First, I want to acknowledge that for this piece I have lifted and paraphrased from a statement by Dr. John Cannell M.D., the head of the Vitamin D Council. So, it is he speaking not me, but I applaud what he is saying.

The Food and Nutrition Board, a division of the National Institute of Medicine, recently released its updated recommendations concerning Vitamin D. What a disappointment! Pregnant women are being advised to take only 600 IUs of Vitamin D daily. That is unbelivable. Professor Bruce Hollis, a leading Vitamin D researcher from the Medical University of South Carolina, has published papers showing that pregnant and lactating women need at least 5000 IUs/day of Vitamin D. 600 IUs is only 200 IUS than the 400 IUs recommended for tiny babies. Since the need for Vitamin D is very dependent on body size, how could a full-grown woman require little more Vitamin D than an 8 pound baby!

To keep these numbers in perspective, realize that a summer sunbath for 30 minutes delivers more than 10,000 IUs of Vitamin D.

As though it's living in the Dark Age, the FNB addressed only the role of Vitamin D in bone health, ignoring its vital role in heart health, brain health, breast health, prostate health, pancreatic health, muscle health, nerve health, eye health, immune health, colon health, liver health, mood health, skin health, and especially fetal health.

The FNB also reported that vitamin D toxicity might occur at an intake of 10,000 IU/day (250 micrograms/day), although they could produce no reproducible evidence that 10,000 IU/day has ever caused toxicity in humans and only one poorly conducted study indicating 20,000 IU/day may cause mild elevations in serum calcium, but not clinical toxicity.

Tens of millions of pregnant women and their breast-feeding infants are severely vitamin D deficient, resulting in a great increase in the medieval disease, rickets. The FNB report seems to reason that if so many pregnant women have low vitamin D blood levels then it must be OK because such low levels are so common. However, such circular logic simply represents the cave man existence (never exposed to the light of the sun) of most modern-day pregnant women.

Hence, if you want to optimize your vitamin D levels - not just optimize the bone effect - supplementing is crucial. But it is almost impossible to significantly raise your vitamin D levels when supplementing at only 600 IU/day (15 micrograms). Pregnant women taking 400 IU/day have the same blood levels as pregnant women not taking vitamin D; that is, 400 IU is a meaninglessly small dose for pregnant women. Even taking 2,000 IU/day of vitamin D will only increase the vitamin D levels of most pregnant women by about 10 points, depending mainly on their weight. Professor Bruce Hollis has shown that 2,000 IU/day does not raise vitamin D to healthy or natural levels in either pregnant or lactating women. Therefore supplementing with higher amounts - like 5000 IU/day - is crucial for those women who want their fetus to enjoy optimal vitamin D levels, and the future health benefits that go along with it.

For example, taking only two of the hundreds of recently published studies: Professor Urashima and colleagues in Japan, gave 1,200 IU/day of vitamin D3 for six months to Japanese 10-year-olds in a randomized controlled trial. They found vitamin D dramatically reduced the incidence of influenza A as well as the episodes of asthma attacks in the treated kids while the placebo group was not so fortunate. If Dr. Urashima had followed the newest FNB recommendations, it is unlikely that 400 IU/day treatment arm would have done much of anything and some of the treated young teenagers may have come to serious harm without the vitamin D. Likewise, a randomized controlled prevention trial of adults by Professor Joan Lappe and colleagues at Creighton University, which showed dramatic improvements in the health of internal organs, used more than twice the FNB's new adult recommendations.

Finally, the FNB committee consulted with 14 vitamin D experts and – after reading these 14 different reports – the FNB decided to suppress their reports. Many of these 14 consultants are either famous vitamin D researchers, like Professor Robert Heaney at Creighton or, as in the case of Professor Walter Willett at Harvard, the single best-known nutritionist in the world. So, the FNB will not tell us what Professors Heaney and Willett thought of their new report? Why not?

Today, the Vitamin D Council directed our attorney to file a federal Freedom of Information (FOI) request to the IOM's FNB for the release of these 14 reports.

Most of my friends, hundreds of patients, and thousands of readers of the Vitamin D Council newsletter (not to mention myself), have been taking 5,000 IU/day for up to eight years. Not only have they reported no significant side-effects, indeed, they have reported greatly improved health in multiple organ systems. My advice, especially for pregnant women: continue taking 5,000 IU/day until your 25(OH)D is between 50-80 ng/mL (the vitamin D blood levels obtained by humans who live and work in the sun and the mid-point of the current reference ranges at all American laboratories). Gestational vitamin D deficiency is not only associated with rickets, but a significantly increased risk of neonatal pneumonia, a doubled risk for preeclampsia, a tripled risk for gestational diabetes, and a quadrupled risk for primary cesarean section.

Today, the FNB has failed millions of pregnant women whose as yet unborn babies will pay the price.

Note from Dr. Cinque: I, too, take 5000 IUs of Vitamin D3 every day. And I have my 25 (OH) Vitamin D tested every year in April. Last time it was 45, which is still a little bit below the optimal range of 50 to 80. So how could a person taking a mere 600 IUs ever get close to optimal and especially when she is pregnant?

