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Supplements of vitamin D may improve cardiovascular health during weight loss, without impacting on how many pounds are shed, suggests a new study.Supplements of vitamin D may improve cardiovascular health during weight loss, without impacting on how many pounds are shed, suggests a new study.
“The results indicate that a vitamin D supplement of 83 micrograms/d does not adversely affect weight loss and is able to significantly improve several cardiovascular disease risk markers in overweight subjects with inadequate vitamin D status participating in a weight-reduction program,” wrote the authors, led by Armin Zittermann from the Clinic for Thorax and Cardiovascular Surgery in Bad Oeynhausen.
With obesity rates still high – not only in developed countries but also, increasingly, in newly wealthy emerging markets, there is considerable attention to ways to trim down waistlines. The results of the new randomised, double-blind, placebo-controlled trial indicate that vitamin D supplements may be useful as a means of boosting heart health during weight loss.
The details on D
Vitamin D refers to two biologically inactive precursors – D3, also known as cholecalciferol, and D2, also known as ergocalciferol. The former, produced in the skin on exposure to UVB radiation (290 to 320 nm), is said to be more bioactive.
While our bodies do manufacture vitamin D on exposure to sunshine,
the levels in some northern countries are so weak during the winter months that our body makes no vitamin D atall, meaning that dietary supplements and fortified foods are seen by many as the best way to boost intakes of vitamin D.
In adults, it is said vitamin D deficiency may precipitate or exacerbate osteopenia, osteoporosis, muscle weakness, fractures, common cancers, autoimmune diseases, infectious diseases and cardiovascular diseases. There is also some evidence that the vitamin may reduce the incidence of several types of cancer and type-1 diabetes.
Zittermann and his co-workers recruited 200 healthy overweight people with average 25(OH)D levels of 30 nmol/L (12 ng/mL) and randomly assigned them to receive either placebo or vitamin D for one year. All the subjects also participated in a weight-reduction program.
At the end of the study, 25(OH)D levels increased in the D group by 55.5 nmol/L, but by only 11.8 nmol/L in the placebo group. Furthermore, a 26.5 per cent reduction in levels of parathyroid hormone (PTH) were observed in the D group, compared with 18.7 per cent in the placebo group. “High blood concentrations of parathyroid hormone […] are considered new cardiovascular disease risk markers,” explained the authors.
Improvements in triglycerides levels were also observed in the vitamin D group, with a 13.5 per cent decrease noted compared with a 3.0 per cent increase in the placebo group.
Finally, levels of the marker of inflammation TNF-alpha decreased by 10.2% per cent following vitamin D supplementation, compared with 3.2 per cent in the placebo group.
“The beneficial biochemical effects were independent of the loss in body
weight, fat mass, and sex,” noted the researchers.
On the downside, the researchers noted that participants receiving the vitamin D supplements did experience an average 5.4 per cent increase in their levels of LDLcholesterol.
Source: American Journal of Clinical Nutrition
May 2009, Volume 89, Pages
“Vitamin D supplementation enhances the beneficial effects of weight loss on
cardiovascular disease risk markers” Authors: A. Zittermann, S. Frisch, H.K. Berthold, C. Götting, J. Kuhn, K. Kleesiek, P. Stehle, H. Koertke, R. Koerfer
Chistakos, a professor of biochemistry, has published extensively on the multiple roles of vitamin D, including inhibition of the growth of malignant cells found in breast cancer. Her current findings on the vitamin D induced protein that inhibits breast cancer growth are published in a recent issue of The Journal of Biological Chemistry. Previous research had determined that increased serum levels of vitamin D are associated with an improved diagnosis in patients with breast cancer. Prior to the current study, little was known about the factors that determine the effect of calcitrol on inhibiting breast cancer growth, she said. During the study, Christakos and coauthor Puneet Dhawan, Ph.D., examined the protein involved in the raction that can reduce the growth of vitamin D in breast cancer cells. “These results provide an important process in which the active form of vitamin D may work to reduce growth of breast cancer cells,” said Christakos. “These studies provide a basis for the design of new anticancer agents that can target the protein as a candidate for breast cancer treatment.”
