Papers showing a correlation between vitamin D ‘deficiency’ and cases of rickets in children are being used to promote supplementation. However there appears to be no evidence that supplementation cures or prevents rickets. The purported correlations are just that: correlations.
Dietary modifications that increase intake of the substance are likely effective because they necessarily decrease the intake of other substances which interfere with calcium regulation.
“a high meat diet seems to reduce the risk of rickets independently of vitamin D intake“
“Modern diets also contain substances that react with calcium or phosphorus to form insoluble salts, thereby depleting the body’s supply of usable calcium and phosphorus. Such substances include phytic acids in commercially processed cereals, sodium bicarbonate in baking soda, and aluminium hydroxide in antacids. Cereal induced rickets has been reported by several authors”
“Thus, among northern peoples, the purported association between rickets and low vitamin D levels may be more apparent than real.”
Louis Kervran was adamant that there is no calcium transport from the gut to the bones and that all bone calcium is manufactured on site via transmutation of other elements such as magnesium or potassium. Calcium is stored in the bones and then transmuted back to magnesium should there be a need to do so.
Almost all studies neglect the possibility of transmutation and so will invariably equate a low level of something with insufficient intake and consequentially recommend supplementation as the solution.
What is claimed: “Rickets and tetany can be cured by peroral administration of one single dose of 600,000 international units of vitamin D.”
What they actually observed:
Levels of calcium and phosphorus in the blood became normal
X-ray evidence of calcification (of bone) shows within one week
Muscle spasms and irritability ceased within two days
“The most impressive effect is the rapid rise of serum calcium“ “Hyper-normal values of serum phosphorus may occur after vitamin D shock therapy. They usually decline to a normal level in from two to four weeks after the treatment.”
What they didn’t do: Cure rickets Rickets is a chronic problem of regulation and a (temporary?) deposition of calcium is surely not a cure for this?
Other studies have shown that a large dose of vitamin D3 will cause a sudden and dramatic drop in the concentration of storage D. An excretory pathway has been opened in response to what even the authors of the paper describe as ‘shock therapy‘
Questions to be asked:
Did they measure the levels of storage D after 600,000 units of D3 were administered?
Did they measure the effect on Active D concentrations?
If the answer is ‘no’ then they may not attribute the results to changes in those concentrations.
They were impressed with the rise of concentrations in the blood of Ca and P.
Where did all the calcium come from?
Why is there too much phosphorous and where did it come from?
99% of all calcium in the body is stored in the bones Similarly almost all of the phosphorous is in the bones. Apatite is identified by the chemical formula Ca5(PO4)
Irritability and muscle spasms are associated with Magnesium deficiency. Kervran gives good arguments to show that Ca and P are transmuted from Mg in about equal amounts. Modern diets seem to result in low magnesium levels.
A steady supply of of calcium in the blood is needed for various functions in the body. Too much calcium can calcify kidneys and cause heart and brain problems. The bones act as storage and regulator for calcium.
Interpretation of the study.
A sudden change (decrease?) in storage D results in a sudden deficiency of active D causing calcium production to cease and a compensatory release of Calcium and Phosphorous into the bloodstream from the bones.
Calcium is now supplied from the bones rather than transmutation so there is no need to use up Magnesium. Magnesium levels are now restored and cramps and irritability disappear.
This will deplete the bones in the long term and actually cause rickets instead of preventing or curing. The correct cure here is more Magnesium.
Biological organisation can be understood as an interlinked system of closed-loop control systems which can be characterised independently of the physical composition of the organs and molecules of which they are comprised.
These systems are well studied in the areas of engineering and cybernetics but are equally applicable to biological systems where similar patterns emerge. The closed loop control system is a specific type of network system (as studied by Bio-regulatory medicine) with an added feedback loop which gives the whole system purpose and stability to perturbations via complex and quasi-intelligent behaviour.
Control systems are essential to the understanding of:
Homeostasis as a definition of health
The understanding of disease as dis-regulation
A correct assessment of dose-response relationships
Rhythmic behaviour of biological systems
The phenomenon of goal-oriented behaviour
The solution to the problem of stability in the presence of disturbances
Control systems are portrayed in slightly different ways but all contain the same basic elements.
