Tag Archives: vitamin D deficiency

Vitamin D Insufficiency: Is there enough evidence for clinical recommendations?

Readers of this blog over the last year, have seen many of my posts on the plethora of studies and recommendations about vitamin D. Now there’s some new data I think you’ll be interested in. Continue reading

What to do with the two vitamin D guidelines?

As we’ve discussed in a number of past blogs, many adults are deficient in vitamin D, placing them at elevated risk for fracture, frequent falls, and a slew of other medical problems including several types of cancer.

But what is the ideal way to prevent this deficiency? And does the method used matter in terms of health outcomes? As I’ve mentioned in the past Osteoporosis Canada recently reviewed these issues and offers bold new recommendations for vitamin D supplementation. But their recommendations are quite different from those offered by the Institute of Medicine. Continue reading

Institute of Medicine says megadoses of vitamin D, calcium unnecessary

In a front-page article, the New York Times says, “The very high levels of vitamin D and calcium that are often recommended by doctors and testing laboratories – and can be achieved only by taking supplements – are unnecessary and could be harmful, an expert committee says” in a low-awaited report.

The “group said most people have adequate amounts of vitamin D in their blood supplied by their diets and natural sources like sunshine.” Dr. Clifford J. Rosen, “a member of the panel and an osteoporosis expert at the Maine Medical Center Research Institute,” said, “For most people, taking extra calcium and vitamin D supplements is not indicated.”

The AP reports, “Long-awaited new dietary guidelines say there’s no proof that megadoses prevent cancer or other ailments – sure to frustrate backers of the so-called sunshine vitamin.”

This “decision by the prestigious Institute of Medicine, the health arm of the National Academy of Sciences, could put some brakes on the nation’s vitamin D craze, warning that super-high levels could be risky.”

Notably, “a National Cancer Institute study last summer was the latest to report no cancer protection from vitamin D and the possibility of an increased risk of pancreatic cancer in people with the very highest D levels. Super-high doses – above 10,000 IUs a day – are known to cause kidney damage, and the report sets 4,000 IUs as an upper daily limit – but not the amount people should strive for.”

According to a report in the Wall Street Journal, the committee members disagreed with previous findings that Americans and Canadians do not consume sufficient vitamin D, and instead suggested that a blood level of 20 nanograms/ml was adequate.

This suggestion contradicts groups such as the Endocrine Society and the International Osteoporsis Foundation, which have recommended 30 ng/ml for good bone health — and is what I recommend for my patients.

Meanwhile, the NIH has begun to recruit participants for a large study that will compare the impact on health of vitamin D and omega-3 fatty acids derived from fish oil.

USA Today reports, “According to the report, children and adults younger than 71 need no more than 600 international units (IUs) of vitamin D a day and should consume 700 to 1,300 milligrams of calcium a day, depending on their age.”

Indeed, the “committee was surprised to see that most Americans are meeting their needs for both of the nutrients, except for adolescent girls who may not be getting enough calcium and some elderly people who don’t get enough of either, says Catharine Ross, professor of nutrition at Pennsylvania State University and chairwoman of the panel that prepared the report.”

Still, Time points out, “Those 71 years or older … may need more vitamin D, up to 800 IU a day, to combat deteriorating bone,” the group said.

Due to “the lack of sufficient data to date, advice on vitamin D up to this point was not considered as a recommended dietary allowance, which is based on stronger scientific evidence, but rather an adequate intake suggestion, and stood at anywhere from 200 IU to 400 IU for adults.”

Notably, the “new recommendations are based on data from more than 1,000 studies, most of which included trials in which volunteers were randomly assigned to receive either vitamin or calcium supplements or a placebo, after which their health outcomes were compared to one another.”

The Washington Post “The Checkup” blog says, “The United States and Canada asked the Institute of Medicine, which is part of the National Academy of Sciences, to update the official vitamin D recommendations for the first time since 1997.”

You read more about my application of this report in my blog, “My Take on the new Vitamin D and Calcium Recommendations.”

How Much Sunlight Is Equivalent to Vitamin D Supplementation?

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:

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.

How much vitamin D is too much?

Now that so many more people are taking vitamin D, some are asking how much vitamin D is too much. And, it’s important to note that vitamin D doses vary widely and toxicity is rare.

Here are some guidelines recommended to healthcare professionals from the evidence-based experts at The Prescriber’s Letter:

To prevent deficiency, recommend 1000 to 2000 IU/day of vitamin D for adults and 400 IU/day for infants and children.

Most people will need supplements. We don’t get much vitamin D from the sun these days due to sunscreens, staying indoors, etc.

Diet usually isn’t enough, either. Very few foods contain vitamin D … and milk only contains only 100 IU per cup.

Higher doses are needed to maintain adequate levels in some patients … or to treat a deficiency.

To treat deficiency in adults, prescribe 50,000 IU/week orally for 6 to 12 weeks then recheck levels. Tell patients it’s okay to consume milk and multivits while on this weekly vitamin D dose.

Optimal blood levels of 25-hydroxyvitamin D for bone health are at least 30 ng/mL … normal levels can reach 100 ng/mL. Increasing the dose by 1000 IU/day increases blood levels about 7 to 10 ng/mL.

