I was born on the SW coast of England at latitude 50 degrees. (Edinburgh, Scotland is at 56 degrees.) St. John's in Newfoundland, Canada, is at latitude 47.6 degrees, so one might expect the average Brit to have a much poorer vitamin D status than the average American, in the absence of supplementation.
"We {assessed} the associations of vitamin D deficiency, insufficiency, and vitamin D supplementation use with mortality from any cancer and 18 specific cancers in 411,436 United Kingdom Biobank participants, aged 40–69 years."
"The majority of the study population had either vitamin D deficiency (21.1%) or insufficiency (34.4%).
Too bad they don't give their definition of sufficiency. Did they use the British definition, which is quite low?
"The UK Scientific Advisory Committee for Nutrition has set the lowest level for defining sufficiency (10 ng/ml or 25 nmol/L) of any national advisory body or scientific society and consequently recommends supplementation with 10 micrograms (400 IU) per day." [2]
Back to the new paper:
"Furthermore, 4.1% and 20.3% of the participants regularly took vitamin D or multivitamin supplements, respectively."
Generally, the vitamin D amount in a multivitamin is low.
"During a median follow-up of 12.7 years, vitamin D deficiency was associated with significantly increased mortality from total cancer and four specific cancers: stomach (hazard ratio ... 1.42 ...), colorectal (1.27 ...), lung (1.24 ...), and prostate (1.36 ...)."
"Compared to non-users, vitamin D use was associated with lower lung cancer (0.75 ...) and total cancer mortality."
No mention of PCa, specifically, for the benefit of supplementation. And no mention of the typical supplement dose.
One problem with vitamin D supplementation for PCa, is that most men (imo) are unaware that PCa cells down-regulate the enzyme needed to convert inactive 25-D to the hormonal 1,25-D. {The 25-D 'reservoir' might be ample, but PCa cell resistance to 1,25-D is an early event and difficult to counter.} Further, I doubt that many are aware that PCa cells upregulate the enzyme that clears 1,25-D. If conversion does occur, the active form will be quickly metabolized.
The strategy for making circulating 1,25-D (from kidney production) more available to PCa cells is:
i) avoid excess calcium intake. The kidneys will not convert 25-D to 1,25-D if they are ditching calcium.
ii) fructose (I use it in coffee) will result in sustained levels of circulating 1,25-D. Be careful when using fruit for this purpose. Sugar profiles vary considerably. Note that table sugar (sucrose) will divide into fructose (good for PCa) & glucose (not good). (In spite of its name, fructose - i.e. fruit sugar - is not the sole sugar in fruit and amounts vary. Some fruits also contain free glucose & some contain sucrose. The USDA database is a useful guide. [3])
iii) Avoid excess phosphorus & phosphates. Some soft drinks & deli meats have phosphates. Also, large portions of fresh meat will provide a significant amount of phosphorus. Kidneys will be working on elimination & will not be converting 25-D to 1,25-D.
Patrick thanks this is very timely because I was going to reach out to you about my latest D3 blood test results which have shown a sharp decline from last year. Latest reading 45.2 ng/ML ( I always have to do the conversion from nmol/L) down from 67 about a year ago. I had been trying to boost my level from 67 by upping my daily D3 supplementation from 5,000 IU to 7,000. I have also been out in the sun a fair bit although not much of it around in England the last 8 weeks Lol. I have upped it to 10,000 a day and will have another test in around 3 weeks time. That will leave about 5 weeks between tests. Maybe I have been taking on a bit too much Calcium which I have cut back. I am wary about Fructose because I have recently taken part in a Zoe study (specialised muffin test) with a glucose monitor in for two weeks. Zoe has studied my response to sugar and fat and have come up with a dietary inflammation profile. They used a finger prick blood test and the blood sugar sensor after I had eaten certain muffins and nothing else for breakfast and different muffins and nothing else for lunch. They send you their curated muffins (not very tasty!). My blood sugar control was assessed at the upper end of poor (4 categories bad, poor, good and excellent) but it was a relatively very “good result “ when compared to age and sex. My score was 47 while the range for same age and sex was 29 (low but still in poor) and 49. Not really of much comfort since there is a stronger presentation of PCA in older men! My blood fat control was in the good range 60 and way better than the normal adjusted scores 22-49 for men of my age in the study. They have produced a food ranking and food combinations for me that takes account of my scores and they are obviously looking to improve my reactions to diet. I appreciate that they are doing this for general health rather than anything PCA specific. Other than fructose are there any other options? My PSA has gone up from c 0.03 to 0.06 over the year when I have been on “vacation” so maybe that is blocking the conversion of D3.
