A Medical Student Blog

Unofficial thoughts on medicine and medical school

Strategies to Prevent and Treat Vitamin D Deficiency

Hi Everyone!   

Wow very sorry for not writing in such a long time.  It’s been a little difficult these days as second-year medical school has been much busier than I thought it would be.  I wanted to post up this table from Dr. Michael Holick’s New England Journal of Medicine review article (N Engl J Med 2007;357:266-81) on Vitamin D defiency and how to prevent it.   Basically, many many people we care about – 1 billion worldwide, have vitamin D deficiency.  It’s very sad, because not having enough vitamin D can contribute to many diseases — like osteoporosis, and even common cancers, autoimmune disease, infectious disease and heart disease.  Please if you get a chance, read the Holick article (http://www.uvadvantage.org/portals/0/pdf/NEJournalofMedicine.pdf).  And check out the following table, which is from that article, which can help you make some of your decisions together with your doctor.

Best wishes!

Jeff

Strategies

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October 13, 2007 - Posted by | Nutrition | , , , , ,

8 Comments »

  1. Hi! I finally did the blog thing. My first writing is rather emotive, but I will start writing more about some research soon. This site is confusing….

    anyway, I look forward to reading more of your stuff.
    Best regards,

    Anja.

    Comment by anjasmith | November 3, 2007 | Reply

  2. hey,i happened to see you videos on youtube.I think your idea is quite interesting und unprecedented(thanks to the modern technolgy,it wouldn’t be possible in the past)
    Anyway,i am a medical student from the University of Heidelberg,Germany.Nice to meet you!

    Greetings from Heidelberg!

    Comment by YH | December 16, 2007 | Reply

  3. oooops!I meant to say interesting “and” unprecedented.”und”=”and” in German ^^

    Comment by YH | December 16, 2007 | Reply

  4. Hello
    First I want to thank you for your website. You are doing great work. I appreciate all the information you have made available.
    I came across your site while searching for information about Vitamin D deficiency. I have been not feeling well for a long long time. I have flu like aches and tired no energy. The doctors always see the depression and although I have tried many kinds of antidepressants,I stopped taking them….none helped some made me feel worse. I have continued to feel really sick. Just last week a doctor I saw did a Vitamin D test and it came back a 5..the lowest on the scale. He had said that he wanted to take the test only because someone in the mental health department had mentioned that sometimes people with depression have low vitamin D levels. I have been reading up about it and am wondering if this could be the reason I have been feeling so badly. No one ever did this test on me. I am waiting to hear from my doctor to see what he is going to advise next. I don’t feel confident that I will get the correct tests because I am in a HMO and getting referred to a specialist is often difficult. After reading about the dangers of such a low reading, I am worried and not sure what to ask for when I talk to my doctor. I am concerned there is an underlying cause for this low reading and if the doctor just prescribes the vitamin D for me to take without ordering the other tests to determine what is causing my low reading, What other tests should be run on someone like me with such a very low reading? I appreciate any suggestions. I am still waiting to hear from my doctor. I viewd my test results on line and three days ago and am still waiting for a response from him as to what he is going to recommend.
    Thank you so much.
    ann

    Comment by ann | March 6, 2009 | Reply

  5. I read your blog for quite a long time and must tell that your posts always prove to be of a high value and quality for readers.

    Comment by Heartburn Home Remedy | April 15, 2009 | Reply

  6. Thought you might find this outline of some interest. If so, can email you the 3 hr PowerPoint talk. I teach BU Med Students that come through our system at Quincy, and Harvard students (fellows) at another hospital. Totally agree on the vitamin D story, keep up the good work.

    Best, Doug Watt

    Rethinking Our Losing Battle Against the Diseases of Aging:
    Why We Are Losing the Battle – What We Can Do Differently

    What is aging, and why does it often lead to the diseases of aging? What can we do about this? These are central biological questions for all the healthcare disciplines, and also questions around which there is now a great deal of fundamental science. Unfortunately, very little of that fundamental science has trickled down into the healthcare system and into the awareness of most healthcare professionals. In addition, almost none of it seems to inform the way our healthcare system currently works. Although the Bible refers to aging as “the wages of sin,” this is at best a colorful metaphor and of course completely scientifically inadequate. Instead, the evidence is that aging is more related to the “wages of metabolism” (oxidative stress and glycation) and the “wages of organism defense and repair” (AKA inflammation).

