What You Should Know About Vitamin D

Vitamin D seems to be a popular topic in the news lately, and many of my patients often have questions about the use of this vitamin. Following is a brief summary of how you can optimize your own vitamin D levels.

Multiple factors influence vitamin D levels

Vitamin D is produced in the body via sunlight. It is also obtained from foods such as oily fish (salmon, mackerel, sardines), fortified milk, cereals, and from supplements. Low vitamin D levels may be caused by a lack of sun exposure, lack of dietary vitamin D, malabsorption, side effects from medications or supplements, chronic diseases such as kidney or liver disease, and other causes. In addition, seniors, infants and toddlers, dark-skinned people, and pregnant or breastfeeding women may be particularly at risk for low vitamin D levels. Now, we are discovering there are other factors that may affect vitamin D levels.

The new study explored the importance of skin pigmentation, total cholesterol, and baseline blood levels of vitamin D (measured as 25- hydroxy vitamin D) on vitamin D production after ultraviolet B (UVB) exposure. Participants in this study had four UVB exposures several days apart to the chest and back, and each exposure was equivalent to about 30 minutes of sun exposure in the middle of a clear summer day in Denmark. Results showed:

• Of the 182 participants screened for baseline vitamin D, 67% were considered vitamin D insufficient and 18% were vitamin D deficient

• Baseline levels of vitamin D were higher in people who ate fish at least once a week

• Among a group of 50 participants, researchers found significantly higher vitamin D production after UVB exposure in participants with a low baseline vitamin D level compared with those with a higher baseline level

• Fair-skinned and dark-skinned people had similar increases in vitamin D levels after UVB exposure

• There is an association between total cholesterol and vitamin D production, and a low cholesterol level might hinder vitamin D production

Checking vitamin D levels

Here are some tips regarding vitamin D levels:

Talk with a doctor. A healthcare professional can help you decide whether or not it is important to check your vitamin D level. People who live in areas with little sunlight or who are at risk or suffering from chronic diseases such as cardiovascular disease or cancer may especially want to discuss the topic of vitamin D with a doctor.

Be careful with sun exposure. Many physicians recommend brief amounts of time (less than 15 minutes a day) of sun exposure for general health, but studies have shown that sun exposure may not be enough to raise vitamin D levels that are low. Further, excess sun can increase the risk of skin cancer, and the authors of this study do not recommend UVB treatment for low vitamin D levels for that reason. Instead they recommend treating low vitamin D levels with vitamin D supplements. Talk with your doctor about treatment strategies for low vitamin D levels.

(J Invest Dermatol 2010;130: 546-53)

Weight Loss and Natural Medicine

Naturopathic Medicine can offer a number of options for helping people to lose weight. From hormonal imbalances to underlying food allergies, the causes of abnormal weight gain are varied, so it’s important to seek an individualized approach to losing weight. Consulting an experienced naturopath will help you identify obstacles to weight loss, allowing you to lose weight in a safe, medically supervised fashion. 

In the meantime, here are some general tips to help you lose or maintain your weight: 

Talk with a professional. Being overweight increases a person’s risk of a number of medical conditions such as type 2 diabetes, high blood pressure, and high cholesterol. If you are overweight, talk with a knowledgeable doctor to come up with a good program for you, and work with a nutritionist who can educate you about what to eat and help you stay motivated and on track for a healthy weight. As this study showed, people who attended more dietary counseling sessions lost greater amounts of weight than those who attended less.

Identify triggers that lead to cravings or overeating. It is important to ask yourself questions such as “Why do I choose foods that are not healthy for me?” and “What feelings or circumstances lead me to crave unhealthy foods or to overeat?” Answering such questions can help you learn how to manage the cravings and feelings that lead to overeating, and help you plan ahead with healthier alternatives in situations where you might normally make unhealthy choices.

Choose the right foods. You know the recommendations by now, but have you taken specific steps to improve your diet? The body needs an abundance of fruits and veggies–at least 5 servings every day–and a source of protein every day in order to optimize health and prevent disease. Eating foods high in sugar increases cravings, so reach for low-sugar, low-fat, nutrient-dense foods when eating regular meals and when snacking.

Plan ahead. Sit down and plan your meals for the week. Try grocery shopping on a Sunday in order to stock the refrigerator with healthy foods to get you through the week. Don’t bring high-sugar, high-fat foods into the house, which may increase the temptation for overeating, but keep looking for healthy foods that you really enjoy so you have options if a snack attack hits.

Exercise regularly. Guidelines recommend 60 minutes of exercise every day for healthy adults and 90 minutes for children. Exercise helps reduce cravings and overeating and also improves risk factors for chronic disease such as high blood pressure, glucose and cholesterol levels. If the optimal amount is too overwhelming either because of your schedule or fitness level, remember that everything helps. Get the all-clear from your doctor, and then start slowly and build over time. As your fitness improves, you will naturally enjoy longer exercise sessions, rather than slogging through. Exercise buddies and cross-training are also good tricks for keeping yourself going.

