Taken from the Vitamin D Council Newsletter
January 30, 2012 — Dr John Cannell
Every year, billions are spent in fertility clinics; the result of which is often in vitro fertilization (IVF). About 5 years ago, I began receiving emails from a nurse practitioner in Indiana who works in a fertility clinic. Her experience was dramatic; 5,000 IU/day for both the man and woman frequently resulted in a healthy baby. However, her last email to me was quite sad, she was in danger of losing her job as her boss, a gynecologist, was losing money due to vitamin D. He ordered her to stop advocating it or lose her job.
Today, the Daily Mail and several other newspapers reviewed a lengthy article in The European Journal of Endocrinology that concluded, “Given the high prevalence of infertility as well as vitamin D insufficiency in otherwise healthy young women and men and the possible role of vitamin D in human reproduction, research might lead to new therapeutic approaches such as vitamin D supplementation in the treatment of female and male reproductive disorders.”
Critical to this carefully caged advice is the fact that men need help as frequently as the women do. “Population-based studies found that in 30-40% of infertile couples the underlying cause is the male factor. In this context it should be mentioned that the overall semen quality of men is decreasing, which might partly be explained by environmental factors. Indeed, as much as 20% of young men have sperm concentration below the WHO recommendation level and 40% present with sperm concentrations below a level that is considered optimal for fertility.” Pretty amazing, especially when you realize these men have normal testosterone levels but that vitamin D levels are steadily decreasing.
The authors go onto say, “In northern countries, where a strong seasonal contrast in luminosity (sunshine intensity) exists, the conception rate is decreased during the dark winter months, whereas a peak in conception rate during summer leading to a maximum in birth rate in spring has been observed. Moreover, ovulation rates and endometrial receptivity seem to be reduced during long dark winters in northern countries.”
While no direct studies exist of vitamin D levels and fertility per se, the authors report, “In a study among 84 infertile women undergoing in vitro fertilization, women with higher levels of 25(OH)D in serum and follicular fluid were significantly more likely to achieve clinical pregnancy following in vitro fertilization . . .”
If you don’t want to work your way through the entire 42 page paper, read the excellent synopsis in the Daily Mail below.
The takeaway message is the same as always, a message so common I should just start saying “ditto.” If you want to get pregnant, make sure you and your partner take 5,000 IU/day. If you don’t want to get pregnant, make sure you and your partner are on 5,000 IU/day plus a reliable method of birth control. I take no responsibility for surprise pregnancies.
Nearly one third of Australian adults are suffering vitamin D deficiency according to a study involving more than 11,000 adults from around the country.
This is the first national study to evaluate the vitamin D status of Australians. Those at greatest risk for deficiency were women, the elderly, the obese, people doing less than 2.5 hours of physical activity a week, and people of non- European background.
The results highlight vitamin D deficiency as a major public health issue for Australia that requires urgent attention, said study leader Professor Robin Daly, Chair of Exercise and Ageing within the Centre for Physical Activity and Nutrition Research at Deakin University, and honorary fellow in the Department of Medicine (Northwest Academic Centre) at the University of Melbourne.
“Vitamin D deficiency is emerging as a major health problem worldwide. It is clear from the results of our study that, despite an abundance of vitamin D rich sunlight, Australians are not immune from this issue,” he said.
“Low levels of vitamin D can contribute to a number of serious, potentially life-threatening, conditions such as softened bones; diseases that cause progressive muscle weakness leading to an increased risk of falls, osteoporosis, cardiovascular disease, certain types of cancer and type 2 diabetes.
“While it was reassuring that only four per cent of the population had severely deficient levels, national strategies are urgently needed to attack the high prevalence of vitamin D deficiency in Australia before the problem worsens.”
For the study, the researchers measured the vitamin D levels of 11,218 adults aged 25-95 years from all six states and the Northern Territory as part of the Australian Diabetes, Obesity and Lifestyle (AusDiab) study conducted by the Baker IDI Heart and Diabetes Institute in 1999-2000.
