Low Vitamin D: A Global Concern

Recent studies suggest that vitamin D is much more important in fighting off disease than previously thought. Being deficient in this vitamin puts one at risk of diseases such as cancer, osteoporosis, and multiple sclerosis. Chances are that if you live in a northerly geographic region you do not get enough vitamin D. Persons who live a rather sedentary lifestyle and do not get outside for at least a 15-minute daily walk in the sun are in the same position. Latinos, African-Americans and others with dark skin tend to have much lower levels of vitamin D, as do people who are overweight or obese. All around the world millions of persons suffer from vitamin D deficiency. This phenomenon is so common that it affects persons on every continent, of all ethnic groups, and across all ages. Some surveys suggest that perhaps half of the world’s population has inadequate blood levels of vitamin D. Sadly, physicians, even in industrialized countries, are seeing the resurgence of rickets, the bone-weakening disease that had been largely eradicated through vitamin D fortification.

As with most research findings, there is plenty of debate. Indeed, as opposed to what many people think, there are few certainties in science; its nature is to be open to criticism, discussion, and revision. The Institute of Medicine (IOM) released a report in November 2010 which recommends a daily vitamin D intake of 600 IU per day, for people ages 1 to 70, and 800 IU, for people over age 70—the report referred to persons living in the U.S. and Canada. The report also recognized the safety of vitamin D by increasing the upper limit from 2,000 to 4,000 IU per day, and acknowledged that even at 4,000 IU per day, there was no good evidence of harm.

Some in the scientific community believe the new guidelines are too conservative about the intake, and that they do not give due consideration to the latest findings about vitamin D and health. They contend that the new guidelines are not enough to prevent chronic disease, and they are not sufficient to help those who have problems with their bones. This is an important debate, and in order to understand it better it is necessary to know the origins of vitamin D and how it functions in the human body.

Vitamin D Sources and Function

Our body makes vitamin D and it is also a nutrient we eat. The body produces vitamin D from cholesterol, which itself is triggered by sun lighting on the skin. Yet many persons do not make enough vitamin D from the sun, persons with darker skin, those who are overweight, and persons who use products that block sunlight being among them. Correctly applied sunscreen reduces our ability to absorb vitamin D by more than 90 percent.

To be sure, not all sunlight is of the same quality and intensity: The sun’s ultraviolet B (UVB) rays—the so-called “tanning” rays, and the rays that trigger the skin to produce vitamin D—are stronger near the equator and weaker at higher latitudes. Indeed, persons who live in places prone to considerable cloudiness and rain can suffer from vitamin D deficiency. The other way we get vitamin D is to eat food that contains a lot of it. However, few foods are naturally rich in vitamin D, so the biggest dietary sources of vitamin D are fortified foods and vitamins supplements.

Vitamin D helps the body absorb and retains calcium and phosphorus, which are critical elements for building bone. Laboratory studies show that vitamin D can reduce cancer cell growth, can increase muscle strength, and can help control infections. There may yet be other functions for vitamin D, and scientists continue to explore the many other uses for this important substance.

New Vitamin D Research: Beyond Building Bones

Vitamin D research has proved to be of considerable fecundity. Although there have been many reports issued over the years, there are only a few that offer enough evidence to constitute a clear medical breakthrough. Here we provide the more promising areas of vitamin D research, highlighting the complex role of vitamin D in disease prevention—and the many unanswered questions that remain.

Vitamin D and Bone and Muscle Strength

A number of random trials have shown that high doses of vitamin D supplements help reduce bone fractures. A summary of the evidence comes from a combined analysis of 12 fracture prevention trials that included more than 40,000 elderly people, most of them women. Researchers found that high intakes of vitamin D supplements—of about 800 IU per day—reduced hip and non-spine fractures by over 20 percent, while lower intakes (400 IU or less) failed to offer any fracture prevention benefit.

It has been shown that vitamin D may also help increase muscle strength, which can help prevent elderly persons from falling, a common problem that leads to increased rates of disability and death among them. A combined meta-analysis found that taking 700 to 1,000 IU of vitamin D per day lowered the risk of falls by 19 percent; the combined studies also show that taking 200 to 600 IU per day offered no such protection. Based on this data, the International Osteoporosis Foundation recommends that adults over age 60 maintain vitamin D blood levels of 30ng/ml. This means that most people will need vitamin D supplements of at least 800 to 1,000 IU per day, and possibly higher, to reach these levels.

