Vitamin Information Center

The flu season is upon us and you may be wondering whether or not you should get vaccinated. Recent evidence would suggest that flu shots aren’t very effective, especially for those most at risk — the elderly. These are the people most likely to come down with the flu, followed by complications like pneumonia. Flu shots also don’t seem to do a very good job at protecting young children.

So what can you do? There is good evidence that vitamin D wards off the flu and common cold. If you live far from the equator, you simply won’t get enough sun at this time of the year to make all the vitamin D you need. Given the importance of the sunshine vitamin for all aspects of your health, supplementation with vitamin D makes sense whether or not you decide to get the flu shot.

Influenza vaccination

“Flu Shots For The Elderly Are Ineffective”. That’s the headline of an Oct. 23, 2008 release from the Orthomolecular Medicine News Service (1). The article picks up on a Sep. 2, 2008 report in the NY Times which claimed that “Doubts Grow Over Flu Vaccine in Elderly” (2).

“A growing number of immunologists and epidemiologists say the vaccine probably does not work very well for people over 70, the group that accounts for three-fourth of all flu deaths.” (2)

The evidence for and against the flu shot’s effectiveness

Flu shots are effective if you believe the results of dozens of observational studies carried out over the last forty years or so. These studies seemed to show that flu shots cut the risk of dying in winter from any cause by almost 50% and reduced the need for hospitalization by nearly 30%. It should be pointed out that unambiguous evidence is hard to come by in this field, since doctors rarely confirm influenza with lab tests.

The only randomized placebo-controlled trial to date, a study published by a Dutch group in 1994, found that the vaccine prevented the flu in about 57% of patients in their sixties. For patients past seventy the rate dropped to just 23%.

A 2005 article, on the other hand, painted quite a different picture. That paper pointed out that, even though the percentage of elderly getting an annual flu shot more than tripled from 1980 to 2001, there was no corresponding drop in the death rate. The authors concluded that the flu probably causes just 5 - 10% of all winter deaths in the elderly.

Vaccination doesn’t appear to protect small children very well either, judging by the experience with the 2003 - 2004 and 2004 - 2005 vaccines. Investigators looked at laboratory-confirmed influenza cases in children 6 to 59 months of age, their vaccination status, and their influenza-related inpatient/outpatient visits to emergency departments and outpatient clinics. Here are the authors’ conclusions: (3)

“In 2 seasons with suboptimal antigenic match between vaccines and circulating strains, we could not demonstrate [vaccine effectiveness] in preventing influenza-related inpatient/[emergency department] or outpatient visits in children younger than 5 years. Further study is needed during years with good vaccine match.”

A new 2008 Lancet article questions earlier findings that flu shots are effective (4). The authors of that paper suggest that the very decision to get vaccinated simply sets healthy seniors apart from the sick and frail. They theorize that healthier and more health-conscious patients are more likely to take the initiative to get a flu shot. Seniors who may have trouble taking care of themselves might simply not get to a doctor’s office for the vaccine. In other words, lower influenza rates in the vaccinated may have little to do with the vaccine’s effectiveness; seniors who get vaccinated may simply be healthier to begin with.

Needless to say, this view isn’t universally shared by the health care community. Proponents of immunization maintain that any reduction in the number of influenza cases has to be welcome, even if there is no sound evidence that this reduction is due to the flu shot. Doubters, on the other hand, simply see this attitude as a triumph of marketing over science.

Why would flu shots be ineffective?

First, there are some 200 to 300 different influenza virus strains, but the vaccine usually contains antigens of only a few. Preparing vaccines for the coming flu season is an annual guessing game. More often than not the vaccine doesn’t contain antigens of the most virulent strains.

Secondly, our immune system weakens with age; older adults do not respond as well as younger people to vaccines. For example, elderly patients may need as much as four times the amount of antigen for the same immune response as people under forty.

Thirdly, flu shots and other vaccines have harmful side effects. The Vaccine Adverse Effect Reporting System (VAERS) of the U.S. Food & Drug Administration (FDA) receives around 11,000 serious adverse reaction reports per year. Serious reactions are defined as death, life-threatening illness, hospitalization, or disability resulting from a vaccine. The FDA admits that in all probability only about 10% of adverse reactions are actually reported. The U.S. National Vaccine Information Center puts that ratio at only 3%.

In addition, the elderly take more medications than younger people. Combined with an already weakened immune system and potential vaccine side effects, the risk of adverse reactions can only grow with age.

What can you do to protect yourself?

