Vitamin D May Have New Measurement

A new measurement technique may lower daily vitamin D recommendation. I say may – because it hasn't been proven yet, but is just listed as a new measurement technique. A claim is made that it is now the gold standard, but there are questions.

After re-measurement of vitamin D by improved technology, the Recommended Dietary Allowance (RDA) for vitamin D intake drops from 800 to 400 International Units (IU) per day, new research reports. The results of the study will be presented Sunday, April 2, at ENDO 2017, the annual scientific meeting of the Endocrine Society, in Orlando, Florida.

"The RDA is easily achievable with a supplement of 400 IU in winter, when vitamin D levels are lowest in North America," said principal investigator J. Christopher Gallagher, M.D., professor and director of the Bone Metabolism Unit in the Division of Endocrinology of Creighton University School of Medicine in Omaha, Nebraska.

"This has important ramifications for public health recommendations. The amount of vitamin D needed, 400 IU daily, is less than the figure recommended by Institute of Medicine," said Gallagher, the study's principal investigator.

"In estimating the RDA for vitamin D intake, the laboratory method used for measuring serum 25-hydroxyvitamin D ? 25(OH)D ? can affect the results," he said. "The estimated RDA based on the older immunoassay (DiaSorin S.p.A., Salugia, Italy) system was 800 IU daily, whereas the newer liquid chromatography tandem-mass spectrometry (LC-MS/MS) technique estimated that 400 IU daily would meet the RDA."

In their earlier double-blind dose-response clinical trial in the winter and spring of 2007 to 2008, Gallagher and his colleagues enrolled 163 healthy postmenopausal Caucasian women 57 through 90 years of age with vitamin D insufficiency and followed them for 1 year. The women were at least 7 years postmenopausal and they had vitamin D insufficiency based on the World Health Organization cutoff (serum 25(OH)D 20 ng/ml or lower).

The participants were randomized to one of seven vitamin D3 doses: 400, 800, 1600, 2400, 3200, 4000, 4800 IU/day or placebo, for 1 year, and all the women were given calcium supplements to maintain a total calcium intake. After analyzing the samples and estimating the RDA using the older immunoassay, the authors reported that 800 IU daily would meet the vitamin D intake requirement for 97.5 percent of the population.

But now that liquid chromatography mass spectrometry (LC-MS/MS) has become the gold standard for measuring 25(OH)D, the researchers have reanalyzed the original samples using this new technology. Able to determine a more precise dose-response curve, they have calculated the RDA for vitamin D to be 400 IU daily.

"Remember, this RDA is for bone health only," Gallagher cautioned. "It may be different for other diseases. Although trials looking into cancer, diabetes, and other diseases are ongoing, we do not have information about this yet."

It will be interesting to see whether the Institute of Medicine agrees with the new measurement technique and government agencies agree.

Can Vitamin D Help with Weight Loss?

Vitamin D is an important micronutrient with major health benefits, including improved immunity and stronger bones. There is also mounting evidence that it could help you lose weight.

Vitamin D is a fat-soluble vitamin that you can get from vitamin D-rich foods or supplements. Your body is also able to make it through sun exposure. Vitamin D is essential for maintaining strong bones and teeth, keeping your immune system healthy and facilitating the absorption of calcium and phosphorus.

Because vitamin D is not found naturally in very many foods, most health professionals recommend getting at least 5–30 minutes of sun exposure daily or taking a supplement to meet the recommended daily amount of 600 IU (15 mcg).

Unfortunately, vitamin D deficiency affects nearly 50% of people worldwide.

Those at risk of deficiency include (2):

• Older adults
• Breastfed infants
• Dark-skinned individuals
• Those with limited sun exposure

Obesity is another risk factor for deficiency. Interestingly, some evidence suggests that getting enough vitamin D could help with weight loss.

Studies show that a higher body mass index and body fat percentage are associated with lower blood levels of vitamin D. Several different theories speculate about the relationship between low vitamin D levels and obesity. Some claim that obese people tend to consume fewer vitamin D-rich foods, thus explaining the association. Others point to behavioral differences, noting that obese individuals tend to expose less skin and may not be absorbing as much vitamin D from the sun.

Certain enzymes are needed to convert vitamin D into its active form, and levels of these enzymes may differ between obese and non-obese individuals. However, a 2012 study noted that once vitamin D levels in obese individuals are adjusted for body size, there’s no difference between levels in obese and non-obese individuals. This indicates that your vitamin D needs depend on body size, meaning obese individuals need more than normal-weight people to reach the same blood levels. This could help explain why obese people are more likely to be deficient.

Interestingly, losing weight can also affect your vitamin D levels. In theory, a reduction in body size would mean a decrease in your vitamin D requirement. However, since the amount of it in your body remains the same when you lose weight, your levels would actually increase.

And, the degree of weight loss may affect the extent to which its levels increase.

One study found that even small amounts of weight loss led to a modest increase in blood levels of vitamin D. Furthermore, participants who lost at least 15% of their body weight experienced increases that were nearly three times greater than those seen in participants who lost 5–10% of their body weight.

Moreover, some evidence shows that increasing vitamin D in the blood can reduce body fat and boost weight loss.

Some evidence suggests that getting enough vitamin D could enhance weight loss and decrease body fat. At least 20 ng/mL (50 nmol/L) is considered an adequate blood level to promote strong bones and overall health. One study looked at 218 overweight and obese women over a one-year period. All were put on a calorie-restricted diet and exercise routine. Half of the women received a vitamin D supplement, while the other half received a placebo.

