Tag Archive for: vitamin D

Research Update on Vitamin D

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Vitamin D supplementation always seems to be in the health news; one day it’s beneficial, the next not so much. One of the problems is that many studies are observational studies. They take a large group of subjects, such as the Nurses Health Study, use food frequency questionnaires to assess vitamin D intake, and report on bone health and other outcomes over time. That has serious limitations in my opinion, not least among them the reliance on food frequency questionnaires, which have been proven inaccurate. Do you remember what you had for dinner last week or the week before? Neither do I.

In a recently published study, researchers did a meta-analysis on vitamin D in observational studies, randomized controlled trials (RCT) on vitamin D supplementation alone, and RCT on vitamin D plus calcium supplementation. The outcomes were all fractures and hip fractures, and the subjects were mostly older than 65.

While there were issues in just about every observational and RCT of some sort, the analysis of each type of trial combined was that vitamin D supplementation did not have a significant effect on the rate of fractures. However, when vitamin D supplementation was combined with vitamin D and calcium supplementation, there was a 6% decrease in all fractures and a 16% decrease in hip fractures over an average of six years. The amounts of vitamin D used were 400 to 800 IU and 1000 to 1200 mg of calcium per day.

While there’s more research to go including the completion of some of randomized controlled trials used in the analysis, take vitamin D and calcium together to reduce the risk of hip fractures and other broken bones. Better together seems to be more effective than overdoing it on a single nutrient.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2019;2(12):e1917789.

New Research Yields One More Factor

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The last recommendation for you in living every day you’re alive involves keeping the body working its best through regular maintenance. That means seeing your healthcare professionals on schedule. Here are some examples of what that can mean.

Researchers recently published a paper on the impact of a narrow band of ultraviolet light on the microbiome. If people were deficient in vitamin D, their microbiome was not as healthy as those who had normal vitamin D levels. The UV light did not improve the microbiome of those who had normal vitamin D levels, only those who did not. That’s why you need to get your bloodwork done regularly, including getting your vitamin D levels checked. Whether by sun or supplement, vitamin D is critical to your microbiome and many other aspects of your health.

A couple of years ago my glasses were broken and I needed a new prescription, so I finally had my eyes examined. It had been at least five years since my last exam. Turns out I have glaucoma; by using a couple of drops a day, I haven’t lost any vision. But if I hadn’t had my eyes checked, who knows what could have happened?

One more. It seemed like I kept getting shorter and shorter every time I had a checkup, so I had a bone density test done. Turns out I have osteopenia. Long-time runners like me aren’t supposed to get that, but there it is. I changed my supplements and I’ll get checked again this year.

I’ve often talked about the importance of protecting your dental health. Yes, teeth can be replaced, but it’s really expensive as Paula and I know from experience. While a dental checkup may seem like lot of money, it’s worth it to protect not only your teeth, but many other aspects of your health such as heart and digestive health.

Today’s lesson is get your body checked on a regular basis. We don’t ignore our hearts (for the most part) but the ability to see, to hear, to have strong bones, even to chew food is dependent on taking care of those specialty organs on a regular basis.

What are you prepared to do today?

        Dr. Chet

Reference: Front. Microbiol., 24 October 2019 | https://doi.org/10.3389/fmicb.2019.02410.

Winterize Yourself

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The official start to winter is quickly approaching, but for most of us the cold, wet, snowy, rainy weather has already begun. Today’s Memo contains some tips on how to winterize your body by focusing on basic nutritional supplementation.

Water: Make sure you increase fluid intake during the winter. The humidity is lower because the heat is on in your home, work, and school. You breathe out more water as a result. You have to replace those fluids. Every day drink one-half your body weight in ounces of water or any other fluid; if you weigh 150 pounds, drink 75 ounces of water daily.

Multivitamin-mineral (MVMM): If you haven’t been consistent in taking your MVMM, this is a good time to begin. Your immune system needs some basic nutrients and a MVMM is a good place to start, especially if it’s one that contains plant concentrates and extracts.

Probiotics: The immune system starts in the gut. Taking a probiotic every day can help your immune system function better. In addition, taking fiber with the probiotic can help feed all the good bacteria in your digestive system.

Vitamin D: Consider adding vitamin D to your regimen because we get a lot less sun during the winter. Ask your physician to test your vitamin D levels; if it’s below 30 ng/ml, add 2,000 IU vitamin D to your supplementation. There’s no real danger in taking vitamin D, so make sure you’re getting some even without a test.

Antioxidants: Help your immune system; add additional vitamins C, E, and beta-carotene to your supplementation.

Supplementation may or may not help you avoid getting a cold or the flu, but it may help reduce the severity and duration of a respiratory infection if you do get one. That’s worth the small expense of the supplements in my opinion.

