Today we explore the clinical literature showing some studies reporting an association between low vitamin D levels and an increased risk of colorectal cancer, but others finding no such link.

Vitamin D and cancer — A randomized study

A 2018 clinical trial randomized participants to a control (marine omega-3 fatty acids, one gram daily) or vitamin D (cholecalciferol, 2000 IU daily).

The VITamin D and OmegA-3 TriaL (VITAL) clinical trial enrolled nearly 26,000 American men (50 and older) and women (55 and older) to examine the impact of vitamin D3 on several outcomes:

• Cancer prevention
• Cardiovascular disease risk (heart attack, stroke, and cardiovascular mortality).
• Secondary endpoints included site-specific cancers, cancer mortality, and additional cardiovascular events.

The results? With a median 5.3-year intervention, vitamin D supplementation did not reduce cancer or cardiovascular risk, the study’s two primary endpoints.

There appeared to be no significant differences in the secondary endpoints, either. The vitamin D3 intervention did not reduce the incidence of total cancer mortality or breast, prostate, or colorectal cancer. Finally, treatment effects did not differ by baseline vitamin D blood levels.

The researchers reported no excess risks of high calcium levels (hypercalcemia) or other side effects associated with vitamin D supplementation.

But are we sure that vitamin D3 supplementation does not reduce cancer risk? A 2019 meta-analysis analysis of the scientific literature concluded that:

Vitamin D3 did not reduce cancer incidence but did drop cancer mortality.

In addition, a secondary analysis of the VITAL clinical trial published in 2019 showed that while vitamin D supplementation did not lower cancer incidence, it appeared to be associated with a reduced incidence of advanced cancer.

My take

The VITAL clinical trial has tremendous strengths, including a large population with racial and geographic diversity. The daily vitamin D dosing seems reasonable, with follow-up blood collection in many participants showing blood levels in the target range.

The study has some significant limitations, however. For example, the researchers examined only a single dose of vitamin D3. Hopefully, future studies will look at another dose. Finally, the follow-up is not nearly long enough. For example, cancer can take decades from its birth before it is clinically observable.

We may also need to consider cancer risk by genotypes of vitamin D-associated genes.

Here are the US Preventative Services Task Force recommendations:

• Premenopausal women. The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium for the primary prevention of fractures in community-dwelling, postmenopausal women. Current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with doses greater than 400 IU of vitamin D and greater than 1000 mg of calcium for the primary prevention of fractures in community-dwelling, postmenopausal women.
• Men and premenopausal women. The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of vitamin D and calcium supplementation, alone or combined, for the primary prevention of fractures in men and premenopausal women.

Note this USPSTF observation: “These recommendations do not apply to persons with a history of osteoporotic fractures, increased risk for falls, or a diagnosis of osteoporosis or vitamin D deficiency.” Given we don’t routinely test for deficiency, how would I know if I am deficient?

Daily vitamin D3 supplementation for five years among initially healthy adults does not appear to lower cancer or major cardiovascular event risk. The evidence is insufficient to make supplement recommendations for community-dwelling individuals.

Thank you for joining me in this look at vitamin D and cancer risk. Today, I will not examine the impact of vitamin D (and vitamin K) on bone fracture risk.

The post Does Vitamin D Drop Cancer Risk? appeared first on Medika Life.

While many think of osteoporosis as a disease of women, while older women have the highest risk, we can get it. Men and women and all races.

Today we look at osteoporosis basics and new findings that remind us of the risk among men. We’ll end with some strategies that may reduce your risk of bone loss.

Osteoporosis basics

Our bones are dynamic — we constantly make new bone tissue and destroy the old. We made new bone faster than breaking it down in our younger days, increasing bone mass.

The bone-building process begins to slow in our early 20s, and we hit our peak bone mass by 30. After that, we lose bone mass faster than we make it.

Your chances of developing osteoporosis hinge on how much bone mass you achieved in your younger years. Bone mass peaks in our 20s and hinges on inherited genetics and ethnicity.

To my young readers: Do what you can to optimize your bone mass while you are young. Bank that bone mass for late in life. I’ll give you some tips at the end.

Osteoporosis: Fixed risk factors

Here are some of the factors that can make you more likely to develop osteoporosis or significant bone loss:

Age. As we observed above, bone density peaks around age 30. After that, you experience bone loss.

Gender. Women over age 50 have a higher risk. Compared with men, women are four times more likely to develop osteoporosis, as females have thinner bones and longer lives. But remember: Men can get significant bone loss, too.

