Search results for vitamin d

Calcium, vitamin D and heart disease. What’s the 4-11?

Posted by on May 2, 2011 in bone health, heart disease | 5 comments

“Calcium supplements cause heart attacks in postmenopausal women.”

Whoa! What?!

If you saw the headlines last week, you may be wondering what’s up with calcium supplementation. Afterall, don’t medical professionals advise the use of supplements to stave off bone loss associated with osteoporosis? And as a result, the Centers for Disease Control reports that over 50% of adults currently use calcium supplements and more than 60% of women over age 60.

It’s important to get away from the sensational headline and take a closer look at what the research shows and what you need to know.

Previous studies have suggested that there may be a link between use of calcium supplements (without vitamin D) and heart attack; in fact, as Reuters‘ reported last year, calcium supplements were shown to increase the risk of heart attack by as much as 31%, possibly as a result of plaque formation in blood vessels. However, is the risk the same if calcium is used alone versus if it is used in conjunction with vitamin D?  In the Women’s Health Initiative study, the use of calcium and vitamin D did not appear to influence heart disease risk at all.

However, researchers decided to take another look at the data because they say that in this trial, more than half of participants were taking ‘personal calcium’ (i.e. not regulated or standardized to all trial participants) and almost half were also adding Vitamin D.

In this reanalysis, published just last week in the British Medical Journal, the researchers discounted the women who were characterized as personal users of calcium supplements and instead, limited their evaluation to a group of women who were not using personal calcium supplements at the study’s start and previously unpublished data from the trial. The findings? The use of calcium with or without vitamin D appeared to cause a 25% to 30% increase in the risk for heart attack and a 15% to 20% increased risk for stroke. However, the researchers say that even small increases in the incidence in heart disease may manifest substantially, especially in the elderly. They add that if you take a look at the risk-benefit ratio, it is unfavourable, meaning that taking calcium with or without vitamin D for five years would cause twice as many heart attacks or strokes than then numbers of fractures that would be prevented.  Additionally, the data analysis suggests that dosing is not a factor, and that the total amount of calcium taken daily is less important than the abrupt changes in blood calcium levels immediately following supplementation.

Although this research answers a few questions about potential risks about calcium supplementation, it also leaves a key question unanswered:  how does the addition of magnesium and vitamin K, which are often included in commercially-available calcium supplements, affect these findings? Data suggest that these minerals and vitamins are added to keep calcium in the bones where it belongs and out the arteries where it does not.

The best guideline, as always, is to visit a physician to assess your bone health and come up with a plan that works specifically for you. Although calcium supplementation appears to be risky, more data are needed before leading organizations start to change their tune about calcium and bone health. Meanwhile, stay ahead of the headlines and try to focus on increasing the amount of calcium-rich foods in your diet:

Table 2: Selected Food Sources of Calcium [Source: National Institutes of Health]
Food Milligrams (mg)
per serving
Percent DV*
Yogurt, plain, low fat, 8 ounces 415 42
Sardines, canned in oil, with bones, 3 ounces 324 32
Cheddar cheese, 1.5 ounces 306 31
Milk, nonfat, 8 ounces 302 30
Milk, reduced-fat (2% milk fat), 8 ounces 297 30
Milk, lactose-reduced, 8 ounces** 285–302 29–30
Milk, whole (3.25% milk fat), 8 ounces 291 29
Milk, buttermilk, 8 ounces 285 29
Mozzarella, part skim, 1.5 ounces 275 28
Yogurt, fruit, low fat, 8 ounces 245–384 25–38
Orange juice, calcium-fortified, 6 ounces 200–260 20–26
Tofu, firm, made with calcium sulfate, ½ cup*** 204 20
Salmon, pink, canned, solids with bone, 3 ounces 181 18
Pudding, chocolate, instant, made with 2% milk, ½ cup 153 15
Cottage cheese, 1% milk fat, 1 cup unpacked 138 14
Tofu, soft, made with calcium sulfate, ½ cup*** 138 14
Spinach, cooked, ½ cup 120 12
Ready-to-eat cereal, calcium-fortified, 1 cup 100–1,000 10–100
Instant breakfast drink, various flavors and brands, powder prepared with water, 8 ounces 105–250 10–25
Frozen yogurt, vanilla, soft serve, ½ cup 103 10
Turnip greens, boiled, ½ cup 99 10
Kale, cooked, 1 cup 94 9
Kale, raw, 1 cup 90 9
Ice cream, vanilla, ½ cup 85 8.5
Soy beverage, calcium-fortified, 8 ounces 80–500 8–50
Chinese cabbage, raw, 1 cup 74 7
Tortilla, corn, ready-to-bake/fry, 1 medium 42 4
Tortilla, flour, ready-to-bake/fry, one 6″ diameter 37 4
Sour cream, reduced fat, cultured, 2 tablespoons 32 3
Bread, white, 1 ounce 31 3
Broccoli, raw, ½ cup 21 2
Bread, whole-wheat, 1 slice 20 2
Cheese, cream, regular, 1 tablespoon 12 1

* DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration to help consumers compare the nutrient contents among products within the context of a total daily diet. The DV for calcium is 1,000 mg for adults and children aged 4 years and older. Foods providing 20% of more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet. The U.S. Department of Agriculture’s Nutrient Database Web site lists the nutrient content of many foods. It also provides a comprehensive list of foods containing calcium.
** Calcium content varies slightly by fat content; the more fat, the less calcium the food contains.
*** Calcium content is for tofu processed with a calcium salt. Tofu processed with other salts does not provide significant amounts of calcium.

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A new equation for midlife: calcium+vitamin D+physical activity+better eating =

Posted by on Jan 16, 2009 in health, general, weight | 1 comment

Weight gain. Data abound that show that women between the ages of 50 and 79 experience age-related changes in body composition, metabolism, and hormones, often accompanied by a decline in physical activity. This leads to a propensity for fat and weight gain.

Okay, so that’s the not-so-good news.

The good news is that daily calcium (1000 mg) plus 400 IU of vitamin D may have a small effect on the risk of weight gain. Even better, coupled with other dietary and lifestyle changes (nutrition counseling, physical activity), weight gain may be a thing of the past, or at least, something that is a lot more controllable than we think!

In one study, 36,282 women who were already participating in the Women’s Health Initiative trial and undergoing dietary modification or hormone replacement therapy were assigned to 1000 mg calcium plus 400 IU vitamin D or placebo daily. Weight and height were measured annually for seven years.

Study results, which were published in the May 2007 edition of Archives of Internal Medicine, suggest that women taking daily calcium plus vitamin D supplementation were 11% less likely to experience  modest weight gain (2 to 6 pounds) and also 11% less likely to gain more than 6 pounds. Interestingly, a reduced risk was seen in women who were ingesting less than 1,200 mg calcium daily, which is the recommended daily amount (RDA) by the Food and Nutrition Board of the National Academy of Sciences. Notably, the researchers do caution that the findings do not alter the RDA and that women should still aim for the 1,200 mg daily RDA of calcium.

In a second, more recent study published in the online edition of  Maturitas, 101 postmenopausal women were assigned to dietary intervention (1200 mg calcium plus .75 mc vitamin D plus fortified dairy products daily), 1200 calcium daily or placebo. Women in the dietary intervention also attended biweekly dietary and lifestyle intervention sessions.

Similar to results of the first study, women receiving dietary interventions had significantly lower increases in skin thickness measures and experience declines in fat mass compared to the other two groups.

In concert, these results suggest that daily intake of calcium plus vitamin D, coupled with dietary restrictions and physical activity, may help to stave off the extra pounds in midlife. As with any regimen, it is essential to discuss a new regimen with your healthcare practitioner before taking the leap.

I’ve written previously about the value of calcium, dietary restrictions and physical activity to overall health, preventing osteoporosis and heart disease, and lowering the risk of weight gain. The addition of vitamin D appears to make the equation even more effective.

