Vitamin D

D is for diet and limited doses of sun

Hi there

This was in the Sydney Morning Herald this weekend and patients may ask you about it.



Vitamin D deficiencies are harmful but, as Nicole Hasham explains, debate rages over its intake.

Susan Torres wasn’t just aware of the risk – it was her life’s work. But even as the nutrition lecturer sat through countless conferences warning of the dangers of vitamin D deficiency, it never dawned that she was the perfect case study.

She has the risk factors: sun-shy and office-bound. But it wasn’t until her naturopath suggested a blood test that the 41-year-old discovered her body was lacking in the vital hormone.

Read more:

via D is for diet and limited doses of sun.

Calcium plus vitamin D may reduce melanoma risks in some women

Another study on a similar subject:

A combination of calcium and vitamin D may cut the chance of melanoma in half for some women at high risk of developing this life-threatening skin cancer, according to a new study by Stanford University School of Medicine researchers.

Using existing data from a large clinical trial, the study zeroed in on women with a history of non-melanoma skin cancer, as people with this generally non-fatal disease are more likely to develop the more lethal illness — melanoma. The researchers found that women who once had non-melanoma and took the calcium-vitamin D combination developed 57 percent fewer melanomas than women with similar histories who were not given the supplements. Non-melanoma skin cancers, such as basal cell or squamous cell cancers, are the most common forms of skin cancer.

“In preventive medicine, we want to target people most at risk for the disease,” said dermatologist Jean Tang, MD, PhD, lead author of the study. “If you previously had a non-melanoma skin cancer, calcium plus vitamin D might reduce your risk of the more deadly melanoma.”

Tang added a note of caution. The study found that a daily dose of 1,000 mg calcium plus 400 IU of vitamin D doesn’t provide skin cancer protection for everybody. Women without a history of non-melanoma skin cancer who took the supplements did not see any reduction of risk compared with their placebo-group counterparts, according to the research.

The study was published online on June 27 in the Journal of Clinical Oncology.

Vitamin D is well-known for its role in bone growth, but it also affects non-skeletal cells. In many parts of the body, including the skin, vitamin D controls how quickly cells replicate, a process that often goes awry in cancer. Reports from various institutions have suggested that vitamin D is associated with lower risks of colon, breast, prostate and other cancers. Nonetheless, the Institute of Medicine published a report last November saying that more research was needed on vitamin D and calcium, as the evidence was insufficient to prove their having a benefit for conditions other than bone health.

This study is the second to look at the effect of vitamin D supplementation on cancer risk with a randomized, controlled trial.

Tang and colleagues analyzed data from the Women’s Health Initiative, a study that followed 36,000 women ages 50 to 79 for an average of seven years. Half of the women took the daily dose of calcium and vitamin D as part of the experiment; the other half took a placebo pill. The WHI calcium plus vitamin D trial was designed to look at the effects of the supplement on hip fractures and colorectal cancers, but its researchers collected data on many other health issues, including other cancers.

Tang and colleagues took advantage of the large and long-term data set provided by the WHI trial to explore whether vitamin D has a protective effect against skin cancer. “Our results include the first positive cancer-reducing effect seen from the calcium plus vitamin D trial,” said Teresa Fu, MD, a co-author of the study and a recent graduate of the School of Medicine.

The lack of protective effect in women without a history of non-melanoma skin cancer may be due to the amount of vitamin D given to the patients in the WHI trial. “The patients in the Women’s Health Initiative were given vitamin D at a very low dose, based on today’s knowledge — only 400 IU per day,” said David Feldman, MD, professor emeritus of endocrinology and a co-author of the study. Furthermore, patients in the placebo group were allowed to take as much vitamin D as patients that were provided the calcium and vitamin D supplements, so the experimental difference between the two groups was small. In light of that small difference, “it’s somewhat surprising that there was an effect on melanoma risk, and I think many potential benefits of vitamin D may not have been detected,” said Feldman.

Because men were not included in the trial, the researchers cannot be certain whether the protective effect of the supplements would also apply to men with a history of non-melanoma skin cancer. Nonetheless, a 2010 study by Tang demonstrated that elderly men with higher blood levels of vitamin D have fewer non-melanoma skin cancers.

Even in a large study like the WHI, the low frequency of melanomas means that the absolute number of cancers was small. Out of the 36,000 participants, only 176 cases of melanoma were reported. “That just highlights how large a trial needs to be to capture cancer as relatively rare as melanoma,” said Marcia Stefanick, PhD, the Stanford WHI principal investigator and senior author of this study.

