For the first time a study proves statins are as effective in preventing heart attacks in women as well as men. Continue reading
The Los Angeles Times “Booster Shots” blog reports, “They’re called ‘risk factors’ for a reason – people with high blood pressure, diabetes, high cholesterol and/or a smoking habit are much more likely to have heart attacks, strokes and other manifestations of cardiovascular disease, including death,” according to a study published in the New England Journal of Medicine. Continue reading
In the past I’ve told you that children younger than two years of age should have NO screen time, while children over two should have less than two hours per day. Now we may have to extend this advice to adults. Continue reading
While writing this blog, I was listening to Simon and Garfunkel singing, “Slow down, you move too fast. You need to make the morning last.” At the same time, I found a Bloomberg News report claiming that “working overtime may be a killer, according to research that finds long hours on the job is a heart risk along with smoking, bad cholesterol and high blood pressure.” Continue reading
I’m surprised how many of my patients are NOT aware of the potential cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) or naproxen (Aleve). If you’re in their camp, don’t miss this report: Continue reading
I often have patients ask if I think diet sodas are a healthy substitute for regular soft drinks. I tell them, “NO!” The primary reason, that I’ve discussed with you in a past blog, is that diet soda consumption may weaken bones and lead to later osteopenia, osteoporosis, and/or bone fractures.
Now, I have another reason to add: Research presented at the American Stroke Association International Stroke Conference earlier this year suggest that diet soda consumption may be linked to increased heart risks. Continue reading
In a previous blog, “Taking low-dose aspirin and NSAIDs can be a challenge – (Part 1),” I wrote:
- I have many patients who are taking low-dose (81 mg) aspirin (ASA) daily and who wonder if they can take a Non-Steroidal Ant-Iinflammatory Drug (NSAID) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) for pain or fever. I warn them that adding an NSAID increases their gastrointestinal (GI) risk … and can possibly increase their cardiovascular (CV) risk. Continue reading
You’re likely hearing a fair bit of controversy over the Institute of Medicine’s (IOM’s) new recommendations (RDA) for vitamin D and calcium. I first reported on this in my blog, “Institute of Medicine says megadoses of vitamin D, calcium unnecessary.”
The IOM calls for MORE vitamin D and LESS calcium … but many experts say the vitamin D doses are still not high enough.
The new RDA is:
- 400 IU for infants,
- 600 IU for ages 1 to 70, and
- 800 IU for over 70.
But these RDAs are based ONLY on the amount needed to prevent bone problems, such as rickets, osteomalacia, osteopenia, osteoporosis, and fractures.
Higher amounts of vitamin D are associated with a lower risk of falls, cancer, heart disease, autoimmune disorders, etc. But the RDA is not set higher because the IOM feels there’s not sufficient proof of these benefits.
The experts at Prescriber’s Letter (PL)are telling healthcare professionals, “Recommend 400 IU for infants, 600 IU for kids, and 800 to 2000 IU for adults. The higher adult dose is safe and may provide extra benefits.” I’m with Prescriber’s Letter on this one. I concur with the new guidelines from Osteoporosis Canada recommending 1000 IU/day for adults under age of 50 and 2000 IU/day for adults over 50.
PL goes on to say, “Discourage adults from taking over 4000 IU/day without monitoring. Consider vitamin D testing for people likely to be deficient due to advanced age … dark skin … limited sun … malabsorption … etc.”
As I’ve told you before (Vitamin D Supplementation and Cancer Prevention): I check a vitamin D level as part of my annual exam. I do this on all adolescents and adults. If the vitamin D level is below 30, I suggest supplementing with vitamin D and rechecking.”
I give my patients two options:
- OTC vitamin D, 2000 IU per day, and recheck the level in 4-6 months, or
- Prescription vitamin D, 50,000 IU per week for 12 weeks and then recheck the level.
PL recommends, “Aim for a serum 25-hydroxyvitamin D level above 20 ng/mL for bone health … but below 60 ng/mL until more is known about the long-term safety of higher levels.” In my practice, we’re aiming for levels of 30 to 50 ng/mL.
