Category: Vitamin D3 and sleep

Sunlight and Heart Disease

Seth Roberts7 Comments

Vitamin D and Cholesterol: The Importance of the Sun (2009) by David Grimes, a British doctor, contains more than a hundred graphs and tables. Most of the book is about heart disease. Grimes argues that a great deal of heart disease is due to too little Vitamin D, usually due to too little sunlight. I recently blogged about other work by Dr. Grimes — about the rise and fall of heart disease.

Part of the book is about problems with the cholesterol hypothesis (high cholesterol causes heart disease). One study found that in men aged 56-65, there was no relationship between death rate and cholesterol level over the next thirty years, during which almost all of them died (Figure 29.2). There is a positive correlation between death rate and cholesterol level for younger men (aged 31-39). The same pattern is seen with women, except that women 60 years or older show the “wrong” correlation: women in the lowest quartile of cholesterol level have by far the highest death rate (Figure 29.5). A female friend of mine in England, who is almost 60, was recently told by her doctor that her cholesterol is dangerously high.

The book was inspired by Grimes’ discovery of a correlation between latitude and heart disease: People who lived further north had more heart disease. This association is clear in the UK, for example (Figure 32.4). Controlling for latitude, he found a correlation between hours of sunshine and heart disease rate (Table 32.3): Towns with more sunshine had less heart disease. No doubt you’ve heard that dietary fat causes heart disease. In the famous Seven Countries study, there was indeed a strong correlation between percent calories from fat and heart disease death rate (Figure 30.2). You haven’t heard that in the same study there was a strong correlation between latitude and dietary fat intake (Figure 30.8): People in the north ate more fat than people in the south. The fat-heart disease correlation in that study could easily be due to a connection between latitude and heart disease. The correlation between latitude and heart disease, on the other hand, persists when diet is controlled for.

Grimes convinced me that the latitude/sunshine correlation with heart disease reflects something important. It is large, appears in many different contexts, and has resisted explanation via confounds. Maybe sunshine reduces heart disease by increasing Vitamin D, as Grimes argues, or maybe by improving sleep — the more sunshine you get, the deeper (= better) your sleep. Sleep is enormously important in fighting off infection, and a variety of data suggest that heart disease has a microbial aspect. As long-time readers of this blog know, I take Vitamin D3 at a fixed time (8 am) every morning, thereby improving my Vitamin D status and improving my sleep.

Grimes and his book illustrate my insider/outsider rule: To make progress, you need to be close enough to the subject (enough of an insider) to have a good understanding but far enough away (enough of an outsider) to be able to speak the truth. As a doctor, Grimes is close to the study of disease etiology. However, he’s a gastroenterologist, not a cardiologist or epidemiologist. This allows him to say whatever he wants about the cause of heart disease. He won’t be punished for heretical ideas.

 

Cod Liver Oil in Morning Improves Sleep

Seth Roberts8 Comments

Kim Øyhus, a programmer who lives in Norway, writes:

Each midwinter and summer I tend to lose my feeling of when it is day or night, especially if I am in the northern parts of Norway, or if the weather is dark clouds for a long time, which often happens. So sorry, no statistics, just my sense of being unhinged from the diurnal cycle.

Taking 1-2 spoons [= 7-14 ml] of cod liver oil in the morning [7-9 am] got me back to this rhythm in about 3-5 hours. It even works for fixing my diurnal rhythm after partying to sunrise, but only after a days rest.

Is this due to Vitamin D3? (I have collected many examples of Vitamin D3 in the morning improving sleep.) Quite possibly. Cod liver oil contains Vitamin D3. When taking a Vitamin D3 supplement, the minimum dose needed to see the effect, based on the examples I’ve collected, seems to be about 1000 IU. I didn’t notice anything when I took 2000 IU. The effect first appeared at a dose of 4000 IU and was a bit larger at 6000 IU. Kim is taking 600-1100 IU of Vitamin D3, so that is consistent with the Vitamin D3 in the cod liver oil being the source of the effect.

Vitamin D3 in Morning Improves Sleep After All (Story 26)

Seth Roberts13 Comments

Adam Clemans (28 years old, about 80 kg, pharmacist, lives in Shanghai) commented on a recent post that Vitamin D3 didn’t seem to improve his sleep (“I can’t say I noticed any improvement in my sleep from Vitamin D”). He took 4000 IU in drop form right after he woke up.