Input to the system (eg. heat from sunlight)
The system – responsible for performing some biological function (cooling down)
Disturbance or noise input into the system – (exercise)
Output – a desired result from the process (correct body temperature)
Feedback from the output back into the system (controller)
It is this last item, feedback, that gives the system its complex characteristics and makes it ideal for biological regulation. In temperature regulation for example, we can imagine that the body somehow monitors all the heat coming in from the outside and calculates all the heat generated by the body to work out how much energy needs to be lost to maintain a constant temperature. This is just not practical however as small errors will be made which could accumulate over time and result in over-heating and death,
The way to proceed then is for the body to monitor its own temperature and adjust heat loss accordingly.
Biological Control Systems: Systems Biology of Diseases and the Design of Effective Treatments – Babatunde Ogunnaike – paper
“Control is everywhere in biological systems; in fact, physiological life as we know it is not possible without control“
Feedback control systems exist at all scales of biological organisation:
System wide regulation – nervous, cardiovascular systems..
Cellular processes – growth regulation, cellular division, DNA repair..
Molecular processes – gene expression, protein synthesis, metabolite regulation..
Biological processes are obviously complex but if they can be characterised as a control system then things are simplified and the system can be studied according to already existing principles.
Disease, from this perspective, is a malfunctioning control system and depending upon which part of the system has gone wrong, typical patterns of malfunction will be observed.
“A short term but significant departure of physiological variables from normal limits is referred to as an ‘illness’ where recovery occurs when the perturbed variables are returned to within normal limits. ‘Chronic illnesses’ are characterized by long term departures from normal limits, but with the affected variables still within nonlethal limits. Death occurs when critical physiological variables fall outside non-lethal limits and are not restored within a reasonable period of time.” – Ogunnaike
An example of diabetes is given whereby the two types of disease are caused by malfunction in two different parts of the control system:
Type 1 diabetes: Non-functioning controller (pancreas not producing insulin)
Type 2 diabetes: Faulty sensor (insulin resistance) leading to bad feedback
Diagnosis is by a perturbation of the system (administration of glucose) and examination of the output (blood glucose levels) for a characteristic response. Knowledge of the bio-chemistry here is irrelevant as the dose response relationship gives sufficient information for diagnosis.
Platelet count control. The chart shows the dose-response curve when a patient with a low platelet count is administered a dose of romiplostim. The platelet counts increases as desired but, crucially, only after a time delay of about 14 days.
The requirement is for a stable elevated platelet count but what happens in practice is that doses are administered every two weeks and an oscillating platelet count is the result – see below left. The reason is obvious given the response curve; the second dose is supplied at the peak of the curve but the current dose will not take effect for another two weeks.
We can turn this into a closed loop system by adding feedback in the form of platelet measurements taken every two weeks which inform the dose to be administered. Unfortunately this doesn’t help at all because the measurements are always synchronised to the peak of the response curve which results in:
An artificially high level measured resulting in a low dose administered
Dose administration at the ‘wrong ‘time in the rhythmic cycle
The establishment of a wildly oscillating count pattern
This problem is very well known in engineering circles and is responsible for all sorts of problems including otherwise well constructed bridges for example that become dangerously unstable when even pedestrians walk across them.
The solution though is equally well known which is simply to ensure that the feedback is out of phase with the characteristic frequency of the system. Above right we see the effect of performing the exact same procedure but on a weekly basis instead of bi-weekly. A damping effect is seen on the response curve and the desired stable target output is achieved.
Note that even daily variations in platelet count are now negligible despite doses occurring only one a week. The system is controllable with remarkably little intervention.
Complex stable systems are now easily constructed by connecting together multiple control systems in various ways.
The fact that each individual sub-system has the tendency to stabilise makes them eminently suitable as building blocks for larger systems and practically guarantees stability of the system as a whole.
Even a few simple connected components can give surprising output. Physicists will typically test the system for its response to spike inputs (single dose) and wave-form inputs (roughly equivalent to regular doses) and can easily expect the following patterns as a result:
Spike input → Spike output
Spike input → Spike output with delay
Spike input → Spike followed by a smooth decay curve
Spike input → Spike followed by oscillating decay curve
It is clearly not possible to deduce the whole output response from just one measurement in many of these cases. Moreover, extreme caution needs to be taken even when performing a large number of experiments as in some of the above the output is not statistically correlated to the input even though the relationship can be said to be ‘causal’.
