Author Archives: Bix

Vitamin E: International Units (IUs) And Milligrams, Conversion

From: Vitamin E, Fact Sheet for Health Professionals, National Institutes of Health

Vitamin E is listed on the Nutrition Facts and Supplement Facts labels in milligrams. The FDA required manufacturers to use milligrams on labels starting in January 2020.

To convert from mg to IU:
1 mg of alpha-tocopherol is equivalent to 1.49 IU of the natural form or 2.22 IU of the synthetic form.

To convert from IU to mg:
1 IU of the natural form is equivalent to 0.67 mg of alpha-tocopherol.
1 IU of the synthetic form is equivalent to 0.45 mg of alpha-tocopherol.

For example:
15 mg of natural alpha-tocopherol = 22.4 IU (15 mg x 1.49 IU/mg = 22.4 IU).
200 IU of natural alpha-tocopherol = 134 mg (200 IU x 0.67 mg/IU = 134 mg).

Vitamin E Supplements Lead To More Severe Respiratory Infections

In this randomized, double blind, placebo-controlled trial – the gold standard for determining cause and effect – older adults who took 200 mg vitamin E had more severe respiratory infections.

Effect Of Daily Vitamin E And Multivitamin-Mineral Supplementation On Acute Respiratory Tract Infections In Elderly Persons, A Randomized Controlled Trial, JAMA, August 2002

Among persons experiencing an infection, those individuals who received vitamin E instead had longer total illness duration, more symptoms, and a higher frequency of fever and restriction of activity.

If our results are confirmed and vitamin E exacerbates respiratory tract infections, elderly people, especially those who are already well-nourished, should be cautious about taking vitamin E supplements.

The authors speculated high-dose vitamin E may become a prooxidant in the body (as opposed to the desirable antioxidant). They may have been on to something: The Pro-Oxidant Activity Of High-Dose Vitamin E Supplements In Vivo.

The RDA for vitamin E is 15 mg. The upper limit is 1000 mg. People think 200 mg is no big deal, that “it’s no harm and could be helping.” It’s more like “it’s no help and could be harming.”

An old chart I made:

When We See Pfizer Exec Scott Gottlieb Talking About COVID, Are We Watching A Commercial?

Alternative Title:
How The Pharmaceutical Industry Uses Its Alliance With Government To Boost Profits, And How The Media Is Complicit

Here’s former FDA Commissioner and current Pfizer Exec Scott Gottlieb promoting his company’s product under guise of Public Health.

Below is a continuation of my last post:

According to Dr. Arnold Relman, the long-term editor of the New England Journal of Medicine (not least of his accomplishments), the pharmaceutical industry bought the medical profession. They bought academia. They bought science. And as you can see in the example below, they bought government. Their influence in this country and around the world is profound.

Scott Gottlieb, a former FDA Commissioner (2017-2019), now serves on Pfizer’s Board, where he oversees “procedures applicable to pharmaceutical sales and marketing activities.” When he’s on TV, introduced as a former FDA Commissioner and promoting COVID vaccines, one of which is Pfizer’s, is he being impartial? Of course not. But that’s what we’re led to believe. Example:

In the graphic below … Gottlieb may be a FORMER FDA Commissioner, but he’s a CURRENT Pfizer board member. Where does it say that? (The host does say this in lead-up, but it’s glossed over and not addressed as a conflict of interest.)

And:

While at FDA, Gottlieb lowered the number of inspections at both foreign and domestic drug manufacturers producing drugs sold in the United States. He also sped up the approval process for experimental and generic drugs, leading many to question whether the “newer and cheaper” drugs hitting the market were actually safe.

[Former] Health and Human Services Secretary Alex Azar — Gottlieb’s former boss — used to be president of Lilly USA, the U.S. branch of pharmaceutical giant Eli Lilly. Trump lauded his appointment [in 2017] by calling Azar a “star for better healthcare and lower drug prices,” but during his time there the company raised the brand’s insulin prices threefold creating a crisis and drawing public outrage.

One way drug companies buy influence with the government is through lobbying. Another way, as above, is through the revolving door, where people move between roles as legislators and regulators on one hand, and members of the industries affected by the legislation and regulation on the other. The revolving door has become so much a part of our lives that we’ve grown numb to its implications.

When we see Scott Gottlieb on TV, on social media, we need to think of it as a commercial. Because that’s what it is. He is selling vaccines.

Pharmaceutical companies don’t exist to help people. They exist to make money. Helping people is a side effect.

