PCOS: Endocrine Society Issues New Guidelines.


An Endocrine Society task force has developed new guidelines for the treatment of polycystic ovary syndrome (PCOS).

The guidelines published online October 24 in the Journal of Clinical Endocrinology & Metabolism, are aimed at helping physicians and patients understand a complex condition that often has diverse symptoms.

Task Force Chair Richard S. Legro, MD, professor in obstetrics and gynecology, Penn State University College of Medicine, Hershey, Pennsylvania, and colleagues developed the evidence-based guidelines, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to rate the strength and quality of recommendations.

“The Society’s recommendations allow physicians to make the diagnosis [of PCOS] if clear symptoms are present without resorting to universal hormone tests or ultrasound screenings,” Dr. Legro said in a press release.

The guidelines advise that an adult woman be diagnosed with PCOS if she has at least 2 of the following symptoms: excess androgen, ovulatory dysfunction, or polycystic ovaries. In addition, any diagnosis of PCOS must rule out other androgen-excess disorders. Physicians should also screen patients for endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease.

Diagnosis of PCOS in adolescent girls should be based on clinical or biochemical signs of hyperandrogenism, after excluding other possible causes, in the presence of persistent oligomenorrhea, the task force advises. A PCOS diagnosis during perimenopause and menopause should be based on a documented, long-term history of oligomenorrhea and hyperandrogenism in reproductive years, the report advises. A finding of PCO morphology via ultrasound would also provide supportive evidence, although the authors note this is least likely in menopausal women. The guidelines recommend against routine ultrasound for endometrial thickness in women with PCOS.

In diagnosing and treating women with PCOS, physicians should look for terminal hair growth, acne, alopecia, acanthosis nigricans, and skin tags during physical examination, according to the new guidelines. The guidelines also recommend screening for ovulatory status using menstrual history.

The guidelines advise assessment of body mass index, waist circumference, blood pressure, and oral glucose tolerance. Overweight and obese patients with PCOS symptoms should be screened for obstructive sleep apnea. Adults and adolescents should be screened and treated for depression and anxiety.

The committee recommends treatment with hormonal contraceptives as the first-line therapy for menstrual abnormalities and hirsutism/acne. Exercise therapy is recommended to manage weight, alone or with a calorie-restricted diet.

The task force advises against the use of metformin as a first-line PCOS treatment, but metformin is recommended for women with PCOS and type 2 diabetes or impaired glucose tolerance who do not succeed with weight loss and exercise. Metformin is also recommended for women who cannot take hormonal contraceptives.

For infertility, the report recommends clomiphene citrate as a first-line treatment. For women undergoing in vitro fertilization, the guidelines recommend metformin as adjuvant therapy to prevent ovarian hyperstimulation.

 

 

Researchers assess multiple vitamin D doses in healthy breast-fed infants.


Researchers in Canada suggest that vitamin D supplementation of 1,600 IU per day increased plasma 25-hydroxyvitamin D concentrations to at least 75 nmol/L among 97.5% of infants aged 3 months. However, this dosage also increased concentrations associated with hypocalcemia, according to data.

The literature has established that vitamin D supplementation for infants is required to support healthy bone mineral accretion. However, conflicting recommendations for this patient population have led to further research.

“We have generated strong support using evidence-based dose response studies that the 400 IU dosage is quite satisfactory and that this is recommended now by the Institute of Medicine, Health Canada, Canadian Pediatric Society and the American Academy of Pediatrics,” researcher Hope Weiler, RD, PhD, of the School of Dietetics and Human Nutrition at McGill University in Quebec, said during a media telebriefing. “We also know that the higher dose recommended by the Canadian Pediatrics Society was well received by our infants and did generate a nice response in 25-hydroxyvitamin D, and the upper limits of 1,000 IU and 1,200 IU would be suitable as safety markers across the first year of life.”

According to data from a double blind, randomized study published in JAMA, Weiler and colleagues investigated the efficacy of various dosages of vitamin D supplements in supporting plasma 25-(OH)D concentrations in healthy, breast-fed infants (n=132) aged 1 month. The patients were randomly assigned to oral cholecalciferol (vitamin D3) supplements of 400 IU per day (n=39), 800 IU per day (n=39), 1,200 IU per day (n=38) or 1,600 IU per day (n=16), and they were followed for 11 months.

According to 3-month data, 55% (95% CI, 38-72) of infants in the 400-IU group demonstrated a 25-(OH)D concentration of at least 75 nmol/L vs. 81% (95% CI, 65-91) in the 800-IU group, 92% (95% CI, 77-98) in the 1,200-IU group and 100% in the 1,600-IU group. Due to elevations in 25-(OH)D concentrations, the 1,600 IU dosage was discontinued, researchers wrote. Moreover, the concentration did not continue in 97.5% of the infants at age 12 months in any of the groups.

Further data indicate that all dosages established 25-(OH)D concentrations of at least 50 nmol/L among 97% (95% CI, 94-100) of the infants at 3 months. This continued in 98% (95% CI, 94-100) at 12 months, the researchers wrote.

