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The following is a transcription of Dr. Robert Heaney's March 5th, 2013 webinar on Vitamin D and Calcium, Fractures and Kidney Stones with his response to the USPSTF recommendations. To view the visuals and slides, click here.  The two windows can be minimized and placed side by side for concurrent viewing.
 

Vitamin D & Calcium, Fractures & Kidney Stones -- What do we do?


Carole: Welcome to GrassrootsHealth’s production of “Scientists Answer Your Questions” webinars. Today we are having a very timely session because just this last week or so the US Preventive Services Task Force made a very unique recommendation  about Vitamin D and Calcium. And I love Dr. Heaney's comment here in this little green box saying “(It) rained on the parade of those of us trying to optimize our health with Vitamin D”. The recommendations said that most of us shouldn't take Vitamin D or supplements towards preventing cancer or bone fractures. I disagree! Dr. Robert Heaney is the John Creighton University professor and professor of Medicine at Creighton University and one of the world’s leading experts on Vitamin D and its metabolism. And he also happens to serve in a role as the Research Director for Grassroots Health. We are absolutely delighted to have him provide his expertise to us today on this. Dr. Heaney, it’s all yours.

Dr. Heaney: Good day, everyone. As Carole pointed out last week the US Preventive Services Task Force issued its final version of its report on calcium and Vitamin D, and I'm going to focus on Vitamin D this morning, but I think it’s useful to recall that it was just about 8 months ago that a draft of this same report was issued and it elicited then a lot of comment and disagreement and what we got last week was simply a rehash of what had been put out in the draft version several months ago. So there's nothing particularly new here that wasn't already there. I suspect most everybody in the general population has forgotten about the release in June and it may be that people will be forgetting about this release in a short time anyway.

So, but let me just go a couple steps further. The report itself said that “the current evidence was not sufficient to assess the balance of benefits and harms of  daily supplementation with doses more than 400 IU of Vitamin D3 and greater than 1000 mg of calcium for the primary prevention of fractures in non-institutionalized postmenopausal women.” Pay attention to that. “For the primary prevention of fractures” - the only focus they had. Now what the headlines said – not the report, but what the headlines said and what people heard and what the talking heads said on television is “well there's no need to supplement with calcium and Vitamin D anymore” or “calcium and Vitamin D won't prevent fractures after all. We used to think so but they don't do it anymore”. Well, that's not what the report said.

Nevertheless, that impression was so widely conveyed that many professional societies, and I've listed just some of them here, immediately issued responses that disagreed in several respects with the US Preventive Services Task Force report. The American Society of Clinical Endocrinologists, the National Osteoporosis Foundation here in the US, the International Osteoporosis Foundation headquartered in Europe speaking for the world and finally the American Society for Bone and Mineral Research. These are all very reputable, very conservative scientific professional organizations and they all said “no, we don't agree with the Preventive Services Task Force.”

So I want to spend a couple minutes describing precisely what the report does mean and to offer some suggestions about what the general public should do. First of all, the charge that the task force had is to evaluate all kinds of preventive actions to see if their potential benefit outweighs their potential harm. One example is at what age is it OK to take routine mammograms? Or should men have routine PSA tests for prostate cancer? Do those things help more than they hurt, that's what the question is. Now the task force's starting point in all of this is that it recognizes that acting, that is doing a test or taking Vitamin D, carries both risks and benefits and what they are concerned about is the balance of those two. It presumes that doing nothing is the best course. Surprisingly, that's what it starts with.

Now, for medical intervention that approach makes some kind of sense, actually, since doing nothing is always an option. The problem is that for nutrients, such as calcium and Vitamin D, doing nothing is never an option because we are always getting some of every nutrient. So the question is how much did they take as their base line? And what happens is the task force takes “current intake,” whatever you are doing today or whatever the population is doing today, well that's the benchmark and they presume it’s probably adequate and they don't, and they require that everything above that have very firm proof or they don't accept it. So it looks for scientific studies of high quality that might establish benefit or harm for higher intake. And if they can't find any, or the studies they do find conflict with one another, then the task force says that the balance of evidence doesn't permit their making a recommendation of higher intake. It doesn't say that they did something different and I do want to stress, as I did a moment ago, that preventing fractures in the elderly is their sole focus in this particular set of recommendations. They paid absolutely no attention to other Vitamin D effects. For example, the effects of Vitamin D on pregnancy outcomes or on blood pressure or resistance to infection or on insulin sensitivity and diabetes and a whole host of others. They were simply not looked at or evaluated and the task force made no recommendations about those things at all.

