Dr Dingle's Blog / vitamins
There were 15 million preterm births (PTB) (<37 weeks) worldwide and more than 1 million infant deaths from PTB complications each year. PTB is the leading cause of neonatal death and multiple short and long term health problems.
Multiple epidemiologic studies have found an association between higher levels of vitamin D ( 25-hydroxyvitamin D [25(OH)D] ) and lower PTB risk. In this study of 1,064 pregnancies with an overall rate of PTB of 13% women with higher vitamin D ≥40 ng/mL had a 62% lower risk of PTB compared to those <20 ng/mL. This is an outstanding finding and should be shared with everone
In clinical trials, 4000 IU/day of vitamin D was found to safely achieve a concentration of at least 32 ng/mL by early in the second trimester in a diverse group of pregnant women.
Unfortunately we are told to stay out of the sun and not to eat fat (which is why i recommend against both of these). The two major sources of vitamin D
Vitamin D is one of the essential nutrients required by the human body. Unlike most vitamins, it is one that we can manufacture on our own, given the right conditions. Despite this, vitamin D is showing up increasingly in populations as the most widespread and critical nutrient deficiency; this deficiency is linked to many diseases and disorders, costing billions of dollars each year. Our changing lifestyles, including increased indoor living and campaigns warning people to stay out of the sun have meant that most people don’t get enough vitamin D. The resulting deficiency is compounded by the consumption of modern and processed foods devoid of any vitamin D.
Vitamin D refers to two biologically inactive precursors: D3, also known as cholecalciferol (made from cholesterol), and D2, also known as ergocalciferol. Vitamin D is the only nutrient that can actually be synthesized by the human body, which technically means that it is not a vitamin. The synthesizing of vitamin D in the body can be achieved through contact with solar ultraviolet B radiation emitted by the sun. Without the presence of this solar radiation the only way to get vitamin D is through diet—hence, it is still classified as a “vitamin.”
In addition to vitamin D obtained through UVB exposure to the sun, this vitamin can be found in foods such as eggs, butter and fortified milk, with the highest levels found in fish. Remember, we evolved as fisher- hunter gatherers and fish used to be an essential part of our nutrition. Vitamin D can also be provided by supplements. Numerous studies have concluded that sensible sun exposure and supplementation are the most effective ways of increasing vitamin D levels.
Other deficiencies in vitamin D have been linked with a range of problems with the musculoskeletal system including low bone and muscle problems, as well as cardiovascular disease, diabetes and metabolic syndrome, cancer and impacts on the immune system, Parkinson’s Disease, asthma, pain, and pre eclampsia.
Studies have indicated that vitamin D supplementation may reduce the risk and difficulties associated with autoimmune disorders. In particular, there is strong evidence that vitamin D reduces the risk of multiple sclerosis and type 1 diabetes mellitus, and weaker evidence for rheumatoid arthritis, osteoarthritis, systematic lupus and erythematosusstar. There is no doubt about the link between vitamin D shortage and multiple sclerosis. There is a 41% decrease in MS risk for every 50 nanomoles per liter increase in 1,25-hydroxyvitamin in the blood. Vitamin D deficiency also predisposes to insulin resistance and pancreatic beta cell dysfunction. In a study of 10,366 Finnish children those given 2,000 IU of vitamin D3 per day throughout the first year of life experienced a 78% reduced risk of type 1 diabetes.
Considering the evidence, there is an overwhelming agreement between vitamin D researchers that current recommendations of 200 IU per day for children and adults up to 50 years of age for vitamin D need to be increased to 800 IU to 1000 IU vitamin D3. Numerous studies have shown supplementation to be effective in raising blood levels of Vitamin D levels with no evidence of intoxication reported in either the short- or long-term trial.
Sensible sun exposure (or UVB irradiation) along with supplements are required to satisfy the body's vitamin D requirement. To achieve adequate levels of vitamin D we need to get one to two hours of sensible sun exposure a day. While it is prudent to avoid too much sun it is important to remember that the costs of vitamin D deficiency far outweigh the cost of skin cancer and some sun may also be necessary to reduce skin cancers. Remember, we did evolve in the sun but not all day, especially for those with fair skin.
The study shows the benefits of more fruit to prevent diabetes and reduce diabetic complications for diabetics. Unfortunately, fruit has been put in with all the foods where sugar is added just because it has sugar in it. People are being driven away from consuming more fruit and I have argued against poor advice given to diabetics for years. If it is no bad show me the evidence.
