Vitamin D status: measurement, interpretation, and clinical application.
Holick MF.
Ann Epidemiol. 2009 Feb;19(2):73-8. Epub 2008 Mar 10. Review.
PMID: 18329892
Conclusion
The only way to determine whether a person is vitamin D deficient or sufficient is to measure their circulating level of 25(OH)D. There are a variety of assays used to measure 25(OH)D. The radioimmunoassays and competitive protein binding assays for 25(OH)D are useful in detecting vitamin D deficiency and sufficiency. However, these assays are fraught with technical difficulties, especially if they are not run routinely (Fig. 4) (33). Several reference laboratories have now switched to LC-MS ,which measures both 25(OH)D2 and 25(OH)D3 quantitatively. The total 25(OH)D, i.e., 25(OH)D2 plus 25(OH)D3, is what physicians need to be aware of for their patients. A level >30 ng/mL is
The Diet-Heart Hypothesis: Subdividing Lipoproteins
Two posts ago, we made the rounds of the commonly measured blood lipids (total cholesterol, LDL, HDL, triglycerides) and how they associate with cardiac risk. It's important to keep in mind that many things associate with cardiac risk, not just blood lipids. For example, men with low serum vitamin D are at a 2.4-fold greater risk of heart attack than men with higher D levels. That alone is roughly equivalent to the predictive power of the blood lipids you get measured at the doctor's office. Coronary calcium scans (a measure of blood vessel calcification) also associate with cardiac risk better than the most commonly measured blood lipids.
Lipoproteins Can be Subdivided into Several Subcategories
In the continual search for better measures of cardiac risk, researchers in the 1980s decided to break down lipoprotein particles into sub-categories. One of these researchers is Dr. Ronald M. Krauss. Krauss published extensively on the association between lipoprotein size and cardiac risk, eventually concluding (source):
The plasma lipoprotein profile accompanying a preponderance of small, dense LDL particles (specifically LDL-III) is associated with up to a threefold increase in the susceptibility of developing [coronary artery disease]. This has been demonstrated in case-control studies of myocardial infarction and angiographically documented coronary disease.
Krauss found that small, dense LDL (sdLDL) doesn't travel alone: it typically comes along with low HDL and high triglycerides*. He called this combination of factors "lipoprotein pattern B"; its opposite is "lipoprotein pattern A": large, buoyant LDL, high HDL and low triglycerides. Incidentally, low HDL and high triglycerides are hallmarks of the metabolic syndrome, the quintessential modern metabolic disorder.
Krauss and his colleagues went on to hypothesize that sdLDL promotes atherosclerosis because of its ability to penetrate the artery wall more easily
High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study.
Wagner CL, Hulsey TC, Fanning D, Ebeling M, Hollis BW.
Breastfeed Med. 2006 Summer;1(2):59-70.
PMID: 17661565
doi:10.1089/bfm.2006.1.59.
Objective: To examine the effect of high-dose maternal vitamin D3 (vitD) supplementation on the nutritional vitD status of breastfeeding (BF) women and their infants compared with maternal and infant controls receiving 400 and 300 IU vitD/day, respectively.
Design: Fully lactating women (n = 19) were enrolled at 1-month postpartum into a randomized- control pilot trial. Each mother received one of two treatments for a 6-month study period: 0 or 6000 IU vitD3 plus a prenatal vitamin containing 400 IU vitD3. The infants of mothers assigned to the control group received 300 IU vitD3/day; those infants of mothers in the high-dose group received 0 IU (placebo). Maternal serum and milk vitD and 25(OH)D were measured at baseline then monthly; infant serum vitD and 25(OH)D were measured at baseline, and months 4 and 7. Urinary calcium/creatinine ratios were measured monthly in both mothers and infants. Dietary and BF history and outdoor activity questionnaires were completed at each visit. Changes in skin pigmentation were measured by spectrophotometry. Data were analyzed using chi-square, t-test, and analysis of variance (ANOVA) on an intent-to-treat basis.
Conclusion: With limited sun exposure, an intake of 400 IU/day vitamin D3 did not sustain circulating maternal 25(OH)D levels, and thus, supplied only extremely limited amounts of vitamin D to the nursing infant via breast milk. Infant levels achieved exclusively through maternal supplementation were equivalent to levels in infants who received oral vitamin D supplementation. Thus, a maternal intake of 6400 IU/day vitamin D elevated circulating 25(OH)D in both mother and nursing infant.
