Whether low levels of vitamin D cause any of these diseases or are simply another abnormality found in people with these illnesses has yet to be determined. Future studies are being planned in which obese type 2 diabetics are treated with vitamin D to see if these diseases can be improved.

Gary Pepper, M.D. Editor-in-Chief, Metabolism.com

The entry Low Vitamin D Linked to Obesity and Atherosclerosis in Diabetics was published at Metabolism Blog . Get the Metabolism book from the same author.

The entry Good News About an Old Enemy….Cholesterol!…….. by Beth Ellen DiLuglio M.S., R.D., C.N.S.D., C.C.N., LD/N was published at Metabolism Blog . Get the Metabolism book from the same author.

When the intestines fail to absorb fats due to surgery or due to disease, Vitamin D which is a fat soluble vitamin, can see its levels fall dramatically. Otherwise healthy people in the U.S., however, are being found to have unacceptably low Vitamin D levels. Is it due to inadequate diet or is it a result of wide spread sunlight phobia?

Here is Annette’s post followed by my response to her question. Answers to these questions are contained in this exchange.

Annette writes:

I had a Bilio Pancreatic Diversion surgery done in 1990. My Vitamin D level is low, at 15.
My Dr. has me on 50,000 iu of Vit D every other day, 4,000 iu on the other days.

May I ask you, what is your opinion on this amount of Vit. D. The 50,000 iu capsules are by prescription.

Thanks so Much,

AS
**************************************************

Metabolism.com responds:

Vitamin D deficiency is a serious problem and has been largely overlooked in the general population until recently. Vitamin D is not only important for bone health but we are learning it is important for the immune system and may help protect against certain cancers. In my medical practice in Florida I am finding an alarming number of my patients with very low and borderline low levels of Vitamin D that were totally unexpected. I assume it is because everyone knows that sunlight is bad because it causes wrinkles and skin cancer. The further north you live the weaker the sunlight so the incidence of vitamin D deficiency is higher.

Until recently the recommended daily Vitamin D allowance was 400 IU but recently this was increased to 800 IU and some authorities recommend higher amounts.
10,000 IU levels daily for the average normal person is thought to be an upper limit before toxicity can be seen. Vitamin D is a fat soluble vitamin so in people who have problems absorbing fat, such in your case after intestinal bypass surgery, higher amounts are needed. Vitamin D doses of 50,000 IU at a time are not unusual but are usually given only a few times weekly or monthly, depending on needs. A handy tip is that deficient Vitamin D causes serum calcium levels to be low, so many clinicians will monitor serum calcium levels to help adjust the prescription.

Although I can’t recommend medical therapy in this forum I have some thoughts I can share. Why not get another blood vitamin D level measured to see if the amount you are getting is okay? Calcium levels go up in vitamin D excess so a serum calcium level that is elevated can be an indication of too much vitamin D.

Hope that helps. Keep us posted.

The metabolism.com website disclaimer applies to this and all my posts.

G. Pepper

The entry What is the Correct Vitamin D Dosage? was published at Metabolism Blog . Get the Metabolism book from the same author.

Nutrition information is notorious for being confusing, contradictory, and not exactly “user friendly”. Actually, the US government not only provides general guidelines for healthy eating but goes as as far as to actually recommend specific amounts of nutrients.

I’ll never forget this very interesting situation that happened during my undergraduate years as a dietetics student at The University of Rhode Island. My senior year, I was doing some house painting to help pay for school. During my lunch break for the day, I pulled out my bad of strawberries. My boss spontaneously asked me: “how much potassium is in a strawberry”? My response (I’ve edited it for this article-metabolism.com is a family friendly site): “I have no clue”. My boss was shocked that I didn’t know, as if I was spending all my time in college memorizing nutrition facts for every food on planet earth.

What I told him was that, not only is memorizing the nutrients of all foods impossible, it’s truly not necessary to eat healthy. In fact, you don’t even need to pay attention to the recommended amounts of nutrients that are on food labels-with 5 crucial exceptions.

10

10 is for the servings of colorful fruit and vegetables to eat everyday. This recommendation is not only based on the drastic reduction in chronic disease risk for those that eat 10 servings, but it most accurately reflects the way our ancestors used to eat.

Unfortunately, most Americans fall far short of this amount. For many, it takes a giant shift in eating patterns to reach 5 servings (the old recommendation), never mind 10.  Trust me, that “giant shift” is well worth it. It will likely not only help your body fight disease, but you will have more energy as well.

