Tag: vitamin D

Summer sun prevents multiple sclerosis

Claus Hancke

April 10, 2007

Still more supports the theory that vitamin D can prevent multiple sclerosis. Enjoy the sun while its there.

Multiple sclerosis (MS) is a feared disease. Many believe that sclerosis is synonymous with a life in a wheelchair, and many have heard about tragic examples of how the disease can progress. It is worth remembering that even 20 years after the emergence of the disease, 75% of patients can walk unaided. Also, the death rate for those suffering from sclerosis is not much higher than that of the rest of the population.

On the other hand, MS affects especially younger people, primarily women. It is disquieting that the frequency of this disease has increased in the last 50 years and continues to increase. Over 80,000 people in the UK suffer from MS, which at a prevalence of over 140 people per 100,000 the highest in the industrialised world.

MS is an “autoimmune” disease, which is to say a disease where the body’s immune system turns against the body itself. In the case of MS the so called myelin sheaths which coat and isolate the nerves are attacked. On average, every fourth person with MS also suffers from another autoimmune disease, for example psoriasis, arthritis, or metabolism diseases.

Can one prevent MS? It is tempting to have this thought when one notices the enormous geographic variations. In England, Denmark, Norway, Sweden, Finland, Germany, and Canada the frequency is about the same. In Greece and Turkey it is about half as common while in northern Spain and Italy the frequency lies in between that of these areas.

These and other figures support a growing belief that MS has something to do with lack of sunlight; or more accurately, lack of vitamin D, of which the sun is the most important source. Vitamin D has in studies prevented an experimental form of MS (EAE, Experimental Autoimmune Encephalitis). In countries north of a latitude of 42, corresponding to Corsica, the sun is so low during the winter months that vitamin D practically cannot be produced in the skin. The result is widespread vitamin D deficiency.

Less than half the risk
Researches from Harvard University among others analyzed the problem in more detail. They studied 257 blood tests from military personnel who contracted MS between 1992 and 2004. The blood tests were taken and frozen before these people became sick. The question was whether they had remarkably little vitamin D in their blood when compared to people who did not contract MS.

It was shown that they did. 25-OH-D, the best measure for vitamin D status, was measured in both the sick and a large number of healthy people who were randomly chosen from 7 million personnel. It was found that “high circulating levels of vitamin D are associated with a lower risk of multiple sclerosis.” Low vitamin D levels were especially risky for people under 20 years of age.

How much vitamin D is enough? When the level of 25-OH-D was at least 99 nannomol/litre serum, the risk of MS was the lowest at about 40% average. The difference was statistically certain. For comparison, levels under 50 are indicative of insufficient levels of vitamin D. Such values can be found in most people during the winter.

The theory that vitamin D prevents MS is thus strengthened. One should attempt to distance oneself from vitamin D deficiency. This is easy during the summer, but from October to April it requires, for the majority of those in our latitudes, supplements.

By: Niels Hertz MD

References:
1. Munger L et al. Serum 25-Hydroxyvitamin D levels and risk of multiple sclerosis. JAMA 2006;296:2832-2838.
2. MS prevalence data for selected countries: http://www.mult-sclerosis.org/prev_tab.html
3. Newsletter from Vitalrådet dec. 27. 2006

jama.ama-assn.org

Vitamin D Can Be Used As Heart Medicine

Claus Hancke

May 23, 2006

The warnings against direct sunlight in the summer should be taken with a grain of salt. The vitamin D synthesized in the skin in the wonderful sunshine, prevents, amongst other things, weakening of the heart, if we look at the latest research.

Sooner or later in the course of the summer a dermatologist will appear on television to warn against direct exposure to the sun. It may lead to skin cancer and also threatening is the feared, deadly birthmark cancer, the incidence of which has risen dramatically in step with more and more people desiring a tan. This is partly true.

On the other hand it is prudent to be skeptical when someone advices us to act against what is natural. Can it really be true that the sun is so dangerous when people in our part of the world have been far more exposed to the sun through thousands of years?

Vitamin D is made in the skin when it is in the sunlight, but not from September till May, when the sun is too low on the horizon to be used for this in our part of the world. Since our diet only contains minimal amounts of this vitamin, in the wintertime we use the vitamin which has been built up in the skin in the course of the summer. During the winter approximately 85 % of the daily D-vitamin usage is taken from reserves, even in cases where the diet is rich in D-vitamin. All in all, approximately 100 mcg. is used in a day.

