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The Power of Vitamin D

Summer is almost over. Kids are back to school. I am back to writing my columns.

A friend wants to know: What should I make of all the news about vitamin D?

I said to him: If you haven’t started taking vitamin D everyday then you better talk to your doctor and start taking one. Talking to your doctor is important to make sure vitamin D is compatible with other medications you take.

We have always known vitamin D is needed for good health and strong bones and teeth. Your doctor will prescribe vitamin D supplements if you don’t get enough in your diet. Vitamin D is also used to treat rickets, low phosphate levels, and parathyroid problems.

In the last few months several reports have appeared which advance the case for universal intake of vitamin D on a daily basis.

A report published in the Journal of the American Geriatrics Society says vitamin D, taken in a high dose, may help prevent falls in the elderly. The study shows that nursing home residents who took a daily dose of 800 international units (IU) of vitamin D for five months were less likely to fall than those who took either lower doses or no vitamin D.

Another report appeared in the journal Nutrition Reviews suggests that adults should daily take 2,000 IU of vitamin D to help prevent some cancers.

The authors reviewed 29 observational studies and concluded that in North America, a projected 50 per cent reduction in colon and breast cancer incidence would require a universal intake of 2,000 to 3,500 IU per day of vitamin D.

A third report came out in the Archives of Internal Medicine. This review paper analyzed the results of 18 vitamin D studies says that taking vitamin D supplements may help people live longer. But it’s not yet clear exactly how vitamin D does that. But it appears to be a life extender.

So how much vitamin D should you take?

It has been previously determined that “adequate intake” of vitamin D is 200 IU per day for the first 50 years of life, 400 IU per day from 51-70, and 600 IU per day after age 71. Researchers now say that 2,000-IU daily dose of vitamin D is currently considered the “tolerable upper limit” for vitamin D. Most commercially available multivitamins contain between 400 and 600 IU.

The Canadian Cancer Society is now recommended taking 1,000 IU of vitamin D daily as a cancer prevention step. Experts suggest taking supplements of no more than 2,000 IU per day.

Some foods – for example, oily fish like salmon and sardines – are a natural source of the vitamin. Milk is commonly fortified with 100 IU per cup. The sun is the most potent source. When the sun’s ultraviolet rays hit the skin, the skin makes the vitamin, which is rapidly absorbed in the blood and can be stored for several months, mostly in the blood and fat tissue. However, excessive sun exposure is not recommended because of the well-known risk of skin cancer.

Are there any side effects if you take too much vitamin D?

Likely side effects are: Constipation, diarrhea, dry mouth, constant headache, thirst, metallic taste, irregular heartbeat, weakness, fatigue, loss of appetite, dry mouth, muscle pain, bone pain, irritability, nausea, and vomiting.

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Did you know…

Did you know the death rate for breast cancer for Canadian women has dropped by 25 per cent since 1986?

A Canadian Cancer Society special report in Canadian Statistics 2007 says increased participation in organized breast screening programs (particularly by women aged 50 to 69) has led to earlier detection and made it more likely that patients who have breast cancer receive successful treatment (CMAJ June 19, 2007).

The national recommendation is that organized breast cancer screening programs actively screen women aged 50 to 69 every two years. Organized screening programs began in British Columbia in 1988 and have since expanded to include all provinces, the Yukon and the Northwest Territories.

If you are under 50 years of age or 70 and over then discuss your risks and screening program with your physician.

The screening program includes mammogram, clinical examination of your breasts by your physician every two years and monthly breast self-examination.

Did you know that early diagnosis and treatment of prostate cancer was first suggested a century ago?

Although prostate-specific antigen (PSA) blood test has been widely used in North America to detect early prostate cancer, it is still unknown whether PSA screening significantly reduces mortality from prostate cancer.

Actually PSA measurements reflect cancer risk, with the risks of cancer and of aggressive cancer increasing with the level of PSA (CMAJ June 19, 2007). Besides PSA blood level, your physician will look at other risk factors before he can advise you on further management. Other risk factors are: family history of prostate cancer, digital rectal examination findings, age, ethnicity and history of previous biopsy with a negative result.

