Not All Sunshine–The Reality of Vitamin D Supplementation

Dear Mrs. Tsai, dear EPOCH Times team, I am responding here to this article which you recently published on the US version of EPOCH times.

It’s a very good written and important contribution at the present time. Taking into acount also the recent reports of EPOCH on Ivermectin and Cholesterol/Statines it is even more important to try to be as precise and clear as possible and do not leave important issues to potentialy wrong and thereby harmful interpretation.

Very short to myself. I’m a physician and researcher since now over 45 years. I was implicated in the discovery of Bosentan® during my 16 years with F.Hoffmann-La Roche and running now a medical praxis and institute (Institute for mitochondrial Medicine) here in Berlin. Hormon“Vitamin“ D3 is since more than 15 years a centerpart of my scientific interest and treatment of my patients. I also published on that, but during the last years nearly exclusively in German, to reach German Physicians which are in there majority not very afine to English.

As another annotation I would like to stress here, that the worldwide treatment of Vitamin D deficiency could have saved allready in the decades before COVID-19 millions of lives, thinking e.g. to the yearly renewing Influenza infections, but also other viral infections and there severity and cause in illness could be mentioned here.

With respect to the changed „landscape“ in science and media specially during the last 4 years and the vast increase in intended, directed desinformation , ideologic-demagogic propaganda, censorship of scientific publication – I’ve just a record of about 400 publications retraced or suppressed, but there might be much much more – I got very sensitive, not to say allergic, too the term >Expert<. We have in the meantime much to much „experts“ who are paid or otherwise ligated to big-pharma and political interests to deal with this word easily, as still in the public it is equalized with knowlegable, neutral, trustworthy. The „Expert“saying has impact! Yes, but in our days very often a very negative! I will just give one example: The german minister of health Karl Lauterbach. How he got to his professor title is still under debate. About 10-14 years ago he superelevated himself to a big Vitamin Expert in German public press. Only intend to get people not to use vitamins and minerals to improve their health. Then he became the „big expert“ designing the phase III trials for Bayer’s statin Lipobay which killed hundrets of patients and nearly the whole company, then he became the one and only „expert“ for Ulla Schmidt (a former health minister, same political party), then – very unfortunately – he became health minister himself, now being an expert in virus, viral disease, and treatment, … but times goes on still minister of healh hes now an expert in climate change, CO2, and since recent in democrathy! To say it right away, this man is a very dangerous idiot, who has many lost lives and sever illness in his package by doing what he did, but is still not stopped. So … this word EXPERT has in the meantime very often a very bad aftertast. I dislike to be called „Expert“, and I dislike to put this lable on others. It has become a dangerous term. [/av_textblock] [av_textblock size='' av-medium-font-size='' av-small-font-size='' av-mini-font-size='' font_color='' color='' id='' custom_class='' template_class='' av_uid='av-lsohpk16' sc_version='1.0' admin_preview_bg=''] Now coming specifically to your article Mrs. Tsai: Im not tackeling here all, but just what I think is very important fort he discussion of Vitamin D3. >It’s a sun-sourced substance acting as both a nutrient and a hormone. This dual role is significant, as hormones, which orchestrate many bodily functions, aren’t typically taken as supplements like vitamins. …. Endocrinologist Dr. Michael Holick, a leading vitamin D expert, tells The Epoch Times, “The body more effectively utilizes vitamin D when it’s naturally synthesized from sunlight, compared to standard supplement doses.”< [/av_textblock]

We are still fighting – especially in science but not only – with paradigms. They are on the one side necessary to give science a structure on the other side very harmful for the progress of knowlede and science, because the „old“ ideas are kept up by the old „matadors“ for ever. I suggest here the book of Thomas S. Kuhn „The structure of scientific revolutions.“

To understand the still „favouring“ of the sun as the „originator“ of Hormon“Vitamin“D one has to look into the history and discovery of cholecalciferol. However, it is very clear by now, that the contribution of the sun to the daily needs of sufficient body cholecalciferol levels is NOT SUFFICIENT. This has many reasons. In the higher latitudes it’s simply the absense of sufficient amount of sun light, or – more precisely – how high the sun reaches over the day over the horizont and thereby sends UVB in a steep enough angle to the skin, that there the conversion of 7-dehydrocholesterin to (finaly) cholecalciferol can happen. In Germany and Sweden this is just so in one month of the year (Germany, August) Sweden (September). All the rest of the year irradiation is not sufficient enough, between October and March it’s practicly absent. Never mind, the public (in german newspapers as DIE ZEIT, Frankfurter, Handelsblatt, Focus, Stern, Spiegel and so forth is told again and again, that 10 minutes in the sun, even in winter, with free hands and face is sufficient. This is a leading ly kept alive by pharma in conjunction with politics.

