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February 16, 2007

Depression and Vitamin D Deficiency: Overlooked

Vitamin D Deficiency and Depression: Undetected is Untreated

Yes, I am still going on about all those comorbid conditions that can drive a person into “incurable” depression. The references in this post require some careful review for anyone interested in why the meds don’t work for serious depression.

If you read either of these two references you will quickly see how Vitamin D deficiency is a common condition, more common in African Americans, and will understand why Vitamin D levels make such a difference. Each of these references is loaded with many additional Pub Med references, so they will keep you busy as you wish.

Are you interested in basic science? How about anthropology? How about bird flu? Read on.

First start with the Vitamin D Council:

Yes, you thought you were getting vitamin D in milk. Well you are, but that D is D2, not the bio-available, the useful, D3. The Vitamin D council has a great newsletter, discusses the various perspectives of the research, and is designed for easy review. Toxicity and levels all discussed in detail.

Now if you have a few moments download this 15 pg file Download Depression.D3.pdf on Depression and Vitamin D also from Dr Cannell at the Vitamin D Council. The references are abundant, and the information is compelling.

So what do you do now?

To get Vitamin D measured you need to have a script [to draw a blood sample] from a medical person with the following [and many labs don’t get this so you have to spell it out]:

25(OH)D, or spelled out: 25-hydroxyvitamin D

-The diagnosis code to have it paid for by insurance: 269.2 Hypo Vitamin D

[not 1-25 dihydroxyvitamin D!]

-The range you are looking for: 50ng/ml. [32 is considered normal by the lab, not by those writing the reviews and enclosed comments] I have seen levels in my office as low as 9ng/ml, and have a colleague in DC who had a patient with 0ng/ml.

Guess how that person felt… does “depressed” sound reasonable?

A simple clinical interview/screening question: Do you suffer from Seasonal Affective Disorder?

Many have been debating the correct dose for supplementation: The US Pharmacist says 4000 iu [not mg]/day during the winter, for the reasons explained in the references. Some are now saying 5000 iu. Don’t use a D2/D3 mix, just D3. Need to supplement with chelated calcium, and remeasure quarterly to stay within guidelines. Toxicity can be a problem if not watched, but it is reportedly rare even with considerable supplementation. Please review these references before running down to your local vitamin shoppe.

First get started thinking and reading about the Vitamin D issue, this post is too short to cover all the many questions. The varieties of medical illness associated with Vitamin D deficiency will roll your socks up and down.

Posted at 06:46 PM in Brain/Body Evidence, Mythbusting, Psych Med Reviews | Permalink

Technorati Tags: Depression, Dose of Vitamin D, Psychiatric Medications, Tanning booths, Untreatable Depression, Vitamin D, Vitamin D testing

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Reassuring to know the D3 cause, and the specific D3 intervention. Been over to your fatigue site – fatigue is so much a part of so many of these psych/metabolic problems. We will be interested to see how you do in the big blog contest.

Will also be interesting to follow up on your dose and your feeling about D3 response, if not too personal. Be sure to take Calcium with the D3-

Chuck

Posted by: Dr Charles Parker | April 12, 2007 at 08:52 PM

I was recently diagnosed with Vitamin D deficiency. I have had CFS for many years now and I never knew how severely deficient on Vitamin D I was. I am taking a heavy duty supplement now to hopefully recover!

Posted by: Fighting Fatigue | April 09, 2007 at 01:16 PM

Yes, there is middle ground and that place is called moderation.

The real health benefits of moderate UV light exposure and vitamin D3 production far outweigh the risks.

There is disagreement among medical professionals about UV light exposure. A dermatologist is going to make different recommendations than an oncologist or an orthopedic doctor or a medical research scientist.

Unfortunately, for dermatologists, the issue has moved from the neutrality of medical science to the bias of political activism.

Politics and science don’t mix very well. Usually, science loses.

Dermatologists with dissenting opinions about moderate UV light exposure must have a real fear of being “Holicked”.

This is similar to what is happening now to meteorologists who disagree with the popular political opinion on “global warming”.

When politics overwhelms science, the public is the biggest loser.

The real consequence of believing the dermatologists “sunscare” hype is the current vitamin D3 deficiency epidemic.

While dermatologists are hiding in a dark room with a flashlight illuminating only what they want to see, the answer to the vitamin D3 deficiency epidemic is outside in the light of day.