I was going to do a separate post on Zoe because I thought that some may be interested in the inflammation management. During the test for 48 hours I did not take my usual supplements. When I had the monitor on it was interesting monitoring the movements in real time. It was very easy to see the impacts of various foods and exercise. For example I take MCP for PCA first thing on an empty stomach and that not surprisingly causes a spike but for 5 out of the 7 days I normally go for a run straight after and this pretty much constrains the spike and levels it back down. I also notice that a 10 min walk after dinner can really reduce the spike considerably and gets the graph back down.
The study also did a micro biome analysis of my gut and looks at gut diversity of microbes and picks out “good” and “bad” microbial species which impact blood fat and blood sugar metabolism. I am in their excellent category for gut diversity. I have 7 out of 15 good bugs and in those 7 generally plenty of them and only 2 out of 15 bad ones and in both cases in quantities well below the average. All this is early stage stuff imo and begs the question if it is right of how bad my blood sugar control would be if I did not have a “good gut” Lol. They then give you a personalised food score that takes into account the 3 metrics blood sugar and blood fat control together with gut boosters and gut detractors. And guess what I should be eating lots of veggies and nuts which I do plus fish and lean meat. Coffee particularly black is good but lots of nice stuff should be reduced or resequenced. After this long reply I am going to have a glass of red wine which probably won’t aid D3 conversion?!
Your muffin experience had me shuddering. If it had been a 'Full English' study, I would have signed up.
You should use vitamin D supplements that are in oil & take them with the meal of the day that has most fat.
I don't know of anything that can induce/prolong 1,25-D exposure other than fructose. At least you can avoid 1,25-D inhibition via excess calcium & phosphates.
Thanks for the advice Patrick. I was shuddering too! I will see next months results and if they are still low I will add some fructose to coffee. I assume you only do in one cup? I normally do D3 supplements at breakfast and evening normally with food involving olive oil and black pepper for absorption.
Thanks for the post, Patrick. I switched over to a liquid Vit D supplement several years back. In the concentration I now use, one drop = 1000 IU, so I can adjust the dosage based on daily sun exposure, time of year, etc. I shoot for a lab in the range of 70 - 90 ng/ML. (I usually combine it with a algae-derived EPA/DHA supplement as fat-based companions to my nightly curcumin dosage.)
Most surprising to me is that in all of the 17 years since cancer #1 diagnosis, no doc has ever seem fit to order a Vit D lab. (Or ask if I knew my levels.) When it was first tested at my request by my PCP back in 2007 (before I started supplementing), it was 37 ng/ML. The lack of interest in regular testing flies in the face of near-universal correlation of low Vit D with the majority of adult diseases and illnesses, including most cancers and COVID.
Patient advocacy save lives. It's in all our interests to stay informed and push back when we are under-served by our medical care professionals.
Green - Thanks for sharing your first-hand experience with Zoe. I first head about the company via a podcast with microbiome expert, Dr. Will Busiewicz, aka "Dr. B".
While I'm always suspicious of such dietary "help" services, Zoe and others are now offering affordable microbiome analysis kits. I have not done one yet, so have not investigated which ones seem to offer the best results. You experience with their addition of "muffin-controlled" glucose monitoring seems unique to Zoe.
I am about to start monitoring glucose responses to specific foods using a finger prick monitor. If it seems useful, I might spring for a CGM for 24-7 monitoring over a month or so.
Thanks again for the first-person account. Knowledge is power. Stay S&W,
It was interesting and I was going to do a specific post on it. The two muffins, breakfast and lunch with no supplements or other food or exercise in between and then a finger prick test measures the individuals reaction to blood sugar and blood fat without any mitigation. They use this to score foods for you on an personalised basis (my wife has some different scores for the same food). But the continuous glucose monitor which you wear for 10 days gives you the real time reaction to your meals which you also record and any mitigation like exercise. Because my diet is pretty good though far from perfect and because I am reasonably active at no stage did my actual blood levels go outside of the Green (ok) zone as measured in real time by the monitor which means that I seem to be containing any spikes despite the muffin test indicating that, absent mitigation, I had relatively poor blood sugar reaction although in line with my age and sex. We are just scratching the surface imo but it is interesting but complex. Good luck in any of your monitoring. 👍
Green - The differing glucose response to the same foods between you and your spouse mirrors that I have seen reported and discussed in podcasts, etc. Someone on one of the PCa forums (maybe Justfor_?) used a CGM for several weeks and reported his amazement at the unexpected spikes he got from foods not known to cause glucose spikes. It all goes to show just how individualized our responses to foods can be* - and the value that new monitoring technologies are just beginning to offer.
Be/Stay Well, Ciao - K9
* and how foolish all the simple-minded, siloed diet-war mentality that pervades most discussion about diet is.
Fructose has the form of a white powder the granularity of which is a bit finer than ordinary sugar. Users can distinguish the two by this, otherwise imperceptible, difference. Diabetics are the principal users of fructose because it is a sweetener and a lot easier on lnsulin control.
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