Whether or not you decide to get the flu shot, you should do everything you can to strengthen your immune system. As the article from the Orthomolecular Medicine News Service puts it:

“Is there an available alternative? Yes, there may be: give the elderly more nutrients, rather than more needles. Older people often have inadequate diets. With ageing and illness, their bodies’ need for vital nutrients goes up, yet frequently their intake actually goes down.” (1)

and

“Over-reliance on vaccinating the elderly ignores their fundamental problems of poor diet and vitamin/mineral deficiencies. These are underlying reasons for a susceptible immune system. Supplemental nutrition is the “other” immune system booster. It is time to use it.” (1)

The authors point out that high doses of vitamin C have been shown to reduce the frequency and severity of influenza. Vitamin D and the minerals selenium and zinc have also been found effective.

The nutritional approach shouldn’t just be seen as a replacement for immunization. Even an effective vaccine still requires a functioning immune system. A vaccine presents the patient’s immune system with a weakened or dead virus. The immune system responds to that viral preparation in exactly the same way as it would to the real thing. By trial and error, the adaptive immune response develops antibodies and memory B and T cells against the viral strains it encountered; this process can take days if not weeks.

The difference between the live virus and the vaccine — and the idea behind vaccination — is that during that delay the live virus multiplies rapidly and may overwhelm the patient, whereas the weakened or dead viral strains cannot. If the vaccination worked, the patient’s adaptive immune system is prepared to respond immediately when it encounters the live virus.

Over-reliance on vaccinating the elderly, as the article from the Orthomolecular Medicine News Service puts it, also ignores another potent component of the host defenses — the innate immune system. Strengthening innate immunity may well pay larger dividends than the focus on adaptive immunity.

This is where vitamin D comes in.

Influenza and vitamin D

The new influenza model

One of the unusual aspects of influenza outbreaks is their seasonality; in temperate climates winter is flu season. The connection between the amount of sunlight and the disease was obvious enough, but the reason for this connection has only recently been understood (5). Vitamin D is essential to innate immunity, and most of our vitamin D is made by exposure to UV-B radiation from the sun; there simply are no significant dietary sources of vitamin D. Unless we supplement in the winter, our innate immunity will be compromised.

It is now believed (5) that much of the population carries various strains of the influenza virus year-round. During the summer months vitamin D is plentiful — unless one avoids the sun — and innate immunity can keep the virus in check. As winter approaches, vitamin D stores drop and the virus gains the upper hand.

That is when people get the flu and spread it. However, it seems that only a minority of influenza carriers are efficient transmitters of the virus. They will infect and sicken those that they come in contact with, but most of the newly infected will not pass the virus on; the epidemic is usually self-limiting.

Vitamin D’s mode of action

The adaptive immune system creates taylor-made antibodies to pathogens by trial and error. It is a match for any pathogen, but that process takes time. The innate immune system, on the other hand, produces antimicrobial peptides (AMPs) with broad-spectrum antimicrobial effects against intact microbes and “Pathogen-Associated Molecular Patterns (PAMPs)”. These AMPs will not be a match for every pathogen, but when they are the innate immune system springs into action immediately.

The influenza virus is spread by coughing and sneezing, and inhaled. The epithelia in the upper airways are surrounded by a thin aqueous layer of AMPs covered by mucus. This double layer of antimicrobiol peptides and mucus creates an antimicrobial shield that rapidly and irreversibly damages the membranes of virus particles that penetrate it.

Viruses that somehow make it through that shield to the endothelium induce endothelial cells to emit a burst of new antimicrobial peptides. These inducible AMPs bind to the carbohydrate portion of a viral glycoprotein, hemagglutinin A, thereby blocking the fusion between virion (virus particle) and endothelial cell; the virion can no longer penetrate the endothelium. The inducible AMPs also recruit macrophages and other white blood cells to limit further damage and clean up the debris.

Where does vitamin D come into the picture? When microbes like the influenza virus end up in the upper airways, they stimulate the production of an enzyme that converts 25(OH)D, the circulating inactive form of vitamin D, into the hormonally active 1,25(OH)2 (1,25-dihydroxyvitamin D). 1,25(OH)2D is required to turn on the genes that code for antimicrobial peptides. Without vitamin D there is no innate immunity.

There is convincing evidence that supplementation with a sufficient amount of vitamin D can prevent the onset of a flu or cold. An analysis of a randomized controlled trial showed that post-menopausal African American women taking 800 IU/day of vitamin D were three times less likely to come down with the flu or cold than those receiving placebo. 2000 IU/day essentially eliminated cold and flu cases altogether (5).

Vitamin D recommendations

The amount of 2000 IU/day is considerably higher than the current recommendations from the Food and Nutrition Board of the U.S. Institute of Medicine: 200 IU/day from birth to age 50, 400 IU/day fom 50 to 70, and 600 IU/day for anyone over 70.

