Vitamin Information Center

Long-term supplementation with vitamin E and vitamin C may not prevent cancer, according to data from the Physician’s Health Study II that was presented at the American Association for Cancer Research’s Seventh Annual International Conference in Washington, D.C. on November 16, 2008.[1]

The role of diet in cancer incidence remains a major focus among researchers, as it is becoming more evident that diet may reduce the risk of developing certain types of cancers. For example, vitamin D appears to have a protective effect against pancreatic cancer and also colorectal adenomas.[2][3] In addition, several studies have linked vitamin E, selenium, and lycopene with a reduction in prostate cancer. However, it has also been discovered that supplementation with specific vitamins and minerals often does not have the same protective role as obtaining the nutrients from foods. In other words, there is still much to be learned about the role of nutrients in the prevention of cancer.

The Physician’s Health Study II is a large-scale, long-term, randomized clinical trial involving over 14,000 physicians over the age of 50. The physicians were given either a) 400 IU of vitamin E every other day or placebo or b) 500 mg of vitamin C daily or placebo and were then followed for up to 10 years. The primary endpoint of the vitamin C group was the development of cancer. The primary endpoint of the vitamin E group was the development of prostate cancer, with a secondary endpoint being the development of any type of cancer.

After nearly 10 years of supplementation, there was no evidence that vitamin E or vitamin C played a protective role against cancer. Thus far, there have been 1,929 cancer cases in the group, including 1,013 cases of prostate cancer. The researchers concluded that neither vitamin E nor vitamin C offers any beneficial effect against cancer.

Research in this field is ongoing; however, the results from this study indicate that vitamin supplements may not provide the same benefits as vitamins included as part of a healthy, balanced diet.

References:

[1] Buring JE, Sesso HD, Gaziano JM, et al. A randomized factorial trial of vitamins E and C in the prevention of cancer in men: the Physicians’ Health Study II. Proceedings from American Association for Cancer Research Annual Meeting. Abstract #PR-1.

[2] Skinner HG, Michaud DS, Giovannucci E, Willett WC, Colditz GA, Fuchs CS. Vitamin D Intake and the Risk for Pancreatic Cancer in Two Cohort Studies. Cancer Epidemiology, Biomarkers, and Prevention. 2006;15:1688-95.

[3] Wei MY, Garland CF, Gorham ED. Vitamin D and prevention of colorectal adenoma: A meta-analysis. Cancer Epidemiology, Biomarkers and Prevention. 2008;17(11):2958-2969.

Next time you visit your local chemist, pause in the aisle containing vitamin supplements, and take in the quantities and varieties of pills and potions on offer. Tiny boxes and bottles stretch as far as the eye can see, affirming that even in these cash-strapped times, the gorging of such “miracle cures” continues to be big business.

But as the UK population continues to shell out millions annually on vitamin supplements, the scientific evidence supporting their efficacy is waning. Earlier this month, US scientists discovered that taking vitamins A and E does not lower your risk of cancer, one of the supposed major benefits of taking them.

“There have been a number of previous studies that have suggested that vitamin E and vitamin C might be important in the prevention of cancer,” says Dr Howard Sesso, one of those involved in the recent research. “The lack of an effect that we observe for vitamin E or C on cancer does convince us that these particular doses that we tested really have no role for recommendation for cancer prevention,” continues the academic. The clinical trials he oversaw involved nearly 15,000 American men.

Another recent study, part-funded by German chemicals firm BASF, whose products include vitamins, working in association with Brigham and Women’s Hospital, Boston, discovered that there were no significant effects on rates of heart disease after taking vitamins E and C. Two months ago, a major trial studying whether vitamin E and selenium (which, among other things, helps regulate hormone metabolism in the thyroid) could lower a man’s risk of prostate cancer ended amid worries that such treatments may do more harm than good. As if that were not enough, doctors at New York’s Memorial Sloan-Kettering Cancer Centre have warned that vitamin C seems to protect not only healthy cells, but cancer cells, too.

So should we be taking vitamin supplements at all? “We say that people don’t need to take vitamin supplements to have a healthy balanced diet. The only situation in which you should have to take vitamin supplements is if you are elderly or suffering from a long-term illness. People should address whether they have a healthy diet rather than seeing vitamins as a complete solution,” says Heather Caswell, nutrition scientist at the British Nutrition Foundation.

