science and Technology Committee, with the intent to issue a report on homeopathy. A leading skeptics organization, Sense about Science, that has been pushing for the re-creation of this Committee is led by a former public relations professional who worked for a PR company that represents many Big Pharma companies. Of additional interest is the fact that other Directors of the Sense about Science organization are a mixture of former or present libertarians, Marxists, and Trotskyists who also, strangely enough, seem to advocate for the GMO industry (ironically, libertarians normally advocate for a “live and let live” philosophy, but in this instance, it seems that they prefer to take choice in medical treatment away from British consumers).

Sense about Science is a registered UK charity despite being a political pressure group. As such they have to divulge their sources of income which they do on their website. Not surprisingly, much of this comes from named pharmaceutical manufacturers.

One of the investigators for the House of Commons Science Committee is a Liberal Democrat MP, Evan Harris. He has collaborated with Sense About Science on various projects, and he was also one of the skeptic demonstrators against the national pharmacy chain, Boots, which sells homeopathic medicines. This advocacy role does not make him an unprejudiced observer as is required for this type of investigation.

A report from this kangaroo court was issued recommending that the National Health Service stop funding for homeopathy and homeopathic doctors, despite the support for homeopathy and for consumer choice from Mike O’Brien, the country’s present Health Minister. This report is only of an advisory nature, and because the Health Minister has already expressed his support for consumers’ right to choose their own health care, it is uncertain what, if anything, will result of this report. What was most surprising about this report was that it verified that when people repeat a lie frequently enough, such as “there is no research on homeopathy,” many people actually believe it, despite its transparent falsity.

Any rational person should and must be very suspicious of this “report.” The MPs (Members of Parliament) who were a part of the Science and Technology Committee which voted for this anti-homeopathy report comprised of five members, with three members barely eking out their victory. Of the three votes, two members did not attend any of the investigational meetings, one of whom was such a new member of the committee that he wasn’t even a member of the committee during the hearings, and the remaining “yes” vote was from Evan Harris, a medical doctor and devout antagonist to homeopathy. This report was not exactly a vote of and for the people.

In Scotland, 12 percent of general practitioners use homeopathic medicines and 49 percent of all general practitioner practices prescribe them (at least one medical doctor in a group practice)(17). The use of homeopathic medicines is not simply popular in the treatment of humans but also animals. Although there is little data presently available on this subject, one survey discovered that 20 percent of Irish milk producers have tried homeopathic medicines to treat mastitis or high cell count cows, and 43 percent believe that they work. In the herds surveyed, 50 percent added homeopathic medicines to the cow’s drinking water, 27 percent administered medicines via injection, six percent orally doses the cows, and six percent of herds placed the medicines in the cow’s vagina (18).

Ireland

A survey in Ireland was conducted at 13 pediatric settings over a 4-month period (19). They found that 57 percent of parents reported using CAM for their child. Use was significantly higher in the two to four years age group. The most common medicinal CAMs used were vitamins (88 percent), fish oils (27 percent) and Echinacea (26 percent). The most common non-medicinal CAMs used were homeopathy (16 percent) and craniosacral therapy (14 percent). Only 13 percent of parents had informed their pediatrician of their child’s CAM use.

Germany

The German people are so supportive of natural medicine that the German government mandated that all medical school curricula include information about natural medicines. Approximately 10 percent of German doctors specialize in homeopathy, with approximately 10 percent more prescribing homeopathic remedies on occasion. In 1993, there were 1,993 medical doctors who had formally qualified in homeopathy, while in 2006, this number jumped over 100 percent to 6,073 (20). In Germany there are 9,000 natural health practitioners called heilpraktikers in 1993 and over 20,000 in 2007. Approximately 20-30 of heilpraktikers specialize in homeopathy.

A cross-sectional survey was conducted in a large random sample of 516 German outpatient care physicians with qualifications in 13 medical fields representative of a basic population of 118,085 statutory health insurance physicians in November and December 2005 as part of a national healthcare survey (21). In this survey, 51 percent were in favor of CAM use (26 percent were very much in favor, 25 percent were in favor). This survey found that 38 percent of the medical doctors prescribed homeopathic medicines.

A survey of departments of obstetrics in hospitals in the state of North Rhine-Westphalia, Germany, found that acupuncture and homeopathic medicine were the two most commonly used CAM practices (22). A total of 187 department of obstetrics were identified, and 138 (73.4 percent) responded to a questionnaire. Almost 96 percent of the obstetrical departments offered homeopathic medicines for obstetrical care.

The 2003-2006 German Health Interview and Examination Survey for Children and Adolescents (KiGGS) found a higher than expected use of homeopathic medicine amongst German children (23). The survey found that pediatric homeopathy is quite popular in Germany, particularly among children from families with a higher socioeconomic status. Nearly half of the homeopathic preparations were obtained by prescriptions from medical doctors or Heilpraktiker (non-medical practitioners) and used most often to treat certain self-limiting conditions. About 60 percent of homeopathy users concomitantly received conventional medicines. Homeopathy use was closely related to socioeconomic factors, with a significantly higher prevalence rate found in the zero to six year age group, among children residing in the former West Germany or the south of Germany, among children with a poor health status, with no immigration background , who received breast-feeding greater than 6 months, were from upper social-class families, and whose children’s mothers were college educated.

In 2002, the British Medical Journal (BMJ) reported that 75 percent of Germans have used complementary or natural medicine (24). They also reported that 5,700 doctors received specialized training in natural medicine, with this number doubling to 10,800 by 2000. Homeopathic medicine is practiced by 4,500 medical doctors in Germany, almost twice as many as did so in 1994. The German government conducted this survey, and it also discovered that there was a 33 percent reduction in sick days if people used natural therapies, especially homeopathy or acupuncture. It was also reported that women used natural therapies more than men did, but when men used them, they benefited more than women did.

