dr hollis dr holick bits and bites
<h3 class="_2cuy _50a1 _2vxa" >dr hollis dr holick bits and bites</h3>
<div class="_2cuy _3dgx _2vxa" >By <a href="https://www.facebook.com/faylou2" >Fay Louise</a> on <a href="https://www.facebook.com/notes/all-things-d-deficiency-education-research/dr-hollis-dr-holick-bits-and-bites/786355384813543/" >Friday, May 22, 2015 at 6:39pm</a></div>
<div class="_2cuy _3dgx _2vxa" >Holick:</div>
<div class="_2cuy _3dgx _2vxa" >There is a great deal to be said about the set SOC recommendations of vitamin D. In my opinion, the current adopted IOM definition and set RDA's for vitamin d are problematic in that they do not adopt the more complete appreciation and utilization of vitamin D in day to day physiological needs outside calcium metabolism. The IOM has vitamin D locked into the endocrine system.</div>
<div class="_2cuy _3dgx _2vxa" >There is a 3 fold increase of getting secondary hyperparathyroidism in levels below 30 ng/ml. PTH tends to level off with around 40 ng/ml. IOM recommends 20 ng/ml Vitamin D3 based on bone health studies. This level has been adopted worldwide as the level of adequacy, ignoring vitamin D's physiological function in extra-renal pathways. Around 50 ng/ml also incorporates the level needed for paracrine function, (Meaning what Vitamin D does beyond the renal calcium endocrine system = immune and gene modulation/expression).</div>
<div class="_2cuy _3dgx _2vxa" >(To quote Holick):"the IOM guidelines were "not intended to direct physicians on care of patients" "it is up to professional associations to establish guidelines for care" "the IOM used a 'population model', not a medical model" so when we look at that, we need to put that into perspective."D deficiency causes neuromuscular irritability it is classic for vitamin D deficiency, you won't see any bony abnormality, you won't see any calcium abnormality but you will see this: "skeletomuscular pain, poor immune function..."</div>
<div class="_2cuy _3dgx _2vxa" >Study done in Boston 600iu/day IOM recommendations for all pregnant women, 76% of mothers, and 81% of newborns were found to be deficient based on the IOM recommendations for vitamin d. (Even at the low IOM recommendation of the 20ng/ml blood range). Milk has very little vitamin D, Food does not provide the needed vitamin D (which is what the IOM recommend). You can not get enough vitamin D from your diet. The Middle east Dubai has close to 90% deficiency and places like Indonesia , people avoid the sun, no vitamin D in food and no reasonably available supplementation.</div>
<div class="_2cuy _3dgx _2vxa" >There is a direct inverse correlation of low vitamin D status and pre-eclampsia. Vitamin d is important for muscle strength which as we know is incredibly important for birthing, there is a high correlation of primary cesarean section with women who are severely vitamin d deficient. A study done in Boston that showed that there is a 400% reduction of c-sec if the women were simply vitamin d sufficient with a marked drop and a leveling out at the 40 ng/ml and higher range of 25D.</div>
<div class="_2cuy _3dgx _2vxa" >How much vitamin D do you need to give a lactating woman in order to satisfy her requirements and the requirements of her developing baby and newborn? 4000 - 6000iu per day! We have all been taught that proving 200 - now 600 iu per/day is enough. An emphatical No! We have been off by a factor of around 10. Studies are clear on this, 600 units of vitamin d per day will keep a pregnant and lactating woman deficient.</div>
<div class="_2cuy _3dgx _2vxa" >Periodontitis is associated with vitamin D deficiency. It is a major health issue across the board of all age ranges and is exacerbated in pregnancy and lactation.</div>
<div class="_2cuy _3dgx _2vxa" >Obese people need 2-3x's more vitamin D to treat and prevent vitamin D deficiency.</div>
<div class="_2cuy _3dgx _2vxa" >Influenza at the dose of 1200iu per day between December through March is reduced by 42%</div>
<div class="_2cuy _3dgx _2vxa" >A study done on teenage black population just increased their 25d level to a minimum 34 from 24 ng/ml, decreased their arterial wall stiffness. Vitamin D deficiency it is a prelude to both hypertension and atherosclerotic heart disease. Just adding a minimum of 2000iu per day is shown to work.</div>
