The D Vitamins

D:

Vitamin D is a fat-soluble vitamin that is naturally present in very few foods, added to others, and available as a dietary supplement. It is also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis [1,2]. Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver and converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol [3].

Vitamin D is essential for promoting calcium absorption in the gut and maintaining adequate serum calcium and phosphate concentrations to enable normal mineralization of bone and prevent hypocalcemic tetany. It is also needed for bone growth and bone remodeling by osteoblasts and osteoclasts [3,4,5]. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults [2,6,7]. Together with calcium, vitamin D also helps protect older adults from osteoporosis.
Vitamin D has other roles in human health, including modulation of neuromuscular and immune function and reduction of inflammation. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D [3,5,8,9]


Natural sources

Fatty fish, such as salmon, are natural sources of vitamin D.Natural sources of vitamin D include:[1]
Fish liver oils, such as cod liver oil, 1 Tbs. (15 ml) provides 1,360 IU (one IU equals 25 ng)
Fatty fish species, such as:
Herring, 85 g (3 ounces (oz)) provides 1383 IU
Catfish, 85 g (3 oz) provides 425 IU
Salmon, cooked, 100 g (3.5 oz]) provides 360 IU
Mackerel, cooked, 100 g (3.5 oz]), 345 IU
Sardines, canned in oil, drained, 50 g (1.75 oz), 250 IU
Tuna, canned in oil, 85 g (3 oz), 200 IU
Eel, cooked, 100 g (3.5 oz), 200 IU
A whole egg, provides 20 IU
Beef liver, cooked, 100 g (3.5 oz), provides 15 IU
UV-irradiated mushrooms (Vitamin D2)[28][29]

In the United States (U.S.), typical diets provide about 100 IU/day. Although milk is usually fortified there, this is insufficient in practice to obtain the levels recommended by various U.S. medical authorities and institutes.[30] Adequate Intake has been defined as 200 IU/day for ages infant to 50, 400/day for 51-70, and 600/day over 70. However, the American Academy of Pediatrics argues that these recommendations are insufficient and instead recommends a minimum of 400 IU, even for infants.[31] The 100% Daily Value used for product labels is 400 IU. The NIH has set the safe upper limit at 2000 IU, but acknowledges newer data supporting a UL as high as 10,000 IU/day.[32] The Institute Of Medicine is revisiting vitamin D and calcium recommendations. The report is expected in spring 2010.



What are deficiency symptoms for vitamin D?


Vitamin D deficiency results in decreased absorption of calcium and phosphorus. As a result, prolonged vitamin D deficiency has a negative impact on bone mineralization. In infants and children, such a deficiency manifests itself as rickets, a condition characterized by bone deformities and growth retardation. Adults with vitamin D deficiency may experience bone pain and/or osteomalacia (soft bone).
It is particularly important for individuals with limited sun exposure to include good sources of vitamin D in their diets. Homebound individuals, people living in northern latitudes, individuals who wear clothing that completely covers the body, and individuals working in occupations that prevent exposure to sunlight are at risk for vitamin D deficiency.
In addition, breast milk may not contain a sufficient amount of vitamin D, so exclusively breast-fed infants may require supplemental vitamin D.



What health conditions require special emphasis on vitamin D?

Vitamin D may play a role in the prevention and/or treatment of the following health conditions:
Atherosclerosis
Breast cancer
Colon cancer
Ovarian cancer
Depression
Epilepsy
Hypertension
Inflammatory bowel disease
Kidney disease
Liver disease
Multiple sclerosis
Osteoporosis
Periodontal disease
Preeclampsia
Psoriasis
Tinnitus
Ulcerative colitis


What are current public health recommendations for vitamin D?

In 1997, the National Academy of Sciences established the following Adequate Intake (AI) levels for vitamin D:

Infants and children: 5 micrograms (200 IU)
Teenagers: 5 micrograms (200 IU)
Adults up to 50 years of age: 5 micrograms (200 IU)
Adults 51-70 years: 10 micrograms (400 IU)
Adults above 70 years: 15 micrograms (600 IU)
Pregnant and lactating women: 5 micrograms (200 IU)
Since the establishment of these vitamin D recommendations in 1997, over 3,000 research studies involving vitamin D have been published in top level science journals. Many of these studies suggest that significantly higher levels of vitamin D may be essential for certain groups of people. These groups include persons living in more northern geographical areas, for example, residents in the Pacific Northwest or New England in the United States; obese persons; persons getting very little sunlight due to indoor jobs or personal habits, including constant use of sunscreen; and persons with naturally darker skin. Individuals in these categories are likely to require at least 1,000 IU per day, an amount significantly higher than the 200-600 IU levels listed above


Links:
http://whfoods.org/genpage.php?tname=nutrient&dbid=110#healthconditions
http://ods.od.nih.gov/factsheets/vitamind.asp
http://en.wikipedia.org/wiki/Vitamin_D

One of the most interesting sessions of the recent 2009 North American Menopause Society discussed the impact of Vitamin D on health issues important to women. Did you know that low levels of vitamin D have been linked to breast cancer, colon cancer, ovarian cancer, high blood pressure, and strokes? This is in addition to the well established role that vitamin D plays in bone health. Condensing the most current research down to a practical level let's answer these questions:

• Is all Vitamin D the same?
• What are some common sources of Vitamin D?
• How much Vitamin D is recommended?
• How much of an impact does vitamin D have on female cancers?
• What about other health problems?
• Should I get my blood Vitamin D level tested?

Is all Vitamin D the same?

