Vitamin D & Vit A as Retinol: "Avoid cod liver oil like the poison it is & check your multivitamins"

tiptoe

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Wed Jul-07-10 08:34 PM
Original message

Vitamin D & Vit A as Retinol: "Avoid cod liver oil like the poison it is & check your multivitamins"

Edited on Wed Jul-07-10 09:21 PM by tiptoe

Dr. John Jacob Cannell -- whose Vitamin D Theory of Autism was accepted by Harvard researchers in August 2009 -- finds "remarkable" a paper that appeared early-2010 in the British Medical Journal, not mostly for its study of 500,000 subjects and authorship by 56 contributors, but because "46 scientists minimized the true significance of their own research..."

...They found that vitamin A, even in relatively low amounts, appears to thwart vitamin D's association with reduced rates of colon cancer.

...
Dr. Mazda Jenab and his 45 colleagues from the International Agency for Research on Cancer confirmed that low vitamin D levels are a risk for colon cancer in a dose response manner; those with the highest levels were about twice as less likely to develop colon cancer compared to those with the lowest levels.

Vitamin A and the U-shaped Curve

However, hidden on page eight is one sentence and a small table, which shows that the benefits of vitamin D are almost entirely negated in those with the highest vitamin A intake. And the retinol intake did not have to be that high in these older adults to begin to negate vitamin D's effects, about 3,000 IU/day. Remember, young autistic children often take 3,500 IU of retinol a day in their powdered multivitamins, which doesn't count any additional vitamin A given in high, single doses.
...

Source: The Vitamin D Newsletter, February 2010, Vitamin D, Vitamin A, and Cancer*

In the same source, further analysis and explanation by Cannell of "anomalies in other papers on vitamin D and cancer" -- e.g., "two similar studies on pancreatic cancer, with startling different results"; ten studies on prostate cancer, eight with no relationship, two with a U-shaped curve; and (possibly) a breast cancer survival study between 1989 and 1996 revealing a statistically-insignificant higher-risk of dying for Toronto women with levels above 40 ng/ml -- additionally show how the cancer-preventative effects of elevated vitamin D status obtained from cod liver oil are blocked by toxic levels of the accompanying form of its vitamin A, i.e, by high intake of retinol, the active form of Vitamin A, in contrast to carotinoid substrate forms of vitamin A, such as beta-carotene. Dr. Cannell elsewhere explains:

...
The crux of the problem is that a form of vitamin A, retinoic acid, weakly activates the vitamin D response element on the gene and perhaps blocks vitamin D's more robust activation. In fact, the authors of a 1993 study state "there is a profound inhibition of vitamin D-activated...gene expression by retinoic acid."

The key is having the proper ratio of vitamin D to vitamin A in your body. To obtain this proper D/A ratio, you must make a choice. (1) Either obtain the D/A ratio Nature intended�-that is, the ratio the human genome evolved on �- or (2) assume one knows better and intervene in a closed system, bypass the controls in the intestine, and inject active A directly into your blood by taking vitamin A or cod liver oil. Vitamin A production is tightly controlled in the body, the source (substrate) being carotenoids from vegetables in your intestine. The body uses these carotenoid substrates to make exactly the right amount of retinol for your body. That is, it is a closed, tightly regulated, system, one designed to perfection by Nature. When you take vitamin A as retinol, such as in cod liver oil, you intervene in this closed system and bypass the controls. Proceed at your peril.

Vitamin D is also a closed, controlled system and I don't recommend intervening in that system either. Vitamin D cholecalciferol is a substrate like carotenoids, it is not the active substance. Taking vitamin A as retinol is like taking activated vitamin D (calcitriol). Doing so bypasses controls and I have never recommended anyone take activated vitamin D except patients with renal failure under the care of a nephrologist.
...
Thus the goal is to provide all the vitamin A and vitamin D substrate the body would have obtained in a natural state, so the body can regulate both systems naturally. This is best done by eating colorful vegetables and by exposing your naked skin to equatorial sun every day. Since most of us can't do the latter, and won't do the former, we have to take the same amount of vitamin D substrate we would have obtained living 100,000 years ago�and may want to take beta-carotene substrate in a multivitamin.
...
Long story short, don't take cod liver oil or vitamin A as a retinol.

