Vitamin D Takes A Hit

Faithful readers of this blog (May 18 and August 29) have read my railings against Vitamin D for some time now. It never made sense to me that so many Americans were deemed to be Vitamin D deficient nor did it make much sense that as people got heavier that their blood test for Vitamin D would report lower levels although they wouldn't develop any deficiency symptoms. I even raised the question if it was possible that fat stored Vitamin D (fat soluble) is available to the body when needed.  While this question remains unanswered, the question of what defines a Vitamin D deficiency just got a new answer and I think it makes sense.

The Institute of Medicine (IOM) just revised the guidelines for what defines a Vitamin D deficiency.

First, a little about the IOM.  The Institute of Medicine (IOM) is an independent, nonprofit organization that

works outside of government to provide unbiased and authoritative advice to decision makers and the public. 

Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863. Nearly 150 years later, the National Academy of Sciences has expanded into what is collectively known as the National Academies, which comprises the National Academy of Sciences, the National Academy of Engineering, the National Research Council, and the IOM.

Under the new IOM guidelines, you are considered to have adequate Vitamin D levels if your level is above 20 ng/mL. The previous level was 30 ng/mL. In one fell swoop, the IOM has essentially removed almost all Americans from the category of being Vitamin D deficient. 

You will no doubt hear push-back from those quarters that make money peddling Vitamin D and related advice, but you should essentially ignore them. The IOM is trustworthy.

So if you didn't have enough reasons yet to push aside your multivitamins and Vitamin D supplements, perhaps this one will do the trick for you.

For the umpteenth time, eat whole foods including a wide variety of vegetables, fruits, beans, nuts, seeds, whole grains and Wild Salmon and you will consume all the vitamins, minerals, antioxidants and all the other health promoting nutrients you need for a healthy mind and body. Get 15-30 minutes of sun each day (earlier or later in the day and avoid reddening) and Vitamin D is also well covered. (You also get it from Wild Salmon.)

The key to a healthy life is to eat healthy every day.

Vitamin D Blood Tests May Be Unreliable--Particularly In Overweight People

As the Vitamin D debate rages on, it seems that practically every day a new related study emerges.

Vitamin D, the reigning health topic du jour, has been linked to cancer, diabetes, obesity, the autism spectrum, unhealthy aging, and a myriad of other health issues--basically everything. (the more illnesses it is linked to, the more pills marketers can sell).

There are many dubious pundits claiming that there is an epidemic of vitamin D deficiency, with some proclaiming that as many as 75% of all people are deficient, and therefore, everyone should be supplementing with Vitamin D tablets, particularly those who get little sun exposure and the elderly.

I don't agree with the statistics regarding the number of people with deficiency because I think the blood tests don't tell the whole story, and a recent study involving obese and non-obese people makes me think I am right. Notice the emphasis on think, not know. (By the way, another recent study revealed that two out of three of the main pieces of equipment used by blood labs to measure Vitamin D often report artificially low numbers.)

Before I get to the main study, here's what everybody seems to agree on in regards to Vitamin D:

1. Vitamin D is a group of fat soluble substance most call a vitamin. (There is some disagreement if it's really a vitamin as the body can produce it on its own, unlike all other vitamins which must be derived from external sources. However, Vitamin D is often called the "sunshine vitamin" because the body can produce it from cholesterol after your skin is exposed to sun.)

2. Human beings can consume two forms of Vitamin D: cholecalciferol (vitamin D₃) or ergocalciferol (vitamin D₂). The liver apparently converts Vitamin D to calcidiol and the kidney converts some of it to the active form called calcitriol. Blood tests measure only calcidiol.

3. Vitamin D deficiency can cause osteomalacia (rickets in children), a disease related to softening of the bones due to problems with bone mineralization.

4. There is more vitamin D stored in fat or adipose tissue than typically circulates in the blood. That makes sense because it is fat-soluble. (There is some disagreement if they are positively or negatively correlated, eg. whether they increase and decrease together.) What is known for sure is that generally the more fat you have, the more Vitamin D is stored in such fat.

