A new study concludes that among older adults – especially those who are frail – low levels of vitamin D could mean a much higher mortality risk. But instead of a knee-jerk reaction rushing to sources of vitamin D, it's important to first measure the level of vitamin D in older adults before older people start buying senior vitamins containing huge doses of vitamin D because vitamin D impacts muscle function and bones.
Therefore, it makes sense that the fat-soluble vitamin plays a big role in frailty. But can enough vitamin D ward-off or slow the progression of frailty? Or will too much vitamin D calcify the aorta of some older people who have a certain genetic variation?
Locally in Sacramento and Davis, the University of California, Davis Health System found low vitamin D levels in people living in Northern California who were suffering from metabolic syndrome, according to the local study, "UC Davis Health System study finds low vitamin-D levels in Northern California Residents with metabolic syndrome. In the U.C. Davis Health System study, scientists noted that supplementation with the "sunshine vitamin" may reduce the risk of diabetes and heart disease.
Thursday's breaking nutrition news from Oregon State University published on July 26, 2012 concludes that among older adults, especially being frail elderly with low levels of vitamin D can mean a much greater risk of death. The latest study found that older adults with low vitamin D levels had a 30 percent greater risk of death than people who had higher levels.
You can check out the original study or its abstract, "The Effect of Vitamin D and Frailty on Mortality Among Non-Institutionalized US Older Adults. European Journal of Clinical Nutrition, 2012. Or see the July 26, 2012 Oregon State University news release, "Lower vitamin D could increase risk of dying, especially for frail, older adults."
Older people who can't chew well may not eat foods high in vitamin D. Good sources of vitamin D like milk and fish, and being physically active outdoors are helpful, but leave out the older adults who are on vegan diets and can't go out frequently because either their neighborhoods aren't safe, they are non-drivers and public transportation is expensive or too distant, or the weather isn't conducive to walking several miles daily. Do they resort to supplements? How would the average older adult interpret the results of this study?
Also last week the Oregon State University published it's research, Study: Frail, older adults with high blood pressure may have lower risk of mortality. The study, published July 16, 2012 in the Journal of the American Medical Association’s (JAMA) Archives of Internal Medicine, looked at a nationally representative group of 2,340 adults ages 65 and older. The researchers found that lower blood pressure protected healthier, robust older adults but the same may not be true for their more frail counterparts. But what about when it comes to taking vitamin D? What source of vitamin D is healthiest for the older adult, since there's no one-size fits all solution?
When it comes to older adults and vitamin D from the sun, foods, or supplements, people need to pay attention to their vitamin D levels and whether they have a genetic variation that could make taking high-dose vitamin D supplements not indicated. You won't know until you check out how your body responds to vitamin D from different sources.
Genetic variations that may make it unhealthy to take vitamin D supplements
There's only one problem with how consumers use this breaking nutrition news. The older adult may have a genetic variation where taking high-dose vitamin D supplements may lead to calcification of the coronary arteries, and/or the aorta.
If the older adult is part of a population with a genetic variation where taking vitamin D in certain amounts may lead to calcification of the person's aorta, think of what would happen if many frail, older adults rushed to buy high-dose vitamin D sofgels without first taking a test to see whether they're deficient in vitamin D in the first place and whether they have the particular genetic variation where a certain amount of excess vitamin D calcifies.
In the latest study from Oregon State University, the randomized, nationally representative study found that overall, people who were frail had more than double the risk of death than those who were not frail. Frail adults with low levels of vitamin D tripled their risk of death over people who were not frail and who had higher levels of vitamin D. You can check out the July 28, 2012 Oregon State University news release, "Lower vitamin D could increase risk of dying, especially for frail, older adults."
The only problem is how would the average older person react to the breaking nutrition news?
You hear all the talk about increasing your daily natural vitamin D3 intake from 400 mg to at least 1,000 mg to prevent arterial calcification, bone loss, and certain diseases. The media says so many diseases could be due to too low vitamin D3 intake. But what happens if you have a certain gene variation that instead causes vitamin D3 to calcify your aortic valves?
If you have a gene variation, does vitamin D cause calcification of your aorta? See the article at the CAT. Inst. site. Another article in the Journal of Vascular Research, Aortic Calcification Produced by Vitamin D3 plus Nicotine, notes that “Calcification of the elastic arteries of the young rat by treatment with vitamin D and nicotine (VDN) has been proposed as an animal model of arterial calcification associated with age and age-related vascular pathology in man.
The calcium-binding protein, S-100, which is found in human atherosclerotic lesions was associated with medial calcification of the aorta in VDN rats, especially in cases of severe calcification.” The abstract’s conclusion is that, “In conclusion, the mechanisms and consequences of aortic calcification in VDN show several similarities with calcification occurring in human athero- and arteriosclerosis.”
