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ACTION ITEM - ontario health insurance curbs vit d testing

Postby jimmylegs » Sun Aug 15, 2010 1:19 pm

O. M. G.

news link
August 13, 2010 11:00 AM

Ontario is listening to expert medical advice and proposing to curb unnecessary Vitamin D testing for otherwise healthy people.

In June, Ontario's Health Technology Advisory Committee concluded that the routine use of Vitamin D testing for the general population could not be justified based on current evidence. This builds on other recent medical expert evidence that recommended changes to sleep studies, bone mineral density and pre-operative testing for cataract surgery.

Since 2004, Vitamin D testing has grown by 2,500 per cent - jumping from 29,000 tests to over 700,000 in 2009. Moving toward evidence based testing supports Ontario's Excellent Care for All agenda to ensure health care investments are getting results and improving patient care. The proposed change to Vitamin D testing would result in resources being redirected to other laboratory services.

The province would continue to cover Vitamin D testing for patients where medical evidence indicates there is a need. Ontario would continue to fund tests for patients with medical conditions such as Osteoporosis, Rickets, Osteopenia, Malabsorption Syndromes and Renal Disease. Ontarians who are on medications that affect Vitamin D metabolism would also still be covered.

The public is invited to comment on the proposed change to Vitamin D testing which will be posted on Ontario's regulatory registry until September 26.

In June, Ontario passed the Excellent Care for All Act, which lays the foundation for these improvements and is part of the Open Ontario Plan to improve the quality and value of health care.


QUICK FACTS

*This year it is expected that the government will be billed up to $66 million on Vitamin D tests compared to $1.7 million in 2004.
*If current trends continue, billings could reach up to $155 million by 2011/12.
*Manitoba, Nova Scotia, Newfoundland, Prince Edward Island, Labrador and Saskatchewan have all moved to limit unnecessary Vitamin D testing.


this is where health care is heading, canada.

ontarians with ms, if multiple sclerosis is not on the list of exceptions, it is time to send the ontario govt our input.
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Postby miracles » Sun Aug 15, 2010 10:51 pm

I had my first major MS flare up when I was visiting the country Equador.

I had to go to the ER cause I couldn't move my left leg, & I got MRIs there, & the doctors told me I was the first patient they ever had in that country that ever got MS.

The neurologists were just amazed to see someone with MS lesions on their MRI.

Equador is right near the equator, so people there get more sunlight than anywhere else.

I grew up in Iowa where I only got sun part of the year, & I didn't know the benefits of sunlight -- so I went years without sun.

Since there's no MS in Equador, & there are lots of people w/ MS in Canada -- I have to agree that vitamin D is an essential factor in why people get this.

So, vitamin D probably can help control it too.
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foods containing vitamin D

Postby hwebb » Mon Aug 16, 2010 1:50 am

Just in case you are not able to get much sunlight, vitamin D is also available in a variety of foods:

Food IUs per serving* Percent DV**
Cod liver oil, 1 tablespoon 1,360 340
Salmon (sockeye), cooked, 3 ounces 794 199
Mushrooms that have been exposed to ultraviolet light to increase vitamin D, 3 ounces (not yet commonly available) 400 100
Mackerel, cooked, 3 ounces 388 97
Tuna fish, canned in water, drained, 3 ounces 154 39
Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 1 cup 115-124 29-31
Orange juice fortified with vitamin D, 1 cup (check product labels, as amount of added vitamin D varies) 100 25
Yogurt, fortified with 20% of the DV for vitamin D, 6 ounces (more heavily fortified yogurts provide more of the DV) 80 20
Margarine, fortified, 1 tablespoon 60 15
Sardines, canned in oil, drained, 2 sardines 46 12
Liver, beef, cooked, 3.5 ounces 46 12
Ready-to-eat cereal, fortified with 10% of the DV for vitamin D, 0.75-1 cup (more heavily fortified cereals might provide more of the DV) 40 10
Egg, 1 whole (vitamin D is found in yolk) 25 6
Cheese, Swiss, 1 ounce 6 2


My first thought on reading this list is "Dr Swank was ahead of his time"...as he recommended consuming cod-liver oil tablets...and lotsa fish. My second thought is that the traditional Japanese breakfast usually includes a serve of salmon (as well as miso soup, rice, and some veges). Tokyo, Japan has a low rate of MS...though it's a similar latitude to Melbourne, Australia. Is MS entirely genetic???
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Postby Algis » Mon Aug 16, 2010 3:11 am

traditional Japanese breakfast usually includes a serve of salmon (as well as miso soup, rice, and some veges).


Sorry to disappoint you; but most 'traditional' breakfast in Japan are fast noodles... Beef noodles; veggies noodles, or even seafood noodles - but Tokyo is a darn busy city; no one has time anymore (since a while) and it is even worse than Hong Kong...