A temperature control system is shown here as a collection of connected feedback control systems and we can imagine such a structure in the human body. Of importance is the existence of a single input (bottom left) representing the desired temperature and all the rest of the diagram will automatically adjust to that goal.
This is a neat solution then to the problem of dynamic stability whereby the body needs to maintain a constant temperature whether standing in the snow or jogging in summer heat but occasionally will need to readjust to a new temperature. In the case of a fever state, say, it will need to attain and maintain a higher yet stable temperature again in the presence of other physiological variations.
Many disease states show typical patterns of temperature variation and we can now see why – it is because the system for maintaining temperature is independent of almost all other input so the same physiological system is in effect no matter what the disease.
Blood pressure is controlled by a control system (right) which at first sight looks to be too complex to understand but upon closer examination reveals itself to be stabilised by a single metric, the signal from the baroreceptor neurons which measures blood pressure in the arteries.
This is the single point of feedback in the entire system and information from it will be used by the cardiovascular centre to adjust the whole system to an appropriate output pressure. Treatments for high blood pressure reflect this fact by, for example, acting upon the signal from these receptors to control the measurement of the pressure rather than acting upon the heart directly [MedlinePlus].
Note however that the system as a whole is unlikely to be either observable or controllable via this parameter alone. We can deduce hardly anything about the rest of the system by just measuring blood pressure and nor can we expect to control the inner state of the system as a whole. Attempts to fix the problem by blocking the baroreceptor signal are really just wall-papering over the problem and hoping for the best; the system is now trying to run on less information than it was before the intervention!
In attempting to fix the problem by altering the baroreceptor signal, an implicit assumption is made that this is the part that has gone wrong, that the rest of the system is in good working order and can somehow adapt to the incorrect information.
It may well be that the desired outcome (lower blood pressure) is achieved but the root cause has not been addressed.
Cell division is a highly organised process that uses information from multiple checkpoints to provide feedback. Proteins are responsible for monitoring the progress of the cell cycle, making decisions as to the integrity of the process and terminating it if necessary. The same mechanisms are present in almost all organisms from bacteria up to humans.
So closed loop control systems are at the very basis of physical life processes from the cellular up to the organ wide scale. Moreover, they can also be seen as forming the basis of consciousness and behaviour as without feedback no action or thought has any particular ‘meaning’ and cannot therefore be preferred over any other.
Shiva Ayyadurai has noticed parallels between elements of Ayurvedic medicine and the various components of closed loop systems and has even gone so far as to suggest a novel way of characterising personality types by the degree to which they are strong or weak on processing, feedback, robustness etc.
Dr Shiv’s Rosetta Stone of Siddha and Ayurveda:
Engineering Input Output Transport Conversion Storage Goal Controller Sensor Disturbance
Different sources have slightly different formulations of Ayurveda but the concept of a modular hierarchy of control systems is ever present:
“The three humours; Vata dosha, Pitta dosha and Kapha dosha are collectively called as Tridoshas and they control the basic physiological functions of the body along with five sub-doshas for each of the principal doshas.” – NIH
Dr. Shiv has also pointed out that the whole of human society actually runs on a closed loop system with behaviour being driven by ‘policy’ and financial incentive and feedback being provided by the many monitoring organisations run by world governments.
Supplementation and medication. There seems to be an overwhelming impression that the functions of pharmaceuticals are largely independent of each other, that there is such a thing as a ‘safe’ dose and that a higher dose has a more pronounced effect whilst at the same time acknowledging phenomena such as allergic reactions and tolerance to repeated doses. Confused.
The view of the body as a collection of connected intelligent systems helps to clarify the situation somewhat. All inputs to this system are interpreted by that system as a whole and the effect observed will be the response of the system as a whole. The overall character of the regulatory system in general is to stabilise in the presence of various disturbances or to put it another way, to resist medication in normal circumstances.
