There is also the possibility that winter darkness worsens CPPS. Instead of absence of vitamin D. or possibly both. So how may winter darkness affect CPPS? Perhaps through melatonin level variation.
Melatonin is thought to affect the “inner clock” (synchronizing the photoperiod of an organism), reproduction, metabolism, thermoregulation and immune function. The effect on the “inner clock” is known since long, while the effects on the immune system are a pretty new area of research.
Recent research indicate that melatonin has an immuno-stimulating effect. It stimulates the production of e.g. IL-1, IL-2, IL-6, IL-12 and gamma-interferon, but not IL-4. Human studies “suggest that melatonin may favour a Th1 cell response”. Th1 regulation needs, as we just saw, vitamin D.
Excessive “melatonin production may be involved in glucocorticoid resistance”, which usually causes inflammation. Sufferers of rheumatoid arthritis (RA) have been found to have higher levels and longer night time peaks of melatonin and thus a more marked up-regulation of immune function than controls. RA sufferers do also normally have more pain and/or muscle/joint stiffness in the morning than in the evening.
What is interesting, is that levels of melatonin, some cytokines and interleukins was higher the more northerly RA-patients lived, thus explaining the higher prevalence of RA in Balto-Scandinavian countries compared to Mediterranean countries. The same study also measured cortisol levels and found no differences in those. “A diurnal rhythmicity in healthy humans between cellular (Th1 type) or humoral (Th2 type) immune responses has been found and related to immunomodulatory actions of cortisol and melatonin.” (1,2)
As CP/CPPS shows a similar south to north gradient it would be very interesting to study if CP/CPPS sufferers show a similar pattern of melatonin secretion. Decreased night-time melatonin secretion during the longer summer daylight above 50 degrees of latitude may explain summer (and early fall) remission in addition to vitamin D. RA has also been shown to improve with higher levels of vitamin D.(3) A bit odd though as a low night-time melatonin (and if the nighttime peak occurs too early or late) level is correlated with e.g. seasonal depression and prostate cancer growth, while CPPS is not correlated with prostate cancer but with winter time depression. On the other hand high night-time levels are correlated with higher anxiety, which seems more common during winter in CPPS.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, överaktiv blåsa, köld, värme, vinter, sommar, D-vitamin, auto-immun sjukdom, Th1/Th2, melatonin.
__________________
(1) Cutolo M, Maestroni GJM. The melatonin-cytokine connection in rheumatoid arthritis.Ann Rheum Dis 64:1109-1111, 2005.
(2) Cutolo M, Sulli A, Pizzorni C, Secchi ME, Soldano S, Seriolo B, Straub RH, Otsa K, Maestroni GJ. Circadian rhythms: glucocorticoids and arthritis. Ann N Y Acad Sci. 1069:289-299, 2006.
(3) Pelajo CF, Lopez-Benitez JM, Miller LC. Vitamin D and Autoimmune Rheumatologic Disorders. Autoimmun Rev. 2010 Feb 8. [Epub ahead of print]
Saturday, March 27, 2010
CPPS, the sun and vitamin D part 2
Calcium, cancer and pituitary
Can rising parathyroid hormone concentrations or changed calcium metabolism / homeostasis with decreasing D-vitamin levels trigger CP/CPPS or some of its symptoms? Maybe, as vitamin D and “calcium malnutrition eventually causes a decrease in calcium concentration in extracellular fluid compartments, resulting in organ-specific… attenuation of signal transduction from the ligand-activated vitamin D receptor and calcium-sensing receptor” causing “perturbation of cellular functions in bone, kidney, intestine, mammary and prostate glands, endocrine pancreas, vascular endothelium, and, importantly, in the immune system.”(1) Calcium deficiency may also promote breast, prostate and colorectal cancer. Adequate calcium levels may also regulate Th1 (cellular) immune response.
It is interesting that the vitamin D receptor (VDR) is present in the pituitary, which is central in diuretic and prostaglandin regulation. Especially as there are many indications of pituitary dysfunction in CPPS sufferers.
Nutritional adequacy
More or less everyone living north of the 60th parallel will have insufficient levels of vitamin D or out-right deficiency by the end of winter. This is because there is not enough sunlight from November to March. This is also exacerbated by indoors living and clothing during the summer months.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, överaktiv blåsa, köld, värme, vinter, sommar, D-vitamin, auto-immun sjukdom, Th1/Th2.
___________________
(1) Peterlik M, Cross HS. Vitamin D and calcium deficits predispose for multiple chronic diseases. Eur J Clin Invest 35(5):290-304, 2005.
Can rising parathyroid hormone concentrations or changed calcium metabolism / homeostasis with decreasing D-vitamin levels trigger CP/CPPS or some of its symptoms? Maybe, as vitamin D and “calcium malnutrition eventually causes a decrease in calcium concentration in extracellular fluid compartments, resulting in organ-specific… attenuation of signal transduction from the ligand-activated vitamin D receptor and calcium-sensing receptor” causing “perturbation of cellular functions in bone, kidney, intestine, mammary and prostate glands, endocrine pancreas, vascular endothelium, and, importantly, in the immune system.”(1) Calcium deficiency may also promote breast, prostate and colorectal cancer. Adequate calcium levels may also regulate Th1 (cellular) immune response.
