Vitamin Information Center

A flurry of recent reports trumpeting the health benefits of vitamin D have vaulted the supplement to a starring role on the merchandise shelves at Burns Drugs in La Jolla.

Pharmacist Wayne Woods, who owns the store, said he’s seeing a growing number of customers asking for bottles of high-dosage vitamin D.

“We barely carried it before, but physicians are recommending it as a normal supplement on a daily basis in addition to taking your multivitamin,” Woods said.

Vitamin D’s role in bone health has long been known – think rickets in malnourished children and osteoporosis in older people. But research tying vitamin D deficiency to cancers, heart disease, diabetes and other illnesses has transformed the nutrient into a potential miracle cure. A global network of influential scientists said daily intake should be up to 10 times higher than the U.S. government’s current recommendations.

Yesterday, more than 100 physicians, nutritionists, acupuncturists, massage therapists and others gathered at the University of California San Diego for a daylong conference extolling vitamin D.

But not everyone is as enthusiastic, especially after a succession of reports dimmed the spotlight on vitamin supplements. Last month, two major clinical trials debunked vitamin B as a treatment for Alzheimer’s disease and vitamins E and C as protectors against cancer.

The scientific uncertainty has generated debate over the virtues and dangers of vitamin D. One big reason for the researchers’ disagreements: The most promising studies suggest a relationship between low vitamin D intake and many diseases, but they have failed to show a direct cause and effect.

Skeptics of dramatically boosting vitamin D supplements point to the lack of large-scale, random and “double blind” clinical studies comparing the nutrient to placebos. Dermatologists also have bristled at suggestions that people spend more time in the sun to increase the natural production of vitamin D.

Those concerns didn’t deter several longtime advocates of vitamin D supplements at yesterday’s meeting, including Dr. Robert Heaney, a professor at Creighton University in Omaha, Neb.

Heaney said studies conducted in North America and Europe found low vitamin D levels in as many as 95 percent of participants. “I think we can take it as a given that the vast majority of patients in the U.S. are vitamin D deficient,” he said.

People get most of their vitamin D from exposure to sunlight, according to the National Institutes of Health. Spending 10 to 15 minutes outdoors two to three times each week is typically enough.

The best food sources of the nutrient are oil-rich fish such as salmon, tuna and mackerel. Milk and some cereals also are fortified with the vitamin.

Another speaker at the conference, Dr. Cedric Garland, said vitamin D might prevent certain cancers partly because it helps to form the glue that binds cells to each other. Without that glue, cells can become malignant and spread to other parts of the body.

Despite the academic nature of the presentations, the gathering at times felt more like a pep rally for campaign partisans.

Carole Baggerly of Encinitas opened the conference by leading the crowd in singing “You Are My Sunshine.”

She is a former computer sales and marketing executive who founded the conference’s sponsor organization, GrassrootsHealth, after surviving breast cancer.

Baggerly called on conference attendees to become part of her organization’s D*action campaign, a “grand mission” to promote testing for vitamin D deficiency.

“There is no need for a vitamin deficiency epidemic to go on and on and on,” she said.

GrassrootsHealth and some of the conference speakers want federal health officials to increase the daily recommended intake of vitamin D to as much as 2,000 international units.

Current U.S. nutritional guidelines call for 200 international units per day for children and adults up to age 50, 400 international units for people up to 70, and 600 international units for those 71 and older.

The American Medical Association and the American Academy of Pediatrics also have called on the government to raise its vitamin D benchmarks.

But the effort is opposed by the American Academy of Dermatology, which last month advised against too much sun exposure because of the heightened risk of developing skin cancer.

While there is a growing body of “exciting” discoveries pointing to the benefits of vitamin D, more research is needed before health officials adjust supplement standards, said Patsy Brannon, a professor of nutritional science at Cornell University in Ithaca, N.Y.

“The evidence on safety and efficacy is not as strong as what we would like it to be,” she said.