Arnold Relman, Former NEJM Editor: Medicine, Academia, And Research Have Been Bought By The Pharmaceutical Industry

In this 2003 article in the BMJ, Arnold Relman is quoted as saying:

Who Pays For The Pizza? Redefining The Relationships Between Doctors And Drug Companies. 1: Entanglement, British Medical Journal (BMJ), May 2003

The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research,” says Arnold Relman, a Harvard professor and former editor of the New England Journal of Medicine [from 1977 to 1991, whose recent critique of the industry’s influence in health care, published in the New Republic, won him and his co-author one of the top awards for magazine journalism in the United States. “The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it’s disgraceful.”

Here’s part of an introduction to his book “A Second Opinion: Rescuing America’s Health Care A Plan For Universal Coverage Serving Patients Over Profit” published in 2007:

The U.S. healthcare system is failing. It is run like a business, increasingly focused on generating income for insurers and providers rather than providing care for patients. It is supported by investors and private markets seeking to grow revenue and resist regulation, thus contributing to higher costs and lessened public accountability.

And, from Amazon’s intro:

The greatest threat to U.S. health care, as he sees it, is the commercialization of medicine since the late 1960s, which, according to free-market ideology, should bring better care at lower cost but hasn’t delivered (and never will, Relman believes). Doctors need to renew the sense of themselves as disinterested and compassionate healers rather than money-grubbing entrepreneurs.

So, the pharmaceutical industry bought the medical profession. They bought academia. They bought science. And as you will see in my next post, they bought government. Their influence in this country and around the world is profound.

In the decades since Relman sounded the alarm, it’s gotten worse – by his own admission. If someone with Relman’s credentials couldn’t turn the tide, who can?

Arnold Releman:

    • Educated at Cornell University and the College of Physicians and Surgeons at Columbia University
    • Professor at Boston University School of Medicine
    • Frank Wister Thomas Professor Of Medicine and Chair of the Department Of Medicine at the University Of Pennsylvania School Of Medicine (now the Perelman School of Medicine)
    • Professor at Harvard Medical School
    • Editor of the Journal of Clinical Investigation from 1962 to 1967
    • Editor of The New England Journal of Medicine (NEJM) from 1977 to 1991
    • President of the American Federation for Clinical Research
    • President of the American Society for Clinical Investigation
    • President of the Association of American Physicians
    • Awarded Honorary Fellowship by the New York University School of Medicine

Update: Here’s the follow-up post, as promised.
When We See Pfizer Exec Scott Gottlieb Talking About COVID, Are We Watching A Commercial?

Keep Moving

The Walking Man. Oil on canvas. Shanna Bruschi.

I can’t stop thinking about this:

One in four women over age 65 is unable to walk two blocks or climb a flight of stairs. Known as mobility disability, it is the leading type of incapacity in the United States and a key contributor to a person’s loss of independence.

The press release for the study says that light-intensity physical activity – a casual walk, shopping, light gardening – can protect mobility. Good, because:

Moderate-to-vigorous physical activity is increasingly more difficult to perform as people age. Considering the aging population in the United States, these findings could have major impacts on public health recommendations.

How much?

The mean time spent in light physical activity was 4.8 hours per day. [However,] the highest levels of light-intensity physical activity are unnecessary. After five hours of activity, we observed no further increase in benefit.

And this:

Light-intensity physical activity was associated with preserved mobility regardless of the amount of higher-intensity physical activities, such as brisk walking, jogging or running, the women engaged in.

As long as we keep moving…

High-Dose Vitamin D Decreases Bone Mineral Density

I just posted about two large trials where high-dose vitamin D increased fractures and falls.

This one found that taking vitamin D decreased bone mineral density:

Effect Of High-Dose Vitamin D Supplementation On Volumetric Bone Density And Bone Strength, A Randomized Clinical Trial, JAMA, August 2019

In this randomized clinical trial that included 311 healthy adults, treatment with vitamin D for 3 years at a dose of 4000 IU per day or 10 000 IU per day, compared with 400 IU per day, resulted in statistically significant lower radial bone mineral density (BMD).

Even participants who took 400 IU had a reduction in bone mineral density.

If high-dose vitamin D does stimulate an increased rate of bone loss, this could have greater clinical significance [fracture risk] in older individuals with osteoporosis.

Fracture risk … Didn’t we just see that?

Another problem with taking vitamin D, especially with calcium, is that it can increase the amount of calcium in blood (hypercalcemia) and urine (hypercalciuria), which it did in this study. Too much calcium in urine is a common cause of kidney stones. Too much calcium in blood effects many systems, has many side effects.