At the end of the study, researchers found that women who fulfilled their vitamin D requirements experienced more weight loss, losing an average of 7 pounds (3.2 kg) more than the women who did not have adequate blood levels.

Another study provided overweight and obese women with vitamin D supplements for 12 weeks. At the end of the study, the women didn’t experience any weight loss, but they did find that increasing levels of vitamin D decreased body fat.

Vitamin D could also be associated with a decrease in weight gain. A study in over 4,600 elderly women found that higher levels of vitamin D were linked to less weight gain between visits during the span of the 4.5-year study. Based on these studies, it seems that the weight-related benefits of vitamin D come from increasing its blood levels, rather than supplementation itself.

Several theories attempt to explain vitamin D’s effects on weight loss. Studies show that vitamin D could potentially stop the formation of new fat cells in the body. It could also prevent the storage of fat cells, effectively reducing fat accumulation.

Additionally, vitamin D can increase levels of serotonin, a neurotransmitter that affects everything from mood to sleep regulation. Serotonin may play a role in controlling your appetite and can increase satiety, reduce body weight and decrease calorie intake.

Finally, higher levels of vitamin D may be associated with higher levels of testosterone, which could trigger weight loss. A 2011 study gave 165 men either vitamin D supplements or a placebo for one year. It found that those receiving the supplements experienced greater increases in testosterone levels than the control group.

Several studies have shown that higher levels of testosterone can reduce body fat and help sustain long-term weight loss. It does this by boosting your metabolism, causing your body to burn more calories after eating. It could also block the formation of new fat cells in the body.

It’s recommended that adults 19–70 years old get at least 600 IU (15 mcg) of vitamin D per day. However, supplementing with vitamin D may not be a “one size fits all” approach, as some research indicates that the dosage should be based on body weight. One study adjusted vitamin D levels for body size and calculated that 32–36 IU per pound (70–80 IU/kg) is needed to maintain adequate levels.

Vitamin D supplements can cause toxicity when consumed in large amounts. It’s best to consult your doctor before exceeding the upper limit of 4,000 IU per day.

It’s clear there’s an intricate relationship between vitamin D status and weight.

Getting enough vitamin D can keep your hormone levels in check and may help enhance weight loss and decrease body fat.

In turn, losing weight can increase vitamin D levels and help you maximize its other benefits, such as maintaining strong bones and protecting against illness.

If you get limited exposure to the sun or are at risk of deficiency, it may be a good idea to consider taking supplements. Supplementing with vitamin D may help keep your weight under control and optimize your overall health.

Bariatric Surgery Has Adverse Effects in Winter

A study of nearly one million patients who underwent bariatric surgery found that both seasonality and latitude were associated with health outcomes following surgery.

Bariatric surgery provides a weight loss option for individuals with severe obesity who have been unable to lose weight using other methods. The surgery causes weight loss by limiting the amount of food the stomach can hold.

Side effects of bariatric surgery may include infection, diarrhea, nutritional deficiencies, gallstones, hernias and dehiscence. Dehiscence refers to a ruptured wound along the surgical incision. These side effects may occur right after surgery, causing a prolonged length of stay (LOS) in the hospital, or the side effects may occur later.

As the obesity epidemic continues to rise, bariatric surgery will likely become more common. Thus, it is critical to optimize the results of these surgeries by managing modifiable risk factors.

In a past study, researchers discovered that 80% of patients who underwent gastric bypass were considered vitamin D deficient a year after surgery, despite all patients receiving vitamin D supplementation after surgery.

Vitamin D strengthens the immune system by increasing the production of antimicrobial proteins, which aid in fighting off infections and disease. Furthermore, research has found low vitamin D status is associated with increased LOS and increased incidence of hospital mortality. Because of these findings, researchers recently became interested in the relationship between vitamin D status and adverse outcomes following bariatric surgery.

In a recent study, researchers assessed proxies of vitamin D status and outcomes after bariatric surgery of 932,091 patients. The researchers used both seasonality and latitude to estimate vitamin D status. Those who live near the equator have more opportunity to synthesize vitamin D from the sun, and therefore, patients who attended hospitals located at or above 37° North were considered to have lower vitamin D levels on average compared to those located below 37° North.

In a separate analysis, the researchers compared seasonality of the surgery to adverse health outcomes. During the summer (July to September), vitamin D status is highest; whereas, during the winter (January to March) vitamin D status is the lowest. Vitamin D status is considered moderate during both fall and spring.

The study presents promising findings for the role of vitamin D in bariatric surgery. The large sample size increased the strength of the findings. Furthermore, the significant relationships between proxies of vitamin D status and adverse outcomes of bariatric surgery remained after adjusting for several confounding factors.

On the other hand, the study did not directly measure vitamin D status. Instead, the researchers looked at latitude and seasonality to represent vitamin D status. The vitamin D status of the patients could be significantly higher than expected based on latitude or season if they supplemented with vitamin D. Lastly, due to the observational design, the study does not prove that Northern latitude or surgery conducted during winter causes adverse outcomes for bariatric surgery patients, but rather, these proxies for low vitamin D status are linked to adverse outcomes.

Please read the full article here.

Are You Getting These Nutrients? - Part 7

Lower-than-optimal blood levels of vitamin D is becoming more common. It is thought this may be because people are spending less time outside (especially in winter and in areas far from the equator) and wearing more sunscreen. It is difficult to get enough in the diet. Very important for our bones, but is turning up as a factor in many aspects of health.

