Vitamin D and Respiratory Infections

A walk on the beach in Maui. (Dr. Noorali Bharwani)

A research article in the British Medical Journal (BMJ February 15, 2017) says vitamin D supplementation is safe and it protects you against acute respiratory tract infection.

The object of the study was to assess the overall effect of vitamin D supplementation on risk of acute respiratory tract infection, and to identify factors modifying this effect.

The researchers looked at the results of 25 eligible randomized controlled trials (total 11,321 participants, aged 0 to 95 years).

They found vitamin D supplementation reduced the risk of acute respiratory tract infection among all participants.

The article says acute respiratory tract infections are a major cause of global morbidity and mortality and are responsible for 10 per cent of ambulatory and emergency department visits in the USA and an estimated 2.65 million deaths worldwide in 2013.

Vitamin D deficiency is associated with many conditions, including bone loss, kidney disease, lung disorders, diabetes, stomach and intestine problems, and heart disease. Vitamin D supplementation has been found to help prevent or treat vitamin D deficiency.

Vitamin D, often called the sunshine vitamin, is mainly obtained from sun exposure of our skin. However, Canadians are not getting enough of sunshine vitamins. Supplements are necessary to obtain adequate levels because a person’s diet has minimal impact, says Osteoporosis Canada website (New Vitamins D Guidelines 2010).

“Canadians are at risk of vitamin D deficiency from October to April because winter sunlight in northern latitudes does not allow for adequate vitamin D production,” says Julie Foley, president & CEO of Osteoporosis Canada. She goes on to say that because vitamin D requirements for an individual may vary considerably depending on many factors, it’s very important to check with your physician about how much vitamin D you should be taking.

Vitamin D is essential to the treatment of osteoporosis because it promotes calcium absorption from the diet and is necessary for normal bone growth. Some research suggests it may also ward off immune diseases, infection and cancer.

How much vitamin D should you take each day?

The new guidelines recommend daily supplements of vitamin D 400 to 1000 IU for adults under age 50 without osteoporosis or conditions affecting vitamin D absorption. For adults over 50, supplements of between 800 and 2000 IU are recommended.

Coming back to our topic – Do vitamin D supplements help prevent respiratory tract infections?

An editorial comment in the British Medical Journal (15 February 2017) says clinically useful effect of vitamin D on respiratory infection remains uncertain despite hints in the new analysis mentioned earlier in this column.

The editorial goes on to say, “Eight trial level meta-analyses have examined this topic since 2012, with conflicting findings: three reported benefits and five no consistent benefits.” The editorial conclusion is… we need more trials to prove the point that vitamin D supplements protect against respiratory infection.

In the meantime there is no reason to avoid taking vitamin D everyday as indicated earlier. There is no doubt vitamin D is required for many more reasons than just preventing lung infection.

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Our Seductive Desire for a Magic Pill

Sunset on a desert tour of Dubai. (Dr. Noorali Bharwani)

There are so many pills in the market that are touted as “magic pills” to keep you healthy, make you strong and boost your physical and sexual powers. But are they any good? Are they safe?

Health supplements are a $1.4-billion industry in Canada, but product testing is questionable, says a CBC report. Supplement products have increased dramatically, from about 4,000 types in 1994 to more than 55,000 in 2012. Roughly half of all US adults say they have used at least one supplement in the past month, most commonly vitamins.

Health Canada confessed to CBC’s Fifth Estate program that most herbal and vitamin supplements are approved for sale in Canada on “weak evidence”. The report also says more than 90 per cent of new products are approved within 10 days.

There is intense pressure from the supplements industry, anxious to cash in on the latest health-care trends. About three-quarters of Canadians regularly take natural health products such as vitamins, minerals, fish oil and herbal remedies, a 2010 Ipsos-Reid survey found.

Research in New Zealand published earlier this year found that 83 per cent of fish oil supplements tested exceeded maximum industry standards for rancidity. And recent tests by CBC’s Marketplace showed that four of seven fish oil supplements tested showed signs of rancidity.

Products for weight loss or increased energy accounted for the most ER visits. These products caused 72 per cent of problems involving chest pain or irregular or too-fast heartbeats, and they were the culprits in more than half of visits among patients ages 5 to 34. Bodybuilding and sexual-enhancement products also led to cardiac symptoms in many seeking ER help.

