Study finds link between low Vitamin D and heart disease, cancer, and all-cause mortality

A vast review of studies on Vitamin D has concluded that people with low levels of the vitamin had a 35 percent increased risk of death from heart disease, a 14 percent higher risk of death from cancer, and a greater risk of death from all causes as well.

The authors of this review, who came from a wide range of European and US universities, also looked at the usefulness of supplements, and found that there was no benefit from taking Vitamin D2. However, when they studied middle-aged and older adults who took Vitamin D3, they found an 11% reduction in risk of death from all causes. They also estimated that up to two-thirds of the people in Europe and the US are deficient in Vitamin D, and they calculated that about 13% of all deaths in the US, and about 9% of all deaths in Europe, are linked to low Vitamin D levels.

NYBC’s comment: This review suggests that it is crucial to supplement with Vitamin D3—-which is the type of Vitamin D stocked by NYBC. Older forms of supplementation, such as Vitamin D2-fortified milk, may not have benefit, according to this research. Secondly, though some have argued that low Vitamin D may simply be a side effect of disease processes that can’t be reversed by supplementing, we believe that this study also offers evidence that, especially when people are known to be deficient in Vitamin D (as is often the case in older populations, or among HIV+ people), supplementing with D3 has the potential to reduce disease risks, and indeed may reduce the overall risk of mortality.

See NYBC’s catalog for more detailed recommendations on Vitamin D3 supplementation:

Vitamins and Minerals – NYBC Catalog

Reference:

Chowdhury, R et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ April 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g1903

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Why Vitamins B12 and D3 Are Especially Important to People with HIV

Our friends at the Canadian AIDS Treatment Information Exchange (CATIE), a Canadian government-supported education and prevention organization, recently published an excellent guide to managing HIV medication side effects. This online guide covers the territory from body shape changes, to gastrointestinal disorders, to neurological effects, to emotional wellness, to fatigue, to sexual difficulties.

The Appendix to this guide focuses on two vitamins, both of which have been highlighted as especially important for people with HIV: B12 and D3. Deficiency of these two vitamins appears to be common among people with HIV, and supplementing to correct the deficiency can bring about major improvements in health. So it’s definitely worthwhile to check your B12 and D3 status, and, if you’re deficient, find a good supplementation strategy. Note that NYBC stocks both of these inexpensive vitamins: the methylcobalamin form of Vitamin B12 recommended below; and several strengths of Vitamin D3, including the commonly recommended D3 – 2500IU format.

Below are the CATIE recommendations:

Vitamin B12

A number of studies have shown that vitamin B12 is deficient in a large percentage of people with HIV, and the deficiency can begin early in the disease. Vitamin B12 deficiency can result in neurologic symptoms — for example, numbness, tingling and loss of dexterity — and the deterioration of mental function, which causes symptoms such as foggy thinking, memory loss, confusion, disorientation, depression, irrational anger and paranoia. Deficiency can also cause anemia. (See the section on Fatigue for more discussion of anemia.) It has also been linked to lower production of the hormone melatonin, which can affect the wake-sleep cycle.

If you have developed any of the emotional or mental symptoms mentioned above, especially combined with chronic fatigue, vitamin B12 deficiency could be contributing. This is especially true if you also have other symptoms that this deficiency can cause, including neuropathy, weakness and difficulty with balance or walking. On the other hand, these symptoms can also be associated with HIV itself, with hypothyroidism or advanced cases of syphilis called neurosyphilis. A thorough workup for all potential diagnoses is key to determining the cause.

Research at Yale University has shown that the standard blood test for vitamin B12 deficiency is not always reliable. Some people who appear to have “normal” blood levels are actually deficient, and could potentially benefit from supplementation.

The dose of vitamin B12 required varies from individual to individual and working with a doctor or naturopathic doctor to determine the correct dose is recommended. Vitamin B12 can be taken orally, by nasal gel or by injection. The best way to take it depends on the underlying cause of the deficiency, so it’s important to be properly assessed before starting supplements. For oral therapy, a typical recommendation is 1,000 to 2,000 mcg daily.

One way to know if supplementation can help you is to do a trial run of vitamin B12 supplementation for at least six to eight weeks. If you are using pills or sublingual lozenges, the most useful form of vitamin B12 is methylcobalamin. Talk to your doctor before starting any new supplement to make sure it is safe for you.

