Health Tips From The Professor Are Vitamin D Supplements Worthless?

Posted October 30, 2018 by Dr. Steve Chaney

Are We Asking The Right Question?

Author: Dr. Stephen Chaney

 

are vitamin d supplements worthlessWe have been told that vitamin D is a miraculous “must have” vitamin. We have been told it’s not just important for healthy bones. It’s also important for a strong immune system, heart health, protection from cancer, and many other health benefits. We have been told that we should get our 25-hydroxy vitamin D levels tested and supplement with extra vitamin D if they are low.

Now, the latest headlines are saying all of that is wrong. They are telling us vitamin D supplements do not improve bone density or protect against falls and bone fractures. They are telling us to forget all the other claimed benefits of vitamin D. Those claims have been disproved. Forget about the 25-hydroxy vitamin D tests. They are a waste of money.

What is the truth? Why is it so confusing? Are vitamin D supplements worthless?  Let me guide you through the claims and counterclaims so you can discover the truth for yourself.

How Did Vitamin D Become So Popular?

are vitamin d supplements worthless popularLet’s start with a brief history of vitamin D. It all started with the industrial revolution in Northern Europe. Suddenly, children and adults in the large cities were spending the bulk of their waking hours in dark factories rather than outdoors on the farm. They were already living in northern latitudes where sunlight was weak during the winter months. To make matters worse pollution from the factories was creating a haze that blocked the sunlight.

That lead directly to the discovery that sunlight was crucial to our body’s ability to synthesize vitamin D and that vitamin D was essential for building strong bones. The solution to the public health crisis of rickets and osteomalacia was to fortify dairy products with vitamin D. The almost universal adaptation of vitamin D fortification virtually eliminated rickets and osteomalacia except in association with certain rare diseases. The two important lessons learned from this experience were:

  • Vitamin D is essential for healthy bone formation.
  • Vitamin D supplementation improves bone health for individuals who are deficient in vitamin D

As we discuss the latest findings, we need to keep in mind that these fundamental principles have not changed.

In the late 20th century our understanding of vitamin D took another leap with the discovery that vitamin D receptors were not restricted to bone cells. Almost every cell in our body contained vitamin D receptors. That lead to studies showing that people with low vitamin D intakes were more likely to experience heart disease, cancer, some autoimmune diseases, and infectious diseases such as flu than people with high vitamin D intakes.

The final leap in our understanding of vitamin D took place when the medical profession started routinely testing blood levels of 25-hydroxy vitamin D. That is when we discovered that some people who appeared to have adequate intake of vitamin D and/or adequate exposure to sunlight had low blood levels of 25-hydroxy vitamin D. Furthermore, follow-up studies showed that low 25-hydroxyvitamin D levels correlated with an increased risk of heart disease, cancer, and infectious disease. The important lessons learned from these experiments were:

  • Vitamin D deficiency is associated with increased risk of multiple diseases.
  • 25-hydroxy vitamin D tests are the best way to measure vitamin D deficiency.

Once again, these fundamental principles have not changed.

What Did The Study Show?

are vitamin d supplements worthless studyThe study (MJ Bolland et al, Lancet Diabetes Endocrinology 2018) behind the headlines was a meta-analysis of 81 randomized, placebo-controlled studies with a total of 53,537 subjects that looked at the effect of vitamin D supplementation in elderly populations on bone mineral density, bone fractures, and falls.

The meta-analysis only included studies in which vitamin D intake was the sole variable. In many cases the subjects were not taking a calcium supplement. If they were taking a calcium supplement, both the vitamin D group and placebo group were taking the same amount of calcium.

 

The results were unequivocal. In this study vitamin D supplementation had no effect on bone mineral density, bone fractures, or falls in elderly populations. The authors concluded “There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health.”

 

Is this conclusion justified? Let’s put the findings of this study into a broader perspective.

 

Are We Asking The Right Questions?

are vitamin d supplements worthless holistic approachBefore throwing out our vitamin D supplements let’s ask whether this study is asking the right question. I have covered this topic in detail in my new book “Slaying The Supplement Myths” (https://slayingthesupplementmyths.com) with respect to similar studies that had called into question the value of calcium supplements for bone health. Let me cover the highlights here.

In my book I created the graphic on the right to put the question of who benefits from supplementation into perspective. For the purposes of this discussion, I will just focus on poor diet (or, in the case of vitamin D, poor exposure to sunlight). As I discussed above, science shows that people who are not getting enough vitamin D from diet and sunlight benefit from vitamin D supplementation. Unfortunately, vitamin D enthusiasts and some supplement companies have muddied the waters by going beyond what good science shows and suggesting or implying that everyone will benefit from vitamin D supplementation.

