What I basically said is that the medical literature supports the possibility that vitamin D deficiency is connected with depression but more studies need to be done to prove the connection.

Now in the Journal of Photochemistry and Photobiology a new article has been published,entitled "Vitamin D, light, and mental health". The author is MB Humble.

In this article the author reviews the medical literature for relationship between vitamin D and mental health. He points out that both vitamin D receptors and vitamin D enzymes are present in the brain. He also points out that active vitamin D affects neurotransmitters and other molecules that are relevant to mental disorders.

He points out that considerable evidence supports a role of less than optimal vitamin D levels being associated with depression. However he quickly points out that further double-blind crossover placebo controlled prospective studies must be done to prove this connection.

He goes on to point out that specifically two diagnoses, schizophrenia and autism has been linked to prenatal vitamin D deficiency.as my readers know I've discussed this previously.

The author also goes on to present two cases of psychiatric improvement coinciding with treatment of their vitamin D deficiency, leading to the question of whether their vitamin D deficiency was the cause of their psychiatric disorder.

We increasingly see articles like this in the medical literature.

Please let me know if you have seen any improvement in your or your families mental health as a result of optimizing your vitamin D levels. Have you had your levels checked? Have your friends with depression or other mental disorders had their levels checked?

I look forward to hearing back from you.

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Before about 10 years ago, patients who presented with these symptoms with told that they were depressed and should take a SSRI drug. These patients realized it was not depression, but they were told it was all in their mind. Within the last years the American College of Rheumatology has finally acknowledged this diagnosisand even given it an ICD-9 code.

In my office we see and treat many patients with this fibromyalgia. We usually use an interdisciplinary approach to helping them. We give the patients anti-inflammatory natural supplements as well as change them to  an anti-inflammatory diet. We also give them support for their adrenals and other stress organs, as well as liver support. In addition, the patients will get acupuncture and bodywork. Bodywork is especially important because often these patients have poor posture and "backwards breathing" and need to learn how to stand and walk sit and breathe in a correct way.

Now I am delighted to see a randomized trial of Tai Chi for fibromyalgia being published in the prestigious New England Journal of Medicine. For those of my readers who do not know, Tai Chi is a mind-body practice which began in China as a martial art. It includes meditation along with slow, gentle, graceful movements as well as deep breathing and relaxation. The idea of it is to move the body's life force called "Chi" throughout the body. The beauty of it is that integrates physical psychosocial, emotional, spiritual and behavioral components. It was thought that because of its mind and body attributes that tai chi would be especially well-suited to the treatment of fibromyalgia.
In the study the authors conducted a trial to compare the physical and psychological benefits of tai chi with those of the control intervention that consisted of wellness education and stretching. The study was12 weeks in duration. In all, 66 patients were in the study.

In the study, all patients filled out the  Fibromyalgia Impact Questionnaire (FIQ). They also used a sleep quality Index, as well as a Depression Index. In addition they used a Chronic Pain Self-efficacy Scale test. They also used the Short Form Health survey (SF — 36), which is a general measure or a persons complaints. In addition to be sure any results were long-lasting they also measured all the scales at 24 weeks after the study was completed.

When all the data was evaluated, it showed that the group of fibromyalgia patients who were in the Tai Chi group had very statistically significant improvement compared with the control group. The Tai Chi group consistently did better on all the various measurements that were taken.

Another nice finding is that at 12 weeks, more of the patients in the Tai Chi group had been able to stop the pharmaceutical medication that they were using to treat fibromyalgia. The number was greater but this difference was not statistically significant.

In my opinion this is a seminal study. The data is so strong that the prestigious New England Journal of Medicine approved it and has published it.

This sets a new bellwether for the management of fibromyalgia, and I hope that more and more patients with this condition will begin to practice Tai Chi.

On a personal note, as a long-time practitioner of yoga, I would like to see if similar results could be obtained with yoga classes instead of Tai Chi.

Do you have fibromyalgia? What have you done to help yourself? Have you tried Tai Chi?  Did it help? Do you have family or friends who could benefit from using Tai Chi to help address their fibromyalgia?.

Let me know. I look forward to hearing from you.
 

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The exact details on the why and why not this vitamin D optimization of patients with these diseases is not discussed in detail in the medical literature.

Now a new study has come out that shows that vitamin D actually appears to HELP patients with two specific types of lymphoma.

