Largest Ever Clinical Study on Vitamin D Shows We’re Wrong About a Crucial Benefit


We are still in love with vitamins a century after they were discovered, with half the US and UK population taking a supplement.

Vitamin D – the sunshine vitamin – is the favourite and is believed to have the most proven benefits.

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Governments, including the UK government, have said that the evidence for vitamin D’s health benefits is so overwhelming that every adult should take it as a supplement for at least six months of the year.

It was first used to cure rickets in Victorian children living in urban poverty and is now routinely given to prevent and treat brittle bone disease (osteoporosis) and fractures.

It has been associated with a reduced risk of over a hundred common diseases in observational studies, ranging from depression to cancer.

The largest ever clinical study on the benefits of vitamin D in preventing fractures has been reported in the BMJ, with over 500,000 people and around 188,000 fractures from 23 cohorts from many countries.

As vitamin D levels are strongly influenced by genes, the researchers used genetic markers for vitamin D blood levels (called Mendelian randomisation or MR) to avoid the normal biases of observational studies, such as confusing cause and consequence of disease and the effects of other related health behaviours (so-called “confounders”).

 

The results showed no association between vitamin D levels over a lifetime and the risk of fracture. This latest study contradicts the UK government’s recent view, but not a host of earlier clinical trials.

In 2014, a review and meta-analysis of 31 vitamin D supplement trials found no effect on all fractures. Much of our strong belief in the benefits of vitamin D came from studies of supplements in care homes in the 1980s, which were never replicated and were probably flawed.

In a more recent meta-analysis of 33 randomised trials of over 50,000 older adults, supplementation with calcium or vitamin D had no effect on the incidence of fractures. There were also no clear benefits on muscle strength or mobility.

So, if all the data points to vitamin D failing to prevent fractures, why worry about all the people with low blood levels of the vitamin? Vitamin D deficiency has become a modern epidemic with a fifth of the UK and US populations reported to have low levels. Will they be more susceptible to other diseases and cancer?

No consensus on deficiency

There is little agreement on what vitamin D deficiency is. Deficiency levels are arbitrary with no international consensus and confusion caused by different units in the US. A “normal” level can vary from 50 to 80 nanomole per litre of blood, but recent studies suggest 30nmol is quite enough.

While clinical deficiency (<10nmol) is often clear cut, wrongly labelling millions of people as vitamin D deficient causes stress and over-medicalisation. Most people assume calcium and vitamin D are safe, and the more you take the better. My clinical practice changed when studies showed calcium supplements, as well as being ineffective against fractures, may cause heart disease. Prescriptions are now dropping.

Vitamin D is fat soluble, so high levels can build up in the body. While recommendations for supplements are usually with modest doses (10 micrograms or 400 international units (IU)), these will inevitably be overdone by some people taking other sources in cod liver oil tablets or in fortified milk, orange juice or bread. More worrying, people increasingly buy high-dose supplements of 4,000-20,000IU on the internet.

Patients with very high vitamin D blood levels (over 100nmol) are becoming routine in my clinic and elsewhere, and toxic overdoses are increasingly being reported. Several randomised trials have shown that patients with high blood levels or taking large doses of vitamin D (above 800IU) had an unexpected increased risk of falls and fractures. Vitamin D is far from safe.

It can no longer be recommended for use in other conditions; the vast majority of the positive published studies in 137 diseases were reviewed as spurious. It was widely believed that vitamin D supplements prevented cardiovascular disease, but meta-analyses and large-scale genetic MR studies have ruled this out.

Pseudo-disease

We have created another pseudo-disease that is encouraged by vitamin companies, patient groups, food manufacturers public health departments and charities. Everyone likes to believe in a miracle vitamin pill and feels “they are doing something”.

Vitamin D, despite its star status, would not be called a vitamin today, as the doses needed are too large, the body can synthesise it from skin, and it is a steroid precursor. Instead of relying on this impostor, healthy people should get vitamin D from small doses of sunshine every day as well as from food, such as fish, oil, mushrooms and dairy products.

