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Patients on the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (MP) must avoid all food and drink that contains supplemental vitamin D or high levels of naturally-occurring vitamin D. A comprehensive list of all foods containing vitamin D is available. This article is meant to provide, by food category, both context to those recommendations as well as some potential substitutes.
Patients on the MP should verify that any dairy products they consume are free of supplemented vitamin D and contain no more than 6% of vitamin A. High vitamin A in dairy products tends to correspond to high vitamin D. The “6% vitamin A” guideline is only for foods that might also be fortified with vitamin D and not labeled as such. As a counter-example, carrots are naturally high in vitamin A but contain no vitamin D.
Some processed dairy products are made from vitamin D-fortified milk, a fact which the manufacturers are not required to disclose on the label.
Dairy products containing fat can have a small amount of naturally-occurring vitamin D, which is stored in the fat. The amount of vitamin D in a product depends on the amount of fat in the product and how the animal from which the product was derived was raised. Most MP patients can eat foods with small amounts of animal fat without fear of a significant increase in 25-DThe vitamin D metabolite widely (and erroneously) considered best indicator of vitamin D "deficiency." Inactivates the Vitamin D Nuclear Receptor. Produced by hydroxylation of vitamin D3 in the liver.. However, those MP patients trying to reduce 25-D to the therapeutic level should avoid all sources of vitamin D, including those that contain even small amounts of animal fat.
Typical dairy products that are not fortified with vitamin D and therefore safe for most MP patients to eat include:
The primary source of vitamin D in milk is there because it has been added during processing in accordance with federal supplementation guidelines.
However, cows' milk, even if it is not fortified with vitamin D, contains a small amount of vitamin D because vitamin D is naturally stored in the fat of mammals. That is why if MP patients do consume small amounts of milk, it should be low-fat or skim milk. MP patients should not be drinking glasses of milk, but using it in cooking or to add to breakfast oatmeal is acceptable.
Dr. Anthony Norman of University of California, Riverside offers a description of the biochemistry related to supplementing milk with vitamin D.
Sources for milk not fortified with vitamin D are listed below. Note, however, that these manufacturers can begin to add vitamin D at any time. MP patients should always check the labels each time products are purchased.
The following are some substitutes for milk acceptable for use by MP patients:
Note that soy milk is contraindicated for MP patients.
While packaged flavored yogurt is quite high in carbohydrates, plain unfortified yogurt can be used in a low-carb diet. The 12 grams per serving carbohydrate count on plain yogurt is inaccurate, however. That is how much carbohydrate - lactose - was in the milk the yogurt was made from, but the yogurt bacteria turns most of that lactose into lactic acid, giving yogurt its characteristically tangy flavor, leaving an effective four grams of carbohydrate per cup of plain yogurt.
Flavoring plus Splenda as a sweetener or Splenda-sweetened drink powder can be added to plain yogurt, if desired.
These is no consensus on how much vitamin D different forms of meat typically contain. Some have suggested that factory feed, the standard diet for many livestock, increases vitamin D levels. Others have said that free-range animals are more exposed to the sun and accrue higher levels of vitamin D that way. Still others have said that fattier meats have higher levels of vitamin D.
Moderation and common sense should guide MP patients on meat consumption. Perioidic testing of 25-D will help a MP patient determine if efforts to avoid ingested vitamin D have been successful or if more diligence is needed.
MP patients should not consume organ meats, such as liver.
There is no consistent indication for how much vitamin D beer contains. In fact, it may vary by the beer. Muller et al reported that vitamin D was not present in a lager, but was present in a yeast rich Weiss bier.1) If the report is valid, a full pint of Weiss beer might contain 250 IU of vitamin D, which 125% the US RDA for the substance.
Mushrooms are very high in vitamin D content and in biochemicals which can be converted to vitamin D with relatively little energy. MP patients should avoid mushroom extract unless it had been tested to make sure it had no plant sterols and none of the vitamin D metabolites.
Egg whites, as opposed to the yolks, have no vitamin D. When buying prepackaged egg whites (or ordering an egg-white omelete in a restaurant), ensure that they have not had vitamin D added to them.
Kelp is the only rich source of vitamin D from a vegetable source. It is often used a food adjuvant.
Kelp can be used in a variety of ways:
There are three broad types of kelp, all of which are used for food products - green algae or Chlorophyta, red algae or Rhodophyta (used in sushi foods) and brown algae or Phaeophyta (used in soups as well as health food capsules and tablets).
Seaweed colloid manufacturing extracts three main chemicals:
It may be unclear how much vitamin D we actually consume through other products.
Products containing kelp and seaweed or their derivatives should not be consumed by patients on the MP.
Safflower oil and many other oils are acceptable to be used by MP patients. In some sunflower oils that have been tested, they were found to not contain any vitamin D. However, manufacturers have been known supplement oils (including sunflower oil) with vitamin D.
Many brands and varieties of margarine are fortified with vitamin D. MP patients should always check the labels each time products are purchased.
Here are two substitutes for mayonnaise, which contains egg yolks:
It should not be stated that mushrooms are high in vitamin D without a reference. Inge
J Dairy Sci. 2010 Nov;93(11):5082-90. Vitamin D content and variability in fluid milks from a US Department of Agriculture nationwide sampling to update values in the National Nutrient Database for Standard Reference. Patterson KY, Phillips KM, Horst RL, Byrdwell WC, Exler J, Lemar LE, Holden JM. USDA, ARS, Beltsville Human Nutrition Research Center, Nutrient Data Laboratory, Beltsville, MD 20705. Abstract This study determined the vitamin D(3) content and variability of retail milk in the United States having a declared fortification level of 400 IU (10 μg) per quart (qt; 1 qt=946.4mL), which is 25% daily value per 8 fluid ounce (236.6mL) serving. In 2007, vitamin D(3) fortified milk (skim, 1%, 2%, whole, and 1% fat chocolate milk) was collected from 24 statistically selected supermarkets in the United States. Additionally, 2% milk samples from an earlier 2001 USDA nationwide collection were reanalyzed. Vitamin D(3) was determined using a specifically validated method involving HPLC with UV spectroscopic detection and vitamin D(2) as an internal standard. Quality control materials were analyzed with the samples. Of the 120 milk samples procured in 2007, 49% had vitamin D(3) within 100 to 125% of 400 IU (10 μg)/qt (label value), 28% had 501 to 600 IU (12.5-15 μg)/qt, 16% had a level below the label amount, and 7% had greater than 600 IU (15 μg)/qt (>150% of label). Even though the mean vitamin D(3) content did not differ statistically between milk types, a wide range in values was found among individual samples, from nondetectable [<20 IU (0.5 μg)/qt] for one sample to almost 800 IU (20 μg)/qt, with a trend toward more samples of whole milk having greater than 150% of the labeled content. On average, vitamin D(3) in 2% milk was higher in 2007 compared with in 2001 [473 vs. 426 IU (11.8 vs. 10.6 μg)/qt]. Copyright © 2010 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.
PMID: 20965322