These values were originally chosen because they were found to prevent osteomalacia (bone softening) and rickets. It is now recognized that vitamin D has many additional physiological functions, for which these levels are totally inadequate. A number of scientists are therefore calling for the Food and Nutrition Board in the U.S. and its counterparts abroad to reassess their current recommendations (6).

Experts in the field now believe that 25(OH)D blood concentrations should at least be 50 ng/ml (nanograms per milliliter), the level normally reached by sun exposure during the summer months. In the flu season, when there simply isn’t enough sunlight, supplementation with at least 2000 IU/day is needed to get to that level. You’ll get that from 2 tbsp of cod liver oil. That amount is considered perfectly safe. A recent risk assessment put the safe tolerable upper intake level (UL) of vitamin D at 10,000 IU/day, i.e. five times the amount now believed necessary.

Summary

Don’t just rely on vaccination to get you through the flu season; flu shots simply don’t seem to be very effective, especially for the most vulnerable groups in society — the very young and the elderly. There are a number of possible reasons for this. The vaccine may not target the most virulent influenza strains, the patient’s immune system may already be too weak to mount an immune response, or the vaccine may have side effects.

Vaccines containing weakened or dead viruses are meant to prepare the adaptive branch of the immune system for the onslaught of the live virus. When everything works, the adaptive immune system is capable of matching any pathogen, but the process takes time. The innate branch of the immune system, on the other hand, has a fixed repertoire of peptides that match the most common pathogen-asociated molecular patterns. There may not always be a match, but when there is then innate immunity is ready immediately.

The proper functioning of the innate branch of the immune system depends on the patient’s stores of vitamin D. If you live in a temperate zone, you simply cannot get enough sun exposure in the winter to reach the necessary vitamin D levels; you need to supplement, for example by taking cod liver oil. Given all its other health benefits, such as improvements in bone strength, insulin regulation, muscle strength, cardiovascular function, and a decrease in the risk of certain cancers, the decision to supplement with vitamin D should be a no-brainer.

Sources:

Flu Shots For The Elderly Are Ineffective. Orthomolecular Medicine News Service, Oct. 23, 2008.

Doubts Grow Over Flu Vaccine in Elderly. Goodman B. NY Times Sep. 2, 2008.

Szilagyi PG et al. Influenza vaccine effectiveness among children 6 to 59 months of age during 2 influenza seasons: a case-cohort study. Arch Pediatr Adolesc Med 2008;162(10):943-951.
http://archpedi.highwire.org/cgi/content/abstract/162/10/943

Jackson ML et al. Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case-controlled study. The Lancet 2008;372:398-405.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61160-5/abstract

Cannell JJ, Zasloff M, Garland CF, Scragg R, Giovannucci E. On the epidemiology of influenza. Virol J 2008;5:29
http://www.virologyj.com/content/pdf/1743-422X-5-29.pdf

Vieth R et al. The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr 2007;85:649-650.
http://www.ajcn.org/cgi/reprint/85/3/649<.li>

During these gray, overcast days, we almost hate to tell you about yet another study touting the health benefits of the “sunshine vitamin” — but we will anyway.

A new study published in the Journal of the American College of Cardiology reveals that people who have a deficiency in vitamin D are more prone to cardiovascular disease, heart attacks and strokes.

Experts are increasingly telling us that vitamin D is essential for our health, in ways that were previously unrecognized. The body of evidence just keeps growing.

People should have between 20 and 30 nanograms per millimeter of the vitamin in their blood, most doctors believe. The Institute of Medicine recommends 200 units daily of vitamin D in children and adults up to age 50, and 400 to 600 units for older adults. That means taking daily supplements, especially in sun-starved Seattle.

Researchers involved in the new study suggest that patients with vitamin D levels below 15 ng/ml were twice as likely to experience a heart attack, stroke or other cardiovascular event within the next five years compared to those with higher levels. The risk remained unchanged even when they adjusted for traditional cardiovascular risk factors.

Half of U.S. adults and 30 percent of children and teenagers have low levels of vitamin D, which activate the rennin-angiotensin-aldosterone system — predisposing patients to hypertension and a stiffening and thickening of the heart and blood vessels, researchers said.

Vitamin D is found in fish, eggs, fortified milk and other foods. The sun also contributes significantly to the body’s production of vitamin D.

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.

The evidence that points unerringly to a link between vitamin D and Scotland’s health statistics can be traced back to a journey undertaken in 1977 by two young Americans, Frank and Cedric Garland, who were studying cancer.

They regularly drove their white Ford Mustang from San Diego, California, to Johns Hopkins Medical School on the east coast, noticing the dramatic change in weather from sunshine to snow. When they saw a map showing that bowel cancer was much more common in the northeast of the United States than it is in the south and west, they immediately understood that sunshine might provide the explanation.

