by Ian Wishart
[22] “On the aetiology of autism,” John Cannell, Acta Paediatrica 2010; 99, Issue 8:1128-1130, http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2010.01883.x/full
[23] “Transcriptomic analysis of human lung development,” Kho et al, American Journal of Respiratory Critical Care Medicine, 2010; 181:54-63
[24] “Letters, Vitamin D Insufficiency,” Weiss S & Litonjua A, NEJM 364:14, April 7 2011, page 1379
CHAPTER 4
ASTHMA & ALLERGIES
“One in five of the babies was born with levels of less than 25 nmol/L (10 ng/ml), thus being seriously deficient”
– Study of NZ births by Dr Carlos Camargo,
Massachusetts General Hospital, 2011
Most of us know someone who has suffered with asthma or allergies. Some of us, as parents, have watched our children puff and wheeze and drain the life-giving drugs out of asthma inhalers. Roughly one in eight people reading this will directly suffer from asthma at some point in their lives.[1] Around one in every 200 of you will die from it.[2]
There have been a number of causes cited for asthma, from diet, vaccinations and even recent studies warning that paracetamol could trigger asthma attacks in children. As you might have gathered from the book so far, there’s a distinct possibility that the published list of possible causes are what we might call ‘final causes’, the straw that broke the camel’s back on the day. The reason the camel was vulnerable, however, may well have been a failure to sunbathe.
Just as there’s strong evidence that vitamin D in fetal development is crucial for lowering the risk of autistic spectrum disorders, it seems equally likely that vitamin D plays the same role in preparing fetal immune systems and organ development.
We’ve seen that unlike most vitamins, vitamin D (which is actually a secosteroid, not a real vitamin) has built in reception areas throughout the human body, known as vitamin D receptors or VDRs. Additionally, those docking bays and pathways have now been mapped to more than 3,000 genes in the human body, with new VDRs being discovered all the time. The human body, it transpires, craves vitamin D so it makes sense those 3,000 genes might start playing up if they don’t get their fix.
It’s hard to imagine that fifteen years ago scientists knew virtually nothing of this. All over the world, while your eyes are scanning this sentence, somewhere on the globe research teams are beavering away, effectively in 24/7 mode, trying to unlock just how significant vitamin D might be for human health.
In the case of asthma, very.
It’s the nation of New Zealand that’s been at the cutting edge of some of this work. Back in the 1960s, New Zealand suffered an explosion of asthma deaths, and again in the 1980s. As an agricultural producer whose food and wines are consumed all over the world, the country pioneered high technology farming and production techniques. Of necessity, advances were sometimes hit and miss until the right formulations were found. One of those areas of experimentation was herbicides and pesticides.
The giant US company Dow Chemicals was a big supplier to New Zealand, and in fact helped manufacture the two key components of the Vietnam War defoliant known as “Agent Orange” from its factory at New Plymouth, on New Zealand’s west coast. A former director of that company told Investigate magazine in 2000 that his company had not only shipped 2,4,5-T and 2,4-D off to be mixed into Agent Orange for the Vietnam War, but they’d also marketed the same mix to New Zealand farmers as a tough farm herbicide.[3]
The magazine found numerous instances of birth defects in farming children, and it’s not hard to imagine that one of the nastiest chemicals in the sixties found its way onto the dinnerplates of all New Zealand children at the time simply by being dropped on farms and then working its way up the food chain. Thus, a previous boom in asthma mortality coincident with this dark period is not entirely surprising.
Additionally, with vast pine plantations and farmland creating plenty of pollen, New Zealand had perfectly natural reasons for rising asthma rates.
Leaving aside those spikes, what those asthma epidemics triggered, however, was ground breaking research into the origins of the disease. Once again, it appears that vitamin D lays the groundwork for whether you or your children are biologically fortified against irritants.
The world, as we know, is full of irritants, but scientists are gradually coming to realise that the irritants are only taking advantage of existing weaknesses that shouldn’t be there.