Although there have been many articles written of late that tout the benefits of vitamin D, like anything, it’s not the panacea for all that ails. Good health starts with thoughtful, well-informed choices. But it’s inspiring to know that there are positive steps you can take to feel good and look even better!

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Newsflash…Before you ‘D’ know the facts. New recommendations from EMAS.

Posted by on Dec 16, 2011 in bone health, diet | 0 comments

Vitamin D. Lately it’s been touted as the cure-all for all that ails. From bone health and diabetes, to cancer and infections, vitamin D is the go-to supplement. But, do you really need it? And how much should you be taking on a daily basis?

Vitamin D levels are reportedly low in women undergoing menopause and because it is necessary to maintain bone health, there is no question that it’s in great demand by our bodies. This is especially true of fair skinned individuals, women, and people who live at higher altitudes. In fact, research shows that a number of factors can influence how the body synthesizes or produces Vitamin D, including altitude, time of year (e.g. winter) time of day, amount of exposed skin at any given time, skin pigmentation, extensive use of sun protection (i.e. sunscreen, protective clothing, shade) and air pollution). However, the more news that comes out about vitamin D, the more confusion abounds as to its true benefits and how much you should be taking.

Some of that much needed detail is provided in a recent statement issued by the European Menopause and Andropause Society. Rather that put you to sleep with all the details, here a few highlights that sets current knowledge about vitamin D on the correct path:

  • Although there have been a ton of studies on vitamin D, linking it to outcomes and risks and benefits in a variety of conditions, evidence for its benefit is strongest in terms of bone/skeletal health.
  • Osteoporosis is very common in postmenopausal women leading to increased fracture risk. It appears that adequate levels of vitamin D may help preserve bone structure and contribute to the function of muscles. In studies, women with the lowest vitamin D blood levels were shown to have the highest fracture risk.
  • Healthy postmenopausal women can insure that their body’s levels of vitamin D are optimized by exposing skin to the sun, 15 minutes at a time at least three to four times a week during Spring, Summer and Fall. This does not include artificial UV exposure from tanning booths.
  • Experts recommend that women supplement sun exposure with no more than 800 to 1,000 IU of vitamin D supplements a day.
  • If you are someone at risk for low vitamin D levels, you should see your doctor or health care practitioner for screening to achieve optimal vitamin D levels.
  • Women who are obese, have conditions that prevent proper absorption of nutrients (for example, HIV or chronic diarrhea) or have liver or kidney issues need to have tailored vitamin D recommendations.

And the news about over supplementation and toxicity? First of all, you can never get vitamin D toxicity through sunlight (although as we know, too much sun can lead to other problems, like skin cancer). And, toxicity issues have been linked to dosages above 50,000 IU over several months time. Last, women with cancer are likely to convert vitamin D in the body faster, so need lower levels. Again, this calls for monitoring by a health practitioner.

Overall, before you ‘D.’ know the facts. These recommendations are a great start.


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GUYSIDE: salty talk about your diet

Posted by on Dec 3, 2014 in aging, diet, Guyside, heart disease, men, stroke, weight | 2 comments

I’ve been keeping an eye on my blood pressure these days. With a family history of hypertension, it just makes sense. And so far, my results are good. A while ago, I stopped at a local pharmacy and used their automated machine and saw a couple of readings heading into the high range. But more accurate readings have put it further down in the normal range, so that’s good.

But when I looked at my profile for hypertension risk factors, I was struck that there wasn’t a great deal I could do. The major risk factors for hypertension, according to the Mayo Clinic, are:

  • Age. (Hypertension is more common in men around 45 or so, and becomes more common in women around 65)
  • Race. (High blood pressure is particularly common among blacks)
  • Family history.
  • Being overweight or obese.
  • Not being physically active.
  • Using tobacco.
  • Too much salt (sodium) in your diet.
  • Too little potassium in your diet.
  • Too little vitamin D in your diet.
  • Drinking too much alcohol.
  • Stress.