“Everyone else was thinking it must be something that people ate, like the amount of fibre or meat burnt on the barbecue,” said Frank Garland. “We were alert to the difference in climate because we had direct experience of it.”

The Garland brothers went on to show with scientific rigour that bowel cancer is linked to sun exposure. Later they showed that breast and ovarian cancers are also less frequent in sunny regions. At the time, their observations were too simple for doctors and scientists, dazzled by DNA and other modern wonders, to pay much attention. So it was 25 years before their discovery was taken seriously outside a small circle. Now this simple idea is crashing through medical research and bringing a revolution in thinking about the cause of chronic disease.
When bare skin is exposed to the sun it produces vitamin D, which, as doctors have known for many years, is essential for growth of strong bones. But in the past ten years it has become increasingly clear that vitamin D also protects us from a range of chronic diseases, including cancer.

By 2005 the Garlands were able to point to 63 studies that suggested increasing people’s vitamin D levels could reduce the risk of cancer at low cost with few or no adverse effects. According to Bill Grant, a former Nasa scientist turned vitamin D expert, 20,000 cancer deaths a year could be prevented in Britain if we received as much sun as the average American - more if we lived in Florida.

Vitamin D also protects us from heart disease of various kinds, raised blood pressure, stroke and several immune system diseases, including multiple sclerosis, inflammatory bowel disease, rheumatoid arthritis and diabetes. Even sporting fitness and strength may fall off in winter when vitamin D levels are low. Vitamin D is active on almost every tissue of the body, affecting 2,000 different genes.

I have often driven along a route in the Borders that tells a story similar to that of the Garland brothers. The route goes westward from Durham over the Cheviots and the Border hills to Carlisle and Glasgow. Durham, lying as it does on the east coast, is a small enclave of relatively sunny territory, but as we go west and north into Scotland we often encounter dull skies. The majority of Scotland’s population live in an open lowland corridor where the prevailing westerly wind blows cloud and rain in from the Atlantic, too often blocking out the sun. As a result Glasgow and its environs get about 50 per cent less sun than Durham. In fact, Glasgow gets little more sunshine than regions in the far north beyond the Arctic Circle.

This is an invaluable pointer to the health problems of the Scots. For years, experts have tried to explain why people living on Clydeside have recovered less well from economic deprivation than those on Teesside or Wearside in County Durham, whose lives are otherwise not so different. Poor diet, alcohol, drugs and smoking have all been blamed. But the missing ingredient is vitamin D. A baby born in Scotland starts with a health disadvantage, because vitamin D is vital for growth and development from the womb onwards.

Those babies born in March or April, at the end of the winter when vitamin D levels are lowest, are more likely to suffer later on from juvenile diabetes or multiple sclerosis than babies born at other times. Scotland also has the highest incidence of multiple sclerosis in the world, costing many millions of pounds per year as well as causing misery and suffering.

The problem is too urgent for Scotland to leave to Westminster, which has been presented with the evidence, but has failed to grapple with it. A learned committee known as SACN has already reviewed the evidence without taking action. The official advice to mothers in the UK remains that their babies do not need vitamin D until they are six months old. No explanation has ever been given why this should be so.

Yet evidence from abroad suggests that this approach is wrong. In France, scientists have coined the phrase “the French paradox” to explain why the average life-span is so much longer than that in England. Credit has been given to the Mediterranean diet, but in the end exposure to longer hours of sunlight probably has been more important, because of the vitamin D

it supplies. French doctors, recognising its importance, give pregnant women mega-doses of 100,000 units of vitamin D. In Canada, the national Cancer Society recommends that Canadians take at least 1,000 units of vitamin D per day in winter for cancer prevention, and the same in summer if they get little exposure to sunlight. In Canada, mothers living at high latitudes, equivalent to those in Scotland, are told to take 2,000 units of vitamin D per day, which is enough not only to improve their health, but also to put a nourishing amount into their milk.

With the British Government apparently unwilling to go down this route, Scotland, with a far worse health problem, faces a challenge - but also an opportunity. Recognising the weight of evidence now available on vitamin D, it could act fast to improve the nation’s health by convening a committee of experts with a brief to revise government advice to the public.

It could study the French or Canadian models, and adapt their programmes to Scottish needs. It could cut through the tangle of controversy over the health of sunbathing and tanning salons that are also useful sources of vitamin D. It could recommend the development of foods such as bread, orange juice, milk and cooking oil fortified with vitamin D.

The overall cost would not be great. The Scottish government has the power to provide fast-track licences for vitamin D prescription products from EU countries at minimal cost. Vitamin D itself need cost little more than £10 per person per year. The benefit for Scotland would be to tackle a set of health statistics that not only cost the nation millions of pounds every year, but are a stain on its reputation throughout the civilised world.