What's been frequently overlooked is that the task force does recommend the use of Vitamin D supplements to prevent falls in persons who are more than 65 of age. But these are precisely the individuals in which one would want to prevent fractures. So if you are going to be taking Vitamin D to prevent falls and it might prevent fractures, so much the better.

So they should definitely be supplemented at least for fall prevention. So in effect, what the task force is really talking about is motivation. A funny thing for a Preventive Services Task Force to talk about but that's what it boils down to. They say “supplements will reduce fall risk but we don't know whether they will reduce fracture risk.” But, I think it’s perfectly clear, that's a far cry from “don't use supplements”. They're simply saying “we don't know whether, in addition to preventing falls, they might prevent fractures too.”

I also want to stress the task force found no evidence that supplements were not effective. I mean, you can prove a negative there if you have a lot of data but that was not what they did. The Task Force does not say “don't use supplements”. It does not say “supplements do no good.” It simply says “we don't know whether or not they help.”

So this is where the scientific disagreement comes in because that's where the professional societies  and many scientists disagree. The International Osteoporosis Foundation was very clear. It says “Yes! Vitamin D does reduce fracture risk!” So the recommendation therefore of the International Osteoporosis Foundation is yes, it would be a good idea to take supplements, as a matter of fact.

Now the problem is, that I pointed out a moment ago, is that these approaches to these issues might work well for diagnostic tests or for medical interventions but we need a better benchmark than the status quo when it comes to nutrients. And I want to suggest one simply from what I think the tests should have been doing. We all know that humans originated in Equatorial East Africa. We didn't have fur like our chimpanzee anthropoid cousins, and we were wearing no clothes so the physiology that we have today in the 21st century was actually fine-tuned in those eras many hundreds of thousands of years ago. Fine tuned to the conditions that were prevailing in Equatorial East Africa. And that included high Vitamin D intake year-round. Not from food, not from supplements but from the skin. From sun converting the precursor of Vitamin D in our skin to the active compound at a high rate so that would have been a high Vitamin D intake.

And we have evidence of what that might have been because there are several groups of individuals in East Africa who are still following ancestral lifestyle. The Masai who herd cattle and there are Hadzabe who are hunter/gatherers. Here's a picture of a Masai herder. You can see that there's a fair amount of skin exposed there. Now what kind of a Vitamin D level does this individual have? Well, there you see it. There's Masai with a serum 25-hydroxy D level of almost 50 ng/ml. And the Hadzabe are essentially in the same place. This is ancestral intake. This is what our bodies were used to when we were evolving our current physiologies.

By contrast, the Institute of Medicine which issued its recommendation now 2 years ago, the Institute of Medicine said “well, 20 ng/ml is fine. Nobody needs any more than that and most of the population is in fact at 20 or higher and so therefore you don't need to supplement.” Well, once again that report elicited a huge amount of response. First of all, a large fraction of the population is below 20, not above 20 the way they said. We don't know where they got their data but it’s wrong. And the Endocrine Society somewhat more progressive, just 6 months after the Institute of Medicine, recommended 30 ng/ml. And that may be enough for some function but the ancestral seems to me to be the best benchmark and that's about 40 some odd, close to 50 ng/ml.

Now, there isn't a lot of time to go into a lot more detail but it is worth noting that when you look at the downside risk of taking Vitamin D supplements a report mentions that there was a small risk, and it’s their term – small - a small risk of kidney stones that might be incurred in those taking Vitamin D supplements. Now this is simply not correct. This caution was based on a just single study – this is not what you would call strong evidence, a single study that used only a very small intake of Vitamin D – so small that it wouldn't have produced any effect at all. But they did get a lot of extra calcium so if there were any basis for the kidney stones it would not be the Vitamin D. I don't happen to think it’s the calcium either but that's not the point. We're talking about Vitamin D today. Moreover, other studies such as some that have come right out of the Grassroots Health database, some studies show exactly the opposite – that kidney stone patients are, if anything, more likely to have low Vitamin D status rather than high Vitamin D status.