Toxicity, hypercalcemia, and hyperphosphatemia usually don’t occur until vitamin D levels exceed 150 ng/mL.

Toxicity can occur with excessive doses such as 40,000 IU/day for one month in infants … and 50,000 IU/day for several months in adults.

Warn parents not to use vitamin D liquids dosed as 400 IU/DROP. Giving one dropperful or 1 mL by mistake can deliver 10,000 IU/day. FDA will force companies to provide no more than 400 IU per dropperful.

Patients sometimes ask if they can take vitamin D once a week or month for maintenance. Explain that it’s okay to take 14,000 IU once a WEEK … or 50,000 IU once a MONTH … instead of 2000 IU/day.

Encourage using D3 (cholecalciferol) since it’s more potent than D2 (ergocalciferol) … but D2 is also effective and okay to use.

Adults may need up to twice the amount of vitamin D than is typically recommended

Here’s news about a new guideline that will change something I do in practice.

The Los Angeles Times “Booster Shots” blog reported, “Older adults need up to twice the amount of vitamin D than is typically recommended, according to guidelines released Monday by the International Osteoporosis Foundation.”

The guidelines “urged adults, defined by this group as 65 and older, to aim for a 25-OHD blood level – the primary marker for vitamin D in the blood – of 75 nanomoles per liter.

In our community, physicians have been aiming for a vitamin D level of 50.

So, the new guideline will be a new practice for me.

To reach that level, one would need an intake of 20 to 25 micrograms per day (or 800 to 1,000 international units) of vitamin D,” as opposed to the amounts suggested by the current US Recommended Daily Allowance of “10 micrograms (400 IU) for people ages 51 to 70, and 15 micrograms (600 IU) for people 71 and older.”

However, in our practice, most of the docs are recommending either tablets with 50,000 IU once a month or 2000 IU per day.

Either way, you have to check a blood level to see if what you’re taking is adequate or not.

Take Vitamin D With Largest Meal

Taking your vitamin D supplement with the largest meal of the day may boost its absorption substantially, according to a new study from researchers at the Cleveland Clinic.

Here are details from WebMD: The researchers  instructed 17 men and women, average age 64, whose blood levels of vitamin D were borderline insufficient despite taking supplements, to take their supplements with the largest meal of the day.

After two or three months, the study participants had about a 50% increase in blood levels of the vitamin, regardless of the dose they took.

Researchers Guy B. Mulligan, MD, and Angelo Licata, MD, had noticed that patients typically report taking the supplement either on an empty stomach or with a light meal.

Because the vitamin is fat-soluble, the researchers speculated that taking it with a big meal would improve absorption.

Vitamin D is crucial not only to maintain bone strength, but research now suggests it plays a role in immune system problems, cancer, and cardiovascular disease.

The researchers measured blood levels of the vitamin at the start of the study and two or three months later. Participants took a range of doses, and the researchers divided them into three groups: less than 50,000 IU a week, 50,000 IU, and more than 50,000 IU. The daily doses ranged from 1,000 IU to 50,000 IU.

A dose of 400 IU is termed adequate for people 51-70, and 600 IU for people 71 and older, as set by the Institute of Medicine, but some experts believe much more is needed, especially in older adults. The current upper tolerable level is set at 2,000 IU daily. The recommendations are under review and an update is expected this month.

At the study start, the average blood level of the form of vitamin D measured, 25(OH)D, was 30.5 nanograms per milliliter. By the end, it was 47.2 ng/mL.  A level of 15 and higher is termed adequate by the Institute of Medicine for healthy people, but the study participants had a range of health problems, such as osteoporosis and thyroid problems.

Few foods contain vitamin D naturally, and some foods are fortified with it. Vitamin D synthesis is also triggered when the body is exposed to sunlight.

Is OJ as good a source of vitamin D as supplements?

A glass of orange juice may not only help the vitamin pill go down. A new study suggests that fortified varieties can also help the body’s vitamin D levels go up – just as effectively as the supplement itself. The finding could bring a welcome addition to a very short list of sources for vitamin D, which is thought to help fend off an array of health problems including brittle bones, diabetes, and cancer.

Here are details from Reuters Health: “A lot of people don’t drink milk,” which has been fortified with vitamin D since the 1930s, “but they do drink OJ in the morning,” the study’s study author, Dr. Michael Holick, of the Boston University School of Medicine, told Reuters Health.

Simply adding a vitamin to a food does not guarantee its absorption in the body. In fact, since vitamin D dissolves in fat but not water, there was concern that only fatty foods such as milk could be used.

But preliminary research several years ago by Holick and his team suggested that orange juice – not known for its fat content — might be an effective way to deliver the vitamin. This prompted Minute Maid and Tropicana to begin adding it, along with calcium, to some of their products. (A division of Coca-Cola, which owns Minute Maid, funded Holick’s study.)

Still, the question remained of whether the body could make use of as much vitamin D from orange juice as it could from a supplement. So the team recruited about 100 adults and had them drink a glass of orange juice every morning and to swallow a capsule every night for 11 weeks.