We should also trust that thousands of years of evolution would cope with a natural drop in vitamin D levels in winter without us snapping our limbs. About half the population take vitamins daily, despite zero benefits, with increasing evidence of harm. The worldwide trend of adding unregulated vitamins to processed food has now to be seriously questioned.

While vitamin D treatment still has a rare medical role in severe deficiency, or those bed bound, the rest of us should avoid being “treated” with this steroid for this pseudo-disease and focus on having a healthy lifestyle, sunshine and importantly save your money and energy on eating a rich diversity of real food.

Vitamin D supplements promote weight loss in weight loss


https://speciality.medicaldialogues.in/vitamin-d-supplements-promote-weight-loss-in-obese-children/

Vitamin D supplements could ease painful Irritable Bowel Syndrome


https://speciality.medicaldialogues.in/vitamin-d-supplements-could-ease-painful-ibs-symptoms/

Calcium and vitamin D supplements may not protect against bone fractures


(iStockphoto)

One of the most contentious questions in nutrition science over the past decade has been whether older adults should be taking supplemental vitamin D and calcium. As the world’s population ages and broken bones and fractures become even more of a public health concern, with huge social and economic consequences, researchers have been trying to make sense of conflicting studies on the association between supplements and fracture risk.

A study published in the Journal of the American Medical Association on Tuesday took a fresh look at this issue by analyzing 33 randomized clinical trials involving a total of more than 50,000 adults over the age of 50. Each of these previous research papers involved comparing calcium, vitamin D or both with a placebo or no treatment. The analysis, conducted by Jia-Guo Zhao of Tianjin Hospital in China, was focused on older adults who live in the general community and did not include those in nursing homes, hospitals and other facilities.

The conclusion was clear: vitamin D and calcium supplements do not seem to be warranted to prevent bone breaks or hip fractures in those adults. Such supplements had no clear benefit regardless of dose, the gender of the patient, history of fractures or the amount of calcium in the diet.

The U.S. Preventive Services Task Force, an influential federal advisory body, has raised questions about these supplements since 2013, when it issued recommendations saying evidence to support the benefit of the supplements in older adults without osteoporosis or vitamin D deficiency was “insufficient.”

Marion Nestle, a professor emerita of food sciences and nutrition at New York University, wrote in an opinion piece at that time that the UPSTF’s statement should caution clinicians “to think carefully before advising calcium and vitamin D supplementation for healthy individuals.”

She said this week bone health involves many different aspects of eating and activity. “Bone preservation throughout life requires eating healthfully, engaging in weight-bearing activity, avoiding excessive alcohol, and not smoking — good advice for everyone,” Nestle said.

Vitamin D is not a vitamin but a hormone that is produced in reaction to sunlight and seems to have many different roles in the body related to bones, cancer, heart disease, diabetes, immune function and reproductive health.

Daniel Fabricant, president of the Natural Products Association, which represents manufacturers and retailers of dietary supplements, said the study draws its conclusions with “too broad of a brush.” He said it focuses on the healthiest segment of the population by looking at people who are able to live at home.

“There is a lot missing,” Fabricant said. “People with prior breaks or family incidence of osteoporosis may still need vitamin D.”

Calcium and vitamin D have been known to be important to bone maintenance for a long time, and the best way to get the daily recommended doses are the natural way. For calcium, that means eating dairy products like milk, cheese, yogurt or calcium-rich leafy greens. For vitamin D, that means getting some sun exposure. Only a few foods contain vitamin D, and they include fatty fish like salmon.

The issue is many Americans don’t get enough calcium or vitamin D — which is why the debate over supplements has become so important. In 2010, the Institute of Medicine (IOM) released recommendations tripling the daily intake of vitamin D for most people to 600 IU per day and raising the calcium intake to 1,000 milligrams. While that report has few explicit mentions of supplements, the use of supplements seems assumed, and it includes a lot of discussion about the importance of setting and following upper limits for intake of vitamin D and calcium.

“As North Americans take more supplements and eat more of foods that have been fortified with vitamin D and calcium, it becomes more likely that people consume high amounts of these nutrients,” the group wrote, warning of the possibility of kidney and tissue damage from overconsumption.