While sugar is a major culprit in diabetes it is not a sugar illness it is a mithochondrial dysfunction brought about by sugar and other poor diet (trans fats, artificial sweeteners etc), microbiome issues and lifestyle including stress, inactivity and loss of metabolic tissue and even toxins in the environment. The difference is that the sugar in fruit comes with a large array of essential nutrients including vitamins, minerals, antioxidants and anti-inflammatory ingredients, fibre, enzymes, water and prebiotics. All of these are potentially involved in repair of the mitochondria.
Of all the studies I have looked at they show that, even for diabetics, fruit is beneficial even when it comes to blood sugar levels. When fruit is consumed the sugar in it does not behave the same way that added sugar does. There are many potential reasons for this but we need to look beyond just basic concepts like if sugar is bad all foods that have sugar in them must be bad. This is naive and does not reflect the complexity of the human body.
This study was of 0.5 million adults in China over 7 years of follow-up. It found that among those without diabetes at baseline, higher fruit consumption was associated with significantly lower risk of developing diabetes with a clear dose–response relationship. That is the more fruit the lower the diabetes. In addition, among those who had diabetes at the beginning of the study, higher fruit consumption was associated with lower risks of all-cause mortality and micro vascular (small blood vessel) and macro vascular (large blood vessel) complications.
"In this large epidemiological study in Chinese adults, higher fresh fruit consumption was associated with significantly lower risk of diabetes and, among diabetic individuals, lower risks of death and development of major vascular complications."
Vitamins for the heart
The science is overwhelming. We can reverse heart disease, unblock arteries and lower blood pressure with good nutrition and lifestyle changes and it can be improved even further with supplementation. There are now thousands of articles in all levels of scientific journals—on the benefits of supplementing, not only for the general population but also for cardio vascular disease conditions. Unfortunately, these do not seem to get media attention despite the fact that they may show dramatic reductions in the incidence and severity of diseases such as heart attack, stroke, and diabetes. However, we may need to re-evaluate our expectations when investigating nutrients used to treat serious chronic disease because it is unrealistic to expect a vitamin to undo a lifetime of unhealthy behaviours on there own and in a short period of time.
In fact, most people do supplement, especially those who know the most. Our own research shows us that people who supplement are usually people who have higher levels of education, enjoy a healthier diet and lifestyle and are more interested in health; these are people who are taking responsibility for their own health. The increasing use of dietary supplements in general is one example of better health through preventative measures, which is a result of consumers wishing to take charge of their wellbeing.
Far too much credit is given to the Recommended Daily Intakes (RDIs) of nutrients, the information on the side of your breakfast food box, as a guide to healthy nutrition. These guides are based on precluding acute nutrient shortages, not preventing or treating modern day chronic disease epidemics. There has been a big shift in thinking from the concept of “adequate nutrition,” being all that is required, to “optimal nutrition” needs, the nutrients that help us flourish and be free of disease. Our early nutrition models were great for preventing scurvy and pellagra but not for the chronic illnesses that afflict so many now. Current evidence suggests that optimising nutrition and metabolism will delay ageing and the diseases of ageing in humans, including CVD. The proof however is in the pudding. I have seen so many people, literally in the hundreds, who have told me how they have personally benefitted from supplementing. Most commonly though, I see people who have a new lease on life: they feel better and have more energy and libido both good indicators of cardiovascular health.
A 2010 Swedish study of 31,671 women found that multivitamin use was associated with a reduction in the rate of heart attack (myocardial infarction), especially long-term use among women with no CVD. During an average of 10 years of follow-up, the women without any history of CVD who took multivitamin supplements had 27% fewer heart attacks over the period. That is better than any drug to lower cholesterol and has no negative side effects. The use of multivitamins over a five-year period—that is, those who took them the longest—saw a reduction of 41%.
Vitamin C supplementation has been shown to benefit many of the underlying mechanisms of the development of atherosclerosis (plaque build up) and hypertension, including preventing oxidation of cholesterol and improving endothelial dysfunction in patients with proven artery disease. A 2011 study found that adequate intake of vitamin C was associated with longer survival in patients with heart failure. The study of 212 patients, average age of 61, found that heart failure patients with low levels of vitamin C had the highest levels of inflammation markers and had more major heart attacks and higher death rates. The heart failure patients in the study with low vitamin C were also about twice as likely to die from heart disease within one year of follow-up.
