Vitamin Information Center

A national campaign to persuade every Scot to take daily supplements of vitamin D is needed if the country’s appalling health record is to be reversed, leading scientists believe.

A report, published this week, links poor weather to the lack of the “sunshine vitamin” in Scotland, and urges the Scottish government to launch a nationwide vitamin D programme to lower the incidence of devastating illnesses, such as heart disease, cancer and multiple sclerosis.

The research points to the country’s damp, cloudy climate as a significant contributor to its bleak record of ill health and disease.

Vitamin D deficiency – caused by lack of exposure to sunshine – is twice as common among the Scots as it is among the English. The average Scot has a vitamin D level four times lower than their neighbour south of the Border.
A five-year research project by Oliver Gillie, a scientist and writer, demonstrates extensive and remarkable parallels between Scotland’s dull weather and indices of disease.

It suggests that the “Scottish effect”, the country’s hitherto unexplained high mortality rate compared with other industrial countries, is in large part down to lack of sun. Crucially, a shortage of the “sunshine vitamin” is established as a factor in higher rates of multiple sclerosis (MS), diabetes, hypertension, arthritis, several types of cancer, cardiovascular disease and other ailments that together give Scotland one of the worst health records and highest premature mortality rates in Western Europe.

Dr Gillie’s study – Scotland’s Health Deficit: An Explanation and a Plan – echoes world-wide research on vitamin D deficiency but goes further, showing how the higher rates of disease in Scotland mirror closely the lower amount of available sunlight.

A lack of sunshine in Glasgow and the West of Scotland reflects levels of chronic illness that which cannot be explained by deprivation alone. A lack of sunshine on Orkney and Shetland – only 24 per cent of the maximum number of hours possible – corresponds to the highest prevalence of MS in the world.

By contrast, the South Coast of England, where such diseases are much less common, receives 400 more hours of sunshine a year than Scotland.

Dr Gillie says that successive reports on the state of Scotland’s health have failed to recognise that insufficient sunlight and vitamin D are important risk factors, and calls for firm action from the Scottish government on supplementation and the fortification of food.

Last week The Times convened a panel of experts who studied the report and endorsed unanimously the importance of vitamin D as an important ingredient in creating a healthy Scottish population.

Dr Harry Burns, the Chief Medical Officer for Scotland, said: “It is important that attempts to improve health in Scotland remain focused on action on the social, economic, behavioural and psychological determinants of health. If vitamin D supplements can be shown to contribute to that agenda then we will make the appropriate recommendations.”

Dr Adrian Martineau from Queen Mary’s School of Medicine, London, who is working on evidence that vitamin D can reduce cold and flu symptoms, said: “This is a very important initiative. What [Dr Gillie] has highlighted is that 85 per cent of us have lower Vitamin D levels than we should have and 85 per cent of our cells need vitamin D to function properly. It’s highly plausible that supplementation would be of great benefit.”

Taking vitamin supplements does not improve health and may increase the risk of premature death, according to media reports.

A review of 67 randomised trials found that taking the supplements vitamin A, vitamin E and beta-carotene could lead to premature death.

The evidence for vitamin C and selenium suggested that the pills did not increase the risk of death, but there was no benefit in taking the pills compared with a placebo.

The researchers concluded that the current evidence does not support the use of antioxidant supplements in a healthy population.

There is no suggestion from the review, however, that a diet rich in natural sources of antioxidants could be damaging to health, say the papers.

Around 12 million people in Britain are taking vitamin supplements fuelling a £330 million industry.

What is the research?
The reports are based on the findings of a Danish study into the impact of antioxidant supplements on mortality rates.

A search of published literature and other studies held by manufacturers identified 815 trials. But only 67 were considered to be adequately run randomised controlled trials. These included 232,550 people aged an average of 62 years.

Twenty-one of the trials focused on the use of supplements in healthy individuals, while the rest tested patients with a range of diseases. Trials including children, pregnant women or patients with acute conditions, such as cancer, were excluded.

Antioxidant supplements were found to increase the risk of premature death in 47 trials.

Overall, antioxidant supplements were linked to a 4 per cent increased risk of death compared with placebo.

But when antioxidants were assessed separately, the researchers found that vitamin A was linked to a 16 per cent increased risk of premature death. For beta-carotene there was a 7 per cent increased risk of death and for vitamin E a 4 per cent increased risk of death.

The use of vitamin C or selenium did not increase the risk of death but showed no beneficial health effects compared with placebo.

Antioxidant supplements could lead to early death by eliminating too many free radicals, suggest the researchers. This could interfere with some essential defensive mechanisms such as apoptosis and detoxification, they say.

What do the researchers say?
Lead author Dr Christian Gluud, from the centre for clinical intervention research at Copenhagen University, called for better regulation of antioxidant supplements.

‘If a patient can eat a healthy, varied diet, then there is no need to take vitamin supplements. According to our results this may even be harmful.

‘Based on our results, as well as the results from other studies, it seems that these supplements might increase the progression of cardiovascular diseases and certain cancers.