I wrote him for details. I said that since 4000 IU was the lowest dose I found effective, he might want to try a higher dose. Adam answered my questions and said he would try a higher dose. Two weeks later he wrote again:

I started taking 4 drops (8000 IU) of Vitamin D3 1st thing in the morning (up from 2 drops or 4000 IU); my sleep seemed to improve immediately and quite dramatically. I had been struggling with middle-of-the-night awakening for a week or so, but after the change I slept like a brick or a baby (pick your metaphor). I would like to experiment with this more before I say I am sold on it, but for now it seems to be working well.

He’d been doing the higher dose for two weeks. Hard to explain as a placebo effect.

Assorted Links

Seth Roberts7 Comments

Thanks to Paul Nash.

JAMA Jumps to Conclusions About Vitamin D

Seth Roberts10 Comments

A recent experiment published in JAMA, one of the most prestigious medical journals in the world, found that giving people a very large dose of Vitamin D (100,000 IU) once/month did not prevent colds, even though it greatly increased blood levels of Vitamin D. This finding supports my view that it is important to take Vitamin D in the morning. (Because a study in which this wasn’t done found no effect.) My view implies that blood levels may not matter — you can get high levels of Vitamin D by taking it at what I consider the wrong times of day. The usual thinking about Vitamin D has been that blood level is all that matters.

The editors of JAMA considered the Vitamin D study so important that they asked someone (Dr. Jeffrey Linder, associated with Harvard Medical School) to write a commentary — an associated editorial that puts the new finding in context.

Linder’s commentary (might be gated) is important because (a) it is a kind of random sample of how top research doctors think (he was selected to write it) and (b) he completely fails to grasp that the time of day Vitamin D is taken might matter. Colds, the immune system, sleep, time of day — it’s not far-fetched. When you do an experiment to see if X causes Y, and find no effect, I believe that there are usually many possible reasons other than X never causes Y. Something was wrong with the equipment, something was wrong with your X (e.g., it was stale), something was wrong with your measurements (e.g., ceiling effect), and on and on. Linder did not see it this way.

The 2011 IOM report called for additional research to determine whether vitamin D therapy reduces the incidence of respiratory tract infections. The VIDARIS trial [= the new study] has rigorously addressed this question. Results suggest that vitamin D should join the therapies listed in the Cochrane reviewsas being ineffective for preventing or treating upper respiratory tract infections in healthy adults.

He seriously thinks one null result proves something. Sure, the new study is “rigorous” in certain ways. But it was far from exhaustive. It did not explore the many ways Vitamin D may be given, for example. It did not consider the possibility that blood levels don’t matter. Linder’s combination of (a) interest in rigor and (b) failure to understand the importance of exhaustive reminds me of a friend. When she was in 1st grade she had a pile of pennies. She knew how many she had — she had counted them. However, she did not know how to subtract. When she spent some of her pennies, to find out how many she had left she had to count them all over again.

My friend had half the skills an accountant needs. Linder’s commentary reflects only half the skills a scientist needs. To the extent that he is representative of top research doctors, this is shocking. It is as if most accountants at Arthur Andersen didn’t know how to subtract.

I have asked Dr. Linder if he has any response. If he does, I will post it.

Vitamin D3 Eliminated Colds and Improved Sleep When Taken in the Morning (Stories 24 and 25)

Seth Roberts12 Comments

A year and a half ago, the father of a friend of mine started taking Vitamin D3, 5000 IU/day at around 7 am — soon after getting up. That his regimen is exactly what I’d recommend (good dose, good time of day) is a coincidence — he doesn’t read this blog. He used to get 3 or 4 terrible colds every year, year after year. Since he started the Vitamin D3, he hasn’t gotten any. “A huge lifestyle improvement,” said my friend. His dad studied engineering at Caltech and is a considerable skeptic about new this and that.

Much more recently his mother changed the time of day she took her usual dose of Vitamin D3. For years she had been taking half in the morning (with a calcium supplement) and half at night. Two weeks ago she started taking the whole dose in the morning. Immediately — the first night — her sleep improved. She used to wake up every 2 hours. Since taking the Vitamin D3 in the morning, she has been waking up only every 3-6 hours. A few days ago, my friend reports she had “her best sleep in years”.

