H1N1 Linked To Vitamin D Deficiency
Date Published:
11/15/2009
Date Posted:
11/15/2009 3:28:11 PM
By:
Herb Denenberg
at
The Bulletin
According to a recent study, as many as 77 percent of
all Americans may be deficient in the vitamin essential for bone health and
which may prevent H1N1 (Swine Flu) and seasonal flu, wheezing, winter-related
eczema, upper respiratory infections and may help prevent cancer, autoimmune
diseases such as multiple sclerosis, Type 1 diabetes, certain infectious
diseases, myocardial infarctions – heart attacks – and many other serious
diseases.
When subgroups of the population are considered, depending on
which of the many reasonable definitions of deficiency are accepted, the picture
is even more ominous. For example, an important new study from Children's
Hospital in Boston found that as many as 80 percent of Hispanic children and 92
percent of black children, what the study calls non-Hispanic black children, may
also be deficient in this vitamin.
We're talking about vitamin D, also
called the sunshine vitamin and often considered the nutrient of the year, if
not the decade. Its power as a determinant of human health can be captured by
what happens when someone is D deficient. They are at risk for what is called
rickets in children and osteomalacia in adults.
In its most extreme form,
the bones soften and almost melt, making them so fragile that the simple act of
walking up steps may cause bones to fracture and slight movement may cause
excruciating pain. In its most severe form, a blood test for vitamin D may show
zero. Dr. Fred Kaplan, an eminent orthopedic surgeon at the Hospital of the
University of Pennsylvania, whose patient had zero D, said this is rare even in
Third World countries.
Why,
in the land of plenty and, now, also in the land of over-consumption, overweight
and obesity, can there be an epidemic of a vitamin D deficiency or any other
nutrient? The reasons may not be fully understood, but the picture is still
clear: Over time, we have obtained most of our vitamin D from the sun. When
ultraviolet B rays hit the skin they cause the formation of vitamin D. But, in
an age of sunscreens and well-placed fear of skin cancer, we tend to either stay
out of the sun or use a sunscreen to shield us from its rays, including the
ultraviolet B ray.
Even if you stayed in the sun all day in some
locations, you would not get enough vitamin D. For example, north of
Philadelphia, between November and March, the suns rays are not strong enough to
precipitate the formation of vitamin D. And, during early morning and late
afternoon, the sun’s rays are not strong enough to generate vitamin D. That’s a
big part of the picture, as authorities find that exposure to the sun is the
main determinant of vitamin D in humans. This leads us to the next source of
vitamin D — our food. Some dairy products, such as milk, are fortified with
vitamin D, but we tend to avoid dairy products due to their cholesterol and
saturated fat content. Other sources are fatty fish such as salmon, tuna,
mackerel, and herring. Still other sources are fortified cereal and other foods
such as orange juice, now, often fortified both with vitamin D and calcium. But,
most people don’t eat enough of these foods to get enough vitamin D. So, that
leaves supplementation with multi-vitamins that include D, combination calcium
and vitamin D pills, or vitamin D stand-alones.
There may be another
reason for the epidemic – the epidemic of the overweight and obese, who cannot
process vitamin D efficiently and are, consequently, more likely to be vitamin D
deficient. One final reason for identifying the epidemic is better testing
methods for vitamin D. There is a simple blood test now used to determine
vitamin D status.
Still another reason for the D epidemic is the aging of
the population, as older people — even the middle-aged — are more likely to have
D deficiency.
There are other risk factors for a D deficiency, but they
probably don’t play a big role in the growing number of people with that
deficiency. Consumer Reports catalogued the following risk factors: “Being
dark-skinned, middle-aged, or overweight; having a history of gastric-bypass
surgery or a condition that interferes with the ability to absorb nutrients from
food, such as celiac disease; having a history of kidney or liver disease,
multiple sclerosis, osteoporosis, or thyroid problems; taking medications that
reduce blood levels of vitamin D, such as cholestyralmine (Questran and
generic), colestripel (Colestid and generic), certain anticonvulsants; or
orlistat (Alli, Xenical)” (Consumer Reports on Health, Nov. 2009).
This
epidemic of vitamin D deficiency recently came into focus with the publication
of an important study led by Dr. Jonathan Mansbach at Children’s Hospital In
Boston. The study appears in the November issue of the journal Pediatrics. The
study looked at vitamin D levels of 5,000 children and, extrapolating to the
entire U.S. population of children, found that millions were receiving what the
study called suboptimal levels of D. As noted above, depending on the definition
of deficiency or suboptimal levels, the study found 80 percent of Hispanics and
92 percent of black children were at the suboptimal levels. Others have
previously documented widespread vitamin D deficiency in children. For example,
Dr. Babette Zemel, a vitamin D expert at Children’s Hospital of Philadelphia
(CHOP), who is Director of the Nutrition and Growth Laboratory of that hospital
and Associate Professor of Pediatrics at Penn’s medical school, found that 55
percent of children she studied were vitamin D deficient, in a study published
in 2007.The Mansbach study notes that we’re far from
knowing everything we should about how to bring children and adults up to
optimal levels, how to avoid any long-run adverse consequences and exactly what
level of vitamin D is optimal.
