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What are you lacking? Probably Vitamin D

Vitamin D promises to be the most talked-about and written-about supplement of the decade. While studies continue to refine optimal blood levels and recommended dietary amounts, the fact remains that a huge part of the population — from robust newborns to the frail elderly, and many others in between — are deficient in this essential nutrient.

Tony Cenicola/The New York Times

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• Health Guide: Vitamin D

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If the findings of existing clinical trials hold up in future research, the potential consequences of this deficiency are likely to go far beyond inadequate bone development and excessive bone loss that can result in falls and fractures. Every tissue in the body, including the brain, heart, muscles and immune system, has receptors for vitamin D, meaning that this nutrient is needed at proper levels for these tissues to function well.

Studies indicate that the effects of a vitamin D deficiency include an elevated risk of developing (and dying from) cancers of the colon, breast and prostate; high blood pressure and cardiovascular disease; osteoarthritis; and immune-system abnormalities that can result in infections and autoimmune disorders like multiple sclerosis, Type 1 diabetes and rheumatoid arthritis.

Most people in the modern world have lifestyles that prevent them from acquiring the levels of vitamin D that evolution intended us to have. The sun’s ultraviolet-B rays absorbed through the skin are the body’s main source of this nutrient. Early humans evolved near the equator, where sun exposure is intense year round, and minimally clothed people spent most of the day outdoors.

“As a species, we do not get as much sun exposure as we used to, and dietary sources of vitamin D are minimal,” Dr. Edward Giovannucci, nutrition researcher at the Harvard School of Public Health, wrote in The Archives of Internal Medicine. Previtamin D forms in sun-exposed skin, and 10 to 15 percent of the previtamin is immediately converted to vitamin D, the form found in supplements. Vitamin D, in turn, is changed in the liver to 25-hydroxyvitamin D, the main circulating form. Finally, the kidneys convert 25-hydroxyvitamin D into the nutrient’s biologically active form, 1,25-dihydroxyvitamin D, also known as vitamin D hormone.

A person’s vitamin D level is measured in the blood as 25-hydroxyvitamin D, considered the best indicator of sufficiency. A recent study showed that maximum bone density is achieved when the blood serum level of 25-hydroxyvitamin D reaches 40 nanograms per milliliter or more.

“Throughout most of human evolution,” Dr. Giovannucci wrote, “when the vitamin D system was developing, the ‘natural’ level of 25-hydroxyvitamin D was probably around 50 nanograms per milliliter or higher. In modern societies, few people attain such high levels.”

A Common Deficiency

Although more foods today are supplemented with vitamin D, experts say it is rarely possible to consume adequate amounts through foods. The main dietary sources are wild-caught oily fish (salmon, mackerel, bluefish, and canned tuna) and fortified milk and baby formula, cereal and orange juice.

People in colder regions form their year’s supply of natural vitamin D in summer, when ultraviolet-B rays are most direct. But the less sun exposure, the darker a person’s skin and the more sunscreen used, the less previtamin D is formed and the lower the serum levels of the vitamin. People who are sun-phobic, babies who are exclusively breast-fed, the elderly and those living in nursing homes are particularly at risk of a serious vitamin D deficiency.

Dr. Michael Holick of Boston University, a leading expert on vitamin D and author of “The Vitamin D Solution” (Penguin Press, 2010), said in an interview, “We want everyone to be above 30 nanograms per milliliter, but currently in the United States, Caucasians average 18 to 22 nanograms and African-Americans average 13 to 15 nanograms.” African-American women are 10 times as likely to have levels at or below 15 nanograms as white women, the third National Health and Nutrition Examination Survey found.

Such low levels could account for the high incidence of several chronic diseases in this country, Dr. Holick maintains. For example, he said, in the Northeast, where sun exposure is reduced and vitamin D levels consequently are lower, cancer rates are higher than in the South. Likewise, rates of high blood pressure, heart disease, and prostate cancer are higher among dark-skinned Americans than among whites.

The rising incidence of Type 1 diabetes may be due, in part, to the current practice of protecting the young from sun exposure. When newborn infants in Finland were given 2,000 international units a day, Type 1 diabetes fell by 88 percent, Dr. Holick said.