Fabricant also said the new study contained limited information on the dosages involved. “Maybe the average dose was on the lower end of dose response curve,” he said. “While it’s a nice exercise of mathematics, it doesn’t get at the actual issue which is what are optimal levels for people who need the supplements.”

The new study did not look at the benefits or risks of vitamin D supplements on other conditions, but previous studies have suggested they can lower risks for diabetes and certain cancers. However, an April 2017 study in JAMA Cardiology found high monthly doses of vitamin D supplements did not seem to do much to help with cardiovascular disease.

One other limitation of the study is some of the trials included in the analysis did not test baseline vitamin D blood concentration for all participants.

Why Should Everyone Take Vitamin D Supplements?


Health officials say everyone in England and Wales should now consider taking vitamin D supplements in autumn and winter.

Previous guidelines were limited to pregnant and breastfeeding women, older people and those who don’t get out in the sun enough.

So why is the advice changing?

What Is Vitamin D and Why Is It Important?

Vitamin D is important for healthy bones, teeth and muscles. In children, a lack of vitamin D can lead to the bone disease rickets. Adults who don’t get enough vitamin D may develop the painful bone condition osteomalacia.

Where Does Vitamin D Come From?

The body’s main natural source of vitamin D is safe exposure to the summer sun.

Safe sun exposure means a short time in the sun without sunscreen – but before burning. The time needed varies from person to person – but a balance is needed because too much sun exposure increases the risk of skin cancer. Sunbeds are not recommended.

Vitamin D also comes from eating certain foods, including oily fish, liver, egg yolks and specially fortified foods, such as breakfast cereals and spreads.

Why Aren’t Many People in the UK Getting Enough Vitamin D?

Around 23% of adults aged 19 to 64, 21% of adults aged 65 years and over and 22% of children aged 11 to 18 in the UK have low levels of vitamin D in their blood. These levels aren’t low enough to make anyone unwell, but they are at risk of going on to have vitamin D deficiency that could affect their health.
The British weather can restrict how much sun is available during the year – plus many adults and children don’t get outside as much as people did in the past. Also the sun is not strong enough here between October and March.

People with darker skin are also at a higher risk of not getting enough vitamin D, as are people who cover up for cultural reasons, and people not well enough to go outdoors.

What’s the New Recommendation?

Health officials from Public Health England and the Welsh Government are now recommending people get 10 micrograms of vitamin D a day though their diet or supplements.

The UK’s Scientific Advisory Committee on Nutrition (SACN) made the recommendation after reviewing all the evidence on vitamin D and health. It couldn’t determine how much vitamin D we get though skin being exposed to the sun – so instead focuses on diet.

It is hard to get the daily amount of vitamin D needed from food, so most adults and children aged 4 and over are asked to consider supplements containing 10 micrograms of vitamin D every day during autumn and winter.

Supplements are recommended all year round for people with dark skin, including people from African, African-Caribbean and South Asian backgrounds.

Children aged 1-4 years should have a 10 microgram vitamin D supplement every day all year round.

All babies under a year old should have a daily 8.5 to 10 microgram vitamin D supplement, even if they are breastfed exclusively up to around 6 months under official advice.

The guidelines are different for formula-fed children who have more than 500ml of infant formula a day. They don’t need extra vitamin D because formula is already fortified with it.

What About Scotland?

In a statement, Scottish public health minister Aileen Campbell says: “We note SACN’s report and recommendations. Our advice for everyone aged six months and over has been updated in line with the recommendations. We are assessing if our advice for infants under 6 months should be revised.”

Is the NHS Providing the Vitamin D Supplements?

Not for most people. However, Vitamin D supplements are available free for low-income families under the Healthy Start scheme.

In Scotland, all pregnant women will be entitled to free vitamins from Spring 2017, which will include the recommended dose of vitamin D. Public health minister Aileen Campbell says: “This is part of a concerted effort to give every child in Scotland the best start in life.”

Single vitamin D supplements are available in pharmacies, some health food shops and supermarkets.

