Vitamin D Deficiency Declared a Pandemic

The latest issue of the American Journal of Clinical Nutrition states that "vitamin D deficiency is now recognized as a pandemic." Those scientists studying vitamin D find that as much as one-fourth (28%) or more of the population living in the upper half of the United states is at significant health risk due to low vitamin D levels. And this problem is worldwide.

Low vitamin D levels result in increased risk for:

• High blood pressure
• Heart disease
• Low bone strength resulting in osteoporosis and fractures
• Autoimmune diseases
• Diabetes
• Many common cancers
• Rickets in children

The major cause of vitamin D deficiency is lack of adequate sunshine, either because of our lifestyle (spending so much time indoors), because the skin is covered by clothing or sun block, or due to living in Northern regions during winter when the body is unable to make vitamin D because of to the sun's low angle on the horizon. Very few foods have vitamin D and those that do have such low levels they are inadequate even for children.

The recommended test for vitamin D is a blood test, checking the level of 25-hydroxyvitamin D (25-OH-D). A blood level of at least 30 ng/mL (75 nmol/L) is required to get the full health benefits of vitamin D. Your doctor can check your blood for vitamin D to see how you are doing. The test is a little costly, but not nearly as costly as a heart attack or cancer!

Supplements. If you live in the northern half of the U.S., taking a vitamin D supplement makes good sense. In the absence of adequate exposure to the summer sun, you need at least 800-1000 IU of vitamin D3 daily – that holds true for children and adults. Daily intakes up to 2000 IU per day are judged safe by the Institute of Medicine

Personal note. I live in Portland, Oregon. When I checked my own blood vitamin D level this winter (February 2008), it was 19.5 ng/mL – only two-thirds of the recommended minimum level. I spend 1-2 hours every day outdoors year around, and I had been taking at least 400 IU daily – but my level was still low. Now I take 2000 IU of Vitamin D3 daily to get my blood levels up to normal.

Television Viewing: A New Health Risk Factor

A new study in the American College of Sports Medicine journal gives evidence that sedentary time, involving prolonged sitting and absence of whole-body movement, is an independent risk factor for several health outcomes.

The study included 2,033 women and 2,031 men, all who reported being physically active at least 2.5 hours a week (30 minutes, 5 days per week). They were also all free of diabetes and heart disease. Researchers then looked at the total number of hours daily spent watching television and compared TV time to the prevalence of metabolic risk factors.

In men they found that as the hours of daily TV viewing increased, so did their:

• Waist circumference (indicating increased abdominal fat)
• Systolic blood pressure
• Blood glucose levels

All increases showed a dose-response relationship (the more TV they watched, the higher their risks). All three of these risks are primary risks for metabolic syndrome, diabetes, and heart disease. These findings were adjusted not only for physical activity but also age, education, smoking, income level, alcohol intake, diet quality, and family history of heart disease or diabetes.

In women they also found a dose response relationship between hours of TV viewing and:

• Waist circumference
• Systolic blood pressure
• Blood glucose levels
• Blood triglyceride levels
• Blood HDL levels

Detrimental health changes were observed in women who watched more than an hour of TV daily, and in men who watched 2 hours or more of TV daily. The highest risks were linked to women watching 2 hours or more of TV daily and men watching 3 or more hours daily.

It appears that, even though all of these people met minimal guidelines for physical activity, long periods of inactivity, such as watching TV, should be considered a unique modifiable behavior, an independent risk factor for metabolic diseases. It seems the body was designed for activity and long periods of inactivity can result in poorer health and increased risk for serious health problems.

Just as there are national guidelines for physical activity, the authors of this study suggest that there also needs to be similar guidelines for inactivity. They suggest no more than 2 hours of leisure-time screen time per day may be a practical starting point. Children are recommended to spend no more than an hour a day of screen time. Persons engaging in more time than this are significantly increasing their risk for obesity, high blood pressure, metabolic syndrome, diabetes, and coronary heart disease.

Excessive TV viewing can now be considered a new risk factor putting people at increased risk for some of our nation's most serious health problems. Excess TV viewing can replace time normally spent in moderate activities such as household chores, gardening, playing with the kids, and other light-intensity activities that contribute to better health in addition to a regular exercise program.

If you just have to watch a favorite, lengthy movie or football game, here is a way to beat the system: Bring your stationary bicycle to the TV, or a treadmill, and put in some active miles while watching. The goal is to avoid long periods of sitting, which is a health hazard.