Women should go for the broccoli when the relish tray comes around during holiday celebrations this season.
While it has been known for some time that eating cruciferous vegetables, such as broccoli, cauliflower, and cabbage, can help prevent breast cancer, the mechanism by which the active substances in these vegetables inhibit cell proliferation was unknown — until now.
Scientists in the UC Santa Barbara laboratories of Leslie Wilson, professor of biochemistry and pharmacology, and Mary Ann Jordan, adjunct professor in the Department of Molecular, Cellular, and Developmental Biology, have shown how the healing power of these vegetables works at the cellular level. Their research is published in this month’s journal Carcinogenesis. “Breast cancer, the second leading cause of cancer deaths in women, can be protected against by eating cruciferous vegetables such as cabbage and near relatives of cabbage such as broccoli and cauliflower,” said first author Olga Azarenko, who is a graduate student at UCSB. “These vegetables contain compounds called isothiocyanates which we believe to be responsible for the cancer-preventive and anti-carcinogenic activities in these vegetables. Broccoli and broccoli sprouts have the highest amount of the isothiocyanates. “Our paper focuses on the anti-cancer activity of one of these compounds, called sulforaphane, or SFN,” Azarenko added. “It has already been shown to reduce the incidence and rate of chemically induced mammary tumors in animals. It inhibits the growth of cultured human breast cancer cells, leading to cell death.” Azarenko made the surprising discovery that SFN inhibits the proliferation of human tumor cells by a mechanism similar to the way that the
anticancer drugs taxol and vincristine inhibit cell division during mitosis.
Mitosis is the process in which the duplicated DNA in the form of chromosomes is accurately distributed to the two daughter cells when a cell divides.
Hundreds of tiny tube-like structures, called microtubules, make up the machinery that cells use to separate the chromosomes. SFN, like the more powerful anticancer agents, interferes with microtubule functioning during mitosis in a similar manner to the more powerful anticancer drugs. However SFN is much weaker than these other plant-based drugs, and thus much less toxic. “SFN may be an effective cancer preventive agent because it inhibits the proliferation and kills precancerous cells,” said Wilson. It is also possible that it could be used as an addition to taxol and other similar drugs to increase effective killing of tumor cells without increased toxicity.
Strong bones, a healthy immune system, protection against some types of cancer: Recent studies suggest there’s yet another item for the expanding list of Vitamin D benefits. Vitamin D, “the sunshine vitamin,” keeps the heart, the body’s long-distance runner, fit for life’s demands.
University of Michigan pharmacologist Robert U. Simpson, Ph.D., thinks it’s apt to call vitamin D “the heart tranquilizer.” In studies in rats, Simpson and his team report the first concrete evidence that treatment with activated vitamin D can protect against heart failure. Their results appear in the July issue of the Journal of Cardiovascular Pharmacology. In the study, treatments with activated vitamin D prevented heart muscle cells from growing bigger – the condition, called hypertrophy, in which the heart becomes enlarged and overworked in people with heart failure. The treatments prevented heart muscle cells from the over-stimulation and increased contractions associated with the
progression of heart failure.
About 5.3 million Americans have heart failure, a progressive, disabling condition in which the heart becomes enlarged as it is forced to work harder and harder, making it a challenge even to perform normal daily activities. Many people with heart disease or poorly controlled high blood pressure go on to experience a form of heart failure called congestive heart failure, in which the heart’s inability to pump blood around the body causes weakness and fluid build-up in lungs and limbs. Many people with heart failure, who tend to be older, have been found to be deficient in vitamin D.
“Heart failure will progress despite the best medications,” says Simpson, a professor of pharmacology at the U-M Medical School. “We think vitamin D retards that progression and protects the heart.”
