Vitamin D and Calcium

JOHNS HOPKINS MEDICINE: Low Vitamin D Levels Associated with Scarring Lung Disease

Vitamin D and Calcium | Johns Hopkins Medicine

Source: Johns Hopkins Medicine

Johns Hopkins Medicine issued the following announcement on June 19.

Reviewing medical information gathered on more than 6,000 adults over a 10-year period, Johns Hopkins researchers have found that lower than normal blood levels of vitamin D were linked to increased risk of early signs of interstitial lung disease (ILD).

Interstitial lung disease is a relatively rare group of disorders characterized by lung scarring and inflammation that may lead to progressive, disabling and irreversible lung damage.

An estimated 200,000 cases a year are diagnosed in the United States, most of them caused by environmental toxins such as asbestos or coal dust, but it can be caused by autoimmune disorders, infections, medication side effects or, sometimes, from unknown causes.

Once diagnosed with the disease, most people don’t live longer than five years.

In a series of studies, the researchers sought to learn about new, and potentially treatable, factors related to early signs of the disease seen by CT scans — imaging abnormalities that may be present long before symptoms develop — which may help guide future preventive strategies.

Results of the most recent data analysis, published in the Journal of Nutrition on June 19, suggest that low vitamin D might be one factor involved in developing interstitial lung disease.

Although the researchers caution their results can’t prove a cause and effect, their data support the need for future studies to investigate whether treatment of vitamin D deficiency, such as with supplements or sunlight exposure, could potentially prevent or slow the progression of the disorder in those at risk. Currently, there is no proven treatment or cure once interstitial lung disease is established.

“We knew that the activated vitamin D hormone has anti-inflammatory properties and helps regulate the immune system, which goes awry in ILD,” says Erin Michos, M.D., M.H.S.

, associate professor of medicine at the Johns Hopkins University School of Medicine and associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease.

“There was also evidence in the literature that vitamin D plays a role in obstructive lung diseases such as asthma and COPD, and we now found that the association exists with this scarring form of lung disease too.”

To search for that association, Michos and her research team used data from the Multi-Ethnic Study of Atherosclerosis (MESA), which from 2000 to 2002 recruited 6,814 people from Forsyth County, North Carolina; New York City; Baltimore, Maryland; St.

Paul, Minnesota; Chicago, Illinois; and Los Angeles, California. The average age of participants was 62, and 53 percent were women.

Thirty-eight percent of participants were white, 28 percent were African-American, 22 percent were Hispanic and 12 percent were Chinese.

At an initial clinical visit, staff took blood samples for each participant and measured, among other things, vitamin D levels.

Those with vitamin D levels less than 20 nanograms per milliliter — about 30 percent of participants — were considered vitamin D deficient (2,051 people).

Those with vitamin D levels of 20–30 nanograms per milliliter were considered to have “intermediate,” although not optimal, levels of the nutrient, while those with 30 nanograms per milliliter or more were considered to have met recommended levels.

All participants underwent heart CT scans at the first visit and some also at later visits, offering incidental and partial views of the lungs.

At 10 years in, 2,668 participants had full lung CT scans evaluated by a radiologist for presence of scar tissue or other abnormalities.

The vitamin D-deficient participants had a larger volume, on average (about 2.

7 centimeters cubed), of bright spots in the lung suggestive of damaged lung tissue, compared with those with adequate vitamin D levels.

These differences were seen after adjusting for age and lifestyle risk factors of lung disease including current smoking status, pack years of smoking, physical inactivity or obesity.

When looking at the data from the full lung scans, the researchers said those with deficient or intermediate vitamin D levels were also 50 to 60 percent more ly to have abnormalities on their full lung scans suggestive of early signs of interstitial lung disease, compared with those with optimal vitamin D levels.

These associations were still seen after additionally adjusting for other cardiovascular and inflammatory risk factors, such as high blood pressure, high cholesterol, diabetes and levels of high-sensitivity C-reactive protein (another inflammatory marker).

“Our study suggests that adequate levels of vitamin D may be important for lung health.