Hintzpeter B. et al. (2008) „Higher prevalence of Vitamin D deficiency is assoziated with immigrant background among children and adolescents in Germany.“ J Nutr. 2008 Aug; 138(8):1482-1490. doi: 10.1093/jn/138.8.1482 PMID 18641195

Rabenberg M. et al. (2015) „Vitamin D status among adults in Germany – results from the German Health Interview and Examination Survey for Adults (DEDS1).“ BMC Public Health 2015 Jul11; 15:641 doi: 10.1186/s12889-015-2016-7 PMID: 26162848.

Also the notion that Vitamin D is more effective when synthetized by the sun in comparision to supplements I disagree with strongly. Please see further down.

William B Grant  1 , Heide S Cross, Cedric F Garland, Edward D Gorham, Johan Moan, Meinrad Peterlik, Alina C Porojnicu, Jörg Reichrath, Armin Zittermann  „Estimated benefit of increased vitamin D status in reducing the economic burden of disease in western Europe.“ Prog Biophys Mol Biol. 2009 Feb-Apr; 99(2-3):104-13. doi: 10.1016/j.pbiomolbio.2009.02.003. Epub 2009 Mar 4. PMID: 19268496.

In this already old publications (2009) these authors suggested already a population wide substitution with 2000-3000 IE D3 daily and calculated a decrease of „health“ costs of 187 Billion € per year for the EU.

Now, a continuous daily substitution with 2000-3000 IE D3 is not – under no circumstances – achievable with the sun! In addition we have here to take in account another aspekt when Dr. Holick is talking about „less good utilisation from the gut“. This might have something to do with – as I learned from your article – that in US there is only D2 (Ergocalciferol) instead of D3 (Cholecalciferol) allowed and on the market. There has been in the past a lifely debate, whether or not these to substances are differently metabolise by our bodies. This debate I regard as decided. Yes, D3 is better metabolised as D2!

„25(OH)D2 half-life is shorter than 25(OH)D3 half-life and is influenced by DBP concentration and genotype.“ Jones KS, Assar S, Harnpanich D, Bouillon R, Lambrechts D, Prentice A, Schoenmakers I. J Clin Endocrinol Metab. 2014 Sep; 99(9):3373-81. doi: 10.1210/jc.2014-1714. Epub 2014 Jun 2. PMID: 2488563

Then – certainly- the resorption from cholecalciferol from the gut is affected by a multitude of parameters starting with the „presentation“ of the compound as oil, or tablet and so on, with food, without food, and then factors of the gut health and physiology itself: e.g. gluten- and or food-intolerant, irritable bole and so force. These are factors which – as you also state later in your article have to be taken into account by individual dosing! This already here points to the nonsense of present „Guidlines“ they can never be goal-leading, and everybody who is not completely stupid can know that. Substitution because of all what has been said so far hast o be individually, to be optimal.

But, coming back to the thesis that sun is the better generator. This assumption does not take into considration the genetic! As it seems – completely. Cholecalciferol is not a „sunhormon“ or what ever, it is an enzymatic product of our own body, starting with 7-dehydrocholesterol, which in this unique case can be transformed by UVB, if energy rich enough, into pre-cholecalciferol which reconfigurates to cholecalciferol.

7-dehydrocholesterin, the last intermediate on the way to cholesterol, is reduced to cholesterol by the 7DHCR (7-dehydrocholesterolreductase). The activity of this enzyme is dependent on it’s mutation status. The SNP rs12785878 influences it’s activity. In the TT switch it reduces, in the GG switch it activates the 7DHCR. In Germany we have about 50,9% TT, 40,6 TG and 8,5% GG. That means, that 51 percent of the population have a because of that a higher availability of 7DHC which is good for higher cholecolciferol production, but 49 percent still have reduced 7DHC because the enzym converts faster to cholesterol. This genetic situation is probably the result of a long selection pressure in the past, because people with an increased production capacity for cholecalciferol have in light-pure areas a selection and longevity advantage. However the TT carrier have by the way a significant higher risk to develope long-covid! In any case we have to take into consideration that the production capacity for a large part of the population (49%) is shrinked here, and I’m just talking about 1 SNP. There are more.

This is a scientific concersation, certainly to granular for your paper. But to convey the notion, „that sunlight is better than substitition“ is not just wrong, it is dangerous and will without doubts lead to the worth even if you and EPOCH might not intend that.

Then, what please is „Standard Supplementation“? Do you reflect here on recommended amounts? If so please state also, that these are ALL political standards, which have nothing to do with necessities! We started with 200IE per day and are now at 400-800IE cholecalciferol (not ergosterol) per day, we would need at least 2000-3000 per day, whereby this is dangerous. I have patients doing well with 1000 IE per day achieving serum calcidiol levels of 50 ng/ml and others taking 30000 IE per day to achieve a level of 30ng/ml! It is high time to realise the complexity of this hormon system, by the way the mightiest we have in our body, reign at least 913 of our 20000 genes!

