Vitamins for Wellness

The importance of good nutrition becomes all too apparent, when one becomes aware of a case, such as the following one. This lady’s diet, if continued, would have caused her many future health problems.

“This case concerns a  26 year old woman who presented in the eye- casualty department in the North East of England, with gradual painless loss of vision, over a period of 6 weeks. Prior to this her vision had been normal.

She was found to have bilateral central retinal vein occlusion with significant anaemia and vitamin B12 and folate deficiency. Patients who develop central retinal vein occlusion are typically over 65 years of age and it is a common cause of visual morbidity .

There is an increased incidence of central retinal vein occlusion in people with conditions such as diabetes mellitus, hypertension, collagen vascular diseases and hyperviscosity syndromes, with smoking and contraceptive pill use being additional risk factors. When young patients develop a central retinal vein occlusion it is important to obtain a detailed nutritional history, as is shown by this case.

Apart from the painless loss of vision over a period of 6 weeks, the only other symptoms she had were occasional headaches, and  more recently increased breathlessness on exertion. She was overweight, was a non smoker, and a weekend drinker.

Blood film showed a megaloblastic anaemia with nucleated red cells, macrocytosis and hypersegmented neutrophils. Absolute reticulocyte count was not raised. Low levels of folate and vitamin B12 were confirmed on serum testing (folate: 1 ng/ml, vitamin B12: 54 ng/l).

On further closer questioning it was found that the patient had not eaten vegetables for several years and lived on a diet involving a processed corn snack, chips and fast food chain meals. She explained that she did not like the taste of vegetables and dairy products.

She was given folic acid, hydroxycobalamin and iron supplementation. She was referred to a dietitian and advised on a healthier diet. Visual acuity improved to (Snellen chart) 6/12 on the right and 6/12 on the left over the subsequent months. Her haemoglobin levels returned to normal over the subsequent months”.

Reference:

Malnutrition and bilateral central retinal vein occlusion in a young woman: a case report
Mark Tauber, Timothy C Dowd, and Angela Wood.
Specialist Registrar in Palliative Medicine, Morriston Hospital, Swansea NHS Trust, Swansea, SA6 6NL, UK
Consultant Ophthalmologist, Department of Ophthalmology, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
Consultant Haematologist, Department of Haematology, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK

Journal of Medical Case Reports 2008, 2:77doi:10.1186/1752-1947-2-7

Is psychiatry that branch of medicine that can explain everything but predict nothing? No group of scientists is working harder to change that definition than those at the National Institute of Mental Health (NIMH).

Among the scientists at NIMH are many of the most famous names in psychiatry and some of my personal heroes. They know that nothing could be a crueler message than to tell those suffering from major depression that physiological amounts of vitamin D will cure it. Premature claims for a variety of nonprescription supplements have given suffering millions hopes that were soon dashed on the rocks of scientific reality. Even the supplements that may help such as SAMe, omega-3/omega-6 intake ratios, or lowering homocysteine with adequate methylating B vitamins/TMG are not cure-alls.

Perhaps raising false hopes of curing an illness as devastating as major depression is not as serious as some of psychiatry’s past crimes, such as telling mothers of schizophrenics that they caused their child’s illness or using false recovered memories of sexual abuse to the destroy innocent families. That said, we must not raise false hopes. Nevertheless, what do we know about major depression and vitamin D?
Bright Light

We know that 15 years ago, Professor Walter E. Stumpf of the University of North Carolina, one of the great pioneers in vitamin D research, predicted a substantial role for both bright light and vitamin D in psychiatry. Stumpf WE, Privette THLight, vitamin D and psychiatry. Role of 1,25 dihydroxyvitamin D3 (soltriol) in etiology and therapy of seasonal affective disorder and other mental processes.Psychopharmacology (Berl). 1989;97(3):285–94.

