Tag: vitamin D

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High blood pressure and possible ethnic differences

On page 66 of a new book Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways, by Thomas Bollyky, it is mentioned that early Western medical personal working in Africa in the 1920s were surprised to find no cases of hypertension/high blood pressure among the native African people. Only one native woman was known to be overweight and it was noted that she worked in a brewery which led the medical person in the document to speculate whether beer drinking could be fattening (yes it can). The first case of hypertension in a native African person wasn’t noted until the 1940s.

Question: Does the Western style of living or working or export of Western products cause hypertension in native Africans? If native Africans living in their traditional environment using their traditional diet have no risk for hypertension then what changed that caused an increased risk? This topic is also important for prenatal health as preeclampsia can include hypertension/high blood pressure and it does tend to be an increased risk for women with African American ancestry. The DASH diet may be helpful, for more on preeclampsia risk factors and possible tips for prevention or management, see Preeclampsia & TRP Channels, effectivecare.info. 

Dr. Agbai’s discovery that helps protect against symptoms of Sickle Cell Anemia – Thiocyanate.

Yes per Dr Agbai who has worked with patients in Africa and in the U.S., the standard diets are different. There is a difference in type of starch and amount of starch in typical African or Jamaican diet and western U.S. style diet, and there is a difference in amounts of foods that contain thiocyanate. The yams commonly grown in Africa are larger and woodier/less sweet than sweet potatoes and they are also a good source of thiocyanate.

Thiocyanate is a phytonutrient that helps protect against Sickle cell anemia by preventing the red blood cells from forming the sickle shape instead of the normal round indented shape (like a tire or doughnut shape that has a filled in shallower center). It is important to eat adequate iodine and protein rich foods that contain methionine (found more in animal product protein sources than in a vegan diet) in order to protect thyroid health.

Listen to interviews with Dr. Agbai by the radio show Your Own Health and Fitness: http://www.yourownhealthandfitness.org/?page_id=509

Agbai O. Anti-sickling effect of dietary thiocyanate in prophylactic control of sickle cell anemia. J Natl Med Assoc. 1986;78(11):1053-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2571427/

There may be a slight difference in retention of calcium and loss of magnesium that would be protective with a diet low in calcium might may increase risk of metabolic syndrome type conditions when excess calcium.

I’ve discussed this topic of potential differences between western style diet and traditional African culture and possible differences in health in my early days of blogging when I found a research article from ~ 1970s that noted ethnic differences in health outcomes but did not take into account possible differences in average ethnic diet at the time. (I haven’t found that article in my files yet. I will update this post if I do find it.) To get to the point directly – people with native African ancestry may have kidney differences that conserve calcium better, and possibly not conserve as much magnesium, as other ethnic groups. This would be protective when calcium was not very available in the diet but then would be an increased negative health risk if the diet contained a lot of calcium or phosphorus.

There is known problems in medical research in the U.S. with bias in research studies towards use of white males as study participants with less information gathered about minority groups and females.

Before discussing calcium and magnesium and kidney health in more detail – briefly – there is bias in medical research towards white males. Research studies over the years have often had more limited numbers of minorities and females among the experimental and control groups or as a focus of research. A summary of the issue was included in a recent article in the New York Times that is focused on the potential benefits and risk of bias in the use of Artificial Intelligence (AI) in medical diagnostic processes or other medical roles.

” Medicine has long struggled to include enough women and minorities in research, despite knowing they have different risk factors for and manifestations of disease. Many genetic studies suffer from a dearth of black patients, leading to erroneous conclusions. Women often experience different symptoms when having a heart attack, causing delays in treatment. Perhaps the most widely used cardiovascular risk score, developed using data from mostly white patients, can be less precise for minorities. ” – Dhruv Khullar

“A.I. Could Worsen Health Disparities,” by Dhruv Khullar, The New York Times, Opinion, Jan. 31, 2019

It is not racist or sexist to discuss differences in physiology and the potential effects those differences might have on health. It is discriminatory to only study one group of people primarily and then try to treat everyone else as if they weren’t individuals but were all instead exactly like the group that had been studied. It is discrimination to not treat individuals as individuals or to pretend that differences don’t exist.

Adequate magnesium is needed for preventing high blood pressure, cardiovascular disease, and many other chronic conditions including dementia.

Low magnesium levels, particularly when there is also plenty of phosphorus may increase cardiovascular risks. Adequate magnesium levels are protective and elevated magnesium is unusual and may be increase cardiovascular risks. In good health the body maintains magnesium and other electrolyte levels within specific ranges. (5) Higher magnesium levels have also been associated with higher levels of potassium and of albumin, a blood plasma protein, (6), which is important for fluid balance and transport of a variety of chemicals in addition to magnesium (such as steroids, fatty acids, and thyroid hormones (wikipedia/serum albumin), about 30% of serum magnesium is carried in a non-electrically active form on proteins, primarily albumin (Clinical Biochemistry/serum magnesium) (9).