Sleep and immune function are linked in many ways beyond the fact that we sleep more when we’re sick. A molecule that promotes sleep turned out to be very close to a molecule that produces fever, for example. I found that when I did two things to improve my sleep (more standing, more morning light) I stopped getting colds. So it makes sense that a treatment that improves one (sleep or immune function) would also improve the other (immune function or sleep).

A few days ago I posted a link about a recent Vitamin D study that found no effect of Vitamin D on colds. The study completely neglected importance of time of day by giving one large injection of Vitamin D (100,000 IU) per month at unspecified time. I commented: “One more Vitamin D experiment that failed to have subjects take the Vitamin D early in the morning — the time it appears most likely to have a good effect.” These two stories, which I learned about after that post, support my comment. What’s interesting is that the researchers who do Vitamin D studies keep failing to take time of day into account and keep failing to find an effect and keep failing to figure out why. I have gathered 23 anecdotes that suggest that their studies are failing because they are failing to make sure their subjects take their Vitamin D early in the morning. Yet these researchers, if they resemble most medical researchers, disparage anecdotes. (Disparagement of anecdotes reaches its apotheosis in “evidence-based medicine”.) The same anecdotes that, I believe, contain the information they need to do a successful Vitamin D clinical trial. Could there be a serious problem with how Vitamin D researchers are trained to do research? A better approach would be to study anecdotes to get ideas about causation and then test those ideas. This isn’t complicated or hard to understand, but I haven’t heard of it being taught. If you understand this method, you treasure anecdotes rather than dismiss them (“anecdotal evidence”).

 

Assorted Links

Seth Roberts4 Comments

Thanks to Bryan Castañeda.

Vitamin D3 Timing and Sleep: More from Tara Grant

Seth Roberts5 Comments

It is from Tara Grant, a California journalist whom I met at the 2011 Ancestral Health Symposium, that I got the idea that the time of day you take Vitamin D3 matters (morning good, evening bad). She recently wrote more about her experience:

I had never had a sleep problem growing up, or during my 20s or early 30s. I kept a regular sleep cycle, woke up rested, preformed well in school and never needed to have naps. However, when I was in my mid-to-late 30s, the sleep problems started. [She woke up many times per night.] This was around the same time I went Primal and adopted several changes in my diet and lifestyle, including taking supplements. One of those supplements was Vitamin D3 [10,000 IU/day], something I had never taken before.

The sleep problems persisted for a couple of years. When I changed the time of day I took my Vitamin D [making sure to take it in the morning, never in the evening], they resolved. I didn’t change anything else, as I didn’t need to.

My experience has been that Vitamin D3 in the morning improved my sleep and that the dose needed to get this improvement was more than 2000 IU. Doses of 4000 IU and more were effective. More than 20 people have had similar experiences. A few people have found that Vitamin D3 in the morning did not improve their sleep.

How Much Vitamin D Should I Take?

Seth Roberts21 Comments

A new study of a quarter million Copenhagen residents found that those with Vitamin D blood levels of 40-70 nmol/L [16-28 ng/ml] had the lowest death rate. People with lower and higher amounts had higher death rates, in other words. The death rate versus blood level function has a reverse-J shape, i.e., too little is worse than too much. About 1% of the sample had levels above 140 nmol/L [56 ng/ml], for practical purposes a “high” level.

Because Vitamin D3 seems to have a big time-of-day-dependent effect on sleep (Vitamin D in the morning improves sleep, Vitamin D in the evening makes sleep worse) it is plausible that people with high Vitamin D levels were more likely to take it in the evening than those with moderate levels and this is why they had higher mortality. Likewise, it is plausible that those with moderate levels were more likely to take Vitamin D in the morning than those with low levels and better sleep explains the lower mortality. Although epidemiologists adjust for smoking in studies like this, they don’t yet adjust for sleep quality. It is also plausible that people who were more sick took more Vitamin D — hoping it would improve their health.

I think I have a better way to decide how much Vitamin D3 to take: choose the minimum amount that produces the best sleep. Sleep is so strongly connected with health that I wouldn’t want to choose worse sleep over better sleep simply because of epidemiology. At the same time that I greatly improved my sleep, I stopped getting easy-to-notice colds. Apparently my immune system was doing a better job of fighting them off.