No part of the system is really independent of any other part and if we don’t know the precise function of a substance within the network then we cannot sensibly predict the effects and even large scale studies are just ‘black box’ science. Experimenters are treating the body as if it were a sealed box, inputting data at one end whilst making observations of outputs at the other and then trying to work out what is going on in between.
In the specific cases of vitamins D and C the supplements (D3 and ascorbic acid) which are held to contain the ‘active’ ingredients turn out to have toxic effects whereas the whole-vitamin complexes obtained naturally via sunlight or oranges have the desired effect of maintaining the required network subsystem as a whole. Vitamin D levels
Final thoughts.
Network systems are not necessarily controllable or observable from a finite subset of observations so it may well turn out that there is a component to health and disease that is simply not accessible to us.
Dose and response can be causally related even though there is no statistical correlation between them.
Their omnipresence and interconnectedness suggests that the characterisation of closed loop control Systems as the Basic Units of Biological Organisation is not too fanciful.
John Campbell is a popular commentator on all things medical who is now starting to wake up to the various forms of medical fraud and incompetence. He still believes in the existence of viruses and is still convinced of the need for and the benefits of, vitamin D supplementation, encouraging higher and higher doses for his followers.
There is no hard evidence that D3 supplementation is beneficial for health and no evidence that the population as a whole is vitamin D ‘deficient’ – so how does Campbell contrive to give the opposite impression?
Here we take a critical look at a single video and find it lacking in credible argument or relevant evidence. There are various vitamin D ‘pushers’ on Twitter and YouTube all using the same techniques and making the same mistakes:
Correlation is not causation
Low levels of D are the result of disease not the cause
Arguments from evolution are not evidence
Levels do not depend on latitude
Skin pigmentation does not affect D3 production
D3 supplementation is not the same as sunlight exposure
There is no scientific rationale for current definitions of ‘deficiency’
The pitch. The video is ostensibly a look at a paper (McCullough et al) which describes a 7 year study that concludes only that long term Vitamin D supplementation is ‘safe’, but the closing comments of the video reveal it to be a call for increased consumption of oral supplements by policy change and individual choice.
From the video at around 13:00: “There is no question at all in my mind that health authorities around the world should increase the recommended amount of vitamin D” and “I can’t tell you what to take .. I am currently taking 8000IU per day“.
These comments amount to an encouragement to take vitamin D supplements and to doubt advice given by the health authorities.
The Hunter Gatherer Argument. “Vitamin D3 is a secosteroid hormone produced in the skin in amounts estimated up to 25,000 international units (IUs) a day by the action of UVB radiation” – McCullough et al
“Given we are supposed to be producing 25,000 IU per day..” – John Campbell
Campbell’s remark is highly deceptive for several reasons:
John has moved from what is to what he thinks ought to be, but you can’t move from an ‘is’ to an ‘ought’. – David Hume
Campbell’s statement makes implicit assumptions about the supposed perfection of human adaptation to our environment thousands of years ago but at the same time concludes that we have lost that connection somehow and need to compensate for it by artificial means, i.e. oral supplementation. We are seeing here an appeal to a naturopathic argument to encourage correction by allopathic medicine. Ugh!
The paper states that 25,000 IUs is the maximum amount of D3 produced in the skin and since we know that production rates are seasonal we can conclude that for most of the year, we will be producing far less than this.
Africans living near the equator are deficient in vitamin D – Kagotho et al
Rural workers in India have ‘low levels’ of vitamin D – Mangin et al
Rising 25(OH)D levels automatically inhibit further production of D3 – Bogh et al
Naturopathy
So if we look again at what is, we find that a mechanism exists to actually prevent maximal production of 25(OH)D , which is the quantity that is usually measured. From a naturopathic viewpoint then, the supplementation as described in the study, is an attempt to actually disturb the body away from its natural processes and rhythms; the body will actively resist supplementation.
The above view is actually supported by the study which found that it takes 12 months of supplementation to raise the concentrations of 25(OH)D to the desired value. John Campbell, in the video has a different interpretation: “It took a year to get to the levels that the body wants it to be“. Again an assumed statement with no justification supplied and seemingly at odds with actual reality; how can it be said that the body wants levels to be high if it tries as hard as possible to keep them within seasonal limits?