>Once vitamin D enters our body through sun, diet, or supplements, it transforms to become active. First, it changes into calcidiol in the liver, then into calcitriol, its active form, in the kidneys.< [/av_textblock]

This is an oversimplification which should not stand like this. It is the paradigma of the past to which Dr Holick contributed, by finding that cholecalciferol on it’s own is inactive. First, whereever cholecalciferol enters the body it hast o be transported. That is done by VDBP (Vitamin D binding Protein, which has also the name GC) and which transports the metabolites of the Hormon-D metabolism with different bind strenght Calcidiol>> Calcitriol>Cholecalciferol. VDPB exists in more then 120 variations the most important are GC1 und GC2 with big population differences and e.g. differences between blacks and whites. It is heavily implicated in a big number of Vitamin D deficiency mediated chronic diseases. GC1-1, GC1-2 and GC2-2 are the predominant formes. Then not just the liver is able to transform cholecalciferol into calcidiol but rather 36 different cell-typs throughout the body. As well is not the only the kidney able to tranform calcidiol into calcitriol but also a high number of other cell in all other body compartments and organs. Then calcidiol can be considered (to the still existing definition) as a hormone, wherase calcitrol fullfils more the definition of an intracrine factor.

>The less recommended 1,25-dihydroxyvitamin D test fails to gauge vitamin D reserves, rendering it ineffective for patient monitoring.< [/av_textblock]

Also this is wrong and should not stand so. It has also a lot to do with the missing understanding of this highly complex system by at least 95% of physicians, Dr. Holick and some others may be excluded.

Vitamin D insufficiency among free-living healthy young adults. Tangpricha V, Pearce EN, Chen TC, Holick MF. Am J Med. 2002 Jun 1;112(8):659-62. doi: 10.1016/s0002-9343(02)01091-4. PMID: 12034416

Tangpricha and colleagues published now about 22 years ago the invers correlation between calcidiol and parathormone (PTH). This has something to do with calcium and magnesium and the Hormon D action in the gut. PTH measures the calcium and magnesium levels in the blood and is upregulated when they are to low. Ca und Mg are taken up in the GI, as stated correctly in your article dependent of the sufficient activity of VDR (Vitamin D receptors) in the GI. Ca to about 80%, Mg to about 50%. Both, calcidiol and calcitriol and their interaction with the VDR are here working together. In the case of insufficient ca/mg plasma level PTH is upregulated and leads to an activation of CYP27B1 (1a-hydroxylase) production which increased the conversion of calcidiol to calcitriol irrespective of the absolute amounts of calcidiol (calcidiol plasma concentration). There is no good correlation between PTH and calcitriol.

So far, to describe the Hormon D3 System in a minimum 3 parameters have tob e determined: PTH, calcidiol AND calcitriol, but more completely also the full blood calcium and magnesium levels are important to understand the regulation of the system. Only people who do not understand this believe, that the determination of serum calcidiol alone is sufficient to describe the system and to decide about substitution.

  1. A high PTH indicates a sever Ca/Mg deficiency of the system which hast o be substituted. In Germany, because of eating habits and bad food quality the majority of the publication is ca and mg deficient. Known to the DGE (Deutsche Gesellschaft für Ernährung) since at least 24 years, but without consequences for nutritional suggestions.
  2. High PTH leads via activation of the CYP27B1 pathway to high Calcitriol levels, which in the bone will lead to degradation e.g. osteoporosis with the physiological goal to increase serum calcium.
  3. The ratio of calcitriol/calcidiol is mandadory for the good functioning Hormon D system. Idealy it should be 0.5
  4. High calcitriol can be very detrimental for the system causing cancer, aging and other unwanted effects.
  5. That calcitriol IS NOT THE ONLY ACTIVE hormon in the hormon D system is clear since long.

Tuohimaa P „Vitamin D and aging.“ J Steroid Biochem Mol Biol. 2009 Mar;114(1-2):78-84. doi: 10.1016/j.jsbmb.2008.12.020. PMID: 19444937

It is interesting to see how many people don’t understand nature. Hormone”Vitamin”D is a steroid hormone, as testosterone and estrogen. When nature over millions of years optimizes prozesses, it normally doesn’t do that just once. Therefore it’s easy to see the amazing paralles between e.g. the testosterone and the Hormon-D system. VDBP equals SHBG, Testosterone equals calcidiol and dehydrotestosterone calcitriol. I think nobody would come to the wild idea to say, that testosterone is not active!?

