Sunday, July 20, 2008

Vitamin D and Mortality

The data continues to mount which strongly suggest a link between low levels of vitamin D many diseases such as cancer and heart disease. This June a new study showed that vitamin-D deficiency is associated doubling the deaths from all causes (known as all-cause mortality).

Why the low vitamin D levels?

We rarely see an optimal vitamin D level in our practice unless we have been helping our guests supplement by checking blood levels and making recommendations.
Over 95% of the results of our new guests show low, often very low vitamin D levels
It is probably related to factors such as urbanization, decreased outdoor activity, use of sun screen, air pollution and decreases in the skin production of vitamin D with age. The highest risk of extremely low vitamin D levels are the elderly and African Americans.

Dangers of low vitamin D

- Bone loss, falls, and fractures
- cancer rates dramatically increase
- immune dysfunction resulting in more infections & autoimmune diseases
- cardiovascular disease (i.e. heart attacks and stroke)
- hypertension – increased blood pressure
- metabolic syndrome (a.k.a. syndrome X or pre-diabetes)
- increased inflammation Low 25-hydroxyvitamin-D levels were also significantly correlated with markers of inflammation (C-reactive protein [CRP] and interleukin 6 [IL-6])
- oxidative stress increase (biologic rusting)
- Osteoporosis (painless) or osteomalacia. With osteomalacia muscle pain and proximal muscle weakness with symptoms such as sensation of heaviness in the legs, rapid fatigue, and problems with climbing stairs and getting up from a chair.
- Autoimmune disease. Any levels below 20 ng/ml are considered serious deficiency states and will increase your risk of breast and prostate cancer and autoimmune diseases like MS and rheumatoid arthritis.
- osteoarthritis and increase in pain experienced from it
- psoriasis
- seasonal affective disorder
- diabetes
- multiple sclerosis
- migraines
- polycystic Ovary Syndrome and Infertility

Vitamin D and Heart Health
Vitamin D has been noted to play a key role in fibrinolysis, blood lipids, thrombogenicity, endothelial regeneration, and smooth-muscle-cell growth.

Vitamin D Status is better than heart catherization at predicting death
The authors also report that the increase in risk of all-cause mortality with lower levels of vitamin D was seen regardless of the degree of coronary artery disease seen on angiography, and they comment: "Low 25-hydroxyvitamin-D and 1,25-dihydroxyvitamin-D levels seem to be important mediators of mortality even when there is little or no indication of overt vascular disease."

Low Vitamin D Correlates with Doubling of Death Rate
Now, in addition to all the above concerns about low vitamin D, we have the doubling of the death rate of all causes.
I have noted that people tend to be diligent in taking their hormones than their vitamins. I hope this new study in the Archives of Internal Medicine will help everyone remember to have their vitamin D level checked and take your vitamin D daily (see Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008; 168:1340-1349).

Action Steps

Know your vitamin D status. The 25-OH Vitamin D level is considered the best test of vitamin D status and is the blood test you would want to get checked. Most labs list 30 100 ng/ml as normal. We consider 50-100 ng/ml to be optimal. We rarely see these levels achieved without supplementation.

Take Vitamin D Supplements
The correct form of vitamin D to take is vitamin D3 (not D2) – this is what we have in Physicians Preference, 1000 IU / cap. We are looking to add a capsule with more D in it to reduce the number of caps.

Pending having your 25-OH (hydroxy) Vitamin D level done I would recommend taking at least 2000 IU of Vitamin D (D3) daily
Note, you may be susceptible to toxicity at lower dosages if you have excess blood calcium levels, hyperparathyroidism or granulomatous diseases such as sarcoidosis

To your health!

Donald P Ellsworth, M.D.
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