Vitamin D: A potential role in cardiovascular disease prevention

Inadequate levels of vitamin D are associated with an increase in the risk of cardiovascular disease and death, a new observational study has found. Dr Tami L Bair (Intermountain Medical Center, Murray, UT) reported the findings here at the American Heart Association 2009 Scientific Sessions.

Bair and colleagues followed more than 27 000 people 50 years or older with no history of cardiovascular disease for just over a year and found that those with very low levels of vitamin D (<15>30 ng/mL). Those deficient in vitamin D were also twice as likely to develop heart failure as those with normal levels.

"We concluded that even a moderate deficiency of vitamin D was associated with developing coronary artery disease, heart failure, stroke, and death," said coauthor Dr Heidi May (Intermountain Medical Center). However, "it is not known whether this is a cause and effect relationship," she told heartwire. Because this study was observational, more research is needed "to better establish the association between vitamin D deficiency and cardiovascular disease," she noted.


Evidence so far suggestive of benefit of vitamin D

Vitamin D was the subject of much discussion in a general session on vitamins at the AHA scientific sessions. Although the evidence supporting the benefits of vitamin D in cardiovascular disease is probably stronger than for any other vitamin, there have been only a few randomized clinical trials, and previous observational studies "show no robust effects," said Dr Harald Dobnig (Medical University of Graz, Austria). The latter suffer from limitations, such as doses of vitamin D supplementation that are too low, low compliance rates, and short study duration, he noted.

There are some large randomized trials underway looking at outcomes with vitamin D; it is hoped that they will provide definitive answers in five to seven years, Dr Eric Rimm (Harvard School of Public Health, Boston, MA) explained.

"I think there's promise for vitamin D. We know that most people have insufficient vitamin D levels in their blood," Rimm told heartwire. "So although it will take five years until some of the trials that are adequately powered to look at cardiovascular disease with vitamin D will report, the epidemiology right now is suggestive that people should have 1000 or 2000 IU of vitamin D a day," he said.


Vitamin D: How do we get it, and how much is enough?

Rimm discussed vitamin D at length, explaining that there are two sources: sunlight in the form of UVB rays, and diet (foods and supplementation). "Many tissue types and cells in the body have vitamin D receptors, and the active form of vitamin D is modulated by calcium and parathyroid hormone," he explained, with potential downstream effects on a number of bodily systems—inflammatory markers and the renin angiotensin system to name just two—he said.

People at highest risk of vitamin D deficiency include those with darker skin, those living at high altitudes, the elderly (because there is less of the precursor for vitamin D in the blood as people age and older people tend to spend less time outside), the obese, those who avoid the sun or cover the skin in the sun, those who are the immobilized or institutionalized, and pregnant and breast-feeding women.

Deficiency in vitamin D is generally agreed to be a blood level of <20>150 ng/mL indicating excessive vitamin D.

Data suggest that many people are likely getting inadequate vitamin D, he said, with studies showing that black Americans have blood levels ranging from 6-18 ng/mL and that white Americans have levels ranging from 16-25 ng/mL.

In general, a supplement of 100 IU of vitamin D per day will increase blood levels of vitamin D by 1 ng/mL, Rimm said. Those taking 1000 IU per day should have blood levels in the range of 25-32 ng/mL and those taking 4000 IU should have levels of 40-50 ng/mL.


Diet and sunshine good sources of vitamin D

However, Rimm stressed that vitamin D need not just come from supplements. "I think for vitamin D, it's a shame just to count on supplementation because, during the right times of year, five to 10 minutes a day of sunlight is sufficient is to make enough vitamin D. I do hear the concerns about skin cancer and I think people should wear suntan lotion, but it's probably better to put it on 10 minutes after you've been in the sun."

He cautioned that "in northern climes, even if you go out in the sun in January, you're not going to make much vitamin D, so there you would need supplementation to get adequate levels."
One of the best dietary sources of vitamin D is fish.

People should remember that diet is an important source of vitamin D, too, he noted. "One of the best dietary sources of vitamin D is fish. We already suggest people eat a couple of servings a week, but having three or four servings a week of fish can get you a fair bit of vitamin D, and would represent an additional 300 to 500 IU of vitamin D. This still might not be sufficient so you might need a little bit of sunlight or to take a vitamin D supplement. It's really a combination of things, that's probably the best approach."

