This week I am continuing my coverage of “The Vitamin D
Solution” by Dr. Michael Holick.

One of the most interesting chapters of the book was the one in which he discussed
autoimmune diseases -especially multiple sclerosis and type 1 diabetes.

Multiple sclerosis (MS) is a disease in which cells ofthe immune system attack the
nerves, leading to loss of muscle coordination, weakness and even loss of sight.

MS generally develops in middle age and is much more prevalent in women than in men.
There is also a genetic component to MS, with people of Scandinavian or Celtic
origin being more prone to developing MS.

But by far the strongest predictor of MS risk is sun exposure. People in North
America or Europe are five times more likely to develop MS than people who live in
the tropics, Even in North America people living above the 37th parallel are twice
as likely to develop MS as people who live below the 37th parallel.

And the most interesting part of it is that the risk of developing MS seems to be
determined by your sun exposure at an early age. Once you’ve reached the age
of 15 you can move anywhere in the world and your risk of MS will not be altered.
It has already been determined by your sun exposure before the age of 15.

Type 1 diabetes is caused by the immune cells attacking the pancreas and rendering
it unable to make insulin.
Once again sun exposure seems to play a significant role. Northern Finland,
for example, has the world’s highest incidence of type 1 diabetes. Since type 1
diabetes generally develops during childhood, the question of whether you could
decrease the incidence of type 1 diabetes by getting more sun exposure after age
15 is a moot point.

The mechanism of this effect is not known, but it is known that the thymus plays
an important role in destroying immune cells that could harm the body. This
function of the thymus is particularly important when we are young and recent
research suggests that it could be regulated by vitamin D.

The evidence that vitamin D could prevent MS is indirect, but there is clinical
evidence that vitamin D can prevent type 1 diabetes.

The Finnish government did a major study with 12,000 children in 1966 in which
they gave half of them 2,000 IU of vitamin D/day during their first year of life and
the other half a placebo.

The children who received the vitamin D supplement during their first year of life
were 80% less likely to develop type 1 diabetes than those who received the
placebo. And when they did the comparison with a subgroup of children who were
demonstrably D deficient (they developed symptoms of rickets), the vitamin D
supplementation decreased the risk of developing type 1 diabetes by 2.4 fold (240%).

However, with both type 1 diabetes and MS it appears that the die is cast early in
life. Dr. Holick and others have tried vitamin D therapy with patients that
have already developed MS or type 1 diabetes without success.

So what is the bottom line?

If you have already developed MS or type 1 diabetes, there is no evidence that
vitamin D supplementation can slow or reverse the disease (although it may reduce the
risk of osteoporosis and many other diseases).

However, one of the greatest gifts that you can give your children may be to make
sure that they get adequate levels of vitamin D from birth through adolescence. And
that is particularly important in light of studies showing that 50 – 70% of our children
may not be getting enough vitamin D.

This week I am continuing my coverage of “The Vitamin D Solution” by Dr. Michael Holick.

There was an interesting chapter of the book in which he discussed fibromyalgia as a
possible symptom of Vitamin D deficiency.

Fibromyalgia is the diagnosis often given to people who experience chronic pain
(bone and muscle pain) and weakness with no apparent cause.

Now to understand why Dr. Holick considers fibromyalgia as a possible symptom of
Vitamin D deficiency we need to first review the known conditions associated with
Vitamin D deficiency.

Practically everyone has heard of rickets. It is a childhood disease that is known to
be associated with Vitamin D deficiency.

Because there is not enough vitamin D present for the growing child to properly
mineralize the new bones as they form, the child ends up with soft, pliable bones.
These, in turn, leads to bowed legs and several other skeletal deformities associated with rickets.

Similarly, practically everyone has heard about osteoporosis.

Osteoporosis is a demineralization of the bones that occurs in older adults
(women past menopause and men over 50). The bones become very fragile and easily break.

Much research over the past decade has shown that we can think of osteoporosis as a
lifelong deficiency of calcium and vitamin D (although several other factors
are also involved).

However, there is a third consequence of vitamin D deficiency that most people are
unaware of – a condition called osteomalacia.

Osteomalacia most often occurs in young adults and it is associated with a softening
of the bone. The most common symptom of osteomalacia is chronic bone and muscle pain.

Most doctors have been trained to identify rickets or osteoporosis, but they haven’t
been trained in how to identify osteomalacia (our medical school is just as
guilty of this as the other schools). Primarily, thisis because most experts considered
osteomalacia to be almost nonexistent because of food fortification with Vitamin D.

However, now that we are starting to learn that 30-80% of the US population may be
Vitamin D deficient, it may be time to re-think this assumption.

Dr. Holick reports that 40-60% of the patients who are referred to his office with
symptoms of fibromyalgia are vitamin D deficient, and those patients who are
vitamin D deficient respond well to vitamin D supplementation.