>This increase in vitamin D testing contrasts with medical associations’ guidelines, which generally discourage routine testing in asymptomatic, low-risk individuals.< [/av_textblock]

It seems clear that not just in Germany but also in the USA there is no interest from the medical/pharmaceutical establishment to invest into preventive medicine. This is a long standing policy. For example, to evalutate the risk for atherosclerosis you dont have to measure cholesterol, but ox-LDL, MDA-LDL, LpPLA2, and MP8/14 to round it up. The vast majority of cardiologist (sadly) even dont know what these parameters mean or what to do with them. The reference values for uric acid differ for women and men. Woman < 5.8-6.2 mg/dl, men < 8.2 mg/dl. Now, the solubility for uric acid is, believe it or not, neither sex nor gender, trans LGBT or what ever else dependent but just from blood plasma solubility. And hyperuricemia (concentrations above 6 mg/dl) can cause gout. The laboratory reference values of the lab I’m working with are from Abott! And the Guidlines say … wait until „shit has happened“ and then prescribe an uric acid lowerer as e.g. Allopurinol.

I would like to give you a .for me even more striking example of how wrong standard medicine in our days act. The reference range for leucoytes in blood is 3.9-4.3 (lower end) to 9.9-10.5 thousand leucocytes per uL of blood. 1. Laboratories don’t give normally CV (coefficient of varation) values for the reproducibility and precision of the values they measure which is a big drawback. We have intra- (normaly more precise) and interassay CV. The last describes the reproducibility of an assay performed at different places or different time, thus, is more important. Lets – for simplicity reasons – assume an upper leucocyte value of 10(thousand per uL) and a CV of 5 percent, then values between 9.5 and 10.5 are not significantly different. However, if 10.0 is the upper end of the reference range, 10.5 would be marked as to high. This, im sure is not clear to the majority of physicians. But the real problem is the leucocyte reference range as such (4 – 10).

Serum anion gap, bicarbonate and biomarkers of inflammation in healthy individuals in a national survey Wildon R. Farwell MD MPH, Eric N. Taylor MD MSc CMAJ 2010. DOI:10.1503/cmaj.090329 182(2):137-141

Wildon at al. show in there study in “healthy” individuals, that Leucocyte values above 6.5 tousand/uL are significantly correlated to increasing inflammation (asymptomatically!). That in a consequence means that leucocyte values about at least 6.5 reflect increasing inflammation and not just those above 10! Coming back to the “guidelines” refered to above, one can simply say, this notion of the people making these guidelines is wrong and will consequently lead to chronic illness.

Times Magazine titled on February 23rd 2004: “The secret killer: The surprising link between Inflammation and Heart Attacks, Cancer, Alzheimers and other diseases” And addressed the question why we do not treat the causes but wait until damage has happened to reat then the consequences with little success. Now, the answer is given above. The system does not want it. It wants damage to be treated with pharmaceutical drugs because this is the much better income source for both, phama and physicians.

Guildlines in our present medicine are the result of year long conversations, to find finally an agreement on the very lowest level, which satisfied everbody, is absolutely absurd with respect to health protection, but supports the interests of Pharma and industrialised medicine. This should be made clearer to your Reades!

>“Vitamin D has been hyped massively,” he states. “We do not need to be checking the vitamin D levels of most healthy individuals.”< [/av_textblock]

This seems to be the view of Dr. Finkelstein. He is a good prototyp of physicians who either don’t possess enough knowledge or deny a neutral view on facts and neccessities for other reasons. Also this should be commented more clearly, it possible. We are here not anymore in the room where different scientific positions are debated, we are with such suggestions and positions on a way to decelerate the health of millions of people for unethical and inacceptable reasons! This man has obviouly understood nothing of the Hormon D System and its implication in chronic disease! It is mandatory to react and take action befor damage has established and not after. This is the classical dispute between preventive medicine and the classical symptomatological medicine, which patiently waits, until huge damage has happened! The latter is the medicine of the past (even so still our standard) it is costy and inefficient, but nobody has to move and nobodys sinecures are in danger.

>He challenges the evolutionary need for high vitamin D, noting its limited presence in natural foods and reduced synthesis in darker skin, common in sun-rich areas.< [/av_textblock]

Finkelstein is obviously a cynical person. It needs something to compare the ancestral living conditions e.g. of the Stone Age, with ours. In addition this man neglects completely the accumulation of new knowledge. I could comment also here in more detail, but I believe that’s not necessary.

>Aligning with this view, Dr. Goodyear emphasizes the tests’ relevance, particularly regarding inflammation and chronic diseases like cancer. [see my commentary above. He’s right.] He told The Epoch Times, “Vitamin D will always be low in the place of significant inflammation, both acute and chronic,” advocating for regular monitoring for proper supplementation.< [/av_textblock]

Modern medicine, that includes modern laboratory analysis, has made the complexity of inflammation much better measurable. I just finished a chapter in a new book about so called „silent inflammation“ where the function/disfunction of the Hormon D system is a major player. When I talk here about silent inflammation I talk directly about the by Finkelstein „so called“ asymptomatic people! By the way, until their first heart attact there are also a majority of people „asymptomatic“. I know examples who finished right before a marathone.

Sorry to say so but cynic’s like Finkelstein are disgusting in any way!

