Understanding of the various ways vitamin D effects the body is growing rapidly. Originally this vitamin was thought to only effect calcium in the blood and bone but recent research shows it possesses important influences on the immune system and cancer development. A study just published in Journal of Endocrinology and Metabolism June 2012 now shows that this same vitamin can possibly influence metabolism. A common disorder of metabolism known as Syndrome X or the Metabolic Syndrome is characterized by high triglycerides and low good cholesterol (HDL), abdominal obesity, along with elevated blood pressure and blood sugar. The researchers discovered those with vitamin D levels between 16 and 20 were 75% more likely to develop the Metabolic Syndrome within 5 years than those with vitamin D levels above 34 (levels below 30 are considered low).
Whether low vitamin D is the cause of the Metabolic Syndrome is unclear. Vitamin D prevents fat cells from reproducing, helps the natural process of triglyceride breakdown and helps regulate blood sugar by making insulin work more efficiently. Without enough vitamin D the fat cells could multiply faster, triglyceride levels accumulate and blood sugar rise as is seen in Metabolic Syndrome.
As I have explained in previous posts at metabolism.com, vitamin D is also related to development of hardening of the arteries (atherosclerosis) and obesity in Type 2 Diabetes which could be considered a more advanced form of Metabolic Syndrome.
Doctorsâ€™ efforts to monitor vitamin D levels are being hindered by new regulations by Medicare and private insurance carriers to deny payment for vitamin D screening. Lately, a number of my patientsâ€™ vitamin D tests were denied by insurance carriers with patients being charged over $200 per test because it was not â€œindicatedâ€.
Recommendations for vitamin D supplementation are debated. When skin is exposed to sunlight it manufactures vitamin D so there is thought that people who get sun exposure should not need vitamin D supplement but that is not borne out in reality. Previously the recommended daily allowance (RDA) was 400 units per day an amount which has been increased slightly for the elderly. Some experts recommend 1000 unit daily or more. In my practice I generally recommend starting at 1000 units and then rechecking 25 hydroxy vitamin D levels a few months later. Some individuals require 4000 unit or more daily to achieve vitamin D levels over 30. When purchasing vitamin D the D3 form appears to be converted in the body more rapidly than the D2 variety. High priced brands of vitamin D, in my opinion, are a waste of money.
Gary Pepper, M.D.
The lawsuits against Avandia are being prepared and opportunists are lining up for a payday. Unfortunately, everyone else will wind up a loser, and here’s why.
Avandia, one of only two available medicines with unique properties to treat diabetes, was approved in 1999. From the very first day Avandia was approved a heated debate arose whether Avandia or its sister drug, Actos, was the better drug for diabetes treatment. Both had similar abilities to lower blood sugar and both had the same downside of causing significant weight gain and fluid retention. Avandia showed a slightly worse effect on cholesterol profiles which convinced many diabetes specialists to choose Actos over Avandia. The choice between drugs has also been heavily influenced by cost considerations such as whether the drug was covered by the patient’s insurance carrier. I personally treated numerous patients with both drugs and found them about equal in all respects.
The lawsuits against Avandia will contend that the medication caused heart attack or stroke. The truth of this contention is very much in question, but the murkiness of the water doesn’t stop the lawyers from trying to take a bite out of the flesh of GSK (GlaxoSmithKline), the maker of Avandia.
Several years ago research studies seemed to indicate a small increased risk of heart attacks in users of Avandia. Ever since there has been a heated debate about whether this was a true risk or just the result of overly aggressive interpretation of the available data. There are two major analyzes on the subject of heart attack risk with Avandia. One, written by a doctor on the payroll of a competing drug company, looked at results from 14 thousand patients on Avandia and found a small increased risk of heart attack or stroke and the other study analyzed another 14 thousand Avandia users and found no such association. Under pressure from the public, in 2007 the FDA placed a strong warning on the label of Avandia regarding the possibility of the drug causing heart disease, but Avandia was permitted to remain on the market. The FDA warning was updated and upgraded in 2010. The publicity surrounding Avandia’s potential risks basically halted the use of the drug in the U.S.
Now enter the opportunists. Advertisements fill my email in-box from lawyers looking for customers who want to sue the drug manufacturer in class action law suits. Try goggling “Avandia side-effects” and you will find the first several pages of results are ads looking for lawsuit clients. In the last month I received two requests for patient records from these lawyers. Both patients had heart disease at the time they started the medication. One patient who recently died was over 80 years old, and the other who had significant heart disease and other diabetes complication to begin with, is still alive more than 7 years after treatment with Avandia. I wonder how much benefit these patients received from the medication which allowed them to survive as long as they did despite all the other problems they had related to their diabetes.
