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Type 2 diabetesType 2 diabetes has become a significant worldwide health care challenge, as it is associated with various health problems and increased mortality risk. There is increasing evidence that vitamin D influences many non-skeletal medical conditions, including heart disease, cancer, certain autoimmune diseases and type-2 diabetes. Observational research has shown that seasonal variation in blood sugar control in the winter may be partly due to vitamin D, since vitamin D levels are generally much lower in the winter.

In a study published in the European Journal of Clinical Nutrition, researchers examined the association between vitamin D status and the incidence of Type 2 diabetes. After a thorough review of the literature, 8 observational studies and 11 randomly controlled trials were included in the review.

Intake of >500 IU/day decreased the risk of type 2 diabetes by 13% when compared to those with a vitamin D intake of <200 IU/day; Adults with the highest vitamin D status (>25 ng/ml or 62.5 mmol/L) had a 43% lower risk of developing type 2 diabetes when compared to those with the lowest serum vitamin D levels (<14 ng/ml or 35 mmol/L). In two trials that included patients with glucose intolerance, vitamin D supplementation improved measures of insulin resistance. No significant effect of vitamin D on glycemic outcomes was evident in the trials that included subjects with normal glucose tolerance at baseline.

The results of this review show that vitamin D may play a role in the prevention of type 2 diabetes, although high-quality studies are needed to determine a potential mechanism between vitamin D concentration and relevant glycemic outcomes.

Source:
J Mitri et al. European Journal of Clinical Nutrition (2011) 65:1005–1015.

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A new study found that calcium and vitamin D supplementation may be beneficial in facilitating fat loss for people adopting to an energy-restricted diet.

Dietary calcium, a non-energy-supplying nutrient, has been identified as playing a pivotal role in the regulation of energy and lipid metabolism. Observational studies have demonstrated calcium intake is inversely associated with body weight, dyslipidemia, type 2 diabetes and hypertension. Higher vitamin D intake and elevated level of serum 25(OH)D have been reported to be related to lower adiposity and metabolic health

A new study investigated the effect of calcium plus vitamin D3 (calcium+D) supplementation on anthropometric and metabolic profiles during energy restriction in healthy, overweight (BMI>=24) and obese (BMI>=28) adults with very-low calcium consumption (<600mg/day).

Forty-three subjects were randomly assigned in an open-label, randomized controlled trial to receive either an energy-restricted diet (−500 kcal/d) supplemented with 600 mg elemental calcium and 125 IU vitamin D3 or energy restriction alone for 12 weeks.  Repeated measurements of variance were performed to evaluate the differences between groups for changes in body weight, BMI, body composition, waist circumference, and blood pressures, as well as plasma TG, TC, HDL, LDL, glucose and insulin concentrations.

The study showed a significantly greater decrease in fat mass loss in the calcium + D group  than in the control group, and no significant difference in body weight change between the two groups. The calcium + D group also exhibited greater decrease in visceral fat mass and visceral fat area.  No significant difference was detected for changes in metabolic variables.

These results indicate that, among overweight and obese people with very-low intake levels of calcium, calcium plus vitamin D3 supplementation for 12 weeks may assist fat loss when combined with a energy restriction diet with 500 Cal/day of calorie deficit.

Source: Zhu et al. Nutrition Journal 2013, 12:8

Vitamin D is necessary for optimal health.  However, nearly one-third of Australian adults over the age of 25 have Vitamin D deficiency which raises a serious public health concern.

Vitamin D deficiency is recognized as a global public health problem, but the population-based prevalence of deficiency and its determinants in Australian adults has not previously been properly examined.

A recent study evaluated the vitamin D status of Australian adults aged ≥25 years and risk factors associated with vitamin D deficiency in this population group. A national sample of 11247 Australian adults enrolled in the AusDiab was drawn from 42 randomly selected districts throughout Australia from Darwin to Hobart.  Serum concentrations of 25-hydroxyvitamin D were measured by immunoassay. Vitamin D deficiency was defined as a concentration <50 nmol/L.