Silent Inflammation Stille Entzündung erkennen und behandeln F-W Tiller, W Mayer (Hrsg.) ISBN 978-3-96474-455-5

>“The process is to evaluate, dose, re-evaluate, and then re-dose,” he adds.< What Dr. Goodyear here states, I think I commented on already, and it is a groundprincipal of my clinic, for everything, the “3M” rule: Measuring-Making-Measuring. The only surprizing in this is the attitude of standard physicians as Finkelstein: Doing without measuring or doing after measuring but without controle. In a so called „evidence based medicine“ the behavior of the majority of exponents of people like him are breathtaking. In this context it is absolutely necessary not just to measure the start conditions, here: full-blood analysis of Calcium and Magnesium, PTH, Calcidiol, Calcitriol, then decide about a medication: the cholecalciferol dose, taking into account age, sex, height, weight plus calcium and magnesium status, then restorate , then treat for 6 to 8 weeks (the half life time of calcidiol is between 15 to 21 days) record the effects with the patient and remeasure. These so simple rules are nearly never followed by standard medicine with respect to vitamins, at least I can say that for the desaster oft he German medicine! [/av_textblock] [av_textblock size='' av-medium-font-size='' av-small-font-size='' av-mini-font-size='' font_color='' color='' id='' custom_class='' template_class='' av_uid='av-lsoi48n9' sc_version='1.0' admin_preview_bg=''] >According to the U.S. Preventative Services Task Force, “No consensus exists on the definition of vitamin D deficiency or the optimal level of total serum 25-hydroxyvitamin.”

The NIH clarifies that optimal vitamin D levels are unestablished, as they “vary by stage of life, by race and ethnicity, and with each physiological measure used.”< [/av_textblock]

To say it short: This is politically motivated bullshit! It has nothing to do with our present level of knowledge. I agree with Dr. Goodyear. The reference values given here are already outdated. There is big acceptance that calcidiol values below 30 ng/ml (75 nmol/l) are indicating a deficiency. These lower limit is too low. Based to our present knowledge calcidiol serum levels should be above or at least around 60 ng/ml. The statement oft he NIH seems to be made under the assumption that all other people are brainless idiots.

I would like to be shown by the NIH one, just one physiological parameter which is not changing with age, sex, race and ethnicity! Are there in the US just stupid or ideologic-demagogic blinded people anymore in leading positions of the NIH or CDC?

I would have liked to see a more straight forward commentary to this from EPOCH. You are otherwise also not shy to point the finger on the hurting point. Why here?

>Dr. Holick cautions that vitamin D intoxication, though extremely rare, is severe. Sun exposure can’t cause Vitamin D toxicity, but excessive supplementation can. “Any excess vitamin D made by the sun is destroyed by the sun. You can never become vitamin D intoxicated from sun exposure, but you can from supplements if you take too much,” he warns.< [/av_textblock]

I disagree with this „warning“ of Dr. Holick in that way that it vastly ovrestimates potentially risks (which can exsist) by indirectly denying the pressing necessity to substitute for the better! It is not goal leading, but misleading in the wrong direction, as it stresses very rare effects in a way to the public intending obviously to scare them. For a man working and fighting for the recognition of “Vitamin D” and its therapeutic potential this is an astonishing (for me not understandable) position.

Im citing here just one of numberous publications, that – as Dr. Holick says himself – potential Vitamin D toxicity appears rarely, but more importantly at ver high doses, which are normaly not achieved, expect in cases of intended missuse.

Frau Lessing zitiert die Publikation von Klingberg et al. „Seasonal variations in serum 25-hydroxy vitamin D levels in a Swedish cohort. Klingberg E, Oleröd G, Konar J, Petzold M, Hammarsten O. Endocrine. 2015 Aug;49(3):800-8. doi: 10.1007/s12020-015-0548-3. Epub 2015 Feb 14. PMID: 25681052.

Halthcock et al. (2007) Am J Clin Nutr 85:6-18

I could cite here much more data. It is not necessary to make the point. The warning against „the overdosing“ of Vitamin D in a standard-medicine enviroment where still 400 IE/d are suggested as sufficient, is bizare and has just one aim: To prevent usefull treatment (and results) by natural medizine! Dr. Goodyear put it right. Measure – Treat – Measure. In addition I am rising here the question, why these people are not warning against Statine’s, a by far much more dangerous drug which causes in >15 percent of the takers sever side effects (lowering testosterone (estrogene can be anticipated, but no study data), lowering calcidiol, increasing T2D risk, and does not reach the goal, as it is clear since 2000 when the WHO MONICA study was published, wrecking up all the big-pharma statements and studies? The answer is simple. Till today statines are the best selling drugs of pharma, making at present about 11 Billion per year but shall bring 20 billion 2030. Therefore the USPSTF and the ESC changed there recommendations towards a more aggressive and earlier treatment with statines in 2022! Potential health increasing effect is not to be expected, but pharma income rises sky high.