See the conclusion of the article in the MD Consult Preview, The vitamin D receptor genotype predisposes to the development of calcific aortic valve stenosis. - Ortlepp JR - Heart - 01-JUN-2001; 85(6): 635-8 (MEDLINE is the source for the citation and abstract of this record) that notes, “There is a significant association of vitamin D receptor polymorphism with calcific aortic valve stenosis. The B allele of the vitamin D receptor is more common in patients with calcific aortic valve stenosis. It now needs to be evaluated whether other genes that control calcium homeostasis are involved in the pathogenesis of this disorder.”
Check out the study at: Oxford Journals, Cardiovascular Research, titled, Uraemic hyperparathyroidism causes a reversible inflammatory process of aortic valve calcification in rats. Uraemic hyperparathyroidism causes a reversible inflammatory process of aortic valve calcification in rats Renal failure is associated with aortic valve calcification (AVC). The researcher's aim was to develop an animal model for exploring the pathophysiology and reversibility of AVC, utilizing rats with diet-induced kidney disease.
You may also want to see the publication, Heart, and Education in Heart, a peer review journal for health professionals in all areas of cardiology. The study, Cardiovascular medicine, “The vitamin D receptor genotype predisposes to the development of calcific aortic valve stenosis”, J R Ortlepp, R Hoffmann, F Ohme, J Lauscher, F Bleckmann, P Hanrath, tests the hypothesis that vitamin D receptor polymorphism is associated with calcific aortic valve stenosis.
The conclusion noted, “There is a significant association of vitamin D receptor polymorphism with calcific aortic valve stenosis. The B allele of the vitamin D receptor is more common in patients with calcific aortic valve stenosis. It now needs to be evaluated whether other genes that control calcium homeostasis are involved in the pathogenesis of this disorder.”
If you have a genetic variation, a polymorphism on your vitamin D receptor, is it associated with calcification of your aortic valve?
What this means, the researchers note, is if you have a genetic variation, a polymorphism on your vitamin D receptor, it’s associated with calcification of your aortic valve. How do you know whether you have this particular gene variation that makes your body react a certain way to vitamin D3 by developing calcium deposits in your aortic valve? You need to be tested to find out how your body reacts to vitamin D from sources other than your food.
When you take all those vitamin D3 supplements that are recommended in so many articles in the media or on the familiar health-related radio programs on health, how do you know whether your body will use it to protect your organs against bone loss or use it to send calcium deposits into your organs, heart valves, and arteries?
Are the genes that control calcium homeostatis involved in the disorder?
What needs to be evaluated right now is whether other genes that control calcium homeostasis are involved in the pathogenesis of this disorder. In plain language, how many gene variations control the way calcium and vitamin D3 are processed in your own body? And how can you find out? Are there genetic tests that show you how your body handles vitamin D3?
The media is full of articles saying that the 400 mg of vitamin D3 is too little to protect you against cardiovascular problems, that you probably need 1,000 mg. But what happens if you have a genetic variation or mutation that communicates to your body in a different way, where when you take vitamin D3 and calcium in supplements or at high food intakes, that the calcium doesn’t go into your bones, but into the arteries and valves around your heart? Will vitamin K2 in the MK-7 form protect you from calcification if you have this genetic variation? And where can you find out if it will?
Another article at BioMed Experts, Osteoporosis and calcification of the aorta, Bone and Mineral, 1992;19(2):185-94,1992: Frye M A; Melton L J; Bryant S C; Fitzpatrick L A; Wahner H W; Schwartz R S; Riggs B L, notes, “Aortic calcification was not associated with any measures of calcium metabolism, after adjusting for age, except for a slight negative association between linear aortic calcifications and 25(OH) vitamin D levels (P < 0.05).”
Another abstract of a 2003 article, "Influence of sex and estrogen on vitamin D-induced arterial calcification in rats" notes, "It is known that the process of arteriosclerosis is affected by sex and estrogen. The present study was thus undertaken to examine the effects of these factors on arterial calcification, a form of arteriosclerosis, using a rat model of vitamin D toxicity. The article concludes with, “These results suggest that sex and estrogen can modify the process of arterial calcification. The mechanisms remain to be determined, although the effects were independent of serum calcium level.”
What happens after menopause when the estrogen level plummets? And were you born with or without the gene variation that takes the vitamin D3 you eat along with the calcium and calcifies your arteries with it instead of putting it into your bones where it belongs? How do you find a genetics/DNA test to tell you whether you have inherited that genetic mutation or variation?
Will taking vitamin K2 in the MK-7 form help you if you have this gene variation? Or not? Only personalized medicine within science can tell you for sure, and the science needs to be tailored to your individual genes. Is science ready yet? Have they developed a test? Or does science still not know yet how many genes need to be tested to see how your body handles vitamin D3 and calcium?