“People get a lot of vitamins from food,” adds health expert and author Oliver Gillie. “The exception is, of course, if you have too many things in your diet that are vitamin-depleted because they are totally refined. This includes cake and biscuits, which have large amounts of refined starches in them. On the other hand, if you are eating brown bread and you are consuming lots of vegetables, and a certain amount of meat and eggs, you will be OK.”

If the evidence against supplements is rapidly becoming insurmountable, why do people keep taking them? Well, some supplements still have proven advantages for people’s health. Vitamins such as B12 – that are good for facilitating normal functioning of the brain and nervous system – are still believed by some to have benefits for women of child-bearing age and the elderly. Furthermore, calcium and vitamin D in women over 65 appear to protect the health of the bones of those taking them.

People seem to experience the placebo effect more than ever with vitamins – thinking that the more they spend, the more they are able to stave off the worst effects of disease and age. The general belief is that they boost the body’s ability to mop up cancer-and-heart-disease-causing free radicals.

In some cases, in the UK at least, there is increasing evidence that some vitamins do have benefits. “Vitamin D is different,” adds Gillie. “A healthy person normally gets 90 per cent of the vitamin D they need from the sun. Unless you are an Eskimo or a Scottish fisherman living 100 years ago where you ate fish every day, then you can’t get enough from your diet.” A lack of vitamin D has been linked to increased rates of cancer, high blood pressure, osteoporosis, depression and schizophrenia.

Today, top Scottish doctors are meeting to discuss how to deal with the fact that, due to the country’s northerly location and consequent lack of sunlight, large swathes of its population are not getting enough of the vitamin, which is believed to support the healthy operation of organs.

“I am going to a conference in Edinburgh called by Scotland’s chief medical officer, Dr Harry Burns, who is concerned with the low levels of vitamin D in the Scottish population. It is an extreme case in the industrial world. In places like Glasgow there is so little ultraviolet light that people are in drastic need of vitamins. They are in an extreme situation because of their maritime climate. Scotland has got more cases of multiple sclerosis [which is believed to be naturally inhibited by vitamin D] than any other country in the world.”

But there’s now increasing evidence that taking too much of some vitamins can cause harm to people’s health. Recent studies – one by the Johns Hopkins School of Medicine – have shown that taking large amounts of vitamin E with other vitamins results in a 6 per cent higher risk of premature death. Another study, reported in the Journal of Clinical Oncology, of 540 patients showed that cancer recurrence rates were higher among vitamin users than among non-users. There seems to be increasing evidence that the death knell for certain vitamin supplements has now well and truly been sounded. Could it be time to step out of the chemist’s and back into the kitchen?

Complete meals: How to get your daily dose

Vitamin A

Liver, full-fat dairy products, spinach, broccoli, tomato juice, peppers and watercress. Orange things, such as mango, dried apricots, butternut squash, carrots, sweet potatoes and pumpkin tend to be good sources of this vitamin.

Vitamin D

Oily fish (salmon, sardines, pilchards, tuna, mackerel, trout or herring), dairy products and eggs. Also exposure to sunlight.

Vitamin E

Broccoli, nuts, soya beans, brussels sprouts, spinach and eggs. Some believe vitamin E is destroyed by heat, so try to eat your vegetables raw or lightly cooked.

Vitamin C

Citrus fruits and juices, kiwi fruit, strawberries, blueberries, tomatoes and peppers.

Vitamin B

Vitamin B1 is found in whole grains, flour and bread and green leafy vegetables; Vitamin B2 is found in eggs, liver, milk, and cheese; B3 is in protein-rich foods like meat, liver and peanuts; B5 is in chicken, eggs, beef and broccoli;

B6 is in fish, chicken and wholegrain cereals; B9 is in raw fruit as well as yeast and liver and B12 is in fish, dairy produce, meat and yeast extract.

Eric Madrid, MD
Physicians and scientists are starting to realize the numerous health benefits of sunshine exposure and vitamin D supplementation. Most doctors know severe vitamin D deficiency causes rickets. Since rickets is rarely seen today, it is incorrectly assumed that vitamin D deficiency is nonexistent.

