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February 4, 2010 – Vol. 4 • No. 6
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The man to see on vitamin D

Of all Douglas Fairhurst’s medical problems, the most bewildering were his weakening muscles. An avid bicyclist, Fairhurst, 74, could barely lift his leg much less pedal a bike. “I could hardly walk,” he said.

That’s when Fairhurst turned to Dr. Douglass Bibuld, the medical director of Mattapan Community Health Center.

An expert on vitamin D, Dr. Bibuld was well aware of the benefits that accrue from the aptly named “Sunshine Vitamin.” Received primarily from the sun’s ultraviolet rays, vitamin D is known for its ability to maintain healthy bones.

But given the fact that almost every cell is equipped to interact with vitamin D, Dr. Bibuld is convinced that the benefits extend far beyond bone health and includes protecting the immune system and preserving muscle strength.

Equally important, Dr. Bibuld was aware of the prevalence of inadequate levels of vitamin D among older blacks — a deficiency that scientists attribute to increased risks for several life-threatening diseases and debilitating conditions.

It didn’t take long before Dr. Bibuld prescribed a heavy dose of vitamin D for Fairhurst — and that appeared to at least restore a barely adequate level.

The 25-hydroxy vitamin D test is the most accurate way to measure how much vitamin D is in the body. A reading below 20 nanograms per milliliter (ng/mL) is deficient; scores between 20 and 29 are considered insufficient. Scores of 30 or more are considered sufficient. Fairhurst’s reading was 32 — and that was after the heavy doses.

And therein lies one of the problems now under serious debate within the medical community: Just what level of vitamin D in the blood is required for optimal health?

The Vitamin D Council, a California-based non-profit established to increase awareness about vitamin D deficiencies and its related diseases, recommends a reading of 50 to 80 ng/ml for everyone all year round.
According to the Council, at levels below 50, the body uses vitamin D as quickly as it is made. Above 50, the body begins to store it for future use.

A related debate swirls around the recommended daily allowance for vitamin D. The Academy of Pediatric Medicine recently increased its recommendations from 200 International Units (IU) to 400 IU a day for children and adolescents.

The Institute of Medicine (IOM), a non-profit organization that provides advice on health issues, recommends 400 IU a day for adults up to the age of 60 and 600 IU for those over 60. But even the Institute has doubts and is revising its recommendations.

Vitamin D specialists, such as Dr. Bibuld and Boston University School of Medicine’s Dr. Michael Holick, argue that 600 IU are barely enough and contend that at least 1,000 IU are needed to allow vitamin D to perform all of its functions.

Don’t get Dr. Bibuld started on the current recommended daily allowance of 400 IU. “That’s way too low,” he said.

He recommends 4,000 IU a day for blacks — and much more for those who are deficient.

The Mattapan Community Health Center is squarely behind Dr. Bibuld on vitamin D. The Center is now part of a collaboration with the American Public Health Association to develop a national policy on vitamin D.

From what the Center has seen, the numbers are alarming in the black community. With the assistance of Dr. Holick, they found that in 2007, 85 percent of their patients tested for vitamin D levels had scores of below 20 ng/mL — well below the recommended minimum of 30, and, worse, the average score was about 13 in the winter months.

Dr. Bibuld understands part of the problem — at least among blacks — is that higher levels of melanin makes it more difficult to process ultraviolet B rays. Melanin tends to block rather than absorb the sun. That process is worse for the elderly whose bodies are unable to produce vitamin D as easily as in their younger days.

Dr. Bibuld believes that everyone should have a baseline test and go from there. For the most part, it’s easy to get a good dose of vitamin D and it doesn’t cost a dime — at least in the summer. Just five to 10 minutes of sun twice a week — or thirty minutes for those of darker skin is enough. It’s possible to make over 10,000 IU in that short period of time. Supplements and fatty fish can complement the sun when necessary.

And don’t worry. According to Dr. Holick, it’s impossible to overdose on vitamin D from the sun. The body stops making the vitamin when it has ample supply. Even overdoses from supplements are basically unheard of.

Dr. Bibuld well recognizes the implications of vitamin D and its potential impact on health. “You can’t correct health disparities overnight,” he acknowledged. “But think of what this could do to health care costs and the impact on the cost of the insurance industry. It’s huge.”

Just ask Fairhurst.

At a subsequent doctor’s appointment, Fairhurst put on a performance.

“Look,” he proudly proclaimed as he held up his leg.

At first Dr. Bibuld missed the point. He thought that Fairhurst wanted his leg examined. But then he realized that Fairhurst’s strength had returned. More important, Fairhurst boasted, he was able to walk without difficulty.

Fairhurst admits he had never heard of vitamin D before meeting Dr. Bibuld and had no understanding of its impact on the body. But he does now. For him, the evidence is clear.

“I can ride my bike again,” he said.

Because of weakness in his legs, Douglas Fairhurst was unable to ride his bike. After several months of a prescription of vitamin D, he’s back in form.

Douglass Bibuld, MD
Medical Director
Mattapan Community Health Center

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