 

Happy Thanksgiving!

Paula and I wish you all a Happy Thanksgiving. We are grateful for your support throughout the year. This week is one to spend with family and friends, so this will be the only Memo of the week. Thanks for being a member of the Dr. Chet family.

What are you prepared to do today?

Dr. Chet

 

Vitamin D: Stay the Course

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Let’s finish this look at the recent paper on vitamin D (1). As you could read in Thursday’s Memo, they included some curious studies in their review. Let’s take a look.

Mixed-Purpose Studies

Have you ever eaten leftovers? Sure. Did you take all the different leftovers—the spaghetti, the fried rice, the mashed potatoes and gravy—mix them together in a stew or smoothie, and eat them? Probably not. And that’s the primary problem with this review paper: too many different types of studies.

There were enough papers using very high doses of vitamin D administered orally to the elderly that could have been combined. There certainly were enough studies to use only 800 or 1,000 IUs that could have been combined.

It is not the statistics; it’s the physiology and biochemistry. There’s going to be a difference in how the body utilizes 100,000 IUs at one time versus 1,000 IU every day for 100 days. That has to be acknowledged as a possibility. That it wasn’t illustrates a typical problem in these types of studies.

The Pharmaceutical Model

The real weakness of the studies that were included in this review was that the vitamin D was used as a treatment for a disease rather than as a nutritional supplement. What gets lost in translation is that in several studies where vitamin D was used to address low vitamin D levels in the elderly with and without fractures, there was actual improvement in bone-mineral density.

It begs the question: why would you give astronomical doses to healthy people? That’s what they did in communities of elderly residents. Their intentions were good (they wanted to try to prevent fractures and falls), but it’s a lousy approach. Would you give someone a one-month dose of a blood pressure medication? You could kill them. If you’re going to use a vitamin that has robust uses in the body, you have to respect it. They considered it a nutrient, but used it as a drug.

The only issue that I could find with the high doses of vitamin D is that for some reason, they were associated with an increase in falls. That seems inexplicable to me, but it was a consistent observation at high doses of vitamin D. The only reason I would consider it suspect was that in most studies included in the review paper, people self-reported falls. Still, it was there.

The Bottom Line

The overall problem with this review of vitamin D is that the authors considered only a single factor; bone building is dependent on a variety of nutritional factors that were never considered. Most of all, the great majority of the studies didn’t consider the role of exercise: fewer than five of the 81 studies gave any mention to exercise. In order for bones to grow and recover, they must be stressed on a regular basis. There’s no way to come to the conclusions the authors did without that data.

While researchers looked at only a single factor involving the musculoskeletal system, the immune and nervous systems can still benefit from vitamin D even if bones don’t benefit as much as some supplements promise. Vitamin D has also been shown to help mental health and depression. Some day nutrition research will be done correctly, but it wasn’t served very well by this paper or the studies that were included. I found no reason to stop taking vitamin D as a supplement. In fact, it’s time to increase your dosage as the days get shorter and your sunlight exposure decreases.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI:https://doi.org/10.1016/S2213-8587(18)30265-1.

 

A Potpourri of Research on Vitamin D

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Scientists try to follow some strict guidelines when they select studies to be included in a meta-analysis. With that in mind, here’s some of what I found in reviewing the studies. Remember, they were looking at fractures, falls, and bone-mineral densities.

  • The length of the studies ranged from as short as eight weeks to as long as seven years. The most popular study length was one year, second was two years.
  • Most of the studies focused on the elderly. Falling and fractures are obvious concerns for that population. But they also included papers on post-parathyroidectomy patients of all ages, renal transplant patients, and young patients that were HIV positive where falling and fractures were not obvious consequences of the age group.
  • For the most part, they selected studies with vitamin D taken via oral supplements. But they also used cod liver oil, with and without vitamin D, as well as intramuscular injections.
  • This one was just simply puzzling. The range of vitamin D administered to the subjects was as low as 400 IU and as high as 600,000 IU in a single dose. Some gave oral vitamin D at 100,000 IUs four times per year, injections of 300,000 IU and 600,000 IU, and one study administered 300,000 IU in a single oral dose.

You don’t have to have any type of scientific degree to see the problem with the apples-and-oranges selection of the studies. Competent scientists may be able to account for differences statistically to do the analysis, but they can’t account for the varying physiological impacts on the subjects.

I’ll finish this up on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI:https://doi.org/10.1016/S2213-8587(18)30265-1.

Update: Vitamin D’s Health Effects

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With all the political headlines last week, an important health headline could have been overlooked. A group of scientists published a paper suggesting vitamin D doesn’t prevent fractures and falls or help increase bone-mineral density, and they recommended that it not be used for that purpose. I’m a strong believer that vitamin D is one of the fundamental supplements we should take, so I took a close look at this paper.

