This UCSD-TV program is presented by University
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up with the latest programs. [MUSIC] I'm going to give you
a broad overview from my perspective
measurement and some of the important healthy
benefits of vitamin D, and I already told you
what my conflict of interests were but not really
for this presentation. So I bring you initially a case, and that is here's a
seven-month old female, muscle weakness, seizures,
her calcium was half normal, and got a lot of publicity in Boston because it turns out it's the first
lowland gorilla, born in captivity to mom at the Franklin Zoo
and about to die. Talking about measurement, they actually had a
pediatrician come in, evaluated the infant, decided
that maybe he had rickets, so he gave 400 units and
it didn't do any good. So he concluded the infant had some rare genetic disorder and wished the
caretaker good luck. Well, the infant complained
to mom, dad's upset. He's knows his daughter's
in deep trouble. Have you ever wondered what
he was really trying to say? [NOISE] It's what he
is trying to say. [LAUGHTER] So indeed,
that's what they did. They got to call me and
I got to see the infant. Infant has classic wide
epiphyseal plates. Talk about a measurement. Here's a classic
skeletal measurement for rickets and how do
you treat aggressively? So I gave this infant 5,000 units of vitamin D a day and the
infant is feeling great. In fact, I was the guest of
honor for her first birthday. But what's the message here? "Mommy, will my
growth be stunted?" If you go to the zoo and saw her for the first couple
of years of her life, her growth was stunted
because of in utero and her first few weeks of life
of vitamin D deficiency. You'll be hearing
a lot more about this from Carol Wagner
in a little bit. But we estimate probably 50 percent of infants
born in the United States today are still being born in a deficient or
insufficient state. 1889 in Boston,
rickets was common. Is it a problem today? You better believe it.
Indeed, we see on average, a dozen cases a year
at our hospital. Again, talking about
measurement, I mean, you don't need a
20-flux ED to tell you that infant is
vitamin D deficient. Indeed, the problem is this, that you're going to be
hearing about more from Carol, that yes docs have been
telling patients to give your infant
human breast milk as a sole source of nutrition. As you've heard,
there's essentially no vitamin D in human breast
milk unless you give them an adequate amount of vitamin D that you heard from Dr. Holly yesterday and you'll be
hearing from Dr. Wagner today. We did a study. I went
to our neonatologist. I said, I'll bet you that your pregnant women are vitamin D deficient and her response
was instantaneous. Get in my office, Holly. We take care of our patients. They take their prenatal
vitamin and in fact, they're taking also two
glasses of milk a day. Sure enough, when we looked
at 40 mother infant pairs, 70 percent taking a multivitamin, two glasses of milk a day, 600 units a day. This is what is recommended by the Institute of Medicine for all adults up to the age of
70, including pregnant women. We had published this
before they met. We showed 76 percent of moms, 81 percent of the newborns were vitamin D deficient at
the time they gave birth. But they consider
it a small study, even though it was a
prospective study. Also, we wanted to show
Lisa BAD preeclampsia, as you've heard a
little while ago, is associated with
vitamin D deficiency. Now, who are they? These are three children
born by cesarean section. You heard yesterday about
the flat pelvis of women who are vitamin D deficient in utero in there first
few years of life. C-sections became popular
because of rickets, because women could not
have normal childbirth. They were born by C-section, by Murdock Cameron, 1889. But you can see how
severely growth retardation that they have because
they still were vitamin D deficient
in Glasgow, Scotland. We did a study
because we also know vitamin D is critically
important for muscle function, which of course is important
for the birthing action. When we looked at
over 200 women at our hospital giving birth, we realized that if they were simply vitamin D sufficient, 400 percent reduced risk
of requiring a C-section. What we usually recommend
to pregnant women, 2000 units of vitamin D a day on top of their
prenatal vitamin, on top of vitamin D coming from other dietary sources
so that they're getting around
3-4000 units a day, just like Dr. Holly and Dr. Wagner have shown very nicely. Now this is Cliff Rosen and I think you've heard
his name many times. He's actually a close
personal friend and he was on the IOM committee and he's asked me to participate in
that NIH Conference. He wanted to know
