Vitamin D article

[Guest guest]

Some Seek Guidelines to Reflect Vitamin D's Benefits

By Rob Stein <http://projects.washingtonpost.com/staff/email/rob+stein/>

Washington Post Staff Writer

Friday, July 4, 2008; Page A01

A flurry of recent research indicating that Vitamin D may have a

dizzying array of health benefits has reignited an intense debate over

whether federal guidelines for the " sunshine vitamin " are outdated,

leaving millions unnecessarily vulnerable to cancer, heart disease,

diabetes and other ailments.

The studies have produced evidence that low levels of Vitamin D make men

more likely to have heart attacks, breast and colon cancer victims less

likely to survive, kidney disease victims more likely to die, and

children more likely to develop diabetes. Two other studies suggested

that higher Vitamin D levels reduce the risk of dying prematurely from

any cause.

In response to these and earlier findings, several medical societies are

considering new recommendations for a minimum daily Vitamin D intake,

the American Medical Association

<http://www.washingtonpost.com/ac2/related/topic/American+Medical+Associ

ation?tid=informline> recently called for the government to update its

guidelines, and federal officials are planning to launch that effort.

But many leading experts caution that it remains premature for people to

start taking large doses of Vitamin D. While the new research is

provocative, experts argue that the benefits remain far from proven.

Vitamin D can be toxic at high doses, and some studies suggest it could

increase the risk for some health problems, experts say. No one knows

what consequences might emerge from exposing millions of people to

megadoses of the vitamin for long periods.

" The data are intriguing and serve as, no pun intended, food for further

fruitful research, " said Frances Picciano, at the Office of Dietary

Supplements of the National Institutes of Health

<http://www.washingtonpost.com/ac2/related/topic/National+Institutes+of+

Health?tid=informline> . " But beyond that, the data are just not solid

enough to make any new recommendations. We have to be cautious. "

The current clash is the latest in a long, often unusually bitter

debate. Some skeptics question whether funding by the tanning, milk and

vitamin industries is biasing some advocates. Frustrated proponents

accuse skeptics of clinging to outdated medical dogma.

" It feels kind of ridiculous working in this field sometimes, " said

Reinhold Vieth, a professor of nutritional sciences and pathobiology at

the University of Toronto

<http://www.washingtonpost.com/ac2/related/topic/University+of+Toronto?t

id=informline> . " Every week, I get interviewed about the next important

publication about Vitamin D. But this field remains mired in the muck. "

Vieth is one of a small but vocal cadre of researchers pushing doctors

and patients to stop waiting for new official guidelines. Physicians

should routinely test their patients for Vitamin D deficiencies, and

more people -- especially African Americans -- should take supplements

and increase their exposure to the sun, they say.

" The bottom line is we now recognize that Vitamin D is important for

health for both children and adults and may help prevent many serious

chronic diseases, " said F. Holick, a professor of medicine,

physiology and biophysics at Boston University

<http://www.washingtonpost.com/ac2/related/topic/Boston+University?tid=i

nformline> .

Scientists have long known that Vitamin D is a vital nutrient the skin

produces when hit by ultraviolet light from sunlight and other sources.

The amount of Vitamin D produced varies, depending on where the person

lives, skin pigment, age and other factors. African Americans and other

dark-skinned people, and anyone living in northern latitudes, make far

less than other groups.

With people spending more time indoors surfing the Web, watching

television, working at desk jobs, and covering up and using sunblock

when they do venture outdoors, the amount of Vitamin D that people

create in their bodies has been falling. Milk and a few other foods are

fortified with Vitamin D, and it occurs naturally in others, such as

fatty fish, but most people get very little through their diets.

" Humans evolved in equatorial Africa wearing no clothes, " said P.

Heaney, a leading Vitamin D researcher at Creighton University

<http://www.washingtonpost.com/ac2/related/topic/Creighton+University?ti

d=informline> in Omaha. " Now we get much less direct sunlight, and so

we don't make nearly as much Vitamin D. "

A number of studies have found that deficiencies may be common, with

perhaps half of adults and children having what some consider inadequate

levels. Federal guidelines call for people to get 200 to 600

international units a day, depending on age and other factors. But those

recommendations were last updated in 1997 and were aimed primarily at

preventing bone diseases, such as rickets in children and osteoporosis

in the elderly.