Typically I call this a Research Update, but I’m intentionally not calling it that this time because there’s no new research in this paper. This was a research review paper that included a re-analysis of prior research, some 81 studies. That’s a meta-analysis, a statistical technique that has risen in popularity in the past 10 years. In fact, it really only included research published since 2014, the last time some of these authors did the exact same analysis. Based on the prior research of the statistician involved who was the lead author, I have to believe the math is correct.

The problem is in the selection of the studies. I did something I don’t always do. I examined almost all of the abstracts of the 81 papers that were used in the meta-analysis. It was tedious to say the least. To be blunt, I don’t understand how some of the papers were selected. On Thursday, I’ll give you the run down on the research review part of the paper.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI:https://doi.org/10.1016/S2213-8587(18)30265-1.

 

My Verdict on D3 vs. D2: A Draw

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The medical community and the health gurus agree, and the research appears to agree with them: vitamin D3 is better than vitamin D2. A no-brainer, it would appear.

No. My call at this point: it’s a draw. Here’s why.

The Current Research

The research on vitamin D and absorption is a mess. There’s little to no consistency. You saw the number and attributes of subjects, quantity of the supplemental forms of vitamin D, and the length of the studies. The bulk of the studies use therapeutic doses, 50,000 IU and up, to see how the forms of D are absorbed to treat serious deficiencies of vitamin D in people. Vitamin D2 has been used for treatment for decades that way and still is today.

It’s true, that vitamin D3 does increase blood levels of vitamin D more and it seems to last longer than D2. So what? This is not a medication, it’s a nutrient. Why would anyone stop taking it? What the research proves is that levels of both forms of D decline after a person stops taking the supplement. I could have predicted that without doing a single study.

The study that came closest to reality that D3 is better than D2 was the study on hip fractures—at least that lasted three months. The studies that last longer give higher doses, up to 500,000 IU in a dose, and see what happens over a year. Why? What will that tell you? No one takes supplements like that.

The Ideal Study

If I could construct a study, I would track a large group of people divided into a placebo group, a group taking vitamin D3 only, a group taking vitamin D2 only, and a group given half the dose each of D3 and D2. It would also use off-the-shelf dietary supplements; when researchers have specific products formulated that are not for sale, the resulting info is worthless to us as consumers. The dose should be reasonable such as 2,000 or 5,000 IU. Subjects should be followed for at least a year. Several variables should be checked regularly.

The Bottom Line

Based on my assessment of the current research, vitamin D3 is better absorbed and converted to active vitamin D than D2, but there’s no evidence that D2 is not effective or that it’s harmful—it’s been used nearly 100 years! In my opinion, it may require a third more D2 to equal D3 to get equivalent effectiveness. Other than that, if you want the vitamin D you take to be effective, the only thing you need to do is take it consistently.

The Super Bowl Webinar is tomorrow. Time to start getting rid of the body fat you’ve been wanting to lose.

What are you prepared to do today?

Dr. Chet

 

The Research on Vitamin D3 vs. D2

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One area that the medical field and the health gurus agree: vitamin D3 is better absorbed and utilized than vitamin D2. Four studies are constantly referenced when the best type of vitamin D is discussed (1-4); here’s a quick look at those studies.

Study 1: 4,000 IU vitamin D3 and D2 supplementation was given to 55 and 17 subjects respectively; the study lasted 14 days.

Study 2: 50,000 IU of each form of vitamin D was given to two groups of 10 men once; the men were followed for the next 28 days to monitor changes in vitamin D levels.

Study 3: 95 inpatients with hip fractures were randomly assigned to receive 1,000 IU of vitamin D3 or vitamin D2; the subjects were tracked for three months.

Study 4: 32 elderly women, split into groups of eight subjects, were given 300,000 IU of vitamin D3 or D2 orally or via muscular injection; they were monitored for the next 60 days.

The results from each study concluded that vitamin D3 was better than vitamin D2 at raising serum vitamin D levels. Is this the final conclusion that can be reached? Could there be questions that weren’t answered in these or any studies so far? I’ll let you know on Saturday.

If you really want to understand the ketogenic diet, join the Super Bowl Webinar in just three days. You’ll learn how it works and how it can work for you.

What are you prepared to do today?

Dr. Chet

 

References:
1. Am J Clin Nutr. 1998 Oct;68(4):854-8.
2. J Clin Endocrinol Metab. 2004 Nov;89(11):5387-91.
3. Bone. 2009 Nov;45(5):870-5.
4. J Clin Endocrinol Metab. 2008. 93:3015-3020.

