Post by cobweb2 on Oct 4, 2008 11:24:36 GMT -8
from a newsletter Dr. Singleton sends out from www.lymedoctor.com
More on the Miracle of Vitamin D - Part Two (of Three)
Last month we began a discussion of vitamin D. As you may recall from my article and my book, The Lyme Disease Solution, I am a major supporter of blood testing for vitamin D levels and of treating vitamin D deficiency aggressively using "vitamin D3". As I expected, I received several responses from readers challenging the notion that vitamin D was, in fact, beneficial in the chronic Lyme disease setting. Therefore, in this article I wish to first of all deal with the idea that vitamin D is harmful to Lyme patients.
Several years ago I became aware of something that many of you know called the "Marshall Protocol" (MP). Originally developed to help patients with sarcoidosis by Trevor Marshall, Ph.D., his theories led him to recommend his protocol for the treatment of patients with other chronic inflammatory conditions such as chronic fatigue, fibromyalgia, and chronic Lyme.
Basically, the protocol consists of 3 components: (1) low dose antibiotics (primarily minocycline), (2) use of an oral antihypertensive (in the ARB class) called Benicar, and (3) severe restriction of vitamin D both via dietary restriction and reduction of sunlight exposure. This protocol got my attention primarily because it was being recommended by an LLMD whom I respect, Dietrich Klinghardt, M.D., Ph.D. (Interestingly, Dr. Klinghardt has subsequently stated on a DVD in 2006 that his MP results had been disappointing.)
A thorough review of the MP is much too large a subject to attempt to tackle in this Newsletter. In short, I do not believe that the preponderance of evidence shows that vitamin D (in either the 25-OH or 1,25-OH form) clinically acts as an immunosuppressive steroid, as alleged by the MP. Rather, I see vitamin D as being a very important immune-modulating substance that ramps up "Th1" when needed and cools down "Th1" when not needed. I refer you a very scholarly webpage that discusses the controversy related to the MP in great depth. Please see the following excellent site that covers the topic very well: stuff.mit.edu/people/london/universe.htm
Meanwhile, if your LLMD is using the MP and you are doing well, I do not recommend that you make any major changes based on this Newsletter alone. However, if you are improving, the truth is that it could very well be due to the low dose antibiotics being used on the MP. I doubt vitamin D deprivation has much to do with any benefit you are gaining. My experience would say that there is not nearly enough evidence to justify restriction of such an important thing as vitamin D.
The next topic I wish to cover transitions nicely from the previous discussion. Did you know that vitamin D has important antibiotic properties? The story of tuberculosis (TB) illustrates this well. Before the advent of antibiotics against TB in the 1950's and 1960's, the treatment for TB was a three step program: get several months of rest (for instance at a "sanitorium"), drink one quart of milk daily, and get several hours of sunlight exposure daily. It turns out that this treatment protocol helped many people recover from TB. The secret to its success was, in great part, due to the effect of sunlight in increasing levels of vitamin D in the body. Vitamin D was instrumental not only in improving immune function, but also in the production of a substance called "cathelicidin". Cathelicidin is produced by the white blood cells and is active against viruses (ex. influenza and cold viruses), tuberculosis, and fungi.
Could it also have effects against Lyme bacteria? If so, is this why Lyme patients generally feel much better in the summer when sunlight exposure raises vitamin D (and cathelicidin) levels in the body? No one knows for sure, but I suspect that trio of sunlight, vitamin D, and cathelicidin is very helpful for both its immune supporting properties and its possible antibiotic effects against Lyme.
What about testing for vitamin D? The consensus among experts is that the best blood test to do is the "25-OH vitamin D" level. It is the form of vitamin D that is made by the liver and is a true indicator of the vitamin D status of the body. It is then activated by the kidneys and at the local tissue level to the active form called "1,25-OH vitamin D". While the MP recommends testing 25-OH and 1,25-OH, I would disagree with the need to test 1,25-OH. And I recommend reading the above mentioned webpage in order to understand all the reasons for omitting the test for 1,25-OH.
Are all labs able to do accurate vitamin D testing? The major commercial labs are Labcorp and Quest. Both do vitamin D 25-OH levels. However, there is a fundamental difference in the methodology used by each lab. Quest uses the LC-MS/MS (liquid chromotatography-mass spectrometry) method. Labcorp uses the more reliable Liaison (DiaSorin) method. My understanding is that the Labcorp methodology is the preferred method and, therefore, this is the lab you should request for having your vitamin D assay done if at all possible.
What are the normal and optimal levels for 25-OH vitamin D? You will find vitamin D levels measured using 2 different types of units: (1) ng/ml and (2) nmol/l. The most common way of reporting vitamin D levels is in the "ng/ml" format (used by the commercial labs) and that is the one we will use in the Newsletter. Here is what we consider to be "normal" and "optimal" levels of vitamin D.
Normal levels: 20-56 ng/ml
Optimal levels: 45-65 ng/ml (and should never fall below 30 ng/ml)
How often should a vitamin D level be checked? In general, I recommend checking vitamin D 25-OH levels two to three times a year - in the fall, the mid winter, and perhaps sometime in the summer (to see if supplementation is necessary when sun exposure is at its greatest).
Next month I will discuss in the Newsletter the best ways to achieve an optimal level of vitamin D. We'll look at sunlight exposure and sunscreens. We'll look oral supplementation - vitamin D2 vs. D3. We'll answer the question of how much to take in order to predictably raise your levels. And more.