I do pretty well on most of these. But of the ones I can control, the one about sodium sticks out. As a man and a lover of food that I KNOW is bad for me, I know that I can be the author of my own hypertensive misfortune. Burgers, fries, onion rings, chicken wings — it would be foolish to pretend they don’t have a lot of sodium in there. But there are a ton of foods  out there that you wouldn’t expect to have  high sodium levels.

We often have pizzas on naan bread for a quick and easy weekday meal. On top, prosciutto, pears, brie, and basil. I knew the prosciutto would be high in sodium — after all, it’s a cured meat. But the naan bread itself has a surprising amount of sodium. Between those two ingredients, one naan pizza is likely delivering more than half my daily allowance of sodium.

Chicken breasts can be injected with brine during processing, increasing their sodium content drastically. A slice of process cheese might have 20% of your daily allowance of sodium!

If you have french fries, you expect them to be salty. But if you add a tablespoon or two of ketchup, you’re looking at 400 mg of sodium just in that!

And none of this counts restaurant or takeout food, which can be extremely high in sodium. You can see just how easy it would be to  end up with more than your roughly 2,500 mg of sodium per day:

  • 350 mg: a bowl of Raisin Bran.
  • 870 mg: a bagel and cream cheese
  • 1220 mg breakfast  
  • 1600 mg: 100 grams of deli ham on white bread with mustard.
  • 1600 mg lunch 
  • 393 mg: baked chicken breast
  • 418 mg: baked potato
  • 460 mg: cup of canned peas
  • 1271 mg supper 
  • 744 mg: 1/2 cup of salsa
  • 420 mg: 24 tortilla chips
  • 1164 mg snack

That’s a whopping 5255 mg of sodium, more than twice the recommended amount in a day, without a single shake of your salt shaker, without eating out, and with lots of things that seem healthy at first glance. (Sodium figures from the Fat Secret website)

You can’t change your age, your race, or your family history of hypertension. But if you start to track things like sodium, you do see where you can help prevent hypertension, or if you have it, improve it without resorting to drugs. And that’s a good thing.

(Pretzel photo is a CC-licenced image from Flickr user Jenn Durfey)

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Fracture me this: is it time to up your D quotient?

Posted by on Sep 29, 2014 in bone health | 0 comments

Depositphotos_2650818_xsToo much D is too much of a good thing, isn’t it? But now, data presented a few weeks ago at the American Society of Bone and Mineral annual meeting is turning recommendations on their head, once again. (If you wish to check the evolving data on Vitamin D, take a look at the Flashfree archives here.) The latest conclusion? If you are in menopause, you need to start maintaining high vitamin D levels >20 ng/mL (500 IU) daily to reduce your risk of fracture.

As I’ve discussed throughout the years, bone loss increases significantly as levels of estrogen and FSH fluctuate and eventually decline.  Moreover, these changes can start as early as age 35 and by the time women reach the age of 50, they have a 40% risk of suffering a fracture due to osteoporosis during the rest of their lifetime. However, in this particular study, which evaluated the role of serum vitamin D in fractures related to falls from standing height or less in women participating in the Study of Women’s Health Across the Nation (SWAN), higher levels of vitamin D were associated with as much as a 45% lower non-traumatic fracture risk compared to levels below the 500 IU daily mark. Additionally, even after the researchers accounted for potential confounding factors, such as the women’s bone mass density and body mass index (BMI), these findings remained. Another important point about this study is that previously, most of the evaluations have been conducted in post menopausal women; this particular group of women were undergoing the menopausal transition. The findings also did not demonstrate any association between vitamin D intake and fractures resulting from traumatic events, such as playing sports or a car accident).

The researchers point out that the underlying role of vitamin D may be its affect on bone quality, adding that they did not set out to measure that so no firm conclusions can be drawn. They also note that they did not see any benefit to upping vitamin D intake between five and one years prior to final menstrual period, meaning that this strategy should be incorporated early on during the pre-menopausal or peri-menopausal years (women between the ages of about 35 to 51, I am talking to you!!!!). Finally, no mention was made of the other risks of high vitamin D intake, such as cardiovascular issues so before you head to your local drugstore, do speak with your health practitioner.

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