Vitamin Information Center

Low serum vitamin D levels in older men are associated with a higher risk of cardiovascular mortality, noncancer mortality, and noncancer, noncardiovascular mortality, according to research presented here at the American Society for Bone and Mineral Research (ASBMR) 30th Annual Meeting.

Although low 25-hydroxy vitamin D (25-OH vitamin D) levels have previously been associated with an increased risk of fractures and some diseases in older men, few studies of all-cause and cause-specific mortality have previously been conducted in elderly males, said Peggy Cawthon, California Pacific Medical Center Research Institute, San Francisco, California, who presented results from the prospective study here on September 12.

“There’s been a lot of interest in vitamin D levels and various health conditions in older adults, and some recent observational studies have suggested there is an association between higher vitamin D and protection for mortality, so the more vitamin D you have, the less likely you are to die,” Cawthon explained.

To test the hypothesis that low serum levels of vitamin D are associated with an increased risk of mortality in older men, the researchers looked at 5,995 men aged 65 years and up at 6 clinics in the United States. All subjects were participating in the Osteoporosis Fractures in Men study. An analysis sample of 1,608 men was randomly selected, and the subjects were followed for 6.1 years.

Proportional hazards models were used to test associations between low vitamin D levels and overall mortality, noncancer mortality, and cancer mortality as well as cardiovascular death. Adjustments were made for factors such as age, clinical centre, and season of the blood draw.

The study found that men with vitamin D deficiency (≤15 ng/mL) had a 2.2-fold increased risk of death due to causes besides cancer, with no significantly increased mortality for those with levels of 15 to 30 ng/mL (P = .008).

The researchers also found, however, that there was no significant association between 25-OH vitamin D deficiency and death due to all types of cancer combined (relative hazard = 0.6; confidence interval, 0.2-1.4), with results for vitamin D deficiency similar to results in the lowest quartile of 25-OH vitamin D levels (≤20 ng/mL) compared to those in men in the highest quartile (≥30 ng/mL) (P = .12).

“We saw the opposite of what we expected,” Cawthon noted. “There’s not any other information in the literature that would suggest that association, and we’re not really sure why that is.”

Potential harmful effects of higher vitamin D levels should be investigated further in larger studies with better power, the investigators concluded. “We’d like to look at this in [the setting of] a randomised, controlled trial,” Cawthon said.

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.”

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.

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!

Vitamin D is known as the “sunshine vitamin” because the human body naturally produces vitamin D when exposed to sunlight. A report in the Archives of General Psychiatry gives new meaning to the term. New research has shown that your risk for depression could be high if your blood is low in vitamin D and high in serum parathyroid hormones, says a report in . (Arch Gen Psychiatry. 2008;65[5]:508-512.)

More specifically, poor vitamin D consumption can cause an increase in serum parathyroid levels, which are frequently accompanied by symptoms of depression. And considering that nearly 15% of older individuals suffer from the blues this could be the relief that they’ve been seeking.

The findings may be important to patients because both low blood vitamin D levels and high parathyroid hormone levels can be treated with higher dietary intake of vitamin D or calcium and increased sunlight exposure. “Moreover, the clinical relevance of the present study is underscored by our finding that 38.8% of men and 56.9% of women in our community-based cohort had an insufficient vitamin D status,” researchers conclude. Additional studies are needed to determine whether changes in levels of vitamin D and parathyroid hormone precede depression or follow it.

The Anti-Aging Bottom Line: Almost 15% of older Americans suffer from depression, which can substantially decrease your quality of life. if you feel like you may be depressed, get your vitamin D levels checked. Recent research has found that vitamin D deficiency is much more common that was previously thought, and that most people need higher amounts of D than the current government mandated recommendations. Vitamin D supplementation has been proven very effective at correcting deficiency. Make sure you are getting at least 1,000 IU of supplemental vitamin D daily.

Exclusive breastfeeding can increase a child’s risk of developing rickets because breast milk alone does not provide adequate levels of vitamin D, a critical ingredient that helps to absorb calcium and build strong bones, the New York Times reports. Rickets develops when a child’s vitamin D levels are too low and is characterized by the curving of a child’s legs and the softening of other bones. Some children are asymptomatic.

