By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
“Look. I understand too little too late. I realize there are things you say and do in life that you can never take back. But what would you be if you didn’t even try. You have to try. So, after a lot of thought, I’d like to reconsider. Please. If it’s not too late. Make it a … cheese burger.” I love the lyrics from the song “Here I am” by Lyle Lovett and His Large Band. You are sure Lyle is going one way and then he U-turns on you. Kinda like when a diabetes talk turns to a fish oil.
When I was at the Diabetes Health Expo at the Senior’s Center in February, people in the audience threw lots of interesting questions at us on the experts panel. However, the question of omega-3 fatty acids, fish oil and vitamin d came up again and again. I was surprised there weren’t more questions about blood sugar machines or different types of insulin pens. In the pharmacy recently a lady stopped me to ask about Vitamin D for cancer prevention. Her doctor had recommended it for her husband. It seems like Vitamin D is on people’s minds again, and there is good reason.
What is Vitamin D? As usual, there isn’t a simple answer. There are different forms of Vitamin D, but the most potent form is called calcitriol. The type of Vitamin D your body makes is called Vitamin D3 (or cholecalciferol). The formation is complicated, but it goes like this. A Pre- Vitamin D3 is converted to Vitamin D3 in the skin with the help of sunlight (UV Radiation). Vitamin D3 is converted to a second form in the liver called calcidiol. The calcidiol is converted to calcitriol by the kidney. Again calcitriol is the most active form. So you can get Vitamin D3 from taking pills, having your skin make it from sunshine or eating things like fish. Then you hope your kidneys are healthy enough to convert the Vitamin D3 to calcitriol. There is another form of Vitamin D called Vitamin D2 . It is formed by plants and it can be converted to calcitriol in your body as well. There are those that argue that Vitamin D2 doesn’t form calcitriol as well at Vitamin D3.
Why do we care about Vitamin D? The most important thing about Vitamin D is still that it helps your gut absorb calcium. We know this because young children who don’t get enough Vitamin D develop rickets. Rickets is a condition characterized by bone deformities and “soft bones” which don’t have enough calcium. If we treat these children with Vitamin D and/or sunlight, their bones get better. This is why we give breast fed babies a Vitamin D supplement called D-Vi-Sol. We assume that the newborns aren’t put in the sun (mostly because we told the mothers not too) and the mothers aren’t in the sun either. Once the babies go onto formula or milk, they don’t need the Vitamin D supplement anymore.
So we need Vitamin D to absorb calcium. That isn’t a new recommendation. Why is Vitamin D in the news? Well, a few things have changed lately. First, we are all probably getting less Vitamin D than we did before. We are using more sunscreen which is good for preventing skin cancer, but it reduces the Vitamin D our skin can produce. We spend less and less time outdoors, and as people age their bodies are less good at absorbing Vitamin D from their diet. The second thing is the recommendations for how much Vitamin D we need keeps going up. It used to be 400 IU of Vitamin D was fine. Now we don’t think 400 IU of Vitamin D will prevent fractures in adults. The recommendations are for at least 400 IU if you are healthy and less than 50. If you are over 50, you should consider 800 to 1000 IU. Vitamin D is generally considered safe up to 2000 IU, and some of the cancer trials are recommending that much. There was even a heart trial in the US that used 4000 IU per day, because that is how much Vitamin D is required to get adequate levels in overweight people. I’m not sure I want to recommend 4000 IU to everyone yet without talking to their doctor first.
Another reason that Vitamin D seems to be in the news more is that it is inexpensive, relatively safe and every time we turn around it seems to do another good thing for us. Let’s look at some of the new health claims Vitamin D has.
I was at care home meeting and a patient’s daughter if her mom could be put on more Vitamin D. “It has been proven to reduce falls,” she said. I had no idea, so I looked it up. Sure enough in the February 2008 issue of the Journal of the American Geriatric Society there was a study that said nursing home patients on 800 IU of Vitamin D fell less than ones on less Vitamin D or on placebo.
Dr. Philippe Autier, MD from the International Agency for Research on Cancer in France did a meta-analysis that was published in the September 10, 2008 issue of Archives of Internal Medicine. A meta-analysis lumps a bunch of other studies together to look for trends. It isn’t considered as reliable as a randomized placebo controlled trial, but they often give us interesting information for further study. This meta-analysis showed Vitamin D supplementation seemed to make you less likely to die from all causes (including cancer, diabetes and heart problems). The problem is that a meta-analysis can’t draw any conclusions about which dose of Vitamin D is best or why Vitamin D does go things.
The Canadian Cancer Society now recommends 1000 IU of Vitamin D ( in consultation with your doctor) during the fall and winter.
Low blood levels of Vitamin D seem to make men more likely to have heart attacks. In the June 9, 2008 Archives of Internal Medicine they looked at a lot of men who hadn’t had heart problems and followed them for 6 years. Then they counted who had heart attacks. Even after they eliminated the differences due to smoking, diabetes, high blood pressure, cholesterol levels and other factors, the men with higher blood levels of Vitamin D had fewer heart attacks.
Multiple Sclerosis and Vitamin D may have a relationship, but that relationship is unclear. The further you live from the equator, the more likely you are to get MS. Is that because you get more sun and thus more Vitamin D near the equator? Maybe. Studies have shown people with high levels of Vitamin D in them have a lower risk of getting MS, but giving people with MS Vitamin D hasn’t shown much success. Recently researchers in Canada and the UK found that if you have a defective gene that normally converts Vitamin D to the active form you are more likely to get MS. So the complicated dance continues.
Other studies have hinted that Vitamin D may make you less likely to get colorectal cancer and or be more likely to survive breast cancer.
So Vitamin D is probably good for you, especially in dark cold Canada where we are covered up much of the year. But exactly what good things Vitamin D does for you is unclear. To paraphrase Mr. Lovett, “If Ford is to Chevrolet, what Dodge is to Chrysler, what Corn Flakes are to Post Toasties, what the clear blue sky is to the deep blue sea, what Hank Williams is to Neil Armstrong, can you doubt you and Vitamin D were made for each other?”
As always if you have any questions or concerns about these products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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Lyle Lovett and His Large Band – “Here I Am” : http://www.youtube.com/watch?v=KvDPezXTzlI