Low-carb sources include salmon, tuna, eggs, yogurt, and liver.

Vitamin D is a fat-soluble vitamin that plays a role in many important body functions. It is best known for working with calcium in your body to help build and maintain strong bones. Vitamin D is also involved in regulating the immune system and cells, where it may help prevent cancer.

Your body stores vitamin D and can make it when your skin is exposed to sunlight. Vitamin D is also found in some foods, mostly ones like milk that have been fortified with vitamin D. There are two forms of vitamin D: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Some research suggests that cholecalciferol is better at raising levels of vitamin D in the blood.

In children, a vitamin D deficiency can cause rickets, a disease that results in soft, weak bones. In adults, many people may not be getting enough vitamin D, especially those who live in northern areas (like the northern half of the U.S.) and the elderly. People with dark skin do not absorb sunlight as easily as those with light skin, so their risk of low vitamin D is even higher. One study of childbearing women in the Northern U.S. found that 54% of African-American women and 42% of white women had low levels of vitamin D.

That’s important because researchers are beginning to find that low levels of vitamin D may be linked to other diseases, including breast and colon cancer, prostate cancer, high blood pressure, depression, and obesity. The evidence doesn’t prove that too little vitamin D causes these conditions, but that people with higher levels of vitamin D are less likely to get these diseases.

Your body make vitamin D when your skin is exposed to the sun. The color of your skin affects the production of vitamin D. A fair-skinned person may need only about 45 minutes of sunlight a week to get enough vitamin D, while a person with dark skin may need up to 3 hours.

Clouds, smog, clothing, sunscreen, and window glass all reduce the amount of sunlight that actually reaches the skin. In northern areas, it is hard to get enough vitamin D from sunlight during the winter, so people living there may need to take vitamin D supplements. In the U.S., people who live above a line running from Los Angeles to South Carolina may not get enough vitamin D in winter.

Vitamin D is included in many multivitamins. It can be found alone as softgel capsules, tablets, and liquid in over-the-counter strengths from 50 - 1,000 IU. Higher doses are also available, but it is best to ask your doctor what the safest, most effective dose for you would be. For those who have trouble digesting fat, vitamin D injections are also available by prescription.

Recommended dietary allowances for vitamin D are listed below. Seniors and people who don’t get exposed to much sunlight may need to take supplements. Seniors may be at risk of developing vitamin D deficiency because, as we age, the body does not make as much vitamin D from sunlight, and it has a harder time converting vitamin D into a form it can use.

If you are concerned about your vitamin D levels, ask your doctor whether you should take a supplement, and how much.

Adult

• 19 - 50 years: 600 IU (recommended dietary allowance)
• 70 years and older: 800 IU (recommended dietary allowance)
• Pregnant and breastfeeding females: 600 IU (recommended dietary allowance)

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable doctor.

Taking too much vitamin D can cause several side effects. However, scientists don’t all agree on how much is too much.

Side effects may include - being very thirsty, metal taste in mouth, poor appetite, weight loss, bone pain, tiredness, sore eyes, itchy skin, vomiting, diarrhea, constipation, a frequent need to urinate, and muscle problems.

You cannot get too much vitamin D from sunlight, and it would be very hard to get too much from food. Generally, too much vitamin D is a result of taking supplements in too high a dose.

People with the following conditions should be careful when considering taking vitamin D supplements - high blood calcium or phosphorus levels, heart problems, kidney disease, sarcoidosis, and tuberculosis.

Being Asked to Speak to Another Group

The weekend after our meeting with the doctor, a group from another town about 20 miles distant, asked Tim and I to speak to them on insulin. Because of the doctor involved, we decided not to accept. We had a suspicion of what may have been behind this and as such, I was thankful I already had another commitment. Tim said he agreed with me and agreed we should not become involved in this since this doctor had the reputation of not wanting his patients on oral medications to test.

Tim sent the regrets explaining that I had a commitment and he would not do this by himself. Tim called me the next day saying something that was a total surprise. This doctor was asking for our help on insulin and testing for all patients with diabetes. He was realizing that he was in the wrong and felt that since our group was having so much success and had in fact converted several of his patients to testing, that he needed to learn about us and to get his patients started in testing. Tim added that he felt we should accept the challenge. I stated that I was committed to my meeting and that he should talk to the local doctor and maybe he could attend with him. I said that maybe Allen should go as well.

The following day, Tim called again to say the local doctor had called this doctor and said that he could come if allowed along with Allen and Tim. Tim said the doctor was happy with this and that yes, he wanted this very much. I said this was great. I then explained my commitment of a late afternoon medical appointment and a speaking engagement in the same town to a diabetes group that had been scheduled a month ago. Tim said this sounds good as three of us were involved in spreading the word. I suggested to Tim that Allen should raise the issue of vitamin and mineral testing on their way there so that if necessary, they could sound out the doctor before the meeting about raising this in the meeting as well. Tim said they would be traveling in the same car and he felt this was worth exploring. I said good, and that we should have a meeting the day following to cover both meetings and learn from each other. Tim agreed and asked about including the doctor and I thought why not and told Tim to explore this.