Alzheimer’s dementia and other types of dementia are more common in blacks than whites in the U.S. and may be a risk earlier in life too, early onset Alzheimer’s can occur in the forties and fifties instead of the more frequent age of diagnosis after age 60. See: African Americans Face Greater Risk of Alzheimer’s Disease than Whites, usatoday.. The reason is not known but the increased frequency on high blood pressure in blacks is thought to be a risk factor.

There may be differences in rate of urinary loss of albumin in different ethnic groups. With the presence of excess abdominal weight participants in a renal study of Hindustani-Surinamese, or African-Surinamese ancestry had an increased likelihood of albuminuria than participants of Dutch ancestry with the greatest risk found in the Hindustani-Surinamese group. (7) Asian Americans and African Americans were found to have better blood albumin levels in a renal study and the Asian Americans had better renal biomarkers compared to other ethnic groups in the study. (8)

When looking at hypertension and high blood pressure risk with the same diet in modern research there is a significant increased risk for African Americans to have high blood pressure and to have it occur earlier in life than in whites. (prevalence in the U.S. of hypertension in adults was “42 % for blacks and 28 % for whites,” (2011-2012)). (2)

So it is a good question – how did hypertension frequency in Africans in the 1920s change from zero to 42% for African Americans in the United States, in 2011-2012? Diet differences that were noted in 2009-2010 between white groups and African American groups were more cholesterol and sugar and less fiber, whole grains, nuts/beans/seeds, fruits and vegetables for the African Americans on average. Dairy intake was not mentioned as being significantly difference. In another research comparison calcium intake was lower on average in African Americans but so was magnesium (Table 1). (2)

Within the introduction and Diet and Blood Pressure sections of the article it is mentioned that ethnic differences in cardiovascular metabolism has been noted in African American groups and that their reduction in blood pressure when following the DASH diet was even better than the reduction in people of other ethnic background who followed the diet (it includes a magnesium rich Beans/Nuts/Seeds group as a daily/weekly recommendation). The INTERMAP study found an increased Sodium to Potassium ratio in urinary excretion and less total Potassium urinary excretion for the African American participants than white participants. (2)

Other research has also supported the idea that high blood pressure may have more to do with excess sodium (salt) intake in relation to low potassium intake than just having to do with the amount of sodium in the diet. Potassium is found in all vegetables and fruits in varying amounts, beans/nuts/seeds, and in liquid milk and yogurt. (Kidney dialysis and other patients with Chronic Kidney Disease have to avoid excess potassium so this article includes a list of potassium rich foods for the purpose of educating regarding what needs to be limited but for people of average kidney health it is a list of good sources to include in the diet: Potassium and Your CKD Diet, National Kidney Foundation.

Learning is an ongoing process, in the meantime some possible health tips for people of any ancestry:

  1. Adequate magnesium is essential for kidney and heart health and high blood pressure is an early symptom of low magnesium levels. Dietary sources may not be sufficient if intestinal absorption is poor or if renal losses are excessive. Epsom salt baths or footsoaks or magnesium chloride are topical forms. Adequate protein and phospholipids in the diet are also important to provide the albumin and other specialized transport molecules that carry magnesium and other chemicals within the vascular or other fluids of body tissue. More information about magnesium sources and symptoms of deficiency are available in a previous post: To have optimal Magnesium needs Protein and Phospholipids too.
  2. Adequate calcium and vitamin D are needed for health however excess may cause an imbalance between calcium and magnesium levels as magnesium is excreted along with excess calcium by the kidneys and less magnesium may be absorbed by the intestines as vitamin D causes increased absorption of calcium and magnesium but calcium may be more available in a modern processed food diet. For more information about vitamin D sources see: Light up your life with Vitamin D, peace-is-happy.org. Deficiency of calcium or of vitamin D can cause secondary hyperparathyroidism which can also be more common in renal failure due to excess phosphorus buildup and deficiency of active vitamin D. The healthy kidney is involved in activating vitamin D. (Secondary hyperparathyroidism, National Kidney Foundation) Calcium is plentiful in most dairy products and is also found in almonds, sesame seeds, beans, dark green leafy vegetables and other produce. Variations of a 2000 calorie menu plan shows that even a vegan diet can provide 1000 milligrams of calcium per day and a menu with dairy products can provide an excess with over 1600 milligrams of calcium, see: Healthy Hair is the Proof-of a healing diet.
  3. The DASH diet (Dietary Approach to Stop Hypertension) may help because it encourages potassium and magnesium rich vegetables, fruits, beans, nuts and seeds. Calcium is provided without being over recommended with two to three servings of dairy group foods. See example daily/weekly diet plan recommendations here: What is the DASH diet?, dashdiet.org.
  4. Adequate without excess protein helps protect the kidneys from having to overwork excreting nitrogen from excess protein breakdown. Adequate water is essential for kidney and vascular health as it helps with excretion of toxins and transport of nutrients and oxygen in the vascular system. More information about protein and water recommendations are available in a previous post: Make every day Kidney Appreciation Day.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