Except when the UV index is low. Then the answer is in a UV bed (or booth) at your local tanning salon. Tan, don’t burn.

Posted by: Jim | February 19, 2007 at 12:08 AM

Jim-

Thanks for your comprehensive and interesting response. Went thru all the papers you suggested, and yes Cannell does encourage careful tanning activity, apparently thinks that once per week in the winter is helpful -and as you noted in your other report, could help with bone density.

Somewhere the middle ground does exist, and as you further point out, water or aspirin can be overdosed. Some sunlight is helpful.

From the chair in my office I do see many people who find themselves stuck in a rut with tanning and not understanding the physiology, the D3 issues, and do overdose on the tanning activities.

In the Dermatologists article:

http://www.medicalnewstoday.com/

medicalnews.php?newsid=23771

They say:

“It is known that there is a high risk of developing skin cancer from repeated and intentional ultraviolet B exposure to boost vitamin D levels; the latter can be safely achieved by nutritional supplements,” said Dr. DeLeo. “Skin cancer is an epidemic in this country and recommending increased UV exposure with claims that sunlight somehow promotes good health is highly irresponsible.”

Now I am not saying that about you personally, I am simply trying to pull this discussion together for our readers.

And here he becomes heavier:

“There is certainly ample scientific evidence proving that vitamin D does not need to be produced from UVB exposure to be effective,” said Dr. DeLeo. “Under no circumstances should anyone be misled into thinking that natural sunlight or tanning beds are better sources of vitamin D than foods or nutritional supplements. The only thing they are proven to be better at is increasing your risk of developing skin cancer.”

What he does say to your side of the discussion regarding limited exposure:

Photosynthesizing vitamin D through natural sunlight is maximized after 20 minutes of ultraviolet B (UVB) exposure, with extended sun exposure providing no additional benefit but instead increasing the likelihood of photodamage and skin cancer.

And one final comment from their side at:

http://www.skincarephysicians.com/skincancernet/prevention.html

They say:

1. Avoid deliberate tanning. Lying in the sun may feel good, but the end result is premature aging (wrinkles, blotchiness, and sagging skin) as well as a 1 in 5 chance of developing skin cancer. Tanning beds and sunlamps are just as dangerous because they, too, emit enough UV radiation to cause premature aging and skin cancer. If you like the look of a tan, consider using a sunless self-tanning product. These products do not protect skin from the sun, so a sunscreen should be used.

2. Get vitamin D safely through a healthy diet that includes vitamin supplements. Don’t seek the sun.

Traditional medicine, the dermatologists who see the most melanoma and squamous cell CA are pretty emphatic. Cannell is looking very specifically at Vit D.

This post is an effort to say to individuals with refractory depression: consider and treat D3 levels, as they can be contributory to your problem.

From a safety point of view supplementation is the safest way to proceed, and careful sunlight exposure may be somewhat helpful, but is not the enduring treatment of choice. Chronic exposure can be dangerous.

Thanks Jim for your interesting remarks. While we may not entirely agree on the methods, this discussion about D3 and sunlight will be helpful to many who struggle with these issues.

Chuck

Posted by: Dr Charles Parker | February 18, 2007 at 10:32 AM

Too much water can kill you too.

I am suggesting occasional moderate exposure in a tanning bed.

You trust Dr. Cannell?

Read: http://www.vitamindcouncil.com/newsletter/2006-aug.shtml

“The real question is, “Which is best: vitamin D supplements or sun exposure?” The answer is tough. First, the sun won’t make much vitamin D during the winter at temperate latitudes above 37 degrees, so if you rely solely on the sun, you’ll need to take supplemental vitamin D, use a UVB lamp or a sunbed during the winter.”

“If you are scientific, try a little experiment. Take someone you know with fair skin who burns easily and who doesn’t go in the sun. Take him or her into a sun tan booth and find out exactly how many minutes it takes for their skin to just begin to turn pink, called one minimal erythemal dose (MED). Then, keep them out of the sun but give them 10,000 units of vitamin D a day for a month. Then take them into the sun tan booth again and see how long it takes for them to get one MED. What you will discover is that their time for one MED is longer. High vitamin D blood levels help prevent burning and facilitate tanning. My teenage daughter, who used to burn easily, discovered this. Against my advice, she took 5,000 units of vitamin D every day and regularly went into a sun tan booth as well. Now all her friends are begging her to tell them why she never burned and got so incredibly tan, tanner than she ever got before. Furthermore, burning in vitamin D deficient people actually may have an evolutionary benefit. Burning heats the skin and the final step in the production of vitamin D is driven by high skin temperatures. It also makes evolutionary and physiological sense that high vitamin D blood levels would facilitate rapid tanning and thus protect against vitamin D toxicity. Just remember, burning is dangerous and should always be avoided.”

