New Evidence for Protective Effects of Vitamin D on Your Heart

By Paolo Boffetta, MD, MPH, Special to Everyday Health

Although vitamin D is obtained from diet and dietary supplements, the main source of vitamin D is production in our skin under the influence of solar radiation.

As sun exposure varies with the latitude of regions and during the year, so vitamin D concentrations of populations vary accordingly. Furthermore, women are generally more prone to low vitamin D concentrations than men. Vitamin D deficiency is especially common among the elderly who often have less sun exposure because of reduced outdoor activity and reduced capacity of the skin to produce vitamin D.

Research on Vitamin D’s Protective Role
We conducted an international study of eight populations from Europe and the United States to investigate the association of level of vitamin D in blood and deaths from all-causes, cardiovascular diseases, and cancer mortality, published in the British Medical Journal in June 2014. We paid attention to differences between countries, sexes, age groups and seasons of blood sampling. The study was conducted with the CHANCES Project, a research initiative funded by the European Commission and coordinated by scientists at the Hellenic Health Foundation in Athens, Greece, and Mount Sinai School of Medicine in New York, and primary authors were from the German Cancer Research Center, in Heidelberg.

A total of 26,018 people had their vitamin D level measured in blood samples collected at enrolment in the study, when they were ages 50 to 79, and were followed for an average of 4 to 16 years, depending on the population. During this period 6,695 of them died, including 2,624 from cardiovascular disease and 2,227 from cancer. We compared the risk of dying between the group with highest vitamin D level and those with lower levels by dividing each study population in five groups of equal size based on their baseline vitamin D level.

Increased Deaths in People With Low Vitamin D Levels
Compared with the group with the highest vitamin D, people in the group with lowest vitamin D had a 57 percent increased mortality for all causes. They also had a 41 percent increased mortality from heart disease for those who were free from heart disease at the study’s start. In addition, individuals with history of cardiovascular disease had a 65 percent increased risk. People with a history of cancer had a 70 percent increased risk. However, for cancer mortality, we saw no benefit in those who were free from cancer at the start.

For all these associations, the three groups with intermediate vitamin D level were at intermediate risk, with a dose-response relation. These associations did not vary by sex, age group, or season of blood collection.

For the US population in the study, the comparison was between people with level of 25-hydroxyvitamin D (the main metabolite of vitamin D, and the active compound measured in blood) just above 85 nmol/L on the high end, and people with a level below about 42 nmol/L on the lowest. In that population, the difference in mortality was 42 percent for all causes and 26 percent for cardiovascular diseases.

Since ours an observational study, it cannot directly address the issue of causality. In other words, it is possible that blood vitamin D is a marker of some other characteristics causally linked to disease and mortality, like general good or poor health status. Controlled vitamin D trials, in which individuals are randomly allocated to vitamin D supplement or placebo, are needed to disentangle the effect of vitamin D from that of other factors. However, such studies can only address the effect of dietary supplementation, not of normal dietary intake and sun-related endogenous production. Prior trials showed a protective effect of vitamin D on mortality, albeit of smaller magnitude than observational studies, including ours.

Why Vitamin D Is Good for the Heart
If indeed the protective effect of vitamin D on mortality is real, our study provides important evidence that the effect is present for cardiovascular disease — but not for cancer. The protective effect is present at all ages and in both sexes. Unfortunately, our study did not include a sufficient number of people of different racial and ethnic groups to provide information on this important issue.

An important question is the identification of who should increase their vitamin D status using supplements. There is no consensus on ideal cut-off values for vitamin D deficiency. Our observation that the use of cut-off levels which were specific for country, age, sex, or season produced comparable results, raises the question whether such factors should be considered for defining vitamin D deficiency.

Future population-based studies with standardized vitamin D measurements are needed to fully resolve this issue; in the meantime, caution should be used in extrapolating results across regions with different latitudes.

Despite these uncertainties, I recommend moderate sun exposure, in particular in the elderly.  The amount of sun exposure depends on the type of skin (15-30 minutes are sufficient for a fair skinned person, while one or two hours are needed for dark skinned person) and on the latitude the person lives (more time is needed in Northern regions, in particular in winter). If sun exposure is not sufficient, people can consider taking supplements, after talking with their doctor.

Paolo Boffetta, MD, MPH is a chronic disease epidemiologist who is Director of the Institute for Translational Epidemiology and Associate Director for Population Sciences of the Tisch Cancer Institute at the Icahn School of Medicine, which is part of Mount Sinai Medical Center in New York City. He is also Adjunct Professor in the Department of Medicine at Vanderbilt University in Nashville, Tenn., and in the Department of Epidemiology at the Harvard School of Public Health.  He has edited 12 books and published more than 1,000 peer-reviewed scientific articles.

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Vitamin D Might Help Kids With Eczema

Daily vitamin D supplements might help children with eczema that gets worse in the winter, a new study suggests.