So the day following our meetings, we met after hours at the doctor's office and had a good discussion. This doctor had forgot there were three groups in our town and the size of the groups. The third group was now at six members and hoping to add more members. The group the local doctor led was now at 10 members and he felt that would be more in the coming months. The group that I had spoken to was 18 members attending and they were hoping to grow. The two doctors leading this group were confident the number would grow. Tim stated that the group they had met with was 9 members and that they were shocked that there were so many groups. The doctor commented that this doctor realized that his diabetes patients were being spread out in different groups and knew he was being called out about not testing. He just did not have the knowledge he should about diabetes. At first, he was angry at what was happening. Then he realized that it was him causing his own problem and he needed to learn.

The doctor from our town said this was good for several reasons. He continued that we were being asked to speak for the next several months and now that this doctor was aware of my blog, he wanted me to speak about that. Allen said he had been asked by several of the people there if I was for real and a few had read some of my blogs, but wanted to know if I meant what I was saying. Allen was happy to say that he was the one I had written about in the testing for B12 and Vitamin D and yes, I was interested in people and helping to educate people about diabetes.

The doctor had discussed vitamin and mineral testing with this doctor before hand and had given Allen permission to bring up the topic. He knew there were tests, but had not taken them seriously, so he would also need to learn more about them. The doctor with us said he will be working with this doctor over the next few months until he can get to some continuing education courses and felt that this was a step in the right direction. We all agreed and Tim said he was surprised that this doctor was actually transferring a few patients to our town that needed insulin. The local doctor confirmed this and said there was too much for him to learn for the patients he had and had asked if this would be possible.

This was why the doctor wanted us back for more talks to his group since we knew insulin and this might help make the transition for these patients easier. I commented that none of us were patients of his.  Our local doctor admitted to having only a couple type 2 patients on insulin, but he would look to us for assistance. I suggested that since the three of us all were at the same diabetes clinic, maybe he could talk to them as well. I pulled out the card I had and photocopied it for him. He looked at it and said thank you, as he was not aware of the clinic being so close. He knew of the one in another larger city south of us, but not this one. He then said that he recognized the doctor's name, but did not realize where he was practicing.

He said he had the permission to refer the patients to our group for education if we were willing. After a short discussion about location, he said he would rather use video and have them learn this mode so they could email us when they had questions and use video if needed at any time. We agreed that would work for us and I explained I was already doing this for several doctors in other states. The doctor wanted to learn more and asked if I would email the contact information so that he could check how this was working. When I said yes, he handed me a card of his with an email address on it. He explained that was the office email address and for this purpose only. Then he added his home email address and said this was the one Tim had. I said I also do some peer-to-peer work for the doctor on the card and he said good. That would give him a good reason to call him and asked other questions.

Then he surprised all three of us and thanked us for our being up front in our recent conversation. He had approached us with other motives and when we had been up front with him, he realized that we were more interested in education than taking patients from doctors. He as very appreciative in being asked to go to the other doctor and felt this was a real help in getting this doctor on the right path. He said this proved to him that we wanted to help more that hurt those doctors that were not as knowledgeable about diabetes. He said that talking about the diversity of topics that Allen and Tim had covered during the meeting even showed that doctor you were more interested in education than pushing patients away from him.

Allen then asked if he knew the doctor he named. He said yes and was there a problem. Allen said this was the doctor he had left because he would not test him for vitamin and mineral shortages. That if it had not been for Tim and I taking him to see their doctor and the tests proving he needed shots and vitamin and mineral supplements, he might not be alive today. The doctor said he would get this corrected if possible, but it may not be easy. He asked us if this is what we do when a doctor does not step up when asked. Allen said yes, and he had not planned to leave this doctor, but when the test were done and he was asked to surrender his license because he was severely deficient in Vitamin B12 and D, he knew that it was severe. He had not liked having his license taken, but after considering the alternative of having to surrender it to the state, and then having so much on record, he said that that made him feel better. He stated that when his levels were normal they had given his license back and that made him feel even better about it. Allen said that our aggressive nature after the doctor refused to do the tests probably saved his life and for that, he was grateful.

The doctor looked at us and said that you normally give the doctor the opportunity to make the mistake first. I said that the doctor they were now working with had a reputation and it was the pharmacist that sent them to another doctor. He said either way, we are not trying to divert patients away without cause, and we all said yes. He then said we could consult any time with him and if we had a doctor that refused to step up, to bring the patient to him and he would see that they were taken care of and what needed to be done. If we were correct in our thinking like we seemed to be, then he would attempt to get the situation corrected. He said even if this meant loosing a friend and colleague which he then told Allen that the doctor was that he had left. He said that yes, he was aware of his position on vitamins and minerals, but for him to let someone on metformin become that deficient was inexcusable and he agreed with our actions.

We concluded and went our way home. Yes, several emails followed, but we wanted to think more about what had transpired.

Nutrients - Vitamin D

Vitamin D

Overview

Many of us are deficient in certain nutrients and our doctors do not test us as we age. Some of us do have sufficient quantities in our diets and then take supplements, which may give us an oversupply. Your doctor should test for all of these (that have testing available) before you run out and buy supplements. You may not need them as part of your diet because you are already obtaining sufficient intake from your diet.

I would be remiss if I did not give you a warning about not overcompensating and ingesting too much of some of these nutrients as there are some medical concerns with toxicity and conflicts with certain prescription medications. More is often not better and can be fatal with some supplements and herbal supplements.

Vitamin D is one large misnomer as it is a hormone, but this is now commonly accepted and will likely never be changed. It is the one that most people will have a difficult time in overdosing, but it has happened.

Tests

This is to inform you that the newer Vitamin D blood tests are over 40 percent unreliable and you need to make sure that the tests are not used. Please read this article in WebMD. Older testing procedures are the better bet.