At least two studies meeting the rigorous criteria of large-scale clinical trials have offered reasons for caution.

The federal Women’s Health Initiative found that women taking 400 international units of vitamin D plus 1,000 milligrams of calcium daily had a 17 percent higher risk of developing kidney stones over seven years. Their risk of developing colorectal cancers was no different than that of women who took a placebo.

In Finland, male smokers who took high doses of vitamin D supplements had a significantly greater risk of developing pancreatic cancer.

Last week, an international group of cancer researchers warned that changes to vitamin D recommendations could end up harming people if higher doses are eventually found to elevate the risk for some diseases.

“There is insufficient evidence (to prove) a lack of harm due to long-term, higher levels of vitamin D,” the scientists wrote in a report prepared for the World Health Organization’s International Agency for Research on Cancer.

The bottom line is “controversy and conflicting evidence,” Brannon said, “so there is no consensus.”

For now, people concerned about their vitamin D levels should make sure they are following the government’s guidelines by tracking their daily intake through food and supplement labels, she said.

Elderly people at risk of developing brittle bones should consult their physicians before taking supplements.

Keith Darce: (619) 293-1020; keith.darce@uniontrib.com

Increased intake of calcium and vitamin D can help prevent or slow bone loss in men, according to a pair of studies conducted by researchers from Deakin University in Melbourne, Australia.

An estimated 75 million women and men in the United States, Europe and Japan suffer from osteoporosis, a disease in which bones become thin and brittle.

Prior research has demonstrated that both calcium and vitamin D are important for the bone health of women, who are four times more likely to develop osteoporosis than men. In a 2006 study published in the journal Bone, scientists also found that older men who drank fortified milk daily experienced a 1.8 percent increase in the bone mineral density of their hip bones and a 1.5 percent increase in the density of their wrist bones.

The fortified milk contained 500 milligrams of calcium and 400 IU of vitamin D3, as well as other vitamins and minerals. The researchers noted that because the participants were given fortified milk instead of individual vitamin supplements, it was not possible to determine whether the bone density increase came from the calcium, the vitamin D, both, or some combination of those nutrients with others found in the milk.

The researchers also noted that while calcium intake was higher in participants who drank fortified milk than in control participants, this difference was not statistically significant.

In a more recent study, published in the American Journal of Clinical Nutrition, researchers followed up with 109 of the original study participants 18 months after that study’s conclusion. During that time, the participants had not been provided with fortified milk, but the bone-density improvements from the first study were still apparent.

The researchers suggested that supplementation of milk with calcium and vitamin D3, as is done in Canada, could lead to long-term bone health benefits for older men.

Having too little vitamin D in the body might raise the risk of premature death, a study by Johns Hopkins researchers shows.

It follows other recent studies showing that low amounts of vitamin D are linked to certain cancers, diabetes, and bone and immune system problems, but this is the first research to connect vitamin D deficiency to a higher risk of death, said the study’s co- author Erin Michos, an assistant professor of cardiology at Johns Hopkins School of Medicine in Baltimore.

The study appears in this week’s Archives of Internal Medicine.

Michos and her colleagues analyzed data from a large government observational survey of more than 13,000 people who represented a realistic, diverse swath of U.S. adults ages 20 or older. Participants’ vitamin D amounts were determined through blood tests from 1988 through 1994.

By 2000, Michos said, 1,807 deaths had occurred, including 777 from cardiovascular disease.

The researchers divided the total population into four groups based on their amounts of vitamin D. One group included people with the least vitamin D, 17.8 ng/mL (nanograms/milliliter) or less.

A normal vitamin D test result for both children and adults is 30 ng/mL or more. Less than 20 ng/mL is considered deficient, and results between 20 and 30 ng/mL are labeled insufficient, said Catherine Gordon, director of the bone health program at Children’s Hospital Boston.

In the study, Michos said, people who had low vitamin D — 17.8 ng/mL or less — were 26 percent more likely to be dead at the end of the study than those with more.

