My week, in perspective.

I get asked quite often what I take.  I hesitate to put it down, line by line, only because I take things that are higher due to need for deficiency, or due to my headaches, or a few other idiosyncricies.  I also tend to not like to label what brands — simply because sometimes this could be seen as an endorsement when it’s not (I shop sales).

But because it does get asked so often, fine.  This is not the order I take them in, but rather the order I put them back in my container.  Hey, I want easy.

As of February 10th, 2010, I take:

  • 2 Members Mark (Centrum) multivites — after this bottle is gone (ha! 450 in a bottle) I have actual Centrums that I got on MASSIVE discount with good expiration dates
  • 5 Vitalady 140mg Tender Magnesium Citrate capsules — magnesium has been shown to help migraine sufferers in clinical trial; I’m actually about to up this another capsule or two; important to note that magnesium helps with calcium absorption, but if taking for migraines, not to take with calcium
  • 1 NatureMade 500mg Vitamin C — taken with the mag citrate to increase absorption
  • 4 Citracal 250mg calcium citrate, 200 IU D3 tablets & 4 Citracal 200mg calcium citrate, 200 IU D3 tablets — 1 of each x 4 servings gives me 1800mg of calcium a day; I buy Citracal because of coupons and the BOGO deals typical of this brand
  • 1 every other day Members Mark 1000mcg B12 — I over absorb b-vites for some reason; I also, for some reason absorb tablet B12.  Don’t try this at home.
  • 1 every other day NatureMade Liquid Softgel Super B-Complex – I over absorb b-vites and am off the chart
  • 1 400mcg CVS folic acid
  • 3 Proferrin ES heme iron — this I love and need and is the only iron that has worked for me in years
  • 4 Vitalady Tender D3-5 5,000 IU
  • 4 Solaray 100mg Vitamin B2 — Riboflavin of doses of 400mgs has been shown in clinical trials to treat migraines, actually thinking of upping this 200mgs to counter malabsorption
  • 1 GNC 2mg Copper
  • 1 NatureMade 30mg Zinc
  • 1 Vitalady 25,000 IU Tender A-25 Retinyl Palmitate
  • 1 Bio-Tech (Vitalady) 100mcg K1-100 (Phytonadione)

This isn’t a listing of what you SHOULD take by any stretch — only what I take.

Calcium+D may reduce fracture risk

On January 22, 2010, in Fat Solubles, Minerals, Vitamins, by Andrea

Um.  Duh?

But for the 2 of you that have not been paying attention.

Take your calcium (citrate) and D.

From Medscape:

Daily Calcium Plus Vitamin D Supplements May Reduce Fracture Risk

Laurie Barclay, MD

January 22, 2010 — Daily supplements of calcium plus vitamin D, but not of vitamin D alone, are associated with significantly reduced fracture risk, according to the results of a patient level-pooled analysis reported in the January 12 issue of the BMJ.

“A large randomised controlled trial in women in French nursing homes or apartments for older people showed that calcium and vitamin D supplementation increased serum 25-hydroxyvitamin D, decreased parathyroid hormone, improved bone density, and decreased hip fractures and other non-vertebral fractures,” write B. Abrahamsen, from Copenhagen University Hospital Gentofte, in Copenhagen, Denmark, and colleagues from the DIPART (vitamin D Individual Patient Analysis of Randomized Trials) Group.

“Subsequent randomised trials examining the effect of vitamin D supplementation — with or without calcium — on the incidence of fractures have produced conflicting results….We used individual patient data methods to do a meta-analysis of randomised controlled trials of vitamin D — with or without calcium — in preventing fractures and investigated if treatment effects are influenced by patients’ characteristics.”

The goals of the study were to identify characteristics affecting the antifracture efficacy of vitamin D or vitamin D plus calcium regarding any fracture, hip fracture, and clinical vertebral fracture and to evaluate the effects of dosing regimens and coadministration of calcium.