what process did the Endocrine Society use to
make his recommendations, which you heard
yesterday were a lot different than what
the IOM recommended. I chaired that committee. I was fortunate enough to
be asked to chair it. Every one of these members
are experts in the field of vitamin D. It turns out that the objective
was clear to evaluate, treat, and prevent
vitamin D deficiency with emphasis on care of
patients who are at risk. The Institute of
Medicine came out, of course in 2010. All of these members are
certainly well known in the nutrition field and
in bone metabolism, but they don't really have a focused expertise
in the field of vitamin D. The IOM was not intended to direct
physicians on patient care. It was up to professional
associations to make these guidelines. They used a population model, not a medical model for
their recommendations. It's not a surprise that we would have different
recommendations. The IOM had realized that the RDA from the adequate
intake should be three times what was
originally thought. They now recommend it for
most children and adults, not 200 a day, but 600 units a day. They also recognize
vitamin D is not as toxic, recommending up to
4,000 units a day for older children and adults. But did they get it right? That's the question. IOM says that you could
get it from your diet. But this is the problem. It's rare in foods as you
heard about yesterday, right? Yes, there's a 100 units in some dairy products as well
as in fortified orange juice. But basically, no one in
the United States can get even the IOM recommendation
from dietary sources. You'd have to drink
six glasses of milk a day in order to be successful. When we did a study from National Health
Survey back in 2002, we showed that for
children and adults, no matter where they were
in the United States, they could not get
enough vitamin D from their diet to satisfy the
new IOM recommendations. You can't get it from your diet. IOM, sunlight plays a little
role in vitamin D status. Well, sunlight is
the major source. I think everybody agrees. In fact, here in Denmark even, no matter what your ethnicity, the peak blood levels are
at the end of the summer, the Nader is always at
the end of the winter. We did a study and
you've heard about this over and over
again where we took healthy adults and put them
on our tanning bed and gave them an oral dose of vitamin D separately
to ask the question, if you get one minimal erythema
dose in a bathing suit, how does that relate to how much oral vitamin
D you're taking? This was the data. Here's a 10,000 unit dose, here's a 25,000 unit dose. Now what you can see very nicely as Dr. Heaney pointed out, is that when you take
vitamin D orally, it rapidly goes up and
comes right back down. But when you're making
it in your skin it slowly increases because
Pre-D is converting to D. Then D is slowly exiting the epidermis of bloodless
tissue into the circulation. You're maintaining
a blood levels of vitamin D for a prolonged
period of time. That's why we can
conclude that the area under the curve is in
fact equivalent to about 20,000 units of
vitamin D. You'll be able to maintain your
vitamin D level much better than taking
it as a supplement. At least two-fold. One exposure equivalent
to about 10-20,000 units of vitamin D. We
showed over and over again, if you give a half an MED
three times a week to young and middle age
Caucasian volunteers, 155 percent increase. That then begins to plateau
after about 4-6 to. Also Burn's here,
right, being older. right know aging markedly
decreases your capacity. But we took some elders, there blood level on average 28 because they were
taking a multivitamin. When we put them in
our tanning bed, a half an MED,
three times a week, we could show very nicely 98 percent increase plateaued at around 55 nanograms per ML. We also looked at both
typed 1, 2, 3, 4 and 5. We could show very nicely type 2 up 60 nanograms per
ML we could achieve, 1,000 units a day is what you would get
right that you would raise it from about 15-18 to
about 28 nanograms per ML. One-half MED three
times a week in elderly Caucasians
increased by 98 percent. Now, people keep asking: when do you want to
measure 25-hydroxy D? Because people just
say just measure it. Well, what if you measure in
the summer or the winter? Is it going to make
any difference? Quest Diagnostics,
which is one of the major reference labs
in the United States, I've consulted for them
for over 35 years, helped them develop both the 125 D and 25-hydroxy D assay. But I have no conflict
because I don't benefit from them doing those assays. We looked at 3.3 million
sample data. What did we find? What we found was that you
could have about 3.3 million samples typically in the
