Vitamin D and Breast Cancer: Are they married or just acquaintances?

With recent headlines like Vitamin D Enhances Breast Cancer Survival, a woman could hardly be faulted for running out and stacking up on Vitamin D pills.  The meta-analysis study (a compilation of studies) upon which this headline and similar ones are based, was published in Anticancer Research and showed that the higher the Vitamin D level at the time of diagnosis, the better the prognosis. On the surface, this would suggest a cause and effect relationship.  To the untrained eye, one might conclude that raising Vitamin D levels has some type of anti-cancer effect.

However, the evidence to date would suggest that this is not the case. First, even in this study, even women with very high levels of Vitamin D were still diagnosed with breast cancer.  The higher levels of vitamin D simply meant average longer survival. So what do I think is going on?

I believe, and a recent study, which I will discuss in a moment, supports my tentative conclusion, that this is a matter of correlation between vitamin D levels and one's state of health..  As correlation does not imply causation, raising vitamin D levels artificially high with Vitamin D supplements will neither prevent cancer, as the first study clearly showed, nor improve its prognosis. Why?

In a study published in the Lancet, the British medical journal, titled,  The effect of Vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta analysis, the researchers compiled a representative group of Vitamin D studies and divided them into two groups. The first group included studies such as the breast cancer study above that showed consistently that higher levels of vitamin D correlated well with better health and disease outcomes. The second group of studies were double.blind randomized controlled studies that showed that Vitamin D supplementation versus placebo had little effect on overall health.

The authors of this study proffered what they believe to be the plausible explanation for the inconsistencies between the two groups of studies.  They tentatively concluded that raising Vitamin D levels above a certain threshold of adequacy doesn't prevent disease; rather, disease lowers Vitamin D levels.  as applied to the breast cancer study, this means that the women with the highest level of Vitamin D at the time of breast cancer diagnosis were healthier than those with lower Vitamin D levels and therefore had a better prognosis.  The worse the breast cancer, the unhealthier the patient, the lower the Vitamin D level, the poorer the prognosis.

As with all studies, one can reach no conclusive decisions from either of these studies. They merely add to our knowledge. My take-away from these studies is that Vitamin D is essential to human health and having levels above 20 mcg is essential and some say above 30 mcg. is ideal. 

The best way to get your Vitamin D remains 15 minutes of daily sun exposure to your torso/extremities. Alternatively, consuming food products with high concentration of Vitamin D like unsweetened Almond Milk and wild Alaskan Salmon are second, with Vitamin D pills coming in third. If you are taking pills because you absolutely can't do the first two then the recommended daily allowance (RDA) if you are below age 70 is 600 iu. and above age 70 it's 800 iu. That's not a typo. By the way, RDAs were developed to cover 97% of the population's needs. 

Supplementing with levels above these numbers has not been shown to have any benefit so save your money.  Again, this is what the current preponderance of evidence shows.  I'll let you know if something changes. Some large population studies are underway with expected publication in 2016 and 2017 so stay tuned.

Do Multivitamins Prevent Cancer? Part 2

The media is having a field day with the recent study titled Physician Health Study II (PHS II) which claims that multivitamins may slightly decrease cancer rates among men.  If you simply read the headlines and you are a man that wants to decrease your risk of developing cancer, you would think that you should immediately run out and buy a multivitamin, and if you are taking one, you should keep taking it.

Don't!

The results are not quite living up to all the hype.

According to the study, after 11.4 years of taking multivitamins, only men, predominantly older than 70, showed mild decreases in certain cancers. In fact, this study included men who had previously been diagnosed with cancer, among whom for some unknown reasons were found the best results.

This study, paid for by the multivitamin manufacturers, including Pfizer, actually showed the following:

Slight increases in prostate cancer (662 placebo takers versus 667 among multivitamin users) and melanoma (89 increased to 100).
Slight decreases in total cancer (1253 to 1195).
Slight decrease in colon cancer (95 to 88).
Total mortality (death) slightly decreased from 1,134 to 1,092. That means for over 13,000 total men in the study, there were still over 2,200 deaths and only a decrease of 42 total deaths.

Get this. By my calculation, over 26,000,000 (million) pills over 11 years were taken by 6,660 men to spare 42 deaths. Ouch!  No wonder the drug companies want to push the results of such a study.

Basically, the men who took a daily multivitamin for over 11 years so no improvement in prostate, colon, and bladder cancer and no change in their overall cancer mortality. Also, a careful review of the study shows that the multivitamin users were also slightly less likely to smoke and slightly more likely to eat fruits and vegetables.

Finally, the study did not identify if any of the men had vitamin deficiencies prior to the start of the study. As they focused on physicians, who generally work long hours, there is a high probability that these men spent little time in the sun and therefore had an increased risk of Vitamin D inadequacy or deficiency.