All of us are exposed, but not all of us develop asthma, eczema or allergies. Just as some people can happily smoke every day and live to a hundred, many more of us are genetically programmed to cark it if we take up smoking. The whole point of public health campaigns is that they address the needs of the majority, or significant minority. They cannot account for occasional exceptions.
In asthma’s case, environmental factors appear to target a certain percentage of individuals. The final trigger may be ill-defined or different in various sufferers, but the result is the same. Maybe there’s something that can predict your risk of developing asthma, however.
In 2010, Harvard University Professor of Medicine Dr Carlos Camargo Jr led a research team focusing on a promising new data sample: umbilical cord blood from 922 newborn babies in New Zealand. With the second highest rate of asthma in the world, behind the UK, Camargo and team wanted to test a promising new hypothesis, that maternal intake of vitamin D during pregnancy reduced the risk of wheezing and asthma in children. Cord blood, they figured, would provide definitive proof at the moment of birth of actual vitamin D levels.
The average vitamin D level in the blood was only 44 nmol/L, or less than 20 ng/ml. In other words, across 922 babies born in the cities of Wellington and Christchurch, New Zealand, at latitudes 41S and 43S respectively,[4] the average vitamin D level was in the “deficient” zone. One in five of the babies was born with levels of less than 25 nmol/L (10 ng/ml), thus being “seriously deficient”.
What did they find?
Babies born with seriously deficient vitamin D levels were nearly 2.4 times more likely to have suffered an infection before the age of three months, in comparison with babies in the highest group who had levels in excess of 75 nmol/L (30 ng/ml, the minimum adequate range). The most deficient babies were more than twice as likely to have suffered a respiratory infection before the age of three months.[5]
The research team speculated that newborns with low vitamin D may be more susceptible to infections of any kind, because vitamin D is known to stimulate the production of natural antibiotics within the human body, and in particular cathelicidin, an “antimicrobial peptide” that is produced to protect bronchial passages as part of the immune defence system.[6]
By definition, low vitamin D = low immunity.
“Interventions to improve vitamin D status [in pregnancy] may provide a simple, safe and inexpensive way to reduce the respiratory infections that cause most asthma exacerbations,” reported the researchers.
Recent studies, they wrote, have shown that asthmatic children with higher levels of vitamin D suffer fewer serious asthma attacks. A Japanese study, for example, found vitamin D supplements of 1200IU a day given to school students with a history of asthma resulted in an 83% reduction in their risks of catching Influenza A.[7]
The low vitamin D status of New Zealand newborns also turned out to be an indicator of wheezing outbreaks by the age of 5. Children with the lowest vitamin D had more than double the risk of developing wheezing by their fifth birthday.
Announcing their findings, Camargo and team reported that one in five “apparently healthy” New Zealand children started life with vitamin D levels below 10 ng/ml. “These low levels were associated with a higher risk of respiratory infection during the first months of life and a higher risk of cumulative wheeze throughout early childhood.”
The team couldn’t find any specific link to full blown asthma by age five, but a unit across the Tasman Sea in Australia did.
In 2011, researchers from the University of Western Aus
tralia made a breakthrough discovery in a study of nearly 2,400 asthma sufferers under the age of 15. Blood serum levels of vitamin D were checked in 989 six year olds and 1,380 14-year-olds.[8]
After running the data for analysis, they found that low vitamin D levels at the age of six were a “significant predictor” of allergy sensitivity and developing asthma by the age of 14.
“Children, particularly males, with inadequate vitamin D are at increased risk of developing atopy [allergic sensitivity], and subsequently bronchial hyper-responsiveness and asthma.”
Analysing these results from Australasia, Dr Scott Weiss of Harvard University’s Channing Laboratory wrote that the Hollams study out of Australia was the first in the world to demonstrate an association between vitamin D levels at age 6 and asthma by age 14, and was one of “the first using [actual] vitamin D levels as a biomarker of vitamin D exposure”.[9]
Weiss said the New Zealand study by Camargo et al filled in the blanks of the first five years of life, which the Hollams study didn’t cover.
