X-Message-Number: 29508
Date: Sun, 13 May 2007 09:48:11 -0700 (PDT)
From: 
Subject: life extension with vitamin D: Part 2

J Am Geriatr Soc. 2007 Feb;55(2):234-9.
A higher dose of vitamin d reduces the risk of falls in nursing home
residents: a randomized, multiple-dose study.
    Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel
DP. Institute for Aging Research, Hebrew SeniorLife, Boston,
Massachusetts 02131, USA.
    OBJECTIVES: To determine the effect of four vitamin D supplement
doses on falls risk in elderly nursing home residents. DESIGN: Secondary
data analysis of a previously conducted randomized clinical
trial. SETTING: Seven hundred twenty-five-bed long-term care
facility. PARTICIPANTS: One hundred twenty-four nursing home residents
(average age 89). INTERVENTION: Participants were randomly assigned to
receive one of four vitamin D supplement doses (200 IU, 400 IU, 600 IU,
or 800 IU) or placebo daily for 5 months. MEASUREMENTS: Number of fallers
and number of falls assessed using facility incident tracking
database. RESULTS: Over the 5-month study period, the proportion of
participants with falls was 44% in the placebo group (11/25), 58%
(15/26) in the 200 IU group, 60% (15/25) in the 400 IU group, 60%
(15/25) in the 600 IU group, and 20% (5/23) in the 800 IU
group. Participants in the 800 IU group had a 72% lower adjusted-incidence
rate ratio of falls than those taking placebo over the 5 months (rate
ratio=0.28; 95% confidence interval=0.11-0.75). No significant
differences were observed for the adjusted fall rates compared to placebo
in any of the other supplement groups. CONCLUSION: Nursing home residents
in the highest vitamin D group (800 IU) had a lower number of fallers and
a lower incidence rate of falls over 5 months than those taking lower
doses. Adequate vitamin D supplementation in elderly nursing home
residents could reduce the number of falls experienced by this high falls
risk group. PMID: 17302660

Mol Aspects Med. 2005 Jun;26(3):203-19.
Vitamin D in the aging musculoskeletal system: an authentic strength
preserving hormone.
    Montero-Odasso M, Duque G. Geriatric Medicine Program, Hospital
Italiano de Buenos Aires, Buenos Aires, Argentina.
Until recently, vitamin D was only considered as one of the calciotrophic
hormones without major significance in other metabolic processes in the
body. Several recent findings have demonstrated that vitamin D plays also
a role as a factor for cell differentiation, function and survival. Two
organs, muscle and bone, are significantly affected by the presence, or
absence, of vitamin D. In bone, vitamin D stimulates bone turnover while
protecting osteoblasts of dying by apoptosis whereas in muscle vitamin D
maintains the function of type II fibers preserving muscle strength and
preventing falls. Furthermore, two major changes associated to
aging: osteoporosis and sarcopenia, have been also linked to the
development of frailty in elderly patients. In both cases vitamin D plays
an important role since the low levels of this vitamin seen in senior
people may be associated to a deficit in bone formation and muscle
function. In this review, the interaction between vitamin D and the
musculoskeletal components of frailty are considered from the basic
mechanisms to the potential therapeutic approach. We expect that these
new considerations about the importance of vitamin D in the elderly will
stimulate an innovative approach to the problem of falls and fractures
which constitutes a significant burden to public health budgets
worldwide. PMID: 15811435