Dr. Holick also referred to a study by Dr. Gregory Plotnikoff of the University of
Minnesota that said that 93% of children and adults who come to his emergency room
with nonspecific muscle aches and pain were found to be vitamin D deficient.

So, what is the bottom line if you or someone that you know has fibromyalgia?

I would not recommend that you think of vitamin D as a magic bullet. There are many
other things involved in fibromyalgia, such as inflammation and possible
autoimmune responses. Your holistic approaches to managing your disease should cover
all the bases.

However, Vitamin D supplements are cheap, easy to use and practically risk free
(You would have to take huge amounts on a daily basis to develop vitamin D toxicity).
If you are experiencing bone and muscle pain for no apparent reason, it would make good sense to add
some vitamin D to your daily regimen.

Diabetes is a deadly scourge.

It is the leading cause of kidney failure, lower limb
amputations and blindness. And it is a major cause of
heart disease and stroke.

And diabetes is an epidemic.

Because type 2 diabetes is closely associated with
obesity (80% of people with type 2 diabetes are
overweight), we have a diabetes epidemic worldwide that
is following right behind the obesity epidemic that you
have been hearing so much about.

In 2010 25.6 million Americans, or 11.3% of the
population, over the age of 20 had type 2 diabetes.

That’s up from 8.3% of the population in the 2005-2008
database, and the prevalence of diabetes in the 20+ age
group in this country is predicted to exceed 15% by
2015.

However, it is not type 2 diabetes that I am focusing
on today. Instead I will talk about a related condition
called pre-diabetes.

But first, a bit of biochemistry (my favorite subject).

What is pre-diabetes and how do we develop it?

When we become overweight our tissues become insulin
resistant. Initially our pancreas responds by pumping
out more insulin to keep our blood sugar levels near
normal. It also starts releasing fatty acids into the
bloodstream.

At this stage our blood sugar levels are pretty well
under control, but our blood levels of insulin and
fatty acids are higher than normal. We are
assymptomatic for the most part, so many of us never
realize that we have a problem.

And lots of us are pre-diabetic!

The National Institute of Health estimates that 35% of
US adults in the 20+ age group and 50% of US adults in
the 65+ age group have pre-diabetes – and most of them
don’t even know it.

That is unfortunate because people with pre-diabetes
are at increased risk of heart disease, strokes and
certain types of cancer. And there is a high
probability that those people with pre-diabetes will go
on to develop type 2 diabetes a few years down the
road.

That’s because high levels of both fatty acids and
insulin damage the pancreas. So every year that an
individual does nothing to reverse the pre-diabetic
condition their pancreas loses more of its capacity to
produce insulin.

Eventually, the pancreas can no longer produce enough
insulin to overcome the insulin resistance, and the
individual develops full blown type 2 diabetes.

With 35% of the population already pre-diabetic – and
most of them not knowing that they have it, anything
that we can do to prevent pre-diabetes from
progressing to type 2 diabetes is big news.

That’s why today’s study (Mitri et al, American Journal
of Clinical Nutrition, 94: 486-494, 2011) is so
interesting.

The scientists directing the study enrolled 92 adults
with an average age of 57 and a BMI of 32 (anything
over 30 is considered obese). The subjects were given
2,000 IU/day of vitamin D and/or 800 mg/day of calcium
in various combinations (placebo, D alone, calcium
alone and calcium + D).

They did not assess for pre-diabetes in this group, but
given the age and BMI of the group it is fairly safe to
assume that most of them had pre-diabetes.

At the end of 16 weeks the group receiving the placebo
had a 14% decline in the ability of their pancreas to
secrete insulin – about what you would expect for
individuals with pre-diabetes.

Calcium had no effect on pancreatic function.

However, the groups receiving 2.000 IU/day of vitamin D
had a 26% improvement in the ability of their pancreas
to secrete insulin.

So what are the take home lessons for you?

#1) The most important message that I can give you is
that if you are overweight, you are probably already
pre-diabetic even if you have not received a formal
diagnosis.

You are likely already at significantly increased risk
of heart disease, stroke and cancer – and you are
likely to develop type 2 diabetes in the not too
distant future.

YOU SHOULD TAKE ACTION NOW!

#2) The authors of this study were careful to point out
that their study did not show that vitamin D alone
could reduce the progression of pre-diabetes to type 2
diabetes. That study has yet to be done.

However, there are several published clinical studies
showing that lifestyle changes (weight loss, exercise
and a healthy diet supplying all of the essential
nutrients) can significantly reduce the progression of
pre-diabetes to type 2 diabetes.

So if you want to act now to reduce your risk of
becoming another statistic, the proven path is clear.

#3) While I consider it unlikely that vitamin D will be
a “magic bullet” for preventing type 2 diabetes, this
study does highlight yet another potential benefit of
making sure that your intake of vitamin D is optimal.