This is part of the problem. Once you have created a paradigm that everyone will benefit from vitamin D supplementation, that paradigm is easy to disprove. If someone already has adequate, or nearly adequate, levels of 25-hydroxy vitamin D, would we expect additional vitamin D to make a difference? Of course not, but that is exactly the question the most recent study was asking.

In discussing the limitations of their study, the authors said: “It is possible that trials of populations with low baseline 25-hydroxy vitamin D might produce different results because only 4 trials, involving 831 participants (1.6% of all participants), reported mean baseline 25-hydroxy vitamin D levels lower than 25 nmol/L (the level indicating vitamin D deficiency).

In other words, the study did not measure the effect of vitamin D supplementation for people who were vitamin D deficient. The only take-home lesson from this study is that people with adequate, or near adequate, vitamin D status do not benefit from vitamin D supplementation. That is a “no-brainer.”

 

Vitamin D And A Bone Healthy Lifestyle

are vitamin d supplements worthless garbage in outThe other glaring deficiency of this study is that it was only measuring the effect of vitamin D on bone health. They purposely excluded any other factor that might influence bone health. That was a fatal flaw because healthy bone requires a holistic approach, not individual nutrients. In my book Slaying the Supplement Myths  I refer to this as a “bone healthy lifestyle.”

The most important feature of a “bone healthy lifestyle” is this:

  • Calcium, vitamin D, and resistance (weight bearing) exercise are all essential for healthy bones.
  • However, none of them is sufficient by itself. You need all three. You need a holistic approach if you wish to build strong bones.

Simply put, that means unless you include adequate calcium and exercise there is no reason to expect vitamin D supplementation to help build strong bones. Unfortunately, none of the studies included in the recent meta-analysis took a holistic approach to bone health. Some included calcium, but many didn’t. Resistance exercise was never considered. The studies were doomed to failure.

When you include flawed studies in your meta-analysis, you have what computer programmers call “Garbage in. Garbage out.” A meta-analysis can never be stronger than the individual studies it includes.

Other features of a “bone healthy lifestyle” include:

  • We need more than calcium and vitamin D for strong bones. We need magnesium, zinc, copper, manganese, vitamin C and vitamin K. If we are deficient in any of these, calcium will not be utilized as efficiently.
  • The foods we eat are also important. Our bones serve as a buffer system to keep our bodies slightly alkaline. Every time we eat acid-forming foods a little bit of bone is dissolved to neutralize the acid. For optimal bone health we need to minimize acid-forming foods and eat more alkaline-forming foods. That means we need to avoid sodas, sweets and refined grains. We also need to minimize meats, eggs, and dairy. Instead, we should focus on fruits, vegetables, peas, beans, lentils, seeds, and nuts.
  • Beware of drugs. The list of common medications that dissolve bones is a long one. Some of the worst offenders are anti-inflammatory steroids such as cortisone and prednisone, drugs to treat depression, drugs to treat acid reflux, and excess thyroid hormone. I am not suggesting that you should avoid properly prescribed medications. I would suggest you ask your doctor or pharmacist whether the drugs you are taking adversely affect bone density. If they do, you should pay a lot more attention to the other aspects of a “bone healthy lifestyle.”

 

Are Vitamin D Supplements Worthless?

are vitamin d supplements worthless bone healthNow we can come back to the question “Are vitamin D supplements worthless?” as the recent headlines have suggested. If you phrase the question as “Does everyone benefit from vitamin D supplementation?” or “Is vitamin D supplementation alone sufficient to build strong bones?” the answer is a clear no.

However, those are the wrong questions. If you ask: “Does vitamin D supplementation benefit people who are vitamin D-deficient?” the answer is a clear yes. If you ask: “Does a holistic approach that includes resistance exercise, adequate calcium, and adequate vitamin D improve bone health?” the answer is likely to be yes as well.

What about the headlines claiming that vitamin D is also worthless for strengthening the immune system and reducing the risk of heart disease, cancer, and auto-immune diseases?  The studies on which these claims are based suffer from the same flaws. They are asking the same wrong questions.