But what happens if the reserves are too small?

In the past half-year a number of studies have shed light over the mysteries of vitamin D. According to one study, the vitamin can help against tuberculosis, which we know was a widespread disease in the 19th and beginning of the 20th century, when many people lived under dire conditions in the cities.

Another study of over 14,000 Americans showed that the people with the largest D-vitamin reserves generally had far better lung function than those with the smallest stores. The difference is as big as the difference between ex-smokers and people who have never smoked before. A possible explanation is that the D-vitamin secures the necessary repairs of worn-out cells.

At about the same time, one of the veterans of vitamin-D research, the American Cedric Garland, concluded that now the proof that vitamin D protects against cancer (especially breast cancer, cancer of the colon and prostate cancer) was very strong. Strong enough to make him regard the connection as definite. He has reviewed all relevant research done since 1966.

Weak Heart and Arthritis
His claims can be compared to the fact that David Feldman of Stanford University now wants to conduct an experiment with calcitriol (the active form of vitamin D, which is made in body from vitamin D in the skin or the food) and ordinary arthritis medication against prostate cancer. In laboratory studies he has found that calcitriol slows the growth of prostate cancer by 25 %, while the combination with arthritis medication slows it by 70 %. A true break-through if it is true.

Everyone knows that vitamin D is necessary for the bones, but it is also necessary for the muscles. A deficiency leads to both muscle pain, weak muscles and for example, a tendency to fall in the elderly. But what about the heart? The heart is also a muscle, and weakening of the heart (cardiac insufficiency) because of atherosclerosis or increased blood pressure occurs in as many as 50,000 Danes. It is a dangerous condition with a high mortality rate.

A German study of 123 patients with a weak heart showed that on average they had quite small amounts of vitamin D in their blood stream, close to a deficiency in the traditional sense. Half of them were given supplements of 50 mcg. D3-vitamin each day for nine months. This is five times as much as the elderly are traditionally recommended given, and is also the upper limit, of what is not dangerous to ingest.
The study was too small to show a difference in mortality, but it did show something interesting. It concerns the protein TNF-alpha, which is produced by the white blood cells in connection with inflammation. TNF-alpha is meant to be a major cause of weakening of the heart. In the patients left untreated, the blood’s content of this protein increased by 5 %. In those treated, there was no worsening. This indicates a stabilizing effect on the inflammation.

This is especially interesting for another reason. TNF-alpha is an important cause of pain and swelling in arthritis. So important that new types of arthritis medication, which blocks TNF-alpha, fittingly, are considered wonder-drugs. If vitamin D decreases the effect of TNF-alpha on the weakened heart, maybe the same happens in arthritic joints. This would also confirm the old assumption that vitamin D protects against arthritis.

When in the sun, one should be sensible and avoid sunburns. Stay in the shadow if the sun is very strong and do not lie about for hours in the sun all covered up in greasy sun lotion.

Also important to know is that it is a risk rather than a virtue to stay out of the sun in the summer.

By: Vitality Council

References
1. Schleithof S S et al. Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: A double blind randomized placebo-controlled trial. Am J Clin Nutr 2006;83:754-9
2. Heaney R et al. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 2003;77:304-10.
3. Moreno J, Krishnan AV, Feldman D. Molecular mechanisms mediating the anti-proliferative effects of Vitamin D in prostate cancer. J Steroid Biochem Mol Biol. 2004 Nov;92(4):317-25

www.ajcn.org
www.elsevier.com/wps/find/journaldescription.cws_home/333/description

Vitamin D Could Prevent Every Third Cancer-related Death

Claus Hancke

April 21, 2006

Several of the World’s leading vitamin researchers advocate a much higher vitamin D-intake. They believe that up to every third death from cancer may be prevented.

“I challenge anyone to find a field or a nutritional substance or any other factor with as effective cancer-fighting properties as vitamin D.”

So said Edward Giovanucci, professor at Harvard University, last year in a speech to the American Society for Cancer Research.

More and more agree with Giovanucci, amongst them, several professors from well-renowned universities. A few months ago Cedric Garland, an absolute pioneer in the field, stated that it has been proved that the risk of cancer can be lowered dramatically with vitamin D. These are big words. Garland is a professor at the University of California in San Diego.