Fallbrook and Temecula medical providers have diagnosed hundreds of patients with vitamin D deficiency, or about 90 percent of all patients tested. Nine out of 10 people reading this story likely suffer from vitamin D deficiency.

Why should you have your vitamin D level checked? Studies have shown that those with lower levels of vitamin D in their blood have a higher risk of developing breast cancer, ovarian cancer, colon cancer, prostate cancer, type 1 diabetes, multiple sclerosis and heart disease. One study showed greater than a 60-percent reduction in breast cancer in those with the highest levels of vitamin D in their blood.

In addition, senior citizens who have lower levels of vitamin D in their blood are at higher risk of falls, osteoporosis and bone fractures. Those who suffer from chronic pain and fibromyalgia also have lower levels of vitamin D.

Vitamin D levels are checked by a simple blood test. Treatment usually requires supplementation with vitamin D3 as opposed to the more commonly sold over the counter vitamin D.

Vitamin D is also made from moderate daily sun exposure to the arms and legs. Caution must be taken to prevent sun burning. Many sunscreens will block out UVB, which is the type of sunlight needed for skin to make vitamin D. Those with darker pigment are higher risk of deficiency, which may explain the higher incidence of diseases in certain ethnic populations.

To check your vitamin D level, contact your physician or call (951) 676-4193 for an appointment.

Eric Madrid MD is a family physician with Rancho Family Medical Group, which has offices in Fallbrook and Temecula. See www.ranchofamilymed.com.

Vitamin D, which the body makes when exposed to sunlight, may help prevent multiple sclerosis (MS), suggests a new study.

What’s more, the principal regulator of calcium in the body may also prevent the production of malignant cells such as breast and prostate cancer cells.

According to an article by Sylvia Christakos, PhD, of the UMDNJ-New Jersey Medical School, the research shows that the incidence of MS decreases as the amount of vitamin D available to the body increases, either through sunlight exposure or diet.

The study has been published online in the Journal of Cellular Biochemistry.

“Since vitamin D is produced in the skin through solar or UV irradiation and high serum levels have been shown to correlate with a reduced risk of MS, this suggests that vitamin D may regulate the immune response and may promote a host’s reaction to a pathogen,” Christakos said.

Christakos’ report focuses on the immunosuppressive actions of the active form of vitamin D, which may inhibit the induction of MS, and emphasizes the importance of maintaining a sufficient vitamin D level.

“Evidence has shown that the maintenance of an adequate vitamin D level may have a protective effect in individuals predisposed to MS,” Christakos said.

“One device of vitamin D action may be to preserve balance in the T-cell reaction and thus avoid autoimmunity,” Christakos added.

Despite the significant evidence of the benefits of vitamin D relative to MS and other autoimmune diseases, Christakos cautions that further studies are needed to determine whether vitamin D alone or combined with other treatments is effective in individuals with active MS.

DEAR DR. DONOHUE: I am a 76-year-old female. Until December 2005, I thought I was in fairly decent health. That’s when I suffered a fractured hip. I didn’t fall, just sort of slipped down. I have recovered and feel great, and I exercise. Last April, my doctor prescribed 50,000 IU vitamin D once a week. I have been taking it ever since. I get lots of sun. I also take 600 mg of calcium with 200 IU vitamin D twice a day. And I take one multivitamin a day, a Centrum Silver. My doctor wants me to consider taking Fosamax. What’s going on? I worry about getting too much vitamin D. How does a person know how much is too much?

— T.W.

Most adults get too little vitamin D. The official recommendation for daily vitamin D intake is 200 IU for those from 19 to 50, 400 IU for those between 51 and 70, and 600 IU for those 71 and older. Many experts believe these recommendations are insufficient and that the daily dose should be 800 IU to 1,000 IU. Vitamin D enhances calcium absorption and plays a critical role, therefore, in keeping bones strong and in preventing fractures. There are hints that vitamin D prevents osteoarthritis, lessens the risk of prostate cancer and helps prevent diabetes and heart disease. Time will tell if all this is true. The stuff about bones is true.