A meta-analysis of 29 clinical trials with a median dose of 500 mg per day for eight weeks showed a reduction in systolic blood pressure of 3.84 mm Hg and 1.48 mm Hg for diastolic blood pressure. In trials in hypertensive participants, corresponding reductions in SBP and DBP were 4.85 mm Hg and 1.67 mm Hg  and higher doses of vitamin C also produced greater reductions in blood pressure. In a meta-analysis of 29 randomised, controlled, clinical trials investigating vitamin C intake, researchers found that taking an average of 500 milligrams of vitamin C daily reduced blood pressure by 3.84 mm Hg in the short term. Among those diagnosed with hypertension, the drop was nearly 5 mm Hg. Patients who take blood pressure medication such as ACE inhibitors or diuretics can expect a roughly 10 millimetre of mercury reduction in blood pressure.
A number of studies have demonstrated that high dosages of vitamin E or supplementation are associated with a significant reduction in cardiovascular diseases  with relative risk reductions up to 65%. The Cambridge Heart Antioxidant Study (CHAOS) examined the effects of vitamin E supplementation on 2,002 patients suffering from coronary atherosclerosis, the buildup of arterial plaque, over a period of three years. Patients with advanced coronary heart disease were able to significantly reduce their risk of suffering a heart attack if they supplemented with vitamin E at the levels of 400 international units (IU) to 800 IU per day. Patients receiving supplementation of vitamin E were less than half as likely to suffer a heart attack than those receiving the placebo. Two additional large prospective studies also found that persons who supplement with vitamin E for at least two years display approximately 40% lower incidence of coronary heart disease than those not taking vitamin E supplements.
In a study of 39,910 US male health professionals 40 to 75 years of age who were free from coronary heart disease, diabetes and high cholesterol, researchers found a lower risk of coronary disease among men with high intakes of vitamin E. Researchers found that men who took at least 100 IU per day for at least two years had a risk reduction for coronary disease of 37%. The maximal reduction in risk of around 40% was seen among men consuming 100 to 249 IU per day with no further decrease at higher levels. In a study of 87,245 female nurses followed for up to eight years, both vitamin E supplements and multivitamins were associated with a lower risk of major coronary disease and the relative risk from multivitamins was a result of the vitamin E content. The use of vitamin E for two or more years was associated with a 41% decreased risk. Researchers found that a dose of less than 100 IU per day was associated with little or no apparent benefit.
Vitamin D is a pro-hormone that plays an essential role in the vasculature and in kidney function not to mention dozens of other functions including immune health. Low vitamin D concentrations appear to significantly associate with left ventricular hypertrophy, increased arterial stiffness, hypertension, endothelial and renal dysfunction  in normal subjects and in patients with chronic kidney disease and type 2 diabetes. Low vitamin D reduces calcium levels in the blood, causing weak heart muscle contraction and strength. Arteries become stiff and blood flow is poor. D3 allows the immune system to address infection that creates build up of plaque in arteries. Large recent populations studies have shown that up to 75% of people are D3 deficient and 40% are severely depleted.
In a study of 12,644 US civilians, systolic BP was inversely and significantly correlated with 25(OH)D levels. Other large international studies have reported similar results.
A growing number of studies suggest that exposure to sunlight improves health overall, because the benefits of reducing blood pressure far outweigh the risk of developing skin cancer. Heart disease and stroke linked to high blood pressure are estimated to lead to around 80 times more deaths than those from skin cancer in the UK. Production of nitric oxide rises after exposure to sunshine. In a study of the blood pressure of 24 volunteers who sat beneath tanning lamps for two sessions of 20 minutes each, the results showed that blood pressure dropped significantly for one hour following exposure to UV rays, but not after the heat-only sessions.
Coenzyme Q10 (CoQ10) is an essential cofactor (helper) of enzymes involved in the process of energy production. Coenzyme Q10, or ubiquinone, helps to convert fats, carbohydrates and protein into energy. Coenzyme Q10 is an obligatory member of the respiratory chain in the mitochondria of all cells. Cells that make up tissue with higher energy demand, such as muscles, have a higher number of mitochondria present. These tissues include the tissues of the heart, where CoQ10 plays an important role in protecting the heart. Coenzyme Q10 has been extensively researched for its ability to strengthen the heart muscle, specifically in patients with heart failure. Coenzyme Q10 (CoQ10) is naturally produced in the body and is the only antioxidant that humans synthesise in the body, but levels drop off as we age.
In a controlled study, researchers found that supplementing with CoQ10 (100mg twice a day) and selenium (200 mg) reduced heart attack risk in the elderly by around 50%. In the study, researchers gave 433 people, aged from 70 years upwards, the supplements or placebo pills every day for five years. Other heart failure medications block, rather than enhance, cellular processes and may have side effects. Supplementation with CoQ10, which is a natural and safe substance, corrects a deficiency in the body and blocks the vicious metabolic cycle in chronic heart failure called the “energy starved heart.”