Giovanucci has together with six others, of these, no less than three are professors from Harvard, confirmed the claim further. In a quite laborious study they have confirmed the close connection between a vitamin D deficiency and cancer.

Since World War II it has been known that especially cancer in the alimentary canal is seen relatively seldom in southern countries. Since sunlight is the most important source of vitamin D, it has earlier been guessed that it was vitamin D and not the sun, which offers protection. In numerous studies the incidence of cancer has been found to be highest where sunlight is weakest, and where the content of vitamin D in the blood is lowest. We are children of the sun. At the same time laboratory research in recent years has shown that this vitamin inhibits the growth of abnormal cells, counteracts the spread of cancer and prevents the formation of blood vessels in tumorous masses.

Giovanucci now finds further proof of the connection. Earlier in humans there has only been found an indirect connection between vitamin D and cancer. There has been a lack of data from whole groups of the population, that have had their blood content of vitamin D measured, and have then been followed for a number of years. But Giovanucci has found something to substitute this data.

Mega doses of Vitamin D
They took 1095 men from the big population study “Health Professionals Follow-Up Study”. These 1095 men had had their vitamin D-status measured (this means the content of vitamin D in the blood). In addition, a lot of things were known about their personal habits etc. Would it be possible to go backwards and calculate their vitamin D-status from their personal habits? Yes! An estimation of the approximate vitamin D blood content could be made, when the individual’s skin colour (eg. race), body mass, height, place of residence (southern/northern in the USA), the amount of physical activity, time of year and the content of vitamin D in the test subject’s diet and possibly supplements was known.

In this manner the group worked out a point-system for the direct calculation of vitamin D status. What especially contributed to a low status was a northern place of residence, dark skin colour, overweight and lack of exercise. The calculations proved correct for the 1095 test subjects. But would they be correct for other people? They were checked for another group of men with known vitamin D status. They were consistent!

Every single subject, of the 47,800 men in Health Professionals Follow-Up Study now had their vitamin D status calculated. In the course of approximately four years, about one in ten got cancer. About half that died from it.

To find the significance of vitamin D, they chose to compare dead men whose plasma values for vitamin D (25(OH)D3) deviated by 25 nmol/L (nanomol/liter). It was found that the risk of dying from cancer was no less than 29 percent lower in men with a high vitamin D status. Concerning cancer of the alimentary canal – it was 45 percent lower for men, who were otherwise identical with regards to age, weight and level of physical activity.

If these results are correct, every third death from cancer may be prevented in the course of a few years. Also in the UK. This is nothing but a sensation. But if one wishes to increase the plasma level of vitamin D by 25 nmol/L, one must receive a supplement of no less than 1,500 units of vitamin D during the winter. This is achieved if a supplement of four vitamin D tablets of 10 mcg (micrograms) is taken daily from August until April.

1,500 units will probably shock many. Is it not toxic? No, it is quite certain that there is no risk, even with a permanent supplement of 2,000 units daily. For comparison, the skin produces 20,000 units during half an hour in the sun in the summer.

Garland, who was mentioned above, recommends 1,000 units (25 micrograms) a day. Others say 2,000. Giovanucci and his colleagues from Harvard strongly recommend 1,500.

Under any circumstances: If you want the full advantage of vitamin D, it seems that the need is far greater than what we have gotten used to believe. Maybe it is close to what stone-age people received naturally from their diet.

By: Vitality Council

References
1. Giovanucci E et al. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst 2006;98:451-9
2. Garland CF et al. The Role of Vitamin D in Cancer Prevention. Am J Public Health. 2006;96(2):9-18. 2005 Dec 27; [Epub ahead of print]

jncicancerspectrum.oxfordjournals.org
www.ajph.org
www.iom.dk

New Theory on the origin of the flu

Claus Hancke

November 15, 2005

A recent theory claims that one does not catch the flu from contagious people, but by the activation of a dormant virus activated by vitamin D deficiency.

Serious medical journals do not often engage themselves with what private individuals think. In the latest issue of “The British Medical Journal” an exception is made on the journal’s last page, which is written regularly by the pretty named but anonymous female doctor, “Minerva.” Minerva has given her readers interesting scientific news, great and small, every week for decades.