In 2009 a survey of Germans who used homeopathy or acupuncture was published (25). This survey found that seven percent of the population used homeopathy and 10 percent used acupuncture. Individuals who had a high education level used homeopathy (68 percent), as compared with 53 percent who used acupuncture.
A survey of patients in Germany with chronic lymphocytic leukemia found that 44 percent had used alternative treatments. No correlation was seen with educational level, gender, or previous or current chemotherapy. The most common alternative or complementary treatment modality was vitamin supplementation (26 percent), followed by mineral (18 percent), homeopathic (14 percent), and mistletoe therapy (9.2 percent) (26).
A 2008 survey of German children with cancer was conducted and which found that 35 percent of the responders had used CAM (27). The most frequently used methods were homeopathy, dietary supplements and anthroposophic medicine including mistletoe therapy. Factors which increased the probability of using CAM were the previous use of CAM, higher social status and poor prognosis of the child’s disease. An impressively high percentage of parents of patients (89 percent) reported that they would recommend CAM to other parents.

The use of homeopathy and CAM in Germany by people with other chronic disease is also high, as was observed in a survey of German’s with multiple sclerosis (28). A 53-item survey was mailed to the members of the German Multiple Sclerosis Society, chapter of Baden-Wuerttemberg. Surveys of 1,573 patients were analyzed. In comparison with conventional medicine, more patients displayed a positive attitude toward complementary and alternative medicine (44 percent vs 38 percent, P less than 0.05), with 70 percent reporting lifetime use of at least one method. Among a wide variety of complementary and alternative medicine, diet modification (41 percent), Omega-three fatty acids (37 percent), vitamins E (28 percent), B (36 percent), and C (28 percent), homeopathy (26 percent), and selenium (24 percent) were cited most frequently. Most respondents (69 percent) were satisfied with the effects of complementary and alternative medicine. Use of complementary and alternative medicine was associated with religiosity, functional independence, female sex, white-collar job, and higher education (P less than 0.05). Compared with conventional therapies, complementary and alternative medicine rarely showed unwanted side effects (9 percent vs 59 percent, P less than 0.00001).

Sales of homeopathic medicines in Germany were approximately $428 million in 1991, growing at a rate of about 10 percent per year. Evidence of the significant support from the German medical community is the fact that 85 percent of these sales are prescriptions from physicians. Surveys indicate that 98 percent of pharmacies sell homeopathic medicines.

Switzerland

A government-sponsored survey was conducted in Switzerland that evaluated patient satisfaction and side effects in primary care and that compared homeopathic treatment and conventional medical treatment (29). A total of 3,126 adult patients responded to a questionnaire, 1,363 of whom received conventional medical treatment and 1,702 who received homeopathic treatment. This survey found that a higher percentage of homeopathic patients had chronic and severe conditions than the conventional medical patients, that homeopathic patients were more often “completely satisfied” with their treatment (53 percent vs. 43 percent), that homeopathic patients experienced significantly fewer side effects (7.3 percent vs. 16.1 percent), that the proportion of patients reporting complete resolution of symptoms was non-significantly higher in the conventional medical patients (28 percent vs. 21 percent). What is particularly important about this survey is the observation that homeopathic patients had a higher percentage of seriously ill patients but they expressed a much higher amount of satisfaction with their treatment than the patients who received conventional medical treatment. This survey also confirmed a common observation about people who seek homeopathic treatment and that is they were much more educated than those who didn’t (32.4 percent vs. 24.7 percent received “higher education”).

The Swiss Federal Office for Public Health issued a report to the government of Switzerland which concluded that “the effectiveness of homeopathy can be supported by clinical evidence, and professional and adequate application be regarded as safe” (30).

Other European countries in which homeopathy has a relatively strong presence include Switzerland, where different surveys have suggested that somewhere between 11 percent and 27 percent of general practitioners and internists prescribe homeopathic medicines; Italy where nine percent of the medical doctors prescribe homeopathic remedies sometimes; and the Netherlands where 45 percent of physicians consider homeopathic medicines effective and 47 percent of medical doctors use one or more complementary therapies, with homeopathy (40 percent of these select doctors) being the most popular (31).

The prevalence of CAM use in a sample of Swiss patients undergoing kidney transplant was 11.8 percent. The most frequently used alternative therapy used among these was homeopathy (42.9 percent) (32).

Italy

In 2004 a total of 7.5 million Italians use homeopathic medicines, 2.5 million more than a survey showed in 2000 (33). Approximately 14 percent of Italian women and 10 percent of men prefer homeopathic medicine to conventional medicine. A total of 9.6 percent of children between three and five years of age are treated with homeopathic medicines. Almost 90 percent of Italians who have used such medicines say these treatments helped by them, with 30 percent saying that they used homeopathic medicines for pain syndromes and 24 percent for severe or chronic diseases.

A 2005 survey on the use of complementary and alternative medicines (CAM) among cancer patients in Europe reported that 73 percent of the Italian cancer patients had used CAM, a number well above the European average of 36 percent (34). The most popular treatment modalities used by cancer patients in Italy were high use of homeopathy, herbal medicine, and spiritual therapies. A 2008 survey in Tuscany, Italy found that the incidence of CAM use after cancer diagnosis was 17 percent, with the most widely used forms being herbal medicine (52 percent), homeopathy (30 percent) and acupuncture (13 percent) (35). Use was higher in the urban area and among women, breast cancer patients, and persons with a higher education.

A survey of Italian children with cancer who were being treated at a conventional pediatric oncology unit found that 12.4 percent of the children used at least one type of CAM, with homeopathy being the most popular (36). Eighty-three percent of the parents of these children reported benefits, ranging from improved immune defenses, regression of diplopia, or improved blood values. This study confirmed the observation of many other surveys which found that users of CAM tended to be more educated than those who did not use CAM (37)(38)(39).