So to wrap up and to open up to your questions: a couple final thoughts... The US Preventive Services Task Force report really changes nothing and it should not cause supplement users to stop. The burden of proof, in my judgment, should fall on those who say that intakes lower than the ancestral intake are safe rather than recommending not going to the ancestral. I think people should have to prove that it’s safe to go below the ancestral. And finally, lacking such proof, the best course is to maintain in you as an individual and the population as a group, ancestral Vitamin D levels – that is 40-60 ng/ml. And with that, I thank you for your attention and Carole, I think you're going to manage the questions for me.

Carole: Alright. Thank you very much, Dr. Heaney. We're going to initiate the questions now that we have received from our viewers online and we have a whole list of those. We will go over as many as we can in the next 15 minutes. Then we will close but Dr. Heaney has agreed to stay on after that to continue answering questions. So while we will close at the end of the 30 minutes, for those of you who can stay on, we will be happy to have you. I will start with this one chart right here in terms of answering questions, before I give it back to Dr. Heaney, because the most frequent question we get almost no matter what our topic is, is how much Vitamin D should I take? And I wanted to share this chart with you, which you can download from our website, grassrootshealth.net, which was actually a result of the paper that Drs Heaney and Garland and others published in 2011 from over 3,000 people in the GrassrootsHealth cohort. And just very simply, if you take a look at where you are: what is your serum level right now, and the example given here was 20 ng/ml, and let’s say you want to be at 50, what would you take based on that study to approximate that level? And right here it shows that you would take an intake of about 4300 IU/day. That is based on an average weight of an adult of 150 lbs. The reason that this chart is of the essence though, is because you can't really tell what you should take without knowing what your starting point is. And you can see that based on those others. But Dr. Heaney, we're going to go on to actually our very next set of questions. So, again, starting with the How much? A participant says “I'm low. How much do I need to get back up?” Would you like to add to what I said about that prior chart or anything else there?

Dr. Heaney: No. I think you covered that pretty well. The only thing I would add is that individuals respond very differently and some people get a lot more bang for their buck than will others. So some people will get up to 50 at less than that 4300 unit number and some people may require more. But you have to recognize that those are just averages and there will be a lot of variation around that.

Now the second question I think can be addressed this way – and I think we're not....

Carole: We have to read the question, Dr. Heaney, and the question is “What is the appropriate daily dose for adults and children?”

Dr. Heaney: Well, the easiest way to answer that question is if you don't know what your baseline is, as Carole just said, you don't know what your daily dose ought to be because what you need is what it takes to get from where you are to where you want to be. But if you don't know where you are then we can't figure that out. But overall, from all sources, those you are getting right now and those you need to get, the dose approximates 75 IU/kg of body weight per day. Now you have to figure out, you have to convert your weight in to kilograms and then you can figure out that way but you may well be getting a fraction of that already from food and sun and one thing or another but that's a handy benchmark. The beauty of that 75 IU/kg figure is that applies across the age range. From 6 month old infant to morbidly obese adults weighing 450 lbs. That will work out for all of them and that will give you a level in the range of 40-60 ng, the target figure that we've been stressing in this presentation.

Carole: Great. Question: a female person who has osteopenia – is there a special recommendation for her?

Dr. Heaney: There's no special recommendation for either sex or any age. The only situation in which the medical condition might make a difference is if you are taking drugs that would increase your body's storing Vitamin D away. We call that “catabolism” or “breakdown”. But osteopenia is not one of those. So people that have too little bone or who have osteoporosis – they need the same amount of Vitamin D as everybody else. So 75 IU/kg per day.

Carole: Great! And we had a number of safety related questions. Is it safe to take 400 IU vitamin D and 1000 mg of calcium daily?