    This talk looks at the impending fiscal collapse of the healthcare system in the United States. We are headed into a situation within the next several years in which roughly 20% of the national GNP is going to be spent on healthcare expenses, while overall health and quality of life is declining (currently the United States ranks around 38th in life expectancy). As the baby boomers (almost a 60,000,000 person demographic) hit the decades of greatest risk for cancers, heart disease, stroke, arthritis, Alzheimer’s disease, macular degeneration, and other diseases of aging, the evidence is that the healthcare system (as it is currently structured) would undergo a slowly progressive but ultimately catastrophic collapse. Obviously, this fiscal collapse will not happen all at once (and instead the system will be slowly swamped over time with subsequent progressive and stark rationing of care). If we continue on our current course, we will see an increasing fraction of our national wealth going to healthcare, but with every indication that our quality of life will not be improved correspondingly at all. Currently, we spend at most 5% of our health care dollar on prevention in any meaningful sense, while somewhere between 75 to 85% goes into the treatment of an established disease of aging, often times emphasizing high-tech tertiary care of an advanced disease of aging, including spending roughly $100,000 or more in the last year or so of life. These figures of course are completely unsustainable within the context of the aging of the baby boomer demographic. (Extrapolating from current trends means that we will spend 6 trillion dollars on end-of-life care for the Baby Boomers). Given the explosion of obesity in this country (a risk factor for all the diseases of aging and not simply diabetes), the incidence of the diseases of aging may actually be on the rise. This suggests that American society as a whole may be headed for a catastrophic failure of prevention in relationship to the diseases of aging on a national and unprecedented scale.

    This talk examines evidence that the classic lifestyle factors of diet, exercise, sleep, and stress all impinge on three fundamental mechanisms that drive all the diseases of aging: 1) oxidative stress which damages numerous cellular compartments especially the mitochondria and mitochondrial DNA (leading to age-related change and apoptosis), nuclear DNA (potentially leading into cancers), and many other membranes and protein structures; 2) chronic auto-inflammation which contributes to oxidative stress (our immune system kills invaders in part by overloading their antioxidant defenses) and which also causes damage to multiple systems and tissues; 3) glycation of proteins, and the creation of increasing amounts of so-called ‘advanced glycation end products’, which potentiate inflammation. These processes also jointly contribute to the over-selection of apoptosis and drive tissues eventually into having increasing populations of senescent cells that are unable to do their assigned physiologic tasks.

    Four lifestyle factors are critical. Sleep, exercise, a healthy diet (which is more than just reducing calories and probably includes many protective phytochemicals (found in fruits and vegetables) and essential fatty acids), and not too much chronic stress, combined with a healthy emotional engagement in life, directly impact these fundamental cellular processes of age-related damage. All of these lifestyle factors contribute to the reduction of inflammation in aging, the optimal management of oxidative stress, and the minimizing of glycation of proteins. Indeed, these four components of a healthy lifestyle probably have synergistic effects, just as a bad diet (too many calories, too few protective phytochemicals, poor Omega 3/Omega 6 ratios among other issues) synergizes with the effects of sleep deprivation, sedentary lifestyle, and excessive stress in promoting inflammation, oxidative stress, and glycation. Jointly these four classic lifestyle factors, interacting with our genome (and presumably multiple unmapped polymorphisms) determine what aging trajectories our systems enter as we get older, and how much our fundamental cellular defenses against cellular damage are supported and enhanced as much as possible, versus overtaxed and overwhelmed. Mechanisms of aging lead invariably into the diseases of aging if given enough time and enough room to work. At this point, there is no cure for virtually any disease of aging, so prevention, instead of being put in the trunk of the car where it sits currently in our healthcare system, needs to be in the driver’s seat. Making this critical change in priorities and approach is likely to be both painful in many ways as well as politically contentious. Unfortunately, the conventional medical perspective on diseases of aging in this country is largely unaware of evidence that they may reflect common mechanisms operating in different tissues and systems. Although prevention is finally gaining traction, it is still woefully underemphasized. Indeed, almost no one talks about preventing Alzheimer’s disease, although the evidence is accumulating that this is a realistic target (outside of familial AD, where perhaps only delaying onset might be possible).

