March 12, 2012, 1:21 pm, Reasons That Vitamin D May Matter

By JANE E. BRODY, Columnist

At least once a week, someone, usually a woman over 50, asks me about vitamin D.
Perhaps a routine checkup has revealed a deficiency, prompting the doctor to recommend
an over-the-counter supplement or, in severe cases, large prescription doses to correct the
problem.

Often, though, the concern is bone health. Without vitamin D, the body cannot
properly absorb calcium, and bones become fragile. At the annual meeting of the
American Academy of Orthopaedic Surgeons last month, researchers reported that among
889 adult patients treated for a fracture at a Missouri trauma center, blood levels of
vitamin D were “insufficient” in 78 percent and “frankly deficient” in 39 percent. The
study group excluded those with known risk factors for vitamin D deficiency.

A second report, by doctors in Seoul, South Korea, found vitamin D levels were
“significantly lower” among 104 postmenopausal women who had broken a wrist than
among 107 age-matched controls without a fracture.

But increasingly I receive inquiries regarding research suggesting that raising blood
levels of vitamin D may protect against chronic or life-threatening diseases. Many studies
in recent years have linked low levels to health risks like heart disease, high blood
pressure, cancer, rheumatoid arthritis and other autoimmune diseases, prompting many
health-conscious men and women to think that supplements of vitamin D are protective.

Alas, there are still no large-scale randomized controlled clinical trials — the gold
standard of human research — to prove or disprove the value of vitamin D
supplementation beyond its well-known benefits to bone health.

Nonetheless, Dr. Kevin A. Fiscella, a public health specialist and family physician at
the University of Rochester, has decided to take 1,000 international units of vitamin D each
day, based on data from his studies linking racial disparities in vitamin D levels to disease
risk and his belief that “it can’t hurt and it may help.”

A Vitamin With Broad Influence

In an interview, Dr. Fiscella emphasized that his findings strongly suggest, but do
not prove, that vitamin D deficiencies cause or contribute to diseases like colorectal cancer,
high blood pressure and kidney and heart disease, which affect black Americans at higher
rates than whites. The findings are bolstered by known biological effects of vitamin D and
by the fact that widespread vitamin D deficiencies occur among blacks living in the
Northern Hemisphere.

Nearly every body tissue has receptors for vitamin D, among them the intestines,
brain, heart, skin, sex organs, breasts and lymphocytes, as well as the placenta. The

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vitamin, which acts as a hormone, is known to influence the expression of more than 200
genes.

In laboratory studies, it has been shown to have anticancer activity, inhibiting the
growth and spread of tumors. There is also suggestive but inconclusive evidence that
vitamin D deficiency plays a role in asthma, Type 2 diabetes, autoimmune diseases like
multiple sclerosis and rheumatoid arthritis, pre-eclampsia and low birth weight, and
neuropsychological disorders like depression, autism and memory loss. Vitamin D is a fat-
soluble essential nutrient that naturally enters the body primarily through the skin, where
ultraviolet B radiation in sunlight stimulates production of previtamin D. This, in turn, is
converted to the biologically active form, vitamin D hormone, in the kidneys.

Very few foods naturally contain meaningful levels of vitamin D; mostly they are
fatty cold-water fish like salmon, mackerel, bluefish, anchovies, sardines and tuna, as well
as cod liver oil. Some foods are fortified with the vitamin, especially milk, infant formula
and, more recently, some brands of orange juice, yogurt, cheese and breakfast cereal.

Several factors work against achieving the levels of vitamin D known to prevent
bone loss, let alone other diseases should a cause-and-effect ever be established.

One is skin color. Dark skin evolved in equatorial Africa, where the sun is intense
year round and just a brief daily exposure to UVB (the sun’s burning rays) is sufficient to
achieve adequate blood levels of vitamin D. But melanin in the skin acts as a natural
sunblock, and among blacks living in the United States, where sun is less intense, less of
the previtamin is produced.

Dr. Fiscella’s studies, based on thousands of adult participants in the National

Health and Nutrition Examination Survey conducted from 2001 to 2006, revealed much
higher rates of vitamin D deficiency among non-Hispanic blacks than non-Hispanic
whites. Furthermore, in separate studies, lower levels of vitamin D among blacks across
the country were associated with a greater incidence of colorectal cancer, high blood
pressure, protein in urine (a precursor of kidney disease) and cardiovascular deaths.

Avoiding Deficiency

Warnings about the cosmetic and cancerous consequences of undue sun exposure
have prompted millions of health-conscious Americans to protect themselves from UVB
with protective clothing and liberal use of sunscreen on exposed skin. The latter can
reduce previtamin D production in skin by more than 90 percent.

In addition, because vitamin D is stored in body fat, the dramatic increase in obesity
in this country is placing more people, regardless of skin color, at risk of inadequate levels
of D in blood serum.