Ladies and gentleman, overall, this study and the numbers presented basically prove nothing. With the overall cancer rate decreasing from 18.4 to 17.6 for every 1,000 years, there remains no reason to believe that multivitamins offer any benefit in the absence of deficiency.

The bottom line is that most importantly, despite taking a multivitamin every day, about 20% of the men still developed cancer and about 20% died.  Save your money!


So once again you are chastened to remember, Caveat Lector! (Let the reader beware).

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.
 

Vitamin D Takes A Couple Of More Hits

Two new studies challenge the sweeping hysteria about the need to supplement with Vitamin D.

In one retrospective study looking at Medicare records, researchers could find no link between Vitamin D deficiency and macular degeneration. Based on this study, if you are self-prescribing Vitamin D to treat your macular degeneration, I would strongly consider stopping.

The second study involved men with prostate cancer who are on hormone depleting therapy. This therapy can lead to osteoporosis so it was always thought wise for these men to supplement with Vitamin D and calcium. This study shows that not only doesn't adding these two supplements help, but they may actually be increasing the severity of the cancer. That's on top of the calcium's effects on adding to the risk of calcification of the arteries and heart attacks.

So based on this information you would say that it is probably best to avoid Vitamin D supplements. But wait, there's more. In April 2012, a study showed that high dose Vitamin D supplementation in patients with low risk prostate cancer seemed to help the patients do better with lower Gleason scores, one of the biomarkers for prostate cancer. But wait again.  In this study, involving 52 patients, led by D.T. Marshall of the Medical University of South Carolina and colleagues, 55% did better, 11% had no change, and 34% did worse.

My read on such a study is to basically ignore it because the number of participants was too low, a good percentage got worse and we know little else about their diets, etc.

So what's the answer on Vitamin D? I say sun. It's the only natural way to increase your Vitamin D levels. Of course, don't burn yourself, but 15-30 minutes a day strategically spread out should avoid any such problems in most people. However, that may not be YOU, so if you can't spend even that amount of time in the sun, your next best choice is wild salmon. If you can't or refuse to eat wild salmon, then fortified foods are your next best choice before supplements.

Yesterday, I reviewed 300 study headlines on supplements, particularly about their antioxidant effects, on pubmed.com, and read about 40 abstracts of some of the studies. This effort fortifies my belief that supplements just aren't cracked up to be what their manufacturers and marketers want YOU to believe.

But I also confirmed something else. The studies showed consistently that even with fruits and vegetables, once your body has the vitamins, minerals, and nutrients it needs, giving it more does nothing. It's like filling a canister. Once it's filled, any more added is just spillover. The principle here is that more of a good thing is not better when it comes to your nutritional state. That's the biggest problem I think posed by most supplement products. They operate mostly on the principle of get more to play it safe. More vitamins, more minerals, more antioxidants. YOU don't need more that YOU need and as recent studies suggest, more may not be safe for YOU.

The real take away from all three studies quoted above is that Vitamin D supplementation may not be the panacea that many proclaim it is on a daily basis. Tread cautiously, my friends, when it comes to taking supplements and heed the Latin phrase, Caveat Lector, "Let the reader beware." That includes reading my blog with a bit of caution as well. Nothing written here should be construed as medical advice. The only medical advice you should heed is from a doctor that knows your medical history personally and discusses treatment with YOU directly.

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.

Something To Laugh About and More On Vitamin D

It's often been said that laughter is the best medicine, and I couldn't agree more. Therefore, I dedicate today's blog to a funny video that a friend shared with me and my wife. I hope you enjoy it as much as we did.

http://www.youtube.com/watch?v=PypsMk_0QxY&feature=youtube_gdata_player

For those hungry for some science, here's a funny, not in terms of humor, but in terms of being a somewhat ridiculous study that was reported on a few days ago. I have no doubt that the results of the study are already being used to feed the recent hysteria about Vitamin D deficiencies.

Why? I'll get to that in a moment but let me first share what happened with an email I received from a service of the U.S. National Library of Medicine and National Institutes of Health that reported on this new study.

Last week, I took exception to material in another article from the same source that implied that calcium could only be obtained from dairy products, which is far from the truth. Here's a link to another government resource listing many other food sources, albeit not all healthy ones. And while dairy products dominate the list, there are other excellent sources as well. Cut and paste: http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

When I wrote to the source of the email, the response was that they simply reported what they received from the newswires. I told them that such a response was a cop-out and that they had a responsibility as a government service to make sure that the information they were disseminating was accurate. We went back and forth in a few emails and the net result was that I received an email from the head librarian in which he essentially disavowed any responsibility for the information being forwarded. I found that quite disappointing.