5. Routine Vitamin D blood tests only measure circulating Vitamin D (calcidiol) and not fat stored Vitamin D. (There are ways, such as liquid chromatography, to measure fat-stored vitamin D, but they are not part of normal testing.)

6. Obese people have lower levels of circulating and higher levels of fat-stored Vitamin D than non-obese people.  Basically, the more fat you have, the more of your Vitamin D is stored in it and the less you have circulating and easily measurable. (This could explain why some scientists claim there is more Vitamin D deficiency today than ever before. It could be a result of an increasing weight among Americans with 2 out of 3 now deemed overweight and 36% purported to be obese.)

7. Vitamin D blood levels increase with weight loss. (It is not clear what happens to the total amount of fat-stored Vitamin D with weight loss, but presumably it decreases.)

8. Wild fish such as salmon are still a great source of Vitamin D.


Here are the questions whose answers have less agreement, if not outright disagreement.

1. What levels of blood circulating Vitamin D define deficiency and inadequacy?

2. Can the body tap into fat-stored Vitamin D when needed?

3. Why do vitamin D blood levels increase with weight loss?

4. Why do obese people have lower levels of circulating blood Vitamin D?

5. When and how much supplementation is necessary and appropriate for different levels of deficiency or inadequacy.

6. In the absence of deficiency or inadequacy, does extra Vitamin D offer any special protection against cancer, diabetes, heart disease, diabetes, etc.?

The recent study about Vitamin D, I referenced above, showed that in comparing obese young men to normal weight young men, the obese young men when exposed to tanning radiation akin to sun exposure actually seemed to produce 57% less Vitamin D than the non-overweight young men exposed to the same radiation. The results suggest that the obese get less Vitamin D from sun exposure that the non-obese. 

The authors of the study contend that the reason for this result is that the fat or adipose tissue in the obese men may absorb the additional Vitamin D produced.  The authors also put forth the supposition that obese people have less Vitamin D to start with because they spend less time in the sun.

This study triggered an exhaustive research effort by me to better understand the science of how vitamin D moves in and out of fat storage. More specifically, I wondered if one has a high level of Vitamin D in fat storage and a low level in blood circulation, would the Vitamin D come out of storage before a clinically evident deficiency develops. In other words, can you depend on your fat-stored Vitamin D to play a helpful role and prevent deficiency? If your fat-stored vitamin D provides the body with necessary Vitamin D, then we can dispense with all the blood tests for circulating Vitamin D because they would be unreliable indicators of deficiency and inadequacy.

The study, among others, seemed to suggest that the more obese you are, the more of your Vitamin D would go into fat storage and therefore there would be less in blood circulation. This means that the more obese you are, the more Vitamin D deficient you would be on blood measurement. If this would be a true deficency, one would expect to see cases of osteomalcia among the morbidly obese.

Guess what? After reviewing every published study available on pubmed, it was startling that there was not a single case or study reported that demonstrated bone related problems with rising obesity. In fact, it doesn't even seem to lead to osteoporosis, another bone related disease, and in fact, scientists have long believed that obesity protects against osteoporosis.  (Some recent studies out of China that differentiate between obesity based on body mass index versus actual body fat composition suggest that obesity based on high fat composition may not be preventive of osteoporosis.)

Furthermore, the only studies linking osteomalacia to obesity involve obese patients who undergo a surgical procedure to lose weight called the jejunal-ileal bypass. This procedure can sometimes lead to malabsorption, a condition in which the body can't absorb certain nutrients, in which case all kinds of problems and deficiencies become more likely.

This knowledge raises a serious question regarding the validity of the widely used Vitamin D blood test. If the test does not correlate to clinical symptoms, of what value is the test?  When the test shows a low level, is it because it is actually absent throughout the body or because much of it is stored in the fat, thereby undetectable by the blood test?

Although the study postulated, and other studies have also shown, that Vitamin D levels increase with weight loss, allegedly due to more outside exercise and therefore more sun exposure, I offer an alternative theory.  I say theory because I can't support what I suspect is the case because I couldn't find a single study that has considered this issue. Like all theories, it needs to be tested.