Vitamin D and Heart Disease

The heart, as a skeletal muscle, is a receptor of vitamin D. A number of studies have found that lack of vitamin D is linked to heart disease. The Health Professional Follow-Up Study observed the vitamin D blood levels in nearly 50,000 men who were healthy. They followed the same group for 10 years and found that men who were low in vitamin D were twice as likely to have a heart attack as men who had adequate levels of vitamin D. Other studies have linked low vitamin D levels to an increased of heart failure, sudden cardiac death, stroke, overall cardiovascular disease, and cardiovascular death. There is some evidence that vitamin D plays a vital role in controlling blood pressure and preventing artery damage. This goes some ways in explaining the findings above. However, more research is needed before a sounder conclusion can be made.

Vitamin D and Cancer

Nearly 30 years ago, researchers discovered an interesting correlation between colon cancer deaths and geographic location. They found that people who lived at higher latitudes, such as in the northern U.S. or Canada, had higher rates of death from colon cancer than people who lived closer to the equator. The sun’s UVB rays are weaker at higher latitudes, and in turn, people’s vitamin D levels in these high latitude locales tend to be lower. Researchers formed the hypothesis that vitamin D deficiency can lead to an increased risk for getting colon cancer

Some time has passed, but dozens of studies suggest a relationship does exist between low vitamin D levels and increased risks of colon and other cancers. The evidence is strongest for colorectal cancer, with observational studies have found that persons with lower vitamin D levels are at higher risk of getting such diseases. Vitamin D levels may also predict cancer survival, but there is as yet little evidence to support this. However, it is not yet certain that taking vitamin D supplements necessarily lowers the risk of contracting cancer. This latter idea will be tested in the VITAL trial. The VITAL trial will look specifically at whether vitamin D supplements lower cancer risk. However, it is likely to be years before the trial produces any results. Additionally, the VITAL trial could fail to detect a real benefit of vitamin D. There are several reasons for this. First, if people in the placebo group decide to take their own vitamin D supplements, the differences between the placebo group and the supplement group could be minimized. Second, the study may not follow participants for a long enough time to show a cancer prevention benefit; or study participants may be starting supplements too late in life to lower their cancer risk.

In any case, given the evidence now on hand, 16 scientists have circulated a “call for action” on vitamin D and cancer prevention. Given the high rates of vitamin D inadequacy in North America, the strong evidence for reduction of osteoporosis and fractures, the potential cancer-fighting benefits of vitamin D, and the low risk of vitamin D supplementation, these scientists recommend vitamin D supplementation of 2,000 IU per day. The Canadian Cancer Society has also recommended that Canadian adults consider taking vitamin D supplements of 1,000 IU per day during the fall and winter. They also recommend that people who are at high risk of having low vitamin D levels because of old age, dark skin, or geographic location take vitamin D supplements year round.

B Vitamins and Heart Disease

Can B vitamins keep your heart healthy?

Sadly, the death of two young children who had died of massive strokes were the catalyst for a 1968 investigation. The Boston pathologist who investigated the death of the children found that they had extraordinarily high levels of a protein breakdown product in their blood. Both children’s arteries were blocked by cholesterol as well, resembling more closely the arteries of a middle-aged unhealthy person than those of a young child. These discoveries led to the hypothesis that elevated levels of this breakdown product (know as homocysteine) had contributed to the process of hardening of the arteries. This condition is called atherosclerosis. So, what is the connection between B vitamins and heart health?

Folate, vitamin B6 and vitamin B12 are instrumental in the body’s ability to convert homocysteine into methionine. Methionine is one of the 20 substances that help the body to build new proteins. Insufficient levels of any or all of these B vitamins can hamper the conversion process, driving homocysteine levels up. Sufficient levels of these vitamisn, on the other hand, can help to keep homocysteine at a safe level.

Many studies over the last few decades have shown that high levels of homocysteine can be associated with an increase in the risk of heart disease and stroke. Some studies have also shown that there is a causal relationship between high intakes of folate and the lower incidence of cardiovascular disease, hypertension and strokes. There cannot be a direct link made, however, between higher homocysteine levels and lower folate levels to an increased risk of heart disease. In other words, it cannot be definitely stated that lower homocysteine levels by taking more folic acid and other B vitamins will lower one’s risk of having a heart attack, stroke or other heart-related condition.

There have been several randomized trials involving B vitamins and heart health, but they have not conclusively shown any relationship between the two. In the studies adutl participants who had a history of heart conditions or who were in the upper risk categories for heart disease were given either a placebo or a pill that contained high doses of vitamins B6, B12 and folic acid. The result of the study was that taking the high doses of the three B vitamins did lower the levels of homocysteine present in the body, but that that reduction did not lead to a reduction in the number of cardiac events in the participants. There is some suggestion that the participants in this study were already too far gone in terms of heart health for the B vitamins to have an effect.