Nevertheless, I knew that henceforth I have to be careful with anything I received from this source. With that in mind, let’s address the headline of the article in a recent email I received from the same source, which was titled, “Low Vitamin D Levels Linked To Weight Gain in Older Women.” Now any reasonable person would conclude based on this headline that women with Vitamin D deficiencies are generally gaining weight as a result of their deficiency. Well, that’s not what the studied showed.

Quoting from the email, “The researchers followed more than 4,600 women aged 65 and older over the course of nearly five years. The study found the women with low levels of vitamin D gained about two more pounds during that time than those with normal levels of the vitamin.” How about that? A whole two pounds more. Is that consistent with what you expected from the headline? Two whole pounds gained over 5 years? I’m sure we all expected that from the headline, right? That’s not all. Which women do you think gained the weight? It turns out to quote the article again, it was the “women [who] generally weighed several pounds more to begin with, the researchers noted.” So the heavier women gained more weight. Not a big surprise that an overweight person would gain more weight as is often the case.

But that’s not the funny part I referenced earlier.

Here’s the funny, or not so funny, part. The article goes on to say, “Although most of the women in the study were not trying to lose weight, over the course of the study 27 percent of the women lost more than 5 percent of their body weight and 12 percent gained more than 5 percent of their body weight, the researchers noted.”So despite the vitamin D deficiency or perhaps because of it, which apparently according to this study was present in 78% of the tested women, more women actually LOST weight than gained it.

Accordingly, why wasn’t the headline “Low Vitamin D Levels Linked To Weight Loss in Older Women” or even “Low Vitamin D Levels Linked To Weight Gain, Weight Loss, and No Weight Change in Older Women.” Now that would have been an accurate headline.

So was the article a total loss? No. Here’s the only semi-reasonable comment coming from the article and I quote, “"Our study only shows an association between insufficient levels of vitamin D and weight gain," study author Dr. Erin LeBlanc, an endocrinologist and researcher at the Kaiser Permanente Center for Health Research in Oregon said. "We would need to do more studies before recommending the supplements to keep people from gaining weight. Since there are so many conflicting recommendations about taking vitamin D for any reason, it's best if patients get advice from their own health care provider."

Finally, a little bit of sense although given the 27% of women actually lost weight it would be more logical to suggest that Vitamin D supplementation should NEVER be used as a weight loss tool.

So as I often recommend, please don’t trust headlines, even from government sources. You need to, at a minimum, read the entire article and ideally, look at the actual study if you want to even get close to the truth. Of course, even looking at the study is not a safe bet because so many studies are done by unreliable sources with an agenda, who manipulate the science, if it even is actual science, in their favor.

So what’s a person to do? Send the article or study it to me. I love to look at interesting studies and dissect them looking for the truth. Consider me your personal truth seeker.

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

What Did Dr. Oz Leave Out About Strontium?

Let me preface today's blog with a head's up that I spent 5 hours researching this subject before writing the blog. It's a little technical, but I thought the detail was important. 

Although I may have a pretty good handle on the subject, I may also have missed something that wasn't available on the internet. Please feel free to comment if you feel I missed something.

Last Thursday, Dr. Oz told his audience about four supplements, extensively researched by his staff, which he highly touts as anti-aging supplements. The four were resveratrol, vitamin D, fish oil, and strontium. Please see my previous blogs about fish oil (Tuesday, April 10, 2012 titled ‘Et tu fish pills?’) and Vitamin D (Tuesday, March 20, 2012 titled ‘What's The Big Deal About Vitamin D? It turns out quite a bit.’   

At a later date, I'll write about resveratrol. In the interim, please note that one of the leading, if not the number one in the world, resveratrol researcher, Depak Das at the University of Connecticut, was dismissed from his university post because he was found to have repeatedly falsified his resveratrol research data. This has thrown the entire field of resveratrol research into dispute and a major conference that was scheduled in India called Resveratrol 2012 was cancelled late last year as he was one of the top experts expected to present. Enough about resveratrol for now; today, let's have some fun with strontium.

Dr. Oz recommended that women take 680 mg of strontium each day separated from the calcium he also recommends they take.  Of course, he made no reference to recent studies that suggest potential harm from taking calcium (see my blog from Friday, May 25, 2012, 'Calcium Pills Raise Concerns -- Again!'). He mentioned on the show that strontium has been studied in Europe and that the studied form is not available in the U.S. 

Here's what he didn’t share. The form of strontium studied in Europe was strontium ranelate, a synthetic salt that combines strontium with ranelic acid.  The studies done in Europe were good studies and one of the studies was published in the New England Journal of Medicine, a peer reviewed prestigious journal published by the Massachusetts Medical Society and associated with Massachusetts General Hospital, the premiere Harvard affiliated public hospital. See reference below.