It is interesting that the vitamin D receptor (VDR) is present in the pituitary, which is central in diuretic and prostaglandin regulation. Especially as there are many indications of pituitary dysfunction in CPPS sufferers.
Nutritional adequacy
More or less everyone living north of the 60th parallel will have insufficient levels of vitamin D or out-right deficiency by the end of winter. This is because there is not enough sunlight from November to March. This is also exacerbated by indoors living and clothing during the summer months.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, överaktiv blåsa, köld, värme, vinter, sommar, D-vitamin, auto-immun sjukdom, Th1/Th2.
___________________
(1) Peterlik M, Cross HS. Vitamin D and calcium deficits predispose for multiple chronic diseases. Eur J Clin Invest 35(5):290-304, 2005.
Sunday, March 21, 2010
CPPS, the sun and vitamin D
Prostatitis is currently not one of the diseases thought to be related to low D levels, but many of the symptoms in CP/CPPS seem to be related to either immunological-inflammatory and/or neuromuscular problems. Anecdotal evidence and the studies mentioned earlier indicate that prostatitis symptoms worsen in winter and late spring when bodily D-vitamin stores are at their lowest. This raises the question if cold or D-vitamin insufficiency/deficiency is the cause, or maybe both? So why may vitamin D play a role?
Immuno-modulation and other properties
It was earlier believed that D3 (cholecalciferol) only use was to aid bone mineralization (calcium and phosphorus metabolism), but research has shown that it is a very “potent” and important substance for many bodily processes(1). D3 (or rather its metabolite calcitriol) is very important as mediator of gene transcription (e.g. the prostate specific antigen), immune response(2) (macrophage functions, T- and B-lymphocyte mediated response, NOS induction), blood pressure regulation, regulation of platelet aggregation, insulin production, cell cycle regulation (proliferation and differentiation) in epithelial tissues, synovial cells and many other cell types and tissues(3) (e.g. pituitary cells), and also of neuromuscular function. This is due to the almost ubiquitous vitamin D receptors (VDR).
Decreasing D-vitamin levels are associated with an increase in vulnerability to infection. Vitamin D (or rather its metabolite calcitriol) is a strong immuno-regulatory hormone (e.g inhibition of IL-1, IL-2, IL-6, IL-12, TNF-alpha, INF-gamma etc) (see Peterlik and Cross, 2005, for references) and recent research has also shown that it promotes production of several anti-microbial peptides.(4-5) Especially cathelicidins(6), which also have been shown to protect the urinary tract against infection.(7)
It is also interesting that recent cancer research has shown that calcitriol regulates “the expression of genes involved in the metabolism of prostaglandins”. It significantly represses expression of COX-2 and EP2 and FP receptors, and also up-regulates 15-hydroxyprostaglandin dehydrogenase.(8)
Diseases correlated with D
Diseases thought to be, or proven to be related with low levels of D are many cancers (stomach, colorectal, liver, gall bladder, pancreas, lung(9), female breast, prostate,(10-11) bladder, kidney(12)), tubercolosis(13), multiple sclerosis,(14-15), rheumatoid arthritis (16) (Merlino, Curtis et al.), diabetes type 1/ insulin resistance (Hypponen, Laara et al.), hyperparathyroidism,(17) systemic lupus erythematosus, osteoarthritis, ankylosing spondylitis and, possibly, fibromyalgia, SAD, schizophrenia,(18-19) Crohn’s disease, ulcerative colitis, irritable bowel syndrome, periodontitis and genigivitis,(20) and colorectal cancer.(21) Epidemiological studies (corrected for other factors) indicate that these diseases are more common and severe the more north you live.
The immune conditions above (RA, SLE, MS, IBS and diabetes) are thought to be caused by too low calcitriol (a vitamin D metabolite) levels to prevent a “pathological activation of Th-1 responses” (Peterlik and Cross, 2005).
Some of these diseases and activation of Th1 (cellular) immunity are also correlated to and overlap with CPPS and other urological problem.
Prostate cancer and D
Prostate cancer (Hanchette and Schwartz, Tuohimaa) is e.g. one of the cancers following the latitudinal pattern and D-vitamin has shown to be effective against pre-cancerous cells (Nonn et al.). The vitamin D receptor (VDR) is present in the prostate.
Muscle pain, weakness and depression
It is interesting to note that D-vitamin deficiency may manifest itself as pain and fatigue (ATP-deficiency), which also is characteristic for fibromyalgia and myofascial syndrome. A study found that people with less than 40 nmol/l walked more slowly and had more problems rising from chairs than people with more than 90 nmol/l.(22) Vitamin D has been proven effective for treating musculoskeletal pain.(23) D-vitamin insufficiency is a known cause of tiredness and depression (especially SAD).
Approximate vitamin D levels in sufferers of various diseases and conditions. Levels at the end of winter (march) and early fall (september), and lifeguards and multiple sclerosis treatedment (24) added for comparison.(25)
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, överaktiv blåsa, köld, värme, vinter, sommar, D-vitamin, auto-immun sjukdom, Th1/Th2.
_____________
Additional information on vitamin D
Vitamin D council
Grassroots health
References
(1) Humble M. D-vitaminbrist kanske vanligare än vi trott. Prevention och behandling skulle kunna ge oanade folkhälsoeffekter. [Vitamin D deficiency probably more common than earlier apprehended. Prevention and treatment could result in unexpected public health effects]. Läkartidningen 104(11):853-857, 2007. Article in Swedish.)