Michos now suspects that low vitamin D is related to heart disease deaths, but that theory has to be tested in further studies, she said.

Originally published by USA TODAY.

(c) 2008 Tulsa World. Provided by ProQuest LLC. All rights Reserved.

Source: Tulsa World

Nidhi Sharma - AHN News Writer

London, England (AHN) - Low levels of Vitamin D may contribute to chronic pain among women and taking an extra daily dose of the sunshine vitamin may prove beneficial, studies suggest.

The same, however, does not hold true for men as they have different hormones, British researchers say in a study published in the Annals of Rheumatic Diseases.

The study by the Institute of Child Health in London is based on the blood analyses and pain scores of almost 7,000 men and women from across England, Scotland and Wales, all of whom were born during one week in March 1958 and were 45 years of age.

Smokers, non-drinkers, the overweight and the underweight all reported higher rates of chronic pain. The extent of chronic widespread pain did not vary among men according to vitamin D levels. However, this was not the case for women.

Women with adequate vitamin D levels had the lowest rates of this type of pain, at just over 8 percent. The recommended level of vitamin D is between 75 and 99 mmol/litre - a level deemed necessary for bone health. Women with levels of less than 25 mmol/litre had the highest rates, at 14.4 percent.

In women, the hormonally active form of vitamin D is also involved in the regulation of immune system responses. At the age of 45, few of the women would have entered menopause, a period during which bone mineral density falls with lack of estrogen production.

Vitamin D is an essential nutrient for healthy bones. It is produced in the body when exposed to sunlight and is also found in oily fish, egg yolks and margarine.

High intake of Vitamin D can reduce chronic pain in women, a new study has suggested. A team of researchers from the Institute of Child Health in London found that women suffering from chronic pain may benefit from an extra daily dose of vitamin D, which comes from sunshine and fortified milk.

Called the “sunshine vitamin” because of its exceptional quality of being produced by the body by just basking in the warm sun, low levels of the vitamin D may contribute to women’s chronic pain that can cause complications such as sleep disorders, loss of appetite and depressiondefine or other serious disorders.

The British researchers reached their findings after studying 7,000 women and men aged 45 in England, Scotland and Wales. In their study the researchers found that chronic widespread pain is linked to low levels of the vitamin D in women, but surprisingly not in men.

Lead researcher Dr Elina Hyppnen of the Institute of Child Health in London and colleagues found that all women, irrespective of whether they were smokers, non-drinkers, overweight or underweight, reported higher rates of chronic pain due to vitamin D deficiency. However, vitamin D levels appeared to make no difference to the number of male participants who reported pain symptoms.

The researchers, who reported their findings in the latest edition of the ‘Annals of Rheumatic Diseases’ journal, found that women with vitamin D levels between 75 and 99 nanomoles of 25-hydroxy-vitaminD (25(OH)D) per liter of blood, a level believed necessary for good bone health, had the lowest rates (8%) of chronic pain, while women with vitamin D levels of less than 25 mmol/liter had the highest rates (14.4%) of this type of pain.

As the deficiency of vitamin D only affects women, the researchers believe female hormonesdefine may have some role to play in women’s chronic pain.

Though the latest research suggested that vitamin D levels could play a role in some cases of chronic pain in women, but lead researcher Hyppnen thinks the follow-up studies are needed to confirm the findings.

Still she thinks, “If I had chronic pain I would certainly check I was getting enough vitamin D.”

But, Kate MacIver of the Pain Research Institute at Liverpool University cautioned that high intake of Vitamin D supplements to prevent or treat chronic pain could result in Vitamin D toxicity and high blood calcium levels.

Technically a hormone, Vitamin D is produced within the body when the skin is exposed to the ultraviolet B (UVB) rays in the sunlight. Known as sunshine vitamin, it is also found in oily fish, egg yolks and margarine.

