05.16.12

Weight Of The Nation

Posted in Wellness at 7:37 AM by Dr. Greathouse

Go to the link below to view the documentary.

http://theweightofthenation.hbo.com/films/main-films/Consequences

A new must see with regard to your health! Time to wake up and stop fooling yourself! Just do it! No more excuses.

05.13.12

Medical Monopoly?

Posted in Uncategorized at 8:34 AM by Dr. Greathouse

Chiropractic: Too Little Too Late?

See Medical Inc. links below!

If you haven’t guessed it already, I’m a bit of a chiropractic heretic. Don’t get me wrong, chiropractic manipulative therapy works wonders on mechanical problems of the spine and extremities but the other health claims to fame are not responsibly or professionally addressed by the profession as a whole and thus many field doctors fail to address informed consent for treatment of what is called somatovisceral disorders. Somatovisceral in the chiropractic sense means treating other illnesses or symptoms such as infantile colic, heartburn, hypertension, etc…, by means of spinal manipulation. While there’s anecdotal evidence of good results along these lines of thought, the scientific evidence of such forms of care is far from valid & reliable.

Chiropractors will argue that the medical establishment does the same thing and on a grander scale but this argument fails to support the fact that what we are doing is right.

The following trailers look good and I’m sure will expose some extraordinary issues within the medical profession. Hopefully there’s some introspection within all health care disciplines as well.

I haven’t seen the DVD in it’s entirety as of yet but did want to get the information out there.

Dr. Greathouse

Medical Inc. (links below)

http://www.kickstarter.com/projects/1098279580/medical-inc-the-movie
http://www.youtube.com/watch?feature=player_embedded&v=uZUXA6mz_JA

04.25.12

New Migraine Guidelines Rank Rx, OTC Efficacy

Posted in Cold Laser, Headaches, McKenzie Mechanical Diagnosis & Treatment, Pain Management at 10:39 AM by Dr. Greathouse

New Migraine Guidelines Rank Rx, OTC Efficacy

By John Gever, Senior Editor, MedPage Today

Published: April 23, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of

Pennsylvania.

NEW ORLEANS — Seven different drugs are proven to be effective for preventing episodic migraine attacks and another half-dozen are probably helpful, according to new guidelines released here by the American Academy of Neurology (AAN).

See PDF attachment for on the latest on meds for migraines! Medical News: New Migraine Guidelines Rank Rx, OTC Efficacy – in , AAN from MedPage Today

Chiropractic and Migraine Headaches

For many  years chiropractors have been getting positive results with migraine headaches as well as other form of headaches. Unfortunately, the chiropractic profession has relied heavily on anecdotal evidence to promote these results, without good research to back it up, but there’s good data to suggest that there’s more to care than placebo effect. The key seems to be in the upper neck. Exactly what that is, has yet to be determine, but there are safe and effective ways to address joint problems in the upper neck. The Youtube clip I’m adding to this post is a good example of one of the safe ways to address headaches mechanically. We provide that technique. The McKenzie mechanical appraoch is also a valid & reliable technique as well, and is extremely effective. Not only is it effective but it puts you in control, not a drug or health care provider! I’ve even had great results with cold laser. If you are looking for an alternative to the medications, these techniques are well worth a try and can be determined in short order as to whether effective or not; saving you time and money. Even if you have been to a chiropractor before, these procedures may be new to you and prove beneficial.

If you have questions please feel free to call me so that I may address some of your concerns before you come.

Or go to YouTube: Chiropractic and Migraine Headaches NBC NEWS.mp4

Dr. Greathouse: 321-725-6314

04.04.12

Sitting straight ‘bad for backs’?

Posted in Spinal Hygiene at 4:23 PM by Dr. Greathouse

seating positions

Sitting up straight is not the best position for office workers, a study has suggested.

Scottish and Canadian researchers used a new form of magnetic resonance imaging (MRI) to show it places an unnecessary strain on your back.

They told the Radiological Society of North America that the best position in which to sit at your desk is leaning back, at about 135 degrees.

Experts said sitting was known to contribute to lower back pain.

Data from the British Chiropractic Association says 32% of the population spends more than 10 hours a day seated.

Half do not leave their desks, even to have lunch.

Two thirds of people also sit down at home when they get home from work.

Spinal angles

The research was carried out at Woodend Hospital in Aberdeen.

Twenty two volunteers with healthy backs were scanned using a positional MRI machine, which allows patients the freedom to move – so they can sit or stand – during the test.