We might now consider adding vitamin D deficiency to the list of factors involved in disease processes, along with the known ILD risk factors such as environmental toxins and smoking,” says Michos.

“However, more research is needed to determine whether optimizing blood vitamin D levels can prevent or slow progression of this lung disease.”

People can boost their vitamin D levels by spending 15 minutes a day in summer sunlight or through a diet that includes fatty fish and fortified dairy products. Supplements may be considered for some people with significant deficiency.

According to the 2013 Global Burden of Disease study, about 595,000 people worldwide develop interstitial lung disease each year, and about 491,000 die each year from it.

Additional authors include Samuel Kim, Di Zhao and Eliseo Guallar of Johns Hopkins; Anna Podolanczuk, R. Graham Barr and David Lederer of Columbia University Medical Center; Pamela Lutsey of University of Minnesota, Minneapolis; Steven Kawut of University of Pennsylvania; and Ian de Boer and Bryan Kestenbaum of University of Washington.

The study was funded by grants from the National Institute on Neurological Disorders and Stroke (R01NS072243), the National Heart, Lung, and Blood Institute (R01HL096875, R01HL077612, R01HL093081, RC1HL100543, R01HL103676, T32HL105323 and K24HL131937) and the National Center for Advancing Translational Sciences (UL1TR000040, UL1TR001079 and UL1TR001420), as well as contracts from the National Heart, Lung, and Blood Institute (HHSN2682015400003I, N01HC95159, N01HC95160, N01HC95161, N01HC95162, N01HC95163, N01HC95164, N01HC95165, N01HC95166, N01HC95167, N01HC95168 and N01HC95169), funds from the Blumenthal Scholars Fund for Preventive Cardiology and a research assistance agreement from the U.S. Environmental Protection Agency (RD831697).

Original source can be found here.

Source: https://patientdaily.com/stories/511463876-johns-hopkins-medicine-low-vitamin-d-levels-associated-with-scarring-lung-disease

Vitamin D

Vitamin D and Calcium | Johns Hopkins Medicine

— The first section of this topic is shown below —

  • Estimated that over 1 billion people worldwide have vitamin D deficiency or insufficiency[7].
  • Frank vitamin D deficiency in children (rickets) or adults (osteomalacia) remains rare in developed countries.
  • Studies ongoing to determine the prevalence of hypovitaminosis D in type 1 diabetes (T1DM) and type 2 diabetes (T2DM); preliminary data suggests prevalence may be as high as 30% in T2DM[13].
  • Vitamin D optimizes intestinal calcium and phosphorus absorption to maintain skeletal mineral content.
  • Sources of vitamin D include sunlight exposure, dietary intake, dietary supplements.
  • Vitamin D derived from sunlight or dietary sources metabolized in the liver to form 25-hydroxyvitamin D (25(OH)D)
  • 25-hydroxyvitamin D metabolized by 1-alpha-hydroxylase in kidneys to active form, 1,25-dihydroxyvitamin D (1,25(OH)D)
  • Vitamin D deficiency in adults can lead to development of osteopenia, osteoporosis, and/or osteomalacia; muscle weakness; and increased risk of fractures and falls.
  • Vitamin D may have other roles in human health including modulation of immune function and reduction of inflammation, though studies are ongoing.
  • Interaction between vitamin D status and other conditions including cardiovascular health, cancer, pregnancy outcomes amd neuromuscular/neuropsychiatric function is not yet well elucidated.