They uses more junk food than you think :)
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Call for Vitamin D in milk to help beat cancer, MS

Postby MSUK » Mon Aug 16, 2010 3:52 am

Image

Milk could be fortified with vitamin D to strengthen bones and prevent heart disease, cancer & MS.

The vitamin is credited with a host of benefits but because the body's stores of it are mainly formed by exposure to sunlight many Britons do not have enough of it.

In England, half of the population is low in the 'sunshine vitamin' when winter ends – in Scotland, it is two-thirds.

Dr Ann Prentice, chairman of the scientific advisory committee on nutrition, said: 'It is widely recognised within Government circles that we have a problem now that needs to be addressed. Milk is one of the potential vehicles that could be used.'... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/1334
MS-UK - http://www.ms-uk.org/
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Vit D influence on DNA

Postby Frank » Tue Aug 24, 2010 4:16 am

Treatment: Gilenya since 01/2011, CCSVI both IJV ballooned 09/2010, Tysabri stopped after 24 Infusions and positive JCV antibody test, after LDN, ABX Wheldon Regime for 1 year.
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Postby shye » Wed Aug 25, 2010 4:26 pm

Jimmylegs-
Can't find my previous D tests, (even posted them somewhere on a discussion here on TIMS re D, but can't find that), but just got mine tested again.
Previously had been deficient, despite ten or so years on about 800 IU per day--then went on 10,000 to 14,000 per day, and brought levels up to a good space (can't remember exact figure, but was still room to take more)--then decreased to pretty steady 5,000 IU, and next test was lower, but still okay--but now, despite continued 5000 IU per day, back down to one above the insufficiency level!!
Only thing I think that is the problem here is the Zinc--I also got my Zinc levels tested at same time as the D, but results came back "no sutiable specimen received", which usually means someone at the lab dropped the specimen tube! So will get the zinc retested tomorrow--will post the results when come in next week.
I seem to need more than the norm in zinc, but had decreased the amt recently (still take more than the RDI), trying to evaluate and decrease supplements taken. Am getting all the symptoms of zinc deficiency--depression the worst. But eyesight worsens, coordination worse, skin not as good, hair seems grayer...
Anyway, will immediately go on 10,000 IUs, and increase the zinc after test tomorrow, and possibly increase both even more after get zinc results.
My copper was fine--did not test iron, but will also do that tomorrow, since copper, zinc, and iron are so closely intertwined in many actions.
Whatever, just taking a relatively high amt of Vit D is not the full answer for sure.
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Postby jimmylegs » Wed Aug 25, 2010 5:31 pm

hey shye, it will be interesting to see those zinc results :)

don't you love lab stuff ups :S ah well it happens.

ttfn

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Postby eric593 » Wed Aug 25, 2010 10:37 pm

It's important to take Vit D3 with the biggest meal of the day for maximum absorption, this may help increase levels.

http://www.ncbi.nlm.nih.gov/pubmed/20200983

J Bone Miner Res. 2010 Apr;25(4):928-30.

Taking vitamin D with the largest meal improves absorption and results in higher serum levels of 25-hydroxyvitamin D.
Mulligan GB, Licata A.

Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.

Abstract
Many patients treated for vitamin D deficiency fail to achieve an adequate serum level of 25-hydroxyvitamin D [25(OH)D] despite high doses of ergo- or cholecalciferol. The objective of this study was to determine whether administration of vitamin D supplement with the largest meal of the day would improve absorption and increase serum levels of 25(OH)D.

This was a prospective cohort study in an ambulatory tertiary-care referral center. Patients seen at the Cleveland Clinic Foundation Bone Clinic for the treatment of vitamin D deficiency who were not responding to treatment make up the study group. Subjects were instructed to take their usual vitamin D supplement with the largest meal of the day. The main outcome measure was the serum 259(OH)D level after 2 to 3 months.

eventeen patients were analyzed. The mean age (+/-SD) and sex (F/M) ratio were 64.5 +/- 11.0 years and 13 females and 4 males, respectively. The dose of 25(OH)D ranged from 1000 to 50,000 IU daily. The mean baseline serum 25(OH)D level (+/-SD) was 30.5 +/- 4.7 ng/mL (range 21.6 to 38.8 ng/mL). The mean serum 25(OH)D level after diet modification (+/-SD) was 47.2 +/- 10.9 ng/mL (range 34.7 to 74.0 ng/mL, p < .01).

Overall, the average serum 25(OH)D level increased by 56.7% +/- 36.7%.