Dr. Heaney: Yes it is safe! And I stress once again that the task force did not say it was unsafe. The task force simply said it couldn't figure out whether taking that much really helps. But the experts in the field are quite convinced  it does help. Oh! As a kind of an aside, I might point out that the task force does not have anybody on it who has ever studied calcium or vitamin D. (laughter) Well, no, they're an all-purpose everything task force. I mean, their charts were looking at psa tests and mammograms and cardiac catheterization and prophylactic penicillin for infection. I mean, they look at everything. So they're kind of all-purpose everything experts but they're not experts on calcium and Vitamin D.

Carole: A person says “I take 1000 IU of D3 daily, is it safe?

Dr. Heaney: Yes it is safe. I take 3000 a day myself.

Carole: Alright. Are there long term studies on D3 supplements to show safety? And this question came in, Dr. Heaney, with a little more explanation implying that taking supplements is brand new and we really don't know their effect yet. And I know that you had quoted another study that was more than 30 years old so if you could fill us in on that.

Dr. Heaney: A natural way that we get Vitamin D is through the skin but those of us who live in temperate latitudes or in Northern Europe, for example we're not going to get very much through the skin because for most of the year the sun is too low on the horizon - even if you were standing in a bathing suit in mid-December outdoors, you're not going to get any Vitamin D. And so we've long recognized that we need to take supplements in one form or another. It was some time in the 1930's that Vitamin D was added to milk in this country and so now you see Vitamin D milk when you go to the grocery store, but if you look at the nutrition label and all the milk have vitamin D added to them. That's a form of supplementation. The Europeans have been doing this for years. Throughout Eastern Europe there was a way of giving large doses of Vitamin D to children 3 times a year just simply to ensure that they would have enough to tide them over between doses. And that's been going on since at least the end of WWII so we're talking there about 60 or 70 years right there. There's huge experience with that. We know how much is too much but you're never going to approach that taking the kinds of doses we're talking about and you'll never get a problem with Vitamin D if your blood level is in that range of 40-60 ng/ml. That's where we want to go. The amount that we take doesn't matter. It's what does it do to our blood level that's important.

Carole: Thank you. Does Vitamin D cause calcium to be deposited in my arteries?

Dr. Heaney: No. There's an emphatic no there. It does not! The idea that it might have done that has come out of experience with patients with end stage kidney disease who have very high levels of serum phosphorus and it’s the serum phosphorus that is responsible for calcium being deposited in walls of arteries. But most of the rest of us who have reasonably good kidney function, there's absolutely no possibility of that happening so there's no need to be concerned about it.

Carole: To our audience, a number of you have asked questions about calcium and Dr. Heaney has very gracefully agreed to put on really a separate webinar at some time in the not too distant future and we will be doing that although we know that certainly it relates to Vitamin D. Now specifically about kidney stones. We've had a lot of questions about that, in part due to the ongoing question about it and it was reemphasized in the report. We also want to highlight to all of you that there is an article on our website that Dr. Heaney wrote specifically about “Vitamin D does not cause kidney stones” and I hope you will take advantage and download that. We've had more than 400 downloads of that in the last week, I will tell you though. But anyway the question specifically on number one was “Does vitamin D create kidney stones? and please explain the relationship.”

Dr. Heaney: Well, the simple answer is Vitamin D doesn't cause kidney stones. There's simply nothing to worry about there. People think “well, vitamin D causes calcium absorption and if you absorb more calcium than you need then you have to store it away in the kidneys and that could lead to kidney stones because calcium is one of the components of kidney stones. Well, there are 2 things wrong with that assumption. First of all, Vitamin D doesn't cause calcium absorption! It simply enables the body to regulate calcium absorption and if you're absorbing enough calcium to meet your bodies needs then taking more vitamin D – taking 10 times as much vitamin D, will not increase your calcium absorption one little bit nor will it increase your urinary calcium content. So there's not a possibility of vitamin D leading to a situation where you might be prone to develop kidney stones.

Carole: Fantastic! And I think the second question: actually causing kidney disease, is separate from kidney stones. So is there a combination of D and calcium to be taking?

