In our ongoing reporting of vitamin D related news stories, a soon to be published study (watch this space) adds support for the need to consider higher vitamin D intake levels in individules with grerater body mass. Several studies have already described an inverse relationship between serum vitamin D3 and cancer risk. Furthermore, higher plasma D3 levels are associated with improved survival in prostate, breast, lung, colorectal, and ovarian cancers. Interestingly, a better vitamin D status at the time of diagnosis and treatment, adjusted for season of diagnosis, has been shown to improve survival buy several factors are involved in the regulation of vitamin D3. The most accacpted factors are known age, gender, race, dietary intake, season and sunlight exposure. However, a new regulating factor is now making the news.
Recently, the relationship between obesity and vitamin D status has been investigated suggesting decreased bioavailability of D3 from skin synthesis and dietary sources in association with obesity. In studies of obese adolescents in the United States, vitamin D deficiency has been correlated with greater weight and elevated BMI. In the healthy adolescent population the distribution of fat was found to be associated with vitamin D status with obese adolescents being found to have D3 deficiency.
The association between vitamin D and obesity assumes even greater importance in cancer, given the alleged role of both obesity and vitamin D in cancer risk and survival. Although it has been recommended that adiposity (fatness) should be considered when assessing vitamin D requirements in obese patients, current dietary recommendations do not take into account a person’s BMI and it remains unclear whether the dose of vitamin D required for repletion is related to the degree of obesity.
There are to date, no studies which indicate whether the presence of malignant disease compounds these issues. In the new study, researchers have addressed the first aspect of this question by investigating the relationship between serum D3 and BMI in a large and diverse population of cancer patients at a comprehensive cancer center. The study found that obese cancer patients (BMI >=30 kg/m2) had significantly lower levels of serum D3 as compared to non-obese patients (BMI <30 kg/m2). The message from this new work suggests that BMI should be taken into account when assessing a patient’s vitamin D status and more aggressive vitamin D supplementation should be considered in obese cancer patients.
When the paper is published we will post a link.
Related HHC blog posts
Vitamin D & Bone Health
The return of rickets in the UK
Dietary vitamin D – the low down
Vitamin D3 and chronic pain
Foods and vitamin D?
In previous blog posts we have talked about the health benefits of vitamin D, especially vitamin D3. As the papers are published it does appear that getting enough of this nutrient is becoming more and more important. However, surprisingly, few foods contain vitamin D unless it’s added to the food. Nature has intended that our bodies build vitamin D via the skin (from sunlight expopsure ) rather than through your mouth (by food). We have populated the world relatively quickly and many of us live in Northern areas where the sunlight is lower. This does appear to match certain geographically dependant health problems. Taking vitamin supplements is the way forward for most people but we all can boost our dietary intake by following the suggestions below;
Here are three vitamin D super foods:
- Salmon (especially wild-caught)
- Mackerel (especially wild-caught; eat up to 12 ounces a week of a variety of fish and shellfish that are low in mercury)
- Mushrooms exposed to ultraviolet light to increase vitamin D
Other food sources of vitamin D include:
- Cod liver oil (warning: cod liver oil is rich in vitamin A; too much may be bad for you)
- Tuna canned in water
- Sardines canned in oil
- Some Milk or yogurt products that are fortified with vitamin D
- Beef or calf liver
- Egg yolks
Nearly all milk in the America is fortified with vitamin D. It has been since the 1930’s. This has caused some confusion in the UK where articles written in magazines have taken American research and applied it to the UK where vitamin D fortification of milk does not occur!
Eat and enjoy!
For those worried about their intake of vitamin D3, we suggest taking 1,000IU’s per day in the form of a dietary supplement.; vitamin D3
“Calcium pills increase the risk of heart attacks” was the latest worrying headline for many a little while ago. As if we don’t have enough to worry about now our trusted and protective calcium dose is out to get us! However, this is not really new news. Taking pure elemental calcium has always been questioned in connection with unwanted calcification of soft tissues and potentially associated with the calcium-based plaques seen in the walls of diseased blood vessels. The current study, published in July issue of the BMJ, took this a stage further by suggesting that those who took elemental calcium in doses of 500mg or more were increasing their risk of a heart attack. The BMJ study analysed 11 previous studies covering some 11,921 people over 4 years. Out of these people 296 had heart attacks of which 166 were taking calcium (over 500mg/day) and the rest (130) were on placebos. The trial participants were mostly female, and the trial only involved elemental calcium, not calcium combined with vitamin D or any other nutrient. In fact, studies that used calcium and vitamin D combinations were actively excluded from the analysis. When the numbers were statistically crunched elemental calcium appeared to increase the risk of a heart attack by roughly 30%. Oddly enough in 2008 the BBC reported on research conducted at the University of Minnesota that showed owning a cat appears to reduce the risk of a heart attack by 40%; could buying a cat be an antidote to the problem?