In a significant paper published in the Journal of Clinical Oncology that was just published online, Matthew Drake, MD and his colleagues from the Mayo Clinic and 2 other schools  tested the theory that vitamin D levels might be predictive of "event free survival" (EFS), and "overall survival" (OS) in non-Hodgkin's lymphomas (NHL). An "event" would be getting so sick the patient would need intervention most likely in a hospital. Otherwise, these terms are self-explanatory.
In the study they looked at over 900 newly diagnosed patients with NHL. 44% of the patients had an insufficient vitamin D level- that was less than 25 ng/ml, measured  within 120 days of their diagnosis. The average patient was followed for almost 3 years, some longer and others shorter.

After adjusting for other factors and treatment, the vitamin D insufficient patients who had defuse large B-cell lymphoma had a 41% lower chance of having event free survival. In addition, this group had a 50% lower likelihood of overall survival in the time they were followed.

Similarly patients with T cell lymphomas also had a significantly shorter event free survival time and a significantly shorter overall survival.

The authors went on to state that it was not clear if normalizing the vitamin D levels in these patients would improve outcome and suggest that more studies of this sort need to be done to find that out.

In my own practice of medicine if I see a patient with one of these types of lymphomas now, I will certainly optimize their vitamin D levels as soon as I start working with them.

The authors were quoted as saying "At this time, there is no definitive evidence for a causative relationship between lower vitamin D levels and poorer outcomes in lymphoma, and our study did not answer the question of whether normalizing vitamin D levels in these patients improves outcome."

This is just one more example where higher vitamin D levels were associated with patients doing better. I look forward to more and more of these studies as vitamin D is not on the researchers map!

Do you have friends or family with one of these types of lymphoma? Have they had their vitamin D levels checked? Let me know what you are doing to help spread the word about vitamin D.

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Preeclampsia is a condition which usually occurs at the end of pregnancy that is characterized by high blood pressure as well as protein in urine. Without treatment it can become very serious and can affect the delivery of the baby.

Early onset preeclampsia is not very common. It occurs in only about 2 or 3% of pregnancies. Nevertheless it is responsible for about 15% of premature births yearly. The definition of "early onset" is when it occurs before the 34th week of pregnancy.
In this new study that was published in the American Journal of Obstetrics and Gynecology, a mere 10 ng/ml increase in vitamin D blood level, resulted in a 63% reduction in the incidence of early onset preeclampsia.

Christopher Robinson, MD, MSCR, the principal author on the paper was quoted as saying " It is biologically plausible that the vitamin could affect preeclampsia risk. Vitamin D acts as a hormone, and lab research has found that it may affect the regulation and function of proteins in the placenta; problems in the development of the placenta are believed to be at the roots of preeclampsia."

The authors of the study were quick to point out that further study is needed to understand the role of vitamin D deficiency in pregnancy. The study, although it had very strong statistics, had only 100 patients.

Once again we now see another aspect of the importance of vitamin D during pregnancy. It is my recommendation in my practice of medicine that pregnant women take 4000 IU of vitamin D every day, and this amount is adjusted according to blood tests that we do every trimester.

Have you had your blood tested for vitamin D? Do your family and friends who are pregnant take enough vitamin D? The amount of vitamin D in a normal prenatal vitamin is only 400 IU, and no vitamin D researchers that I know consider this to be nearly sufficient for pregnancy.

I look forward to hearing your comments.

Reference
 

Now a new study published in the New England Journal of Medicine has  been published showing the importance of vitamin A and its relationship to lung development in the womb.

In this study, that was led by Wiliam Checkley, M.D., over 1600 children in Nepal were evaluated. Some of the mothers were given vitamin A pills during pregnancy and others were given placebo. An additional set of women was given beta-carotene which is a derivative of vitamin A.
The findings were that the children whose mothers had received vitamin A had significantly better lung function than those whose mothers who were given placebo or beta-carotene during pregnancy. These benefits were even measurable at age 9 in the children.

This study allows us to see the benefit of another nutrient, in this case vitamin A,  and, and it's importance for optimal fetal development.

It is estimated that 190 million preschool age children and 19 million pregnant women have vitamin A deficiency worldwide. This deficiency can cause health problems during the development of the child, including lung issues.

Dr. Wiliam Checkley, the author of this study, was quoted as saying "Early interventions involving vitamin A supplementation in communities where undernutrition is highly prevalent may have long-lasting consequences for lung health". He went on to say     "The magnitude of the effect observed in this study is slightly greater than that associated with preventing exposure to parental smoking in school-aged children."