The new RDA for elemental calcium is:
- 1300 mg for adolescents,
- 1000 mg for women up to 50 and men up to 70, and
- 1200 mg for older adults.
PL says, “Advise people not to get carried away with calcium supplements. Recommend not going over 2000 mg/day from food AND supplements for adults over 50. Too much calcium FROM SUPPLEMENTS might increase the risk of kidney stones and POSSIBLY heart attacks.
You can read more in my blog, “Can Calcium Supplements Cause Heart Attacks?“
An easy-to-remember formula for good health (0, 5, 10, 30, 150) is proposed in a wonderful editorial in American Family Physician titled “Preventive Health: Time for Change.” The author suggests this formula to physicians to “help patients achieve healthy lifestyle goals”:
- 0 = no cigarettes or tobacco products
- 5 = five servings of fruits and vegetables per day
- 10 = ten minutes of silence, relaxation, prayer, or meditation per day
- 30 = keep your BMI (body mass index) below 30
- 150 = number of minutes of exercise per week (e.g., brisk walking or equivalent)
The editorial is penned y Colin Kopes-Kerr, MD, from the Santa Rosa Family Medicine Residency in Santa Rosa, California:
It is time to make a decision. Which will be our health promotion strategy—primary prevention or secondary prevention?
Traditionally, the only one available to us was secondary prevention. Medicine consisted of a one-on-one physician-patient relationship, and taking care of patients meant minimizing the impact of any diseases the patient had. We did not have the time or tools to do anything else. More recently, we have been able to reduce a patient’s mortality by 20 to 30 percent by treating heart disease with a statin or beta blocker. These two medications have had the most dramatic effects in secondary prevention.
But now, the way we practice medicine has changed. We have a real choice to make. According to recent literature, primary prevention appears to work better than any other strategy in medicine. So why do some physicians not implement primary prevention? Despite the literature, maybe physicians are not getting the news. We need to keep repeating the message to physicians and patients that primary prevention is simple and effective. Next, we need to take a look at our own behavior as physicians and determine if it makes sense in the context of primary prevention.
There are 10 major studies on the effects of primary prevention.(1–15) These studies demonstrate very large correlations between specific healthy lifestyle behaviors and decreases in major chronic diseases (e.g., diabetes mellitus, heart disease, stroke, cancer) and all-cause mortality.
Although these studies offer a complex array of data to sift through, the elements of a healthy lifestyle are clear: not smoking, regular exercise, healthy diet, healthy body weight, and reduced stress.
Although exercise guidelines vary, I ascribe to the U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans, which recommends at least 150 minutes of brisk walking or the equivalent per week.(16) For the diet criterion, the Atherosclerosis Risk in Communities study illustrates that merely consuming five servings of fruits and vegetables per day is associated with the same benefits as consumption of a Mediterranean-style diet.(11) A standard of five servings of fruits and vegetables is much easier to remember and adhere to.
There is strong support for at least one weight-related variable in a healthy lifestyle. This may include body weight, body mass index (BMI), waist circumference, or waist:hip ratio. The INTERHEART study showed waist:hip ratio to be the most predictive of cardiovascular disease.(6) However, unlike BMI calculation, measurement of weight:hip ratio has not yet become standard in U.S. practices. I use BMI as the metric, and a value less than 30 kg per m2 as the cutoff between a healthy and unhealthy lifestyle. The goal is to move away from this outer limit toward a more ideal parameter, such as less than 25 kg per m2.
The final variable of a healthy lifestyle, which has strong support from the INTERHEART study, is stress reduction.(7) The INTERHEART study offers useful suggestions for measuring stress—perception of severe stress at home or at work, financial stress, or major life events.(7)
The minimal lifestyle intervention that would be beneficial is not defined. However, 15 to 20 minutes of silence, relaxation, or meditation appears to be a common interval.(17) To be more inclusive of patients, I set the criterion to an even less restrictive amount, about 10 minutes per day.(17) This is enough time to produce a change in biorhythms and is achievable for most patients.
