When you talk about Vitamin D, there are a number of things you can say about it.
Protects your bones from osteoarthritis and osteoporosis? Duh?
Helps fight against 17 different forms of cancer? Yup!
Wards against auto-immune disease, stroke, diabetes, depression, and hypertension? Sure!
Keeps you from getting Piggy Flu? Yes.. wait.. what?
The experts over at the Vitamin D Council — those guys that actually know what the heck they are talking about when it comes to this stuff — have gotten two emails concerning the efficacy of Vitamin D protecting against H1N1:
Dr. Cannell: Your recent newsletters and video about Swine flu (H1N1) prompted me to convey our recent experience with an H1N1 outbreak at Central Wisconsin Center (CWC). Unfortunately, the state epidemiologist was not interested in studying it further so I pass it on to you since I think it is noteworthy.
CWC is a long-term care facility for people with developmental disabilities, home for approx. 275 people with approx. 800 staff. Serum 25-OHD has been monitored in virtually all residents for several years and patients supplemented with vitamin D.
In June, 2009, at the time of the well-publicized Wisconsin spike in H1N1 cases, two residents developed influenza-like illness (ILI) and had positive tests for H1N1: one was a long-term resident; the other, a child, was transferred to us with what was later proven to be H1N1.
On the other hand, 60 staff members developed ILI or were documented to have H1N1: of 17 tested for ILI, eight were positive. An additional 43 staff members called in sick with ILI. (Approx. 11–12 staff developed ILI after working on the unit where the child was given care, several of whom had positive H1N1 tests.)
So, it is rather remarkable that only two residents of 275 developed ILI, one of which did not develop it here, while 103 of 800 staff members had ILI. It appears that the spread of H1N1 was not from staff-to-resident but from resident-to-staff (most obvious in the imported case) and between staff, implying that staff were susceptible and our residents protected. Sincerely, Norris Glick, MD Central Wisconsin Center Madison, WI
This is the first hard data that I am aware of concerning H1N1 and vitamin D. It appears vitamin D is incredibly protective against H1N1. Dr. Carlos Camargo at Mass General ran the numbers in an email to me. Even if one excludes 43 staff members who called in sick with influenza, 0.73% of residents were affected, as compared to 7.5% of staff. This 10-fold difference was statistically significant (P<0.001). That is, the chance that this was a chance occurrence is one less than one in a thousand.
Dr. Cannell: Thanks for your update about the hospital in Wisconsin. I have had similar anecdotal evidence from my medical practice here in Georgia. We are one of the 5 states with widespread H1N1 outbreaks.
I share an office with another family physician. I aggressively measure and replete vitamin D. He does not. He is seeing one to 10 cases per week of influenza-like illness.
In my practice— I have had zero cases. My patients are universally on 2000–5000 IU to maintain serum levels 50–80 ng/ml. Ellie Campbell, DO Campbell Family Medicine 3925 Johns Creek Court Ste A Suwannee GA 30024
Critics say we should not recommend vitamin D to prevent influenza until it is proven to do so (It has not been).
The critics are thus saying, although they seem not to know it, you should be vitamin D deficient this winter until science proves being vitamin D sufficient is better than being Vitamin D deficient. Such advice is clearly unethical and has never ever been the standard of care.
This is not rocket science. If I am wrong, and Vitamin D does not prevent influenza, what is lost? A few dollars. If they are wrong, and it does prevent influenza, what is lost? So far, the CDC says 41 kids are dead from H1N1, and the flu season has not yet started.
I read this, called in DH from his gaming adventures, and gave him 5k of dry D3. I agree with Dr. Cannell — if it’s just a coincidence, then he’s taking a pill that might make him a bit happier, lower his chances of stroke, cancer, hypertension, and diabetes (and given the amount of Mt. Dew he drinks, he needs all the help he can get in that department). But hey, given how miraculous Vitamin D seems to be? Yeah, he’s taking the damned little capsule anyway.
Flintstones and Tums aren’t enough postop.
Some of us know this already — but heya! there’s a study that gives some credence to what some of us have been saying. There was an article published in The American Journal of Clinical Nutrition, the Official Journal of the American Society for Clinical Nutrition, Inc.
Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation, by Christoph Gasteyger, Michel Suter, Rolf C Gaillard, and Vittorio Giusti. (Article can be read here.)
Before you ask, the numbers are based off of an unknown, regular multivitamin. The studies are not based off of a bariatric multivitamin, or using ASMBS recommendations. However, this just proves why we should heed those recommendations. Lots of numbers ahead – scary numbers, actually.
The study, in the end, included 137 morbidly obese patients (110 women and 27 men) — these were the ones who maintained the lab requirements, the supplementation requirements, the doctor visits, etc. Initially, there were 348 patients in the study, but only about 33% complied with the postoperative care requirements, which, in of itself, is a sobering statistic.
Lab testing was done at 3, 6, 12, 18, and 24 months postoperatively.
This, folks, is where it gets really scary.
