Monthly Archives: August 2008

Recent Summary of Vitamin D Literature to July 2008

Recent Summary of Vitamin D Literature to July 2008

Competency # 17: Vitamin D

Reference: Indicated below.

The news on Vitamin (Hormone) D continues to roll out.  I’m flooded with it.  I could write an email every week for those who are interested.  But to make it simple, here is a brief synopsis of recent articles.

Stroke Risk with low Vitamin D.  July 24th, 2008 Journal Stroke.  From Heidelberg Germany.  Following some 3315 folks referred for angioplasty, the authors found that low Vit D was an independent predictor for stroke, with all other factors accounted for.  They consider Vit D to be antithrombotic and neuroprotective and suggest that a minimum concentration of 30 ng should be a target for supplementation, particularly after a stroke.

Low Vit D Associated with Double All Cause Mortality:  Archives of Internal Medicine June 23rd, 2008 Dobnig et al.   The lowest quarter of folks had Vit D levels of 7.6-13 ngs.  Their mortality was DOUBLE the highest quartile whose level was 28.  They also found that low D levels correlated significantly with higher C-reactive protein, oxidative burden and cell adhesion.  I want a level of 50-70 for me (folks living in the tropics naturally have that level.)

Diabetes in Pregnancy has Lower D Levels:  Diabetes Metab Res Rev 2008; 24: 27–32.  Maghbooli et al from Tehran.  Dr. Maghbooli found that women who became diabetic in pregnancy had Vit D levels around 16 ng.  Normals were around 23.  Again, a minimum of 32 and a optimum level of 50 might have changed things.  This is just an association.  But the association is pretty strong.  Reduce diabetes in pregnancy!

You Need 6000 IU of Vit D in Pregnancy to have Adequate Blood Levels: JOURNAL OF BONE AND MINERAL RESEARCH Volume 22, Supplement 2, 2007  Hollis.  Dr. Hollis shows elegantly that 400 IU does not raise pregnant and lactating women’s blood level.  Adequate Vit D during pregnancy is critical to fetal health. Lots of details and measures.

Cardiomyopathy in Infants from Severe D Deficiency.   Heart May 2008 Vol 94 No 5  This May, looking at 16 infants from England with cardiomyopathy.  All were from mothers with pigmented skin (6 Indian, 10 African)  Most presented in late winter.  All were breast feeding.  None had D supplements.  3 infants died.  The others all recovered by 12 months after being supplemented with Vit D.  My read:  D affects your heart too.  Every growing cell needs to mature into its intended function.  Hormone D does just that – helps cells mature into what they were intended to be.

Enough already!  I get it.  It’s still a bit of summer left.  We’re talking sunshine here.

WWW:  What will work for me.  I have skin cancers on my head.  I’m older.  Protecting myself from sun is an issue.  These aren’t a lot of randomized controlled trials yet.  A few show very dramatic effects.  Getting my D level to what it would be if I were in sun more is my goal.  I want a blood level of at least 50.  So should you.  Good things happen when you get to 32.  It appears better things happen when you get to 60.  Supplementation is the only way around it.  My body gobbles up D.  I only got to a blood level of 35 on 5000 IU a day.  A Dr. Garland published the following graph at a recent conference.  Your blood level, without supplementation, is likely around 40 during the summer if you are young and Caucasian.  It will drop to 20 during the upcoming winter.  You can increase it by 10 points for every 1000 IU a day you take.  To get to 50 ng reliably, you need 3,000-4,000 IU a day.  That’s what works.  See your doctor and ask!  It’s my belief that your D level may turn out to be a more important predictor of risk than any other factor.

Brought to you by John E. Whitcomb, M.D.


Hope for the Middle Aged Pleasingly Plump

Hope for the  Middle Aged Pleasingly Plump

Competency # 3 Understanding the Metabolic Syndrome

Reference: Archives Internal Medicine August 5th, 2008 (168) 1617-1624 Wildman et al

Two articles this week in the same journal on the same topic.  What is your risk for a heart attack by being just a wee bit overweight? The rising rate of obesity worldwide has correlated with a rising rate of diabetes and heart attack.  We have asked the question, again and again, does being overweight cause diabetes or is it associated with diabetes?  Those are two very different questions.  Causing it means you have to get skinny, otherwise you are toast.  Being associated means you may be.  Some of us can live just fine being a “comfortable” weight.

From Tubingen Germany, Dr. Stefan et al found that overweight Germans are not universally at “metabolic” risk.  Half of the obese Germans had normal insulin sensitivity, and normal lipids.  (At least half of Germans: we are pretty sure different ethnic groups have different risk profiles.  South Asians are much more at risk with obesity, for example.)  This suggests that being obese is NOT always the cause of diabetes and heart disease.  The second study, from Albert Einstein Medical Center in New York looking at the American population found the same thing.  Half of obese folks are metabolically in trouble with elevated fats and insulin resistance.  But half were not.  Even more interesting to me is that a quarter of folks from the normal weight group had a profile of resistance to insulin and out of whack blood fats.