Some of the juices were fortified with 1,000 international units (IU) of vitamin D; others were vitamin-free placebos that looked and tasted the same. The capsules also came with or without vitamin D. Participants were randomly assigned one of each.

About 85 percent of the participants began the study with blood levels of vitamin D below the recommended healthy minimums, report the researchers in the American Journal of Clinical Nutrition. Over the course of the 11 weeks, levels among those receiving vitamin D rose significantly. And the rise appeared to be the same regardless of whether the vitamin was consumed in juice or capsule form.

As expected, participants who had received both placebos showed no improvement in their vitamin D levels.

“The consumer now has one more option for obtaining vitamin D in the diet,” Dennis Wagner, a PhD candidate at the University of Toronto, told Reuters Health by email. His research group recently added to the list themselves: cheese.

Unfortunately, he said, government regulations currently allow only 100 IU of vitamin D to be added to a serving of food or drink.

While that number could go up when the U.S. government revises its dietary guidelines this summer, Holick is concerned that it will still be too low to ensure healthy levels of vitamin D through diet alone. He recommends 2,000 IU a day for adults, and 1,000 IU for children.

Natural food sources are rare – mostly just oily fish and mushrooms – and Holick thinks it would be unrealistic to expect everyone to start taking supplements.

His solution is a controversial one: short spurts of unprotected time in the sun, the major natural source of vitamin D. He does, however, advise always protecting the face.

“Mother Nature designed the system very early to guarantee that we got enough vitamin D,” said Holick. “Everyone was outside all the time, making it for free.'”

Wagner agrees, saying that humans are able to make a healthy dose of vitamin D in a relatively short amount of time before the skin starts to turn red and the risk of skin cancer begins to rise.

“However, the reliance on sunlight exposure as the primary source of vitamin D is often impractical, especially in northern latitudes during the winter,” added Wagner. “An increase in the number and variety of foods fortified with vitamin D will increase the availability of this important vitamin … and prevent the detrimental health consequences associated with vitamin D deficiency.”

Vitamin D Supplementation and Cancer Prevention

Readers of this blog know that, in general, I’m in favor of healthcare professionals checking vitamin D levels as part of routine exams. I do this on all adolescents and adults. And, I’ve blogged more on the topic of vitamin D this year than any other topic. So, I’m trying to post less on the topic, but this and the next too blogs were too important not to mention to you.

The subject of this blog is based upon an abstract of an amazing study titled “Vitamin D Supplementation and Cancer Prevention.” It is authored by Thomas L. Lenz, PharmD, and published in the American Journal of Lifestyle Medicine (2009;3[5]:365-368):

It is estimated that approximately 1 billion people worldwide have blood concentrations of vitamin D that are considered suboptimal.

Much research has been conducted over the past 30 years linking low vitamin D serum concentrations to both skeletal and nonskeletal conditions, including several types of cancers, cardiovascular disease, diabetes, upper respiratory tract infections, all-cause mortality, and many others.

Several observational studies and a few prospectively randomized controlled trials have demonstrated that adequate levels of vitamin D can decrease the risk and improve survival rates for several types of cancers including breast, rectum, ovary, prostate, stomach, bladder, esophagus, kidney, lung, pancreas, uterus, non-Hodgkin lymphoma, and multiple myeloma.

Individuals with serum vitamin D concentrations less than 20 ng/mL are considered most at risk, whereas those who achieve levels of 32 to 100 ng/mL are considered to have sufficient serum vitamin D concentrations.

Vitamin D can be obtained from exposure to the sun, through dietary intake, and via supplementation.

Obtaining a total of approximately 4000 IU/d of vitamin D3 from all sources has been shown to achieve serum concentrations considered to be in the sufficient range. However, most individuals will require a dietary supplement of 2000 IU/d of vitamin D3 to achieve sufficient levels as up to 10,000 IU/d is considered safe.

Vitamin D3 is available as an over-the-counter product at most pharmacies and is relatively inexpensive, especially when compared with the demonstrated benefits.

What am I doing in my practice? As mentioned above, 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 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.

Increasing vitamin D levels may cut heart disease risk

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.

Babies should take vitamin D supplement

Frequent readers to this blog are aware of the growing incidence of vitamin D insufficiency and deficiency in all age groups in the US. Now, according to a new study published online in the journal Pediatrics, “most babies should take a daily vitamin D supplement.” USA Today reports that the researchers say, “only 1% to 13% of infants under one year now get a vitamin D supplement, available in inexpensive drops.”

The study said “those drops are needed … because only 5% to 37% of American infants met the standard for vitamin D set by the American Academy of Pediatrics (AAP) in 2008: 400 international units (IU) a day.

This matches what I am recommending for my pediatric patients (from infancy, through childhood, and into adolescence): give a supplement of 400 IU of vitamin D each day. It’s inexpensive. It’s safe. And, it may well help a child grow up to be more highly healthy.

“CDC researchers analyzed data from a nationwide survey of infant feeding practices conducted between 2005 and 2007 to estimate how many babies were getting enough vitamin D in their diets during their first year of life,” WebMD reported.

The team found that “exclusively breastfed babies got the least vitamin D in their diets, followed by babies who drank both breast milk and formula. Babies who were exclusively formula-fed got the most vitamin D,” but only about a third of those drank enough formula (approximately a liter) to get the amount of vitamin D recommended by the AAP.