Information alone does not lead to behavior change, however. Motivational interviewing or brief negotiation is a new framework that can close the gap between knowledge of available lifestyle interventions and changing behaviors. The framework has already been proven markedly effective for tobacco, drug, and alcohol addiction.(18) Few physicians have received the training necessary to implement motivational interviewing or brief negotiation. Resources for learning about these skills include the Kaiser Permanente Medical Group Web site and the book Motivational Interviewing in Health Care: Helping Patients Change Behavior.(18)
In terms of health, we can have it all. We have the requisite tools to convert knowledge into healthy behaviors. This newfound power to reduce diabetes, heart disease, stroke, cancer, and all-cause mortality with primary prevention strategies should impel us to change how we counsel patients. Research is needed to explore why some physicians are not making this change.
Address correspondence to Colin Kopes-Kerr, MD, at email@example.com. Reprints are not available from the author.
Author disclosure: Nothing to disclose.
- Stampfer MJ, Hu FB, Manson JE, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343(1):16–22. View here
- Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790–797. View here
- Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 2009;302(4):401–411. View here
- Knowler WC, Barrett-Connor E, Fowler SE, et al.; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. View here
- Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004;292(12):1433–1439. View here
- Yusuf S, Hawken S, Ounpuu S, et al.; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infraction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–952. View here
- Rosengren A, Hawken S, Ounpuu S, et al.; INTERHEART Investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):953–962. View here
- Chiuve SE, McCullough ML, Sacks FM, et al. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation. 2006;114(2):160–167. View here
- Chiuve SE, Rexrode KM, Spiegelman D, et al. Primary prevention of stroke by healthy lifestyle. Circulation. 2008;118(9):947–954. View here
- Kurth T, Moore SC, Gaziano JM, et al. Healthy lifestyle and the risk of stroke in women. Arch Intern Med. 2006;166(13):1403–1409. View here
- King DE, Mainous AG III, Geesey ME. Turning back the clock: adopting a healthy lifestyle in middle age. Am J Med. 2007;120(7):598–603. View here
- Khaw KT, Wareham N, Bingham S, et al. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study [published correction appears in PLoS Med. 2008;5(3):e70]. PLoS Med. 2008;5(1):e12. View here
- Ford ES, Bergmann MM, Kröger J, et al. Healthy living is the best revenge: findings from the European Prospective Investigation into Cancer and nutrition–Potsdam study. Arch Intern Med. 2009;169(15):1355–1362. View here
- Lee CD, Sui X, Blair SN. Combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men. Arch Intern Med. 2009;169(22):2096–2101. View here
- Djoussé L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009;302(4):394–400. View here
- U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. View here.
- Dialogue Partner. View here
- Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: Guilford Press; 2008. View here
Calcium supplements are coming under scrutiny due to concerns that they might increase heart attacks. A new study shows that patients over 40 who take 500 mg/day or more of calcium have an increased risk of heart attack.
And, the theory is plausible as too much calcium might lead to vascular calcification and atherosclerosis.
But it is WAY, WAY, WAY too soon to jump to any conclusions for at least a couple of reasons:
- The analysis only looked at people taking calcium supplements alone.
- It doesn’t address the role of dietary calcium or taking vitamin D along with calcium. Especially since some research suggests that taking calcium plus vitamin D does not significantly affect coronary artery calcification.
The Doctors of Pharmacology at the Natural Medicines Comprehensive Database tell prescribers this:
Continue to advise people to use calcium supplements if needed, but not to exceed recommended amounts.
Advise patients to consider their TOTAL calcium intake from supplements PLUS foods. Recommend aiming for calcium 1000 mg/day for adults under 50 and 1200 mg/day for adults over 50. Many people get about half this amount in their diet.
To this I add, if you’re going to take a calcium supplement (and, I do), then be sure to take it with vitamin D (and consider having your doctor test your vitamin D level).
To figure out dietary calcium intake, I have my patients count 300 mg/day from NON-dairy foods plus 300 mg/cup of milk, fortified orange juice, etc.