Traditional scanners mean patients have to lie flat, which may mask causes of pain that stem from different movements or postures.

In this study, the patients assumed three different sitting positions: a slouching position, in which the body is hunched forward as if they were leaning over a desk or a video game console, an upright 90-degree sitting position; and a “relaxed” position where they leaned back at 135 degrees while their feet remained on the floor.

The researchers then took measurements of spinal angles and spinal disk height and movement across the different positions.

Spinal disk movement occurs when weight-bearing strain is placed on the spine, causing the disk to move out of place.

Disk movement was found to be most pronounced with a 90-degree upright sitting posture.

It was least pronounced with the 135-degree posture, suggesting less strain is placed on the spinal disks and associated muscles and tendons in a more relaxed sitting position.

The “slouch” position revealed a reduction in spinal disk height, signifying a high rate of wear and tear on the lowest two spinal levels.

When they looked at all test results, the researchers said the 135-degree position was the best for backs, and say this is how people should sit.

‘Tendency to slide’

Dr Waseem Bashir of the Department of Radiology and Diagnostic Imaging at the University of Alberta Hospital, Canada, who led the study, said: “Sitting in a sound anatomic position is essential, since the strain put on the spine and its associated ligaments over time can lead to pain, deformity and chronic illness.”

Rishi Loatey of the British Chiropractic Association said: “One in three people suffer from lower back pain and to sit for long periods of time certainly contributes to this, as our bodies are not designed to be so sedentary.”

Levent Caglar from the charity BackCare, added: “In general, opening up the angle between the trunk and the thighs in a seated posture is a good idea and it will improve the shape of the spine, making it more like the natural S-shape in a standing posture.

“As to what is the best angle between thigh and torso when seated, reclining at 135 degrees can make sitting more difficult as there is a tendency to slide off the seat: 120 degrees or less may be better.”

03.28.12

Women Drivers at Greater Risk in Car Crashes

Posted in Motor Vehicle Accidents at 4:57 AM by Dr. Greathouse

By Maggy Patrick

Oct 20, 2011 4:09pm

Women Drivers at Greater Risk in Car Crashes, Says Study

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gty woman driving car jt 111020 main Women Drivers at Greater Risk in Car Crashes, Says Study

A new report by the American Journal of Public Health finds that female drivers are at a greater risk of injury or death when involved in car crashes, because seatbelts and other lifesaving devices installed in cars are not designed for their bodies.

The report said that on average, women are shorter, lighter, tend to sit in different positions and drive newer passenger cars when compared with men. Because of these factors, the odds of a woman sustaining an injury while wearing a seatbelt were 47 percent higher than for  men wearing seatbelts.

One reason safety systems are designed more for the male population is that men  are three times more likely to be involved in a car crash that leads to serious or fatal injuries. In recent years, however, there has been an increase in female drivers getting into these types of accidents.

Although Clarence Ditlow of the Center for Auto Safety says that the study had the right concept,  it doesn’t apply to today’s vehicles. The researchers focused on crashes (and cars) between 1998 and 2008. All of the cars used in the study were an average of six years old.

“The average life of a car is around 12 years,” said Ditlow. “The study would have a lot more value if it were limited to 2000 and later model year vehicles to make sure all vehicles had female friendly airbags,” he said. Since new 2012 models are coming out now, some of the cars used in the study are almost 20 years old.

“There wasn’t even a dynamic side impact test standard in effect in 1992,” said Ditlow.

Ditlow also said that while the study did highlight the disparity between the risks for male and female drivers, that’s something  the government and industry have been working on over the past three decades.

The authors of the study said in a statement that “female motor vehicle drivers today may not be as safe as their male counterparts; therefore, the relative higher vulnerability of female drivers … when exposed to moderate and serious crashes must be taken into account.”

03.19.12

Soda Heart & Disease

Posted in Nutrition, Wellness at 4:52 PM by Dr. Greathouse

A Soda a Day Raises CHD Risk by 20%

Lisa Nainggolan

March 12, 2012 (Boston, Massachusetts) — Sugary drinks are associated with an increased risk of coronary heart disease (CHD) as well as some adverse changes in lipids, inflammatory factors, and leptin, according to a new analysis of men participating in the Health Professionals Follow-up Study, reported by Dr Lawrence de Koning (Children’s Hospital Boston, MA) and colleagues online March 12, 2012 in Circulation [1].