I postulate that as body fat shrinks, stored Vitamin D is released into circulation. What I don't know if having more blood circulating versus fat-stored Vitamin D actually makes a health difference? The answer to this question is imperative to know definitively before we compel so many people, particularly the overweight and obese to unnecessarily supplement with Vitamin D for the sole purpose of increasing circulating levels of Vitamin D.

Until the role of fat-stored Vitamin D is elucidated, I think most of the rest of the studies on Vitamin D will be essentially meaningless because you aren't measuring all the Vitamin D in the body.

For example, another study showed that there is an increased incidence of developing metabolic syndrome and a larger waist circumference after five years in patients with low blood Vitamin D.

My questions, which this study did not fully answer, are did they really have low total body Vitamin D or was it low in the blood because most of it was stored in fat. Also, did the low Vitamin D levels put them at greater risk because they were already overweight and/or pre-diabetic or because they had low sun exposure and poor dietary intake?  Finally, does low Vitamin D cause problems or indicate they already exist?

Perhaps it is not the Vitamin D blood level that matters but the presence of excess fat? Perhaps it is the excess Vitamin D that is stored in the fat that is causing the problems? We must know more about the role and activity of the fat-stored Vitamin D to answer these questions.

Maybe Vitamin D is a proxy for something else. It won't be the first time in medicine that we discovered that something was not what we thought it was. For example, we thought ulcers were caused by stress and it turned out to be mostly bacteria infections. We thought homocysteine controlled heart disease and it turned out to be only a bio-marker. We thought taking beta-carotene would prevent cancer, but it turned out that to be just the opposite. We thought statins were great for us...wait, many, but fewer still think that but maybe that will change some day as well.

From my perspective, I will no longer be recommending, in the absence of symptoms, Vitamin D supplementation for levels above 25 in overweight and obese patients. I will however, continue to strongly recommend (and offer extensive support to) overweight people to help them lose weight, not only for the sake of increasing their Vitamin D levels, but also for all the other health benefits such weight loss confers.

Also, for those without history of skin cancer, I continue to advocate for at least 15 minutes per day of sun exposure to extremities or belly, as long as reddening of the skin is avoided. Based on my current knowledge, this appears to beat supplementation almost every time, even in the elderly.

Vitamin D is obviously a complicated issue that begs for real clarity. Major studies are underway which may offer some real answers.  However, if they don't consider the role of fat-stored Vitamin D, they may actually be of little value. Let's hope for the some good answers and in the interim, try to stay healthy the old fashioned way- get up, get out, and move around.  Of course, watch what you eat because it is still the single most important determinant of health.

A Vitamin D Study Worth Ignoring and Good News at MDPrevent

It seems like everyone wants in on the Vitamin D hoopla. A study published in Mongolia (not sure if it's Outer Mongolia-the place many often refer to as a wasteland) shows that children who increase their Vitamin D levels suffer fewer cold symptoms. The only problem is that it only works with children who are Vitamin D deficient due to lack of sun during their winter (maybe it is Outer Mongolia).

There is no one, including me, that will argue that the body needs Vitamin D and without an ample supply your body will not function properly. And by not function, that includes an immune system incapable of warding off even the simple and ubiquitous cold virus. But the real debate is what defines a clinical relevant deficiency and what's the best way to treat it. I vote sun, wild Salmon, and almond milk in that order over supplements. Nevertheless, while the question of deficiency still begs an answer, with all the studies now underway, I hope the question won't stay unanswered for long. For the moment, I encourage patients to consciously raise their levels if it is below 30.

On another note, it's turned out to be an unexpectedly busy summer. Without warning, MDPrevent is suddenly inundated with patients wanting access to our medical care, particularly our weight loss and diabetes education services. Word of mouth has generated excitement about our drug-free, fully paid for by Medicare approach to successful weight loss. Even doctors such as cardiologists and endocrinologists we've never met are now referring patients to us because they are witnessing first-hand the weight loss success their other patients are enjoying.  It's both exhilarating and exhausting at the same time. It's actually getting tough to schedule new patients.

