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.
Once a common solution for the Miseries of Menopause, hormone replacement therapy (HRT) with estrogen was abandoned almost overnight in 2002 with the publication of the Women’s Health Initiative (WHI) results. The WHI did not dispute the fact that HRT is the best method of reversing post-menopausal symptoms such as hot flashes and insomnia but it did overturn some cherished beliefs as far as women’s heart health is concerned.
Women have a much lower risk of heart attack then men until they reach menopause. At menopause when the ovaries stop making estrogen the risk of heart attack climbs rapidly until it equals that of men. Common sense suggests that if losing estrogen causes increased heart attack risk then replacing the estrogen should prevent this. What the WHI appears to show is that HRT does not protect women from heart disease, but may actually increase the risk above the normal post-menopausal risk. Worse yet is the WHI conclusion that HRT increases the risk of breast cancer and of blood clot complications (thromboembolic disease). It is no wonder that in 2002 HRT took its place with smoking as the scourge of womens’ health.
Since that time scientists have reevaluated the WHI data and more work on HRT risk versus benefit has been done. What is evolving from this reassessment is that the use of progesterone in the WHI participants and the time from onset of menopause until the time HRT was started, both play important roles in how often women developed heart disease or cancer. Additionally, a new class of drugs when use together with HRT may block the cancer risks associated with HRT. In Part 2 of this article I will be covering these aspects. Stay tuned!
Gary Pepper, M.D.
Editor-in- Chief, metabolism.com
The adrenal glands sitting on top of the kidneys make several hormones critical to life. The central part of the adrenal makes the hormone we refer to as adrenalin, technically from the group known as catecholamines. This is the stress responsive hormone causing rapid heart rate, sweating, increased mental alertness, preparing the body for “fight or flight”. The outer portion of the adrenal makes the hormone cortisol, also known as cortisone. Cortisol maintains, among other things, the blood pressure, fluid and salt balance. Without sufficient cortisol production by the adrenals, life cannot be sustained. What is surprising is that excess cortisol can be as harmful to health as insufficient cortisol.
Deficient cortisol production is referred to as adrenal insufficiency (Addison’s disease is one form of this), while excess adrenal function is termed Cushing’s Syndrome. During certain types of stress such as severe infection the adrenal gland can produce up to 10 times the normal amount of cortisol. If cortisol levels remain elevated for prolonged periods of time the hormone’s destructive nature is revealed by the break down of soft tissue such as skin and muscle and weakening of the immune system with frequent and aggressive infections occurring sometimes with fatal outcome. Heart disease has not been associated with high cortisol levels until a recent study suggested this possibility.
Researchers from the U.K. examined morning cortisol levels in 1066 men and women with Type 2 diabetes participating in the Edinburgh Type 2 Diabetes Study. A positive relationship was discovered between cortisol levels and the occurrence of heart disease such as heart attack and angina. The higher the cortisol levels were the greater the risk of heart disease. Cortisol levels in diabetics were found to be higher than in non-diabetics, in general. The researchers could not explain why the cortisol levels caused heart disease or why levels were higher in diabetics. (From the April edition of the Journal of Clinical Endocrinology and Metabolism 95:1602-1608).
‘Adrenal fatigue’ is a recently proposed diagnosis used to explain a variety of general symptoms such as fatigue, moodiness, muscle aches, and diminished mental function. Supposedly, adrenal fatigue results from mild impairment of cortisol production. Practitioners who diagnose “adrenal fatigue” are prescribing synthetic versions of cortisol as treatment. The possibility of heart disease resulting from excess cortisol should be a factor that patients and medical professionals must consider before embarking on adrenal “supplementation” programs.
This information is for educational purposes only and is not intended as medical advice or treatment.
Gary Pepper, M.D.
Why is everyone picking on cholesterol !? Â It is certainly one of the most misunderstood, demonized molecules that our bodies make! Â It is so important as a precursor to many important molecules in our bodies and even acts as an antioxidant and anti-inflammatory! Â We produce cholesterol on an ongoing basis, for an ongoing reason. Â If we make too much or eat too much cholesterol, a feedback loop will kick in and slow down production for most people. Â Cholesterol drugs called “statins” triger that feedback loop and inhibit cholesterol production. Â Unfortunately they reduce production of squalene and Coenzyme Q10 (CoQ10) as well Â so people on statin drugs often experience side effects such as muscle cramping and exhaustion.