I also recommend vitamin D (based upon the new guidelines from Osteoporosis Canada) 1000 IU/day for adults under age of 50 and up to 2000 IU/day for adults over 50, to maintain adequate levels and help prevent fractures. I recommend using vitamin D3 (cholecalciferol) because it’s more active, but vitamin D2 (ergocalciferol) is also fine for increasing vitamin D levels. And, I do not recommend sunlight exposure for increasing vitamin D levels. You can read my reasons here.
Keep in mind, as I’ve told you before, the Institute of Medicine will come out with new calcium and vitamin D recommendations later this fall.
Krill oil is now being promoted as a better alternative to fish oil supplements. Krill are tiny shrimp-like crustaceans.
Promoters say that krill oil provides similar cardiac benefits as fish oil, but with fewer capsules and no fishy taste.
However, krill oil supplements contain less of the omega-3s EPA and DHA than fish oil supplements. Nevertheless, manufacturers claim krill oil is better absorbed because the omega-3s are in a phospholipid form.
According to the experts at the Natural Medicines Comprehensive Database, “Preliminary evidence shows that a specific krill oil product (Neptune Krill Oil NKO, Neptune Technologies & Bioresources, Inc) can lower cholesterol and triglycerides.”
“But,” they add, “overall there’s much better evidence that fish oil can lower triglycerides and cardiovascular risk.”
Furthermore, krill oil usually costs more than fish oil.
So, the NMCD recommends to prescribers, “For now, advise patients to stick with fish oil. Recommend taking it with food or trying an enteric-coated product if fishy taste is a problem. Suggest krill oil only for healthy people who want to add these omega-3s to their diet but can’t tolerate fish oil.”
Readers of this blog are well aware than many (if not most) Americans have insufficient to deficient levels of vitamin D. Other than prescribing oral vitamin D or vitamin D-containing foods, we doctors were left with prescribing a little sunshine. But, we know that exposing your skin to unprotected UVA or UVB light can increase your risk of skin cancer. And, there has been controversy about exactly how much sunlight one might need to avoid vitamin D supplements. Now, I may have an answer for you.
But, first a few basics. Vitamin D is essential for bone mineralization and may have a wide variety of other health benefits. Here are just a few I’ve blogged about:
- Vitamin D Supplementation and Cancer Prevention
- Vitamin D helps fend off flu and asthma attacks
- Increasing vitamin D levels may cut heart disease risk
- Vitamin D Supplementation Helps Prevent Falls in Older Adults
- Vitamin D Linked to Lower Heart Risk
- Can Vitamin D Ease Fibromyalgia Pain?
- In Lab Tests Vitamin D Shrinks Breast Cancer Cells
- Vitamin D May Lower Colon Cancer Risk
- Daily Calcium Plus Vitamin D Supplements May Reduce Fracture Risk
- Low levels of vitamin D may be linked to greater asthma severity
- Heart patients lacking vitamin D more likely to be depressed
- More reasons to consider having your vitamin D level checked – you may think better and have less arthritis
- Vitamin D tests soar as deficiency, diseases linked
Experts disagree on the serum vitamin D level necessary to maintain health. Some recommend concentrations above 30 ng/mL and consider the range between 20 and 30 ng/mL insufficient and concentrations lower than 20 ng/mL deficient. In our area, most experts are recommending level of 50 ng/mL (and, indeed, we are supplementing to this level).
By this reckoning, many, perhaps most, Americans are vitamin D insufficient or deficient.
Because it is difficult to obtain enough vitamin D from food intake, oral supplements and sunlight have been recommended for individuals with low serum D levels.
The suggested dose for supplements is 400 to 1000 IU/day.
It has also been suggested that a few minutes of sunlight each day to the face, neck, hands, and arms are all that is necessary to restore vitamin D sufficiency, but the amount of sunlight required for photoconversion of 7-dehydrocholesterol to pre–vitamin D varies considerably depending on a person’s age, Fitzpatrick sun-reactive skin type, geographic location, and season.
The six Fitzpatrick skin types classify sensitivity to ultraviolet light; skin type I is fair skin that always burns, never tans; type III is darker white skin that burns and tans; type V is brown skin that rarely burns, tans easily.