I certainly urge you to speak with all your friends and relatives about being sure that the pregnant women in their life are taking a prenatal vitamin containing vitamin A.

Studies like this one, along with the many studies of the role of vitamin D during pregnancy that I have discussed here,  make me wonder what would the health of the planet be like, if fetuses received an optimal degree of nutrition while in the womb? Given the epidemic of Vitamin D deficiency in pregnancy and combining it with this information on vitamin A makes me wonder if these deficiencies are associated with the asthma epidemic we now see in American children

Let me know your thoughts? Do your friends and family take a prenatal and vitamin A while they were pregnant?

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After more than 30 years of practicing integrative medicine, I realize that it is time to share what I have learned and what I've been doing with young medical students and medical doctors, as well as the general public.

Through my blog I have been sharing my knowledge with the general public. However, I felt it was a necessity in my life to also be able to train young medical doctors.

Starting this September, I will be teaching a course to second-year medical students called "Doctoring". In this course I will be paired with a psychologist and we will be teaching young medical students how to interview patients, and get their history and how to help patients deal with difficult problems, from drug addiction to a cancer diagnosis. This course is not so much about the science of medicine at the art of meeting with the patient, and meeting their needs.

A recent study in  JAMA showed that if a patient comes to their doctor with more than two complaints, that the chance of the second complaint ever being addressed is 8%. This study was shocking to me as an integrative doctor, because I recognize that the body is an inter — connected web of organs and not just a narrow view of one organ system and one complaint. So knowing ALL the patients symptoms is important.

This course at UCLA is a required course and all medical students must take it. It goes on their permanent deans record that they use to get into a residency program.

I will be specifically teaching eight or nine students throughout the year. I expect it to be a very fun course. That is because UCLA uses what are called "standardized patients". When I heard this expression I asked what it meant?  A "standardized patient" is a professional actor who has been taught and trained to act out all parts of any given disease that the doctors are assigned for the day. The "patient"  will know the signs and symptoms of the disease and they will be able to intelligently answer the medical students questions while the psychologist and I look on and teach the students how to interact with them as a patient.

My partner in the course,who is a psychologist, has been doing this for a number of years and she told me that it is not only very valuable but also can be fun.

I look forward to telling you about the "cases" that we see, but  most importantly I  look forward to helping the students to learn that they must listen to the whole patient, with a compassionate ear.

It is wonderful that medical schools are starting to do this.

What has been your experience with interacting with physicians? Have you had to interact with physicians taking care of a loved one? How has your experience been? Let me know what you think?

The recent study by Kristin AV and others, has recently been published in the medical journal Heart.

In this specific study they looked at congestive heart failure. This is a condition where the heart, due to illness is unable to pump sufficient blood to the rest of the body. It can vary from very mild, to the extreme that a person is unable to walk without oxygen. 4.8 million Americans have this condition. This includes 10% of people over the age of 70.

In this study the authors took 17 patients who were stable with congestive heart failure. All of them were already receiving an optimized medication program for  their heart failure when they entered the study.

The study is all the more impressive because they did use a control group. One group of patients got real acupuncture in the other group received "sham" acupuncture.

After the series of acupuncture treatments, the group that received the real acupuncture significantly increased their ability to walk with less symptoms,. In addition in this group, they found a significant improvement in their "recovery" in regards to their ability to breathe after the exercise.

Furthermore heart rate variability which is a sign of the health of the heart increased after the real acupuncture but actually decreased after the "sham" acupuncture

In addition the "general health" score and "body pain" score improved after the real acupuncture.

In a press statement the research group noted that heart failure is recognized to be much more complex than had previously been assumed. Specifically it involves an imbalance in the autonomic nervous system, as well as in various neurotransmitters.

In a press release the authors were quoted as saying "This is precisely where acupuncture may intervene, by bringing these processes back into balance — it influences the autonomic sympathetic nervous system (excitation), boosts the parasympathetic nervous system (relaxation), and also has an anti-inflammatory affect,"

Furthermore, Dr.Arnt Kristen, one of the authors of the study stated "The blood level of a certain messenger, tumor necrosis factor alpha (TNF alpha) actually drops after the real acupuncture treatment. Since TNF alpha leads to a reduction of muscle mass and muscle strength among other things, this would explain the positive effect (of acupuncture) on skeletal muscle function"

I've been using acupuncture in my practice on a regular basis for the last 30 years. I've seen remarkable results in almost every medical condition with acupuncture over and over again. It is wonderful that these types of studies are now coming out that objectively show the benefits of acupuncture for much more than just pain control. This will encourage conventional doctors to begin to be open to the use of acupuncture in congestive heart failure.