The U-M researchers wanted to show whether a form of vitamin D could have beneficial effects on hearts that have developed or are at risk of developing
heart failure. They used a breed of laboratory rats predisposed to develop human-like heart failure. The researchers measured the effects of activated Vitamin D (1,25 dihydroxyvitamin D3, a form called calcitriol) in rats given a normal diet or a high-salt diet, compared to control group rats given either of the same two diets, but no vitamin D treatment. The rats on the high-salt diet were likely to develop heart failure within months.
The rats on the high-salt diet, comparable to the fast food that many humans feast on, quickly revealed the difference vitamin D could make. “From these animals, we have obtained exciting and very important results,” Simpson says.
After 13 weeks, the researchers found that the heart failure-prone rats on the high-salt diet that were given the calcitriol treatment had significantly lower levels of several key indicators of heart failure than the untreated high-salt diet rats in the study. The treated rats had lower heart weight. Also, the left ventricles of the treated rats’ hearts were smaller and their hearts worked less for each beat while blood pressure was maintained, indicating that their heart function did not deteriorate as it did in the untreated rats. Decreased heart weight, meaning that enlargement was not occurring, also showed up in the treated rats fed a normal diet, compared to their untreated counterparts. Simpson and his colleagues have explored vitamin D’s effects on heart muscle and the cardiovascular system for more than 20 years. In 1987, when Simpson showed the link between vitamin D and heart health, the idea seemed far-fetched and research funding was scarce. Now, a number of studies worldwide attest to the vitamin D-heart health link.
The new heart insights add to the growing awareness that widespread vitamin D deficiency—thought to affect one-third to one-half of U.S. adults middle-aged and older—may be putting people at greater risk of many common diseases. Pharmaceutical companies are developing anti-cancer drugs using vitamin D analogs, which are synthetic compounds that produce vitamin D’s effects. There’s also increasing interest in using vitamin D or its analogs to treat autoimmune disorders.
In more than a dozen types of tissues and cells in the body, activated vitamin acts as a powerful hormone, regulating expression of essential genes and rapidly activating already expressed enzymes and proteins. In the heart, Simpson’s team has revealed precisely how activated vitamin D connects with specific vitamin D receptors and produces its calming, protective effects. Those results appeared in the February issue of Endocrinology. Sunlight causes the skin to make activated vitamin D.
People also get vitamin D from certain foods and vitamin D supplements. Taking vitamin D supplements and for many people, getting sun exposure in safe ways, are certainly good options for people who want to keep their hearts healthy. But people with heart failure or at risk of heart failure will likely need a drug made of a compound or analog of vitamin D that will more powerfully produce vitamin D’s effects in the heart if they are to see improvement in their symptoms, Simpson says.
Vitamin D analogs already are on the market for some conditions. One present drawback of these compounds is that they tend to increase blood calcium to undesirable levels. Simpson’s lab is conducting studies of a specific analog which may be less toxic, so efforts to develop a vitamin Dbased drug to treat heart failure are moving a step closer to initial trials in people.
left: Heart muscle cells in untreated rats bred to develop heart failure show signs of disease: Cells are irregular in size and shape and show fibrotic lesions (areas in purple). Right: Heart muscle cells remain healthy in rats treated with calcitriol, the hormone that Vitamin D becomes in the body. (Credit: Image courtesy of University of Michigan Health System)
Exercise for Your Bone Health
Vital at every age for healthy bones, exercise is important for treating and preventing osteoporosis. Not only does exercise improve your bone health, it also increases muscle strength, coordination, and balance, and leads to better overall health.
Like muscle, bone is living tissue that responds to exercise by becoming stronger. Young women and men who exercise regularly generally achieve greater peak bone mass (maximum bone density and strength) than those who do not. For most people, bone mass peaks during the third decade of life. After that time, we can begin to lose bone. Women and men older than age 20 can help prevent bone loss with regular exercise. Exercising allows us to maintain muscle strength, coordination, and balance, which in turn help to prevent falls and related fractures. This is especially important for older adults and people who have been diagnosed with osteoporosis.