Recently, I was contacted by a 60 year old woman who wanted me to go over her blood work. Her fasting blood sugar was nice and low at 75. That's actually lower than mine, so I was a little envious. However, at the same time, she had marginally elevated HA1C.

HA1C measures the percentage of hemologbin that shows glycation damage. Glacation is a reaction between sugar moleculres and proteins in which the proteins get damaged. An example would be the proteins in the lens of the eye, which in their healthy state are completely translucent, but when they undergo glycation, they become opaque. Think of it like the change from raw egg white to cooked egg white, a process which is called "denaturing." Obviously, you can't see through cooked egg white, and it's the same for the ocular lens.

This woman's HA1C was 5.9% where normal is considered 5.7% or less. And, the fact is that some labs designate 5.9 as the top of the normal range, so really it was marginal. Nevertheless, it concerned her a lot, which is why she contacted me. I will point out that this woman is not the least bit overweight- if anything she is on the slim side. And she's feeling fine- there are no symptomatic issues.

The reason why HA1C is becoming recognized as a valuable tool is because it reflects the status of long-term glucose control. A simple glucose test only tells you what the blood sugar was at a single moment in time. But, blood glucose can fluctuate wildly. So, by looking at HA1C, you get an idea of how well glucose is being controlled over a period of several months.

It is probably true that HA1C is at least as predictive of future problems as any of the cholesterol tests and probably more predictive. And if I had to choose between being stuck with a high cholesterol or a high HA1C, I think I'd rather be stuck with high cholesterol. It would worry me more to have an elevated HA1C.

Now, what can you do about it? Well obviously, all of the factors that go into diabetes prevention apply, which means: eating a whole natural foods diet and emphasizing plant foods over animal foods, exercising regularly including aerobic and resistance exercise, maintaining a healthy lean to fat ratio (meaning retaining quite a lot of bodily muscle and not much bodily fat), and that's about it for the frontline defense. However, if you want to do more, you can consider taking anti-glycation supplements. Two of the best are Carnosine and Benfotiamine. Carnosine is a dipeptide, which means two amino acids holding hands, in this case alanine and histidine. It sounds simple, but Carnosine is as powerful an antiglycation agent as they come. Even the FDA realizes it because they have made Carnosine eyedrops a prescription treatment for cataracts. And Benfotiamine is the fat-soluble form of Vitamin B1 which has been used for decades in Europe to treat and prevent diabetes. It's commonly prescribed by doctors over there, and it's as safe to take as regular thiamine.

Those are the two anti-glycation supplements that I take. Another good one is P5P, which is an advanced form of Vitamin B6. I don't take it separately, but there is some P5P in the Extend Core multi that I take every day.

I am going to include the HA1C test in my annual blood work next April, and frankly, it will be for the first time. I never thought about doing it before because my blood sugar was always nice and low, so I figured, why bother? But now that I know that it's possible to have enviably low blood sugar while still having marginally high HA1C, I will start tracking it.

The USDA issued new salt guidelines in 2010 advising all Americans not to exceed 1500 mgs in their daily salt consumption. This was in sharp contrast to their previous advice which allowed most people to consume up to 2400 mgs daily. A lot of people, including some doctors, are screaming bloody murder about this, and the online community seems particuarly incensed about it. But, let me give you my take.

We know how much sodium the human body actually needs each day. It's about 500 mgs, and the body can actually get by on less by ratcheting up its sodium-conserving mechanisms. The body can squeak by on 250 mgs/daily if it has to. But, the body gets by with ease on 500 mgs/day with no strain at all. So, even 1500 mgs is 3x as much as required. However, the sodium-excreting mechanisms of the body are so efficient that most people can handle that much sodium load without a problem. But, I'll tell you, honestly, that there is no good reason to go higher than that. So in this case, I don't have a problem with the government's decree, and what I mean is that I think it's a good target to aim for.

In my life, I try to control my sodium intake, and I'm sure that on many days, I do consume less than 1500 mgs. However, I know that there are some days that I do go a bit higher, maybe as high as 2000 mgs. That is still below average because the average American consumes 3000 to 5000 mgs of sodium daily, and heavy salt users may go as high as 10,000 mgs or higher. But, I don't mind being reminded to keep trying to lower my salt intake because it's a worthy endeavor.

What's the harm from sodium? Well, obviously high blood pressure is an issue. It has not been a problem for me. My blood pressure has stayed low despite moderate salt intake. But if my pressure were to start rising, I would indeed lower my salt intake dramatically. But besides that, we know that excess sodium is bad for the bones. You know how salt corrodes the underside of cars and the surfaces of roads when they salt them in the winter? You might say it does the same thing to bones. Salt is an irritant, and it irritates the stomach. The high rate of stomach cancer in Japan is believed to be due to the high salt consumption. And salt may play a role in hardening of the arteries- not in the plaquing, which is soft, but in the hardening which comes later.