(2)van Etten E, Mathieu C. Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. J Steroid Biochem Mol Biol. 97(1-2):93-101, 2005.
(3) Peterlik M, Cross HS. Dysfunction of the vitamin D endocrine system as common cause for multiple malignant and other chronic diseases. Anticancer Res 26(4A):2581-2588, 2006.
(4) Cannell JJ, Vieth J, Umhau C, Holick MF, Grant B, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Epidemiology and Infection 136:1129-1140, 2006.
(5) Weber G, Ståhle M Vitamin D induces the antimicrobial protein hCAP18 in human skin. J Invest Dermatol 124(5):1080-1082, 2005.
(6) ”Cathelicidins have a very broad spectrum of activity, and promote wound healing and re-epthelialization of breaks in the skin: they are absent in chronic (non-healing) ulcers. [Heilborn JD, Nilsson MF, Kratz G, et al., The cathelicidin anti-microbial peptide LL-37 is involved in re-epithelialization of human skin wounds and is lacking in chronic ulcer epithelium. J Invest Dermatol. 120(3): 379-89, 2003] Cathelicidins have activity against intracellular bacteria; this has been demonstrated in Mycobacterium tuberculosis [Liu PT, Stenger S, Li H, Wenzel L. et al., Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006 Mar 24;311(5768):1770-3] Cathelicidins are active in the innate defence system of the gut, lining the mucosa and preventing attachment by epithelial-adherent bacterial pathogens. [Dann SM, Eckmann L. Innate immune defenses in the intestinal tract. Curr Opin Gastroenterol. 2007 Mar;23(2):115-20.] Cathelicidins are active in vitro against Herpes Simplex Virus and cathelicidin deficiency has been found in persons with eczema herpeticum. [Howell MD, Wollenberg A, Gallo RL. et al., Cathelicidin deficiency predisposes to eczema herpeticum. J Allergy Clin Immunol. 2006 Apr;117(4):836-41.]” (http://www.davidwheldon.co.uk/vit_D.html.)
(7) Chromek M, Gallo RL The antimicrobial cathelicidin protects the urinary tract against invasive bacterial infection. Nature Medicine 12:636-641, 2006.
(8) Moreno J, Krishnan AV, Swami S, Nonn L, Peehl DM, Feldman D. Regulation of prostaglandin metabolism by calcitriol attenuates growth stimulation in prostate cancer cells. Cancer Res 65(17):7917-7925, 2005.
(9) Porojnicu AC, Robsahm TE, Dahlback A, Berg JP, Christiani D, Bruland OS, Moan J. Seasonal and geographical variations in lung cancer prognosis in Norway. Does Vitamin D from the sun play a role? Lung Cancer. 55(3):263-270, 2007.
(10) Lagunova Z, Porojnicu AC, Dahlback A, Berg JP, Beer TM, Moan J. Prostate cancer survival is dependent on season of diagnosis. Prostate 67(12):1362-1370, 2007.
(11) Schwartz GG, Hanchette CL. UV, latitude, and spatial trends in prostate cancer mortality: all sunlight is not the same (United States). Cancer Causes Control. 17(8):1091-1101, 2006.
(12) Tuohimaa P, Pukkala E, Scélo G, Olsen JH, Brewster DH, Hemminki K, Tracey E, Weiderpass E, Kliewer EV, Pompe-Kirn V, McBride ML, Martos C, Chia KS, Tonita JM, Jonasson JG, Boffetta P, Brennan P. Does solar exposure, as indicated by the non-melanoma skin cancers, protect from solid cancers: Vitamin D as a possible explanation. Eur J Cancer 43(11):1701-12, 2007.
(13) People with D-vitamin deficiency are much easier infected, and an increase in active D in the body helps fight the infection (remember the sanatorium treatments with lots of “fresh air”, i.e. sunlight !)
(14) There is also concern that nutritional factors help promote MS. Like: cereals, legumes, dairy products, too little Omega-3 and too much Omega-6, antioxidant deficiencies and low fibre (from fruits and vegetables) consumption (A Embry, http://www.direct-ms.org).
(15) Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA 296(23):2832-2838, 2006.
(16) Cutolo M, Otsa K, Laas K, Yprus M, Lehtme R, Secchi ME, Sulli A, Paolino S, Seriolo B. Circannual vitamin d serum levels and disease activity in rheumatoid arthritis: Northern versus Southern Europe. Clin Exp Rheumatol. 24(6):702-704, 2006.
(17) Chronic vitamin-D insufficiency or deficiency may cause any of the parathyroid glands to become “stuck in high gear” while trying to keep calcium levels in the body within “safe” limits, which may cause a lot of problems when you really do get D-vitamin see www.parathyroid.com for more info.
(18) Carrión-Baralt JR, Fuentes-Rivera Z, Schmeidler J, Silverman JM. A case-control study of the seasonality effects on schizophrenic births on a tropical island. Schizophr Res. 71(1):145-53, 2004
(19) Carrión-Baralt JR, Smith CJ, Rossy-Fullana E, Lewis-Fernández R, Davis KL, Silverman JM. Seasonality effects on schizophrenic births in multiplex families in a tropical island. Psychiatry Res 142(1):93-7, 2006
(20) Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence? BJN 89:552-572, 2003.
