Vitamin Information Center

By Maureen Williams, ND

Healthnotes Newswire (September 11, 2008)—People with digestive diseases, such as ulcerative colitis and Crohn’s disease, are especially susceptible to osteoporosis and bone fractures, due in part to nutrient deficiencies caused by malabsorption and medication side effects. A new study found that people with good vitamin D status early in the course of their disease had higher bone density and a greater likelihood of increasing bone density over time.

Healthy vitamin D levels predict healthy bones

The study, published in the American Journal of Gastroenterology, included 101 people who had recently been diagnosed with inflammatory bowel disease (IBD). Vitamin D levels in the blood and bone mineral density were measured at the beginning of the study, and bone density measurements were repeated approximately two years later.

Only 22% of the people had optimal vitamin D levels at the beginning of the study. Higher vitamin D levels were associated with higher bone density in the spine, hip, and total body. People with better vitamin D status were more likely than others to have an increase in bone mineral density over the course of the study.

The link between IBD and bone density

IBD is a group of inflammatory conditions affecting the large and small intestines. Ulcerative colitis and Crohn’s disease are the most common types, both of which are believed to be autoimmune (when the immune system attacks the body’s cells) in nature. People with IBD usually experience chronic abdominal pain and diarrhea, often with bleeding and mucus.

In people with IBD, inflammation in the bowel wall and diarrhea compromise absorption and result in nutrient deficiencies. In addition, corticosteroid medicines that are used to treat IBD can interfere with calcium absorption and metabolism. Maintaining healthy bone density requires the integrated work of a number of nutrients, including calcium and vitamin D, so it is not surprising that people with IBD have high rates of low bone density (osteopenia and osteoporosis).

Improving vitamin D status

Vitamin D is made in the body through a series of chemical reactions that begins in sun-exposed skin. Modern lifestyles with limited outdoor time and widespread use of sunscreens have led to increasing rates of vitamin D deficiency in the general population, and these rates are even higher in the elderly and people with chronic disease.

“Poorer vitamin D correlates with lower baseline bone mineral density and better vitamin D status is correlated with a gain in total bone mineral density. Early optimization of vitamin D may play an important role in preventing IBD-related bone disease,” said the researchers from the University of Manitoba in Winnipeg. Small amounts of vitamin D are found in eggs and fish, as well as fortified dairy foods and some dairy substitutes, but the authors noted that their findings suggest that adding vitamin D supplements is warranted for most people with IBD.

It is a well known fact that ‘we are what we eat’. Food not only affects us physically, but psychologically as well. However, researchers are now looking into the effects of food on chronic ailments like osteoarthritis, only to find that food plays a vital role in dealing with this ailment. Here’s more on this newly developing field of study.

Osteoarthritis or Degenerative Joint Disease (DJD) is the wear and tear of our joints caused by the breakdown of cartilage in them. Cartilage, which is a hard but slippery tissue between joints, is more of a cushion for the bones which form the joints. It not only avoids direct friction between the bones but, also helps to absorb shock, allowing them to move smoothly over each other, as it is composed of 65-80% water, collagen, proteoglycans and chondrocytes.

This is what happens when you suffer from osteoarthritis –
• Cartilage loss is there.
• Joints begin to deteriorate due to constant rubbing of bones with each other.
• Fluid accumulates in the joints.
• Structural changes and bony overgrowths can be seen around the joint.
• Patient suffers chronic pain.
• Problem can affect the joints of fingers, hips, knees, feet and spine too.
• Severe symptoms might lead to loss of mobility in the patient or disability.

With over 21 million Americans living with the disease, commonly seen in elderly people above the age of 65 years, researchers are now delving into different ways of tackling the problem to gain more control over it, the most recent one being dietary changes for osteoarthritis.

There are various factors which pave way for a person to develop osteoarthritis, like – obesity, vitamin C deficiency, low bone mineral density and vitamin D deficiency. Thus keeping these in mind dieticians suggest some additions and subtractions in your diet to avoid and also keep under control this ailment.