“These results spur us to do more studies,” said Tang. She is planning multiple lines of research to examine the potential relationship between vitamin D and cancer prevention, including a study that will compare blood levels of vitamin D with melanoma outcomes. Another line of research will examine the effect of larger doses of vitamin D on the behavior of skin cells in patients with high skin-cancer risk.

Taking Vitamin D with the largest meal of the day

This is something that I have known about but have never seen a study:
Taking vitamin D with the largest meal improves absorption and results in higher serum levels of 25-hydroxyvitamin D.


Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.


Many patients treated for vitamin D deficiency fail to achieve an adequate serum level of 25-hydroxyvitamin D [25(OH)D] despite high doses of ergo- or cholecalciferol. The objective of this study was to determine whether administration of vitamin D supplement with the largest meal of the day would improve absorption and increase serum levels of 25(OH)D. This was a prospective cohort study in an ambulatory tertiary-care referral center. Patients seen at the Cleveland Clinic Foundation Bone Clinic for the treatment of vitamin D deficiency who were not responding to treatment make up the study group. Subjects were instructed to take their usual vitamin D supplement with the largest meal of the day. The main outcome measure was the serum 259(OH)D level after 2 to 3 months. Seventeen patients were analyzed. The mean age (+/-SD) and sex (F/M) ratio were 64.5 +/- 11.0 years and 13 females and 4 males, respectively. The dose of 25(OH)D ranged from 1000 to 50,000 IU daily. The mean baseline serum 25(OH)D level (+/-SD) was 30.5 +/- 4.7 ng/mL (range 21.6 to 38.8 ng/mL). The mean serum 25(OH)D level after diet modification (+/-SD) was 47.2 +/- 10.9 ng/mL (range 34.7 to 74.0 ng/mL, p < .01). Overall, the average serum 25(OH)D level increased by 56.7% +/- 36.7%. A subgroup analysis based on the weekly dose of vitamin D was performed, and a similar trend was observed.Thus it is concluded that taking vitamin D with the largest meal improves absorption and results in about a 50% increase in serum levels of 25(OH)D levels achieved. Similar increases were observed in a wide range of vitamin D doses taken for a variety of medical conditions.

Copyright 2010 American Society for Bone and Mineral Research.

Newborns with low levels of vitamin D have higher rates of respiratory infection and wheezing than infants born with more vitamin D in their systems.

As reported in the LA Times

Even as a high-profile panel of experts recently disputed the conventional wisdom that Americans don’t get enough vitamin D — and that vitamin D deficiencies create greater risk of disease — new research shows that newborns with low levels of vitamin D have higher rates of respiratory infection and wheezing than infants born with more vitamin D in their systems.

There was no correlation, however, between low vitamin D levels and asthma.

The study, published Monday in the journal Pediatrics, expanded on earlier work by Dr. Carlos Camargo of the Massachusetts General Hospital in Boston that had shown that babies born to mothers who took vitamin D supplements were less likely to develop wheezing during childhood.

This time around, instead of focusing on supplement intake, Camargo and his team looked at the levels of vitamin D in newborn cord blood samples collected from a group of 922 children in New Zealand who had participated in a study on asthma and allergies between 1997 and 2001.

In addition to allowing researchers to collect cord blood, the babies’ mothers had filled out periodic questionnaires about their children’s health up until the children turned 5.  The researchers mined these data to determine rates of wheezing, infections and asthma in the group and correlate them with vitamin D levels in the cord blood.

They found that the lower the amount of vitamin D, the higher the risk of wheezing.  Newborns with particularly low levels of the vitamin — about one in five — were twice as likely to develop respiratory infections such as colds, coughs and ear infections during the first three months of life, the team reported.  Those babies also had an increased risk of other types of infections.

The researchers found higher levels of vitamin D in children born to slightly older mothers and to mothers of European ethnicity.  They observed lower levels in kids born in winter and in children of lower socioeconomic status.

The paper reported that the team was surprised that children with less vitamin D in their cord blood didn’t also develop asthma at a higher rate than other babies.  In the past, some had speculated that vitamin D deficiency might be a cause of the high incidence of asthma in the world today.

But even though asthma doesn’t appear to result directly from low vitamin D levels, treating asthmatic kids with vitamin D could still be effective because it might reduce respiratory infections that can exacerbate the condition, the authors wrote.