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Whoa!  Lay Off the Vitamins!
Posted: 15 April 2014 04:32 PM   [ Ignore ]   [ # 421 ]
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I’m curious.  Perhaps the medical experts here can answer my concerns.

1.  Is it true that as one gets older, his/her intestines don’t absorb quite as efficiently as do those of younger people?

2.  Do older people need fewer calories, both because of decreased activity and slower metabolism?

3.  Do older people’s internal chemistry doesn’t function as well as the chemistry of younger people?

4.  We are told that to avoid obesity, we should eat less than we did as we did when we were younger.  If we were getting an adequate amount of micro-nutrients then, how do we assure that we are still getting enough even though we are eating significantly less?

Thanks for your expert advice. smile

Occam

[ Edited: 15 April 2014 04:34 PM by Occam. ]
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Posted: 15 April 2014 05:28 PM   [ Ignore ]   [ # 422 ]
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Obviously, I’m no expert on human medicine, so I’ll defer to macgyver. By coincidence, however, I just wrote a paper on malnutrition and infectious disease in the elderly for a class I’m taking as part of my master’s in epidemiology, and it touches on the issue of nutrition and aging, as well as the subject of the pros and cons of supplementation. I’ll email it to you (and anyone else interested) in case it has anything useful for you on these questions.

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Posted: 15 April 2014 07:19 PM   [ Ignore ]   [ # 423 ]
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Occam. - 13 April 2014 03:53 PM

I don’t think the two Ms are claiming that the supplements are evil, Vy, just that no one needs them because all of Americans get adequate amounts of all the supplements in our diets so we’re wasting money by taking them.  After all, we have to recognize the value of the fast food industry in their efforts to provide low fat, low calorie, high quality foods which supply all our nutritional needs to everyone.  LOL

Of course, the response to this is:  Americans should work to eat an adequate diet rather than the junk foods.  And that’s true, just as is:  Americans should all be atheistic, liberal, humanists who care for and respect each other. 

Occam

I would love to see what would happen to the population if flour, rice, milk, cooking oils, fruit juices and cereal had all of their supplementation/fortification removed.
I mean from a statistical sense in regards to increase of disease.

I wonder if studies could be done regarding this. Studies have already been done by WHO in regards to why they are fortifying
foods. Either voluntarily or through government regulation. From Wikipedia:

The WHO and FAO, among many other nationally recognized organizations, have recognized that there are over 2 billion people worldwide who suffer from a variety of micronutrient deficiencies. In 1992, 159 countries pledged at the FAO/WHO International Conference on Nutrition to make efforts to help combat these issues of micronutrient deficiencies, highlighting the importance of decreasing the number of those with iodine, vitamin A, and iron deficiencies.[2] A significant statistic that led to these efforts was the discovery that approximately 1 in 3 people worldwide were at risk for either an iodine, vitamin A, or iron deficiency. Although it is recognized that food fortification alone will not combat this deficiency, it is a step towards reducing the prevalence of these deficiencies and their associated health conditions.[5]

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Posted: 15 April 2014 07:42 PM   [ Ignore ]   [ # 424 ]
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Occam. - 15 April 2014 04:32 PM

I’m curious.  Perhaps the medical experts here can answer my concerns.

1.  Is it true that as one gets older, his/her intestines don’t absorb quite as efficiently as do those of younger people?

2.  Do older people need fewer calories, both because of decreased activity and slower metabolism?

3.  Do older people’s internal chemistry doesn’t function as well as the chemistry of younger people?

4.  We are told that to avoid obesity, we should eat less than we did as we did when we were younger.  If we were getting an adequate amount of micro-nutrients then, how do we assure that we are still getting enough even though we are eating significantly less?

Thanks for your expert advice. smile

Occam

These are actually very complex questions and I really am not prepared to give a comprehensive answer without reviewing this subject. I can give you some basic information though

1) As we get older we do absorb some things less efficiently but it would be simplistic to say that applies to all substances since we use different mechanisms to absorb different molecules. Digestion actually begins in the mouth with both the mechanical breakdown of food by chewing as well as some initial action of enzymes in found in saliva. Complex molecules like proteins and starches for example need to be broken down first into simpler molecules by enzymes. Once that happens they must then be transported across the the intestinal mucosa for transport throughout the body. Some substances like B12 for example require special transport mechanisms B12 must be first bound to intrinsic factor in the stomach which allows tissue in the small intestine to latch onto the B12 and absorb it. In order for B12 to bind to intrinsic factor it must first be released from the food it is bound within and this requires acid. As we get older we tend to produce less acid and this can lead to an increased risk of B12 malabsorption. There may be other substances with other mechanisms of age related malabsorption but this is just one example.