  1. Thomas Bollyky, Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways, 2018, MIT Press, https://mitpress.mit.edu/books/plagues-and-paradox-progress
  2. Chan Q, Stamler J, Elliott P. Dietary factors and higher blood pressure in African-Americans. Curr Hypertens Rep. 2015;17(2):10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315875/“Marked ethnic differences exist in bone metabolism and development of calcified atherosclerotic plaque (CP). Relative to European-Americans, African-Americans have lower rates of osteoporosis (despite ingesting less dietary calcium), form fewer calcium-containing kidney stones and manifest skeletal resistance to PTH (1,2,3). Systemic differences in regulation of calcium and phosphorus appear to be involved (4). Related phenomena may include the markedly lower amounts of calcified CP in African-Americans, despite the presence of more severe conventional cardiovascular disease risk factors (5,6,7,8,9). Together these observations suggest biologically mediated ethnic differences in the regulation of bone and vascular health.” […]  “The DASH/DASH-Na diet BP reduction was more pronounced for blacks compared to whites [31, 36, 37]. Although the DASH dietary approach has been incorporated into lifestyle changes recommended for patients with HTN [3], data show that few hypertensive Americans consume diets even modestly concordant with the DASH diet and less so for blacks [38]. Only about 19 % of individuals with known HTN from NHANES 1999–2004 had DASH-concordant diets.”
  3. Barry I. Freedman, et al, Vitamin D, Adiposity, and Calcified Atherosclerotic Plaque in African-Americans,J Clin Endocrinol Metab. 2010 March; 95(3): 1076–1083. [ncbi.nlm.nih.gov/pmc/articles/PMC2841532/?tool=pubmed]  
  4. Potassium and Your CKD Diet, National Kidney Foundation, https://www.kidney.org/atoz/content/potassium
  5. Ryota Ikee, Cardiovascular disease, mortality, and magnesium in chronic kidney disease: growing interest in magnesium-related interventions, Renal Replacement Therapy, 2018 4:1,   https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-017-0142-7
  6. Noriaki Kurita, Tadao Akizawa, Masafumi Fukagawa, Yoshihiro Onishi, Kiyoshi Kurokawa, Shunichi Fukuhara; Contribution of dysregulated serum magnesium to mortality in hemodialysis patients with secondary hyperparathyroidism: a 3-year cohort study, Clinical Kidney Journal, Volume 8, Issue 6, 1 December 2015, Pages 744–752, https://doi.org/10.1093/ckj/sfv097
  7. van Valkengoed IG, Agyemang C, Krediet RT, Stronks K. Ethnic differences in the association between waist-to-height ratio and albumin-creatinine ratio: the observational SUNSET study. BMC Nephrol. 2012;13:26. Published 2012 May 7. doi:10.1186/1471-2369-13-26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492102/
  8. Frankenfield DL, et al., Differences in intermediate outcomes for Asian and non-Asian adult hemodialysis patients in the United States, Kidney International, Vol 64, Issue 2, Aug. 2003, pp 623-631 https://www.sciencedirect.com/science/article/pii/S0085253815493706
  9. M H Kroll, R J Elin, Relationships between magnesium and protein concentrations in serum. Clinical Chemistry Feb 1985, 31 (2) 244-246; http://clinchem.aaccjnls.org/content/31/2/244.long
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Distractions from nutrition – a timeline

Goals for the chronically ill often are different than for those who enjoy typical health – avoiding a cold is less difficult than avoiding increased inflammation that can lead to an inability to digest food, or to heal small wounds, or to grow skin in areas where skin cells are replaced on a weekly basis such as in mucous membranes of the nose or mouth or in the ear canal. Those rapidly growing areas represent all of the lining of the intestinal tract. If your skin isn’t healing well from minor scrapes and you have frequent nose bleeds then likely your entire digestive tract isn’t in good shape either. Cells are replaced throughout the body on a regular basis but some areas have a longer life cycle for the replacement than other areas.

