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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Supplementation Supports Healthy Birthweight

by Sean Wells

Having a baby is an experience that can be beautiful, but also very harrowing. It is a matter of balancing many things, especially when it comes to prenatal eating.
Expecting mothers typically are presented with an extensive list of foods to avoid from their doctors, while being encouraged to simply “eat for two” by well-meaning friends and relatives. Between all this is the obvious and natural maternal interest to provide the unborn baby with all the nutrients needed for proper growth and development. The complexity of the situation can be daunting.
One of the primary indicators of health for a newborn baby is birth weight—babies born within the healthy range are far less likely to experience health problems later in life as compared to babies who are either overweight or underweight. The latter category, in particular, is typically indicative of some form of undernourishment taking place during pregnancy.
One possibility for effectively splitting the difference between all these demands is through dietary supplementation. This approach ensures that a baby is not overfed, but not undernourished.
In a recent study, the fetal growth and development of 1500 babies was studied in Burkina Faso, along with the effect of supplementation with either a comprehensive multivitamin, or with a pairing of iron and folic acid (or Vitamin B9)—a combination considered of primary importance by the World Health Organization. In both cases—the multivitamin supplemented group and the group receiving only the B9/iron combination—the longer the supplements were taken, the larger and heavier the baby.
This would seem to confirm that, at the very least, the recommended matching of folic acid and iron are positively linked with a healthy birthweight. As phrased by the leader of the study, Dr. Dominique Roberfroid, “Even in women who are not deficient in iron, there is a benefit for fetal growth.”
Supplementation provides a potential answer for maintaining the balance between avoiding excess weight gain during pregnancy, while also helping to ensure that growing babies are receiving all the nutrients they need. Expecting mothers, who typically have plenty of other worries, are likely to be pleased with such a simple solution.

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The Facts About Celiac Disease

by Theresa Greenwell

Celiac disease is a genetically inherited autoimmune condition that is triggered by the ingestion of a specific food protein known as gluten, which is found in most grains, including wheat, barley and rye. Celiac disease is not an actual allergy to gluten, but a disease that is characterized by a permanent intolerance to dietary gluten. These grains and the flour made from them are used in the vast majority of baked goods, thickening agents for gravies and broths, flavor enhancers and protein supplements.
These represent many popular food products in the United States, and our gluten intake is correspondingly high as a result. In the United States it is believed that celiac disease affects approximately one out of every 125 individuals.
The exact number of individuals affected worldwide is very difficult to determine, as the diagnosis of ‘celiac disease’ is often used to refer collectively to those with the disease as well as those who are predisposed to developing the disease, and even those who are merely gluten sensitive.
Whenever a person with celiac disease eats any gluten their body will have some reaction. As gluten enters the intestinal tract, it triggers an immune-regulated toxic reaction that results in the damage and destruction of the villi—the tiny, hair-like structures that line the small intestine and allow for the breakdown of foods and the absorption of nutrients. When these villi are damaged or missing, a person cannot effectively absorb the basic nutrients necessary for good health such as proteins, carbohydrates, fats, vitamins and minerals.
As a result of the celiac patient’s inability to break down foods, the person can experience vomiting, abdominal pain, bloating, flatulence, diarrhea or loose stools, weight loss, fatigue and weakness. Not only can celiac disease affect the nutritional status of those who have it, it can influence the onset of other conditions and diseases. Iron-deficiency anemia, depression or anxiety, delayed growth, bone and joint pain, bone loss or osteoporosis, arthritis, dermatitis (dermatitis herpetiformis), mouth and canker sores, seizures and even muscle soreness are just some of the conditions that have been associated with celiac disease.
The only treatment for celiac disease is the lifelong avoidance of dietary gluten. This dietary change can be challenging and tedious. Celiac patients must learn to read labels in order to identify the various foods and ingredients that can contain hidden amounts of gluten. They often must give up foods they enjoy and learn to cook using substitutions for products they have used for years. Pharmaceuticals, supplements and even beer can contain gluten. By following a gluten-free diet, the celiac patient allows the body to heal and recover while decreasing the likelihood of developing other health-related conditions.
Celiac disease is a genetic condition, so the offspring and siblings of celiac patients have the possibility of developing it also. As the disease can develop at any point during one’s life, this prospect of not knowing whether to avoid gluten or not can be daunting. Genetic testing is now being used to identify the presence of specific genes that are considered necessary for developing the disease. If one does have these genes it does not guarantee that the individual will develop celiac disease, it only indicates that they have the predisposition to do so. If gluten is not ingested, the disease cannot develop

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