— To view the remaining sections of this topic, please sign in or purchase a subscription —

  • Estimated that over 1 billion people worldwide have vitamin D deficiency or insufficiency[7].
  • Frank vitamin D deficiency in children (rickets) or adults (osteomalacia) remains rare in developed countries.
  • Studies ongoing to determine the prevalence of hypovitaminosis D in type 1 diabetes (T1DM) and type 2 diabetes (T2DM); preliminary data suggests prevalence may be as high as 30% in T2DM[13].
  • Vitamin D optimizes intestinal calcium and phosphorus absorption to maintain skeletal mineral content.
  • Sources of vitamin D include sunlight exposure, dietary intake, dietary supplements.
  • Vitamin D derived from sunlight or dietary sources metabolized in the liver to form 25-hydroxyvitamin D (25(OH)D)
  • 25-hydroxyvitamin D metabolized by 1-alpha-hydroxylase in kidneys to active form, 1,25-dihydroxyvitamin D (1,25(OH)D)
  • Vitamin D deficiency in adults can lead to development of osteopenia, osteoporosis, and/or osteomalacia; muscle weakness; and increased risk of fractures and falls.
  • Vitamin D may have other roles in human health including modulation of immune function and reduction of inflammation, though studies are ongoing.
  • Interaction between vitamin D status and other conditions including cardiovascular health, cancer, pregnancy outcomes amd neuromuscular/neuropsychiatric function is not yet well elucidated.

There's more to see — the rest of this entry is available only to subscribers.

Moseley, Kendall, and Todd T Brown. “Vitamin D.” Johns Hopkins Diabetes Guide, 2017. Johns Hopkins Guide, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547149/all/Vitamin_D. Moseley K, Brown TT. Vitamin D. Johns Hopkins Diabetes Guide. 2017. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547149/all/Vitamin_D. Accessed May 18, 2020.Moseley, K., & Brown, T. T. (2017). Vitamin D. In Johns Hopkins Diabetes Guide Retrieved May 18, 2020, from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547149/all/Vitamin_DMoseley K, Brown TT. Vitamin D [Internet]. In: Johns Hopkins Diabetes Guide. ; 2017. [cited 2020 May 18]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547149/all/Vitamin_D.* Article titles in AMA citation format should be in sentence-caseMLAAMAAPAVANCOUVERTY – ELECT1 – Vitamin DID – 547149A1 – Moseley,Kendall,M.D.AU – Brown,Todd,M.D., Ph.D.Y1 – 2017/01/05/BT – Johns Hopkins Diabetes GuideUR – https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547149/all/Vitamin_DDB – Johns Hopkins GuideDP – Unbound MedicineER –

Source: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/547149/all/Vitamin_D

Vitamin D is good for the bones, but what about the heart?

Vitamin D and Calcium | Johns Hopkins Medicine
(BrianAJackson, Getty Images)

Vitamin D plays an important role in overall health, but if you've been taking supplements to strengthen your heart, recent research may disappoint you.

Although vitamin D is best known for its role in developing strong bones, low blood levels have been linked to an increased risk of heart attacks and strokes. But recent studies found vitamin D supplements did not bolster heart health.

“Initially there was a lot of enthusiasm for vitamin D treatment for cardiovascular disease, and this was observational data,” said Dr. Erin Michos, an associate professor of medicine at Johns Hopkins School of Medicine in Baltimore.

“The link was that individuals who have low blood levels of vitamin D have increased risk of a lot of bad things,” she said, “including increased risk of heart attacks, stroke, heart failure and even increased risk of death. It was a really strong association.”

But associations don't always mean causation. In June, an analysis in JAMA Cardiology that included 21 clinical trials showed vitamin D supplements do not reduce the risk of having or dying from a heart attack or stroke.

A highly publicized 2018 study called VITAL was part of that analysis. Researchers studied more than 25,000 people across the United States taking either a daily vitamin D supplement of 2,000 IUs or a placebo.

“The key question is, do you need more vitamin D than what is required for bone health in order to have optimal heart health?” said Dr. JoAnn Manson, the lead author of VITAL, published in the New England Journal of Medicine. “And the answer, available research, seems to be no.”

Manson, a professor of medicine at Harvard Medical School and chief of preventive medicine at Brigham and Women's Hospital in Boston, said even study participants with lower levels of vitamin D at the start of the study did not see a decreased risk of heart attack or stroke from supplementation.

“There is some promising research that vitamin D may reduce the risk of heart failure, and that requires additional research,” Manson said. “However, the evidence to date is that moderate to high vitamin D supplementation does not appear to reduce the risk of heart attacks or strokes.”