Bright light in the visible spectrum (without any vitamin D producing UVB) clearly improves mood, although it is hard to conduct good studies due to the lack of a control condition. So the question is: does vitamin D have an effect on mood that differs from, or is complimentary to, the effect of bright light?
Seasonal Affective Disorder

Harris and Dawson-Hughes found 400 IU of ergocalciferol (vitamin D2) did not help the seasonal mood swings of 125 Boston women compared to placebo. Harris S, Dawson-Hughes BSeasonal mood changes in 250 normal women.Psychiatry Res. 1993 Oct;49(1):77–87. Such mood swings can be severe and are related to season, latitude and sun exposure. The authors did not obtain 25(OH)D levels but we now know 400 IU of ergocalciferol is close to a homeopathic dose of vitamin D. We also know ergocalciferol is a significantly less potent form of vitamin D than is the naturally occurring vitamin D3, cholecalciferol. One of the authors, Professor Dawson-Hughes, will be the first one to tell you 400 IU of ergocalciferol is an inadequate dose of vitamin D.

If you are thinking that Oren, Schulkin and Rosenthal have already shown that vitamin D has nothing to do with seasonal affective disorder, I am sorry to tell you they measured the wrong vitamin D metabolite, 1,25(OH)2D3 (calcitriol), which can be high, low, or normal in almost any condition. Oren DA, Schulkin J, Rosenthal NE1,25(OH)2 vitamin D3 levels in seasonal affective disorder: effects of light.Psychopharmacology (Berl). 1994 Dec;116(4):515–6. The only lab test that should be used to measure vitamin D stores, vitamin D deficiency and vitamin D adequacy is 25(OH)D, which they did not measure.

In a 1998 controlled experiment, Australian researchers found that cholecalciferol (400 and 800 IU), significantly enhanced positive affect when given to healthy individuals. Forty-four subjects were given 400 IU cholecalciferol, 800 IU cholecalciferol, or placebo for 5 days during late winter in a random double-blind study. Results on a self-report measure showed that vitamin D3 enhanced positive affect a full standard deviation and there was some evidence of a reduction in negative affect. The authors concluded: “vitamin D3 deficiency provides a compelling and parsimonious explanation for seasonal variations in mood.” Lansdowne AT, Provost SCVitamin D3 enhances mood in healthy subjects during winter.Psychopharmacology (Berl). 1998 Feb;135(4):319–23.

In 1999, in an even more interesting study, the vitamin D scientist, Bruce Hollis, teamed up with Michael Gloth and Wasif Alam to find that 100,000 IU of vitamin D given as a one time oral dose improved depression scales better than light therapy in a small group of patients with seasonal affective disorder. Gloth FM 3rd, Alam W, Hollis BVitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder.J Nutr Health Aging. 1999;3(1):5–7. All subjects in the vitamin D group improved in all measures and, more importantly, improvement in 25(OH)D levels levels was significantly associated with the degree of improvement.

German authors found healthy controls had an average serum 25(OH)D of 46 ng/L while depressed subjects had 37 ng/L. Schneider B, Weber B, Frensch A, Stein J, Fritz JVitamin D in schizophrenia, major depression and alcoholism.J Neural Transm. 2000;107(7):839–42.Finnish authors found no seasonal differences between seasonal affective disorder patients and normal controls but also found no seasonal variations in 25(OH)D levels in the same patients. Partonen T, Vakkuri O, Lamberg-Allardt C, Lonnqvist JEffects of bright light on sleepiness, melatonin, and 25-hydroxyvitamin D(3) in winter seasonal affective disorder.Biol Psychiatry. 1996 May 15;39(10):865–72.Most recently, a direct correlation was found between 25(OH)D levels and mental health scores in a group of healthy, elderly adults—although 1,000 IU of cholecalciferol did not improve mental health scores of these highly-functional subjects. Kenny AM, Biskup B, Robbins B, Marcella G, Burleson JAEffects of vitamin D supplementation on strength, physical function, and health perception in older, community-dwelling men.J Am Geriatr Soc. 2003 Dec;51(12):1762–7.
Reduced Sunlight, Increasing Depression

To further strengthen the case that vitamin D deficiency causes some cases of depression, evidence should exist that the incidence of depression has increased over the last century. During that time, humans have reduced their sunlight exposure via urbanization (tall buildings and pollution reduce UVB ), industrialization (working inside reduces UVB exposure), cars (glass totally blocks UVB), clothes (even light clothing blocks UVB), sunblock and misguided medical advice to never let sunlight strike you unprotected skin.

