Vitamin D and osteoporosis

bigstock-Vitamin-D-Written-In-The-Sand-38126068See the latest headlines that vitamin D supplementation doesn’t reduce hip fracture and osteoporosis risk? If you saw it, or herd it, just ignore it, otherwise you could suffer.  This is another example of researchers using selective criteria in a meta analysis to get the results they want. In this case they ignored the science of bone health and selected only one nutrient, vitamin-D, to study.

When they looked at vitamin D supplementation alone, there wasn’t much of reduction in osteoporosis. but when you look at vitamin D and Calcium together there was a 14% reduction. Had they looked at all the vitamins and minerals necessary for bone growth and remineralization, calcium, magnesium, vitamin D, vitamin K, boron, and selenium, then there would have been a very positive result.  Vitamin D is necessary and must be present for calcium to be absorbed into the bone matrix, but calcium and the other vitamins and minerals listed must also be present. A deficiency in any listed above will hamper calcium absorption.

Many studies you see regarding various vitamins and minerals tend to look at just one vitamin or mineral to measure its impact and treat it like they are studying a drug. Vitamins, minerals, and trace elements all work together to support your bodies biological functions, they don’t work in isolation.

When you see mention of a meta analysis be especially wary. A meta analysis is not a new research study. In a meta analysis they look at multiple existing studies and attempt to draw a conclusion from those. In selecting studies to include in the meta analysis they have selection criteria, in this case studies involving vitamin D and osteoporosis.  What that did was exclude studies which looked at vitamin D and calcium, or vitamin D, calcium, magnesium, vitamin K, boron, and silicon. Had they found studies with the latter combination of nutrients the results would have been much different.

So why would a researcher not look at other studies? To answer that you usually have to look at who funded the study. Often pharmaceutical drug companies will fund such studies to discredit natural alternatives vs. their high profit drugs, and there have been studies showing that who funded the study has a very good likelihood that the researcher will find results favorable to who is paying the bill.  I couldn’t find the source of the funding for this study, but my guess they had an interest in promoting high cost drugs vs inexpensive supplements.

The Institute of Medicine recommends dietary intake for adults of 600-800 IU of vitamin D and 1000-1300 mg of calcium daily, and the 2010 Dietary Guidelines for Americans identifies supplements containing combinations of certain nutrients such as calcium and vitamin D as useful in postmenopausal women who have low levels of these nutrients in their diets to reduce the risk of osteoporosis. In addition, the Food and Drug Administration has an approved health claim for calcium, vitamin D and osteoporosis.

Osteoporosis-related fractures in the U.S. cost an estimated $14 billion in 2012. They also place tremendous financial, mental and physical burdens on the individual. A new economic report from Frost and Sullivan found that over $12 billion in cumulative osteoporosis-attributed cost savings is potentially realizable, between 2013 and 2020, if U.S. women over the age of 55 diagnosed with osteoporosis were to use calcium and vitamin D dietary supplements at what the report identified as preventive intake levels. The daily cost per person in the targeted population to supplement would be $.16—not ‘expensive’ compared to the costs one, or the overall system, would incur if appropriate levels of vitamin D were not met. Supplementation is smart prevention.

Source: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61647-5/abstract

Strontium for Bone Health, Does it work?

I had a dear friend ask about taking strontium to increase her bone strength. Below I’ll briefly discuss what strontium is what it can do, and other alternatives to maintaining or rebuilding bone strength.

  • First what is strontium? Strontium is a mineral which is very similar to calcium. If you remember back to your high school chemistry class, look at the Periodic Table of the Elements you’ll see it just below calcium (2nd column from the left) with the symbol Sr. Being further down on table, it is a heavier molecule. Being in the same column as Calcium, it has some similar chemical properties which lets it mimic calcium to some degree.
  • What can it do? Strontium in the form of strontium ranelate is used in Europe as a prescription drug to help treat osteoporosis. It both helps aid in mineral uptake by the bone matrix and also reduced the reabsorption of calcium out of the bones. Since strontium is a heavier molecule that calcium it can cause your bones to appear more dense on bone scans, but the bones may not be any stronger. So if you are in Europe and using stronium ranelate, let your doctor know so he/she can adjust the bone scan.
  • Can I get strontium ranelate in the US? No. strontium ranelate is not available in the US and is not approved by the US FDA.  You will find supplements advertising they are strontium for bone health, but looking closely all that I have found contained strontium carbonate, citrate, and other salts, which have no published research to support their effectiveness and may not provide any benefit aside from taking your money.  One website advertised in big letters that they had strontium ranelate, but looking at the actual label on the bottle it had strontium citrate. All the FDA looks at is what is listed on the Supplement Fact Panel, they don’t care what is elsewhere on the label.