Recommended Daily Allowance

The current RDA for vitamin D is being revised, and some experts suggest that adults should take at least 2000 IU of vitamin D daily. I personally use 3000 IU of Vitamin D3 daily and some that I know take as high as 10,000 IU.

Recommended dietary allowances currently for vitamin D are listed below. Seniors and people who don't get exposed too much sunlight may need to take supplements. Seniors may be at risk of developing vitamin D deficiency because, as we age, the body does not make as much vitamin D from sunlight, and it has a harder time converting vitamin D into a form it can use.

If you are concerned about your vitamin D levels, ask your doctor whether you should take a supplement, and how much.

Pediatric

1. Infants birth to 12 months: 400 IU (adequate intake)

2. Children 1 - 18 years: 600 IU (recommended dietary allowance)

Note: The American Academy of Pediatrics (AAP) recommends 400 IU of vitamin D daily for breastfed infants until they are weaned and drinking at least 1 liter of whole milk or formula fortified with vitamin D. The AAP also recommends that children and teens who drink less than 1 liter of milk a day take 400 IU of vitamin D.

Ask your doctor before giving a vitamin D supplement to a child.

Adult

1. 19 - 50 years: 600 IU (recommended dietary allowance)

2. 70 years and older: 800 IU (recommended dietary allowance)

3. Pregnant and breastfeeding females: 600 IU (recommended dietary allowance)

Food Sources

There are two dietary forms of vitamin D:

1. Cholecalciferol - D3

2. Ergocalciferol - D2

These are naturally found in foods and are added to milk. Not all yogurt and cheese are fortified with vitamin D. Food sources of vitamin D include:

1. Cod liver oil (best source). Cod liver oil often contains very high levels of vitamin A, which can be toxic over time. Ask your health care provider about this source of vitamin D.

2. Fatty fish such as salmon, mackerel, tuna, sardines, herring

3. Vitamin D-fortified milk and cereal

4. Eggs

Functions

Taking the proper amount of vitamin D may help prevent several serious health conditions. These conditions include:

1. Osteoporosis - Vitamin D helps your body absorb and use calcium, which you need for strong bones. Getting enough vitamin D throughout your life is important, since most bone is formed when you are young. For post-menopausal women who are at higher risk of osteoporosis, taking vitamin D along with calcium supplements can reduce the rate of bone loss, help prevent osteoporosis, and may reduce the risk of fractures.

2. Other Bone Disorders - Vitamin D protects against rickets and osteomalacia, softening of the bones in adults. Seniors who live in northern areas and people who do not get direct sunlight for at least 45 minutes per week should make sure they get enough vitamin D through fortified milk and dairy products. Or, they can take a vitamin D supplement or a multivitamin with vitamin D.

3. Prevention of Falls - People who have low levels of vitamin D are at greater risk of falling, and studies have found that taking a vitamin D supplement (700 - 1000 IU daily) may reduce that risk. In seniors, vitamin D may reduce falls by 22%.

4. Parathyroid Problems - The four parathyroid glands are located in the neck. They make parathyroid hormone (PTH), which helps the body store and use calcium and phosphorus. Vitamin D is often used to treat disorders of the parathyroid gland.

5. High Blood Pressure (Hypertension) - People with low levels of vitamin D seem to have a high risk of developing high blood pressure than those with higher levels of vitamin D. However, there's no proof that low levels of vitamin D cause high blood pressure in healthy people. Evidence about vitamin D and blood pressure has been mixed.

6. Cancer - There is some evidence that getting enough vitamin D may lower your risk of certain cancers, especially of the colon, breast, prostate, skin, and pancreas. This evidence is based mostly on studies of large groups of people, population studies, and doesn't prove a connection between taking vitamin D and lowering your cancer risk. Some research suggests that postmenopausal women who take calcium and vitamin D supplements may have a lower risk of developing cancer of any kind compared to those who don' t take these supplements.

7. Seasonal Affective Disorder (SAD) - SAD is a type of depression that happens during the winter months, when there's not much sunlight. It's often treated with photo (light) therapy. A few studies suggest that the mood of people with SAD improves when they take vitamin D. Talk to your doctor about whether vitamin D might help your treatment for SAD.

8. Diabetes - Studies find that people who have lower levels of vitamin D are more likely to develop type 2 diabetes than people who have higher levels of vitamin D. But there is no evidence that taking vitamin D can help prevent or treat type 2 diabetes. One study found that giving infants doses of 2,000 IU per day of vitamin D during the first year of life may help protect them from developing type 1 diabetes when they are older.

9. Heart Disease - Studies suggest that people with low levels of vitamin D have a greater risk of developing heart disease, including heart attack, stroke, and heart failure compared to people with higher levels of vitamin D. Low levels of vitamin D may increase the risk of calcium build-up in the arteries. Calcium build-up is part of the plaque that forms in arteries when you have atherosclerosis and can lead to a heart attack or stroke.

10. Multiple Sclerosis (MS) - Studies have found that women who take at least 400 IU of vitamin D daily lower their risk of developing MS. And higher levels of vitamin D in the blood seem to be associated with a lower risk of developing MS in white men and women, although the same may not be true of African American and Hispanic men and women. However, this does not mean that vitamin D supplements will help prevent or treat MS in people.

11. Obesity - Studies have found that people who have lower levels of vitamin D are more likely to be obese compared to people with higher levels of vitamin D. One high-quality study also found that postmenopausal women who took 400 IU vitamin D plus 1,000 mg calcium daily for 3 years were less likely to gain weight than those who took placebo, although the weight difference was small. Women who were not getting enough calcium to start with (less than 1,200 mg per day) saw the most benefit.

