H1N1 Linked To Vitamin D Deficiency

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H1N1 Linked To Vitamin D Deficiency

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By HERB DENENBERG, For The Bulletin

Sunday, November 15,

2009

According to a recent study, as many as 77 percent of

all Americans may be deficient in the vitamin essential for bone health and

which may prevent H1N1 (Swine Flu) and seasonal flu, wheezing, winter-related

eczema, upper respiratory infections and may help prevent cancer, autoimmune

diseases such as multiple sclerosis, Type 1 diabetes, certain infectious

diseases, myocardial infarctions – heart attacks – and many other serious

diseases.

When subgroups of the population are considered, depending on

which of the many reasonable definitions of deficiency are accepted, the picture

is even more ominous. For example, an important new study from Children's

Hospital in Boston found that as many as 80 percent of Hispanic children and 92

percent of black children, what the study calls non-Hispanic black children, may

also be deficient in this vitamin.

We're talking about vitamin D, also

called the sunshine vitamin and often considered the nutrient of the year, if

not the decade. Its power as a determinant of human health can be captured by

what happens when someone is D deficient. They are at risk for what is called

rickets in children and osteomalacia in adults.

In its most extreme form,

the bones soften and almost melt, making them so fragile that the simple act of

walking up steps may cause bones to fracture and slight movement may cause

excruciating pain. In its most severe form, a blood test for vitamin D may show

zero. Dr. Fred Kaplan, an eminent orthopedic surgeon at the Hospital of the

University of Pennsylvania, whose patient had zero D, said this is rare even in

Third World countries.

Why,

in the land of plenty and, now, also in the land of over-consumption, overweight

and obesity, can there be an epidemic of a vitamin D deficiency or any other

nutrient? The reasons may not be fully understood, but the picture is still

clear: Over time, we have obtained most of our vitamin D from the sun. When

ultraviolet B rays hit the skin they cause the formation of vitamin D. But, in

an age of sunscreens and well-placed fear of skin cancer, we tend to either stay

out of the sun or use a sunscreen to shield us from its rays, including the

ultraviolet B ray.

Even if you stayed in the sun all day in some

locations, you would not get enough vitamin D. For example, north of

Philadelphia, between November and March, the suns rays are not strong enough to

precipitate the formation of vitamin D. And, during early morning and late

afternoon, the sun’s rays are not strong enough to generate vitamin D.

That’s a

big part of the picture, as authorities find that exposure to the sun is the

main determinant of vitamin D in humans. This leads us to the next source of

vitamin D — our food. Some dairy products, such as milk, are fortified with

vitamin D, but we tend to avoid dairy products due to their cholesterol and

saturated fat content. Other sources are fatty fish such as salmon, tuna,

mackerel, and herring. Still other sources are fortified cereal and other foods

such as orange juice, now, often fortified both with vitamin D and calcium. But,

most people don’t eat enough of these foods to get enough vitamin D. So, that

leaves supplementation with multi-vitamins that include D, combination calcium

and vitamin D pills, or vitamin D stand-alones.

There may be another

reason for the epidemic – the epidemic of the overweight and obese, who cannot

process vitamin D efficiently and are, consequently, more likely to be vitamin D

deficient.  One final reason for identifying the epidemic is better testing

methods for vitamin D. There is a simple blood test now used to determine

vitamin D status.

Still another reason for the D epidemic is the aging of

the population, as older people — even the middle-aged — are more likely to

have

D deficiency.

There are other risk factors for a D deficiency, but they

probably don’t play a big role in the growing number of people with that

deficiency. Consumer Reports catalogued the following risk factors: “Being

dark-skinned, middle-aged, or overweight; having a history of gastric-bypass

surgery or a condition that interferes with the ability to absorb nutrients from

food, such as celiac disease; having a history of kidney or liver disease,

multiple sclerosis, osteoporosis, or thyroid problems; taking medications that

reduce blood levels of vitamin D, such as cholestyralmine (Questran and

generic), colestripel (Colestid and generic), certain anticonvulsants; or

orlistat  (Alli, Xenical)†(Consumer Reports on Health, Nov.

2009).

This epidemic of vitamin D deficiency recently came into focus

with the publication of an important study led by Dr. Mansbach at

Children’s Hospital In Boston. The study appears in the November issue of the

journal Pediatrics. The study looked at vitamin D levels of 5,000 children and,

extrapolating to the entire U.S. population of children, found that millions

were receiving what the study called suboptimal levels of D. As noted above,

depending on the definition of deficiency or suboptimal levels, the study found

80 percent of Hispanics and 92 percent of black children were at the suboptimal

levels. Others have previously documented widespread vitamin D deficiency in

children. For example, Dr. Babette Zemel, a vitamin D expert at Children’s

Hospital of Philadelphia (CHOP), who is Director of the Nutrition and Growth

Laboratory of that hospital and Associate Professor of Pediatrics at Penn’s

medical school, found that 55 percent of children she studied were vitamin D

deficient, in a study published in 2007.

The Mansbach study

notes that we’re far from knowing everything we should about how to bring

children and adults up to optimal levels, how to avoid any long-run adverse

consequences and exactly what level of vitamin D is optimal.