VITAL researchers soon will report results on other outcomes, including heart failure, diabetes, cognition and autoimmune disorders, she said.

Vitamin D is created when people are exposed to sunlight and can also be found in a handful of foods, including fatty fish such as salmon and fortified dairy products. It helps the body absorb calcium and phosphorous and protects against bone loss.

Because vitamin D is primarily produced through skin synthesis after exposure to sunlight, the VITAL study also focused on the effect of supplements on people with darker skin pigmentation; more than 5,000 of the 25,871 participants in the study were African American.

“We had a very strong interest in determining whether vitamin D might have a greater benefit in African Americans,” Manson said. “We did see some signals that there might be some benefit in terms of cancer reduction – it was not statistically significant – but for heart health, we did not see an added benefit race or ethnicity.”

Manson said these latest findings also are important because people who take megadoses of vitamin D supplements, such as more than 10,000 IUs a day, without a true medical need may be doing themselves harm.

“There has been some concern that very high doses of supplementation could increase the risk of blood vessel calcification and could actually have adverse effects,” she said. “So, an important principle is that more is not necessarily better, and in fact, mega-dosing on vitamin D can have some harmful effects.”

Michos said people who take vitamin supplements despite not having a diagnosed deficiency – the “worried well” – would be better served by focusing on living a healthier lifestyle instead.

“People are just wasting their money on supplements, hoping for this panacea benefit,” Michos said. “Really, for most things, you can get all the nutrients you need from a heart-healthy diet … and from getting normal physical activity and maintaining a healthy body weight.

“People are trying to find a magic bullet in a pill form, and it's just not there.”

If you have questions or comments about this story, please email editor@heart.org.

Source: https://www.heart.org/en/news/2019/09/17/vitamin-d-is-good-for-the-bones-but-what-about-the-heart

Vitamin D deficiency is a global problem

Vitamin D and Calcium | Johns Hopkins Medicine

As full-time students, most of us spend a lot of time indoors, and that could be hurting our health.

Vitamin D, one of the 13 vitamins our body needs, is in such deficient quantity in many of us that vitamin D deficiency is now considered a global health problem, affecting an estimated one billion people worldwide.

Vitamin D is a fat-soluble vitamin. Thus, excess is stored in our fat tissue, un water-soluble vitamins vitamin C, excess of which is expelled through urine. You would think that this would help us to keep our vitamin D levels up to where they should be — with enough stored in our fat cells to use in times of need.

The problem is that vitamin D is naturally present in very few foods, such as the flesh of fatty fish such as salmon and tuna, as well as beef liver, cheese and egg yolks.

Fortified foods provide most of the vitamin D in the diets of Americans. Most milk sold in the U.S. is fortified with vitamin D. Companies began adding vitamin D to milk in the 1930s to prevent bone diseases such as rickets in children and osteomalacia in adults.

Another source of vitamin D is from the reaction the skin has to exposure to sunlight. So, if we don’t eat the proper foods, drink enough milk or get sufficient exposure to the sun, we are setting ourselves up for vitamin D deficiency.

Vitamins are considered essential nutrients because our bodies cannot make them, or they are made in very small amounts.

What this means to people interested in their health is that they need to derive the proper amount of vitamins from the food that they consume, or in the case of vitamin D, proper food and sun exposure.

Lacking the amount that our bodies need may result in diseases or other health problems.

Vitamin D promotes calcium absorption and maintains proper serum calcium levels to enable normal bone mineralization. Without the proper amount of vitamin D, bone can become brittle and thin.

It is particularly important in older adults where, together with calcium, it helps protect against osteoporosis.

Vitamin D also modulates cell growth, immune and neuromuscular function and the reduction of inflammation.

Serum concentration of 25(OH)D derived from a simple blood test is the best indicator of vitamin D status, according to the National Institutes of Health (NIH) Office of Dietary Supplements.

Recently, the proper amount of vitamin D intake has been brought into question. Researchers at UC San Diego and Creighton University have disputed the intake of vitamin D recommended by the National Academy of Sciences (NAS) Institute of Medicine (IOM), which provides dietary recommendations to the U.S. government.