Source: "Proper Vitamin D�Vitamin A Ratio", The Vitamin D Newsletter, Dec 2008, Vitamin A Toxicity*

The kinetics of "subclinical vitamin A toxicity" and vitamin D are elaborated in a response by Dr. Cannell to a disillusioned, critical mother of two autistic children...

...a girl age 21 months and a boy age 3 1/2 years, who both tested as Vitamin D deficient (among other things,) and we have been supplementing them with 1,000 IU for the 21-month-old and 2,000 IU per day for the 3-year-old. They have been on the vitamin D for six months. Both of them are now at sufficient levels�74 and 87 ng/mL, respectively�and yet I assure you, while they have improved, they are still very much autistic. They also take Vitamin A in their powdered multivitamins, including 3,500 IU per day of retinyl palmitate. They've never received a large dose of vitamin A (or anything else) in our DAN doctor's office.
...

Your children have subclinical vitamin A toxicity, which blocks the effect of Vitamin D. The 3,500 IU of preformed retinol they are taking would be as if I were taking 25,000 IU of preformed retinol a day. It may take years for the toxic amounts of vitamin A to be removed from their system because, unlike vitamin D, the body has no good system to remove vitamin A quickly.

Vitamin A competes with vitamin D directly at the receptor site. When vitamin A levels are too high, the two retinoic acid molecules bind to each other instead of one vitamin A molecule binding with one vitamin D. When the two vitamin A molecules bind with each other, as occurs with high doses of vitamin A, the two vitamin A molecules then bind to the Vitamin D receptor and weakly stimulate the receptor, and may act as a weak agonist. But, weak agonists block the function of receptors, preventing the vitamin D from working.

Many DAN Doctors use Vitamin A, either as a large bolus dose or in the powdered multivitamins your child is taking. As such, I predict DAN treated children will be less responsive to Vitamin D until their Vitamin A toxicity clears. For more on the dangers of Vitamin A, see the last part of the paper Cod Liver Oil, Vitamin A Toxicity, Frequent Respiratory Infections, and the Vitamin D Deficiency Epidemic, written by 16 experts, warning of the dangers of Vitamin A.

Indeed, a recent Cochrane Review found that vitamin A supplements increased total mortality rate by 16%.

I would stop all vitamin A and increase the Vitamin D to 2,000 IU/day for the 21 month old and 4,000 IU/day for the 3-year-old until your children have 25(OH)D levels around 100 ng/mL, which is perfectly safe, and keep their levels that high for the rest of their childhood. By that time, my prophecy will be fact.

Source: The Vitamin D Newsletter, February 2010, More Letters on Autism*

The bottomline message in Dr. Cannell's findings in Vitamin D, Vitamin A, and Cancer* is his concluding advice for maintaining wellness and effectively treating with Vitamin D:

...
So it is not just autistic children that are being harmed by vitamin A. Avoid cod liver oil like the poison it is and check your multivitamins. Life Extension Foundation just reformulated their multivitamin to contain only 500 IU of preformed retinol. And, I am happy to report that Purity Products, which markets my vitamin D, has no preformed retinol at all in any of their multivitamins, only beta-carotene. Purity has also stopped selling cod liver oil. Now, if only Carlson, Solgar, Nature's Way, and other companies would stop selling cod liver oil and stop selling their concentrated vitamin A supplements to a country whose problem is widespread sub-clinical vitamin A toxicity, I'd be a happier agitator.

Remember, we are a non-profit and rely on your donations to publish our newsletter, maintain our website, and pursue our objectives. Send your tax-deductible contributions to:
...

*The Vitamin D Newsletter is licensed under a Creative Commons License.

Other exemplifying and clarifying excerpts from issues of The Vitamin D Newsletter:

1,000�2,000 IU/day for autistic children is inadequate. Aggressive vitamin D deficiency diseases need aggressive vitamin D treatment. Start with a minimum of 5,000 IU/day day in autistic children and check 25(OH)D levels every month. Many autistic children will need even more to see a full treatment effect. Please remember the difference between a treatment effect and a cure.

