Vitamin D Update

By Bonnie Jenkins, Advanced Natural Medicine

It’s no secret that vitamin D can keep bones strong and healthy and helps prevent osteoporosis. But the “sunshine vitamin” can also help to maintain and even improve your bones once osteoporosis has begun its slippery slope toward bone loss – especially for women taking bone-saving bisphosphonates like Fosamax, Actonel or Boniva. At least that’s what a new study from Kings College London found. Bisphosphonates slow the rate at which bone dissolves and is absorbed into the body. This increases bone density and strength, decreasing the risk of spinal fractures by 50 percent and other fractures (think wrist) by 30 to 49 percent. Both Fosamax and Actonel also lower the risk of a hip fracture. The problem is, even though bisphosphonates can slow bone loss, bone mineral density (BMD) continues to decline in up to 15 percent of women taking these drugs. But simply adding some supplemental vitamin D can help protect your hips and spine from unnecessary bone loss.

A Boost For Bones

The Kings College team looked at how vitamin D impacts bone mineral density (BMD) in postmenopausal women – some who were taking bisphosphonates and some who weren’t. What they saw was that women who took the drugs and vitamin D supplements had significantly less bone loss in the hip – proving that it’s never too late to build better bones.

The researchers recruited two groups of patients suffering from bone loss – the first included 112 women receiving bisphosphonates and the second was comprised of 35 women who had stopped taking the drug but continued to take calcium and vitamin D supplements. In the first group, high serum vitamin D concentrations were associated with lower levels of parathyroid hormone (PTH) - a measure of calcium metabolism. And when it comes to PTH, lower is better. In fact, levels under 41 nanograms per litre were linked to significantly higher hip BMD increases following treatment with bisphosphonates, compared to women with PTH levels greater than 41 ng/L.

In the second study group, the women who had discontinued taking bisphosphonates for 15 months but continued taking a daily vitamin D/calcium supplement didn’t show any significant bone loss in either the spine or the hip.

After reviewing the results of both groups, the researchers concluded that adding 800 to 1,000 IU of vitamin D to a bisphosphonate regieme slows bone loss even more than the drugs alone. So if you’ve been diagnosed with osteoporosis and are on one of the bisphosphonate drugs, add some D to the equation. Just be aware that you should take both calcium and vitamin D at least two hours before or after taking the medication.

Falling for the Sunshine Vitamin

Vitamin D may also have an indirect benefit to bones. Because people who are vitamin D deficient are more prone to falling, this nutrient may help prevent fractures. According to a 2004 study by Swiss scientists, taking extra vitamin D reduces the risk of falling by 22 percent. In this study, this decreased risk didn’t seem to be related to calcium supplementation. But a more recent study of 450 participants by the same group of researchers found that taking a combination of 700 IU of vitamin D and 500 mg. of calcium every day reduces the odds of falling by 46 percent – and the effect was even more pronounced in less active women. Those Sedentary Sally’s had a 65 percent lower risk of having a fall!

While this study used relatively low levels of both vitamin D and calcium, to prevent falls, take 800 IU of vitamin D and 1,200 mg. of calcium daily. If you suffer from osteoporosis, you may need even more. Check with your doctor to see what levels are right for you.

On the D-Cline

Of course, vitamin D isn’t just for bone health. It modulates the immune system, regulates cell growth and controls insulin production and blood pressure. Recent studies show that this critical nutrient may also play an important role in preventing certain types of cancer – especially prostate cancer, breast cancer, colon cancer and thyroid cancer. There’s only one problem – we aren’t getting enough.

Older adults may be most at risk. In a study of 40 people with mild signs of Alzheimer’s disease and another 40 with no dementia, researchers found that 58 percent had abnormally low levels of vitamin D. They also discovered something else: a vitamin D deficiency was directly linked to mood disorders and a poor performance on two out of four cognitive measures.

The typical recommendation is 400 to 800 IU of vitamin D per day, but some researchers want to raise that dose to 1,500 IU, especially for those who get limited amounts of sun exposure and don’t consume much dairy. Another problem – and one doctor’s won’t tell you about – is that certain medications can reduce vitamin D levels. The primary culprits are anticonvulsant medications, oral corticosteroids, bile acid sequestrants, anticoagulants and some antibiotics.

If you’re concerned about your vitamin D levels – especially if you are a postmenopausal woman – as your healthcare provider to test your blood level of the nutrient. Once you and your doctor know your level, the right dosage can be calculated to meet your individual needs.

One Last Thing ...

If you are a long-time reader, you know I’m not a fan of pharmaceutical anti-depressants – especially selective serotonin reuptake inhibitors like Prozac or Zoloft. While some people who truly suffer from long-term clinical depression really do need these drugs, many more people who are taking them don’t. It’s just become the first line defense for doctors and psychiatrists with patients walking into their offices with stress or anxiety. Never mind that SSRIs can lead to sleep disturbances, sexual dysfunction, weight gain and, most troubling, suicide. But now there’s another side effect to add to the list – broken bones.

Antidepressants have historically been linked with low blood pressure and dizziness leading to falls, which can increase risks for broken bones. But a new study of more than 5,000 people has found that people over 50 who take antidepressants, faced double the risk of broken bones compared with those who didn't use the drugs. Broken forearms, ankles, feet, hips and ribs were the most common fractures. And these findings were independent of low blood pressure or dizziness.

Earlier animal studies show that SSRIs have a direct effect on bone cells, decreasing bone strength and size. But this is the first study to show how these findings translate to humans. The take-away message? If you don’t actually need an anti-depressant, don’t take them. Instead, opt for herbal anti-depressants like St. John’s wort or 5-HTP. You can also try exercise, yoga or meditation to ease stress and anxiety – and build stronger bones. If you are already taking one of these drugs, work with your doctor to gradually wean yourself off the SSRI. Stopping the drug abruptly can cause dizziness, nausea, flu-like symptoms, body aches, anxiety, irritability, fatigue and vivid dreams.

This Just In ...

Want to live longer? Tickle your tongue with tofu, say investigators at Hong Kong University. The researchers came to this conclusion after using the Hong Kong Lifestyle and Mortality database to analyze the lifestyles of all adults above age 60 that died in 1998. The results showed that those who consumed tofu products or soy milk four or more times a week had a 30 percent lower risk of death than those who dined on soy products less than once a month. Even those who only ate soy one to three times a week had a 15 percent reduction in their risk. Since the researchers' findings also showed that eating lots of meat and dairy products can cause an increased risk of death, try replacing these foods with soy alternatives. If you aren’t used to soy, try easing into it with flavored soy milk, soy crumbles you can use just like ground beef or tofu-based cheese. While they may seem a bit different at first, if you’re like me, you’ll soon prefer them over the real thing!

Bon appetite!

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References:

Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. “Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial.” Archives of Internal Medicine. 2006;166:424-430.

Brent Richards J, Papaioannou A, Adachi JD, et al. “Effect of Selective Serotonin Reuptake Inhibitors on the Risk of Fracture.” Archives of Internal Medicine. 2007;167:188-194.

Deane A, Constancio L, Fogelman I, et al. “The impact of vitamin D status on changes in bone mineral density during treatment with bisphosphonates and after discontinuation following long-term use in post-menopausal osteoporosis” BMC Musculoskeletal Disorders. 2007;8:doi 1471-2474-8-3.

Magee J. “Soy reduces health risks, study finds.” The Standard. January 19, 2007.

Wilkins CH, Sheline YI, Roe CM, et al. “Vitamin D deficiency is associated with low mood and worse cognitive performance in older adults.” American Journal of Geriatric Psychiatry. 2006;14:1032-1040