Selection criteria were randomized trials with at least 1 intervention group in which vitamin D was given, in which there were at least 1000 participants, and in which fracture was an outcome. The investigators identified 7 major randomized trials of supplementation with vitamin D plus calcium or with vitamin D alone, enrolling a total of 68,517 participants. Mean age was 69.9 years (range, 47 – 107 years), and 14.7% of participants were men. Significant interaction terms were identified with logistic regression analysis, followed by Cox’s proportional hazards models incorporating age, sex, fracture history, and use of hormone therapy and bisphosphonates.

Overall risk for fracture was decreased in trials using vitamin D with calcium (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.86 – 0.99; P = .025), and risk for hip fracture was also decreased (HR for all studies, 0.84; 95% CI, 0.70 – 1.01; P = .07; HR for studies using 10 μg of vitamin D given with calcium, 0.74; 95% CI, 0.60 – 0.91; P = .005). There were no significant effects for vitamin D alone in daily doses of 10 μg or 20 μg, nor was there any apparent interaction between fracture history and treatment response. No interaction was noted for age, sex, or use of hormone replacement therapy.

“This individual patient data analysis indicates that vitamin D given alone in doses of 10-20 μg is not effective in preventing fractures,” the study authors write. “By contrast, calcium and vitamin D given together reduce hip fractures and total fractures, and probably vertebral fractures, irrespective of age, sex, or previous fractures.”

Limitations of this study include lack of data for 4 of the 11 identified studies meeting inclusion criteria, and insufficient information about compliance to do a per protocol analysis. In addition, only a single study provided data for vitamin D given alone at the lower dose.

“We must emphasise that this analysis does not allow for a direct comparison of vitamin D against vitamin D given with calcium, but only comparisons between each intervention and no treatment,” the study authors conclude. “Whether intermittent doses of vitamin D given without calcium supplements can reduce the risk of fractures remains unresolved from the studies in this analysis. Additional studies of vitamin D are also needed, especially trials of vitamin D given daily at higher doses without calcium.”

In an accompanying editorial, Dr. Opinder Sahota, from Queen’s Medical Centre in Nottingham, United Kingdom, notes that these findings are important because they show that vitamin D alone, irrespective of dose, does not reduce the risk for fracture.

“Although the evidence is still confusing, there is growing consensus that combined calcium and vitamin D is more effective than vitamin D alone in reducing non-vertebral fractures,” Dr. Sahota writes. “Higher doses are probably necessary in people who are more deficient in vitamin D, and treatment is probably more effective in those who maintain long term compliance. Further studies are needed to define the optimal dose, duration, route of administration, and dose of the calcium combination.”

The National Heart, Lung, and Blood Institute, National Institutes of Health, supported this study. Some of the study authors have disclosed various financial relationships with Novartis, Amgen, Nycomed, Eli Lilly, Procter & Gamble, Merck, Roche, Shire, ProStrakan, Servier, Celltech, ProStrakan, Alliance for Better Bone Health, GlaxoSmithKline, Pfizer, Sanofi-Aventis, and/or Osteologix.

Dr. Sahota has disclosed no relevant financial relationships.

BMJ. 2010;340:b5463.

Proof.

On January 21, 2010, in Fat Solubles, Minerals, Vitamins, Water Solubles, by Andrea

Just giving you proof — I practice what I preach.

This is my week’s worth of vitamins.  Well, six days’ worth.  I’ve lost the 7th day somewhere and I really like this set, so I make do with what I’ve got.

My week, in perspective.

Each day may be divided into 4 compartments, but that does not mean that I only take vitamins 4 times per day.  Several compartments have 2 doses in them.

I just thought that I’d put this out there — that I do, in fact, take the vitamins that I write about.

Please note!  From sun exposure.  This study did not, did not, did not! study high levels of vitamin D from supplemental use.  There is much evidence that shows that a high D level actually helps in heart disease, stroke, and several cancer risks.

With that in mind, high levels of serum D have been linked to basal cell carcinoma.  That’s skin cancer.