“Even a moderate amount of sugary beverage consumption — we are talking about one can of soda every day — is associated with a significant 20% increased risk of heart disease even after adjusting for a wide range of cardiovascular risk factors,” senior author Dr Frank B Hu (Harvard School of Public Health, Boston, MA) told heartwire . “The increased risk is quite substantial, and I think has important public-health implications given the widespread consumption of soda, not only in the US but also increasing very rapidly in developing countries.”

The increased risk is quite substantial, and I think has important public-health implications given the widespread consumption of soda.

The researchers did not find an increased risk of CHD with artificially sweetened beverages in this analysis, however. “Diet soda has been shown to be associated with weight gain and metabolic diseases in previous studies, even though this hasn’t been substantiated in our study,” says Hu. “The problem with diet soda is its high-intensity sweet taste, which may condition people’s taste. It’s still an open question whether diet soda is an optimal alternative to regular soda; we need more data on this. ”

Hu says water is the best thing to drink, or coffee or tea. Fruit juice is “not a very good alternative, because of the high amount of sugar,” he adds, although if diluted with water, “it’s much better than a can of soda,” he notes.

And Hu says although the current results apply only to men, prior data from his group in women in the Nurses’ Health Study [from 2009] were comparable, “which really boosts the credibility of the findings.”

Inflammation could be a pathway for impact of soda upon CHD risk

Hu and colleagues explain that while much research has shown a link between the consumption of sugar-sweetened beverages and type 2 diabetes, few studies have looked at the association of these drinks with CHD.

Hence, they analyzed the associations of cumulatively averaged sugar-sweetened (eg, sodas) and artificially sweetened (eg, diet sodas) beverage intake with incident fatal and nonfatal CHD (MI) in 42 883 men in the Health Professionals Follow-up study. Beginning in 1986 and every two years until December 2008, participants answered questionnaires about diet and other health habits. A blood sample was provided midway through the study.

There were 3683 CHD cases over 22 years of follow-up. Those in the top quartile of sugar-sweetened-beverage intake had a 20% higher relative risk of CHD than those in the bottom quartile (RR 1.20; p for trend < 0.001) after adjustment for age, smoking, physical activity, alcohol, multivitamins, family history, diet quality, energy intake, body-mass index, preenrollment weight change, and dieting.

Adjustment for self-reported high cholesterol, high triglycerides, high blood pressure, and diagnosed type 2 diabetes only slightly attenuated these associations, which suggests that drinking soda “may impact on CHD risk above and beyond traditional risk factors,” say the researchers.

Consumption of artificially sweetened drinks was not significantly associated with CHD (multivariate RR 1.02; p for trend=0.28).

Intake of sugar-sweetened drinks, but not artificially sweetened ones, was also significantly associated with increased triglycerides and several circulating inflammatory factors — including C-reactive protein, interleukin 6 (IL-6), and tumor-necrosis-factor receptor 1 (TNFr1) — as well as decreased HDL cholesterol, lipoprotein (a) (Lp[a]), and leptin (p < 0.02).

“Inflammation is a key factor in the pathogenesis of cardiovascular disease and cardiometabolic disease and could represent an additional pathway by which sugar-sweetened beverages influence risk,” say Hu et al.

Cutting consumption of soda is one of easiest behaviors to change

Hu says that one of the major constituents of soda, high-fructose corn syrup, is subsidized in the US, making such drinks “ridiculously cheap” and helping explain why consumption is so high, particularly in lower socioeconomic groups.

Doctors should be advising people with heart disease or at risk to cut back on sugary beverages; it’s almost a no-brainer.

“Doctors should set an example for their patients first,” he stresses. “Then, for people who already have heart disease or who are at high risk, physicians should be advising them to cut back on sugary beverages; it’s almost a no-brainer, like recommending that they stop smoking and do more exercise. The consumption of sugary beverages is a relatively easy behavior to change.”

And although this particular study included mostly white subjects and there are few data on the risk of cardiovascular disease associated with the consumption of soda in people of other ethnicities, there are data on its effect on type 2 diabetes in these groups, he says.

“It has been shown for minority groups — such as African Americans and Asians — that they are more susceptible to the detrimental effects” of sugary drinks on diabetes incidence, he notes.

The authors report no conflicts of interest.

References

  1. de Koning L, Malik VS, Kellogg MD et al. Sweetened beverage consumption, incident coronary heart disease and biomarkers of risk in men. Circulation 2012; DOI: 10.1161/CIRCULATIONAHA.111.067017. Available at: http://circ.ahajournals.org.

