Calcium, vitamin D, and coronaries
Vitamin D and depression in elderly
Dietary lignans lower breast cancer
Meat, fish and inflammatory bowel
Oral hygiene lowers heart disease
Alcohol may not help heart disease
Over the years, there has been some concern that vitamin D and calcium supplements might cause excessive deposits of calcium in tissues, including the coronary arteries. In the past, some of my colleagues have cautioned against taking too much vitamin D, defining that amount at a very low level. When I first started learning from these colleagues in 1983, I had been recommending 1000 to 2000 IU of vitamin D, but then reduced it to just 100 IU daily. It now appears that those concerns were inappropriate, and I have again been recommending higher doses.
New evidence shows that vitamin D and calcium supplements do not cause coronary arterial calcification. Although the dose of vitamin D that was studied was only 400 IU daily, this is a level that had been of some concern to the medical community. As part of the Women’s Health Initiative study of hormone replacement, a subgroup of 754 women was randomized to receive either a placebo or a combination of the vitamin D with 1000 mg of calcium.
At the start of the study, using CT scans, the research team measured the amount of calcification in the coronary arteries, which is a marker for atherosclerotic plaque and an indicator of risk of future heart attacks. The level was similar (91.6 average) in both groups at the start of the study. At the end of seven years, the levels were virtually the same in both groups. (Manson JE, et al., Calcium/vitamin D supplementation and coronary artery calcification in the Women's Health Initiative. Menopause. 2010 Jun 14. [Epub ahead of print])
This research does not reveal anything about higher doses of vitamin D, but other research indicates that vitamin D is related to a lower risk of both hypertension and heart disease. As I have noted before, the only way to know if you are getting enough vitamin D is to have your blood level checked and aim for a level from 60 to 100 nmol/L of 25-hydroxy vitamin D.
Inadequate levels of vitamin D are particularly prevalent among the elderly, and depression is also common in this age group. A new study examined whether low vitamin D might be contributing to depression. Researchers followed 531 women and 423 men over 65 for six years. At the start of the study, they were assessed using a depression scale and had blood levels of vitamin D (25(OH)D) analyzed. In addition, they were evaluated for possible confounding variables, such as sociodemographics, physical health, and functional capacity. (Milaneschi Y, et al., Serum 25-Hydroxyvitamin D and Depressive Symptoms in Older Women and Men. J Clin Endocrinol Metab. 2010 May 5. [Epub ahead of print])
At the 3-year and 6-year follow-ups, women with less than 50 nmol/liter of vitamin D3 had double the risk of becoming depressed compared to those with higher levels of vitamin D. Men with low vitamin D had a 60 percent higher risk than those with higher levels. This study does not prove any causal relationship of low vitamin D to depression, but it is very suggestive, and it reinforces the importance of vitamin D as a supplement, which is the safest and most secure way to raise blood levels.
In an effort to prevent cancer, every little help is of value because there is no one magic approach that works in all cases. In a recent evaluation of studies on diet and breast cancer, researchers found that foods rich in lignans provided a significant benefit for post-menopausal women. Plant chemicals that resemble estrogens in their structure and activity or have estrogenic (or anti-estrogenic) effects are called “phytoestrogens” and have been associated with lower risk of breast cancer (although not everyone agrees with this evaluation).
Lignans are one of the main types of phytoestrogens. They are found in flaxseeds and sesame seeds in exceedingly high amounts, but they are also present in whole grains, fruits (including berries especially), broccoli and kale. In evaluating exposure to lignans, researchers examined dietary intake, enterolignan (those modified in the intestinal tract), and enterolactone in the blood and urine.
In this meta-analysis (study of studies), researchers reviewed 21 reports. They found that in post-menopausal women overall breast cancer risk in the group with the highest lignan intake was 14 percent lower than in the group with the lowest lignan intake. This relationship was independent of the estrogen-receptor status of the cancers. (Buck K, et al., Meta-analyses of lignans and enterolignans in relation to breast cancer risk. Am J Clin Nutr. 2010 Jul;92(1):141-53. Epub 2010 May 12.) Lignans have also been associated with reduction of other cancers, such as prostate cancer.