“Future studies should be larger and, hopefully, be able to detect early, as well as [determine], long-term benefits to bone. We may also consider other health benefits such as the immune system. Our future studies should consider other populations,” Weiler said. “We should also consider those at higher risk for deficiency, whether it’s due to geographic location where a mother’s exposure to sunshine is limited or the infant is born with vitamin D deficiency.”

In an accompanying editorial, Steven A. Abrams, MD, of the department of pediatrics at the US Department of Agriculture/Agricultural Research Service Children’s Nutrition Research Center at Baylor College of Medicine and Texas Children’s Hospital in Houston, said the study did not answer the question of what the target should be for plasma 25-(OH)D concentrations.

“Of importance, higher vitamin D dosages in this study did not lead to improved bone outcomes as reflected by DXA results for bone mineral content,” Abrams wrote.

He suggested that higher vitamin D intake and target plasma 25-(OH)D concentrations should be tested in clinical trials with markedly defined outcomes and precise safety monitoring.

 

Weiler H. JAMA. Theme Issue on Child Health: New research on the optimal dosing and possible adverse effects of different levels of vitamin D supplementation, important for bone health, for infants. Presented at: the JAMA Network 2013 Media Briefing; April 30, 2013; New York.

Disclosure: Abrams reports payment for lectures’/speakers’ bureaus from Mead-Johnson Nutrition and Abbott Nutrition and grants to his institution from Mead-Johnson Nutrition. Gallo reports travel support from CIHR Human Development Child and Youth Health and the American Society for Bone and Mineral Research. Sharma reports consulting fees for analyses prepared for Rodd and Weiler. Jones reports being cofounder and scientific advisory board member for Cytochroma Inc., and for receiving payment for speakers’ bureaus from Genzyme/Sanofi.

 

 

PERSPECTIVE

 

  • I  think it’s a helpful study in terms of the fact that they had different groups of newborn children treated with vitamin D with 400 IU being the recommended dose up to 12 months according to the Institute of Medicine and Endocrine Society guidelines. It was a well-designed study and relevant because vitamin D is a very hot topic right now due to the deficiencies in children and adults.

I agree with the editorial. This group of patients was a mostly white group with relatively high socioeconomic status. In the group that was administered 400 IU per day, researchers found that those infants reached 25(OH)D level of at least 20 ng/mL. That is a big debate. The IOM thinks 25(OH)D levels of 20 ng/mL are adequate for most, and I think a lot of endocrinologists and the Endocrine Society says most people need a level of 30 ng/mL.

This study shows that infants who were administered up to 400 IU per day reached a level of at least 20 ng/mL by 3 months. The whole group did not attain the level of 30 ng/mL, which again is what some endocrinologists think is an optimal level. To achieve a level of 30 ng/mL, perhaps 400 IU is not enough per day for some infants (especially those with darker skin pigmentation or at higher risk for deficiencies).

In addition to looking at the levels or how much vitamin D is needed to achieve a level of 20 ng/mL or 30 ng/mL, they also looked at the bone mineral content but found no significant difference in the groups. I think the editorial comment summed up this point. In treating infants with higher doses of vitamin D corresponding to higher serum levels above 30 ng/mL; does that confer other benefits? There are many early studies now looking at the relationship between vitamin D and asthma, food allergies, incidence of type 1 diabetes and autoimmune disease.

The important point Abrams raises is that we need more long-term studies to see if there is a skeletal benefit in terms of having a higher vitamin D level which would correspond to having a higher dose of vitamin D administered.

  • Dominique Noё Long, MD
  • Instructor of pediatric endocrinology
    The Johns Hopkins Children’s Center
    Baltimore, Md.

PERSPECTIVE

 

  • The strengths and usefulness of the study are the quantification of serum 25-OH vitamin D levels with various doses of vitamin D supplementation. The currently recommended dose of vitamin D, 400 IU daily, was chosen because historically this dose has proven to prevent rickets, which as pediatric endocrinologists, is our main objective. Therefore this study helps provide information in the ongoing debate regarding the optimal serum level of 25(OH) D. Interestingly, all doses of cholecalciferol increased serum levels of 25(OH) D to >50 nmol/L. Higher doses of cholecalciferol correlated with higher levels of 25(OH) D, however no group sustained >97.5% of infants to vitamin D levels >75 nmol/L. No one truly knows the ideal serum level of vitamin D, but this study suggests that >50 nmol/L was sufficient in this patient population. This study also provides information on the safety of higher doses of vitamin D supplementation. It may be harder to extrapolate in the darker-skin pigmented population who may need more vs. the white population. It’s just another piece to the puzzle of the debate on vitamin D.
  • Janet Crane, MD
  • Clinical research fellow in pediatric endocrinology
    The Johns Hopkins Children’s Center
    Baltimore, Md.

 

 

Endocrine Society Releases Guidelines on Managing Hypertriglyceridemia .


The Endocrine Society has published new guidelines on diagnosing and managing hypertriglyceridemia in the Journal of Clinical Endocrinology and Metabolism.