OK, so if you are in the US, chances are very slim you’ll find any strontium ranelate, so what else can you do? Lets look at what it takes to get calcium into your bones: 


In order to move calcium into your bones you obviously need a adequate supply of calcium, but in addition you must also have magnesium, vitamin D3, vitamin K, boron, and silicon. The boron and silicon must be in the chelated forms, which means they are bound to an organic compound (names may be like boron citrate). If it is the inorganic form, like silicone oxide, then you won’t absorb it.

If you are lacking in any of the above ingredients, or they are in the wrong proportions, you won’t absorb calcium into your bones.  Most of the calcium supplements on the market contain only calcium, or maybe calcium and vitamin D. Like your milk, it is a great source of calcium and much of the milk is fortified with vitamin D. But without the others, you’ll lose bone mass, especially, if you are a post menopausal women.

My recommendation: Take a high quality supplement that has all of the above ingredients in the correct proportions and from a quality company who follows strict pharmaceutical manufacturing practices to insure that what is on the label is actually in the bottle. Give this six months and I’m sure you’ll be very pleased with the results.

The supplement I use and recommend has the following ingredients (serving size is 4 tablets day):

  • Calcium Citrate & Calcium Carbonate             800 mg
  • Magnesium Citrate, chelate, & oxide                400 mg
  • Boron Citrate                                                            1.32 mg
  • Silicone Chelate                                                       9 mg
  • Vitamin D3                                                            400 iu
  • Vitamin K                                                                 60 mcg


Is Calcium Really Dangerous Like We’ve Seen on the News?

There have been several news reports and studies lately saying that calcium supplements lead to an increase in heart disease and that even calcium plus low dose vitamin D leads to an increase in heart disease. In addition they claimed it showed no, or minimal improvement in osteoporosis.   Most are relying on a study published online May 23rd in the journal Heart.

I saw one report in a daily email targeted to doctors that prescribing calcium and vitamin D doesn’t help osteoporosis and leads to increased heart disease, so they are better off to make sure their patients aren’t taking them and they should stay on their prescription drugs for osteoporosis.

So with these kinds of headlines, is it safe to take Calcium and or Vitamin D supplements?  Yes it is, but you need to take a critical look at these studies and understand the basis of how calcium is used in our bodies.

First, Calcium alone can lead to the problems above due to the calcification of soft tissues, like hardening of the arteries and atherosclerotic plaque. What these studies failed to do was provide adequate amounts of magnesium along with calcium. When you eat a well balanced diet you are receiving both calcium and magnesium, unfortunately according to the USDA 57% of americans suffer from inadequate magnesium. Magnesium is a key ingredient to reduce the risk of heart disease because it is a calcium channel blocker.

Second these studies omitted adding vitamin K to the supplements. Studies have shown numerous times that we receive far too little vitamin K in our diets and that once vitamin K levels are raised that there is a 57% reduction from dying from cardiovascular disease  and most of those with blocked arteries and heart valve damage show low vitamin K status.  Furthermore, women taking vitamin K have reduced fractures by 81%.  So vitamin K both helps increase circulatory health and reduces fractures.

So these studies which have looked at just calcium or calcium and vitamin D omitted two other key nutrients which would have completely reversed the outcome of the studies – Magnesium and Vitamin K.

