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.
Type 2 diabetics are more prone to heart attacks, peripheral vascular disease and stroke. All of these can be linked to hardening of the arteries (atherosclerosis). Known risk factors for atherosclerosis are high cholesterol levels, obesity and high blood pressure. A recent study now demonstrates that atherosclerosis and obesity are associated with low vitamin D 25 levels in African-American type 2 diabetics. This study published in the March issue of JCEM was conducted at Wake Forest University School of Medicine. The researchers found that low vitamin D levels in diabetics are more common with increasing obesity and also with greater degrees of atherosclerosis of the aorta and carotid arteries (which supply the brain with blood).
Whether low levels of vitamin D cause any of these diseases or are simply another abnormality found in people with these illnesses has yet to be determined. Future studies are being planned in which obese type 2 diabetics are treated with vitamin D to see if these diseases can be improved.
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
Annette posts a question to metabolism.com since she is on a high dosage of vitamin D due to intestinal surgery. Is the dosage too much for her, she wonders?
When the intestines fail to absorb fats due to surgery or due to disease, Vitamin D which is a fat soluble vitamin, can see its levels fall dramatically. Otherwise healthy people in the U.S., however, are being found to have unacceptably low Vitamin D levels. Is it due to inadequate diet or is it a result of wide spread sunlight phobia?
Here is Annette’s post followed by my response to her question. Answers to these questions are contained in this exchange.
I had a Bilio Pancreatic Diversion surgery done in 1990. My Vitamin D level is low, at 15. My Dr. has me on 50,000 iu of Vit D every other day, 4,000 iu on the other days.
May I ask you, what is your opinion on this amount of Vit. D. The 50,000 iu capsules are by prescription.
Thanks so Much,
Vitamin D deficiency is a serious problem and has been largely overlooked in the general population until recently. Vitamin D is not only important for bone health but we are learning it is important for the immune system and may help protect against certain cancers. In my medical practice in Florida I am finding an alarming number of my patients with very low and borderline low levels of Vitamin D that were totally unexpected. I assume it is because everyone knows that sunlight is bad because it causes wrinkles and skin cancer. The further north you live the weaker the sunlight so the incidence of vitamin D deficiency is higher.
Until recently the recommended daily Vitamin D allowance was 400 IU but recently this was increased to 800 IU and some authorities recommend higher amounts. 10,000 IU levels daily for the average normal person is thought to be an upper limit before toxicity can be seen. Vitamin D is a fat soluble vitamin so in people who have problems absorbing fat, such in your case after intestinal bypass surgery, higher amounts are needed. Vitamin D doses of 50,000 IU at a time are not unusual but are usually given only a few times weekly or monthly, depending on needs. A handy tip is that deficient Vitamin D causes serum calcium levels to be low, so many clinicians will monitor serum calcium levels to help adjust the prescription.
Although I canâ€™t recommend medical therapy in this forum I have some thoughts I can share. Why not get another blood vitamin D level measured to see if the amount you are getting is okay? Calcium levels go up in vitamin D excess so a serum calcium level that is elevated can be an indication of too much vitamin D.
Hope that helps. Keep us posted.
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Recent information published in the British medical journal Lancet, supports using calcium and vitamin D supplementation to prevent fractures and bone loss in older people. A 12% reduction in bone fractures linked to osteoporosis was seen in people aged 50 and older who used calcium and Vitamin D supplements. Osteoporotic fractures are common with one in six people over the age of 50 experiencing this type of fracture in their lifetime. In people over 70, the occurence of a bone fracture, particularly of the hip is associated with a very high risk of mortality. One study showed a one year mortality of about 33% in elderly people after hip fracture. To achieve the bone benefits from supplements the researchers recommend a daily dose of 1,200 mg of calcium and 800 IU of vitamin D for people over 50.
The staff of metabolism.com wants to add a warning to people shopping for calcium and vitamin D supplementation. When shopping for these items be aware that there is a great variation in price among the various brands of supplements. The higher price brands often claim to be significantly better than cheaper competitors in terms of absorption and results. Be aware that many of these claims are false or exaggerated. Why spend $12 for 50 coral calcium pills when 100 Tums (calcium carbonate) can be gotten for half the price? If coral calcium is actually 20% better absorbed then calcium carbonate then an extra Tums per day will more than balance off any difference.
The mission of the The Thyroid Project is to encourage sharing of information and experience between the public and the medical community about the treatment of hypothyroidism (low thyroid function). For at least the past few decades there is a growing awareness of â€œsomething missingâ€ in the way suffers of hypothyroidism are treated for their disease.
Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors.
