Calcium supplements and cardiovascular risk?

On July 31, 2010, in Minerals, by Andrea

A prime example of how media will take a study and leave out key points in order to scare people.  Gotta love it.

All over, the news outlets are talking about how people should maybe lay off the calcium because there may be too much risk for a cardiovascular incident versus osteoporosis prevention.  What they conveniently forget to mention is that the calcium used did not contain any vitamin D, which is pretty much standard faire in the US.  Vitamin D is renowned for lowering cardiovascular risk.. perhaps this study highlights that now more than ever?  I can say fairly confidently that people are waking up to the need of vitamin D and post-WLS folks are some of the most educated in that realm.  WTG WLSers!

Additionally, it should be noted that the problem is with fluctuating serum calcium levels — something that doesn’t happen as often with post-WLS patients as our absorption does not work the same way.  Food for thought:  how many post-ops, people who routinely take 1500-2000mg of calcium citrate a day (or should be..) are dropping like flies with heart disease?  Not many.

Am I worried?  No.

Continue reading »

Heart Disease to kill 400,000 in US in 2010

On February 1, 2010, in Uncategorized, by Andrea

Wow.  That’s sobering.

And we know what the number one cause for heart disease is, right?

(Don’t make me slap you silly.  Cause I will.)


Heart disease to kill 400,000 in U.S. in 2010

Experts: Progress against cutting cholesterol stalled by rising obesity rates

LONDON – Decades of progress in the United States on cutting cholesterol, blood pressure and smoking are being stalled by rising obesity rates, and heart disease will kill around 400,000 Americans this year, experts said on Monday.

A study by British scientists found that around half of those deaths could be averted if people ate healthier food and quit smoking, and experts warned there was no room for complacency when it came to heart health risks.

Simon Capewell of the University of Liverpool said recent weight trends were “alarming,” with 1.5 billion adults worldwide expected to be overweight by 2015.

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“Although (heart disease) death rates have been falling in the United States for four decades, they are now leveling off in young men and women,” he wrote in a study in the World Health Organization’s weekly journal.

“Recent declines in total blood cholesterol have been modest, blood pressure is now rising among women and obesity and diabetes are rising steeply in both sexes.”

The researchers calculated the number of deaths based on lifestyle trends, taking the year 2000 as a base.

They found that almost 200,000 lives could be saved if certain heart risk factors were cut, even modestly, in particular, Capewell said, “if people ate healthier food and stopped smoking.”

Two-thirds of U.S. adults and nearly one in three children are overweight or obese — a condition that increases their risk for diabetes, heart disease and other chronic illnesses.

U.S. health officials last week introduced first lady Michelle Obama as their latest weapon in a fresh campaign against the increasingly-costly weight burden.

But Shanthi Mendis, an expert on chronic disease prevention at the Geneva-based WHO, noted that the United States was not alone in facing an obesity epidemic, and said lifestyle choices now directly affected the health of many of the world’s people.

“Worldwide, nearly one billion adults are overweight and, if no action is taken, this figure will surpass 1.5 billion by 2015,” she said in the study.

“By avoiding tobacco, eating a healthy diet and engaging in regular physical activity, people can dramatically reduce their risk of developing heart disease, stroke or diabetes.”

Not a good day, news-wise.

From Medscape:

Obesity on All Measures Linked to Increased Ischemic Stroke Risk

Pauline Anderson

January 22, 2010 — No matter how it is measured, obesity is a significant risk factor for ischemic stroke, not only in men and women but also in both blacks and whites, a new study has found.

The study, which used all 3 measures of obesity — body mass index (BMI), waist circumference, and waist to hip ratio (WHR) — was among the first to look at the association between obesity and stroke risk in blacks and whites.

“This was the first study that shows consistently that obesity increases risk of stroke in both blacks and whites,” said lead author Hiroshi Yatsuya, MD, PhD, visiting associate professor in the Division of Epidemiology & Community Health at the School of Public Health, University of Minnesota, Minneapolis.