3

3 is for the servings of fatty fish to be eaten on a weekly basis. Fatty fish provides a boatload of omega-3 fats. The omega-3 fats found in fish are incredibly good at decreasing inflammation-the underlying cause of chronic disease. Besides the long-term health benefits, there is some very interesting research that suggests eating fatty fish can actually boost memory and mood.

0

0 is for the amount of trans fat that you should allow into your body. A consistent intake of trans fat drastically increases chronic inflammation. The increase in chronic disease in people who eat trans fat is so strongly documented that certain cities (New York City) and countries (Denmark) have either set limits or outright banned trans fat altogether.

25

25 is the minimum grams of fiber that should be consumed daily. Fiber regulates appetite, reduces colon cancer risk, and even aids in weight control. If you eat 10 colorful fruits and veggies everyday, you will be well on your way to achieving this. It’s important to note that it’s preferable to get fiber from food sources such as produce and whole grains as opposed to fiber supplements. But however you get it-make sure you are getting at least 25 grams!

2000

2000 is the amount (in international units, or IUs) of vitamin D you need everyday. Vitamin D’s role in human health cannot be understated. A deficiency in vitamin D negatively impacts your entire body. Despite this, most Americans are vitamin D deficient.  This is because getting 2000 IUs everyday can be a real challenge. Most of our vitamin D comes from sunlight-something that is difficult to get considering that nowadays we spend most of our time indoors. Diet is no help-there are very few foods that contain significant amounts of vitamin D. Taking a daily vitamin D supplement can make this a sinch.

10, 3, 25, 0, 2000: the 5 most important numbers you may ever learn.

Brian Dean MS, RD is a registered dietitian and researcher. After years of research, Brian has set his sights on helping those with lower back pain.  He serves on the Medical Nutrition Committee for The American Society for Nutrition and is a professional member of numerous research organizations including the International Association for The Study of Pain, American Chronic Pain Society, and The American Dietetic Association. He recently created a research-based lower back pain treatment program called The Back Pain Diet which is available from his website Stop Lower Back Pain.

The entry The 5 Numbers You NEED to Know To Eat Healthy was published at Metabolism Blog . Get the Metabolism book from the same author.

Over half of us take a multivitamin regularly for the purpose of improving our health. A slew of recent studies question whether they are doing us any good-or maybe even harm.

How Might Multi’s Help?

Here are some of the theories of how multivitamins may be beneficial:

1. Extra nutrients

2. A “safetey net” for nutrients that we may not get enough of

3. Reducing risk of chronic disease

The question remains: are these theories justified?

Most of the recent research says no. Let’s take a look at two of these recent studies to learn more.

Do They Work?

A recent paper published in the Archives of Internal Medicine set out to answer this very question. They took a look at the results from 12  studies that were previously published.

What they found was fairly inconsistent. Looking at the 12 studies individually, the results were all over the map. Some showed that multivitamins help prevent heart disease in men but not women, another would show the opposite. One study would show that women lived longer with a multivitamin while another would show no difference.

Combining the data was no help. The effect that a multivitamin had on reducing chronic disease risk or longevity was too small to conclude that it was anything more than chance. The authors concluded:

“Evidence is insufficient to prove the presence or absence of benefits from use of multivitamin and mineral supplements to prevent cancer and chronic disease”.

In other words: we’re not sure.

Why Don’t Multivitamins Work?

Another study, this one published in the American Journal of Clinical Nutrition, looked primarily at who tends to use multivitamins. Although about 50% of Americans take a multi, that 50% is far from evenly distributed among the population. In fact, the 50% that tends to use them are the ones that need the extra nutrient boost the least.

Multivitamin users tend to be affluent, non-Hispanic white, have a lower BMI, and engage in a higher level of physical activity-the exact group that tends to get enough vitamins and minerals from foods. The authors of the study suggested that taking a multivitamin may actually be harmful to this group as they may be getting toxic amounts of vitamins from the combination of healthy diet and the multivitamin.

This may explain why multivitamins don’t fight disease or increase lifespan: the people who take them have already “maxed out” their benefit from vitamins and minerals. However, it would be interesting to see how a multivitamin would affect a group that ate poorly. It may be unlikely that a multivitamin could partially compensate for poor eating habits, but it’s a possibility.