Both Rimm and Dobnig said it is nearly impossible for anyone to suffer adverse effects from too much vitamin D. Those who spend whole days in the sun, such as lifeguards, have vitamin D levels ranging from 45 to 65 ng/mL, said Rimm. "Vitamin D is safe. Hypercalcemia is not a problem, with the rare exception of granulomatous disease," said Dobnig. He added that because vitamin D is a fat-soluble vitamin, it can be given weekly, or even monthly.


Results of two large randomized trials eagerly awaited

Rimm said he hopes ongoing research will inform the vitamin D debate. Data are needed on intermediate end points, such as inflammatory markers and parathyroid hormone, and on "hard" end points, such as coronary artery disease, sudden death, and heart failure, both in primary prevention and in high-risk populations, including those with chronic kidney disease and heart failure.

The results of two large randomized trials are eagerly awaited, he said, including the National Institutes of Health-sponsored VITAL study looking at whether 2000 IU vitamin D and/or 1 g of fish oil (omega-3 fatty-acid supplementation) can reduce the risk of developing heart disease, stroke, or cancer in 20 000 men and women, which is slated to begin in January 2010.

The Thiazolidinedione Intervention with Vitamin D Evaluation (TIDE) study is being coordinated by researchers at McMaster University, Hamilton, ON. This trial is looking at rosiglitazone versus pioglitazone in people with type 2 diabetes at risk of heart disease, but also has a vitamin D versus placebo arm. The primary outcome for the vitamin D arm will be cancer, but there are a number of secondary cardiovascular end points, said Dobnig. Right now, I think the evidence for vitamin D probably is stronger than the evidence for other vitamins.

"The evidence for vitamins is not great," Rimm said. "The best thing we can say now is to stop smoking, eat a good diet, and don't be overweight. I think people sometimes lose touch with the most important message of prevention, and jump right to the vitamins thinking that's going to sustain them, so doing what we know first and best is probably the best place to start."

"After that, right now, I think the evidence for vitamin D probably is stronger than the evidence for other vitamins," he concluded.



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Deviled Eggs Recipe and 10 Health Benefits of Eggs

There are many traditional Thanksgiving Day recipes that everyone looks forward to and deviled eggs are a classic. Whether they are made with using a traditional deviled eggs recipes or one of the newer versions -- including spicy, gluten free , or even a caviar deviled eggs-- Thanksgiving Day isn't the same without this tasty appetizer. Even better? Eggs have great health benefits.

Deviled eggs are hard-boiled eggs cut in half and filled with the hard-boiled egg's yolk mixed with different ingredients. Deviled eggs are usually served cold. They are served as a side dish, appetizer or a main course, and are a common holiday or party food.

Eggs are full of protein and have so many good health benefits that consuming eggs on Thanksgiving is a great idea. Try a few new recipes or stick with the classic deviled eggs recipe for a delicious Thanksgiving Day appetizer.

Easy Deviled Eggs Recipes

Classic Deviled Eggs

Crab & Celery Deviled Eggs

Caviar Deviled Eggs

Gluten Free Deviled Eggs

Health Benefits of Eggs

1. Eggs are great for the eyes. According to one study, an egg a day may prevent macular degeneraton due to the carotenoid content, specifically lutein and zeaxanthin. Both nutrients are more readily available to our bodies from eggs than from other sources.

2. In another study, researchers found that people who eat eggs every day lower their risk of developing cataracts, also because of the lutein and zeaxanthin in eggs.

3. One egg contains 6 grams of high-quality protein and all 9 essential amino acids.

4. According to a study by the Harvard School of Public Health, there is no significant link between egg consumption and heart disease. In fact, according to one study, regular consumption of eggs may help prevent blood clots, stroke, and heart attacks.

5. They are a good source of choline. One egg yolk has about 300 micrograms of choline. Choline is an important nutrient that helps regulate the brain, nervous system, and cardiovascular system.