2) For the most part the answer to this question is yes. Metabolism on average does decrease with age as does activity levels but there are of course exceptions and individual variation. In addition there are disease states such as infections and cancer and situations such as surgery which may increase calorie requirements.

3) Not really sure how to answer this question. I am inclined to say yes as the accumulation of DNA damage over time causes derangement of many proteins and this most likely includes enzymes that catalyze reactions in biochemical pathways, but as the subject is a bit to broad and I have never really researched this issue I can;t really answer in more detail.

4) While we may eat less as we get older we are doing so because our requirements are less. Our requirements are less because cell turnover is slower, muscle mass is lower and one would think that as a result some of our nutrient requirements are less as well. This is a complex question though because as I mentioned above some nutrients are absorbed less effectively in some older patients so reduced needs and reduced consumption may not necessarily balance each other.

If the purpose of these questions is to construct a logical opinion about whether older people should take vitamin supplements its really an ineffective way to get the answer. There are too many variables and too many unknowns. The only effective way of answering the question is by doing randomized trials and looking at outcomes. You may want to search pubmed for more information on the subject. You may want to email mckenzie for a copy of his paper as well since it sounds like he may have done a lot of the work for you.

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Posted: 15 April 2014 09:09 PM   [ Ignore ]   [ # 425 ]
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I’m far from an expert, but I read somewhere, (or processed something that I read somewhere, to understand) that after a certain age we need less protein, but then as we get even older we’re better off with increased protein, again.  If this is true, Occam, you may be free to be more carnivorous, than some of us medium-old folks.

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Posted: 16 April 2014 10:45 AM   [ Ignore ]   [ # 426 ]
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HERE is an article on the history of food fortification.  Interesting subject I haven’t previously thought much about.

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Posted: 16 April 2014 11:13 AM   [ Ignore ]   [ # 427 ]
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mckenzievmd - 16 April 2014 10:45 AM

HERE is an article on the history of food fortification.  Interesting subject I haven’t previously thought much about.

Yes. Interestingly the fortification of foods lies on the halfway point of your’s and my continuing debate on the subject of supplementation.

You make excellent points about evolving knowledge of the role of vitamins, and vitamin supplements on the human body as far as
metabolism, prevention, and general health, dosages, as well as what was thought and what is now known on what vitamins do for us beneficially and harmfully.

Obviously I make no claims about the efficacy for supplements to prevent specific disease.
Only in the sense of whole nutrition do I treat the idea of disease prevention. Whether or not that nutrition is supplemented or “natural”.
Obviously there is no doubt that nutrition is one of the key components of disease prevention.
That leads us to the ambiguous comments that have been made here concerning ” a normal diet” and such, that MacGeyver and you have tried to level at me regarding the uselessness of supplements.

It is quite clear that worldwide and here in the US, many people do not have a normal diet for many different reasons.(especially if foods were NOT fortified)

The discussion of food fortification(supplementation) brings light to bear on both of our arguments.
I’m sure as the excellent article you cited here reveals, that even food fortification is an evolving science.

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Posted: 15 September 2014 02:07 PM   [ Ignore ]   [ # 428 ]
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Latest review of the evidence concerning Vitamin D and calcium supplements finds little evidence of consistent relationship between these vitamins and health.

In solid agreement with the findings of the original report, the majority of the findings concerning vitamin D, alone or in combination with calcium, on the health outcomes of interest were inconsistent. Associations observed in prospective cohort and nested case-control studies were inconsistent, or when consistent, were rarely supported by the results of randomized controlled trials. Clear dose-response relationships between intakes of vitamin D and health outcomes were rarely observed. Although a large number of new studies (and longer followups to older studies) were identified, particularly for cardiovascular outcomes, all-cause mortality, several types of cancer, and intermediate outcomes for bone health, no firm conclusions can be drawn…it is difficult to make any substantive statements on the basis of the available evidence concerning the association of either serum 25(OH)D concentration, vitamin D supplementation, calcium intake, or the combination of both nutrients, with the various health outcomes because most of the findings were inconsistent.