Neurology. 2006 Dec 12;67(11):2005-14.
Two randomized vitamin D trials in ambulatory patients on
anticonvulsants: impact on bone.
    Mikati MA, Dib L, Yamout B, Sawaya R, Rahi AC, Fuleihan Gel-H. Adult
and Pediatric Epilepsy Program, Department of Pediatrics, American
University of Beirut Medical Center, Beirut, Lebanon.
    OBJECTIVE: To investigate the effects of two doses of vitamin D given
over 1 year on bone density in ambulatory patients on long-term
antiepileptic drug (AED) therapy. METHODS: We conducted two parallel,
randomized, controlled trials in 72 adults (18 to 54 years old) and 78
children and adolescents (10 to 18 years) on long-term AED therapy. They
received either low-dose vitamin D 400 IU/day or high-dose vitamin D
4,000 IU/day (adults) and 2,000 IU/day (children/adolescents). Bone
mineral density (BMD) was measured using dual-energy x-ray
absorptiometry. RESULTS: In adults, baseline BMD was lower than that of
age- and gender-matched controls vs either a Western or an ethnically
identical population. After 1 year, there were significant increases in
BMD at all skeletal sites compared to baseline in the high-, but not in
the low-dose treatment group. However, BMD at 1 year remained below
normal. In children, baseline BMD was normal vs age- and gender-matched
controls and showed significant and comparable increases in both
treatment groups. CONCLUSIONS: In ambulatory adults on antiepileptic
drugs, high-dose vitamin D therapy substantially increased bone mineral
density at several skeletal sites. In children, both doses resulted in
comparable increases in bone mass. PMID: 17159108

Osteoporos Int. 2007 Apr;18(4):401-7. Epub 2006 Dec 7.
How to select the doses of vitamin D in the management of osteoporosis.
    Bischoff-Ferrari HA.Department of Rheumatology and Institute of
Physical Medicine, University Hospital Zurich, Gloriastrasse 25, 8091,
Zurich, Switzerland.
    The dose of vitamin D in the management of osteoporosis should be no
less than 700-800 IU per day. An optimal dose of vitamin D should raise
serum concentrations of 25(OH)D to the desirable range of at least 75
nmol/l. Higher intermittent oral doses of vitamin D may overcome low
adherence. Vitamin D supplementation in the management of osteoporosis
holds a significant public health potential because of its low cost,
excellent tolerability, and combined musculo-skeletal benefits. Fall and
fracture prevention with vitamin D is especially appealing in the
treatment of older individuals at risk for fall-related
fractures. However, bone density, strength, and function benefits with
vitamin D include active and inactive subgroups of community-dwelling
older men and women. Based on a recent expert panel and supportive
evidence presented in this review, serum concentrations of at least
75 nmol/l 25(OH)D will be referred to as desirable. Today, desirable
serum 25(OH)D levels of at least 75 nmol/l may only be reached in about
one third of US older individuals and even fewer European older
individuals. Two main factors discussed in this review may help public
health efforts to ensure desirable vitamin D levels for fall and fracture
prevention, including (1) a sufficient dose of vitamin D and (2) improved
adherence to supplementation. PMID: 17151835

Med Hypotheses. 2007;68(5):1026-34. Epub 2006 Dec 4.
Vitamin D toxicity redefined: vitamin K and the molecular mechanism.
    Masterjohn C.Weston A. Price Foundation, 4200 Wisconsin Ave., NW,
Washington, DC 20016, United States.
    The dose of vitamin D that some researchers recommend as optimally
therapeutic exceeds that officially recognized as safe by a factor of
two; it is therefore important to determine the precise mechanism by
which excessive doses of vitamin D exert toxicity so that physicians and
other health care practitioners may understand how to use optimally
therapeutic doses of this vitamin without the risk of adverse
effects. Although the toxicity of vitamin D has conventionally been
attributed to its induction of hypercalcemia, animal studies show that
the toxic endpoints observed in response to hypervitaminosis D such as
anorexia, lethargy, growth retardation, bone resorption, soft tissue
calcification, and death can be dissociated from the hypercalcemia that
usually accompanies them, demanding that an alternative explanation for
the mechanism of vitamin D toxicity be developed. The hypothesis presented
in this paper proposes the novel understanding that vitamin D exerts
toxicity by inducing a deficiency of vitamin K. According to this model,
vitamin D increases the expression of proteins whose activation depends
on vitamin K-mediated carboxylation; as the demand for carboxylation
increases, the pool of vitamin K is depleted. Since vitamin K is
essential to the nervous system and plays important roles in protecting
against bone loss and calcification of the peripheral soft tissues, its
deficiency results in the symptoms associated with hypervitaminosis
D. This hypothesis is circumstantially supported by the observation that
animals deficient in vitamin K or vitamin K-dependent proteins exhibit
remarkable similarities to animals fed toxic doses of vitamin D, and the
observation that vitamin D and the vitamin K-inhibitor Warfarin have
similar toxicity profiles and exert toxicity synergistically when
combined. The hypothesis further proposes that vitamin A protects against
the toxicity of vitamin D by decreasing the expression of vitamin
K-dependent proteins and thereby exerting a vitamin K-sparing effect. If
animal experiments can confirm this hypothesis, the models by which the
maximum safe dose is determined would need to be revised. Physicians and
other health care practitioners would be able to treat patients with
doses of vitamin D that possess greater therapeutic value than those
currently being used while avoiding the risk of adverse effects by
administering vitamin D together with vitamins A and K. PMID: 17145139