The overall prevalence of vitamin D deficiency (<50 nmol/L) was 31% with women being more commonly affected (39% in women vs 23% in men).

When evaluated by season and latitude, deficiency was more common during winter and in people residing in southern Australia (latitude >35°S); 42% of women and 27% of men in southern Australia during summer/autumn had deficient levels, which increased to 58% and 35% in women and men, respectively, during winter/spring.

The prevalence of vitamin D deficiency also increased significantly with age, in women, in those of non-European origin, in the obese and those who were physically inactive and with a higher level of education.

Low levels of vitamin D has been found to be associated with a number of medical conditions such as softened bones; diseases that cause progressive muscle weakness leading to an increased risk of falls, osteoporosis, cardiovascular disease, certain types of cancer and type 2 diabetes.

Results from this latest study confirmed that vitamin D deficiency is common in Australia affecting nearly one-third of adults aged 25 years and older.  The study authors further commented that national strategies are urgently needed to develop an awareness campaign for balancing safe sun exposure and adequate vitamin D intake, and to tackle the high prevalence of vitamin D deficiency in Australia before the problem worsens.

Source:
Daly RM et al. Clin Endocrinol (Oxf). 2012 Jul; 77(1):26-35.

 

 

November 2011

In a recent population based study of men and women over 65 years of age, those experiencing chronic moderate to extreme pain were twice as likely to be vitamin D deficient than those not reporting pain.

Inadequate vitamin D levels are common in older adults and may result in osteoporosis, osteoma-lacia and a wide range of other non-communicable diseases that have potential effects on health outcomes. Moderate to extreme pain is also more likely to present in older adults.

A recent study published in the British Journal of Nutrition has shown that older men and women experiencing moderate to extreme chronic pain are more likely than others to have poor vitamin D status.

Researchers sought to examine the connection between chronic pain and serum vitamin D levels among a population of men and women aged 65 years or older. The study included 2,070 adults who took part in the 2005 annual Health Survey for England, which assessed health and health-related behaviors in children and adults.

The results of this study show that symptoms of chronic pain were associated with poor vitamin D status, independent of other variables. Of the 53% of participants that reported experiencing moderate or extreme pain or discomfort, 80% had chronic illnesses and 60% had been diagnosed with musculoskeletal conditions.

The odds of experiencing moderate to severe pain increased with decreasing levels of serum vitamin D.  In those reporting pain, the odds of being deficient in vitamin D (less than 25 nmol/l, or 10 ng/ml) were double that of subjects who did not report pain.

These results support previous research showing an association between increased pain and poor vitamin D status. The researchers suggest that the active form of the vitamin may be associated with a reduction in inflammation. The results of this study also support the supposition that it is important to screen older patients reporting pain for vitamin D status so that appropriate interventions can be provided.

Source:
Hirani V. British Journal of Nutrition; pp 1-5 Published online: 28 September 2011.

By Jackie Khor

20 September 2011

Whatever condition and disease you study, Vitamin D keeps coming up as a major factor. Vitamin D is an essential nutrient that plays multiple roles in human health.

Vitamin D in calcium metabolism and bone health is well recognized but more recently, its role in cardiovascular health, immune function, glucose metabolism, and cell differentiation and proliferation have been defined.

It is well established that vitamin D deficiency leads to rickets in developing children but more current research has also linked vitamin D deficiency with osteoporosis, osteomalacia, impaired muscle function, infection, autoimmune disorders, diabetes, and some cancers in adults. Thus, achieving optimal vitamin D status throughout life is essential to maintaining overall health.

Vitamin D is unique among other vitamins, in that very little is obtained through a normal diet. The principal source of circulating vitamin D is endogenous production in the skin following exposure to sunlight. Thus, factors that limit sun exposure and/or endogenous vitamin D synthesis greatly reduce circulating vitamin D concentrations. Some of these factors include geographic latitude, season of the year, melanin content of the skin, use of sunblock, lack of outdoor activity, age, and more. Any of these factors, among others, can lead to chronic vitamin D deficiency.