The researchers believe that their findings suggest that the IOM has substantially underestimated how much vitamin D we should be getting.

The error has broad implications for public health with regards to disease prevention and achieving the stated goal of ensuring that the whole population has enough of the vitamin to maintain proper bone health.

The recommended intake of vitamin D specified by the IOM is 600 international units (IU) per day through age 70 and 800 IU per day for older individuals. The researchers said that their calculations have shown that these doses are only about one-tenth of those needed to cut the incidence of diseases related to vitamin D deficiency.

So, the next time you are soaking in the sun while studying on the Beach, and your friends walk by and question your commitment to your education, just tell them that you are studying hard and working on increasing your vitamin D level. And we could all use a little more sun.

Source: https://www.jhunewsletter.com/article/2015/04/vitamin-d-deficiency-is-a-global-problem-41587

Exercise and vitamin D work better together for heart health

Vitamin D and Calcium | Johns Hopkins Medicine

Vitamin D and exercise make a good couple, according to new Johns Hopkins research that finds a link between the two factors in improving heart health.

The study found that the two factors working together seem to do better than either on their own for protecting the cardiovascular system—and reducing the risk of events heart attacks and strokes.

The study found that Vitamin D and exercise working together seem to do better than either on their own for protecting the cardiovascular system—and reducing the risk of events heart attacks and strokes.

The findings, published this month in The Journal of Clinical Endocrinology & Metabolism, also suggest that exercise may play a role itself in boosting vitamin D levels in the blood.

For their study, researchers from Johns Hopkins University's School of Medicine analyzed surveys and health records of more than 10,000 American adults for nearly 20 years.

Though both vitamin D (the “sunshine” vitamin) and exercise have long been known to reduce heart disease risks, this research looked at the direct relationship between the two factors and their joint role in heart health.

“In our study, both failure to meet the recommended physical activity levels and having vitamin D deficiency were very common” says Erin Michos, associate director of preventive cardiology and associate professor of medicine at the Ciccarone Center for the Prevention of Heart Disease at Hopkins. “The bottom line is we need to encourage people to move more in the name of heart health.”

The team found that exercise levels positively and directly corresponded to vitamin D levels—meaning that the more one exercised, the higher their vitamin D seemed. Participants who met recommended exercise levels had a 31 percent lower risk of vitamin D deficiency.

Notably, though, the researchers only saw this positive relationship in white participants, not African-Americans.

A second phase of the study found that the most active participants with the highest vitamin D levels had the lowest risk for future cardiovascular disease. Specifically, participants in that category experienced about a 23 percent less chance of an adverse cardiac event such as a heart attack, stroke, or death due to heart disease or stroke.

On the other hand, participants who had adequate exercise but were vitamin D deficient didn't have reduced risk of adverse events. In other words, the combined benefit of vitamin D and exercise was stronger than either health factor alone.

Michos says that sun exposure may not be the whole story in the link between vitamin D and exercise, since levels of the vitamin didn't taper off for the study's participants as they do when the body produces enough via sunlight. She says this suggests other factors at play causing vitamin D and exercise to influence each other—possibly overall healthier lifestyles and habits for those who exercise.

As for the racial disparity the study found, it could suggest that increased physical activity may not be as effective for raising vitamin D in African-Americans as in whites. Michos notes that people with darker skin produce vitamin D less efficiently after sun exposure, possibly due to higher amounts of melanin.

On the topic of vitamin D supplements, Michos cautions that people who meet the recommended daily amount of the vitamin (600 to 800 International Units) shouldn't need more. And for many, she says, the best way to ensure adequate levels are from sun exposure and healthy diet and lifestyle.

The benefits of vitamin D supplements are not yet proven when it comes to heart health, Michos notes, pointing to a recent clinical trial that failed to show any cardiovascular benefit with high monthly doses of the supplement.

Read more from Hopkins Medicine

Source: https://hub.jhu.edu/2017/04/28/vitamin-d-exercise-heart-health/