Other sources of phytoestrogens include soybeans (containing isoflavones) and other beans such as lima beans, pinto beans, and split peas (containing coumestans). The estrogenic effects of these compounds is relatively weak, so they bind with estrogen receptors and block the attachment of stronger estrogens, either from glandular production, hormone replacement with horse-derived estrogens, or foreign chemicals such as pesticides. The suggestion that soy or other sources of phytoestrogens might increase the risk of cancer does not seem to be warranted.
In the past, some gastroenterologists have suggested that inflammatory bowel disease (IBD) is unrelated to diet, but in my experience with patients they are closely associated. I recently received an email from a patient whom I saw a few years ago noting that the program that I put her on completely relieved her ulcerative colitis, and after her recent endoscopy her doctor said she could not believe that she had ever been so ill.
A new study also shows that diet is associated with IBD. In a study of 67,581 women in France, aged 40 to 65, researchers evaluated them for dietary habits at the start of the study and every two years for an average of 10 years. They had no major illnesses at the start of the study period.
Those women with the highest protein intake had more than triple the risk of developing IBD. The greatest association was with animal protein from meat and fish, but not from eggs or dairy products. (Jantchou P, et al., Animal Protein Intake and Risk of Inflammatory Bowel Disease: The E3N Prospective Study. Am J Gastroenterol. 2010 May 11. [Epub ahead of print].) It is interesting to note that all of the women in the study were eating more than the recommended amount of dietary protein, which is typical of today’s developed societies.
IBD has also been linked in other studies to vitamin D deficiency, and to excess fat and sugar in the diet. It appears that omega-3 oils are beneficial, but processed oils that are mostly omega-6 fatty acids increase the risk of IBD. My patient also took a number of anti-inflammatory supplements plus L-glutamine, an amino acid that helps heal the lining cells of the intestinal tract.
Dental care is an important component of preventive medicine. Research shows that those people who do not brush their teeth twice a day have higher heart disease risk and increased markers of inflammation. A Scottish study of 11,869 men and women with an average age of 50 showed that those with poorer oral hygiene had a 70 percent higher relative risk of heart disease than those who brushed their teeth regularly.
In this report, those with poor oral hygiene had higher levels of fibrinogen (a clotting factor associated with heart risk) and higher levels of C-reactive protein (CRP), a marker of inflammation. (de Oliveira C, et al., Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey. BMJ. 2010 May 27;340:c2451. doi: 10.1136/bmj.c2451) These may all be due to gingivitis, which is much less prevalent in people who take good care of their teeth. I advise brushing twice a day and flossing at least once.
While it is “common knowledge” that moderate alcohol consumption is associated with lower rates of heart disease, it might not be related to the alcohol itself, but to other lifestyle factors that are common among those who drink moderately. Two recent studies challenge the currently accepted conclusion about alcohol. One of the studies was done in France and the other in India.
In the French study of 149,773 subjects, moderate drinkers consumed less than one ounce per day and high consumption was defined as averaging more than one drink per day. Those in the moderate consumption group had lower risk factors for heart disease (such as lower blood pressure, body mass index, and depression scores, and higher social status and exercise levels).
After multiple risk factor analyses, the researchers concluded that the alcohol itself did not cause the lower heart disease rates, but that it was due to the other lifestyle factors. (Hansel B, et al., Relationship between alcohol intake, health and social status and cardiovascular risk factors in the urban Paris-Ile-De-France Cohort: is the cardioprotective action of alcohol a myth? Eur J Clin Nutr. 2010 Jun;64(6):561-8.)
In the Indian study of 4465 subjects, moderate drinkers did have lower total cholesterol levels and higher HDL levels than non-drinkers. However this did not translate into lower heart disease risk. After adjusting for tobacco use, body mass index, and education, alcohol users had an average 40 percent higher rate of heart disease.
The rate was only 20 percent higher in occasional users and 60 percent higher in regular alcohol users. (Roy A, et al., Impact of alcohol on coronary heart disease in Indian men. Atherosclerosis. 2010 Jun;210(2):531-5.) The indications from this study are that alcohol is not beneficial and may actually increase heart disease risk.
Click here to receive the Healthy Living newsletter free.