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Adaptive Innovations in Surgery: Vitamin D, Iodine, and Selenium

Adaptive Innovations in Surgery: Vitamin D, Iodine, and Selenium. Donald W. Miller, Jr., M.D. Professor of Surgery, Division of Cardiothoracic Surgery University of Washington School of Medicine Surgery Grand Rounds October, 2007.

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Adaptive Innovations in Surgery: Vitamin D, Iodine, and Selenium

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  1. Adaptive Innovations in Surgery: Vitamin D, Iodine, andSelenium Donald W. Miller, Jr., M.D. Professor of Surgery, Division of Cardiothoracic Surgery University of Washington School of Medicine Surgery Grand Rounds October, 2007

  2. Christensen CM, Bohmer R, Kenagy J. Will Disruptive Innovations Cure Health Care? Harvard Business Review 2000;78(Sept-Oct):106-112.

  3. Christensen CM, Bohmer R, Kenagy J. Will Disruptive Innovations Cure Health Care? Harvard Business Review 2000;78(Sept-Oct):106-112.

  4. Vitamin D 26 + cells throughout the body UVB photons 7-dehydrocholesterol

  5. Recommended Dietary Allowance (RDA) for Vitamin D: 400 IU/day (to prevent rickets in children, osteomalacia in adults, and osteoporosis in the elderly)

  6. Colon Cancer Mortality Rates: White Females, 1970-1994

  7. Breast Cancer Mortality Rates and Contours of Annual Mean Daily Solar Irradiance Lappe JM, etal. Vitamin D and calcium supplementation reduces cancer risk: Results of a randomized trial. Am J Clin Nutr 2007;85:1586-1591.

  8. Multiple Sclerosis in World War II Veterans by Latitude and State of Residence Wallin MT, etal. Multiple sclerosis in US veterans… Ann Neurol 2004;55:65-71

  9. Seasonal Variation in 25-hydroxy D3 Levels in People at Latitude 48° N Cannell JJ, etal. Epidemic influenza and vitamin D. Epidemiol Infect 2006;134:1129-1140.

  10. Cannell JJ, etal. Epidemic influenza and vitamin D. Epidemiol Infect 2006;134:1129-1140

  11. Noncalcemic Functions of 1,25 dihydroxyvitamin D3 Cytokines Adaptive Innate Immune modulation

  12. Tuberculosis Treated with Sunshine

  13. Immunomodulatory Effects of 1,25-dihydroxyvitamin D3

  14. 25-hydroxyvitamin D3 Blood Levels Calcium Absorption Severely deficient < 8 ng/ml Deficient 8-19 ng/ml Insufficient 20-29 ng/ml Sufficient 30-49 ng/ml Optimal 50-99 ng/ml Excessive 100-150 ng/ml Toxic >150 ng/ml 32 ng/ml PTH Levels (1 ng/ml = 2.5 nmol/L, 1 nmol/L = O.4 ng/ml)

  15. Preop Vitamin D3 levels in 73 Veterans Undergoing Heart Surgery at VAPSHCS * Prostrate cancer – 3; Colon cancer – 1; Tonsillar cancer – 1; Melanoma -- 1 Surgery performed December 2006 – July 2007

  16. Sources of Vitamin D Cholecalciferol (D3) and Ergocalciferol (D2) Dietary Natural Salmon (wild, 3.5 oz) 800 IU D3 Salmon (farmed, 3.5 oz) 150 IU D2 or D3 Cod liver oil (1 tsp) 400-1100 IU D3 Tuna (canned, 3.6 oz) 230 IU D3 Egg yolk 20 IU D 2 or D3 Fortified Foods Milk (8 oz) 100 IU D3 Orange juice (8 oz) 100 IU D3 Infant formula (8 oz) 100 IU D3 Butter (3.5 oz) 50 IU D3 Breakfast cereals/serving 100 IU D3 Supplements Prescription Ergocalciferol (D2) 50,000 IU/capsule Over the Counter Multivitamins 400 IU D2 or D 3 Cholecalciferol (D3) 400, 800, 1000, 2000, 5000 and 50,000 IU/tablet Skin synthesizes 20,000 IU D3 in 20 minutes when exposed to sunlight 5,000 IU D3 50,000 IU D3 OTC at vitalady.com, lifespannutrition.com

  17. Human Migration Out of Africa 35° N 35° S Lamson Rl, etal. SLC24A5, a putative cation exchanger, affects pigmentation in zebrafish and humans. Science 2005;310:1782-1786.