(21) Garland C, Shekelle RB, Barrett-Connor E, Criqui MH, Rossof AH, Paul O. Dietary vitamin D and calcium and risk of colorectal cancer: a 19 year prospective study in men. Lancet 1:307-309, 1985.
(22) Dawson-Hughes B. Vitamin D, how much is enough and why. 5th International Symposium on Nutritional Aspects of Osteoporosis. Lausanne, May 14-17, 2003.
(23) Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, non-specific muscoloskeletal pain. Mayo Clinic Proc. 78(12):1463-1470, 2003.
(24) Kimball SM, Ursell MR, O'Connor P, Vieth R. Safety of vitamin D3 in adults with multiple sclerosis. Am J Clin Nutr 86:645–5, 2007.
(25) From left to right: Chronic pain/fibromyalgia, pain in general, rickets, osteporosis/osteopaenia, respiratory tract infection/ILI, connective tissue disease, polymyalgia rheumatica/giant cell arteritis, inflammatory arthritis/rheumatism in general, osteoarthritis, propensity of falling, general muscle weakness, fatigue, melanoma stage IV, breast cancer, cardio-vascular disease, diabetes mellitus, multiple sclerosis, CPPS (hypothetical), march levesl found in many people living in Europe and northern USA, september levels found in people tanning or moving about a lot in the sun, americam life-guards, people in MS remission due to vitamin D treatment.
Immuno-modulation and other properties
It was earlier believed that D3 (cholecalciferol) only use was to aid bone mineralization (calcium and phosphorus metabolism), but research has shown that it is a very “potent” and important substance for many bodily processes(1). D3 (or rather its metabolite calcitriol) is very important as mediator of gene transcription (e.g. the prostate specific antigen), immune response(2) (macrophage functions, T- and B-lymphocyte mediated response, NOS induction), blood pressure regulation, regulation of platelet aggregation, insulin production, cell cycle regulation (proliferation and differentiation) in epithelial tissues, synovial cells and many other cell types and tissues(3) (e.g. pituitary cells), and also of neuromuscular function. This is due to the almost ubiquitous vitamin D receptors (VDR).
Decreasing D-vitamin levels are associated with an increase in vulnerability to infection. Vitamin D (or rather its metabolite calcitriol) is a strong immuno-regulatory hormone (e.g inhibition of IL-1, IL-2, IL-6, IL-12, TNF-alpha, INF-gamma etc) (see Peterlik and Cross, 2005, for references) and recent research has also shown that it promotes production of several anti-microbial peptides.(4-5) Especially cathelicidins(6), which also have been shown to protect the urinary tract against infection.(7)
It is also interesting that recent cancer research has shown that calcitriol regulates “the expression of genes involved in the metabolism of prostaglandins”. It significantly represses expression of COX-2 and EP2 and FP receptors, and also up-regulates 15-hydroxyprostaglandin dehydrogenase.(8)
Diseases correlated with D
Diseases thought to be, or proven to be related with low levels of D are many cancers (stomach, colorectal, liver, gall bladder, pancreas, lung(9), female breast, prostate,(10-11) bladder, kidney(12)), tubercolosis(13), multiple sclerosis,(14-15), rheumatoid arthritis (16) (Merlino, Curtis et al.), diabetes type 1/ insulin resistance (Hypponen, Laara et al.), hyperparathyroidism,(17) systemic lupus erythematosus, osteoarthritis, ankylosing spondylitis and, possibly, fibromyalgia, SAD, schizophrenia,(18-19) Crohn’s disease, ulcerative colitis, irritable bowel syndrome, periodontitis and genigivitis,(20) and colorectal cancer.(21) Epidemiological studies (corrected for other factors) indicate that these diseases are more common and severe the more north you live.
The immune conditions above (RA, SLE, MS, IBS and diabetes) are thought to be caused by too low calcitriol (a vitamin D metabolite) levels to prevent a “pathological activation of Th-1 responses” (Peterlik and Cross, 2005).
Some of these diseases and activation of Th1 (cellular) immunity are also correlated to and overlap with CPPS and other urological problem.
Prostate cancer and D
Prostate cancer (Hanchette and Schwartz, Tuohimaa) is e.g. one of the cancers following the latitudinal pattern and D-vitamin has shown to be effective against pre-cancerous cells (Nonn et al.). The vitamin D receptor (VDR) is present in the prostate.
Muscle pain, weakness and depression
It is interesting to note that D-vitamin deficiency may manifest itself as pain and fatigue (ATP-deficiency), which also is characteristic for fibromyalgia and myofascial syndrome. A study found that people with less than 40 nmol/l walked more slowly and had more problems rising from chairs than people with more than 90 nmol/l.(22) Vitamin D has been proven effective for treating musculoskeletal pain.(23) D-vitamin insufficiency is a known cause of tiredness and depression (especially SAD).
Approximate vitamin D levels in sufferers of various diseases and conditions. Levels at the end of winter (march) and early fall (september), and lifeguards and multiple sclerosis treatedment (24) added for comparison.(25)
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, överaktiv blåsa, köld, värme, vinter, sommar, D-vitamin, auto-immun sjukdom, Th1/Th2.
