Millions of American Children Have Low Vitamin D Levels, Putting Them at Risk for Bone Problems, Heart Disease, Diabetes, and other Ailments

This is the lead in a Washington Post story published Aug. 3, 2009, which summarizes findings from two new studies that provide the first national snapshot of a nutrient whose importance to health has been emphasized by a raft of recent investigations. (Check the entry “Vitamin D” in this blog for some of these other research findings.)

The new studies on Vitamin D come as the National Academy of Sciences Institute of Medicine is reviewing official guidelines for daily intake of Vitamin D. Many researchers in recent years have suggested that the recommended daily intake should be increased, particularly to counteract deficiencies detected in certain groups with chronic conditions.

The national studies, which showed millions of American children deficient in Vitamin D, also highlighted worrisome associations between low Vitamin D levels and high blood pressure, high blood sugar, and “metabolic syndrome,” a condition that increases risk of heart disease and diabetes.

One source of Vitamin D is sunlight–the body manufactures the vitamin in response to exposure to the sun. And the recent research suggests that American children, prone to watch TV and play videogames, may not be getting enough outdoor time and sunlight, leading to the Vitamin D deficiency. Others point out that too much exposure to the sun may lead to higher rates of skin cancer, already the leading type of cancer in the US. Of course–we note–supplementing with Vitamin D could address the deficiency, while also avoiding the increased skin cancer risk that comes with exposure to sun.

See the following product entries on the NYBC website for further information on Vitamin D:

D3-1000 (Jarrow)

D3-400 (Jarrow)

Bone-Up (Jarrow) – includes D3 plus other nutrients important for bone health

Bone-Up – Ultra (Jarrow) – additional nutrients compared to the regular “Bone-Up”, plus a larger quantity

Advertisements

Book Review: “Supplement Your Prescription — What Your Doctor Doesn’t Know About Nutrition,” by Hyla Cass, M.D.

This is an excellent guide to managing the side effects of prescription drugs through better nutrition and nutritional supplements. Published in 2007 by Basic Health Publications, it synthesizes much recent research on how the most frequently prescribed drugs for Type 2 diabetes, cardiovascular disease, osteoarthritis, and depression often cause nutrient deficiencies that can lead to additional health problems. Dr. Cass, who is a practicing physician and a specialist in integrative medicine, provides clear analyses of these damaging side effects and offers recommendations on how to address them.

The first condition discussed by the book is Type 2 Diabetes/insulin resistance/metabolic syndrome. For those who are taking the most commonly prescribed drug for Type 2 Diabetes, metformin, Dr. Cass stresses the importance of supplementing with Vitamin B12 (200-1000mg/day) folic acid (400-800mg/day) and CoQ 10 (30-200mg/day) to make up for the nutrient-depleting effects of the medication. Vitamin B12 and folic acid, together with Vitamin B6, are crucial for keeping levels of an amino acid called homocysteine in check in the body. Since elevated levels of homocysteine are associated with heart disease, stroke, hypertension, neuropathy, and Alzheimer’s, it’s a top priority to keep the body supplied with the B vitamins that can control it.

Dr. Cass also provides a “Diabetes Supplement Program” especially directed to pre-diabetics who may be able to address their condition with diet, exercise, and supplements (the B vitamins and CoQ 10 mentioned above, plus alpha lipoic acid, antioxidants, and the trace minerals chromium and vanadium, which are needed in blood sugar processing).

Much more to discuss in this very useful book, so we will come back to it again!

Fish oil, inflammation and metabolic complications in HIV: a clinical trial and related research

We noticed with interest that Dr. Todd T Brown, a Johns Hopkins researcher who has studied body fat changes in people with HIV, has recently started a wide-ranging investigation of fish oil / omega-3 fatty acid supplementation as a way of preventing/treating metabolic complications associated with highly active antiretroviral therapy (HAART). Metabolic complications, including fat wasting, central body fat build-up, insulin resistance, high cholesterol and triglycerides, and bone loss, have been some of the major side effects experienced by people with HIV on medication, so it’s quite interesting to see research that may “connect the dots” and find links between these various problems. 

Furthermore, this is a study that focuses on fish oil / omega-3 fatty acids, which have quite recently gained more respect in US medical circles, especially as a means of preventing/treating cardiovascular disease, but also for a surprising effect on depression. (You can read more about this aspect of fish oil supplementation in the “depression” category on this blog.)