Longevity Predictors from the Physicians' Health Study

Would you like to live to be at least 90 years old and enjoy good health during those years? That was the focus of the latest report of the Physicians' Health Study. Looking back over the past 25 years on the lives of 2,357 healthy men who reached the age of 90 or older, researchers asked, "What were the best predictors of reaching old age and still feeling good?" Here is what they found, in order of importance:

• Not smoking was the strongest predictor. Smokers were more than twice as likely to die before reaching 90+ years of age.
• Maintaining a healthy blood sugar level with good diet, a healthy weight, and physical activity was another strong predictor. Those with high blood sugar were nearly twice as likely to die during the study.
• Maintaining a healthy weight with good diet and physical activity also improved their chances of reaching 90+. Those who gained weight and became obese increased their mortality rate by 44%.
• Regular exercise was the best next predictor. Men not getting exercise were 28% more likely to die early.
• Maintaining a healthy blood pressure was also a significant predictor, again influenced by good food choices, a healthy weight, and regular physical activity. Those men who developed high blood pressure were 28% more likely to die early.

These 5 longevity predictors are all largely under our control by making good lifestyle choices. Here is how it affected there chances of reaching 90 years of age:

• Men who had all 5 of these good health indicators had a 54% chance of living to the age of 90 or older.
• If they only had 3 of the 5, their chances dropped to 22-36% (depending upon which risks they had).
• If they had none of the 5 good health indicators, they had less than a 4% chance of reaching age 90. That's a 13-fold difference compared to men with all 5 good health indicators.

Those men who had healthy lifestyles (at least 4 of the 5 factors listed above) and who reached the age of 90 or older had a lower incidence of chronic disease, better late-life physical function, and better mental well-being scores than those with poorer lifestyles. More than two-thirds (68%) of the 90+ year olds with a healthy lifestyle reported their health as "Very good to excellent." Only 8% reported their health as "Fair or poor."

This clearly illustrates that investing time and effort to maintain good health can greatly increase your odds of living a full life, and enjoying good health even up through 90 years of life and longer.

Breastfeeding in the United States

One of the health goals of the U.S. (Healthy People 2010) is to increase breastfeeding. Human milk is the ideal food for promoting babies' health. Breastfed babies receive antibodies from breast milk, which protects them from infection in the vulnerable early weeks of life. Breastfeeding is also less expensive, decreases the risk of introducing food-born illness (diarrhea), and has health advantages for the mother.

A recent survey by the National Center for Health Statistics (NCHS) reports that breastfeeding is on the increase. Of the babies born in 2005-2006, 77% have been breastfed. People 2010 target of 75%. Older mothers (30 years +) had significantly higher rates of breastfeeding (75%) compared to mothers younger than 20 years (43%).

The Healthy People 2010 target for continued breastfeeding by 6 months is 50%. The survey found that only about one-third of mothers (35%) still breastfeed at 6 months. Of the various ethnic groups, Hispanic mothers have the best rates of beast feeding at 6 months (40%), Caucasian mothers are next (35%), and African Americans have the lowest rate (20%). It's important to point out, however, that these rates are up for all groups.

While this is a good improvement over past years, there is still clearly a need to make further improvement in breastfeeding. Diet is an integral component of an infant's growth and development, and healthy feeding practices, such as breastfeeding, have benefits that continue into childhood, adolescence, and adulthood. Use every opportunity you can as a parent, grandparent, physician, educator, public health worker, or wellness coordinator to encourage breastfeeding by all new mothers.

Should Eggs Be Part of a Healthy Diet?

Eggs are a traditional part of the North American diet and most other cultures throughout the world. But, are they good for us? A new large study reveals that eating an egg a day may increase your risk of early death.1

When early heart studies connected blood cholesterol levels to increased risk of heart disease, eggs developed a bad reputation. They were one of the richest sources of dietary cholesterol of any food. One egg has about 200 mg of cholesterol, and the dietary guidelines recommend eating less than 300 mg of cholesterol per day.2 Later studies found that dietary cholesterol had only a modest effect on blood cholesterol levels (one egg raises LDL cholesterol about 4 mg/mL),3 but that the primary culprit was saturated fat.

The best way to determine if eggs are good for you or not is to study egg consumption in large numbers of people, follow them for many years, and see if it affects their health. This has been done for eggs in several studies. Let's briefly review results from some of these largest studies

The Nurses' Health Study4 included 80,082 women followed for 14 years. They found no significant increase in heart disease or stroke when comparing low to high egg consumption in healthy women. Diabetic women, however, had a 49% increased risk of developing coronary heart disease if they ate an egg or more per day compared to those eating less than 1 egg per day.

The Health Professional Follow-up Study4 found similar results in a study of 37,581 men followed for 8 years. They found no significant increase in coronary heart disease when comparing low to high egg intake in healthy men. In diabetic men, however, they found that those who ate an egg a day compared to those who ate less than an egg per day had twice the risk (RR 2.02) of developing coronary heart disease.

The Physicians' Health Study1 is the latest reported research on egg consumption and health risks. This study includes 21,327 participants with 20 years of follow-up, with egg intake evaluated every 2 years. In healthy persons, researchers found no significant association of egg intake with coronary heart disease, but they did find that those who ate an egg or more per day were 41% more likely to die from any cause (after adjusting for age) compared to those who ate less than 1 egg per week. After adjusting for other risk factors (smoking, BMI, high blood pressure, physical activity, alcohol intake, diabetes, high cholesterol, vegetable intake, etc.) eating an egg a day still was a significant predictor of early mortally (23% increased risk of dying from any cause) compared to eating less than 1 egg per week. This is one in every four deaths during the 20-year study.

