By: James O’Keefe

Here is an interesting article written by Shelley Wood on theheart.org regarding Vitamin D abstracts presented at the American College of Cardiology, (ACC). I have highlighted two major points from the article. I have also attached the story.

Two major points:

• Among 9491 individuals with Vitamin D deficiency (≤30 ng/mL) those who subsequently normalized their vitamin D level during follow up had a substantially lower risk of CV events, and all-cause mortality was reduced by 30%. This was not a randomized trial, but is pretty compelling observational data.

• Ideal vitamin D level for reducing risk of CV risk was at least 43 ng/mL.. Most of the emerging data point to an ideal target Vit D level of 40 to 60 ng/mL. Most Americans have levels in the mid 20’s which means the typical American adult will need about 2000 iu per day to get into the ideal range. This is quite variable however, and I have found that 25-OH vit D levels are very helpful in directing therapy.

Death, CVD risk declines in people who “normalize” vitamin-D levels

Atlanta, GA – Adding heft to the hypothesis that vitamin-D deficiency is linked to cardiovascular disease, a new study has found that people with low vitamin-D levels who managed to normalize their levels were significantly less likely to develop cardiovascular events over up to six years of follow-up.

The study was presented as a poster by Dr Tami L Bair (Intermountain Medical Center Heart Institute, Murray, UT) earlier this week at the American College of Cardiology (ACC) 2010 Scientific Sessions.

According to coauthor Dr Joseph B Muhlestein (Intermountain Medical Center Heart Institute), the study looked at baseline and subsequent vitamin-D levels in 9491 subjects with known vitamin-D deficiency, rechecked their vitamin D, then compared subsequent rates of death, coronary artery disease, MI, heart failure, stroke, and renal failure among those who managed to bring up their vitamin-D levels with those who remained vitamin-D deficient. A cut point of <30 ng/mL was used to define vitamin-D deficiency.

“This wasn’t a randomized trial, but all of these patients started with low vitamin D, and then the question is, if they treated their vitamin D, did it have an effect? We don’t know what they did . . . the presumption is that they were told their vitamin D was low, then started supplementation or got their swimsuit out and went into the sun a lot to treat it.”

Getting to normal

After a mean of one-year of follow-up, those who had normalized their vitamin-D levels were significantly less likely to have died, developed heart failure, or developed coronary artery disease. A composite end point, looking at all outcomes combined, showed a highly statistically significant reduction among those with normalized vitamin-D levels.

Muhlestein drew particular attention to the 30% reduced risk of death in the normalized vitamin-D group. “A 30% reduction in risk is about the same you could hope to get from taking a statin or treating your blood pressure, so we thought it was certainly promising. It doesn’t eliminate the need for a real randomized trial, although I’m trying to figure out a good way to do one.”

There are a number of vitamin-D trials under way, most notably VITAL, a National Institutes of Health (NIH) study, launched in January.

But Muhlestein is concerned that the NIH trial may come up empty-handed for two reasons. For one, the trial, he says, is not measuring baseline levels or checking whether patients actually reach the optimal vitamin-D range in the intervention arm. “I can see why they aren’t [measuring vitamin D at baseline], because if they find vitamin D is deficient is it ethical to say, ‘I want you to stay vitamin-D deficient’?”

Vitamin-D deficiency is already known to increase the risks of skeletal disease, he notes. But without knowing if participants actually normalize their levels, it will be impossible to link normalization with an effect on events.

His second concern is with the dose chosen in VITAL: 2000 international units (IU) per day. “What I’ve found is that there are lots of my patients who don’t become normalized with 2000 units, so 2000 units may not be enough to treat the really deficient patients.”

But what’s normal?

In fact, Muhlestein and colleagues conducted a second study, also presented as a poster during the ACC meeting, trying to identify the optimal level of vitamin D by categorizing over 31 000 patients into three levels of vitamin D. When those levels were then linked to rates of 10 adverse outcomes (most of them cardiovascular), the authors demonstrated decreasing risk of adverse outcomes with increasing vitamin-D levels, with a vitamin D level >43 ng/mL to be the cutoff point for optimal.

Currently, they point out, a level of 30 ng/ML is considered “normal”—that cut point may be too low, based on their analysis.

But also of note, “above 43 ng/mL there was no added benefit,” Muhlestein observed. “So if your level was 70 ng/mL, you were good, but you weren’t any better than if [your level] was 43 ng/mL.”