More on the Miracle of Vitamin D - Part Two (of Three)
Last month we began a discussion of vitamin D. As you may recall from my article and my book, The Lyme Disease Solution, I am a major supporter of blood testing for vitamin D levels and of treating vitamin D deficiency aggressively using "vitamin D3". As I expected, I received several responses from readers challenging the notion that vitamin D was, in fact, beneficial in the chronic Lyme disease setting. Therefore, in this article I wish to first of all deal with the idea that vitamin D is harmful to Lyme patients.
Several years ago I became aware of something that many of you know called the "Marshall Protocol" (MP). Originally developed to help patients with sarcoidosis by Trevor Marshall, Ph.D., his theories led him to recommend his protocol for the treatment of patients with other chronic inflammatory conditions such as chronic fatigue, fibromyalgia, and chronic Lyme.
Basically, the protocol consists of 3 components: (1) low dose antibiotics (primarily minocycline), (2) use of an oral antihypertensive (in the ARB class) called Benicar, and (3) severe restriction of vitamin D both via dietary restriction and reduction of sunlight exposure. This protocol got my attention primarily because it was being recommended by an LLMD whom I respect, Dietrich Klinghardt, M.D., Ph.D. (Interestingly, Dr. Klinghardt has subsequently stated on a DVD in 2006 that his MP results had been disappointing.)
A thorough review of the MP is much too large a subject to attempt to tackle in this Newsletter. In short, I do not believe that the preponderance of evidence shows that vitamin D (in either the 25-OH or 1,25-OH form) clinically acts as an immunosuppressive steroid, as alleged by the MP. Rather, I see vitamin D as being a very important immune-modulating substance that ramps up "Th1" when needed and cools down "Th1" when not needed. I refer you a very scholarly webpage that discusses the controversy related to the MP in great depth. Please see the following excellent site that covers the topic very well: stuff.mit.edu/people/london/universe.htm
Meanwhile, if your LLMD is using the MP and you are doing well, I do not recommend that you make any major changes based on this Newsletter alone. However, if you are improving, the truth is that it could very well be due to the low dose antibiotics being used on the MP. I doubt vitamin D deprivation has much to do with any benefit you are gaining. My experience would say that there is not nearly enough evidence to justify restriction of such an important thing as vitamin D.
The next topic I wish to cover transitions nicely from the previous discussion. Did you know that vitamin D has important antibiotic properties? The story of tuberculosis (TB) illustrates this well. Before the advent of antibiotics against TB in the 1950's and 1960's, the treatment for TB was a three step program: get several months of rest (for instance at a "sanitorium"), drink one quart of milk daily, and get several hours of sunlight exposure daily. It turns out that this treatment protocol helped many people recover from TB. The secret to its success was, in great part, due to the effect of sunlight in increasing levels of vitamin D in the body. Vitamin D was instrumental not only in improving immune function, but also in the production of a substance called "cathelicidin". Cathelicidin is produced by the white blood cells and is active against viruses (ex. influenza and cold viruses), tuberculosis, and fungi.
Could it also have effects against Lyme bacteria? If so, is this why Lyme patients generally feel much better in the summer when sunlight exposure raises vitamin D (and cathelicidin) levels in the body? No one knows for sure, but I suspect that trio of sunlight, vitamin D, and cathelicidin is very helpful for both its immune supporting properties and its possible antibiotic effects against Lyme.
What about testing for vitamin D? The consensus among experts is that the best blood test to do is the "25-OH vitamin D" level. It is the form of vitamin D that is made by the liver and is a true indicator of the vitamin D status of the body. It is then activated by the kidneys and at the local tissue level to the active form called "1,25-OH vitamin D". While the MP recommends testing 25-OH and 1,25-OH, I would disagree with the need to test 1,25-OH. And I recommend reading the above mentioned webpage in order to understand all the reasons for omitting the test for 1,25-OH.
Are all labs able to do accurate vitamin D testing? The major commercial labs are Labcorp and Quest. Both do vitamin D 25-OH levels. However, there is a fundamental difference in the methodology used by each lab. Quest uses the LC-MS/MS (liquid chromotatography-mass spectrometry) method. Labcorp uses the more reliable Liaison (DiaSorin) method. My understanding is that the Labcorp methodology is the preferred method and, therefore, this is the lab you should request for having your vitamin D assay done if at all possible.
What are the normal and optimal levels for 25-OH vitamin D? You will find vitamin D levels measured using 2 different types of units: (1) ng/ml and (2) nmol/l. The most common way of reporting vitamin D levels is in the "ng/ml" format (used by the commercial labs) and that is the one we will use in the Newsletter. Here is what we consider to be "normal" and "optimal" levels of vitamin D.
Normal levels: 20-56 ng/ml
Optimal levels: 45-65 ng/ml (and should never fall below 30 ng/ml)
How often should a vitamin D level be checked? In general, I recommend checking vitamin D 25-OH levels two to three times a year - in the fall, the mid winter, and perhaps sometime in the summer (to see if supplementation is necessary when sun exposure is at its greatest).
Next month I will discuss in the Newsletter the best ways to achieve an optimal level of vitamin D. We'll look at sunlight exposure and sunscreens. We'll look oral supplementation - vitamin D2 vs. D3. We'll answer the question of how much to take in order to predictably raise your levels. And more.