Vitamin D from sunlight, foods, and even vitamin supplements is not biologically active. It has to undergo two processes, the first occurring in the liver which converts vitamin D to the 25(OH)D form, also known as calcidiol or Vitamin D². The kidney then makes the most active form 1,25(OH)²D, also known as calcitriol or Vitamin D³. If you check your bottle of vitamins, or calcium + vitamin D supplements, you can see which type you have been taking. Currently the preferred supplement form may be Vitamin D³ as it increases the amount of active Vitamin D while increasing the time Vitamin D is active in the blood and tissues.

What are some common sources of Vitamin D?

Vitamin D is made when UV-B rays strike the skin. One general recommendation has been to have 20 minutes of sun exposure to face, arms, leg or back twice a week during the most intense times for sun exposure (i.e., 10:00 AM through 3:00 PM). Alas, the amount of Vitamin D that can be obtained this way can be limited by several factors. If one has dark skin, uses an 8 or greater SPF sunscreen, wears occlusive clothing, or gets sun exposure only through window glass-the amount of Vitamin D is greatly decreased. If one lives above the 42nd parallel, the months of November through February do not produce sufficient Vitamin D even when the sun is not hidden by clouds. Cloud cover, shade, and air pollution will further reduce the amount of UV-B.

Many of us prefer to get vitamins naturally from whole foods as opposed to supplements. Some of the highest sources of Vitamin D are listed below:

Cod liver oil, 1 tablespoon 1360 IU
Cooked salmon, 3.5 ounces 400 IU
Sardines in oil, drained 1.75 ounces 250 IU
Tuna in oil, drained 3 ounces 200 IU
Vit D fortified orange juice, 1 cup 142 IU
Vit D fortified milk, 1 cup 98 IU
Vit D fortified yoghurts, 6 ounces 80 IU
Egg yolk, 1 20 IU

For comparison, the usual amount of Vitamin D in a multivitamin pill is 400 IU (International Units).

How much Vitamin D is recommended?

Since the 1930's, when milk was first fortified with vitamin D to prevent rickets, the usual recommendation has been 200 IU to 400 IU daily during times of inadequate sun exposure. Women above age 50 should be receiving 400 IU to 800 IU. Recently, experts in the area have been lobbying for a new recommended level of 1000 IU daily among adults (Vieth, 2007). The Food and Nutritional Board at the Institute of Medicine began reviewing the published studies in 2008 and are expected to publish new guidelines in spring of 2010.

For comparison, the upper tolerable limit (adverse results begin to appear) has been reputed to be 2000 IU/day. Many researchers in the field have suggested that the toxic level is closer to 10,000 IU/day over a more prolonged period of time.

How much of an impact does Vitamin D have on female cancers?

Breast Cancer
Given what you now know about the different types of Vitamin D and the different amounts used by women you can appreciate the difficulties in trying to establish the clear cut role of Vitamin D in cancer prevention. In the most recent, largest study (meta-analysis) of Vitamin D, calcium and the prevention of breast cancer (Chen, 2009), both Vitamin D and calcium seemed to be protective for the development of breast cancer. The best results were among women with the highest intakes of Vitamin D and calcium as compared to the lowest levels of consumption. The top quarter of women having the highest blood 25(OH)D levels had a 45% decreased risk of breast cancer.

Another study of 562 women (Rejnmark, 2009) found that the 142 women with a diagnosed breast cancer had, on average, lower blood levels of 25(OH)D. Women with the highest levels of 25(OH)D had a significantly reduced risk for breast cancer. Surprisingly, use of Vitamin D supplements, sunbathing, and fish intake did increase blood levels of 25(OH)D-but the lifestyle factors did not directly impact the risk of breast cancer.

Conversely McCullough and colleagues (2009), studying almost 22,000 women, found no impact of blood levels of 25(OH)D on the risk of breast cancer. A study of almost 42,000 Swedish women (Kuper, 2009) did not identify linkages between breast cancer risk and sun exposure, nor Vitamin D intake through diet or multivitamin use.

Ovarian Cancer
The impact of Vitamin D on ovarian cancer has not been as well studied but it has been purported to have a protective effect. Researchers at the Channing Laboratory (associated with Harvard University) used data from four large studies to examine the effects of Vitamin D (Tworoger, 2009) on ovarian cancer. It was determined that blood levels of Vitamin D did not directly impact cancer risk from any of the four genotypes. However, a specific type of the Vitamin D receptor gene was significantly tied to ovarian cancer risk.

What about other health problems?

Colon Cancer
Several studies have found that blood levels of 25(OH)D could be predictive of colon cancer risk. More recently Ng (2009) and fellow investigators looked at both risk for getting colon cancer, and the ability to survive, as it related to 25(OH)D blood levels among 1017 persons. Participants in the top quarter of 25(OH)D levels, as opposed to the lowest quarter, had significantly less colon cancer. They also had the lowest death rates from colon cancer, and the lowest rates of over all mortality.

Cardiovascular Disease
In Finland a 25-30 year study of over 6,000 persons found an increased risk of fatal vascular disease in those who had the lowest blood levels of 25(OH)D. Interestingly, this relationship was apparent for the incidence of strokes but not heart attacks (Kikkinen, 2009). Proposed mechanisms for improved blood vessel health include Vitamin D's beneficial impact on high blood pressure via kidney hormones, decreased inflammation inside the arteries, and improved insulin resistance via changes in parathyroid hormone (Lee, 2008).

Depression
There have been studies suggesting that high dose supplements of Vitamin D, or fish oil supplements, may improve mild depression. Jorde (2008) noted an improvement in scores on the Beck Depression Inventory after a year of supplementation with 20,000-40,000 IU per week of Vitamin D as compared to placebo. This was a study of overweight and obese subjects, not persons with diagnosed depression. At this point, treatment with high dose Vitamin D for depressive symptoms is considered experimental and should be considered only with medical supervision.