Among the recommendations:

  • All adults should be screened for elevated triglyceride levels at least every 5 years as part of a lipid panel.
  • Diagnosis should be based on fasting triglyceride levels.
  • Medications and endocrine conditions should be ruled out as potential causes of elevated levels.
  • For patients with primary hypertriglyceridemia, clinicians should assess other cardiovascular risk factors and family history.
  • Mild-to-moderate hypertriglyceridemia (triglycerides of 150-999 mg/dL) should initially be managed with lifestyle therapy.
  • For patients with severe hypertriglyceridemia (1000 mg/dL or higher), a fibrate should be the first-line therapy.

Source: Journal of Clinical Endocrinology and Metabolism

 

Surprise! Vitamin D Can Help or Hinder Your Weight Management.


Vitamin D, once thought to influence little more than bone diseases such as rickets and osteoporosis, is now recognized as a major player in overall human health. Most recently, new studies suggest that your vitamin D status can even help or hinder your weight management, which I’ll review below.

It’s a tragedy that dermatologists and sunscreen manufacturers have done such a thorough job of scaring people out of the sun. Their widely dispersed message to avoid the sun as much as possible, combined with an overall cultural trend of spending more time indoors during work and leisure time has greatly contributed to the widespread vitamin D deficiency seen today.

Vitamin D is actually not a vitamin at all but a potent neuroregulatory steroidal hormone, shown to influence about 10 percent of all the genes in your body. We now know this is one of the primary reasons it can impact such a wide variety of diseases, including:

Cancer Hypertension Heart disease
Autism Obesity Rheumatoid arthritis
Diabetes 1 and 2 Multiple Sclerosis Crohn’s disease
Flu Colds Tuberculosis
Septicemia Aging Psoriasis
Eczema Insomnia Hearing lossex
Muscle pain Cavities Periodontal disease
Athletic performance Macular degeneration Myopia
Pre eclampsia Seizures Fertility
Asthma Cystic fibrosis Migraines
Depression Alzheimer’s disease Schizophrenia

Vitamin D Deficiency Contributes to Weight Gain in Older Women

A new study of more than 4,600 women age 65 and older shows that having low vitamin D levels can contribute to mild weight gain1. Previous research has already showed that obese individuals tend to have low vitamin D levels. Women who had insufficient levels of vitamin D gained about two pounds more compared to those with adequate blood levels of vitamin D during the 4.5-year long study. Those with insufficient levels also weighed more at the outset of the study.

According to Medicine.net2:

“The study can’t say whether low vitamin D is causing the weight gain or just reflecting it.”The study is the first step that we need to evaluate whether vitamin D might be contributing to weight gain,” [lead researcher Erin] LeBlanc says. But there are some theoretical ways that low vitamin D could contribute to weight gain, she says. Fat cells do have vitamin D receptors. “Vitamin D could affect where fat cells shrink or get bigger.”

Here, vitamin D levels above 30 nanograms per milliliter (ng/ml) were considered “sufficient.” As I’ve previously reported, based on the latest vitamin D research this is still far below optimal, so it’s difficult to say what the outcome might be if you were to actually optimize your levels by getting your blood level above 50 ng/ml. Still, despite this low “sufficient” level, 80 percent of the women in the study were found to have insufficient levels, meaning below 30 ng/ml. This gives you an idea of just how widespread this problem really is.

Vitamin D Deficiency Common among Adolescents Evaluated for Weight Loss Surgery

A second study found that more than half of obese adolescents seeking weight loss surgery are deficient in vitamin D. Eight percent were found to have severe deficiencies, and teens with the highest BMIs were the most likely to be vitamin D deficient. Less than 20 percent had adequate vitamin D levels. The research correlates with previous studies showing vitamin D deficiency in adults seeking bariatric surgery. (The results were presented at The Endocrine Society‘s 94th Annual Meeting in Houston on June 26.)

According to Science Daily3:

“This is particularly important prior to bariatric surgery where weight loss and decreased calcium and vitamin D absorption in some procedures may place these patients at further risk,” said study lead author Marisa Censani, M.D., pediatric-endocrinology fellow at Columbia University Medical Center, in New York City.

… “These results support screening all morbidly obese adolescents for vitamin D deficiency, and treating those who are deficient, particularly prior to bariatric procedures that could place these patients at further risk,” Censani said.”

In the US, bariatric weight-loss surgery, such as gastric bypass surgery, is becoming increasingly common among all age groups, including children. Gastric-bypass surgery involves surgically removing a section of your stomach, which limits the amount of food it can hold. However, this procedure is fraught with risks, and maintaining proper nutrition post-surgery is a common challenge that can result in malabsorption syndromes. It’s important to remember that vitamin D, as well as vitamin A, E, and K are fat-soluble, and need a certain amount of healthy fat to be absorbed properly.

What is the OPTIMAL Level of Vitamin D?

The ideal way to optimize your vitamin D levels is through adequate, safe sun exposure or using a safe tanning bed. However, whether you’re tanning or using a vitamin D supplement, it’s important to get your vitamin D levels tested to ensure you’re within the optimal range of 50-70 ng/ml. For more information about proper sun exposure and how to determine whether you can actually get enough vitamin D from the sun at your location during different times of year, please see this previous article.As mentioned earlier, the “normal” 25-hydroxyvitamin D lab values are typically between 20-56 ng/ml. “Sufficient” levels are often considered to be around 30 ng/ml, as in the studies above.