Has science found all the genes necessary to tell you how your body handles vitamin D from sources besides your foods?
What should you do? Keep asking whether the test is ready yet. And keep searching to find out whether science has found all the genes necessary to tell you how your body handles vitamin D3 supplements versus natural food intake, calcium, magnesium, and fish oils containing vitamin D3. Until you know, eat whole foods, get enough sunshine or other natural light, and keep researching.
Find out whether you have the B allele of the vitamin D receptor. Science knows those with it, at least in rats and some human patients, it is more common to see calcification of the aortic valve. But because it is more common, how does that tell us whether the gene variation is a risk? Or how many genes or alleles are involved? That's why you have to keep asking those experts that are talking about health care with you.
In the latest Oregon State Study it's important to measure vitamin D levels in older adults
“What this really means is that it is important to assess vitamin D levels in older adults, and especially among people who are frail,” said lead author Ellen Smit of Oregon State University, according to the news release.
Smit said past studies have separately associated frailty and low vitamin D with a greater mortality risk, but this is the first to look at the combined effect. This study, published online in the European Journal of Clinical Nutrition, examined more than 4,300 adults older than 60 using data from the Third National Health and Nutrition Examination Survey.
“Older adults need to be screened for vitamin D,” said Smit in the news release. Ellen Smit is a nutritional epidemiologist at OSU’s College of Public Health and Human Sciences. Her research is focused on diet, metabolism, and physical activity in relation to both chronic disease and HIV infection.
Is sunshine more important for older adults than taking vitamin D supplements?
“As you age, there is an increased risk of melanoma, but older adults should try and get more activity in the sunshine,” she said in the news release. “Our study suggests that there is an opportunity for intervention with those who are in the pre-frail group, but could live longer, more independent lives if they get proper nutrition and exercise.”
Frailty is when a person experiences a decrease in physical functioning characterized by at least three of the following five criteria: muscle weakness, slow walking, exhaustion, low physical activity, and unintentional weight loss. People are considered “pre-frail” when they have one or two of the five criteria.
The pre-frail have one or two of the five criteria for frailty
Because of the cross-sectional nature of the survey, researchers could not determine if low vitamin D contributed to frailty, or whether frail people became vitamin D deficient because of health problems. However, Smit explained in the news release that the longitudinal analysis on death showed it may not matter which came first.
“If you have both, it may not really matter which came first because you are worse off and at greater risk of dying than other older people who are frail and who don’t have low vitamin D,” she said in the news release. “This is an important finding because we already know there is a biological basis for this. Vitamin D impacts muscle function and bones, so it makes sense that it plays a big role in frailty.”
The latest study showed about 70% of Americans have insufficient levels of vitamin D
The study divided people into four groups. The low group had levels less than 50 nanomole per liter; the highest group had vitamin D of 84 or higher. In general, those who had lower vitamin D levels were more likely to be frail.
About 70 percent of Americans, and up to a billion people worldwide, have insufficient levels of vitamin D. And during the winter months in northern climates, it can be difficult to get enough just from the sun. OSU’s Linus Pauling Institute recommends adults take 2,000 IU of supplemental vitamin D daily. The current federal guidelines are 600 IU for most adults, and 800 for those older than 70.
“We want the older population to be able to live as independent for as long as possible, and those who are frail have a number of health problems as they age,” Smit explained in the Oregon State University news release. “A balanced diet including good sources of vitamin D like milk and fish, and being physically active outdoors, will go a long way in helping older adults to stay independent and healthy for longer.”
Researchers from Portland State University, Drexel University of Philadelphia, University of Puerto Rico and McGill University in Montreal contributed to this study. The National Institutes of Health and a grant from Oregon State University (OSU) funded the study in part.
As for the Sacramento/Davis study at U.C. Davis that covered Northern California, the researchers from UC Davis Health System found in its study that compared with healthy controls, blood levels of vitamin D are significantly reduced in patients in the Sacramento area with metabolic syndrome, a constellation of disease risk factors that affects about one in three U.S. adults and predisposes them to diabetes, heart disease and stroke.
The local U.C. Davis study is the first to examine vitamin-D status in patients with metabolic syndrome living in Northern California, where the many hours of sunshine make the vitamin-D deficiency finding surprising. The study, entitled “Low vitamin D levels in North American adults with the metabolic syndrome,” appears in the January 2011 issue of the journal Hormone and Metabolic Research.
If Northern California participants in the study showed that 30 percent of patients with metabolic syndrome have vitamin-D deficiency, and even many subjects in the control group had inadequate levels, this year's 2012 Oregon State University study confirms that the sunshine in the state may not be adequate.
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