Monday, December 17, 2012

Vitamin D – Beyond Bone Health

by Dr. Robert Blair

Vitamin D has long been known to be an important vitamin for bone health. This was first realized with the discovery that rickets, a childhood bone disease, was due to a nutritional deficiency of vitamin D. Vitamin D is critical to bone health because of its role in making sure that our body absorbs and retains calcium and phosphorus, minerals critical to bone formation.
Several studies have demonstrated that adequate vitamin D levels help reduce the incidence of falls and fractures. These studies have reported that daily supplementation with 700 IU/day vitamin D reduced the risk of falls by about 22% and reduced the risk of non-vertebral fractures by more than 20%. The benefits of vitamin D for the reduction of fracture risk appears to be due to ability of vitamin D to support both bone strength and muscle strength.
The theory that vitamin D might have additional health benefits came with the discovery that the vitamin D receptor (VDR) was present in many tissues throughout the body. Since this discovery, research efforts have suggested that a lack of vitamin D is linked to several chronic health conditions including heart disease, diabetes, cancer, and multiple sclerosis.
Heart Health
Analysis of the NHANES III (National Health and Nutrition Examination Survey) data set indicates that individuals with circulating vitamin D levels below 21 ng/ml are at increased risk for high blood pressure, diabetes, obesity, and high triglyceride levels, all possible risk factors for poor heart health. It has also been reported that men with low vitamin D levels were twice as likely to have a heart attack compared to men with adequate vitamin D blood levels. Other studies have suggested that vitamin D has modest blood pressure benefits. These heart health benefits might be part of the reason that higher vitamin D blood levels reduce the risk for cardiovascular mortality.
Type 2 Diabetes
Vitamin D has been shown to be essential for insulin secretion and a lack of vitamin D can lead to the inhibition of insulin secretion and glucose intolerance, indicating the potential importance of vitamin D for type 2 diabetes. Population-based studies have suggested that adequate vitamin D levels can reduce one’s risk for type 2 diabetes. One study reported that daily supplementation with >800 IU vitamin D plus >1,200 mg calcium reduced the risk for type 2 diabetes by 33%. Other studies have reported that higher blood levels of vitamin D reduce the prevalence of diabetes and future insulin resistance. Furthermore, data from NHANES III indicates that teens with vitamin D blood levels below 15 ng/ml were 2.5 times more likely to have high blood glucose levels.
Cancer
Vitamin D has been shown to promote cell differentiation and suppress cell growth. Additionally, studies using tumor models indicate that vitamin D can suppress metastasis and reduce new blood vessel growth, which is necessary for tumor formation. These properties of vitamin D suggest vitamin D could have benefits for reducing cancer risk. However, research studies to date are inconsistent.
Observational studies on vitamin D and breast cancer suggest that individuals with higher blood levels of vitamin D have about a 45% lower risk for breast cancer compared to individuals with low blood levels of vitamin D. Similarly, it has been reported that lower exposure to sunlight is linked to a higher risk of breast cancer, again suggesting a possible role for vitamin D in reducing breast cancer risk. In contrast to these observational studies, the Women’s Health Initiative randomized, controlled clinical trial reported that vitamin D supplementation (400 IU per day) had no benefit on breast cancer risk. However, a separate clinical trial reported that supplementation with 1,400 – 1,500 mg calcium plus 1,000 IU vitamin D daily reduced all-cancer risk compared to women taking only calcium or nothing. This second study suggests that the amount of vitamin D taken is important to the benefits observed.
Like breast cancer, some research studies have suggested that prostate and colorectal cancer risk might be reduced by vitamin D. These studies have reported that colorectal cancer risk was reduced with higher blood levels of vitamin D, particularly vitamin D levels above 30 ng/ml. Similarly, it has been demonstrated that low blood levels of vitamin D are linked to a higher risk for prostate cancer.
Overall Mortality
These and other health benefits of vitamin D have been reported to lead to an overall decline in mortality, though the overall impact differs between studies. In an analysis of the NHANES III data, individuals with blood levels of vitamin D above 40 ng/ml had a 45% lower risk of death compared to individuals with blood levels of vitamin D below 10 ng/ml. In contrast, an analysis of 18 clinical trials reported that supplementation with vitamin D (300 – 2,000 IU/day) lowered the risk of death by only 7%.
How Much Is Enough?
The current Recommended Dietary Allowance (RDA) for vitamin D is 600 IU per day for individuals between 1 to70 years of age and 800 IU per day for adults over 70 years of age. However, there remains a lot of debate as to whether these amounts are truly sufficient. Based on the scientific research, groups like the Harvard School of Public Health and the Linus Pauling Institute recommend daily intakes of 1,000 – 2,000 IU per day to obtain the optimal benefits of vitamin D. Anyone wanting to take more than the current recommended RDA should discuss their vitamin D supplementation with their own physician.


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