You must be asking why would we produce cholesterol when drug companies are telling us it is bad for us, so let’s review “Cholesterol 101”. Â We are able to convert cholesterol into “vitamin” D, bile acids, cortisol and other vital hormones including DHEA, progesterone, testosterone and estrogen. Cholesterol is incorporated into our cell membranes and is one of the primary lipids in brain tissue! Does that sound like a poison to you? Â OF COURSE NOT! Cholesterol is clearly vital to our health.
I put “vitamin” D in quotes for emphasis and to get your attention. Vitamin D is actually a hormone, but that’s another lecture! Â It is produced from cholesterol in the skin, in the presence of UV light from the sun. Â We can make up to 10,000 units of vitamin D with 30 minutes or so in the sun. Â Vitamin D has several target organs including the central nervous system, GI tract, immune system, pancreas and reproductive organs. Â Vitamin D is thought to protect us from tuberculosis, multiple sclerosis and even some cancers! Â Make sure you are making or taking plenty of the “sunshine vitamin”!
What about “bad” or “good” cholesterol? Â People like to call LDL a “bad” cholesterol but that is actually misleading.
The liver produces cholesterol and sends it out for delivery on the “LDL bus.” Â It can be delivered to the cells that need it at the time. Â The “HDL taxi” will pick up left over cholesterol and return it to the liver for recycling or disposal. Â Be aware that LDL and HDL can become elevated in response to toxins such as organic solvents, pesticides, heavy metals or even dry cleaning fluid! Â Elevated blood lipids should be completely assessed before any drug therapy is initiated!
There is one “bad” cholesterol and that is OXIDIZED cholesterol. Â This can lead to a cascade of events that build up plaque in our arteries. Â So, how do we prevent OXIDATION? Â ANTI-OXIDANTS of course! Â Vitamin C and full spectrum natural Vitamin E are especially important. Â No wonder why a deficiency of Vitamin C (master antioxidant) can lead to a type of heart disease known as Â atherosclerosis (“hardening of the arteries). Â Apparently heart disease and atherosclerosis are not “statin deficiency” diseases after all!
P.S., eat the yolk of your eggs. Â Not only do they contain cholesterol that should kick in your feedback loop, but they contain important nutrients such as choline, B12, vitamin E and even vitamin D!
So there, I hope you’ve started to fall in love with cholesterol. Â I just had to defend that vital, yet defenseless molecule! Stay tuned for more ! Â Clinical Nutritionist Beth Ellen DiLuglio, MS, RD, CNSD, CCN, LD/N. Â Metabolism.com
Theresa is concerned that failure to fully treat hypothyroidism can lead to complications including heart disease. Thank you Theresa for your informative post:
Theresa posts the following:
I find it odd that on all the thyroid forums I have seen, not one mentions the risk of cardiovascular fatality due to under medication of hypothyroidism.
In 1988 I had radioactive iodine ablation therapy and was euthroid for 8-years. Diagnosed in 1996 as hypothyroid. Prescribed Synthroid and have never felt well.
On Synthroid, my TSH, Free T3, and Free T4 are in the normal range, with a myriad of continued hypothyroid symptomsâ€¦ My new doctor ordered a Reverse T3 test. All levels look ok except my Reverse T3 level is 399 pg/mL. The Reverse T3 reference range: 90 to 350 pg/mL.
Due to the prescribed non-treatment (Synthroid) of my hypothyroidism, I have become deficient in Vitamin B12, B6, Folate, and Vitamin D. All of which are required for cardiovascular health. The result is that my homocysteine levels are off the charts.
The high sensitivity C-reaction protein test (hs-CRP) test measures homocysteine (inflammation of arteries). The high-sensitivity CRP test (hs-CRP) is done to find out if you have an increased chance of having a sudden heart attack or stroke.
Inflammation can damage the inner lining of the arteries and make having a heart attack more likely. Multiple studies now show that elevated C-reactive protein (CRP) levels are correlated with increased risk of cardiac events and mortality.
CRP Levels: Low Vitamin B and Elevated Homocysteine:
There is a correlation that the lower the vitamin B levels the higher the homocysteine levels. High homocysteine levels are linked to damage to the arteries, which can cause atherosclerosis and thrombosis.
There is also a link between low Vitamin D and cardiovascular disease.