Since PSA test is not a perfect test for detecting early prostate cancer, you should discuss with your doctor the risks and benefits of ordering such a test. PSA blood test for screening is not recommended by the Canadian Task Force on Preventive Health Care as there is insufficient evidence to promote it for screening for early detection of prostate cancer. Canadian Urological Association and Prostate Cancer Alliance have recommended that it be performed only after detailed discussion of the pros and cons between doctor and patient.

What is interesting is that recent nationwide survey indicated that almost half of Canadian men over 50 years of age reported receiving PSA screening during their lifetime. PSA blood test and digital rectal examination have become part of annual physical examination for men over 50 by their family physician and 72 per cent of these men had these tests in the last one year (CMAJ).

Prostate cancer is thought to be the disease of older men. But autopsy studies have found that 27 per cent of men in their 30s and 34 per cent of men in their 40s have histological evidence of the disease (not necessarily clinically known disease). The current lifetime risk of disease diagnosis is 18 per cent and lifetime risk of dying from prostate cancer is three per cent.

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Diverticulosis

Dear Dr. B: I was recently diagnosed with diverticulosis of the colon. Is it true that I should avoid nuts, seeds and popcorn in my diet?

Answer: That is the advice given to patients with diverticulosis. I didn’t agree with that. My advice to patients with diverticulosis is to eat whatever they like as long as they chew well. Recent studies have suggested there should be no diet restriction for patients with diverticulosis

Diverticular disease of the colon is a very common condition. Many people have this condition and have no symptoms and are not even aware of its presence.

What does the term diverticular disease mean?

This means there are little sacks or pockets sticking out of the wall of the colon – called diverticula (if multiple) or diverticulum (if single). Usually, they are multiple and are mainly concentrated in the sigmoid colon in the left lower abdomen. There may be more in the rest of the colon. In Latin the word diverticulum means a wayside inn – presumably a place of ill repute!

Diverticulosis of the colon was first described in 1849. So it has been with us for a long time. But why do people get this condition is not very clear. It is an acquired condition. One textbook of surgery says that it is reasonable to believe that colonic diverticula develop at weak points in the bowel wall under the influence of increased intraluminal pressure.

Many other hypotheses have been advanced but one most convincing is the spasm of the muscles of the wall of the bowel with irregular contractions of the affected part that increases the intraluminal pressure.

This condition is very uncommon under the age of 35. Above 35 years the incidence increases steadily so that by the sixth decade nearly 30 percent of all patients have diverticulosis.

There are many complications associated with diverticulosis and diverticulitis. These are bleeding, bowel obstruction due to narrowing of the colon, perforation and peritonitis, fistula (tunnel) formation between the colon and urinary bladder, vagina, and small intestine. Diverticulosis does not turn into cancer but it can hide cancer and make diagnoses of cancer difficult.

Uncomplicated diverticulosis is generally believed to be without symptoms and is discovered incidentally during barium enema or colonoscopic examination. Ill-defined symptoms of abdominal discomfort, gas, bloating and some change in bowel habit are difficult to ascribe to diverticulosis. But could be part of the spastic bowel syndrome.

How can I get rid of the condition?

There is only one way to do this is to surgically remove the affected piece of bowel. When is the right time to do this depends on many factors including associated symptoms and complications. The best thing is to get a surgical opinion. Planned resection generally requires no colostomy.

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Protecting yourself outdoors: skin cancers, mosquito bites, and eye protection

This is another entry into my video blog series produced specifically for my website. I hope you have enjoyed the past entries, and will continue to do so in the future.

Today, I would like to speak to you about protecting yourself outdoors. It is summer time, the weather is great, and lots of people want to enjoy the weather while it is here. The three concerns I would like to speak about are skin cancer, mosquito bites, and protecting your eyes. I will also touch base on keeping yourself properly hydrated.

Enjoy! And as usual, comments can be left by clicking on the video and leaving them on youtube’s website. Cheers!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!