Tag: vitamins

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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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More on Vitamin B12: Diagnosis and Treatment

My last column was on vitamin B12, also known as Cobalamin. Some of my colleagues said that I took a very simplistic approach to diagnosis and treatment of vitamin B12 deficiency. There is more to it than what my column implied.

In this column I will elaborate on the following two points: diagnosis and oral vs. injection treatment of B12 deficiency.

Is blood test a good way of confirming the diagnosis of B12 deficiency?

I discussed this point with Dr. Michael O’Connor, Medical Director of the Medicine Hat Regional Hospital Laboratories. He said there is a difference between the very common asymptomatic B12 deficiency and the much less common symptomatic and clinically apparent B12 deficiency. He says interpretation of low B12 result is hugely dependent on the clinical situation of that individual patient.

If the patient has symptoms of B12 deficiency (anaemia, neurological and psychiatric problems) and the blood results shows B12 to be low then the diagnosis of B12 deficiency is easy to make. If an individual has no symptoms then there is probably no role for screening for B12 deficiency, says Dr. O’Connor.

The process is difficult because there is lack of a diagnostic gold standard among the many available tests, there are too many patients with sub-clinical deficiency and there is decreased availability of reliable tests to identify the causes of a patient’s cobalamin deficiency, says an article in Hematology.

How to treat B12 deficiency: by oral pills or monthly injections?

I received the following information from the Medicine Hat Regional Hospital Pharmacy.

Either oral or injection formulations are effective for treating B12 deficiency.

The main mechanism of B12 absorption is via its binding of intrinsic factor in the stomach and its subsequent absorption in the intestine. Approximately 60 per cent of cobalamin is absorbed by this system. A secondary mechanism of its absorption does not require intrinsic factor and involves passive diffusion across the intestinal wall. When given orally only one per cent of a dose will be absorbed by this mechanism.

The daily requirement of cobalamin is 2-3mcg. Dosing with intramuscular or deep subcutaneous injections to treat deficiency involves 100mcg daily for five to 10 days, then 100-200mcg monthly until levels are normalized followed by 100mcg monthly for maintenance.

High oral doses in the range of 1000 to 2000mcg daily are just as effective for treating deficiency due to the secondary mechanism of absorption. Cobalamin can also be administered sublingually both safe and effectively (2000mcg). The benefit to sublingual cobalamin vs. oral is not well defined.

There are disadvantages to give patients regular injections of B12. They are: pain at the injection site, injection site reactions, inconvenience and higher cost due to the need for a health professional to administer the injection.

Despite these disadvantages injection treatment is still preferred for those patients who are unable to take medications orally, those who experience severe diarrhea or vomiting, those with compliance issues to a daily dosage regimen, as well as those with neurological symptoms.

Oral and sublingual cobalamin have no evidence of toxicity when used at high doses, are cost effective, less burdensome to the patient and are equally as efficacious when used at the appropriate doses as compared to injection dosage forms. The only disadvantage to choosing an oral or sublingual regimen is the potential for adherence issues. Hence oral cobalamin is an excellent option for treatment and prevention of mild to moderate cobalamin deficiency.

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Vitamin B12 Deficiency

Dear Dr. B: Can you please tell me about vitamin B12 deficiency?

Answer: This is a very important subject. I have written about this in the past. And it is worth repeating as 30 per cent of the adults older than 50 may have vitamin B12 deficiency. It is estimated up to 40 per cent of the general population may be deficient in this vitamin.

Vitamin B12, also known as cobalamin, was first isolated in 1948 and was immediately shown to be effective in the treatment of pernicious anaemia. Pernicious anaemia is a fairly common condition in which the stomach does not have enough acid and does not make intrinsic factor normally. Intrinsic factor is essential for the absorption of B12 in the stomach.

Absorption of B12 is also impaired in individuals who have had intestinal illness or intestinal surgery, which makes it hard for the intestines to absorb vitamin B12. Absorption of vitamin B12 from foods is complex. A defect in any step can lead to deficiency.

B12 is obtained primarily from animal proteins (red meat, poultry, fish, eggs, and dairy). But the vegetarians can get enough of it from legumes. The cause of B12 deficiency is not usually poor diet but problems with absorption as explained earlier.

