Michael Carlston, M.D. - Family Practice & Complementary Medicine

Carlston, M.D.
Family Practice and Complementary Medicine

www.carlstonmd.com

April 11, 2008

Dear Patients,

What a busy time! I hope you are engaged in many activities that are stimulating and constructive to yourself and the community. Wednesday I took a quick trip to San Diego to attend what promised to be great meeting on the latest vitamin D research. It turned out to be as good as I had hoped. Interesting times when one can be awakened by an earthquake in Northern California, fly 500 miles to learn important information at a national medical meeting and sleep (safely?) back at home in Santa Rosa.

Best
Michael Carlston, MD
www.carlstonmd.com

Moving Towards Consensus on Optimal Vitamin D Levels
Vaccinations Protect Herds Not Individuals

Moving Towards Consensus on Optimal Vitamin D Levels
The accumulating and dramatic evidence of association between vitamin D levels and a seemingly infinite variety of diseases is very important. What to do with this information is more important. Academic discovery is one thing. Clinical application of that information to better peoples’ lives is what medicine is all about.

The first step is identifying the problem. Here, that is the recognition that vitamin D is influential in the development of many diseases. Done. Some can argue that we need to better enumerate all the problems created by vitamin D deficiency. While it is hard to disagree, as a clinician it seems evident that action to prevent and treat the consequences of D deficiency is much more important. At this point it is not unreasonable to presume that nearly any symptom suffered by an individual whose vitamin D level is low might be related to that deficiency. There are essentially no adverse effects of correcting that deficiency (even the cost is quite low, limiting the financially adverse effects). So, my job is to help the patient correct his/her deficiency. If the health problem does not improve, the vitamin D deficiency was probably not an important factor contributing to that problem. We still made a positive and valuable change in that person’s long-term health risk.

Pretty simple. Well, nearly so.

You see, while we have been in the dark about vitamin D’s innumerable roles in human physiology, we have been utterly blind as to what constitutes an ideal vitamin D blood level. We HAVE learned that “normal’ is unhealthy, so we can’t just test a bunch of average people and decide that everyone should be like ….. well, everyone.

This week I attended a meeting of vitamin D experts organized by GrassrootsHealth. You can review three of the presentations at http://www.grassrootshealth.org/seminar_presentations.htm

Reviewing the chart of disease reduction by vitamin D level might be the simplest way for you to “eyeball” the published research on this topic to date:
Disease Incidence Prevention by Serum 25(OH)D Level

Other studies have shown that people living like our hunter-gatherer ancestors (in tropical environments, outside most of the day and with much of their skin exposed) typically have vitamin D levels of at least 60, and in some cases up to 140. The amount of data is somewhat limited because modern humans, even in the tropics, tend to wear clothing and spend time indoors in front of their computers. Primates, our closest relatives in the animal kingdom, tend to run vitamin D levels over 100.

The food supply in many Western nations is fortified with various nutrients to prevent certain diseases. Milk in the US is commonly fortified with a very small amount of vitamin D at the present time. Dr. Robert Heaney suggests that fortifying the American diet with 2,000 iu vitamin D3 would not achieve optimal D levels, but it would raise over 97% of Americans to a threshold of reduced risk (32 ng/ml).

My recommendation to you is, by whatever means possible, keep your vitamin D level above 50 throughout the year. You can have your vitamin D tested repeatedly to assess your own individual response to sunlight, supplementation and diet or you can get tested once annually in the second half of the winter when your blood with be at its lowest level of the year. The test to ask for is 25 hydroxyvitamin D.

Vaccinations Protect Herds Not Individuals
That title says it all, except that you are part of a herd of human beings. My apology for the sometimes rude or crass terms we use in medicine but, in this case, the character of the term seems suitable to me.

Among the many controversial aspects of immunizations is the fact that immunizing a certain individual is far from a guarantee that that person will not get sick with the disease. Immunizing a group of individuals creates what is called “herd immunity”, meaning the rate of disease in that herd/group will be reduced.

In one example, around 1980 there was an outbreak of measles at UCLA. Those who were immunized were less likely to get the disease (the rate of infection was lower among those immunized). However, the great majority of those who got sick were fully immunized. The relatively fewer number of students who were unimmunized represented a proportionately larger number of the sick individuals.

The CDC recently released data from their investigation of the largest epidemic of measles in the US in nearly 20 years. In 2006 nearly 7,000 individuals in the Midwest (mostly young adults attending colleges there) came down with the mumps. Of those who knew their vaccination history, 84% had received the recommended two dose series.

Studies of parents who choose to limit the number of vaccinations their children receive, find that they are better educated and financially better off. While there are good arguments in favor of vaccines, there are also good arguments opposing them.

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April 11, 2008

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