Vitamin D uptdate 7/20/2008

July 20, 2008

I’ve continued to research the vitamin D issues referred to in my last alert. 

Trevor Marshall, Ph.D., has proposed a theory of chronic disease which relates to bacterial suppression of the body’s immune system through an inactivating effect on the vitamin D receptor.  By “switching off” this receptor, the body’s production of natural antibiotics (anti-microbial peptides) is disabled, allowing bacterial infection to persist.  These are bacteria that can live inside certain cells in the body’s immune system, and Vitamin D can be converted, in those cells, from the inactive to the active form.  With the inactivation of the vitamin D receptor, the normal feedback controls on the levels of the active form of Vitamin D  are lost, resulting in low levels of the precursor (25D) and high levels of the active form (1,25D).  I have seen this pattern, in a few patients, though not in others (I’ve only tested about 6-8 people so far, so it is too soon to comment).

Very high levels of 1,25D can have negative impacts on the body.  It is very accepted that vitamin D has an immunosuppressive effect in inflammatory diseases.  The Marshall Protocol agrees, but notes that this immunosuppression, although it reduces symptoms, allows the (presumed) underlying infection to progress. I must confess that I have a philosophical bias towards supporting the body’s normal defenses, and not suppressing those defenses.  I am sympathetic, therefore, to the Marshall Protocol. 

If I were to investigate the vitamin D levels in a patient with, for example, Rheumatoid Arthritis, and find that their levels of 25D and 1,25D were both low, I would consider this to be contradictory to the ideas of the Marshall Protocol, and would probably seek to raise the vitamin D level.  But, if the 1,25 D was in a good range, especially more towards the high end, I would NOT consider the patient to be vitamin D deficient, and would see raising the vitamin D level to be an immunosuppressive act which might produce short-term benefit and long-term harm (if the Marshall Protocol logic is correct).

There are some assumptions and speculations in the logic behind the protocol, but I note, on the Bacteriality website, an impressive number of interviews with patients successfully treated by the protocol.  If these accounts are true and do not represent placebo responses, the Marshall protocol may be an extremely important breakthrough in the understanding and treatment of various forms of chronic disease.  It does, however, represent a radical departure from current thinking.

At the moment, I continue to have concerns for people with auto-immune disease, persistent lyme disease, chronic fatigue syndromes, and sarcoidosis.  I am not able to make firm recommendations for this group of people, but I do feel that their vitamin D status should be more fully investigated.

For those of us without these diagnoses, but who have been found vitamin D deficient by measuring 25D (everyone tested prior to the last few weeks), we should also consider measuring the active form of the hormone.  I have one patient who has been on vitamin D supplementation for over a year, with a marginal effect in raising the 25D, but whose 1,25D level came in at a relatively high level.  So for him, what appeared to be Vitamin D deficiency may not be so at all!  This patient is not known to have any of the diseases listed in the paragraph above.

For the rest of us, it is summer-time and we should all get some sun.  It doesn’t take much to generate a good amount of vitamin D.  We don’t need to tan, and certainly not to burn.  Even 10-15 minutes of exposure of relative small parts of the body can generate 20,000 Units of vitamin D.

I’ll continue to update this topic as my research progresses.  Thanks for your patience with these investigations.