The study reinforces the message that controlling obesity, which may help prevent hypertension and diabetes, may reduce the risk for stroke, he said.

The study was published online January 21 and will appear in the March issue of Stroke.

Obesity Measurements

The analysis included 13,549 participants (5930 men and 7619 women and 3694 blacks and 9855 whites) aged 46 to 64 years from the Atherosclerosis Risk in Communities (ARIC) Study who were recruited from 4 US communities and followed up from 1987 to 2005.

Participants were interviewed over the telephone and completed several clinic visits.

To determine obesity, researchers used BMI, that is, weight in kilograms divided by height in meters squared, waist circumference alone, and WHR, the ratio of waist circumference taken at umbilical level to hip measurement taken at maximum buttock circumference.

Table. Mean Obesity Measures at Baseline by Race and Sex

Group BMI Waist Circumference Waist to Hip Ratio
Black women 30.8 100.3 0.90
Black men 27.6 96.7 0.94
White women 26.6 93.0 0.89
White men 27.4 99.5 0.97

BMI = body mass index

During follow-up, there were 598 ischemic strokes. Researchers confirmed the incidence of stroke through hospital discharge records and imaging information. Blacks had a 2 to 3 times higher incidence of ischemic stroke compared with whites in each obesity group.

The researchers calculated stroke incidence according to different quintiles of obesity, using all 3 obesity measures. For BMI, they found that the stroke incidence per 1000 person-years ranged from 1.2 for white women in the lowest category to 8.0 for black men in the highest category.

Linear Relationship Between Stroke and Obesity

For other obesity measurements, the stroke incidence rate had a similar range. Using waist circumference, the rates ranged from a low of 1.1 per 1000 person-years for white women in the lowest quintile to 8.2 in black men in the highest quintile. Using WHR, the lowest rate was 1.1 for white women in the lowest category, and the highest was 8.2 for black women in the top category.

No matter what obesity measure was used, the results showed about twice the stroke risk among patients in the highest category compared with those in the lowest. For example, for BMI, the risk for patients in the highest category was 1.4 to 2.1 times higher than those in the lowest BMI category (varying modestly by race and sex).

Dr. Yatsuya noted that the correlation between increasing stroke incidence and increasing degree of obesity was apparent in both races and sexes.

However, said Dr. Yatsuya, much of the association between stroke and obesity in this study could be explained by diabetes and hypertension, both of which are well-established risk factors for stroke.

“Either blood pressure or diabetes mellitus alone could have eliminated significant associations between obesity measure quintiles and ischemic stroke incidence,” the study authors point out.

Given the strong association between obesity and hypertension and other risk factors, including diabetes, they conclude that “obesity would be an important target for prevention of ischemic stroke.”

Best Measure?

There is still a debate in the scientific community about which measure of obesity is most accurate. According to Dr. Yatsuya, BMI might be the easiest to obtain because a clinician just needs to know height and weight. Getting an accurate waist circumference and WHR may be challenging in obese patients, he said.

Using proportion attributable fraction values — the proportion that might be prevented by eliminating a risk factor — the researchers estimated that 18% to 20% of ischemic stroke may be accounted for by a BMI of 28 or more.

Stroke is the third leading cause of death and the leading cause of serious long-term disability in the United States.

Reinforces Obesity Importance

Reached for a comment, Ralph L. Sacco, MS, MD, professor and chair of neurology at the University of Miami in Florida and a member of the American Academy of Neurology, said the study is a “well-done, large, prospective study” that reinforces the importance of obesity as a risk factor not just for heart attack but also for stroke.

One of Dr. Sacco’s own studies, using data from the Northern Manhattan Stroke Study and published in 2003, showed an elevated stroke risk for both blacks and whites using WHR but not BMI (Suk SH, et al. Stroke 2003;34:1586-1592).