_____________
Additional information on vitamin D
Vitamin D council
Grassroots health
References
(1) Humble M. D-vitaminbrist kanske vanligare än vi trott. Prevention och behandling skulle kunna ge oanade folkhälsoeffekter. [Vitamin D deficiency probably more common than earlier apprehended. Prevention and treatment could result in unexpected public health effects]. Läkartidningen 104(11):853-857, 2007. Article in Swedish.)
(2)van Etten E, Mathieu C. Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. J Steroid Biochem Mol Biol. 97(1-2):93-101, 2005.
(3) Peterlik M, Cross HS. Dysfunction of the vitamin D endocrine system as common cause for multiple malignant and other chronic diseases. Anticancer Res 26(4A):2581-2588, 2006.
(4) Cannell JJ, Vieth J, Umhau C, Holick MF, Grant B, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Epidemiology and Infection 136:1129-1140, 2006.
(5) Weber G, Ståhle M Vitamin D induces the antimicrobial protein hCAP18 in human skin. J Invest Dermatol 124(5):1080-1082, 2005.
(6) ”Cathelicidins have a very broad spectrum of activity, and promote wound healing and re-epthelialization of breaks in the skin: they are absent in chronic (non-healing) ulcers. [Heilborn JD, Nilsson MF, Kratz G, et al., The cathelicidin anti-microbial peptide LL-37 is involved in re-epithelialization of human skin wounds and is lacking in chronic ulcer epithelium. J Invest Dermatol. 120(3): 379-89, 2003] Cathelicidins have activity against intracellular bacteria; this has been demonstrated in Mycobacterium tuberculosis [Liu PT, Stenger S, Li H, Wenzel L. et al., Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006 Mar 24;311(5768):1770-3] Cathelicidins are active in the innate defence system of the gut, lining the mucosa and preventing attachment by epithelial-adherent bacterial pathogens. [Dann SM, Eckmann L. Innate immune defenses in the intestinal tract. Curr Opin Gastroenterol. 2007 Mar;23(2):115-20.] Cathelicidins are active in vitro against Herpes Simplex Virus and cathelicidin deficiency has been found in persons with eczema herpeticum. [Howell MD, Wollenberg A, Gallo RL. et al., Cathelicidin deficiency predisposes to eczema herpeticum. J Allergy Clin Immunol. 2006 Apr;117(4):836-41.]” (http://www.davidwheldon.co.uk/vit_D.html.)
(7) Chromek M, Gallo RL The antimicrobial cathelicidin protects the urinary tract against invasive bacterial infection. Nature Medicine 12:636-641, 2006.
(8) Moreno J, Krishnan AV, Swami S, Nonn L, Peehl DM, Feldman D. Regulation of prostaglandin metabolism by calcitriol attenuates growth stimulation in prostate cancer cells. Cancer Res 65(17):7917-7925, 2005.
(9) Porojnicu AC, Robsahm TE, Dahlback A, Berg JP, Christiani D, Bruland OS, Moan J. Seasonal and geographical variations in lung cancer prognosis in Norway. Does Vitamin D from the sun play a role? Lung Cancer. 55(3):263-270, 2007.
(10) Lagunova Z, Porojnicu AC, Dahlback A, Berg JP, Beer TM, Moan J. Prostate cancer survival is dependent on season of diagnosis. Prostate 67(12):1362-1370, 2007.
(11) Schwartz GG, Hanchette CL. UV, latitude, and spatial trends in prostate cancer mortality: all sunlight is not the same (United States). Cancer Causes Control. 17(8):1091-1101, 2006.
(12) Tuohimaa P, Pukkala E, Scélo G, Olsen JH, Brewster DH, Hemminki K, Tracey E, Weiderpass E, Kliewer EV, Pompe-Kirn V, McBride ML, Martos C, Chia KS, Tonita JM, Jonasson JG, Boffetta P, Brennan P. Does solar exposure, as indicated by the non-melanoma skin cancers, protect from solid cancers: Vitamin D as a possible explanation. Eur J Cancer 43(11):1701-12, 2007.
(13) People with D-vitamin deficiency are much easier infected, and an increase in active D in the body helps fight the infection (remember the sanatorium treatments with lots of “fresh air”, i.e. sunlight !)
(14) There is also concern that nutritional factors help promote MS. Like: cereals, legumes, dairy products, too little Omega-3 and too much Omega-6, antioxidant deficiencies and low fibre (from fruits and vegetables) consumption (A Embry, http://www.direct-ms.org).
(15) Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA 296(23):2832-2838, 2006.
(16) Cutolo M, Otsa K, Laas K, Yprus M, Lehtme R, Secchi ME, Sulli A, Paolino S, Seriolo B. Circannual vitamin d serum levels and disease activity in rheumatoid arthritis: Northern versus Southern Europe. Clin Exp Rheumatol. 24(6):702-704, 2006.
(17) Chronic vitamin-D insufficiency or deficiency may cause any of the parathyroid glands to become “stuck in high gear” while trying to keep calcium levels in the body within “safe” limits, which may cause a lot of problems when you really do get D-vitamin see www.parathyroid.com for more info.
