Dr. Bruce Hollis' NIH Vitamin D in Pregnancy Study is Now Complete. High Dose Vitamin D (4000 IUs) Significantly Improved Health & Outcomes for Moms and Babies. And Harvard Researchers' Theory of a Vitamin D - Autism Connection.

"I'm telling every pregnant mother I see to to take 4000 IUs and every nursing mother to take 6,400 IUs of Vitamin D. 

I think it is medical malpractice for obstetricians not to know what the Vitamin D level of their patients is.  This study will put them on notice."

-Dr. Bruce W. Hollis, Professor of Pediatrics and Biochemistry and Molecular Biology, Director of Pediatric Nutritional Sciences at the Medical University of South Carolina in Charleston, SC-

If you are pregnant, planning to become pregnant, or know someone who is pregnant--do them a huge favor and pass this information on to them!

OK, I admit it.  I'm a wild and crazy cheerleader for Vitamin D.  Anyone who is paying attention knows that unless you are regular sunbather (and who is?), or you're religiously taking a Vitamin D supplement of at least 2000 IUs a day, you are probably woefully deficient in this important hormone--that we all think of as a vitamin.

Why does Vitamin D have such an important influence on our health? 

Since the Human Genome Project, we now know that Vitamin D is responsible for regulating over 10% of our genes.  It's not just responsible for skeletal health--but cells throughout the entire body are dependent on Vitamin D in order to work properly.

Which is exactly why Dr. Bruce Hollis decided back in 2000 to figure out how much Vitamin D pregnant women and babies optimally need!  When it comes to a developing fetus, and a fast growing infant--there is no more important time to make sure that all our cells and systems are getting exactly what they need to work & develop properly.

I'm talking  about brain function, nerve function, immune function, skeletal function--all dependent on adequate supplies of Vitamin D--including its important role in preventing 14 types of cancer, heart disease, autoimmune disease, diabetes, inflammation/inflammatory diseases, infection, and osteoporosis. Yep, I'm a Vitamin D cheerleader!

Pregnancy and breastfeeding is a unique time in development when getting enough Vitamin D has a direct impact on both the mother and baby's bone health, cardiovascular health, immune function and glucose metabolism. 

Research continues to mount about its important role in brain development and in preventing brain disorders.

Recent theories (Harvard scientists publishing in Jan. 2010 in Medical Hypotheses) speculate that Vitamin D deficiency might be linked to autism--and adequate supplementation might have a role in preventing it.

Target tissues for Vitamin D--Curr Opin Clin Nutr Metab Care 10:12-19, 2007

 

So, when I heard about the exciting results of Dr. Hollis' just completed NIH Study on the Evaluation of Vitamin D Requirements During Pregnancy, I couldn't wait to blog about it.

Drs. Bruce W. Hollis and Carol Wagner just presented their study results at the 14th International Workshop on Vitamin D, in Bruges, Belgium--and I'm doing my part to get the word out. 

It will probably take years before the academic pediatric and obstetric associations modify their recommendations to reflect the study's high level of supplementation.  In fact, before beginning this study, Dr. Hollis had to first get FDA approval in order to use 4000 IUs of Vitamin D as an "investigational drug".  In November Hollis sent his findings to the pediatric academic associations--so we'll have to wait & see if their Vitamin D guidelines are changed as a result.

Just so you know--Dr. Hollis is one of the world's leading authorities on Vitamin D--with a keen interest in making sure pregnant woman and infants get a "full supply" of this critical vitamin.

Here's What You Need to Know About Hollis'  Vitamin D in Pregnancy Study

• 600 pregnancy women were enrolled from January 2004-December 2008--including African Americans, Hispanics, and whites.  Because dark pigmented skin prevents adequate absorption of Vitamin D from sunlight--it was important to include multiple races in this study.  For the details of the study proposal click here.
• Vitamin D supplementation began at 12 weeks and continued until the end of the pregnancy.  The control group took the usual standard recommendation of 400 IUs; one group took 2000 IUs of Vitamin  D; one group took 4000 IUs of Vitamin D--which is 10 times the recommended amount.