United States, men and women, and you can see here that males are a little bit
lower than females, is that 19 on average
on the wintertime, 27 is the peak in the summertime. But look at this
PTH, in the North, much bigger variation, again, because in the South you're making vitamin D for
a longer period of time than you are in the
North compared to the South. Also, 25-hydroxy D peaks at the summertime here over
a three-year period of time. PTH levels peak in
the wintertime, there's almost a mirror image. In fact, if you want to look at the PTH levels when they
are at their nadir, it's about four weeks later when the 25-hydroxyvitamin
D is up. If you're going to get
a 25-hydroxyvitamin D, you really want to
get it at its nadir, because if it is 30
in the summertime, you're likely to be at around
21 or 25 in the wintertime. This is one of the questions that nobody seems to ever ask. Probably, our
hunter-gatherer forefathers every day making
vitamin D constantly, probably maintained a
steady level of PTH. But we now know in
the United States, that essentially everyone has this fluctuation in PTH levels, and no one knows what
the potential impact is. We know that PTH
actually has affects on your immune system
and it has, of course, effects on calcium
and bone metabolism, as well as a whole variety of other physiologic processes. Ten million tanners years
in the United States, it's estimated about
one million tan in the United States every day. We asked a question:
tanners in Boston, what are their blood
levels at the wintertime? We know from the
National Health Survey data that whether you are white, or Mexican American, or black, you have higher
bone density for a higher 25-hydroxy D. We wondered, would tanners have
higher levels of 25-hydroxy D and have
higher bone density? We did an analysis of their bone density
and look at this, non-tanners in this
wintertime just about right, about 18 nanograms per ML. Tanners usually go to a
tanning bed maybe once a week, average 48 nanograms per ML. When we looked at
their bone density, we showed very
nicely that they had a statistically
significant increase in their femoral neck bone density just based on their
higher blood level of 25-hydroxy vitamin D. How do you know your
vitamin D status? Well, we know, of course,
you want to measure 25 hydroxy D and
you never want to order the active form because it tells you nothing about
vitamin D status. It's normal or elevated in vitamin D deficient state, why? It circulates at 1,000
times less concentration. As you heard from Dr. Heaney, the half-life is very short, only 2-4 hours, and also
PTH, as it's going up, it's telling the kidneys
to activate more vitamin D. But the
Institute of Medicine, what they cared about
was this study, which is: 675 German adults
that died in an accident, they got their bones
and their blood, and they looked at the biopsies, and sure enough, here's
normal trabecular bone. Here, you see hardly
any black areas. This is low bone density, poor connectivity, osteoporosis, and you see
this pink stuff here? This is classic
unmineralized osteoid, classic for vitamin D deficiency. Even though reasonable
amount of trabeculae, it's mainly vitamin D deficient. The Institute of
Medicine said, well, maybe we could relate 25-hydroxy vitamin D levels to the degree of osteomalacia, and give us an estimate of how important 25-hydroxy D
is regarding bone health. The authors had said
up to 25 percent, up to 36 percent had some evidence of
vitamin D deficiency. These are otherwise
healthy adult Germans ages 20-90 years of age. The authors concluded, to
guarantee sufficiency, you need to be above 30. But the instruments
has done enough, and we'd looked at your
data much more carefully, and we concluded that
you didn't have to worry about this if you're above
20. This is what they said. They took this group
here between 21 and 29, over this group here, and they concluded it's
less than one percent. Therefore, you don't
need to be above 20. But they made a seventh
grade high-school error. Mathematical error. They should have taken this group here over this group here. If you do that, 24 percent of otherwise healthy adult Germans had evidence of vitamin D
deficiency bone disease, and that's what they
should have concluded, and that's why the
author suggested and the Endocrine Society recommended at a minimum for bone health, you should be greater
than 30 nanograms per ML. PTH levels, we talked
about briefly. There's a lot of scatter. People said, well, if
there's so much scatter, how can you really make
any sense out of this? But studies have shown
that PTH levels really began to plateau at around
30 nanograms per ML. We did a study throughout the entire United States
in post-menopausal women, and these are within standard