Now if we look beyond just cardiovascular health and also look at skeletal health and avoidance of osteoporosis, which is why most people take calcium in the first place, then three other nutrients are critical to enable your body to move calcium into the bone matrix:

  • Vitamin D – Vitamin D, the new wonder nutrient, enhances calcium absorption in the small intestine and calcium utilization in bone formation. Vitamin D also influences the utilization of phosphorus, another mineral that is important for strong bones.
  • Silicon – This gives stability to all the connective tissues of the body and is essential for proper calcium utilization. Silicone is key to the calcium mineralization of the bone matrix.
  • Boron – Boron reduces calcium excretion and increases the deposition of calcium in the bone.
So if you’re taking calcium supplement for bone health, make sure it also has magnesium, vitamin K, vitamin D, silicon, and boron. The omission of any of these key nutrients will reduce the effectiveness in the prevention of osteoporosis.
The proportions of these nutrients in your supplement and diet are also important. Ideally the amount of calcium should be twice the amount of magnesium. In the the case of the supplement we use and recommend, it has 800 mg of calcium and 400 mg of magnesium  per serving. (proper dosage is 2 servings per day, so twice the above amounts.)
As always just because the label says it has certain amounts of certain nutrients isn’t necessarily a guarantee that it does. ConsumerLabs has found far too often that supplements are lacking in stated nutrients and often, contain lead as well. Inexpensive super market, big box, and drug store brands often use minerals as found in the earth which brings along lead and other undesirable elements.  High quality supplement will use primarily chelated minerals. That means they are bound to organic amino acids, just like they are when you obtain them from fruits and vegetables.

Vitamin D and the Reduced Risk of Many Diseases

Vitamin D and the Reduced Risk of Many Diseases
Vitamin D deficiency is associated with osteoporosis, bone fracture, muscle weakness, cancers (particularly breast and colon), autoimmune diseases, obesity, diabetes, schizophrenia, depression, asthma, lung dysfunction, influenza, kidney disease, and high blood pressure, and cardiovascular disease. During pregnancy and infancy vitamin D insufficiency is also associated with preeclampsia (pregnancy-induced hypertension), low birth weight, neonatal hypocalcemia (low blood calcium), poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases and childhood asthma.
There is no debate in the medical community that there is a vitamin D deficiency epidemic that is causing a myriad of problems, and that people need to be supplementing with much higher doses than the traditionally-recommended dose of 400 IU per day. It’s clear that optimal supplementation should be at least 2000 IU/day, if not 4000 IU/day or higher.

Osteoporosis
Vitamin D Helps Prevent Osteoporosis
For years, the recommended dose of vitamin D (400 IU/day) was to help strengthen bones and reduce falls and hip fractures. However, there has been an explosion of research (both retrospective and prospective controlled studies), particularly over the last 5 years advancing our understanding that the worldwide vitamin D deficiency epidemic has an effect on much more than bone development and maintenance.
Vitamin D May Help Prevent Insulin Resistance
Adult-Onset Diabetes begins with insulin resistance. It is known that vitamin D deficiency is a common cause of insulin resistance. Although not all studies have been consistent, the studies that have shown a reduction in insulin resistance revealed the association at blood serum vitamin D concentrations ( 25-hydroxvitamin D, or 25-OH-D) in the range of 35 – 42 ng/ml. 1, 2, 3
Vitamin D is Associated with Decreased Risk of Breast and Colon Cancer

Breast Cancer
Blood serum levels of vitamin D (25-OH-D) above 40 ng/ml are associated with a decreased risk of breast and colon cancer. Vitamin D appears to enter breast cancer cells and trigger apoptosis (programmed cell death), much like many antioxidants.
Pooled data from observational studies showed that women whose serum 25-OH-D levels were at least 52 ng/ml had a 50% associated decreased incidence of breast cancer. Certainly, prospective controlled studies are needed to provide further information, but given the safety of vitamin D and encouraging studies thus far there appears to be no reason for anyone to wait on supplementing with optimal doses now. 4, 5, 6, 7
Vitamin D and Reduced Risk of Heart Disease