All these factors contribute to reduce circulating 25(OH)D levels. Klerman and Weissman’s claim that major depression has increased dramatically over the last 80 years is one of the most famous (and controversial) findings in modern psychiatry. Klerman GL, Weissman MMIncreasing rates of depression.JAMA. 1989 Apr 21;261(15):2229–35.Something called recall bias (a type of selective remembering) may explain some of the reported increase, but does it explain it all?

To learn more about increasing rates of mental illness over the last 2.5 centuries I recommend the incredible book, The Invisible Plague: The Rise Of Mental Illness From 1750 To The Present, by E. Fuller Torrey—the scientist the Washington Post called “the most famous psychiatrist in America.”
Which Came First?

Is depression associated with other conditions thought to be associated with vitamin D deficiency, such as heart disease, diabetes, hypertension, rheumatoid arthritis, cancer, or osteoporosis?  Zittermann AVitamin D in preventive medicine: are we ignoring the evidence?Br J Nutr. 2003 May;89(5):552–72.For example, there is a strong association between heart disease and depression, and countless theories to explain it. The obvious one—that heart disease would cause anyone to get depressed—is incorrect. You see, depression often precedes the heart disease, suggesting a third factor causes both. Moreover, if depression were associated with heart disease, one would expect excess unexplained mortality in major depression, which is a well-established finding. Rugulies RDepression as a predictor for coronary heart disease. a review and meta-analysis.Am J Prev Med. 2002 Jul;23(1):51–61. Cuijpers P, Smit FExcess mortality in depression: a meta-analysis of community studies.J Affect Disord. 2002 Dec;72(3):227–36.

Remember that association does not mean causation. If A is associated with B, then A could cause B, B could cause A, or a third factor(s), C, could cause both A and B. Therefore, if heart disease is associated with depression then the possibilities are depression caused the heart disease, heart disease caused the depression, or an unknown factor(s), perhaps vitamin D deficiency, caused some portion of both the depression and the heart disease. “Perhaps” being the key word. Remember, most of the serious errors in psychiatry (and medicine) are made when associations are confused with causation; or when subsequence is confused with consequence.
Deficiency Diseases and Depression

What about other diseases associated with vitamin D deficiency? What explains the significant association between depression and diabetes, Musselman DL, Betan E, Larsen H, Phillips LSRelationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment.Biol Psychiatry. 2003 Aug 1;54(3):317–29. hypertension, Scherrer JF, Xian H, Bucholz KK, Eisen SA, Lyons MJ, Goldberg J, Tsuang M, True WRA twin study of depression symptoms, hypertension, and heart disease in middle-aged men.Psychosom Med. 2003 Jul–Aug;65(4):548–57. rheumatoid arthritis, Abdel-Nasser AM, Abd El-Azim S, Taal E, El-Badawy SA, Rasker JJ, Valkenburg HADepression and depressive symptoms in rheumatoid arthritis patients: an analysis of their occurrence and determinants.Br J Rheumatol. 1998 Apr;37(4):391–7. cancer, Benedito Monleon MC, Lopez Andreu JA, Serra EstellesI I, Harto Castano M, Gisbert Aguilar J, Mulas Delgado F, Ferris I Tortajada JPsychological sequelae in longterm cancer survivors.An Esp Pediatr. 2000 Dec;53(6):553–60. advanced cancer, Smith EM, Gomm SA, Dickens CMAssessing the independent contribution to quality of life from anxiety and depression in patients with advanced cancer.Palliat Med. 2003 Sep;17(6):509–13. pancreatic cancer, Carney CP, Jones L, Woolson RF, Noyes R Jr, Doebbeling BNRelationship between depression and pancreatic cancer in the general population.Psychosom Med. 2003 Sep–Oct;65(5):884–8. and decreased bone mineral density in women? Yazici KM, Akinci A, Sutcu A, Ozcakar LBone mineral density in premenopausal women with major depressive disorder.Psychiatry Res. 2003 Mar 25;117(3):271–5. Coelho R, Silva C, Maia A, Prata J, Barros HBone mineral density and depression: a community study in women.J Psychosom Res. 1999 Jan;46(1):29–35. Michelson D, Stratakis C, Hill L, Reynolds J, Galliven E, Chrousos G, Gold PBone mineral density in women with depression.N Engl J Med. 1996 Oct 17;335(16):1176–81.