1,000 IU/day during pregnancy is also entirely inadequate. You need 5,000 IU/day, often more, and a 25(OH)D blood test to assure 5,000 IU/day gets you up above 50 ng/mL. � John Cannell, MD Mar 2009
The study showed that men with biopsy proven prostate cancer, who had the highest vitamin D levels, were up to 6 times less likely to die than men with the lowest levels over the 4 years of the study. Six times! That is a treatment effect, so yes you should take vitamin D. How much, I don't know. If it was me, I'd take enough to get my levels up to 80�90 ng/mL and I'd do it quick. Be prepared for your body to become a battlefield as the vitamin D attacks and attempts to kill the cancer cells. Also, check your serum calcium frequently, as the macrophages in the battlefield may start producing high amounts of activated vitamin D and drive up your serum calcium. � John Cannell, MD Mar 2009
Isotretinoin, or 13-cis-Retinoic Acid (Accutane in the USA), is a retinoid used in severe acne and rosacea as well as in cancer chemotherapy. It may have the same effects on the vitamin D receptor as other retinols. It certainly interferes with vitamin D metabolism.

For those taking Isotretinoin for cancer, continue doing what your oncologist says to do, but also get your 25(OH)D to at least 100 ng/mL. If you are taking Isotretinoin for acne, my advice is to stop the Isotretinoin and take adequate doses of vitamin D. � John Cannell, MD May 2010
While vitamin D may improve hypertension, it is not the be all and end all of hypertensive disease. If your doctor can stop your high blood pressure medication after you start taking Vitamin D, great, but I doubt that will happen. Most people will have to continue taking their antihypertensive medication even after adequate vitamin D supplementation, albeit sometimes at a lower dose.

While I am on the subject, remember, that vitamin D will not prevent all cancer or heart disease, or respiratory infections. True, evidence is accumulating that it will help, but you can still develop cancer, heart disease, and respiratory infections with adequate blood levels of vitamin D. That's why I believe in complementary, not alternative, medicine. � John Cannell, MD Mar 2010
3. Stock your home's pharmacy with several fresh bottles of 50,000 IU capsules of Vitamin D3 (a medicine at this dosage, not a supplement) and if you get this flu, take 2,000 IU per kg of body weight per day for a week. As I weigh 220 pounds, I would take 200,000 IU per day for seven days if I thought I had an infection with a 1918-like influenza virus. � John Cannell, MD May 2009
My best guess is that 5,000 IU/day and a 25(OH)D of > 50 ng/mL will be at least partially protective . Remember, at 50 ng/mL, you are assured that you are not suffering from substrate starvation, that is, your body has enough Vitamin D for its needs and some left over to store. At a level of 30 ng/mL, most people are still suffering from Vitamin D substrate starvation.

As I have written before, 25(OH)D levels are like water from a mountain spring. The topmost pool is the calcium economy. When that pool is full, excess 25(OH)D flows down to hundreds of pools below, cancer, heart disease, infection, etc. In a lethal pandemic, you want Vitamin D to do two things, increase production of natural antibiotics (AMPs) and quell excessive immune responses. Are these two pools at the same level? Is the AMP pool above the cytokine dampening pool? If so, people with 25(OH)D levels of 30 ng/mL may have enough D to strengthen their innate immunity but not enough to prevent the cytokine storm that kills in a lethal pandemic. Thus, people taking only 1,000�2,000 IU/day, with levels around 30 ng/mL, may risk death from a cytokine storm their body is unable to prevent. While only a theory, it would explain why the people with the allegedly highest 25(OH)D levels in both Mexico and 1918 (young adults) were the most likely to die. That is why I caution people that, if you are going to take Vitamin D, take enough, take 5,000 IU/day, which is usually enough to get your 25(OH)D levels into the mid range of the reference range (30�100 ng/mL), which would be 50�70 ng/mL. � John Cannell, MD May 2009

From "Dr. Cannell Interview on Vitamin D":

I would caution people to think that Vitamin D is the cure for influenza, although I think it's going to be proven to be a major weapon against influenza and even the common cold...Vitamin D does a couple of things: It not only upregulates production of cathelicidins and probably other antimicrobial peptides, but it also dampens the arm of the immune system that is invested in order to cause inflammation (inflammation is what makes the body respond to it), what's called a "cytokine storm" -- which is what killed many people in 1918, this explosion of the immune system -- where it strips, it denudes the epithelial lining of the respiratory tract, and people choke to death because they can't ventilate themselves...There's lots of diseases in medicine of excess inflammation. And vitamin D, again, makes the immune system smarter...not stronger...smarter. � John Cannell, MD :04:45, Dec 30, 2009

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SheilaT

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Wed Jul-07-10 08:48 PM
Response to Original message

1. The conclusion I draw from this

is that eating a healthy and varied diet is probably a lot better than supplements.