And read: http://www.vitamindcouncil.com/newsletter/2006-jan.shtml

“Keep in mind that if you use a sunlamp or a tanning parlor once a week during the winter, you don’t have to worry about blood tests because your body will maintain adequate vitamin D blood levels. Just don’t get burned.”

Perhaps you are more comfortable reading a medical study? http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd;=Retrieve&dopt;=AbstractPlus&list;_uids=15585781

Tanning is associated with optimal vitamin D status (serum 25-hydroxyvitamin D concentration) and higher bone mineral density.

Tangpricha V, Turner A, Spina C, Decastro S, Chen TC, Holick MF.

Vitamin D, Skin and Bone Research Laboratory and the Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.

BACKGROUND: Vitamin D is made in the skin on exposure to solar radiation, and it is necessary to optimal skeletal health. Subjects who use a tanning bed that emits ultraviolet B radiation (290-315 nm) are likely to have higher 25-hydroxyvitamin D [25(OH)D] concentrations than do subjects who do not regularly use a tanning bed. OBJECTIVE: The first objective of this study was to ascertain whether subjects who regularly use a tanning bed have higher 25(OH)D concentrations than do subjects who do not use a tanning bed. The second objective was to ascertain whether higher 25(OH)D concentrations correlated positively with bone mineral density. DESIGN: This cross-sectional analysis examined 50 subjects who used a tanning bed at least once a week and 106 control subjects. Each subject gave a blood specimen for measurement of serum 25(OH)D and parathyroid hormone concentrations. Each subject underwent bone mineral density testing of the hip and spine. RESULTS: Subjects who used a tanning bed had serum 25(OH)D concentrations 90% higher than those of control subjects (115.5 +/- 8.0 and 60.3 +/- 3.0 nmol/L, respectively; P <0.001). Subjects who used a tanning bed had parathyroid hormone concentrations 18% lower than those of control subjects (21.4 +/- 1.0 and 25.3 +/- 0.8 pg/mL, respectively; P=0.01). Tanners had significantly higher BMD and z scores at the total hip than did nontanners. CONCLUSION: The regular use of a tanning bed that emits vitamin D-producing ultraviolet radiation is associated with higher 25(OH)D concentrations and thus may have a benefit for the skeleton.

PMID: 15585781 [PubMed – indexed for MEDLINE]

There isn’t one single medical study that concludes that if you tan in a tanning bed, you will catch skin cancer.

The benefits of moderate exposure to UV light in a tanning bed far outweigh the risks.

Don’t sunburn. And enjoy your healthy looking tan.

And the best advice I can offer you is this: If a dermatologist offers you a glass of Kool-Aid, don’t drink it.

Posted by: Jim | February 18, 2007 at 04:19 AM

Derm site didn’t transfer-

http://www.medicalnewstoday.com/

medicalnews.php?newsid=23771

cp

Posted by: Dr Charles Parker | February 18, 2007 at 02:38 AM

Yes Jim, those two elephants were ignored because they can kill you whilst fixing D3 with tanning beds.

Their names are malignant melanoma and squamous cell CA. See these two sites for further elaboration on this interesting different approach:

The Dermatologists say:

http://www.medicalnewstoday.com/medicalnews.php?newsid=23771

The FDA breaks down the types of light and is also negative on your suggestion:

http://www.fda.gov/cdrh/consumer/tanning.html

Thanks for bring the subject to our attention because this issue is frequently misunderstood.

Chuck

Posted by: Dr Charles Parker | February 18, 2007 at 02:32 AM

You are ignoring the elephant in the parlour.

Just one or two sessions a week in a tanning bed will produce all the healthy vitamin D a human body can use.

Moderate exposure to UV light in a tanning bed is healthy behavior.

An attractive tan is just a side effect.

Posted by: Jim | February 18, 2007 at 12:36 AM

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