The abstract of our favorite study showing the association between depression and bone mineral density concludes with the following sentence: “We postulate that there may be an unmeasured third factor, such as an endogenous steroid, that is responsible for both low BMD and depression.” The paper says not a word about the steroid hormone, vitamin D.

Therefore, heart disease, hypertension, diabetes, rheumatoid arthritis, cancer and low bone mineral density are all associated with depression. One parsimonious explanation is that vitamin D deficiency causes some portion of all these illnesses. Remember, all these diseases are multifactorial, so we are only talking about the percentage of the illness possibly caused by vitamin D deficiency. See Zittermann for the best review of diseases associated with vitamin D deficiency. Zittermann AVitamin D in preventive medicine: are we ignoring the evidence?Br J Nutr. 2003 May;89(5):552–72.
Does Vitamin D Affect The Brain?

Vitamin D rapidly increases the in-vitro genetic expression of tyrosine hydroxylase (the rate-limiting enzyme for the catecholamine biosynthesis) by threefold. Puchacz E, Stumpf WE, Stachowiak EK, Stachowiak MKVitamin D increases expression of the tyrosine hydroxylase gene in adrenal medullary cells.Brain Res Mol Brain Res. 1996 Feb;36(1):193–6.

Summer sunlight increases brain serotonin levels twice as much as winter sunlight, a finding compatible with both bright light in the visible spectrum and vitamin D affecting mood. Lambert GW, Reid C, Kaye DM, Jennings GL, Esler MDEffect of sunlight and season on serotonin turnover in the brain.Lancet. 2002 Dec 7;360(9348):1840–2.

Vitamin D is widely involved in brain function with nuclear receptors for vitamin D localized in neurons and glial cells. Genes encoding the enzymes involved in the metabolism of vitamin D are expressed in brain cells. The reported biological effects of vitamin D in the nervous system include the biosynthesis of neurotrophic factors, inhibition of the synthesis of inducible nitric oxide synthase and increased glutathione levels, suggesting a role for the hormone in brain detoxification pathways. Garcion E, Wion-Barbot N, Montero-Menei CN, Berger F, Wion DNew clues about vitamin D functions in the nervous system.Trends Endocrinol Metab. 2002 Apr;13(3):100–5.

Evidence suggests that vitamin D may help mood but that evidence is not conclusive. (Remember, the way our medical literature system works, scientists often do not publish negative studies). The two positive studies above used vitamin D to treat seasonal affective disorder, not major depression. We were unable to find any studies in the literature in which patients with depression were treated with enough natural sunlight, artificial sunlight or plain old cholecalciferol to raise their levels to 35 ng/mL or higher. We all know how we feel after a week at the beach, but is that bright light, vitamin D, or something else?