Oliver Gillie is a scientist and medical journalist. His new book: Scotland’s Health Deficit: An Explanation and a Plan is published today and is available from www.healthresearchforum.org.uk.

Chronc disease linked to vitiamin D deficiency

Cardiovascular Disease

Insufficient vitamin D is known to be a risk factor in heart disease, strokes and high blood pressure. Only the Finns suffer more cardiovascular illness than the Scots, and Scots’ women have had the highest morality rates for heart disease in Europe since the 1950s.

Raised blood pressure is associated with low sun exposure and insufficient vitamin D. Men with low levels of vitamin D are six times more likely to have raised blood pressure than those with high levels. Women with low vitamin D are 2.67 times more likely to have raised blood pressure. Research has shown blood pressure can be lowered by exposing the body to UV or by taking a Vitamin D supplement. A Finnish study shows people with low Vitamin D are at increased risk of having a stroke.

Cancer

People living in higher latitudes are at increased risk of cancer. Experts agree that the cancer risk is likely to be reduced by increasing the average individual’s exposure to the sun and/or by taking a vitamin D supplement of 1,000 units or more per day. In one study there was a 77per cent reduction in cancer in women in their 60s who took this supplement for four years. In another study, women with the lowest vitamin D were found to have a risk of breast cancer five times higher than women with the highest vitamin D levels. One scientist, William Grant, estimates that 17 cancer types are sensitive to UV light and that cancer deaths could be reduced by 14-19 per cent in the UK if everyone took daily vitamin D supplements.

Multiple Sclerosis

Vitamin D modulates the immune system. MS is more prevalent in Scotland than anywhere else in the world: the figure in England and Wales is typically half that of some parts of Scotland. Evidence linking the disease to lack of sunlight has grown. In Tasmania, a cloudier, temperate region of Australia, it is six times more prevalent than in tropical Queensland. In Canada, three times more women now get MS than men.

Diabetes

While obesity appears to be the prime factor in the growth in juvenile diabetes in Scotland, lack of vitamin D is also implicated. Scotland’s incidence of diabetes is surpassed only by Finland, Sweden and Sardinia. Figures for children in Scotland under 15 show the incidence of the disease at almost double that in England. Studies have shown vitamin D supplements given to children can protect against diabetes. The onset of diabetes follows a seasonal pattern - with the fewest new cases in the summer months - in Scotland, North America, Europe and the Southern Hemisphere. Dr Gillie suggests all pregnant and nursing mothers should receive 2,000 to 4,000 units of vitamin D a day. All Infants and children should take a vitamin supplement.

Rheumatoid Arthritis

Low vitamin D levels have been observed in patients and the prevalence of rheumatoid arthritis in Scotland seems to be the highest anywhere. A low prevalence is found in sunny countries. The disease is twice as common in Pakistani women living in England than those living in Pakistan where the sun is much stronger.

Osteomalacia

Insufficient vitamin D may also cause muscle weakness, pains and body sway. Dark skinned people are particularly vulnerable to such aches. An Edinburgh GP tested 99 of her patients aged 15 to 85, many of whom complained of vague musculo-skeletal symptoms or were housebound. About half were Asian. Only 2 per cent had a satisfactory vitamin D level and almost half were deficient.

Inflammatory bowel disease

Low levels of vitamin D together with weak bones are associated with Crohn’s disease. Scotland is more affected by this disease than almost any country in the world. Only Denmark has more deaths. In Aberdeen, since the late 1950s, the incidence has increased five fold, perhaps reflecting a move away from a traditional fish-rich diet.

Colds and Flu

The sunshine vitamin has a dramatic effect on the immune system that enables it to fight infection. Infections occur most during winter, when vitamin D levels are lowest. Evidence suggests severe colds and flu might be much reduced if Vitamin D was taken by the public.

By Jean Carper
Anti-Aging Expert, Best-Selling Author and USA Weekend Columnist
Vitamin D is the hottest nutrient in medical circles now. It has been credited with fighting everything from cancer to chronic pain. The latest news:

Cuts heart attacks. Men with low levels of vitamin D are about two times more apt to suffer a heart attack than men with sufficient D, Harvard researchers say. Their theory: Vitamin D lessens inflammation, high blood pressure and vascular calcification, all factors in cardiovascular disease.

Curbs cancer. A research team at the University of California-San Diego says that 2,000 IU of vitamin D daily could reduce breast cancer rates by half and slash the risk of colon cancer by two-thirds.

Prevents diabetes. Men with blood richest in vitamin D were 72% less apt to develop type 2 diabetes after age 40 than men with the least vitamin D, says a new Finnish study.