Systemic Lupus Erythematosus (SLE) & Rheumatoid Arthritis (RA)
Vitamin D has found to have effects on immune function and inflammation. Earlier studies suggested a relationship of Vitamin D to autoimmune conditions. A group of women within the Nurses Health Study was targeted with food and vitamin questionnaires. There was no apparent association between increasing Vitamin D intake and the risk of developing these autoimmune disorders (Costenbader, 2008).

Should I get my blood level of Vitamin D checked?

As with many blood tests (e.g., hormone levels) there can be considerable variation in results from lab to lab, time of day or season (e.g., Vitamin D levels tend to be best at the end of summer). Perhaps the best indicator of general Vitamin D levels is 25(OH)D blood test for it measures Vitamin D from both sun and dietary sources. This form of Vitamin D also lasts in the body for around 30 days.

In many cases the "normal" or preventative level of Vitamin D has yet to be determined. Cardiovascular risk begins to rise steeply when the blood level of 25(OH)D is below 10-15 ng/mL. Optimal levels may be at least 30 ng/mL. Depending upon all other factors present it might take a daily intake of 1000-2000 IU per day get to blood levels of 30 ng/mL (Giovannucci, 2009). The following blood 25(OH)D levels are taken from an updated National Institutes of Health document:

Blood level Health Status
Ng/mL nmo/L
<10-15 <25>15 >37.5 Adequate for healthy persons
>200 >500 Potentially toxic

Some Vitamin D researchers have stated that most benefits level out at blood levels of 30-40 ng/mL (Giovannucci, NAMS 2009). It will remain to be seen if the new recommendations due to be published in May of 2010 will have different cut off levels for defining optimal blood levels.

So, who should push for blood testing? Bearing in mind that the 25(OH)D blood test can cost upwards of $200, many primary care providers have chosen to just recommend an increased intake of Vitamin D. The dose is based upon the person's specific health history. Until there are studies set specifically to establish optimal dosage and blood levels the primary care model makes sense. Among healthy adult women, without excessive sun contact, consuming 800 IU per day of Vitamin D is a reasonable choice. For your specific Vitamin D recommendation, check with your GYN or primary care provider.

Link:
http://blogs.webmd.com/womens-health/2009/11/vitamin-d-and-womens-health.html

Nutrition 101: Vitamin D
Published in March 2007
Prepared by Jessica Hookham
Reviewed by Gloria Tsang, RD








Common names
Vitamin D, Calciferol, Cholecalciferol


Recommended Intake
Males and females 19-50 yrs: 5 ug/day (200 IU/day)
Males and females 51-70 yrs: 10 ug/day (400 IU/day)
Males and females > 70 yrs: 15 ug/day (600 IU/day)
Note: these intakes assume no vitamin D is being synthesized in the body from sunlight


What's Vitamin D for?
Maintains levels of calcium and phosphorous in the body, thus assisting in bone and teeth formation
Prevents bone deformation diseases, such as rickets in children and osteomalacia in adults
Assists in immune function, cell growth, and fetal development
Lately, it has been shown to lower cancer risk


Best Food sources
Synthesized in the skin upon exposure to the UV rays in sunlight

Fatty fish sources, such as cod liver oil, salmon, tuna, sardines, and mackerel
Milk and some breakfast cereals are fortified with vitamin D
Egg yolk, beef liver, swiss cheese



Link: http://www.healthcastle.com/nutrition101_vitaminD.shtml
_________________

Vitamin D lowers Cancer Risk
Written by Gloria Tsang, RD of HealthCastle.com
last updated: April 2006

Another Study affirmed High Levels of Vitamin D lowers Cancer Risk
Researchers from the Harvard School of Public Health examined cancer incidence and vitamin D exposure of over 47,000 men in the Health Professionals Follow-Up Study. They found that a high level of Vitamin D (~1500 IU daily) was associated with a 17 percent reduction in all cancer incidences. The benefit of 1500 IU of Vitamin D was even greater in digestive cancers, with a 45 percent reduction of deaths from digestive cancers. Results of this study were published in the Journal of the National Cancer Institute on April 5, 2006.

Editor's Note - Increase Vitamin D Intake?
Recent studies have suggested daily intake of vitamin D should be raised from 400 IU to 1000 IU. In December 2005, we reported a Vitamin D review study. Researchers from the University of California found that oral intake of 1000 IU vitamin D can reduce the risk of colon, breast and ovarian cancers by as much as 50 percent. Since it is difficult to obtain 1000 IU of Vitamin D daily from food sources alone, the author recommended taking 1000 IU of the active form Vitamin D, i.e. D3 supplement, daily.

Similarly, the author of this study also suggested a daily supplementation of 1500 IU of Vitamin D to optimize benefits on cancer risk. These recommended levels are much higher than the current recommendations. The current Vitamin D recommendations for people of 1 - 50 years of age is 200 IU daily; 400 IU for adults of 51 - 69 years of age. After age 70, 600 IU of vitamin D are recommended each day. The tolerable upper intake level (UL) for Vitamin D is 2000 IU - in other words it is safe to consume up to 2000 IU of vitamin D daily.

Although promising, it is still too early to start recommending everyone to pop a Vitamin D pill a day. However it is wise to start including more Vitamin D-rich foods in your diet. One glass of milk contains 100 IU of Vitamin D. Other food source includes fatty fish and egg yolks. Also look for Vitamin D fortified-products such as yogurt and breakfast cereals.