This time she has pointed out a “blog” (an internet forum) with a gripping story on the virtues of vitamin D and why the flu sets in during the winter. She relates that the blog’s author is a member of “The vitamin D council,” a non-profit organisation which wishes to combat vitamin D deficiency.

Minerva recounts that he may be just another person who has hopped aboard the flu bandwagon. But could he possibly have found something important?

The blog is written by the Californian Dr. John Cannell. He explains, including many citations, first and foremost his theory about how the flu arises. The theory states that the flu is not so much the result of contagion, but more the activation of a dormant virus which we already have in our bodies. This virus can be activated and cause the flu when we are weakened by vitamin D deficiency during the winter. It is similar to the mechanisms behind cold sores, where the virus is dormant but can be activated causing a break out.

Does this sound like nonsense? In 2003, a department in the United State’s Center for Disease Control (CDC) disclosed that they had been unable to find any English language documentation for the flu being able to be infectious from person to person.

The recently dead epidemiologist, Edward Hope-Simpson discovered that when the elderly get shingles, it is caused by the same virus which causes chickenpox as a child. It becomes dormant in the body but can cause shingles when one is weakened by age.

Hope-Simpson became interested in the well known, but quite strange, fact that the flu only arises when the sun weakens during the winter. In the tropics, one gets the flu during the rainy season. He found that influenza outbreaks with exactly the same virus occurred year after year at almost exactly the same time in two far separated places, Prague and his English home town, Cirencester. With the help of old church records he found that, despite our faster daily lives, flu epidemics arise at the same time of year as they have for the last 400 years. This is true even in isolated towns; in such places the flu comes at the same time as in big cities.

Therefore, Hope-Simpson believed that flu epidemics are not cause by infection, but by a weakened state caused by the absence of sunlight. Canning now adds that vitamin D has a meaningful effect on the immune system and that the Japanese, as far back as 1945, found that it can protect rats against the flu. The well known vitamin D deficiency during the winter could be the reason for the weakened state that Hope-Simpson postulated.

Canning proposes that we should stock up on capsules of 50,000 units vitamin D in the event of a bird flu pandemic. He does not know if this will do any good, but says that it might save your life.

In any event, as Minerva also believes, his blog (as Minerva also believes) gives us something to think about.

By: Vitality Council

References:
1. www.knowledgeofhealth.com/report.asp?story=Why%20Flu%20Epidemics%20Occur%20in%20Winter
2. Minerva. British Medical Journal 2005;331:1152.

www.knowledgeofhealth.com/report.asp
bmj.bmjjournals.com
www.iom.dk

Vitamin D as a Universal Remedy

Claus Hancke

September 13, 2005

Vitamin D, which most people lack in the winter and many lack in the summer, has an increasing number of roles to play. A deficiency in Vitamin D increases the risk of multiple sclerosis, several types of cancer, skin diseases, and even increased blood pressure.

Vitamin D plays an important role in the public consciousness, but even a bigger role in the minds of those who develop new medicine. Substances which are related to vitamin D are central to the treatment of many serious diseases. This is shown by a comprehensive and very well documented summary from the American pharmaceutical giant Eli-Lily.

In this summary the status and possibility of vitamin D treatment for (among others) prostate cancer, enlarged prostate, breast cancer, rheumatoid arthritis, psoriasis, leukaemia, multiple sclerosis, type I diabetes, skin cancer, hypertension, and of course osteoporosis is examined.

Here are some examples:

Multiple sclerosis (MS) is a so called autoimmune disease, which means that it is a disease where the body’s immune system turns against parts of the body itself, in this case nerve tissue. In animal models of this disease it is possible to avoid outbreaks with the help of calcitriol. Calcitriol is the active version of the vitamin and is created as needed by the body so long as the vitamin D deposits are sufficient. MS is most common in temperate countries, where the sun in relatively low in the sky and vitamin D deficiency is common.

Rheumatoid arthritis is also an autoimmune disease, but with this disease the joints are attacked by the immune system. People with small vitamin D depots more often suffer from rheumatoid arthritis and the risk is higher in temperate countries than in subtropical climes. In animals it is possible to avoid worsening of symptoms if calcitriol is given early enough.