I post this only because many times, docs tell us to go outside to get our D rather than take our supplements.  I’m thinking I’d rather take a 10,000 IU pill…

From Medscape:

Higher Vitamin D Levels Linked to Risk for Basal Cell Carcinoma

NEW YORK (Reuters Health) Jan 18 – Even years after measurement, high serum levels of vitamin D (25(OH)D) are associated with an elevated risk of basal cell carcinoma, findings from a nested case-control study suggest.

According to the report in the December 31 advanced online issue of the Journal of Investigative Dermatology, “The same spectrum of UV radiation causes both DNA damage to keratinocytes and vitamin D synthesis by these cells.”

This could mean that “vitamin D formation in keratinocytes may be an innate protective mechanism against UV damage,” according to the authors. On the other hand, they add, in vitro and in vivo evidence suggests that vitamin D and its receptor are involved in cutaneous carcinogenesis.

But until now, no one has directly examined the relationship between serum vitamin D levels and basal cell carcinoma in humans.

Lead author Dr. Maryam M. Asgari and colleagues did just that, using a Kaiser Permanente electronic database of pathology specimens of basal cell carcinomas. The pathology reports were matched with data on each patient’s serum level of 25(OH)D before the skin cancer developed.

In the 220 Caucasian patients and 220 controls, 25(OH)D had been measured between 1968 and 1970. Cancer cases were diagnosed between 1974 and 1979. The mean time between measurement and diagnosis was 8.74 years.

Dr. Asgari, from Kaiser Permanente Northern California, Oakland, and her team found that for every 1 ng/mL rise in serum 25(OH)D levels, the risk of basal cell carcinoma rose by 3%. For subjects with levels in the highest quintile, the unadjusted odds ratio was 2.32 compared with the lowest quintile (p = 0.03 for trend).

Moreover, individuals who had clinically sufficient 25(OH)D levels (at least 30 ng/mL) were at significantly increased risk compared with those who were deficient (< 10 ng/mL), with an unadjusted odds ratio of 3.98 (p < 0.01).

In multivariate analysis adjusted for body mass index, smoking status, education, estimates of sun exposure, X-ray exposure, and personal history of cancer, the risk of basal cell carcinoma rose by 2% with each ng/mL increase in 25(OH)D. Comparing sufficient with deficient levels still yielded an adjusted odds ratio of 3.61 (p = 0.03).

This analysis was limited by the use of surrogates for sun exposure (e.g., leisure time activities, occupation), none of which was associated with levels of serum 25(OH)D or a significant risk factor for basal cell carcinoma, the authors note. Moreover, the model did not take into account variables such as supplemental vitamin D use or healthcare screening bias.

“Future studies that can accurately measure acute and intermittent sun exposure, supplemental vitamin D use, and other potential confounding factors may be warranted,” the research team concludes.

J Invest Dermatol 2009.

Yet more evidence for D

On January 7, 2010, in Fat Solubles, Vitamins, by Andrea

At some point, people are going to figure out that vitamin D is important.  I don’t know when, but they will, and it will be tested for all people — not just those of us who scream loudly for it, and not just by those docs that pay attention to the studies.

Pay attention — vitamin D has been linked to cardiovascular disease, bone health, depression, stroke, diabetes, and many types of cancer.

Two reports in one day — one video and one report from Medscape — that show a corollary between heart disease in blacks and deficiency in vitamin D.

First, from Medscape:

Could Vitamin-D Deficiency Account for Higher CV Mortality in Blacks?

Sue Hughes

January 6, 2010 (Rochester, New York)Another paper suggesting a link between low levels of vitamin D and cardiovascular mortality has been published [1]. It also suggests that low vitamin-D levels may contribute to the increased cardiovascular mortality seen in the black population.

The study, published in the January-February 2010 issue of Annals of Family Medicine, was conducted by Drs Kevin Fiscella (University of Rochester School of Medicine, NY) and Peter Franks (University of California, Davis).

Fiscella commented to heartwire : “We know that people with darker skin have lower vitamin-D levels. And we know that African Americans have higher rates of cardiovascular disease than the white population. In our study, just two factors–poverty and low vitamin-D levels–seemed to explain the higher risk of cardiovascular mortality in the black population.”