error of the mean levels. These are very tight
levels of 1,500 women. Again, around 30 nanograms
per ML, it plateaus. We went out to show
if you're at 21, you have a three times
higher risk of having secondary hyperparathyroidism
than if you were above 30. All of this information
that was gathered, endocrine practice
guidelines committee recommended at a minimum
for bone health, your blood level should be
above 30 nanograms per ML. But because of the variability
in the assays that are out there, to
guarantee sufficiency, we thought a good
range was minimum 40 up to 60 is really
quite reasonable, but 100 is certainly
perfectly safe. Indeed, you've heard this over and over again is
that Maasai warriors, and we've done a study
now in African children, found exactly the same thing. On average, their levels were about 40-50 nanograms per ML. Is vitamin D deficiency
a health issue? You've already heard this
very nicely from Dr. Gorman. But here's a study that I worked with Clifford rose
up in Bangor Maine. Young white girls taking
a Flintstones vitamin, two glasses of milk a day, 600 units a day, 48 percent were
vitamin D deficient. Here. Catherine Gordon
showed in Boston, 42 percent of teenagers
vitamin D deficient, and even the CDC says, 32 percent of all children and adults are
vitamin D deficient. They even published
their data showing very nicely at every age group that vitamin D
deficiency was common. Indeed, if you'd pick 30 as the cut-off from the
National Health Survey, 50 percent of our children
are vitamin D deficient, 1-5 years of age, 70 percent 6-11 years of age. Globally, we now
recognize basically 40 percent of the
population is deficient, and 60 percent is insufficient. Whether you're in Australia
or Canada or Korea, basically you see the same
thing and it's all because you basically can't get vitamin D from significant
amounts from your diet. As a result, everybody
has vitamin D deficiency. How do you treat and prevent it? Well, what we do
is when you treat vitamin D deficiency is
50,000 units of d2 or d3, and we can talk
about this drawing our break in terms of d2 issues. eight weeks. That's basically 6,500 units of Vitamin D a day. Then, to prevent recurrence, I put them on to 50,000 units every two weeks and I do
it for a couple reasons. One is, patients that come
to me want a prescription, they're more likely to follow the doctor's advice rather than telling them to go
and buy a supplement. They may remember that
for a couple of months, but they're not going to
remember that year after year. I agree with Bruce that it's probably better to be
taking it on a daily basis, but it's certainly
better to at least have something rather than nothing, and that's why most of my
patients are on this program, about 3,000 units a day. We'll talk a little bit
about toxicity in a minute. But here, Einstein, just
like everyone else, thinks vitamin D is toxic and maybe it's going to build up
in your body fat over time. So yeah, maybe couple of weeks
or months or even a year, you're not going to see toxicity. But what about year after year? We published a paper in Archives of Internal
Medicine in '09. After six years on
3,00 units a day, the blood levels plateau and are maintained at around
40-60 nanograms per ML. Also, recommendation for
children is a 600-1,000 units. For adults, Endocrine
Society said 1,500-2,000. If you ever wonder what
he was trying to say. [NOISE] That's a real
problem. Here, Barney is even amazed to hear this. Reason is that vitamin D is fat-soluble and it gets
covered in your body fat. As a result, the higher your BMI, lower is your vitamin D status. We and others have
shown very nicely that there's lots of
vitamin D in your fat. If you take obese people, give them an oral
dose or put them on a tanning bed compared
to an obese person, normal-weight versus
an obese person, there are 55 percent reduction
just in a blood level of vitamin D. This study out of Pure North
shows very nicely. If you look at, say,
the 40 nanogram cutoff for underweight, overweight, and obese, that here, 2,000 units a day will get to
40 if you're normal weight. You need at least
6,000 if you're obese. The conclusion of this study of over several thousand people, 2.5-3 times more vitamin D, if you have a BMI
of greater than 30, to satisfy your
vitamin D requirement. It's no question that it's there. We and others have
shown very nicely that vitamin D is certainly
in your body fat. Obese people need 2-3 times more. I'm not sure what he's thinking about here,
but tell you what? Do you know why vitamin D is so regulated and so
considered to be so toxic? You'd heard already from John
Canal yesterday that, yes, patients with rheumatoid
arthritis were treated with hundreds of thousands of units of vitamin D, they became toxic. Because now this