What Are Experts Saying About the New Guidelines?

In a statement, Dr Louis Levy, head of nutrition science at Public Health England, says: “A healthy, balanced diet and short bursts of sunshine will mean most people get all the vitamin D they need in spring and summer. However, everyone will need to consider taking a supplement in the autumn and winter if you don’t eat enough foods that naturally contain vitamin D or are fortified with it. And those who don’t get out in the sun or always cover their skin when they do, should take a vitamin D supplement throughout the year.”

Wales’ minister for social services and public health, Rebecca Evans, says: “We will now act on the findings of the [Scientific Advisory Committee on Nutrition] report and will raise awareness and support people to achieve this intake as part of our wider approach to health and wellbeing.”

In a statement, Susan Fairweather-Tait, professor of mineral metabolism at the University of East Anglia says the new guidelines take a conservative approach and it is possible that in future evidence will emerge for a higher daily intake of vitamin D, “and the Dietary Reference Values may need to be revised upwards.”

Should Patients With MS Get Vitamin D Supplements?


Though evidence is mounting that low vitamin D levels may increase risk for the development and perhaps progression of multiple sclerosis, clinicians still do not have definitive safety and efficacy data or guidance on whom to supplement and when, appropriate dosage, or duration of supplementation.

And yet it seems that vitamin D supplementation is being added to the standard MS toolbox.

“I think a lot of people are widely accepting it in the MS community, but I worry that it’s because it’s easy, not because it’s evidence-based,” Ellen Mowry, MD, MCR, associate professor of neurology and epidemiology at Johns Hopkins University, Baltimore, Maryland, told Medscape Medical News.

Although she offers vitamin D in her practice, “I tell my patients that we actually don’t know if supplementing will help,” she said. And supplementation comes with risks in people who have heart disease or a history of kidney stones, for instance. “It’s important for people to think about their own risk background,” she said.

Dr Mowry, who has conducted a number of vitamin D studies and is the primary investigator in the ongoing VIDAMS (Vitamin D to Ameliorate MS) trial, presented an overview of the current evidence on vitamin D here at the Consortium of Multiple Sclerosis Centers (CMSC) 2016 Annual Meeting. She sounded a note of caution to attendees, reminding them that promising supplementation stories have gone wrong in the past.

βCarotene, for instance, was associated with a lower risk for heart disease, but after study, it was found to be linked to more heart disease deaths and an increased risk for lung cancer.

And, while higher vitamin D levels appear to be associated with a decreased risk for MS development or progression, that association might be masking a different relationship, she said.
“It’s really important to make sure that we don’t get burned,” Dr Mowry told attendees. “We should probably subject vitamin D to same kind of rigorous evidence that we would any therapeutic that we give to our patients,” she said.

It’s really important to make sure that we don’t get burned.
Dr Ellen Mowry

Tantalizing Associations

After years of observational data, two studies helped cement the idea “that lower vitamin D levels preceded the onset of disease,” said Dr Mowry.

One, published in 2006 (JAMA. 2006;296:2832-2838), found that military personnel who had serum 25-hydroxyvitamin D25 levels of 100 ng/mL had a 50% lower risk for MS, while those with lower levels were more prone to the disease. Swedish researchers replicated the findings in 2012, showing that people with levels above 75 ng/mL had a reduced risk.

A more recent trial (JAMA Neurol. 2016;73:515-519) showed that women with higher vitamin D levels in pregnancy had children who were less likely to develop MS. “That’s pretty interesting,” said Dr Mowry, but she pointed out that it’s possible other things could be at work — for instance, perhaps the offspring who did not develop MS received more ultraviolent (UV) light exposure during childhood.

UV light may itself have immunomodulatory effects, she said, pointing to an Australian study (Neurology. 2011:76;540-548) that found sun exposure seemed to reduce the risk for MS more than did higher vitamin D levels. If sun exposure is more important, “vitamin D supplementation might not help MS at all,” said Dr Mowry.