Marketplace (November 12, 2015) also found Vitamin C products make illegal claims. Canadians are constantly misled into thinking Vitamin C fights colds. Marketplace found Vitamin C products that make health claims are not allowed by Health Canada. While independent testing is done in the US to verify the accuracy of supplement ingredients, similar testing is not done in Canada. So what you take may not be safe.

University of Guelph botanist Steven Newmaster and his team conducted DNA tests on 44 herbal supplements bought in Canada and the US. Their study, published in the journal BMC Medicine in October 2013, found that nearly 60 per cent of the supplements contained ingredients not listed on the label and 32 per cent were outright frauds.

Subsequently, New York Attorney General Eric Schneiderman commissioned his own DNA tests of supplements sold by four major chains in the US. His study produced even more disturbing results, and Schneiderman ordered the retailers to stop selling the supplements, says CBC report. But no action by Health Canada.

The New England Journal of Medicine (October 2015) says supplements send 23,000 people to hospitals each year in the US. Products for weight loss or increased energy accounted for the most ER visits. So be careful before you consume any supplement not ordered by your doctor.

Best thing you can do for yourself is to exercise regularly, eat lots of fruits and vegetables, eat fish, meditate and do yoga. Don’t be seduced by a magic pill!

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Herbal remedies and vitamin supplements can be good, bad and ugly.

Cloud Gate, nicknamed The Bean, in Millenium Park, Chicago. (Dr. Noorali Bharwani)

Recent CBC investigation report (Fifth Estate) revealed that herbal remedies and vitamins are frequently approved for sale in Canada with only minimal review. Even Health Canada acknowledges that their approval of these products is based on “weak evidence,” says the CBC report. That indeed is shocking.

The CBC report indicates that Health Canada approves more than 90 per cent of applications to sell new natural health products. And under updated rules, products can be approved in as little as 10 days.

Are we fully aware of the quality and safety of many of these supplements? The answer is no. We don’t. U.S. statistics show supplements send 23,000 people to hospital each year. Annual sales in Canada total about $1.4 billion, and Health Canada’s Natural and Non-Prescription Health Products directorate must approve supplements before they go on sale.

According to the CBC report, some leading researchers also say there is mounting evidence that many of the most popular supplements don’t live up to their claims and could even be dangerous. Common complaints about these products included contamination, purposeful adulteration, incorrect strength and incorrect identity.

Medically speaking a healthy individual, who eats a good diet, does not require vitamin supplements. But almost 30 percent of our population does not follow that dictum.

On the other hand, there is a consensus among medical experts that taking certain vitamin supplements on a daily basis does more good than harm.

Here are some examples:

  1. Folic acid (400 ug/day) reduces the risk of birth defects during pregnancy.
  2. Multivitamin tablet – one a day. Vitamin B such as B6 and B12, may help lower blood levels of a substance called homocysteine that may help reduce the risk of heart disease and stroke.
  3. Vitamin D (1000 – 2000 IU/day) minimizes the risk of osteoporosis and fractures and colon and breast cancer.
  4. Omega-3 fatty acids – 1000 mg/day or eat fish three times a week. This reduces the risk of sudden heart attack by 50 to 80 per cent. It can help ward off the serious heart rhythm disturbances associated with sudden cardiac death. It also appears to reduce the risk of strokes, mental decline in old age and prostate cancer.

In summary, one multivitamin, vitamin D and omega-3 should cover what you need if you are otherwise healthy. Remember, this is just a guideline. Discuss with your family doctor before you start these pills. If you opt to use herbal remedies for prevention or treatment of an illness check whether there is any science associated with the recommendation.

Vitamin supplement is just an icing on the cake – so to speak. Too much of icing and/or too much of cake is not good for your health!

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The Importance of Vitamins in Our Diet

Tablets. (iStockphoto/Thinkstock)

In general, most people know the importance of vitamins in our diet. But many people do not know which vitamins are really important in maintaining good health.

I would like to revisit an article I had discussed about ten years ago on this topic. Not much has changed since. The topic was also discussed in a Clinical Practice article in the New England Journal of Medicine (NEJM) titled, “What vitamins should I be taking, doctor?”

Medical teaching says that a healthy individual, who eats a good diet, does not require vitamin supplements. He should be able to meet his vitamin needs from his healthy diet. But the public interest in vitamin supplements is enormous – sometimes due to misguided reasons. Almost 30 percent of our population takes vitamin supplements. And there is no control over it.

Because the food we eat contains too many nutrients, it would be almost impossible to conduct double blind trials to see if vitamins do have improved clinical outcomes. Also the users of vitamin supplements may have healthier lifestyles or behaviours than nonusers. This would distort any clinical trial results.