Take Home Message

As of today, the research is far from conclusive on the effect of a multivitamin on health. Don’t hold your breath: the studies currently being done on multivitamin use are mostly observational. This means that even if they do find an effect, the results may not be reliable. In the future, we may see studies that are more reliable (called randomized control trials). Regardless of the type of study, because the multivitamin research tends to look at diseases that take years to develop and have a laundry list of risk factors, the final word on multivitamins may not happen during our lifetime.

In the meantime, I would recommend that unless you have a stellar diet, taking a multi is not going to hurt you and may actually be beneficial. Also, they are a great supplement for the recession (some are as low as $.10 a pill) and provide nutrients that Americans tend to not get enough of like Vitamin D, Calcium, Magnesium, and Potassium.

If you take a multivitamin, you may be wasting your money, but at least it’s not much.

Here are the full-text links to the multivitamin studies:

Archives of Internal Medicine Article

AJCN Article

After years of research, Brian has set his sights on helping those with lower back pain.  He serves on the Medical Nutrition Committee for The American Society for Nutrition and is a professional member of numerous research organizations including the International Association for The Study of Pain, American Chronic Pain Society, and The American Dietetic Association. He recently created a research-based lower back pain treatment program called The Back Pain Diet which is available from his website www.backpaindiet.com

The entry Multiple Vitamins, Multiple Questions was published at Metabolism Blog . Get the Metabolism book from the same author.

The staff of metabolism.com wants to add a warning to people shopping for calcium and vitamin D supplementation. When shopping for these items be aware that there is a great variation in price among the various brands of supplements. The higher price brands often claim to be significantly better than cheaper competitors in terms of absorption and results. Be aware that many of these claims are false or exaggerated. Why spend $12 for 50 coral calcium pills when 100 Tums (calcium carbonate) can be gotten for half the price? If coral calcium is actually 20% better absorbed then calcium carbonate then an extra Tums per day will more than balance off any difference.

© Photographer: Ginosphotos | Agency: Dreamstime.com

The entry Calcium and Vitamin D supplements reduce fractures was published at Metabolism Blog . Get the Metabolism book from the same author.

Recent studies however, have shown that Vitamin D may serve many other important functions in the body. Several investigators found that low Vitamin D plays a role in “seasonal affective disorder” which is a form of depression occurring during the winter when little sunlight is available. Low levels of Vitamin D can be found in Alzheimer’s patients, and some researchers believe low levels of this vitamin may contribute to loss of muscle tone and frequent falling in the elderly. Recent studies link low Vitamin D levels in pregnant women to the development of preeclampsia (toxemia of pregnancy). Vitamin D was also shown to help lung function and to delay a common but serious eye disorder known as macular degeneration.

Studies also show that Vitamin D may help benefit the immune system and help reduce the incidence of certain cancers. Recent studies suggest vitamin D may help prevent or delay colon, breast and ovarian cancer. One study showed that 1000 IU of vitamin daily could cut the risk of colon cancer by 50% while another study found a similar risk reduction for pancreatic cancer in those who took vitamin D supplementation. Results of these studies are still inconclusive and require verification but point to an important role of vitamin D in cancer protection.

Until recently the recommended daily allowance of Vitamin D was 400 IU. Some researchers now state that this amount is too low and advocate a daily intake of 1000 IU. Vitamin D can be found in Vitamin D supplemented milk, many multivitamins and calcium supplements. Yoghurt, margarine, cooking oils, breakfast cereal and bread may also be fortified with vitamin D. Oily types of fish such as salmon, tuna, and sardines are excellent sources of vitamin D. In particular the fish liver stores much of the vitamin, hence “cod liver oil” is an excellent vitamin D source.

The vitamin D we ingest in pills and food is an inactive form of the vitamin which then must be activated in the kidney. For this reason those with kidney disease frequently must receive medication with activated vitamin D to prevent bone disease or other conditions related to low calcium levels in the blood.

A note of caution about vitamin D is sounded by some experts. While there is still plenty of debate about the amount of vitamin D which could be toxic, most authorities believe that up to 2000IU daily should be safe.

Only you and your doctor can decide on what medical treatments are best for you. The articles on metabolism.com such as this one are meant for educational purposes only and should not be used to guide you in your medical care. Speak to your health professional before undertaking to change or initiate medical treatment plans.

Gary Pepper M.D.
Editor-in-Chief
Metabolism.com

The entry The Vitamin D Story. An Old Dog with Some New Tricks. was published at Metabolism Blog . Get the Metabolism book from the same author.