The Best Bone Building Exercise
The best exercise for your bones is the weight-bearing kind, which forces you to work against gravity. Some examples of weight-bearing exercises include lifting weights, walking, hiking, jogging, climbing stairs, tennis, and dancing. Examples of exercises that are not weight-bearing include swimming and bicycling. While these activities help build and maintain strong muscles and have excellent cardiovascular benefits, they are not the best way to exercise your bones.
If you have health problems – such as heart trouble, high blood pressure, diabetes, or obesity – or if you are over age 40, check with your doctor before you begin a regular exercise program. According to the Surgeon General, the optimal goal is at least 30 minutes of physical activity on most days, preferably daily. Listen to your body. When starting an exercise routine, you may have some muscle soreness and discomfort at the beginning, but this should not be painful or last more than 48 hours. If it does, you may be working too hard and need to ease up. STOP exercising if you have any chest pain or discomfort, and see your doctor before your next exercise session.
If you have osteoporosis, ask your doctor which activities are safe for you. If you have low bone mass, experts recommend that you protect your spine by avoiding exercises or activities that flex, bend, or twist it. Furthermore, you should avoid high-impact exercise in order to lower the risk of breaking a bone. You also might want to consult with an exercise specialist to learn the proper progression of activity, how to stretch and strengthen muscles safely, and how to correct poor posture habits. An exercise specialist should have a degree in exercise physiology, physical education, physical therapy, or a similar specialty. Be sure to ask if he or she is familiar with the special needs of people with osteoporosis.
A Complete Osteoporosis Program
Remember, exercise is only one part of an osteoporosis prevention or treatment program. Like a diet rich in calcium and vitamin D, exercise helps strengthen bones at any age. But proper exercise and diet may not be enough to stop bone loss caused by medical conditions, menopause, or lifestyle choices such as tobacco use and excessive alcohol consumption. It is important to speak with your doctor about your bone health. Discuss when you might be a candidate for a bone mineral density test. If you are diagnosed with low bone mass, ask what medications might help keep your
Vitamin A is one of the 4 fat soluble vitamins along with vitamin D, Vitamin E and Vitamin K. It is multifunctional and essential which means that it is not produced by the body. In this article we will touch on aspects of Vitamin A absorption and it’s effect on wound healing as well as its metabolism.
We often think of Vitamin A as the critical vitamin for vision, however it has several other roles that related to immune function, protein synthesis, and cellular communication. Vitamin A deficiency is a concern world wide because of the natural of the side effects. Vitamin A deficiency is the leading cause of preventable childhood blindness in the world according to UNICEF and sometimes it may be undetected until there is irreversible damage.
There are 2 chemical forms of vitamin A in diet:
Retinoids (Preformed vitamin A) This group include retinol, retinyl esters, and retinal they are mostly found in animal sources like liver, egg yolk or fish oils.
Carotenoids (Provitamin A) This group includes beta-carotene, alpha-carotene and lycopene, mainly found in plant sources like leafy vegetables or yellow/orange vegetables and fruits.
1.- Ingested food is digested in the stomach where retinyl palmitates (esters) are released from proteins. Retinol and beta-carotene are absorbed directly into the small intestine where retinyl esters and betacarotene are transformed into retinol . Retinol is the most easily absorbed form of vitamin A.
2.-That retinol absorbed by the enterocytes in the ileum (small intestine) along with bile is then transported to the liver with the help of chylomicrons a protein that transports fat.
3.-Fifty to 80% of the vitamin A is stored in the liver and the remaining is deposited into adipose tissue, lungs and kidneys.
4.-When stored retinol is released from the liver into the circulation to target organs, it is bound to plasma retinol-binding protein (RBP4) a transporting protein produced by the liver that requires ZINC, which is synthesized by the liver; This complex is stabilized by transthyretin (TTR), which reduces renal excretion.