Evidence exists that major depression is associated with low vitamin D levels and that depression has increased in the last century as vitamin D levels have surely fallen. Evidence exists that depression is associated with heart disease, hypertension, diabetes, rheumatoid arthritis, cancer and low bone mineral density, all illnesses thought to be caused, in part, by vitamin D deficiency. Finally, vitamin D has profound effects on the brain including the neurotransmitters involved in major depression.
Further Research Needed

Therefore, vitamin D may help major depression. It is too early to say. To know for sure, patients with severe major depression would have to have baseline 25(OH)D blood levels, be treated with doses of vitamin D adequate to raise their levels to at least 35 ng/mL for several months and be compared to a normal control group treated with placebo. No one has ever published such a study.

However, it is not to early to heed the following advice: If you suffer from depression, get your 25(OH)D level checked and, if it is lower than 35 ng/mL (87 nM/L), you are vitamin D deficient and should begin treatment. If you are not depressed, get your 25(OH)D level checked anyway. If it is lower than 35 ng/mL (87 nM/L), you are vitamin D deficient and should begin treatment.

John Jacob Cannell MD Executive Director 2004.03.20

Vitamin D appears to be a very popular study for researchers these days, so much has been written about vitamin D benefits, and what diseases are likely to appear if there is a vitamin D deficit.

Most people are aware that one can get an adequate supply of vitamin D from exposure to the sun. This may not be a problem for those who live in areas where the sun shines most of the year, but what of those people who live in northern latitudes, where winters are long and the appearance of the sun is a rare event?

These people will most certainly need to supplement their diet with vitamin D, for although vitamin D is present in a small number of foods such as: fish liver oils, fatty fish, egg yolks, dandelion greens, and dairy foods, the vitamin D may not always be available.

The vitamin D obtained from food needs to be activated by the liver and kidneys, and this will only occur if both organs are in an healthy condition.

Research has found that Vitamin D has many important roles to play aside from regulating calcium and phosphorus metabolism. It protects against muscle weakness,  is involved in regulating the heartbeat, blood clotting, enhances immunity, and is essential for thyroid function.

Vitamin D levels may be linked to cancer risk,  to diabetes, both 1 and 2, also research has found that vitamin D supplements were associated with a reduction in mortality from any cause.

Researchers have found that women with low vitamin D levels are more prone to experience chronic widespread pain, this has not been the case with males.

Vitamin D supplements should be treated with caution,  the RDA should not be exceeded, unless on the advice of a qualified health therapist.  The very best way to get one’s vitamin D is by exposing the skin  for about 15 minutes a day to sunlight, if this is not possible, then supplement with cod liver oil .

From the deep, unpolluted waters near Norway, Carlson bring you the finest cod liver oil which is naturally rich in vitamin A, Vitamin D3, EPA and DHA. Only cod fish caught during the winter and early spring are used, as the liver oil content is highest at this time of year. The oil is separated from the liver tissues without the use of chemicals. To insure freshness of Carlson Norwegian Cod Liver Oil, the air inside the glass bottle has been replaced with nitrogen.

Probiotics For Life-Antibiotics-Against Life

Probiotic supplements are intended to replace and maintain healthy gut bacteria, which may have been destroyed as a result of taking antibiotics. Maintaining healthy gut bacteria is dependent on eating healthy nutritious food, as well as taking a probiotic supplement. Probiotic bacterial cultures are intended to assist the body’s naturally occurring gut flora, an ecology of microbes, to re-establish themselves.

Certain strains of probiotics which have been tested, have been found to manage lactose intolerance, lower cholesterol, lower blood pressure, improve immune function, and prevent infections. Diarrhea resulting from antibiotics has been relieved, inflammation has been reduced, and mineral absorption has been improved.

Most human trials have found that the strains tested may exert anti-carcinogenic effects by decreasing the activity of an enzyme called ß-glucuronidase  (which can generate carcinogens in the digestive system). Lower rates of colon cancer among higher consumers of fermented dairy products have been observed in some population studies.