Dr. Heaney: Well, no there's not a correct combination to be taking but let me amplify on that – that's the simple answer. First of all, Vitamin D and calcium do not cause kidney disease. And 2, there is no correct combination. The reason for saying that is that Vitamin D and calcium come into our bodies independently, separately. They're not in the same sources. We don't get calcium through our skin but if we're working outdoors we do get Vitamin D through the skin. And similarly, if we drink a lot of milk then we get a lot of calcium. We'll get some Vitamin D but we won't get a lot. So what your bodies need for Vitamin D depends upon what your blood level of 25-hydroxy Vitamin D is. The test that Carole was talking about just before we started the questions. Whether you need Vitamin D depends on where you are and where you want to be. And do you need calcium? Depends on how much calcium you are getting from your diet. I told you I was taking 3,000 IU of Vitamin D per day. Why? Well, I don't get out in the sun! I work here in a darkened room in front of a computer without a window and when I go home the sun is too low on the horizon. And I don't walk home, I drive home in a car. Leaving a covered garage and parking in a covered garage. I could go on for weeks on end without seeing the sun except through glass and that doesn't count. However, I typically have 4-5 dairy servings per day so I'm getting all the calcium my body needs that way. I don't take any. There's no reason to take them together. The Vitamin D that helps your body regulate calcium absorption has to be modified within your body after you get it in your system in order to help the body control calcium absorption so taking them together and in some fixed combination makes no sense. There is nothing required there. The body is really very forgiving. Just get enough. That's what the answer is: just get enough.

Carole: Dr. Heaney, we've been getting a lot of questions coming in as you were speaking, about toxicity and specifically how much is too much and what is Vitamin D toxicity so could you address that for us, please?

Dr. Heaney: Vitamin D toxicity occurs when you have so much Vitamin D in your system that it overrides the body’s ability to regulate the blood calcium level and then the blood calcium begins to rise. And that can cause all kinds of problems including kidney stones. No question about that. But before I go further with that, let me say this: careful studies evaluating all the known cases of Vitamin D intoxication in the medical literature have shown that there have been no reported cases ever at doses less than 30,000 IU/day and no reported cases at blood levels less than 200 ng/ml. And you recall that what we are recommending is 40-60 ng, a long way away from that toxicity threshold. Does that mean that if you go above 200 you're going to get toxicity? No. Most people won't, as a matter of fact, but some sensitive people will. So we say that 200 is the bottom end. We don't want to go above 200 except under medical supervision. And there may be some times when that might be necessary but not for the average healthy person. Stick to 40-60 ng. That should be quite ample for most of us. So don't worry about toxicity.

Carole: Thank you very much on that one. And this very last one here and then we're going to close off this part of the session, A number of doctors have commented that some people are still wary, regardless of the factual information that you have just provided about taking D3, so is there some kind of recommendation right now that can be made “make sure you take at least this amount of D3 and we guarantee that you shouldn't be worried about life, liberty, kidney stones.... I guess really to get some benefits, so maybe what really the minimum amount one could do and get some benefit. Or do we go immediately back to “well, what's the serum level?”

Dr. Heaney: Well, a lot of people don't know their serum level and are not going to know it, realistically. We recommend that you do so, if you can, and Grassroots makes that possible for you, but realistically you're not going to know that. It’s true that the biggest response is going to occur at the bottom end of the dosage range so if you take 1000 IU/day, you'll get a benefit. You may not be able to feel it but it will – although many of you will. But what will happen is you'll reduce your chances of getting other disorders, chronic diseases of various sorts. But you don't worry about those for the most part every day so you'll just have to take our word for it that in fact, that will reduce your risk.

But I want to share a  story with you. A couple years ago I was participating in a meeting being held by the Centers for Disease control in Atlanta who had the responsibility of developing guidelines for vitamin D dosage for the infirm elderly. I've never been clear about why the Centers for Disease control had the responsibility for falls and fractures of the elderly but it does, wisdom of congress and that's kind of how it sorted out. But there were 9 working Vitamin D scientists sitting around the table as we were kind of weighing the evidence and formulating the recommendations. I passed a piece of paper around the room and said please write down how many units you now take per day and then pass it on. You don't have to put your name down, you don't have to identify. Just give me a number. By the time it got back to me and I averaged them all out that group of working scientists averaged 5500 IU/day. They were voting with their lives and bodies and they thought it was a good thing to be doing. And I think the same. As I say, I'm taking 3000/day now, myself.