Retinol is a crucial component for reproduction, embryological development, cellular differentiation, growth, protein synthesis, and immunity in the form of retinoic acid and vision in the form of retinal.
One of Vitamin A additional roles is in epithelial health of skin and mucous membranes. It increases epithelial turnover which is crucial during would healing. It also has anti-oxidative effects which prevent cell damage and can prevent or reverse the effects of other damaging agents. In addition to these benefits it has also been associated with increasing collagen, fibronectin, keratinocytes and fibroblast, all important in wound tissue structure. There have been some studies that suggest giving higher doses of Vitamin A in patients with non or slow healing wounds.
It is important to remember that we have documents delayed diagnosis of adult vitamin A deficiency leading to significant night blindness in adults. It is critical that the patients and their primary care physicians are acutely aware of this possibility. In majority of the patients with low vitamin A, post weight loss surgery, aggressive supplementations, including injections need to be considered as a part of the treatment regimen.
We would like to thank Miguel Rosado, MD for his significant contribution provided for this Blog.
During a recent group meeting, questions were raised regarding supplementing with Vitamin K1 or Vitamin K2 along with anticoagulant treatment. The table below provides a generalized summary of the Vitamin K1 and K2. The forms of Vitamin K in dietary supplements may differ depending on the supplement and the choice of the supplements may affect their absorptive behavior. This creates a challenge in regulating lab values, especially in patient who require anticoagulation therapy.
In summary K1 and K2 counteract the function of the anticoagulant medications. You should consult the physician prescribing the anticoagulant before taking any vitamin K1 or K2. Even as we think of K2 having less to do with coagulation pathways, it is recommended that the patients do not take any vitamin K supplements unless cleared by their physician, since K2 may also affect the anticoagulation treatment. As a patient who is prescribed anticoagulation treatment you should make your prescribing physician aware of ANY changes in your medications or supplements either over the counter or prescribed.
Unfortunately, we have been informed that the company we order our Vitamin A injections from will no longer have Vitamin A available. We have contacted several other companies and they also do not have it available. The manufacturer of Vitamin A states that there is a nationwide shortage of injectable Vitamin A and it may be available next year.
Our office has a few vials left and we are hoping that we can get to as many people as possible before we are completely out. We will continue to look for a source of Vitamin A injections. We will let you know when it is no longer available and when we receive a new shipment. Thank you for your understanding and we apologize for this issue.
Information on Vitamin A deficiency here.
You can find our list of recommended supplements here.
Just as a reminder, we have no financial interest in any of the vendors that are recommended on our website. Also, please note that this is not in ANY form or fashion a substitute for the evaluation by your surgeon or primary care physician. This is informational only and is not to be taken as a recommendation for any patients’ condition.
Vitamin K1 is a found in dark green leafy vegetables, asparagus, brussels sprouts, some grains, olive oil, prunes, soy bean oil, and canola oil. The body has limited storage capacity for Vitamin K and uses a recycle system to reuse it.
Vitamin K1 is a fat-soluble vitamin that after Duodenal Switch is not as easily absorbed due to the limiting contact of the food product with the bile until the common channel. Bile is needed to absorb fatty acids and fat-soluble vitamins.
Duodenal Switch patients in need of Vitamin K1 supplements should take “Dry” or water miscible type of Vitamin K1, such as Biotech brand. The patients laboratory studies will determine if a patient requires Vitamin K1 supplement. Duodenal Switch patients should have laboratory studies drawn and evaluated at least on a yearly basis. Vitamin K works in a delicate balance with other supplements and should be monitored by a physician, in at risk people.
Vitamin K1 is most know for it’s coagulation effect and the clotting cascade. Vitamin K1 works with calcium and proteins in order to accomplish coagulation synethesis. Care should be taken with Vitamin K supplementation and anti-coagulation (blood thinners) therapy. Please see your physician regarding any supplementation of Vitamin K and blood thinner medications.
