An Apple A Day

A study was just published with exclamatory headlines warning about vitamin D and calcium raising the risk of kidney stones. They studied the blood and urine of 163 healthy, postmenopausal women for a year. Investigators gave the women from 0-4,800 iu of vitamin D and raised their calcium to 1,200 - 1,400 mg/day. 1/3 of the women had high levels of urinary calcium and some had elevated blood levels.

That would seem scary, except it isn’t. First, no one actually had a kidney stone or other trouble. More important to me is a much bigger study, involving more than 10 times as many women over a 10-20 times longer time span, also showing no kidney stones and no otherwise unaccounted for calcium elevations on blood work. That bigger study is my clinical practice.

Maybe this is because I insist that my patients drink enough water. Dehydration is the major factor leading to kidney stones and calcium is notoriously insoluble.

It may also be another example of our ignorance about calcium metabolism. For decades, the standard medical advice for patients who had a common calcium-based kidney stone was to avoid calcium. Then someone actually did a study instead of just making it all up, and found that low calcium intake was associated with INCREASED risk of kidney stones.

Another contradictory example can be seen in the disease called hyperparathyroidism. More common than once thought, people with hyperparathyroidism have high calcium levels which can potentially become lethal. Many feared that giving these patients vitamin D would make things worse. Turns out that taking vitamin D does not raise calcium levels in patients with hyperparathyroidism. In fact, in many of these patients, taking vitamin D lowers calcium and helps the patient otherwise.

Bottom line - get as much calcium as you can from food, use calcium supplements to make up for what you can’t eat, take lots of vitamin D (targeting a blood level over 50) and DRINK enough WATER so that your urine just slightly tints the water in your toilet.

If you read about vitamin supplements you must be confused. Actually, it would be hard not to be. Vitamins are, by definition, essential to health. Studies of hundreds of millions of people confirm that truth. However, a rash of recent studies have linked taking vitamin supplements to higher rates of a variety of diseases, especially cancer. What’s up?

The fundamental problem is bad research. This bad research is the consequence of poor understanding, plus the difficulties inherent in designing and conduct nutritional studies that apply to the real world. The best examples of the faults in these nutritional studies are probably those dealing with folic acid and vitamin E.

Many studies show that dietary folic acid reduces the risk of many diseases, particularly cancer. The prevention of congenital spinal malformations is the main reason our food supply has been fortified with folic acid for decades. Surveys of the American population show that this approach works. That is the simple part. The confusing part is that some studies have shown an increased risk of cancer with folic acid supplementation, while others have shown that folic acid lowers the risk of the very same cancers.

As many of you have heard me explain following your own blood testing, nearly 20% of us have a genetic inability to convert folic acid to its metabolically active form. Those individuals among us need to take a special form of folate. If they take the common, most widely available kind of folic acid, not only does it not help, it seems to cause problems consistent with the unhappy research findings. After MERCK, which holds a patent on this form of folic acid, allowed others to use it, I had it added to my multiple vitamin. Very few multiple vitamins contain this form of folic acid, as it is more expensive. Two months ago I read an editorial in a major medical journal wherein a couple of prominent experts pointed out that negative studies on folic acid in diabetics had neglected to address this issue. Their opinion, with which I am in complete agreement, was that these studies were fundamentally flawed and almost certainly drawing incorrect conclusions as a consequence.

Vitamin E has also taken a lot of heat due, to a similar lack of understanding. Most of the vitamin E you can buy in supplements comes as alpha tocopherol. Unless you are a chemist, your brain won’t want to swallow that word or distinguish it from beta, gamma, delta or any other tocopherols. It is not even that simple, because even with all of those tocopherols, an additional class of compounds called tocotrienols are part of the Vitamin E family and seem to be important. Food contains all of these compounds, and it appears that alpha tocopherol might be the least important of all. As one vitamin E researcher wrote, “taking a mixture of vitamin E that resembles what is in our diet would be the most prudent supplement to take”. I would amend that statement to read, “taking a mixture of vitamin E that resembles what would be in an ideal diet and considers your individual needs, would be the most prudent supplement to take”.

A recent survey concluded that very few Americans were low on any vitamins or minerals. While that got significant media attention, the fact that hundreds of studies have shown the opposite, did not. Many of those studies actually measured body levels. That is especially important as estimates from dietary records are woefully misleading. Dietary records are infamously different from the truth of what people really do eat. On top of that, absorption varies tremendously from person to person and even time to time for the same person.

Thankfully, there is evidence that some who write about and study nutrition are thinking more clearly. The “experts” are becoming more expert. Also, those with a better understanding are getting at least some attention for their criticisms.

Positive evidence of the benefits of dietary supplementation continues to accumulate (of course). Recent studies have shown that the brains of people of all ages, from young children to elderly adults, function better beginning just days after starting to take a multiple vitamin. The same holds true of omega-3 supplements. In an example of the complexity of nutrient interaction, vitamin E lowers the rate of prostate cancer but only when taken along with selenium.

Bottom line-

Think critically - If something is vital, many of us need it.

Don’t forget the food - A vitamin pill cannot entirely replace good food.

Don’t go crazy - Take moderate amounts of nutrients as a safety net.

Go crazy if YOU need to - Some people, especially when ill, need much more.

Vitamins vary - Cheap forms of nutrients cost less, but they are usually a waste of money and can be harmful

900 pages and zero thought. That is my summation of the IOM’s new calcium and vitamin D statement. Having been a member of such consensus panels in the past, I am sympathetic to their tendency to fall to the most conservative “lowest common denominator” opinion. However, this document is far from a reasonable scientific assessment. Considering the research they ignored and my clinical experience, I am disappointed for the people who will suffer needlessly.

Go to http://www.grassrootshealth.net/iomquotes if you want to read comments from other scientists. Also, the Vitamin D Council is filing a request under the Freedom of Information Act that IOM release the recommendations submitted to them by vitamin D researchers and Walter Willett from Harvard, all of whom supposedly recommended higher standards than IOM.

Health advocate Gary Null has provided an unintentional educational lesson for those of us using dietary supplements. Taking one of his own products, he developed vitamin D toxicity. As there have been only a few cases of vitamin D toxicity ever reported, there is an inevitably interesting story behind this announcement.

Also, a recent independent analysis of St John’s Wort products found that fully one half of those tested were either contaminated with heavy metals (lead, cadmium) or deficient in the active marker compounds essential to the herb’s effects. 12 years ago a similar study found that the majority of products sold as St John’s Wort at health food stores was not actually St John’s Wort.

Please use these as a reminder to make sure that you purchase good supplements that have been analyzed for purity and content. As you can see on my MVM bottles, look for USP certification on vitamins. Purchase the best quality herbs, processed by manufacturers who comply with Good Manufacturing Practices, tested for marker compounds as noted on the label and ideally confirmed by independent testing.