Boosts brain. Older people with depression or dementia may benefit from extra vitamin D, Dutch researchers say. Men and women over 65 with major or minor depression had 14% lower vitamin D levels than their non-depressed peers. And among Alzheimer’s patients, those with higher vitamin D levels scored better on tests of cognitive function.

RELATED PRODUCTS: Our Multi Nutrient Formula contain 1,000 IU of vitamin D. In 2007, we increased the amount in our formulas from 600 IU to 1,000 IU, in response to research indicating that the RDA for vitamin D is far too low for most adults.

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.

Everywhere you look this month, someone seems to be talking about Vitamin D. Good Morning America, Parenting Magazine, and numerous news organizations have focused on the possible benefits of the vitamin your body produces itself, yet most people seem to lack.

All this attention has led to some confusion. South Jersey Healthcare outpatient dietitian Deborah Stump helped shine some light on vitamin D last week by answering more than a dozen questions submitted to The Daily Journal’s Healthline.

“It’s a big topic right now,” said Stump. She added that recent studies have linked vitamin D to everything from diabetes to cancer prevention.
What is it?

Vitamin D helps the body absorb calcium and form bone. It also strengthens the immune system.
How do I get it?

Getting vitamin D is as easy as going outside. Your skin turns UVB rays from sunlight into vitamin D. It also is found in most multi-vitamin supplements, stand-alone supplements, and in “fortified” foods such as milk and some fruit juices and cereals.

So, if it’s so easy to get, why are more than half of children and some 65 percent of adults not getting enough?

Turns out, according to Stump, some generally-accepted, healthy habits have had the unintended consequence of restricting vitamin D. The first: sunscreen.

“You need 10-20 minutes of sun exposure three times a week,” she said, adding that the exposure should come between 11 a.m. and 3 p.m., when the sun is strongest. Sunscreen, of course, blocks those rays.

And yes, you have to go outside.

“One question asked if you can get sunlight through glass,” Stump said. “Glass lets about 78 percent of UVA rays through,” she said, “but it blocks all but about 5 percent of the important UVB rays. So, you have to get outside.”

Stump added that people should spend a little more time outside during the winter months, when the sun is not as strong.

Vitamin D took another hit as people moved away from eating saturated fats.

“As people started eating more poly and unsaturated fats, we saw a decrease in vitamin D,” she said.
How much do I need?

This was the most common Healthline question.

The Dietary Reference Intake for vitamin D is 200 International Units per day for kids and adults up to age 50, but that is being hotly debated. The American Academy of Pediatrics recommends 400 IU per day, and a quick check of a bottle of One-A-Day vitamins says that 400 IU covers 100 percent of my daily requirement.

Stump said even that may not be enough.

“There is a lot of research supporting 800-1,000 IU of Vitamin D per day,” she said.
What’s the use?

So why so much interest in vitamin D? Well, besides forming bone and helping the immune system, Stump said there is an association between vitamin D deficiency and Type 1 and 2 diabetes. Also, there is evidence that vitamin D can fight prostate, breast, and colon cancers as well as fight depression and improve cardio-vascular health.

By Skowron, Jared M

Myth 1: Vitamin D is a vitamin. The Truth: Vitamin D is a hormone. It’s derived from cholesterol. It activates cellular processes and does not do so as a co-factor. Vitamin D receptors nave direct effects on the following cells: adipose, adrenal, bone, brain, breast, cancer, cartilage, colon, endothelium, epididymis, ganglion, hair follicle, intestine, kidney, liver, lung, muscle, osteoblasts, ovary, pancreatic B, parathyroid, parotid, pituitary, placenta, prostate, skin, stomach, testis, thymus, thyroid and uterus.

Myth 2: Normal activity provides us enough vitamin D from sun exposure.

The truth: Most people do not get enough sunshine to maintain adequate vitamin D levels. Our ancestors spent most of the day in the sun, farming, fishing and hunting. Our bodies physiologically developed to need that much vitamin D. Today’s indoor society of office workers, television watchers and hermits gets much less sun exposure and vitamin D production. Add on clothing and sunscreen, which also inhibit vitamin D production, and you understand the problem.

Myth 3: Supplemented vitamin D in foods is adequate.

The truth: Vitamin D^sub 2^ is one-third as effective in the body as naturally occurring vitamin D^sub 3^. Most foods have D^sub 2^ added. A study that analyzed vitamin D^sub 2^ levels in milk off supermarket shelves showed almost 50 percent had less than the label claim of 400 IU of D^sub 2^. A support scientist from the USDA believes no food-label claims are accurate and these labels cannot be trusted.

Myth 4:1,25(OH)D3 is the best analysis for vitamin D levels.

The truth: Vitamin D is mostly stored in adipose and should not be routinely measured. It then converts to 25(OH) D3, which has a long half-life and is the best analysis of vitamin D levels. It then converts to bi-hydroxy forms such as 1,25(OH)D3, 24,25(OH) D3 and other forms, which have the actual action of the cell receptors. However, this form has a short half-life and is not a good measurement.

