The vitamin D controversy

The group said most people have adequate amounts of vitamin D in their blood supplied by their diets and natural sources like sunshine, the committee says in a report that is to be released on Tuesday.

“For most people, taking extra calcium and vitamin D supplements is not indicated,” said Dr. Clifford J. Rosen, a member of the panel and an osteoporosis expert at the Maine Medical Center Research Institute.

Dr. J. Christopher Gallagher, director of the bone metabolism unit at the Creighton University School of Medicine in Omaha, Neb., agreed, adding, “The onus is on the people who propose extra calcium and vitamin D to show it is safe before they push it on people.”

Over the past few years, the idea that nearly everyone needs extra calcium and vitamin D — especially vitamin D — has swept the nation.

With calcium, adolescent girls may be the only group that is getting too little, the panel found. Older women, on the other hand, may take too much, putting themselves at risk for kidney stones. And there is evidence that excess calcium can increase the risk of heart disease, the group wrote.

As for vitamin D, some prominent doctors have said that most people need supplements or they will be at increased risk for a wide variety of illnesses, including heart disease, cancer and autoimmune diseases.

And these days more and more people know their vitamin D levels because they are being tested for it as part of routine physical exams.

“The number of vitamin D tests has exploded,” said Dennis Black, a reviewer of the report who is a professor of epidemiology and biostatistics at the University of California, San Francisco.

At the same time, vitamin D sales have soared, growing faster than those of any supplement, according to The Nutrition Business Journal. Sales rose 82 percent from 2008 to 2009, reaching $430 million. “Everyone was hoping vitamin D would be kind of a panacea,” Dr. Black said. The report, he added, might quell the craze.

“I think this will have an impact on a lot of primary care providers,” he said.

The 14-member expert committee was convened by the Institute of Medicine, an independent nonprofit scientific body, at the request of the United States and Canadian governments. It was asked to examine the available data — nearly 1,000 publications — to determine how much vitamin D and calcium people were getting, how much was needed for optimal health and how much was too much.

The two nutrients work together for bone health.

Bone health, though, is only one of the benefits that have been attributed to vitamin D, and there is not enough good evidence to support most other claims, the committee said.

Some labs have started reporting levels of less than 30 nanograms of vitamin D per milliliter of blood as a deficiency. With that as a standard, 80 percent of the population would be deemed deficient of vitamin D, Dr. Rosen said. Most people need to take supplements to reach levels above 30 nanograms per milliliter, he added.

But, the committee concluded, a level of 20 to 30 nanograms is all that is needed for bone health, and nearly everyone is in that range.

Vitamin D is being added to more and more foods, said Paul R. Thomas of the Office of Dietary Supplements at the National Institutes of Health. Not only is it in orange juice and milk, but more is being added to breakfast cereals, and it now can be found in very high doses in supplement pills. Most vitamin D pills, he said, used to contain no more than 1,000 international units of it. Now it is easy to find pills, even in places like Wal-Mart, with 5,000 international units. The committee, though, said people need only 600 international units a day.

To assess the amounts of vitamin D and calcium people are getting, the panel looked at national data on diets. Most people, they concluded, get enough calcium from the foods they eat, about 1,000 milligrams a day for most adults (1,200 for women ages 51 to 70).

Vitamin D is more complicated, the group said. In general, most people are not getting enough vitamin D from their diets, but they have enough of the vitamin in their blood, probably because they are also making it naturally after being out in the sun and storing it in their bodies.

The American Society for Bone and Mineral Research and other groups applauded the report. It is “a very balanced set of recommendations,” said Dr. Sundeep Khosla, a Mayo Clinic endocrinologist and the society’s president.

But Andrew Shao, an executive vice president at the Council for Responsible Nutrition, a trade group, said the panel was being overly cautious, especially in its recommendations about vitamin D. He said there was no convincing evidence that people were being harmed by taking supplements, and he said higher levels of vitamin D, in particular, could be beneficial.

Such claims “are not supported by the available evidence,” the committee wrote. They were based on studies that observed populations and concluded that people with lower levels of the vitamin had more of various diseases. Such studies have been misleading and most scientists agree that they cannot determine cause and effect.

It is not clear how or why the claims for high vitamin D levels started, medical experts say. First there were two studies, which turned out to be incorrect, that said people needed 30 nanograms of vitamin D per milliliter of blood, the upper end of what the committee says is a normal range. They were followed by articles and claims and books saying much higher levels — 40 to 50 nanograms or even higher — were needed.

After reviewing the data, the committee concluded that the evidence for the benefits of high levels of vitamin D was “inconsistent and/or conflicting and did not demonstrate causality.”