Family history. Inherited genetics play a role: If your parents or grandparents had osteoporosis (or hints of it, such as a broken hip after a minor fall), your risk is likely higher.

Bone structure and body weight. Petite and thin women have a higher risk of osteoporosis. Thin men have a higher risk than men with larger body frames and higher weights.

Broken bones. If you have a history of bone breaks, you may have a higher risk.

Ethnicity. White and Asian women are more likely to develop osteoporosis than others.

Certain diseases. Rheumatoid arthritis and other conditions can raise your risk of osteoporosis. The risk of osteoporosis is higher in people who have some medical issues, including:

• Celiac disease
• Inflammatory bowel disease
• Kidney or liver disease
• Cancer
• Multiple myeloma
• Rheumatoid arthritis

Osteoporosis: Modifiable risk factors

Let’s take a look at some modifiable risk factors. We begin with this observation — osteoporosis is more common among individuals who have too much (or too little) of certain hormones.

For example, lower levels of sex hormones can cause weaker bones. With a drop in estrogen levels at menopause, the risk of osteoporosis rises among women. Some treatments for breast cancer (aromatase inhibitor pills) and prostate cancer can lead to more bone loss.

Making high thyroid hormone levels can accelerate bone loss. In addition, overactive parathyroid or adrenal glands lead to a higher chance of getting significant bone loss.

Some medicines, such as long-term steroids (for example, prednisone), can lift your chances of getting osteoporosis. Finally, smoking and heavy drinking — don’t do it.

Bone loss and men

I don’t think about osteoporosis when I think about my health. I don’t have any factors that put me at high risk. But am I being too casual about it? A new study reminds us that men get osteoporosis too.

Here are the new study findings:

Men with high body fat levels have lower bone density and appear more likely to experience a bone fracture than those with normal body fat levels.

Researchers from the University of Chicago Medicine (USA) analyzed bone mineral density and body composition of nearly 11,000 individuals under 60 years.

Listen to study author Rajesh K. Jain, M.D.: “We found that higher fat mass was related to lower bone density, and these trends were stronger in men than women. Our research suggests that the effect of body weight depends on a person’s makeup of lean and fat mass and that high body weight alone is not a guarantee against osteoporosis.”

Full disclosure: The study authors report receiving no external funding.

Dr. Jain wonders if we health care providers should consider osteoporosis screening for those with high body weight, also taking into account other risk factors.

So what can we do to try to reduce our risk of osteoporosis?

Osteoporosis — How can you reduce bone loss risk?

I often talk about aerobic-type exercise. But we probably should focus as well on bone-strengthening activities. Webmd suggests these weight-bearing activities:

• Aerobics
• Stair climbing
• Dancing
• Jogging
• Tennis and other racket sports
• Running
• Tai chi
• Walking
• Water aerobics
• Yoga

I do various weight-bearing and strength-training sessions for most days of the week, aiming for 30 to 40 minutes.

But strength training is more than these formal activities. We build bone and muscle when we do activities such as lifting bags of groceries or small children.

Some benefit from lifting weights, but I find bodyweight movements more appealing as I age. I prefer pushups to bench presses and have recently begun using elastic resistance bands.

Vitamin D and calcium

Vitamin D and calcium promote bone density. We can generally absorb the calcium we need from our diet with vitamin D. Consider some sun — to make reasonable vitamin D levels, we need to get some sun on most days of the week. Of course, remember the recommendations for sun exposure and skin cancer risk reduction.

While you won’t get a lot of vitamin D from food, some options in the dietary realm include liver (a hard pass for this writer), fatty fish such as salmon or mackerel, eggs, or foods fortified with vitamin D.

Can we get enough vitamin D through food? Ask a knowledgeable health care provider if you might benefit from vitamin D supplements.

According to WebMD folks, most adults should get about 1,000 milligrams of calcium daily. But if you’re a male over 70 or a female over 50, you should aim for 1,200 milligrams.

Good sources of calcium include:

• Low-fat dairy products
• Dark green leafy vegetables
• Canned salmon or sardines with bones
• Soy products, such as tofu
• Calcium-fortified cereals and orange juice

If you take supplements, please be careful — too much can lead to kidney stones, poor muscle tone, constipation, and other problems.

The National Academies of Sciences, Engineering, and Medicine recommends that total calcium intake from supplements and diet combined be no more than 2,000 milligrams daily for people older than 50.