 Here’s the description of Dr. Brown’s research, as provided on the website of NCCAM/NIH, one of the major sponsors of the study:

Abstract: DESCRIPTION (provided by applicant): The overall goal of this proposal is to understand the role of inflammatory cytokines in the metabolic and skeletal abnormalities in HIV disease and to determine whether omega-3 fatty acid supplementation, in the form of fish oil, will alter the pathophysiology of these clinical disorders. Complementary and alternative medicines (CAM) are used widely among HIV-infected patients, often with the hope of preventing or treating complications associated with highly active antiretroviral therapy (HAART). Metabolic abnormalities, including peripheral fat wasting, central adiposity, insulin resistance, and dyslipidemia, and skeletal abnormalities (reduced bone mineral density and high bone turnover), are common in HIV-infected patients on HAART, yet their relationship is unclear. We hypothesize that these metabolic and skeletal abnormalities are related by abnormal inflammatory cytokine expression and that these conditions can be improved with fish oil, a widely-used CAM agent with anti-inflammatory properties. We have the following specific aims: 1) To understand the association between the metabolic and skeletal abnormalities in HIV-infected subjects and their relationship to inflammation, 2) To determine whether treatment with omega-3 fatty acids will have hypotriglyeridemic, anti-inflammatory, and anti-bone resorptive effects in a randomized trial of HIV-infected patients, and 3) To clarify the mechanisms of action of omega-3 fatty acids, namely the effect on lipolysis and bone turnover using stable isotope infusion techniques. To accomplish our specific aims, I intend to do a secondary analysis of data from two cohorts of HIV-infected subjects, and to then perform a randomized trial using a standardized fish oil product. These results will help to define the pathophysiology of the metabolic and skeletal abnormalities in HIV and evaluate the efficacy and potential mechanisms of action of an important complementary treatment […]

(According to the published information, the clinical trial of fish oil is scheduled to run from 2006-2010.)

Note: An interview with Dr. Brown on body fat changes in people with HIV can be found on the website of our friends at www.thebody.com.

Are HIV+ patients resistant to statin therapy?

This was a post on the yahoo group pozhealth from Nelson Vergel. As the piece suggests, statin therapy for people with HIV can be a more complex treatment choice than it is for the HIV negative.

 

We suggest that readers also keep in mind the information on Niacin + statin combination therapy, as presented recently in this Blog (see the “Niacin” category).

—–

 

 

Lipids Health Dis. 2007 Oct 24;6(1):27 [Epub ahead of print]

Are HIV+ patients resistant to statin therapy?

Johns KW, Bennett MT, Bondy GP.

ABSTRACT: BACKGROUND: Patients with HIV are subject to development of HIV metabolic syndrome characterized by dyslipidemia, lipodystrophy and insulin resistance secondary to highly active antiretroviral therapy (HAART). Rosuvastatin is a highly potent HMG-CoA reductase inhibitor. Rosuvastatin is effective at lowering LDL and poses a low risk for drug-drug interaction as it does not share the same metabolic pathway as HAART drugs. This study sought to determine the efficacy of rosuvastatin on lipid parameters in HIV positive patients with HIV metabolic syndrome. RESULTS: Mean TC decreased from 6.54 to 4.89 mmol/L (25.0% reduction, p<0.001). Mean LDL-C decreased from 3.39 to 2.24 mmol/L (30.8% reduction, p<0.001). Mean HDL rose from 1.04 to 1.06 mmol/L (2.0% increase, p=ns). Mean triglycerides decreased from 5.26 to 3.68 mmol/L (30.1% reduction, p<0.001). Secondary analysis examining the effectiveness of rosuvastatin monotherapy (n=70) vs. rosuvastatin plus fenofibrate (n=43) showed an improvement of 21.3% in TG and a decrease of 4.1% in HDL-C in the monotherapy group. The rosuvastatin plus fenofibrate showed a greater drop in triglycerides (45.3%, p<0.001) and an increase in HDL of 7.6% (p=0.08). CONCLUSIONS: This study found that rosuvastatin is effective at improving potentially atherogenic lipid parameters in HIV-positive patients. The lipid changes we observed were of a smaller magnitude compared to non-HIV subjects. Our results are further supported by a small, pilot trial examining rosuvastatin effectiveness in HIV who reported similar median changes from baseline of -21.7% (TC), -22.4% (LDL-C), -30.1% (TG) with the exception of a 28.5% median increase in HDL. In light of the results revealed by this pilot study, clinicians may want to consider a possible resistance to statin therapy when treating patients with HIV metabolic syndrome.