(Non-healing sores may be more common in autoimmune condition Lupus, patient forum, may also occur with vasculitis – migraines may involve vasculitis. Patient forums for people with odd diseases can be comforting if only to let them know they aren’t alone. Sunlight exposure can make Lupus worse or be a trigger for some types of vasculitis sores.  The patient forum tips also included a warning not to use petroleum jelly (Vasoline TM) within the nasal passages as it can increase risk for a type of lung infection. Coconut oil was recommended by another forum comment and is the active ingredient in a product that I’ve found helpful for moistening the dry scabby tissue – pain is the common complaint along with bleeding or seeping plasma from the sore tissue. Applying tiny amount within the nasal passage or ear area is not easy but pain is unpleasant. /(After reading the patient forum tips I’ve switched to plain coconut oil as was suggested and it does seem more healing than the thicker chapstick which likely contains some waxes in addition to coconut oil. While a humid, moist air quality is helpful I’ve also found that clean air is important, smoke or smog like air made the skin condition worse whether there was a humidifier or not.)/

I’ve also found relief after a magnesium sulfate/Epsom salt bath and the dryness is reduced with adequate humidity in the air. A damp towel hung near a heating vent can help add humidity to a closed small room if a commercial humidifier isn’t available or seems inadequate. Commercial humidifiers should be cleaned with bleach water or another sanitizing agent occasionally or they may be adding mold or other infectious pathogens to the air – the damp towel dries each night and needs to be remoistened and simply washed occasionally as it doesn’t really get dirty or mold because it doesn’t stay damp. Mold and pathogens can grow on the commercial humidifiers because they tend to always retain some moisture in portions of the machinery. )

Not having a severe headache, migraine pain, and being able to breathe through both nostrils at the same time due to frequent congestion problems are also part of my good days versus bad days. Severe exhaustion and just having the energy to get dressed can be a limiting factor for a day’s goals to get anything else accomplished. Chronic illness is becoming more common rather than less common and how to help prevent or manage it is something that nutrition can help in ways that a bottle of medication can’t because the cell repair throughout the body needs many trace nutrients, vitamins and minerals, and an adequate amount and variety of protein and essential fats and carbohydrates – every day, throughout the day.

Strolling through the distractions used to suggest my concerns about nutrition are unfounded simply reveal the accuracy. (More on the “Weaponization of Social Media” by the U.S. and others) My providing free information is simply in the hope that it might be helpful to someone. I will be fine because I’ve found the research and am using it for my own benefit. Living in a desert is not something that my health can handle however and has never been my goal. The advantage of a virtual world is that if twenty readers find my information valuable then they can benefit from it wherever they are sitting and don’t need me to be present or to be living in a desert area.

Do your own research or find a health care practitioner that is trained in nutrition to help guide you if you are interested in taking better care of yourself now rather than waiting for worse chronic illness or brain degeneration. You could be one of the twenty readers who are interested or not, life is full of choice but consider whether you are choosing for yourself or whether you are accepting society’s Darwin Award of chronic illness via modern lifestyle. The United States is becoming one of the most unhealthy countries on average. Qatar is leading the group too but only since the decades since switching to a modern lifestyle and dietary habits.  (20% diabetes rate in Qatar)(Magnesium deficiency causes insulin resistance)

Supporting big business profit goals is noble but so is survival of the ecosystem over the next thousand years – if we make it through the next one hundred I have hope that we will have figured out more sustainable ways to produce energy and use renewable agricultural methods and that we will survive the next thousand – we are at a turning point where pretending the status quo is working is no longer helpful and is harmful even over the short term.