Measuring 25-hydroxyvitamin D in a clinical environment: challenges and needs.
Hollis BW.
Am J Clin Nutr. 2008 Aug;88(2):507S-510S. Review.
PMID: 18689391
In this article, I provide an overview of the techniques available for measuring 25(OH)D, compare these techniques with one another, and assess their clinical utility. I also briefly discuss the stability of 25(OH)D in biological media and present an overview of the Vitamin D External Quality Assessment Scheme.
A recently published study in Nutrition and Cancer (60(5), 643-651) by researchers at Kansai Medical University in Osaka, Japan has shown that AHCC (Active Hexose Correlated Compound) enhances immune function by increasing the number of dendritic cells (DCs).
DCs are a key part of the immune system responsible for presenting foreign substances to other immune system cells.
The study was conducted in a double-blind randomized fashion where twenty-one healthy subjects received a placebo or AHCC at 3.0 g/day for 4 weeks. Blood samples were obtained and measured at baseline and at 4 weeks. The number of circulating types of DCs was measured which included CD 11c+ DCs (myeloid DC population; DC1) and CD11c- DCs (lymphoid DC population; DC2). Other parameters measured included mixed-leukocyte reaction (MLR), natural killer (NK) cell activity, the proliferative response of T lymphocytes toward mitogen (phytohemagglutinin [PHA]) and cytokine production of interleukin (IL)-2, IL-4, IL-6, IL-10, interferon gamma-gamma, and (alpha)-tumor necrosis factor.
A team of chemists has developed a mathematical computer model to measure the "heat" inside a chili pepper, a process that could provide quicker and cheaper information to certain food and drug industries.
An international comparison of serum 25-hydroxyvitamin D measurements.
Lips P, Chapuy MC, Dawson-Hughes B, Pols HA, Holick MF.
Osteoporos Int. 1999;9(5):394-7.
PMID: 10550457
DOI: 10.1007/s001980050162
The results show that 25(OH)D values from different laboratories can not be assumed to be comparable unless a careful cross-calibration has been performed.
Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder.
Gloth FM 3rd, Alam W, Hollis B.
J Nutr Health Aging. 1999;3(1):5-7.
PMID: 10888476
All subjects receiving vitamin D improved in all outcome measures. The phototherapy group showed no significant change in depression scale measures. Vitamin D status improved in both groups (74% vitamin D group, p < 0.005 and 36% phototherapy group, p < 0.01). Improvement in 25-OH D was significantly associated with improvement in depression scale scores (r2=0.26; p=0.05). Vitamin D may be an important treatment for SAD. Further studies will be necessary to confirm these findings..
Tofu and cognitive function: food for thought.
Grodstein F, Mayeux R, Stampfer MJ.
J Am Coll Nutr. 2000 Apr;19(2):207-9. Review.
PMID: 10763901
In addition, a plausible biologic hypothesis is generally an important part of judging epidemiologic relations. While high tofu intake may lead to lower plasma estrogen levels [12], we do not know how tofu influences estrogen levels in the brain; we also know very little about estrogen effects in men. Furthermore, data have not even consistently indicated that low endogenous estrogen levels are directly related to cognitive function in non-demented subjects [13]. The authors also posit a non-estrogen mediated hypothesis for the effects of tofu, namely that soy inhibits hippocampal tyrosine kinase and may block long-term potentiation (the likely mechanism by which humans learn and remember). Still, considerably more work must be done to substantiate this hypothesis.
Finally, the single measures of outcome used in this study may have limited value, as cognitive function and brain structure change over time. Factors which predict these measures at one point may or may not be the same as those which predict decline over time; fundamentally, the public health interest is in preventing cognitive decline, as the steepness of the decline trajectory likely provides an early marker for risk of the more clinically relevant result-dementia.
Serum 25(OH)-vitamin D concentration and risk of esophageal squamous dysplasia.
Abnet CC, Chen W, Dawsey SM, Wei WQ, Roth MJ, Liu B, Lu N, Taylor PR, Qiao YL.
Cancer Epidemiol Biomarkers Prev. 2007 Sep;16(9):1889-93.