Some people will see improvements after a few days of taking vitamin B12 and may do well taking it in a tablet or lozenge that goes under the tongue. Others will need several months to see results and may need nasal gel or injections for the best improvements. For many people, supplementation has been a very important part of an approach to resolving mental and emotional problems.

Vitamin D

Some studies show that vitamin D deficiency, and often quite severe deficiency, is a common problem in people with HIV. Vitamin D is intimately linked with calcium levels, and deficiency has been linked to a number of health problems, including bone problems, depression, sleep problems, peripheral neuropathy, joint and muscle pain and muscle weakness. It is worth noting that in many of these cases there is a link between vitamin D and the health condition, but it is not certain that a lack of vitamin D causes the health problem.

A blood test can determine whether or not you are deficient in vitamin D. If you are taking vitamin D, the test will show whether you are taking a proper dose for health, while avoiding any risk of taking an amount that could be toxic (although research has shown that toxicity is highly unlikely, even in doses up to 10,000 IU daily when done under medical supervision). The cost of the test may not be covered by all provincial or territorial healthcare plans or may be covered only in certain situations. Check with your doctor for availability in your region.

The best test for vitamin D is the 25-hydroxyvitamin D blood test. There is some debate about the best levels of vitamin D, but most experts believe that the minimum value for health is between 50 and 75 nmol/l. Many people use supplements to boost their levels to more than 100 nmol/l.

While sunlight and fortified foods are two possible sources of vitamin D, the surest way to get adequate levels of this vitamin is by taking a supplement. The best dose to take depends on the person. A daily dose of 1,000 to 2,000 IU is common, but your doctor may recommend a lower or higher dose for you, depending on the level of vitamin D in your blood and any health conditions you might have. People should not take more than 4,000 IU per day without letting their doctor know. Look for the D3 form of the vitamin rather than the D2 form. Vitamin D3 is the active form of the vitamin and there is some evidence that people with HIV have difficulty converting vitamin D2 to vitamin D3. Historically, vitamin D3 supplements are less commonly associated with reports of toxicity than the D2 form.

It is best to do a baseline test so you know your initial level of vitamin D. Then, have regular follow-up tests to see if supplementation has gotten you to an optimal level and that you are not taking too much. Regular testing is the only way to be sure you attain — and then maintain — the optimal level for health.

With proper supplementation, problems caused by vitamin D deficiency can usually be efficiently reversed.

Higher Vitamin D levels linked to lower colorectal cancer risk

A January 2010 article in the British Medical Journal looked at large population samples from Western Europe and found that higher Vitamin D levels were associated with a substantial reduction in risk of colorectal cancer.

Many public health advocates are now suggesting that supplementation in the range of 1,800 to 4,000 IU vitamin D per day may provide multiple benefits, including reduction in risk of some cancers.

Reference: Jenab, M, et al. Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: a nested case-control study.
British Medical Journal, 21 January 2010.

See the NYBC entries Vitamin D 3 – 2500IU and Vitamin D3 – 1000IU for more details.

Vitamin D3 and Omega-3 Study

There’s a new study funded by the National Institutes of Health that seeks to understand whether supplementing on a regular basis with Vitamin D3 (about 2000IU/day) and fish oil (about 1 gram of omega-3 fatty acids/day) can decrease rates of heart disease, stroke or cancer in people who do not have a history of these diseases. It’s called the VITamin D and OmegA-3 TriaL (VITAL) research study, and will attempt to enroll 20,000 men and women in the US and follow their medical histories for a number of years. Note that the study will enroll only men over 60 and women over 65–ages at which heart disease, stroke and cancer begin to occur with greater frequency.

Here’s the website of the study, which is being run by Harvard Medical School and the Brigham and Women’s Hospital in Boston, MA:

http://www.vitalstudy.org/

The designers of this research were interested in looking at both Vitamin D3 and fish oil/omega-3 fatty acids because of the accumulating evidence for the health benefits of these two widely investigated supplements, and because the two show different mechanisms of action in inhibiting inflammatory responses in the body. The study is designed to separate out the effect of each of the two supplements, but also investigate whether combining the two produces the added benefit in terms of disease prevention.