So, there are good reasons for all of us to limit our salt intake- even if we are lucky enough not to experience a rise in blood pressure from it.

Is sea salt better than standard table salt? I believe it is because it does contain other minerals. However, keep in mind that it's still 97% sodium chloride, and sodium chloride is sodium chloride whether it's mined from the sea or from the land. So, I'm all for sea salt, but let's not get over-enthused about it. Let's not mistakenly think that we can use it willy-nilly just because it's from the sea.

There is one important caveat: There are people with salt-wasting diseases, such as Addison's disease, where the adrenal glands fail to signal the kidneys to conserve sodium. These people lose copious amounts of sodium in their urine and hence have an unusually large daily requirement. But fortunately, Addison's disease is quite rare, and if you had it, you'd know about it by now.

Keep in mind that many people consume a lot of sodium without ever picking up a salt shaker. Cheese, bread, chips, canned foods, commercial soups, frozen dinners, and almost all restaurant dishes are loaded with salt. They add salt to everything. You don't think of cookies as being salty, but they are. Did you know that they add salt to ice cream? In my life, I avoid most of that stuff. I do eat whole grain bread which has about 100 mgs of sodium per slice. That's actually considered low by commercial standards. I eat canned beans, but I buy ones that are low in salt. Yet, they still have about half as much salt as the regular ones.  The saltiest thing I eat is a frozen vegetarian dinner which has 700 mgs. It's the nights I eat that that my total daily consumption may exceed 1500 mgs.

So, I don't consider myself a purist about salt by any means. But, if I were having major health problems, I would immediately cut way back to less than 1000 mgs a day.

Anyway, the bottom line is that when you do the Math, you realize that it really does make sense to minimize your salt consumption. And I can tell you that just from writing this little article, I am feeling empowered and motivated to try harder to get my salt consumption down.

Would you believe that pomegranate protects the kidneys of patients undergoing dialysis? I think that's amazing. In a small study out of Israel involving 101 dialysis patients, some got pomegranate juice 3X a week while the rest got a placebo drink. The patients receiving pomegranate juice showed marked reduction in inflammation and damage caused by free radicals. The doctors also observed significant improvement in cardiovascular risk factors among the patients getting pomegranate, which was important because many kidney patients die from cardiovascular events. Their conclusion was:

"Considering the expected epidemic of chronic kidney disease in the next decade, further clinical trials using pomegranate juice aimed at reducing the high cardiovascular morbidity of chronic kidney disease patients and their deterioration to end-stage renal disease should be conducted."

The study was presented during the American Society of Nephrology's Renal Week 2010 in New York City, the largest nephrology meeting in the world.

My first thought was that if pomegranate could do that much good for those who are in kidney failure, how much good could it do for a relatively healthy person?

I don't know about you but this time of year (autumn) I am consuming pomegranate juice every day. I make it in my Champion juicer. I realize that I could just eat the pomegranate seeds and pulp, but the seeds are rather gritty, which I don't like. So, I prefer to make juice. Sometimes, I just drink the juice by itself, but often I make a smoothie consisting of fresh pomegranate juice, organic tofu made from sprouted soybeans, and ripe bananas. Talk about a great smoothie! It is like a jolt of energy.

I hope you are making the most of this pomegranate season.

A reader has asked my opinion about the use of retinol, which is Vitamin A, in skin creams, and whether it might cause cancer.

 

The use of retinol in skin creams has been around for quite a long time- at least 25 years. The prescription forms of it usually contain an analogue of Vitamin A, such as Retin-A, and the over the counter forms contain regular Vitamin A, retinol.

 

Whether it's the natural Vitamin A or an analogue, the benefit from using it comes from its mildly irritating effect, which causes the outer skin cells to shed. A comparison has been made to an onion. If you peel the outer, dry, crusty layers of an onion, you get to a layer that is smooth and soft and moist. And it certainly looks much younger.

 

As to whether the use of retinol might cause or increase the risk of skin cancer, it is, after all, an irritant, and chronic irritation is a factor in many cancers. Moreover, it increases sun sensitivity, and the sun is obviously a factor in skin cancer. That's the reason why the use of sunscreen is recommended to all those using Vitamin A creams.

 

But, you should also know that some dermatologists prescribe Retin-A as an ancillary treatment for some kinds of skin cancer. The same is true for pre-cancers such as actinic keratosis.  And I mean they have the patient apply the Retin-A directly on the affected skin.

 

I feel that as long as the individual pays attention to the signs of excess irritation (such as redness, excessive shedding, peeling) and backs off when necessary, and so long as sunscreen is applied daily, that there should be no cause for concern. I think it's safe, and used properly and cautiously, it may actually reduce the risk of skin cancer.

 

However, I would not use a sunscreen that contained retinol. We're talking apples and oranges here. An anti-aging skin cream with retinol or one of its derivatives is one thing. A sunscreen is something else. They're two separate products, or at least they should be.  

 

Again, used properly, I feel that retinol creams are safe, and I have no compunction to discourage their use.