The evidence on asthma, he noted, was strong enough to justify full clinical trials of vitamin D as part of the inhalant mix for asthmatics, and those trials are now underway. But he warned that whilst higher vitamin D during pregnancy appears to reduce the incidence of asthma, it does not eliminate it completely, and should the trials clarify the issue, “some degree of post-natal supplementation will also probably be necessary to maintain normal immune function in the long term.”
In 2012, the Arab emirate of Qatar corroborated the Australasian studies, noting vitamin D deficiency is “the major predictor of Asthma in Qatari children”.[10] Researchers found those with the lowest levels were 482% – almost five times – more likely to suffer asthma. Coming from a family with low vitamin D levels was also a risk factor for asthmatic children – possible evidence of the dangers when sun avoidance practices become intergenerational.
In July 2012, a study of 1024 asthmatic American children in a random trial found those with high vitamin D levels had twice as much health benefit from their corticosteroid asthma medication as children with low vitamin D, illustrating that the vitamin enhanced the effect of the medicine.[11]
Asthma, allergies and respiratory problems are not the only things that vitamin D may protect you from in the chest area.
[1] Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey Raw Data, 1997-2009.
[2] “The Burden of Asthma in New Zealand”, Holt S & Beasley R, Asthma & Respiratory Foundation of NZ, December 2001
[3]Investigate magazine, Jan/Feb 2001, pp26-33, http://www.investigatemagazine.com/pdf%27s/jan2.pdf
[4] As a reference point, Boston is at latitude 42N.
[5] “Cord blood 25-hydroxyvitamin D levels and risk of respiratory infection, wheezing and asthma,” Camargo et al, Pediatrics 2011, Vol 127, Issue 1:e180-e187
[6] “Induction of cathelicidin in normal and CF bronchial epithelial cells by 1,25-dihydroxyvitamin D(3)”, Yim et al, Journal of Cystic Fibrosis, 2007; 6(6):403-410. See also “UVB radiation induces the expression of antimicrobial peptides in human keratinocytes in vitro and in vivo,” Glaser et al, Journal of Allergy & Clinical Immunology 2009; 123(5):1117-1123
[7] “Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren”, Urashima et al, American Journal of Clinical Nutrition, March 10, 2010 doi: 10.3945/ajcn.2009.29094, http://www.anaboliclabs.com/User/Document/Articles/Vitamin%20D/11.%20Urashima,%20Vit%20D,%202010.pdf
[8] “Vitamin D and atopy and asthma phenotypes in children: a longitudinal cohort study”, Hollams et al, European Respiratory Journal, December 2011, Vol 38 No. 6:1320-1327
[9] “Vitamin D in asthma and allergy: what next?”, Weiss S & Litonjua A, European Respiratory Journal, December 2011, Vol 38 No. 6:1255-1257
[10] “Vitamin D deficiency as a strong predictor of asthma in children,” Bener et al, International Archives of Allergy and Immunology, 2012; 157(2):168-175
[11] “The Effect of Vitamin D and Inhaled Corticosteroid Treatment on Lung Function in Children”, Wu et al, Am. J. Respir. Crit. Care Med. July 12, 2012 rccm.201202-0351OC
CHAPTER 5
CANCER, BREAST
“High vitamin D levels at early breast cancer diagnosis correlate with lower tumour size and better overall survival”
– findings published in Carcinogenesis, 2012
Each year, more than 200,000 women in the USA, 14,000 from Australia, 22,000 Canadians, 48,000 Brits and 2,500 in New Zealand are diagnosed with breast cancer. Roughly one in five victims die from it or related complications over time – the most recent figures from 2008 disclose a global death toll of 458,000 people that year. In the western world, around one in every eight women will develop breast cancer during their lifetime.
For all of the above reasons, and the huge financial cost, and community and personal trauma associated with cancer, there are very good reasons for seizing hold of anything that could reduce the incidence of breast cancer or improve survival rates from it.