In diabetics, the health risk increased even more. In this group, egg intake was dose-response related: the more eggs eaten, the higher the risk. Even eating 1 egg per week showed a 30% increased risk in mortality. Eating 2-4 eggs per week showed a 49% increased mortality rate. Diabetics who ate 5 or more eggs per week had more than twice the risk of death compared to those who seldom or never ate eggs.

So what can we conclude? In healthy persons (no diabetes) there appears to be no significant increased risk of death from eating eggs if you eat them moderately (e.g., 2-4 eggs per week). In the editorial accompanying this latest research, the authors suggested that in healthy persons (no diabetes) eating a few eggs per week (3-4) can still be "part of an overall heart healthy diet." Eggs are good sources of protein, riboflavin, and selenium – all good for the heart. Just use them moderately. Don't forget to count those eggs found in foods such as pancakes, cake, cookies, certain roasts, pudding, and other "hidden" sources.

If you are a diabetic, you would do well to greatly limit or eliminate eggs from your diet. If you still want an omelet occasionally, try one of the egg replacers (made mostly from egg whites). They make a good omelet, work well in cooking (pancakes, etc.), and may be a healthier alternative. Learning to cook without eggs appears to be best for diabetics.

Prevalence of Overweight in Children and Adolescents

The National Center for Health Statistics (NCHS) monitors the weight of children and adolescents. Since 1980 the weights of children have been rising at an alarming rate. This rapid increase in weight has increased the risk for diabetes and other weight related
health concerns.

In the last four years, however, it appears that their weights have stabilized. This is good news, but is too short a time to tell if the trend has stopped, or if it just slowed for a few years.

Here is the current prevalence of excess weight:

• 6.3% of children and adolescents (2-19 years) are obese (BMI in the top 95 percentile of the 2000 BMI-for-age growth charts). This is about 9 million children over 6 years of age who meet obesity criteria and are at risk for significant health problems.
• 32% are overweight (BMI in the 85th percentile or higher range) putting them at increased health risk.

Weight standards for children and adolescents are based on weight-for-height growth charts published in 2000 by the Centers for Disease Control and Prevention (CDC). These charts are based on children's average weights back in the 1980s, when weights were rather stable and before they began to increase so rapidly.

A new weight category was introduced in this latest survey – children above the 97th percentile – to identify the heaviest children who are at very high risk. In this survey, 11.3% of all children were in this highest weight category. This high percentage is alarming. This means that about 1 out of every 9 children today are in the highest weight risk category and are at significant increased health risk.

This indicates a great need in our society to encourage better eating habits and provide greater emphasis on physical activity, at least an hour daily, for all children and adolescents. Unless this trend is reversed, our nation's health will continue to erode and chronic health problems and healthcare costs will continue to rise to unprecedented levels.

To determine if children are overweight, download the CDC Body Mass Index (BMI) for Age and Gender Percentile Charts

Boys
Girls

Blood Sugar Control in Diabetics – How Low Should Blood Sugar Go?

Research with diabetics has clearly shown that lowering blood sugar levels, as measured by A1C blood tests, helps prevent microvascular complications from diabetes, such as eye, nerve, and kidney damage. Two new large trials with diabetics report findings on strict blood sugar control and macrovascular damage, particularly cardiovascular disease.

The two studies, called ACCORD and ADVANCE, one included large numbers of diabetics (both had more than 10,000 participants) for 3.5 to 5 years of follow-up. Medications and insulin were used to achieve "near normal" blood sugar levels or intensive glucose-lowering, and were compared to controls who followed standard blood sugar control guidelines for diabetics (target A1C levels of 7.0%).

After several years of follow-up, researchers discovered that persons in the intensive glucose-lowering group had higher mortality rates (22% higher) than those in the control group. While intensive blood sugar control had some benefit in lowering kidney disease, cardiovascular disease was only minimally affected, and their overall mortality rate was higher, just the opposite of what they were trying to achieve.

The researchers concluded that the most appropriate target for glycated hemoglobin levels (A1C levels) should remain 7%. They also recommended that to lower risk of cardiovascular disease (which is very high in diabetics) treatment emphasis should focus on smoking cessation, healthy eating habits, exercise counseling, blood pressure control, providing aspirin, and providing statin drugs to lower cholesterol, in addition to standard glycemic control.

All of these therapies have been shown to be effective in lowering deaths from cardiovascular disease. In fact, some of the lifestyle changes, such as getting regular physical activity, are highly effective. One large study (2,896 diabetics) showed that diabetics who exercised regularly (walked briskly 3-4 hours/week) cut their risk of death in half (during the study period) compared to diabetics who didn't exercise. This simply illustrates the value of a healthy lifestyle in conjunction with medications and good medical care for improving health outcomes.