huge amount was in a body fat and being released, they remain toxic for years. But it was this observation that really got
everybody's attention. Before 1950, even in England, custard was fortified with
vitamin D. In Chicago, hot dogs fortified with vitamin D. Everything
in the world was being fortified with vitamin
D because it was thought to be this
miracle nutrient. Then in the 1950s,
all of a sudden, there appeared infants
with high blood calcium, altered faces, mental
retardation, heart problems. Now there was hysteria. Now the experts wanted to
find out what was the reason. The legislative body brought in the experts and they
looked at the literature. They had not a clue
what this could be. They decided that if you give pregnant rats intoxicating doses of vitamin D, guess what? They have high blood
calcium in their pups, funny altered faces,
heart problems. They couldn't figure out if
there were mentally retarded. It turns out that
the experts [NOISE] concluded that the outbreak was due to overfortification milk with vitamin D. They had
no evidence for this, but they assumed this
based on that rotten data. Europe banned all
vitamin D fortification in dairy and all products. In England, you [NOISE] cannot put vitamin D in a skin cream. It is against the
law still today. It's likely though that what they have is William Syndrome. It's a rare genetic disorder. Curiously, they elfin faces
and they have heart problems, they have mild retardation,
and guess what? They have hypersensitivity to vitamin D causing hypercalcemia. We know that this is
the likely cause, but no one in Europe is still taking this seriously
and thinking about changing the
health recommendations in most of European countries. Vitamin D fortification
continues to be a major issue in many
countries around the world. What about the intoxication? It turns out, like
you've heard before, up to 10,000 units
is perfectly safe. Many have shown this. But this study coming out of Pure Norths says it very nicely. That is here, 15,000 units a day, 20,000 units a day, if you think
25-Hydroxyvitamin D levels on average of about 60, with the upper limit
certainly being a 100, you need to take huge amounts of vitamin
D to get above a 100. The conversation that we
had yesterday about being 100-200 is really very
difficult to get there. These data really
show very nicely what happens when you increase
your vitamin D intake, and that no way will
you become toxic. But this is the other issue. You've heard about
the mortality issue, the very nice study from Cedric. Here's a study out of
Germany showed again, 25 percent reduction in all-cause mortality with
the higher blood levels of 25 Hydroxyvitamin
D. You already saw this from Cedric Garland's work. But the IOM said, "Wait a second. We agree if you have
vitamin D deficient, then you're at increased
risk for mortality. But there's this J-curve when you get around 30
nanograms per ML, we say that you now have
an increased risk." Well, we went back and
looked at some of this data, and this is one of the
papers that they actually quoted as part of that
data set. Guess what? The authors suggested actually, lower risk for mortality
up to 49 nanograms per ML, and only greater in
50 nanograms per ML for mortality in women. That's a lot different than
what the IOM concluded. But this is really
what you need to ask, who is having [NOISE]
a blood level 3-4 years ago of greater than 50? There has to be a reason. They're not simply all of a sudden having a light turned on saying they're taking lots of vitamin D and they're now
capturing this group. Most likely they're
being treated for vitamin D deficiency and maybe taking mega
doses of other stuff. How can you figure that out? It turns out, go back to that 3.3 million samples from Quest because we could show very
nicely that if you can detect [NOISE] vitamin
D2 in the circulation, it's likely coming from being treated for vitamin D deficiency. Sure enough, 59 percent of the total 25-Hydroxyvitamin
D levels greater than 50 had detectable levels
of 25-Hydroxyvitamin D2, suggesting that this
so-called J-curve may actually be due to the fact that they were D deficient
in the first place. Those with the
25-Hydroxyvitamin D of greater than 50 most had detectable levels thus being treated for vitamin D deficiency. IOM, bottom line,
they're recommending 400 units for infants, 600 units for children, and 600 units for
adults until you're 70, and then they give you
a little boost of 800. [LAUGHTER] Now, this paper just came out again from the [NOISE] Pure North's group and they said, "Hey guys," at the IOM, "If you are saying
that this is an RDA, that means it has to be 97.5 percent upper limit
and lower limit." They said that this is where