J Bone Miner Res. 2007 Apr;22(4):509-19.
Two-year randomized controlled trial of vitamin K1 (phylloquinone) and
vitamin D3 plus calcium on the bone health of older women.
    Bolton-Smith C, McMurdo ME, Paterson CR, Mole PA, Harvey JM, Fenton
ST, Prynne CJ, Mishra GD, Shearer MJ.
Nutrition Research Group, CVEU, University of Dundee, Ninewells Hospital
and Medical School, Dundee, Scotland, UK.
    Dietary supplementation with vitamin K(1), with vitamin D(3) and
calcium or their combination, was examined in healthy older women during
a 2-year, double-blind, placebo-controlled trial. Combined vitamin K with
vitamin D plus calcium was associated with a modest but significant
increase in BMC at the ultradistal radius but not at other sites in the
hip or radius. INTRODUCTION: The putative beneficial role of high dietary
vitamin K(1) (phylloquinone) on BMD and the possibility of interactive
benefits with vitamin D were studied in a 2-year double-blind,
placebo-controlled trial in healthy Scottish women > or =60 years of
age. MATERIALS AND METHODS: Healthy, nonosteoporotic women (n = 244) were
randomized to receive either (1) placebo, (2) 200 microg/day vitamin
K(1), (3) 10 microg (400 IU) vitamin D(3) plus 1000 mg calcium/day, or
(4) combined vitamins K(1) and D(3) plus calcium. Baseline and 6-month
measurements included DXA bone mineral scans of the hip and wrist,
markers of bone turnover, and vitamin status. Supplementation effects
were tested using multivariate general linear modeling, with full
adjustment for baseline and potential confounding variables. RESULTS:
Significant bone mineral loss was seen only at the mid-distal radius but
with no significant difference between groups. However, women who took
combined vitamin K and vitamin D plus calcium showed a significant and
sustained increase in both BMD and BMC at the site of the ultradistal
radius. Serum status indicators responded significantly to respective
supplementation with vitamins K and D. Over 2 years, serum vitamin
K(1) increased by 157% (p < 0.001), the percentage of undercarboxylated
osteocalcin (%GluOC) decreased by 51% (p < 0.001), serum 2
5-hydroxyvitamin D [25(OH)D] increased by 17% (p < 0.001), and PTH
decreased by 11% (p = 0.049). CONCLUSIONS: These results provide evidence
of a modest synergy in healthy older women from nutritionally relevant
intakes of vitamin K(1) together with supplements of calcium plus
moderate vitamin D(3) to enhance BMC at the ultradistal radius, a
site consisting of principally trabecular bone. The substantial increase
in gamma-carboxylation of osteocalcin by vitamin K may have long-term
benefits and is potentially achievable by increased dietary intakes of
vitamin K rather than by supplementation. PMID: 17243866

[Quick summary: It's probably a good idea to take 1,000 IU of vitamin D
during the summer, and 2000 IU during the winter, as well as plenty of
deep green vegetables or a supplement to provide adequate vitamin K as
well.]

Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=29508