However, this range is too broad to be ideal, and too low to support optimal health.

Beware that any level below 20 ng/ml is considered a serious deficiency state, increasing your risk of as many as 16 different cancers and autoimmune diseases like multiple sclerosis and rheumatoid arthritis. The OPTIMAL value that you’re looking for is 50-70 ng/ml. Keeping your level in this range, and even erring toward the higher numbers in this range, is going to give you the most protective benefit.

But how do you get within that range?

While vitamin D experts typically recommend 35 IU’s of vitamin D per pound of body weight, it’s important to understand that there’s no one dosage recommendation that will be applicable for everyone. The only way to determine how much vitamin D you really need is to get your levels tested at regular intervals to make sure you’re staying within the optimal range of 50-70 ng/ml, and adjust your dosage accordingly. If you’re supplementing, you may find that you don’t need to supplement during the summer, if you’re getting sufficient amounts of sun exposure, for example. But you won’t know if you don’t get your levels tested.

What is the OPTIMAL Way to Obtain Vitamin D?

There is simply no question in my mind that you were designed to receive your vitamin D from ultraviolet B exposure on your exposed skin and ideally this should come from the sun. For virtually the entire history of the human race this is how vitamin D was obtained.  Although vitamin D is in some animal foods it is in relatively low quantities and to my knowledge there are no known ancestral populations that thrived on oral vitamin D sources. Although we can absorb vitamin D orally because it is a fat soluble vitamin, there is strong emerging research that suggests this lacks many of the benefits of vitamin D.

The majority of the research documenting the benefits of optimized vitamin D levels was done with those that had not taken oral vitamin D but had increased their levels naturally through exposure to the sun. I personally have not taken any oral vitamin D for over two years and have been able to consistently keep my levels over 60 ng/ml.   This is partly related to the fact that I work in a sub-tropical environment in the winter.

If I could not do that there is no question that I would still not use oral vitamin D but would use a high quality safe tanning bed that used electronic ballasts that did not emit any dangerous EMF.

How to Know if You’re Getting Vitamin D from Your Sun Exposure

The caveat here is that not all sun exposure will allow for vitamin D production. The key point to understand is that sunlight is composed of about 1500 wavelengths, but the only wavelength that makes your body produce vitamin D are UVB-rays, when they hit exposed skin. The UVB-rays from the sun must pass through the atmosphere and reach where you are on the earth in order for this to take place. This obviously does not occur in the winter for most of us, but the sun’s rays are also impeded during a fair amount of the year for people living in temperate climates.

So how do you know if you have entered into the summer season and into the time of year, for your location, where enough UVB is actually able to penetrate the atmosphere to allow for vitamin D production in your skin?

Due to the physics and wavelength of UVB rays, they will only penetrate the atmosphere when the sun is above an angle of about 50° from the horizon. When the sun is lower than 50°, the ozone layer reflects the UVB-rays but let through the longer UVA-rays.

So the first step is to determine the latitude and longitude of your location. You can easily do this on Google Earth, or if you are in the U.S. you can use the TravelMath Latitude Longitude Calculator to find your latitude and longitude. Once you have obtained that you can go to the U.S. Navy site to calculate a table to determine the times and days of the year that the sun is above 50 degrees from the horizon.

Translated to the date and time of some places on the globe, it means for example: In my hometown of Chicago, the UVB rays are not potentially present until March 25, and by September 16th it is not possible to produce any vitamin D from the sun in Chicago. Please understand it is only theoretically possible to get UVB rays during those times. If it happens to be cloudy or raining, the clouds will also block the UVB rays.

Even Easier if You Have Apple System

Alternatively, if you have an iPhone or iPad you can download a free app called D Minder, which will make all the calculations for you. It was made by an Apple developer who was motivated to simplify the process after he watched the video above.

From a health perspective it doesn’t make much sense to expose your skin to the sun when it is lower than 50 degrees above the horizon because you will not receive any valuable UVB rays, but you will expose yourself to the more dangerous and potentially deadly UVA rays. UVA’s have a longer wavelength than UVB and can more easily penetrate the ozone layer and other obstacles (like clouds and pollution) on their way from the sun to the earth. UVA is what radically increases your risk of skin cancer and photoaging of your skin. So while it will give you a tan, unless the companion UVB rays are available you’re likely doing more harm than good and should probably stay out of the sun to protect your skin.

During the times of the year when UVB rays are not present where you live you essentially have two options: You can use a safe tanning bed or you can swallow oral vitamin D3.

During the summer months, you can generally get enough vitamin D from just spending some time outside every day. Under optimal environmental exposures your body can produce about 20,000 IU of vitamin D per day with full body exposure, about 5,000 IU with 50 percent of your body exposed, and as much as 1,000 IU with just 10 percent of your body exposed.

In the winter months however, and/or times of the year when insufficient amounts of UVB rays reach your location, you will most likely not get enough vitamin D. In that case, I recommend using a safe tanning bed, which is still better than oral vitamin D.