‘It seems that the increased mortality comes from an acceleration of disease progression rather than from the development of new diseases.’

The team has not looked at whether a diet rich in natural antioxidants could be harmful to health but it would be good to conduct some large scale trials into this, said Dr Gluud.

What do other experts say?
Anne Sidnell, nutrition scientist at the British Nutrition Foundation, said: ‘The findings of this study are in line with other studies that have shown that antioxidants have no health benefits when consumed as supplements rather than through food.

‘Our bodies are designed to take in the correct amounts of nutrients from food, but there is a danger of overdosing when using supplements.’

There may be occasions when supplements are needed, such as vitamin D supplements for the elderly or folic acid for pregnant women, but overall a balanced diet is the best way to stay healthy, she added.

But Pamela Mason, nutritionist and spokeswomen for the Health Supplements Information Service, said: ‘Trials using antioxidant supplements have shown inconsistent findings and yet another review or meta-analysis is not going to tell us anything at this stage.

‘Antioxidants, including these noted in the Cochrane review, are essential for health and UK national dietary surveys have shown that some people have poor intakes of such nutrients.’

Antioxidants are not ‘magic bullets’ and were never intended for the prevention of chronic disease and mortality but for health maintenance, she added.

Chronic kidney disease patients may see their risk of death drop by one quarter if they take a form of vitamin D, a new study says.

In a study of more than 1,400 people with chronic kidney disease, those that were taking the drug calcitriol, a form of activated vitamin D, had a 26 per cent reduction in their risk of death versus those who were not on the drug. Overall, the patients on calcitriol had their risk of either death or dialysis due to a loss of kidney function fall by 20 per cent.

The study is published in the Journal of the American Society of Nephrology.

A healthy human body uses first the liver and then the kidneys to convert vitamin D obtained through diet and sunlight into an active form that the body can use. However, it is believed that patients with chronic kidney disease are unable to do complete the second step.

They are often prescribed activated vitamin D to help lower elevated levels of the parathyroid hormone, which can lead to a weakening of the bones. However, people with kidney disease often suffer from calcified, or stiff, blood vessels, which can lead to a host of cardiovascular problems. Vitamin D increases calcium levels in the blood, which doctors fear could exacerbate this problem.

“We did find that people who got the activated vitamin D drug did have a higher risk of having a high calcium level in the blood,” study author Dr. Bryan Kestenbaum of the University of Washington told Ctv.ca.

“But the overall amount of people that that happened to was relatively small, and the overall balance was that people who got the activated vitamin D drug survived longer.”

Kestenbaum speculated that vitamin D leads to decreased mortality rates because of its known ability to lower risk factors for cardiovascular disease, including high blood pressure, diabetes and inflammation.

He said that the next step in this field of research would be to conduct randomized clinical trials to confirm vitamin D’s effect on survival rates among patients with kidney disease.

Research reports keep rolling in on the importance of vitamin D in our diet-beyond its familiar role in helping us to build strong bones. Here are some of the findings: Periodontal disease, in a dental study of 6,700 people from 13 to 90, the gums of patients with higher blood levels of vitamin D were 20 percent less likely to bleed. “The evidence on gingivitis and tooth loss suggests that vitamin D influences oral health by decreasing inflammation,” said Bess Dawson-Hughes, director of the Bone Metabolism Lab at the Human Nutrition Research Center on Aging at Tufts University.

Cancer. Studies by Reinhold Vieth at the University of Toronto have reported a substantial reduction in the rates of colon cancer as blood levels of vitamin D went up. Dr. Vieth suggests that vitamin D inhibits a mechanism by which cancer cells spread or it may boost the function of blood vessels or the immune system.

Diabetes. A number of studies have found that people with higher blood levels of vitamin D had a lower risk of diabetes than people with lower levels. Researchers have suggested that vitamin D seems to influence responsiveness to insulin.

Fitness. A study at the Wake Forest University School of Medicine found that people with low blood levels of vitamin D scored from 5 to 10 percent lower on tests measuring grip strength, balance and walking speed than those who had higher levels. Apparently vitamin D helps build and repair muscles as well as bones.

Longevity. People who take vitamin D supplements may also live longer, according to Sara Gandini, Ph.D., of the European Institute of Oncology in Italy, and Philippe Autier, M.D., of the International Agency for Research on Cancer in France. “The intake of ordinary doses of vitamin D supplements seems to be associated with decreases in total mortality rates,” they reported.

“The results are remarkable,” according to Edward Giovannucci, M.D., ScD., of the Harvard School of Public Health, in an editorial on vitamin D research in the Archives of Internal Medicine.

What to do. Adults should try to get 800 international units (IU) daily of vitamin D-or 1000 IUs a day if you are 70 or older. The average U.S. adult intake of vitamin D is 230 IUs daily, according to a study reported in the journal Nutrition Reviews. Vitamin D is available from sunlight, of course, and from foods such as fatty fish, eggs, fortified milk and fortified cereals as well as supplements.

-Sources: Bottom Line Health, CSPI Nutrition Action Letter, and Tufts University Health & Nutrition Letter