We get vitamin D when sunlight strikes the skin. It turns a substance in the skin known as a “provitamin” into vitamin D. Ten minutes of sunlight on the face and arms, three times a week to daily, is all the sunlight needed for this conversion. Older people’s skin is not so efficient in making the vitamin, and those living in northern latitudes can’t depend on sunlight conversion in the winter months.

From your weekly 50,000 IU tablet, you get about 7,000 IU of the vitamin daily. Centrum Silver has 500 IU. You get another 400 IU with your daily calcium tablets. So your daily intake is around 8,000 IU. Too much vitamin D can be a problem. It can damage the kidneys and can actually draw calcium from the bones. The upper daily limit is set at 10,000 IU. You haven’t crossed the border, but you’re in its neighborhood. The 50,000 IU tablet can correct a vitamin D deficiency in six to eight weeks. I’d say you’ve made that correction. Ask your doctor about stopping this high-dose vitamin therapy. If there is a question about the adequacy of your body store of vitamin D, a blood test can determine if it is too low, too high or just right.

DEAR DR. DONOHUE: Our 21-year-old daughter has been diagnosed with peripheral neuropathy. Her finger turned a shade of blue. She went to the emergency room and got the diagnosis there. What kind of doctor should we consult to determine if this is her condition?

— V.C.

Your family doesn’t have a history of having peripheral neuropathy, right? So let’s remove all the genetic causes of it from consideration.

Twenty-one is young to come down with it. It’s more of an older person’s illness. People with diabetes and a few other diseases also are targets for it, but your daughter is in otherwise good health.

A blue finger isn’t a usual sign. Your daughter should see a neurologist or a vascular specialist to confirm this diagnosis, which appears a bit strange to me.

Readers may write to Dr. Donohue or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

April 11th 2008, Lysaker, Norway - An increased intake of vitamin K2 may reduce the risk of prostate cancer by 35 per cent, suggest results from the European Prospective Investigation into Cancer and Nutrition (EPIC).

The findings, based on dietary intake from 11,319 men taking part in the EPIC Heidelberg cohort, are published in this month’s issue of the American Journal of Clinical Nutrition.

The study, by Katharina Nimptsch, Sabine Rohrmann and Jakob Linseisen, adds to a growing body of science supporting the potential health benefits of vitamin K2, most notable for bone and blood health.

In this recent study, dietary intake of vitamin K2 was linked to an inverse association with prostate cancer, while vitamin K1 intake did not offer any prostate benefits, report the researchers from the German Cancer Research Centre in Heidelberg.

Dr. Anne Bjørnebye Vik, Vice President R&D for NattoPharma, says: “ The potential anti-tumor effect of vitamin K2, in this case specifically prostate cancer, adds to the great potential for NattoPharma’s natural vitamin K2, MenaQ7™, one of the more documented derivatives in the group of vitamin K2’s or the so called long-chain menaquinones. As this interesting field of nutrition and cancer now also include vitamin K2, we are excited that NattoPharma’s natural menaquione-7, branded as MenaQ7™, shows to be the optimal form of vitamin K2.”

The study has also been welcomed by leading vitamin K researcher Cees Vermeer, PhD, from the VitaK and Cardiovascular Research Institute CARIM at the University of Maastricht. Commenting on the research, Dr. Vermeer says: “the beneficial effect of the long-chain menaquinones has previously been reported for cardiovascular disease; this specific form of vitamin K2 is characterized by preferential transport (via LDL) to extra-hepatic tissues (such as prostate and arterial vessel wall), and by very long half-life times (three days versus 1.5 hours) as compared to vitamin K1 and the short-chain menaquinone-4.

“I am highly pleased by this paper, which underpins the (widely underestimated) importance of long chain menaquinones for disease prevention,” Dr. Vermeer says.

“It also supports my opinion that intake of vitamin K2 supplements may have a significant contribution to public health.”

Study details

Nimptsch, Rohrmann and Linseisen from the Division of Cancer Epidemiology at the German Cancer Research Centre state that epidemiologic studies of dietary vitamin K intakes have not been conducted in relation to prostate cancer risk.