One of the caveats here is to make sure you’re not being exposed to harmful EMF exposure. Most tanning equipment, and nearly all of the early beds from which these studies were conducted, use magnetic ballasts to generate light. These magnetic ballasts are well known sources of EMF fields that can contribute to cancer. If you hear a loud buzzing noise while in a tanning bed, it has a magnetic ballast system. I strongly recommend you avoid these types of beds and restrict your use of tanning beds to those that use electronic ballasts.

Warning: Newer Vitamin D Tests Often Inaccurate, Study Finds

Doctors are becoming increasingly aware of the importance of vitamin D,According to Medscape, vitamin D testing has increased six- to 10-fold over the last decade, and has become one of the most frequently ordered lab tests. However, it’s important to know that there can be significant differences between available vitamin D tests, and according to a recent study, two newer tests appear to be inaccurate more than 40 percent of the time.

The findings are still preliminary and have not yet been peer-reviewed. The study was presented at the annual meeting of The Endocrine Society in Houston on June 23-264. According to Medscape.com5:

“Researchers say newer tests tend to overestimate the number of people who are deficient in vitamin D… The new tests, made by Abbott and Siemens, were approved by the FDA last fall. They’re part of a wave of faster, less expensive tests designed to help laboratories keep up with a boom in demand for vitamin D testing… Holmes and his team wanted to see how well the new tests performed compared to an older, more expensive, and more time-consuming reference method… They ran blood samples from 163 patients on all three tests.

The Abbott Architect test was outside an acceptable margin of error — meaning that the results were either 25% too high or too low, about 40% of the time.

The Siemens Centaur2 test was either too high or too low in 48% of samples.

… The new tests use blood proteins called antibodies that bind to vitamin D. They’re faster because they look for vitamin D in samples of whole blood. In the older, reference method, vitamin D is separated from the blood and measured. The older test can also measure two different forms of vitamin D: Vitamin D2… found in fortified foods and… high-potency supplements that doctors prescribe… and Vitamin D3, the form of the vitamin that the body makes naturally after skin is exposed to sunlight.

The newer test can’t distinguish between the two different types of D.

Holmes says vitamin D2 seems to confuse the tests. He says the tests’ inability to accurately measure that form of the vitamin means that doctors can’t tell if their patients are getting any benefit from it or if they’re taking their supplements as directed.

… In absolute numbers, the reference test showed 33 patients out of 163 were deficient in vitamin D, while the Abbott test showed 45 people were vitamin D deficient, and the Siemens test pointed to deficiency in 71 patients.” [Emphasis mine]

Your Best Bet for Regular Testing: Sign Up with the D*Action Project

To avoid such testing problems and help you get on an inexpensive, regular testing schedule, I highly recommend joining the GrassrootsHealth D*Action Project6; a worldwide public health campaign aiming to solve the vitamin D deficiency epidemic through focus on testing, education, and grassroots word of mouth. When you join D*action, you agree to test your vitamin D levels twice a year during a 5 year program, and to share your health status to demonstrate the public health impact of this nutrient.

There is a $60 fee each 6 months for your sponsorship of the project, which includes a complete new test kit to be used at home (except in the state of New York), and electronic reports on your ongoing progress. When you finish the questionnaire, you can choose your subscription option. You will get a follow up email every 6 months reminding you “it’s time for your next test and health survey.”

This is probably one of the least expensive and most convenient ways to take control of your health. To join now, please follow this link to the D*Action sign-up.

Source: Dr. Mercola

 

Surprise! Vitamin D Can Help or Hinder Your Weight Management.


Vitamin D, once thought to influence little more than bone diseases such as rickets and osteoporosis, is now recognized as a major player in overall human health. Most recently, new studies suggest that your vitamin D status can even help or hinder your weight management, which I’ll review below.

It’s a tragedy that dermatologists and sunscreen manufacturers have done such a thorough job of scaring people out of the sun. Their widely dispersed message to avoid the sun as much as possible, combined with an overall cultural trend of spending more time indoors during work and leisure time has greatly contributed to the widespread vitamin D deficiency seen today.

Vitamin D is actually not a vitamin at all but a potent neuroregulatory steroidal hormone, shown to influence about 10 percent of all the genes in your body. We now know this is one of the primary reasons it can impact such a wide variety of diseases, including:

Cancer Hypertension Heart disease
Autism Obesity Rheumatoid arthritis
Diabetes 1 and 2 Multiple Sclerosis Crohn’s disease
Flu Colds Tuberculosis
Septicemia Aging Psoriasis
Eczema Insomnia Hearing lossex
Muscle pain Cavities Periodontal disease
Athletic performance Macular degeneration Myopia
Pre eclampsia Seizures Fertility
Asthma Cystic fibrosis Migraines
Depression Alzheimer’s disease Schizophrenia

Vitamin D Deficiency Contributes to Weight Gain in Older Women

A new study of more than 4,600 women age 65 and older shows that having low vitamin D levels can contribute to mild weight gain1. Previous research has already showed that obese individuals tend to have low vitamin D levels. Women who had insufficient levels of vitamin D gained about two pounds more compared to those with adequate blood levels of vitamin D during the 4.5-year long study. Those with insufficient levels also weighed more at the outset of the study.