The basic function of vitamin D is to regulate the levels of calcium and phosphorous in the blood, thus helping to build strong bones and healthy teeth. It’s also believed to strengthen the immune systemdefine and possibly prevent some forms of cancerdefine, including prostate, breast and especially colondefine cancer.

Deficiency of Vitamin D can occur due to inadequate dietary intake of preformed vitamin D, malabsorption of vitamin D, or too little exposure to sunlight. The deficiency can lead to problems such as liver or kidney disorders or hereditary disorders. In adults, vitamin D deficiency can lead to osteoporosis, as well as rickets in children and osteoporosis in pregnant and post menopausal women.

As little as 30 minutes of early morning or late afternoon sunlight on the face, hands and arms two or three times a week can supply the entire Vitamin D one needs. In addition, many experts recommend 400-600 IU a day for people over the age of 50 and 800 IU for those over the age of 70. For younger adults, 200-400 IU a day is probably sufficient.

New knowledge of the biological and clinical importance of the steroid hormone 1alpha,25-dihydroxyvitamin D3 [1alpha,25(OH)2D3] and its receptor, the vitamin D receptor (VDR), has resulted in significant contributions to good bone health.

However, worldwide reports have highlighted a variety of vitamin D insufficiency and deficiency diseases. Despite many publications and scientific meetings reporting advances in vitamin D science, a disturbing realization is growing that the newer scientific and clinical knowledge is not being translated into better human health.

Over the past several decades, the biological sphere of influence of vitamin D3, as defined by the tissue distribution of the VDR, has broadened at least 9-fold from the target organs required for calcium homeostasis (intestine, bone, kidney, and parathyroid). Now, research has shown that the pluripotent steroid hormone 1alpha,25(OH)2D3 initiates the physiologic responses of 36 or more cell types that possess the VDR.

In addition to the kidney’s endocrine production of circulating 1alpha,25(OH)2D3, researchers have found a paracrine production of this steroid hormone in 10 or more extrarenal organs.

This article identifies the fundamentals of the vitamin D endocrine system, including its potential for contributions to good health in 5 physiologic arenas in which investigators have clearly documented new biological actions of 1alpha,25(OH)2D3 through the VDR.

As a consequence, the nutritional guidelines for vitamin D3 intake (defined by serum hydroxyvitamin D3 concentrations) should be reevaluated, taking into account the contributions to good health that all 36 VDR target organs can provide.

Source: American Journal of Clinical Nutrition, Aug 2008. 88(2), 491S-499S. PMID: 18689389, by Norman, AW. Department of Biochemistry and Division of Biomedical Sciences, University of California, Riverside, California, USA. [E-mail: anthony.norman@ucr.edu]

By Will Dunham

WASHINGTON (Reuters) - Vitamin D may protect against an artery disease in which fatty deposits restrict blood flow to the limbs, researchers said on Wednesday.

Scientists at the Albert Einstein College of Medicine of Yeshiva University in New York found that people with low levels of vitamin D in their blood experience an increased risk for a condition known as peripheral artery disease, or PAD.

PAD most often reduces blood flow to the legs, causing pain and numbness, impairing the ability to walk and in some cases leading to amputation. It develops when fatty deposits accumulate in the inner linings of artery walls, cutting blood flow and oxygen to the legs, feet, arms and elsewhere.

The researchers based the findings on a U.S. government health survey involving 4,839 adults who had their blood vitamin D levels measured and underwent a screening method for PAD that assesses blood flow to the legs.

The people in the lowest 25 percent of vitamin D levels were 80 percent more likely to have PAD than those in the highest 25 percent, the researchers said.

“Participants in the survey who had the lowest vitamin D levels had a much higher prevalence of peripheral artery disease,” Dr. Michal Melamed of Albert Einstein College of Medicine, who led the study, said in a telephone interview.

But Melamed said it would be premature for people to start taking vitamin D supplements because more studies are needed to confirm that it is protective.

Melamed noted that other vitamins that had been thought to possibly help prevent cardiovascular disease such as vitamin E did not pan out after further research.