Let me know — do you have loved ones who have congestive heart failure? Have they tried acupuncture as an adjunct to their medications? I look forward to hearing from you.

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Now, for the first time, a study on the economic burden of vitamin D deficiency in Canada has been published. It is especially important for Canada to pay attention to their population's vitamin D levels because most of the Canadian population lives north of the 43rd parallel. Because of this, making vitamin D from sun UVB radiation is impossible for at least 4 to 5 months of the year. ("Vitamin D Winter")The Canadian diet provides about 200 IU of D from food every day, which is not enough to maintain normal blood levels. Therefore the people of Canada should all be taking supplementary Vitamin D for at least those winter months.

This article was written by William B. Grant and others. The authors carefully searched the medical literature for articles that showed the dose-response relationships for vitamin D and disease outcomes. For example they reviewed one study which I discussed in my book that showed increasing vitamin D levels could reduce the risk for death from cardiovascular disease by 25% or more. They looked at many other diseases including cancer, diabetes, influenza, falls and fractures, multiple sclerosis and even pregnancy outcomes.

They then obtained data from Health Canada, on mortality rates for 2005.

The authors then estimated the benefit in reducing disease based on increasing the average person's vitamin D level from 27 ng/ml to 42 ng/ml.
The results were astounding. It was estimated that the death rate in Canada would fall by 37,000 deaths per year, which represented over 16% of annual deaths and that the economic burden of disease could be reduced by 6.9% which is equal to over $14 billion per year.

Their conclusion was that they recommended that "Canadian health policy leaders consider measures to increase serum vitamin D levels for all Canadians". Of course I would certainly agree with this!

I would ask all of my readers who live in Canada or anyplace that far north to check their vitamin D levels at least once a year. My book has been translated into the Estonia language and I would remind my Estonia readers that the latitude of Estonia is 58 degrees. Even more north than Canada! And all of Scandinavia is north of Estonia ! They need vitamin D even more!

So if you have family or friends in these northern countries, call or email them to remind them to take their D at least during the winter.

Let me know what you think of all this information? Have you notified your friends even in the north of the United States about taking vitamin D?

REFERENCE

The other speakers included my friend Myles Spar MD, MPH who is the director of the Venice Integrative Medicine Clinic, at the Venice Family Clinic. Also Richard Pietras MD, Ph.D. who is the chairman of the Stile Program in Integrative Oncology at UCLA spoke. And Ping Ho, MA,MPH who is the director of the UCLArts and Healing Center spoke.

We each spoke to the students about our work and showed slides of our offices and projects.

After our talks we then all sat on a panel and answered questions from the students about integrative medicine from our perspective.

I had a really good time and enjoyed meeting my colleagues to see what they are doing. I look forward to more teaching opportunities in the near future.

Here is a nice picture of the five of us!

From left to right : Dr Pietras, Dr Hui, Ping Ho, Dr Soram, Dr Spar
 
 

The researchers tested overall cognition which includes thinking, learning, and memory. They also tested attention and executive function. Executive function is the ability to plan, organize and prioritize.

The results of the study showed that those patients who were deficient in vitamin D were 60% more likely to have a significant decline in overall cognition and 31% more likely to have declines in executive function, than those who had sufficient vitamin D levels. A significant aspect of this study is that none of the elderly patients had any signs of dementia at the beginning of the study.

In an e-mail to WebMD Dr Llewellyn said that "This raises the possibility that vitamin D supplements may have therapeutic potential for the prevention of dementia and clinical trials are now urgently needed. We do not yet know the optimal intake of vitamin D to protect the brain as we need the results of clinical trials to confirm this."

This study is of major importance. I don't know how you and your families are but my patients and friends are  more afraid of getting Alzheimer's disease than almost any other condition including cancer. This study was the first of its type to look retrospectively over a significant number of years to watch cognitive decline occur in those who are vitamin D deficient.

As my conventional colleagues always advise, of course prospective double-blind studies must be conducted. But these take years, and there is no reason for you not to now take vitamin D and optimize the levels of you and your family.

You can check your blood level with your doctor or my at-home blood test kit and replace your vitamin D with inexpensive pills. From my previous post, be careful what brand of vitamin D you take so you know you are getting the amount of vitamin D that  is on the label.

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