February 16, 2017


Director's Letter 
Carole Baggerly 
Director, GrassrootsHealth 

GrassrootsHealth was founded in 2007 in order to bring the science of vitamin D to the public - as fast as possible. At that time there was some great research on vitamin D and immune function that was not widely known by doctors. The doctors knew about the skeletal benefits of vitamin D, but not the immune function benefits.

Guess what - we (all of you participants and us) are making waves! On Monday this week, Orthomolecular Medicine News Service released " The Top 18 Vitamin D Vitamin D Papers in 2015-2016," three of which included authors from GrassrootsHealth. In addition to these papers, GrassrootsHealth has been the catalyst for the start of a change in how research outcomes are reported - based on vitamin D levels, not simply dosage groups. This will be the key trend moving forward, based on the research done by Dr. Robert Heaney - nutrient trials need to report outcomes on change in nutrient status. 

We are pleased to share with you this summary of vitamin D research for the years 2015 and 2016. You can read the whole paper here, or continue on below - the important thing is to get this out to as many people as possible.

Shout it from the rooftops! 

Bring it to your doctor on your next visit!

Let's get as many people on board as possible - lives depend on it.

Carole Baggerly 
Director, GrassrootsHealth 
A Public Health Promotion & Research Organization 
Moving Research into Practice NOW!
Paper of the Week

The Top 18 Vitamin D Papers in 2015-2016
William B. Grant, PhD

Dr. William Grant cites 8,744 papers on vitamin D were published in the years 2015 and 2016. The papers cited in this article are based on their potential impact to medical and public health policies. 
UVB exposure

GrassrootsHealth's paper, Sunlight and Vitamin D: Necessary for Public Health, is cited as one of the key papers to report on not only the vitamin D benefits of sunlight, but other benefits as well. This paper is unique in that it is a peer-reviewed, published summary of a seminar we conducted in the fall of 2014. It was a 2 day seminar in San Diego, where attendees heard from 13 different presenters on the benefits of sunlight as it relates to a myriad of topics including cancer, diabetes, pregnancy, and overall public health costs. Every presentation was recorded and all are available on our video page from the seminar. Some of these have been turned into free CME courses. (Continuing Medical Education)

The key take-away in all the papers referenced by Grant in this section is that sensible sun exposure (non-burning) IS good for your health - as noted by lower disease incidence in sunnier climates and higher death rates in winter. 

Pregnancy and Lactation

GrassrootsHealth led the way, with a paper that took existing data and changed the analysis - from dosage group to achieved serum level. The serum level data came from the two RCTs done by Drs Bruce Hollis and Carol Wagner. We found that raising serum levels from 20 ng/ml to 40 ng/ml reduced the risk of preterm birth by 59%. We also compared the risk of preterm birth for those women who achieved a serum level of at least 40 ng/ml to the reference rate of preterm birth published by the March of Dimes for the same county and found a 46% lower risk overall. Since preterm birth can lead to many more conditions, it is a key predictor in the health of the child and in overall healthcare costs. 

Another paper by Drs Hollis and Wagner - cited in our change.org petition - was also on the list. The conclusion of this paper was that 6,400 IU/day for lactating mothers provides adequate vitamin D for both herself and her baby. This RCT showed that giving mothers 6,400 IU/day not only allowed the mothers to be sufficient, but also the babies. The babies in this group had similar serum levels (with no supplementation) as the group of control babies on 400 IU/day vitamin D drops whose mothers also received 400 IU/day.

Mirzakhani et al. showed a drop in preeclampsia rates with a raise in serum level and De-Regil et al. did a meta-analysis of vitamin D and calcium which found that high dose vitamin D reduced preterm birth, but vitamin D with high doses of calcium did not. 

Autism Spectrum Disease

One of the scientists from our panel  and the founder of Vitamin D Council, Dr. John Cannell, hypothesized in 2008 that there was a connection between vitamin D and autism. Two different papers are cited on children with autism who were given differing amounts of vitamin D based on weight of the child, with significant improvement of most autism scores (CARS). 
Broken Bones in Infancy

We reported on this in our change.org petition about breastfeeding. There is a tendency for infants to come into the ER with unknown sickness - the parents are distressed. Over the course of diagnosis the infants are taken away from the parents because broken bones are found and child abuse is suspected. Three of our scientist panel members have helped to fight these cases in court - Drs John Cannell, Michael Holick and Carol Wagner. A paper published on this issue by Cannell and Holick highlighted that X-rays will miss a diagnosis of rickets 80% of the time, and doctors will miss the connection that the broken bones are a result of severe vitamin D deficiency, or rickets, which can be solved with sunlight and supplementation. 


GrassrootsHealth's paper, " Serum Vitamin D > 40 ng/ml Are Associated with > 65% Lower Cancer Risk," is highlighted. Similar to the preterm birth study above, GrassrootsHealth took data from past RCTs and analyzed them by serum level, not dosage groups. 

The second publication is by Dr. Joan Lappe, another GrassrootsHealth panel member, who conducted an RCT in which subjects were given either 2000 IU/day vitamin D and 1500 mg/day calcium, or placebo. Cancer incidence was decreased by one third in the treatment group. The preliminary results were presented at the American Public Health Association Annual Meeting in November 2016; the full paper from this RCT, including results analyzed by serum level, is expected to be published later this year. We will let you know as soon as this new paper is available!

Public Health Policy and Vitamin D

Three papers were mentioned in this area. One study from France noted that the public is NOT aware of the benefits of vitamin D, nor does the public truly understand vitamin D. 