  18. Indigenous Human Skin Color by Latitude 35° N 35° S Jablonski NG, Chaplin G. The evolution of human skin coloration. J Hum Evol 2000;39:57-106

  19. Serum 25-hydroxyvitamin D3 Levels on 0, 1000, 5000, and 10,000 IU of Vitamin D3 a Day (80 ng/ml) 80 ng/ml 10,000 IU qd 60 ng/ml (60 ng/ml) 5000 IU qd 30 ng/ml (30 ng/ml) 1000 IU qd 0 Heany RP, etal. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 2003;77:204-210.

  20. Benefits of Vitamin D • Skeletal-muscular • Strong muscles and bones • Infections • Prevent influenza, treat tuberculosis • Cancer • Prevent breast, colon, and prostate cancer • ? Suppress metastasizes • Autoimmune Diseases • Prevent multiple sclerosis and type 1 diabetes • Cardiovascular Disease • Slow progression of atherosclerosis • Treat hypertension and congestive heart failure • Neuropsychiatric Disorders • Prevent schizophrenia and relieve depression

  21. Iodine

  22. Iodine in Surgery

  23. Iodine in Thyroid Hormones Iodine atoms

  24. Iodine Deficiency Disorders Goiter Mental Retardation Cretinism

  25. The Earth’s 3rd Atmosphere, from 2.2 Ga Oxygen Level in Atmosphere (Percent) 4.6 3.6 2.6 1.6 0.6 Billion Years Ago • Photosynthesis first done by Cyanobacteria: • 6CO2 + 6H2O → C 6H12O6 + 6O2 • Cyanobacteria are also the first life forms to tolerate and use………………… Iodine

  26. Iodine as an Antioxidant Reactive Oxygen Species I-+ H2O2 HIO + OH- HIO + I- + H+I2 + H2O Kupper FC, et al. Iodine uptake in Laminariales involves extracellular, haloperoxidase-mediated oxidation of iodide. Planta 1998;207:163-171.

  27. Reactive Oxygen Species Ionizing Radiation Photosynthesis: Chlorophyll Sunlight CO2 Lane, N. Oxygen: The Molecule that Changed the World London: Oxford University Press, 2004.

  28. Iodine as an Antioxidant PreventLipid Peroxidation Omega 6 Arachidonic Acid (AA) Iodolactone I- Omega 3 Docosahexaenoic Acid (DHA)

  29. Functions of Iodine Organic (Thyroidal) A Component of Thyroxine and T3 Inorganic (Extrathyroidal) An Antioxidant Trigger Apoptosis Other Detoxify chemicals and biological toxins Coat external proteins rendering them non-allergic Suppress auto-immunity Strengthen immune system Mucosal defense in stomach, mouth, vagina ? Prevent cardiac arrhythmias

  30. Iodine-Induced Apoptosis in Lung Cancer Iodine Sensitive Lung Cancer Cells Parent (unmodified) Lung Cancer Cells Zhang L. et al. Nonradioactive iodide effectively induces apoptosis in genetically modified lung cancer cells. Cancer Res 2003;63:5065-5072

  31. Effect of Iodine on Tumor Growth in Mice Genetically Modified Tumor Xenograft Controls Genetically Modified Tumor Xenograft with Iodine Zhang L. et al. Nonradioactive Iodide Effectively Induces Apoptosis in Genetically Modified Lung Cancer Cells. Cancer Res 2003;63:5065-5072

  32. Organs with Iodine Concentrating AbilityVia the Sodium/Iodine Symporter Pump Stomach Mucosa Mammary Glands Salivary Glands Other:Cervix andOvaries Thymus Epidermis Choroid Plexus Articular, Arterial, and Skeletal Systems 125I total-body scintiscans 30 min 6 hr 20 hr Venturi S, et al. Role of Iodine in Evolution and Carcinogenesis of Thyroid, Breast and Stomach. Adv Clin Path 2000;4:11-17.

  33. The Conventional MedicineView of Iodine • Iodine is needed only by the thyroid gland in microgram amounts for biosynthesis of thyroid hormones. • RDA for Iodine:100-150 μg/day • 2)A daily intake of more than 1-2 mg/day of iodine isexcessive and potentially harmful.

  34. Worldwide Iodine Nutrition Median urinary iodine concentration of 100-199 ug/L with corresponding approximate iodine intake 150-299 ug/day International Council for the Control of Iodine Deficiency Disorders. Current IDD Status Database, 2003.

