5 replies to this topic

[maineman]

http://www.nytimes.c...xprod=permalink



Try this link. If it doesn't work, go to the Tuesday NY TImes Science section for this article by Jane Brody (the health editor):

To Avoid 'Boomeritis,' Exercise, Exercise, Exercise

[stocks]

http://www.nytimes.c...xprod=permalink



Try this link. If it doesn't work, go to the Tuesday NY TImes Science section for this article by Jane Brody (the health editor):

To Avoid 'Boomeritis,' Exercise, Exercise, Exercise

MM,
The article says "Vitamin supplements are crucial, because adequate amounts of vitamin D cannot be absorbed through diet and sunshine alone."

How do you reconcile this with your statement "There are NO supplements that have been shown, in spite of excellent research, to do much good. "

[maineman]

http://www.nytimes.c...xprod=permalink



Try this link. If it doesn't work, go to the Tuesday NY TImes Science section for this article by Jane Brody (the health editor):

To Avoid 'Boomeritis,' Exercise, Exercise, Exercise

MM,
The article says "Vitamin supplements are crucial, because adequate amounts of vitamin D cannot be absorbed through diet and sunshine alone."

How do you reconcile this with your statement "There are NO supplements that have been shown, in spite of excellent research, to do much good. "

I was hoping someone would notice that and bring it up. Thanks. The conclusion you reference is from the authors and appears in Jane Brody's NY Times article. No references are given. You can see how opinionated even well-intentioned work is.



As for the issue of Vitamin D, there was a series of superb articles earlier this year in the New England Journal that tried to hone in on the risk/reward aspect of supplements. In one study that recruited 37,000 post menopausal women aged 50 to 80 years old and gave vitamin d and calcium supplements over 7 years they found Among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hip bone density, did not significantly reduce hip fracture, and increased the risk of kidney stones. I assume the authors of the Jane Brody book have not read this study yet.



In another study the group looked a nearly 37,000 adults and gave them vitamin d over many years to assess the potential to reduce the incidence of colorectal cancer and found no benefit.



And we have others. The current level of research on vitamins is intense and very exciting.



FWIW, the professional view, based on superb clinical research, currently stands as follows:



Given the greater likelihood of benefit versus harm and considering the low cost, we conclude that a multivitamin that does not exceed the RDA makes sense for most people. HOwever we believe that a vitamin pill is no substitute for a healthy lifestyle and diet. Healthy food contains far more important ingredients than can be obtained in a supplement (e.g. fiber, fatty acids, proteins, etc). In addition, we teach that a vitamin supplement cannot begin to compensate for the massive risks associated with smoking, obesity, or inactivity.



*source for our professional view comes from : The Departments of Nutrition and Epidemiology, Harvard School of Public Health, and the Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital.



i hope this helps.



mm

[stocks]

As for the issue of Vitamin D, there was a series of superb articles earlier this year in the New England Journal that tried to hone in on the risk/reward aspect of supplements. In one study that recruited 37,000 post menopausal women aged 50 to 80 years old and gave vitamin d and calcium supplements over 7 years they found Among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hip bone density, did not significantly reduce hip fracture, and increased the risk of kidney stones. I assume the authors of the Jane Brody book have not read this study yet.



mm

From an earlier post in the cancer thread:

Vitamin D Dosage and Cancer Chemoprevention

A new paper1 in the Journal of the National Cancer Institute performs an analysis of cancer risk in the Health Professionals Follow-Up Study of 51,529 male subjects and multiple sources of vitamin D (including sun exposure, dietary and supplemental vitamin D, skin pigmentation, adiposity (“Higher body mass index or obesity has usually been associated with substantially lower blood concentrations of 25(OH)D, probably as a result of decreased bioavailability of 25(OH)D because of its deposition in body fat compartments”1), geographic residence (lower sun exposure in northern latitudes), and leisure-time physical activity. The researchers updated nondietary vitamin D exposures every 2 years and dietary information every 4 years from 1986 to 2000.

They found that the absolute annual rate of total cancer was 758 per 100,000 men in the lowest decile (lowest 10%) of predicted vitamin D (estimated from analysis of the above factors) and 674 per 100,000 men in the highest decile. Cancer mortality was 326 per 100,000 in the lowest decile compared to 277 per 100,000 in the highest decile. Digestive-system cancer mortality was reduced from 128 to 78 per 100,000 in the lowest compared to the highest decile. An increment of 25 nmol/L of vitamin D was associated with a 17% reduction in total cancer incidence and a 29% reduction in total cancer mortality, as well as a 45% reduction in digestive-system cancer mortality.

The authors conclude that “Low levels of vitamin D may be associated with increased cancer incidence and mortality in men, particularly for digestive-system cancers. The vitamin D supplementation necessary to achieve a 25(OH)D increment of 25 nmol/L may be at least 1500 IU/day.” [Emphasis added]

In the editorial accompanying the above paper,2 the authors state that “… the present recommended allowance for vitamin D—400 IU—for individuals aged 50–70 years is inadequate even to maintain skeletal health and is probably too low for meaningful anticancer effects. A dose of 400 IU of vitamin D3 will raise serum levels of 25(OH)D3 only modestly, by about 7 nmol/L or less than 3 ng/mL. The use of this low dose, in conjunction with the relatively short duration of the trial, may explain the recent failure of vitamin D to reduce the incidence of colorectal cancer in the Women’s Health Initiative.”

References

1. Giovannucci et al. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst 98(7):451-9 (2006).
2. Schwartz and Blot. Vitamin D status and cancer incidence and mortality: something new under the sun. J Natl Cancer Inst 98(7):428-9 (2006).

I don't know if the "Women's Health Initiative" is the study you refer to.

[maineman]

You are right on top of things. Okay... you see the dilema facing a physician with integrity. Let's say you are faced with 2 excellent studies that suggest some extra vitamin d might strengthen your bone density (as measured by a bone density x-ray), but does NOT actually prevent your bones from breaking and, does not prevent cancer of the colon. AND the extra doses of vit d and calcium resulted in many more kidney stones (ever have one ? REALLY painful). Then you see a study, just as good, that "may" show some benefit. Now, as a doctor, you step back and try to formulate a plan, based on our practice principle (our oath) of "FIrst do no harm". What are YOU going to reccomend to your patients? PS. don't forget that we are not treating life-threatening illness here, we are looking at long - term studies that are trying to fine tune what we already know - i.e. healthy diets and healthy life-styles and proper health maintenance (i.e. annual blood work, early detection for colon, breast prostate,blood pressure, cholesterol, etc) are all currently standard of care. When one is faced with life threatening illness/risk of course we explore all options at the time. mm

[stocks]

Now, as a doctor, you step back and try to formulate a plan, based on our practice principle (our oath)

of "FIrst do no harm".


What are YOU going to reccomend to your patients?


mm

Yes, doctors should not experiment with their patients and doctors can be sued.
Individuals should be able to make their own health choices (if the FDA will let them),
with doctors being one important resource.