"Vitamin D Deficiency Elevates Colorectal Cancer Risk" (includes discussion of inflammatory disease and gut microbiome)

[Webdog]

Though this video/article is primarily about vitamin D and colorectal cancer risk, it delves into Vitamin D's role in the gut microbiome and inflammatory/infectious disease. It covers research that will be published in 2019.

It concludes that it's time for doctors right now to consider Vitamin D supplementation for at-risk patients, and that the traditional levels are too low.

I found it interesting, as Vitamin D is one of the very few supplements that I get a clear benefit from. I was once chastised by a doctor for having a "much too high" Vitamin D3 level of just over 100 nmol/L (edit: 25(OH)), which is what Dr. Johnson is recommending here.

Vitamin D Deficiency Elevates Colorectal Cancer Risk
https://www.medscape.com/viewarticle/904115

Vitamin D affects the microbiome. There's a mechanistic role in T-cell trafficking and a significant effect as it relates to the immune function. Regarding the potential for promotion of synthesis and the bad things that upregulate cancers and inflammation, we know that vitamin D actually inhibits the response of tumor necrosis factor-alpha. There's an anti-inflammatory response with cytokine interleukin-10.

The results essentially show that the more vitamin D you get, the better. However, there seemed to be a plateau effect at 100 nmol/L. It didn't mean that more was better forever; there wasn't a linear relationship. Nonetheless, it raises the bar for vitamin D supplementation in our patients.

Putting It Into Practice
I've also used supplementation in patients with diverticulitis, which we know to occur more frequently in patients with lower vitamin D. When you get into some of the anti-inflammatory effects of vitamin D on proliferation, differentiation, barrier function, and immune response, it makes sense to start looking at this in inflammatory/infectious disease as well.

In summary, vitamin D is really essential in homeostasis and signaling. It affects the microbiome and has a direct effect on host intestinal inflammation. We do know that this certainly plays out in inflammatory bowel disease.

It remains to be determined whether supplementation makes a big difference as far as clinical outcomes. However, to me, there's clear evidence that it modulates inflammation, maintains epithelial integrity, and reduces intestinal proliferation. In my practice, it's ready for primetime. I think it should be in yours as well.

Start to look at supplementation; perhaps measure the patient's vitamin D levels, and monitor and target it in patients—particularly those at risk. I do think this represents translational, bench-to-bedside research that is ready for primetime now.

 

[Peter T]

When I took vitamin D regularly it was as part of a range of supplements, so though at the time I believed they were helpful, I could not say which individually were responsible for any benefit. When I took a lot of supplements some years ago it was under a nutritionalist and though they seemed to help it was such a lot of money (£80 to £90 a month in the mid 1990s for the supplements alone), and I could not really be certain they did not just serve to produce brightly coloured expensive urine. Now I am no longer working I could not afford that ongoing expenditure.

Further it is hard sorting out cause and effect. In general good diet and taking supplements (fairly random which I now take) happen for me at times when I am feeling better, when I am bad, I eat whatever I can and my diet is poor and any supplement taking is erratic. So I can not be sure of cause and effect, does good diet and supplements improve my health or is it a consequence of having more energy during spells of better health to devote to ensuring a better diet. (Or obviously the third alternative a combination of both, when better able to achieve a better diet, this reinforces better health.)

I have taken vitamin D by itself too, but so erratically I can not comment on whether or not it seemed useful.

One issue with assessing subjectively the benefits of taking a particular vitamin is illustrated by my experience with B12 injections. A B12 injection when my levels are low does subjectively seem to result in a noticeable improvement in energy and general ME symptoms, however when having injections regularly an individual injection does not seem to result in any change in symptoms, though it may be preventing the negative effects of a B12 deficiency.

Further when we take a food supplement we can not be sure how much of that vitamin is already in our diet. Is the supplement taking us upto our daily requirement or in addition to our already achieved daily requirement in our diet? Also is the effect of a vitamin dose dependant, does a supplement help just to ensure the necessary minimum or is more than the necessary minimum actually therapeutic? Do larger doses help or just create expensive pee?

Brain fog today so may not be clear.

There is so much info out there on vitamins and diet supplements, is there some way we could use discussion threads to collate what we know and our personal experiences? Obviously there is already a lot of discussion here on this in diverse threads, but could we make it more structured and accessible?

Diet is such a big topic for us, and though I suspect getting right it helps my ME, I am very unsure how reliable my personal observations are and how to evaluate the mass of information out there that ranges from the rational to the total crank.

However diet is also such an emotive topic. I just caught the tail end of a discussion on the wireless yesterday about tribalism in modern diet approaches/fads. How any public statement on diet now produces strong responses, both pro and anti.