The study was presented at an American Heart Association meeting in Atlanta and was published in the association’s journal Arteriosclerosis, Thrombosis and Vascular Biology.

Vitamin D helps the body absorb calcium and is considered important for bone health. In adults, vitamin D deficiency can lead to osteoporosis, and it can lead to rickets in children.

Some studies have indicated it might provide other benefits. For example, one published in January found that people with low vitamin D levels had an elevated risk for heart attack, heart failure and stroke, suggesting the vitamin may protect against cardiovascular disease.

The body makes vitamin D when skin is exposed to sunlight. It is found in fatty fish such as salmon. Milk commonly is fortified with it.

People with PAD have a four to five times greater risk of heart attack or stroke, according to the American Heart Association. The group said 8 million Americans have PAD.

(Editing by Xavier Briand)

Mothers everywhere probably will not be surprised to hear that they were right. Drinking your milk is, of course, good for you. Not only is milk chock-full of calcium, most milk has been fortified with vitamin D — and both nutrients are necessary for good bone health, among other things. And in recent years, a growing body of research has caused experts to conclude that many adults, particularly those over 50, are not getting enough calcium or vitamin D, says Dr. Michelle Germain, a part-time faculty member in the Department of Gynecology and Division of Urogynecology at Greater Baltimore Medical Center.

What is vitamin D?

Vitamin D is a fat-soluble vitamin. It is absorbed from food through the GI [gastrointestinal] tract and also is made by the body. The body needs it because it helps with absorption of calcium and phosphorus, both of which the body needs for bone health.

You said that, in addition to absorbing vitamin D from food, the body also manufactures it. How does the body make vitamin D?

The skin manufactures the vitamin D with the help of ultraviolet rays from the sun. So you need sun exposure to make it. Once we have vitamin D in our bodies, the liver and the kidneys convert the vitamin D into the active form that is used for bone health.

What foods contain vitamin D?

Cod-liver oil is the best way to get vitamin D, but we don’t see many people taking that these days. So other really great sources of vitamin D are fish, such as salmon, mackerel and tuna, and vitamin D-fortified foods, such as dairy products and cereals.

What happens if we don’t get enough vitamin D?

You can become vitamin D-deficient. Children can develop “rickets,” in which the bone doesn’t properly mineralize, and the children develop very soft bones and deformities of their skeleton. In adults, too little vitamin D can lead to osteoporosis. [Too much vitamin D, on the other hand, can make the intestines absorb too much calcium.]

How pervasive is rickets?

In developed countries like the United States, it is pretty uncommon because we fortify so many foods with vitamin D. But there has been a resurgence of rickets in African-American infants and children in poorer states, especially in the South such as Tennessee and Mississippi. The resurgence is being caused by poverty and poor nutrition. It also has to do with darker pigmentation of the skin, which converts sunlight less effectively into vitamin D.

Rickets also is more prevalent in immigrants from Africa, the Middle East and Asia because of their diets before they arrive in the United States and because they may not have enough money to afford good nutrition once here. Again, if they have darker skin, they are not converting UV rays into vitamin D as effectively as people with lighter skins.

Are there other populations for which vitamin D is particularly important?

Older women. If older women are vitamin D-deficient then they are at increased risk for osteoporosis. This is of special concern for menopausal women because once their estrogen levels drop, they begin to lose bone. The vitamin D is necessary to absorb calcium and utilize it in bone formation. And people who have any kind of gastrointestinal illness like Crohn’s disease or celiac disease or any kind of liver disease also are at increased risk for vitamin D deficiency.

Are there any symptoms of vitamin D deficiency that might occur before bone loss?

Unfortunately, there are really no symptoms of it until you are diagnosed with osteoporosis.

What do you tell your patients about vitamin D?

