Granulomas in sarcoidosis can make their own vitamin D

DEAR DR ROACH: Many years ago, while I was battling breast cancer, a scan showed spots of concern in my midthoracic area. Upon further testing, it was determined that I have sarcoidosis. My pulmonologist warned me to stop all calcium and vitamin D supplements. Now, after 15 years, my primary care doctor wants me to begin taking a multivitamin. I am 70, and my diet is not the best it could be. But I can find no supplements that eliminate calcium and/or vitamin D. My husband was a pharmacist and I still use his partner as my current pharmacist. He can think of no way to get past this requirement. 

ANSWER: First, let me tell you why your pulmonologist is concerned about calcium and vitamin D. Sarcoidosis is a disease affecting potentially all organs of the body with granulomas: large collections of cells that coalesce together. Most commonly affecting the lungs, sarcoidosis also affects the skin, joints and eyes.

These granulomas have the ability to make an active type of vitamin D called 1,25-dihydroxyvitamin D. The active form occasionally can cause calcium levels in the blood to increase, although many people with sarcoidosis have low vitamin D. I suspect your pulmonologist has found normal or high levels of calcium and vitamin D, hence the advice to avoid supplementation.

I seldom recommend multivitamins. Recently, study after study has shown no benefit to taking them. I would much rather people add more fresh vegetables, fruits and legumes to their diet. These have proven benefit beyond their vitamin content.

I'd ask your doctor if there is a specific reason to be concerned about vitamin intake beyond your suboptimal diet. If you still want to take a vitamin, you could consider "B complex" vitamins with vitamin C. These have negligible calcium and no vitamin D.

DEAR DR. ROACH: Some studies show that people who have their appendix removed do not develop Parkinson's disease or do so more slowly. My father had some symptoms of Parkinson's but never became as ill as his brothers and sisters, who had severe cases. My father had his appendix removed. I am curious about this. Do you think more research will be done? 

ANSWER: More research has indeed been done, even since A.L.R. submitted this question. A study from last year in October looked at records of 1.7 million people and showed a 20% decreased incidence of Parkinson's disease -- a progressive neurological disease predominantly affecting movement -- in people who had undergone appendectomy. Further, the study showed a delay of over three years in the onset of Parkinson's, suggesting that the appendix may play a role.

However, in May, a different study came to the opposite conclusion. Researchers studied the medical records of 62 million patients, and compared the risk of Parkinson's based on whether they had had their appendix out. Those who had surgical removal had a 1% risk of Parkinson's; those who did not have surgery had only a 0.3% risk of Parkinson's, showing an apparent tripling in risk for Parkinson's among those who had surgery.

It's not unknown to have conflicting studies in medical science, and it does seem that something "bad" for you one day is "good" for you a few years later. I'm thinking about coffee, for example. The type of study design in both studies only indicates an association, not whether the appendectomy increases or decreases risk.

Given that when you have appendicitis, Parkinson's risk is far from your (or your surgeon's) mind, the question is largely academic. Further research may help scientists better understand the underlying causes of Parkinson's.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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