According to the European School of Oncology, over half a million new cases of prostate cancer are diagnosed every year worldwide, and the cancer is the direct cause of over 200,000 deaths. More worryingly, the incidence of the disease is increasing with a rise of 1.7 per cent over 15 years.

A food frequency questionnaire was used to assess habitual dietary intakes at the start of the study, with vitamin K intakes divided into phylloquinone (vitamin K1) and menaquinones (vitamin K2) and total and advanced prostate cancer in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition.

The researchers documented 268 incident cases of prostate cancer during the 8.6 years of follow-up. Of these, 113 cases were classified as advanced prostate cancer. While no reduction in the risk of prostate cancer was observed for vitamin K1 (phylloquinone), an increased intake of all menaquinones (vitamin K2) was associated with a 35 per cent reduction in risk. However, the researchers stated that this association was “non-significant”.

Furthermore, a strong association was documented when they considered only advanced prostate cancer, with increased intake of menaquinones linked to a 63 per cent reduction in risk.

While dietary sources of menaquinones include meat and fermented food products like cheese, and natto, Nimptsch and co-workers report that menaquinones from dairy had a stronger inverse association with advanced prostate cancer than did menaquinones from meat.

“Our results suggest an inverse association between the intake of menaquinones, but not that of phylloquinone, and prostate cancer,” concluded the researchers. “Further studies of dietary vitamin K and prostate cancer are warranted.”

Source: American Journal of Clinical Nutrition
April 2008, Volume 87, Number 4, Pages 985-992
“Dietary intake of vitamin K and risk of prostate cancer in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Heidelberg)”
Authors: K. Nimptsch, S. Rohrmann, J. Linseisen
NattoPharma, Norway offers a natural vitamin K2 under the trade name MenaQ7.

K definitions

There are two main forms of vitamin K: phylloquinone, also known as phytonadione, (vitamin K1) and menaquinones (vitamins K2). K1 is found in green leafy vegetables such as lettuce, broccoli and spinach, and makes up about 90 per cent of the vitamin K in a typical Western diet; while K2, which makes up about 10 per cent of Western vitamin K consumption, is found mainly in fermented dairy products as e.g. cheese. The Japanese food Natto (fermented soybeans) is especially rich in vitamin K2.

A synthetic form of vitamin K, known as K3, does exist but is not recommended for human consumption.

The vitamin K’s are less well known than vitamins A to E, but this increasing body of research, as well as increased marketing and advertising from supplement makers, is raising public awareness of vitamin K.

BALTIMORE, March 27 (UPI) — Folate — vitamin B 9 – potentially may be used to limit the damage of a heart attack, U.S. researchers say.The study, scheduled to be published in the April 8 edition of the journal Circulation, finds the vitamin blunted the damage from heart attack in animal studies.

“We want to emphasize that it is premature for people to begin taking high doses of folic acid,” senior study investigator Dr. David Kass, of The Johns Hopkins University School of Medicine in Baltimore says in a statement. “But if human studies prove equally effective, then high-dose folate could be given to high-risk groups to guard against possible heart attack or to people while they are having one.”

“We do not know how much or how little of it is needed to be effective,” Kass cautions. A large amount could yield unpredictable side effects and studies have linked folic acid supplements to increased rates of colon and prostate cancer, Kass says.

Folate — naturally found in leafy green vegetables, beans and nuts — is sometimes used as a general term to include folic acid — the form of vitamin B9 put in supplements and added to foods, especially grain products.

Vitamin D kills prostate cancer cells in the laboratory. Now, specialists at the Hollings Cancer Center at the Medical University of South Carolina are studying whether vitamin D will halt the cancer’s progression in early-stage patients.

Drs. Sebastiano Gattoni-Celli and David Marshall hope to add a large dosage of vitamin D to “watchful waiting.”

Watchful waiting is an approach some men with slow-growing prostate cancer choose. Doctors monitor the disease for signs of growth. If and when that occurs, treatment may be sought.

“We offer something more than monitoring,” said Gattoni-Celli, principal investigator.

That “something more” is vitamin D — a nutrient mainly absorbed through sun exposure and long touted as a cancer-prevention agent.

The prostate is a walnut-sized gland below the bladder responsible for making and storing fluid that transports sperm. The gland is known to sequester vitamin D, which helps it function.