Evidence also suggests that high levels of vitamin D can increase the risks for fractures and the overall death rate and can raise the risk for other diseases. While those studies are not conclusive, any risk looms large when there is no demonstrable benefit. Those hints of risk are “challenging the concept that ‘more is better,’ ” the committee wrote.

That is what surprised Dr. Black. “We thought that probably higher is better,” he said.

He has changed his mind, and expects others will too: “I think this report will make people more cautious.” (NY Times)



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Vitamin D Deficiency More Prevalent In Winter.... Experts Say Get Tested.

Vitamin D is much more than a vitamin; technically it’s a hormone. Vitamin D is manufactured through exposure to direct sunlight. Once it is metabolized and absorbed, it has profound benefits in nearly every aspect of immunity.

Vitamin D deficiency increases risk for acute sickness as well as susceptibility to chronic diseases, including cancer.

It’s no coincidence that the number of coughs and colds increase in the winter when sunlight is at seasonal low in most climates. The American Journal of Public Health sites over 60 studies that implicate a protective relationship that vitamin D has over cancer. The European Journal of Clinical Nutrition reported that children with low vitamin D levels were 11 times more susceptible to respiratory infections.

The best way to know if you are vitamin D deficient is through a simple blood test. Seek a qualified practitioner who can order a serum 25-hydroxyvitamin D [25 (OH) D] test. The baseline minimum should be 30 ng/mL, although evidence is mounting to establish higher levels for optimal health and cancer prevention. The Vitamin D Council recommends enough sunlight, supplementation and/or artificial light to maintain levels between 80-100 ng/mL year round. Supplementation to increase levels of vitamin D can also be surprisingly inexpensive, especially when one looks at the cost of sick care.

Older adults require higher amounts of vitamin D due to an inability to absorb it efficiently. Research has shown that blacks may require as much as two times the sun exposure to accumulate the same amounts of vitamin D.

The American Journal of Clinical Nutrition performed a study on vitamin D supplementation that showed a decreased incidence of cancer by over 75% compared to those in the placebo group who were given a sugar pill. The best food sources of vitamin D are fatty fish, eggs, meat and mushrooms. Although most people think of vitamin D for osteoporosis prevention it also assists in reducing inflammation and improving neuromuscular function. The Vitamin D Council recommends 2000 IU per day in the summer and 5000 IU in the winter. The Canadian Cancer Society has now officially recommended vitamin D supplements to help reduce risk of cancer.



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The benefits of breastfeeding

Numerous major health organizations, including the American Academy of Pediatrics and the American Dietetic Association, strongly support breastfeeding. Their position statements urge women when possible, to exclusively breast feed their babies for the first six month of life and to continue breastfeeding with complimentary foods from six months to at least 12 months of age.

The belief is that this pattern provides optimal nutrition and health protection for the baby. It can be especially important for pre-term and low birth weight babies.

When the recommendations state "exclusively," they mean attempting breast feeding shortly after birth and not giving the infant supplemental bottles of formula, water, other liquids, or pacifiers. Doing so appears to lower the success rate of initiation and continuation of breastfeeding, and reduces the nutrition the baby receives.

Not only does breast milk contain a perfect balance of nutrients, but these nutrients are in a form that infants can better digest and absorb. This potentially means a reduced risk of digestive problems and optimal nutrient uptake. The amounts of the various nutrients are also at a level appropriate for the infant's immature kidneys and in the right proportions for growth and development needs.

Breast milk also has the unique advantage of changing composition over time. As the baby's nutritional needs change, the breast milk changes to meet those needs. The first milk (colostrum) is perfect for newborns, while the mature milk later on is appropriate for older babies. Breast milk is also bacterially safe, as well as cost and time effective.

The only additional nutrients a young infant may need are vitamin D and possibly fluoride. The American Academy of Pediatrics recommends intake of 400 IU vitamin D daily from birth to at least 18 years of age for all infants — breast or formula fed (formulas may cover some of the need but probably not the full amount).

Breast milk contains numerous substances that assist with immunity. When it comes to health, research shows that breast-fed infants tend to have fewer infections and illnesses, resulting in fewer hospitalizations and visits to a health-care provider. Examples are ear and respiratory tract infections, including pneumonia.

Breast feeding is also associated with reduced risk of infant deaths in general, childhood leukemia, and sudden infant death syndrome (SIDS). For premature infants, breastfeeding reduces the incidence of the potentially fatal necrotizing enterocolitis (NEC).

For baby, long term, breast feeding is associated with a lower lifetime risk of chronic diseases, such as type 1 and 2 diabetes, heart disease, high blood pressure, and high cholesterol. Breast fed babies also tend to have healthier body weights and are less likely to become overweight or obese as adolescents and adults.