Darker-skinned children have a greater risk of vitamin D deficiency than other children because they do not absorb vitamin D as easily through the skin. Sunlight enables the skin to synthesize vitamin D.

Cases of nutritional rickets among infants and young children in the U.S. have been “accumulating over the last decade or so,” and children with the condition are more likely to be black or dark-skinned and have been breastfed exclusively for an extended period of time without vitamin supplementation, according to the Times. Some experts say that an increase in infants being exclusively breastfed, more children drinking soda or juice and less milk, and children spending less time in the sun could contribute to rickets re-emerging as a public health problem, the Times reports.

According to the Times, while physicians have known for years that exclusive breastfeeding is associated with vitamin D deficiency in infants and rickets, many are “reluctant to say anything that might discourage breastfeeding.” The American Academy of Pediatrics in 2003 recommended that infants who are exclusively breastfed receive vitamin D drops daily.

According to one study on rickets and vitamin D that included mostly black and Hispanic infants and toddlers, 40% of the participants had low levels of vitamin D, 12% were vitamin D deficient, 13 children showed evidence of bone loss and three children had signs of rickets. The study, published in the June issue Archives of Pediatrics & Adolescent Medicine, also found that breastfeeding without vitamin supplementation was a significant risk factor for rickets.

Study author Catherine Gordon, director of Children’s Hospital Boston’s bone health program, said, “I completely support breastfeeding, and I think breast milk is the perfect food, and the healthiest way to nourish an infant. However, we’re finding so many mothers are vitamin D deficient themselves that the milk is therefore deficient, so many babies can’t keep their levels up.” She added, “They may start their lives vitamin D deficient, and then all they’re getting is vitamin D deficient breast milk” (Rabin, New York Times, 8/26).

Vitamin D is the key to preventing rickets and osteoporosis, but Rockefeller University scientists suspect it may also play a role in heading off atherosclerosis in people with chronic kidney disease. In a new clinical study, investigators at The Rockefeller University Hospital are examining patients with moderately reduced kidney function to investigate the effect of vitamin D therapy on endotoxemia, a condition that is common among those with renal disease and is widely viewed as a contributor to heart disease. The study, led by Instructor in Clinical Investigation Manish Ponda, is partially funded by a $25,000 grant from the Center for Clinical and Translational Science.

The high rate of atherosclerosis among patients with kidney disease is well documented but little understood by medical experts. Endotoxins, products of the natural breakdown process of bacteria, are a hot topic of clinical investigation with regard to both heart and kidney disease. “The number one killer among people with kidney disease is heart disease, just like in the rest of the population, except that in people with kidney disease, the heart disease exhibits an accelerated course,” says Ponda, a member of Jan Breslow’s Laboratory of Biochemical Genetics and Metabolism at Rockefeller. The research is an extension of earlier clinical work by Ponda that showed a high incidence of vitamin D deficiency among early-stage kidney disease patients.

Study participants — males and postmenopausal females between ages 50 and 80 with stage three chronic kidney disease and vitamin D deficiency — will be provided with thrice-weekly doses of vitamin D3, also known as cholecalciferol, the form of vitamin D produced by the body in response to sunlight. Participants will make three outpatient visits at intervals of four weeks each to The Rockefeller University Hospital, where investigators test for levels of endotoxins in response to vitamin D repletion.

The dose of vitamin D prescribed for the study — 30,000 international units per week — equals more than 20 times the intake recommended by the United States Department of Agriculture and approximately 10 times the amount in an average multivitamin supplement. The dosage is designated to safely reverse vitamin D deficiency.

If Ponda’s hypothesis — that vitamin D repletion will be accompanied by decreases in blood endotoxin levels — holds true, a larger, more-extensive, “progression” study will follow, to chart the connection over longer periods of treatment and in later stages of renal disease. “Kidney disease puts a person at significantly higher risk for cardiovascular disease, but it is often asymptomatic even as late as stage three,” says Ponda. “The more definitively we can characterize renal disease, the closer we are to effectively treating both it and its comorbid conditions.”