Why is it working? What have we discovered that seems to elude others? The answer is simple. Teamwork. Our program combines the skills of a physician, a registered dietitian, and a clinical psychologist. Each of us works in unison to guide, encourage, and cheer each patient on. The result is that patients are steadily losing weight, lowering cholesterol, and starting to enjoy their former selves again.

For those of you who have referred friends, relatives, and neighbors, we say thank you. I suspect so do the people you referred.

Finally, someone asked me the other day if I enjoy what I do. I said of course because what can be more gratifying than seeing people turn their lives around and feel in control again for the first time in many years!  It really does feel good to do good!

I hope you all have a wonderful and relaxing Labor Day weekend.
 

IMPORTANT ALERT: Blood Pressure Medication and Lip Cancer

This is a special alert for patients taking blood pressure medications such as hydrochlorothiazide (a diuretic) and Nifedipine (calcium channel blockers).  According to a new observational study, both of these drug classes appear to increase a patient's hypersensitivity to sunlight. The study shows a link between these medications and the development of squamous cell skin cancer of the lips. It is believed that the combination of increased sun sensitivity and sun exposure is the culprit.

DO NOT stop taking these medications without the advice of a doctor. However, if you are on these medications, please limit your sun exposure. If you limit your sun exposure, you will unfortunately increase your risk of a Vitamin D deficiency. Therefore, please make sure to get more Vitamin D in your diet from sea kelp, sea vegetables, wild salmon, and vitamin D fortified foods.

The Only Thing I Know For Sure Is That We Need To Keep Learning

About 30 years ago, I read an article about agriculture that had a profound impact on my thinking. The article was about soil erosion and basically stated that what had long been considered an incontrovertible truth about how to avoid soil erosion turned out to be the exact opposite. The idea that something held as an absolute truth could prove to be absolutely wrong has given me pause to think about such 'truths' to this day.

Thirty years later, a new study about exercise emerges that reminds me of what we consider absolute truths may not be so. For as long as I can remember, exercise has been associated with increasing your metabolism. It's been widely believed that exercise contributes to weight loss by burning calories and increasing your metabolism, which is believed to keep revving and burning calories even during the cool down phase.  While certain people argued that exercise was not an effective way to lose weight because they were unsuccessful losing weight despite much exercise, it was still a tenet of the weight loss movement. For example, Weight Watchers allows you to add extra "points" based on the amount of exercise you do.

The new study, which is a wonderful study, titled Hunter-Gatherer Energetics and Human Obesity, (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0040503) studied the Hadza tribe of hunter-gatherers in Tanzania. Strapping members of the tribe with a GPS device and having them swallow so-called doubly labeled water, a liquid in which the normal hydrogen and oxygen molecules have been replaced with versions containing tracers, researchers were able to quantify their levels of physical activity, energy expenditures and metabolic rates. What they discovered is groundbreaking!

The study showed that contrary to popular belief, exercise slows down one's metabolic rate so that calories burned are actually far less than expected.  What's amazing is that this is intuitive and yet for so long everyone believed otherwise. Think about it for a moment. If your body doesn't eat for several hours, we think (I'm now officially afraid to say anything for certain any more; well, maybe some things) your metabolic rate slows down as your body tries to conserve energy, as it doesn't know when energy will be replenished. Applying that same principle to exercise, when the body senses a loss of energy consumed by increased activity, it makes sense that it will slow down its burn rate to conserve energy.

This doesn't mean that you aren't burning calories and you can't lose weight by exercising. It simply means that you burn less than you think, which means don't think you can eat a lot more because you had a good exercise session.

By now you couch potatoes are turning to your spouses or friends and smugly telling them you were right all along about exercise. Well not so fast.  Exercise is still critical to good heart and brain health. Exercise keeps the heart functioning well and exercise has been shown to be as effective as anti-depressants in treating many cases of mild to moderate depression. But that's not all. Two new studies published online in the Archives of Internal Medicine support the tremendous impact of exercise on lowering the risk of death among diabetic patients, and that weight training may reduce the risk for the disease even without aerobic activity.