These two studies will be quoted for years in many venues.  It means that we must rethink the way we look at metabolic syndrome, the constellation of abnormalities that constitute risk for heart disease, in a new way.   In America, we have put primary emphasis on your waist size and your body mass index as being the beginning of all difficulties.  We have suggested that getting overweight was going to do you in as sure as the sun would come up tomorrow.  These studies clearly demonstrate a different point.  Being overweight puts you at higher RISK of diabetes, as the obese folks were at 50%, the overweight folks (BMI from 25-30) were at 30% risk, and the normal weight folks were at 25% risk.  But taken the other way, 50% of obese folks had normal insulin sensitivity and blood fats, 70 % of overweight folks were okay, and 75 % of normal weight folks were okay.  Conclusion:  The primary problem with cardio-metabolic risk is NOT obesity; it is INSULIN resistance.  That crosses all lines.  To catch things early while lifestyle changes will still work means we can’t let even the normal weight folks go without an occasional review to see if they are internally still safe.

WHO (The World Health Organization) has argued that insulin resistance is primary to metabolic syndrome.  The Europeans have tended to go along.  These studies might just convince the American medical crowd to start singing in the same choir.

And just what might be the difference?  The factors the authors studied to call someone normal were BP, white blood count, EKGs, blood lipids, fibrinogen (clotting protein or a way of looking at “inflammation”,).  That’s a pretty easy combination of tests to get from your doctor.  I think the difference comes down to the genes you inherit, the daily exercise you do, and the foods you choose.

WWW:  What will work for me?  If I’m going to catch medical problems early, this study suggests that getting skinny isn’t the whole story.  Insulin sensitivity is, and that, you are either born with or without.  If you have a tendency to be insulin resistant, which I personally do, then you and I have to adopt those life style parameters that keep us as healthy and insulin sensitive as we can.  As best as I can tell, that means daily exercise (which keeps you more insulin sensitive for 18 hours at a time), avoiding heavy meals and having smaller frequent meals, and avoiding high doses of sugar.  Let’s see, today I get a C (only walked 10 minutes), a B, (4 small snack meals) and D, (half a milk shake at Kopp’s – fell off the wagon).  Time to get the annual physical and see what my sugars are doing…  maybe next week, after I walk a bit more.

Broccoli is a Superfood

Eat for your Genes: Your Food as Your Medicine – Why Broccoli is a Superfood

Competency # 14 Superfoods

Reference: Public Library of Science On Line PloS One 3 (7): e2568 doi:10.1371/journal.pone.0002568

Once upon a time, doctors took care of bad diseases.  Heart attacks, cancer, appendicitis.  We still do.  But, as science progressed, we started getting smarter.  We started to figure out the risks for heart attacks.  They were high blood pressure, diabetes, smoking, sedentary life style, (no red wine).  So, we started taking care of those risks, to prevent a heart attack.  Then, we started figuring out the risks for high blood pressure and diabetes.  The cutting edge of current health care is all about addressing the RISKS for the RISKS.  I get diabetes because… I develop metabolic syndrome in my twenties and thirties because I get overweight, eat too much fructose, get inflammation from huge meals, eat too much saturated fat, eat trans fats.  Those are all various theories that are floating around about the RISKS for the RISKS.  This column has dealt with each of those ideas, and will again as they come forward.

But the real cutting edge is the next step.  What are the risks for the risks for the risks.  R3. Those are your genes.  And we are now discovering that the food you eat, in the right circumstances affects your genes.  Your food becomes your medicine.  The line between the pill you take for medical care, and the food choices you make is blurring.  As science progresses, we are getting the sophistication to understand just what makes some foods so good for you, and just how they act.  Eating to affect your genes is not a question any more of how well you fit in them.  It’s not the jeans, baby, it’s the genes.

Broccoli is the example de jour.  One serving of broccoli a week was given to men with early precancerous changes in their prostate glands.  These men were studied by the Institute for Food Research in Britain. Tissue samples and genetic analysis before, at 6 months and after 12 months were studied.  What the researchers found was that there were hundreds of changes in the cells tilting in a fashion that demonstrated a wide variety of genetic changes going on that affected cancer cells.  There were good effects towards less cancer and more normal growth.  Those men with the GSTM1 gene benefited the most.  Half of men have that gene.  Broccoli has been known to be the champion example of all the isothiocyanate-rich cruciferous vegetables.  Brussels sprouts, cauliflower and cabbage count too.

We’ve known for years that broccoli contains sulforaphane, a particularly potent isothiocyanate.  In fact, there are even “Brocco-sprouts” on the market that are sprouted broccoli seeds that have a huge amount of sulforaphane in them, just for that reason.  We also know that a diet rich in extra vegetables and fruits dramatically reduces your risk for cancer, at a far more effective rate of cancer reduction than doses of chemotherapy after the fact.  So, this story is interesting.  The science is progressing and the story is getting more clear.  It’s the risks for the risks for the risks.   All in your genes.  Your food is your medicine.

WWW:  What will work for me?  I like broccoli.  Not everyone does.  Some folks tastebuds are very sensitive to its flavor and they can’t stand it.  As for me, I’m choosing to eat it more often.  At the Chinese buffet, I got the stir fry with broccoli and tried not to think about all the MSG.  With some help, even Brussels sprouts can be fantastic.