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December 2010

Vitamin D report misleading
Childhood caffeine intake and sleep
Relationships affect heart risks
Pesticides may lead to dementia
Whole grains lower body fat, heart risk
Vitamin D reduces falls

Vitamin D report misleading

A recent report from the Institute of Medicine’s (IOM) Food and Nutrition Board (FNB) suggested daily intake levels should be raised, but their new recommendation was far lower than much of the recent research suggests. They also said that lower blood levels than are currently recommended were adequate. Although they raised the recommended daily intake (Dietary Reference Intake, or DRI) level compared to their last report in 1997, they did not raise it enough according to the most recent research. Their recommended daily amount is 600 IU for everyone until it rises to 800 IU for those over 70 years old.

This report ignores much of the evidence for benefits from much higher amounts, and it claims that over 4000 IU daily is the upper limit of safe intake. This is higher than the former level of 2,000 IU, however, it is an unreasonable limit. A commentary from The Vitamin D Council ( pointed out a number of flaws in the IOM report. One of which is that it ignores pregnant women, whose vitamin D needs are higher than non-pregnant women. Also, higher levels of vitamin D intake have benefits beyond bone health (which is what the IOM addressed), and they did not consider these.

Beyond this, the FNB consulted with 14 vitamin D experts and suppressed their reports in coming to their conclusions. The experts included Professors Robert Heaney and Walter Willett who are renowned for their work in vitamin D in particular and nutrition in general. They IOM FNB report lowered the blood level considered adequate from 30 to 20 ng/ml, which allowed them to state that most people were not deficient. This is one way to “define away” a problem the way Orwell can define slavery as freedom. (The dairy industry lauded the report because they found that people could meet the new requirements with enough milk in the diet, ignoring those who do not take milk for health, environmental, or ethical reasons).

I have reported on the many benefits of higher vitamin D intake and supplementation (and do again later in this issue), and the healthier range for the blood level of 50 to 80 ng/ml) of 25-OH vitamin D3 (others suggest 60- 100 ng/ml would be a better range).

The IOM report discounted the numerous benefits from higher intake of vitamin D supplements and higher blood levels in pregnancy, blood pressure, cancer prevention, heart disease, infectious diseases, and other conditions. I was taking 4400 IU daily and found my blood level was about 55 ng/ml, at which time I increased my intake to 8400 IU, and I will get a new blood level done this week to see how much the new intake has raised my level. This IOM report generated a lot of concern among my patients and readers, but at least it made it clear that it was safe to take 4000 IU per day by their very arbitrary standard, and based on the current evidence, even higher levels are safe.

Childhood caffeine intake and sleep

Children have been consuming large amounts of caffeine in recent years and this has a negative effect on their sleep and it has detrimental effects on cognitive function in adolescents. A recent report on a study of 200 children showed that those aged 8 to 12 consumed an average of 109 mg of caffeine per day, the amount in three 12-ounce cans of soda. Children from 5 to 7 years old consumed an average of 52 mg of caffeine, equivalent to one can of soda per day. (Warzak WJ, et al., Caffeine consumption in young children. J Pediatr. 2010 Dec 15. [Epub ahead of print]

This amount of caffeine is enough to have a negative effect on sleep. Parents of the children consuming more caffeine reported that increasing caffeine intake meant fewer hours of sleep. However, in this study bedwetting was not related to caffeine intake in spite of its diuretic effect.

Other studies have shown that adolescents have more daytime sleepiness with increasing caffeine intake. This may be due to the effects on sleep amount or quality, but in both this and the current study of children, some of the effects might be due to the sugar contained in the drinks. Three cans of soda contain nearly 30 teaspoons of sugar, which is almost 700 calories from sugar alone, not to mention the collection of other substances in these beverages.

Relationships affect heart risks

relationships, whether family or friends, can be very beneficial for heart health, but stressful relationships can have the opposite effects. Researchers evaluated 4573 middle-aged Danish men and women who had no heart disease at the start of the study. They followed them for six years. During that time, nine percent developed angina pectoris (heart pain due to hardening of the coronary arteries).