It does

recommend, in view of its findings, that children take vitamin D supplements

because of the clear health benefits from doing so. The study doesn’t make

specific recommendations, but the American Academy of Pediatrics recommends that

children with inadequate sun exposure get a daily intake of at least 400

International Units of vitamin D — vitamin D3 is now recommended as it is

better

absorbed than D2. The adult recommendations, according to a report in The

American Family Physician, as cataloged by www.medscape. com, are as follows:

•

In older adults, vitamin D supplementation of 700 to 800 IU per day is

associated with a lower risk for falls ... and fractures.

•  To

prevent vitamin D deficiency, adults with inadequate sun exposure should have a

vitamin D intake of 400 to 600 IU per day.

•  Adults with vitamin D

deficiency, except for those with malabsorption syndromes, should receive

maintenance dosages of 800 to 1,000 IU of vitamin D per day.

Dr. Zemel

recommends that most adults take vitamin D supplementation of between 1,000 and

2,000 IU of vitamin D, which seems to make the most sense in view of the

evidence that I’ve reviewed. Of course, you may want to run this issue past

your

doctor at your next visit. She said there is some variability in the response to

vitamin D so, some may reach optimal levels with 1,000 IU, while others may

require more. In severe deficiency cases, more aggressive supplementation may be

called for, such as 500,000 IU by injection.

The Medscape report also

notes that excessive amounts of vitamin D can be toxic. It states, “Because

vitamin D is fat soluble and can be stored in fat, there are concerns regarding

toxicity from excessive supplementation. Signs and symptoms of vitamin D

toxicity may include headache, metallic taste, nephrocalcinosis or vascular

calcinosis, pancreatitis, nausea, and vomiting.â€Â  There is a study

indicating toxicity is reached at 10,000 I.U. daily. Dr. Zemel told me vitamin D

toxicity is extraordinarily rare.

You can be sure there will be

continuing and extensive studies of vitamin D to answer many questions. Dr.

Mansbach says, “We need to perform randomized controlled trials to understand

if

vitamin D actually improves these wide-ranging health outcomes. At present,

however, there are a lot of studies demonstrating associations between low

levels of vitamin D and poor health. Therefore, we believe many U.S. children

would likely benefit from more vitamin D.â€

Although evidence is not clear

on how to prevent H1N1 flu, the suggestions for prevention include taking

vitamin D supplements, especially in the winter. In a report in the

Examiner.com, five simple steps are recommended

to prevent H1N1:

• Get enough vitamin D.

• Use proper hygiene —

for example, frequent hand washing, cough into your elbow instead of your hands

and avoid contact with public surfaces with your hands whenever

possible.

• Adequately rinse the nose and throat.

• Get enough

sleep.

• Consume plenty of garlic and other antiviral herbs.

Dr.

Zemel believes it is too early to make hard and fast conclusions on the vitamin

D/H1N1 connection. Dr. Charlene Compher, an expert on diet and health at Penn,

agrees it is too early to draw conclusions on H1N1. But, Dr. Zemel and others

note that vitamin D does strengthen the immune response and, therefore, may be

useful in preventing H1N1.

Dr. E. Dowd, a professor of medicine at

Michigan State University and Diane Stafford stated, in their book The Vitamin D

Cure, about the flu/vitamin D connection, “More respiratory infections during

the winter are probably directly related to lower vitamin D production.†They

note several factors contribute to the winter infection scenario. In the winter,

there aren’t as much ultraviolet B rays, which inactivate many viruses. With

less ultraviolet B getting through, humans produce less vitamin D of their own.

Finally, vitamin D is important to mobilize the immune system response to

infections. As a result of all this, respiratory infections start to rise in

late September and peak in February. So, Dr. Dowd’s final advice is to forget

the chicken soup with too many noodles, too much salt, and too little chicken

and take vitamin D instead. My final advice is to get chicken soup that

doesn’t

have too much salt, too many noodles, and too little chicken and get someone who

can make unsalted chicken soup, with the noodles and chicken you want and, then,

take your vitamin D.

Dr. Bruce Kinosian, a geriatrician at Penn and an

expert on diet and health, did sound a cautionary note, that vitamins thought to

be a magical cure-all often turn out to have quite the opposite effect. He cites

a long list of such vitamins of the year, which later fizzled. The most

prominent case involved vitamin E, which, in excessive doses, was found to cause

lung cancer in a segment of the population.

Perhaps the most fundamental

preventive approach was recently recommended by Dr. Sidney Wolfe of the Health

Research Group. He said take the most powerful and effective drug — a healthy

lifestyle. This is the same prescription written over 800 years ago by the

eminent Jewish physician and philosopher Maimonides, who said most of us die as

a result of our lifestyle. Sometimes ancient wisdom is more powerful than modern

technology.

I can’t resist one more observation on Maimonides. He was

born In Cordoba, Spain in 1135. But Cordoba was soon taken over by a Muslim sect

that demanded all infidels convert to Islam. So the family had to emigrate. He

ended up in Cairo, where he practiced medicine. Of course, I doubt, if he were

alive today, even the greatest physician of his time would not be allowed to

practice medicine there. Does this piece of history suggest, the more things

change, the more they stay the same, and does it also after a sad commentary on

the state of human progress?

Herb Denenberg can be reached at advocate@thebulleti n.us.