The study revealed:
- 31 per cent of the population were vitamin D deficient
- Nearly three quarters (73 per cent) had levels considered by many experts as below the optimal for musculoskeletal health
- The prevalence of vitamin D deficiency increased with age, especially in women; 26 per cent of women aged 25-34 years were deficient which increased to 57 per cent for those aged 75 years and over. This is an important finding as vitamin D deficiency is a key risk factor for falls and fractures in the elderly.
- People of non-European origin were 4-5 times more likely to be deficient
- Those who were obese and physically inactive were around twice as likely to be vitamin D deficient
The prevalence of deficiency was also found to vary markedly by season and location, with deficiency more common during winter and in people residing in the southern states of Australia.
“For example, 42 per cent of women and 27 per cent of men living in the southern states were deficient during summer-autumn, which increased to 58 per cent of women and 35 per cent of men during winter-spring. Even in the northern states 31 per cent of women and 15 per cent of men were vitamin D deficient during winter-spring,” Professor Daly said.
Professor Daly and his co-authors from the University of Melbourne and the Baker IDI Heart and Diabetes Institute said it was timely and appropriate to develop national strategies across the whole population and further awareness campaigns for balancing safe sun exposure and adequate vitamin D intake to ensure optimal vitamin D status year-round for all Australians.
The results are published in the journal Clinical Endocrinology.
Notes
In this study vitamin D levels in the blood (also referred to as serum 25-hydroxyvitamin D) of less than 50 nmol/L represent deficiency and values less than 75 nmol/L represent insufficient level. Levels below 25 nmol/L are considered as severe deficiency.
Ethnicity was categorised into ‘Europid’ and non-Europid based on country of birth. The majority of participants were categorised as Europids which included those born in Australia, Northern Europe, Canada, USA and New Zealand. Non-Eurpoids included those born in Southern Europe, Asia, the Middle East, India and Sri Lanka, Pacific Islands, Africa and South and Central America.
Source: Deakin University
The highly prestigious British Medical Journal (BMJ) has again published damaging findings of scientific fraud. The BMJ markets itself with the tagline “Helping doctors make better decisions” but one has to question the quality of decisions based on faked science. The BMJ noted that the current findings of fraudulent behaviour are similar to findings in a 2001 survey. This decade of non-improvement may indicate a chronic and resistant problem that may remain until we experience a scientific revolution of sorts.
According to the BMJ:
One in seven UK based scientists or doctors has witnessed colleagues intentionally altering or fabricating data during their research or for the purposes of publication, found a survey of more than 2700 researchers conducted by the BMJ.
The survey, which was emailed to 9036 academics and clinicians who had submitted articles to the BMJ or acted as peer reviewers for the journal (response rate 31%), found that 13% of these researchers admitted knowledge of colleagues “inappropriately adjusting, excluding, altering, or fabricating data” for the purpose of publication.
Aniket Tavare, ‘Scientific misconduct is worryingly prevalent in the UK, shows BMJ survey’ BMJ 2012;344:e377
Unfortunately, it appears that the BMJ, while criticising the quality of the research done by others that it publishes, failed to be sufficiently diligent in the design, execution and analysis of its own survey. Professor Sheila Bird, a biostatistician from Cambridge, appears to have had a field day in providing a critique (http://www.bmj.com/content/344/bmj.e377?tab=responses). Perhaps the designers thought that a truly well crafted survey tool might frighten potential respondents, as if to suggest that this is indeed a matter that will be taken seriously. Who can tell just what was in their minds? In any case surveys can be notoriously weak if not performed well. Perhaps indeed, the BMJ feared that a better survey might reveal even more damaging findings.