They used questionnaires to evaluate the worry and excessive demands of their relationships, particularly their spouses or intimate partners, but also from children, other relatives, neighbors, or friends. Stressful relationships with spouses was associated with 3.5 times more angina. With children, the risk was more than doubled, while with other family the risk was not quite doubled. (Lund R, et al., Are negative aspects of social relations predictive of angina pectoris? A 6-year follow-up study of middle-aged Danish women and men. J Epidemiol Community Health. 2010 Dec 22. [Epub ahead of print].)

They found no correlation of angina with difficult interactions between friends and neighbors (unless arguments with the neighbors were frequent). The results were about the same for both men and women. This is not an argument to abandon all relationships, but to make an effort to resolve conflicts or to move on to more rewarding and supportive interactions. However, supportive relationships in themselves did not counter the negative effects from worrisome/demanding relationships.

Pesticides may lead to dementia

Pesticides are toxic, which is one of the reasons that I choose organic foods whenever possible. It is also better for the environment to choose organic foods. In addition, it is better for farmers to avoid exposure to such chemicals, and buying organic foods means more farmers will be able to do so. New research shows that long-term exposure to pesticides among French vineyard workers led to neuro-behavioral effects.

Researchers classified the workers as having direct exposure (those who mixed and applied the chemicals), indirect exposure (working with the treated plants or other contact in the buildings or cellars), or non-exposure. They evaluated 614 workers, 40 to 60 years old, using nine neurobehavioral tests, including the Mini-Mental state Examination (MMSE).

They followed workers for up to six years. At follow-up, those with exposure had a 1.35 to 5.6 times the performance decline than those who were not exposed. (Baldi I, et al., Neurobehavioral effects of long-term exposure to pesticides: results from the 4-year follow-up of the PHYTONER Study. Occup Environ Med. 2010 Nov 22. [Epub ahead of print]). Those with the most exposure had twice the risk of having a two point decline in their MMSE score. The MMSE is used to determine if someone has dementia. Other tests measured memory, verbal skills, word retrieval, and reaction time.

If you are not a farmer this may not seem relevant to you, but this is evaluating exposure levels over a six-year period. My concern is the effect of lesser exposure over a longer time, which one might get from eating pesticides in common foods. You can find out the 12 foods most likely to be contaminated (the “Dirty Dozen”) at, the website of the Environmental Working Group. You should make a special effort to buy these from organic sources. They also list those least likely to be contaminated (the “Clean Fifteen”).

Whole grains lower body fat, heart risk

Whole grains are the unprocessed versions of commonly eaten refined foods such as white flour and white rice. Whole wheat, kamut and spelt (different versions of wheat), rye, brown rice, oats, barley, millet, and corn, are in this family of foods. While they are high in carbohydrates, they are the good kind that are high in fiber and many nutrients, and provide vitamins, minerals, isoflavones, and essential fatty acids, and they provide protein to complement other sources.

A new study shows that consuming whole grains can lower the amount of body fat, both subcutaneous abdominal fat (SAT, the kind just under the surface) and visceral abdominal fat (VAT, the kind that surrounds the organs in the abdominal cavity). Excessive VAT is associated with an increased risk of insulin resistance, diabetes, and heart disease. (McKeown NM, Whole- and refined-grain intakes are differentially associated with abdominal visceral and subcutaneous adiposity in healthy adults: the Framingham Heart Study. Am J Clin Nutr. 2010 Nov;92(5):1165-71.)

Evaluating 2834 participants, researchers found that the highest whole grain intake lowered both kinds of fat, but only the VAT lowering was statistically significant. Refined grains increased the level of VAT.

Vitamin D reduces falls

Falls are a leading cause of disability, loss of independence, and even death in those over 65 years old. A meta-analysis of data from 54 controlled trials showed that exercise and vitamin D supplementation both reduced the risk of falls, exercise by 13 percent and vitamin D supplements by 17 percent. (Michael YL, et al., Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010 Dec 21;153(12):815-25.)

Combining exercise and vitamin D might provide the most benefits, and other interventions, such as specific strength and balance training, and other supplements might help even more.

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From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

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Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.