According to Medicine.net2:

“The study can’t say whether low vitamin D is causing the weight gain or just reflecting it.”The study is the first step that we need to evaluate whether vitamin D might be contributing to weight gain,” [lead researcher Erin] LeBlanc says. But there are some theoretical ways that low vitamin D could contribute to weight gain, she says. Fat cells do have vitamin D receptors. “Vitamin D could affect where fat cells shrink or get bigger.”

Here, vitamin D levels above 30 nanograms per milliliter (ng/ml) were considered “sufficient.” As I’ve previously reported, based on the latest vitamin D research this is still far below optimal, so it’s difficult to say what the outcome might be if you were to actually optimize your levels by getting your blood level above 50 ng/ml. Still, despite this low “sufficient” level, 80 percent of the women in the study were found to have insufficient levels, meaning below 30 ng/ml. This gives you an idea of just how widespread this problem really is.

Vitamin D Deficiency Common among Adolescents Evaluated for Weight Loss Surgery

A second study found that more than half of obese adolescents seeking weight loss surgery are deficient in vitamin D. Eight percent were found to have severe deficiencies, and teens with the highest BMIs were the most likely to be vitamin D deficient. Less than 20 percent had adequate vitamin D levels. The research correlates with previous studies showing vitamin D deficiency in adults seeking bariatric surgery. (The results were presented at The Endocrine Society‘s 94th Annual Meeting in Houston on June 26.)

According to Science Daily3:

“This is particularly important prior to bariatric surgery where weight loss and decreased calcium and vitamin D absorption in some procedures may place these patients at further risk,” said study lead author Marisa Censani, M.D., pediatric-endocrinology fellow at Columbia University Medical Center, in New York City.

… “These results support screening all morbidly obese adolescents for vitamin D deficiency, and treating those who are deficient, particularly prior to bariatric procedures that could place these patients at further risk,” Censani said.”

In the US, bariatric weight-loss surgery, such as gastric bypass surgery, is becoming increasingly common among all age groups, including children. Gastric-bypass surgery involves surgically removing a section of your stomach, which limits the amount of food it can hold. However, this procedure is fraught with risks, and maintaining proper nutrition post-surgery is a common challenge that can result in malabsorption syndromes. It’s important to remember that vitamin D, as well as vitamin A, E, and K are fat-soluble, and need a certain amount of healthy fat to be absorbed properly.

What is the OPTIMAL Level of Vitamin D?

The ideal way to optimize your vitamin D levels is through adequate, safe sun exposure or using a safe tanning bed. However, whether you’re tanning or using a vitamin D supplement, it’s important to get your vitamin D levels tested to ensure you’re within the optimal range of 50-70 ng/ml. For more information about proper sun exposure and how to determine whether you can actually get enough vitamin D from the sun at your location during different times of year, please see this previous article.As mentioned earlier, the “normal” 25-hydroxyvitamin D lab values are typically between 20-56 ng/ml. “Sufficient” levels are often considered to be around 30 ng/ml, as in the studies above.

However, this range is too broad to be ideal, and too low to support optimal health.

Beware that any level below 20 ng/ml is considered a serious deficiency state, increasing your risk of as many as 16 different cancers and autoimmune diseases like multiple sclerosis and rheumatoid arthritis. The OPTIMAL value that you’re looking for is 50-70 ng/ml. Keeping your level in this range, and even erring toward the higher numbers in this range, is going to give you the most protective benefit.

But how do you get within that range?

While vitamin D experts typically recommend 35 IU’s of vitamin D per pound of body weight, it’s important to understand that there’s no one dosage recommendation that will be applicable for everyone. The only way to determine how much vitamin D you really need is to get your levels tested at regular intervals to make sure you’re staying within the optimal range of 50-70 ng/ml, and adjust your dosage accordingly. If you’re supplementing, you may find that you don’t need to supplement during the summer, if you’re getting sufficient amounts of sun exposure, for example. But you won’t know if you don’t get your levels tested.

What is the OPTIMAL Way to Obtain Vitamin D?

There is simply no question in my mind that you were designed to receive your vitamin D from ultraviolet B exposure on your exposed skin and ideally this should come from the sun. For virtually the entire history of the human race this is how vitamin D was obtained.  Although vitamin D is in some animal foods it is in relatively low quantities and to my knowledge there are no known ancestral populations that thrived on oral vitamin D sources. Although we can absorb vitamin D orally because it is a fat soluble vitamin, there is strong emerging research that suggests this lacks many of the benefits of vitamin D.

The majority of the research documenting the benefits of optimized vitamin D levels was done with those that had not taken oral vitamin D but had increased their levels naturally through exposure to the sun. I personally have not taken any oral vitamin D for over two years and have been able to consistently keep my levels over 60 ng/ml.   This is partly related to the fact that I work in a sub-tropical environment in the winter.

If I could not do that there is no question that I would still not use oral vitamin D but would use a high quality safe tanning bed that used electronic ballasts that did not emit any dangerous EMF.