Heart Disease
Although further studies are needed to determine the full extent of the protective nature of vitamin D against heart disease, it is apparent that vitamin D deficiency increases the risk of both ischemic and non-ischemic heart disease. Vitamin D may influence how heart muscle functions, helps control blood pressure, influences parathyroid hormone levels, and plays a role in reducing inflammation and calcification of blood vessels, thus reducing plaque formation.
When 25-hydroxy-vitamin D levels are below 15 ng/ml the risk for heart disease is particularly elevated. With 25-OH vitamin D levels above 30 ng/ml cardiac benefits may be substantial, and possibly even greater at the optimal serum range of 50 – 80 ng/ml. 8
Vitamin D and Reduced Risk of Influenza

Influenza Infection
Vitamin D reduces the incidence of respiratory infections. 9, 10 Children with the lowest levels of vitamin D are 11 times more likely to develop respiratory infections. 11 When 60,000 IU of vitamin D was given each week for six weeks to children susceptible to respiratory infections the children were completely free of all such infections over the following six months. 12
The influenza virus (the “flu”) causes damage and kills people by causing massive inflammation through uncontrolled over-production of pro-inflammatory cytokines. Vitamin D down-regulates the expression of pro-inflammatory cytokines (such as tumor necrosis factor-alpha). 13 This is the same destructive pro-inflammatory cytokine process that occurs as we age …leading to aging and chronic disease of all organs, vessels, joints, and neurons. 14 , 15
Much could be said about reducing the incidence and severity of influenza, let alone chronic disease, simply by down-regulating the excessive pro-inflammatory cytokine production with optimal supplementation of vitamin D, …in particular with other vitamins, minerals, and antioxidants. If this weren’t enough, vitamin D up-regulates the expression of anti-microbial peptides, (bits of proteins) in immune cells. Anti-microbial peptides damage influenza viruses, bacteria, and fungi (by damaging their outer lipid membranes), allowing the immune system to eliminate them from the body. 16
Vitamin D and Reduced Risk of Complications of Pregnancy

Pregnancy Complications
Vitamin D is essential and a key modulator of calcium metabolism in children and adults, to avoid rickets and osteomalcia, respectively. As the fetus grows during the third trimester calcium demands rapidly increase, and vitamin D requirements become crucial for proper skeletal growth and optimal maternal and fetal outcomes. As with the majority of the population, and despite prenatal vitamin supplementation, vitamin D deficiency is an epidemic among pregnant and lactating women. (As a result vitamin D deficiency is common, if not an epidemic, among breastfed infants as well.)
Adverse health outcomes such as preeclampsia, low birth weight, neonatal hypocalcemia, poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases have been linked to low vitamin D levels during pregnancy and infancy. 17, 18
Minimum adequate blood levels of vitamin D (25-OH-D) during pregnancy should be greater or equal to 32 ng/ml (and possibly closer to 50 ng/ml). In order to achieve and maintain 25-hydroxvitamin D serum levels at 32 – 50 ng/ml, pregnant and lactating women need to supplement with at least 2000 to 4000 IU/day of vitamin D3 per day, which is both safe and effective.
Childhood Asthma Linked to Vitamin D Deficiency.

Childhood Asthma
Vitamin D deficiency may partially explain the asthma epidemic. Recently, low serum vitamin D levels have been associated with higher risks for asthma exacerbations. Vitamin D plays a role in fetal lung growth and development. Epidemiologic studies have also suggested that higher prenatal vitamin D intakes have a protective role against wheezing illnesses in young children. Vitamin D may protect against wheezing illnesses through its multiple immune effects. In addition, vitamin D may play a therapeutic role in steroid resistant asthmatics. 19
Supplementing with vitamin D may help prevent asthma and the exacerbation of this disease, as well as help treat steroid resistance.
Measuring Your Vitamin D Status