>Sunshine, a prime vitamin D source, can fulfill needs with minimal exposure. Dr. Tavel notes, “Your vitamin D storage generally lasts for about 10 to 12 weeks,” questioning the need for constant supplementation. … Supporting Dr. Tavel, New England Journal of Medicine research found no fracture risk reduction in healthy adults supplementing with 2000 IU of vitamin D compared to non-supplementers.

Vitamin D’s necessity varies. Dr. Tavel reminds us, “For much of human history, people got their vitamin D mostly from the sun,” highlighting our body’s innate ability to regulate this nutrient.< [/av_textblock]

First it has to be stated, that the guy obiously has no clue about pharmacokinetic. The halflive of calcidiol is 15-21 days with respect to different studies. Taking 21 days and 12 weeks = 84 days, during this time span calcidiol would fall from 100% to 6.25%. Is this guy really serious???

You are reflecting in your article to: „Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults.“ Meryl S. LeBoff, M.D., Sharon H. Chou, M.D., Kristin A. Ratliff, B.A., Nancy R. Cook, Sc.D., Bharti Khurana, M.D. https://orcid.org/0000-0002-7159-3435, Eunjung Kim, M.S., Peggy M. Cawthon, Ph.D., M.P.H., +5 , and JoAnn E. Manson, M.D., Dr. PhD Published July 27, 2022 N Engl J Med 2022;387:299-309 DOI: 10.1056/NEJMoa2202106 VOL. 387 NO.

I dont find Dr. Tavel under the authors, but never mind. This is an example of a hugh study, which did cost I dont know how much million € and years of working time, and is performed at the same time so badly, that one should do just one thing, one should forget this whole study, part of the even bigger „Vitamin D and Omega-3 Trial (VITAL)“. It starts with the fact that in all publications of this trial already one point is presented intentionally wrong. In this study NO!!! Omega-3 has been used: The VITAL Manson JE et al. Contemp Clin Trial (2012) 31(1): 159-171 Manson states already in the abstract „The ongoing VITamin D and omegA-3 fattie acid omacor® (1 g/d) fish oilTriaL … supplements in primary prevention of cancer and CVD … „ Thus, 1) not omega-3 oil was used but an industrial chemically changed omega-3 analogue.

Out of one of my presentations

In addition:

The dose choosen for the VITAL trial could have been identified as insufficient from the very beginning! How can one do such a mistake unintended????

Coming back to the study of Le Boff et al. 25871 participants, thereof 50.6% women, 20.2 % black. The mean starting Vitamin D serum levels is given as 30.7 + 10.0 ng/ml. I want to make aware that this is with respect to the size of the group a big standard deviation, indicating some heterogeneity in the data. There are no data available about the treatment effect of 2000 IE D3 per day! Not a trace of it. But we learn about income differences and other „very“ important matters. Then, and that is realy a stroke into the face, the study really!!!! had 401 individuals with D3 serum levels < 12 ng/ml (this, see above, would be a Vitamin D deficiency!) I dont know why I’m not impressed by the finding that Vitamin d did not have an effect on osteoporosis?! Nothing else would have been to be expected! In addition, all parameters which would have been to be measured for a good an thorough result are missing! (What a wonder.). It would have been needed to show the results for the different ethnic and „racial“ groups (Black-Americans have significantly lower D3 serum levels. I don’t show the studies here but I could easily ad them) It would have been necessary to determine and show the calcitriol levels. Calcitriol in the bone is involved in osteoporosis and is increased when Vitamin D is given without taking into account the calcium/magnesium homesostasis. To document this parathormon would have to be measured (high = calcium/magnesium deficiency; low = good calcium/magnesium status) VDBP and free calcidiol would have had tob e measured. Osteoporosis status and development is NOT first line related to total calcidiol, but to free calcidiol! All this by the way was known already when this study was performed! [/av_textblock] [av_textblock size='' av-medium-font-size='' av-small-font-size='' av-mini-font-size='' font_color='' color='' id='' custom_class='' template_class='' av_uid='av-luwdcd7p' sc_version='1.0' admin_preview_bg=''] Powe CE et al.(2011) „Vitamin D-binding protein modifies the vitamin D-bone mineral density relationship.“ J Bone Miner Res. 2011 Jul;26(7):1609-16. doi: 10.1002/jbmr.387).

In addition it was known before had has been shown in several studies, that the substation of Vitamin D without substitution of e.g. 1000 mg Calcium in parallel is insufficient, and as we are in a physiological system (and not in the simple minded “pharma paradigm world” (one drug = one result) Vitamin K2, more precisely MK4 (menaquinon 4) would have also to be measured and, if needed to be substituted.