Five hundred and fifty-two patients who had inflammatory bowel disease and who were under treatment at an Italian tertiary medical referral center completed the questionnaire (40); 156 (28 percent) reported using alternative and complementary therapies, of which mainly involved homeopathy (43.6 percent), followed by controlled diets or dietary supplements (35.5 percent), herbs (28.2 percent), exercise (25.6 percent) and prayer (14.7 percent). An improvement in well-being (45.5 percent) and inflammatory bowel disease symptoms (40.3 percent) were the most commonly reported benefits. A higher education (P equal to 0.027), a more frequently relapsing disease (P equal to 0.001) and dissatisfaction with the doctor’s communication (P equal to 0.001) correlated with alternative and complementary therapy use. Non-compliance with conventional drugs, disease severity and curiosity regarding novel therapies were predictors of alternative and complementary therapy use.

Spain

In Spain, homeopathy has gotten so popular that INE, the country’s statistic institute, added expenditures on homeopathic medicines to their calculations for monthly inflation rates (41). Sales of homeopathic medicines in Spain are growing at 10-15 percent annually, with approximately 15 percent of the population saying that they have used a homeopathic medicine and 25 percent said that they would be happy to try one (42).

Eastern Europe
When the Iron Curtain was up, Hungary, Czechoslovakia, and East Germany banned homeopathy, but this medical iron curtain fell with communism. Homeopathy holds a unique place in Russia, where it has been widely accepted, but is not sanctioned by the state medical bureaucracy. Thus, homeopathic care is not free and has been a part of the new Russian economy where fees are paid for health services. Demand for homeopathic care is so great that Russians prefer to pay for homeopathic care than to receive free conventional medical care.

Some skeptics have asserted that homeopathy and natural medicines are becoming increasingly popular in Russia because “real medicine” is either unavailable or too expensive (43). However, this assumption has been disproven, because the trend toward homeopathic and natural medicine is particularly popular among those Russians who are more educated and are in higher economic classes. Journalists and skeptics tend to assume that homeopathic medicines simply do not work, and thus they create fanciful theories about why the use of homeopathy is increasing.
A survey of Russian physicians in three academic hospitals in St. Petersburg was published in 2008 (44). This survey found that 100 percent of the respondents had practice CAM and/or referred patients to at least two CAM therapies. On average, each physician had practiced or referred patients to 12.7 different CAM treatments. Homeopathic medicine was the 8th most popular, with 58 percent using or referring for homeopathic treatment, 31 percent using on themselves, 29 percent using it on their own patients, and 38 percent referring for homeopathic care.

In Hungary, homeopathic literature was banned for 40 years until 1990. Homeopathy has now been accepted and integrated into regular medical education and is taught in two medical schools. The Hungarian Homeopathic Medical Association started with 11 members in 1990, grew to 75 after 18 months, and grew further to 302 members in 1994.
After the fall of communism in Czecholslovakia, a homeopathic organization in the Czech Republic was established in November, 1990, and it was immediately accepted and integrated within the larger conventional medical society. Within a year, the Ministry of Health officially recognized homeopathy as a medical specialty.

REFERENCES:

(1) Rothstein, W. Physicians in the Nineteenth Century. Baltimore: Johns Hopkins University Press, 1972.
(2) Prasad R. Homoeopathy booming in India. Lancet, 370:November 17, 2007,1679-80. (Additional note: Even though the overall mortality rate in India is quite poor compared with most modern First World countries, this is primarily due to the large number of exceedingly poor people. The mortality rate of urban middle and upper class people in India is comparable, if not better, than similar populations in the USA.)
(3) A C Neilsen survey backs homeopathy benefits. Business Standard. September 4, 2007. http://www.business-standard.com/india/news/a-c-nielsen-survey-backs-homeopathy-benefits/295891/
(4) “Alternative Medicine/Alternative Medical Market,” Frost and Sullivan Ltd. Report #E874, London, 1986.
(5) Norges offentlige utredninger, NOU 1998:21 Alternativ medisin. (Official report published by the Norwegian Department of Health. Available at: http://www.regjeringen.no/en/ministries/hod/Documents/NOUer/1998/NOU-1998-21.html?id=141407
(6) di Sarsina PR, Iseppato I. Looking for a person-centered medicine:non convent8onal medicine in the conventional European and Italian setting. eCAM, 2009; doi:10.1093/ecam/nep048.
(7) ECHAMP, Facts and Figures, Second edition, 2007. www.echamp.eu
(8) L’Homeopathie en 1993. Lyons: Syndicat National de la Pharmacie Homeopathique, 1993 (Quoting COFREMCA and IFOP public opinion surveys).
(9) Transactions, Nutrition Business Journal, July 7 2004.
(10) Damase-Michel, C., Vie, C., Lacroix, I., Lapeyre-Mestre, M., Montastruc, J.L. Drug Counselling in Pregnancy: An Opinion Survey of French Community Pharmacists, Pharmacoepidemiol Drug Saf. 2004 March, 18;13(10):711.
(11) House of Lords Science and Technology Report, November, 2000
http://www.publications.parliament.uk/pa/ld199900/ldselect/ldsctech/123/12303.htm
(12) Richard Wharton and George Lewith, “Complementary Medicine and the General Practitioner,” British Medical Journal, 292 (June 7, 1986): 1498-1500.
(13) Nelson, op. cit.
(14) Steven Kayne, “Homeopathic Pharmacy: Education, Research and Optimism,” British Homoeopathic Journal, October, 1993: 225.
(15) British Medical Association, Complementary Medicine: New Approaches to Good Practice, Oxford: Oxford University, 1993.
(16) Universal News Services, June 16, 1994.
(17) Ross, S, Simpson, CR, McLay, JS. British Homoeopathic and herbal prescribing in general practice in Scotland. Journal of Clinical Pharmacology, 62,6: December 2006, 647-652.
(18) Buss, Jessica. Irish Turn to Homoeopathy. Farmers Weekly, October 16, 1998.
(19) Low E, Murray DM, O’Mahony O, O’B Hourihane J. Complementary and alternative medicine use in Irish paediatric patients. Ir J Med Sci. 2008 Apr 22.
(20) Joos S, Musselmann B, Miksch A, Rosemann T, and Szecsenyi J. The role of complementary and alternative medicine (CAM) in Germany – a focus group study of GPs.
BMC Health Services Research 2008, 8:127. doi:10.1186/1472-6963-8-127
(21) Stange R, Amhof R, Moebus S. Complementary and alternative medicine: attitudes and patterns of use by German physicians in a national survey. J Altern Complement Med. 2008 Dec;14(10):1255-61.
(22) Munstedt K, et al. Clinical indications and perceived effectiveness of complementary and alternative medicine in departments of obstetrics in Germany: A questionnaire study. Eur J Obstet Gynecol (2009), doi:10.1016/j.ejogrb.2009.05.013
(23) Du Y, Knopf H. Paediatric homoeopathy in Germany: results of the German health interview and examination survey for children and adolescents (KiGGS). Pharmacoepidemiol Drug Saf. 2009 Feb 23.
(24) Tuffs, Annette, Three out of Four Germans Have Used Complementary or Natural Remedies, BMJ, November 2 2002;325:990.
(25) Bussing A, Matthiessen PF, Ostermann T. Differential usage of homeopathy and acpunture in German individuals. 2009 North American Research Conference on Complementary and Integrative Medicine, May 2009, Minneapolis, MN. Published in Alternative Therapies. May/June 2009, 15,3:S141.
(26) Hensel M, Zoz M, Ho AD. Complementary and alternative medicine in patients with chronic lymphocytic leukemia. Support Care Cancer. 2008 May 6.
(27) Laengler A, Spix C, Seifert G, Gottschling S, Graf N, Kaatsch P. Complementary and alternative treatment methods in children with cancer: A population-based retrospective survey on the prevalence of use in Germany. Eur J Cancer. 2008 Oct;44(15):2233-40.
(28) Schwarz S, Knorr C, Geiger H, Flachenecker P. Complementary and alternative medicine for multiple sclerosis. Mult Scler. 2008 Sep;14(8):1113-9.
(29) Marian F, Joost K, Saini KD, et al Patient satisfaction and side effects in primary care: an observational study comparing homeopathy and conventional medicine. BMC Comp Alt Med 2008, 8:52. doi:10.1186/1472-6882-8-52.
(30) Bornhoft, G, Wolf, U., von Ammon, et al, Effectiveness, Safety, and Cost-Effectiveness of Homeopathy in General Practice–Summarized Health Technology Assessment, Forschende Komplementarmedizin, 2006;13(suppl 2):19-29.
(31) Fisher, Peter and Ward, Adam. “Complementary Medicine in Europe,” British Medical Journal, 309, July 9, 1994: 107-10.
(32) Hess S, De Geest S, Halter K, Dickenmann M, Denhaerynck K. Prevalence and correlates of selected alternative and complementary medicine in adult renal transplant patients. Clin Transplant. 2008 Sep 11. Clin Transplant. 2008 Sep 11.
(33) ANSA English Corporate Service, 7.5 Million Italians Use Homeopathic Drugs, May 20, 2004.
(34) Molassiotis A, Fernadez-Ortega P, Pud D, et al, Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol, 16: 655-663, 2005.
(35) Johannessen H, von Bornemann Hjelmborg J, Pasquarelli E, Fiorentini G, Di Costanzos F, Miccinesi G., Prevalence in the use of complementary medicine among cancer patients in Tuscany, Italy. Tumori. 2008 May-Jun;94(3):406-10.
(36) Clerici CA, Veneroni L, Giacon B, et al., Complementary and alternative medical therapies used by children with cancer treated at an Italian pediatric oncology unit. Pediatric Blood Cancer. June 2009. doi 10.1002/pbc.22093.
(37) Gomez-Martinez R, Tlacuilo-Parra A, Garibaldi-Covarrubias R. Use of complementary and alternative medicine in children with cancer in Occidental, Mexico. Pediatr Blood Cancer 2007;49:820-823.
(38) Gozum S, Arikan D, Bu¨yu¨kavci M. Complementary and alternative medicine use in pediatric oncology patients in eastern Turkey. Cancer Nurs 2007;30:38-44.
(39) Nathanson I, Sandler E, Ramı´rez-Garnica G, et al. Factors influencing complementary and alternative medicine use in a multisite pediatric oncology practice. J Pediatr Hematol Oncol 2007;29:705-708.
(40) D’Inca R, Garribba AT, Vettorato MG, Martin A, Martines D, Di Leo V, Buda A, Sturniolo GC, Use of alternative and complementary therapies by inflammatory bowel disease patients in an Italian tertiary referral centre, Dig Liver Dis. 2007 Apr 10.
(41) Reuters (Madrid) Tummy tucks join inflation calculation. February 12, 2007.
(42) Izmirlieva, Milena. Global Insight, March 28, 2007 (found in Homeopathy Today, May/June 2007, p.9).
(43) Clines, F. “With Medicine Itself Sick, Russians Turn to Herbs,” New York Times, December 31, 1990.
(44) Brown, Samuel, Use of Complementary and Alternative Medicine by Physicians in St. Petersburg, Russia. The Journal of Alternative and Complementary Medicine Apr 2008, Vol. 14, No. 3: 315-319.