6. They contain the right kind of fat. One egg contains just 5 grams of fat and only 1.5 grams of that is saturated fat.

7. New research shows that, contrary to previous belief, moderate consumption of eggs does not have a negative impact on cholesterol. In fact, recent studies have shown that regular consumption of two eggs per day does not affect a person's lipid profile and may, in fact, improve it. Research suggests that it is saturated fat that raises cholesterol rather than dietary cholesterol.

8. Eggs are one of the only foods that contain naturally occurring vitamin D.

9. Eggs may prevent breast cancer. In one study, women who consumed at least 6 eggs per week lowered their risk of breast cancer by 44%.

10. Eggs promote healthy hair and nails because of their high sulphur content and wide array of vitamins and minerals. Many people find their hair growing faster after adding eggs to their diet, especially if they were previously deficient in foods containing sulphur or B12.

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Chocolate Milk Good or Bad?

Milk, filled with calcium and vitamin D, may help children grow into strong healthy adults, but many won’t touch it without adding chocolate syrup. A blog on the New Yorker Web site asked New Yorker Food Issue contributors if adding chocolate cancelled the health benefits of milk, or if it is a necessary incentive to get kids to consume nutrients.

Mimi Sheraton said the chocolate is OK because otherwise children may not get the much-needed calcium and vitamin D from the milk. She suggested using high-quality, low-sugar chocolate syrup in lowfat milk. She added chocolate may even add benefits, as recent studies have shown its ability to increase high-density lipoprotein (HDL) cholesterol and reduce inflammation.

While the other contributors gave jokes for answers (Raffi Khatchadourian spoke about genetically engineered cows that produce chocolate milk from their udders; and John Colapinto said he didn’t want his son to drink chocolate milk or even eat sandwiches because of their negative health benefits), the article brings up a good point about how a spoonful of sugar helps the medicine go down. Or, in this era of childhood obesity and kids who experience adult disease, should we skip the sugar and try to give only the medicine?

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Vitamin D Has Numerous Health Benefits

Vitamin D is called as "nature's antibiotic" as recent discoveries have brought to light its numerous health benefits.

Right from the health of your immune system to prevention of heart disease and even vulnerability to influenza, vitamin D is now seen as one of the most critical nutrients for overall health.

But it is also one of those most likely to be deficient - especially during winter when production of the "sunshine vitamin" almost grinds to a halt for people.

Analogs of the vitamin are even being considered for use as new therapies against tuberculosis, AIDS, and other concerns.

And federal experts are considering an increase in the recommended daily intake of the vitamin as more evidence of its value emerges, especially for the elderly.

"About 70 percent of the population of the United States has insufficient levels of vitamin D. This is a critical issue as we learn more about the many roles it may play in fighting infection, balancing your immune response, helping to address autoimmune problems, and even preventing heart disease," said Adrian Gombart, a principal investigator with the Linus Pauling Institute at Oregon State University.

Among other findings about benefits of Vitamin D is the ones made by OSU scientists that it induces the "expression" of cathelicidin, an antimicrobial peptide gene.

This explains in part how it helps serve as the first line of defense in your immune response against minor wounds, cuts, and both bacterial and viral infections.

Experts believe advances in the use of cathelicidin may form the basis for new therapies.

"Vitamin D insufficiency and deficiency is a world-wide, public health problem in both developed and developing nations. Nearly one billion people world-wide are deficient," the new report concluded.

The new report found that low levels of circulating vitamin D are associated with increased risk and mortality from cancer.

Vitamin D plays an important role in activating the immune system, fostering the "innate" immune response and controlling over-reaction of adaptive immunity, and as such may help control autoimmune diseases such as multiple sclerosis, psoriasis and rheumatoid arthritis.

The regulation of cathelicidin by vitamin D, a unique biological pathway for the function of vitamin D that could help explain its multiple roles in proper immune function
, is so important that it's only known to exist in two groups of animals - humans and non-human primates - and has been conserved in them through millions of years of evolution.

Epidemiological studies show a link between vitamin D deficiency and increased rates of respiratory infection and influenza, and it has been hypothesized that flu epidemics may be the result of vitamin D deficiency.

Higher levels of a protein linked to vitamin D have been associated with reduced infections and longer survival of dialysis patients.

Vitamin D has important roles in reducing inflammation, blood pressure and helping to protect against heart disease.