- 3 months postop, 34% required at least one additional supplement to the multivite
- 6 months postop, 59% required at least one additional supplement
- 12 months postop, 86% required at least one additional supplement
- 18 months postop, 93% required at least one additional supplement
- 24 months postop, 98% required at least one additional supplement to the multivite
- After 2 years, 2.2% took 0 additional supplements
- 18.3% took 1 additional supplement
- 19.7% took 2 additional supplements
- 22.6% took 3 additional supplements
- 27.7% took 4 additional supplements to the multivite
- 6.6% took 5 additional supplements
- 2.9% took 6 additional supplements
- B12 was the most often supplemented — 10% were taking it at 3 months and 80% were taking it at 2 years
- Iron was next — 15% at 3 months, and 60% at 2 years
- Calcium +D — 17% at 3 months, 60% at 2 years
- Folic Acid — 7% at 3 months, 45% at 2 years
- B1 — 1% at 3 months, 4% at 2 years
- B6 — 1% at 3 months, 13% at 2 years
- Magnesium — 1% at 3 months, 13% at 2 years
- Zinc — 1% at 3 months, 12% at 2 years
So what does all of this tell us? Quite a bit. First off.. 33% of the people included in this study were able to pop a single pill, keep up with doctor appointments, get blood draws, add supplements as needed? Only 33% could comply for a measly two years? They got their insides sliced and diced, knowing this was going to be for life, knowing they would need vitamins for life, and they couldn’t maintain a simple protocol for a measly two years? This frightens the heck out of me more than the numbers above do. I mean.. what happens at year three? Or, if they are still kicking, year ten?
But while we’re looking at the numbers, and let’s keep in mind that these are only for two years — and let’s not think about those of us kicking around the five year mark — that 98% of those in the study were at least on one additional supplement to a multivite. That tells us that we need much, much more than the average bear. So maybe, perhaps, the ASMBS has it right with their recommendations for doubling the multivite, adding some calcium, some iron, some b12, etc.? That Flintstones and Tums aren’t going to cut it for long.
Yes, sobering statistics to be certain.
To keep the FTC happy, let’s put it up at the top that Click has not paid me for this post. In fact, they did not even know I was blogging this until I Tweeted about it, oh, maybe 30 seconds ago while I was modifying the picture to kill out the kids’ toys in the background (I am a full-time mother, remember?) so there can be no question that this is Andrea’s unvarnished opinion.
So these Click packets, that you see pictured were in our OH swag bags from the Atlanta event. I’ve had Click before, and so I snagged (ie stole) a few extras. I make no apologies for this because I like Click. Well, no, I really like Click.
Being the very busy, and, well, very lazy mom that I am, I tend to use shakers rather than blenders. I’m also not one for ice-cold anything. I found that cute little 10oz shaker at the Atlanta event (thank you Tupperware ladies — if I knew who you were, I’d link you in) and that’s now what I’m fixing my drinks in.
In any case, the Click doesn’t mix wonderfully well in the shaker.. this could have been because I did not shake it long enough, violently enough, etc. It still had some clumps, but I honestly feel this is due to a lack of shaking on my part rather than the quality of the product. I’ve been told this is a wonderful drink made with some ice and a blender. I’m sorry — I can’t be bothered with a blender, and the ice turns me off as I don’t like ice-cold anything. This may be an excellent option for you, though.
When I first tried Click, I felt that it was too strong. Now that I routinely drink 6-shot venti lattes from the buxx, I don’t think they are nearly as strong as they once were. I am a Splenda-whore.. I have a sweet tooth (which is why I am fat in the first place I’m sure) and add a few extra Splenda to my Click. One of these packets contain two “scoops” from a canister, and I used 10oz of cold tap water. Of course, more water or fewer scoops will modify the strength of the Click.
I’ve seen some ideas for things like “Clicktini’s” and the like — this, this is something Andrea will be exploring with some of the packets that have been.. procured.. yes, that’s the term we will use.
As for nutritional stats, this is better most:
Considering it’s a protein drink, it also contains vitamins that postop patients need? Really? So I can get some extra B12 with my espresso fix? WIN. SHINY WIN.
Final result? Yes, Andrea would drink this. In fact, I’ve already finished the shaker-full that was in the picture. More, please?
A few suggested biochemical monitoring tools for nutritional status
Serum thiamin – B1 (thiamin)
Normal range: 10-64 ng/mL
Postop deficiency: Rare, but occurs with RYGB, AGB, and BPD/DS
PLP – B6 (pyridoxine)
Normal range: 5-24 ng/mL
Postop deficiency: Rare
Serum B12 – B12 (cobalamin)
Normal range: 200-1000pg/mL (Andrea’s ideal is around 1200-1800)
Postop deficiency: Common with RYGB in absence of supplementation, 12-33%
RBC folate – Folate
Normal range: 280-791 ng/mL
Postop deficiency: uncommon
Ferritin – Iron
Normal range: Males 15-200 ng/mL, Females 12-150 ng/mL (Andrea’s ideal is 200)
Postop deficiency: common with RYGB for menstruating women (51%) and patients with super obesity (49-52%)
Plasma retinol – Vitamin A
Normal range: 20-80 mcg/dL
Postop deficiency: common (50%) with BPD/DS after 1 yr, <= 70% at 4 yrl may occur with RYGB/AGB
25(OH)D – Vitamin D
Normal range: 25-40 ng/mL (Andrea’s optimal is 80-100)
Postop deficiency: Common with BPD/DS after 1 yr; may occur with RYGB; prevalence unknown
Plasma alpha tocopherol – Vtiamin E
Normal range: 5-20 mcg/mL
Postop deficiency: Uncommon
PT – Vitmain K
Normal range: 10-13 s
Postop deficiency: Common with BPD/DS after 1 yr
Plasma zinc – Zinc
Normal range: 60-130 mcg/dL
Postop deficiency: Common with BPD/DS after 1 yr; may occur with RYGB
Serum albumin – Protein
Serum total protein
Normal range: albumin 4-6 g/dL; total protein 6-8 g/dL
Postop deficiency: Rare, but can occur with RYGB, AGB, and BPD/DS if protein intake is low in total intake or indispensible amino acids