Quoting medpagetoday.com, "In a large prospective trial, moderately active patients with diabetes had a lower risk of total mortality compared with those who were completely inactive...according to Diewertje Sluik, MSc, of the German Institute of Human Nutrition in Potsdam, and colleagues. And in a separate prospective study, men who did weight training only at least 150 minutes per week had a 34% lower risk of developing diabetes to begin with ...according to Frank Hu, MD, PhD, of the Harvard School of Public Health in Boston, and colleagues."

I also previously wrote about a study that shows that exercise can return the inflexible blood vessels of pre-diabetics to normal as well.

So while exercise is not the great weight loss panacea it was once thought to be, it is still a critical component of a healthy lifestyle. Keep exercising, but more importantly, if you want to stay slim or lose weight avoid the four whites--white sugar, white flour, white pasta, and white rice. If you watched 60 Minutes this past Sunday, you now know that some scientists view sugar as toxic and cancer causing. Just another good reason to choose whole foods like fruits, vegetables, nuts, beans, and whole grains. And of course, don't forget my favorite, Wild Salmon.  Bon appetite!

Another Benefit of Wild Salmon

To say I am a wild salmon fan would be an understatement. The more I learn about it, the more excited I get. The other day I wrote about how I was in heaven consuming it in the great Northwest.

Here's another reason (for some a caution) to ingest wild salmon. Interestingly, I just learned about this not very well known benefit.  It's why I say you can never stop pursuing knowledge.

The omega-3 fatty acids in Salmon, eicosapentaenoic acid (EPA, 20 carbons and 5 double bonds), docosahexaenoic acid (DHA, 22 carbons and 6 double bonds), in addition to their positive anti-inflammatory, cholesterol lowering, and brain health effects, also have apparent anti-coagulant benefits that can prevent blood clots.

For most people that's a really good thing to have a natural source of blood thinning as protection against heart attacks and strokes. However, for people on anti-coagulants such as Coumadin, aspirin, Plavix, etc. this may be problematic. If you are on any anti-coagulant(s) and commonly consume salmon, my favorite food, please check with your doctor to determine if your medication needs to be adjusted.

Do not take fish oil pills for this purpose because they are not processed similarly in the body. Flax seeds, which also contain the α-linolenic acid (ALA, 18 carbons and 3 double bonds) omega-3 fatty acids are also noted to have similar benefits.

This is not intended as medical advice and consulting with your own physician is always advised.

Wild Salmon Country

Regular readers of my blog know that I haven't written much of late.  There are two reasons for my literary absence. First, I recently returned from visiting Seattle and Vancouver, Canada. For a wild salmon lover,  I had died and gone to heaven. I was in Wild Salmon country.

Here on this east-side of the country, it is a foregone conclusion that unless stated otherwise, any salmon sold in a restaurant is farm-raised. In Seattle and Vancouver, it is just the opposite. In fact, I got tired of having restaurateurs and wait staff look at me strangely when asked if the fish they were serving was wild. "Of course," was the repeated response.

It was nirvana. I even visited a place where you can see the salmon leap up out of the water and swim against the current. It was an amazing sight to behold. I just couldn't get enough of the wild fish and its incredible nutritional contents. Rich with omega-3s, Vitamin D, and the healthiest saturated fat, it is the perfect source of fatty acids and protein for almost any diet.  In fact, I love wild salmon's bounty so much that I carried about six pounds of an assorted variety back home with me.

The other reason for my absence was my ongoing work on my two forthcoming books. One book is about eating and living for longevity based on centenarian diets and lifestyles, and the second book is on the dangers of taking medical advice from celebrity doctors and the mass media.

Much progress has been made on both books and one publisher has already offered to publish one of the books. So stay tuned and I'll keep updating you when something worth writing about comes along.