  1. Obsessive about vitamin D, must be crazy – no my recommendation to not take excessive vitamin D and calcium supplements as it is not a sure way to protect against bone fracture risk and may be harmful, has been since supported by research and is now the standard recommendation. My initial recommendation was in February 2011, this update is December 2017:  https://www.acsh.org/news/2017/12/27/calcium-and-vitamin-d-supplements-still-do-not-prevent-fractures-12329
  2. Some people may truly have low vitamin and hormone D levels while others may have a condition that causes the inactive vitamin D level to be low while the active hormone D level is elevated and likely causing an elevation or tendency to elevation of the body’s calcium levels through increased absorption and decreased excretion and which also leads decreased magnesium absorption and increased magnesium excretion as the minerals are kind of a team. In ancient times magnesium was very plentiful in the water and food supply while calcium is rare so our evolutionary physiology tipped towards conserving calcium and wasting magnesium. Ideally simply ask to have both your inactive vitamin D level (25-D) and your active (1-25-D) hormone D levels to be tested but the current treatment and research recommendations generally just test the less expensive measurement of 25-D. Sarcoidosis, HIV, tuberculosis, Rheumatoid Arthritis are some examples of diseases that may have altered balances of 25-D and 1-25-D. The metabolism of vitamin D is complicated and the commonly used herbicide Roundup which contains glyphosate may be inhibiting the CYP enzymes that are needed to make the active form of hormone D from the inactive form or to make the inactive form with sunshine. This is not a widely accepted theory yet (more on the topic in a previous post) but my own health is better for having reduced my intake of foods that may contain glyphosate and by adding a powdered form of the amino acid glycine to my daily routine. I added the supplemental powder when I had a genetic screening performed that revealed a double gene difference in my ability to digest larger proteins down to the individual glycine. It has active roles within the brain which can help reduce anxiety as well as performing other functions and my health has been much improved. Glyphosate is only one methyl group (-OH, one atom of oxygen and one of hydrogen) different from glycine. (more on glycine & glyphosate in this previous post) Inhibition of CYP enzymes might also increase risk of pancreas problems and diabetes and may play a role in risk of developing autism but it isn’t the only chemical that is likely involved and deficiency of vitamin D is likely not the only nutrient deficiency involved – (more on that in this post.)  By the way, I’m looking for a particular link and just haven’t found it yet – please be patient. Still looking but here is a post with some dietary guidance for prenatal or other people interested in reducing intake of foods that may contain glyphosate: (Self care for prenatal care, part one) Okay I found it, see link [page 19, 1] “Other pathogens that have been shown to reduce the activity of the Vitamin D Receptor, in addition to the pathogen that causes Tuberculosis, include the mold Aspergillus, the viruses that cause Epstein-Barr chronic fatigue syndrome and HIV/AIDS, and the autoimmune diseases sarcoidosis, Crohn’s Disease, and Rheumatoid Arthritis. Elevated levels of 1, 25(OH)2D are seen with the bacterial infections: “Elevated 1,25(OH)2D appears to be evidence of a disabled immune system’s attempt to activate the VDR to combat infection.” [page 19, 1]”  an excerpt from post: [https://transcendingsquare.com/2015/08/11/whether-to-be-compliant-or-to-be-healthy-seems-like-an-easy-question-to-answer/]” which I included in (Preventing autism perinatally – before conception) Newborn umbilical cord samples which are already collected could be tested for more chemicals in order to help identify which infants are likely to be more at risk for developing autism – I would be because of my genetic difference in my ability to digest protein down to the individual amino acid glycine. A researcher found 15 lab test biomarkers/chemicals in common and to save money organized them into three groups – if an infant has the first five, then pay for the screening of the second set of five and if the infant also has those differences then screen for the last set of three chemicals. If all fifteen or most of the fifteen are different than average than the infant may need dietary modifications to help with special methyl forms of B vitamins or supplements of glycine or methionine or help with detoxifying heavy metals for example. See (Newborn Sceening for Autism – 3 sets of 5 potential biomarkers) As an overview and update I will add a link to an article about a recent review of research on the finding that low vitamin D levels are associated with increased risk for many types of cancer – but – excess levels of vitamin D don’t help protect even more than adequate or good levels. Some nutrients and chemicals are safe at elevated levels because they are excreted easily while others are safe and helpful in a -U- shape, too little or too much can be unsafe to health. Vitamin D when activated to the hormone can help control our own immune system’s ability to make antibiotic type chemicals of our own – all day, everyday as long as the nutrient building blocks are available. Too much or too little vitamin/hormone D can increase risk of cancer or of autoimmune disease.
  3. This isn’t about “I told you so” it is about our government or some other agent actively preventing helpful information from being shared. I will keep sharing information that can be helpful because I know how much pain hurts and some chronic degeneration of body and brain function can not be reversed it can only be prevented – seeing your loved ones and having them not remember basic facts about themselves or their family members hurts emotionally – having them forget how to be able to swallow food hurts them physically unless caregivers to spoon feed them can be afforded or are available within the family. You may have to physically massage their throat to help stimulate a swallow reflex, simply putting the spoon in the mouth may not be enough to stimulate a swallow reflex in end stage Alzheimer’s Disease.
  4. Magnesium matters – and Epsom salt baths or foot-soaks (about one cup magnseium sulfate salt to a half bath for 20 minutes every 3 to 4 days or half cup in a tub of water for a 20-40 minute footsoak) can be a better absorbed method – this is now supported by research. It may also help protect against and reverse early stages of Alzheimer’s  Disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182554/
  5. Symptoms of magnesium deficiency can include mood changes such as depression, anxiety, or anger and irritability and physical symptoms such as muscle cramps, eye twitches, or dry eye. https://www.healingtheeye.com/dry_eye.html
  6. Magnesium is nature’s method for blocking calcium channels – and it doesn’t cause the potential side effects that pharmaceuticals may cause (PPIs such as Pprilosec, Nexium and Prevacid.) https://transcendingsquare.com/2015/10/18/magnesium-deficiency-can-cause-irritability-anxiety-and-chronic-degeneration/
  7. Iodine is an essential nutrient for a healthy weight and appetite for adults and infants and moderate deficiency during pregnancy may be an under lying cause of later development of autism. For some reason I can’t imagine the U.S. nutrient database for iodine content was deleted some point in time between when I first started writing about it in 2010/2011 and now. I keep checking in the hope that the information has been restored – but that day isn’t today: https://ndb.nal.usda.gov/ndb/nutrients/index
  8. Zinc, B12 and vitamin D deficiency can mimic symptoms of schizophrenia which is a mental disorder where the brain isn’t recognizing the person’s own subvocal thoughts and mutterings. Treating with psychiatric drugs or only one of the missing nutrients wouldn’t cure the person of the symptoms if multiple nutrient deficiencies were the cause.  Low thyroid levels may also be a risk factor and elevated C-reactive protein or an elevated copper to zinc ratio may also be a factor. https://transcendingsquare.com/2016/03/19/the-voices-that-people-with-schizophrenia-are-hearing-are-probably-their-own-inner-thoughts/
  9. Calcium or vitamin D deficiency can cause hyperparathyroidism which can cause disoriented thinking and may cause self injury or suicidal urges. https://transcendingsquare.com/2016/04/23/self-injurious-behavior-in-autism-patients-with-low-calcium-levels/