25-OH Vitamin D Test
The only true way to know your vitamin D status, and therefore your proper daily dose, is with a blood test, in which the metabolically-active form of vitamin D, 25-hydroxvitamin D (25-OH-D, or calcidiol) is measured. Relatively recently (over the past 5 to 7 years) when vitamin D’s role in the prevention of degenerative diseases beyond prevention of osteoporosis was recognized, the medical experts recommended a minimum target blood level of 30 ng/ml of 25-hydroxyvitamin D. (I emphasize that “minimum target level” means just that, “minimum!” It does not mean “optimal.”) Therefore, the reference lab ranges was raised to 32 – 100 ng/ml. Most experts in the field of researching and treating vitamin D deficiencies have recommended that “optimal” serum 25-OH-D levels begin at 42 ng/ml, with the ideal target range being achieved between 50 – 80 ng/ml.
What Dose of Vitamin D is Optimal?
The vitamin D dose required to attain a serum level range of 50 – 80 ng/ml will vary from person to person, mostly based upon body mass (weight) and sun exposure. Although this will vary considerably, a 150 lb person who supplements with 2000 IU of vitamin D per day may attain blood level range of 25-OH-D between 30 and 45 ng/ml, depending upon sun exposure. To attain the optimal levels between 50 and 80 ng/ml that same person may need to supplement with 4000 IU per day or more.
On the other hand, a person who weighs 225 lbs. may require 10,000 IU/day to maintain 25-hydroxy vitamin D blood serum levels between 50 and 80 ng/ml. In all instances, the only way to accurately know the “true daily dosage” for a particular person would be to first estimate a starting vitamin D dose, get a serum 25-OH vitamin D test; adjust the dose accordingly, and get re-tested several weeks later.
Are High Doses of Vitamin D Safe?
What dose of vitamin D, or more accurately, what serum blood level, is required to prevent chronic disease and maintain optimal health AND not have toxic side effects? In other words, is long-term “high dose” vitamin D3 supplementation safe?
There is concern that high doses of vitamin D may elevate serum calcium levels and cause kidney stones in those at risk. To partially answer that question we can look at one study in which participants were administered extremely high doses of vitamin D. In a 12 week study, 69 vitamin D deficient patients received either a single oral, or a single intramuscular injection of 300,000 IU of vitamin D. During the 12 week study no cases of hypercalcemia (elevation of blood calcium) were observed. 20
There are no credible reports of vitamin D toxicity with chronic daily vitamin D3 supplementation up to 10,000 IU/day. Many vitamin D expert clinicians are routinely recommending doses well above 10,000 IU/day. Hypercalcemia (an elevated serum calcium level) is only observed with synthetic vitamin D analogues, such as calcitriol. 21
Are there Contraindications for High-Dose Vitamin D?
Primary hyperparathyroidism is the main contraindication. Also, high dose vitamin D supplementation may cause elevation of serum calcium levels in patients with sarcoidosis, tuberculosis, or lymphoma. Therefore, in such cases, patients dosing with levels above 2000 IU per day should do so only with caution AND under the care and direction of a physician.
One Last Word: Maintain Proper Ratios and Balance of Vitamins

Vitamin Ratio and Balance
Vitamin D is one powerful, important, and safe nutrient in which we all should be taking. However, it should be taken with a full balance, and proper spectrum and ratio of vitamins, minerals, essential fatty acids and other antioxidants for optimal health. One example of proper ratios and understanding of supplementation is the fact that supplementing with vitamin A can neutralize the beneficial effects of vitamin D. 22
Most people are aware that high levels of vitamin A can cause birth defects and harm the liver. However, most are not aware that vitamin A and vitamin D compete for each other’s function in the body. Supplementing with excess amounts of vitamin A can suppress the important cancer-fighting effects of vitamin D. 23, 24
Most multivitamin preparations contain vitamin A. Vitamin A (or pre-formed vitamin A) is different from pro-vitamin A, or beta-carotene. Beta-carotene does not interfere with vitamin D. Nor is beta-carotene associated with birth defects or liver problems.
Therefore, in choosing a quality, broad spectrum supplement brand, it is important to choose one that provides beta-carotene (a.k.a. “pro-vitamin A”), not vitamin A. This is just one of many criteria in choosing a quality supplement brand. As it relates to this article, choose a supplement that provides a daily dose of vitamin D3 of at least 2000 IU/day, and consider taking 4000 IU/day and having your blood tested to achieve the target range of 50 – 80 ng/ml.
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