How Did Increased Vitamin D Benefit the Moms & Babies?

• Women taking the 4000 IUs increased their vitamin D level by about 50%--to a normal level of 40 ng/mL.
  
• Premature births and premature labor were reduced by 50% at both 32 and 37 weeks in those taking the highest levels.
• Fewer babies were born "small for dates"--which means smaller than expected for the time spent in the womb.  This is a little-known pregnancy complication of taking inadequate amounts of vitamin D.
• Women in the 2000 & 4000 IU groups reduced their number of infections throughout pregnancy by 50%: including respiratory infections, like colds and flu, as well as fewer vaginal and periodontal (gum) infections.
• The common complications of pregnancy like gestational diabetes, increased blood pressure, and pre-eclampsia were reduced by 30%.
  
• The babies born to moms getting the highest vitamin D levels had fewer colds and less eczema.

The Infection Connection and Vitamin D

• The 50% drop in maternal infections for moms receiving 4000 IUs of Vitamin D did not surprise Hollis at all.  Vitamin D is in charge of firing up our "Rapid Response" immune function.  When we get enough Vitamin D--it works optimally--quickly nipping infections in the bud.

• According to Dr. Michael Holick, moms who got adequate Vitamin D during pregnancy reduced the risk of wheezing disorders in their children by 61%.

Dr. Michael Holick's Two Cents on the Benefits of Vitamin D During Pregnancy

• Vitamin-D deficient infants will never attain their genetically preprogrammed bone density or height.  That's one scary thought!
• A Boston study looked at 40 mother-infant pairs--the moms took the recommended 400 IU/day Vitamin D in their prenatal vitamin and drank 2.3 glasses of milk a day--at birth, 76% of moms were Vitamin D deficient--81% of newborns were deficient.  Exactly what Dr. Hollis found out in his study.
• Higher Vitamin D levels decreased the likelihood of preeclampsia, and reduced the need for C-sections.  Exactly what Dr. Hollis found out in his study.
• Breast-feeding moms need to be vigilant that their babies are getting enough Vitamin D.  The breast milk of moms who are not getting enough Vitamin D has a paltry 25 IUs of Vitamin D per liter (1 quart, 2 ounces).  Not even close to the 400 IUs their babies need.  It would take 4000-6400 IUs/a day for a breast-feeding mom to get enough Vitamin D into her breast milk to meet the baby's requirement of 400 IUs a day.  But according to Holick, until more studies are done, "it's not something we're recommending."  Hopefully, we'll be able to in the near future."  In the meantime--breast-feeding moms need to make sure their babies are getting 400 IUs/a day of a Vitamin D supplement.

Drs. Bruce Hollis & Carol Wagner on the Importance of 6400 IUs of Vitamin for Breastfeeding

• Infants exclusively breastfed, without sun exposure or supplementation have an increased risk of developing Vitamin D deficiency, unless their moms have more than adequate supplies of Vitamin D.
• Darkly pigmented infants--living in Northern latitudes--are more at risk because dark skin only absorbs 50% of the sun's Vitamin D.
• Recent studies show that in order for the Vitamin D in a mom's milk to reach adequate levels--mom's need to supplement to a level of 4000-6400 IUs of Vitamin D.
• Drs. Hollis & Wagner are currently conducting a NIH trial on the effect of High Vitamin D on breastfeeding moms & their babies.  The results of their pilot trials were shocking.  Only the infants whose mothers supplemented at the highest level--6400 IUs--had Vitamin D levels equivalent to those of infants who received 300 IUs/day of Vitamin D drops.
• Hollis & Wagner strongly advocate for moms to supplement at high levels, rather than relying on infant supplement drops.  Why?  Because it is the only way to insure that both the mother & baby are adequately supplied. 
• The Current Catch-22 Situation:  Until the large studies on high-dose Vitamin D for breastfeeding are completed, no one can officially recommend high-dose Vitamin D for breastfeeding moms.  Which means, in the meantime--infant supplementation is in order.  American Academy of Pediatrics now recommends 400 IUs for infants.
• Gold standard:  pregnant & nursing moms need to get an inexpensive 25-hydroxy-Vitamin D level test to see just how adequate their Vitamin D supply is.  It's the only way to know!
• To read an excellent review of scope of Vitamin D in pregnancy & lactation, click here. Breastfeeding Medicine 3(4):239-50, Dec. 2008. Wagner, CE, Taylor, SE, Hollis, BW. "Does Vitamin D Make the World Go 'Round'?"