If you would like to adopt a healthy eating pattern to reduce cancer risk, try eating a lower fat diet rich in antioxidants and fiber with plenty of fruits & vegetables as well as whole grains.
http://www.healthcastle.com/vitamin-d-cancer2.shtml

Vitamin D - Anti-inflammatory in Congestive Heart Failure
Written by Gloria Tsang, RD of HealthCastle.com
last updated: April 2006

Study suggested High Levels of Vitamin D may curb inflammation in Congestive Heart Failure
German researchers investigated the anti-inflammatory property of Vitamin D in over 100 patients with congestive heart failure. Patients were supplemented with either 50 mcg (2000 IU) of vitamin D3 plus 500 mg of calcium, or placebo with 500 mg of calcium. After 9 months of supplementation, significantly higher levels of the anti-inflammatory agent, cytokine interleukin 10, were found among patients in the Vitamin D group. Results of this study were published in the American Journal of Clinical Nutrition in April 2006.

Editor's Note - More potential benefits of Vitamin D were found!
It is exciting to learn that more potential benefits of Vitamin D have been uncovered. The author of this study suggested that Vitamin D3 may serve as a new anti-inflammatory agent for treatment of congestive heart failure. Despite this promising finding, more studies are needed to investigate the role of Vitamin D in congestive heart failures. The current Vitamin D recommendations for people of 1 - 50 years of age is 200 IU daily; 400 IU for adults of 51 - 69 years of age. After age 70, 600 IU of vitamin D are recommended each day. It is important to note that the dosage of Vitamin D supplements used in this study was rather high - 2000 IU of Vitamin D is the upper tolerable level. Based on current recommended daily intake values, additional Vitamin D obtained through food or converted from sunlight will surpass this limit and hence may lead to toxicity.

However, recent studies have suggested the daily intake of vitamin D should be raised to 1000 IU. In December 2005, we reported a Vitamin D review study. Researchers from the University of California found that oral intake of 1000 IU vitamin D supplements can reduce the risk of colon, breast and ovarian cancers by as much as 50 percent.

Similarly, another study we reported in early April 2006 also suggested a daily supplementation of 1500 IU of Vitamin D to optimize benefits of cancer risk.

Although promising, it is still too early to start recommending everyone to pop a Vitamin D pill a day. However it is wise to start including more Vitamin D-rich foods in your diet. One glass of milk contains 100 IU of Vitamin D. Other food sources include fatty fish and egg yolks. Also look for Vitamin D fortified-products such as yogurt and breakfast cereals.

Link:
http://www.healthcastle.com/vitamin-d-heart.shtml

Wednesday, February 17, 2010
Vitamin D Strikes Again!

The vitamin that may reduce your chances of developing heart disease and diabetes by 43%.

If you are considered "middle aged" or older, you might want to listen up. According to researchers at the University of Warwick Medical School, high levels of vitamin D could reduce your chances of developing heart disease by 33% and diabetes by 55%, compared to people with low levels of D.

Through a review of 28 studies including almost 100,000 men and women, an association between high levels of vitamin D and a substantial decrease in cardiovascular disease, type 2 diabetes, and metabolic syndrome was revealed.

Vitamin D is the vitamin of the decade. It seems to be popping into the news and research on an almost daily basis. The tricky thing about this fat-soluble vitamin is that it is found naturally in only a few foods - oysters, most types of fish( but particularly fatty fish like mackerel and salmon), and egg yolks from chickens fed vitamin D. And vitamin D is synthesized by your body when skin is exposed to UV rays from sunlight.

More and more foods and products are being fortified with vitamin D: milk, yogurt, margarine and cereals. When you have a choice between a food or product with vitamin D added and one without, think about the results of this research analysis. See below for some examples of vitamin D fortified foods and the adequate daily dietary intake for vitamin D.

A Sampling of Vitamin D Fortified Foods



Qty. Vit. D
Cereals:


Wheat Chex 1 cup 40 IU
Total Raisin Bran 1 cup 40 IU
Total with Strawberries 1 cup 40 IU
Smart Start Antioxidants 1 cup 40 IU
Yogurt:


Dannon Light & Fit 6 oz 80 IU
Yoplait Original 6 oz 80 IU
Yoplait Light 6 oz 80 IU
Margarine:


Canola Harvest 1 Tbsp 60 IU
Smart Balance 67% Buttery Spread 1 Tbsp 60 IU
Promise Buttery Spread 1 Tbsp 60 IU
Fleischmann's Original 1 Tbsp 60 IU
Soy Products:


Soy cheese, assorted flavors 1 slice 80 IU
Gimme Lean! Ground Beef Style 2 oz 40 IU
Meatless Chick'n Nuggets 4 pc 80 IU
Tofu, extra firm or firm 2.8 oz 60 IU
Meatless burgers 1 patty 60 IU

Link: http://blogs.webmd.com/healthy-recipe-doctor/2010/02/vitamin-d-strikes-again.html?ecd=wnl_wmh_030110

6 Reasons to Get Your Dairy
Low-fat dairy offers many health benefits
By Elaine Magee, MPH, RD
WebMD Weight Loss Clinic - Expert ColumnI'll admit to being part of the Baby Boomer generation, albeit one of the younger members. If you're a Boomer, too, you probably recall that many of us grew up drinking milk at every meal. Unlike today, soda was reserved for parties and the occasional trip to the Golden Arches or a downtown diner.

You may no longer have a glass of cold milk with each meal, but mom was right about one thing: dairy foods offer a bounty of health benefits (just make sure to choose low-fat this time around).

And we do love our dairy. Statistics show that while Americans' consumption of whole milk and butter has been going down, cheese and premium ice cream are on the rise (does that mean we're trading one type of high-fat dairy food for another?).

The good news is that while we baby boomers have been climbing toward (and past) 50, the yogurt aisle has exploded with choices beyond our wildest imaginings. Reduced-fat cheeses have taken their permanent place on the dairy shelf as well. Never has it been easier to work in a few servings of healthy dairy every day.