Knee Replacement Data Scarce for Long-Term Safety, Effectiveness

Posted in Extremities at 1:40 PM by Dr. Greathouse

From Medscape Medical News

Not my area of expertise to be sure, but, I see my share of knee problems. Not to mention I have knee problems too. I know of patients I treat that still have knee pain after total knee replacement. I know that low back surgery outcomes are poor, but they continue and cost has continued to rise, but back pain prevails. At any rate, more food for thought and more reason perhaps, to exhaust conservative care before the big move to surgery. If you really need it, thank goodness it’s available! Be kind to your spine (and knees)!

Knee Replacement Data Scarce for Long-Term Safety, Effectiveness

March 5, 2012 — Knee replacement surgery is a success story of modern medicine, yet not enough is known about patient outcomes or the effectiveness of various implants, and consensus is lacking about the precise indications for the procedure, according to a study published online March 6 in the Lancet.

The authors, based in the United Kingdom, Sweden, and Australia, write that surgeons need improved decision-making as more and more possible candidates for new knees fall are younger than 55 years — a group that has a higher rate of revision or follow-up surgery. On another problematic note, some patients undergo the operation despite having good functional ability and only mild pain beforehand.

The article, based on a literature review going back to 1970, is the second in less than a week raising doubts about the evidence on orthopaedic joint implant safety and effectiveness. On February 28, the British Medical Journal published an article charging that hundreds of thousands of patients with metal-on-metal hip replacements were kept in the dark about possible exposure to toxic substances.

Andrew Carr, FRCS FmedSci, lead author of the Lancet article, and coauthors write that the number of total knee replacements (TKRs) in the United States increased from 31.2 per 100,000 person-years in the period from 1971 to 1976 to 220.9 per 100,000 person-years in 2008, for a total that year of more than 650,000 procedures. The authors predict that the demand for knee replacement will continue to grow in developed countries, in light of aging populations and rising obesity rates, which both portend higher rates of osteoarthritis, the main clinical indication for the operation.

Although more and more people are getting new hardware for their knees, fuzzy thinking prevails as to who really needs it.

“No clear consensus exists within the surgical community about exact indications, particularly severity of preoperative symptoms, obesity, and age,” Dr. Carr and coauthors write. They point to a task force organized by the Osteoarthritis Research Society International and a rheumatology organization that found that “pain, function, and radiographic severity are not associated with a surgeon’s recommendation for knee replacement.

03.15.12

Medicare Says ‘No’ to TENS for Low Back Pain

Posted in Pain Management at 6:28 PM by Dr. Greathouse

Medicare is set to withdraw most coverage of transcutaneous electrical nerve stimulation (TENS) for chronic low back pain, the Centers for Medicare and Medicaid Services indicated Tuesday.

Reimbursements for this indication would be available only when patients are participating in a randomized, controlled trial of the technology’s clinical effectiveness, according to a proposeddecision memo from CMS.

Currently, Medicare pays for FDA-approved TENS equipment and supplies when prescribed by a physician for chronic intractable pain, and reimburses physicians and physical therapists for evaluating patients’ suitability for the treatment, which is typically used at home.

CMS decided on its own to review its coverage of TENS for chronic low back pain in the wake of a 2010 report by an American Academy of Neurology panel that found the treatment was not effective.

The panel had conducted a systematic review of published studies of TENS. “The review concluded that there was conflicting evidence for the use of TENS in the treatment of chronic low back pain and that TENS should be deemed ineffective for this purpose,” the CMS memo said.

CMS also cited a series of other reviews that failed to find clear support for the technology’s efficacy. On the other hand, some individual studies had shown that it can reduce pain and improve patients’ physical function.

The memo also noted that the National Institute of Neurological Disorders and Stroke has listed TENS as a “possible treatment option” for lower back pain that has not responded to conventional therapies.

But in the absence of consistent evidence of TENS’s efficacy in this indication, CMS plans to withhold coverage except in the context of randomized trials.

Patients in such trials must have been suffering for low back pain for at least three months, with the pain not resulting from conditions such as inflammatory autoimmune disease or metastatic spinal tumors. The trials must also directly address TENS’s clinical efficacy and be designed and powered to yield clear-cut answers. Listing on the Clinicaltrials.gov website is mandatory.

CMS emphasized that Medicare will continue to reimburse for TENS when prescribed for chronic, treatment-refractory pain indications other than low back pain, such as for patients with chronic or severe post-operative pain.