Breast feeding may also lower the chance of food allergies and intolerances. Some studies even show a relationship to higher intelligence test scores. Orally, breast feeding helps promote proper teeth and jaw development. Some studies suggest it can even act as a mild analgesic or pain reliever. Emotionally, the act of breast feeding assists with bonding between the mother and her infant.

In addition to knowing that she is providing the best nourishment for her child, mom can also benefit from breast feeding. To start, her recovery from delivery is quicker than if she does not breast feed. Because it delays menstruation, it can also help mom to recover her iron stores from losses at delivery.

The longer women breast feed, the lower their lifetime risk of getting breast and ovarian cancers, type 2 diabetes (except for those who have had gestational diabetes) and rheumatoid arthritis. This is especially significant with breastfeeding more than 12 months all children combined. Breast feeding can also lower blood pressure in women before, during and after breastfeeding sessions.

Moms may also benefit emotionally. Studies have shown that breast feeding women tend to have a lesser chance of experiencing postpartum depression.

While breastfeeding, a woman's need for protein is 25 gm/day above pre-pregnant needs (similar to needs during pregnancy). Calcium needs are slightly higher as well (1200-1500 mg/day) with adequate vitamin D. She should also increase her fluid intake to cover milk production. For weight maintenance, her calorie needs are similar to those during pregnancy. For postpartum weight loss, a slightly lower calorie intake does not appear to negatively affect milk production, but a more restrictive diet is not recommended.

Women who take prescription or over-the-counter medications or herbal supplements should check with their pharmacist and/or health-care provider to evaluate the safety of what they are taking with regard to breastfeeding. They should also reduce their exposure to chemical contaminants, including those found in foods (such as methyl mercury, which can be high in some fish).

If a woman anticipates pregnancy followed by breastfeeding, achieving a healthy body weight before pregnancy appears to improve breastfeeding success, as obesity triggers factors that may negatively affect milk production.

For a number of reasons, new moms may not be able to achieve the recommended goal of breastfeeding for at least a year. Although this longer duration of breastfeeding is optimal, be assured that any amount of time spent breastfeeding provides benefits. The good news is that there are many resources available to help — medical professionals, lactation specialists, registered dietitians, and breastfeeding support groups.



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Learn why vitamin D is the "SUNSHINE VITAMIN"

Is 10 minutes a day exposure to the sun with no sunscreen a bad thing or a good thing?

The jury is still out among a lot of health professionals, but one thing is certain: there are many people in our country that are deficient in vitamin D, the sunshine vitamin.

Vitamin D is a fat-soluble supplement needed to maintain normal levels of calcium and phosphorus in the blood. Over the last few years, vitamin D deficiency has been blamed for a number of conditions including depression, chronic pain, kidney disease, diabetes, osteoporosis, colon and breast cancer, and cardiovascular disease.

Much research has been done and much more will be done on the vitamin D debate. Many health professional are very excited about the health benefits of vitamin D and highly recommend it to their patients.

According to an article by Brian Alexander in the American Council on Exercise’s (ACE) Fitness Matters magazine, here are some things we know about vitamin D:

Vitamin D was discovered 87 years ago by a team of scientists at John Hopkins University who cured mice with rickets by feeding them cod liver oil. Oily fish like sardines remain one the few natural food sources of vitamin D.

It was later found that certain wavelengths of ultraviolet light prompts our bodies to synthesize vitamin D, eventually making a hormone called calcitriol.

Once this was understood vitamin D was produced synthetically, and foods, mainly milk, were fortified with it.

If you are Caucasian and expose 40 percent of your skin to midday summer sun in most of the United States, you will receive a dose of roughly 1,000 IUs per minute. An international unit (IU) is an internationally accepted amount of a substance. This type of measure is used for the fat-soluble vitamins (such as vitamins A, D and E) and certain hormones, enzymes and biologicals (such as vaccines).

As we age, we gradually lose our ability to absorb vitamin D.

The darker your skin, the less vitamin D you will receive from the sun.

Where you live can affect your vitamin D levels. Those living north of Atlanta, Ga., do not get enough ultraviolet rays in the winter for their bodies to produce the vitamin D that they need. Therefore, it is important to get your level tested by you physician and let him suggest alternatives.

In the same ACE article, Boston University physician and vitamin D researcher Dr. Michael Holick said, "When I first heard the claims about vitamin D, I thought it was kind of crazy."

But Holick has become convinced of vitamin D’s effectiveness. "Heart, colon, prostrate, brain, all those cells have receptors for vitamin D, we also know it stimulates serotonin production [important in depression], and it is important in muscle function."

Other studies have been inconclusive on the positive health benefits of vitamin D. So the arguments on both sides of the debate continue.