She has conducted several trials looking at vitamin D status in people who already have MS. In children, “we saw striking association between higher levels of vitamin D and lower risk of subsequent relapse,” she said, noting that for every 10-ng/mL increase, relapse risk decreased 34% (Ann Neurol.2010;67:618-624). Adults with MS in another trial (Ann Neurol.2012;72:234-240) had a reduced risk for new MRI lesions.

Pilot studies specifically looking at supplementation in people with MS have not provided much evidence, she said. One — with just 23 patients — showed no improvement in patients given 6000 IU of vitamin D daily (Neurology. 2011;77:1611-1618), but that trial was not powered to detect significance, said Dr Mowry.

She said many trials underway may soon provide more answers about supplementation, including the following:

  • SOLAR (Supplementation of VigantOL Oil Versus Placebo as Add-on in Patients With Relapsing Remitting Multiple Sclerosis Receiving Rebif Treatment);
  • CHOLINE (A Multicentre Study of the Efficacy and Safety of Supplementary Treatment With Cholecalciferol in Patients With Relapsing Multiple Sclerosis Treated With Subcutaneous Interferon Beta-1a 44 μg 3 Times Weekly), recently completed;
  • VITADEM;
  • EVIDIMS (Efficacy of vitamin D supplementation in multiple sclerosis);
  • PrevANZ (Preventing the risk of Multiple Sclerosis using Vitamin D in patients with a first demyelinating event in Australia and New Zealand); and
  • D-Lay-MS (Efficacy of Cholecalciferol (Vitamin D3) for Delaying the Diagnosis of MS After a Clinically Isolated Syndrome).

Her study — VIDAMS, which is sponsored by the National Multiple Sclerosis Society — is the only United States–based trial. Patients will receive glatiramer acetate for a month and, if they tolerate it, will be randomly assigned to 5000 IU daily or 600 IU daily. The 15-site study will evaluate the effect of vitamin D on relapses.

How to Supplement?

Many MS clinicians and patients are not waiting for trial results. “Most MS patients we run into now are getting supplements,” she said.

It’s unclear what dosing frequency should be, but she says that a daily, weekly, or monthly dose is fine and that studies have shown that infrequent, very high doses might be more toxic than lower, routine dose levels.

Many patients she sees are taking vitamin D2, but she prefers D3, which she says is a more natural pathway that gets activated by sun exposure. It’s also available over the counter, which makes it easier for patients.

Dr Mowry says that if she has decided to supplement, she first checks serum 25-hydroxyvitamin D25 levels. With supplementation, the goal is to bring vitamin D levels up to a range of 40 to 60 ng/mL. At 40 or above, the evidence suggests a lower risk for MS, whereas 60 is the highest end at which evidence has shown a continued association.

The VIDAMS investigators chose a 5000-IU daily dose because kinetics studies have shown that it gets patients with MS into the 40- to 60-ng/mL range, she said. “In my clinical practice, I find people take 1000 or 2000 international units a day, up to 4000 to 5000, depending on the individual,” Dr Mowry said.

At 3 months, she tests 25-hydroxyvitamin D25 levels again, but “I don’t check it much more after that as long as they are staying on current dose.”

In any patient, “we really need to think carefully about the likely benefits,” when weighed against the risks, particularly in those with a history of heart disease, kidney stones, or inflammatory disease, said Dr Mowry.

“I always tell people when they ask me about it — we might be doing the wrong thing.”

Why Take Vitamin D Supplements if They Don’t Improve Health?


One of the questions I’m asked most often at The Incidental Economist blog, on my YouTube channel, and through other means of communication is whether vitamin D supplementation is a good thing. I’m amazed at the persistence of this question, as study after study seems to show that vitamin D isn’t doing most of us much good at all.

In a recent issue of JAMA, researchers tested whether 2 years of taking supplemental vitamin D might help patients with symptomatic osteoarthritis of the knee. The main outcomes of interest involved measurements of tibial cartilage volume, pain scores, cartilage defects, and bone marrow lesions. After the study period, there were no significant improvements in any of these outcomes. There were, however, significantly more adverse events in those taking the vitamin D.