CMS is accepting public comments on the proposed decision through April 12, after which it will issue a final determination.

By John Gever, Senior Editor, MedPage Today

Published: March 14, 2012

02.13.12

Vitamin B3 (cardiovascular, fatigue, depression, irritability, digestive disorders, detoxification, cholesterol & more….)

Posted in Uncategorized at 1:04 PM by Dr. Greathouse

Staying Healthy with Nutrition

Elson M. Haas, M.D.

Niacin (Vitamin B3)


Information on this site is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. If you have or suspect that you have a medical problem, promptly contact your medical health care provider.

What got my attention about this vitamin was some information I came across where vitamin B3 was being used for severe depression with great results. I see so many patients today who are on mood altering medication. The above book “Staying Healthy with Nutrition” by Dr. Haas, is a wonderful resource on how food and supplements affect our health. Below is info from his book on vitamin B3. Many health experts attribute our ill health issues, physical and psychological,  to the lack of nutritional value of our food. Niacin is used to support a variety of metabolic functions and to treat a number of conditions. Nutritional therapy is a viable alternative to drugs in many cases. As you learn to connect your health issues with food deficiencies, find an expert to help guide you  through these alternative treatment pathways.

Niacin plays a key role in glycolysis (extracting energy from carbohydrate and glucose), is important in fatty acid synthesis and in the deamination (nitrogen removal) of amino acids, and is needed in the formation of blood cells and steroids, and is helpful in the metabolism of some drugs and toxins.  It is a vital precursor for the coenzymes that supply energy to body cells. Basically, the coenzymes of Niacin help break down and utilize proteins, fat and carbohydrates.

Vitamin B3 also simulates circulation, reduces cholesterol levels in the blood of some people, and is important to help the activity of the nervous system and normal brain function.  Niacin supports the health of skin, tongue, and digestive tract tissues.  Also, this important vitamin is needed for the synthesis of sex hormones such as estrogen, progesterone, and testosterone, as well as other corticosteroids.

Niacin helps increase energy through improving food utilization and has been beneficial for treating fatigue, irritability, and digestive disorders such as diarrhea, constipation, and indigestion.  It also stimulates extra hydrochloric acid, helps in the regulation of blood sugar (as part of glucose tolerance factor) and gives all of us a greater ability to handle stress.  It’s helpful in treating anxiety and possibly depression.  Niacin has been used for a variety of skin reactions and acne, as well as for problems on the teeth and gums.  It is sometimes helpful in the treatment of migraine headaches and arthritis, probably in both cases through stimulation of blood flow and capillaries.  This vitamin has also been used to stimulate sex drive and enhance sexual experience, to help detoxify the body, and to protect it from certain toxins and pollutants.  For most of these problems and cardiovascular related ones mentioned below, the preference is to taking the “flushing” form of Niacin, or Nicotinic acid, not niacinamide. This includes cholesterol reduction.

Nicotinic acid works rapidly, particularly in its beneficial effects on the cardiovascular system.  It simulates circulation and for this reason may be helpful in treating leg cramps caused by circulatory deficiency; headaches, especially the migraine type; and Meniere’s syndrome, associated with hearing loss and vertigo.  Nicotinic acid also helped reduce blood pressure and very importantly, acts as an agent to lower serum cholesterol.  Treatment with about 2 g a day of Nicotinic acid has produced significant reductions in both blood cholesterol and triglyceride levels.  To lower the LDL component and raise the good HDL cholesterol, people usually take 50 to 100 mg.  Twice daily and then increase the amount slowly over two or three weeks to 1500 to 2500 mg.  Generally, for those with high cholesterol levels it has been used to help reduce the risk for atherosclerosis.

Because of its vascular stimulation and effects of lowering cholesterol and blood pressure, vitamin B3 has been used preventatively for such serious secondary problems of cardiovascular disease as myocardial infarction (heart attacks) and strokes.  Also, some neurological problems, such as Bell’s palsy and trigeminal neuralgia have been helped by Niacin supplementation.  In osteoarthritis, to help reduce joint pain and improve mobility, niacinamide has been used in amounts beginning at 500 mg twice daily up 2000 mg 3 times per day along with 100 mg of daily B complex.