Myth 5: The reference range for vitamin D levels is accurate.

The truth: The reference range for 25(OH)D3 is horribly inaccurate and is maintaining our vitamin D deficiency in this country. The current reference range of 20-100 is too low. Levels <25 are disease level. Levels between 25 and 75 are suboptimal. Levels between 75 and 200 are optimal.

Myth 6: Vitamin D supplementation is nontoxic.

The truth: The major consequence of vitamin D toxicity is hypercalcemia, which should be monitored periodically while under therapy. Changes in cardiac rhythms or lithiasis are common concerns. Urine calcium monitoring is not accurate. Serum calcium .should be monitored monthly to check vitamin D toxicity, which normally occurs at 40,000 IU/day. Right now, 10,000 IU/day is being proposed as the safe upper limit.

Myth 7: The RDA for vitamin D is accurate.

The truth: People taking only the RDA of vitamin D will lower their 25(OH) D3 levels. The RDA is too low. When treating with vitamin D supplementation, three months of daily dosing is sufficient to max out 25(OH)D3 levels. Five thousand IU/day for three months should elevate 25(OH) D3 by 80 nmol/L, and 10,000 IU/ day for three months should elevate 25(OH) D3 by 120 nmol/L. People on 1,000 IU/day will elevate their levels by only 10 nmol/L.

Myth 8: Different forms of vitamin D are all the same.

The truth: Vitamin D^sub 3^ is the preferred form. Avoid D^sub 2^ at all costs. D^sub 3^ is derived either from plant sources or from lanolin. Lanolin-derived D^sub 3^ is more active and absorbable. I take the 10,000 IU capsules of D^su 3^.

Myth 9: Vitamin D only treats osteoporosis and rickets.

The truth: The therapeutic benefits of vitamin D are still being discovered. Benefits relative to cancer, cardiac, immune-boosting, diabetes and neurological (such as multiple sclerosis) therapies, as well as low bone density, are just the tip of the iceberg. I test all of my patients for vitamin D deficiency and supplement regularly up to the 75-200 reference range of 25(OH)D3.

Myth 10: Vitamin D should be avoided in pregnancy and breastfeeding.

The truth: Pregnant women should receive 4,000 IU of daily vitamin D supplementation. Breast-feeding women should receive 6,000 IU of daily vitamin D supplementation. Vitamin D, not 25(OH)D3, crosses into the breast milk, and daily doses are preferred over weekly doses. Avoid supplementing the infant and instead supplement the breast-feeding mother directly. If the infant is bottle-fed, supplement with 400-800 IU/day.

By Jared M. Skowron, ND

Bio

Dr. Jared M. Skowron is in private practice in Hamden, Conn., where he specializes in pediatrics and treating autistic spectrum disorders in children. He is the senior naturopathic physician with Metabolic Maintenance and an adjunct professor at the University of Bridgeport, teaching pediatrics, CPD and EENT.

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.

Hardly a week goes by, it seems, without a press release regarding a new vitamin D study appearing in my email box.

For example:

“Men with Low Vitamin D May Have Increased Risk of Heart Attack”
“Study Links Vitamin D to Colon Cancer Survival”
“Vitamin D Inadequacy May Exacerbate Chronic Pain”
“Low Vitamin D Levels May Worsen Osteoarthritis of the Knee”
“Low Levels of Vitamin D Associated with Depression in Older Adults”
“Study Links Vitamin D, Type 1 Diabetes”
“Vitamin D Linked to Reduced Mortality Rate in Chronic Kidney Disease”

Then, last Friday, came the uber-vitamin D press release:

“Low Vitamin D Levels Pose Large Threat to Health”

That study, published this week in the Archives of Internal Medicine, found a 26 percent increase in risk of early death from any cause among people with inadequate levels of vitamin D.

What’s going on? Why this sudden (or so it seems) interest in the “sunshine vitamin”? (The nickname comes from the fact that the vitamin is produced in the skin from sunlight.) And what are health consumers – especially here in Minnesota, where the low angle of the winter sun makes it difficult to sustain adequate vitamin D levels – to make of it all?

Old interest, new connections
Despite the current flurry of studies, research into vitamin D’s multipronged impact on human health “is not all that new,” said Kurt Kennel, M.D., an assistant professor of medicine at the Mayo Clinic in Rochester. Scientists have known since the 1970s that vitamin D’s effect on the body went beyond regulating calcium and helping to build strong bones.

Much of the past research, however, was confined to the laboratory. In recent years, thanks to better ways of assaying (or measuring) vitamin D in the body, scientists have been able to give it a more clinical face, linking it to the risk of developing different diseases.