My recommendations:

  • Have your blood levels of 25-hydroxy vitamin D tested on a regular basis. I have them tested each year when I get my physical.
  • If your blood levels of 25-hydroxy vitamin D are below 25 nmol/L (which the NIH considers deficient), you are likely to benefit from vitamin D supplementation. If they are above 50 nmol/L (which the NIH considers sufficient), vitamin D supplementation is unlikely to provide additional benefit. However, that level of vitamin D doesn’t guarantee that you will have strong bones. You also need sufficient calcium and resistance exercise.
  • If your blood levels are in the insufficient range (between 25 nmol/L and 50 nmol/L), the situation is more complicated. If you are close to 50 nmol/L, you may benefit slightly from adding a vitamin D supplement, but the benefit will be too small to show up in a clinical study such as the one that resulted in the recent headlines. My advice is to look at your diet and medication use. If they put you at risk for low bone density, my recommendation would be to add a vitamin D supplement – along with adequate calcium and resistance exercise, of course. If you are closer to 25 nmol/L, you will likely benefit from a vitamin D supplement along with adequate calcium and exercise.
  • Don’t think of vitamin D supplementation as a “magic bullet” that will solve all your ills. Instead, think of it as just one component of a holistic approach to a bone healthy lifestyle.

 

The Bottom Line

 

A recent meta-analysis concluded that vitamin D supplementation did not improve bone mineral density, reduce bone fractures, or reduce falls in the elderly. While this conclusion was definitive, the study was asking the wrong questions.

  • We know that vitamin D improves bone health for people who are vitamin D-deficient. However, only 1.6% of the people in this study were vitamin D-deficient at the beginning of the study. That means the study was really asking: “If people have adequate, or near adequate, vitamin D status, does vitamin D supplementation provide any additional benefit?”  The answer to that question is a “no-brainer.”  There is no reason to expect that additional vitamin D would provide benefit.
  • We know that while vitamin D is essential for building strong bones, it is not sufficient by itself. Strong bones require a holistic approach that includes resistance exercise, adequate calcium, and adequate vitamin D. However, this study only looked at the effect of vitamin D on bone health. Calcium and exercise were excluded from consideration. That means the study was really asking: “Is vitamin D a “magic bullet” that can build strong bones by itself?” Again, there is no reason to expect vitamin D to provide much benefit under those conditions.

My recommendations:

  • Have your blood levels of 25-hydroxy vitamin D tested on a regular basis. I have them tested each year when I get my physical.
  • If your blood levels of 25-hydroxy vitamin D are low, you are likely to benefit from vitamin D supplementation. If they are already optimal, vitamin D supplementation is unlikely to provide additional benefit.
  • Don’t think of vitamin D supplementation as a “magic bullet” that will keep your bones strong by itself. Instead, think of it as just one component of a holistic “bone healthy lifestyle.”

 

For more details and to see my detailed recommendations, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Health Tips From The Professor Does Vitamin D Reduce Cholesterol In Children?

 

Posted August 7, 2018 by Dr. Steve Chaney

Is Vitamin D Associated With Heart Disease Risk?

Author: Dr. Stephen Chaney

vitamin-d-reduce-cholesterol-childrenNot too many years ago, we thought of vitamin D as affecting bone density and little else. Then we discovered that almost every cell in our body has vitamin D receptors. This has lead to research suggesting that vitamin D affects our health in many ways that were unimaginable only a couple of decades ago.

For example, low vitamin D levels are associated with increased risk of heart disease. The linkage between vitamin D and heart disease has not been proven. Nor do we know the mechanism. However, this has lead to ongoing research asking if there is any relationship between vitamin D and cholesterol metabolism.

The answer appears to be yes. Several studies have suggested a correlation between low vitamin D levels and elevated total cholesterol, LDL cholesterol, and triglycerides – all risk factors for heart disease.

The next question is how early in life is this correlation found. Again, some studies have suggested that the same correlation between low vitamin D and high levels of unhealthy lipids are found in teens. But, what about pre-teens, children who haven’t gone through puberty yet? That’s what this study was designed to determine.

How Was The Study Done?

vitamin-d-reduce-cholesterol-children studyThe current study  was based on data collected from 419 children, ages 6-8, in the Physical Activity and Nutrition in Children (PANIC) Study in Eastern Finland. This was a lifestyle study that collected information on body weight, diet, and activity levels.

Fasting blood samples were also collected and analyzed for blood lipid levels (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides) and for 25-hydroxyvitamin D (25(OH)D), which is considered the most accurate measure of vitamin D status. The National Institutes of Health considers:

  • <30 nmol/L of 25(OH)D an indicator of vitamin D deficiency.
  • 30 to <50 nmol/L 25(OH)D an indicator of vitamin D insufficiency.
  • ≥50 nmol/L 25(OH)D an indicator of adequate vitamin D status.