The questions surrounding supplements continue to grow and though knowledge and understanding have also grown, pharmaceutical companies continue to hamper this quest by spending more and more money on their own studies and funding lobbyists that try to hamper our pursuit of a more natural approach to health. There is no doubt that the drugs we have developed are saving lives but they could save many more lives if they were part of an integrative lifestyle combining a healthy balance of diet, exercise, necessary supplements, and when these fail, pharmaceutical medications.

In integrative medicine we speak about the “core” nutrients. These are the vitamins and minerals that we all require. I generally start people on a multivitamin and mineral complex first. There are many out there so selecting an appropriate combination is not that difficult. Some of the new age-targeted formulas combine most of a person’s needs into one formula for ease of use. So a women’s formula for women over forty will include more calcium, magnesium and trace minerals than a formula designed for younger women. This simplifies what a person needs and often taking fewer products increases compliance. The next core nutrient necessary is a good healthy source of essential fatty acids, also known as EFA’s. EFA’s are essential because we cannot make them. We need to ingest them so that our bodies can then use them as raw materials for other things we do make. These include cholesterol (much needed), hormones, prostaglandins (messengers that help us control all sorts of processes in the body, including inflammation). There are so many problems with the environment and this includes our water. Eating fish that is not contaminated has become a problem and there is nothing in the literature that leads me to believe that things will change any time soon. Keeping your “ toxic burden “ low is the only thing we can control in trying to prevent cancer and other autoimmune diseases that seem to be growing in numbers in spite of all the new “ scientific advances”. In order to get the omega 3’s that you can get from one or two capsules of oil a day, you would probably need to eat 4 to 6 servings of fish a week, and thereby risk exposure to elevated levels of mercury, arsenic, cadmium, and lead. If you ate farm raised fish, than you increase your risk of exposure to dioxins ( carcinogens ) and PCB’s ( also carcinogens ). The amount of fish oil a person should take also varies according to need.

The next core nutrient is a probiotic. This is what many people commonly refer to as “acidophilus” but in reality is a whole family of beneficial bacteria that is comprised of many different “friendly” bacteria that thrive throughout the gastrointestinal tract, starting in the mouth and ending in the rectum. For women without any serious or chronic gut issues, eating a good organic yogurt containing live cultures of friendly bacteria, on a regular basis, is adequate.

For women, the big question today is about calcium. While we have all become conscious of our need for calcium many people are unaware of the need for magnesium, adequate amounts of vitamin D and the need for other trace minerals that aid in absorption. The amount of minerals that are needed varies from person to person. Women after the age of forty should begin to get bone density studies done to assess their need for minerals. The average woman needs 1000mg of calcium a day, 400 to 800mg of magnesium a day, and at least 2000 units of vitamin D3 but we are finding more cases of severe deficiency and under medical guidance we use as much as 10,000 units a day. If the bone density test, also called a Dexa scan, shows osteopenia or the beginnings of osteoporosis than I increase the calcium to 1200 to 1500mgs a day and increase the magnesium accordingly. I often request that patients have their vitamin D levels measured because many people supplementing with calcium and magnesium are still showing signs of progression of their bone density issues. In our search for answers why, the question of the right amount of D has come to be a new insight into possible failures of other therapies. In osteopenia and osteoarthritis, weight resistance exercise is essential for stopping progression.

There are a million supplements on the market and I encourage all women to try and get as much of their nutrition from food and then target the remaining imbalances with the supplements that are necessary. I encourage all my patients to eat as organically as possible. We need to reduce our exposure to chemicals. As long term studies are limited, I assume that all chemicals are bad and try to reduce them every where possible. Animal protein like chicken, fish, beef, and pork, as well as all dairy carry a heavy burden of toxins with them. First they contain the herbicides and pesticides from the foods they are grown on, and second they are usually given hormones and antibiotics to maximize the yield. All of these are passed to us when we eat these things. I implore all people to buy as much of their foods organically but animal derived products especially. With ovarian and breast cancer on the rise, you have to question the “estrogen dominant “ nature of society due mostly from the consumption of xeno estrogens and phyto estrogens from the food supply. With vegetables and fruits I take an aggressive approach to washing them before I consume them.

You may have never even considered the fact that your Birth control pills, allergy medicine, or over the counter antacids could be depleting your nutrients, but they could be. Here’s the scoop on just a few drugs and their nutritional effects.

Birth control pills deplete vitamin B2 (ribofl avin), vitamin B12 (cobalamin), folic acid, vitamin C, and zinc. Estrogen supplementation can lower serum magnesium levels. Acid blockers (Protein Pump Inhibitors and H2 blockers)  are commonly used either in prescription or over the counter medications by people who have heartburn and indigestion. The acid in our stomach is important for absorption of minerals, digestion of protein, and protection from food poisoning. Studies show that acid blockers increase risk of defi ciencies of : vitamin B12, folic acid, iron, and zinc. Animal studies also show lowered calcium levels and altered the way we use vitamin D.

Statin drugs are used commonly to lower cholesterol. It’s been known since 1985 that statin medications can deplete CoEnzyme Q10 levels. Research suggests that some of the muscle aches and weakness and liver toxicity of these medications is caused by CoQ10 depletion. If you are taking a statin medication, take 60-200 mg of CoQ10 daily to insure that you have adequate amounts. (Higher dosages would be for people who have heart disease.)

Resveratrol first came to public attention when the researchers noted that people in France have less heart disease but eat so much fatty food, and called it the French Paradox. Could it be the red wine? And what in the wine: Resveratrol!

Resveratrol is a powerful, antioxidant phenol that is found in grapes. The highest concentrations are found in red wine, but purple grape juice, the skin of young unripe red grapes, and grape seeds also have significant amounts. It’s also found in small amounts in peanuts.