On a more clinical note, the reassuring aspect of this story is that pure elemental calcium, taken in isolation, appears to be the issue. Personally, I can’t remember the last time I came across a patient that was taking pure calcium in the absence of other key factors such as vitamin D or vitamin K or as part of a multiple bone complex, such as OsteoPrime. I feel reassurance is needed in these cases where the benefits clearly outweigh the risks for bone health.
The latest issue of our popular newsletter, The Alternative View (aka TAV) is now available to down load. Simply click here to obtain your copy now.
This issue tackles the rather tricky and controversial area of cholesterol levels and the use of statin medications. With the growing use of statins more and more users are noticing side effects to a level where they are forced to stop taking the medication. We discuss this growing problem and what can be done from an alternative point of view.
A recent media story highlighted the blood pressure lowering ability of beetroots. TAV6 explains how beetroots can lower blood pressure through come rather cleaver chemistry that is driven by bacteria in our salivary glands… However, it’s true, beetroots can lower blood pressure!
FInally, we focus on a recently discovered link between vitamin D, headaches and your geographical location. Cause and effect in full swing here!
I hope you enjoy TAV6. If you do why not visit our archive section and read the back issues as well? Click here.
Its an ongoing issue; getting enough vitamin D but not getting excessive exposure to the damaging effects of UV rays from the sun. It is now becoming well acecpted that low levels of vitamin D appear to be associated persistent pain syndromes and impaired functioning of the neuro-muscular system. There is growing interest in the observation by specialists dealing with musculoskeletal pain that those suffering or previously diagnosed or labelled with fibromyalgia are actually suffering from a vitamin D deficiency. This may affect those with darker skins or people who do not get much sun light exposure.
The key issue of interest in the study (published in the journal Pain Medicine) showed that those with low levels of vitamin D needed nearly twice as much pain medication compared to those with normal levels.
Vitamin D is a safe supplement for most people. Those suffering from chronic pain syndromes or fibromyalgia should consider using it for a good 3 months and especially during the dark winter months. However, supplements of vitamin D should be avoided by those with kidney failure or stones, primary hyperparathyroidism or sarcoidosis.
Similar findings have been reported in the New Zealand Medical Journal. For those interested in the effects of vitamin D on bone health click here for a previous blog entry on the subject.
Did you know that you get a new skeleton every eight years? (for more information on bone turnover and what influences it click here) Just like your skin, bone is a living tissue and is constantly being renewed and replaced. Our commonly held view is that bone is a hard brittle material that does not change needs to be revisited in light of ongoing research into bone health and the new ways it can be improved and influenced. The fact is that bone is an incredibly changeable tissue explains how it is able to adapt to different stresses placed upon it (click here for some background on this aspect of bone biology). Indeed its very shape and thickness can alter in response to different stimuli. For example, a professional tennis player will place so much stress through his right arm bones that in time the bone cells become more active and remodel the architecture of the forearm bones making them thicker and stronger. The skeletons ability to change and adapt is a key factor in maintaining bone health and an equally important aspect in certain diseases. This has been dramatically illustrated in certain extreme environment. Studies performed by NASA clearly show that space flight had severe complications on the skeleton. Due to the weightless nature of the body in space, gravity cannot act on the skeleton, with an end result of a rapid thinning and weakening of bone. Special bone loading exercises and equipment have to be used to help those living and working in zero gravity maintain their bone and muscle health as this image shows keeping bone health in top form on the International Space Station is not without its complications and fuss! Otherwise ultrafit Astronauts develop osteoporosis, the thin bone disease commonly associated with older or menopausal women! Interestingly this is no news to the Russians who have been working with manned space stations for years. The Russian Cosmonauts (click on the manual download option if you follow this link) routinely take vitamin K supplements. This nutrient is known to boost bone health by stimulating the growth of the bone proteins needed to support the calcium and other minerals found in the skeleton. For those interested in the nutritional demands and requirement in zero gravity click here for an abstract on the subject, if you click on the option “PDF 334 KB” on the right side of the new screen that pops up you can get a fascinating download on this subject.
Vitamin K has only relatively recently become a hot topic in the osteoporosis world outside Russia. Despite it’s potential interaction with blood thinning drugs such as warfarin (those on blood thinners should avoid vitamin K) vitamin K is a very safe and well tolerated nutrient. Studies indicate that taking certain forms of vitamin K are associated with a 77% reduced risk of hip fracture and an 60% reduction in vertebral fractures. The mechanism behind this dramatic finding appears to involve the bone protein osteocalcin. Without a good framework to act as a guide minerals simply cannot bind on to strengthen the bones.