Niacin has been an important boon to the field of orthomolecular psychiatry for its use in a variety of mental disorders.  It was initially demonstrated to be helpful for the neuroses and psychosis described as the “dementia of Pellagra,” the Niacin deficiency disease.  Since then, it has been used in high amounts, well over 100 mg per day and often over 1000 mg per day (up to 6000 mg), to treat a wide variety of psychological symptoms, including senility, alcoholism, drug problems, depression, and schizophrenia.  Niacin has been helpful in reversing the hallucinatory experience, delusional thinking or a wide mood in energy shifts of some psychological disturbances.  Though this therapy has its skeptics, as does all applications and nutritional medicine, some studies show promising results in treatment of schizophrenia with Niacin and other supplements.  Other studies show little or no effect.  More research is definitely needed on Niacin’s effect and mental disorders.

People on high blood pressure medication and those who have ulcers, gout, or diabetes should be very careful taking high doses of of Niacin because of its effects of lowering blood pressure, it’s acidity, its liver toxicity, its potential to raise uric acid levels, and its effect in raising blood sugar; though recently Niacin has been shown to have a positive effect on glucose tolerance (is part of glucose tolerance factor) and, thereby, on diabetes as well.  Exercise and Niacin are helpful for people with adult diabetes through their positive effects on blood sugar and cholesterol.

Deficiency & Toxicity

As with other B vitamins, there are really no toxic effects from even the high doses of Niacin, though the “Niacin flush” previously described may be uncomfortable for some.  However, with the use of high does Niacin in recent years, the occasional person experiencing some minor problems, such as irritation of the gastrointestinal tract and/or the liver, both of which subside with decreased intake of Niacin.  In addition, some people taking Niacin experience sedation rather than stimulation.

Deficiency problems have been much more common than toxicity, and for a long period of history, the Niacin deficiency disease, Pellagra, was a very serious and fatal problem.  Characterized as a disease of the “three D’s,” Pellagra causes its victims to experience dermatitis, diarrhea, and dementia.  The fourth D was death.

The classic B3 deficiency occurs mainly in cultures whose diets rely heavily on corn and where the corn is not prepared in a way that releases its Niacin.  One of the first signs of Pellagra or Niacin deficiency, is skin sensitivity to light, and the skin becomes raw, thick, and dry (Pellagra means “skin that is rough” in Italian).  The skin then becomes darkly pigmented, especially in areas of the body prolonged by hot and sweaty with those exposed to the sun.  The first stage of this condition is extreme redness and sensitivity of those exposed areas, and it is from the symptom that the term “redneck,” describing the bright rednecks of 18th and 19th Century Niacin deficiency field workers, came into being.

n general, Niacin deficiency affects every cell, especially in those systems with rapid turnover, such as the skin, gastrointestinal tract, and nervous system.  Other than photosensitivity, the first signs of Niacin deficiency are noted as decreased energy production and problems with maintaining healthy functioning of the skin and intestines.  The symptoms include weakness in general, fatigue, anorexia, indigestion, and skin eruptions.  These can progress to other problems, such as sore, red tongue, canker sores, nausea, vomiting, tender gums, bad breath, and diarrhea.  The neurological symptoms may begin with irritability, insomnia, and headaches and then progress to tremors, extreme anxiety, depression; all the way to full-blown psychosis.  The skin will worsen, as will the diarrhea and inflammation of the now in intestinal tract.  There will be a lack of stomach acid production (Achlorhydria) and a decrease in fat digestion and, thus lower availability from food absorption of the fat soluble vitamins, such as A, D, and E. along with other signs, symptoms and deficiency syndromes associated with these fat soluble vitamins.

02.06.12

Vitamin D Supplementation News

Posted in Nutrition, Wellness at 2:42 PM by Dr. Greathouse

Vitamin D Supplementation: An Update

Christine Gonzalez, PharmD, CHHC

Posted: 11/11/2010; US Pharmacist © 2010 Jobson Publishing

Abstract and Introduction

Introduction

An estimated 1 billion people worldwide, across all ethnicities and age groups, have a vitamin D deficiency.[1–3] This is mostly attributable to people getting less sun exposure because of climate, lifestyle, and concerns about skin cancer. The 1997 Dietary Reference Intake (DRI) values for vitamin D, initially established to prevent rickets and osteomalacia, are considered too low by many experts.[4] DRI values are 200 IU for infants, children, adults up to age 50 years, and pregnant and lactating women; 400 IU for adults aged 50 to 70 years; and 600 IU for adults older than 70 years. Current studies suggest that we may need more vitamin D than presently recommended to prevent chronic disease. Emerging research supports the possible role of vitamin D in protecting against cancer, heart disease, fractures and falls, autoimmune diseases, influenza, type 2 diabetes, and depression. Many health care providers have increased their recommendations for vitamin D supplementation to at least 1,000 IU.[5] As a result, more patients are asking their pharmacists about supplementing with vitamin D.