“This [new] study is much larger and has much more statistical power and was able to show BMI, as well as waist circumference and waist-to-hip ratio, all great markers for obesity, increased risk in both blacks and whites,” he notes.

Another report from the Northern Manhattan Cohort Study by Dr. Sacco and colleagues, published last year in the Journal of the American College of Cardiology, showed that an elevated waist circumference in both men and women and across whites, blacks, and Hispanics increased the risk not only for stroke but also for myocardial infarction and vascular death (Sacco RL, et al. J Am Coll Cardiol. 2009;54:2303-2311).

All this research is important because obesity is becoming “an alarming trend,” with Americans being less physically active and following unhealthy diets, said Dr. Sacco. “We’re concerned about a higher proportion of the US population that will be obese and at higher risk for high blood pressure, diabetes, and now definitely stroke.”

Dr. Sacco also noted that in this new study, the stroke risk drops after controlling for other factors. “To us, this just means that some of the effect that obesity has is through high blood pressure, diabetes, and other vascular risk factors.”

The ARIC Study was funded by the National Heart, Lung, and Blood Institute. The authors have disclosed no relevant financial relationships.

Stroke. Published online January 21, 2010.

The Vitamin D Newsletter

More Vitamin D Studies of Interest

December 3, 2009.

This is a periodic newsletter from the Vitamin D Council, a non-profit trying to end the epidemic of vitamin D deficiency. If you want to unsubscribe, go to the end of this newsletter. If you are not subscribed, you can do so on the Vitamin D Council’s website.

This newsletter may be reproduced as long as you properly and prominently attribute it source. Please reproduce it, post it on Internet sites, and forward it to your friends.

Five million dollar randomized controlled trial sponsored by Thrasher Research Fund and NIH

Scientists around the world presented their work at the recent Vitamin D conference in Brugge, Belgium. Many, but not all, of the scientists opined that we have to wait for randomized controlled trials (RCT) before recommending Vitamin D. In a future newsletter, I will review many of these presentations.
However, one was extraordinary. Professor Bruce Hollis presented findings from his and Carol Wagner’s five million dollar Thrasher Research Fund and NIH sponsored randomized controlled trials of about 500 pregnant women. Bruce and Carol’s discoveries are vital for every pregnant woman. Their studies had three arms: 400, 2,000, and 4,000 IU/day.
1. 4,000 IU/day during pregnancy was safe (not a single adverse event) but only resulted in a mean Vitamin D blood level of 27 ng/ml in the newborn infants, indicating to me that 4,000 IU per day during pregnancy is not enough.
2. During pregnancy, 25(OH)D (Vitamin D) levels had a direct influence on activated Vitamin D levels in the mother’s blood, with a minimum Vitamin D level of 40 ng/ml needed for mothers to obtain maximum activated vitamin D levels. (As most pregnant women have Vitamin D levels less than 40 ng/ml, this implies most pregnant women suffer from chronic substrate starvation and cannot make as much activated Vitamin D as their placenta wants to make.)
3. Complications of pregnancy, such as preterm labor, preterm birth, and infection were lowest in women taking 4,000 IU/day, Women taking 2,000 IU per day had more infections than women taking 4,000 IU/day. Women taking 400 IU/day, as exists in prenatal vitamins, had double the pregnancy complications of the women taking 4,000 IU/day.
What does this huge randomized controlled trial mean?
We have long known that blood levels of activated Vitamin D usually rise during very early pregnancy, and some of it crosses the placenta to bathe the fetus, especially the developing fetal brain, in activated vitamin D, before the fetus can make its own. However, we have never known why some pregnant women have much higher activated Vitamin D levels than other women. Now we know; many, in fact most, pregnant women just don’t have enough substrate, the 25(OH)D building block, to make all the activated Vitamin D that their placenta wants to make.
Of course fetal tissues, at some time in their development, acquire the ability to make and regulate their own activated Vitamin D. However, mom’s activated Vitamin D goes up very quickly after conception and supplies it to baby, during that critical window when fetal development is occurring but the baby has yet to acquire the metabolic machinery needed to make its own activated Vitamin D.
The other possibility, that this is too much activated Vitamin D for pregnancy, cannot stand careful scrutiny. First, the amount of activated vitamin D made during pregnancy does not rise after the mother’s 25(OH)D reaches a mean of 40 ng/ml, so the metabolism is controlled. Second, levels above 40 ng/ml are natural, routinely obtained by mothers only a few short decades ago, such as President Barack Obama’s mom probably did, before the sun scare. (President Obama was born in Hawaii in late August before the sun-scare to a mother with little melanin in her skin) Third, higher blood levels of Vitamin D during pregnancy reduce risk of infection and other pregnancy complications, the opposite may be expected if 25(OH)D levels above 40 ng/ml constituted harm.
It is heartening to see the Thrasher Research Fund and NIH support such a large randomized controlled trial. In fact the Thrasher Research Fund has already funded a three year follow up and the NIH request for a follow up grant is pending. Nevertheless, a large number of medical scientists keep saying, “We need even more science before recommending Vitamin D.” What are they really saying?
First they said we need randomized controlled trials (RCT) before we do anything. Well here is a big one. Then they say, as they did in Brugge, “We don’t believe this RCT, we need more money for more RCTs.” If you think about it, they are saying pregnant women should remain Vitamin D deficient until scientists get all the money for all the RCTs they want, which may take another ten years. How many children will be forever damaged in that ten years?