Thus, the publication of LeBoff et al. is not worth a dime! It is a catastroph and it should be removed fom NEJM! But there are so so so many more. It is a good example for an intentially misleading publication which in science is not different from ideologic-demagogic propaganda! One cannot talk here anymore about a „small mistake“ or about issues which are debatable! Here is nothing more to say as „Pfui“. I could elongate here the recent list of similar concoctions. Specially in NEJM. I last year read two, one about Vitamin D and T2D (negative as planned) second on Vitamin D and colon caner (negative as planned). Both also used the same way. Starting D levels much to high (only a neglectable fraction of the patients were D3 deficient, but claming that they wanted to explore the effect of D3 deficiency on T2D / colon cancer. If one looks into the very long list of financial supporters of these studies it is hard to overlook all leading pharma-giants noted there. I think it is obvious that phama-giants which make there money – billions of € – with antidiabetics and chemotherapeutics are interested into studies which show that you could reduce the incidence significantly by improving the vitamin D status of the general population, or what are you thinking?

Marcia Angell, the former Editor in chief of NEJM left her position in protest, and published 2005, so nearly 19 years ago her book: “The truth about the Drug Companies. How they deceive us and what to do about it.” It became a bestseller, but nothing changed and when we look at the present scenerie of COVID-19, modRNA drugs and so on, one gets the same impression. These devils will get away with what they did to millions of people, without being made responsible!

>While this market growth mirrors a shift in health consciousness, it prompts concerns about self-prescribed supplementation and underscores the importance of a balanced approach to vitamin D consumption.< [/av_textblock]

It has to be stated here, that the „consumer“ or better the patient is left alone by „standard medicine“ and „standard“ educated physisians! This is a real problem as well here in Germany and as it seems also in US. But this deficiency in knowledege is intended by the system and big-pharma! So we dont need „a balanced approach“ we urgently need a tremendously better education of physicians!

>Sun exposure is key in vitamin D production. UVB (ultraviolet B) rays convert skin cholesterol into vitamin D3, later transformed into calcitriol, its usable form.< [/av_textblock]

This statement cannot be more wrong in the light of our present knowlede and understanding of the hormone“Vitamin-D“metabolizm. It is an overcome paradigm that holds not true anymore. The utmost what one could say is, that UVB is one factor in the system. We are not lving anymore in Stone Age but in a modern enviroment. There are numberous publications, special in US from e.g. Dr. Grant but also a big number of other authors, stressing the fact, that the mordern homo-civilicus is not anymore exposed to enough sunlight. But even if he would, we are not anymore dealing with a life span of 40 to 50 years, but with one of 70 to 100 years, and people want to expand that. And in addition we have to find a balance between sun exposure = high risk of melanoma and progressive skin aging.

I include here a fact sheet from the swiss „Bundesamt für Gesundheit BAG from 9. Juni 2021“ It is in German, sorry for that, but you will be able to see easily that sun exposure is NOT sufficient to achieve 2000-3000 IE cholecalciferol per day constantly throughout the year. Even not if an individual who has not to work and just enjoys laze!

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These official data by the swiss Bundesamt give no clue about how these 600 IU are translating into calcidiol plasma concentrations or differentiat by age, sex, body weight and so on. They also do take into account that the skin when aging looses ist capacity to produce cholecalciferol between 20 and 60 years of age by about 80 percent!

Already because of that the „old“ guildline driven reference values are outdated. We are fighting in our modern enviroment chronic diseases as CHD, multiple sclerosis, cancer, colitis ulcerosa and so on and so force. Good clinical (at present still rare) but animal models show the tremendous impact of Cholecalciferol in the PREVENTION and treatment of all of these, but not with low levels of 20-30 ng/ml! And not without understanding the vast complexity of this system.

I am implementing here three figures of a recent publication of mine, I am happy to forward it to you, but so far it’s just published in German.

There are numberous SNP’s on the way of the synthesis and degradation of calcidiol and calcitriol, and this here is nearly an oversimplification to give some german general physicians a first glimps. It takes not into account the whole complexity.

Only taking VDBP and it’s three major forms GC1-1, GC1-2 and GC2-2, we are facing a complexity which is amazing:

These are just a part of the studies and data summarized in the paper of Karras et al.

Karras SN et al. (2018) „Deconvoluting the Biological Roles of Vitamin D-Binding Protein During Pregnancy: A Both Clinical and Theoretical Challenge.“ Frontiers in Endocrinology (Mini Review) 23. May 2018 doi: 10.3389/fendo.2018.00259

And here we are just looking at the transportation step of Hormon D3 metabolites through the body! We even did not look at the crucial following steps, from which the mutations of CYP2R1 and of CYP24A1 might be in the present light of evidence are the most important for the synthesis and degradation cascade.

However, we do not have to forget, that a hormon has a receptor, in our case a cellnucleus receptor VDR, which again carries a number of muations from which the above mentioned are at present the best investigated SNP’s. Just taking these 3 mutations of the VDR we have 3to the 3 combination possibilities (27!) , which will turn out to interfere with the functioning of the whole system.