The Recent Vitamin D-Autism Connection Theory

Remember, this is all theory right now.  But the theory recently came to my attention through a forthcoming paper in Medical Hypotheses 74:102-106, January 2010, "Environmental risk factors for autism: Do they help cause de novo genetic mutations that contribute to the disorder?", by Dennis Kinney, et al. 

When five Harvard researchers publish a hypothesis--it's worth reading.  And they are not the first to speculate about this connection. 

For an easy-to-understand version of this theory, click here to read:  "What If Vitamin D Deficiency Is A Cause of Autism?  A few researchers are turning their attention to the sunshine vitamin as a culprit, prompted by the experience of immigrants that have moved from their equatorial country to two northern latitude locations.  Scientific American News.  April 24, 2009.

In a nutshell here's how the dots are being connected with Vitamin D & autism:

• A number of De Novo (meaning, "new" not copied from the parents) genetic mutations are risk factors for autism.
• The Harvard researchers theorize that environmental & urban chemicals like mercury, cadmium, nickel, trichloroethylene, and vinyl chloride might trigger the genetic mutations responsible for autism. It turns out that children from areas exposed to higher levels of these contaminants have significantly higher rates of autism than children living in areas of low exposure.
• Vitamin D plays a tremendous role in repairing DNA damage--and protecting against oxidative stress--which is a key cause of DNA damage.
• Vitamin D deficiency can lead to higher rates of mutation and impaired DNA repair--conversely, adequate Vitamin D appears to prevent DNA mutations.
• Here's the vitamin D connection: Higher rates of autism exist in areas where there is less sun, in areas of higher precipitation (lots of rain)--where people spend more time indoors, and where Vitamin deficiency is highest.
• The Centers for Disease Control found higher rates of autism for children living in northern latitudes (less sun) compared to those living in southern states.
• Recent reports surfaced about the high incidence of autism found in the children of new Somali immigrants (dark-skinned Africans) who moved to northern latitude cities in Minnesota and Sweden.  In Minnesota, these rates are 2 to 7 times greater than the rates for non-Somalis.
• Autism was unheard of in these families when they lived in Africa--and only surfaced after moving to Minnesota and Sweden.  Dark skin makes Vitamin D absorption extremely difficult at northern latitudes--added to which many of these Somalis are Muslim, and the women are wearing burkas.
• The Harvard researchers cite the work of Cannell, Chatterjee, and Bao that demonstrates how adequate Vitamin D has the ability not only to prevent genetic damage, but to repair damage that has occurred.
• They recommend that we begin controlled clinical trials  of Vitamin D supplementation for adults living in areas where Vitamin D deficiency is prevalent (U.S. & northern Europe)--who are planning to conceive children in a few years.  In other words--if you are considering having a baby any time soon--prevent potential problems now--start supplementing with Vitamin D.
• For another perspective on the Vitamin D/autism connection, read Dr. John Cannell's (one of the originators of the theory) review of the Medical Hypotheses article.  Click here. 

Coming Next Week:

More on what Dr. Bruce Hollis has to say about the importance of Vitamin D for adults--how it affects autoimmune diseases like rheumatoid arthritis, multiple sclerosis, cancer, bone pain and heart disease.

In the meantime, how much vitamin D does Dr. Hollis take?  He's an international expert on Vitamin D who lives in sunny Charleston, SC.

4000 IUs a day.  This consistently gets his blood levels up to around 60 ng/mL. After years of study he has never seen any adverse effects with higher doses of Vitamin D, as long as the level does not exceed 10,000 IUs/day. 

He strongly believes that sufficient levels of Vitamin D are what we would naturally have if we could be fully sun-exposed--and he's found this level to fall somewhere between 50 ng/mL to 70 or 80 ng/mL.   Current recommendations now put the normal level anywhere over 30 ng/mL.  Do yourself a favor and get your vitamin D level tested.

