Dr. Shevin

Vitamin D uptdate 7/20/2008

2008-07-20T16:11:58Z

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.

Problems with Vitamin D?

2008-06-30T01:32:57Z

6/29/2008 -- In the last couple of years, following medical research and guidelines published by medical authorities, I have been recommending that many people supplement with Vitamin D-3. There is a lot of data suggesting that a variety of clinical problems can be helped by having high levels.

However, information that I've recently run across has created serious questions in my mind. The situation is too complicated to describe in a short note, but there are claims being made that the anti-inflammatory effect of vitamin D-3, while helping people with certain diseases to feel better, may ultimate down-regulate (turn off) the immune system. This down-regulation reduces symptoms, but it is possible that the "underlying disease" may continue. This is certainly true of steroids such as Prednisone, which although increasing well-being allow for the progression of the underlying disease, and reduces the ability of the immune system to fight infection ("resistance").

In the Marshall Protocol theory, the "underlying disease" is thought to be a chronic infection by bacteria existing in "biofilms" and which can mutate into forms which can "hide" in the cells of the immune system (this is well-known in the case of Lyme disease). More information can be found at www.bacteriality.com.

An interesting article was recently published on that site, and can be found here. Healthy people from India, where sun and exposure to sun is plentiful, were found to be "deficient" despite this sun exposure. Deficiency was defined according to criteria set in the United States based on available research.

Since the study subjects were healthy prior to the study, rather than judging them as deficient, an alternative conclusion could be that the current thinking on Vitamin D is incorrect. This study is in accord with 2 others (done in different populations). These studies all measured the Vitamin D-3 (25-hydroxy vitamin D) level, and not the active hormone (1,25-dihidroxy vitamin D).

Other studies have failed to show a clear relationship of sun exposure to Vitamin D-3 levels (see, for example, http://jcem.endojournals.org/cgi/content/abstract/92/6/2130)

My concern came about while researching the Marshall Protocol, which is a treatment for such infections, and linked by basic science and clinical results to a variety of diseases, such as chronic Lyme disease, rheumatoid arthritis, multiple sclerosis, chronic fatigue syndrome, psoriasis, Hashimoto's disease, etc. The Bacteriality site has a huge amount of information regarding the theory and practice of the Marshall Protocol, and a large number of patient interviews.

While I'm not ready to make a final judgment regarding the Marshall Protocol, or the correctness of the very different view of Vitamin D, I have to say that the research that I've done so far concerns me greatly.

Accordingly, I recommend the following:

1. Anyone with an autoimmune disease, such as those listed above, should stop taking any supplemental vitamin D. In addition, in the Marshall protocol, avoidance of sunlight, especially with advanced disease, should be considered.. This is especially true for anyone with any negative reaction to either sunlight or other bright light.

2. Anyone who is using Vitamin D supplementation as a basic nutritional supplement, but who is otherwise well, should probably also stop, and be sure to get some natural sunlight at this time of year. In the Marshall protocol theory, the bacterial infection itself can "turn off" the vitamin D receptor, and thus inactivate the immune system. The theory also suggests that high doses of D-3 in themselves can also switch off the receptor.

I'll be continuing to research this in the next few weeks, and will post more when it is appropriate to do so.

Another New Answering Service

2008-06-11T02:43:43Z

6/10/2008 -- Last week I changed my answering service. While I expect the new service to function very well, I wish to stress again that if you need to speak to me on an urgent basis, please do not leave a voice mail, but rather press "O" to get a live operator who will call me.

Please also note that I pay for this service by the minute used, so please keep your messages brief. If you are my patient and you need to speak to me, I've instructed the operators to trust your judgment.

Similarly, if you do leave a voice mail message (which means that you don't need me to hear your message until perhaps the next day I'm in the office), please keep the message brief. Long reports are much better handled through email.

If you have any experiences with the new service which are problematic, please let me know what happened, including the date and time of the incident.