Carole: Dr. Heaney, thank you and we will continue with Dr. Heaney's responses to some of our questions but I need to close for those of you who need to back out now. This set will definitely be online on our webinar series and you can listen to the whole thing at your convenience. Thank you very much for coming.

Next Tuesday Dr. Heaney will be back to talk about why test Vitamin D and I have a quick update to give all of you. Dr. Heaney mentioned the 75 IU/kg. For those of you who don't deal with kilograms that translates in to about 34-35 IU/lb. So put that in there as a way to do a quick calculation as to where you should be starting.

So again thank you all for coming. I hope that some of you will take a look at participating in the GrassrootsHealth D*Action process and that's available to look at on our website grassrootshealth.net and have a beautiful, great sunny day. And for those of you who are staying, we will carry on with our questions. Thank you again.

Dr. Heaney: Carole, how will you handle this?

Carole: I am going right back to the questions, Dr. Heaney. Here we are. With the balance and calcium type questions. So if everyone sees them on their screen now, I hope, we have a participant saying they're taking 10,000 IU of D3/day and what should she attend to about her calcium levels?

Dr. Heaney: Well first of all one would want to know why she is taking 10,000 IU/day. That is generally safe but there may be a specific condition. If she's just an otherwise healthy individual then I'm not sure that 10,000 is necessary and I'd be more inclined to think about something a little bit closer to what the average Vitamin D scientists were taking – 5000/day. But if she were to attend to her calcium levels, one of the most sensitive ways to do that is to analyze the calcium content of the urine. If the blood level is high it’s going to spill over into the kidneys and so you should be able to see it in the urine. Alternatively, if the blood calcium goes up you can measure that so those are things you could look at. But 10,000/day shouldn't – we have a lot of experience with people taking 10,000/day and we don't see any problems with calcium but I don't know about this persons medical conditions so I can't specifically say there.

Carole: My own quick contribution there is that if that person is watching their serum level and they are taking their 10,000 IU/day to reach their desired serum level then that's a different ball of wax than just taking 10,000 IU/day, I think.

Dr. Heaney: That's a good point, Carole.

Carole: Is there a maximum of calcium, Dr. Heaney? Is there a reading?

Dr. Heaney: Well the Institute of Medicine first addressed that question in 1997 in the development of what is called dietary reference intakes, and it said that 2500 mg/day was the upper level. It didn't say upper limit, it said upper level. What an upper level is, is an intake that is safe for everybody. So 2500 would be an intake that would be effectively safe for everybody. Now in this most recent iteration of the Dietary Reference Intake, some 2 years ago, the Institute of Medicine lowered that to 2000. I don't think there's any evidence for that but if - the most important point I'd like to make about calcium, and I'll come back to that if we ever revisit this issue, is that the right way to get your calcium is not from a supplement but from food. Supplements have a roll but it should be what their name says. It should supplement an otherwise good diet, not a substitute for it. The practical way to get enough calcium in your diet is from dairy foods. Milk, yogurt, hard cheese, these are excellent sources of calcium. The reason that dairy foods are such an important source of calcium is not because the calcium is any better, it’s not because it absorbs any better, it’s because low calcium diets have been shown to be poor diets overall. They're generally down in half a dozen critical nutrients. It’s different from person to person but the point is the overall diet quality is poor if you are low on dairy. You may have some problems with dairy and so you need to work that out with your friendly neighborhood nutritionist or dietician but the fact of the matter is that dairy is going to be a strong basis for an adequate diet given contemporary exercise levels. We're simply not burning the calories that our great-grandparents did and so we simply can't eat as much! The problem is that the foods we can buy in the grocery stores are filled with empty calories. They're not providing the key nutrients that you want and if you're low on calcium you're going to be low on a host of others as well. In its last 2 issues, the Dietary Guidelines for Americans upped the dietary recommendation from 2 to 3 servings a day for everybody after age 9. And the reason for that was not just the calcium but because they couldn't put together a probable healthy diet without having that much dairy in it. So do get your calcium from dairy and then on top of that a 500 mg calcium tablet of some sort or another would be helpful. But it’s not going to give you the real benefit of calcium if you're low on all these other nutrients too.