Psoriasis is already treated with salves which contain the vitamin D containing substance calcipotirol (Daivonex), which helps at least 70% of sufferers. Sunlight also helps. Like vitamin D, calcipotirol has the ability to help cells become mature and specialized without growing uncontrolled.

Death rates from prostate cancer are lowest in sunny countries, and the risk of getting this disease is highest in men who have small vitamin D deposits. In a study prostate cancer growth was inhibited in six out of seven patients with the help of calcitriol tablets (0.5-2.5 microgram per day). This is also explained by the vitamin’s effects on the cells. Because normal prostate cell growth is also slowed, researchers also see a possibility of using such treatment for enlarged prostate.

Breast cancer and colon cancer are more common in people who do no get much sun. Both the growth and the spread of breast cancer are reduced by calcitriol in animal studies. Regarding colon cancer, increased growth has been seen in animals that were artificially given vitamin D deficiency. This cancer inhibiting property is predicted to play an important role in future treatment.

Finally, hypertension should be considered. Lack of sunlight and vitamin D in the blood are believed to contribute to high blood pressure. High blood pressure is quickly caused (in mice) by avoiding vitamin D.

All of the above illnesses have the common factor that they can be provoked by lack of sunlight, the most important source of vitamin D. They are also counteracted by vitamin D and vitamin D like substances.

One could wish that it would be possible to treat and prevent these illnesses with the active form of vitamin D, calcitriol. But this is a risky method which can lead to increase calcium levels in the blood and kidney stones. Therefore we must be content with getting vitamin D the natural way, which is to say from sunlight or by eating fatty fish, and then let the organism create calcitriol as needed.

Unfortunately at our latitudes the fours summer months from May to August are the only months where there is enough sun that we create vitamin D in the skin. Those who do not come out in the sun or are covered in clothing, do not create near enough. This makes it necessary to take vitamin D in pill form.

The task is to get enough vitamin D. This is not possible during the dark months without vitamin supplements or eating a lot of fatty fish. Deficiency creates a larger problem than many are aware.

By: Vitality Council

Reference:
Nagpal S et al. Noncalcemic actions of vitamin D receptor ligands. Endocrine Reviews 2005;26:662-87.

edrv.endojournals.org
www.iom.dk

Vitamin D Together With NSAID Medicine Fights Prostate Cancer

Claus Hancke

September 3, 2005

A world-famous Vitamin-D researcher has initiated a study with a very simple treatment of cancer of the prostate. If expectations are met, then it could result in a revolution in the treatment of the most frequent form of cancer in men.

Among men over 60 at least every other have cancer in the prostate, usually without knowing it. It has been discovered many years ago by investigating men who died for some other reason. Cancer in the prostate is typically a disease that you do not die from – but with! Nevertheless, it is the most frequent cause of cancer among men after lung cancer.

It is therefore difficult to deny that there is an obvious need for an effective treatment, but the treatment has been at a standstill for many years. Only now something is about to happen. More and more, the disease has been associated with the extremely widespread lack of vitamin D. Vitamin D has a normalizing and growth-inhibiting effect in many tissues.

Faith in vitamin D has now become so great that one of the world’s leading vitamin D researchers, Professor David Feldman from Stanford University, has launched a clinical study. It targets men with prostate cancer who have relapsed during usual treatment.

Feldman will give them a combination of active vitamin D (calcitriol, see below) and regular arthritis pills (ibumetin or naproxen), both in moderate doses. To avoid side effects of calcitriol, it is given only once a week, but the exact dose is not stated.

Several years of laboratory studies have preceded this. Here, it has recently been shown that calcitriol reduces the growth of prostate cancer by 25%. The same result is obtained by treatment with traditional anti-rheumatic drugs (NSAID preparations, e.g. ibumetin and naproxen).

But most convincingly, when vitamin D and anti-rheumatic drugs are combined, growth slows down by as much as 70%, even if you are content with tolerable doses of each. Both agents counteract the formation of the so-called prostaglandins, which cause the cancer cells to grow and – in another context – cause arthritic pain, etc. If they are combined, the effect is enhanced.

This, as well as the announcement of the new trial, can be seen in, among other things, of a new press release from Stanford University. If the trial fulfills expectations, it will not only have enormous significance for the treatment. It will also be a sleight-of-hand tip for healthy men to get more vitamin D – perhaps a lot more – so they can make enough calcitriol themselves (calcitriol is only available by prescription).