In the paper, the authors note that low levels of vitamin D have been linked to cardiovascular disease and to cardiovascular risk factors such as obesity, hypertension, diabetes, peripheral arterial disease, and chronic renal disease.

They conducted a retrospective cohort study to examine the association of serum 25(OH)D levels with cardiovascular mortality and to look at the possible contribution of vitamin-D levels to black-white disparities in cardiovascular mortality. They used baseline data from the National Health and Nutrition Examination Survey collected between 1988 and 1994 (NHANES III) and data on cause-specific mortality through 2001 from the National Death Index. Complete data for all variables were available on 15 363 persons.

Results showed that participants with 25(OH)D levels in the lowest quartile (mean 13.9 ng/mL) compared with those in the three higher quartiles (mean 21.6, 28.4, and 41.6 ng/mL) had higher adjusted risk of cardiovascular death. There appeared to be a threshold effect, with little reduction in cardiovascular deaths above the 25th percentile. Those in the lowest quartile had an adjusted cardiovascular mortality risk 40% higher than the other three 25(OH)D quartiles (95% CI 16%–69%; p=0.001).

The relationship between race and cardiovascular mortality and the potential mediating effect of 25(OH)D was examined in a series of nested models. In the model adjusting only for outside variables (age, sex, month, and region), blacks showed significantly higher cardiovascular mortality than whites (incident rate ratio [IRR] 1.38). When 25(OH)D was added, there was a significant reduction of around 60% in the risk associated with black race (IRR 1.14), and when 25(OH)D and income were added together to the model, the increased risk in blacks was completely eliminated (IRR 1.01). The authors say this suggests that low 25(OH)D levels and poverty exert separate, additive effects on black cardiovascular mortality.

They add: “These findings are consistent with the notion that higher cardiovascular risk for blacks is partly related to lower levels of 25(OH)D,” but they add that supplements higher than those currently recommended would be needed to substantially increase levels among those in the lowest quartile.

They note that there are several sources of potential residual confounding in their analysis. For example, low 25(OH)D levels may represent a marker for poor health, or poor health may result in reduced sun exposure and consequent lower 25(OH)D levels. And unmeasured risk factors could also confound the results.

They point out that there are limited data from randomized controlled trials regarding the impact of vitamin-D supplementation on cardiovascular disease. But a meta-analysis of randomized trials of vitamin-D supplementation for other purposes, such as improvement in bone density and reduction in fractures, has shown a reduction in all-cause mortality, and other studies have suggested that vitamin-D supplementation may be associated with reductions in systolic blood pressure and reductions in proteinuria among patients with chronic kidney disease. It has also been suggested that statins represent analogs of vitamin D, they add.

Is It a Causal Relationship?

To heartwire , Fiscella commented: “If vitamin D is proven to be a causal risk factor (and this remains to be shown), then supplementing with vitamin D could help reduce cardiovascular disease and mortality in the whole population and to reduce the disparity we see between whites and blacks.

“We desperately need a randomized trial to look at vitamin-D supplementation in reducing cardiovascular disease. We have had a lot of false hopes before with vitamins, but there is a lot of basic science and epidemiology supporting a possible role for vitamin D in cardiovascular disease. There are many studies linking low vitamin-D levels to diabetes, hypertension, and peripheral vascular disease, and all of these are drivers of cardiovascular disease.”

He added: “We know low vitamin-D levels are implicated in poor health, but we don’t know which way that relationship works. Is it the lack of vitamin D that causes illness, or is it that people in poor health have suppressed appetites and don’t go outside enough and therefore don’t take in enough vitamin D?. And if vitamin-D deficiency is causal, will supplementation have a relatively quick benefit, or would you need to take it for years to see a benefit”?

Fiscella pointed out that the dose of vitamin D needed is also unknown. “The current recommendations are for a vitamin D intake of 400 units daily. But it may take much higher doses than this to have an effect on cardiovascular disease.”

And then from CNN.com:

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