Amazing study just presented at American Heart Association meeting
Dr. Tami Bair and Dr. Heidi May, of the Intermountain Medical Center in Utah, report yet another study showing that your risk of heart attack, stroke, congestive heart failure and death are dramatically increased by Vitamin D deficiency. In a presentation at the American heart Association meeting, they found that people with low levels (< 15 ng/ml) had a 45% increased risk for cardiovascular disease, 78% greater risk of stroke and double the risk for congestive heart failure, not to mention a 77% increased risk of death, compared to people with Vitamin D levels > 30 ng/ml. All that disease and death occurred in only 13 months of follow up for the 27,000 people in the study.
So how many Americans died this last year from Vitamin D deficiency? Ten thousand? A hundred thousand? More? How many will die next year? Someone is responsible. Medical scientists who want more money before recommending that Vitamin D deficiency be treated have to assume responsibility. I am all for more studies but we have to act now, like we did with cigarettes. Remember, no human randomized controlled trials exist showing cigarettes are dangerous, so we have much more and better science than we did when we warned about smoking. If we fail to act on the dangers of Vitamin D deficiency, someone will end up with blood on their hands.

The Great Disappearing Act
We are currently witnessing one of the great mysteries of the natural world. The H1N1 outbreak is rapidly disappearing, despite a wealth of potential victims without antibodies to the virus, and yes, in spite of plummeting Vitamin D levels. In several weeks, the CDC will announce that perhaps one-third of Americans were infected in the last nine months and now have Swine flu antibodies, leaving the majority of the population still susceptible.
But this H1N1 virus is rapidly refusing the invitation to infect the two-third of Americans who are mostly immunological virgins and will soon recede until the next widespread outbreak, which may come this spring or next fall and winter. When H1N1 returns again, I predict it will cause more illness and death than it did this fall despite the fact it will attack a population with more H1N1 specific antibodies. Measles, another virus thought to transmit via respiratory secretions, would never forego the opportunity to infect so many virgins.
Influenzologists have no idea why this Disappearing Act happens. Dr. Edgar Hope-Simpson believed the reason lay in the mode of transmission; the current outbreak is ending despite a wealth of potential victims because the people transmitting the flu are suddenly no longer contagious. I recommend Hope-Simpson’s book:
I also believe that only a small population was transmitting, not all those infected. If these good transmitters – and not all the sick – usually spread the virus, and their transmission period is limited, the epidemic would end shortly after the good transmitters lose their infectivity. Why they lose their infectivity is yet another mystery, but a mystery that fits the epidemiology of influenza.
Another incredible Disappearing Act, one that usually follows the introduction of a pandemic virus, is the rapid and usually complete replacement of seasonal flu with the pandemic one. It is as if the pandemic virus murders the seasonal flu. We will have to wait to see if that happens worldwide with this pandemic, but in the USA it has already happened. Last week the CDC reported that more than 99% of all influenza viruses identified in the USA were Swine flu. Only 1 of 1,874 influenza A viruses identified last week was seasonal flu. Where did the seasonal flu virus go?