Low-Fat Is the Answer
A recent study showed that the more servings of dairy foods that adults consumed, the greater the percentage of their total calories that came from saturated fat (definitely not a good thing).

But the other side to the story is that their intake of many key nutrients -- like protein, calcium, magnesium, folate, B1, B2, B6, B12, and vitamins A, D, and E -- also increased along with the number of dairy servings.

So how do you get all those great nutrients from dairy without the drawbacks? Low-fat dairy is the answer! As you decrease the fat in dairy products, you cut calories, saturated fat, and cholesterol, while protein, calcium, and most other vitamins and minerals remain high.

6 Reasons to Get More Dairy
Here are six reasons you should include low-fat dairy foods in your diet:

Calcium and Protein

Some dairy items have impressive levels of two things many of us need more of: calcium and protein. I'm sorry to say that ice cream falls a bit short on these two nutrients, but low-fat milk, yogurt, cottage cheese, and reduced-fat cheese pack a protein and calcium punch in every serving. Just a cup of lite nonfat yogurt, for example, gives you a third of your daily recommended calcium intake, along with 17% of your estimated daily protein intake.

Food Calcium (mgs) Protein (grams)
Kraft 2% sharp cheddar cheese, 1 ounce 200 7
Part-skim mozzarella cheese, 1 ounce 207 8
Skim milk, 1 cup 301 8.4
Low-fat milk (1%), vitamins A &amp; D added, 1 cup 270 9
Low-fat (2%) cottage cheese, 1 cup 180 26
Low-fat plain yogurt, 1 cup 448 13
Nonfat lite raspberry yogurt, 1 cup 350 8
6 Reasons to Get More Dairy continued...
Vitamin D

Many brands of milk are fortified with vitamin D, and now some yogurt manufacturers are joining in. Vitamin D is an important vitamin, yet many of us don't get enough in our diets. Our bodies can actually make vitamin D if we get adequate sunlight, but this can be a problem for people who are housebound or who live in areas that don't get a lot of sun.

Drinking vitamin D-fortified low-fat milk is an easy way to boost your vitamin D. Vitamin D has long been known for promoting healthy bones through its role in calcium absorption. And recent research has indicated that it may be helpful for all sorts of other things, from reducing the risk of certain cancers to lowering blood pressure.

Bone Density

Getting calcium from food, rather than supplements, seems to do your bones good. A study in Finland looked at changes in bone thickness and density in girls 10 years old-12 years old whose diets were supplemented with either cheese, calcium, or calcium plus vitamin D. The cheese-eating group appeared to have bigger increases in bone mass than the other groups.

Blood Pressure

Researchers in Spain who studied more than 5,000 adults found that those who reported consuming the most low-fat dairy (mostly skim and reduced-fat milk) were 54% less likely to develop high blood pressure over a two-year period than those with the lowest intakes of low-fat dairy.

Calcium has been suspected of having an effect on blood pressure in the past. But the Spanish researchers found that only calcium from low-fat dairy products was related to a lower blood-pressure risk. The researchers suggested that this could have something to do with the proteins found in low-fat dairy (caseins and whey), which may have actions similar to those of blood pressure-lowering drugs.

Metabolic syndrome

After studying data from 827 men and women, Iranian researchers concluded that those who consumed the most dairy (milk, yogurt, and cheese) were less likely to have enlarged waists and metabolic syndrome, a group of symptoms that has been shown to increase the risk of diabetes and heart disease.

Weight

In a recent review article, a researcher from the University of Alabama at Birmingham noted that although an analysis of overall calcium consumption has not linked calcium to greater weight loss, there is increasing evidence that calcium from dairy products may play a role in body-weight regulation.

For any or all of the above reasons, aim to work in some low-fat dairy each day, whether it's from skim or 1% low-fat milk, low-fat yogurt, cottage cheese, reduced-fat cheese, or a combination.

Link: http://www.webmd.com/diet/features/6-reasons-to-get-your-diary

Vitamin D Linked to Lower Heart Risk
Studies Show Supplements of Vitamin D May Help Protect Against Heart Disease
By Jennifer Warner
WebMD Health NewsReviewed by Elizabeth Klodas, MD, FACCMarch 1, 2010 -- Vitamin D supplements may not only help your bones, they may help protect your heart.

A new review of research on vitamin D and calcium supplements shows that people who take moderate to high doses of vitamin D have a lower risk of heart disease. Calcium supplements seemed to have little effect on heart disease risk.

Vitamin D is produced by the body in response to exposure to sunlight but is also commonly found in fortified dairy products and supplements. It is already known to play a critical role in calcium absorption and bone health, but a growing number of studies suggest that vitamin D supplementation may also lower the risk of heart disease.

Researchers say vitamin D and calcium deficiency is a common problem among the elderly throughout the world. In the United States, the Institute of Medicine recommends vitamin D supplements at a dose of 400 to 600 International Units (IU) per day and calcium at a dose of 1,200 milligrams per day for adults over age 50.

But recent research suggests that significantly higher doses of vitamin D may be required to reap the maximum health benefits of vitamin D supplements.

To help clarify the role of vitamin D and calcium in heart disease risk, researchers analyzed 17 studies published between 1966 and 2009 on vitamin D and calcium supplementation and heart disease. The results appear in the Annals of Internal Medicine.

Researchers found six studies (five of which involved people on dialysis and one which included the general population) showed a consistent reduction in heart-related deaths among people who took vitamin D supplements. But four studies of initially healthy individuals found no differences in development of heart disease between those who received calcium supplements and those who did not.

A second analysis of eight studies showed a slight, but statistically insignificant 10% reduction in heart disease risk among those who took moderate to high doses of vitamin D supplements. No such reduction in heart disease risk was found among those who took calcium or a combination of calcium and vitamin D supplements.