To put this study in perspective, vitamin D status is a major concern in Finland because of its proximity to the Arctic Circle. There is little sunlight in the winter, and, although the days are long in the summer, the sun is weak. The major sources of vitamin D in the Finnish diet are fish, vitamin D-fortified fluid milk products, vitamin D-fortified fat spreads, and vitamin D supplementation. Vitamin D fortification was introduced in Finland in 2003. Vitamin D supplementation has also become increasing popular. The number of people using vitamin D supplements has increased from 11% in 2000 to 41% in 2011.

A recent study  looking a vitamin D status between 2000 and 2011 found that the combination of food fortification and vitamin D supplementation has been successful at improving vitamin D status in the Finnish population, increasing average 25(OH)D levels from 48 nmol/L to 65 nmol/L.

 

Does Vitamin D Reduce Cholesterol In Children?

vitamin dIn this study the mean serum 25(OH)D in the children was 68.1 nmol/L. 20% of the children had serum 25(OH)D below 50 nmol/L, and only 4 children (1%) had serum 25(OH)D below 30 nmol/L. When 25(OH)D levels were compared with blood lipid levels:

  • Higher serum 25(OH)D levels Forskolin Keto Complete were associated with lower plasma levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
  • The association between higher 25(OH)D levels and lower blood levels of total cholesterol, LDL cholesterol, and HDL cholesterol remained after correcting for weight, physical activity, sedentary behavior, diet, daylight time, parental education, and genetic mutations known to affect vitamin D metabolism.

What Does This Mean For You?

I don’t want to overinterpret the study. Not all studies show an inverse association between 25(OH)D and cholesterol levels. Most of the previous studies have also indicated that higher 25(OH)D levels were associated increased HDL levels, while this study found higher 25(OH)D levels associated with decreased HDL levels. Much more research needs to be done.

However, this study is yet another indication that optimal vitamin D status may be important for heart health, even in young children. While the correlation between vitamin D status and heart health is not definitive at present, virtually everyone agrees that adequate vitamin D status is a good thing.

My recommendations are to:

  • Get as much vitamin D as possible from vitamin D-fortified foods, oily fish, and sensible sun exposure.
  • Get your serum 25(OH)D level determined and take vitamin D supplements if it is low.

The Bottom Line

A recent study of vitamin D status in Finnish children ages 6-8 found:

  • Higher vitamin D status was associated with lower plasma levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
  • The association between better vitamin D status and lower blood levels of total cholesterol, LDL cholesterol, and HDL cholesterol remained after correcting for weight, physical activity, sedentary behavior, diet, daylight time, parental education, and genetic mutations known to affect vitamin D metabolism.

This study is another indication that optimal vitamin D status may be important for heart health, even in young children. While the correlation between vitamin D status and heart health is not definitive at present, virtually everyone agrees that adequate vitamin D status is a good thing.

My recommendations are to:

  • Get as much vitamin D as possible from vitamin D-fortified foods, oily fish, and sensible sun exposure.
  • Get your serum 25-hydroxyvitamin D level determined and take vitamin D supplements if it is low.
  • Make sure your children are getting enough vitamin D in their diet and have optimal serum 25-hydroxyvitamin D.

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Health Tips From The Professor Vitamin D and Cancer Risk?

Posted June 12, 2018 by Dr. Steve Chaney

Do Eggs Reduce Heart Disease Risk?

Author: Dr. Stephen Chaney

Are eggs good for you?

are eggs good for youIf you are like most Americans, you are probably confused about whether you should eat eggs or not. It’s no wonder. The story about eggs keeps changing.

Just a few years ago we were told that eggs were full of cholesterol. They would increase our risk of heart disease. We should avoid them. If we did eat eggs, it should just be the egg whites because all the cholesterol was in the yolk.

Then we were told that the latest science showed that dietary cholesterol didn’t have much of an effect on serum cholesterol levels. It was saturated fats, trans fats, and obesity that raised serum cholesterol levels. Several major studies found that eggs didn’t increase heart disease risk. But we were told not to overdo it. Two to three eggs a week were probably OK, but more might be risky.

Now the headlines proclaim that eggs are good for our heart. They decrease heart disease risk. You can eat an egg every day and actually reduce your risk of heart disease. What is the truth? Let’s start by looking at the study (C. Qin et al, Heart, doi: 10.1136/heartjnl-2017-312651 ).

How Was The Study Done?

are eggs good for you and your heartThe study was performed in China. 500,000 adults (aged 30-79 years) from 10 diverse sites in China were enrolled in the study between 2004 and 2008. At the beginning of the study, the participants were asked about the frequency of egg consumption. A subset of the participants was asked about egg consumption at regular intervals during the first year to assess whether egg consumption was constant. The participants were followed for 8.9 years and cardiovascular incidents were determined from multiple health registries in China.