How to Know if You’re Getting Vitamin D from Your Sun Exposure

The caveat here is that not all sun exposure will allow for vitamin D production. The key point to understand is that sunlight is composed of about 1500 wavelengths, but the only wavelength that makes your body produce vitamin D are UVB-rays, when they hit exposed skin. The UVB-rays from the sun must pass through the atmosphere and reach where you are on the earth in order for this to take place. This obviously does not occur in the winter for most of us, but the sun’s rays are also impeded during a fair amount of the year for people living in temperate climates.

So how do you know if you have entered into the summer season and into the time of year, for your location, where enough UVB is actually able to penetrate the atmosphere to allow for vitamin D production in your skin?

Due to the physics and wavelength of UVB rays, they will only penetrate the atmosphere when the sun is above an angle of about 50° from the horizon. When the sun is lower than 50°, the ozone layer reflects the UVB-rays but let through the longer UVA-rays.

So the first step is to determine the latitude and longitude of your location. You can easily do this on Google Earth, or if you are in the U.S. you can use the TravelMath Latitude Longitude Calculator to find your latitude and longitude. Once you have obtained that you can go to the U.S. Navy site to calculate a table to determine the times and days of the year that the sun is above 50 degrees from the horizon.

Translated to the date and time of some places on the globe, it means for example: In my hometown of Chicago, the UVB rays are not potentially present until March 25, and by September 16th it is not possible to produce any vitamin D from the sun in Chicago. Please understand it is only theoretically possible to get UVB rays during those times. If it happens to be cloudy or raining, the clouds will also block the UVB rays.

Even Easier if You Have Apple System

Alternatively, if you have an iPhone or iPad you can download a free app called D Minder, which will make all the calculations for you. It was made by an Apple developer who was motivated to simplify the process after he watched the video above.

From a health perspective it doesn’t make much sense to expose your skin to the sun when it is lower than 50 degrees above the horizon because you will not receive any valuable UVB rays, but you will expose yourself to the more dangerous and potentially deadly UVA rays. UVA’s have a longer wavelength than UVB and can more easily penetrate the ozone layer and other obstacles (like clouds and pollution) on their way from the sun to the earth. UVA is what radically increases your risk of skin cancer and photoaging of your skin. So while it will give you a tan, unless the companion UVB rays are available you’re likely doing more harm than good and should probably stay out of the sun to protect your skin.

During the times of the year when UVB rays are not present where you live you essentially have two options: You can use a safe tanning bed or you can swallow oral vitamin D3.

During the summer months, you can generally get enough vitamin D from just spending some time outside every day. Under optimal environmental exposures your body can produce about 20,000 IU of vitamin D per day with full body exposure, about 5,000 IU with 50 percent of your body exposed, and as much as 1,000 IU with just 10 percent of your body exposed.

In the winter months however, and/or times of the year when insufficient amounts of UVB rays reach your location, you will most likely not get enough vitamin D. In that case, I recommend using a safe tanning bed, which is still better than oral vitamin D.

One of the caveats here is to make sure you’re not being exposed to harmful EMF exposure. Most tanning equipment, and nearly all of the early beds from which these studies were conducted, use magnetic ballasts to generate light. These magnetic ballasts are well known sources of EMF fields that can contribute to cancer. If you hear a loud buzzing noise while in a tanning bed, it has a magnetic ballast system. I strongly recommend you avoid these types of beds and restrict your use of tanning beds to those that use electronic ballasts.

Warning: Newer Vitamin D Tests Often Inaccurate, Study Finds

Doctors are becoming increasingly aware of the importance of vitamin D,According to Medscape, vitamin D testing has increased six- to 10-fold over the last decade, and has become one of the most frequently ordered lab tests. However, it’s important to know that there can be significant differences between available vitamin D tests, and according to a recent study, two newer tests appear to be inaccurate more than 40 percent of the time.

The findings are still preliminary and have not yet been peer-reviewed. The study was presented at the annual meeting of The Endocrine Society in Houston on June 23-264. According to Medscape.com5:

“Researchers say newer tests tend to overestimate the number of people who are deficient in vitamin D… The new tests, made by Abbott and Siemens, were approved by the FDA last fall. They’re part of a wave of faster, less expensive tests designed to help laboratories keep up with a boom in demand for vitamin D testing… Holmes and his team wanted to see how well the new tests performed compared to an older, more expensive, and more time-consuming reference method… They ran blood samples from 163 patients on all three tests.

The Abbott Architect test was outside an acceptable margin of error — meaning that the results were either 25% too high or too low, about 40% of the time.

The Siemens Centaur2 test was either too high or too low in 48% of samples.

… The new tests use blood proteins called antibodies that bind to vitamin D. They’re faster because they look for vitamin D in samples of whole blood. In the older, reference method, vitamin D is separated from the blood and measured. The older test can also measure two different forms of vitamin D: Vitamin D2… found in fortified foods and… high-potency supplements that doctors prescribe… and Vitamin D3, the form of the vitamin that the body makes naturally after skin is exposed to sunlight.

The newer test can’t distinguish between the two different types of D.