The study involved the consumption of 2 grams of strontium ranelate each day for a period just short of five years. The strontium clearly increased bone density on scans and decreased fracture risks in post-menopausal women. It was generally well tolerated except for increased nausea and diarrhea during the first three months of administration.  All study participants also consumed calcium and Vitamin D at different dosages.  As a result of the study, the drug was approved and is only available by doctor prescription for dispensing by a pharmacist to people at high risk of fractures in Europe, and requires strict medical supervision. 

Why strict medical supervision? Strontium competes with calcium and magnesium and displaces them. What that does to your bone health and overall health has not been studied and is unknown.  There are reports that it can cause a condition called osteomalacia, which involves the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium, or because of overactive resorption of calcium from the bone, often as a result of hyperparathyroidism. In other words, taking strontium may interfere with your normal function of calcium uptake by bones.

A review of comments from users found on the internet included, a doctor “urged caution and told me about the deaths due to 'hypersensitivity syndrome' and a second consultant told me she was still not happy with calculation of DEXA scores.” The reference to the DEXA scores is that when doing the diagnostic DEXA Scan tests for osteoporosis, the test results are apparently skewed by the use of strontium.  There were many comments that indicated no problems.

So why isn’t it available in the U.S.? The answer is because the French company that owns the patent has not pursued FDA approval. The apparent reason for this and the one most often cited is that the FDA would require some homegrown research before approving it and the company doesn’t want to foot the bill. So you can’t get it here.

Of course, some entrepreneurial folks decided that if you can get the synthetic strontium ranelate here, they should cook up some strontium citrate because as it has no synthetic compound involved (ranelic acid is synthetic and citrate is not) and therefore can be sold as a supplement here in the U.S.  How did they come up with the recommended 680 mg dose? Apparently, strontium ranelate contains 680 mg of strontium. How much strontium does strontium citrate contain? I can’t tell you.

Also, what’s the difference between the way citrate and ranelate act in your body? I don’t know and nor does anyone else because it hasn’t been studied. Let’s look at an example of two other different chemical molecules binding together. Sodium when combined with chloride becomes sodium chloride, the salt we eat. When sodium is combined with citrate, it becomes monosodium citrate, a salt used to prevent anticoagulation of stored blood. Different chemicals when combined create different compounds.

So what’s the biggest problem with taking strontium citrate to prevent or treat osteoporosis? Beyond some of the concerns cited above, it’s never been studied and reported on in humans.

There was a study begun in the U.S. at University of California Davis Medical Center a few years ago that was meant to be completed and results reported in 2010, but the study, named the Scope Study, has mysteriously disappeared.  I’m not kidding. There are conspiracy theories all over the internet regarding what happened to this study. Some claim the bisphosphonate companies got to them. Just theories with no evidence whatsoever to support them. My experience is when a research institute goes mum on a study, it’s often due to something going wrong with the study.  Nonetheless, the results never came out. That gives me pause to ever recommend such a drug under such circumstances.  

Furthermore, while strontium ranelate was studied with 680 mg of strontium, studies with far less amounts have never been reported. If it is actually good for you, could less work just as well?

Strontium is present in our food supply. For example, it is available in vegetables such as spinach, lettuce, carrots, peas, beans, potatoes and celery. Wheat, barley and other grains used to make bread also have significant levels of strontium. According to one source I found, flour, grains and breads average 2,150 mg per gram of stable strontium.

So as always, before taking a pill containing a super high dose of a mineral which has not been studied for a prolonged period of time, you should increase your intake of foods containing that mineral that have been used for millions of years.

It is important to remember that high-dose strontium is essentially a bone drug, and, as with all bone drugs, it is only indicated when there is a clear high risk of fracture defined as a 20% likelihood of a major osteoporotic fracture over the next 10 years.

The bottom line is that the long-term safety and efficacy of strontium citrate has not been evaluated on humans in large-scale medical trials.

That’s why once again I say shame on Dr. Oz for recommending it to the general population without good science to support what is available in the U.S. It only serves to make people more anxious and confused that maybe they have misssed something. It is often dangerous to experiment on your own body.

By the way, here are the chemical structures for strontium ranelate and strontium citrate. Do they look similar? If no, it's because they are not. One, ranelate binds with two atoms of strontium, while the other, citrate, only binds with one atom.

Strontium Ranelate 

 

Strontium Citrate

MDPrevent

References:

Meunier PJ, Roux C, Seeman E, et al. The effects of Strontium Ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. NEJM 2004 350;459 -68

Reginster JY, Seeman E, DE Vernejoul MC, et al . Tropos Study. J Clin Endocrinol Metab 2004–1774. Strontium ranelate reduces the risk of nonvertebral fractures in post-menopausal women with osteoporosis.