If you do a search in Google Scholar for the phrases breast cancer and vitamin D, it’ll throw up more than 58,000 references. Studies are pouring out literally every week, not just because the research on vitamin D has been so promising, but also because the early studies were flawed.
Here’s an example. In 2008, researchers disclosed how they’d given 36,000 American women either a daily supplement of vitamin D and calcium, or a placebo, as part of research into bone fractures carried out by the Women’s Health Initiatives. The icing on the cake was the sample was also large enough to catch subsets of women who subsequently developed cancer over the seven year trial period.
The study – one of the largest randomised controlled trials – found no difference in invasive breast cancer between those on the vitamin D supplements and those on the placebo.[1] It also looked for a protective effect in women who developed colorectal cancer, and found no benefit there either.[2]
Federal health agencies in various countries used this study to declare that “the science is not settled” on the benefits of vitamin D, but in truth they’d fallen victim to human error. The problem with the vitamin D study wasn’t that the vitamin had no benefit, but that the supplements they’d given the women contained too little of the vitamin to make a difference against cancer, and/or, they had not properly adjusted for women who were already taking vitamin D before the trial started.
Those supplements in the trial contained only 400IU of vitamin D3, which scientists now admit was like throwing one bucket of water on a house fire. Additionally in a study measuring change there was unlikely to be any change if many of the women were already on supplements earlier.
In 2011, researchers re-adjusted for precisely that error and found that – despite the low 400IU dose – there was in fact a change:
“In 15,646 women (43%) who were not taking personal calcium or vitamin D supplements at randomization, [the Vitamin D plus Calcium dose] significantly decreased the risk of total, breast, and invasive breast cancers by 14–20% and nonsignificantly reduced the risk of colorectal cancer by 17%.”[3]
As you’ll see, the cancer risk reduction, despite being good, isn’t a patch on what was achieved with higher doses of vitamin D3.
To cover the totality of research would take an encyclopedia, rather than a book. Instead, let’s examine simply some of the most recent studies.
In May 2012, the journal Carcinogenesis reported on a Belgian study that measured the blood serum vitamin D levels of nearly 1,800 women when they were initially diagnosed with breast cancer, and then compared the course of the disease with their initial vitamin D status.[4]
This wasn’t a trial measuring supplements, but instead directly measuring the blood levels of vitamin D which, of course, is the ultimate point. You take supplements, or sunbathe, in order to raise your blood levels of vitamin D.
Women with the highest levels of v
itamin D (above 30 ng/ml or 75 nmol/L) when first diagnosed, managed to cut by half their risk of dying within five years, when compared with women who had vitamin D levels below 30 ng/ml. Further nailing the link to vitamin D, every 10 ng/ml rise in levels on diagnosis gave that patient an average 20% reduction in risk of dying within five years.
The researchers found the massive drop in the mortality rate remained intact even after making allowances for other factors like body size that could have influenced survival rates.
Another big finding from the study was that women with the highest vitamin D levels had the smallest – and therefore most curable – tumours. That’s important, because it showed high vitamin D levels appear to hamper tumour growth and slow down the spread of cancer cells.
Women with the highest levels also enjoyed the longest periods of remission, although this particular benefit only applied to post-menopausal women. Given that 60% of breast cancers strike after menopause, that’s highly relevant. Researchers suspect the bodies of post-menopausal women use vitamin D in different ways as a result of lower estrogen. Unfortunately, women are far more likely to be deficient in vitamin D after menopause, making supplementation or sunlight all the more important in the fight against breast cancer.
In their conclusion, the Carcinogenesis researchers state: “High vitamin D levels at early breast cancer diagnosis correlate with lower tumor size and better OS [overall survival], and improve breast cancer-specific outcome, especially in postmenopausal patients.”[5]
It’s certainly not the first study to find women have much better odds of beating cancer if they keep their vitamin D levels up. Joan Lappe’s groundbreaking report in the Journal of Clinical Nutrition that followed more than 400 Nebraska women getting 1100IU of vitamin D daily for four years found they reduced their risk of cancer of any kind by 77% during that time, in comparison with the placebo group.[6]