PMID: 17855710
doi: 10.1158/1055-9965.EPI-07-0461
Background: Squamous dysplasia is the precursor lesion for esophageal squamous cell carcinoma, and nutritional factors play an important role in the etiology of this cancer. Previous studies using a variety of measures for vitamin D exposure have reached different conclusions about the association between vitamin D and the risk of developing esophageal cancer.
Conclusions: Higher serum 25(OH)D concentrations were associated with significantly increased risk of squamous dysplasia. No obvious source of measured or unmeasured confounding explains this finding.
In conclusion, we found that a higher serum 25(OH)D concentration was associated with an increased risk of esophageal squamous dysplasia, the precursor lesion for ESCC. This finding concurs with our previous prospective study which found that higher vitamin D status was associated with increased risk of incident ESCC in this same population. These unexpected findings suggest that further studies of the association of vitamin D and digestive tract cancers are needed before the effect of vitamin D in different populations can be elucidated.
Serum 25-hydroxyvitamin D levels in vitamin D-insufficient hip fracture patients after supplementation with ergocalciferol and cholecalciferol.
Glendenning P, Chew GT, Seymour HM, Gillett MJ, Goldswain PR, Inderjeeth CA, Vasikaran SD, Taranto M, Musk AA, Fraser WD.
Bone. 2009 Nov;45(5):870-5. Epub 2009 Jul 23.
PMID: 19631774
doi:10.1016/j.bone.2009.07.015
Cholecalciferol supplementation resulted in a 31% greater increase in total HPLC-measured 25OHD (p=0.010) and 52% greater rise in RIA-measured 25OHD (p0.05). In vitamin D-insufficient hip fracture patients, supplementation with cholecalciferol 1000 IU/day for three months was more effective in increasing serum 25OHD than an equivalent dose of ergocalciferol. However, the lack of difference in PTH lowering between calciferol treatments raises questions about the biological importance of this observation.
July 29, 2008 - The low rate of atherosclerosis and heart disease in Japanese people may be related to their very high levels of marine-derived omega-3 fatty acids rather than genetic factors, a new study suggests [1].
The study, known as Electron-Beam Tomography, Risk Factor Assessment Among Japanese and US Men in the Post-World War II Birth Cohort (ERA JUMP) included 868 randomly selected men aged 40 to 49. Of these, 281 were Japanese men living in Japan; 306 were white men living in the US, and 281 were third- or fourth-generation Japanese American men from Hawaii. All study participants had a physical examination, completed a lifestyle questionnaire, and had blood tests to measure cholesterol levels and levels of omega-3 fatty acids. Atherosclerosis was assessed by measuring carotid intima-medial thickness (IMT) and coronary artery calcification (CAC).
Results showed that the Japanese men had the lowest levels of atherosclerosis, whereas whites and Japanese Americans had similar higher levels. The Japanese men also had twofold higher levels of marine-derived omega-3 fatty acids than white and Japanese Americans.
The study, published in the August 5, 2008 issue of the Journal of the American College of Cardiology (available online July 28), was conducted by a group led by Dr Akira Sekikawa (University of Pittsburgh, PA, and Shiga University of Medical Science, Japan).
They found that compared with white or Japanese American men living in the US, Japanese men living in Japan had twice the blood levels of omega-3 fatty acids - a finding that was independently linked to low levels of atherosclerosis.
Foran SE, Flood JG, Lewandrowski KB.
Measurement of mercury levels in concentrated over-the-counter fish
oil preparations: is fish oil healthier than fish?
Arch Pathol Lab Med. 2003 Dec;127(12):1603-5.
PMID: 14632570 [PubMed - indexed for MEDLINE]
Measurement of vitamin D levels in inflammatory bowel disease patients reveals a subset of Crohn's disease patients with elevated 1,25-dihydroxyvitamin D and low bone mineral density.
Abreu MT, Kantorovich V, Vasiliauskas EA, Gruntmanis U, Matuk R, Daigle K, Chen S, Zehnder D, Lin YC, Yang H, Hewison M, Adams JS.
Gut. 2004 Aug;53(8):1129-36.
PMID: 15247180
doi: 10.1136/gut.2003.036657.