I've long since noticed that it's those who are most gung-ho about supplements who seem to have all sorts of odd things wrong with them.

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tiptoe

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Wed Jul-07-10 09:01 PM
Response to Reply #1

2. Can't get all the daily vitamin D from diet, and latitude and lack of sufficient opportunity for sun

year-round kind of dictates supplementation with vitamin D3 for many people.

...
Thus the goal is to provide all the vitamin A and vitamin D substrate the body would have obtained in a natural state, so the body can regulate both systems naturally. This is best done by eating colorful vegetables and by exposing your naked skin to equatorial sun every day. Since most of us can't do the latter, and won't do the former, we have to take the same amount of vitamin D substrate we would have obtained living 100,000 years ago�and may want to take beta-carotene substrate in a multivitamin.
...

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elocs

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Wed Jul-07-10 09:28 PM
Response to Reply #1

3. So what percentage of Americans actually eat a healthy & varied diet?

Maybe 5 or 10%?

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SheilaT

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Thu Jul-08-10 10:05 AM
Response to Reply #1

8. Kind of makes you wonder how

humans survive at all.

All I can go by is my own experience. I don't take any supplements. I eat a reasonably varied diet, although I'll be the first to admit it probably isn't by any means perfect. I don't let myself get caught up in any of the hype about some food being poison, or some other food being magic. I get out in the sun reasonably often. I live in northern New Mexico, so the sun is generally shining when I'm outside. But I have lived in Minnesota and Kansas, two places which can have a lot of overcast certain times of the year. I'm pretty much the healthiest person I know.

Every few years the hype changes about what nutrient we ABSOLUTELY MUST HAVE, and about how we are all fatally short of some needed nutrient. I just muddle along not worrying about any of that, and to repeat myself, I'm pretty much the healthiest person I know. Coincidence?

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bemildred

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Thu Jul-08-10 10:47 AM
Response to Reply #8

9. Yeah, lots of hype.

There are certain things I find helpful, like Chromium and EFAs, some extra Vitamin D, but on the whole you do better with low stress, good diet, exercise, and moderation in ones "bad habits", than by freaking out about magic pills.

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lib2DaBone

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Wed Jul-07-10 10:04 PM
Response to Original message

4. I'm confused. So what are they saying..I should not take Omega 3 -4 Fish Oil?

I have terrible arthritis.

I take Omega 3 and Omega 4 fish oil. It helps!

So what are they saying?

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hlthe2b

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Wed Jul-07-10 11:31 PM
Response to Reply #4

6. No no no...

Edited on Wed Jul-07-10 11:39 PM by hlthe2b

Omega 3 fatty acid containing fish oil supplements should contain only minimal levels of vitamin A. Cod liver oil, on the other hand can contain as much as 15000 to 30000 IU of vitamin A and some multivitamins can also contain exceedingly high levels of pre-formed vitamin A (retinols or retinyl esters). The latter are the problem, not the omega 3 fish oil capsules-- for which there is tremendous consensus for the value of supplementing.

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tiptoe

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Thu Jul-15-10 04:58 PM
Response to Reply #4

11. re Omega-3: Cannell wouldn't advise as Dr. Oz did Diane Sawyer on 11/25/09 on Good Morning America:

Edited on Thu Jul-15-10 05:13 PM by tiptoe

The information Dr. Oz relates "On the Importance of Vitamin D" is pretty good and, for the most part, updated info.

However, what Dr. Oz advised as desirable vitamin D status levels (above 50 == "good", 30-50 use supplements, below 30 = "way off the scale"/deficient...Diane Sawyer was "15" a few years ago) cannot be attained using the recommended daily doses on his website, where, basically, are displayed the 1997 daily recommended doses of Vitamin D by age group, called "grossly inadequate" at a clinical endocrinologists congress meeting in 2009:

From Dr. Oz' website, Daily Dose: Vitamin D:

So exactly how much Vitamin D should you aim for each day? The answer varies depending on your age.

For ages 0-50 (including pregnant and lactating women), 5 mcg or 200 international units is adequate
For ages 50-70, 10 mcg or 400 international units is better
For ages 71+, aim for at least 15 mcg (600 international units)

However, on the show, Dr. Oz mentions that his father-in-law takes 5000 IU/day of Vitamin D (just as post-1999 vitamin D experts like Dr. Cannell might minimally, routinely advise for most adults, adjustable up or down, as per vitamin-d status-test feedback dictates). So, between some recent TV shows and Dr. Oz' website, there's conflicting info.