Investigators in a new study employed the FastRT computational tool to predict the length of daily exposure required to obtain the sunlight equivalent of 400 and 1000 IU oral vitamin D supplementation.
At noon in Miami, someone with Fitzpatrick skin type III would require 6 minutes to synthesize 1000 IU of vitamin D in the summer and 15 minutes in the winter.
Someone with skin type V would need 15 and 29 minutes, respectively.
At noon in the summer in Boston, necessary exposure times approximate those in Miami, but in winter, it would take about 1 hour for type III skin and 2 hours for type V skin to synthesize 1000 IU of D.
After 2 PM in the winter in Boston, it is impossible for even someone with Fitzpatrick type I skin to receive enough sun to equal even 400 IU of vitamin D.
About this study, Craig A. Elmets, MD, writes, “These findings raise serious questions about the recommendation that a ‘little bit’ of outdoor sun exposure is sufficient to maintain adequate vitamin D levels.
“Moreover, predictions of the time required to achieve adequate vitamin D photosynthesis are probably underestimates, because it is unlikely that people would walk around Boston for an hour or two in the winter with face, neck, and arms exposed.
“These findings corroborate another study that casts doubt on sun exposure as a way to prevent vitamin D deficiency.”
The bottom line is that it looks like oral vitamin D supplements are going to end up being shown to be the safest and most effective to gain adequate vitamin D levels.
Reuters Health has a report I thought you might find interesting. It’s based upon a new study answering the question, “If milk does the heart good, does it do the heart better if it comes from dairy cows grazed on grass instead of on feedlots?” The bottom line? Cow’s milk from cows grazed on grass may actually be heart healthy.
Earlier experiments have shown that cows on a diet of fresh grass produce milk with five times as much of an unsaturated fat called conjugated linoleic acid (CLA) than do cows fed processed grains. Studies in animals have suggested that CLAs can protect the heart, and help in weight loss.
Hannia Campos of the Harvard School of Public Health in Boston and her colleagues found, in a study of 4,000 people, that people with the highest concentrations of CLAs — the top fifth among all participants — had a 36 percent lower risk of heart attack compared to those with the lowest concentrations.
Those findings held true even once the researchers took into account heart disease risk factors such as high blood pressure and smoking.
The new findings suggest that CLA offers heart-healthy benefits that could more than offset the harms of saturated fat in milk, Campos said.
“Because pasture grazing leads to higher CLA in milk, and it is the natural feed for cattle, it seems like more emphasis should be given to this type of feeding,” she told Reuters Health by email.
Dairy products in the U.S. come almost exclusively from feedlots, she added. And cow’s milk is the primary source of CLA. (Beef contains a small amount.)
Campos and her colleagues looked to Costa Rica for their study, where pasture grazing of dairy cows is still the norm. They identified nearly 2,000 Costa Ricans who had suffered a non-fatal heart attack, and another 2,000 who had not. Then they measured the amount of CLA in fat tissues to estimate each person’s intake.
Since CLA typically travels with a host of other fats, the researchers went a step further to tease apart its effects from those of its predominantly unhealthful companions, they report in the American Journal of Clinical Nutrition. The difference in risk attributed to CLA subsequently rose to 49 percent.
“Whole-fat milk and dairy products have gotten such a bad reputation in recent years due to their saturated fat and cholesterol contents, and now we find that CLA may be incredibly health-promoting,” Michelle McGuire, spokesperson for the journal’s publisher, the American Society for Nutrition, and associate professor at Washington State University, told Reuters Health in an email. “Whole milk is not the villain!”
Each year, approximately 1.5 million Americans will suffer a heart attack. A third will not survive.
The evidence may now be piling up: another paper out of Sweden in the same issue of the journal as the Costa Rican study also hints at heart attack protection through milk fat.
Further, the benefits of CLA may extend beyond the heart to the prevention of cancer and diabetes, suggests McGuire, pointing to results of other animal studies.