Deficiencies of vitamin D are common. It is currently estimated that more than 1 billion people worldwide and 30-to-40% of the population between 15 and 49 years of age in the United States suffer from vitamin D deficiency. Consensus is building that adequate circulating vitamin D concentrations should be greater than 30 ng/mL and optimally above 50 ng/mL (7-10). Because relatively small amounts of vitamin D are obtained through the diet and so many lifestyle factors reduce endogenous vitamin D synthesis, supplementation becomes an important avenue for achieving and maintaining optimal vitamin D status. It has been shown that 100 IU of vitamin D per day increases circulating concentrations of vitamin D by ~1 ng/mL (7-10). Thus, supplementation with advanced doses of vitamin D (2000-4000 IU/day) depending on lifestyle, are required to reverse vitamin D deficiency, boost vitamin D levels into the optimal range, and maintain them thereafter.

There are several forms of vitamin D including D1, D2 and D3. You want to take D3 (calciferol). Vitamin D3 is converted in our bodies to the active form which is dihydroxy vitamin D. Doctors and pharmaceutical corporations keep promoting dangerous, synthetic, expensive, prescription only analogs of vitamin D. These can be patented and not sold over the counter. It is important not to take too much D3 as it is oil soluble, toxic in excess, and can result in side effects. Since you can’t get any meaningful amounts in common foods, this is not a problem at all.

Remember how popular cod liver oil has been for decades now? This is really because of the vitamin D content. People often really do get dramatic results from simply taking a spoonful of cod liver oil. This is because they are getting the vitamin D they need so badly. Of course, taking a multivitamin of inexpensive 400 IU vitamin D supplement is a much more practical and tasty way to do this.

There are many reasons we suffer from so many diseases and conditions in the richest country in the world with the highest standard of living. One important and proven reason is lack of vitamin D in most people. Study after study shows people of all ages in most countries are deficient in vitamin D by blood analysis. This is especially true of the poor and the elderly. Along with your multiple vitamin just take an extra 400 IU capsule of inexpensive vitamin D when you’re not getting out in the sun regularly. No matter how well you eat you aren’t going to get any significant amount in your diet.

The science behind this is just overwhelming. People of all ages should take it. The international published science here is endless and growing. Vitamin D deficiency is a worldwide epidemic.

High prevalence rates of suboptimal vitamin D levels have been observed in women who are not considered ‘at risk’.  A recent Australian study suggested that all pregnant women in Australia should take a daily vitamin D supplement.

Vitamin D deficiency is common in pregnant women and in breastfed infants, despite the widespread use of prenatal vitamins. Adverse health outcomes such as preeclampsia, low birthweight, neonatal hypocalcemia, poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases have been linked to low vitamin D levels during pregnancy and infancy.

A cross-sectional study of pregnant women was performed to determine prevalence and predictive factors of suboptimal vitamin D levels in 2 antenatal clinics in Australia – Campbelltown, NSW and Canberra, ACT.

The researchers found behavioural factors, such as sun exposure, were not as predictive of suboptimal vitamin D levels as ethnicity, season and BMI among pregnant woman.  The prevalence of vitamin D deficiency and insufficiency was 35% in Canberra and 26% in Campbelltown.  Among the vitamin D-deficient women, 38% were Caucasian and all had a BMI of more than 30kg/m2. Vitamin D supplementation at 500 IU/day was inadequate to prevent insufficiency.

The study suggested routine supplementation for all pregnant women with a higher dose of vitamin D (1000 IU/day) regardless of their ethnicity or exposure to the sun.  Targeted screening of the women at highest risk of vitamin D deficiency should also be continued and supplemented if necessary.

Source:
Sumathy Perampalam et al. Australian and New Zealand Journal of Obstetrics and Gynaecology published online 18 May 2011

Pregnant mothers who have deficient levels of serum vitamin D are more likely to have children with reduced bone mineral density. Low bone mineral density in childhood increases the risk of osteoporosis and fractures later in life.