you really need to be to get 30 nanograms per ML by the
IOM at 2,000 units a day. But the Pure North's
group said, "No, no, no. If you actually take the 97.5
percent confidence limit, you have a group
down here [NOISE]. You would need 6,000-8,000 units a day to be able
to reach that level", which is now we all recognize
is right on target. Bottom line, there's no downside to increasing your
vitamin D intake. We don't need to be a
genius to know this. This is not a hypothesis. The issue is going
to be this though because it's extremely
expensive and time-consuming to
get a blood level drawn and so both the
Institute of Medicine and the Endocrine Society and most other societies don't
recommend screening. Simply increase your
vitamin D intake. It's a much more effective
and cheaper way. But if you're obese,
malabsorption, if you have sarcoid, no question,
you should be followed. Recommendation from
the Endocrine Society, 400-1,000 for neonates,
600-1,000 for children. Teenagers probably need at
least 1,500-2,000 like adults, that certainly we recommend for adults at least 1,500-2,000, and recognize that if you're
obese, 2-3 times more. Upper limit easily for
neonates 2,000 units a day, based on opponents data, basically 1-18 years
of age easily 4,000, and for adults easily
10,000 units a day. If you're over 70, same thing. Long story short, we
show a 1,000 units a day to healthy students
at our medical school, not one person basically
was sufficient, a 1000 units a day will
not make you sufficient. Indeed, I typically
recommend it's just easy for adults to take
2,000 units a day. I tell my friends that get their children to take
a 1,000 units a day. Vitamin D is really
good for your health. Thank you for your
kind attention. [APPLAUSE] Carole Baggerly asked me to do another short presentation
on measurement, after she had put
me on the website. Anyway, she made me an offer
I could not refuse, I guess. [BACKGROUND] This time, [BACKGROUND] I think
it's essential to look again at the disclosures since two of these companies are manufacturers
of tanning beds. Some of the measurements I did are only able
with funding from the industry because
taking vitamin D levels of AD subjects six times costs
quite a lot of money. But this is the only
way to learn about the particular properties of these units and in
order to improve them. Why is it important to measure? There are a lot of words around. For example, full spectrum. Have you ever stumbled across
the full spectrum lamps? Who has full spectrum
lamps in use? In the office, for example. Some of you. For that reason, I want to start with an
example which focuses on the spectral
measurement of sunlight. Here we have a spectrum
distribution which is typical for direct sunlight. We see the color temperature. The CCT stands for correlated
color temperature, which means we have
glowing bodies which give off thermal spectrum
light from heat. This is the case in the sun. With sunlight we have the correlated color
temperature of 5,200 or 5,500 kelvin equals the
real physical temperature of this glowing body. By the way, the color rendering
index of sunlight is 99. It's an index, it's not present, but it's a value of 99 from 100. Yesterday, we saw this spectral distribution
curve of sunlight. When we put these
two curves together, we find it's somehow identical
or it's at least similar. Just to give you an idea of what is possible today in terms of spectrum analysis or measuring
the quality of sunlight, I want to show you this slide. Do you have any idea what
this slide could represent? [BACKGROUND] It's a very high resolution spectral analysis of sunlight. These are 50 lines. You have to put them all together to get the full spectrum in the visible part of electromagnetic
radiation which is given off from our sun. Who has an idea of
these black lines we find dissecting this spectrum? [BACKGROUND] Pardon? There are some frequencies
or some wavelength absent. These black lines, they are
called Fraunhofer lines, according to the famous
German optician, Joseph von Fraunhofer. When I said yesterday
that we will never be able to mimic or to produce sunlight in its real quality in
artificial manner, then these Fraunhofer lines are explanation for this
claim because this is really, it's like a bar code. It's very complicated
and it carries a very specific information. What we can even tell from astronomical or astrophysical
solar physics measurements that these Fraunhofer lines, they shift in the spectrum with the breathing
rhythm of the sun. This is about five minutes. Within these five minutes, these Fraunhofer lines move
in their relative position. This information can never
be produced artificially. Just one suggestion. When you think about what Dr.