When eczema, a chronic inflammatory skin disorder, flares up in the winter it's known as winter-related atopic dermatitis.

Researchers found vitamin D significantly reduced the uncomfortable symptoms associated with this disorder.

"While we don't know the exact proportion of patients with atopic dermatitis whose symptoms worsen in the winter, the problem is common," said study leader Dr. Carlos Camargo, of Massachusetts General Hospital's department of emergency medicine.

"In this large group of patients, who probably had low levels of vitamin D, taking daily vitamin D supplements -- which are inexpensive, safe and widely available -- proved to be quite helpful," he said in a hospital news release.

A common treatment for severe atopic dermatitis is the controlled use of ultraviolet light, which stimulates production of vitamin D in the skin, the study's authors said. In conducting their research, they explored the possibility that vitamin D deficiency -- the so-called sunshine vitamin -- could help explain why the condition often gets worse during winter.

The study, conducted with the help of scientists at the Health Sciences University of Mongolia, involved 107 Mongolian children between the ages of 2 and 17 from nine outpatient clinics in the capital city of Ulaanbaatar.

All of the children had atopic dermatitis that flared up in cold weather or during the transition from fall to winter. The participants were randomly divided into two groups: those who received a 1000 IU daily dose of vitamin D and those who received a placebo.

The children's symptoms were evaluated when the study began, and one month later when it ended. The children's parents were also asked whether or not they felt their child's skin condition had improved.

The study, published in the October issue of the Journal of Allergy and Clinical Immunology, revealed the children who received the vitamin D supplements had an average 29 percent improvement in their symptoms. In contrast, the children who received the placebo had a 16 percent improvement.

Although the study authors did not determine whether or not the children in the study had a vitamin D deficiency when the study began, they pointed out that another larger study involving Mongolian children found 98 percent had low levels of vitamin D. The researchers said it was very likely the children in their study also had this deficiency.

Although more studies are needed to determine if vitamin D could help adults and children with year-round symptoms of atopic dermatitis, the researchers concluded children with symptoms that get worse during the winter months could try a vitamin D supplement for a few weeks to see if their condition improves. They advised parents to discuss the benefits of vitamin D and the findings with their child's doctor.

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Who Needs Omega-3s?

You’ve likely heard about the many health benefits of omega-3 fatty acids. Are you getting enough of them in your diet?

According to experts, probably not. And most people you know -- your spouse, your toddler, and your mom – probably aren’t either.

“Pretty much everybody’s diet is deficient in omega-3s,” says David C. Leopold, MD, director of integrative medical education at the Scripps Center for Integrative Medicine in San Diego. “I think that’s why adding them back in seems to have so many health benefits. We’re just balancing out what’s normally” there.

Omega-3s are rapidly becoming an important tool in mainstream medicine. They seem to have health benefits for every age group – from before birth to old age. There’s conclusive evidence that they protect against heart disease and lower triglycerides. There’s also some research showing that they might help with dozens of other conditions, too.

To help you better understand the benefits -- and some of the risks -- of omega-3s, here’s a primer on using omega-3 fatty acids. WebMD has also surveyed the evidence of how omega-3s help four groups of people -- infants, children and teens, young adults, and middle-aged to older adults.

What Are Omega-3s?

Omega-3s are essential fatty acids -- we need them for our bodies to work properly. One of their most important benefits is that they seem to have an anti-inflammatory effect.

“A lot of diseases, like heart disease and arthritis, seem to be related to an inflammatory process,” says Leopold. “Omega-3s can tune down the body’s inflammation, and that may be how they help prevent some of these chronic diseases.”

So how do omega-3s benefit people at different ages? Here’s the rundown on the research.

Keep in mind that few of these studies are definitive, and larger studies are needed to determine therapeutic benefit.  Also, some studies used food sources of omega-3s, and others used omega-3 supplements.

Always discuss the use of any medication or supplement with your doctor.

Omega-3s for Infants, Prenatal Health, and Pregnancy

Omega-3s are important for children’s health right from the start – actually, before they’re even born. Here’s some of the evidence.

Cognitive development. Some studies show that infants fed formulas enriched with the omega-3 fatty acid DHA show improvements in hand-eye coordination, attention span, social skills, and intelligence test scores. Studies have shown that children born to mothers who took supplements of omega-3s (DHA and EPA) during pregnancy and the during the first months of breastfeeding scored higher on cognitive tests at 4 years of age compared to children whose mothers did not take supplements of DHA and EPA.
Asthma risk. A 2008 study found that the teenage children of women who took fish oil during pregnancy were less likely to have developed asthma.
Growth. There’s some evidence that when omega-3s are added to formula, it promotes growth and brain development in premature infants.
Preterm labor. A 2003 study found that women who ate eggs enriched with omega-3s were less likely to go into premature labor than women who ate standard eggs.
Although none of these studies are conclusive, there’s good reason to make sure that infants – and pregnant women -- are getting their omega 3s such as DHA and EPA.