Perhaps a thread on each individual vitamin, start off with a poll
- have you tried [vitamin or food supplement] - Yes/No
- if 'Yes', has [vitamin or food supplement] helped you - Yes/?/No
- if 'Yes', do you feel any benefit from [vitamin or food supplement] was a general health effect or a specific improvement of your ME symptoms - Yes/?/No

If this worked we could repeat it particular diets or for food intolerances?

This approach is potentially unreliable as we are relying on subjective anecdotal evidence, doing exactly what we criticise the BPS crew for, subjective measures in open label trials. Though experience over longer periods of time and trying things out can perhaps be more reliable, for example trying supplements, then stopping them, then starting again, observing different effects from different supplements.

However if we gathered a large enough sample it could be the basis of designing a double blinded randomised control trial.

Obviously the Admins will have a better idea of what is possible or practicable to achieve on this site.

 

[Trish]

Perhaps a thread on each individual vitamin, start off with a poll
- have you tried [vitamin or food supplement] - Yes/No
- if 'Yes', has [vitamin or food supplement] helped you - Yes/?/No
- if 'Yes', do you feel any benefit from [vitamin or food supplement] was a general health effect or a specific improvement of your ME symptoms - Yes/?/No

None of the members polls we do on the forum should be regarded as the least bit scientific, so nobody should draw any conclusions from them! We are a self selected sample which makes them a non starter for any sort of serious science. We do the polls as a way of inviting others to share experiences.

And I take seriously the warning by Ron Davis that we shouldn't try to treat ourselves with supplements beyond normal daily requirements, as it can cause serious harm. We are all different with different diets and needs, so what helps one person can harm another. I'm not saying don't set up a few diet polls, just be wary of drawing conclusions from them.

 

[Peter T]

None of the members polls we do on the forum should be regarded as the least bit scientific, so nobody should draw any conclusions from them! We are a self selected sample which makes them a non starter for any sort of serious science. We do the polls as a way of inviting others to share experiences.

And I take seriously the warning by Ron Davis that we shouldn't try to treat ourselves with supplements beyond normal daily requirements, as it can cause serious harm. We are all different with different diets and needs, so what helps one person can harm another. I'm not saying don't set up a few diet polls, just be wary of drawing conclusions from them.

@Trish point taken. I had wondered also whether this was getting dangerously near suggesting we share information that could be mistakenly taken as medical advice.

I had been grappling personally with how I could compensate for my memory problems by externally storing and organising information, rather than every time a new issue arrives starting searches that
I have previously done, again from scratch. Currently only using an iPad, and really need to get back to using a PC to be able to do anything serious for myself. But also I had been pondering my failure to make efficient use of the vast amounts of information stored in the various forum threads here, as well as valuing the potential of the S4ME hive mind.

Diet and supplements seemed an example of an enormous information field, that is difficult to navigate. It is also an area that we tend to focus on, perhaps because it is something that we have a reasonable level of control over. However it is also a field rife with misinformation and unevidenced assertions, that may turn out, beyond ensuring a good basic diet, to be irrelevant to the management of ME.

 

[MeSci]

This is info I typed up on 14.1.16 re my own level, taking supplements:

'Serum Vitamin D (~4QB44 Combined total vit D2 + D3 lvl) 61nmol/L

(50-300 adequate; >75 may be optimal for bone health).

MedlinePlus says “Many experts recommend a level between 20 and 40 ng/mL. Others recommend a level between 30 and 50 ng/mL.”

But there is a lot of controversy over accuracy of Vitamin D tests, and I think MedlinePlus may be talking about 25-hydroxyvitamin D.

http://www.nejm.org/doi/full/10.1056/NEJMc1513502?query=TOC says “Our results underscore the importance of the choice of assay for vitamin D–binding protein in the calculation of free 25-hydroxyvitamin D in diverse populations and support the measurement of total 25-hydroxyvitamin D in the general population as a marker of vitamin D status, regardless of race or GC genotype.”'

 

[Webdog]

One observational study suggests the optimal Vitamin D 25(OH) level for sleep for those with neurological symptoms is 60-80 ng/ml.

The world epidemic of sleep disorders is linked to vitamin D deficiency (2012) Gominak SC1, Stumpf WE.
https://www.ncbi.nlm.nih.gov/pubmed/22583560

The conversion factor from ng/mL to nmol/L is 2.5, so
60 ng/mL = 150 nmol/L
80 ng/mL = 200 nmol/L

 

[Mithriel]

I am rarely outside so I take vit D. I asked to be tested for my levels but was given a calcium test instead as they said that was the same thing - no, but I did not have the energy to argue (calcium levels fine by the way!)

At the MS therapy centre I attend they started selling vit D at cost and everyone was taking them. Some people, particularly thin women, found it made their osteoporosis worse, though the 2 I knew got a lot of sunshine, foreign holidays and outside a lot.

I would like to see a proper study done which brought us to normal levels. Faisal Khan did a study a few years ago but everyone was given the same dose (probably for cost reasons) and some people did not reach normal levels so it did not really tell us anything.