There was a dose-response effect:

Episodes of hypercalcemia and hypercalciuria were more common with increasing vitamin D dose, consistent with previous reports.

Surprisingly, it also affected those in the 400 IU group:

However, in the 400-IU group that was following the National Academy of Medicine–recommended dietary allowance of calcium and vitamin D3, 17% had hypercalciuria on at least 1 occasion over the study duration.

Conclusions:

These findings do not support a benefit of high-dose vitamin D supplementation for bone health.

High Dose Vitamin D Increases Risk For Fractures And Falls

Lots of people are taking lots of vitamin D. Can you take too much? I happened across:

Is High Dose Vitamin D Harmful?, Calcified Tissue International, February 2013

With the potential to minimize the risk of many chronic diseases and the apparent biochemical safety of ingesting doses of oral vitamin D several-fold higher than the current recommended intakes, recent research has focussed on supplementing individuals with intermittent, high-dose vitamin D.

However, two recent randomized controlled trials (RCTs) both using annual high-dose vitamin D reported an increase, rather than a decrease, in the primary outcome of fractures.

Results from observational, population-based studies with evidence of a U- or J-shaped curve are also presented as these findings suggest an increased risk in those with the highest serum 25D levels.

Here are those two RCTs:

Effect Of Annual Intramuscular Vitamin D On Fracture Risk In Elderly Men And Women–a Population-Based, Randomized, Double-Blind, Placebo-Controlled Trial, Rheumatology, December 2007

Annual High-Dose Oral Vitamin D And Falls And Fractures In Older Women A Randomized Controlled Trial, JAMA 2010

The first one was out of the UK:

Randomized, double-blind, placebo-controlled trial of 300,000 IU intramuscular (i.m.) vitamin D2 (ergocalciferol) injection or matching placebo every autumn over 3 years. 9440 people (4354 men and 5086 women) aged 75 yrs and over were recruited from general practice registers in Wessex, England.

The vitamin D group showed an almost 50% increased risk of hip and femur (thigh bone) fractures compared with placebo group. Fracture risks were higher in women:

When the genders were analysed separately, the tendency for an increase in fracture risk was particularly observed among women, in whom there was a 59% increase in hazard at the proximal femur or distal forearm (wrist) among those treated with vitamin D compared with placebo (P = 0.003).

The second one was out of Australia:

Double-blind, placebo-controlled trial of 2256 community-dwelling women, aged 70 years or older … randomly assigned to receive cholecalciferol (vitamin D3, 500 000 IU, oral) or placebo each autumn to winter for 3 to 5 years.

Participants receiving annual high-dose oral cholecalciferol experienced 15% more falls and 26% more fractures than the placebo group. Women not only experienced excess fractures after more frequent falls but also experienced more fractures that were not associated with a fall.

I thought that the delivery method (very high dose once a year) might be having an effect. They think not:

The evidence of harm relating to high-dose vitamin D centers on the findings of two RCTs that used annual high-dose vitamin D (Table 3), although results from RCTs using lower, more frequent dosing regimens have not been consistently clear. The different forms of the vitamin used in the studies and the different delivery modes demonstrate that the adverse outcomes are not restricted to one form of the vitamin.

The mechanism for these increased falls and fractures isn’t understood. Sanders et al. speculates that vitamin D supplementation may result in a “decline in muscle strength” (there are vitamin D receptors in muscle). It may also impact the central nervous system (there are vitamin D receptors in CNS and the brain) affecting balance and coordination.

From Concluding Summary:

In addition to evidence from enzyme kinetics relating to vitamin D metabolism [44], there is now high-level RCT evidence that vitamin D supplementation has potential toxicities other than simply hypercalcemia/-uria.

Emerging evidence from both observational studies and RCTs suggests that there should be a degree of caution about recommending high serum 25(OH)D concentrations for the entire population.

Some notes about doses:

  • They defined high-dose as: “High dose refers to an intermittent bolus dose of at least 20,000 IU or a daily dose of 4,000 IU.”
  • 4000 IUs is 100 micrograms.
  • Conversion: 1 µg (microgram) = 40 IU (international units)
  • For comparison, 2000 IU a day is 60,000 IU a month is 720,000 IU a year is more than the 300,000 and 500,000 IU/year used in these trials.
  • “Peak 25(OH)D levels from these studies tend to be around 120-140 nmol/L (48-56 ng/ml).”
  • Conversion: One nmol/L is equal to 0.4 ng/mL, and 1 ng/mL is equal to 2.5 nmol/L.

So, high-dose vitamin D could be acting in the brain? Affecting balance and coordination? Isn’t that the last thing we need?