(18) Carrión-Baralt JR, Fuentes-Rivera Z, Schmeidler J, Silverman JM. A case-control study of the seasonality effects on schizophrenic births on a tropical island. Schizophr Res. 71(1):145-53, 2004
(19) Carrión-Baralt JR, Smith CJ, Rossy-Fullana E, Lewis-Fernández R, Davis KL, Silverman JM. Seasonality effects on schizophrenic births in multiplex families in a tropical island. Psychiatry Res 142(1):93-7, 2006
(20) Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence? BJN 89:552-572, 2003.
(21) Garland C, Shekelle RB, Barrett-Connor E, Criqui MH, Rossof AH, Paul O. Dietary vitamin D and calcium and risk of colorectal cancer: a 19 year prospective study in men. Lancet 1:307-309, 1985.
(22) Dawson-Hughes B. Vitamin D, how much is enough and why. 5th International Symposium on Nutritional Aspects of Osteoporosis. Lausanne, May 14-17, 2003.
(23) Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, non-specific muscoloskeletal pain. Mayo Clinic Proc. 78(12):1463-1470, 2003.
(24) Kimball SM, Ursell MR, O'Connor P, Vieth R. Safety of vitamin D3 in adults with multiple sclerosis. Am J Clin Nutr 86:645–5, 2007.
(25) From left to right: Chronic pain/fibromyalgia, pain in general, rickets, osteporosis/osteopaenia, respiratory tract infection/ILI, connective tissue disease, polymyalgia rheumatica/giant cell arteritis, inflammatory arthritis/rheumatism in general, osteoarthritis, propensity of falling, general muscle weakness, fatigue, melanoma stage IV, breast cancer, cardio-vascular disease, diabetes mellitus, multiple sclerosis, CPPS (hypothetical), march levesl found in many people living in Europe and northern USA, september levels found in people tanning or moving about a lot in the sun, americam life-guards, people in MS remission due to vitamin D treatment.
Saturday, March 13, 2010
Cold-induced diuresis (CID)
As CPPS micturition problems worsen in winter and cold it may be of interest to know that diuresis can be induced by cold weather (<10-15 C) or cold water (<18-23 C). CPPS sufferers seem to have a more easily induced CID. This may be indicative of low AVP levels, as the reflex can be blocked by administration of AVP or a synthetic analogue (e.g. desmopressin). Murine experiments have also shown that “genetic AVP deficiency abolishes cold-induced diuresis but does not attenuate cold-induced hypertension” and that acute CID is due to AVP reduction, while chronic CID is due to suppression of renal V2 receptors and the associated AQP-2 water channels, rather than inhibition of AVP release.(1)
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, överaktiv blåsa, köld, värme, vinter, sommar, D-vitamin.
______________
(1) Sun Z. Genetic AVP deficiency abolishes cold-induced diuresis but does not attenuate cold-induced hypertension. Am J Physiol Renal Physiol.290(6):F1472-7, 2006.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, överaktiv blåsa, köld, värme, vinter, sommar, D-vitamin.
______________
(1) Sun Z. Genetic AVP deficiency abolishes cold-induced diuresis but does not attenuate cold-induced hypertension. Am J Physiol Renal Physiol.290(6):F1472-7, 2006.
Cold and CPPS
Two interesting facts have been reported by a Finnish study(1). The authors found that prevalence of prostatitis was higher in married men, which could mean that a causal agent could be found in female pathogens. But, they also found that symptoms were worst from November through March (63% of the men, self-reported) and in northern Finland 14% of the men were diagnosed compared to 5-9% in central and southern Europe.
A Swedish study corroborates this data: “Nearly every other man stated that the disease had started in association with a specific event, which for 15 men (31%) included exposure to cold. Forty men (83%) reported that cold caused symptom aggravation and/or induced a relapse. Thirty men (63%) stated that taking a hot bath and 22 (46%) reported that spending time in a hot climate decreased the symptoms.”(2)
This is very interesting as it indicates a cold related factor (as the authors also suggest) or a sun-related problem (like D-vitamin deficiency) or both. The latter is also indicated by a Korean study(3). that found that increased exposure to sunlight decreased CPPS symptoms. The Koreans did not find any correlation with temperature.
Why may cold aggravate symptoms? One obvious cause is muscular tension, another less obvious may be that cold seems to slightly stimulate the immune system. The acute effect of (severe) chilling is a suppression of parts of the cellular and humoral immune response and the induction of heat shock proteins(4). But afterwards levels of proinflammatory cytokines (especially IL-6), natural killer cells, leukocytes, catecholamines and stress hormones are raised. Possibly due to the increased metabolic rate and effort to keep the core body temperature stable (peripheral vasoconstriction, shivering etc).(5-7)
But there is also the possibility of a correlation with blood viscosity and clotting propensity. Cold increases blood viscosity (makes it "thicker" and "less runny"). Viscosity is also higher in the morning, which anecdotally sees worse CPPS problems. Inflammation / infection is also correlated with increased viscosity and clotting propensity.(8) Curiously many treatments (I will discuss those later this year) decreases viscosity and clotting.
Another point of interest is that vitamin D levels are at their lowest in march. And accumulating evidence indicates that infection risk and immune dysregulation increases with lower D levels. Of wich I'll talk in my next installment.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, överaktiv blåsa, köld, värme, vinter, sommar, D-vitamin.