HealthDay News reported lead researcher, Cria G. Perrine, from the CDC, “Vitamin D receptors are present in almost every type of cell in the body …  lack of vitamin D has been linked to many diseases including cancer, type 1 diabetes and respiratory problems.”

“Most infants, starting at birth, will need a vitamin D supplement,” Perrine said.

To make sure your baby is getting enough vitamin D, Perrine said there are vitamin D drops and liquid multivitamins for infants. “Pretty much all the drops are single doses for 400 IUs,” the researcher noted.

The researchers found that among infants who were exclusively breast-fed, only 5 percent to 13 percent, depending on age, were getting enough vitamin D.

For infants who were breast-fed but also got formula, 28 percent to 35 percent were getting 200 IUs of vitamin D a day, but only 9 percent to 14 percent were getting 400 IUs a day.

For infants fed exclusively with formula, 81 percent to 98 percent were getting 200 IUs a day, but only 20 percent to 37 percent were getting the recommended 400 IUs.

“In the past, it was assumed that children receiving formula didn’t need a vitamin D supplement, because they were getting it from the formula,” Perrine said.

Although they were getting enough formula to meet the 200 IU recommendation, most formula-fed infants won’t get enough vitamin D to meet the 400 IU recommendation, Perrine noted.

In addition, the investigators found that only 1 percent to 13 percent of infants were being given a vitamin D supplement.

“Most infants need a vitamin D supplement, and we are not only talking about only breast-fed children,” Perrine said.

Samantha Heller, a dietitian, nutritionist and exercise physiologist, said that “low levels of vitamin D may not seem like a big deal but we are finding out it is. Research is suggesting that low vitamin D levels are linked to autoimmune diseases such as multiple sclerosis, psoriasis, as well as cardiovascular disease, hypertension, osteoporosis, mood dysregulation, muscle problems, certain cancers and more.”

Heller added: “Sun exposure is one of the best ways to get vitamin D since it is not found in many foods. However, for people living in northern latitudes the sun is not strong enough to generate vitamin D production many months of the year. In addition, we encourage people to use sunscreen to protect against skin cancers, which also minimizes skin’s ability to produce vitamin D.”

Supplements are the next best option, Heller said. “Experts now recommend a minimum of 800 to 1,000 IU per day for adults and children year round.

In July 2008, the American Academy of Pediatrics recommended that infants who are exclusively or partially breast-fed receive 400 IU of supplemental vitamin D daily, beginning in the first few days of life,” she said.

“This study suggests that parents are unaware of the need for vitamin D supplementation in infants and other studies show the same for older children. Health professionals need to get the word out to the public that infants, children, adolescents and adults need to get appropriate amounts of vitamin D all year,” she added.

Vitamin D Supplementation Helps Prevent Falls in Older Adults

Each year, one third of adults 65 years and older have at least one fall. And, 9% of those falls require an emergency department visit and up to 6%result in a fracture. Consequently, strategies to prevent falls have become an important public health goal for the elderly.

A recent review of multiple published studies concluded that vitamin D supplementation taken in dosages of 700 to 1,000 IU per day (achieving a serum 25-hydroxyvitamin D level of at least 24) reduces falls in older persons by 26%.

And, for good news for the cost conscious, the more expensive active forms of vitamin D (which also had double the rate of a significant side effect) were no more effective than the very inexpensive and safer over-the-counter supplemental vitamin D.

A vitamin D level (as a blood test) is inexpensive, and treating a low vitamin D level even more inexpensive.

Some studies of vitamin D supplementation in older adults have shown improved strength, function, and balance in addition to reduced falls. Other studies have not found any benefit, which may be attributed to differences in dosing and the use of open trial designs.

Vitamin D is now available as an over-the-counter supplement (vitamin D3 or vitamin D2), or in an active form (1α-hydroxyvitamin D3 or 1,25-dihydroxyvitamin D3). So, researcher Bischoff-Ferrari and colleagues conducted a meta-analysis to determine the effectiveness of various vitamin D formulations on the prevention of falls in older persons.

The authors evaluated articles from 1991 to 2008, highlighting randomized, double-blind, controlled clinical trials of fall prevention using defined dosages and types of vitamin D in adults 65 years and older. The primary outcome was the risk of at least one fall while on vitamin D supplementation, with or without calcium, compared with persons on placebo or on calcium alone.

Of 164 articles identified, 10 were included in the final analysis; five trials used vitamin D3, three used vitamin D2, and two studied active forms of vitamin D.

Of the 2,426 participants in the eight trials of vitamin D2 or D3, the average age was 80 years, and 81% were women. All participants were in stable health and were living in the community or in nursing homes.

Daily dosages ranged from 200 IU to 1,000 IU during a treatment course of two to 36 months. Calcium supplementation (500 to 1,200 mg per day) was used in both the treatment and placebo arms in five trials, was used only in the treatment group of one trial, and was not used in two studies (vitamin D compared with placebo). In seven of the eight trials, the rate of adherence was reported to be 80 to 100 percent.