<div class="_2cuy _3dgx _2vxa" >Most melanomas occur on the least sun exposed areas.</div>
<div class="_2cuy _3dgx _2vxa" >IOM dismissed all the other evidence of health benefits other than calcium regulation.</div>
<div class="_2cuy _3dgx _2vxa" >Most people have a hard time even getting the 600 iu/400iu recommendation by diet alone per day of vitamin D.</div>
<div class="_2cuy _3dgx _2vxa" >You don't have to worry about vitamin d intoxication till you are above 150 ng/ml (375 nmol/L)</div>
<div class="_2cuy _3dgx _2vxa" >Dr Hollis:</div>
<div class="_2cuy _3dgx _2vxa" >A low vitamin D in that cord blood will compromise the infection-fighting capability of that child on the fetal side of the placenta. I believe that a pregnant woman should have at least a circulating level of 50 ng/ml of 25D to make all these pathways normal and optimal. Vitamin D is important in the reduction of infections, preterm labor and preeclampsia and overall reduction of comorbidities. You are taught in med school that human milk is perfect for everything except one thing. That is vitamin D. We challenge that by saying that the recommendations are what is deficient.</div>
<div class="_2cuy _3dgx _2vxa" >vitamin D's primary function in pregnancy in the neonate is as an immune modulator not calcium homeostasis. A certain amount of vitamin D is required in the cord blood to enable the neonate to mount innate immune responses appropriately to deal with cell differentiation issues and infection issues.Also vitamin D turns on and modulates adaptive immunity it pushs from T1 to T2, that means you don't auto reject the fetus, it also turns on your innate immune system which is your primitive barrier function protection, vitamin D does that. Vitamin D compounds affect immune function and expression.</div>
<div class="_2cuy _3dgx _2vxa" >The pregnant woman needs minimum 40ng/ml 25D just to normalize 1,25 conversion.Cholecalciferol vitamin D has a half-life of about one day (24 hrs), It has to be replenished every day,. Whereas calcidiol 25D has a half life of around 3-4 weeks and is more stable,. they are very different metabolites and they have different interactions and actions in the body.Very little 25D circulating passes into the milk, what does cross into the milk is cholecalciferol the parent compound vitamin d.</div>
<div class="_2cuy _3dgx _2vxa" >The important take away is: in milk it is the parent compound that gets transferred vitamin D cholecalciferol with the half life of about a day, it needs daily supplementation. 25D does not get get transferred. They have known this for more 25 years. The transfer rate of 25D is about half of percent, however vitamin D will transfer in at a rate of about 40%.</div>
<div class="_2cuy _3dgx _2vxa" >I can say this without reserve, if you have a lactating mother and you want her to be able to supply through her milk enough vit d to her baby (and you don't want to or can't give the baby drops) then give her minimum 6000iu per day, give 10,000 iu per day, you can even give 20,000iu it depends if you want to take them that high, and the rule of thumb is that for every thousand units you give of cholecalciferol vitamin D parent compound she'll transfer a hundred units of activity into her milk. So you can calculate roughly how much you want that mother to transfer to her child. So about 6000iu the baby is going to get 500-600 units in the milk, and the 10,000 they will get 1000iu of vitamin D.</div>
<div class="_2cuy _3dgx _2vxa" >It is important to remember that the half-life of circulating 25D is about three weeks, and 1,25 a few hours. The infant level of 25(oh)D is about 60% of the mothers level, so if the infant is around 80 nmol/L the mother is around 175 nmol/L (60 ng/ml)</div>
<div class="_2cuy _3dgx _2vxa" >In cord blood 1,25 and 25D are linearly tied and are involved in innate immune responses.</div>
<div class="_2cuy _3dgx _2vxa" >A low vitamin D in that cord blood will compromise the infection-fighting capability of that child on the fetal side of the placenta.</div>
<div class="_2cuy _3dgx _2vxa" >I believe that a pregnant woman should have at least a circulating level of 50 ng/ml of 25d to make all these pathways normal and optimal.</div>