That’s the short list.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

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Calcium and vitamin D supplements are not recommended to help prevent hip fractures

A recent meta-analysis  published in JAMA (2) of research on the efficacy of calcium and vitamin D supplements to help prevent hip fractures and other types of bone fractures in Senior Citizens or post-menopausal women found no benefit compared to placebo or no treatment.  The meta-analysis included 33 clinical trials involving 51,145 participants.

The brief overview article does not mention if harm was found but concludes with the simple statement that the findings do not support a routine recommendation or use of calcium and vitamin D supplements in community dwelling older people. Read more: Thumbs Down on Calcium and Vitamin D to Prevent Hip Fracture (1)

Adequate magnesium in a form the body is able to absorb well, which may require a topical form such as soaking with magnesium sulfate salt (Epsom salt) or magnesium chloride products, is required for maintaining bone health. The minerals silicon and boron are also important and the mineral strontium in microgram amounts may help. Vitamin K from leafy green vegetables and green herbs and spices (or in the form of vitamin K2 supplementally may be helpful) is also important for maintaining bone density. (3)

  1. Jack Cush, MD, Thumbs Down on Calcium and Vitamin D to Prevent Hip Fracture, Medpage Today, Jan 13, 2018, https://www.medpagetoday.com/primarycare/dietnutrition/70497?xid=nl_mpt_DHE_2018-01-16 (Medpage Today)

  2. Jia-Guo Zhao, MD; Xian-Tie Zeng, MD; Jia Wang, MD; et al, Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis, JAMA. 2017;318(24):2466-2482,     https://jamanetwork.com/journals/jama/article-abstract/2667071?redirect=true (2)

  3. Charles T Price, Joshua R Langford, and Frank A Liporace,

    Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet, Open Orthop J. 2012; 6: 143–149.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330619/ (3)

 

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Nutrients Rock – “School house” style

More recently in the past than the days of my childhood, at some point when I was first writing online ~ 2010/2011, I mentioned a goal or rather an idea to “be like” a pop singer and I think my admiration and what my idea actually was may have been misunderstood. Memorable and entertaining music can be a fun way to deliver educational messages not just fill stadium shows for adults.

The children’s song and video series called School House Rock is an early example of education set to rock music. Examples are available online: [Youtube: Preamble to the Constitution]

Teaching in song goes farther back though to early nursery rhymes and the “clean up, clean up, time to clean up” song. I don’t know if that tune has a title, I learned it as an adult after my kids were already too old for it to have worked. Some lessons are learned at certain stages of development and then unlearning those habits can be difficult later in life.

Here’s a slightly different tune than I remember but – use it regularly during preschool and you may be more likely to end up with a teenager who simply is used to and prefers to have and maintain a neat room. Sing the song while cleaning up with the children everyday while they are young and need the help. In a few years they’ll be singing the song and cleaning up naturally and may even teach younger kids how much fun it is: [Youtube: Clean up song]