Disease Prevention

Cancer

Vitamin D decreases cell proliferation and increases cell differentiation, stops the growth of new blood vessels, and has significant anti-inflammatory effects. Many studies have suggested a link between low vitamin D levels and an increased risk of cancer, with the strongest evidence for colorectal cancer. A Creighton University study found that postmenopausal women given 1,100 IU of vitamin D3 (plus calcium) versus placebo were 77% less likely to be diagnosed with cancer over the next 4 years.[10] In the Health Professionals Follow-up Study (HPFS), subjects with high vitamin D concentrations were half as likely to be diagnosed with colon cancer as those with low concentrations.[11]

Some studies have shown less positive results, however. The Women’s Health Initiative found that women taking 400 IU of vitamin D3 (plus calcium) versus placebo did not have a lower risk of breast cancer.[12] Many critics have argued that this dosage of vitamin D is too low to prevent cancer. A 2006 Finnish study of male smokers found that those with higher vitamin D concentrations had a threefold increased risk for pancreatic cancer, with cigarette smoking not found to be a confounding factor.[13] A 2009 U.S. study of men and women (mostly nonsmokers) did not confirm these results, finding no association between vitamin D concentrations and pancreatic cancer overall, except in subjects with low sun exposure.[14] In this subgroup, higher versus lower vitamin D concentrations had a positive association with pancreatic cancer.[14] A definitive conclusion cannot yet be made about the association between vitamin D concentration and cancer risk, but results from many studies are promising.

Heart Disease

Several studies are providing evidence that the protective effect of vitamin D on the heart could be via the renin-angiotensin hormone system, through the suppression of inflammation, or directly on the cells of the heart and blood-vessel walls. In the Framingham Heart Study, patients with low vitamin D concentrations (<15 ng/mL) had a 60% higher risk of heart disease than those with higher concentrations.[15] The HPFS found that subjects with low vitamin D concentrations (<15 ng/mL) were two times more likely to have a heart attack than those with high concentrations (>30 ng/mL).[16] In another study, which followed men and women for 4 years, patients with low vitamin D concentrations (<15 ng/mL) were three times more likely to be diagnosed with hypertension than those with high concentrations (>30 ng/mL).[17] As is the case with cancer and vitamin D, more studies are needed to determine the role of vitamin D in preventing heart disease, but the evidence thus far is positive.

Fractures and Falls

Vitamin D is known to help the body absorb calcium, and it plays a role in bone health. Also, vitamin D receptors are located on the fast-twitch muscle fibers, which are the first to respond in a fall.[18] It is theorized that vitamin D may increase muscle strength, thereby preventing falls.[5] Many studies have shown an association between low vitamin D concentrations and an increased risk of fractures and falls in older adults.

A combined analysis of 12 fracture-prevention trials found that supplementation with about 800 IU of vitamin D per day reduced hip and nonspinal fractures by about 20%, and that supplementation with about 400 IU per day showed no benefit.[19] Researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University have examined the best trials of vitamin D versus placebo for falls. Their conclusion is that “fall risk reduction begins at 700 IU and increases progressively with higher doses.”[18] Overall, the evidence is strong in support of supplementing with vitamin D to prevent fractures and falls.

Autoimmune Diseases and Influenza

Since vitamin D has a role in regulating the immune system and a strong anti-inflammatory effect, it has been theorized that vitamin D deficiency could contribute to autoimmune diseases such as multiple sclerosis (MS), type 1 diabetes, rheumatoid arthritis, and autoimmune thyroid disease. Scientists have suggested that vitamin D deficiency in the winter months may be the seasonal stimulus that triggers influenza outbreaks in the winter.[20] Numerous trials have evaluated the association between vitamin D and immune-system diseases.

A prospective study of white subjects found that those with the highest vitamin D concentrations had a 62% lower risk of developing MS versus those with the lowest concentrations.[21] A Finnish study that followed children from birth noted that those given vitamin D supplements during infancy had a nearly 90% lower risk of developing type 1 diabetes compared with children who did not receive supplements.22 In a Japanese randomized, controlled trial, children given a daily vitamin D supplement of 1,200 IU had a 40% lower rate of influenza type A compared with those given placebo; there was no significant difference in rates of influenza type B.[23] More studies of the influence of vitamin D on immunity will be emerging, as this is an area of great interest and it remains unclear whether there is a link.