Researchers say very few studies have specifically investigated the effect of vitamin D supplements alone or in combination with calcium on heart disease risk in healthy people.

But evidence to date "suggests that vitamin D supplementation at moderate to high doses may have beneficial effects on reducing the risk for CVD [heart disease], whereas calcium supplementation seems to have no apparent effect," write researcher Lu Wang, MD, PhD of the division of preventive medicine at Brigham and Women's Hospital in Boston and colleagues.

They say more research is "urgently needed" to better explain the role of vitamin D in preventing heart disease.

The data should not be interpreted to mean that calcium supplements are harmful. Although calcium had only a neutral effect on heart health in the current analysis, calcium is known to be important for bone health. Calcium intake remains below recommended levels for a large portion of the U.S. population.

Link: http://www.webmd.com/heart-disease/news/20100301/vitamin-d-linked-to-lower-heart-risk?

Even on formula, babies not getting enough vitamin D


(Health.com) -- The vast majority of infants in the U.S. are not getting the vitamin D that they need, even if they are fed vitamin-enriched formula, a new study has found.

Roughly 9 out of 10 breast-fed babies receive less vitamin D than experts recommend, according to the study, which was conducted by researchers at the U.S. Centers for Disease Control and Prevention. Among formula-fed babies, fewer than 37 percent consume the recommended amount.

It is well-known that breast-fed infants are at risk for vitamin D deficiency. But the study findings suggest that most babies will require a supplement regardless of how they're fed.

"We have to educate moms and the health-care community that vitamin D supplementation is something that they should do [and] recommend," says the lead author of the study, Cria Perrine, Ph.D., of the CDC's division of nutrition, physical activity, and obesity.

The study, published this week in the journal Pediatrics, comes amid growing awareness of the extent - and the health risks - of vitamin D deficiency in both children and adults. Known as the sunshine vitamin, because the human body produces it when exposed to sunlight, vitamin D is essential for healthy bones, a strong immune system, and a range of other bodily processes.

In children, too little vitamin D has been associated with bone softness and an increased risk of heart disease later in life, among other health problems. In 2008, the nation's leading organization of pediatricians, the American Academy of Pediatrics, doubled its recommendation for the amount of vitamin D that infants and children should consume daily, from 200 to 400 international units.

Health.com: The most important nutrient you're not getting

"Most infants will require a vitamin D supplement to reach the new AAP recommendations, while in the past we only thought that breast-fed infants would need supplementation," says Perrine. "Formula-fed infants would need to consume a liter of formula a day to meet the new recommendations, and most infants don't do that - especially those who are being fed with both formula and breast milk."

New mothers should discuss vitamin D supplements with their pediatricians, Perrine adds. (Although it takes just 10 to 15 minutes of sun exposure for the body to produce a day's worth of vitamin D, the AAP discourages sun exposure for infants younger than 6 months, and advises the use of sunscreen after that.)

Health.com: Why you need vitamin D now

Perrine and her colleagues reviewed data from a national study that monitored what new mothers fed their babies between 2005 and 2007. The study, known as the Infant Feeding Practices Study II, included more than 1,500 infants ages 1 to 10.5 months who were fed only breast milk, only formula, or a combination of the two.

By analyzing the infants' diet and whether they were receiving a vitamin D supplement, the researchers estimated what percentage of infants met the then-current AAP guidelines of 200 IU of vitamin D per day, as well as what percentage would have met the new intake guidelines released in 2008.

Very few infants who consumed breast milk alone - between 5 percent and 13 percent - met the current or former recommendation for vitamin D intake. Among the formula-fed infants, 81 percent to 98 percent met the former recommendation, but just 20 percent to 37 percent of the same infants would have met the current recommendation.

Most babies did not receive vitamin D supplements. No more than 13 percent of the breast-fed infants were given supplements, and fewer than 4 percent of the formula-fed babies received them.

The results - especially concerning formula-fed babies- are eye-opening, says Carrie Drazba, M.D., a pediatrician at Rush University Medical Center, in Chicago. "I don't think a lot of us realized that formula-fed babies are not meeting their vitamin D requirements," she says.

Although the most obvious health problem associated with vitamin D deficiency in babies is rickets, or soft bones, pediatricians are increasingly mindful of respiratory infections and chronic diseases (such as type 1 diabetes) that have been linked to inadequate intake of the vitamin in that age group, Drazba says.

A pair of studies published last year, for instance, found that children with low levels of vitamin D were more likely to have several risk factors that contribute to heart disease, including high blood pressure, high blood glucose, and low HDL (or good cholesterol).

"We're finding out that there are other risks associated with vitamin D deficiency besides rickets," says Drazba. "A lot of cells in our body have receptors for vitamin D."

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A second study, also published in Pediatrics this week, provides a snapshot of vitamin D deficiency among infants and their mothers in Boston during the same time period, 2005 to 2007. Fifty-eight percent of newborns and 36 percent of mothers were vitamin D deficient, the study found; the deficiency was deemed "severe" in 38 percent and 23 percent of the babies and moms, respectively.

Babies were less likely to be vitamin D deficient if their mothers took prenatal vitamins in their second and third trimesters, the study found. On the other hand, being born in the winter months increased the risk of vitamin D deficiency, as did being black. (Most of the individuals in the new study were black or Hispanic, and people with darker skin do not produce vitamin D as efficiently as lighter skin individuals when they are exposed to sunlight.)

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The new studies underscore that vitamin D deficiency is an issue that mothers and doctors need to address from birth through childhood and beyond, Drazba says.