Many infant formulas are now supplemented with DHA. A mother’s breast milk is an ideal source of omega-3s, although it may be affected by how many omega-3s she’s getting in her diet.


Omega-3s for Children and Teens

Some of the childhood conditions that have been studied include:

ADHD. Kids with ADHD may have lower levels of omega-3s in their bodies than normal, and a few small studies have looked at fish oil supplements as a treatment. They found that the supplements might improve behavior, reduce hyperactivity, and boost attention in kids under 12.
Depression. Fish oil is often used as a treatment for depression in adults; there have been a few studies in children too. One small 2006 study of fish oil in depressed 6- to 12-year-olds found it helped their symptoms significantly.
Diabetes. One small study looked at kids who were at high risk of developing type 2 diabetes. The researchers found that those who ate a high omega-3 diet were less likely to develop the condition.
Asthma. Omega-3s may reduce inflammation in the airways, which could benefit those with asthma. One small study of 29 children with asthma found that those taking fish oil for 10 months had fewer symptoms than those who didn’t. However, other studies of omega-3s as an asthma treatment have not found consistent evidence that they help.
Keep in mind that many of these studies were small and other studies have sometimes found contradictory evidence. More research needs to be done before we’ll know the full implications.

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Vitamin D in your child's diet

Vitamin D is crucial for children's good health and development. Read on to find out how much vitamin D your child needs, which sources are the best, and how to avoid getting too little or too much.

Why vitamin D is important

Vitamin D helps the body absorb minerals like calcium and builds strong teeth and bones. According to researcher Michael F. Holick, professor of medicine, physiology, and biophysics at Boston University School of Medicine, vitamin D deficiency can not only cause rickets (a disease that can lead to bone deformity and fractures), it can also keep a child from reaching her genetically programmed height and peak bone mass.

Vitamin D also functions as a hormone with many other jobs in the body, including regulation of the immune system, insulin production, and cell growth.

How much vitamin D does my child need?

Infants up to 12 months old need 400 international units (IU), or 10 micrograms (mcg), a day. Children older than 1 need 600 IU, or 15 mcg, a day.

Your child doesn't have to get enough vitamin D every day. Instead, aim to get the recommended amount as an average over the course of a few days or a week.

The best sources of vitamin D

Vitamin D is called the "sunshine vitamin" because the body can produce it when the skin is exposed to sunlight. But your child's body isn't able to make vitamin D when covered with clothing or sunscreen to block the sun's rays. Other obstacles to vitamin D production from sun exposure include smog, clouds, dark skin, and geographic location.

Though it's hard to estimate how much time a person needs to spend in the sun to make the recommended amount of vitamin D, some researchers say spending 5 to 30 minutes outside between 10 a.m. and 3 p.m. at least twice a week should do it.

But experts warn that UV radiation from the sun is the main cause of skin cancer, and it's hard to judge whether you can get enough vitamin D from the sun without increasing your risk of a potentially deadly skin cancer. So consider finding other ways to get the vitamin D you need.

The American Academy of Pediatrics recommends that all infants, children, and teens take vitamin D supplements of 400 IU each day. Kids who are too young for chewable vitamins can take liquid supplements.

Some of the best food sources of vitamin D:

1 ounce salmon: 102 IU
6 ounces fortified yogurt: 80 IU
1 ounce canned tuna, drained and packed in oil: 66 IU
1/2 cup orange juice, fortified with 25 percent of daily value for vitamin D: 50 IU
1/2 cup fortified milk (whole, low-fat, or skim): 49 IU
one slice fortified American cheese: 40 IU
1/2 cup fortified, ready-to-eat cereal: 19 IU
1 ounce mackerel: 11.6 IU
1/2 large egg yolk: 10 IU
1/2 teaspoon fortified margarine: 10 IU
1/2 ounce Swiss cheese: 6 IU
The amount of vitamin D in a food varies somewhat, depending on the brand of the product.

Kids may eat more or less than the amounts shown, given their age and appetite. Estimate the nutrient content accordingly.

Can my child get too much vitamin D?

It's unlikely but possible. On the contrary, many health experts are concerned that the current recommended amount is too low and that children actually need much more.

That said, vitamin D can be harmful if you get too much. According to the Office of Dietary Supplements (a department of the National Institutes of Health), the safe upper limit for infants up to 12 months old is 1,000 to 1,500 IU daily. For kids 1 to 8 years old, the safe upper limit is 2,500 to 3,000 IU each day.

Vitamin D is stored in body tissue, so it's best not to get more than what health experts recommend. (Vitamin C, by contrast, isn't stored in the body – any excess is simply eliminated in urine.)

To be safe, if you have a very young child, stick to the 400 IUs recommended as an infant supplement. More than 400 IUs may be fine for an older child, but check with your child's doctor to be sure.

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