Monday, January 18, 2016

Easy New Year's Resolutions - Know Your Vitamin D Level

According to the Harvard School of Public Health – ‘If you live north of the line connecting San Francisco to Philadelphia and Athens to Beijing, odds are that you don’t get enough vitamin D. African-Americans and others with dark skin, as well as older individuals, tend to have much lower levels of vitamin D, as do people who are overweight or obese. Being “D-ficient” may increase the risk of a host of chronic diseases, such as osteoporosis, heart disease, some cancers, and multiple sclerosis, as well as infectious diseases, such as tuberculosis and even the seasonal flu.   Several studies link low vitamin D levels with an increased risk of fractures in older adults, and they suggest that vitamin D supplementation may prevent such fractures—as long as it is taken in a high enough dose. A summary of the evidence comes from a combined analysis of 12 fracture prevention trials that included more than 40,000 elderly people, most of them women. Researchers found that high intakes of vitamin D supplements—of about 800 IU per day—reduced hip and non-spine fractures by 20 percent, while lower intakes (400 IU or less) failed to offer any fracture prevention benefit.

Vitamin D may also help increase muscle strength, which in turn helps to prevent falls, a common problem that leads to substantial disability and death in older people.  Once again, vitamin D dose matters: A combined analysis of multiple studies found that taking 700 to 1,000 IU of vitamin D per day lowered the risk of falls by 19 percent, but taking 200 to 600 IU per day did not offer any such protection.

The heart is basically a large muscle, and like skeletal muscle, it has receptors for vitamin D. So perhaps it’s no surprise that studies are finding vitamin D deficiency may be linked to heart disease. The Health Professional Follow-Up Study checked the vitamin D blood levels in nearly 50,000 men who were healthy, and then followed them for 10 years. They found that men who were deficient in vitamin D were twice as likely to have a heart attack as men who had adequate levels of vitamin D. Other studies have found that low vitamin D levels were associated with higher risk of heart failure, sudden cardiac death, stroke, overall cardiovascular disease, and cardiovascular death. How exactly might vitamin D help prevent heart disease? There’s evidence that vitamin D plays a role in controlling blood pressure and preventing artery damage, and this may explain these findings.
Dozens of studies suggest an association between low vitamin D levels and increased risks of colon and other cancers. The evidence is strongest for colorectal cancer, with most (but not all) observational studies finding that the lower the vitamin D levels, the higher the risk of this disease. Vitamin D levels may also predict cancer survival, but evidence for this is still limited.  Yet finding such associations does not necessarily mean that taking vitamin D supplements will lower cancer risk.
 Multiple sclerosis (MS) rates are much higher far north (or far south) of the equator than in sunnier climes, and researchers suspect that chronic vitamin D deficiencies may be one reason why. One prospective study to look at this question found that among white men and women, those with the highest vitamin D blood levels had a 62 percent lower risk of developing MS than those with the lowest vitamin D levels.  The study didn’t find this effect among black men and women, most likely because there were fewer black study participants and most of them had low vitamin D levels, making it harder to find any link between vitamin D and MS if one exists.
The flu virus wreaks the most havoc in the winter, abating in the summer months. This seasonality led a British doctor to hypothesize that a sunlight-related “seasonal stimulus” triggered influenza outbreaks. More than 20 years after this initial hypothesis, several scientists published a paper suggesting that vitamin D may be the seasonal stimulus. Among the evidence they cite: Vitamin D levels are lowest in the winter months. The active form of vitamin D tempers the inflammatory response of some white blood cells, while it also boosts immune cell’s production of microbe fighting proteins. Children who have vitamin D-deficiency rickets are more likely to get respiratory infections, while children exposed to sunlight seem to have fewer respiratory infections. Adults who have low vitamin D levels are more likely to report having had a recent cough, cold, or upper respiratory tract infection.
For most people, the best way to get enough vitamin D is taking a supplement, but the level in most multivitamins (400 IU) is too low. Encouragingly, some manufacturers have begun adding 800 or 1,000 IU of vitamin D to their standard multivitamin preparations. If the multivitamin you take does not have 1,000 IU of vitamin D, you may want to consider adding a separate vitamin D supplement, especially if you don’t spend much time in the sun.’
 It is important to know your blood level of vitamin D – most researchers agree it should be 30 ng/ml or above. Talk to your healthcare provider. Knowing your level will enable you to take the correct dose of vitamin D.
Daily Probiotic – In my last column I wrote about the benefits of probiotic supplements.  It is posted on this blog.  Here are two supplements that are easy to obtain and are of high quality; each pill contains 5 billion or more of the most helpful bacteria for your gut: Jarro-Dophilus and Floragen3.  Keep your probiotic refrigerated – not frozen – and take one daily with water on an empty stomach first thing in the morning.  It is helpful to use a probiotic daily, rather than intermittently if you have a digestive upset or need an antibiotic.  Foods containing helpful probiotics include plain yogurt, kefir, and many fermented foods.
Sadja Greenwood, MD. MPH  stay tuned for another easy resolution.