"We're realizing that with the combination of more women breast-feeding and how we slather kids with sunscreen and don't let them run in the sun anymore, [kids] aren't getting the vitamin D exposure that they used to, or that they need," she says.

Vitamin D deficiency is a concern in adulthood as well. By some estimates, more than half of adults in the U.S. don't get enough vitamin D from sunlight or from fortified foods such as milk, the other main source of the vitamin. And in recent years studies have linked vitamin D deficiency in adults to a long list of serious health conditions, including heart disease, certain cancers, osteoporosis, diabetes, Alzheimer's disease, schizophrenia, depression, and some autoimmune disorders.

In response, the Institute of Medicine, an independent nonprofit organization that advises the U.S. government on health and medical matters, is now considering whether to raise its guidelines for vitamin D intake for adults and children of all ages. The institute is expected to announce its decision by the end of the summer

http://www.cnn.com/2010/HEALTH/03/22/vitamin.d.babies/index.html

Higher Vitamin D, Better Golden Years?
Older Adults With Higher Vitamin D Levels Have Improved Mobility, Study Finds


April 26, 2010 (Anaheim, Calif.) -- Vitamin D, already considered a way to help fight colds, cancer, diabetes, heart disease, and other ills, may also keep people mobile in their golden years, according to a new study.

Older adults who had higher blood levels of vitamin D had better physical functioning, says Denise Houston, PhD, RD, assistant professor of internal medicine at Wake Forest University in Winston-Salem, N.C. She presented the findings Sunday at the Experimental Biology 2010 meeting.

"Those with better vitamin D levels started out better and ended up better on physical performance tests," she tells WebMD.

Vitamin D in Older Adults: Study Details
Results have been mixed in previous studies looking at whether vitamin D helps physical functioning in older adults, Houston says. Some studies found no effect of boosting low vitamin D levels in seniors and other studies showed an association.

Vitamin D, important for promoting calcium absorption, maintaining muscle strength, promoting bone growth and repair, and other activities, is produced when ultraviolet rays from the sun strike the skin and spark its synthesis.

It's found naturally in few foods and is added to others. Deficiency is common, especially with age, because the ability to synthesize vitamin D declines. Older adults also have difficulty converting vitamin D to its active hormone form.

In the new study, researchers wanted to see if vitamin D could delay age-related changes in physical functioning.

So Houston and her colleagues evaluated 2,641 older men and women, on average age 75.

The older adults were part of the Health, Aging, and Body Composition (Health ABC) Study that looked at the links between body composition, health conditions, and mobility with age.

For this new analysis, Houston divided the adults into three groups, depending on whether their vitamin D levels as evaluated from blood samples was low, medium, or high.

Those terms were relative, she tells WebMD, as ''two-thirds had vitamin D insufficiency."

For the study, low blood levels of vitamin D were under 50 nanomoles per liter (nmol/L), high blood levels were those 75 or higher, and levels of 50-75 were intermediate.

All the adults were tested to assess physical function, including walking 400 meters (about 1/4 mile) as fast as possible, standing from a chair without using the arms, balance tasks, and other tests of their lower extremity strength and functioning.

The tests were given at the start of the study and repeated two and four years later.

Vitamin D Levels and Physical Functioning
"Over time, everybody declined in the tasks, as expected," Houston says.

However, those who started out with higher vitamin D did better on the tests than those whose vitamin D levels were lower at the start. "People who had higher levels started out with better physical functioning and because they started out better, they remained at higher physical functioning,'' Houston says.

''Those with adequate or optimal vitamin D status [the highest group] had approximately 5% higher physical performance scores and 5% faster walk speed on the 400-meter walk compared to those with insufficient vitamin D status at the 4-year follow up," she says.

Next, Houston wants to focus on whether vitamin D blood levels can predict disability in older adults and whether supplements can ward off disability and mobility problems.

Vitamin D Levels and Mobility: Second View
The study results aren't surprising to Erica T. Goode, MD, MPH, a physician at the California Pacific Medical Center's Health & Healing Center-Clinic in San Francisco, who was attending the meeting.

''I'm sure that this is accurate," she says of the finding that those adults with higher vitamin D levels performed better on the physical functioning tests.

Vitamin D: How Much Is Enough?
Exactly how much vitamin D is enough for older adults (and others, as well) is a matter of ongoing debate.

According to the Institute of Medicine, an adequate intake is 400 international units (IU) for adults 51 to 70 and 600 IU for people older than 70. A level of 2,000 IU is considered the ''upper tolerable limit" by the IOM.

But some nutrition scientists have challenged those recommendations, contending that up to 10,000 IU a day of the vitamin is generally safe.

''By all means, try to get at least 1,000 IU,'' Goode says.

The IOM is reviewing the data and is expected to have an update in May 2010.

Vitamin D is found in such foods as fatty fish (salmon, 794 IU per 3 oz serving), fortified milk (115-124 IU per cup) and cod liver oil (1,360 IU per tablespoon).

Link: WebMd.com

Take Vitamin D With Largest Meal
Absorption Increases by 50% When Vitamin D Is Taken with Biggest Meal, Study Finds
By Kathleen Doheny
WebMD Health NewsReviewed by Laura J. Martin, MDMay 7, 2010 -- Taking your vitamin D supplement with the largest meal of the day may boost its absorption substantially, according to a new study.

Researchers from the Cleveland Clinic instructed 17 men and women, average age 64, whose blood levels of vitamin D were borderline insufficient despite taking supplements, to take their supplements with the largest meal of the day.

After two or three months, the study participants had about a 50% increase in blood levels of the vitamin, regardless of the dose they took.

Researchers Guy B. Mulligan, MD, and Angelo Licata, MD, had noticed that patients typically report taking the supplement either on an empty stomach or with a light meal.