Vitamin D insufficiency is common in women of childbearing age, and increasing evidence suggests that the risk of osteoporosis and bone fracture in adulthood could be influenced by a mother’s vitamin D status during pregnancy.

Scientists conducted a nine-year follow up of the mothers of 198 children where the mother’s nutrition and vitamin D status had been evaluated during pregnancy. 31% of the mothers had vitamin D levels considered insufficient, and 18 % had deficient levels during late pregnancy. Women who used vitamin D supplements had higher average vitamin D levels than non-supplement users.

Not surprisingly, an association was found between lower concentrations of serum vitamin D in late pregnancy and children with reduced bone mineral content, bone area, and bone mineral density at nine years of age. The bone mineral content of children where the mother was vitamin D deficient was significantly lower than that of children whose mothers had adequate vitamin D levels. Children of women who had taken vitamin D supplements experienced significantly greater bone mineral content and bone areas than those of non-supplement users.

The study authors concluded that vitamin D supplementation of pregnant mothers could lead to a longlasting reduction in the risk of osteoporosis and bone fractures in their offspring.

Source: Lancet 2006 Jan 7;367(9504):36-43

A doos-response relationship between vitamin D and fracture reduction is supported by epidemiologic data showing a significant positive trend between serum 25-hydroxvitamin D concentrations and hip bone density and lower extremity strength.

To assess the amtifracture efficacy of oral vitamin D supplementation in the elderly, a recent study performed a meta-analysis on the efficacy of oral supplemental vitamin D in preventing nonvertebral and hip fractures among older individuals (> or = 65 years). This study included 12 double-blind randomized controlled trials (RCTs) for nonvertebral fractures (n = 42279) and 8 RCTs for hip fractures (n = 40886) comparing oral vitamin D with or without calcium, with calcium, or placebo.

The meta-analysis found that antifracture efficacy increased significantly with a higher dose and higher achieved blood 25-hydroxyvitamin D levels for prevention of both non-vertebral fractures and hip fractures.  The higher dose (>400IU) reduced nonvertebral fractures in community-dwelling individuals (-29%) and institutionalized older individuals (-15%), and its effect was independent of additional calcium supplementation.

CONCLUSION: Nonvertebral fracture prevention with vitamin D is dose dependent, and a higher dose should reduce fractures by at least 20% for individuals aged 65 years or older.

Source: Arch Intern Med. 2009 Mar 23;169(6):551-61

Elderly nursing home residents have a high risk of falls and are often deficient in vitamin D.  Fall-related fracture and injury is a serious problem affecting the quality of life and cost of healthcare for these elderly nursing home residents.  Effective interventions to reduce falls are needed in those at high risk of falling.

To determine the effect vitamin D supplement doses on falls risk in elderly nursing home residents, 124 nursing home residents (average age 89) in a 725-bed long-term care facility were randomly assigned to receive one of four vitamin D supplement doses (200 IU, 400 IU, 600 IU, or 800 IU) or placebo daily for 5 months.  Number of fallers and number of falls were assessed using facility incident tracking database.

Over the 5-month study period, the proportion of participants with falls was 44% in the placebo group (11/25), 58% (15/26) in the 200 IU group, 60% (15/25) in the 400 IU group, 60% (15/25) in the 600 IU group, and 20% (5/23) in the 800 IU group. Participants in the 800 IU group had a 72% lower adjusted-incidence rate ratio of falls than those taking placebo over the 5 months. No significant differences were observed for the adjusted fall rates compared to placebo in any of the other supplement groups.

This study indicates that nursing home residents in the highest vitamin D group (800 IU) had a lower number of fallers and a lower incidence rate of falls over 5 months than those taking lower doses. Adequate vitamin D supplementation in elderly nursing home residents could reduce the number of falls experienced by this high falls risk group.

Source: J Am Geriatr Soc 2007;55:234-239

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