Type 2 Diabetes and Depression

Some studies have shown that vitamin D may lower the risk of type 2 diabetes, but few studies have examined the effect of vitamin D on depression. A trial of nondiabetic patients aged 65 years and older found that those who received 700 IU of vitamin D (plus calcium) had a smaller rise in fasting plasma glucose over 3 years versus those who received placebo.[24] A Norwegian trial of overweight subjects showed that those receiving a high dose of vitamin D (20,000 or 40,000 IU weekly) had a significant improvement in depressive symptom scale scores after 1 year versus those receiving placebo.[25] These results need to be replicated in order to determine a correlation between vitamin D and the risk of diabetes or depression.

Dosing

Only a few foods are a good source of vitamin D. These include fortified dairy products and breakfast cereals, fatty fish, beef liver, and egg yolks. Besides increasing sun exposure, the best way to get additional vitamin D is through supplementation. Traditional multivitamins contain about 400 IU of vitamin D, but many multivitamins now contain 800 to 1,000 IU. A variety of options are available for individual vitamin D supplements, including capsules, chewable tablets, liquids, and drops. Cod liver oil is a good source of vitamin D, but in large doses there is a risk of vitamin A toxicity.[26]

The two forms of vitamin D used in supplements are D2 (ergocalciferol) and D3 (cholecalciferol). D3 is the preferred form, as it is chemically similar to the form of vitamin D produced by the body and is more effective than D2 at raising the blood concentration of vitamin D.[27] Since vitamin D is fat soluble, it should be taken with a snack or meal containing fat. In general, 100 IU of vitamin D daily can raise blood concentrations 1 ng/mL after 2 to 3 months (TABLE 2).[28] Once the desired blood concentration is achieved, most people can maintain it with 800 to 1,000 IU of vitamin D daily.[28] Even though dosages up to 10,000 IU daily do not cause toxicity, it generally is not recommended to take more than 2,000 IU daily in supplement form without the advice of a health care provider.[29] Individuals at high risk for deficiency should have a vitamin D blood test first; a dosage of up to 3,000 to 4,000 IU may be required to restore blood concentrations.[29]

Table 2. Dosing and Blood Concentrations

Dosage Expected Increase in Blood Concentration
100 IU 1 ng/mL
200 IU 2 ng/mL
400 IU 4 ng/mL
800 IU 8 ng/mL
1,000 IU 10 ng/mL
2,000 IU 20 ng/mL

Source: Reference 30.

Drug Interactions

Vitamin D supplements may interact with several types of medications. Corticosteroids can reduce calcium absorption, which results in impaired vitamin D metabolism.[6] Since vitamin D is fat soluble, orlistat and cholestyramine can reduce its absorption and should be taken several hours apart from it.[6] Phenobarbital and phenytoin increase the hepatic metabolism of vitamin D to inactive compounds and decrease calcium absorption, which also impairs vitamin D metabolism.[6]

Future Research

While considerable research supports the importance of vitamin D beyond bone health, further trials are required before broad claims can be made about vitamin D and prevention of chronic disease. The Institute of Medicine (IOM) is reviewing the research on vitamin D and plans to report in late 2010 regarding any updates to the DRIs for vitamin D (and calcium).[30] Specifically, the IOM will consider the relation of vitamin D to cancer, bone health, and other chronic diseases.[30] An important study, the Vitamin D and Omega-3 Trial, was launched in early 2010 to determine whether 2,000 IU of vitamin D3 and 1,000 mg of EPA (eicosopentaenoic acid) plus DHA (docosahexaenoic acid) daily can lower the risk of cancer, heart disease, stroke, and other diseases.[31] This randomized trial, which will enroll about 20,000 healthy men and women, should provide more insight on vitamin D supplementation.

Conclusion

As the number of people with vitamin D deficiency continues to increase, the importance of this hormone in overall health and the prevention of chronic diseases is at the forefront of research. The best evidence for the possible role of vitamin D in protecting against cancer comes from colorectal cancer studies. Evidence also is strong for the potential role of vitamin D in preventing fractures and falls. At this time, further studies are needed to evaluate the role of vitamin D in protecting against heart disease, autoimmune diseases, influenza, diabetes, and depression.

References

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