  • Teaching healthy eating habits and a love for a variety of flavors starts with pregnancy when mom eats a variety of healthy and flavorful foods and continues during breastfeeding. The fetus and infant do sense some of the flavor variety in their nutrition they receive from mom.
  • Offering a variety of easy to digest foods as the toddler and child grows helps teach them that a variety of flavors are interesting and enjoyable. There can be a tendency for children to prefer a favorite but offer it too often and then they may suddenly get tired of it and not want it again. Offering a variety regularly and encouraging tastes of new things without forcing a certain amount can help make an environment that feels safe for a child to explore new tastes without negative effects resulting due to feeling pressured.
  • Controlling food intake can make disordered eating habits more of a risk later on in life; eating too much, too little, or too limited a variety can be examples of disordered eating habits. Ideally it is best to encourage a child to learn to listen to their own body’s hunger and fullness signals and eat when their are hungry of a variety of foods and stop when full. A healthy microbiome, the good guy bacteria in the gastro-intestinal tract, also is important for appetite control and a good mood.
  • Fiber rich vegetables and other fiber foods are helpful for supporting the healthy types of GI tract bacteria. The good strains help protect us from bad strains and from yeast and other types of microscopic organisms. The good strains of GI bacteria have also been associated with a healthy weight and normal appetite. Some other types have been found to be common in patients with obesity and the bacteria may be playing a role in promoting an increased appetite and weight gain, more research is needed. Certain types of GI bacteria have also been found to produce different types of brain neurotransmitters, some that can increase anxiety and some that can increase a good mood.
  • So the take home point may be that bacteria that promote a good mood and healthy appetite sound like better passengers to feed and maintain during our journey through life.

Having wandered from my initial point, I’ll return to it, School-house rock style songs about nutrients might be a catchy, memorable way to learn about the nutrients. Young children could just be getting familiar with the larger message about their function and then the songs might be useful again during high-school or college along with flashcards to help learn the more complex nutrient names that go with the basic roles in the body. Chemistry students with a talent for tongue twisters can sing along with Tom Lehrer’s 1967 version of song from a Gilbert and Sullivan musical Pirates of Penzance where he shares all the chemical elements that were known at the time. [Youtube]

Now in a trip back through time you need either a time machine or a well-organized file cabinet. I’ve tried to organize my file cabinets over the years but at this particular stage of my life they are as rare as time machines – so instead of worrying about finding a particular scrap of paper with song lyrics about the vitamin B group from ten years ago I just grabbed a pencil and notepad:

B, B, B

You light my fire,

B, B, B

and give me energy

for all I require.

B, B, B

You light my fire,

B, B, B

energize my day

like a live wire.

Thiamin, Riboflavin,

Pyroxidine too,

Pantothenic acid, Cobalamin

and folate or folic acid are B’s,

Choline and biotin too,

Niacin or Niacinamide,

are also all B’s on my side.

B, B, B, B’s

Keep lightin’ my fire,

B, B, B, B’s

and I’ll never tire.*

(*obviously people do get tired eventually even with a good supply of B vitamins – lyrically the last line has more punch with the stronger statement then a more physiologically correct “so I won’t tire.” – this is why teams are helpful.) More info on the group of B vitamins: medlineplus.gov/bvitamins

Since I didn’t waste any time digging through old boxes or building a time machine, I just kept writing:

Iron, a red corpuscle’s friend,

helping make our muscles bend,

as we move about and play,

Iron carries oxygen all day,

delivering energy

throughout,

each muscle needs

a fair amount

to shorten and

lengthen as we

bend about.

And I kept writing, there are lots of nutrients:

Phosphorus, potassium,

Molybdenum, manganese,

Magnesium, calcium,

Sodium and copper

Are all trace minerals

We need each day

for enzymes to work

so that we can play.

And a draft to introduce the macro-nutrients too:

Protein, carbohydrates,

and fats,

are the three,

big macro-nutrients

on the nutrient

family tree.

As drafts for song lyrics go, it might be time to hire a song lyricist.

Addition: But finding a song lyricist also takes time so I wrote a couple more drafts instead,

The discovery of Vitamin C is an exciting story:

Ascorbic acid,

also known as vitamin C,

protected sailors from scurvy,

while they were away at sea.

Limes were a source

of the mysterious stuff

that helped men stay well

when oceans were rough,

and journeys were long

without a single stop

for fresh supplies

and a chance to shop.

Limes would stay fresh

for months, while at sea,

and provided the sailors

a good source of vitamin C.

Scurvy was the feared

disease of the sea

until it was seen

that citrus fruit cured

and prevented the dread disease.

Bleeding gums and sore knees?

How could a sailor chew hard tack

or climb trees?

Let alone scurry up the ship’s mast

to keep watch in the lookout’s post?

Vitamin D was also discovered early for its role in preventing rickets in children, but now it has a new story to share as well:

Vitamin D, we know,

helps our bones

be strong and grow,

and now we also know

Vitamin D acts as defense

for our nutrient family tree.

It helps immune cells

learn to know

which other cells are

friend or foe

and helps mom and baby

safely get to know

each other’s cells as family

and not as foe.

Not quite ready for Youtube yet, but everything starts somewhere.

