Tag: vitamins

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

A vitamin capsule. (iStockphoto/Thinkstock)
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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Fractures in Osteoporotic Men and Women

Osteoporosis is a condition in which there is a gradual softening of the bones which makes them fragile. It is caused by the loss of calcium. Our current understanding has been that osteoporosis occurs most often in women after the age of menopause. Men can suffer from osteoporosis as well when they experience low levels of testosterone.

Bone fracture is a common complication of osteoporosis. One in two women and one in five men over the age of 50 will have a fracture. A person may lose height if the vertebra collapses due to osteoporosis. One may develop a hump if several vertebrae collapse.

Other causes of osteoporosis for men and women are: long-term use of corticosteroid medication, maternal osteoporosis, smoking, heavy drinking, sedentary lifestyle, low body weight and medical conditions that affect absorption, such as celiac disease. Diagnosis of osteoporosis is made by measuring bone mineral density.

A recent article in the CMAJ says that our understanding of and approach to osteoporosis is in the middle of a revolution. Research now shows the bone loss begins before menopause and involves other hormones in addition to estrogen, and that measuring bone mineral density alone is an inefficient way of addressing the clinical burden of osteoporosis.

The ongoing Canadian Multicentre Osteoporosis Study also shows that both men and women experienced an additional phase of accelerated bone loss from age 70 onward. Hormone replacement therapy with estrogen in women does protect against bone loss over time.

The finding that bone loss began before menopause indicates that estrogen loss alone cannot account for the changes. Therefore, interest has focused on other hormones whose levels change in early menopause such as follicle-stimulating hormone and the activins and inhibins. The role of steroid produced in the body and the size of the body composition is being determined.

The current national guidelines recommend that the test for osteoporosis (measuring bone mineral density) should be done every 2-3 years. In one of the CMAJ articles, Berger and colleagues suggest that densitometry for most women can be repeated every five years rather than every 2–3 years because the average changes in bone density over 2–3 years is small and comparable to the measurement error in the scanning technique.

There is also a question whether women who are already receiving treatment for osteoporosis should have follow-up assessments of bone density at all, since changes in density as a result of therapy account for only a small component of the effectiveness of these medications, says the CMAJ article.

There are four key points in the CMAJ articles: bone loss in women begins before menopause and is accelerated in old age, medications which reduce the loss of calcium from the bone helps preserve bone density, the interval between bone density assessments can safely be increased to 5 years for many untreated women and finally, decisions about when to test and treat will increasingly focus on estimates of absolute fracture risk as indicated by the bone density test.

Osteoporosis is treated with calcium and vitamin D supplements, a variety of hormone treatments (hormone replacement therapy like estrogen) and Bisphosphonates, a group of drugs that prevent bone breakdown and can be very effective in osteoporosis. But prevention is better than cure. So, increase calcium and vitamin D in your diet, increase the amount of weight-bearing exercise you do, reduce your alcohol intake and quit smoking.

The reduction in risk was greatest among elderly individuals who were most adherent to therapy and among those who received at least 1200 mg of calcium and 800 IU of vitamin D daily.

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Vitamin Supplements Are Recommended For Healthy Individuals

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.

On the other hand, there is a consensus among experts that taking certain vitamin supplements on a daily basis does more good than harm to healthy individuals. This was well written in an article in the New England Journal of Medicine (NEJM 20 Dec, 2001) titled What Vitamins Should I Be Taking, Doctor? Here is some information of vitamins you should consider taking on a daily basis.

Folic acid (400 ug/day) reduces the risk of birth defects during pregnancy. There is some evidence that B vitamins, including folic acid, B6 and B12, may help lower blood levels of a substance called homocysteine. A good deal of research has implicated high homocysteine levels in heart disease and stroke. Significantly fewer deaths, nonfatal heart attacks or repeat angioplasties occurred among patients given folic acid, vitamin B12 and vitamin B6 compared with those who got a placebo (Harvard Health Publications website).

Recommended daily dose of vitamin B6 is 2 mg/day and vitamin B12 is 6 ug/day. One multivitamin tablet a day plus a tablet of folic acid will ensure an adequate intake of these vitamins.

Vitamin D (400 IU/day) minimizes risk of osteoporosis and fractures and certain types of cancer. Recently, much has been written about the advantages of taking 1000 to 2000 IU/day of vitamin D.

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

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. The Canadian Cancer Society is now recommended taking 1,000 IU of vitamin D daily as a cancer prevention step.

Regular use of vitamin E and C remains controversial. The authors feel that vitamin E supplements are reasonable for most middle-aged and older individuals who are at increased risk for coronary artery disease. But this should be reviewed annually as more information becomes available.

To the list of vitamins you can add omega-3 fatty acids. These are a family of unsaturated fatty acids to be taken everyday (1000 mg/day or eat fish three times a week). Omega-3 has many benefits including the risk of sudden heart attack is reduced 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, a healthy individual (after consultation with your doctor) should consider taking one multivitamin tablet, one folic acid 5 mg. tablet (under certain conditions), vitamin D 1000 IU, omeg-3 fatty acids 1000 mg (or eat fish three times a week) and vitamin E if your doctor thinks it may benefit you.

You should understand that excessive use of vitamins or omeg-3 fatty acids may be detrimental to your health. Vitamin pills do not compensate for the massive risks associated with unhealthy lifestyle with smoking, obesity or inactivity. Healthy nutritious diet and regular exercise is the basic foundation of good health. Vitamin supplement is just an icing on the cake – so to speak. A healthy layer of icing on a healthy cake.

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