Monday, January 11, 2016

Easy New Year's Resolutions - Take a Daily Probiotic

Here is my advice on feeling better in 2016, by making some easy changes.  This week it is: take a probiotic daily.  Next week – know your Vitamin D level. After that – keep moving!
*From Harvard : Since the mid-1990s, clinical studies suggest that probiotic therapy can help treat several gastrointestinal ills, delay the development of allergies in children, and treat and prevent vaginal and urinary infections in women. 
*From the University of Maryland: Now, researchers at the University of Maryland School of Medicine (UM SOM) have come up with an explanation. It appears that LGG (Lactobacillus rhamnosus GG) LGG may act as a facilitator, modifying the activity of other gut bacteria. This is the first time this mechanism has been described; the discovery could eventually help scientists create more effective strategies to foster a healthy gut. Claire M. Fraser, PhD, professor of medicine at the UM SOM, as well as director of the Institute for Genome Sciences, studied the effect of LGG on a group of elderly subjects “This species of bacteria has a reputation for being really useful to humans,” says Prof. Fraser. “So we wanted to better understand how it might work in the human intestine.”  She and her collaborator, Dr. Patricia Hibberd at Massachusetts General Hospital, tested 12 subjects, who ingested LGG twice a day for 28 days. She analyzed gut bacteria before and after this regimen, and found that ingesting LGG led to increases in several genes that foster several species of gut bacteria, including Bacteroides, Eubacterium, Faecalibacterium, Bifidobacterium and Streptococcus. These microbes have been shown to have a range of benefits in humans, including the promotion of a healthy immune system. “This is a new idea, that some probiotics may work by affecting the overall ecosystem of the gut,” said Prof. Fraser. “Previously we tended to think that LGG and other probiotics worked directly on the host. I think this finding has many exciting implications.” For one, Fraser says, it lends support to the idea that we need to look at the microbes in the gut as an interconnected ecosystem rather than a series of solitary bacteria. Modifying the behavior of microbes already in the gut may be just as important as adding any single species to this population.
*From the Leiden Institute of Brain and Cognition at Leiden University in the Netherlands A new study suggests that probiotics may actually aid in improving mood. They might be a good way to fight anxiety or depression, or simply make you feel better after a bad day.
The researchers examined 40 healthy young adults who had no mood disorders. Half of them consumed a powdered probiotic supplement every night for four weeks. The probiotic supplement was called Ecologic Barrier, and contains eight types of bacteria, such as Bifidobacterium, Lactobacillus, and Lactococcus (these three types of bacteria that have been shown in the past to mitigate anxiety and depression). The other half of the participants took a placebo, although they thought they were taking probiotics.
The people who took probiotic supplements began to see improvements in their moods; they reported less reactivity to sad moods than those who took placebos. They had fewer depressive thoughts following bouts of sadness.“Even if preliminary, these results provide the first evidence that the intake of probiotics may help reduce negative thoughts associated with sad mood,” said Lorenza S. Colzato, an author of the study. “As such, our findings shed an interesting new light on the potential of probiotics to serve as adjuvant or preventive therapy for depression.” One recent study examined this link and found that people who took probiotics experienced lower levels of anxiety and depression, and had lower levels of cortisol — the stress hormone — in their saliva when they woke up in the morning..
Sadja Greenwood, MD, MPH