B vitamins have been associated with a 24% reduction in heart disease risk in women who take four to seven multivitamins a week. There was a significant inverse relation between dietary intake of folate and vitamin B6 and mortality and morbidity from cardiovascular disease in the Nurses’ Health Study of 80,082 women over 14 years. Each 100-microgram-per-day increase in folate was associated with a 5.8% lower risk of coronary heart disease. In a retrospective cohort study of 5,056 men and women aged 35 to 79 years, there was a 69% increase risk of coronary mortality among those in the lowest levels compared with the highest blood levels of folate.
In a study of 38 patients with atherosclerosis of the carotid arteries, supplementation with folic acid pyridoxine and vitamin B12 was associated with regression of the arterial plaque—that is, reversing the plaque in the arteries. WOW. The benefits of folic acid supplementation are further emphasised by a 1996 meta-analysis that calculated that around 56,000 deaths due to heart disease could be prevented yearly with adequate folic acid supplementation alone.
One study reported a folate intake of 400 micrograms per day reduced total homocysteine (a major risk factor for heart disease) to the lowest level. A controlled study of 46 people (42 men, average age 73) found that even a low-dose folic acid supplement (400 micrograms) could lead to significant reductions in hyperhomocysteinemic elderly people. The researchers report that, while the low-dose folic acid supplements had no significant effect on homocysteine concentrations in the general study population, levels did significantly decrease in hyperhomocysteinemic subjects by 1.8 micromoles per litre.
Vitamin K is a fat-soluble vitamin also known as phylloquinone or phytomenadione. Increased intake of vitamin K reduces the buildup of calcium in arteries that leads to hardening of the blood vessels. A study found that higher intake of vitamin K2 (menaquinone), but not K1, was associated with a 20% reduction in calcification of the arteries (atherosclerosis). On the other hand, another study found that supplements of K1, also known as phylloquinone, might slow hardening of the arteries in people already suffering from the condition. In support of the clinical human studies, in a study of rats high doses of vitamin K led to reduced arterial calcification. The study found that high vitamin K intake not only prevents calcification but also even regresses arterial calcification. After six weeks of treatment with warfarin (supposed to reduce risk), researchers reported that the rats showed signs of significant arterial hardening. However, in both high-dose groups (K1 and K2) no continued calcification occurred, and the existing hardening was found to be reversed by about 40% after six weeks of supplementation. The reduced calcification was also accompanied by improved arterial elasticity in the high vitamin K groups to a similar level as in the control rats. Similar results have been shown on improving elasticity and reversing calcification of the skin with vitamin K supplements.
Time to look at supplementing with more vitamins to lower your risk of heart disease.
1 Gokce et al. 1999; Vinta et al. 1998; Ting et al. 1997; Huang et al. 2000; Fonorow and Till 2003; Sakuma et al. 2001; Fernandez 2001.
2 Song et al. 2011.
3 Juraschek et al. 2012.
4 Miller et al. 2012.
5 Stampher et al. 1993; Rimm et al. 1993; Knekt et al. 1994; Kushi et al. 1996.
6 Stephens et al. 1996.
7 Stampher and Rimm 1995.
8 Stampher et al. 1993.
9 Liu et al. 2013.
10 Reis 2007.
11 International Journal of Cardiology (2012).
12 Harvard Heart Letter 1998.
13 Rimm et al. 1998.
14 Morrison et al. 1996.
15 Peterson et al. 1998.
16 Boushey et al. 1995.
17 Selhub et al. 1993.
18 Journal of Nutrition Research Vol. 26.
19 American Journal of Clinical Nutrition (2009).
20 Schurgers 2006.
21 Gheduzzi et al. 2007
 Gokce et al. 1999; Vinta et al. 1998; Ting et al. 1997; Huang et al. 2000; Fonorow and Till 2003; Sakuma et al. 2001; Fernandez 2001.
 Song et al. 2011.
 Miller et al. 2012.
 Stampher et al. 1993; Rimm et al. 1993; Knekt et al. 1994; Kushi et al. 1996.
 Stephens et al. 1996.
 Stampher and Rimm 1995.
 Stampher et al. 1993.
 Reis 2007.
 International Journal of Cardiology (2012).
 Harvard Heart Letter 1998.
 Rimm et al. 1998.
 Morrison et al. 1996.
 Peterson et al. 1998.
 Boushey 1995.
 Selhub et al. 1993.
 Journal of Nutrition Research Vol. 26.
 American Journal of Clinical Nutrition (2009).
 Schurgers 2006.
 Gheduzzi et al. 2007.