Health and Nutrition

November 28, 2011

Low Serum Vitamin D Levels and Recurrent Inflammatory Spinal Cord Disease

Filed under: Vitamin D — Doc Joe @ 3:29 pm

Maureen A. Mealy, RN, BSN; Scott Newsome, DO; Benjamin M. Greenberg, MD, MHS; Dean Wingerchuk, MD, MSc; Peter Calabresi, MD; Michael Levy, MD, PhD

Arch Neurol. Published online November 14, 2011. doi:10.1001/archneurol.2011.1974

Background  Low 25-hydroxyvitamin D levels have been associated with a higher risk of developing multiple sclerosis and increased relapse rates in patients with multiple sclerosis. As a sterol hormone involved in multiple immunologic pathways, vitamin D may play a role in preventing monophasic immune-mediated central nervous system attacks from developing into recurrent disease.

Objective  To investigate the association between low serum vitamin D levels and recurrent spinal cord disease.

Design, Setting, and Patients  We performed a retrospective analysis at Johns Hopkins Transverse Myelitis Center, Baltimore, Maryland, evaluating 25-hydroxyvitamin D levels in 77 patients with monophasic and recurrent inflammatory diseases of the spinal cord.

Main Outcome Measure  Levels of 25-hydroxyvitamin D.

Results  Vitamin D levels are significantly lower in patients who developed recurrent spinal cord disease, adjusting for season, age, sex, and race.

Conclusions  This study provides a basis for a prospective trial of measuring 25-hydroxyvitamin D levels in these patient populations and assessing the influence of vitamin D supplementation on the frequency of relapses in those with recurrent inflammatory spinal cord disease.

November 20, 2011

Splenda alters gut microflora and increases intestinal p-glycoprotein and cytochrome p-450 in male rats.

Filed under: Diet,Nutrition — Doc Joe @ 3:42 pm

J Toxicol Environ Health A. 2008;71(21):1415-29.

Splenda alters gut microflora and increases intestinal p-glycoprotein and cytochrome p-450 in male rats.

Abou-Donia MBEl-Masry EMAbdel-Rahman AAMcLendon RESchiffman SS.

Source

Department of Pharmacology, Duke University Medical Center, Durham, North Carolina 27708, USA. donia@duke.edu

Abstract

Splenda is comprised of the high-potency artificial sweetener sucralose (1.1%) and the fillers maltodextrin and glucose. Splenda was administered by oral gavage at 100, 300, 500, or 1000 mg/kg to male Sprague-Dawley rats for 12-wk, during which fecal samples were collected weekly for bacterial analysis and measurement of fecal pH. After 12-wk, half of the animals from each treatment group were sacrificed to determine the intestinal expression of the membrane efflux transporter P-glycoprotein (P-gp) and the cytochrome P-450 (CYP) metabolism system by Western blot. The remaining animals were allowed to recover for an additional 12-wk, and further assessments of fecal microflora, fecal pH, and expression of P-gp and CYP were determined. At the end of the 12-wk treatment period, the numbers of total anaerobes, bifidobacteria, lactobacilli, Bacteroides, clostridia, and total aerobic bacteria were significantly decreased; however, there was no significant treatment effect on enterobacteria. Splenda also increased fecal pH and enhanced the expression of P-gp by 2.43-fold, CYP3A4 by 2.51-fold, and CYP2D1 by 3.49-fold. Following the 12-wk recovery period, only the total anaerobes and bifidobacteria remained significantly depressed, whereas pH values, P-gp, and CYP3A4 and CYP2D1 remained elevated. These changes occurred at Splenda dosages that contained sucralose at 1.1-11 mg/kg (the US FDA Acceptable Daily Intake for sucralose is 5 mg/kg). Evidence indicates that a 12-wk administration ofSplenda exerted numerous adverse effects, including (1) reduction in beneficial fecal microflora, (2) increased fecal pH, and (3) enhanced expression levels of P-gp, CYP3A4, and CYP2D1, which are known to limit the bioavailability of orally administered drugs.

November 18, 2011

Low Vitamin D Common in Spine Surgery Patients

Filed under: General Health,Nutrition,Vitamin D — Doc Joe @ 5:28 pm

November 2011

A new study indicates that many patients undergoing spine surgery have low levels of vitamin D, which may delay their recovery.

In a study of 313 patients undergoing spinal fusion surgery, orthopedic surgeons at Washington University School of Medicine in St. Louis found that more than half had inadequate levels of vitamin D, including one-fourth who were more severely deficient.

The researchers reported their findings at the 26th Annual Meeting of the North American Spine Society.