Last October, JAMA Internal Medicine published a randomized, controlled trial of vitamin D examining its effects on musculoskeletal health. Postmenopausal women were given either the supplement or placebo for one year. Measurements included total fractional calcium absorption, bone mineral density, muscle mass, fitness tests, functional status, and physical activity. On almost no measures did vitamin D make a difference.

The accompanying editor’s note observed that the data provided no support for the use of any dose of vitamin D for bone or muscle health.

Last year, also in JAMA Internal Medicine, a randomized controlled trial examined whether exercise and vitamin D supplementation might reduce falls and falls resulting in injury among elderly women. Its robust factorial design allowed for the examination of the independent and joined effectiveness of these 2 interventions. Exercise reduced the rate of injuries, but vitamin D did nothing to reduce either falls or injuries from falls.

In the same issue, a systematic review and meta-analysis looked at whether evidence supports the contention that vitamin D can improve hypertension. A total of 46 randomized, placebo controlled trials were included in the analysis. At the trial level, at the individual patient level, and even in subgroup analyses, vitamin D was ineffective in lowering blood pressure.

A recent study by US researchers and another by Danish researchers found that vitamin D supplementation during pregnancy didn’t prevent asthma in young offspring.

A Cochrane review found it unlikely that vitamin D can help treat chronic pain, although many people still try. Anotherfound that vitamin D supplementation decreases cancer occurrence in elderly people. A Lancet meta-analysis argued that “continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.”

One Cochrane review from 2012 found that vitamin D3, but not vitamin D2, alfacalcidol, or calcitriol, decreased mortality in women older than 70 years who were in institutions or under dependent care. But 150 such women had to be treated for 5 years to prevent 1 death.

Few would argue that people who are deficient in vitamins, including vitamin D, should not be supplemented. But screening turns up so few truly deficient people that the US Preventive Services Task Force does not recommendscreening widely for it. Yet millions of people take vitamin D every day.

Vitamin D supplementation is just the tip of the iceberg, though. We spent $21 billion in the United States on vitamins and herbal supplements in 2015 alone, and it’s likely that the vast majority of that is doing us no good.

That may seem like chump change in the scheme of health care spending. But it’s indicative of a larger problem in our health care system. We are willing to spend vast amounts of money on things that we have found don’t work when we study them. Whether these are surgical procedures that have been proven no better than sham surgery in controlled trials, screening that seems less and less effective, or drugs with little or no proven benefit.

The Choosing Wisely  campaign is premised on the idea that there are many, many things we do in medicine that we shouldn’t. Almost all of them cost money.

Too often, when confronted with the massive cost of health care in the United States, we throw up our hands in despair, as if there’s nothing we can do to stem the tide without negatively affecting health. That’s untrue. There’s billions of dollars in wasteful medical spending that could be cut with no negative effect on outcomes. Unfortunately, too many people think of that waste as “care.”

Ending that spending will be unpopular in the short run. Many will likely call it “rationing.” But in this election season, as politicians cast around looking for ways to reduce the cost of our health care in a way that maintains or improves quality, it’s a good place to start.

***

About the author: Aaron E. Carroll, MD, MS, is a health services researcher and the Vice Chair for Health Policy and Outcomes Research in the Department of Pediatrics at Indiana University School of Medicine. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

Aaron Carroll, MD, MS

About The JAMA Forum:  JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association.

Vit D supplementation ineffective for hypertension


Vitamin D supplements are ineffective at controlling blood pressure (BP) and should not be used as an antihypertensive agent, according to a meta-analysis of randomised controlled trials (RCTs).

Vitamin D had no effect on systolic BP and diastolic BP (p=0.97 and p=0.84, respectively for RCTs and p=0.27 and p=0.38, respectively for individual patients). [JAMA Intern Med 2015;doi:10.1001/jamainternmed.2015.0237]

“The results do not support the use of vitamin D or its analogues as an individual treatment for hypertension or as a population-level intervention to lower BP,” said lead author Dr. Miles Witham from the University of Dundee, Dundee, Scotland.  “The lack of efficacy of vitamin D treatment on BP also argues against routine measurement of25-hydroxyvitamin D [25OHD] levels in patients with hypertension.”