Processed Foods And Depression

Eating a diet high in processed food increases the risk of depression, research suggests.

What is more, people who ate plenty of vegetables, fruit and fish actually had a lower risk of depression, the University College London team found.

Data on diet among 3,500 middle-aged civil servants was compared with depression five years later, the British Journal of Psychiatry reported.

The team said the study was the first to look at the UK diet and depression.

 The UK population is consuming less nutritious, fresh produce and more saturated fats and sugars 
Dr Andrew McCulloch, Mental Health Foundation

They split the participants into two types of diet – those who ate a diet largely based on whole foods, which includes lots of fruit, vegetables and fish, and those who ate a mainly processed food diet, such as sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products.

After accounting for factors such as gender, age, education, physical activity, smoking habits and chronic diseases, they found a significant difference in future depression risk with the different diets.

Those who ate the most whole foods had a 26% lower risk of future depression than those who at the least whole foods.

By contrast people with a diet high in processed food had a 58% higher risk of depression than those who ate very few processed foods.

Mediterranean diet

Although the researchers cannot totally rule out the possibility that people with depression may eat a less healthy diet they believe it is unlikely to be the reason for the findings because there was no association with diet and previous diagnosis of depression.

Study author Dr Archana Singh-Manoux pointed out there is a chance the finding could be explained by a lifestyle factor they had not accounted for.

“There was a paper showing a Mediterranean diet was associated with a lower risk of depression but the problem with that is if you live in Britain the likelihood of you eating a Mediterranean diet is not very high.

“So we wanted to look at bit differently at the link between diet and mental health.”

It is not yet clear why some foods may protect against or increase the risk of depression but scientists think there may be a link with inflammation as with conditions such as heart disease.

Dr Andrew McCulloch, chief executive of the Mental Health Foundation, said: “This study adds to an existing body of solid research that shows the strong links between what we eat and our mental health.

“Major studies like this are crucial because they hold the key to us better understanding mental illness.”

He added people’s diets were becoming increasingly unhealthy.

“The UK population is consuming less nutritious, fresh produce and more saturated fats and sugars.

“We are particularly concerned about those who cannot access fresh produce easily or live in areas where there are a high number of fast food restaurants and takeaways.”

Margaret Edwards, head of strategy at the mental health charity SANE, said: “Physical and mental health are closely related, so we should not be too surprised by these results, but we hope there will be further research which may help us to understand more fully the relationship between diet and mental health.”

PMS and Vitex

Clinically, I’ve seen such great results with this herb, so it’s nice to see further confirmation that it’s truly effective!

Vitex and PMS in Chinese Women

Chinese women suffering from moderate to severe premenstrual syndrome (PMS) were studied in a prospective, double-blind, placebo controlled, parallel-group, multi-center clinical trial. A Vitex agnus castus extract, VAC BNO 1095, contained 4.0 mg of dried ethanolic (70%) extract of VAC, corresponding to 40 mg of the herbal drug and was given once daily throughout the three cycles during the treatment phase. Two hundred and seventeen women were randomly assigned to the treatment group or the placebo group. 

The mean total Premenstrual Syndrome Diary (PMSD) score decreased from 29.23 at baseline to 6.41 at the end of the third cycle for the Vitex group and from 28.14 at baseline to 12.64 at the end of the third cycle for the placebo group. The difference in the PMSD score from baseline to the third cycle was significantly lower in the treatment group than in the placebo group. The Premenstrual Tension Syndrome Self-Rating Scale (PMTS) decreased from 26.17 at baseline to 9.92 for the treatment group and from 27.10 to 14.59 for the placebo group; similar positive results to the PMSD scores. 

Comments: Vitex extracts have so far been the best investigated botanical therapies for PMS and several placebo controlled clinical trials have been done that confirms its efficacy. The current study adds to the clinical relevance of this plant in the treatment of moderate to severe symptoms of PMS. In addition, no significant adverse events were reported.

He Z, Chen R, Zhou Y, et al. Treatment for premenstrual syndrome with Vitex agnus castus: A prospective, randomized, multi-center placebo controlled study in China. Maturitas 2009; 63:99-103. 

Cholesterol and Red Yeast Rice

High cholesterol should often be considered an indicator of excess oxidation, inflammation, and other underlying factors. However, despite the appropriate lifestyle changes, genetics often stand in the way of achieving optimal cholesterol levels. In these instances, supplements such as red yeast rice may prove beneficial:

Red Yeast Rice Extract Lowers M.I. Incidence and Mortality from Coronary Disease

Author: Steve Austin, N.D.