Holmes says vitamin D2 seems to confuse the tests. He says the tests’ inability to accurately measure that form of the vitamin means that doctors can’t tell if their patients are getting any benefit from it or if they’re taking their supplements as directed.

… In absolute numbers, the reference test showed 33 patients out of 163 were deficient in vitamin D, while the Abbott test showed 45 people were vitamin D deficient, and the Siemens test pointed to deficiency in 71 patients.” [Emphasis mine]

Your Best Bet for Regular Testing: Sign Up with the D*Action Project

To avoid such testing problems and help you get on an inexpensive, regular testing schedule, I highly recommend joining the GrassrootsHealth D*Action Project6; a worldwide public health campaign aiming to solve the vitamin D deficiency epidemic through focus on testing, education, and grassroots word of mouth. When you join D*action, you agree to test your vitamin D levels twice a year during a 5 year program, and to share your health status to demonstrate the public health impact of this nutrient.

There is a $60 fee each 6 months for your sponsorship of the project, which includes a complete new test kit to be used at home (except in the state of New York), and electronic reports on your ongoing progress. When you finish the questionnaire, you can choose your subscription option. You will get a follow up email every 6 months reminding you “it’s time for your next test and health survey.”

This is probably one of the least expensive and most convenient ways to take control of your health.

To join now, please follow this link to the D*Action sign-up.

Source: Dr. Mercola

 

Endocrine Society revises recommendations for thyroid disease during pregnancy, postpartum.


The Endocrine Society has revised its 2007 Clinical Practice Guideline on the management of thyroid disease in pregnant and postpartum women. Updates include recommendations regarding diagnosis and treatment before, during and after pregnancy.

“Pregnancy may affect the course of thyroid diseases, and conversely, thyroid diseases may affect the course of pregnancy,” Leslie De Groot, MD, a researcher from the University of Rhode Island, said in a press release. “Pregnant women may be under the care of multiple health care professionals, including obstetricians, nurse midwives, family practitioners and endocrinologists, making the development of guidelines all the more critical.”

Key updates

According to the release, revisions include:

  • Caution should be used in the interpretation of serum free thyroxine levels during pregnancy and each laboratory should establish trimester-specific reference ranges for pregnant women using a free T4 assay. The non-pregnant total T4 range (5 mcg/dL to 12mcg/dL or 50 nmol/L to 150 nmol/L) can be adapted in the second and third trimesters by multiplying this range by 1.5-fold. Alternatively, the free T4 index appears to be a reliable assay during pregnancy.
  • Propylthiouracil (PTU), if available, should be the first-line drug for treatment of hyperthyroidism during the first trimester of pregnancy because of the possible association of methimazole (Tapazole, King Pharma) with congenital abnormalities. Methimazole may also be prescribed if PTU is not available or if a patient cannot tolerate or has an adverse response to PTU. Recent analyses by the FDA indicate that PTU may rarely be associated with severe liver toxicity. For this reason, clinicians should change treatment of patients from PTU to methimazole after completion of the first trimester.
  • Breast-feeding women should maintain a daily intake of 250 mcg of iodine to ensure breast milk provides 100 mcg of iodine per day to the infant.
  • Once-daily prenatal vitamins should contain 150 mcg to 200 mcg iodine in the form of potassium iodide or iodate — the content of which is verified to ensure that all pregnant women taking prenatal vitamins are protected from iodine deficiency.
  • Since thyroid receptor antibodies (thyroid receptor stimulating, binding or inhibiting antibodies) freely cross the placenta and can stimulate or inhibit the fetal thyroid, these antibodies should be measured before 22 weeks gestational age in mothers with 1) current Graves’ disease; 2) a history of Graves’ disease and treatment with radioactive iodine (I-131) or thyroidectomy before pregnancy; 3) a previous neonate with Graves’ disease; or 4) previously elevated thyroid-stimulating hormone receptor antibodies.
  • In women with thyroid-stimulating hormone receptor antibodies, at least two- to threefold the normal level and women treated with antithyroid drugs, fetal thyroid dysfunction should be screened for during the fetal anatomy ultrasound (18 to 22 weeks) and repeated every 4 to 6 weeks or as clinically indicated. Evidence of fetal thyroid dysfunction could include thyroid enlargement, growth restriction, hydrops, presence of goiter, advanced bone age or cardiac failure.
  • Women with nodules ranging from 5 mm to 1 cm in size should be considered for fine-needle aspiration (FNA) if they have a high-risk history or suspicious findings on ultrasound. Women with complex nodules ranging from 1.5 cm to 2 cm in size should also receive an FNA. During the last 6 weeks of pregnancy, FNA can reasonably be delayed until after delivery. Ultrasound-guided FNA is likely to have an advantage for maximizing adequate sampling.

Up for debate

The committee charged with updating the guidelines, however, did not reach a consensus on screening recommendations for all newly pregnant women. For instance, some members recommended screening all pregnant women for serum TSH abnormalities by the ninth week or at the time of their visit, whereas others supported aggressive case finding to identify and test high-risk women.

A full summary of the changes between the 2007 and the 2012 recommendations can be found in the August issue of the Journal of Clinical Endocrinology and Metabolism.

Source: Endocrine Today.