As for whether vitamin D can be too high, Muhlestein noted that there are problems with vitamin-D toxicities typically associated with hypercalcemia, but these tend to arise in people with levels higher than 100 ng/mL, and many people believe the level must be well over 150 ng/mL. “The only way I know of that people can get vitamin D that high is by overdosing on prescription vitamin D, which is supposed to be taken once a week. If someone were to make a mistake and take it once per day, they might get vitamin-D toxicity.”

The findings from both studies have convinced Muhlestein that vitamin-D deficiency is worth treating, but he urges physicians to make sure they check to see what a patient’s vitamin-D levels are to begin with and to adjust the dose accordingly. Individualization is essential, he noted, which is one reason he’s worried about the blanket 2000-IU approach being used in VITAL.

“Effective dose varies from patient to patient, which is one of the problems with the NIH trial. No one is going to become toxic on 2000 IU per day, but there will be lots who are at the highest risk who are not going to become normalized.”

here is a link to the Web site

Every once in a while a reader will ask us our opinions about whole body, colon cleanses, or detox cleanses. This is a great question and one that I’d like to share the answer with everyone.

Do I recommend cleanses? NO! Absolutely not.

First, know that cleansing is an ongoing process. It’s not something that should happen once or twice a year. The body does a very good job of cleansing itself when given the right tools. If you are following an anti-inflammatory diet like Forever Young, your body is cleansing itself regularly. A good diet will help your body cleanse daily. An anti-inflammatory diet full of colorful fruits and vegetables will sweep any toxins from your body and also sweep your colon. Fruits and vegetables are full of antioxidants, which help reduce inflammation-causing free radicals, thereby reducing toxins in the body that cause disease.

Should you consider a cleanse prior to starting your new anti-inflammatory diet and lifestyle? No! Consider your diet your cleanse. Following a good anti-inflammatory diet is not only perfectly safe (unlike some cleansing systems), but will cost you no extra money. A once yearly cleanse is not going to reduce your chance of disease, but following a good diet (your body’s natural daily cleanse) certainly will.

Many people are also under the assumption that so-called detox cleanses will undo all the damage caused by a poor diet and lifestyle. Not so. Only a healthy diet and lifestyle followed every day will keep your body running clean and efficiently.

By: Dr. James O’Keefe

A recent New York Times article profiled a group of New Yorkers who consider themselves “modern cavemen.” The hunter-gatherer lifestyle really can be ideal. Here is a link to a Mayo Clinic Proceedings article I co-authored with Dr. Loren Cordain, one of the leaders of the hunter-gatherer movement. The article, Cardiovascular Disease Resulting From a Diet and Lifestyle at Odds With Our Paleolithic Genome: How to Become a 21st-Century Hunter-Gatherer, can be found here.  When you eat the Forever Young way, you are essentially eating a hunter-gatherer style diet. Straight from our book, The Forever Young Diet and Lifestyle, here are the basics you need to know to live a hunter-gatherer’s lifestyle and eat the hunter-gatherer diet.

Nine Steps Toward a Hunter-Gatherer’s Diet

If you want to be in sync with your genetic heritage, here are the steps you should follow to become a hunter-gatherer.
1. Thrive on the earth’s natural bounty. Eat whole, natural, fresh foods; avoid highly processed foods.

2. Consume a diet high in fruits, vegetables, nuts and berries, and low in refined grains and sugars.

3. Increase consumption of omega-3 fatty acids from fish, fish oil, and plant sources like walnuts, canola oil, greens, soybeans, and flaxseed.

4. Avoid trans fats entirely. Eliminate fried foods, hard margarine commercial baked goods, and most packaged and processed snack foods. Also eliminate consumption of fatty meats and high-fat dairy.

5. Increase consumption of lean protein such as skinless poultry, fish, game meats, and whey protein. Eat only lean, fresh cuts of red meat and limit consumption of saturated fats, including fatty, salty processed meats like bacon, sausage and deli meats.

6. Incorporate olive oil or canola oil into your diet, Avoid corn, safflower, sunflower, and vegetable oils.

7. Choose purified water, tea, nonfat unsweetened dairy or soy milk, and red wine. Avoid soft drinks, fruit juices, high-fat dairy, and sports drinks. Even 100 percent fruit juices are still loaded with too much sugar and should be considered off-limits. However, low sodium vegetable juices are very nutritious.

8. Use your body as it was designed and programmed over the millennia and engage in daily exercise from a variety of activities that incorporate aerobic and strength training as well as stretching exercises. Outdoor activities are ideal.

9. Develop and maintain relationships that provide social support (e.g., spouse, family, friends, neighbors, community, etc.) Try to also include some activities that involve altruism and nurturing.