Why should you care about whether a small army of opportunists each get a few thousand dollars from the drug manufacturer and a few lawyers become millionaires? Because it is just this sort of legal action which is convincing drug makers to back away from developing other potential diabetes treatments. It takes a decade and a billion dollars to bring a new drug in front of the FDA. This doesn’t include the cost of developing drugs which fail to even make it to FDA review. Then the FDA approval process is tortuous and uncertain. Passing this hurdle, any new drug can come under attack (like Avandia) for “possible” side effects making the company vulnerable to devastating legal costs and bad publicity. It isn’t economically feasible to develop new diabetes drugs in the United States. As a result, new drug development is grinding to a halt. We will all suffer due to lack of innovation, not only for diabetes treatment but for treatment of many other dangerous diseases.
Gary Pepper, M.D.
Editor in Chief, Metabolism.com
Over eating and emotional eating is just another sign that you are in fact human.
knowing why is more than half the battle
You’ll see a lot of articles about how to fight the occasional eat-fest, in fact I dare you to find one woman’s or man’s magazine near the holidays and at the beginning of summer that doesn’t address this issue.
In these magazines, and even on weight loss forums all over the net, you’ll see suggestions with how to beat it: eat this food, don’t eat that food. Go for a walk, take a bath. But let’s be honest, if these things worked, we’d all be prunes from taking all of those bubble baths and ben and jerry’s would be out of business….well, okay, they’d have to at least sell the summer home in Buenos Aires.
So here’s some more practical advice on discovering your reasons for binging and how to heal from them:
There are only 2 possibilities for eating past hunger:
1) you’re not getting enough nutrients from the foods you eat.
If this is true, your cravings will be for very particular food groups and will often come with other health problems like light headedness, cranky moodswings, headaches, muscle cramps, etc.
For example, someone that does not get enough protein or is getting too much protein will crave sugary foods because both proteins and sugars will show up in your blood sugar insulin levels, keeping the right amount of proteins in your diet will keep sugar cravings at bay. If this is you, you may feel fatigued in your workouts, have irregular periods or feel sluggish.
People on over restrictive diets low on calories will crave carbohydrates and sugars because these are the sources more quickly turned into energy in the body.
If you know that you’re not eating well or are on a ___diet (fill the blank in with any one food item and you KNOW it’s a bad idea), this could be your reason. Do you feel hungry constantly, do you have trouble sleeping? These could be signs of imbalanced carbohydrates in your diet.
2)you’re not getting enough emotional outlets in your life.
Look, we’re emotional beings. We eat for hunger, yes, but we also eat because we’re stressed, tired, lonely, bored, celebrating. And we’re not the only ones. I’ve watched my cat eat until she puked (and then eat the puke, and then puke the puked food and eat it again) because she was lonely, so why should we expect more from ourselves? Okay, fine, don’t eat what you’ve puked.
If you know this is why you over eat, I ask you to think of one question: What feeling am I seeking when I eat too much?
This one question will get you a lot more than you may think. If you eat until you feel happy, what happened today or earlier that made you UNhappy? If you eat until you feel calm, what made you irritated? Generally, emotional eating form their own kind of food groups:
Crunchy salty foods = aggravation, irritation.
Sweet, soft doughy,creamy foods = sadness, need for consolation.
Soft, salty foods = boredom, loneliness.
Fatty, fried foods = feeling spacy, ungrounded, unsure.
Now of course there’s no science book that’s going to break down these parallels in what you eat, when and why. You could be ready to punch your boss in the face and reach for ice cream, not chips, but hey, don’t you want someone to console you after you punch him?
In the end, if you can start with knowing why YOU eat too much, that’s more than half the battle.
So I’m not saying the next time you go shopping to distract yourself from the Dorito aisle because it’s “bad”, but just think, what do I want to feel after I eat this? and see if that changes anything.
Kimberly, counselor since 1998 and founder of www.RedAppleYoga.com, holds a Masters in Health & Healing as a Certified Nutritional Counselor, a Masters in Education and is an internationally trained advanced Â Yoga and Yoga Therapy instructor that has worked and studied in New York, Spain and in Southern India. Her practice is based in New York City. She believes in showing her clients how to combine time-tested ancient theories with modern knowledge to get the best benefits from both worlds.