The good thing about vitamin supplements is that there is greater likelihood of good than harm and cost of supplements is not that high so the authors of the article in the NEJM recommend the following vitamin supplements for healthy individuals. There is substantial evidence that higher intake of:
1. folic acid (400 ug/day),
2. vitamin B6 (2 mg/day),
3. vitamin B12 (6 ug/day), and
4. vitamin D (400 IU/day) will benefit many people, and a
5. a multivitamin will ensure an adequate intake of other vitamins for which the evidence of benefit is indirect.

The authors say a multivitamin is especially important:
-for women who might become pregnant
-for persons who regularly consume one or two alcoholic drinks per day
-for the elderly, who tend to absorb vitamin B12 poorly and are often deficient in vitamin D
-for vegetarians, who require supplemental vitamin B12 and
-for poor urban residents, who may be unable to afford adequate intakes of fruits and vegetables.

It should be noted that recent recommendation for vitamin D suggests all adults should take 1,000 to 2,000 IU daily. The upper level for safe vitamin D intake has not been well defined but is probably as high as 250 μg (10,000 IU) daily but in clinical practice, supplementation with this dose of vitamin D is rarely required.

Physicians who encourage their patients to take vitamin supplements should also educate their patients regarding healthy lifestyle and about healthy nutritious diet. Foods contain many additional important components, such as fiber and essential fatty acids and vitamin pills cannot be a substitute. Vitamin pills do not compensate for the massive risks associated with smoking, obesity, or inactivity, say the authors of the NEJM.

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Eat Fruits and Vegetables to Produce Healthier Sperm

A sperm fertilizing an egg. (iStockphoto/Thinkstock)

A study published in Fertility and Sterility reported men who consume a high amount of certain nutrients may produce healthier sperm than men who do not. The study also found this effect to be more pronounced in older men.

Dr. Andrew Wyrobeck and his colleagues from Lawrence Berkeley National Laboratory, Berkeley, California determined dietary micronutrient intake among 80 individuals aged 22 to 80 years. Examples of micronutrients are vitamin C, vitamin E, and zinc. These nutrients are required by the body in small quantities for a whole range of physiological functions. The human body does not produce these micronutrients. Sperms from these individuals were also analysed.

The study found men with a higher intake of vitamin C, vitamin E, folate, and zinc produced sperm that had significantly less DNA damage than men who consumed lower amounts. Analysis showed that older men with an intake below that of the population’s median levels for vitamin C, vitamin E, and zinc (but not β-carotene or folate) had significantly more sperm DNA damage compared with all other groups, including older men with above median intakes.

What does this mean? It means older men who are planning to father a child in the near future should start eating a healthy diet if they are not doing so already. Older fathers, with DNA-damaged sperm, may be contributing to the increasing rates of autism, schizophrenia and other diseases among children and adolescents.

Researchers say consuming micronutrients such as vitamin C, E, folate and zinc helps turn back the clock for older men. The analysis revealed that men older than 44 who consumed the most vitamins and micronutrients had 20 per cent less sperm DNA damage compared to men their own age who consumed the fewest nutrients.

In younger men, a higher intake of micronutrients didn’t improve the quality of the DNA in their sperm. The benefit was observed solely among the older men. But, of course, they are the ones most vulnerable to sperm DNA damage – and therefore have the most to gain from an improved diet.

Future studies are needed to determine whether increased antioxidant intake in older fathers will improve fertility, reduce risks for genetically defective pregnancies, and result in healthier children, concludes the team.

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Salty Advice About Dietary Salt

A spilled salt shaker. (iStockphoto/Thinkstock)

None of us are strangers to table salt. Everytime you eat something, you probably make a remark regarding the amount of salt in the food. Some people may think it is just right, some may find it too salty and some may feel extra salt is required.

Our body contains many salts. Table salt (sodium chloride) is a major one making up around 0.4 per cent of the body’s weight at a concentration pretty much equivalent to that in seawater. Somebody has calculated a 50 kg person would have around 200 gm of sodium chloride in his body. That makes around 40 teaspoons.

We continually lose salt when we lose water from our body as salt is in a solution. So when we are sweating, vomiting, having diarrhea or voiding water by act of urination, we are losing salt. Salt cannot be made in our body so we have to replenish it otherwise there can be serious consequences.

Salt is needed to maintain our blood volume and blood pressure. Sodium is also needed for nerves and muscles to work properly. Low levels of body sodium can make our brain swell and cause confusion.