Among the seven high-dose trials (i.e., those that used 700 to 1,000 IU of supplemental vitamin D per day), dose stratification showed that daily dosages of 700 IU or more resulted in a relative risk reduction of 19%.

Subgroup analysis of the trials using high-dose vitamin D3 showed a fall reduction of 26%.

For all supplemental vitamin D, the number needed to treat was 11 for two to 36 months to achieve significant fall reduction.

Dosages of less than 700 IU per day did not confer any benefit in reducing falls.

Serum 25-hydroxyvitamin D levels of 24 ng per mL (60 nmol per L) or more were associated with a 23 percent reduction in falls. And, in a subgroup analysis of the high-dose trials, there were no significant differences among participants who used calcium supplementation and those who did not.

Finally, the two studies using the active forms of vitamin D showed a relative risk reduction similar to that of the supplemental forms, but had twice the hypercalcemia rate compared with placebo.

SOURCE: Bischoff-Ferrari  HA, et al.  Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. October  1, 2009;339:b3692.

Vitamin D Linked to Lower Heart Risk

According to new research, vitamin D supplements may not only help your bones, they may help protect your heart. A new review of research on vitamin D and calcium supplements shows that people who take moderate to high doses of vitamin D have a lower risk of heart disease — while calcium supplements seemed to have little effect on heart disease risk. Here’s the full report from WebMD:

Vitamin D is produced by the body in response to exposure to sunlight but is also commonly found in fortified dairy products and supplements. It is already known to play a critical role in calcium absorption and bone health, but a growing number of studies suggest that vitamin D supplementation may also lower the risk of heart disease.

Researchers say vitamin D and calcium deficiency is a common problem among the elderly throughout the world. In the United States, the Institute of Medicine recommends vitamin D supplements at a dose of 400 to 600 International Units (IU) per day and calcium at a dose of 1,200 milligrams per day for adults over age 50.

But recent research suggests that significantly higher doses of vitamin D may be required to reap the maximum health benefits of vitamin D supplements.

To help clarify the role of vitamin D and calcium in heart disease risk, researchers analyzed 17 studies published between 1966 and 2009 on vitamin D and calcium supplementation and heart disease. The results appear in the Annals of Internal Medicine.

Researchers found six studies (five of which involved people on dialysis and one which included the general population) showed a consistent reduction in heart-related deaths among people who took vitamin D supplements. But four studies of initially healthy individuals found no differences in development of heart disease between those who received calcium supplements and those who did not.

A second analysis of eight studies showed a slight, but statistically insignificant 10% reduction in heart disease risk among those who took moderate to high doses of vitamin D supplements. No such reduction in heart disease risk was found among those who took calcium or a combination of calcium and vitamin D supplements.

Researchers say very few studies have specifically investigated the effect of vitamin D supplements alone or in combination with calcium on heart disease risk in healthy people.

But evidence to date “suggests that vitamin D supplementation at moderate to high doses may have beneficial effects on reducing the risk for CVD [heart disease], whereas calcium supplementation seems to have no apparent effect,” write researcher Lu Wang, MD, PhD of the division of preventive medicine at Brigham and Women’s Hospital in Boston and colleagues.

They say more research is “urgently needed” to better explain the role of vitamin D in preventing heart disease.

The data should not be interpreted to mean that calcium supplements are harmful.  Although calcium had only a neutral effect on heart health in the current analysis, calcium is known to be important for bone health. Calcium intake remains below recommended levels for a large portion of the U.S. population.

Can Vitamin D Ease Fibromyalgia Pain?

Vitamin D is known as the sunshine vitamin because when sunlight hits skin, the body produces this vitamin, essential for strong, healthy bones. However, a mountain of new evidence suggests that the vitamin may have a more versatile role than previously thought, particularly when it comes to maintaining a healthy immune system and boosting mood. Low levels of vitamin D have been associated with more severe asthma, colds, seasonal affective disorder, depression, a number of types of cancer, and even chronic pain or fibromyalgia.

So does that mean that taking more vitamin D (or spending a bit more time in the sun) can combat fibromyalgia? Not just yet. But, here’s a hopeful report from Health.com on the topic that may be of help to those wrestling with fibromyalgia:

Studies have found that pain patients, including those with fibromyalgia, are more likely to be vitamin D deficient than their pain-free peers.

However, it’s not clear which came first; people in pain may get less sun (presumably because they may be more likely to stay inside, due to pain), which could lead to a vitamin D deficiency, rather than vice versa—a vitamin D deficiency leading to pain.

And it’s also not clear if making sure you have adequate levels of the vitamin will help relieve pain or other fibromyalgia symptoms, such as lack of energy or difficulty sleeping.

What’s known about vitamin D:

Our bodies make vitamin D naturally when exposed to sunlight. It only takes 10 to 15 minutes a day outside (without sunscreen) to make an adequate amount, but according to studies, about half of adults and 70% of children don’t get enough.

In a 2003 study, 93% of pain patients had low levels of vitamin D.

The current dietary reference intake for people up to age 50 is 200 international units (IU) per day of vitamin D. Adults ages 51 to 70 need 400 IU/day, and those older than 70 need 600 IU/day, with an upper limit of 2,000 IU/day deemed safe.