A Hodgepodge of New Studies

Making Sense of Two Recent Testosterone Studies:

I am always trying to make sense of the studies I come across. In the past couple of days, I came across two studies involving testosterone, the male hormone. One study showed that overweight men who suffered from hypogonadism (a medical term which describes a diminished functional activity of the gonads, the testes in males) who received testosterone lost weight; the other study showed that men who suffered from hypogonadism who lost weight increased their testosterone to a level where they no longer had hypogonadism (incidence of hypogonadism went from 20% to 11%, about a 50% improvement).

After reading the two studies, I had to ponder for a while how they related to each other and then it came to me. Although I claim no absolute certainty in these conclusions, it seems that for certain overweight men, increasing testosterone, either endogenously (from within) or exogenously (from outside) helps them lose weight. Given the choice, it would seem better to naturally increase a hormone as opposed to getting it from some other derived source. The best way to do so if you are overweight is to change your diet to the a mostly plant-based diet, increase your exercise to moderately-intense 150 minutes per week, and get at least 7 hours of sleep a night.

Are Vitamin D Blood Tests Always Accurate?

Apparently not. A recent study showed that 40% of the time, blood-labs misdiagnose Vitamin D deficiency by reporting lower than actual levels. This may not be true for all labs or all types of equipment used. The equipment/tests that seemed to be the worst offenders were the Architect and Centaur-2 tests. The liquid chromatography/mass spectrometry (LC/MS) test is the gold standard and can generally be relied upon. So the next time you have a test, ask what equipment they are using and consider going to another lab with LC/MS equipment for greater peace of mind.


Is There A Link Between Vitamin B6 and Heart Disease?

A new study shows a link between low Vitamin B6 levels and increased risk for heart disease. The study does not show causality, which means it isn't clear if the low Vitamin6 causes the heart disease or the heart disease causes the low Vitamin B6. It is possible that the inflammation often seen in heart disease may decrease blood levels of the vitamin. Nevertheless, it is important to maintain adequate levels of all vitamins, including B6, so I include the reference table below for your edification.

This table is not meant to be a recommended diet; rather, it is meant to give you a representative sample of sources of Vitamin B6 in regularly available foods.  A healthy diet is one that contains fruits, vegetables, nuts, legumes (beans), whole grains, and fat from fatty fish like Wild Salmon and Wild Cod. It can also include some olive oil, limited red wine, and very occasional chicken or meat. This is often referred to as the Mediterranean Diet and it still seems to pack the most bang for the buck.
Food	Milligrams (mg) per serving	Percent DV*
Chickpeas, canned, 1 cup	1.1	55
Tuna, yellowfin, fresh, cooked, 3 ounces	0.9	45
Salmon, sockeye, cooked, 3 ounces	0.6	30
Chicken breast, roasted, 3 ounces	0.5	25
Breakfast cereals, fortified with 25% of the DV for vitamin B6	0.5	25
Potatoes, boiled, 1 cup	0.4	20
Turkey, meat only, roasted, 3 ounces	0.4	20
Banana, 1 medium	0.4	20
Marinara (spaghetti) sauce, ready to serve, 1 cup	0.4	20
Ground beef, patty, 85% lean, broiled, 3 ounces
Waffles, plain, ready to heat, toasted, 1 waffle	0.3	15
Bulgur, cooked, 1 cup	0.2	10
Cottage cheese, 1% low-fat, 1 cup	0.2	10
Squash, winter, baked, ½ cup	0.2	10
Rice, white, long-grain, enriched, cooked, 1 cup	0.1	5
Nuts, mixed, dry-roasted, 1 ounce	0.1	5
Raisins, seedless, ½ cup	0.1	5
Onions, chopped, ½ cup	0.1	5
Spinach, frozen, chopped, boiled, ½ cup	0.1	5
Tofu, raw, firm, prepared with calcium sulfate, ½ cup	0.1	5
Watermelon, raw, 1 cup	0.1	5

*DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers compare the nutrient contents of products within the context of a total diet. The DV for vitamin B6 is 2 mg for adults and children age 4 and older. However, the FDA does not require food labels to list vitamin B6 content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.