12. Overall Mortality - Studies suggest that people with lower levels of vitamin D have a higher risk of dying from any cause.

Precautions

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable health care provider.

Taking too much vitamin D can cause several side effects. However, scientists don' t all agree on how much is too much. The National Institutes of Health has set the maximum tolerable upper limit at 1,000 IU daily for infants 0 - 6 months, 1,500 IU daily for infants 6 months to one year, 2,500 IU daily for children 1 - 3 years, 3,000 IU daily for children 4 - 8 years, and 4,000 IU daily for anyone over 9. Ask your doctor to determine the right dose for you or your child.

Side effects may include:

• Being very thirsty
• Metal taste in mouth
• Poor appetite
• Weight loss
• Bone pain
• Tiredness
• Sore eyes
• Itchy skin
• Vomiting
• Diarrhea
• Constipation
• A frequent need to urinate
• Muscle problems

You cannot get too much vitamin D from sunlight, and it would be very hard to get too much from food. Generally, too much vitamin D is a result of taking supplements in too high a dose.

People with the following conditions should be careful when considering taking vitamin D supplements:

 High blood calcium or phosphorus levels

 Heart problems

 Kidney disease

 Sarcoidosis

 Tuberculosis

Possible Interactions

If you are currently being treated with any of the following medications, you should not use vitamin D supplements without first talking to your health care provider.

Atorvastatin (Lipitor) -- Taking vitamin D may reduce the amount of Lipitor absorbed by the body, making it less effective. If you take Lipitor or any statin (drugs used to lower cholesterol), ask your doctor before taking vitamin D.

Calcipotriene (Dovonex) -- It's possible that taking vitamin D supplements and using calcipotriene, a medication applied to the skin for psoriasis, could cause calcium levels to get dangerously high in the blood.

Calcium channel blockers -- Vitamin D may interfere with these medications, used to treat high blood pressure and heart conditions. If you take any of these medications, do not take vitamin D without first asking your doctor. Calcium channel blockers include:

 Nifedipine (Procardia)

 Verapamil (Calan)

 Nicardipine (Cardene)

 DiltiaZem (Cardizem, Dilacor)

 Amlodipine (Norvasc)

Corticosteroids (prednisone) -- Taking corticosteroids long-term can cause bone loss, leading to osteoporosis. Supplements of calcium and vitamin D can help maintain bone strength. If you take corticosteroids for 6 months or more, ask your doctor about taking a calcium and vitamin D supplement.

Digoxin (Lanoxin) -- a medication used to treat irregular heart rhythms. Taking vitamin D if you take digoxin may cause levels of calcium to get dangerously high in the blood.

These drugs may raise the amount of vitamin D in the blood:

Estrogen -- Hormone replacement therapy with estrogen seems to raise vitamin D levels in the blood, which may have a positive effect on calcium and bone strength. In addition, taking vitamin D supplements along with estrogen replacement therapy (ERT) increases bone mass more than ERT alone. However, that may not be true if you also take progesterone.

Isoniazid (INH) -- a medication used to treat tuberculosis.

Thiazide -- A diuretic or water pill that helps your body get rid of too much fluid. It can increase vitamin D activity and lead to high calcium levels in the blood.

Vitamin D levels may be lowered by the following medications. If you take any of these medications, ask your doctor if you need more vitamin D:

Antacids -- Taking certain antacids for long periods of time may alter the levels, metabolism, and availability of vitamin D.

Anti-seizure medications -- these medications include:

 Phenobarbital

 Phenytoin (Dilantin)

 Primidone (Mysoline)

 Valproic acid (Depakote)

Bile acid sequestrants -- used to lower cholesterol. These medications include:

 Cholestyramine (Questran, Prevalite)

 Cholestipol (Colestid)

Rifampin -- used to treat tuberculosis

Mineral oil -- Mineral oil also interferes with absorption of vitamin D.

Orlistat (Alli) -- a medication used for weight loss that prevents your body for absorbing fat. Because of how it works, orlistat may also prevent the absorption of fat-soluble vitamins such as vitamin D. Doctors who prescribe orlistat tell their patients to take a multivitamin with fat-soluble vitamins.

Introduction to Series on Vitamins and Minerals

Many of us are deficient in certain nutrients and our doctors do not or will not test us for deficiencies as we age. Some of us do have sufficient quantities in our diets and then take supplements, which may give us an oversupply. I will give the name of the test when it is available. Your doctor should test for all of these (that have testing available) before you run out and buy supplements. You may not need them because you are already obtaining sufficient intake from your diet. If you have a doctor that will not test because you should be eating foods with sufficient nutrients, then you will have a decision to make about retaining your current doctor.

I realize that many of you may be aware of them, but it never hurts to review them. In the coming blogs I will cover iodine, selenium, choline, manganese, magnesium, potassium, Vitamin D, Vitamin K, and Vitamin B12. These may not be what you would think is needed for those of us with diabetes; however, they are still important. If you would like more detailed information, please read the links supplied with each blog as there may be several links. Some are water-soluble and others are fat-soluble. Vitamin D is neither as it is correctly a hormone. This will not change because of acceptance.

I would be remiss if I did not give you a warning about not overcompensating and ingesting too much of some of these nutrients as there are some medical concerns with toxicity and conflicts with certain prescription medications. More is often not better and can be fatal with some supplements. I will give warnings where they apply.