Children and young adults need to consume a diet that is rich in vitamin D-fortified foods. At least 15 minutes of exposure to sunlight twice a week should be adequate to make sufficient amounts of vitamin D. But I also tell them that if you put on sunscreen with an SPF greater than 8, it can interfere with making vitamin D, so diet is very important. Particularly in winter, they should concentrate on eating a diet with plenty of vitamin D-rich foods.

What do you tell adults?

If a woman has osteoporosis, she should ask the doctor if she is potentially vitamin D-deficient. Very often, after a woman has a hip fracture, we check her vitamin D level, and it turns out to be ridiculously low. So, if you have osteoporosis or a fracture, ask about your vitamin D level.

How much vitamin D do we need?

Last year, the National Osteoporosis Foundation released new recommendations about vitamin D. The National Institutes of Health also are due to release this spring new guidelines. According to the National Osteoporosis Foundation, adults under age 50 need 400 to 800 IU [International Units] of vitamin D3 daily. [Also called cholecalciferol, vitamin D3 is the kind of vitamin D that best enhances healthy bones.] And menopausal women and adults over the age of 50 need 800 to 1,000 IU of vitamin D3 daily.

New research has concluded vitamin K2 consumption can aid recovery from hip fractures as well as have potential osteoporosis benefits.

Published in the European Journal of Epidemiology, Japanese researchers found a positive link between vitamin K2 and hip fractures and osteoporosis, and suggested a review of the, “dietary reference value of vitamin K from the perspective of osteoporosis would be useful.”

The current Japanese reference value is 55mcg for women and 65mcg per day for men. In the US and Canada it is 120mcg per day for men and 90mcg per day for women. In France the limit is 65mcg per day for both men and women.

“Since regions which consumed a lot of vitamin K, especially vitamin K2, showed a low incidence of hip fracture, we considered that vitamin K intake, not absorption, of over 300 mcg/day would be helpful to reduce the incidence of hip fracture,” the researchers concluded.

Family K

The vitamin K family includes the forms phylloquinone (K1) that are typically found in cruciferous vegetables and menaquinone (K2), which are sourced from bacteria. Studies have shown K2 to be the more important nutrient in regard to bone health.

“Menaquinone-7 (K2) showed a very long half-life time compared to vitamin K1,” the researchers wrote. With this in mind they recommended higher doses in regions like Europe and North America, where vitamin K1 consumption is higher.

The study also investigated vitamin D, calcium and magnesium, which have strong clinical bone health backing, and found when these were adjusted for, vitamin K2 continued to reveal a beneficial effect.

Dietary sources

The study assessed population diets in various regions of Japan as well as dietary differences, and found that those regions where certain vitamin K-rich fruits and vegetables were prominent had reduced rates of hip fracture.

“There was also a striking pattern of high intake of vitamin K and low incidence of hip fracture in eastern areas of Japan, with the opposite pattern-a low intake of vegetables rich in vitamin K and a high incidence of hip fracture-in western areas,” they wrote.

“These findings lend support to the idea that vitamin K is an important factor explaining regional differences in the incidence of hip fracture.”

Natto, a food made from fermented soy beans, was singled out as being a particularly abundant vitamin K source.

K for bones

The researchers recognised that the role of Vitamin K role in assisting bone health is relatively new.

“Calcium, the most studied nutrient in the area of bone health, is known for its effectiveness in retarding bone loss in postmenopausal women,” they said. “Magnesium and vitamin D play important roles in calcium and bone metabolism. Vitamin K, originally recognised as a factor required for normal blood coagulation, is beginning to receive more attention for its role in bone metabolism.”

Due to the ecological nature of the study, a “causal linkage between the incidence of hip fracture and intake of vitamin K” could not be confirmed but the researchers said, “further research using more robust epidemiological methods is warranted.”

Estimates suggest that in the absence of primary prevention the number of hip fractures worldwide will increase to approximately 2.6 million by the year 2025, and 4.5 million by the year 2050.

Osteoporosis weakens bone strength which increases the likelihood of hip fracture, a problem that increases with age.