All sides do agree on one thing: more research is needed.



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Consumers Reassured Regarding Benefits of Calcium Supplements

The New Zealand Self Medication Industry (NZSMI), the industry body representing non-prescription consumer healthcare products, said today that the benefits of calcium supplements in strengthening bones outweigh any known risks.

Tim Roper, executive director of the NZSMI, says consumers should maintain their current calcium supplements or consult their doctor if they have any concerns.

Mr Roper welcomed Medsafe's statement at the weekend that there is insufficient proof that there is a link between calcium and heart disease as suggested by a recent study highlighted in the media recently.

"The study, which concluded that calcium supplements modestly increased the risk of heart attacks, was not designed to measure a link between calcium and heart disease. It was limited in its scope and only dealt with people over 70. It's not surprising that people in this age group are more at risk of heart attacks.

"Most people in New Zealand who are taking calcium supplements are younger than the age group investigated. They are usually women under the age of 50 who are pregnant, breastfeeding or menopausal, taking calcium to strengthen bones and maintain bone density."

Mr Roper says media reports on the study also failed to mention that the study group of 70 year-olds were taking calcium supplements without the recommended addition of Vitamin D which aids absorption of calcium into the bones.

He adds that the researchers involved in this study also admit it has "some limitations...and the results may not apply to co-administered calcium and Vitamin D supplements."



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Calcium Supplements Lead to Heart Attack

Thirty percent is the susceptibility to heart attack of people taking calcium supplements.

Dr. Ian Reid of the Department of Medicine at the University of Auckland was the head of the study. Higher blood serum levels lead to hardening of the arteries of the heart. These findings are consistent even after considering gender, age and the type of supplements taken.

The study excluded patients who were taking both calcium and Vitamin D supplements. Vitamin D helps in calcium absorption.

Calcium is not only for bone health but it regulates muscle contraction, which includes heartbeat and normal blood clotting.

Dr. Ian Reid suggests taking in calcium the natural way; through food: milk, yogurt (low-fat, nonfat), cheeses, pudding, soy milk and orange juice fortified with calcium, canned salmon and sardines both with bones, tofu processed with calcium and leafy vegetables.

“Given the modest benefits of calcium supplements, a reassessment of the role of calcium supplements is warranted” the scientists behind the study wrote in the British Medical Journal.

Experts however added, “Anyone who has been advised by their doctor to take calcium supplements shouldn’t stop because of this research alone.”



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Study: Supplement Vitamin D For More Muscle, Less Fat

Vitamin D has seen a lot of popularity lately thanks to discoveries about its mood-boosting abilities. The so-called “sunshine vitamin” (the term refers to the fact that it can be absorbed via sunlight) is now being sold not only on its own but as a part of many other foods and beverages. Milk fortified with Vitamin D, for example, is a big seller. The vitamin is considered to be particularly important for those in areas such as the north east, where the sun doesn’t shine as readily as it does other areas.

But don’t think that just because you live in a warm, sunny climate that you don’t need to worry about Vitamin D. In addition to possibly contributing to your happiness, studies have indicated that Vitamin D can enhance your immune system and protect against disease. In addition, Vitamin D aids in the utilization of calcium, which helps maintain healthy bones. Research has shown that Vitamin D helps keep levels of calcium in the bloodstream at ideal levels. This benefits the function of the nervous system in addition to benefiting bone growth and maintenance (1).

And if you’re still not swayed, perhaps the latest Vitamin D discovery will convince you of the need for this vitamin. Fitness enthusiasts, or anyone generally interested in their physical fitness and appearance, will be interested to see the results of a study from the journal Nutritional Research.

In the study, researchers separated rats into two groups: one fed excessive amounts of calories thanks to a significant amount of added oil for fat content, and the other group fed a high-calorie diet driven by sugar. Each of these groups was split in half, with one half receiving a “sub-optimal” dose of Vitamin D and the other receiving 10,000 IE of Vitamin D, and a slightly higher amount of calcium than what the other half received.

The researchers were surprised to find that despite the overfeeding, the rats receiving the large dose of Vitamin D and calcium actually got thinner and more muscular. According to analysis, the rats receiving the high Vitamin D and calcium doses manufactured more of a protein that helps muscles burn fat for energy. The researchers believe that this change, as well as an increase in insulin receptors prompted by the supplements, led to the improvements in body composition (2). Obviously, this information is valuable for those dieting and those looking to gain lean muscle mass – who couldn’t use extra muscle and less fat? All it takes, according to this research, is a lot more Vitamin D and some calcium – which makes Vitamin D-fortified milk look like an ideal addition to one’s diet, as it would deliver both nutrients plus protein.



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