Resveratrol has been shown to have anti-aging effects and to boost athletic performance (in mice, rats and primates). It also is anti-oxidant, anti-cancer, and helps promote weight loss, is anti-infl ammatory, has cholesterol lowering abilities, and increases insulin sensitivity. Studies also show that Resveratrol may also lower the risk of colon cancer and slow the progression of Alzheimer’s disease.

Current research shows that resveratrol’s powerful protective effects come from its ability by activating a group of genes called sirtuins (also called silent information regulator proteins, specifically SIRT-1 and SIRT-2. ) Sirutins protect our DNA, extend life span, protect our cells from radiation, and speed up cellular repair.

It’s not known what the optimal amount of resveratrol is, but based on animal research, most of us would benefit from between 5 mg daily for prevention, and 40 to 150 mg daily therapeutically. Although many more studies on people need to be done, there doesn’t seem to be any negative effects from taking these amounts daily. Based on the French Paradox studies, drinking one glass of red wine daily can be protective. A glass supplies about 1 mg of resveratrol.

This may be a supplement you’d like to try, you may look for it in a multivitamin, or you may want to drink your one glass of wine daily, or drink more purple grape juice, or eat the seeds you find in your grapes.

The Pearl: Resveratrol is just one more reason to put more colorful food into your daily diet.

There is an old Italian saying “Where the sun does not go the doctor does.”

For about the last 25 years, doctors (dermatologists in particular) have demonized sun exposure and repeatedly told us it is bad for you and causes cancer. But is that true? In the last few years, numerous studies have shown that modest exposure to sunlight may actually be good for you, helping the body produce the vitamin D it needs to keep bones healthy and protect against cancer, including skin cancer. Though repeated sunburns–in children and very fair-skinned people–have been linked to melanoma, there is no credible scientific evidence that moderate sun exposure causes it. Since it’s almost impossible to get adequate amounts of vitamin D from food alone (including fortified milk and fatty wild fish), sun is your best source. I’m not suggesting you go bake in the sun with your suntan oil or go to tanning salons. But getting some sun without getting sunburned makes healthy sense.

We evolved in the sun; we were made to get some sun, not to live our lives indoors and slather on sunscreen every time we go outside. If the sun is shining where you are today, get out and enjoy it, talk about a free natural treatment! All you need is a little common sense when heading outdoors, do it gradually and always avoid sunburn.

Special Note: Remember to take antioxidants when you sit in the sun, as these can help prevent skin cells from sun damage.

What is vitamin D?

Although it’s called a vitamin, vitamin D is really a hormone and not actually a vitamin. Vitamins cannot be produced by your body, we get them from dietary sources, whereas vitamin D is made in your body. It’s your body’s only source of calcitrol (activated vitamin D), the most potent steroid hormone in the body.

What does vitamin D do?

Like all steroid hormones, vitamin D is involved in making hundreds of enzymes and proteins, which are crucial for preserving health and preventing disease. It has the ability to interact and affect more than 2,000 genes in the body. It enhances muscle strength and builds bone. It has anti-inflammatory effects and bolsters the immune system. It helps the action of insulin and has anti-cancer activity. This is why vitamin D deficiency has been linked with so many of the diseases of modern society. Because of its vast array of benefits, maintaining optimal levels of D is essential for your health

Where do I get vitamin D from?

Only about 10% of your vitamin D comes from diet, so it is nearly impossible to get adequate amounts of vitamin D from your diet.

The only 2 reliable sources of vitamin D are the sun and supplements.

Sunlight exposure is the only reliable way to generate vitamin D in your own body. Vitamin D is produced by your skin in response to exposure to ultraviolet radiation from the sun. In fact, this is such an efficient system that most of us make 20,000 units of vitamin D after only 20 minutes of summer sun without suntan lotion. That’s 100 times more than the government recommends per day! There must be a good reason why we make so much in so little time.

But these rays cannot penetrate glass to generate vitamin D in your skin, so you don’t generate vitamin D when sitting behind a glass window, whether in your car or at home.

Also sunscreens, even weak ones, almost completely block your body’s ability to generate vitamin D.

The other reliable source is supplements. Most important is that you take vitamin D3, (cholecalciferol) the active form of vitamin D. Do not take vitamin D2 as it is not as biologically active nor as effective, and nor as safe as vitamin D3. And taking the right amount is crucial, most doctors tend to under dose. The current recommendations from the Food and Nutrition Board of the U.S. Institute of Medicine: from 200 to 600 IU/day depending on one’s age, are way too low. These values were originally chosen because they were found to prevent osteomalacia (bone softening) and rickets

How much sunshine do you need?

All living things need sun, the key is balance. Too much sun exposure can cause melanoma and skin aging, while too little creates an inadequate production of vitamin D. The amount needed depends on the season, time of day, where you live, skin pigmentation and other factors. As a general rule, if you are not vitamin D deficient, about 20 minutes a day in the spring, summer and fall on your face and arms or legs without sunscreen is adequate. It doesn’t matter which part of the body you expose to the sun. Many people want to protect their face, so just don’t put sunscreen on the other exposed parts for those 20 minutes.

If you live north of 37 degrees latitude (approximately a line drawn horizontally connecting Norfolk, Virginia to San Francisco, California) sunlight is not sufficient to create Vitamin D in your skin in the winter months, even if you are sitting in the sun in a bathing suit on a warm January day! The further you live from the equator, the longer exposure you need to the sun in order to generate vitamin D

Can I take cod liver oil to get my vitamin D?

Although Cod liver oil contains a fair amount of vitamin D, it also contains high amounts of vitamin A. Vitamin A antagonizes the action of vitamin D and can be toxic at high levels.