Reference: Li J-J, Lu Z-L, Kou W-R, et al. Beneficial impact of Xuezhikang on cardiovascular events and mortality in elderly hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS). J Clin Pharmacol 2009;49:947-56.

Design: Randomized double-blind intervention trial

Participants: 1530 elderly (≥65 years of age) hypertensive subjects with a history of myocardial infarction (MI)

Study Medication and Dosage: Subjects received either Xuezhikang, a red yeast rice (RYR) extract, administered as 600 mg b.i.d., or placebo for an average of 4.5 years. Each 600 mg capsule of RYR contained 2.5-3.2 mg of monacolin K plus “a small quantity of lovastatin hydroxyl acid as well as ergosterol and some other components.”

Primary Outcome Measures: Recurrent coronary events

Key Findings: Compared with the placebo group, there was a 38% reduced risk of suffering a coronary event (primarily MIs) (P=0.0009). Similarly there was a 29% reduced risk of dying from coronary disease during the course of the trial (P=0.05). Secondary endpoints revealed a 21% decline in LDL levels in the RYR group (P=0.0001) and a 12% decline in triglyceride levels (P=0.003) compared with trivial declines in the placebo group. Total mortality also declined by 36% in the group receiving RYR (P=0.003).

Practice Implications: RYR extracts are known to reduce cholesterol levels in humans and have been traditionally used in China to treat people with cardiovascular disease. RYR naturally contains the same molecule found in the prescription drug lovastatin. Previous RYR research has focused primarily on cholesterol reduction, though some evidenc
e for reduction in inflammatory markers has also surfaced.

The current trial goes several steps further, showing clinically (and statistically) significant reductions in coronary disease incidence and mortality. Hidden in the data is a near-statistically significant (P=0.06) 37% reduction in the risk of stroke and a statistically significant (P<0.04) reduction in total cancer incidence when compared with the placebo group. No current understanding of the effects of RYR clearly explains these additional positive findings.

One caveat requires mentioning: a previous report studying the pharmacokinetics of a related statin drug found that area-under-the-curve response was twice as great in Chinese subjects compared with white subjects (Clin Pharmacol Ther 2005;78:330-41). Should further investigations confirm these findings in regard to monacolins found in RYR, white (and potentially black) patients might require significantly higher doses of RYR to achieve the same clinical outcomes that occurred in the new report, which studied Chinese subjects. 

More BPA Risks

Several more reasons to be wary of plastics:

Scientists link plastics chemical to health risks 

By Kate Kelland 

Exposure to a chemical found in plastic containers is linked to heart disease, scientists said on Wednesday, confirming earlier findings and adding to pressure to ban its use in bottles and food packaging. 

British and U.S. researchers studied the effects of the chemical bisphenol A using data from a U.S. government national nutrition survey in 2006 and found that high levels of it in urine samples were associated with heart disease. 

Bisphenol A, known as BPA, is widely used in plastics and has been a growing concern for scientists in countries such as Britain, Canada and the United States, where food and drug regulators are examining its safety. 

David Melzer, professor of epidemiology and public health at the Peninsula Medical School in Exeter, England, who led the study, said the research confirmed earlier findings of a link between BPA and heart problems. 

The analysis also confirmed that BPA plays a role in diabetes and some forms of liver disease, said Melzer’s team, who studied data on 1,493 people aged 18 to 74. 
“Our latest analysis largely confirms the first analysis, and excludes the possibility that the original report was a statistical blip,” they said in a statement. 

BPA, used to stiffen plastic bottles and line cans, belongs to a class of compounds sometimes called endocrine disruptors. 

The U.S. Endocrine Society called last June for better studies into BPA and presented research showing the chemical can affect the hearts of women and permanently damage the DNA of mice. 
“The risks associated with exposure to BPA may be small, but they are relevant to very large numbers of people. This information is important since it provides a great opportunity for intervention to reduce the risks,” said Exeter’s Tamara Galloway, who worked on the study published by the Public Library of Science online science journal PLoS One. 

U.S. environmental health advocacy groups are urging a federal ban on BPA. 
“There’s enough research to take definitive action on this chemical to reduce exposures in people and the environment,” Dr. Anila Jacob of the Environmental Working Group, a non-profit organization, said in a telephone interview. 

The U.S. Food and Drug Administration is considering whether any action needs to be taken. 
U.S. government toxicologists at the National Institutes of Health concluded in 2008 that BPA presents concern for harmful effects on development of the prostate and brain and for behavioral changes in fetuses, infants and children. 

Canada’s government plans to outlaw plastic baby bottles made with BPA. The charity Breast Cancer UK last month urged the British government to do the same because they said there was “compelling” evidence linking the chemical to breast cancer risk. 

Experts estimate BPA is detectable in the bodies of more than 90 percent of U.S. and European populations. It is one of the world’s highest production volume chemicals, with more than 2.2 million tonnes produced annually. 

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