Too much sodium is bad for us as well. Excessive consumption of sodium can increase blood pressure, and that salt is a major determinant of population blood pressure levels. Some research estimates suggest the numbers of deaths averted by moderate reductions in population salt consumption would be at least as many as those achieved by plausible reductions in population smoking rates (CMAJ June 12, 2012).

The fast food industry is making its own contribution towards increasing the general population’s salt intake. Fairly large population is relying on fast food industry to provide their daily food needs. Fast food tends to be more energy dense, contain more saturated fat and salt, contain fewer micronutrients and be eaten in larger portions than other foods, says the CMAJ article.

Fast food items such as fried potatoes, pizzas and sugar-sweetened soft drinks typically provide between one-third and one-half of daily energy intake but less than one-quarter of most micronutrients.

Now what? Too much or too little salt in the diet can lead to muscle cramps, dizziness, or electrolyte disturbance, which can cause neurological problems, or death. Generally, more emphasis is given to the evidence showing an association between salt intakes and blood pressure among adults. We also know reduced salt intake results in a small reduction in blood pressure. Evidence suggests that high salt intake causes enlargement of the heart and swelling of the legs.

There is a clear scientific evidence that a modest and long term reduction in population salt intake can result in a lower population blood pressure, and a reduction in strokes, heart attacks and heart failure.

Then what are we waiting for? Most of us consume more salt than we need. General recommendation is no more than six grams (about one teaspoon) of table salt a day. This includes salt used in cooking and at the table. If you have high blood pressure or heart disease then less than two grams of table salt per day will be helpful. Are you willing to try that?

So, how is your food tasting today?

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How much vitamin D do you need daily to prevent fractures?

A vitamin capsule. (iStockphoto/Thinkstock)

Basking in the sun is one way to obtain vitamin D

Basking in the sun is one way to obtain vitamin D although the risk of skin cancer increases. Other sources of vitamin D are fortified dairy products, fatty fish and egg yolks.

Answer to this question appears in an article in the New England Journal of Medicine (NEJM) published in July, 2012. The authors examined the relationship between vitamin D supplementation and fracture reduction.

They looked at 11 double-blind, randomized, controlled trials of oral vitamin D supplementation (daily, weekly, or every 4 months), with or without calcium, in persons 65 years of age or older. The goal was to look for the incidence of hip and any nonspinal fractures.

The study included 31,022 persons (mean age, 76 years; 91 per cent women) with 1111 incident hip fractures and 3770 nonspinal fractures.

When they looked at a subgroup of participants by actual intake of vitamin D, they found reduction in the risk of fracture was shown only at the highest intake level (median, 800 IU daily; range, 792 to 2000), with a 30 per cent reduction in the risk of hip fracture and a 14 per cent reduction in the risk of any nonspinal fracture.

“Benefits at the highest level of vitamin D intake were fairly consistent across subgroups defined by age group, type of dwelling, baseline 25-hydroxyvitamin D level, and additional calcium intake,” says the NEJM paper.

The conclusion of the study was that high-dose vitamin D supplementation (≥800 IU daily) was somewhat favorable in the prevention of hip fracture and any nonspinal fracture in persons 65 years of age or older.

As we know, vitamin D is a nutrient that helps the body use calcium and phosphorous to build and maintain strong bones and teeth. Vitamin D is unique in that it can be synthesized by the body after exposure to ultraviolet rays from sunlight.

Too much vitamin D can cause too much calcium to be deposited in the body, which can lead to calcification of the kidney and other soft tissues including the heart, lungs and blood vessels. But it is hard to define what is too much. Some expert recommend daily intake of 1000 to 2000 IU of vitamin D to prevent certain types of cancers.

Health Canada’s recommendation for daily dietary intake of vitamin D in adults age 70 and over is 800 IU (20 mcg). This is based on the assumption that there is minimum of exposure to sunlight. The major sources of vitamin D are fortified foods. In Canada, cow’s milk and margarine must be fortified with vitamin D. The only natural sources of vitamin D in the Canadian food supply are fatty fish and egg yolks.

Many people meet at least some of their vitamin D needs through exposure to sunlight. Although there is some risk of skin cancer. But you never know how much vitamin D you are getting through sun exposure. It all depends on the season, time of day, cloud cover, smog, skin pigmentation, and sunscreen use.

Daily intake of vitamin D recommendation depends on a person’s age. Talk to your doctor or see Health Canada website for more details. But do not forget to drink your milk everyday.

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