“Milk is actually the only food ever ‘designed by nature’ to be fed to mammals,” she added. “We need to look to milk as the perfect food and learn everything we can from it.”
People who regularly put in overtime and work 10 or 11-hour days increase their heart disease risk by nearly two-thirds, research suggests. The findings come from a study of 6,000 British civil servants, published online in the European Heart Journal.
The bottom line, according to the researchers is, “… the findings highlighted the importance of work-life balance.” If you’re having trouble finding that balance, you may want to read my book 10 Essentials of Happy, Healthy People: Becoming and staying highly healthy — which is chock full of suggestions for measuring and balancing what I call “the four wheels of health:” physical, emotional, relational, and spiritual.
Here are some of the details on the study from the BBC: After accounting for known heart risk factors such as smoking, doctors found those who worked three to four hours of overtime a day ran a 60% higher risk.
Overall, there were 369 cases where people suffered heart disease that caused death, had a heart attack or developed angina. And the number of hours spent working overtime appeared to be strongly linked in many cases.
The researchers said there could be a number of explanations for this. People who spend more time at work have less time to exercise, relax and unwind. They may also be more stressed, anxious, or have depression.
A career-minded person will also tend to be a “Type A” personality who is highly driven, aggressive or irritable, they say.
“Employees who work overtime may also be likely to work while ill — that is, be reluctant to be absent from work despite illness,” they add.
Lead researcher Mianna Virtanen, an epidemiologist at the Finnish Institute of Occupational Health in Helsinki and University College London, said: “More research is needed before we can be confident that overtime work would cause coronary heart disease.”
Cathy Ross, senior cardiac nurse at the British Heart Foundation, which part-funded the research, said: “This study raises further questions about how our working lives can influence our risk of heart disease.
“Although the researchers showed a link between working more than three hours overtime every day and heart problems, the reasons for the increased risk weren’t clear.
“Until researchers understand how our working lives can affect the risk to our heart health, there are simple ways to look after your heart health at work, like taking a brisk walk at lunch, taking the stairs instead of the lift, or by swapping that biscuit for a piece of fruit.”
Dr John Challenor, from the Society of Occupational Medicine, said: “In many ways it confirms what we as occupational health doctors already know – that work/life balance plays a vital role in well-being.
“Employers and patients need to be aware of all of the risk factors for coronary heart disease and should consider overtime as one factor that may lead to a number of medical conditions.”
The amount of fish oil one has to take each day depends upon why one is taking it. Here are some diseases and the amount of the effective daily doses of total fish oil or EPA and DHA (the most active components of fish oil) needed for each disorder (according to the experts at the Natural Medicines Comprehensive Database): Continue reading
I may have blogged more on vitamin D this year than any other topic. And, now, the Los Angeles Times is reporting, “Raising the amount of vitamin D in the blood appears to help some people — at least those deficient in the vitamin — reduce their risk of heart disease by about 30%.” This is according to research presented at the American College of Cardiology annual meeting.
In the past, “researchers have been uncomfortable randomizing people with low vitamin D into a group that … does not” receive treatment, because deficiency “can contribute to weaker bones and” has “been associated with increased risks of several diseases, including several types of cancer.”
The Salt Lake Tribune reports that the researchers reported that “patients who increased their vitamin D levels to 43 nanograms per milliliter of blood or higher reduced their risks of the chronic diseases.” Currently, 30 nanograms is “considered ‘normal'” by some (although in our community, many of the specialists want vitamin D levels to be 50 or higher).
Meanwhile, researchers also found that “patients who raised their vitamin D levels were 33% less likely to have a heart attack, 20% less likely to develop heart failure, and 30% less likely to die between” visits to their physician, WebMD reported. HealthDay also covered the story.
What am I doing in my practice? Checking a vitamin D level as part of my annual exam. I do this on all adolescents and adults. If the vitamin D level is below 50, I suggest supplementing with vitamin D and rechecking. I give my patients two options. (1) OTC vitamin D, 2000 IU per day, and recheck the level in 4-6 months, or (2) Prescription vitamin D, 50,000 IU per week for 12 weeks and then recheck the level.