By Gary M. Pepper, M.D. Ozempic, Rybelsus, Trulicity, Wegovy, Saxenda are the central players in the weight loss craze sweeping across the globe. Metabolisim.com has been monitoring this phenomenon from its beginnings in 2008 with its report “Lizard Spit Reduces Blood Sugar and Appetite”, regarding the first drug in this class, Byetta (exenatide). Caught In the middle of the current chaos are the medical experts who treat diabetes and have been prescribing these medications for more than a decade. Here is a brief commentary from one such board certified endocrinologist; “I started treating Type 2 diabetics with GLP-1 agonists more than 10 years ago. In some respects, these medications have revolutionized the treatment of diabetes by lowering blood sugar effectively and promoting weight loss at the same time, a unique combination of benefits. Not everyone benefits from these drugs to the same degree unfortunately, and I have seen lots of patients experience unacceptable side effects from them. Nothing though, has prepared me for what is happening now. Too often, I find myself confronting someone who expects me to prescribe one of these drugs just so they can lose weight. Sadly, one extreme example was someone who, despite battling a life threatening medical condition, was insistent on getting a prescription. At the same time my diabetic patients are scrambling to find a place to buy their medications if they can even afford it. It is disheartening, to say the least, and I dread the negative interactions with some of my patients I now face almost daily.”
Off- Label Use
The FDA is the U.S. government’s department tasked with evaluating and approving drugs for specific medical conditions. When a new medication is approved for treating a medical condition by the FDA the agency will, at the same time, set strict guidelines for exactly which patients may use the newly approved drug. When a medication is used “off-label” it means that these limitations are being overridden by the provider for a potential benefit which outweighs the drugs risks. It is a general misconception that off-label means illegal; it does not. This practice has been going on for ages and more than 20% of prescriptions in the United States are prescribed off-label. A common example is the use of beta-blockers (approved for heart problems) for the treatment of performance anxiety.
GLP-1 agonist drugs, as discussed recently by metabolism.com. were originally approved for the treatment of Type 2 diabetes in adults. In the past few years most of these same medications have gained unprecedented popularity for their “off-label” weight loss benefit. Of the 5 GLP-1 agents presently in U.S. pharmacies only Wegovy (semaglutide) and Saxenda (liraglutide) are FDA approved for treating obesity. Of these two, Wegovy is the newer and had been much more popular that its sister drug Saxenda, probably due to being dosed only once weekly compared to daily for Saxenda and less likely to cause side effects. Due to Wegovy’s soaring popularity, its manufacturer, Novo Nordisk, increased the price of Wegovy two times since its initial release.
by Gary M. Pepper, M.D. and Sam Jeans, MSc The global anti-obesity drug market, in 2021was valued at over $2 billion. Within one year this figure had skyrocketed to $8 billion and is expected to climb to nearly $ 20 billion by 2027. This astounding growth is a reflection of soaring obesity rates, and the arrival of a new class of weight loss medication fueling a craze both in the USA and across the world.
The FDA and global health regulators, until very recently, had maintained a very tight ship when it comes to treating obesity with medication, placing the emphasis on diet and exercise rather than weight loss drugs. Since the 80s, anti-obesity drugs continued to be controversial, and a more stringent FDA implemented ongoing safety trials along with other precautions. There is some speculation that a shift in attitude toward approval of weight loss medication by the FDA , is underway
Weight loss drug controversies are far from over and, in fact, may soon rival the amphetamine crisis of the 70’s. For that reason, metabolism.com has felt it important to provide our guide to weight loss drug issues, past and present.
Anti-Obesity Drugs Timeline
Prescription drugs for lifestyle diseases such as obesity were marketed heavily throughout the 1950s to the 1970s. Amphetamines entered the public domain after the Second World War where they were used extensively in the military.
In the 50s, walk-in clinics prescribed diet pills with other medications almost at random, with or without genuine concern for one’s weight. These brightly colored pills became known as “rainbow pills”.
In the 1960s and 1970s, the so-called “rainbow pill diet” of pills was finally coming to an end as the FDA began to systematically ban many of the drugs involved. A high-profile expose by investigative journalist Susanna Mcbee, published in Life magazine, brought attention to this new modern public health crisis.
The rainbow pill diet combined amphetamines, laxatives, thyroid hormones, and even diuretics to produce extreme weight loss, combined with benzodiazepines, barbiturates, and steroids to reduce side effects, and antidepressants to suppress medication-induced insomnia and anxiety.
In 1968, rainbow pills were linked to over 60 deaths, with numerous accounts of their devastating impact surfacing in the news and media. Within just two months, 48 million pills were seized and destroyed. Nevertheless, amphetamine-based diet pills remained extremely popular throughout the 1970s. In 1978, some 3.3 million prescriptions for amphetamines were written each year, with some 50 million pills a year ending up in the black market.
In 1979, the FDA banned amphetamines as a weight loss aid, but that is hardly the end of the USA’s love affair with obesity medication.
Here’s a brief timeline of recent anti-obesity drugs:
Lack of energy and inability to lose weight are constant challenges for many people and are every day complaints encountered in the doctor’s office. Almost anyone can find some relief from these problems by accessing the healing properties of physical activity. Mentioning to a patient the need for ‘more exercise’ often causes rolling of the eyes, sighing, shrugging, snorting or worse yet, the hundred-yard stare. We all know exercise is important but who has the energy for that? It seems like a vicious cycle. Surprisingly, when done correctly, exercise can improve energy with the additional advantage of promoting weight loss and restoring tone and stamina. It is helpful to remember that the human body was designed for a lot more physical activity and a lot less food than we are privileged to experience in present day life. It therefore takes will power and knowledge to maintain the environment required for optimal health. Here are eight steps to get in the swing of regular exercise. Some suggestions may surprise you.