It does recommend, in view of its
findings, that children take vitamin D supplements because of the clear health
benefits from doing so. The study doesn’t make specific recommendations, but the
American Academy of Pediatrics recommends that children with inadequate sun
exposure get a daily intake of at least 400 International Units of vitamin D —
vitamin D3 is now recommended as it is better absorbed than D2. The adult
recommendations, according to a report in The American Family Physician, as
cataloged by www.medscape.com, are as
follows:
• In older adults, vitamin D supplementation of 700 to 800 IU
per day is associated with a lower risk for falls ... and fractures.
•
To prevent vitamin D deficiency, adults with inadequate sun exposure should have
a vitamin D intake of 400 to 600 IU per day.
• Adults with vitamin D
deficiency, except for those with malabsorption syndromes, should receive
maintenance dosages of 800 to 1,000 IU of vitamin D per day.
Dr. Zemel
recommends that most adults take vitamin D supplementation of between 1,000 and
2,000 IU of vitamin D, which seems to make the most sense in view of the
evidence that I’ve reviewed. Of course, you may want to run this issue past your
doctor at your next visit. She said there is some variability in the response to
vitamin D so, some may reach optimal levels with 1,000 IU, while others may
require more. In severe deficiency cases, more aggressive supplementation may be
called for, such as 500,000 IU by injection.
The Medscape report also
notes that excessive amounts of vitamin D can be toxic. It states, “Because
vitamin D is fat soluble and can be stored in fat, there are concerns regarding
toxicity from excessive supplementation. Signs and symptoms of vitamin D
toxicity may include headache, metallic taste, nephrocalcinosis or vascular
calcinosis, pancreatitis, nausea, and vomiting.” There is a study indicating
toxicity is reached at 10,000 I.U. daily. Dr. Zemel told me vitamin D toxicity
is extraordinarily rare.
You can be sure there will be continuing and
extensive studies of vitamin D to answer many questions. Dr. Mansbach says, “We
need to perform randomized controlled trials to understand if vitamin D actually
improves these wide-ranging health outcomes. At present, however, there are a
lot of studies demonstrating associations between low levels of vitamin D and
poor health. Therefore, we believe many U.S. children would likely benefit from
more vitamin D.”
Although evidence is not clear on how to prevent H1N1
flu, the suggestions for prevention include taking vitamin D supplements,
especially in the winter. In a report in the Examiner.com, five simple steps are recommended
to prevent H1N1:
• Get enough vitamin D.
• Use proper hygiene —
for example, frequent hand washing, cough into your elbow instead of your hands
and avoid contact with public surfaces with your hands whenever
possible.
• Adequately rinse the nose and throat.
• Get enough
sleep.
• Consume plenty of garlic and other antiviral herbs.
Dr.
Zemel believes it is too early to make hard and fast conclusions on the vitamin
D/H1N1 connection. Dr. Charlene Compher, an expert on diet and health at Penn,
agrees it is too early to draw conclusions on H1N1. But, Dr. Zemel and others
note that vitamin D does strengthen the immune response and, therefore, may be
useful in preventing H1N1.
Dr. James E. Dowd, a professor of medicine at
Michigan State University and Diane Stafford stated, in their book The Vitamin D
Cure, about the flu/vitamin D connection, “More respiratory infections during
the winter are probably directly related to lower vitamin D production.” They
note several factors contribute to the winter infection scenario. In the winter,
there aren’t as much ultraviolet B rays, which inactivate many viruses. With
less ultraviolet B getting through, humans produce less vitamin D of their own.
Finally, vitamin D is important to mobilize the immune system response to
infections. As a result of all this, respiratory infections start to rise in
late September and peak in February. So, Dr. Dowd’s final advice is to forget
the chicken soup with too many noodles, too much salt, and too little chicken
and take vitamin D instead. My final advice is to get chicken soup that doesn’t
have too much salt, too many noodles, and too little chicken and get someone who
can make unsalted chicken soup, with the noodles and chicken you want and, then,
take your vitamin D.
Dr. Bruce Kinosian, a geriatrician at Penn and an
expert on diet and health, did sound a cautionary note, that vitamins thought to
be a magical cure-all often turn out to have quite the opposite effect. He cites
a long list of such vitamins of the year, which later fizzled. The most
prominent case involved vitamin E, which, in excessive doses, was found to cause
lung cancer in a segment of the population.
Perhaps the most fundamental
preventive approach was recently recommended by Dr. Sidney Wolfe of the Health
Research Group. He said take the most powerful and effective drug — a healthy
lifestyle. This is the same prescription written over 800 years ago by the
eminent Jewish physician and philosopher Maimonides, who said most of us die as
a result of our lifestyle. Sometimes ancient wisdom is more powerful than modern
technology.
I can’t resist one more observation on Maimonides. He was
born In Cordoba, Spain in 1135. But Cordoba was soon taken over by a Muslim sect
that demanded all infidels convert to Islam. So the family had to emigrate. He
ended up in Cairo, where he practiced medicine. Of course, I doubt, if he were
alive today, even the greatest physician of his time would not be allowed to
practice medicine there. Does this piece of history suggest, the more things
change, the more they stay the same, and does it also after a sad commentary on
the state of human progress?
Herb Denenberg can be reached at advocate@thebulletin.us.
|