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Posted: 15 September 2014 05:36 PM   [ Ignore ]   [ # 429 ]
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Wow 929 pages. Thanks for the link tongue laugh. Seriously though this only shows the level of interest in this vitamin over the past few years. It has become a significant and frequent topic of discussion. I wish I could say the medical community was on board with the findings of the document you linked to but unfortunately a lot of my colleagues have bought into the idea that Vit D is the solution for everything that ails you despite a lack of good evidence to support these ideas.

It has become common place for physicians to include Vit D levels as part of the routine blood work on annual exams and then supplement with large doses of Vit D if they are low despite the fact that there are no studies at all which examine this approach for safety and benefit.

That’s the crazy world we live in though. Physicians and patients are allowing the media to set the tone and getting ahead of the evidence.

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Posted: 16 September 2014 12:30 AM   [ Ignore ]   [ # 430 ]
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macgyver - 15 September 2014 05:36 PM

Wow 929 pages. Thanks for the link tongue laugh. Seriously though this only shows the level of interest in this vitamin over the past few years. It has become a significant and frequent topic of discussion. I wish I could say the medical community was on board with the findings of the document you linked to but unfortunately a lot of my colleagues have bought into the idea that Vit D is the solution for everything that ails you despite a lack of good evidence to support these ideas.

It has become common place for physicians to include Vit D levels as part of the routine blood work on annual exams and then supplement with large doses of Vit D if they are low despite the fact that there are no studies at all which examine this approach for safety and benefit.

That’s the crazy world we live in though. Physicians and patients are allowing the media to set the tone and getting ahead of the evidence.

No, it’s only 28 pages. I read the article and it implies that there is some benefit to supplementation and fortification of foods. This particular article does not cite any research that says they are of no use, but suggests further research.

This website from the National Institutes of Health says Vitamin D supplements are effective for several conditions.  http://www.nlm.nih.gov/medlineplus/druginfo/natural/929.html

My own doctor said my Vit D levels are low and suggested I take a Calcium and D supplement.  I think most patients would take the supplements if their doctor said a blood test indicated a deficiency. I agree that supplements may not be doing much and are probably being overprescribed.

But what is a patient to do when his or her doctor prescribes a supplement? Most patients are not going to wade through medical reports and will take the doctor’s advice.

Lois

[ Edited: 16 September 2014 01:13 AM by LoisL ]
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Posted: 16 September 2014 05:40 AM   [ Ignore ]   [ # 431 ]
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LoisL - 16 September 2014 12:30 AM

My own doctor said my Vit D levels are low and suggested I take a Calcium and D supplement.  I think most patients would take the supplements if their doctor said a blood test indicated a deficiency. I agree that supplements may not be doing much and are probably being overprescribed.

But what is a patient to do when his or her doctor prescribes a supplement? Most patients are not going to wade through medical reports and will take the doctor’s advice.

Lois

Lois I agree that its difficult to know what to do when your doctor prescribes something and you are not sure if its the right thing to do. I am not suggesting that you ever ignore your doctors advice but I am suggesting that you ask questions. What I advise people is to ask your doctor if he or she can refer you to some studies or recommendations from professional organizations that support their approach. The USPSTF is a a good source for recommendations. They are a governmental agency made up of experts in the field who review all of the current literature on a given subject and then come up with a recommendation based on that evidence. In regards to Vit D their recommendation can be found here, but to quot from it

“Screening for Vitamin D Deficiency in Adults
Potential Benefits and Harms of Screening for Vitamin D Deficiency
The Task Force reviewed studies on the benefits and harms of screening for vitamin D deficiency. They found that there is not enough
evidence to determine whether screening healthy adults leads to improvements in health. They also did not find enough evidence to
understand the potential harms of screening for vitamin D deficiency. Because current scientific evidence does not clearly tell us what
an unhealthy blood level of vitamin D is, the screening test may suggest that some people are vitamin D deficient when they are actually
healthy. These people may get vitamin D treatment when they do not really need it.”