The recommended daily dose of vitamin D for men ages 51 to 70 is 400 International Units, or IUs. Study participants take 4,000 IUs of vitamin D daily.

The Food and Drug Administration approved the study-prescribed dosage as having minimal to no toxicity, said Gattoni-Celli, who has taken 4,000 IUs of vitamin D daily for three years.

“A good number of people may be deficient in vitamin D because we live and work indoors,” he said.

Participants in the watchful waiting and vitamin D study are monitored every eight weeks. If their levels of prostate-specific antigen — a protein found in blood that correlates with prostate cancer — rise twice consecutively, they will be counseled to reassess their treatment options.

Vitamin D is found in fortified milk, eggs and fatty fish, but people absorb most of what they need through ultraviolet rays. Fifteen minutes of sun exposure twice a week to the face, arms, hands or back without sunscreen is sufficient for most people to produce enough vitamin D, according to the National Institutes of Health.

People with dark skin might have difficulty getting enough vitamin D from the sun. Increased melanin, which gives dark skin its color, reduces the skin’s ability to synthesize the vitamin from sunlight.

Gattoni-Celli said he is not surprised by the fact that prostate cancer affects black men disproportionately. “The hunch is there,” he said about a link between vitamin D and prostate cancer, but the reality of collecting scientific evidence requires patience.

Patients can opt out of the study any time to pursue treatment, said Marshall, the study’s co- investigator. The only risk of watchful waiting is that treatment later might prove more complex than if used earlier, he said.

Watchful waiting is advisable because some forms of prostate cancer can proceed very slowly, Gattoni-Celli said.

Autopsies of older men who died of causes other than prostate cancer revealed that 50 percent of them had the disease, Gattoni-Celli said.

Some experts now worry that prostate cancer might be overdiagnosed and overtreated with the increased availability of prostate-specific antigen screening in the last 25 years. Men who otherwise might have lived the rest of their lives without suffering symptoms of the disease now could be receiving aggressive treatment.

Some prostate cancer patient advocates are critical of the watchful waiting approach, however.

Bob Strobel leads the Charleston chapter of Us TOO, a prostate cancer education and support group. “Anytime someone mentions watchful waiting to someone with prostate cancer, you’ll see them get irate,” he said.

Strobel pointed to advances in treatments. “The things that are happening now with medical treatment, it’s astounding,” he said.

Treatments include the surgical removal of the gland, radiation and hormone therapy. Doctors also can implant radioactive seeds into the gland or freeze the cancer. All treatment options can cause problems such as incontinence and erectile dysfunction.

UroToday.com - Many of the 10 million cancer patients in the US are taking nutritional supplements, but an accurate assessment of the frequency is not well appreciated. In the February 1, 2008 issue of the Journal of Clinical Oncology, Christine Velicer and Cornelia Ulrich report a systematic review of supplement use among US cancer patients. Prostate cancer patients are among the lowest users of supplements.

A total of 32 studies published between 1999 and 2006 met the criteria for review of prevalence of vitamin and mineral supplement use among patients undergoing active cancer treatment. The review revealed that a range of 64% to 81% of survivors reported any vitamin or mineral supplement use and 26% to 77% reported using any vitamins. Nine studies reported use among breast cancer survivors, and use of any vitamins or minerals was 67%-87% and multivitamin use was 57%-62%. The increase in use after breast cancer diagnosis was up to 32%. Complimentary and alternative medicine (CAM) use was associated with younger age, higher education, greater physical activity and psychosocial factors. Use of any vitamins was 38%-43% for colorectal cancer patients and 60% for lung cancer patients.

In comparison, use of any vitamins among prostate cancer patients was 26%-35% and multivitamin use ranged from 13%-23%. Megavitamin use was 4%-24%. CAM use for prostate cancer patients was associated with higher education and higher income, but not cancer stage. Age and ethnicity were not clearly associated. In one study, 15% of patients undergoing radiotherapy used high-dose vitamins, but the treating physicians actually estimated that less than 5% were using them. After a diagnosis of prostate cancer, 15% of patients began using CAM (57% were already using CAM) but only 51% informed their physicians. In one study 20% of patients reported that their treating urologist or radiotherapist never raised the issue of CAM use with them.