“Our findings suggest it may be worthwhile to screen surgery patients for vitamin D,” says Jacob M. Buchowski, MD, the study’s principle investigator. “We think those with insufficient levels of vitamin D may benefit from taking 50,000 international units of the vitamin once a week for eight weeks before surgery as this may help the recovery after spinal fusion surgery.”

Vitamin D helps with calcium absorption and patients with a deficiency can have difficulty producing new bone. They are at risk for a condition called osteomalacia. Unlike osteoporosis or osteopenia, which result from low bone mineral density, osteomalacia interferes with new bone formation.

All the patients in the study had spinal fusion surgery. In that procedure, surgeons remove discs between two or more vertebrae. The bones in the spine are then attached with hardware and treated with growth factors. As the spine heals, new bone begins to form and the vertebrae fuse together.

Dr. Buchowski became aware of the vitamin D problem when a patient in her 40s experienced a slow recovery after spinal fusion surgery.

“I was examining her and trying to figure out why the vertebrae didn’t fuse,” he said. “She mentioned that she had recently been diagnosed with vitamin D deficiency, and it was like a ‘light bulb’ went off.”

As a result, Dr. Buchowski, an Associate Professor of Orthopedic Surgery and Neurological Surgery, and his Washington University colleagues at Barnes-Jewish Hospital started routinely screening spinal fusion surgery patients for vitamin D deficiency.

Low vitamin D levels are known to be common in elderly patients. Surprisingly, in this study, the patients most likely to have inadequate levels of the bone-building vitamin were younger.

Those in the study averaged 55 years of age, 56% were female, 41% were obese and 95% were white. Although an earlier study had shown inadequate vitamin D levels in 43% of patients undergoing orthopedic procedures, this is the first look solely at spine surgery patients.

As a follow-up, Dr. Buchowski and his colleagues are planning a study to see whether there is a link between low vitamin D and poor outcomes following spinal fusion. In the meantime, he’s recommending that patients having orthopedic surgery ensure they’re getting enough vitamin D.

Presented at the 26th Annual Meeting of the North American Spine Society in Chicago, IL.

November 16, 2011

Prescription vitamin D (D2) less effective than over-the-counter vitamin D (D3) according to a meta-analysis.

Filed under: General Health,Nutrition,Supplements,Vitamin D — Doc Joe @ 4:38 pm

Meta-analysis looks at efficacy of D2 vs D3
Prescription vitamin D (D2) less effective than over-the-counter vitamin D (D3) according to a meta-analysis.

Written by John J. Cannell, M.D.
November 16, 2011
Permission to reprint

SAN LUIS OBISPO, CA — Many people write me and ask, “My doctor prescribed Drisdol, is that OK?” Drisdol is D2 and the form of vitamin D that doctors write prescriptions for. The body doesn’t produce vitamin D2 in response to sun exposure. It is made by irradiating fungus and plant matter. When you take it, a number of metabolic forms of D2 are found in the body, and some studies show D3 (produced by the skin) is more potent, meaning it is more effective at raising blood levels than D2, while some show they are equal. However, there are few studies comparing the efficacy of D2 vs. D3. Or in other words, which form has better health outcomes, better mortality rates?

Recently, a review and meta-analysis address this question. The meta-analysis study was led by Professor Dr. Goran Bjelakovic.

Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD007470.

He analyzed 50 randomized controlled trials (RCTs) with a total of 94,000 participants that used some form of vitamin D and reported mortality rates as either primary or secondary outcomes. Within these RCTs, 32 of the studies used D3 (74,000 subjects) and 12 of them used D2 (18,000 subjects). He found there was a 6% relative risk reduction when supplementing with vitamin D3, as opposed to a 2% relative risk increase when supplementing with vitamin D2

Amazingly, this study somehow slipped under the radar and neither the press nor I picked up this study in July. Luckily, Professor Dr. Harvey Murff of Vanderbilt University reviewed this study yesterday in the Annals of Internal Medicine recently, allowing the general public to examine the study once again.

Murff HJ. Review: Cholecalciferol (vitamin D3) reduces mortality in adults; other forms of vitamin D do not. Ann Intern Med. 2011; 155:JC5-04.

You would think a paper that took a look at tens of thousands of subjects and analyzed the efficacy of prescription vitamin D (D2) and over-the-counter vitamin D (D3) would warrant a news story or two. To my knowledge, these papers are the first to paint such a clear picture about the efficacy between D3 and D2. While there may be explanations for D3’s superiority other than improved efficacy, for the time being, these papers send doctors a message: use D3, not D2.

Contacts:

Vitamin D Council: newsletter@vitamindcouncil.org

Professor Harvey Murff, Vanderbilt University: harvey.j.murff@vanderbilt.edu

Professor Dr Goran Bjelakovic G, University of Nis, Serbia: g.bjelakovic@ctu.rh.dk or goranb@junis.ni.ac.yu

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