There is evidence that Vitamin D improves immune function independently of its effect on sleep. A 2009 survey found that “those with less than 10 nanograms of vitamin D per milliliter [25 nmol/L] of blood, considered low, were nearly 40 percent more likely to have had a respiratory infection [over what period of time?] than those with vitamin D levels of 30 ng/ml [75 nmol/L] or higher.”

So those three studies (epidemiology, lab, epidemiology) taken together make a good case that my Vitamin D levels should be at least 25 ng/ml. I will have my Vitamin D level measured soon and it will be interesting to see how much an approach based purely on self-measurement (find the minimum amount of Vitamin D that optimizes sleep) agrees with this.

Thanks to Chase Saunders.

More. In an earlier version of this post I confused ng/ml with nmol/L.

Vitamin D3 in Morning: Moving D3 to Morning Improves Sleep (Story 23)

Seth Roberts3 Comments

Jim Breed has been taking large amounts of Vitamin D3 (5000-10000 IU/day) since 2008. Yet when he switched to taking it in the morning, his sleep quickly improved. Here’s what happened:

I’m a married man, 230-240 pounds over the past 4 years, born in 1957, and I work as an engineer for the Department of Energy in an office. I try to do cardio for thirty minutes four times a week.

In 2008, I began taking 5-10000 IU Vitamin D3 daily. My blood tests:

October 2009 50 ng/ml
August 2010 65 ng/ml
May 2012 84 ng/ml

My doctor said to reduce my intake from 10000 IU to 5000 IU when it hit 84, as he prefers levels under 80.

Prior to beginning the morning D, I took one 5000 IU gel cap two times during the day. I usually took my supplements at breakfast, lunch, and dinner. I might take 5000 at lunch and 5000 at dinner. Since I started taking Vitamin D in 2008, I have not missed a day of work due to illnessk. This is unusual. Throughout grade school, high school, college, and my work for the Federal Government, I have never had a complete year where I wasn’t sidelined by some cold, flu, what have you for an unscheduled absence due to sickness

In November 2011, I started reading posts on your blog about morning D affecting sleep. I tried taking my Vitamin D in the morning — upon awakening, which is usually 6:30 am. Definitely by 8:30 am. Within a week, I noticed two things:

1. I started sleeping all night without waking in the middle of the night. For years, I have had trouble sleeping throughout the night. I usually slept with earphones so I could listen to the radio around 2 am for an hour until I fell asleep again. Once I woke up, it took a lot to get back to sleep. Now, I may stir for a few minutes or get up to use the toilet, but I fall back to sleep very quickly.

2. My bed times became more consistent and earlier. I married my wife in 2005. It had been a consistent source of tension between us that she liked to go to bed earlier than me (10:30 pm for her 11:30 for me). I wasn’t tired. Midnight would have been better for me. Since the morning D, I have consistently beaten my wife to bed. I am just done for the day and ready to go to sleep by 10:30. This is truly a change for the better.

I did not expect these results. I reasoned that since my blood levels were so high, when I took D would not matter. I was surprised to be wrong.

I also found that an unexpected reduction in my dosage screwed up my sleep. This was really exciting. My wife and I traveled to Livermore, CA from our home in KS. She gave me some travel supplement packs that she makes up and it did not have our usual brand of D. Here is how the trip went.

  1. Friday-fly to CA 10,000 iu at waking; great sleep in hotel room
  2. Saturday-travel D; great sleep in hotel room
  3. Sunday-travel D; great sleep in hotel room
  4. Monday-travel D; great sleep in hotel room
  5. Tues-travel D; restless sleep in hotel room. I heard the A/C unit. The bed was uncomfortable. I fell asleep during a meeting with the lights down at work
  6. Wed-travel D; terrible sleep in hotel room. In a meeting at the lab I make a mental note to ask my wife what the travel dosage is.

It turns out that the travel dosage was 1000 IU. I thought it was just a different brand. Definitely, 1000 IU was not enough. I immediately went to Walgreens and got some 5000 IU gelcaps and began taking the 10000 IU upon waking. It took about a week to re-establish my previous restful sleep.

Reducing my dosage from 10000 IU to 5000 IU did not disturb my restful sleep patterns- When my doctor had me cut back to 5000 IU at the beginning of May, I didn’t notice any decrease in restful sleep. If anything, it seems to be better than when I was taking 10000 IU.