<div class="_2cuy _3dgx _2vxa" >Vitamin D is important in reduction of infections, preterm labor and preeclampsia and overall reduction of comorbidities.</div>
<div class="_2cuy _3dgx _2vxa" >Take home: in their studies it is unethical to give SOC to pregnant women, if they are deficient they will stay deficient. they will have compromised health outcomes for themselves and their babies.</div>
<div class="_2cuy _3dgx _2vxa" >You are taught in med school that human milk is perfect for everything except one thing. that is vitamin D. We challenge that by saying that the recommendations are what is deficient, essentially causing and maintaining generations of vitamin d deficient humans in our population.</div>
<div class="_2cuy _3dgx _2vxa" >Large dosing intervals of vitamin D is not conducive for healthy pregnancies and lactation.</div>
<div class="_2cuy _3dgx _2vxa" >Supplementing with recommended dosing will not get anyone out of deficiency. If you start deficient, you'll end up deficient, and it only may raise the level enough to stop rickets.</div>
<div class="_2cuy _3dgx _2vxa" >"How can ingesting human milk cause vitamin d deficiency? breast feeding then is a clear example of a situation where circulating vitamin D is critical in assuring vitamin D provision for the infant and where circulating 25(OH)D does not substitute for the intact vitamin." If the mother is deficient he baby will be too.What is new, is the current understanding of metabolites and binding proteins, and what is critical for us to understand, is the importance of these vitamin d metabolites. The necessary parent compound vitamin D will transfer passively at a rate of about 10% of that of the mother's level to the baby through the milk. Circulating 25(OH)D will not.</div>
<div class="_2cuy _3dgx _2vxa" >The frequency of dosing intervals and the amount of dosing units are equally important and have to mimic 'nature' as close as possible in order for the vitamin D dependent pathways to develop optimally and allow normal and optimal function.The megalin cubalin endocytotic system is active at the kidney/parathyroid glands and very active in the placenta and is key to the conversion of 25(oh)d to 1,25, which is crucial for the activation of the immune system of the foetus.</div>
<div class="_2cuy _3dgx _2vxa" >The parent compound vitamin D is crucial, as that is what is transferred in the milk to the infant. It is very likely that the parent vitamin D plays an equally crucial role in autocrine/paracrine pathways throughout the body and a regular daily intake is necessary for health.</div>
<div class="_2cuy _3dgx _2vxa" >Take home: What is clear is that "any dosing schedule that does not allow the stable circulating concentration of the parent compound will not provide an optimal autocrine environment for vitamin D metabolism in non-bony tissues."</div>
<div class="_2cuy _3dgx _2vxa" >Carol and Heaney:</div>
<div class="_2cuy _3dgx _2vxa" >Concept of substrate starvation: Nutrient status, one or more:Low level Across a Lifespan.Vitamin D is the only steroid system in the body that is almost always limited by substrate availability due to latitude, lifestyle, race, etc... there is a great deal of variability depending on a wide range of factors.</div>
<div class="_2cuy _3dgx _2vxa" >Rickets is a short-term manifestation, and we have no idea, what vitamin D deficiency in early life does or means, for expression and development of long latency diseases.</div>
<div class="_2cuy _3dgx _2vxa" >We are just beginning to understand its profundity. Those adult diseases have their origin in childhood and before, (breast cancer, MS, diabetes, OP, autoimmune, prostate cancer, colon cancer, psoriasis, CVD, fetal growth, fetal dentition, bone mass, immune function, disease expression, innate immunity, adaptive immunity, gene modulation, and epigenetic expression)</div>
<div class="_2cuy _3dgx _2vxa" >If we are going to impact health we have to go look, understand and address the origin/source and not put off over a lifetime; only then to have to deal with a manifestation of a disease and dysfunction in its irreversible late stages as "suddenly" "now we treat it".</div>
<div class="_2cuy _3dgx _2vxa" >Dr. Carole Wagner: in regards to sunscreen and sun avoidance:</div>