When there is a list of foods that may give you sufficient supply of a nutrient, they will be listed.

Since most of these vitamins and minerals have recommended daily allowances (RDAs) that vary by age, the entire table will be given. Some sources list only the adult RDAs and I prefer to give you the full list.

Please refer back to this blog if you question something and I will update this blog with each blog as I publish it. Some of my blogs will refer to my other blogs, as the nutrients can be essential for the same thing. Example - iodine and selenium both are essential for the thyroid gland to work properly. There may be others, but as of yet, I am not into research for each of them. I had intended to put two or three nutrients in a single blog, but with all that I am discovering, this would make the blog too long and essential points less obvious.

Iodine

Selenium

Choline

Manganese

Magnesium

Potassium

Vitamin D

Vitamin K

Vitamin B12

Metformin and B12 Deficiency

This is something my endocrinologist tests for and tells patients taking Metformin to take a Vitamin B12 supplement. Yet there are many doctors that do not tell their patients to add Vitamin B12 to their supplement regimen. One of the members of our group (Allen) is taking Metformin and was surprised when we told him to take Vitamin B12. After his last appointment, he said his doctor told him not to be taking supplements and said there was no reason to be on supplements if he was eating the right foods.

We decided to use this blog to discuss this with Allen. After reading this and following the links, he was still hesitant to go against his doctor. We did take time to explain that doctor or not, Metformin would cause the Vitamin B12 deficiency and that he should add this to his regimen. He did state that he had been on Metformin for almost eight years and we suggested strongly that he have the test to determine the level of B12. A call to his regular doctor confirmed that they would not do the test. We then suggested he go to the doctor that I see and he agreed

I was able to get him in the following day and went with him. After a quick talk with the doctor, he wanted to do several tests that his doctor was not doing. We waited for the lab to be available and he had a blood draw. Next, we sat for about 20 minutes and Allen asked if they will have the results that quickly. I said this was normal and depending on the tests ordered, he should receive most of them in another 10 to 15 minutes. He did ask me to accompany him when he saw the doctor and I agreed.

After updating and reviewing his medications, the nurse left and the doctor came in. He sat down, asked a couple of questions about allergies, and said he was going to get two shots. The first shot would be a Vitamin B12 injection. Then he surprised both of us by saying he would also have a large dose injection of Vitamin D. I stepped out for a few minutes and then was invited back in.

Allen was asking why the two shots. The doctor said that his Vitamin B12 was very low and required another test already ordered from the blood sample. The Vitamin D level was below minimum guidelines and he was given the shot just to prevent something that the doctor feared might happen. He did not say what it was, but for three days, Allen would need to return for the two shots. Or he said he could be admitted to the hospital. Allen said he could drive back and forth and the doctor said no driving until after two weeks or the tests were at or above minimum guidelines.

Then the doctor said he was also prescribing both B12 and D3 for him to start on the fifth day. He was to return in seven days for another round to tests and then in 14 days for repeat of tests to see if he could then drive. We asked why and he would only say that he was the first person they had seen with deficiencies that low and he and the head of the department did not want him to drive. He then asked for his license stating he could surrender it temporarily to them, or possibly a lot longer to the highway patrol. Allen looked at me and gave it up.

The doctor did say that the remainder of the tests would be available the next day and the head of the department was requesting two additional tests that would also be available. On the way home with me driving, Allen was somewhat surprised at the thoroughness and was wondering if he should consider changing doctors. I did suggest that he wait until the two weeks were done and see what he thought then. He agreed, but commented this had raised some serious issues in his mind and I had to agree.

Allen wanted to meet with Tim when we returned so he called him and Tim was there when we arrived. Tim was surprised at what had transpired, but agreed with the tests and asked if he was needed to drive. I said yes, to get me home, and for at least one or two trips. Allen asked about their taking his drivers license, and Tim said no, it was probably not legal, but that it was preferable to giving it up to the highway patrol where it would become part of his records, and that they could enforce it longer. Tim asked about which doctor he would keep and I said that Allen should not make a decision until at least this was done. Tim said that was probably best, but should be seriously considered. I agreed and said this should be discussed along with other possibilities.

Allen did want some reading and Tim said he would stop back after he took me home. We did discuss some reading and search words for him to leave Allen. Tim said he would take Allen the next day and we could alternate. I said that would work, but we should let Allen decide if he had preferences. Tim said he would, but that he could not go every time.

The next day, Allen asked me to come by when he returned home. So with Tim and me present, Allen asked what was he to do. He had all the test results now and he was really frightened. All the tests had been out of range on the low to extreme low side and the doctor had suggested he see another doctor for more tests. I agreed with Tim when he said that he should see the second doctor and get his health checked out. Tim did state that it was time to decide on making a change in doctors. He said he felt from what had been discussed today, that Allen was being given a second chance and he should take full advantage of it by switching doctors now and having his records transferred.

I could see some fear in Allen, so I asked him when his VA appointment would be. He said in about five months and I said that would be good. Therefore, if he ended up with some expensive medications and the VA had them or ones in the same drug family, the doctors would synchronize with the VA and he would be ready. I could see Allen relax visibly and he asked if the doctors would work with the VA? I said not the way he was thinking, but that he would give the doctors the name of his VA doctor and they would send a fax or call them with what they were suggesting for medications and see if the VA could get them started coming to him. The doctors would also forward copies of the tests and the reasons for the drug request.