The current recommended intake of vitamin D, established by the Institute of Medicine, is 200 I.U. a day from birth to age 50 (including pregnant women); 400 for adults aged 50 to 70; and 600 for those older than 70. While a revision upward of these amounts is in the works, most experts expect it will err on the low side. Dr. Holick, among others, recommends a daily supplement of 1,000 to 2,000 units for all sun-deprived individuals, pregnant and lactating women, and adults older than 50. The American Academy of Pediatrics recommends that breast-fed infants receive a daily supplement of 400 units until they are weaned and consuming a quart or more each day of fortified milk or formula.

Given appropriate sun exposure in summer, it is possible to meet the body’s yearlong need for vitamin D. But so many factors influence the rate of vitamin D formation in skin that it is difficult to establish a universal public health recommendation. Asked for a general recommendation, Dr. Holick suggests going outside in summer unprotected by sunscreen (except for the face, which should always be protected) wearing minimal clothing from 10 a.m. to 3 p.m. two or three times a week for 5 to 10 minutes.

Slathering skin with sunscreen with an SPF of 30 will reduce exposure to ultraviolet-B rays by 95 to 98 percent. But if you make enough vitamin D in your skin in summer, it can meet the body’s needs for the rest of the year, Dr. Holick said.

Can You Get Too Much?

If acquired naturally through skin, the body’s supply of vitamin D has a built-in cutoff. When enough is made, further exposure to sunlight will destroy any excess. Not so when the source is an ingested supplement, which goes directly to the liver.

Symptoms of vitamin D toxicity include nausea, vomiting, poor appetite, constipation, weakness and weight loss, as well as dangerous amounts of calcium that can result in kidney stones, confusion and abnormal heart rhythms.

But both Dr. Giovannucci and Dr. Holick say it is very hard to reach such toxic levels. Healthy adults have taken 10,000 I.U. a day for six months or longer with no adverse effects. People with a serious vitamin D deficiency are often prescribed weekly doses of 50,000 units until the problem is corrected. To minimize the risk of any long-term toxicity, these experts recommend that adults take a daily supplement of 1,000 to 2,000 units.

Belly fat boosts diabetes risks in seniors

It's a demonstrated fact that belly fat increases type 2 diabetes risk, and a new study confirms that's true for seniors too.

Gaining weight in your 50s and after age 65 can double your risk of diabetes later in life, according to a new University of Washington study. Being obese and having excess body fat around the waist also contributes to the risk of getting diabetes.

More than 80 percent of people with type 2 diabetes are overweight, according to the National Institutes of Health.

The new study confirms the importance of weight control in mid-life, and it suggests that "weight control remains important as we age," says lead study author, Mary Lou Biggs. "Prior to the study it was well established that adiposity [fat] was a strong risk factor in young and middle-age adults, but there was limited information on older adults," says Biggs.

Seniors are the fastest growing segment of our population and in the United States, and 12.2 million people or 23.1 percent of the people age 60 or older have diabetes, according to the National Institutes of Health. As we age we tend to experience loss of muscle mass, height, says Biggs, which is why she wanted to find out whether the risk factors for determining diabetes in older adults would be the same as younger adults.

The study looked at more than 4,000 participants and found 339 new cases of type 2 diabetes over an average of 12 years between 1989 and 2007. Researchers examined height, body weight, waist and hip circumference, body mass index (BMI), and body fat composition.

To have a baseline, participants were asked to self-report their weight at age 50. Researchers used that information to look at how BMI in midlife affects the risk of diabetes in later life, says Biggs.

The study in the current issue of the Journal of American Medical Association found those who were obese in midlife were more likely to develop diabetes later in life. Researchers also found that if people gained a substantial amount of weight between age 50 and older and after 65, they were more likely to develop diabetes. So it's really a combination says Biggs: Higher body fat and gaining weight are pretty strongly related to diabetes in older age.

The study also suggest that losing weight when you're over 65 doesn't reduce the risk of diabetes, as studies in younger people have shown.

However, preventing weight gain as you age may contribute to diabetes prevention. Consistent exercise can help reduce abdominal fat, even when your scale doesn't register a loss. To maintain weight but reduce belly fat, activities such as strength training can help reduce the waistline.

Study – Cayenne Fights Fat with an Extra Kick

June 9, 2010 by Isagenix Nutritional Sciences

Eating red chili peppers helps with weight loss, suggests study.