Recently, analysis of several studies seems to suggest that taking folic acid supplements can reduce the likelihood of a stroke in a person who had never before suffered a stroke. The risk reduction does not occur, however, in people who have already had a stroke. Further, folic acid was most effective in promoting heart health when combined with vitamins B6 and B12 as opposed to when it is consumed in isolation.

In the United States and in Canada, since the governments in those countries have mandated that certain products such as bread and pasta be fortified with folic acid, the rate of death from stroke has fallen dramatically. In the UK, where folic acid fortification is not yet mandated, there has been no significant change in the rate of death from strokes.

The long and the short of it is this: Folic acid supplementation may reduce the risk of heart disease in people who have lower levels of folate in their systems. This will typically include those people living in countries where folic acid fortification of food is not yet the rule. In countries where people already get adequate levels of folic acid from their food, further supplementation, even levels that are much higher than can be found in a standard multivitamin, has not been sufficiently shown to be of any significant benefit and, actually, may cause harm.

Currently, what constitutes a sufficient daily intake of B vitamins isn’t clearly defined. The definition would likely change over time anyway, as more data are collected from randomized trials. Currently in the United States, folic acid fortification of food has led to an increase in the percentage of adults who have adequate levels of folate in their systems. Still, only a small percentage of American adults currently get the recommended daily intake of all B vitamins derived just from their diets alone.

Resistance Training

More and more people are using weight training to maintain muscle mass or to strengthen specific areas like the lower back.

George has been active all of his 57 years but never thought about training with weights… until two years ago when he had a massive stroke. “I was paralyzed from my head to my toes on my right side.”

Doctors said he might not walk again. So he started pumping iron… the right way… with a trainer… instead of plunging into a gym on his own.

Everett is a personal trainer, “They’ll go to a specialist to get their dishwasher fixed. But they’ll go into the gym and not even consult a professional. Isn’t your body as important to you as your car or dishwasher?”

A common mistake most people make… they try to learn on their own.

Everett, “They’re doing exercises they’ve never seen or someone has shown them that really aren’t for their body or their goals.”

Everett says technique, not tonnage, is the key to getting the most out of weight training.

Lisa has been working out for 10 years. Now she’s un-learning bad habits.

Lisa, “Because it gives me the body I want, it gives me the shape I want and actually it can help protect the weaker areas of my body.”

There are more than 600 muscles in your body. Exercising them is good for the long and short run. But, if you learn bad habits early on, you could be doing more harm than good.

If you are interested in starting a weight training program, most gyms and workout facilities have a professional trainer to help get you started. And remember, it is important to consult your physician before starting any exercise program.

Understanding your blood pressure for diabetes

Myth “You know if you have high blood pressure because it gives you headaches”

Truth High blood pressure does not always give you symptoms, and it is often found by chance during routine health checkups. Having your blood pressure checked at your annual diabetes reviews, and more frequently if your health professional suggest it, will be a more reliable indicator of whether your blood pressure is high.

My doctor tested me for Type 2 diabetes because I am having treatment for high blood pressure. Why is that?

Type 2 diabetes and high blood pressure are both linked to insulin resistance, so if you have one of these conditions it is common to have the other, too. If you keep both your blood pressure and your blood glucose level under control, your chances of developing long-term complications, especially heart disease, are greatly reduced.

What is high blood pressure?

If your larger blood vessels become more rigid and your smaller blood vessels start to constrict, your blood has to flow through a narrower space than before. The result is greater pressure on your blood vessel walls, which is known as high blood pressure or, medically, as hypertension. Having high blood pressure is common when you have Type 2 diabetes.

I have high blood pressure but I don’t feel sick. Why does it need to be treated?

Having high blood pressure makes you much more prone to cardiovascular disease (CVD) – a serious condition that develops over many years as your blood vessels gradually become narrower and less flexible. You may have high blood pressure without knowing it and, if it remains untreated, you may develop angina (severe chest pain) or have a heart attack or a stroke. Taking your blood pressure treatment as prescribed and having regular checkups can help prevent these serious conditions.

What should my blood pressure be?

If you have Type 2 diabetes your blood pressure should be below 130/80 millimeters of mercury (mmHg). In some situations, for example if you have already developed kidney damage (nephropathy), you may need to keep your blood pressure lower, for example, 125/75 millimeters of mercury (mmHg) to prevent further damage. Discussing your ideal blood pressure level, and ways to achieve it, with your health professional will give you the level that is right for you.

Why are there two figures in my blood pressure measurement?