What are other food sources of vitamin D?

• Fatty wild fish like mackerel, salmon, halibut, tuna, sardines and herring
• Fortified milk, orange juice and cereal
• Dried Shitake mushrooms
• Egg yolks

To get adequate amounts of vitamin D from food, you would have to eat at least 5 servings of salmon a day or drink 20 cups of fortified milk.

My doctor prescribed Drisdol, 50,000 IU per week. What is it?

Drisdol is a prescription of 50,000 IU tablets of vitamin D2 or ergocalciferol. Ergocalciferol is not vitamin D but it is similar. D2 is not normally found in humans and most studies show it does not raise 25(OH)D levels as well as (cholecalciferol or vit D3) does. If you are vitamin D deficient, the best thing to do, is to take vitamin D3

What about the use of tanning beds to get my vitamin D?

I tend not to recommend them because we don’t really know if they are safe. Because the light sources vary with different tanning beds, it makes them unpredictable and possibly unsafe. In addition, most commercial tanning beds emit an unknown amount of EMF and because one is so close to the actual bed, it may be an unnecessary high dose. Theoretically both these problems could be overcome, but in reality they usually are not.

Why is there an epidemic of vitamin D deficiency?

It is estimated that anywhere from 30 to 100% of Americans, depending upon their age and community living environments, are deficient in Vitamin D. More than half of all American children are vitamin deficient. Supposedly almost 3/4s of pregnant women are vitamin D deficient, predisposing their unborn children to all sorts of problems. Worldwide, it is estimated that the epidemic of vitamin D deficiency affects one billion people. In my practice over 80% of patients whose vitamin D levels I check are deficient.

No one is exactly sure why this is happening apart from the fact that we spend too much time indoors and when we go out into the sun, we lather sunscreen on ourselves. I think it must be more than that. But whatever the reason, the reality is we have a major epidemic on our hands.

How much vitamin D do I need?

How much vitamin D you need varies with age, body weight, percent of body fat, latitude, skin coloration, season of the year, use of sun block, individual variation in sun exposure, and – probably – how ill you are.

As a general rule, old people need more than young people, big people need more that little people, fat people need more than skinny people, northern people need more than southern people, dark-skinned people need more than fair skinned people, winter people need more than summer people, sun block lovers need more than sun block haters, sun-phobes need more than sun worshipers, and ill people may need more than well people.

What I and many of my colleagues around the country are finding is that even people spending what we thought was adequate amount of time in the sun, are still showing up with low blood vitamin D levels. I am not sure why at this stage but there is an easy and cheap solution…vitamin D supplementation.

Here are some guidelines:

• If your blood level is above 45ng/ml and for maintenance, I recommend 2,000-4,000 IU daily depending on age, weight, season, how much time is spent outdoors, where one lives, skin color and obviously blood levels. In other words if you are older, larger, living in the northern latitudes during the winter, are not getting sun and have dark skin, I recommend the higher maintenance dose.
• If your blood level is 35-45 ng/ml, I recommend you correct it with 5,000 of vitamin D3 a day for 3 months under a doctor’s supervision and then recheck your blood levels.
• If your blood level is less than 35 ng/ml, I recommend you correct it with 10,000 of vitamin D3 a day under a doctor’s supervision and then recheck your blood levels after 3 months. It takes a good 6 months usually to optimize your vitamin D levels if you’re deficient. Once this occurs, you can lower the dose to the maintenance dose of 2,000 – 4,000 IU a day.

What are the symptoms of vit D deficiency?

There is no clear pattern of symptoms. In fact many people remain asymptomatic despite low levels. But here are the more common symptoms

• Fatigue
• General muscle pain and weakness
• Muscle cramps
• Joint pain
• Chronic pain
• Weight gain
• High blood pressure
• Restless sleep
• Poor concentration
• Headaches
• Bladder problems
• Constipation or diarrhea

What diseases are associated with Vit D deficiency?

Vitamin D deficiency has been shown to play a role in almost every major disease. This includes:

• Osteoporosis and Osteopenia
• 17 varieties of Cancer (including breast, prostate and colon)
• Heart disease
• High blood pressure
• Obesity
• Metabolic Syndrome and Diabetes
• Autoimmune diseases
• Multiple sclerosis
• Rheumatoid arthritis
• Osteoarthritis
• Bursitis
• Gout
• Infertility and PMS
• Parkinson’s Disease
• Depression and Seasonal Affective Disorder
• Alzheimer’s Disease
• Chronic fatigue syndrome
• Fibromyalgia
• Chronic Pain
• Periodontal disease
• Psoriasis

What about vitamin D toxicity?

It is impossible to generate too much vitamin D in your body from sunlight exposure: your body will self-regulate and only generate what it needs. Although very rare, it is possible to overdose and become toxic with supplementation as vitamin D is a fat soluble vitamin and therefore stored in the body for longer periods of time. Therefore if you are taking 5,000 IU or more daily, you should have your blood levels monitored approximately every 3 months.

What blood test should I have to check my vitamin D levels?

The only blood test that can diagnose vitamin D deficiency is a 25-hydroxy-vitamin D (25 OH vitamin D). Unfortunately, some doctors are still ordering the wrong test, 1,25-dihydroxy-vitamin D. In fact a common cause of high 1,25-dihydroxy-vitamin D is a low 25(OH)D or vitamin D deficiency. So when doctors see the 1,25-dihydroxy-vitamin D is normal or high and tell their patients that they are OK, they are often vitamin D deficient.
Your doctor should do this test for you. Unfortunately even some of the labs, in particular Qwest, have had problems with correct results, usually giving erroneously high results.

If you don’t want to go through your doctor, the ZRT lab does a blood spot test that you can order without going through a doctor.