Tim did say that the doctor had suggested that with his A1c and creatinine level that Allen should consider changing oral medications or start on insulin. He also said he would make a referral to the endocrinologist. Allen did say he would like to stay on oral medications if possible, but he was going to pay more attention to our discussions about insulins and not leave it as a medication of last resort. We said that was okay. I suggested that he should ask for the test for determining how much insulin he was still producing before he made that decision. Tim said that was another test they had done and his own insulin production was still okay, but on the low side. He said to Allen that just the fact he wanted to learn about insulin was a good sign and would make him ready when the change was right.

The following two days I drove Allen and we had some interesting discussions about the different oral medications and insulin. He did say that since the doctor had given him some time to read about the different oral medications and their side effects, he was thinking seriously about insulin. I did suggest that he ask which oral medications they would be recommending and Allen said that would give him a better idea instead of learning about all the oral medications.

One the fourth day, Allen said doctor (after conferring with the endocrinologist) would have a recommendation for him when he came in for the blood draw the following Tuesday, and that he should seriously consider insulin. So we asked several others to meet with us on Saturday and we would research and discuss oral medications in more detail and insulin. Even Brenda asked to be included so we would be only short one person as Sue had another commitment.

Too Much Vitamin D Can Be Toxic

When I read the following article by Dr. John Cannell, I had to reread it several times to be sure I was not missing something. I have been researching and have a couple of friends researching to find other such problems with Vitamin D toxicity. To date there have been other cases found, but none as severe as the ones Cr. Cannell reports.

Should we be concerned? Generally no, but the warning message is there and needs to be heeded. Always know what you are taking and why. Is there a possibility of taking too large a dose? Yes, as Dr. Cannell shows with the three cases, it is possible when you buy from the wrong manufacturer or misread the directions for the dosage. In general, most people do not need excessive doses of Vitamin D unless a doctor prescribes a short-term need.

One of the problems that can arise is when the doctor orders the wrong test for levels of Vitamin D. While this is not uncommon, you need to have some knowledge of the tests ordered and why. First and most common is 25-hydroxyvitamin D (25(OH)D) Vitamin D test for Vitamin D levels. Do not expect a range result as there is currently no consensus on the level which indicates deficiency and the high end is also in question. Most doctors expect high results to be under 100 ng/ml (nanograms per milliliter (ng/ml) 250 nmol/L) and reflect total serum 25(OH)D.

One word of warning – be sure to get a hard copy of your test results. “Many doctors still consider a result of 30 ng/ml (75 nmol/L) to be sufficient when studies indicate otherwise. For this reason, it is a good idea to ask for the exact number value of the results or a hard copy. Results conveyed by use of the words "normal," "within range," or similar wording might still be inadequate.” Many doctors that are knowledgeable like to see results between 50 ng/ml (125 nmol/L) and 90 ng/ml (225 nmol/L).

The other test that doctors may order (but seldom need) is 1,25-dihydroxyvitamin D.
"This test is needed if calcium is high or the patient has a disease that might produce excess amounts of vitamin D, such as sarcoidosis or some forms of lymphoma, 1,25-dihydroxyvitamin D usually is ordered. Rarely, this testing may be indicated when abnormalities of 1-alphahydroxylase are suspected.” Sarcoidosis is a disease of unknown cause, characterized by granulomatous tubercles of the skin, lymph nodes, lungs, eyes, and other structures.

Dr. John Cannell strongly advises that if you take more than 10,000 IU/day that you must check you 25(OH)D regularly.

Please read this article by Dr. Cannell about the three cases of Vitamin D toxicity. Then read this (click in the blue tabs for specific information). Dr. Cannell also discusses Vitamin D deficiency and has a video in this article.

RDA for Vitamin D Needs Change

At least I feel vindicated by what I said in my blog of December 20, 2010. Others including Dr. Miller are also pointing out more accurately the problems of the report issued by Institute of Medicine of the National Academies of Science (IOM). There are some glaring errors that punch holes in the report by IOM. These errors make me wonder how these men of science could miss this or do they simply lack the education necessary for their duties.

Harsh, yes. But these errors are serious. Even David Mendosa has told me to be careful not to take vitamin-D2, but to take vitamin-D3. What bothers me is that people will go to the doctor for a vitamin D prescription and pay the doctor fee and a higher cost for vitamin-D2, when vitamin-D3 is on the shelves and a lot cheaper.

Vitamin-D2 is much less effective in humans than vitamin-D3. D2 is largely human made and added to foods as a fortifier. Vitamin-D3 is also consumed by consuming animal based foods. So those on non-meat lifestyles, should have their doctor check their vitamin D levels and consider taking vitamin-D3 supplements.

Vitamin D, also known as calciferol, comprises a group of fat-soluble seco-sterols. The two major forms are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). In addition to having markedly lower potency, D2 also has a significantly shorter duration of action relative to vitamin D3. Both forms of vitamin D produce similar initial rises in serum 25OHD over the first 3 days, but 25OHD continues to rise with D3 supplementation, peaking at 14 days, and serum 25OHD falls rapidly in D2 treated subjects.

I think that this statement in the American Journal of Clinical Nutrition is most effective and needs to be heeded. They say that vitamin-D2 should not be used as a nutrient suitable for supplementation or fortification.

Dr Miller's blog is well stated and has some excellent comments to read here and read his latest blog here. Jon Barron writes his understanding of the IOM study and publishing of standards here. He is very factual and reports on the errors.  NOTE:  The two links for Dr. Miller's information are no longer functional.