Note that there is already a great deal of evidence to support the health benefit of omega-3 fatty acids for people with heart disease. And there is likewise evidence to support the benefit of Vitamin D3 (plus calcium) for those with deficiency-related conditions like bone loss. The VITAL study, on the other hand, has the specific goal of looking at whether regular supplementation can actually prevent development of cardiovascular disease and/or cancer in healthy people.

NYBC stocks Vitamin D3 1000IU and ProOmega (1000mg/60 softgels).
Purchasing these two at the member’s cost of about $26 will give you a two months supply at the VITAL study’s dosages.

Vitamin D for heart health

Our hometown newspaper, The New York Times, carried an article
on 11/16/2009 entitled “Vitamin D Shows Heart Benefits in Study.” The piece will not come as any terrific surprise to readers of this blog, since we’ve already cited under “Vitamin D” a recent article in the American Journal of Cardiology that suggested supplementing with Vitamin D as an important and economical option for preventing cardiovascular disease.

Quite a few NYT readers sent in comments on the article, mentioning a variety of other recent findings about the “sunshine Vitamin” (many of which we’ve already cited on this blog). We do know that a federal panel is reviewing recommendations on daily intake of Vitamin D, and is expected to issue new guidelines in the next year or so. But we hadn’t heard, as one NYT reader pointed out, that, as of recent years, the general practice in Canada is to recommend up to 2000IU of Vitamin D3/day for children to support and promote good health. Here’s an extract from the Canadian Paediatric Society’s 2007 position statement on Vitamin D supplementation (yes, all of those numbers in parenthese refer to scientific journal articles):

The emphasis is no longer solely on preventing rickets,
which requires only a relatively small amount of vitamin D
supplementation. The focus is now also on the prevention
of associated childhood and adult diseases. New findings
suggest that adequate vitamin D status in mothers during
pregnancy and in their infants may have lifetime implications.
These findings modify our knowledge and understanding of
vitamin D metabolism, our basis for diagnosis of vitamin D
deficiency and our recommendations for supplementation.

It is now clear that vitamin D is involved in the regulation
of cell growth, immunity and cell metabolism. Vitamin D
receptors are found in most tissues and cells in the body (7).
The interaction of 1,25(OH)2D with these receptors may
result in a variety of biological responses influencing disease
processes (8). Vitamin D deficiency has been linked to
osteoporosis (9); asthma (10); autoimmune diseases such as
rheumatoid arthritis, multiple sclerosis (11) and inflammatory
bowel diseases (12); diabetes (13); disturbed muscle function
(14); resistance to tuberculosis (15); and the pathogenesis of
specific types of cancer (16,17) (evidence level III).

Maternal vitamin D status during gestation and lactation
may influence the health status of the child later in life.
Bone density in nine-year-old children (evidence level II-3)
(9), the severity of asthma in three-year-old children (10)
(evidence level II-2) and the susceptibility to type 1 diabetes
(11) (evidence level II-2) have been linked to low
vitamin D status during fetal life. Intervention trials have
demonstrated that supplementation with vitamin D or its
metabolites may improve blood glucose levels in diabetics
and decrease symptoms of rheumatoid arthritis and multiple
sclerosis (11,13) (evidence level III).

Read the full text at:

http://www.cps.ca/ENGLISH/statements/II/VitaminD.pdf

See also the NYBC entries:

Vitamin D3 2500IU

Vitamin D3 1000IU

Vitamin D3 400IU

Vitamin D3 and Flu Prevention

There has been rising interest in the past few years about Vitamin D’s potential for preventing/controlling flu and other respiratory illnesses.
One notable advocate for Vitamin D as a preventative against flu is Dr. John Cannell, lead author of a 2008 review article in the journal Virology. Cannell and his co-authors build on a decades-old insight from a British researcher, Hope-Simpson, who speculated that influenza was seasonal because of a co-factor related to sun exposure. The co-factor, this article asserts, is Vitamin D and its positive effects on immunity.

The second paragraph quoted below (from the same 2008 article in Virology) reports rather dramatic evidence that African-Americans, who are especially prone to Vitamin D deficiency, might very substantially decrease their susceptibility to colds and flu by supplementing with 2000IU daily during winter months.