 

Vitamin D3 vs. Vitamin D2

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Many of you have questions about the different forms of vitamin D available in supplement form: vitamin D3, known as cholecalciferol, and vitamin D2, called ergocalciferol. Although they’re slightly structurally different, both have been used for years to help with vitamin D deficiency.

Vitamin D is necessary for bone health, of course, but research has found D to be related to other conditions such as depression, multiple sclerosis, and more. Vitamin D is a vitamin we can make ourselves when exposed to the correct ultraviolet radiation, but we shun the sun these days for a variety of reasons; both D2 and D3 are available in foods such as fish and dairy. Today getting a vitamin D blood test is commonplace; if it’s low, vitamin D will be prescribed by your physician, and of course you can buy vitamin D as a supplement.

Why the controversy about the form D3 or D2? Many Internet gurus and medical blogs from major health organizations claim that D3 is the only supplement you should use; D2 is not as good because it’s not as well absorbed and it can cost more.

What does the research say? What form should you take? We’ll find out this week as I review the research on both forms of vitamin D.

Remember, the Super Bowl Webinar is this Sunday. You don’t want to miss this one! All you have to lose is some fat.

What are you prepared to do today?

Dr. Chet

 

Why Nutrition Is a Process

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A celebrity doctor who specializes in cancer treatment said something that caught my attention, and it goes to this question: why are some people cured by specific treatments while others don’t respond at all? In his opinion, it’s because the cancer creates a new system in the body that competes with the other systems.

The new system may be different in each body once the cancer is established, which could mean that everyone really requires an individual approach. A systems approach would be necessary only if the cancer gets too established; early diagnosis can use treatments that work in most people. Late diagnosis means the cancer has established a system with strengths and weaknesses that are unknown. But the systems approach isn’t limited to cancer.

What’s a Systems Approach?

A systems approach is simply this: we attempt to reach a goal by looking at the interactive nature and interdependence of all the factors in an entity.

Here’s an analogy: you flip the switch for the light in your kitchen, but the light doesn’t go on. What could be wrong? The light won’t work if:

  • Your bulb is burned out
  • Your circuit breaker needs to be reset
  • An electrical outlet somewhere has a tripped GFCI
  • Your switch has gone bad
  • A wire is loose in your light fixture
  • The power is out to your whole house

Turning on a light is easy—my grandson Riley is very good at it and he’s not even three. But if it’s not working, you have to look at each element of the system to find the problem and get the kitchen light back on.

How Vitamin D is Part of Your Bone Health System

While osteoporosis or weight gain doesn’t create a new system like cancer does, there are numerous steps in both processes. On top of that, if we’ve been on the path to bone loss or weight gain, there may be changes in normal metabolism that have to be overcome.

Let me explain using vitamin D for bone health. Whether we make vitamin D in our skin, get it from food, or take it in supplement form, it has to be processed by the liver to become the active form to promote bone growth. If there’s a defect in getting the raw vitamin D from food or a supplement into the bloodstream and on to the liver, not enough vitamin D would be made into the active form. Or there may be a defect in the processing of the raw vitamin D once it gets to the liver. Or there may a defect in the receptor for the active vitamin D on the target tissue. I could go on and on about where issues could occur, but I hope you get the point. Right now, we have no idea where the issue might be for the use of vitamin D in an individual just as we don’t know where the weak point of a cancer system might be and thus where we should attack.

Do we quit? No. We simply use a systems approach—we look at every step necessary to reach our goal and what we can do at each step. We begin with taking vitamin D for a specific period of time. We then get re-tested, most likely a bone density scan. If there’s growth, great. If there’s not, then we either add more D or add calcium or switch to a different form of calcium. Then retest. If that doesn’t work we can add vitamin C or glucosamine, both critical to the manufacture of connective tissue. There are other factors such as smoking and exercise that also impact bone growth. We systematically add new variables or add more of some that we’re already doing. Might this take a long time? Yes. Would we have to pay attention? Yes. But is it a natural approach to complicated conditions? Again, yes. No matter what the condition, if you’re going to try to deal with it nutritionally, that’s the approach you’ll have to take. You have to find what works for you.

The Bottom Line on Vitamin D

The systems approach goes a long way to explain why some people benefitted from vitamin D and calcium to prevent fractures and others did not. The only fact the meta-analysis study proves is that vitamin D and calcium supplementation don’t work for everyone. The key is to move on to the next approach; it may be different supplements or it may even be a medication. More options must be tried until a solution is found for each individual.

Over time, I’m going to continue to explore this concept of a systems approach to nutrition. I have no idea where it will lead, but it’s worth spending more time thinking and researching it.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2017;318(24):2466-2482. doi:10.1001/jama.2017.19344.