Carole: Thank you. My Vitamin D leave is too low. My calcium level is too high. What do I do?

Dr. Heaney: You get your D level up! It’s not going to change your calcium level. That’s the answer. You can take Vitamin D until you get it up to where you want it. As I say, we recommend 40-60. But that's not going to change the calcium level.

Carole: Which calcium and D to take for bone loss and fracture?

Dr. Heaney: Dairy. Dairy. Dairy.

Carole: Alright. And you've already mentioned what's the best source to get calcium. Source of vitamin D: tanning beds or supplements?

Dr. Heaney: Both tanning beds and supplements work. For people who cannot absorb vitamin D because they have intestinal problems such as colitis or ileitis or Crohn's disease or malabsorption syndromes of one kind or another, oral supplements won't work and so tanning beds become absolutely essential. Or home UV lamps that are used carefully, that can produce the same kind of a benefit. But supplements are a lot cheaper than tanning beds.

Carole: What is your opinion on large single doses of D3 of 50,000 IU, to prevent early symptoms of cold or flu?

Dr. Heaney: I don't know of any evidence to suggest that a large single dose at the beginning of flu season would do you any good at all. Well, I mean it would help get your vitamin D level up, but this is obviously related to preventing early symptoms of cold or flu. My recommendation is just get your Vitamin D level up to where you want it. This is not a magic bullet. This is something that is going to guarantee the best health you can have. That doesn't mean you won't get sick. It doesn't mean you're not going to get hit by a car when you jay-walk. It doesn't mean any of these other things aren't going to happen to you. It’s just that you're going to optimize your chances of getting through all these problems. If you do get a cold, it's likely to be less severe than if you didn't have adequate vitamin D status. If you do get the flu, it’s likely to be less severe than if you don't… than if you have low vitamin D status. So all these things are optimizing your chances. It’s not preventing stuff; it’s just helping your body cope. So get it up to 40-60. I know of no evidence for these big mega doses doing anything at all for us.

Carole:  What's the difference between D2 and D3?

Dr. Heaney: There are 2 differences between D2 and D3. The first one: D2 is a synthetic product that is derived from plant precursors. D3 is a natural product that's produced in all animals upon exposure to sunlight. And the second difference between the two of them is that D2, being somewhat unnatural, is metabolized by the body more rapidly. That is it's thrown away, it’s not utilized as efficiently whereas D3 is conserved by the body and used. So you get more effect if you use D3. And although both forms of Vitamin D are relatively inexpensive, as it turns out D3 is today somewhat cheaper than D2. So I can't have anything against D2 but it’s hard to have anything for it either. D3 is the way to go.

Carole: Should we be measuring magnesium levels as well as D levels?

Dr. Heaney: No. We don't know how to assess magnesium status in any practical, easy way. People can have perfectly normal blood magnesium levels and still have substantial magnesium deficiency. Magnesium is kind of an orphan nutrient. We need to know a lot more about it than we do right now. But the truth of the matter is we don't know very much except that measuring magnesium won't tell you very much except in very sick people but you're talking about healthy people trying to optimize. Measuring magnesium isn't going to help them.

Carole: Before we go on to the next one there I want to ask you about Vitamin A. There has been some confusions about Vitamin A. You need to have some, you need not to have so much. Is there an amount of Vitamin A that one needs to match a Vitamin D level? Can you give us a little bit of guidance on Vitamin A, Dr. Heaney?