Feldman is not just anyone when it comes to vitamin D. Together with two others, he is behind the book “Vitamin D” (Academic Press), which is a standard work for researchers with 1,800 pages. The newly revised edition costs DKK 3,445, so it is unlikely to be a bestseller. Feldman has been researching vitamin D for many years and has more than 200 scientific articles behind him.

Vitamin D is not a vitamin, but a hormone. It is formed in the skin by sun exposure, but must be converted in the liver and kidneys to become the active calcitriol. It is by now accepted by everyone that the elderly in particular cannot possibly get enough vitamin D if they do not receive supplements or eat plenty of oily fish. This is because, with age, the skin largely loses the ability to form the vitamin. In the dark half-year, the sun is also so low in the sky (in our northern latitudes) that neither young nor old form anything of importance, whether they get sun or not.

There are less than five micrograms of vitamin D in a typical Danish daily diet, but officially it is now recommended that adults get twice as much, nursing home residents four times as much. It is not difficult to find researchers who believe that this too is too little. The upper limit of risk-free intake is estimated at 50 micrograms per day.

By: Vitality Council

Reference:
Moreno J, Krishnan AV, Feldman D. Molecular mechanisms mediating the anti-proliferative effects of Vitamin D in prostate cancer. J Steroid Biochem Mol Biol. 2004 Nov;92(4):317-25

Breast Cancer may be Caused by Vitamin D Deficiency

Claus Hancke

October 19, 2004

Women who do not utilize vitamin D well enough will often get breast cancer and fibrocystic breasts are a sign of calcium and vitamin D deficiency.

Much suggests that vitamin D prevents breast cancer. If so, sunlight, which is the overall dominant source of vitamin D, can significantly prevent breast cancer.

The theory is now supported by a new English study that has shown that women who utilize vitamin D badly have doubled the risk of getting breast cancer.

Researchers from St. George’s Hospital in London compared tissue from approx. 400 women with breast cancer with tissue from an equal number of healthy women. In doing so, they discovered that women with aberrant receptors for vitamin D appeared twice as often in breast cancer statistics as others.

It is known that vitamin D exerts a normalizing effect on the cells in e.g. breast tissue. When the vitamin activates a receptor, a regulatory and growth-reducing effect is triggered inside the cell. Experiments have further shown that breast tissue can activate vitamin D so that it chemically matches the receptors. Previously, it was thought that this only happened in the kidneys.

The connection between vitamin D and breast cancer is supported by a new Canadian study of more than 500 40-60-year-old women. Mammograms showed that women with low vitamin D status have four times as many small nodules in their breasts as those who are better supplied with the vitamin.

Both a high intake of vitamin D and plenty of calcium in the diet were statistically very reliably associated with a tendency to nodules. It is already known that lumpy breasts are a pronounced risk factor for breast cancer.

The scientific interest in vitamin D as a remedy against cancer is increasing rapidly. In November, a three-day conference will be held in Maryland, supported by the American Institute of Health (NIH), with numerous presentations from the USA, Canada, France, England, Germany, Belgium, Austria and others. on this subject alone.

The interest was initially stimulated by the fact that the frequency of, among other things, cancer of the colon, prostate and breast is significantly less in sunny countries than in e.g. Denmark, where the sun is so low from October to May that the skin does not produce vitamin D.

Among researchers, strong voices have advocated for several years that the intake of vitamin D should be raised from the 10 micrograms per day recommended for the elderly (younger people are recommended half), to 25 micrograms per day or even more. The 25 micrograms correspond to the content in 10 ml of cod liver oil. Normal Danish diet contains only a few micrograms.

By: Vitality Council

 

References:
1. Guy M, Lowe LC, Bretherton-Watt D et al. Vitamin D receptor gene polymorphisms and breast cancer risk. Clin Cancer Res. 2004 Aug 15;10(16):5472-81.
2. Bérubé S et al. Vitamin D, calcium, and mammographic breast densities. Cancer Epidemiology, Biomarkers & Prevention. 2004;13(9):1466-72.

clincancerres.aacrjournals.org
www.cbcrp.org/research/PagePeriodical.asp
www.iom.dk