The authors point out that while some therapies such as St. John’s wort may interfere with drug metabolism, a great understanding of the effects and utilization of CAM among cancer patients is needed. At the very least, physicians should gather intake about CAM use among their patients.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS Professor & Chairman Department of Urology University of California, Davis, School of Medicine Sacramento, CA

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

Vitamin D helps build strong bones by promoting the absorption of calcium.

There’s something simple you can do to help protect yourself against ailments ranging from cancer to depression. Chances are, you’re not taking the cure.

It’s vitamin D and some experts believe as many as 50 percent of healthy adults and children are deficient in this essential nutrient.

Doctors across the country have begun prescribing high doses to patients who are surprised to learn they’re deficient. Yet doctors and researchers say the vitamin D problem could be solved if we just got out in the sun.

Question: What’s so important about vitamin D?

Answer: For years, doctors have known vitamin D helps build strong bones by promoting the absorption of calcium. (The vitamin was added to milk more than 50 years ago to successfully combat the common childhood bone disease of rickets.) But recent research indicates D is important to almost all body tissues. Low levels of vitamin D have been linked to increased risk of breast and prostate cancer, colon polyps, multiple sclerosis, Type 1 diabetes, muscle weakness , even depression and schizophrenia.

Q: Why are so many people deficient?

A: Two reasons. People aren’t spending enough time in the sun and it’s hard to get enough vitamin D from food. The best way to get it is by being in the sun, since skin produces plenty of D when exposed to the sun’s rays. But office workers and kids playing video games often don’t spend enough time outdoors to make the D they need. And when they are outside, they’re probably wearing sunscreen. Sunscreen with an SPF of 8 blocks more than 95 percent of the sun’s capacity to make vitamin D in your skin.

Fortified milk, yogurt and orange juice contain about 100 International Units of vitamin D per one-cup serving. Canned salmon contains 300 to 600 IU. Doctors used to think 400 IU daily was enough for most adults. But new research indicates that is too low. Dr. Michael McClung, director of the Oregon Osteoporosis Center, recommends adults get 1,000 to 2,000 IU of vitamin D each day, unless their blood calcium is too high or they’ve had kidney stones.

Q: Who is most at risk of vitamin D deficiency?

A: “The farther you live from the equator and the less opportunity you have for regular sun exposure, the more likely you are to be deficient,” says Charlotte internist Dr. Charles Rich.

Older adults are more at risk. Obesity and liver or kidney disease also increase your risk. Blacks and people with darker skin are more at risk, because their skin is less able to synthesize Vitamin D from the sun.

Q: What are the symptoms of deficiency?

A: Often there are none. Debra Wilform, 49, of Charlotte, N.C., learned she was low in vitamin D after a blood test during a routine physical last year. She had no symptoms. Her doctor prescribed 50,000 IU of D2 once a week for six weeks, then once a month for six months. She’ll be re-tested in March.

Q: How much Vitamin D do I need and what are the best sources?

A: There’s still disagreement on how much D is enough. The New England Journal of Medicine says adults and children need 800 to 1,000 IU of vitamin D daily if they’re not getting enough sun exposure. McClung says it’s safe for adults to take 1,000 to 2,000 IU daily. (You’d need to drink 10 glasses of milk to get 1,000 IU.) Cautious sun exposure is the easiest way to get enough vitamin D. The National Institutes of Health says 10 to 15 minutes in the sun at least twice a week with your arms, hands, face or back exposed without sunscreen is usually enough.

Children and healthy adults make about 25,000 IU of D by spending 15 minutes in the sun with their face and arms exposed before applying sunscreen, says McClung. Because D is stored in fat and muscle, you can build up reserves to draw on later. But the farther north you live, the harder it is to get enough D from sun exposure alone. From November through February, people living north of Atlanta make little or no vitamin D by being outdoors.

Q: Should I be tested?

A: Ask your doctor. The test costs about $100 and is often covered by insurance. For many people, McClung just recommends over-the-counter supplements.

By spending 10 to 15 minutes in the sun at least twice a week with your arms, hands, face or back exposed you can increase your vitamin D intake.