Other osteoporosis avoidance strategies include avoiding smoking, drinking alcohol in moderation (if at all), and dodging excess caffeine.

That’s it for today. Thank you for joining me. I hope you have a joy-filled day. As for me, there is little vitamin D coming from that orb in the sky on this cloudy Seattle day.

[The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you seek medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.]

The post Is Bone Loss a Male Problem, Too? appeared first on Medika Life.

This statement is the provocative observation of Dr. Jyrki Virtanen, a co-principal investigator of a recent study examining the effects of vitamin D supplementation in Finland.

Do you supplement with vitamin D? Today, we examine the evidence, focusing on a new randomized trial examining the effects of two doses of supplementation with the sun vitamin.

“Keep your face to the sun, and you will never see the shadows.”
― Helen Keller

Why do we need vitamin D?

We need vitamin D to absorb calcium and promote bone growth. Deficient levels can lead to soft bones in children, a condition known as rickets. In adults, insufficient amounts of vitamin D can cause fragile and misshapen bones or osteomalacia.

Did you know that vitamin D deficiency has been associated with depression, cardiovascular problems, and weight gain? Or that vitamin D deficiency has been associated with several cancers, including of the breast, colon, and prostate?What You Need to Know About Vitamin D and CancerDISAPPOINTMENT IS USUALLY associated with studies examining the use of supplemental vitamins or minerals to decrease…medium.com

To be clear, while people with higher vitamin D levels have a lower probability of these conditions, we have no proof that lack of vitamin D causes disease.

Moreover, we have no high-level evidence that vitamin D supplementation helps with most health-related problems I have cited, provided one does not have exceedingly low levels.

Vitamin D, heart disease, and cancer

There is abundant evidence (such as observational studies) that vitamin D deficiency is associated with nearly all major chronic diseases and mortality. But what about causality? We have little evidence from randomized clinical trials that improving vitamin D levels with supplementation reduces disease risk.

In this context, let’s turn to the Finnish Vitamin D Trial, a clinical study that explored the relationship between vitamin D, cancer, and cardiovascular disease. This randomized clinical trial ran from 2012 through 2018.

Here are the findings, published online January 4 in the American Journal of Clinical Nutrition. Note that most subjects had sufficient vitamin D levels at baseline and thus received higher than recommended doses of vitamin D during the study.

The researchers analyzed data from 2,495 individuals. They included males 60 years or older and postmenopausal females, ages 65 or older. None had a history of cancer or cardiovascular disease.

The subjects took a placebo, vitamin D 1,600 international units (IU) daily, or 3,200 IU daily.

The subjects completed annual study questionnaires, and the researchers also had access to national registry data. A representative subgroup of 551 participants did in-depth, in-person interviews.

Fot this subgroup, the average vitamin D concentration was 75 nmol/L (30 ng/mL) at baseline; 91 percent had levels under 50 nmol/L (20 ng/mL) and 50 percent had concentrations of at lease 75 nmol/L (30 ng/mL).

Vitamin D — No cancer or cardiovascular upside

The results?

Compared with the placebo, neither dose of vitamin D reduced the incidence of cancer or cardiovascular disease.

Study co-lead investigator Dr. Virtanen adds color to the results, exclaiming that “It is likely that vitamin D supplementation does not provide major health benefits, especially in populations where the vitamin D situation is already good at the start of the trial.”

These high initial levels are likely the product of implementing policies to fortify foods with vitamin D in Finland, which began in 2003–2011.

Those who might benefit from vitamin D Supplementation — that is, those with low vitamin D levels — were a small proportion of the study population.

Is there no good news from the study? The study did offer this: The study group had lower cancer, and cardiovascular disease incidences than the national statistics gathered before national vitamin D fortification began.

Vitamin D, heart disease, and cancer — My take

The researchers used two vitamin D doses to find a dose-response effect over five years. Despite relatively large doses, vitamin D supplementation did not lower the incidence of cancer or cardiovascular disease.

Supplementation may benefit those who live at northern latitudes (or spend little time outdoors), where we cannot make much vitamin D from sunlight. I would love to see a randomized trial including only those with low levels of vitamin D. I would like to see a much more extended follow-up period in an ethnically diverse population.

In the future, the researchers look forward to publishing other results from the Finnish Vitamin D Trial, for example, effects on heart arrhythmias, type 2 diabetes, falls and fractures, infections, pain, and mood changes.

Thank you for joining me today.

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