A discovery of Vitamin K dependent proteins has led to research on Vitamin K1 in bone health. Bone matrix proteins, specifically osteocalcin, undergo gamma carboxylation with calcium much the way coagulation factors do; this process also requires Vitamin K. Osteocalcin is a Gla-protein that is regulated by Vitamin D. The calcium binding ability of osteocalcin requires several Vitamin K carboxylations to exert it’s effects on bone mineralization.
In adults, the causes of Vitamin K1 deficiency include the following :
Multiple abdominal surgeries
Long-term parenteral nutrition
Parenchymal liver disease
Inflammatory bowel disease
Medications: Antibiotics (cephalosporin), cholestyramines, warfarin, salicylates, anticonvulsants, Cefamandole, cefoperazone, salicylates, hydantoins, rifampin, isoniazid, barbiturates, and certain sulfa drugs, higher Vitamin E can antagonized Vitamin K)
Disseminated intravascular coagulation (DIC) – Severe
Chronic kidney disease/hemodialysis
Additional information: https://lpi.oregonstate.edu/infocenter/vitamins/vitaminK/
As always, discuss with your physicians and/or surgeon any changes in medications and supplements. This is not meant to be an all inclusive discussion of Vitamin K.
In recent years, we have noticed a trend of increased Vitamin B6 (Pyroxidine) levels in post Duodenal Switch patients’ laboratory studies. Vitamin B6 is a water soluble vitamin, however, toxicity can happen with an increase in supplementation. The increased availability and amounts of Vitamin B6 in more supplements such as Calcium, multivitamins and B Complex supplements could be the cause of the trend post weight loss surgery. Please be sure to check the amounts of Vitamin B6 within your daily supplements.
Vitamin B6 Function:
Vitamin B6 is an important water soluble vitamin which functions as co-enzymes in a number of metabolic pathways including amino acids, fatty acids, glycogen, and steroid hormones (estrogen, cortisol, androgens and Vitamin D) metabolism. Other biological functions are hemoglobin synthesis, immune function and inflamation, neurotransmission and gene expression. B6 has been shown to improve carpal tunnel syndrome, PMS, AADHD, Alzheimer’s, acne, lung cancer, high homocysteine levels, asthma, kidney sones, and some cases of depression and arthritis. The U.S. Daily Recommended dose ins 1.2-2mg for adults.
Toxicity has most often happened from increased supplementation and rarely from food alone except for in a subset of people who may have increased sensitivity, gene mutations or other issues with Vitamin B6. In the average person, doses of 1000mg per day which is about 800 times the daily amount from food can cause neuropathy and neurotoxicity. There have been instances of toxicity issues at doses of 500mg daily. Other symptoms associated with high levels of B6 are skin rashes, nausea, vomiting, loss of appetite, increased liver function tests, sensitivity to sunlight. Nerve damage or numbness and tingling of the feet, legs and hand, if left untreated, can become irreversible. Stop taking B6 if you experience any of these symptoms. The daily U.S. no adverse effects dose is set at a max of 200mg daily. The daily recommend max limit is 100mg daily.
Drug interactions with high doses of B6 levels are phenobarbital, phenytoin and L-Dopa and cause decrease effectiveness. B6 deficiency is a side effect of oral contraceptives, isoniazid, cycloserine, pencil amine, methylxanthines, and long term NSAIDs use due to impaired Vitamin B6 metabolism.
Once B6 levels are elevated it is important to to try to decrease intake as much as possible and levels will usually drop in weeks to months. Read your labels of drinks, energy drinks, multi-vitamin, cold supplements, high B6 foods, protein supplements, and other sources. These are items that typically have added high levels of B6 supplement. You can also avoid group Vitamin B supplements and go to individual B vitamins that are needed.
Additional information on Vitamin B6. Please have your surgeon or your primary care physician review your laboratory studies. Seek medical attention if you are experiencing any of the above symptoms or any other unusual symptoms.