Another problem is that studies keep popping up that report J-shaped or U-shaped curves - which leads researchers to surmise that there is a sweet pocket of benefit, but above certain levels vitamin D can do harm. Grant et al. tackled this notion in their paper, " Do studies reporting U-shaped serum 25-hydroxyvitamin D-health outcome relationships reflect adverse effects?" and found little evidence that 25(OH)D levels up to 100 ng/ml were a cause for harm. Part of the issue has been that the people in the studies were ill and had had vitamin D prescribed to them by their doctors and, thus, more likely to be ill to start with.

Another paper makes a case for more vitamin D fortification in the food supply, to try and get 400-800 IU/day through daily food intake. 

Time is Short

If you only have time for a few papers, these are the ones to start with and share with your doctor. Below is the list of papers with links to all that are available online.

Top 18 Vitamin D Papers of 2015-2016

Sunlight and Vitamin D: Necessary for Public Health
A GrassrootsHealth paper
J Am Coll Nutr
June 2015

The Role of geographical ecological studies in identifying diseases linked to UVB exposure and/or vitamin D
Grant WB
January 2016

Serum 25-Hydroxyvitamin D Concentrations ≥ 40 ng/ml Are Associated with > 65% Lower Cancer Risk
A GrassrootsHealth paper
PLoS One
April 2016
Do studies reporting 'U'-shaped serum 25-hydroxyvitamin D-health outcome relationships reflect adverse effects?
Grant WB et al.
May 2016

Post-hoc analysis of vitamin D status and reduced risk of preterm birth in two vitamin D pregnancy cohorts compared with South Carolina March of Dimes 2009-2011
A GrassrootsHealth paper
J Steroid Biochem Mol Biol
January 2016

The risks and benefits of sun exposure 2016
Hoel DG et al.
October 2016
Multiple unexplained fractures in infants and child physical abuse
Cannell JJ, Holick MF
J Steroid Biochem Mol Biol
September 2016
Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial
Hollis BW et al.
Otober 2015

Vitamin D deficiency in Europe: pandemic?
Cashman KD et al.
Am J Clin Nutr
April 2016
Vitamin D3 and calcium supplementation significantly decreases cancer risk in older women
Lappe J. et al.
American Public Health Association Meeting
October 2016

Major inter-personal variation in the increase and maximal level of 25-hydroxy vitamin D induced by UVB
Datta P. et al.
Photochem Photobiol Sci.
April 2016

Early Pregnancy vitamin D status and risk of preeclampsia
Mirzakhani H. et al.
J Clin Invest
December 2016
What Do People Know and Believe about Vitamin D?
Deschasaux M et al.
November 2016
Vitamin D status in autism spectrum disorders and the efficacy of vitamin D supplementation in autistic children
Saad K et al.
October 2016

Vitamin D supplementation for women during pregnancy
De-Regil LM et al.
Cochrane Db Syst Rev
January 2016
Randomized controlled trial of vitamin D supplementation in children with autism spectrum disorder
Saad K et al.
J Child Psychol Psychiatry
November 2016
Read Paper

Widespread seasonal gene expression reveals annual differences in human immunity and physiology
Dopico XC et al.
Nat Commun
May 2015
Read Paper
Regular sun exposure benefits health
van der Rhee HJ et al.
Med Hypotheses
December 2016
Read Paper

Dr. William Grant

Author's Editorial

Dr. William Grant is an epidemiologist and founder of the nonprofit organization Sunlight, Nutrition and Health Research Center (SUNARC). Grant holds a PhD in Physics from UC Berkeley and worked as a senior research scientist in the field of optical and laser remote sensing of the atmosphere and atmospheric sciences at SRI International, the Jet Propulsion Laboratory, and the NASA Langley Research Center. His career included pioneering development of laser remote sensing instrumentation, while the latter half included participating on many NASA-led airborne atmospheric chemistry field missions to the far corners of the world. Since 2000, he has focused on ultraviolet-B (UVB) radiation and vitamin D and their relation to cancer and other diseases. He has written over 140 peer-reviewed articles and editorials on vitamin D and health, edited two books, and contributed half a dozen chapters to other books.

Additional Information from Dr. Grant

Research on the roles of solar UVB exposure and vitamin D has come a long way in the past two decades, finding that there are many health benefits beyond bone health. Studies are of three major types: ecological, observational, and interventional. 

In ecological studies, populations are defined geographically and variations in health status or disease rates are investigated as a function of location or time. Cancer incidence and mortality rates vary considerably with respect to solar UVB doses. On the other hand, influenza rates are highest in winter. 

Observational studies enroll people and look at health/disease outcomes as a function of blood levels of vitamin D or UVB exposures. 

Interventional studies enroll people, then give some of them vitamin D supplements or ask them to spend more time getting solar UVB exposure, then look at health/disease outcomes. 

One thing that has researchers puzzled is that the findings from ecological and observational studies have not always been supported by vitamin D supplementation studies. The reasons could be that the trials were not properly designed, conducted, and/or analyzed, or it could be that vitamin D levels might be related to the disease state, such as if a sick person stopped going out of doors. Many are anxiously awaiting the results of major vitamin D supplementation studies, which will be reported in the next few years. In addition, some of the completed and reported vitamin D supplementation trial results will be reanalyzed in terms of vitamin D levels rather than vitamin D dose since vitamin D level responds in a nonlinear fashion to vitamin D supplementation, and disease risk also has a nonlinear relation to vitamin D level.

However, there is enough evidence now from the various types of studies to recommend both sensible sun exposure and vitamin D supplementation, especially when sun exposure is not feasible. The optimal vitamin D level appears to be at least 40 ng/mL (100 nmol/L), with no adverse effects expected for concentrations of at least double those values. Measurement of vitamin D levels is recommended since each person increases vitamin D levels differently in response to UVB exposure and vitamin D supplementation.

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Vitamin D in the Prevention of Health Disparities During Pregnancy and Early Infancy

Thursday, March 23
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Medical University of South Carolina

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