Feeding the bones
Bones demand feeding in a special way for a lifetime of optimal health. Certain dietary factors are known to have a bad effect on bone health and may actually increase your risk of developing thin bones in later life. Processed foods, excessive sugar, alcohol, fizzy drinks, cigarettes, coffee all can have a detrimental effect on the bones. Many pre-made ready meals come loaded with added salt. Salt has the effect of making food tasty but the extra salt (sodium) not only plays havoc with your blood pressure and fluid balance but it can also increase the calcium loss significantly. Estimates have this loss in the region of 52grams of calcium if your sodium intake jumps from 1000mg per day to 4000mg. Eating a healthy and balanced diet is such a common phrase we tend to forget how important it is to tissues we don’t normally think about; be honest, when was the last time you thought about the health of your hip bone?
When it comes to foods there is a great deal of controversy. Many authorities list milk and dairy products as key sources of calcium needed for healthy bones while some raise the worry that dairy derived calcium may actually have a detrimental effect on the skeleton. The Vegan society has some interesting information on this rather controversial subject, click here. Protein is another potential point of confusion. We need adequate protein for bone to make the basic scaffolding onto which minerals are deposited. High protein intakes, however, are associated with an increased los of calcium from the body, click here for come additional background information. Beans and pulses may offer a solution in this situation. A 100g portion of beans (dry weight) has a neutral effect on calcium balance while a similar amount of animal derived protein may cause a loss of calcium from the body. Increasing your intake of beans and pulses will boost your protein intake and have no adverse effect on calcium balance. To reassure you though, a moderate intakes of animal products, as part of a balanced diet, will not cause a drastic enough loss when off set against the additional calcium intake of that meal. Most balanced diets offset losses with the gains.
While we are on the subject of absorbing calcium it would be a good idea to mention the importance of vitamin D, or specifically vitamin D3. Acting in a hormone-like way, this key vitamin not only boosts the immune systems ability to keep us fit and well, it plays a pivotal part in the absorption of calcium from the gut. Many of us simply don’t get enough vitamin D3 from sunlight exposure and there is a negligible amount on offer from the diet. Contrary to the commonly accepted idea, milk offers no vitamin D. This confusion may have originally come from America where milk is fortified with added vitamin D, but this is not the case in the UK. Taking extra vitamin D3 would appear to be the answer for all of us, especially over the dark winter months.
To appreciate how important it is to keep bones well fed it is worth understanding how the nutritional needs change with age. During infancy our bodies are very efficient at absorbing calcium, especially from breast milk. A baby can absorb 66% of the available calcium from breast milk compared to less than a 40% absorbency rate from infant formula milk. During childhood (between one and ten years of age) the efficiency of calcium absorbency reduces to about 35%, but by adolescence it rises again to 40% to match the growth spurts associated with this phase of life. Crash diets and eating fads can seriously reduce the nutrient intake over this crucial phase of skeletal development. By the time adulthood is reached much of the final skeletal form is set. The peak bone mass is achieved by 35 years of age. Calcium absorption reduces slightly to about 30%. Adulthood also brings with it other natural diversions as far as calcium goes. It has been suggested that during the first three months of pregnancy, maternal bone density reduces as well as during lactation. During the menopause a complex interaction between hormones, calcium and other trace elements occur. Increasing calcium alone appears to be pointless. There are in fact 22 nutrients associated with the maintenance of optimal bone health. All must be in the correct balance for the benefit to be seen.
When it comes to exercise it is the load bearing, bone stressing forms that boost strength. Keep those fit astronauts in mind. Take away gravity and you take away the stimulus for bone health. If you don’t feel that your joints are up to a pounding work out there are other options. Consider balance exercises that strengthen your legs and challenge your balance, such as Tai Chi, can decrease your risk of falls. There are also posture exercises that can improve your posture and reduce rounded or “sloping” shoulders can help you decrease the risk of fractures, especially in the spine. Finally there are a range of functional exercises designed to improve how well you move can help you in everyday activities and decrease your risk of falls and fractures. For example, if you have trouble getting up from a chair or climbing stairs, you should do these activities as exercises, simply try standing up and sitting down several times until you are tired – it’s a start! There is a growing interest in both Yoga and Pilates. Both these methods can also improve strength, balance and flexibility; however people with low bone density or osteoporosis should avoid certain positions to prevent fractures.
All in all, there is a lot you can do to protect and build your bone health.
• Eat well and choose from a variety of foods.
• Move towards a more vegetarian style of eating and rely less on meats for protein.
• Stop smoking and curb any regular excessive alcohol intake.
• Start an exercise plan aimed at loading bones or improving posture and balance.
• Take extra vitamin D3 along with a good all-round bone nutrient such as OsteoPrime or Osteo Factors.
• If you think your bones may be at risk get a heel scan or bone density scan to be on the safe side.
Further Reading: Preventing and Reversing Osteoporosis by Dr Alan Gaby MD.