Taking all these into consideration under the goal to provide maximal health prevention and minimize the risk of chronic disease, Vitamin D supplementation is absolute necessary, it is mandatory. The “sun” doesn’t play here anymore a primary role! In addtion it is mandatory to optimize the other factors in this system which are, Calcium, Magnesium, Bor, Parathormon, VDBP, free-calcidiol, the calcitriol/calcidiol ratio, to say the least.

There is a higly significant correlation between the total as well as the free calcidiol and the calcitriol/calcidiol coefficient, which I call “D-Status”. I leave out here details which have been published till 2015.  A D-status > 1 is correlated with increased inflammation and systemic dysfunction. One possibility to change this is the level of calcidiol in the system, as it signals to decrease PTH and thereby calcitriol production. The free calcidiol (as the free testosterone) is finally the important factor for the systeme function. This has implications for the VDBP status and mutation situation.

And so far I did not talk about a-klotho and FGF23 and the complexities of organ regulation. Just someone who is living in the past or neglecting availabe evidence for other reasons can take the position, that sunlight is the most important factor!

>Supplementation, particularly beneficial for those in higher latitudes, is another method. A study showed that while both sun and oral D3 supplements raise vitamin D levels, supplements were more effective due to compliance. Simply put, more people took supplements than spent time in the sun.< [/av_textblock]

See my comments above.

>However, Dr. Holick asserts that “physiologic doses of D2 and D3 raise vitamin D levels in the blood the same,” effectively debunking myths about their differing impacts on health.< [/av_textblock]

See my comments and data above. This notion of Dr. Holick do not hold true anymore. May be they have something to do with the special situation in the US where, according to your article, only D2 is readily available. The convertion of D2 into D3 which is a necessary step in mamalians is affecting the whole system negatively as compared to the use and availability of D3, which is – as I believe – selfexplaining.

>Dr. Holick also touches on the regulatory history of these supplements in the United States, explaining that vitamin D2 remains the only pharmaceutical form available due to historical U.S. Food and Drug Administration approval processes. “No one ever got approval for D3,” he notes, highlighting a regulatory, rather than a health-based, reason for vitamin D2’s dominance in the market.

Though sunlight is the prime vitamin D source, its availability is inconsistent. Diet and supplements thus serve as vital alternatives to ensure sufficient vitamin D for optimal health.<

This notion of Dr. Holick explains the situation, but does not justify the view, that ergosterol, a plant product is superior to cholecalciferol an animal product. As far as I know we are animals belonging their families, and not plants. We are also not producing chlorophyll to satify our energy needs with the sun, if I may say so!

This article from Mrs. Tsai is a nice trial, but needs thorrow revision. Please, dont understand me wrong. This shall not be taken as negative criticism. As I understand the intention of Mrs. Tsai and of EPOCH you try to shed more light on the necessity of supplementing D3 in sufficient amounts to the vast majority of the – also in the States – Vitamin D deficient population. If so, you have to takle the problems and the forces standing against it more clearly as you did here. EPOCH publishes intensively about COVID-19, the vacine desaster, recently the Ivermectin case! All this has a common rute: Big-Pharma, FDA, CDC and so on what to hide the truth and are planning the next attacke (via the empoverment of the WHO on our all health and wellbeing.

I probably dont have to make you aware on this publication:

Dor AA et al. „Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness“ PLOS ONE. 2022 Feb 3; 17(2):e0263069. doi: 10.1371/journal.pone.0263069. eCollection 2022

Latest since February 2022 it is clear, that Vitamin D deficiency leads to sever COVID-19 infection and high death probability. At least for Germany I can state that ALL the responsible institutions: Health Minister, RKI, PEI, chamber of physicians, public press and so on DID NOTHING stay back from further propagating modRNA vacines in a environment with made more and more clear how big the risks of this strategy was and is! There is up to now NO move towards minimizing Vitamin D deficiency in Germany or changing also clinical strategies e.g. giving covid-patients at risk high dose D3 injections combined with high dose Vitamin C (30 – 50g) combined with high dose of Lysine (which interrupts virus production). The evidence for such interventions “are laying on the street” but are neglected with an amazing amount of arrogance and ignorance.

Vitamin D could have delivered a substantial impact on viral diseases since at least 30 years. During the whole COVID-19 catastrophe it was suppressed, as before and was subjected to laughableness! It is very late but not too late to change this perception, and to press standard medicine to accept the power and the possibilities of natural medicine besides pharmacophoric medicine. You might be aware that this fight was started by the American billionair Rockefeller long ago with the intention to destroy the American plant based medicine and implement big-pharma. There is good and sufficient material about that available e.g. on youtube.

I hope you understand my response to Mrs. Tsai and you in this constructive way. I would be happy to hear from you, and remain

With best wishes

Bernd Löffler

P.S.: I will publish my resonse to you on my internet page www.imm.institute in both, English and German. For questions you can reach me also on my phone +49 177 566 31 78