But where things really get dicey for viewers -- and potentially serious, healthwise, based on Cannell's "Vitamin D, Vitamin A and Cancer" findings reported in February 2010 -- is what Dr. Oz recommends to Diane Sawyer, beginning :04:43 in the video: http://www.youtube.com/watch?v=6D9aANoN0-Y

Dr. Oz challenges Diane Sawyer to take what appears a shot glass of cod liver oil (but can't really tell how much is being downed, and Oz doesn't say). According to Cannell, only 3000 IU of retinol is needed to block the cancer-preventing effect of vitamin D in elders. Almost all dairy products have retinol-based vitamin A in them (milks between 6% and 10% of probably-too-high DV per 8-ounce serving, cheese slice ~ 4%), so with recommendations of cod liver oil as a supplement, the retinol can accumulate to inadvisable levels unwittingly, quickly.

Also, on Dr. Oz' show with answers to "What supplements do you take?", he mentions he buys multivitamins only from BIG companies (no affiliations with ANY company, he's sure to emphasize) 'so you know won't be cheated'...and he just looks for basic vitamins A,B,C,D,E...nothing fancy. Okaaay, fine...but...

Dr. Oz makes no qualification or warning about the content and quantity of vitamin A as a retinol vs beta-carotene in the multivitamin. Last cursory check, only ~25% of multivitamins offer 100% beta-carotene, and Centrum still offers vitamin A as 71% retinol.

Dr. Oz also recommended cod liver oil for DHA Omega-3's on June 1, 2009 ( http://www.youtube.com/watch?v=JKU0MkqNAN0&feature=related ).

Maybe Dr. Oz has adjusted his vitamin A and cod liver oil recommendations (seems nowhere does he mention 'how much' cod liver oil per day), but, just in case, doctors' recommendations should be date-checked -- the info can change fast in vitamin d-related research.

Again, Dr. Cannell advice re taking vitamin A as a retinol: "Proceed at your peril...Avoid cod liver oil like the poison it is."

(I wonder if Diane Sawyer has been clued in about retinol.)

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hlthe2b

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Wed Jul-07-10 11:26 PM
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5. I read several of the studies referred to (and others in the literature)

Edited on Wed Jul-07-10 11:38 PM by hlthe2b

I think there is a compelling case to be made to halt inclusion of pre-formed vitamin A (retinols) in multivitamins while simultaneously dramatically increasing Vit D as D3 (cholecalciferol). Or they can include only beta carotene (substrate) forms of vitamin A, since they do not appear to be the problem. When I read this data, I started taking my usual multivit (that contains way too much vitamin A as retinyl palmitate) every other day or even every third day, while bumping up daily vit D3.

When I researched this for my own purposes some time back, I was appalled at how much willy nilly supplementation of retinols in food was occurring, considering this is a fat-soluble vitamin that ones body stores and has a hard time removing. At the same time, it is really really hard to get adequate vitamin D from diet alone and like most folks, I use sunscreen religiously and am not going to entertain increasing risk from natural sun exposure.

While it would be nice if diet alone could provide everything we need, I do believe that omega 3 fatty acids, vitamin D, calcium and magnesium are not likely to be acquired in sufficient amounts from diet alone and I fully intend to continue supplementing these specifically. But, once I go through my long dated supply of daily multi-vitamins (which taken every second or third day will take a while), I will probably cease that practice.

Just my own thoughts. I really really really wish that physicians received more nutritional training and primary care practitioners were careful to keep up on the emerging science on this score. Diet has everything to do with health and not just based on number of calories and level of fat.... :shrug:

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tiptoe

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Thu Jul-08-10 02:33 AM
Response to Reply #5

7. k & R

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tiptoe

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Mon Aug-09-10 06:27 AM
Response to Reply #5

12. re-kick in appreciation for the sound perspective nt

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tiptoe

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Sat Sep-25-10 12:33 AM
Response to Reply #12

13. k nt

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wishlist

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Sun Jul-11-10 01:02 PM
Response to Original message

10. Indicates Vit A from betacarotene is okay, but not A from retinol (cod liver)

My current multivitamin (NatureMade) has Vit A from betacarotene only at 50% the RDA. Article indicates vitamin companies are aware of the problem and have begun eliminating retinol cod liver oil as a source.

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