Article from ChineseNews.com

InspireHealth release – Vancouver-based InspireHealth – Canada’s leader in integrated cancer care and prevention – today announced that a newly-released U.S. study, which provides evidence that Vitamin D substantially reduces the risk of cancer development, is the most important cancer prevention study ever published.

The study released today by researchers from Creighton University in Nebraska is a double-blind, randomized placebo-controlled trial – the highest standard in medical research, and is being published in the American Journal of Clinical Nutrition.

“The study shows that in women over 55, Vitamin D supplementation may be able to reduce cancer incidence by 60 per cent. That’s a staggering finding,” said Dr. Hal Gunn, M.D., Co-Founder and CEO of InspireHealth. “Translated into numbers, more than 35,000 Canadian women could be saved from getting cancer each year. If Vitamin D is helpful for younger women and men as well – which seems likely based on other evidence – the numbers are even greater. This is remarkable for something as simple as Vitamin D supplementation.”

Physicians at InspireHealth, aware of the growing body of research supporting the use of Vitamin D in recent years, have been prescribing Vitamin D for cancer prevention and treatment for the last 10 years since InspireHealth’s founding in 1997. “Over the last 15 years, there has been a growing body of research showing that Vitamin D plays a very important role in the prevention of cancer of the colon, breast, prostate, lung, stomach, bladder, pancreas, uterus and ovary,” said Dr. Gunn. “This new study proves that link, and demonstrates that Vitamin D supplementation may provide a simple means to prevent the majority of cancer cases.”

“In short, this study clearly indicates for the first time, we may have a simple and effective means to prevent the majority of cancer cases, and put an end to the cancer epidemic that has plagued the western world for the last century,” said Dr. Gunn. “The Vitamin D study is a landmark study in cancer prevention.”

The researchers, who were originally studying the effects of Vitamin D and calcium on osteoporosis, found that this combination (vitamin D 1,000 IU per day and calcium 1400-1500 mg per day) substantially reduced the incidence of cancer (by 60 per cent) during the four-year period of the study. Researchers found that Vitamin D provided even greater protection when used longer term – a 77 per cent reduction in cancer incidence after one year of Vitamin D use.

Assuming Vitamin D has a similar benefit in all age groups and both genders, this may mean that up to 15,000 cases of cancer in BC alone could be prevented each year, and 123,000 cases in Canada, by simply ensuring that all Canadians take Vitamin D supplements on an ongoing basis.

Baseline and treatment-induced Vitamin D levels were found to be strong predictors of cancer risk in this study, providing further evidence of the value of Vitamin D in cancer prevention.

“It is important that all physicians and Canadians are aware of the results of this study and adequately supplement with Vitamin D”, said Dr. Gunn. “Vitamin D has many other health benefits besides cancer prevention and is important in the promotion and maintenance of optimal health and immune system function.”

“An important challenge in incorporating health-related research into medical practice is that much of this health-related research – such as Vitamin D supplementation, nutrition and exercise – gets ‘lost’ in the medical literature. At InspireHealth, we have created a Research Information System – the first of its kind in the world – that tracks world-wide research on integrative approaches to cancer prevention and treatment, enabling physicians and patients from around the world to access this research free-of-charge simply by logging on to our website at www.InspireHealth.ca,” Dr. Gunn added.

InspireHealth, Canada’s leader in integrative cancer prevention and treatment, was founded to help people with cancer explore the many ways they can support their own health before, during and after cancer treatment. InspireHealth is a non-profit society funded by the Lotte and John Hecht Foundation, the Canadian Cancer Society, the Canadian Breast Cancer Foundation, the Provincial Government and other foundations, corporations and individuals. It has served over 4,000 patients to date and aims to increase that number to 2,000 patients annually by 2012. InspireHealth has working partnerships with the Canadian Cancer Society, the Canadian Breast Cancer Foundation, BC/Yukon Chapter, the BC Cancer Agency, and the BC Foundation for Prostate Research.