Vitamin D, innate immunity, and influenza

Hope-Simpson’s model theorized that an unidentified “seasonal stimulus,” inextricably bound to solar radiation, substantially controlled the seasonality of influenza. Recent evidence suggests the “seasonal stimulus” may be seasonal impairments of the antimicrobial peptide (AMPs) systems crucial to innate immunity, impairments caused by dramatic seasonal fluctuations in 25-hydroxy-vitamin D [25(OH)D] levels. The evidence that vitamin D has profound effects on innate immunity is rapidly growing.

In fact, Aloia and Li-Ng presented evidence of a dramatic vitamin D preventative effect from a randomized controlled trial (RCT). In a post-hoc analysis of the side effect questions of their original three-year RCT, they discovered 104 post-menopausal African American women given vitamin D were three times less likely to report cold and flu symptoms than 104 placebo controls. A low dose (800 IU/day) not only reduced reported incidence, it abolished the seasonality of reported colds and flu. A higher dose (2000 IU/day), given during the last year of their trial, virtually eradicated all reports of colds or flu. Recent discoveries about vitamin D’s mechanism of action in combating infections led Science News to suggest that vitamin D is the “antibiotic vitamin” due primarily to its robust effects on innate immunity.

References:

Cannell, John J, Michael Zasloff, Cedric F Garland, Robert Scragg and Edward Giovannucci. On the epidemiology of influenza. Virology Journal 2008, 5:29. We accessed this 11/10/2009 at http://www.virologyj.com/content/5/1/29.

Aloia J F, Li-Ng M: Epidemic influenza and vitamin D. Epidemiol Infect 2007; 135: 1095–1096.

See the NYBC entry Vitamin D3 2500IU for additional information. This format of D3 is a convenient way to supplement at approximately the levels discussed by Cannell and others. (NYBC also stocks D3 1000IU and D3 400IU formats.)

Recommendations from the Vitamin D Council

The Vitamin D Council is a California non-profit that promotes education about the health benefits of Vitamin D, and advocates for wider use of supplementation, at a much higher dose than the current RDA, to ward off a variety of diseases, including several types of cancer, diabetes, and cardiovascular disease.

Here are some highlights from the Council’s home page, as accessed by us 10/22/2009:

Current research has implicated vitamin D deficiency as a major factor in the pathology of at least 17 varieties of cancer as well as heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis, muscle weakness, muscle wasting, birth defects, periodontal disease, and more.

Vitamin D’s influence on key biological functions vital to one’s health and well-being mandates that vitamin D no longer be ignored by the health care industry nor by individuals striving to achieve and maintain a greater state of health.

Sunshine and Your Health

If well adults and adolescents regularly avoid sunlight exposure, research indicates a necessity to supplement with at least 5,000 units (IU) of vitamin D daily. To obtain this amount from milk one would need to consume 50 glasses. With a multivitamin more than 10 tablets would be necessary. Neither is advisable.

The skin produces approximately 10,000 IU vitamin D in response 20–30 minutes summer sun exposure—50 times more than the US government’s recommendation of 200 IU per day!

On this website, we also noted with interest a letter from a Wisconsin doctor/long-term care facility manager on the apparent protective value of Vitamin D during a spike in the state’s swine flu rate in June 2009. The doctor had mandated Vitamin D supplementation for the long-term care facility’s residents, whereas staff at the facility were under no such requirement. During the June swine flu peak, less than 1% of the facility residents developed swine flu, while at least 7% of the staff did–a significant variation in outcomes.

We’ll stay tuned to the Vitamin D Council’s website, which seems to us a useful clearinghouse of information on a supplement that holds a great deal of promise, if we’re to judge by the flood of positive new research results coming out in just the past few years. On the practical side, we also note that Vitamin D supplementation is inexpensive; that blood levels of the vitamin are easily monitored; and that overdose is rare (though we certainly recommend checking with your doctor if you plan to supplement at the levels advocated by the Vitamin D Council).

SEE ALSO THE NYBC ENTRY:

D3 – 2500IU (This format provides a convenient way to supplement for those wishing to follow the recommendations of the Vitamin D Council; other strengths are also available at NYBC.)