My past posts on Vitamin D:

Everything You Ever Wanted to Know About Vitamin D from the Expert, Dr. Michael Holick. How Much Do We Need? Why Is It So Hard to Get Enough? What About Breast-Fed Babies? Why Is It So Important for Good Health?

Why is Vitamin D my favorite? Let me count the reasons.

Caroline Adams Miller's Ten Non-Negotiable Pearls to a Life Well-Lived - Successful Balanced Happy. And the Possible Dementia Vitamin D Connection

Comments

[JK]

Great post! Looking forward to next week's post!

[Dr. Hilla Abel]

I'm wondering if this study used D3 or D2? (I read your previous note--and the linked article--showing they were equivalent...I'm still curious, though.) Thanks for this great post and your other vitamin D posts as well!

[The Healthy Librarian]

It's D3! And it's right in his NIH research proposal. Dr. Holick's study showed both D2 & D3 could both raise the blood levels of D equivalently--which was the big question.

But, Dr. Hollis is 100% in favor of using D3 over D2 unless there's no option. It's the more natural form. Hope that helps!

[ek]

I'm new to your blog and really enjoying it. Thanks for all the great information! I've always been reluctant to take supplements because they aren't regulated. Do you have any advice for choosing high quality supplements?

[The Healthy Librarian]

EK,

Check the reliability of any supplements you choose to take. Check the Consumer Labs website to find out the reliability and safety of the vitamins and supplements you are taking. They've done a lot of analysis on supplements and you'll be able to find out which brands are better than others. The good news is that most of them are just fine. For the link to Consumer Labs, click here: http://www.consumerlab.com/

To get reports you will probably have to join--which is around $25/year. Solgar. Carlson, and NOW are reliable brands. When I have a chance I'll check the vitamin D report on the Consumer Union.

[Dr. Elaine]

This study, as well as countless others indicate the true breakthrough in our understanding of disease risk and development. It is the most profound medical finding, in my opinion, since the discovery of penicillin.

[Samantha]

Wondering where I could get full-text of his recent study. I work for a high-risk OB/GYN & we need a full-text reference to discuss with colleagues. Any chance someone could point me in the right direction? The NIH website has the study listed as in progress with no results posted yet, and it's not in our clinical database. Would really appreciate it! Thanks

[V. Zawistowski]

Hi Healthy Librarian,
I read your posts on the NYT Well Blog comments with interest, and came here today looking for more information on the Hollis study on vitamin D and preeclampsia.
But I'm a bit dismayed that you have mischaracterized the Minnesota Department of Health report that I worked on about autism in the Minneapolis Somali community (see here: http://www.health.state.mn.us/ommh/projects/autism/reportfs090331.cfm). We looked at "administrative prevalence" of the ASD special education label among preschoolers, which is quite different from an actual medical dx of ASD - work still needs to be done to confirm whether or not these Somali children would be dx with ASD by medical professionals. This is complicated by a lack of good tools to dx ASD in this population with varying English literacy (since language expression is such a big part of ASD). Add to that various issues with possible under identification of preschoolers who should receive special ed help for ASD among other ethnic groups (notably Asians and Native Americans). So, it is not accurate to say that ASD incidence rates are 2-7x higher among MN Somalis compared with non-Somalis - we just don't know enough yet to make that statement.
About your statement "Autism was unheard of in these families when they lived in Africa": there could be a lot of reasons for that unrelated to actual ASD prevalence - for example, the places that Somali refugees in Africa lived in didn't have the same kind of medical and educational systems that we have here in the US, so of course they aren't going to screen, diagnose, and treat children for developmental disabilities in the same way. Also, it is only pretty recently here in the US that ASD has become known to the general public - a generation ago most people probably had not heard of it.
Anyway, the Vitamin D-autism hypothesis is interesting, but there is so much more work that needs to be done just to establish whether or not there are real differences in ASD prevalence between populations, let alone why that may be.
I look forward to reading more of your blog.