Since then, studies have indicated that Vitamin D offers a plethora of

health benefits, possibly protecting against heart disease, many forms

of cancer, immune system disorders such as multiple sclerosis and

rheumatoid arthritis, infectious diseases such as tuberculosis and the

flu, and perhaps mental illnesses including schizophrenia and

depression.

" Vitamin D has a global effect on many systems, " said Bruce Hollis, a

professor of pediatrics, biochemistry and molecular biology at the

Medical University of South Carolina.

The Canadian Cancer Society upped its recommendation to 1,000 units a

day last year. Hollis and others believe Americans should routinely

consume at least 2,000 international units a day.

" The first thing we'd see is a reduction by 80 percent in the incidence

of Type 1 diabetes, " said Cedric Garland, a professor of family and

preventive medicine at the University of California at San Diego

<http://www.washingtonpost.com/ac2/related/topic/University+of+Californi

a-San+Diego?tid=informline> . " The next thing we'd see is a reduction by

about 75 percent of all invasive cancers combined, as well as similar

reductions in colon cancer and breast cancer, and probably about a 25

percent reduction in ovarian cancer. "

Holick urges people to take 1,000 international units a day along with a

multivitamin with 400 international units, as well as exposing their

arms and legs to the sun for about 15 minutes several times a week.

But others have reservations. Dermatologists worry that encouraging

people to get unprotected sun exposure or use tanning salons may

increase the rate of skin cancer.

" We're in the middle of a skin cancer epidemic, " said C. Hanke,

president of the American Academy of Dermatology

<http://www.washingtonpost.com/ac2/related/topic/American+Academy+of+Der

matology?tid=informline> . " Tanning is risky and dangerous behavior.

Ultraviolet light is classified as a carcinogen. We need to protect our

skin. "

Studies of other nutrients, such as Vitamin E, beta carotene and folate,

have previously produced similarly promising findings only to turn out

to be ineffective or even possibly dangerous, others say.

" We've gotten very excited in the past, " said Alice Lichtenstein, a

professor of nutrition at Tufts University

<http://www.washingtonpost.com/ac2/related/topic/Tufts+University?tid=in

formline> who is a spokeswoman for the American Heart Association

<http://www.washingtonpost.com/ac2/related/topic/American+Heart+Associat

ion?tid=informline> .

" It seems like an easy answer: We don't have to worry about losing

weight or exercising. While I know the literature on Vitamin D is

exploding, I think we have to be cautious until we've done the proper

studies, " Lichtenstein said.

Other skeptics go further, saying the Vitamin D already added to foods

may be fueling increases in chronic diseases, such as diabetes and

obesity.

" We call it a vitamin, but it's really a steroid, " said Trevor G.

Marshall, a molecular biologist at Murdoch University in Australia.

" It's not something we should be playing with. "

While still cautious, another skeptic, Leonard Lichtenfeld, deputy chief

medical officer at the American Cancer Society

<http://www.washingtonpost.com/ac2/related/topic/American+Cancer+Society

?tid=informline> , acknowledges that the evidence for Vitamin D is

getting harder to ignore.

" I had a fair degree of skepticism. But now, while not a full-blown

proponent, I believe it's definitely an area that needs more attention, "

Lichtenfeld said.

The National Academies' Institute of Medicine is negotiating with NIH

and the Agriculture Department

<http://www.washingtonpost.com/ac2/related/topic/U.S.+Department+of+Agri

culture?tid=informline> to make Vitamin D the first nutrient to be

reassessed under a new system of evaluating nutritional requirements.

" Within the last four or five months, it's become a much more intensive

dialogue, " said of the institute's Food and Nutrition

Board. She cautioned, however, that the review, which could begin as

early as the fall and take more than year, might leave the current

recommendation unchanged.

" Some would argue there are significant new data about Vitamin D, "

said. " That doesn't mean that would change the requirement. But

it implies a timely review is in order. "

S. Kalman PhD, RD, CCRC, FACN

Miami Research Associates

Director, Nutrition & Applied Clinical Research

6141 Sunset Drive #301

Miami, FL. 33143

(fax)

www.miamiresearch.com <http://www.miamiresearch.com>