Conclusions: These data demonstrate that elevated 1,25(OH)2D is more common in CD than previously appreciated and is independently associated with low bone mineral density. The source of the active vitamin D may be the inflamed intestine. Treatment of the underlying inflammation may improve metabolic bone disease in this subgroup of patients.
Active specific immunotherapy with supportive measures in the treatment of advanced palliatively nephrectomised renal adenocarcinoma. A controlled clinical study.
Tykkä H.
Scand J Urol Nephrol Suppl. 1981;63:1-107.
PMID: 6184775
Active specific immunotherapy with supportive measures in the treatment of palliatively nephrectomized, renal adenocarcinoma patients. A thirteen-year follow-up study.
Tallberg T, Tykkä H, Mahlberg K, Halttunen P, Lehtonen T, Kalima T, Sarna S.
Eur Urol. 1985;11(4):233-43.
PMID: 2412827
Postoperative active specific immunotherapy with supportive measures in patients suffering from recurrent metastasized melanoma: case reports of six patients.\nTallberg T, Kalima T, Halttunen P, Tykkä H, Mahlberg K, Matous B, Sundell B.\nJ Surg Oncol. 1986 Oct;33(2):115-9.\nPMID: 3762183
Written by, Samuel K. Burlum, Investigative Reporter
and author of The Green Lane, a syndicated column
Published on 4/30/16, a SamBurlum.com Exclusive
Source: As we take a look at the poor water quality issues that have hit major metro centers such as Flint, Michigan and Newark, New Jersey, we examine the source of these issues and what some are doing to rush in protecting the most important natural resource vital to the existence of the human race.
As our world's population grows and our available sources of clean drinkable freshwater dwindle, the race to find ways to preserve and protect our current water supplies have rapidly increased; while other alternatives on how to clean up used and polluted water supplies are explored. Schools of thought and tech companies are eager to find ways to filter recycled water for reuse; fresh water supplies continue to be maxed out.
According to the U.S. Geological Survey; only 2.5% of the Earth's water supply is fresh water. The main sources of available drinkable freshwater supply mainly come from glaciers and ice caps; ground ice and permafrost, and lakes and ground water. It is so surprising that with this natural resource being so scarce, we as a society don't do more to preserve and protect it. And so as a society, we continue to sabotage ourselves by contributing to actions and behaviors that increase pollution of our rivers and lakes. Only about half of the world's population has access to clean drinking water, leaving the other 3 billion people to fight for a source of quality water. In addition to that, according to United Nations Educational, Scientific and Cultural Organization (UNESCO); 783 Million people have no access to any clean water sources. They must rely on "dirty" water or no water at all.
This seems like a problem that would only plague impoverished countries, countries without infrastructure and societies without developed economies; however that stereo-typical outlook has been crushed by
Written by, Samuel K. Burlum, Investigative Reporter
and author of The Green Lane, a syndicated column
Published on 4/30/16, a SamBurlum.com Exclusive
Source: As we take a look at the poor water quality issues that have hit major metro centers such as Flint, Michigan and Newark, New Jersey, we examine the source of these issues and what some are doing to rush in protecting the most important natural resource vital to the existence of the human race.
As our world's population grows and our available sources of clean drinkable freshwater dwindle, the race to find ways to preserve and protect our current water supplies have rapidly increased; while other alternatives on how to clean up used and polluted water supplies are explored. Schools of thought and tech companies are eager to find ways to filter recycled water for reuse; fresh water supplies continue to be maxed out.
According to the U.S. Geological Survey; only 2.5% of the Earth's water supply is fresh water. The main sources of available drinkable freshwater supply mainly come from glaciers and ice caps; ground ice and permafrost, and lakes and ground water. It is so surprising that with this natural resource being so scarce, we as a society don't do more to preserve and protect it. And so as a society, we continue to sabotage ourselves by contributing to actions and behaviors that increase pollution of our rivers and lakes. Only about half of the world's population has access to clean drinking water, leaving the other 3 billion people to fight for a source of quality water. In addition to that, according to United Nations Educational, Scientific and Cultural Organization (UNESCO); 783 Million people have no access to any clean water sources. They must rely on "dirty" water or no water at all.
This seems like a problem that would only plague impoverished countries, countries without infrastructure and societies without developed economies; however that stereo-typical outlook has been crushed by th