But some experts suggest raising that upper limit. Toxicity levels, they say, are closer to 10,000 IU/day, and 2,000 may be closer to the baseline of what healthy bodies need.

Current recommendations were established by the Institute of Medicine in 1997 to promote optimal bone health and are under review to possibly be revised in the summer of 2010.

Screening for vitamin D deficiency is as easy as an inexpensive blood test, and deficiency can be righted with a few minutes of sunscreen-free time in the sun, supplemental pills, or by incorporating foods like eggs, mushrooms, and salmon—all natural carriers of vitamin D—into a healthy diet.

Getting vitamin D from natural sources can stop you from getting too much of the vitamin, since the body makes only what it needs.

Although it’s hard to overdose on vitamin D, it is possible if you take megadoses of the vitamin, which can cause hypercalcemia, an above-average concentration of calcium in the blood that can lead to kidney failure and nervous system problems, and hyperphosphatemia, an increase in levels of phosphates in the blood, which can affect bone density and increase the risk of osteoporosis.

Manywho lack vitamin D—especially during the dark and dreary winter months when sunlight isn’t abundant—do turn to supplements. In 2008, Americans spent $235 million on vitamin D supplements, up from $40 million in 2001.

So, can vitamin D help fibromhyalgia symptoms?

While more research is needed, experts believe supplementing with vitamin D may lessen pain, says Gregory A. Plotnikoff, MD, the medical director at the Penny George Institute for Health and Healing at Abbott Northwestern Hospital, in Minneapolis.

“Many Americans are reporting that replenishing their vitamin D results in significantly reduced pain, increased energy, and better sense of well-being,” says Dr. Plotnikoff, who published a 2003 study of the link.

However, W. Michael Hooten, MD, an assistant professor of anesthesiology and the medical director at the Mayo Clinic Pain Rehabilitation Center, in Rochester, Minn., notes that patients in pain may be more inactive and spend less time in the sun than people who are pain free.

“They may stay indoors more, their diet may become altered, which may predispose them to develop a vitamin D deficiency,” he says.

In a study published last year and co-authored by Dr. Hooten, pain patients with a vitamin D deficiency took almost double the amount of pain medication to control their symptoms as pain patients with adequate levels of the vitamin.

In the study of 267 chronic pain patients, 66 had been diagnosed with fibromyalgia. Over half of the participants had such intense pain that they were using opioid painkillers daily.

“If you’re choking down 150 milligrams of morphine per day, you don’t have energy, you feel lousy, you’re staying at home all the time,” he says. “Clinicians should be suspect of chronic pain patients. What we measured justifies screening for [vitamin D deficiency].”

For now, more research is needed to determine whether exposure to more vitamin D will truly help cut fibromyalgia pain.

It is known that vitamin D can help lessen pain caused by osteomalacia, a softening or weakening of the bones caused by a severe, long-term lack of vitamin D. Researchers aren’t sure how many people suffer from osteomalacia, says Dr. Hooten, but it can be misdiagnosed as fibromyalgia or other conditions.

But even if an adequate intake of vitamin D doesn’t alleviate pain, it may boost mood and could potentially prevent 150,000 cases of cancer annually.

According to a 2009 study, supplementing vitamin D may also protect you from the common cold.

In a study of nearly 19,000 people 12 and older, colds and other respiratory tract infections were found more frequently in people with lower levels of vitamin D.

People with asthma and low vitamin D are six times more likely to get a cold, and people with chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema, were at two to three times the risk.

“Simply replenishing vitamin D,” says Dr. Plotnikoff, “can have profoundly positive effects.”