What is the ideal blood level of 25 hydroxy vitamin D?

The current ranges for “normal” are 20 to 55 ng/ml. These are much too low!!! They may be fine if you want to prevent rickets or osteomalacia, but not for optimal health. The ideal range for optimal health is 50-80 ng/ml.

How often should I have a 25 hydroxy vitamin D blood test?

At least once a year especially at the beginning of winter. If you are supplementing, I suggest you monitor your vitamin D levels approximately every 3months until you are in the optimal range. If you are taking high doses (10,000 IU a day) your doctor must also check your calcium, phosphorous, and parathyroid hormone levels every 3 months.

It is estimated that anywhere from 30 to 100% of Americans, depending upon their age and community living environments, are deficient in Vitamin D. More than half of all American children are vitamin deficient. Supposedly almost 3/4s of pregnant women are vitamin D deficient, predisposing their unborn children to all sorts of problems. Worldwide, it is estimated that the epidemic of vitamin D deficiency affects one billion people. In my practice over 80% of patients whose vitamin D levels I check are deficient.

No one is exactly sure why this is happening apart from the fact that we spend too much time indoors and when we go out into the sun, we lather sunscreen on ourselves. I think it must be more than that. But whatever the reason, the reality is we have a major epidemic on our hands.

How much vitamin D do I need?

How much vitamin D you need varies with age, body weight, percent of body fat, latitude, skin coloration, season of the year, use of sun block, individual variation in sun exposure, and – probably – how ill you are.

As a general rule, old people need more than young people, big people need more that little people, fat people need more than skinny people, northern people need more than southern people, dark-skinned people need more than fair skinned people, winter people need more than summer people, sun block lovers need more than sun block haters, sun-phobes need more than sun worshipers, and ill people may need more than well people.

What I and many of my colleagues around the country are finding is that even people spending what we thought was adequate amount of time in the sun, are still showing up with low blood vitamin D levels. I am not sure why at this stage but there is an easy and cheap solution…vitamin D supplementation.

Here are some guidelines:

• If your blood level is above 45ng/ml and for maintenance, I recommend 2,000-4,000 IU daily depending on age, weight, season, how much time is spent outdoors, where one lives, skin color and obviously blood levels. In other words if you are older, larger, living in the northern latitudes during the winter, are not getting sun and have dark skin, I recommend the higher maintenance dose.
• If your blood level is 35-45 ng/ml, I recommend you correct it with 5,000 of vitamin D3 a day for 3 months under a doctor’s supervision and then recheck your blood levels.
• If your blood level is less than 35 ng/ml, I recommend you correct it with 10,000 of vitamin D3 a day under a doctor’s supervision and then recheck your blood levels after 3 months. It takes a good 6 months usually to optimize your vitamin D levels if you’re deficient. Once this occurs, you can lower the dose to the maintenance dose of 2,000 – 4,000 IU a day.

What are the symptoms of vit D deficiency?

There is no clear pattern of symptoms. In fact many people remain asymptomatic despite low levels. But here are the more common symptoms

• Fatigue
• General muscle pain and weakness
• Muscle cramps
• Joint pain
• Chronic pain
• Weight gain
• High blood pressure
• Restless sleep
• Poor concentration
• Headaches
• Bladder problems
• Constipation or diarrhea

What diseases are associated with Vit D deficiency?

Vitamin D deficiency has been shown to play a role in almost every major disease. This includes:

• Osteoporosis and Osteopenia
• 17 varieties of Cancer (including breast, prostate and colon)
• Heart disease
• High blood pressure
• Obesity
• Metabolic Syndrome and Diabetes
• Autoimmune diseases
• Multiple sclerosis
• Rheumatoid arthritis
• Osteoarthritis
• Bursitis
• Gout
• Infertility and PMS
• Parkinson’s Disease
• Depression and Seasonal Affective Disorder
• Alzheimer’s Disease
• Chronic fatigue syndrome
• Fibromyalgia
• Chronic Pain
• Periodontal disease
• Psoriasis

What about vitamin D toxicity?

It is impossible to generate too much vitamin D in your body from sunlight exposure: your body will self-regulate and only generate what it needs. Although very rare, it is possible to overdose and become toxic with supplementation as vitamin D is a fat soluble vitamin and therefore stored in the body for longer periods of time. Therefore if you are taking 5,000 IU or more daily, you should have your blood levels monitored approximately every 3 months.

What blood test should I have to check my vitamin D levels?

The only blood test that can diagnose vitamin D deficiency is a 25-hydroxy-vitamin D (25 OH vitamin D). Unfortunately, some doctors are still ordering the wrong test, 1,25-dihydroxy-vitamin D. In fact a common cause of high 1,25-dihydroxy-vitamin D is a low 25(OH)D or vitamin D deficiency. So when doctors see the 1,25-dihydroxy-vitamin D is normal or high and tell their patients that they are OK, they are often vitamin D deficient.
Your doctor should do this test for you. Unfortunately even some of the labs, in particular Qwest, have had problems with correct results, usually giving erroneously high results.

If you don’t want to go through your doctor, the ZRT lab does a blood spot test that you can order without going through a doctor.

What is the ideal blood level of 25 hydroxy vitamin D?

The current ranges for “normal” are 20 to 55 ng/ml. These are much too low!!! They may be fine if you want to prevent rickets or osteomalacia, but not for optimal health. The ideal range for optimal health is 50-80 ng/ml.

How often should I have a 25 hydroxy vitamin D blood test?

At least once a year especially at the beginning of winter. If you are supplementing, I suggest you monitor your vitamin D levels approximately every 3months until you are in the optimal range. If you are taking high doses (10,000 IU a day) your doctor must also check your calcium, phosphorous, and parathyroid hormone levels every 3 months.