Unfortunately lots of physicians do things either because patients ask for something or because they hear about it from unreliable sources like the mainstream media or because colleagues are doing it. Such is the case with Vit D measurements.

Lots of doctors are measuring and treating vitamin D levels today. We have gotten into this situation with Vit D because a number of studies over the past few years seem to have shown a correlation between low Vit D levels and a number of diseases. These studies have not shown a causative ink, only a correlation. Many have jumped to the conclusion that these studies are enough and we dont need to show causation hence the rush to measure levels on patients but this logic is flawed for several reasons

1) There are NO studies which demonstrate that measuring and treating low levels of Vit D is either beneficial or safe.
2) Safety is an important issue as supplementation of other vitamins has been found on occasion to be harmful. Vit A supplementation can cause an increase in lung cancer and Vit E supplementation has been shown to increase the risk of prostate cancer.
3) No one knows what level of Vit D is “healthy”. The current “normal” level is 30-100 in most labs but this normal range is somewhat arbitrary and no one really knows what level is the best level for good health.
4) We don’t even now if blood levels of Vit D accurately portray body stores of Vit D. Vit D is a fat soluble vitamin and is stored in body fat and the liver. These stores are not always in equilibrium with the vitamin D found in our blood such that blood levels may not be an accurate measure of total body Vit D.

Among my own patients I did Vit D levels for a few months out of curiosity among those who asked for it ( I have since stopped offering this test). Among the 100 patients I tested only a couple had normal levels. Other studies have shown abnormal levels in 25-80% of patients. If we are gong to begin a program of Vit D testing and treatment on a population of healthy people and the vast majority are then going to be treated we need far better evidence than we currently have to verify that this approach will cause more benefit than harm.

Again, I am not asking you to ignore your doctors advice, but ask him about this and ask him about the USPSTF recommendation. He may be surprised or not even be aware of it since the whole world around him seems to have accepted Vit D testing and treatment as “the thing to do”.

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Posted: 16 September 2014 10:37 AM   [ Ignore ]   [ # 432 ]
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Lois,

MacGyver was responding to the most recent post I made (Post #428) which contained a link to a long, comprehensive evidence review. The article you read was from Post # 426, which was ONLY talking about fortification of foods. The longer review reports the results of studies done over many years in thousands of people, and generally finds no evidence of benefit for Vitamin D screening or supplementation in almost all of the uses commonly recommended. While one can never prove something is never helpful without testing an infinite number of possible individuals, doses, uses, etc., the failure to find a benefit after extensive research like this is pretty good evidence there is little or no benefit to find.

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Posted: 16 September 2014 12:06 PM   [ Ignore ]   [ # 433 ]
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mckenzievmd - 16 September 2014 10:37 AM

Lois,

MacGyver was responding to the most recent post I made (Post #428) which contained a link to a long, comprehensive evidence review. The article you read was from Post # 426, which was ONLY talking about fortification of foods. The longer review reports the results of studies done over many years in thousands of people, and generally finds no evidence of benefit for Vitamin D screening or supplementation in almost all of the uses commonly recommended. While one can never prove something is never helpful without testing an infinite number of possible individuals, doses, uses, etc., the failure to find a benefit after extensive research like this is pretty good evidence there is little or no benefit to find.

Ok, thanks.

Yes, that one iS 929 pages. I wonder who would read it. Certanly not laymen. Probably not even most physicians!


Lois

[ Edited: 16 September 2014 12:10 PM by LoisL ]
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Posted: 16 September 2014 12:30 PM   [ Ignore ]   [ # 434 ]
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macgyver - 16 September 2014 05:40 AM
LoisL - 16 September 2014 12:30 AM

My own doctor said my Vit D levels are low and suggested I take a Calcium and D supplement.  I think most patients would take the supplements if their doctor said a blood test indicated a deficiency. I agree that supplements may not be doing much and are probably being overprescribed.

But what is a patient to do when his or her doctor prescribes a supplement? Most patients are not going to wade through medical reports and will take the doctor’s advice.