In terms of egg consumption:

  • 9% of the population never consumed eggs or consumed them very infrequently.
  • 20% of the population consumed eggs 1-3 days/month.
  • 47% of the population consumed eggs 1-3 days/week.
  • 11% of the population consumed eggs 4-6 days/week.
  • 13% of the population consumed eggs daily (average = 0.76 eggs/day).

 

Are Eggs Good For You?

 

are eggs good for you and reduce heart diseaseWhen the scientists conducting the study compared participants reporting daily egg consumption with those who never or rarely consumed eggs:

  • Overall risk of cardiovascular disease was lowered by 11%
  • Risk of heart attacks was lowered by 12%
  • Risk of major cardiovascular events was lowered by 12%.
  • Risk of hemorrhagic stroke (stroke caused by bleeding in the brain) was lowered by 26%
  • Risk of ischemic stroke (stroke caused by a blood clot) was lowered by 10%.

In addition, daily egg consumers lowered their risk of:

  • Cardiovascular death by 18%.
  • Hemorrhagic stroke death by 28%.

The reduction in hemorrhagic stroke risk is particularly significant for the Chinese. In China stroke is the leading cause of death and disability. The reasons for the high stroke risk in China are not well understood. However, the smoking rate and the incidence of high blood pressure are both higher in China than in the United States.

 

What Does This Study Mean For You?

There are some weaknesses to this study. For example, participants reporting daily egg consumption had a higher level of education and household income, were more likely to take a multivitamin supplement, and less likely to have high blood pressure than participants reporting little or no egg consumption. The authors did their best to compensate for these differences statistically, but there is always the concern that they might have introduced bias into the conclusions.

More to the point, diet and lifestyle are very different in China than in the United States. That also could have influenced the results. Thus, it is, perhaps, premature to claim the eggs reduce the risk of heart disease. However, several major studies performed in the United States have shown that eggs do not increase heart disease risk. That means eggs can be part of a heart healthy diet. According to the Mayo Clinic : “Most healthy adults can eat up to seven eggs a week with no increase in their risk of heart disease.”

That is fortunate because eggs are a very healthy food. According to the authors of this study:

  • Studies have shown that egg protein results in better blood sugar control, better satiety (feeling of fullness), and reduced subsequent food intake in healthy and overweight individuals. In layman’s terms that means egg protein can help you achieve and maintain a healthy weight.
  • Egg yolks are a good source of lutein and zeaxanthin. We think of lutein and zeaxanthin as good for eye health. But, they also play an important role in protecting against oxidation, inflammation, and atherosclerosis.
  • Egg yolks also contain choline. We think of choline as good for brain and nerves. But, choline and other phospholipids in the yolk also raise HDL levels and enhance HDL function.
  • Eggs are a good source of vitamin A, vitamin D, vitamin B12, riboflavin, selenium and iron.
  • Eggs contain almost twice as much monounsaturated and polyunsaturated fats as saturated fats.

are eggs good for you but not sausage and baconThere is one other possible takeaway from this study. Let’s return to the differences between the Chinese study and US studies. There is one other major study showing that daily egg consumption reduces heart disease risk, and it was performed in Japan. What is different between Japan, China, and the United States you might ask. The answer is simple. They consume primarily plant-based diets.

That suggests eggs may be healthier as part of a primarily plant-based diet than they are as part of the typical American diet. In short, eggs are healthy. It’s the sausage, bacon, ham, breakfast muffin, and biscuits that are the problem.

Are eggs good for you? Yes.

For more information on heart healthy diets, read my book “Slaying The Food Myths.”

 

The Bottom Line:

A recent study looked at the effect of egg consumption on heart disease risk in China. It found that people who consumed one egg per day had significantly lower risk of heart disease risk than people who seldom or never consumed eggs.

This study has some shortcomings and may not be directly applicable to those of us in the United States. However, several major studies in the United States have concluded that egg consumption does not increase heart disease risk. That means eggs can be part of a heart healthy diet. According to the Mayo Clinic: “Most healthy adults can eat up to seven eggs a week with no increase in their risk of heart disease.” That is fortunate because eggs are a very healthy food.

There is one other major study showing that daily egg consumption reduces heart disease risk, and it was performed in Japan. What is different between Japan, China, and the United States you might ask. The answer is simple. They consume primarily plant-based diets.

That suggests eggs may be healthier as part of a primarily plant-based diet than they are as part of the typical American diet. Are eggs good for you? Yes, eggs are healthy. It’s the sausage, bacon, ham, breakfast muffin, and biscuits that are the problem.

For more information on heart healthy diets, read my book “Slaying The Food Myths.”

For more details on this study, read the article above:

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.