The top figure refers to the level of pressure in your blood vessels as your heart contracts and pumps blood around your body. This is known as the systolic blood pressure. The second figure is the lowest pressure as your heart relaxes between beats. This is known as the diastolic blood pressure.

What can I do to lower my blood pressure?

Stop smoking and lose weight if you need to, eating more fresh fruit and vegetables and less saturated fat and salt (for example, less processed or commercially prepared meals) to help reduce your blood pressure. Physical activity will also lower your blood pressure. Take any blood pressure pills that you have been prescribed, even if they do not affect the way you feel, to help keep your blood pressure in the recommended range.

How low can my blood pressure go?

It would be unusual for your blood pressure to be under 100/60 mmHg if you are otherwise healthy. For every 10 mmHg drop in your systolic blood pressure (the first figure) toward this level, you benefit by reducing your risk of heart attack or stroke.

Smoker’s Nutrition

Containing over 4,000 chemicals, including more than sixty known carcinogenic (cancer-causing) substances, tobacco smoke has an obvious negative impact on health. People who smoke cigarettes or any other form of tobacco are at greater risk for such serious respiratory illnesses as lung, cancer, emphysema, and chronic bronchitis, as well as coronary heart disease, stroke, circulatory problems, periodontal disease, and osteoporosis.

Smoking robs the body of a number of important vitamins and minerals, and it also affects the body’s ability to absorb these essential nutrients. The primary nutrient affected by cigarette smoke is vitamin C, which helps boost the immune system, is needed for maintaining healthy bones and teeth, and is essential for healing wounds. It is also necessary to form collagen, a protein that is required to make blood vessels, skin, scar tissue, and ligaments. As one of the body’s many antioxidants, vitamin C helps block some of the damage caused by free radicals.

Supplements for smokers

• Alpha-lipoic acid
• Carnitine
• Coenzyme Q10
• N-acetylcysteine (NAC)
• Selenium
• Vitamin C
• Vitamin E

Warning – You already know that very high dosages of vitamin A and beta-carotene can cause certain health risks. However, recent studies have shown that smokers who intake high dosages of vitamin A and/or beta-carotene may hve an increased risk of developing lung cancer. Consequently, do not take more than 8,000 IU a day of vitamin A or beta-carotene – especially if you are a smoker.

Physical Activities for Diabetes

Myth “You have to spend a lot of time being active to get any benefit”

Truth The recommended amount of activity is 30 minutes five times a week. But you don’t’ necessarily have to dedicate specific times to this – you can feel the benefits just by being more active in your day-to-day life. Everyday things such as climbing stairs, going shopping, gardening, and housework all count as activity.

Will I still need to take my diabetes medication if I become more active?

Yes, but you may need a lower dose to achieve the same effect. If you are on insulin-stimulating pills, you may be more at risk of a hypoglycemic attack when you become more active, so you may need a reduction in the dose of your pills or a change to a different type of pill. Also, if you are more active, you may find that you lose weight. If you lose more than a few pounds you are likely to need a lower dose of pills or insulin.

I’ve been told I have impaired glucose tolerance. Will being more physically active help me?

Yes, people who have impaired glucose tolerance are more likely to go on to develop Type 2 diabetes. Becoming more active, especially if you also lose weight, will help your natural insulin work as effectively as possible to regulate your blood glucose level. You will always be at risk of developing diabetes, but the more active you are, the longer it may take to develop.

How does being more active help prevent the long-term complications of diabetes?

Regular physical activity helps the insulin you have produced or injected work more efficiently, which in turn contributes toward keeping your blood glucose and your blood pressure in the recommended ranges. These two benefits make the long-term complications of diabetes less likely.

How will being active help my heart?

Regular activity helps lower your blood pressure and your blood cholesterol levels, and consequently, you have less chance of having a heart attack or a stroke. It also makes your heart stronger and more efficient so that it can pump more blood with every heartbeat, and it reduces your risk of having a heart attack from clots forming in your coronary arteries. The more active you are, the less likely you are to have a heart attack, and the greater your chance of surviving a heart attack if you have one.

I’m prone to depression. Will being active help me?

Yes, activity raises your levels of endorphins and serotonin. These brain chemicals influence your mood and sense of well-being and have a strong antidepressant effect. Some types of activity, for example, playing golf or tennis, also entail spending time with other people, and this can help lift your spirits, too.

I don’t’ take pills or insulin yet. Will staying active allow me to continue without medication?

Because of the progressive nature of diabetes, you will probably need pills or insulin eventually, but with an active lifestyle, you may delay the need for medication because regular activity reduces your insulin resistance. Activity can help at any stage. If you already take tablets, increasing your activity levels may help delay the need to start injecting insulin and reduce the dose you need.