Is Vitamin D Shooting Me in the Foot?

Just the other day Nurse Wendy offhandedly commented that she'd noticed we were doing fewer "freezes" lately.  A "freeze" is when we use a cryogen (very cold substance) to destroy a skin lesion, usually a precancerous one, or a very shallow skin cancer.  As I thought about this, I had to agree.  No scientific study done or anything, but I was definitely aware of the trend of not having to get out the Freeze-Can nearly as often.  Why could this be?

We've been doing cryotherapy here in our little town since 2002, and it seems well known in the community that we offer this service.  We have done thousands of freezes over the years, with excellent results, so just where were all the pre-cancers?  Then a possible answer dawned on me...

2000 IU

About two years ago I kept reading on that blasted internet about how everyone was vitamin D deficient.  I vaguely remembered how Vitamin D was not really a vitamin at all but actually a pro-hormone, so my interest was piqued.  I kept reading and thinking about all the implications.  Intrigued, i started to check a Vitamin-D-25 level in a few folks I thought most likely to be deficient.  Bam!  Lab result after result came back revealing deficient levels in the patients I checked. Worried at this point, I begin to check even more Vitamin-D-25 levels, and to read about the best way to replace Vitamin-D.

Soon thereafter, my trusty, usually mild-mannered, Medical Scientist (that's the latest term for lab tech) came to me with a puzzled look on her face and respectfully said, "What the hell is up with all these low Vitamin-D levels, and how did you know to check'em anyway?"  She also works in the lab of one of the larger hospitals in the area, and she hadn't seen any other doctors ordering Vitamin-D levels.  "It's my job to know", I said wisely as I walked away, not ready to reveal the shallowness of my pool of knowledge on this subject just yet.  I tried at lunch that day to think back to medical school...

We had one course in nutrition in medical school.  It was a small course, very small.  It was taught by a diabetic biochemist from New Zealand who only seemed to want to talk about diabetes and pasta.  The paste-thing sticks with me because he said it like, "paaasta".  I couldn't remember a thing about Vitamin D from the class and after some digging I turned up the tiny little textbook-let that accompanied the class.  There was two pages concerning Vitamin-D (I was right about the pro-hormone thing!) But, that was it.  It said nothing about why all the adults in my small Southern town would be Vitamin-D deficient, or what that could lead to (except rickets...)  It recommended Vitamin-D-2 as a replacement and that was about it.

A Great Book

So, about two years ago I started checking Vitamin-D levels in many of my older patients, and replacing the deficiencies with Vitamin-D-2 initially, and then later with Vitamin-D-3.  We've easily checked levels on over a thousand patients.  In the beginning they were all low, and I mean ALL!

We would consider it a huge deal if all of a sudden 1 out of every 5 patients was abnormal in one certain lab, but 9 out of 10?  Out of 100 folks over 65 years of age, 95 would be low, with levels anywhere from 6 to 20.  The other five would have a level in the low thirties, just in the normal range.  The current normal range of the reference lab I use is from 32-100 ng/mL.

Since starting to have folks take a daily Vitamin-D-3 supplement (usually 2000 IU/day) I now see many more normal readings on Vitamin-D levels.  Sometimes I have a patient who is worried they may be taking too much.  It's a rational concern from  their perspective, but it is of no concern to me as the prescriber.  You see, since starting to prescribe what most would consider a large daily dose of Vitamin-D-3 I have seen exactly ZERO patients have a level above 100 ng/mL.  That's right, not a single person has tested above the upper limit cut-off level since I began looking.  I have a few patients who take 5000 IU daily and their levels are normal as well.  Honestly, the highest Vitamin-D-25 level I have ever seen was in the 60's, no where near the upper cut-off.  I'd be interested to hear from any Doc who has seen a Vitamin-D-25 level above 100...

So, you ask, do I really think the Vitamin-D-3 supplements are decreasing the incidence of skin cancers and pre-cancers?  Well, I was strongly considering the possibility, trying to think of any other reason why we would be seeing this decrease in skin pre-cancer, when Ms. Truvie made her appointment.

Ms. Truvie is one of my most beloved patients.  She is 93 years old and must have had the fairest skin in all the land, and must have gotten one thousand sun-burns in her life.  For you see, Ms. Truvie was covered with actinic keratosis (pre-cancerous skin lesions).  She has been my patient for about seven years now and I've lost count of the number of times I've sat and talked with her about the good old days as I froze off one lesion after the other.  Her's was one of the first Vitamin-D-25 levels I ever checked, and she clocked in at 6.2; one of the lowest I've ever seen.

Another Great Book

So, two years ago I started her on 50,000 IU of Vitamin-D2/week for about a year, and for the last year she has taken 2000 IU/day of Vitamin-D3.  I see Ms. Truvie about every 3 months due to her age; to check bloodwork, freeze the worst patch of lesions, and get her refills.  For a while I saw the trend of her actinic keratosis being generally smaller, and fewer in number.

But today I have to admit that her skin is 95% better.  There was really nothing that needed freezing, a first for her (which she commented on because she is still very sharp).  I stopped Nurse Wendy in the hall and said, "Did you see her face today?"  Without even asking who I was talking about she returned a nod and a knowing, "Yep, this Vitamin-D kick of yours is gonna cost you a lot of freeze-money, huh?"

Of course she knows that I'm very happy to find another way to supplement my income besides freezing the flesh of my very nice neighbors.  I'm just happy to have been able to jump on the problem early and be making a difference.  I've had hundreds of patients comment of improved skin, decreased bone pain, fewer falls, and I have noticed substantially fewer broken hips in our elderly population since starting our Vitamin-D program.

Ms. Truvie's levels now run in the high 50's most times, and she thinks that her legs hurt her less since she has been taking the Vitamin-D as well.  Now of course neither Ms. Truvie nor I have studied this scientifically, but common sense is what it is and neither of us can think of another reason for her actinic keratosis to just dry up; not just a few of them, mind you, but almost all of them.  So, although Vitamin-D of any kind is not FDA-Approved, I for one will be recommending it to all of my adult patients, and taking it myself every morning.
kb.