  35. Iodine Intake in Japan Iodine Intake 1950-1963: 13.8 mg/per capita/day (average 4.5 gm seaweed a day. Measured Iodine content 0.3mg/gm) Seaweed consumption in 2001: 14.6 gm (dry weight) Iodine Intake 2001: 43.8 mg If Iodine content the same (was not measured) Nutrition in Japan, 1964. Nutrition Section, Bureau of Public Health, Ministry of Health and Welfare, Tokyo, Japan, March 1965.

  36. Iodine Intake in the United States NHANES I, 1971-741 NHANES III, 1988-911 NHANES 2000 Median 32.00 14.5 16.1 SE 0.6   0.3 0.7 1Hollowell, JE et al. Iodine nutrition in the United States. Trends and public health implications: Iodine excretion data from National Health and Nutrition Examination Surveys I and III (1971-74 and 1988-94). J Clin Endocrinol Metab 83:3401-3408. 1998. Urinary iodine levels (µg/L) in the United States, age 6-74 Current Average Daily Intake of Iodine: 240 µg (0.24 mg) Iodine Intake in 1970s: 480 µg (0.48 mg) 320 161 145

  37. Health Comparisons: United States and Japan United States Japan Incidence of Breast Highest in World Lowest Cancer Life Expectancy77.85 years 81.25 years (48th/226 countries) (No. 6) Infant Mortality Rate 7.0 3.5 (deaths under age 1 per (Lowest in World) 1,000 live births)

  38. When you seek a new path to truth, you must expect to find it blocked by expert opinion. Albert Guérard Education of a Humanist

  39. The Real Truth on IodineDose-Related Benefits In microgram (μg) amounts: In milligram (mg) amounts: In gram (g) amounts: For thyroid hormone Achieve optimal health Prevent (and treat) fibrocystic disease of the breast Prevent cancer Civil Defense Treat multiple diseases: dermatologic, pulmonary, cardiovascular, fungal

  40. Iodine Poisoning Ingested 15 gmof Iodine – 100,000 x the RDA of 0.00015 gm (150 μg) Serum Iodide level was 2,950 ug/dL (normal is 3.5 μg/dL with daily intake of 150 ug Iodine) Salivary Iodide Level 60,000 ug/dL (normal 105 μg/dL)

  41. Albert Szent-Györygi (1893-1986) In 1983, at the Marine Biological Laboratory, Woods Hole, MA In 1937, when awarded the Noble Prize for discovering vitamin C

  42. Iodine in Dermatology Sporotrichosis Sterling JB, Heymann WR. Potassium iodide In dermatology: A 19th century drug for the 21st century—uses, pharmacology, adverse effects, and contraindications. J Am Acad Dermatol 2000;43:691-697. Nodular Vasculitis Pyoderma Gangrenosum

  43. Fibrocystic Breast Disease Cyst Fibrous tissue Epithelial and apocrine hyperplasia Elemental Iodine, I2, more effective than Iodide, I- Ghent WR, Eskin BA, Low DA, Hill LP. Iodine replacement in fibrocystic disease of the breast. Can J Surg 1993;36:453-460.

  44. Diatomic Iodine (I2)Treatment for Fibrocystic DiseaseSpecial Report of Efficacy and Safety Results(Submitted to FDA 21 March 1995) The Virginia Mason Randomized Controlled Trial

  45. Iodine Prevents Breast Cancer Animal Studies Reduced incidence in rats given carcinogens Human Studies Kills cancer cells grown in vitro Absorbed by cancer-prone ductal epithelium Epidemiological Studies Increased incidence with goiter Lower incidence in people who eat seaweed and fish Miller DW. Extrathyroidal Benefits of Iodine. J Am Phys Surg 2006;11(4-Winter):106-110.

  46. Different Kinds of Iodine Inorganic, Nonradioactive (127I) KI, SSKI, Lugol’s Solution, Iodoral, Tincture of Iodine, Povidone-Iodine Organic Endogenous Thyroid hormones Synthetic Amiodarone Radiocontrast media Iopanoic acid, Meglumine Iotroxate, Propyliodone, etc. (Inorganic) Radioactive Isotopes

  47. Oral Iodine KI (Potassium Iodide) A 130 mg tablet contains 100 mg of iodide SSKI (Saturated Solution of Potassium Iodide) 38 mg/drop iodide (760 mg/ml) 19 mg/drop in Tahoma Clinic’s SSKI Tri-Quench Lugol’s Solution -- 5% iodine (I2) and 10% KI 6.5 mg/drop blend of iodine and iodide (130 mg/ml) Iodoral -- 5% iodine and 10% KI One tablet = 12.5 mg blend of iodine and iodide

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