Lois

Lois I agree that its difficult to know what to do when your doctor prescribes something and you are not sure if its the right thing to do. I am not suggesting that you ever ignore your doctors advice but I am suggesting that you ask questions. What I advise people is to ask your doctor if he or she can refer you to some studies or recommendations from professional organizations that support their approach. The USPSTF is a a good source for recommendations. They are a governmental agency made up of experts in the field who review all of the current literature on a given subject and then come up with a recommendation based on that evidence. In regards to Vit D their recommendation can be found here, but to quot from it

“Screening for Vitamin D Deficiency in Adults
Potential Benefits and Harms of Screening for Vitamin D Deficiency
The Task Force reviewed studies on the benefits and harms of screening for vitamin D deficiency. They found that there is not enough
evidence to determine whether screening healthy adults leads to improvements in health. They also did not find enough evidence to
understand the potential harms of screening for vitamin D deficiency. Because current scientific evidence does not clearly tell us what
an unhealthy blood level of vitamin D is, the screening test may suggest that some people are vitamin D deficient when they are actually
healthy. These people may get vitamin D treatment when they do not really need it.”

Unfortunately lots of physicians do things either because patients ask for something or because they hear about it from unreliable sources like the mainstream media or because colleagues are doing it. Such is the case with Vit D measurements.

Lots of doctors are measuring and treating vitamin D levels today. We have gotten into this situation with Vit D because a number of studies over the past few years seem to have shown a correlation between low Vit D levels and a number of diseases. These studies have not shown a causative ink, only a correlation. Many have jumped to the conclusion that these studies are enough and we dont need to show causation hence the rush to measure levels on patients but this logic is flawed for several reasons

1) There are NO studies which demonstrate that measuring and treating low levels of Vit D is either beneficial or safe.
2) Safety is an important issue as supplementation of other vitamins has been found on occasion to be harmful. Vit A supplementation can cause an increase in lung cancer and Vit E supplementation has been shown to increase the risk of prostate cancer.
3) No one knows what level of Vit D is “healthy”. The current “normal” level is 30-100 in most labs but this normal range is somewhat arbitrary and no one really knows what level is the best level for good health.
4) We don’t even now if blood levels of Vit D accurately portray body stores of Vit D. Vit D is a fat soluble vitamin and is stored in body fat and the liver. These stores are not always in equilibrium with the vitamin D found in our blood such that blood levels may not be an accurate measure of total body Vit D.

Among my own patients I did Vit D levels for a few months out of curiosity among those who asked for it ( I have since stopped offering this test). Among the 100 patients I tested only a couple had normal levels. Other studies have shown abnormal levels in 25-80% of patients. If we are gong to begin a program of Vit D testing and treatment on a population of healthy people and the vast majority are then going to be treated we need far better evidence than we currently have to verify that this approach will cause more benefit than harm.

Again, I am not asking you to ignore your doctors advice, but ask him about this and ask him about the USPSTF recommendation. He may be surprised or not even be aware of it since the whole world around him seems to have accepted Vit D testing and treatment as “the thing to do”.

Thanks. That makes sense. In my case the laboratory checked my D levels without my asking for it. Presumably my doctor directed them to do this—also without my request. I was already skeptical of this because a few friends said their doctors tested for Vit D levels and recommended supplements. One said her doctor retested her blood Vit D level after she took the supplements he recommended and said the level was still not high enough, so ordered an even higher dose of Vit D. This made me suspicious about the practice of testing for Vit D levels. Unfortunately my friend is not a skeptic and follows her doctor’s advice unquestioningly and looks askance at any suggestion that her doctor might be following a poor protocol. So do most of my friends. So I guess that’s where the problem lies.

I will take your advice amd question my doctor for studies and recommendations. I guess many doctors are as easily influenced by the latest fads as the lay public is.

Lois

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Posted: 11 October 2014 08:43 PM   [ Ignore ]   [ # 435 ]
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Many doctors are businessmen.
Most doctors are ethical.

How many doctors out there, that are businessmen and unethical? This is a rhetorical question.

We all have seen/read about doctors getting paid by pharma representatives in pretty much every country:
http://www.news.com.au/lifestyle/health/hundreds-of-doctors-paid-thousands-to-advise-drug-companies-on-their-products/story-fneuzlbd-1226673435918

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