<div class="_2cuy _3dgx _2vxa" >Can you imagine if you had the ability to block a hormone in our body? Do you really think the FDA would have regulated that a little bit more if we knew back then what it was?</div>
<div class="_2cuy _3dgx _2vxa" >On vitamin D our common medical knowledge lore:</div>
<div class="_2cuy _3dgx _2vxa" >The view that we only needed vitamin D for growing bones and that's it, with little requirement beyond childhood. and the premise that all one needs can be obtained from milk, is still what is the defining mantra today. It's false and it has damaged us.</div>
<div class="_2cuy _3dgx _2vxa" >Vitamin D deficiency:</div>
<div class="_2cuy _3dgx _2vxa" >On pregnancy and lactation:</div>
<div class="_2cuy _3dgx _2vxa" >on pregnancy:</div>
<div class="_2cuy _3dgx _2vxa" >- Impaired fetal growth and development</div>
<div class="_2cuy _3dgx _2vxa" >- increased risk for gingivitis and periodontal disease</div>
<div class="_2cuy _3dgx _2vxa" >- higher risk of maternal preeclampsia</div>
<div class="_2cuy _3dgx _2vxa" >- impaired dentition</div>
<div class="_2cuy _3dgx _2vxa" >- preterm labor</div>
<div class="_2cuy _3dgx _2vxa" >- infections</div>
<div class="_2cuy _3dgx _2vxa" >- gestational diabetes</div>
<div class="_2cuy _3dgx _2vxa" >- pregnancy induced hypertension</div>
<div class="_2cuy _3dgx _2vxa" >Women who were on 4000iu daily of vitamin D as compared to the IOM 400iu (now 600iu) their risk for all these comorbidities was half.</div>
<div class="_2cuy _3dgx _2vxa" >Rates of infection were all inversely related to rate of vitamin D status time at all three markers (baseline, chronic level, one month prior to delivery)</div>
<div class="_2cuy _3dgx _2vxa" >On lactation:</div>
<div class="_2cuy _3dgx _2vxa" >our dogma lore:</div>
<div class="_2cuy _3dgx _2vxa" >Human milk is deficient in vitamin D</div>
<div class="_2cuy _3dgx _2vxa" >Is this really true? Has nature designed it that way?</div>
<div class="_2cuy _3dgx _2vxa" >We asked questions:</div>
<div class="_2cuy _3dgx _2vxa" >At what level and how much vitamin D will the mother be replete and will have enough to pass on to her child to also have her child replete?</div>
<div class="_2cuy _3dgx _2vxa" >Our answer: 6400iu daily vitamin D.</div>
<div class="_2cuy _3dgx _2vxa" >Dr Heaney:</div>
<div class="_2cuy _3dgx _2vxa" >In the average medical school, a physician gets approximately 4 hours total of nutrition, and the sad part is that physicians are generally recognized as the prime source of nutritional information and that's just completely false. Not so surprising that they are not knowledgeable. Their concern is in "fixing what is broken", and nutrition is "maintaining good health" and we don't educate for that, we should, but we don't.</div>
<div class="_2cuy _3dgx _2vxa" >At the Round Table, an anonymous survey, the average dose was 5,500iu per day of vitamin D taken by the experts.</div>
<div class="_2cuy _3dgx _2vxa" >holick</div>
<div class="2cuy _3dgx _2vxa" ><a href="http://trafficlight.bitdefender.com/info?url=https%3A//youtu.be/2lRtx-4_FOY&language=en_US" ><img alt="" id="bd_nd_B937DB990D1548698380D65CF906E308_36" src="data:image/png;base64,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" /></a><a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fyoutu.be%2F2lRtx-4_FOY&h=ATOCuIaB66MOaW7B_smEOm7_53iQqmqaNnBrh3AbtmsoPYGgB79RnCR5iLDKNcWHO3WP4SBwLCviU0CKOPJoadg12xw5ov5kKZ4BpSdQvLbg-wH4jIOveCVtvgtWTpOlO2D-&s=1" target="blank" rel="nofollow noopener" onmouseover='LinkshimAsyncLink.swap(this, "https:\/\/youtu.be\/2lRtx-4_FOY");' onclick='LinkshimAsyncLink.referrer_log(this, "https:\/\/youtu.be\/2lRtx-4_FOY", "\/si\/ajax\/l\/render_linkshim_log\/?u=https\u00253A\u00252F\u00252Fyoutu.be\u00252F2lRtx-4_FOY&h=ATOCuIaB66MOaW7B_smEOm7_53iQqmqaNnBrh3AbtmsoPYGgB79RnCR5iLDKNcWHO3WP4SBwLCviU0CKOPJoadg12xw5ov5kKZ4BpSdQvLbg-wH4jIOveCVtvgtWTpOlO2D-&enc&d");' >https://youtu.be/2lRtx-4_FOY</a></div>
<div class="_2cuy _3dgx _2vxa" >hollis</div>
<div class="2cuy _3dgx _2vxa" ><a href="http://trafficlight.bitdefender.com/info?url=https%3A//youtu.be/O0elnh4D08g&language=en_US" ><img alt="" id="bd_nd_B937DB990D1548698380D65CF906E308_37" 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" 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<p> </p>