Dr. Heaney: Well, all vitamins are essential for health. All nutrients are essential for health. We need Vitamin A. We need Vitamin D too, as well. Excuse me, we need Vitamin D as well. The point of the fact is that probably 80-90% of the population is getting the recommend amount of Vitamin A per day and in my judgment not even 20% of the population is getting the recommended Vitamin D. So the emphasis has got to be on Vitamin D because that's where the shortfall is. If you happen to be Vitamin A deficient, and a lot of people worldwide are but it’s much less common in the United States, Vitamin A deficiency is just not a major public health concern. There may be individuals, particularly where malabsorption or intestinal problems - it’s a fat soluble vitamin and they can't absorb it very well, so those people need to take, I mean they should go to their physician and get some kind of a way to fix that but for the most part … we have this… there's kind of a myth out there that nutrients have to be taken in in some kind of balance. If you don't have some of this then taking that won't do you any good, etc. For the most part those balances are myths. They don't exist. There just isn't anything to them. So I encourage you, everybody, to have enough vitamin A but if you're taking a multivitamin then you're going to be getting enough Vitamin A for the most part. You won't have enough Vitamin D because that multi-vitamin does not have enough vitamin D in it to get you up there. But Vitamin A is in lots of food and if you're topping that off with a multi-vitamin supplement, you're going to be getting enough A. Just not anything to worry about.

Carole: The next two questions really have been already addressed. I have another one "are there any cases where it’s dangerous to take Vitamin D?"

Dr. Heaney: Yes, there are a few conditions. If you have any kind of what are called granulomatous diseases, the cells that are fighting an infection for us are able to make the active form of Vitamin D and to secrete it into the blood stream and bypass the body’s ability to control blood calcium. And when that happens you can get a form of Vitamin D intoxication but those are relatively rare and that has nothing to do with how the normal person would respond to Vitamin D. So if you've got an ordinary garden variety of health or even most illnesses, if anything you need more vitamin D rather than less. So we only worry about Vitamin D intoxication under these other circumstances. And those are medical issues and we need to consult our physicians.

Carole: And then last but not at all least, "I'm concerned that the media reports may send a message to consumers that Vitamin D and calcium are not that important for bone health." What else can you tell us about how should health professionals respond to this?

Dr. Heaney: Well, there are a couple of issues here, Carole. First, as I pointed out at the outset, how many of those listening in today were aware of the early report of this Task Force in June which got a lot of media coverage? I think we've all forgotten about it and my prediction is that the general public will have forgotten about this February one within 6 months from now. How should health professionals respond? Well, if they keep up on their continuing education they should respond positively which is to say to you the patient "be sure you're getting enough calcium and vitamin D." They should recommend Vitamin D, it should be a part of essentially every treatment regimen. If you have high blood pressure and your doctor is treating you for high blood pressure then you definitely need to have enough Vitamin D because its known that vitamin D will lower your blood pressure a little bit. Basically what it does is help your body control blood pressure. If you've got a vitamin D deficiency then the body's trying to do it without the help that vitamin D would have provided and it doesn't let the drugs do their job adequately. So every disease that you have should have Vitamin D in it. Not all doctors are fully aware of that and one of the thrusts behind GrassrootsHealth is a commitment to helping individuals take responsibility for their own health. So maybe you can help educate the health professionals who tell you "no, I'm not going to measure Vitamin D in you because you don't need it. You're getting enough right now." Well, I just have to say that chances are that physician is wrong when he or she says that and you can get your own blood level tested through GrassrootsHealth or other ways. Many labs will do it for you if you drop in. So you can get that kind of information and then you can be informed and then you can make your own decisions and you can help educate that professional. It should be a two way street. We help them, they help us.

Carole: Dr. Heaney, thank you so very much for your participation this morning and I want to tell you all, back again to the testing and whatever, the reason that GrassrootsHealth initiated its D*Action project in 2009 was a result of 2 years of time that both Dr. Baggerly and I, Carole Baggerly, toured the US talking about Vitamin D and we were faced with audiences filled with people who said "my doctor won't give me a vitamin D test" so we figured out there's a way to do that and things have changed substantially in the last few years on that and I'm very delighted to see that. But we have a group of people now numbering  more 10,000 around the world that are participating in this project and we welcome all people to come and do that. Secondly, we have a chart which is on our website. Our disease incidence prevention chart - you can also download that, thousands of copies of that have been downloaded for the express purpose of taking them to physicians by participants in this study so we are delighted to do that. Again, thank you all for attending today, thank you Dr. Heaney and we look forward to next week’s webinar on Why Test Vitamin D. Have a beautiful day.