The analysis included studies that used vitamin D for a minimum of 4 weeks for any indication, published between January 1966 and March 2014. Nearly 7,600 participants were involved in the study.

Subgroup analysis did not reveal any baseline factors predictive of a better response to treatment. There were also no significant differences between patients with or without diabetes, those taking or not taking angiotensin-converting enzyme (ACE) inhibitors, irrespective of BP, parathyroid hormone, and 25OHD levels.

Witham however said there are a few caveats to the study, among them inclusion of single-centre trials and background cardiovascular medications. Other potential confounders are ageing, obesity, smoking, and inactivity, which could have influenced the results.

Previous studies have linked low levels of vitamin D with elevated BP and future cardiovascular events. Intervention studies however yielded conflicting findings.

Seasonal Affective Disorder Out The Door: 6 Ways To Stave Off The Winter Blues


Sad woman with umbrella on a rainy day
Break out of the winter blues with these cool ways, from breathing out the blues to eating chocolate.

Less hours of daylight, cold weather, and cold and flu season in the winter can make even the most optimistic of us feel down in the dumps. Therefore, it makes sense that five to six percent of Americans experience seasonal affective disorder (SAD), with 90 percent of those being women and young adults. It is common to feel downhearted during the winter months — even for those without SAD — but you don’t need to fly out to a tropical paradise to fight the winter blues.

We still have a long ways to go before basking in the summer sun. In the interim, we end up sleeping more, socializing less, and endlessly indulging in carb-laden foods. Although it may be tempting to hibernate for the season and roll out of bed once spring comes, there are do-it-yourself ways to stave off the winter blues, even for those without SAD.

1. Take Your Vitamins

Since the days are shorter and the nights are longer, vitamin D levels drop during the colder and darker months. A way to get vitamin D — as if you were soaking up the sun — would be to take vitamin D supplements. An NYU study found people with SAD saw improvements in various measures of mood.

Dr. Jennifer Strider, naturopathic doctor at Simple Family Health in Oakland, Calif., believes it makes common sense for vitamin D to have a strong effect on mood. The body produces vitamin D when it is exposed to the sun, which may help explain why we tend to be more alert and active during the warm sunny months.

“There are vitamin D receptors on every cell in the body, including cells in the nervous system, so having appropriate vitamin D levels help those cells to function optimally, which in turns results in a better mood,” she told Medical Daily in an email.

2. Breathe Out The Blues

Randomly experiencing levels of sadness during the winter months could be an indicator something is not in sync with your body. The key is to relax and return to a peaceful state of mind.

“Returning to a place of balance with mindfulness exercises, such as tai chi and yoga, doesn’t just bring with it the mood-boosting benefits of exercise, but can also restore you to a contemplative, restful, peaceful state where you can better handle the fluctuations that come with changing seasons,” Joshua Duvauchelle, a managing editor for LIVE Health Magazine in Vancouver, B.C., told Medical Daily in an email.

Practicing yoga can help people cope with anxiety, depression, and cold and flu illnesses. Yoga can modulate the stress response system by reducing perceived stress and anxiety. A 2005study published in the Medical Science Monitor found after three months of taking two 90-minute yoga classes a week, women who originally described themselves as “emotionally distressed,” showed improvements in perceived stress, depression, anxiety, energy, fatigue, and well-being.

3. Exercise

A good workout can be one of the best ways to combat the winter blues. Exercise can make you feel like you have accomplished something and make progress toward goals rather than feeling inactive. While exercising, “not only do you get a boost of endorphins you also decrease your stress hormone cortisol,” Dr. Simon Rego, director of Psychology Training at Montefiore Medical Center/Albert Einstein College of Medicine told Medical Daily in an email.

You don’t have to do extreme exercise to reap its depression-reducing benefits. A 2005 Harvard Medical School study found walking fast for about 35 minutes a day five times a week or 60 minutes a day three times a week did have a significant influence on mild to moderate depression symptoms. This is no surprise, since exercise boosts endorphins which improve natural immunity and reduce the perception of pain.