    The talk also summarizes work on calorie restriction, which is clearly the gold standard in relationship to both aging and the diseases of aging. Calorie restriction (CR) functions as a kind of global metabolic reprogramming for virtually all organisms, extends lifespan and reduces penetration of the diseases of aging significantly if not dramatically in every species in which it has been studied. Increasing evidence suggests that the mitochondria are a major nexus for aging and thus for the diseases of aging. CR appears to significantly reduce oxidative stress in the mitochondria and at the plasma membrane, and slows progressive damage to mitochondrial DNA and mitochondrial function intrinsic to aging, in every species studied. The talk briefly examines what we know about calorie restriction mimetics (substances that mimic the effects of calorie restriction without the ‘pain’ of substantially reduced calories), particularly resveratrol, which is the most popular and best-researched calorie restriction mimetic that is relatively available. It also briefly examines effects of other common polyphenols, widely regarded as “antioxidants” such as turmeric and catechins (found in many teas), summarizing evidence for a very multifactorial pattern of effects from polyphenols, beyond their simplistic designation as “antioxidants”. The antioxidant vitamins (A., C., and E) have been a complete bust in relationship to the diseases of aging leading to enormous skepticism about the value of anything labeled as an ‘antioxidant’. However, polyphenols are fundamentally different from the antioxidant vitamins, with quite pleiotropic effects, affecting cell signaling and cell physiology in a wide variety of ways, in the direction of enhancing antioxidant defenses, modulating excessive inflammation, regulating growth versus apoptosis pathways (a critical part of their anticancer effects), and protecting against glycation of proteins. As a class, polyphenols increasingly appear to be the most protective common dietary compounds in relationship to aging and the diseases of aging. Large-scale trials are now underway of resveratrol and other polyphenols in relationship to several diseases of aging.

    The talk concludes by emphasizing how far Western technological societies have moved from an original evolutionary environment (a great deal of daily aerobic exercise and sleep, low-calorie, high phytochemical diets, within socially intimate groups), while modern societies have reversed every one of these environmental variables (little to no exercise, poor sleep, high calorie, low phytochemical diets, frequent social isolation and lack of intimacy). This suggests that the diseases of aging may emerge from our living longer (we have mostly conquered bacterial infection, the likely cause of death for most of the humans that lived on this planet prior to the 1930s) but while creating a biological environment fundamentally alien from the one in which we have evolved. Two long-term solutions (to both avoid the long-term financial collapse of the healthcare system and enhance quality of life) might emphasize: 1) finding and using effective calorie restriction mimetics; 2) major lifestyle changes, so that we exercise and sleep more, eat less, eat better, and aim more for quality of social connection than quantity of consumption. Unfortunately, relentless drug company advertising and the overvaluation of high-technology medicine have led to the mass culture notion that the diseases of aging are nothing to be especially afraid of, as long as one has first-line drugs and high-technology care (typically aimed at a disease of aging that is well installed if not advanced). Nothing could be further from the truth. One could argue that one basic reason why prevention is failing that we are not sufficiently scared of the diseases of aging. We should be, as substantive progress in stopping them let alone reversing them remains a very elusive scientific target. Given their close relationship to the intrinsic mechanisms of aging itself, it may prove a very tall order to reverse any disease of aging.

    Healthcare professionals of virtually all disciplinary persuasions need to take responsibility for educating both patients and the general public about these issues, as a critical part of the reprioritizing of prevention.

    Comment by Dr Douglas Watt | February 4, 2010 | Reply

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