Scientists have already known for some time that capsaicin found in cayenne pepper (Capsicum anuum), or red chili pepper, is able to increase fat-burning potential by influencing secretion of adrenal gland hormones. A new study now suggests that this spicy compound may also combat weight gain in other ways by changing the make-up of proteins in fat cells.

Jong Won Yun and his colleagues at Daegu University, of South Korea, who published in April’s issue of Journal of Proteome Research, say they discovered that capsaicin alters proteins in fat cells that lead to markedly increased thermogenesis and fat metabolism, which suggests that this spice commonly used for flavoring foods “may be a useful phytochemical” for battling the bulge.

To better understand the chili compound’s mechanisms, the researchers compared its effects versus a saline solution on rats fed high-fat diets. The rats whose diets included 10 milligrams of capsaicin per kilogram per day had altered proteins that led to increased fat oxidation. They also lost an average of 8 percent of body fat during the study.

The study’s findings are red hot as the prevalence of overweight and obesity has reached epidemic proportions globally, with the World Health Organization reporting more than 1 billion people overweight and at least 300 million of them clinically obese. Consultation with a healthcare professional is always advised when beginning a weight management program and individual weight loss results will depend on level of activity and caloric intake.

Scientists must continue to perform more research to determine if cayenne pepper has similar effects on humans as it has in animals, although this study hints that there may be some benefit to ordering Indian, Thai or Mexican food “extra spicy.”

Previous research has also linked capsaicin with helping to assist in reducing fat levels in blood, reducing growth of fat cells, and inhibiting fat cell maturation. Capsaicin also may influence signaling pathways that lead to increased fat cell self-destruction.

Source: Joo JI, Kim DH, Choi JW, Yun JW. Proteomic Analysis for Antiobesity Potential of Capsaicin on White Adipose Tissue in Rats Fed with a High Fat Diet. J Proteome Res 2010.

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Pollutants and Pesticides Linked to Type 2 Diabetes

A unique analysis, led by Atul Butte, assistant professor of medical informatics and pediatrics at the Stanford University School of Medicine, used a government database to examine 266 potential environmental contributors to type 2 diabetes and confirmed links between several pollutants and the disease that affects about 24 million Americans. The research appears online in the May 20th edition of PLoS One.

Butte and colleagues examined data collected by the Centers for Disease Control and Prevention as part of the National Health and Nutrition Examination Survey (NHANES). The participants in the survey answer questionnaires about their health and submit blood and urine samples every two years. The agency then tests each sample for hundreds of pollutants and nutrients and, if present, measures the concentration.

Read: Study Shows Link Between Bad Air and Diabetes

Using this data, the researchers identified three factors linked to high blood sugar levels, including polychlorinated biphenyls (PCB’s), heptachlor epoxide, and a form of vitamin E called gamma-tocopherol. A positive factor affecting blood glucose levels was beta-carotene; those with the highest levels had 40% lower prevalence of diabetes.

PCB’s are a group of man-made organic chemicals that were used in a variety of products such as industrial electrical, heat transfer, and hydraulic equipment. They can also be found in oil-based paint, plastics, and floor finish. They have been banned from use in the United States since 1979 but may still be present in some products and materials made before that time.

Heptachlor, a breakdown product of a previously common pesticide, was banned in 1988 however it persists in water and soil and can accumulate in the tissues of animals. The chemical is known to be able to be passed from mothers to infants through breast milk.

Read: Children Plus Pesticides Don't Mix, Link to ADHD

Vitamin E appears in eight different molecular forms: four tocopherols and four tocotrienols. While alpha-tocopherol is the main vitamin E source in dietary supplement products and preferentially absorbed by the human body, gamma tocopherol is the most common form in the standard American diet.
Beta-carotene is a precursor to vitamin A and found mainly in yellow- and orange-colored foods such as carrots, pumpkins, mangoes, and sweet potatoes. It is also found in dark, leafy greens such as spinach and kale.

The scientists are careful to caution, however, that an association doesn't necessarily mean cause, and that more research is needed to fully understand these complex relationships. Also, Butte considers his study a “first step” toward broader examinations of environmental influences on disease, because the analysis only examines a small number of factors.

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