Dr. Oz's Vitamin D Recommendation Doesn't Hold Up To USPSTF Review

Yesterday, a patient came to see me again because she was concerned that I had recommended that she stop supplementing with Vitamin D. I had previously told her that she should get her Vitamin D (and fish oil) naturally from eating Wild Alaskan Salmon and other fish rich in Omega-3 fatty acids such as halibut, cod, sardines, anchovies, herring, etc. at least three times a week, and from fortified foods such as unsweetened almond milk.

She had just been to another doctor for the thyroid disorder I had diagnosed who suggested she reinstate her taking Vitamin D. She wasn't happy in general with this particular endocrinologist, but wanted to discuss what to do next with her thyroid disease and his advice about Vitamin D.

I explained again that my recommendation was based on the prevailing science and the fact that she had a very good level of Vitamin D based on her bloodwork.

As fate would have it, in a draft recommendation released yesterday, the United States Preventive Task Force (USPSTF), confirming my recommendation, said there is no value for postmenopausal women in taking supplements up to 400 IU of vitamin D and 1,000 mg of calcium.

The USPSTF also found the evidence too scant to draw conclusions about vitamin D supplements, at any dose and with or without calcium, for cancer prevention in adults.

It was based on an evidence review finding that "in postmenopausal women, there is adequate evidence that daily supplementation with 400 IU of vitamin D3 combined with 1,000 mg of calcium carbonate has no effect on the incidence of osteoporotic fractures. However, there is inadequate evidence regarding the effect of higher doses of combined vitamin D and calcium supplementation on fracture incidence in postmenopausal women."

At the same time, the USPSTF found, doses at or below 400 IU of vitamin D and 1,000 mg of calcium increase the risk of kidney stones, albeit to a small degree.

But with no benefit from the supplements, even the small risk of harm is enough to tip the balance against them at these low doses, the group indicated.

The bottom line is there are no clear benefits of taking Vitamin D and calcium supplements and you can get all the Vitamin D your body needs, in the absence of deficiency, from natural sources including sun exposure, Wild Salmon, other fishes, etc.

Nevertheless, Dr. Oz repeatedly recommends Vitamin D as a top anti-aging supplement.

What are you going to follow: Science or marketing?

MDPrevent

Another Reason To Go Wild Over Wild Salmon

Too many doctors have bought into the hyperbole regarding vitamins and other dietary supplements, often recommending them without all the facts. Some even go so far as to sell them without regard to consequences. Don't even get me started again about Dr. Oz.

For example, there has been such a preponderance of media coverage about Vitamin D deficiencies that you would think that everyone has a Vitamin D deficiency. It's simply not true. We often search without success.

Nevertheless, by now, unless you have been living in a cave, you've most likely heard the Vitamin D Story. If not, it goes like this. We need Vitamin D and we can get from 15 minutes a day of sun exposure. However, because some people don't get much some exposure for good parts of the year based on their geographic location, or because of they are afraid of sun exposure due to skin cancer, or because as people age they produce less Vitamin D from sun exposure, we need to supplement with Vitamin D.

Although products like Almond milk and regular milk are fortified with Vitamin D, as are a number of other processed foods like cereals, many still recommend supplementation in case we are not getting enough.  I do not recommend supplementation in the absence of known deficiency and because there is a viable alternative.

There is a great source of Vitamin D that also offers other potent nutrients and that is Wild Salmon. I sing the praise of Wild Salmon so much you'd think I owned a fish company. Well, I don't. But I am a huge fan because of the medicinal benefits of Wild Salmon. First, the wild variety has 4 times the Vitamin D than the farm raised variety. A 3.5 ounce Wild Salmon steak also has over 200% of the recommended daily allowance of Vitamin D.  In addition, Wild Salmon also has the omega-3s (EPA and DPH) which have cholesterol lowering, anti-inflammatory, and apparent pro-brain health effects. Finally, Wild Salmon is a great source of protein for your diet.

Cod liver oil is another great source of Vitamin D, but it has its own set of issues so I recommend Wild Salmon any day over it. In fact, consuming Wild Salmon 3 to 4 times a week would be wise.

So isn't it time you got rid of your Vitamin D pills and consumed a natural source of it?