Our body needs vitamin B12 to make blood cells. Persons with the deficiency may have no symptoms or may have symptoms related to blood disorder or disorders of the nervous system including psychiatric problems. Fatigue may be one of the first indications of B12 deficiency.

The liver stores most of the body’s B12 followed by the kidneys, heart, spleen, and brain. The stored B12 can last up to two years in conditions where our body is deprived of B12.

The diagnoses of B12 deficiency is made by checking the blood levels in patients who have symptoms or who are prone to B12 deficiency. Screening for B12 deficiency (by way of a blood test) is recommended in the following groups of people:

-all elderly patients who are malnourished
-all patients in institutions and psychiatric hospitals
-all patients who have blood disorders, neurological or psychiatric problems.

Treatment is by B12 injections on regular basis for the rest of person’s life.

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The golf season has started. It’s time to have little fun here before we get miserable on the golf course. Here is a joke from Golf Digest:

A man is stranded for years on a desert island. One day he looks up to see a gorgeous blond in scuba gear wading out of the water.

“Want a cigarette?” she asks, opening a waterproof pocket on her right arm, pulling out a pack and lighting one for him.

“How about a sip of whiskey?” she asks next, opening a pocket on her left arm and removing a flask.

As the man puffs on the cigarette and sips the whiskey, she slowly begins to unzip the front of her wet suit.

“Want to play around?” she asks.

And he says, “Oh, Lord, don’t tell me you’ve got a set of golf clubs in there, too.”

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

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Vitamin B12

Dear Dr. B: What is the importance of vitamin B12? What are the causes of its deficiency?

Answer: Our body needs vitamin B12 to make blood cells. It is also important for normal function of nerve cells in the brain and the peripheral nerves.

Vitamin B12 deficiency frequently occurs in elderly people although it may also be present in the young, particularly women. It is estimated that 30 per cent of the adults older than 50 may have vitamin B12 deficiency.

Lack of vitamin B12 causes anemia and causes damage to the spinal cord and the peripheral nerves. The symptoms of these conditions may be obvious or quite subtle. Screening for B12 deficiency (by way of a blood test) is recommended in the following groups of people:
-all elderly patients who are malnourished
-all patients in institutions and psychiatric hospitals
-all patients who have blood disorders, neurological or psychiatric problems.

Vitamin B12 is an important vitamin that we usually get from our food. It is mainly found in meat and dairy products.

There are various reasons why a person is low in vitamin B12. There may not be enough of it in our diet. Especially vegetarians who do not eat meat or dairy products are at risk for vitamin B12 deficiency. But the vegetarians can get enough of it from legumes.

Quiet often the cause of B12 deficiency is not poor diet but problems with absorption in the gastro-intestinal tract.

The vitamin is absorbed through the last part of our small intestine. It can be absorbed after a protein called intrinsic factor attaches to it. Intrinsic factor is made in our stomach and attaches to vitamin B12 only if there is enough acid in the stomach.

But there are many individuals who take medication to reduce acid in the stomach in cases like gastritis, gastro-esophageal reflux disease or bacterial infection (H. pylori). These individuals are at risk of vitamin B12 deficiency if they are on these medications on a long term basis.

Pernicious anaemia is a fairly common condition in which the stomach does not have enough acid and does not make intrinsic factor normally. Absorption of vitamin B12 is also impaired in individuals who have had intestinal illness or intestinal surgery, which makes it hard for the intestines to absorb vitamin B12.

Vitamin B12 is also known as cobalamin was first isolated in 1948 and was immediately shown to be effective in the treatment of pernicious anaemia. The liver contains most of the body’s B12 (about 1.5 mg), followed by the kidneys, heart, spleen, and brain. The Recommended Dietary Allowance (RDA) for vitamin B12 is 2.4 micrograms/day for persons aged 14 to 70 years. The average diet contains about 5 micrograms daily.

Treatment of vitamin B12 deficiency is by B12 injections on a regular basis for the rest of person’s life.

Thought for the week:

“Age does not protect you from love but love to some extent protects you from age.”
-Jean Moreau

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