History of Discovery of Vitamin D, Use of Vitamin D in Chronic Disease, Origins of Vitamin D Toxicity

It is always interesting to read about the origins of discoveries.  The history of the origins of Vitamin D deficiency and its relationship to sunlight dates back millennia.

The discovery and role of vitamin D in medicine starts with the disease Rickets, a condition in children characterized by a defect in bone mineralization leading to growth retardation, bony deformities, pain in the spine, pelvis, and legs, muscle weakness, and death. The most common cause of rickets worldwide is extreme and prolonged vitamin D deficiency.

The history of Rickets leading to the discovery of Vitamin D is spread over centuries A recent study revealed rickets was widespread between the 1st-6th centuries AD. Eighteen cemeteries across the Roman Empire from northern England to southern Spain, including 2,787 skeletons, showed evidence of rickets in more than 1 in 20 children. How and why was it so prevalent then?

The study found rickets to be more common in northern parts of the Roman Empire than Mediterranean lands speculating the disease was due to weaker sunshine in the north. The study suggests the high prevalence in infants could be explained by keeping babies indoors from the cold. It was also more prominent in an area where people lived in small-windowed apartments on narrow streets. This all points to limited sun exposure. Rickets became worse in the 19th century with the Industrial Revolution.

The first recorded history of vitamin D stems back over 350 years. The first human deficiency was described in the 1600s in children with rickets and adults with osteomalacia. Prior to 1789, a folk remedy to treat rickets was cod liver oil. At the time, it was not known why. Now we know, cod liver oil is a good source of vitamin D and the use of cod liver oil continues today.

Medical Light Therapy for Chronic and Infectious Diseases and Relationship to Vitamin D 

Medical light therapy came to use in 1877 after fungal growth was inhibited in test tubes when exposed to light.

Tuberculosis (TB) was treated with natural sunlight and phototherapy via light device by Dr. Niels Finsen who first used his lamp on a friend suffering from TB. Within a few months, he was cured. Finsen carried on to treat 800 TB patients with a cure rate of 80%.

In 1903, Finsen received the Nobel Prize for pioneering light therapy to successfully treat and cure TB. Finsen’s phototherapy lamp was the standard of care for treatment of TB until the discovery of antibiotics in the 1940s.

In the early 1900s, biochemists and physicians defined the cause of vitamin D deficiency by identifying the chemical structure of vitamin D and its response to sunlight. Between 1905-1907, light baths were used at Massachusetts General Hospital for patients with psoriasis, Raynaud’s and eczema. Ten years later, light therapy was extended to treat rheumatic and gouty infections, diabetes, obesity, respiratory tract infections, arteriosclerosis and inflammation of the kidneys.

The first studies to associate sun exposure with reduced cancer risk were reported in 1916. Cancer mortality was observed to increase with further distance from the equator.

Light therapy was used as a treatment in those wounded in the World War I in which the most extensive and serious wounds were reported to heal much more rapidly, “gangrenous wounds became inodorous,” and it was also efficient in cases of general exhaustion. Another 35 years later, vitamin D metabolism was described in its relationship to sunlight exposure.

In cities throughout the US and Europe in the late 19th and early 20th centuries, rickets was demonstrated in more than 80% of children evidenced by growth retardation and bony deformities. In 1921, sunlight was published as the cure for rickets.

Following this development, it was observed by exposing foods to UV radiation, it decreased progression of Rickets. A provitamin form of vitamin D3,  vitamin D2, ergosterol, was added to milk by exposing milk to UVB radiation producing vitamin D2. Just like that, we had the creation of vitamin D fortified milk. Children who drank it did not develop rickets and therefore this spread quickly across the US and Europe. Soon after, various foods from bread to beer to hot dogs were fortified with vitamin D.

In 1932, the American Medical Association published a review on the use of UV therapy for dermatological conditions, including its use for 34 skin conditions.

Origins of Therapeutic High Dose Vitamin D and Definition of Vitamin D Toxicity

In the 1940s, vitamin D was reported to be effective in treatment of a host of diseases including asthma, psoriasis, rickets, TB and rheumatoid arthritis (RA).

High-dose vitamin D therapy was used ranging from:

• 60,000 – 300,000 IU per day for asthma, 

• 200,000 – 600,000 IU per day for RA, 
• 100,000 – 150,000 IU per day for 2-3 months led to complete cure of TB. 

Shortly after high dose therapy, it was reported toxicity could occur from such high doses leading to hypercalcemia.  Vitamin D toxicity was defined as the use of high dose vitamin D therapy with subsequent high calcium on blood work.

There is no recorded data for how many toxic cases there were. There were reports describing the success of patients who took such high doses for prolonged periods of time without complications. A patient was reported to take 150,000 – 600,000 IU per day for 2-18 months for the treatment of RA without complication.

Instead of researching vitamin D toxicity, how much vitamin D ingestion it took to induce hypercalcemia, and at what point hypercalcemia may be detrimental to the person;  physicians determined vitamin D to be toxic at high doses and high dose treatment ceased despite high dose vitamin D treatment being successful in multiple chronic medical conditions without complications.

Fortification in foods continued until the 1950s when there were several cases reported of infants with hypercalcemia, supravalvular aortic stenosis, mental retardation, and facial abnormalities. It was only assumed these children had high vitamin D levels. There was no documentation of high Vitamin D levels.

It was concluded the cause of the infant cases above was overfortification of milk with vitamin D leading to excessive consumption. The Royal Academy of Physicians admitted there was no direct evidence for this conclusion and it was based on a report that “pregnant rodents receiving intoxicating doses of vitamin D delivered pups” with the same ailments as the infants. The intoxicating doses of vitamin D were not defined.

Soon after, legislation was passed in Great Britain forbidding vitamin D fortification in food. This rapidly spread around the world, banning fortification of milk in many countries except for the US, Canada, and a few European countries.

It has since been reported the infants were likely suffering from a rare genetic disorder, enzyme deficiency or other vitamin D hypersensitivity disorders rather than being precipitated by high doses of vitamin D.

From that moment on, however, the idea vitamin D was one of the most toxic fat-soluble vitamins spread like wildfire, became instilled in the medical community and perpetuates today without validation!!!   

Vitamin D toxicity is commonly and recurrently stated as truth in our medical establishment and passed on to the lay person who also spreads this word.

The origins of vitamin D deficiency led us to the importance of natural synthesis of vitamin D through the skin via sunlight. The next blog will cover optimal levels of vitamin D and how they were established, and natural ways of increasing vitamin D levels.

Please remember the large numbers of people who have had documented reversal of disease by use of high dose vitamin D therapy.  Should we revisit this therapeutic treatment?

Have an awesome day!   Dr D