Finally, consumption of milk has declined significantly, and most other popular
dairy products are not fortified with D.

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 As a result, growing numbers of light-skinned Americans are finding that they, too,
are not getting enough D to bring their serum levels to 20 nanograms per milliliter, the
level deemed adequate by the Institute of Medicine, and even fewer reach 30 nanograms,
the level many bone specialists and vitamin D researchers consider more desirable.

A placebo-controlled clinical trial called Vital, sponsored by the National Institutes

of Health and due to be completed in 2016, is assessing the effect of a daily supplement of
2,000 I.U. of vitamin D on the risk of developing heart disease, cancer and stroke among
20,000 men over 50 and women over 55 with no prior history of these diseases.

Meanwhile, the Endocrine Society recommends that people at risk for vitamin D
deficiency be screened to determine their serum levels, including those with bone disease,
chronic kidney disease, liver failure, malabsorption syndromes (resulting from cystic
fibrosis, irritable bowel disease, weight-reduction surgery or abdominal radiation),
overactive parathyroid and granuloma-forming disorders. People taking drugs like
anticonvulsants, glucocorticoids, antiretrovirals, antifungals and cholestyramine also
should be tested, as well as older adults with a history of falls or nontraumatic fracture.

Certain groups at risk for a deficiency also warrant screening: blacks, obese children
and adults, and pregnant or nursing women, Dr. Fiscella said.

Lives Restored, Finding Purpose After Living With Delusion

By BENEDICT CAREY
Published: November 25, 2011

ATHENS, Ohio — She was gone for good, and no amount of meditation could
resolve the grief, even out here in the deep quiet of the woods.
Milt Greek pushed to his feet. It was Mother’s Day 2006, not long after his mother’s
funeral, and he headed back home knowing that he needed help. A change in the
medication for his schizophrenia, for sure. A change in focus, too; time with his family, to
forget himself.

And, oh yes, he had to act on an urge expressed in his psychotic delusions: to save
the world.

So after cleaning the yard around his house — a big job, a gift to his wife — in the
coming days he sat down and wrote a letter to the editor of the local newspaper,
supporting a noise-pollution ordinance.

Small things, maybe, but Mr. Greek has learned to live with his diagnosis in part by
understanding and acting on its underlying messages, and along the way has built
something exceptional: a full life, complete with a family and a career.

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 He is one of a small number of successful people with a severe psychiatric diagnosis
who have chosen to tell their story publicly. In doing so, they are contributing to a deeper
understanding of mental illness — and setting an example that can help others recover.

“I started feeling better, stronger, the next day,” said Mr. Greek, 49, a computer
programmer who for years, before receiving medical treatment, had delusions of meeting
God and Jesus.

“I have such anxiety if I’m not organizing or doing some good work. I don’t feel
right,” he said. “That’s what the psychosis has given me, and I consider it to be a gift.”

Doctors generally consider the delusional beliefs of schizophrenia to be just that —

delusional — and any attempt to indulge them to be an exercise in reckless collusion that
could make matters worse. There is no point, they say, in trying to explain the
psychological significance of someone’s belief that the C.I.A. is spying through the TV; it
has no basis, other than psychosis.

Yet people who have had such experiences often disagree, arguing that delusions
have their origin not solely in the illness, but also in fears, longings and psychological
wounds that, once understood, can help people sustain recovery after they receive
treatment.

Now, these psychiatric veterans are coming together in increasing numbers, at

meetings and conferences, and they are writing up their own case histories, developing
their own theories of psychosis, with the benefit of far more data than they have ever had
before: one another’s stories.

“It’s a thrilling time, because people with lived experience are beginning to
collaborate in large numbers,” said Gail A. Hornstein, a psychologist at Mount Holyoke
College and author of “Agnes’s Jacket: A Psychologist’s Search for the Meanings of
Madness.” “They are developing their own theories, their own language about what their
experiences means from the inside.”

Mr. Greek is one of the most exceptional, having built a successful life and career
despite having schizophrenia — and, he says, because of it. He manages the disorder with
medication, personal routines, and by minding the messages in his own strange delusions.

“Schizophrenia is the best thing that ever happened to me,” he said. “I know a lot of
people with the diagnosis don’t feel that way, but the experience changed me, for the
better. I was so arrogant, so narcissistic, so self-involved, and it humbled me. It gave me a
purpose, and that purpose has been very much a part of my recovery.”

The Village Eccentric

Like many idealistic undergraduates, Mr. Greek arrived at Ohio University in

Athens on a mission. Only, like many undergrads, he wasn’t completely sure what it was.

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 “To discover a psychological code that people should live by, to create world
peace,” he said. “Something like that.”

The town was ready to listen, regardless. It was the fall of 1981, and Athens still had
one sandal planted in the 1960s; communes thrived in the Appalachian foothills to the
north, and big ideas were in the air, at least in the streets and bars near campus, where
professors and students gathered.