20100314 edited the vitamin D - Korea paras and clarified the viscosity note.
___________
(1) Mehik A, Hellstrom P, Lukkarinen O, Sarpola A, Jarvelin M. Epidemiology of prostatitis in finnish men: a population based cross-sectional study. BJU Int 86(4):443-448, 2000.
(2) Hedelin H, Jonsson K. Chronic prostatitis/chronic pelvic pain syndrome: Symptoms are aggravated by cold and become less distressing with age and time. Scand J Urol Nephrol. 2007 Jun 21;:1-5 [Epub ahead of print]
(3) Ku JH, Kim ME, Lee NK, Park YH. Influence of environmental factors on chronic prostatitis-like symptoms in young men: results of a community based survey. Urology, 58(6):853-858, 2001.
(4) Shephard RJ, Shek PN. Cold exposure and immune function. Can J Physiol Pharmacol. 76(9):828-836, 1998.
(5) Janskyl L, Pospiilova D, Honzova S, Uliny B, Ramek P, Zeman V, Kamnikova J. Immune system of cold exposed and cold adapted humans. European Journal of Applied Physiology. 72(5-6):445-450, 1996.
(6) Walsh NP, Whitham M. Exercising in environmental extremes: a greater threat to immune function? Sports Medicine 36(11):941-976, 2006.
(7) Brenner IKM, Castellani JW, Gabaree C, Young AJ, Zamecnik J, Shepard RJ, Shek PN. Immune changes in humans during cold exposure: effects of prior heating and exercise. J Appl Physiol 87:699-710, 1999.
(8) Pop GAM, Duncker DJ, Gardien M, Vranckx P, Versluis S, Hasan D, Slager CJ. The clinical significance of whole blood viscosity in (cardio)vascular medicine. Neth Heart J. 10(12):512–516, 2002.
A Swedish study corroborates this data: “Nearly every other man stated that the disease had started in association with a specific event, which for 15 men (31%) included exposure to cold. Forty men (83%) reported that cold caused symptom aggravation and/or induced a relapse. Thirty men (63%) stated that taking a hot bath and 22 (46%) reported that spending time in a hot climate decreased the symptoms.”(2)
This is very interesting as it indicates a cold related factor (as the authors also suggest) or a sun-related problem (like D-vitamin deficiency) or both. The latter is also indicated by a Korean study(3). that found that increased exposure to sunlight decreased CPPS symptoms. The Koreans did not find any correlation with temperature.
Why may cold aggravate symptoms? One obvious cause is muscular tension, another less obvious may be that cold seems to slightly stimulate the immune system. The acute effect of (severe) chilling is a suppression of parts of the cellular and humoral immune response and the induction of heat shock proteins(4). But afterwards levels of proinflammatory cytokines (especially IL-6), natural killer cells, leukocytes, catecholamines and stress hormones are raised. Possibly due to the increased metabolic rate and effort to keep the core body temperature stable (peripheral vasoconstriction, shivering etc).(5-7)
But there is also the possibility of a correlation with blood viscosity and clotting propensity. Cold increases blood viscosity (makes it "thicker" and "less runny"). Viscosity is also higher in the morning, which anecdotally sees worse CPPS problems. Inflammation / infection is also correlated with increased viscosity and clotting propensity.(8) Curiously many treatments (I will discuss those later this year) decreases viscosity and clotting.
Another point of interest is that vitamin D levels are at their lowest in march. And accumulating evidence indicates that infection risk and immune dysregulation increases with lower D levels. Of wich I'll talk in my next installment.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, överaktiv blåsa, köld, värme, vinter, sommar, D-vitamin.
20100314 edited the vitamin D - Korea paras and clarified the viscosity note.
___________
(1) Mehik A, Hellstrom P, Lukkarinen O, Sarpola A, Jarvelin M. Epidemiology of prostatitis in finnish men: a population based cross-sectional study. BJU Int 86(4):443-448, 2000.
(2) Hedelin H, Jonsson K. Chronic prostatitis/chronic pelvic pain syndrome: Symptoms are aggravated by cold and become less distressing with age and time. Scand J Urol Nephrol. 2007 Jun 21;:1-5 [Epub ahead of print]
(3) Ku JH, Kim ME, Lee NK, Park YH. Influence of environmental factors on chronic prostatitis-like symptoms in young men: results of a community based survey. Urology, 58(6):853-858, 2001.
(4) Shephard RJ, Shek PN. Cold exposure and immune function. Can J Physiol Pharmacol. 76(9):828-836, 1998.
(5) Janskyl L, Pospiilova D, Honzova S, Uliny B, Ramek P, Zeman V, Kamnikova J. Immune system of cold exposed and cold adapted humans. European Journal of Applied Physiology. 72(5-6):445-450, 1996.
(6) Walsh NP, Whitham M. Exercising in environmental extremes: a greater threat to immune function? Sports Medicine 36(11):941-976, 2006.
(7) Brenner IKM, Castellani JW, Gabaree C, Young AJ, Zamecnik J, Shepard RJ, Shek PN. Immune changes in humans during cold exposure: effects of prior heating and exercise. J Appl Physiol 87:699-710, 1999.