Hollich told us yesterday, that sunlight was known in
the 1920s and '30s to cure more than [OVERLAPPING]
165 different diseases. We had hyperactivities
and hypoactivities. What these doctors
from 80 years ago had to learn that sunlight balances the situation
in the body. When I think about the tenth
of a millimeter and I think about the bloodstream under
the surface of the skin, which is reached
by this radiation. By the way, we have to explain another thing,
these Fraunhofer lines, they come from all the
elements which are in the outmost layer in
the solar atmosphere. In a way, we have all these chemical elements
in our bloodstream, and sunlight produces
a photonic pressure in these zones where
we have color here, and in the zones where
we have the black lines, there is nothing, no
photonic pressure. Maybe sunlight is
even able to regulate the intracellular distribution
of chemical elements. It's an hypothesis,
it's not proven. But when you look at this, you might get a better
understanding about the special constitution
of sunlight. We can tell this today
and maybe explain things our ancestors discovered in a phenomenal logical way. Coming back to this more
simple measurement, this is sunlight measured directly without
anything in between. This is sunlight behind
modern window panes. Do you see any difference
between this and that? Near in the red and in the near infrared
part of the spectrum, we have some filtering, which comes from the
window technology. Because when the architects don't use this kind
of window technology, that building will heat up much more so they need more
energy for cooling purposes. Everything in the
lighting industry and daylight technology seems to be driven by energy
efficiency ideas. Now I will come to this
particular spectrum. This is a so-called full spectrum fluorescent
lamp spectrum. We can see similar correlated
color temperature, but it comes from a
cold light source. You can see in the
spectral distribution that this really does not deserve
the name full spectrum. It's too much disrupted and there are wavelengths missing, especially in the longer
wavelength range, where we already talked about the benefits of
near-infrared yesterday. This near-infrared is
lacking completely, more or less completely
in fluorescent lamps. It's just a quantitative
difference between a standard compact
fluorescent lamp and this so-called full
spectrum fluorescent lamp. But what they would tell you
it is sun like spectrum. Why? Because the correlated
color temperature is similar to the real
temperature of our glowing star. Sometimes the logic is
even if we have more, if we have a higher
color temperature, then we are even
better than the sun. You might believe this
as long as you do not measure the spectra
we are talking about. This by the way, is a
typical spectrum of a white fluorescent LED,
light emitting diode, which is featured at the moment, and which can be found, for example, in our hotel. Who is staying at this
at the Stanza Hotel? Have you registered
or realized that the lighting there is some LED lighting with
high color temperatures? It's not very comfortable and cozy in the afternoon
or in the evening. This is the spectrum you find in this particular
kind of technology. I would dare to say, this is not better than the sun. What I wanted to show you in this section of my
short presentation, when you start measuring, you go beyond the words, full spectrum, what
a pretty word. But as long as you
didn't measure, you will never understand
what lies behind. Coming now to the measurement
of blood levels of vitamin D. The measurements
enable us to make research, for example, in order to
improve the technology in artificial insulation or for producing
artificial sunlight, artificial UV, and probably
fuller spectrum light. For me as a physician, I see patients and when I draw blood from
a patient of mine, especially if it's
a chronic patient, then I take the
vitamin D levels in order to monitor
how the patient's react if I administer
vitamin D orally. I really want to know, but I run a private practice, so I don't have to look
at the financial aspects. If you give recommendations
to the public, we are talking about millions
and millions of people. In this context, it's
not so easy to make measurements of the
blood levels on a regular basis for
example, twice a year. But I think for me
as a physician, it's just part of being precise. That I control what the
intervention will result in, in my individual cases. Here, this is a word
I like very much. It's the civilizational
anheliosis. It's the lack of sunlight
caused by civilization. This is optimal prophylaxis of the civilizational anheliosis, but who is able to practice
this kind of prevention? Would you please
raise your hands? High noon everyday because regular exposure is better
than intermittent exposure. Who is able to practice
it in a proper way? Five percent in the
audience may be. This might be a problem. We saw this slide yesterday
and what this chart explains is a lot about the
technique of heliotherapy. What you can see here, time measured in minutes is a crucial factor to perform proper heliotherapy
in the right way. Because this patient
needs a blanket and this blanket has to be moved from the feet up to the upper
parts of the body. In a timeline of five
minutes, every five minutes, you have to shift or pull up the blanket a little bit more. For proper heliotherapy, the most important measurement under the sun is to
measure the time. We heard that avoiding sunburn, avoiding over dosage
is essential. When we look at different
effects of sunlight, it acts upon the body, but it as well, acts
upon mind and soul. So the mind starts wandering. You feel cozy, you
feel comfortable, you start kind of dreaming. You go into a theta
rhythm in your brain, and suddenly you go into the
delta rhythm of your brain. What does this mean?