4. Color Your Sadness Away

Color therapy can help boost your mood and stimulate certain feelings during the dark and gray winter months. Duvauchelle affirms this is a powerful way to help you stay emotionally balanced.

“Violet and red increases energy,” he said, “and yellow and green have been shown to make people feel more upbeat and happy.” Duvauchelle suggests incorporating these colors into your surroundings with either a painting, a vibrant coffee mug, a potted houseplant, or a comfy blanket.

5. Aromatherapy

Scents can be utilized to provide solace and evoke pleasant memories. Using aromatherapy can enhance your sense of pleasure and improve your mood. A 2009 study published in theJournal of Alternative and Complementary Medicine found aromatherapy can be effective for people with depression symptoms, specifically lavender. However, Dr. Moe Gelbart, a licensed clinical psychologist at Torrance Memorial Medical Center in Torrance, Calif., told Medical Daily in an email: “Just be careful not to rely on them too much and to add to mix activities that also give you a sense of mastery/accomplishment.”

6. Eat Chocolate

Chocoholics may rejoice by the fact dark chocolate can actually boost your dopamine levels in your brain. This is because chocolate is high in tryptophan and phenylalanine, and tyrosine, and like other amino acids, these nitrogen-rich compounds are building blocks of all the body’s proteins, according to the Harvard Health Publications. They are precursors of adrenaline and dopamine. So munch away on dark chocolate. It’s at least 70 percent cocoa and boosts the production of phenylalanine.

These cool ways will help stave off your winter blues effectively.

Vitamin D Screening: What About the Adult With Cognitive Changes?


Question

Are there particular populations of adults for whom you would recommend screening, or vitamin D supplementation in the absence of screening?
Response from David B. Reuben, MD

Professor and Archstone Foundation Endowed Chair, Department of Medicine, University of California Los Angeles; Chief, Division of Geriatrics, UCLA Medical Center, Santa Monica, California
Several prospective epidemiologic studies have shown associations of low serum vitamin D levels with lower global cognition and more rapid functional decline,[1-4] as well as the development of dementia and Alzheimer disease.[5] In a recent review of nine epidemiologic studies, the serum level that was associated with worse cognitive health was found to be around 10 ng/mL.[1] However, such studies cannot determine whether low vitamin D was causal or whether persons with memory problems were less likely to leave their homes and therefore have less sun exposure, leading to lower vitamin levels.

It is less clear whether and how much vitamin D supplementation would improve cognition or prevent decline in older populations. To date, there are no randomized clinical trial data supporting supplementation for improving cognition or preventing decline.

In the Women’s Health Initiative Memory Study, calcium and 400 IU vitamin D3 supplements given to a randomized sample of women did not result in differences in performance (attention, working memory, word knowledge, spatial ability, verbal fluency, verbal memory, figural memory, or fine motor speed) over 7.8 years.[6] Moreover, in observational studies, high levels of 25-hydroxyvitamin D, especially among those taking vitamin D supplements, have been associated with cognitive impairment on a battery of attention tests, suggesting a possible U-shaped curve relationship.[7]

Recently, the US Preventive Services Task Force has reviewed the evidence for screening for vitamin D deficiency and concluded that the current evidence is “insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults.”[8] Part of the rationale for this recommendation stemmed from the paucity of studies that used an internationally recognized reference standard and the lack of consensus on the laboratory values that define vitamin D deficiency.
In summary, the best evidence supports the recommendation of daily dietary vitamin D intake of 600 IU in adults aged 18-70 years and 800 IU in adults older than 70 years (1000 IU is commonly marketed).[9] Vitamin D levels should be obtained in patients with symptoms of osteomalacia (eg, diffuse bone and joint pain, fractures, muscle weakness, and difficulty walking), especially in malabsorption states, and before starting intravenous bisphosphonate therapy for osteoporosis because of the potential for precipitating hypocalcemia in patients with hypovitaminosis D receiving these medications. Currently, there is no indication for screening asymptomatic patients for vitamin D levels for the purpose of potentially supplementing with vitamin D in order to prevent changes in cognitive outcomes.

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