Because the vitamin is fat-soluble, the researchers speculated that taking it with a big meal would improve absorption.

Vitamin D is crucial not only to maintain bone strength, but research now suggests it plays a role in immune system problems, cancer, and cardiovascular disease.

The researchers measured blood levels of the vitamin at the start of the study and two or three months later. Participants took a range of doses, and the researchers divided them into three groups: less than 50,000 IU a week, 50,000 IU, and more than 50,000 IU. The daily doses ranged from 1,000 IU to 50,000 IU.

A dose of 400 IU is termed adequate for people 51-70, and 600 IU for people 71 and older, as set by the Institute of Medicine, but some experts believe much more is needed, especially in older adults. The current upper tolerable level is set at 2,000 IU daily. The recommendations are under review and an update is expected this month.

At the study start, the average blood level of the form of vitamin D measured, 25(OH)D, was 30.5 nanograms per milliliter. By the end, it was 47.2 ng/mL. A level of 15 and higher is termed adequate by the Institute of Medicine for healthy people, but the study participants had a range of health problems, such as osteoporosis and thyroid problems.

Few foods contain vitamin D naturally, and some foods are fortified with it. Vitamin D synthesis is also triggered when the body is exposed to sunlight.

The research is published in the Journal of Bone and Mineral Research.


Link: WebMD.com

Low Vitamin D Linked to Poor Diabetes Control

Study Finds Vitamin D Deficiency Common in People With Diabetes
By Kathleen Doheny
WebMD Health NewsReviewed by Laura J. Martin, MDJune 21, 2010 -- Vitamin D deficiency, long suspected to be a risk factor for glucose intolerance, is commonly found in people with poor diabetes control, according to a new study.

''Our study could not show cause and effect," says Esther Krug, MD, an endocrinologist at Sinai Hospital of Baltimore and assistant professor of medicine at Johns Hopkins University School of Medicine, Baltimore, who presented the findings at ENDO 2010, the annual meeting of The Endocrine Society, in San Diego.

But she did find that vitamin D deficiency was common in her study, with more than 91% of participants deficient. As the deficiency worsened, so did diabetes control. Only eight of the 124 participants took vitamin D supplements, she found.

About 18 million people in the U.S. have been diagnosed with diabetes, according to the American Diabetes Association, and about 6 million more are believed to have the condition but are undiagnosed.

Low Vitamin D, Poor Diabetes Control: The Study
Krug and her colleagues decided to look at vitamin D deficiency in the wake of reports suggesting that vitamin D has an active role in regulating pancreatic beta cells, which make insulin.

So they evaluated the medical charts of 124 people with type 2 diabetes (in which the body doesn't make enough insulin or the cells ignore the insulin) seen at an outpatient clinic from 2003 to 2008. The charts contained information on the patients' age, race, vitamin D levels, calcium intake, family history of diabetes, and results of their hemoglobin A1c blood test. The A1c provides an average measurement of blood sugar control over about a 12-week span. (For people with diabetes, the goal is 7%; for people without, the normal range is 4%-6%.)

Krug's team divided the vitamin D levels they found into four groups: normal (defined in the study as above 32 nanograms per deciliter), mild deficiency, moderate deficiency, or severe.

In all, 113 of the 124 patients (91.1%) were vitamin D deficient -- 35.5% severely, 38.7% moderately, and 16.9% mildly.

The average A1c was higher in patients with severe vitamin D deficiency compared to those with normal levels of vitamin D. Those with severe deficiency had an average of 8.1%; those with normal vitamin D levels averaged 7.1%.

Krug found racial differences. ''In people of color, vitamin D levels were even lower than in Caucasians and they were associated with even poorer diabetes control," she tells WebMD.

Only 6.4% were on vitamin D supplementation. This was true, Krug says, even though they had medical coverage and saw their doctors. She suspects a lack of awareness on the part of the physicians partly explains the frequent deficiencies she found.

Aggressive screening of vitamin D levels is crucial for people with diabetes, Krug says. Once a supplement is recommended, she says, the blood levels should be rechecked to see if the supplement sufficiently increases vitamin D levels.

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Vitamin D Facts
Vitamin D is crucial not only to maintain bone strength, but research also suggests it plays a role in immune system functioning, cancer prevention, and cardiovascular health. It is produced when ultraviolet rays from the sun strike the skin and is also found in fish, eggs, fortified milk, cod liver oil, and supplements.

Adequate intakes, set by the Institute of Medicine of The National Academies, are 200 international units (IU) a day for adults up to age 50, 400 IU for people aged 51-70, and 600 IU for people 71 and older. But some experts say much more is needed; the recommendations are under review, with an update expected in 2010.

Second Opinion
The new study lends support to a growing body of scientific and clinical data linking vitamin D with insulin and glucose, says Ruchi Mathur, MD, an endocrinologist and assistant professor of medicine at Cedars-Sinai Medical Center, Los Angeles, who reviewed the study for WebMD.

Other research has shown that supplementing with vitamin D and calcium slows the progression to type 2 diabetes, Mathur says. Even so, she tells WebMD, ''At present, a direct link between vitamin D and type 2 diabetes is not conclusively established."

She has another caveat. ''One important point that is missing ... is the prevalence of vitamin D deficiency in the general population" compared to those in the study. As vitamin D deficiency is being noted with ''an alarming increase in frequency'' overall, she says, ''it may shed doubts on the authors' conclusions."

It's also possible, she says, that people with poor glycemic control have it because of a general unhealthy lifestyle, not just their low vitamin D status. They may engage in less outdoor exercise, for instance, or have unhealthy eating habits.

Because of the possible link, however, she agrees that screening for vitamin D deficiency in people with type 2 diabetes may be warranted.

This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

www.webMD.com