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Vitamin D might be just as important as vaccine to prevent effects of H1N1 swine flu, researchers say

The world's leading vitamin D experts say that raising your levels of "the sunshine vitamin" this winter might be the best way to help your body naturally raise its resistance to all forms of the flu virus - including the H1N1 swine flu virus.

That's the message vitamin D advocate Dr. William Grant wants you to take to the bank.

"I'm a little hesitant to say it will reduce your risk of being infected, but it certainly will reduce your risk of dying from the complications, such as pneumonia, if you are infected," says Grant, founder of the Sunlight, Nutrition and Health Research Center - a vitamin D research and advocacy group.

Grant is concerned that epidemic vitamin D deficiency in Canada -- 97 percent of Canadians are vitamin D deficient in the winter due to Canada's northerly latitudes and relatively weak sunlight 4-6 months of the year -- means that Canadians could be more susceptible to flu virus in the winter.

Grant points to research suggesting:

    -  Higher vitamin D levels assist the body's innate immune system. Some
     studies suggest taking 2,000 IU of vitamin D/day will decrease your
     risk of seasonal flu.
  -  The groups most affected by the H1N1 swine flu virus have been those
     most likely to be vitamin D deficient: pregnant women, obese people,
     those with Type II diabetes and children with neurological disorders.
  -  Many of the deaths associated with the H1N1 virus have been pneumonia
     related, which means anything that would assist your body's innate
     immune system would make you less likely to be affected.

The worldwide vitamin D research community now recommends getting your vitamin D levels checked with a calcidiol test and maintaining vitamin D levels of 40-60 ng/ml.

November is Vitamin D Awareness Month in Canada. For more information about the benefits of vitamin D visit:

    www.vitaminDsociety.org
  www.GrassRootsHealth.org
  www.VitaminDcouncil.org

For further information: Michelle Di Rocco, (416) 360-6522 ext 251, michelle@punchcanada.com or Danna Barak at danna@punchcanada.com

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Low vitamin D linked to high risk of leg artery disease

A new study published in the June 2008 issue of Arteriosclerosis, Thrombosis, and Vascular Biology suggests that taking vitamin D supplements or getting exposed to enough sunshine may help prevent peripheral artery disease (PAD).

PAD is a condition in which the legs are narrowed or clogged by fatty deposit and blood flow is restricted to the legs. It affects an estimated 8 to 12 million Americans, according to the American Heart Association.

Dr. Michal L. Melamed from Albert Einstein College of Medicine, Bronx, New York and colleagues analyzed data from a national survey of 4,839 U.S. adults whose vitamin D levels were measured.

People with PAD had significantly lower levels of vitamin D than those without. Of those with the highest levels of the vitamin, only 3.7 percent had PAD compared to 8.1 percent of those with the lowest levels of vitamin D, the researchers found.

After other factors including age, gender and race were adjusted, people with the lowest levels of vitamin D were 2.18 times more likely to have PAD than those with the highest levels.

Specifically, a 10-nanogram-per-milliliter decrease in the blood vitamin D level was linked to a 35 percent increase in the incidence of PAD.

This study is not a trial, meaning the association is not necessarily a causal relation between PAD and the blood vitamin D level. Because of this, no one knows for sure if taking vitamin D supplements would definitely reduce the risk.



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Low vitamin D linked to high risk of premature death

People with lower blood levels of sunshine vitamin D in their blood appear to have an increased risk of death from all causes and from cardiovascular diseases, according to an Austrian study in the June 23 issue of the Archives of Internal Medicine.

The study found that people with the lowest level of vitamin D in their blood were twice as likely to die from any cause including death from heart disease during an eight-year period as those who had a high level.

Vitamin D is naturally produced in the body when the skin is exposed to sunshine. Exposure of the face and both hands for 20 minutes to strong sunshine is believed to generate enough vitamin D, while a dietary regimen is needed to have a preventative effect against certain diseases or death, particularly in dark-skinned individuals and the elderly who produce less vitamin D.

An estimated 50 to 60 percent of older people in North America and the rest of the world do not have sufficient vitamin D levels, and a similar percentage of young people have the same problem, according to the background information in the report.