Some dietary changes to keep osteoarthritis at bay -

Foods to avoid -

• Reduce the consumption of fatty foods in your daily intake as the more weight your body has to carry, greater is the burden on the joints and greater the risk.
• Identify the inflammatory elements of your diet by eliminating all short listed ones from the food you consume. Reintroduce them one by one, noting your body’s reactions to them. This would help you identify the culprit food items, which you need to remove at the earliest.
• Common inflammatory foods are – wheat, potato, pepper, egg plant, tobacco, tomatoes etc. you need to stay away from them for about a month and then start reintroducing.
• Elimination of dairy products and animal food has proven to help many. Thus staying on a vegetarian diet would be best for high risk patients.
• Research has shown that periodic fasting has helped show improvement for arthritis patients. It helps to cleanse and restore the digestive system and kidneys, relaxes the mind and nervous system and is good for the well being of the body as whole.
• Lifestyle changes involving elimination of alcohol, smoking, tobacco, coffee, fats, sugar and excessive salt, are now known as ways to overcome the problem at best.

Foods to add -
• Vitamin C is known to develop cartilage, thus foods rich in the vitamin should be deliberately had on a regular basis, in addition to tablets. Some foods are citrus fruits etc.
• Vitamin D helps to decrease the narrowing of joint spacing, thus a daily supplement of the Vit-D tablet is a must for osteoarthritis patients.
• Osteoarthritis symptoms are said to show a slowdown with foods rich in glucosamine and chondroitin.
• In general eating green leafy vegetables, carrots, avocado, sea weeds, fish, soy products, sprouts, oats, barley, rice, millet, and fish like salmons, tuna, sardines etc, help patients suffering from the disease and also help to overcome the above mentioned deficiencies.
• Regular intake of calcium supplements is a must.
• Lifestyle changes like weight reduction, exercising and diet control, not only help reduce weight, they also help people with low bone mineral density.

So eat healthy and live healthy!

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.

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.

The benefits of a combined vitamin D3 and calcium for bones, reported to stop or slow bone loss, may extend for up to 18 months after stopping supplementation, suggests a new study from Australia.

The increases in bone mineral density of about 1.65 per cent observed in men after receiving vitamin D and calcium supplements were still evident 18 months after the men stopped taking the supplements, researchers report in this month’s American Journal of Clinical Nutrition.

The study shows that elderly men, a population that is often overlooked in bone health studies, could also benefit from daily supplements of fortified milk.

Much focus has been on the vitamin D and calcium combination for bone health in women since elderly females are four times as likely to develop osteoporosis than their male counterparts. The new study, which follows on from an earlier study in the journal Bone (doi: 10.1016/j.bone.2006.04.003), reports that elderly men benefited from daily supplements of fortified milk.

Osteoporosis is estimated to affect about 75m people in Europe, the USA and Japan. According to the International Osteoporosis Foundation, the total direct cost of osteoporotic fractures is €31.7bn in Europe, and 17.5bn in the US (2002 figure).

Robin Daly and co-workers from Deakin University in Melbourne followed 109 who had completed the earlier study for a further 18 months, during which no more fortified milk was provided.

The benefits on bone mineral density observed in the on the hip bone (femoral neck) and wrist (ultra-distal radius) at the end of the intervention of 1.8 and 1.5 per cent, respectively, were still evident 18 months later.

Furthermore, non-significant increases at the total hip of 0.8 per cent were also sustained.

“The average total dietary calcium intake in the milk supplementation group at follow-up approximated recommended amounts for Australian men older than 50 (1000 mg/d) but did not differ significantly from that in the control subjects (1021 versus 890 mg/d),” stated the researchers for clarification.

“Supplementation with calcium- and vitamin D3-fortified milk for two years may provide some sustained benefits for BMD in older men after withdrawal of supplementation,” they concluded.

The researchers reported in the earlier study in Bone that, due to the complicated nutritional mixture of the milk, it was not known whether the benefits were due to vitamin D3, calcium, or a combination of these plus other nutrients. They did state however that the results show a reduction in bone resorption in this elderly male population sample.

The fortified milk used in the initial intervention contained 500 milligrams of calcium (milk calcium salt NatraCal) and 400 International Units (IU) of vitamin D3 (DSM Nutritional Products), and was formulated by Murray Goulburn Co-operative in Brinswick, Australia.

Some countries, like Canada, already fortify their milk and a 250 ml cup provides about 90 IU of vitamin D. In the UK, where milk is not fortified, a 250 ml cup contains only a trace of the vitamin.

The 1999 USDA survey on food intakes by individuals reported that less than 15 per cent of over-sixty year-old men were meeting their recommended daily intake of calcium.

Source: American Journal of Clinical Nutrition
March 2008, Volume 87, Number 3, Pages 771-777
“The skeletal benefits of calcium- and vitamin D3-fortified milk are sustained in older men after withdrawal of supplementation: an 18-mo follow-up study”
Authors: R.M. Daly, N. Petrass, S. Bass, C.A Nowson