A subgroup analysis based on the weekly dose of vitamin D was performed, and a similar trend was observed.Thus it is concluded that taking vitamin D with the largest meal improves absorption and results in about a 50% increase in serum levels of 25(OH)D levels achieved. Similar increases were observed in a wide range of vitamin D doses taken for a variety of medical conditions.

PMID: 20200983 [PubMed - in process]
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Re: My doctor's thoughts on vitamin D

Postby Mirry » Thu Aug 26, 2010 7:07 am

He also strongly advocates getting plenty of sun, as the body of a white person can produce 25,000 untis simple by spending a half hour in the sun.


At my appointment yesterday I asked my specialist if there was anything I should avoid with MS. He pointed out of the window to the "sun" and told me to stay out of it as it is not good for people with MS :? I did tell him it's a little difficult living in Las Vegas.

Has anyone else heard this, as so far, most things I read, say a little sun is good for those with MS

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Re: My doctor's thoughts on vitamin D

Postby L » Thu Aug 26, 2010 7:35 am

Mirry wrote:He also strongly advocates getting plenty of sun, as the body of a white person can produce 25,000 untis simple by spending a half hour in the sun.


At my appointment yesterday I asked my specialist if there was anything I should avoid with MS. He pointed out of the window to the "sun" and told me to stay out of it as it is not good for people with MS :? I did tell him it's a little difficult living in Las Vegas.

Has anyone else heard this, as so far, most things I read, say a little sun is good for those with MS

Mirry


I'm disappointed with your neurologist! Sack him! Unless heat intolerance is specifically bad with you then the sun's good. I read somewhere that, for MS, the UV component may be beneficial as well as the D3!

Unfortunately summer seems to have ended in London..
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Postby jimmylegs » Thu Aug 26, 2010 7:47 am

sounds like there's some mix up going on between heat sensitivity, and d3 synthesis!

also, re how much d3 is made in skin in 30 minutes, if you have not seen them before it sounds like your doc is referring to articles like these:

Am J Clin Nutr. 1999 May;69(5):842-56.
Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety.
Vieth R.

Abstract
...Total-body sun exposure easily provides the equivalent of 250 microg (10,000 IU) vitamin D/d, suggesting that this is a physiologic limit.

...The assembled data from many vitamin D supplementation studies reveal a curve for vitamin D dose versus serum 25-hydroxyvitamin D [25(OH)D] response that is surprisingly flat up to 250 microg (10,000 IU) vitamin D/d.

...To ensure that serum 25(OH)D concentrations exceed 100 nmol/L, a total vitamin D supply of 100 microg (4000 IU)/d is required.

Except in those with conditions causing hypersensitivity, there is no evidence of adverse effects with serum 25(OH)D concentrations <140 nmol/L, which require a total vitamin D supply of 250 microg (10000 IU)/d to attain.

Published cases of vitamin D toxicity with hypercalcemia, for which the 25(OH)D concentration and vitamin D dose are known, all involve intake of > or = 1000 microg (40,000 IU)/d.

Because vitamin D is potentially toxic, intake of >25 microg (1000 IU)/d has been avoided even though the weight of evidence shows that the currently accepted, no observed adverse effect limit of 50 microg (2000 IU)/d is too low by at least 5-fold.


there's also this other article (Adams and Hollis, "Vitamin D: Synthesis, Metabolism, and Clinical Measurement." In: Coe and Favus, eds., Disorders of Bone and Mineral Metabolism, Philadelphia: Lippincott Williams and Wilkins (2002) p. 159.) but i can't get full text right now - just a reference to its content at this site:

http://www.cholesterol-and-health.com/Vitamin-D.html#2
When atmospheric conditions are ideal and skies are clear, 30 minutes of whole-body exposure of pale skin to sunlight without clothing or sunscreen can result in the synthesis of between 10,000 and 20,000 IU of vitamin D. These quantities of vitamin D are large, and therefore capable of supplying the body's full needs.
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Postby shye » Thu Aug 26, 2010 3:20 pm

Taking vitamin D with the largest meal improves absorption and results in higher serum levels of 25-hydroxyvitamin D.

I've been taking it with the largest meal, AND usually with 1 tsp cod oil--yet not absorbing it. As I say, will take 10,000 IU of D and will up the zinc quite a bit, and test levels again in 2 months.
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vitamin D metabolism

Postby hwebb » Mon Aug 30, 2010 2:54 pm

It may not be your exposure to sun, but your ability to metabolise vitamin D which is important.

http://www.abc.net.au/science/articles/ ... 596859.htm
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Postby jimmylegs » Tue Aug 31, 2010 10:14 am

i have personally found that adequate mineral status (calcium, magnesium, zinc) is key for absorption. my D3 dose response changed dramatically after dealing with magnesium and zinc problems.
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