Vitamin D is known as the sunshine vitamin because when sunlight hits skin, the body produces this vitamin, essential for strong, healthy bones. (That’s the reason your mother told you to slurp down your vitamin D-fortified milk.)
However, a mountain of new evidence suggests that the vitamin may have a more versatile role than previously thought, particularly when it comes to maintaining a healthy immune system and boosting mood.
Low levels have been associated with more severe asthma, colds, seasonal affective disorder, depression, and even chronic pain or fibromyalgia.
So does that mean that taking more vitamin D (or spending a bit more time in the sun) can combat fibromyalgia? Not just yet.
Studies have found that pain patients, including those with fibromyalgia, are more likely to be vitamin D deficient than their pain-free peers. However, it’s not clear which came first; people in pain may get less sun (presumably because they may be more likely to stay inside, due to pain), which could lead to a vitamin D deficiency, rather than vice versa—a vitamin D deficiency leading to pain.
And it’s also not clear if making sure you have adequate levels of the vitamin will help relieve pain or other fibromyalgia symptoms, such as lack of energy or difficulty sleeping.
What’s known about vitamin D
Our bodies make vitamin D naturally when exposed to sunlight. It only takes 10 to 15 minutes a day outside (without sunscreen) to make an adequate amount, but according to studies, about half of adults and 70% of children don’t get enough. In a 2003 study, 93% of pain patients had low levels of vitamin D. The current dietary reference intake for people up to age 50 is 200 international units (IU) per day of vitamin D. Adults ages 51 to 70 need 400 IU/day, and those older than 70 need 600 IU/day, with an upper limit of 2,000 IU/day deemed safe.
But some experts suggest raising that upper limit. Toxicity levels, they say, are closer to 10,000 IU/day, and 2,000 may be closer to the baseline of what healthy bodies need. Current recommendations were established by the Institute of Medicine in 1997 to promote optimal bone health and are under review to possibly be revised in the summer of 2010.
Screening for vitamin D deficiency is as easy as a blood test, and deficiency can be righted with a few minutes of sunscreen-free time in the sun, supplemental pills, or by incorporating foods like eggs, mushrooms, and salmon—all natural carriers of vitamin D—into a healthy diet.
Getting vitamin D from natural sources can stop you from getting too much of the vitamin, since the body makes only what it needs.
Although it’s hard to overdose on vitamin D, it is possible if you take megadoses of the vitamin, which can cause hypercalcemia, an above-average concentration of calcium in the blood that can lead to kidney failure and nervous system problems, and hyperphosphatemia, an increase in levels of phosphates in the blood, which can affect bone density and increase the risk of osteoporosis.
Manywho lack vitamin D—especially during the dark and dreary winter months when sunlight isn’t abundant—do turn to supplements. In 2008, Americans spent $235 million on vitamin D supplements, up from $40 million in 2001.
Can vitamin D help fibro symptoms?
While more research is needed, experts believe supplementing with vitamin D may lessen pain, says Gregory A. Plotnikoff, MD, the medical director at the Penny George Institute for Health and Healing at Abbott Northwestern Hospital, in Minneapolis. “Many Americans are reporting that replenishing their vitamin D results in significantly reduced pain, increased energy, and better sense of well-being,” says Dr. Plotnikoff, who published a 2003 study of the link.
However, W. Michael Hooten, MD, an assistant professor of anesthesiology and the medical director at the Mayo Clinic Pain Rehabilitation Center, in Rochester, Minn., notes that patients in pain may be more inactive and spend less time in the sun than people who are pain free.
“They may stay indoors more, their diet may become altered, which may predispose them to develop a vitamin D deficiency,” he says.
In a study published last year and co-authored by Dr. Hooten, pain patients with a vitamin D deficiency took almost double the amount of pain medication to control their symptoms as pain patients with adequate levels of the vitamin.
In the study of 267 chronic pain patients, 66 had been diagnosed with fibromyalgia. Over half of the participants had such intense pain that they were using opioid painkillers daily.
“If you’re choking down 150 milligrams of morphine per day, you don’t have energy, you feel lousy, you’re staying at home all the time,” he says. “Clinicians should be suspect of chronic pain patients. What we measured justifies screening for [vitamin D deficiency].”
For now, more research is needed to determine whether exposure to more vitamin D will truly help cut fibromyalgia pain.
It is known that vitamin D can help lessen pain caused by osteomalacia, a softening or weakening of the bones caused by a severe, long-term lack of vitamin D. Researchers aren’t sure how many people suffer from osteomalacia, says Dr. Hooten, but it can be misdiagnosed as fibromyalgia or other conditions.
But even if an adequate intake of vitamin D doesn’t alleviate pain, it may boost mood and could potentially prevent 150,000 cases of cancer annually.
According to a 2009 study, supplementing vitamin D may also protect you from the common cold. In a study of nearly 19,000 people 12 and older, colds and other respiratory tract infections were found more frequently in people with lower levels of vitamin D. People with asthma and low vitamin D are six times more likely to get a cold, and people with chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema, were at two to three times the risk.
“Simply replenishing vitamin D,” says Dr. Plotnikoff, “can have profoundly positive eff

In Lab Tests Vitamin D Shrinks Breast Cancer Cells

I’ve posted a number of blogs about the fact that vitamin D deficiency or insufficiency (low levels of serum vitamin D) is associated with a number of types of cancer, as well as diabetes and asthma, but now new research also shows that vitamin D can kill human cancer cells. The results of this new research fall far short of an immediate cancer cure, but they are encouraging, medical professionals say in a report from ABC News.

JoEllen Welsh, a researcher with the State University of New York at Albany, has studied the effects of vitamin D for 25 years. Part of her research involves taking human breast cancer cells and treating them with a potent form of vitamin D.

She reports that within a few days, half the cancer cells shriveled up and died. Welsh said the vitamin has the same effect as a drug used for breast cancer treatment.

“What happens is that vitamin D enters the cells and triggers the cell death process,” she told “Good Morning America.” “It’s similar to what we see when we treat cells with Tamoxifen,” a drug used to treat breast cancer.

The vitamin’s effects were even more dramatic on breast cancer cells injected into mice.

After several weeks of treatment, the cancer tumors in the mice shrank by an average of more than 50 percent. Some tumors disappeared.

Similar results have been achieved on colon and prostate cancer tumors in mice.

My sense is that, at least for now, you should NOT read too much into these laboratory studies as positive effects in a petri dish or in rats may not necessarily mean similar results in humans.

In addition, it’s also easier to treat cancer in mice than in people.

Nevertheless, it’s another reason either to consider either (1) having an inexpensive vitamin D level drawn during your next medical check up — so as to see if you levels are adequate or not, or (2) taking an inexpensive vitamin D supplement on a daily basis.