Thanks to those who volunteered!
If your email address begins with A through E, you may have gotten my email asking for volunteers to help give feedback on our new website. We were overwhelmed with the response, ten times more than we needed. Thank you.
The reason for the request is that the Vitamin D Council has contracted with Minervation Ltd for $40,000 to build a new website over the next several years. We can only afford $1,000 per month so it take three and a half years to pay them, however; the first version of the new site is scheduled to go up in the late fall of 2010.
We decided to make our site more accessible, so if you only want to know about Vitamin D and pregnancy, you will be able to pull up the information quickly. Our new website will also update Vitamin D articles in the press and scientific studies from the National Library of Medicine automatically every day.
We also want to clearly separate fact from opinion, so readers can easily see what the science is and what our opinion is. Finally, as you know, the Vitamin D Council unfortunately has to market products, like the in-home Vitamin D blood test, to stay in business. The new website will prominently display all of our potential conflicts so readers will know them up front.
If you want our new website up and running sooner than 12 months, consider making a dedicated donation, either by using the snail mail address below or via PayPal on our website. We are now going on our seventh year of operation and plan on 20 more years, in spite of the fact that all 15 of our requests for grants were recently turned down.
Did you know that when you Google “Vitamin D,” you will get more than 12 million hits? Our current website is usually ranked either number 1 or 2 of those 12 million, beating out the NIH, Mayo Clinic and Wikipedia on most days? This is almost entirely due to our webmaster Dana Clark. However, we believe we can dramatically improve our website, with your help.

John Cannell, MD
This newsletter may be reproduced as long as you properly and prominently attribute it source. Please reproduce it, post it on Internet sites, and forward it to your friends.
Remember, we are a non-profit and rely on your donations to publish our newsletter, maintain our website, and pursue our objectives. Send your tax-deductible contributions to:
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More evidence for D

On November 17, 2009, in Fat Solubles, by Andrea


About time people are getting the message.  Vitamin D has been linked to everything from lowering cancer risk, stroke, heart disease, hypertension, auto-immune disorders, diabetes, and depression.

A few notables..

In the first study, May and her colleagues measured blood levels of vitamin D in 8,680 people age 50 or older who had been diagnosed with heart disease, stroke, or another type of cardiovascular disease. vitamin D levels above 30 nanograms per milliliter of blood (ng/mL) were considered normal, levels between 15 and 30 ng/mL were low, and those 15 ng/mL and below were deemed very low.

Among those with very low levels of vitamin D, 32 percent were depressed, as were 25 percent of the people with low levels, and 21 percent of those with normal levels. This trend was seen even among individuals with no history of depression.

In the second study, which looked at 27,686 people age 50 or older with no history of cardiovascular disease, May and her colleagues found that, compared to individuals with normal levels of the vitamin, people with very low levels of vitamin D were 77 percent more likely to die, 45 percent more likely to develop heart disease, and 78 percent more likely to have a stroke during the study, which lasted for more than a year. They also had double the risk of heart failure.

Holick advocates raising the daily limit to 10,000 IU. Many researchers agree and have suggested that the toxic level of vitamin D is closer to 10,000 IU/day.

Keep in mind that 10,000 IU / day number is for normies.. not for those with designer guts.