Website difficulties resolved

2008-06-11T02:40:52Z

6/10/2008 -- Thanks to Jennifer McGroary, of Creative Solutions, Inc., my previous website difficulties have been resolved. You should get no further viruses on the site through Internet Explorer or any other browser, for that matter. If you have problems, please report them to me. Thank you for your forbearance while this got straightened out!

Influenza report 3/18/2008

2007-12-16T20:29:02Z

3/18/2008 -- As of the latest CDC report, from 3/8/2008, influenza is widespread in much of the country, although a few states have been downgraded to to "regional" outbreaks, rather than "widespread.". Thirty two pediatric deaths have been reported nationwide. A fourth pediatric death was reported in Massachusetts, this morning. All the children who died had other significant medical issues that the influenza complicated.

Unfortunately, the current vaccine does not confer immunity to the A(H3N2) strain which started to become evident in the last two weeks in January.

Several weeks ago, I'd spoken with a number of people with flu-like illness. While I could confirm that these were, in fact, influenza (which would require laboratory testing), I can say that the most common remedy that I'd prescribed at that time was Antimonium tartaricum.

Typical of that remedy is a strong feeling of lethargy and weakness, a loose, wet cough which may not, however, be productive, and a desire to be left alone (if not frank irritability). If used in a low potency (12C, 30C), frequent administration is useful. The response is not rapid, however, but I have seen good improvements within 12-36 hours.

More recently, Rhus toxicodendron is the remedy I've most often advised. In Rhus toxicodendron, the main symptoms are strong fatigue, with aching of the body (joints, muscles, etc.) which is aggravated when first moving, relieved with continued motion, but then stiffness and aching sets in again after a period of rest. It is a more physical restlessness, from stiffness and aching, than a mental or emotional restlessness (as might be seen with Arsenicum album, for example).

If I see more cases of this remedy, then I will recommend that this replace Influenzinum as the "genus epidemicus." More informaton on this concept can be found in the article on Influenza elsewhere in my site. For the purpose of prevention, this remedy can be used 2-3 times daily, even in the absence of symptoms, especially if you are exposed to someone ill with a flu-like illness.

You may view the most current CDC report here .

You may access my article on Influenza here.

Homeoprophylaxis should have been started by this time, and you may take Influenzinum weekly while we see what the next few weeks brings.

Charles Darwin cured by Homeopathy

2007-12-13T19:03:41Z

For a description of Charles Darwin's successful encounter with homeopathy, see Homeopathy in the Press, elsewhere in the website. It is quite interesting.

Patient Mailing November 2007

2007-11-20T23:39:46Z

Click here to read the mailing sent to all my patients on 11/6/2007.

Debate on Homeopathy at UConn

2007-11-03T19:37:45Z

A debate at the University of Connecticut Health Center was held on October 25th, regarding the validity of homeopathic medicine. I was able to attend this debate, which can be viewed by clicking here.

Although it was billed as "historic," I don't think that it lived up to its billing. Those of us who practice and believe in homeopathy are past the kinds of arguments marshaled by the anti-homeopathy brigade. It was apparent, though the points they made were often misrepresentations, misunderstandings, and refuted by evidence presented by homeopathy's proponents, that their minds had already been made up. In fairness, the proponents were hardly going to be swayed either, and we are obviously biased (but by experience and evidence, not the "implausibility" arguments mounted by the opponents).

Debates like this have their purpose, I suppose, but hopefully may lead to actual dialog, which might then actually be useful. Still, this occasion, hosted by the Integrative Medicine Department at the University of Connecticut Medical school, may provide an opening.

Rather than extend my impressions, I urge you to view the debate yourself. The site above works, but there is some black screen at the beginning that you'll need to fast forward through.

Iodine Conference Report

2007-10-22T03:04:51Z

I’ve presented my clinical experience with iodine supplementation twice in 2007 (Phoenix in February, and in San Diego in early October). This last time I was able to report on the status of 287 patients whom I’ve been able to adequately analyze, to describe some of the difficulties and problems I’ve encountered, and most significantly for me, to discuss these issues with my colleagues.

The conference report may be viewed as the last section of the iodine deficiency article.