Previous studies have linked blood levels of 25-hydroxyvitamin D in the blood lower than 20 to 30 nanograms per milliliter with risk of falls, fractures, cancer, immune dysfunction, cardiovascular disease and hypertension.

In the study, Harald Dobnig, M.D., an internist and endocrinologist at the Medical University of Graz, Austria, and colleagues measured 25-hydroxyvitamin D and 1, 25-dihydroxyvitamin D levels in 3,258 patients of an average age of 62 years who underwent coronary angiography testing between 1997 and 2000.

During the 7.7-year follow-up, 22.6 percent of participants died and among the dead, 62.8 percent were from cardiovascular causes.

Death rates from any cause and from the cardiovascular causes were higher in those with their blood 25-hydroxyvitamin D levels in the lower 50 percent and in the lowest one-fourth of 1, 25-dihydroxyvitamin D levels, the study found.

Low 25-hydroxyvitamin D levels were also linked with markers of inflammation such as c-reactive protein, as well as signs of oxidative damage to cells, the study found.

"Apart from the proved effects that vitamin D has on bone metabolism and neuromuscular function, appropriate serum levels (that may also be higher than in the present investigation) are associated with a decrease in mortality," the researchers concluded.

"Although not proved, it seems possible that at least part of this effect may be due to lowering of a risk profile promoting atherosclerosis [narrowing of the arteries] and preventing cardiovascular end points," the researchers said.

"Based on the findings of this study, a serum 25-hydroxyvitamin D level of 20 nanograms per milliliter or higher may be advised for maintaining general health." (Editor’s note: many other studies have suggested that 30 nanograms per milliliter are needed.)

The current study merely established an association between the serum vitamin D level and death risk and it did not prove that taking vitamin D supplements to increase its level in the body would actually reduce the risk of death from all causes although the possibility cannot be excluded either.

However, many clinical trials have already demonstrated the preventative effect of vitamin D against premature deaths from all causes including cardiovascular causes.

One study meta-analyzed data from 18 separate trials of 57,000 participants who had a dietary supplement of vitamin D at a dose ranging from 300 to 2000 International Units and found that those who took vitamin D had a 7 percent lower risk of death than those who did not.

The study was conducted by Philippe Autier, M.D., of the International Agency for Research on Cancer, Lyon, France, and Sara Gandini, Ph.D., of the European Institute of Oncology in Milan, Italy, and published in the September 10, 2007 issue of the Archives of Internal Medicine.

Overall, earlier studies showed that deficiencies in vitamin D are associated with a higher risk of death from cancers (including breast, prostate, and colon cancer), heart disease, and diabetes-illnesses, which overall are responsible for 60 to 70 percent of deaths in developed countries.

Another study conducted by Edward Giovannucci, M.D., Sc.D., at the Harvard School of Public Health and colleagues revealed that it is 2.42 times more common to find people with 15 nanograms per milliliter of blood or less (deficiency) than it is to find those with a sufficient amount (30 nanograms per milliliter). The findings were published in the June 9, 2008 issue of Archives of Internal Medicine.

The researchers came to this conclusion after they compared 454 men ages 40 to 75 who had non-fatal heart attacks or fatal heart disease during the follow-up period with 900 men who did not have a history of cardiovascular disease.

Sunshine is the basic source of vitamin D. But readers should be careful about the advice they receive from news media, a health observer affiliated with foodconsumer.org suggested. Exposure to ultraviolet rays is widely viewed as a risk for developing skin cancer, and people are often urged to use screens to block exposure to sunshine. Be aware though that vitamin D deficiency can put an individual at a higher risk of dying from other more serious types of cancers and a variety of other chronic diseases.

Other sources include fortified foods such as fortified milk and cereals, natural foods such as cod liver oil, fatty fish such as cooked salmon, mackerel, tuna, and sardines, egg yolks, liver, and supplements.

The current recommended daily allowance for vitamin D is 200 IU per day for people under 50, 400 IUs for those between 50 and 70, and 600 IUs for those over 70. Older people need higher doses. Research has found that healthy people can tolerate intake of up to 10,000 IU per day. Vitamin D experts have already complained that the current RDA is too low to have a protective effect, and have recommended that the RDA should be increased to at least 1,000 IU per day.



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