Here are some of my other blogs on vitamin D:

Low levels of vitamin D may be linked to greater asthma severity

Study suggests 70 percent of children, young adults do not get enough vitamin D
More reasons to consider having your vitamin D level checked – you may think better and have less arthritis
Specific vitamins and a supplement (B vitamins, vitamin D, and calcium) may lower risk of stroke, blindness, and cancer
Vitamin D tests soar as deficiency, diseases linked
Lack of vitamin D raises death risk
Vitamin D Recommendations for Teens May Be Too Low
Vitamin D may protect against heart attack
Low Vitamin D Levels Associated with Artery Disease

The Los Angeles Times “Booster Shots” blog reported that researchers at the National Jewish Health in Denver found that “adult asthma patients with the highest levels of vitamin D in their blood had better lung function compared with people with the lowest levels” in a study published in the American Journal of Respiratory and Critical Care Medicine.

“For every 1-ng/mL increase in serum levels of 25-hydroxyvitamin D (25-OH-D), forced one-second expiratory volume (FEV1) increased by 21 mL,” MedPage Today reported. The 54-patient study “also showed that airway hyperreactivity in those with serum 25-OH-D levels below 30 ng/mL — defined as vitamin D insufficiency — measured at almost twice the average levels seen in those with normal levels of 25-OH-D.”

“Low vitamin D levels were also associated with a worse response to steroid therapy and increased production of the pro-inflammatory cytokine, TNF-alpha,” HealthDay reported. “This raises the possibility that low vitamin D levels are tied to increased inflammation of the airways.” Nothing that the “heaviest participants had the lowest levels of vitamin D,” the authors say that the “(lack of vitamin D) may be a factor linking” obesity and asthma.

WebMD quotes lead investigator E. Rand Sutherland, MD, MPH, as saying, “The next question to answer is whether giving supplemental vitamin D will lead to clinical improvements in patients with asthma.”

However, given the incredible safety of vitamin D supplements, combined with how very inexpensive these supplements are, pending further data, I’ll be offering all of my asthmatic patients two options: (1) test their blood vitamin D level and use supplements in anyone with a level below 40, or (2) just take 800-1000 IU of vitamin D per day as a supplement.

Here are some of my other blogs on vitamin D:

Vitamin D deficiency in kids is getting more attention

A recent cross country study sample suggests that MOST children in the U.S. have suboptimal vitamin D levels. Healthy blood levels of vitamin D are at least 30 ng/mL; but 2 out of 3 kids have levels below this, and about 1 in 5 kids ages 1 to 11 are deficient with a vitamin D level below 20 ng/mL.

The problem is especially severe in Black and Hispanic children. HALF are deficient, with levels below 20 ng/mL. This is likely because their darker skin blocks out more of the sun’s UV-B rays needed for making natural vitamin D.

The American Academy of Pediatrics recommends 400 IU/day of vitamin D, starting days after birth all the way through adolescence.

A cup of cow’s milk or baby formula contains only about 100 IU of vitamin D. So only kids who drink a quart/day are getting enough. Therefore, my recommendation to the parents in my practice is to use a vitamin D supplement in all children.

Tri-Vi-Sol or Poly-Vi-Sol vitamin drops can be recommended for both breast-fed and bottle-fed infants if more vitamin D is needed. For older kids, a multivitamin with vitamin D 400 IU can be used.

The Natural Medicines Comprehensive Database says, “Explain to parents not to be overly concerned about getting too much vitamin D. The blood levels and doses we need are higher than we used to think.”

Here are some of my other blogs on vitamin D:

Study suggests 70 percent of children, young adults do not get enough vitamin D

USA Today reports that “seven out of 10 children and young adults don’t get enough vitamin D, which could increase their risk for bone and heart problems,” according to a study published online in the journal Pediatrics. Is your child at risk? And, what can you do?

More Information: Continue reading

More reasons to consider having your vitamin D level checked – you may think better and have less arthritis

Low vitamin D levels may impair thinking and adequate vitamin D levels may help prevent knee osteoarthritis, according to two studies released this last week. Both of these studies, added to the others I’ve discussed in this blog in the past, may lead you to get your doctor to check your vitamin D level at your next physical exam.

More Information: Continue reading

Most Children are Vitamin D Deficient Also

Vitamin D deficiency is a growing problem in the United States. A 2004 study reported that 42 percent of otherwise healthy adolescents in a primary care setting were vitamin D deficient. Among infants, dark skin pigmentation and breastfeeding without supplementation have been cited as risk factors. Most studies have examined infants, but there are fewer data as to whether this problem persists as children are weaned to fortified milk and solid foods. A new study should raise a red flag for parents.

More Information: Continue reading

Vitamin D tests soar as deficiency, diseases linked

USA Today is reporting that testing for vitamin D levels, once uncommon, has skyrocketed as medical studies raise awareness about vitamin D deficiencies. Physicians agree that they’re increasingly using the blood test to find out whether their patients are low on the vital vitamin.

My Take? Continue reading

Dr. Walt’s Take on the Health Headlines – May 28, 2008

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Best Treatment for Vertigo Is Easiest One

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