The lyrics about vitamin D contain information that is not part of standard education about the nutrient – yet. The area of immunology during pregnancy and early implantation is advancing. The fetus plays a role in decreasing the activity of the maternal immune T cells. A decrease in the internal level of tryptophan within the maternal T cells seems to be involved. A diet containing large amounts of tryptophan was associated with more fetal loss than a standard diet in animal research. For ethical reasons this field of research takes place with lab animals or murine animals. [1]

“And third, fetal survival depends on tolerogenic mechanisms
that block maternal T cell responses.” [1]

The estrogen level of the mother may affect the ability of the fetus to inhibit her immune T cells:

“Estrogen treatment and pregnancy both induced FoxP3 protein expression to a similar degree both in vitro and in vivo, suggesting that high estrogen levels during pregnancy may help maintain fetal tolerance by promoting regulation (65). Trophoblast-derived chemokines have also been implicated (63).” [2]

It had previously been known that estrogen has protective effects against autoimmune disease. Symptoms for some types can improve for a woman during her pregnancy and then flair back up after delivery.

“Estrogen has been shown to protect against the development of autoimmune disease, yet the mechanism is not known.” (65)

The study found that estrogen treatment led to an increase in the FoxP3 protein in CD4+CD25− T cells. These are a type of regulatory T cell of the immune system which are essential for protecting against self intolerance – ie autoimmunity:

“Recently, in a TCR-transgenic mouse model where full protection against spontaneous experimental autoimmune encephalomyelitis could be achieved by the transfer of wild-type CD4+CD25− T cells, Furtado et al. (47) showed that responsiveness to IL-2 was required for the suppressive function.”  [5]

Having walked this around a ball park or ocean going vessel, I’ll get to the point, cholecalciferol, vitamin D3, helps the body make adequate supplies of Treg immune cells, and it is better at it than calcitriol. [7] Calcitriol is a synthetic form of vitamin D3 called “Rocaltrol“, [8] I’m not sure of the exact difference chemically – but they both can help our body tell us who is friend and who is foe.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

  1. A. L. Mellor and D. H. Munn, Immunology at the Maternal-Fetal Interface: Lessons for T Cell Tolerance and Suppression. Annu. Rev. Immunol. 2000. 18:367–391. https://www.researchgate.net/profile/Andrew_Mellor2/publication/12481340_Immunology_at_the_Maternal-Fetal_Interface_Lessons_for_T_Cell_Tolerance_and_Suppression/links/0912f50aa0af8ce00b000000.pdf [1]
  2. Indira Guleria and Mohamed H. Sayegh, Maternal Acceptance of the Fetus: True Human Tolerance. J Immunol 2007; 178:3345-3351; https://www.researchgate.net/profile/Indira_Guleria/publication/6468186_Maternal_Acceptance_of_the_Fetus_True_Human_Tolerance/links/55a4f85008ae5e82ab1f718a/Maternal-Acceptance-of-the-Fetus-True-Human-Tolerance.pdf [2]
  3. Saito, S., Y. Sasaki, and M. Sakai. 2005. CD4(+)CD25 +high regulatory T cells in human pregnancy. J. Reprod. Immunol. 65: 111–120. https://www.ncbi.nlm.nih.gov/labs/articles/15811516/ (63)
  4. Polanczyk, M. J., B. D. Carson, S. Subramanian, M. Afentoulis, A. A. Vandenbark,
    S. F. Ziegler, and H. Offner. 2004. Cutting edge: estrogen drives expansion of the CD4 (+)CD25(+) regulatory T cell compartment. J. Immunol. 173: 2227–2230. http://www.jimmunol.org/content/173/4/2227.long (65)

  5. Pascal Feunou, Lionel Poulin, Claude Habran, Alain Le Moine, Michel Goldman and Michel Y. Braun, CD4+CD25+ and CD4+CD25− T Cells Act Respectively as Inducer and Effector T Suppressor Cells in Superantigen-Induced Tolerance. J Immunol October 1, 2003, 171 (7) 3475-3484; http://www.jimmunol.org/content/171/7/3475 [5]

  6. G. C. Furtado, M. A. Curotto de Lafaille, N. Kutchukhidze, J. Lafaille. Interleukin-2 is required for CD4+ regulatory T cell function. J. Exp. Med. 196:851. 2002. Abstract/FREE Full Text (47)
  7. Mostafa G. Aly, Karina Trojan, Rolf Weimer, Christian Morath, Gerhard Opelz, Mohammed A. Tohamy, and Volker Daniel,

    Low-dose oral cholecalciferol is associated with higher numbers of Helios+ and total Tregs than oral calcitriol in renal allograft recipients: an observational study. BMC Pharmacol Toxicol. 2016; 17: 24.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906900/ [7]

  8. “Rocaltrol,” “Calcitriol,” http://www.rxlist.com/rocaltrol-drug.htm [8]