In addition, aging baby boomers have developed a deep and personal interest in the bone-weakening disease osteoporosis.

“That put vitamin D on the map,” said Kennel.

A misnomer
To understand vitamin D’s ubiquitous role in the body, we need to stop thinking of it as a traditional vitamin.

“If we named it today, we’d call it a hormone,” said Kennel.

Like insulin, adrenaline, estrogen and other hormones, vitamin D is produced by a body organ (in this case, the skin). It’s then carried through the body by a fluid (blood) to other organs and tissues (the heart, brain, breasts, kidneys, muscles, and so on). At each of these destinations, vitamin D adeptly attaches itself to receptors on the DNA of genes in the cells’ nuclei.

As we’re now learning, the resulting effects appear to be remarkably beneficial, possibly protecting against heart disease, kidney disease, diabetes, osteoporosis, multiple sclerosis, certain types of cancers (including breast, lung and colon) and other major illnesses and conditions.

The latest study
In the newly published study – considered the most compelling evidence of vitamin D’s overall health benefits to date – a team of John Hopkins researchers analyzed vitamin D levels in more than 13,000 men and women aged 20 and older who participated in a large ongoing health survey conducted by the Centers for Disease Control and Prevention. The data was collected between 1988 and 1994.

To ensure comparable results, vitamin D levels were surveyed during the summer among participants living in northern states and during the winter among those in southern states.

All participants were tracked until Dec. 31, 2000, by which time 1,806 had died. Those whose vitamin D levels had been the lowest (less than 17.8 nanograms per milliliter of blood) had a 26 percent increased rate of death from any cause compared to those with the highest vitamin D levels (above 50 nanograms per milliliter).

Cardiovascular disease seemed to be the major factor in these deaths, although the study wasn’t able to determine with scientific certainty a cause-effect relationship between low vitamin D levels and heart attacks and strokes.

“In the past few months, several other papers have confirmed that low vitamin D levels are associated with increased risk of heart attacks and strokes,” said Erin Michos, M.D., one of the study’s lead investigators.

In fact, earlier this year, Michos and her team showed an 80 percent increased risk of peripheral artery disease among people with vitamin D deficiency.

It may not be long before vitamin D deficiency is added to the long list of risk factors for heart disease, she said.

What’s a consumer to do?
Vitamin D deficiency is, by some accounts, reaching epidemic proportions. A review article published in The New England Journal of Medicine last year reported that up to 50 percent of children and adults in the United States have insufficient levels (less than 20 nanograms per milliliter).

“Vitamin D deficiency is getting a lot more common because we’re getting more obese and sedentary, and we’re spending less time in the sun,” said Michos.

People who are over the age of 50, who have dark skin, or who wear clothing that covers most of their skin are also at increased risk. (The last two reasons, said Kennel, are partly why Minnesota’s Somali immigrants have higher-than-average rates of vitamin D deficiency.)

Both Kennel and Michos recommend that people boost their vitamin D levels by eating salmon, mackerel and other fatty fish and fortified dairy products. (Years ago, vitamin D used to be added to beer, but, alas, no longer.) You can also take cod-liver oil (yes, just as your great-grandparents did) and/or vitamin supplements.

Federal guidelines currently recommend that adults get 200 to 600 international units (IU) of vitamin D daily. Those recommendations are currently under review, said Kennel, and will most likely be upped.

The National Osteoporosis Society already recommends 800 to 1,000 IU to people aged 50 and older. And the Canadian Cancer Society, citing Canada’s northern latitude, recommends that adults living there take 1,000 IU of vitamin D daily during fall and winter.

Currently, most experts put the safe upper limit of vitamin D from supplementary sources at 2,000 IU per day. But that number, too, may be increased.

Out in the noonday sun
The best way to get vitamin D, of course, is to spend time in the sun. In a single 10-minute midday outing, your skin will produce about 10,000 IU.

Fortunately, your skin won’t let you overdose on vitamin D from the sun. But spending unprotected time in the sun increases your risk of skin cancer, which has also reached epidemic proportions in the United States.

“Unfortunately, the time of the day the dermatologist wants you to be out – the morning and the evening – is the worst time for your body to make vitamin D,” said Kennel.

If you think you’re at increased risk for vitamin D deficiency, talk with your physician about having your blood levels of the vitamin checked. You’ll then have a better idea of whether you need supplements.

And remember: Although the recent findings about vitamin D are intriguing and promising, the benefits are not yet proven.

Studies of other nutrients and hormones – vitamin E, vitamin A, and estrogen, to name a few – were also found to benefit the heart in observational studies. But when it came time for the clinical trials, not only did they fail to prevent heart disease, they actually increased the risk.

Stay tuned.