Vitamin D levels normally rise and fall on a seasonal basis in accordance with sunlight exposure.
Take a look at the chart and try to understand what it means to force the levels up for a whole year to reach and maintain, at a ‘plateau’, levels that are actually higher than those naturally achieved in the northern hemisphere and way above those of an equatorial African! When did they start to push the levels up? In summer? In winter?
“Correlation is not the same as causation – but sometimes it is!” is a favourite saying of Dr John and he uses this idea to its fullest in this video by citing many cases of correlation between disease and low concentrations of 25(OH)D. I am guessing he has not read Mangin et al which lays out a strong argument that much, if not all of the time, it is the disease that is causing the low levels and not the low levels causing disease.
At 4:50 in the video, we have “Deficiency is strongly linked to increased risk for a multitude of diseases several of which have been shown to improve dramatically with either adequate UVB exposure to the skin, or to oral supplementation“. This is horribly ambiguous and introduces a (deliberate?) conflation between sunlight exposure and D3 supplementation, trying to imply that they have the same effect. They are not the same thing at all with sunlight exposure conferring additional benefits such as vitamin A production, which will just not happen with oral supplementation of D3.
Even if sunlight exposure is causal in improving health this cannot automatically be attributed to increased vitamin D concentrations and therefore cannot be used to justify supplementation.
“Vitamin D3 (cholecalciferol) is a seco-steroid hormone” – McCullough et al
“They say vitamin D is a hormone produced in the skin which is true.” – Campbell
“Only 1,25-dihydroxyvitamin Dcalcitriol can function as a hormone” – Goddek et al
Summary. We have not looked in detail at the referenced paper but the video really is a horrible mash up of cherry picked irrelevancies, linguistic tricks and logical fallacies with the design of creating a specific narrative which seems on first viewing to be valid but falls apart upon closer examination.
The scientific arguments are weak and the evidence is ambiguous. We are asked to believe that rural Indians, equatorial Africans, white Europeans and native Inuit have all lived for thousands of years with inadequate nutrition owing to insufficient sunlight exposure!
John seems like a nice guy with a genuine desire to help but he has used the term ‘vitamin D deniers’ in another video which is a very lazy way of disparaging those who disagree with him.
Must try harder.
Addendum. In this video John finally comes clean about the lack of studies that show the efficacy of vitamin D supplementation .. and yet continues to encourage vitamin D supplementation!
“There’s lots of studies that show correlations between various diseases like Alzheimer’s disease, heart disease, diabetes and many others, with vitamin D deficiency. But there’s not the evidence that shows that if you supplement with vitamin D these go away or are prevented” – John Campbell
“Currently, the role of vitamin D supplementation, and the optimal vitamin D dose and status, is a subject of debate, because large interventional studies have been unable to show a clear benefit (in mostly vitamin D replete populations). This may be attributed to limitations in trial design, as most studies did not meet the basic requirements of a nutrient intervention study, including vitamin D-replete populations, too small sample sizes, and inconsistent intervention methods regarding dose and metabolites.” – Amrein et al
Daily oral dosing of vitamin D3 using 5000 TO 50,000 international units a day in long-term hospitalized patients: Insights from a seven year experience Authors: Patrick J McCullough, Douglas S Lehrer, Jeffrey Amend https://www.sciencedirect.com/science/article/abs/pii/S0960076018306228
Vitamin D production after UVB exposure depends on baseline vitamin D and total cholesterol but not on skin pigmentation – Bogh MK, Schmedes AV, Philipsen PA, Theiden E, Wulf HC. https://pubmed.ncbi.nlm.nih.gov/19812604/
Vitamin D deficiency 2.0: an update on the current status worldwide – Amrein et al “Currently, the role of vitamin D supplementation, and the optimal vitamin D dose and status, is a subject of debate, because large interventional studies have been unable to show a clear benefit (in mostly vitamin D replete populations). This may be attributed to limitations in trial design, as most studies did not meet the basic requirements of a nutrient intervention study, including vitamin D-replete populations, too small sample sizes, and inconsistent intervention methods regarding dose and metabolites. “ https://www.nature.com/articles/s41430-020-0558-y