(8) Pop GAM, Duncker DJ, Gardien M, Vranckx P, Versluis S, Hasan D, Slager CJ. The clinical significance of whole blood viscosity in (cardio)vascular medicine. Neth Heart J. 10(12):512–516, 2002.
Wednesday, March 3, 2010
Micturition and the soul II -- antidepressants against CPPS ?
Mood disorders and pelvic disorders are commonly comorbid and antidepressants are effective treatments of nocturia and bowel disorders. Thus suggesting “a common, or at least overlapping, pathophysiology at a level where the functions of the different pelvic viscera are integrated” e.g.viscerosensory nerves, vagus nerve, the lumbosacral spinal cord and the pons (more specifically the locus coeruleus, Barrington’s nucleus, vagus nerve termini). (1,2) (Regarding the use of anti-depressants and cytokine-suppressants, e.g. etanercept, a TNF-alpha inhibitor, for CPPS, some studies have been done, but I have not found any information about what the results where. May I assume no success or too much side effects?)
Murine studies show “diffuse overlap within the brain stem and spinal cord of autonomic innervation to peripheral tissues” indicating a possible cause of referred pain from the bladder/pelvis and that “ongoing pathology” from a “dysfunctional lower urinary tract may cause symptoms and functional changes in distinct peripheral regions of the body” and that “flooding of these neuronal circuitries with noxious information from one peripheral organ may also cause changes within the system and other organs”.(3)
Experiments also indicate that even short time bladder obstruction / dysfunction may lead to neurobehavioural effects like hyper-arousal, sleep changes, anxiety, attention disorders and “disruption of sensorimotor integration”. (4) Question is if these disturbances are directly caused by the underlying cause of the bladder dysfunction, or as a consequence of the sleep disruption or some other factor. (Also see Micturition and the soul part I.)
Interestingly enough the same pathways are sensitized by chronic cold exposure, which may explain why cold worsens CPPS symptoms.(5) About which I'll talk inte next installment.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, nokturi, överaktiv blåsa, anti-depressiva medel, köld, etanercept, neurologiska besvär.
________________
(1) Valentino RJ, Miselis RR, Pavcovich LA. Pontine regulation of pelvic viscera: pharmacological target for pelvic visceral dysfunctions. Trends Pharmacol Sci 20:253-260, 1999.
(2) Goehler LE, Lyte M, Gaykema RPA. Infection-induced viscerosensory signals from the gut enhance anxiety: implications for psychoneurimmunology. Brain Behav Immun 21:721-726, 2007.
(3) Zermann DH, Ishigooka M, Schubert J, Schmidt RA. Is there a relationship between chronic bladder dysfunction and somatic symptoms in other body regions? 2. An experimental neuroanatomical approach. Int Urol Nephrol 37:263-273, 2005.
(4) Rickenbacher E, Baez MA, Hale L, Leiser SC, Zderic SA, Valentino RJ. Impact of overactive bladder on the brain: central sequelae of a visceral pathology. PNAS 105(30):10589-10594, 2008.
(5) Jedema H, Finlay JM, Sved AF, Grace AA. Chronic cold exposure potentiates CRH-evoked increases in electrophysiologic activity of locu coeruleus neurons.
Murine studies show “diffuse overlap within the brain stem and spinal cord of autonomic innervation to peripheral tissues” indicating a possible cause of referred pain from the bladder/pelvis and that “ongoing pathology” from a “dysfunctional lower urinary tract may cause symptoms and functional changes in distinct peripheral regions of the body” and that “flooding of these neuronal circuitries with noxious information from one peripheral organ may also cause changes within the system and other organs”.(3)
Experiments also indicate that even short time bladder obstruction / dysfunction may lead to neurobehavioural effects like hyper-arousal, sleep changes, anxiety, attention disorders and “disruption of sensorimotor integration”. (4) Question is if these disturbances are directly caused by the underlying cause of the bladder dysfunction, or as a consequence of the sleep disruption or some other factor. (Also see Micturition and the soul part I.)
Interestingly enough the same pathways are sensitized by chronic cold exposure, which may explain why cold worsens CPPS symptoms.(5) About which I'll talk inte next installment.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, nokturi, överaktiv blåsa, anti-depressiva medel, köld, etanercept, neurologiska besvär.
________________
(1) Valentino RJ, Miselis RR, Pavcovich LA. Pontine regulation of pelvic viscera: pharmacological target for pelvic visceral dysfunctions. Trends Pharmacol Sci 20:253-260, 1999.
(2) Goehler LE, Lyte M, Gaykema RPA. Infection-induced viscerosensory signals from the gut enhance anxiety: implications for psychoneurimmunology. Brain Behav Immun 21:721-726, 2007.
(3) Zermann DH, Ishigooka M, Schubert J, Schmidt RA. Is there a relationship between chronic bladder dysfunction and somatic symptoms in other body regions? 2. An experimental neuroanatomical approach. Int Urol Nephrol 37:263-273, 2005.
(4) Rickenbacher E, Baez MA, Hale L, Leiser SC, Zderic SA, Valentino RJ. Impact of overactive bladder on the brain: central sequelae of a visceral pathology. PNAS 105(30):10589-10594, 2008.
(5) Jedema H, Finlay JM, Sved AF, Grace AA. Chronic cold exposure potentiates CRH-evoked increases in electrophysiologic activity of locu coeruleus neurons.
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