You fall asleep. Many of the sunburn cases come from falling
asleep in the sun. Don't fall asleep. A smartphone is not resistant to sunlight,
it will heat up. I experienced myself that
my smartphone switched off before it could alert me
that the time is over. [LAUGHTER] Thankfully, I have
an inner clock I can rely upon as long as I didn't travel to the US in
the six weeks before. But now it's not a problem because we have
winter in Germany. [LAUGHTER] No risk. My circadian rhythms at
least are not travel proof. I come to the last part of my measurement
presentation talking about technologies which
automatically provide the right dose and stop
when the time is over. Here is a publication, a paper on the effect of small sub erythematosus in
medical ultraviolet cabinet. But medical cabinets are
not limited in output. It's clear that they can
help to build up vitamin D, but they are not available to the public, not
freely available. These are not
over-the-counter units. Here is a paper
published in 2012. This was before we
had the regulation in the European Union which
limits the fluence, the energy density,
the energy output of the tanning beds to 0.3
watts per square meter. The question has to be raised to these limitations in
output performance have a negative impact on the potential to build
up vitamin D. Here we see this paper which has been examining a
commercial tanning bed, which was not restricted
in output that much compared to
those we have to use. Today, we have an
energy density of 375-525 joule per square meter. This was a single
exposition exposure, and the mean increase was about 1.8 nanograms per milliliter, which is not much, but you at least can prevent the vitamin D level
from decreasing. Here, I would like to present some numbers from a trial
I performed last year. The data you saw from Dr. Hollich before may be difficult
to achieve nowadays. Because as I said, nowadays we have
different conditions. We have much lower
output of the units. But what we can see here in
the interventional group, the vitamin D level rose from about 16 nanograms per
milliliter to nearly 26. After 16 treatments, here you see the changes in
percent compared to baseline, and here we asked our subjects, do they tan regularly? Sometimes, only rarely or never. What you can tell from this chart is that the never tanners, they had value around 12.5
nanograms per milliliter and nearly double the amount was found in the
regular tanning group. We applied a total dose
which lay in-between the 375 and 525. We applied independent from the skin type here
for four treatments, 460 joule per square meter, and to make I learned
from you Paul, from your presentation yesterday, I just changed the logic
of sorting these data. You can say that those with the lowest
levels at baseline, these are the blue blocks. They had the highest benefit in terms of increase
in vitamin D. This was after four
treatments with around 100 joule per
square meter each. But what is interesting to me, when we look at those
with a higher level, then we find
significant decreases from baseline to the values
after four treatments. I asked Dr. Hollich this morning if he
has any explanation, and you hadn't, I have not. But this slide with these examples is good
for highlighting again, how important
measurement in fact is. Because there are cases in which we are unable to predict
the individual reaction. It's very important to
monitor what you do. The next step study, by the way, I have planned
measures of the effect of treatments with so-called
hybrid tanning beds. It's one step closer to full
spectrum artificial tanning. We reduce the dose of ultraviolet radiation by
a factor of two again, but we add long-wave radiation in the orange-red
part of the spectrum. We know from the reports from users that it's much better, it's much more comfortable and smoother and easier for the skin. At least the tanning
performance is comparable to the
standard UV beds. Now we will apply our idea, our principle of measurement. Again, in order to
find out if there is also an effect on the
vitamin D production. If we treat not only with
the short wavelength, but with the longer
wavelengths as well. Here is an Internet address
where you can find, I think four or five audio
visual presentations of mine which are in English. If you are interested to
go into other topics, may be, you can visit this
page and have a look for free. Thank you very much for
your kind attention. [APPLAUSE] [MUSIC]