In the Editorials section of the BMJ published 4 January 2012 Fiona Godlee, BMJ Editor in Chief and Elizabeth Wager, Chair Committee on Publication Ethics, UK said “Research misconduct can harm patients, distort the evidence base, misdirect research effort, waste funds, and damage public trust in science.” It is reassuring to see they have some sense of the gravity of daily reality. They go on to argue for the establishment of some “formal mechanisms for overseeing research integrity” but one might be forgiven for sounding a little cynical by replying “good luck with that.” I would suggest that the problems they are attempting to solve are far more fundamental than any form of monitoring can deal with.
In the meantime I continue to recommend intelligent, critical consumption of anything and everything. Only the ignorant, the foolish and the lazy accept the pontifications of “science” uncritically. It is disturbing to see so much modern clinical practice that is highly dubious or obviously unsafe that becomes “normal practice” because individuals have become afraid to think for themselves, instead scurrying to the comfort of the crowd, the mantle of “approval” and the dictates of various authorities.
Tags: BMJ, Fraud in medical science
The February 2012 edition of The Health Gazette Ezine will be published as scheduled on February 1st.
The February edition revisits aging in the first of three articles on the topic.
Subscribers will find the ezine in their mailbox soon. It is already posted in the subscribers’ archive.
Tags: Aging, Health Gazette Ezine
January 11, 2012 — Dr John Cannell
In a paper critical of higher levels of vitamin D for allegedly increasing a marker of inflammation, c-reactive protein (CRP), Drs. Muhammad Amer and Rehan Qayyum of the Johns Hopkins School of Medicine, began their paper by saying:
“The cardiovascular protection offered by vitamin D and its analogues is probably mediated by modulation of inflammatory cytokines.”
If you will notice, both physicians know that vitamin D offers “cardiovascular protection.” However, they are concerned 25(OH)D levels higher than 20 ng/ml will increase inflammation as measured by CRP and thus worsen cardiovascular protection. CRP is a protein in the blood which tends to rise in response to inflammation or injury. Its physiologic role is to take part in the “complement system.”
The authors arrived at this conclusion by adjusting their data for up to 9 variables and finding that a 25(OH)D of 20 ng/ml is associated with a CRP (range 0-5) of approximately 1.7 while a 25(OH)D of 50 ng/ml is associated with a CRP of 1.9. Their raw findings contradict their adjusted data in that the raw data showed what we have known for some time and that is that in the lower ranges of 25(OH)D, vitamin D reduces CRP. As with most biomarkers of vitamin D, the big improvement is in people who get their 25(OH)D up from 5 ng/ml up to 20 ng/ml. We know that in most cases, the biggest bang for the buck is in treating severe deficiency in people with such low levels.
So if you have natural levels of vitamin D, say a 25(OH)D of 50 ng/ml, and you want to decrease your CRP by 0.2, then stop your vitamin D and stay out of the sun, get your levels to 20 ng/ml, and see if all the corrections and adjustments the doctors performed were correct. I certainly am not going to do such a silly thing.
Dozens of studies now exist showing supplemental vitamin D3 reduces mortality rates, in part due to its cardiovascular protection. The majority of these studies show that improvement in mortality continues through 30 ng/ml and even up to 40 ng/ml. Not enough people have levels of 50 ng/ml for scientists to see if such levels offer further protection. However, cardiovascular disease is rare in native peoples around the equator where vitamin D levels of 50 ng/ml are not uncommon.
The takeaway message from this paper is that scientists will need to recalculate lots of different “normals,” using vitamin D sufficient subjects. It’s not just that normal CRP may be a bit higher in vitamin D sufficient people, their red blood count and the protein albumin may be a bit lower, for example. The point is that pathologists and epidemiologists will need to redo much of their work. We don’t know the normal range of CRP in 65-year-old men; we know the range of CRP in 65-year-old vitamin D deficient men. Likewise, we don’t know the incidence of heart disease in 65-year-old men; we know the incidence of heart disease in vitamin D deficient 65 year-old men. We have lots of work to do.
Source: Vitamin D Council Newsletter
Tags: CRP and vitamin D, vitamin D