A slew of recent books and studies have touted the benefits of vitamin D and the perils of not getting enough vitamin D; some even encourage lying in the sun and taking vitamin supplements in order to prevent depression. But dermatologists say more time soaking up the rays isn’t necessary—most Americans get all the vitamin D they need just by going outside in the course of their daily duties, and beyond that, it’s easy to get adequate levels of the vitamin through nutrients in food. “Sunlight helps us produce vitamin D, but the amount of sunlight you need is so low that you could walk outside for probably five minutes and have enough,” says Craig Austin, a New York-based dermatologist and founder of AB Skincare.

Vitamin D is important because it helps with calcium absorption; it’s found in foods ranging from milk and cheese to liver, beef, fish and eggs. Many cereals are now fortified with vitamin D, as well; most people who follow normal diets probably don’t need to take vitamin D or calcium supplements, Austin says. “Vitamin D deficiency, I don’t think, is really all that common.”

During the winter, people who live in northern climates might consider taking daily supplements, says New Jersey-based dermatologist Eric Siegel. But overdoing the vitamins has side effects, too, including nausea, vomiting, poor appetite and constipation. “You can also start suffering kidney disease, and, believe it or not, once you go past a certain dose of vitamin D, you can start clogging up the kidneys, because there’s too much calcium absorbed into the blood,” he says.

So don’t use vitamin D as a reason to lie in the sun that extra half hour, Siegel says. “Why not get [vitamin D] out of food or supplements?” he asks. “Why give yourself skin cancer?”

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

Unalaska has many great things to offer, but intense sunlight is not one of them. Although the lack of powerful sun may be good for reducing our skin cancer risk, it is not good for our vitamin D levels. The body uses sunlight to make vitamin D from molecules in the skin. Many who live at northern latitudes, especially in the winter, have inadequate vitamin D levels. A study in the British Medical Journal estimates at least 1 billion people worldwide are vitamin D deficient.

Most tissues in the body have receptors for this important vitamin. All of its many functions are still being discovered. The primary role of vitamin D is maintaining normal blood levels of calcium and phosphorous. Long term vitamin D deficiency leads to rickets in children and a softening of the bones in adults.

Currently there is much research being done to discover the additional effects of vitamin D in our bodies. A recent study published in the journal Dibetologia suggests that vitamin D may play a role in preventing type 1 diabetes in children. Vitamin D deficiency has been associated with increased risk of cardiovascular disease, according to a 2008 article in the journal Circulation.

A 2007 article in the New England Journal of Medicine states that people who live at higher latitudes who have vitamin D deficiency, or lack exposure to the sun, have an increased risk of many cancers. The same article suggests vitamin D may also provide protection from hypertension, psoriasis, several autoimmune diseases (including multiple sclerosis and rheumatoid arthritis) and reduce the incidence of fractured bones.

Make sure that you are getting enough vitamin D. It is difficult to get enough from the sun in the summer in Unalaska and impossible in the winter. Check out this Web site from the Norwegian Institute for Air Research to calculate how much vitamin D you are getting from the sun based on your location, weather, skin color, and clothing: http://nadir.nilu.no/~olaeng/fastrt/VitD_quartMED.html.

Obtaining adequate levels of vitamin D from your diet is not easy either. Good dietary sources include fortified milk, eggs, and fatty fish. Some studies, such as one published in the European Journal of Clinical Nutrition last year, have shown that the vitamin D fortification of milk products is not adequate to prevent vitamin D deficiency.

Infants who are breast fed are at particular risk vitamin D deficiency according to a 2004 study published in the American Journal of Clinical Nutrition. Human milk contains little vitamin D, and women who are vitamin D deficient provide even less to their breast-fed infants.

There are differing opinions on the recommended daily intake, especially in light of new studies coming out every day. The USDA recommended daily intake is 400 IUs for a healthy adult. Some physicians recommend much more than that, particularly for those deficient in the vitamin. Because vitamin D can be stored in our bodies, there are high dosages available that can be taken only once a week or once a month.

A 2003 study published in the Journal of Pediatrics looked at the vitamin D levels of women and infants in Alaska. Based on this study, the American Academy of Pediatrics recommends a universal supplement for all infants not receiving vitamin D fortified milk. Talk to your health care provider about getting the right amount of vitamin D for your health.

Tiffany Kelly is medical student from the University of Washington who visited Unalaska for the month of July, 2008. She now lives in Anchorage.