Vitamin D - How Much Do We Need?

Vitamin D has been a hotly debated micronutrient over the last few years.  Current dietary recommendations as set by the Institute of Medicine are that adults up to 50 years of age require 200 International Units (IU) per day, that adults 51 - 70 years of age should obtain 400 IU per day, and adults over 70 years of age should get 600 IU per day.  For purposes of safety the Institute of Medicine has set a tolerable upper level intake at 2,000 IU per day.  Since these recommendations were set, science has continued to explore the health benefits of vitamin D with many of these studies suggesting that much higher doses of vitamin D are needed to achieve health benefits beyond meeting basic nutritional requirements.  The weight of the evidence for a higher daily recommendation has led the Institute of Medicine to re-evaluate their recommendations for dietary vitamin D with a final report due to be released in the very near future.

In an attempt to provide relevant data for the re-evaluation of dietary vitamin D recommendations, a new vitamin D research study aimed at determining the appropriate amounts of vitamin D for health benefits and safety was conducted.  For their assessment of vitamin D the nutrition researchers analyzed previously published research trials on the potential benefits of vitamin D for fractures, falls, heart health, and cancer and on the safety of vitamin D at high doses.  The results of this data analysis showed:

• Fractures - Doses of vitamin D between 482-770 IU per day reduced the risk for non-vertebral fractures by about 20% and reduced the risk for hip fractures by about 18%.  Lower doses of vitamin D did not reduce fracture risk.  Optimum fracture prevention occurred with blood levels of vitamin D between 75-110 nmol/L (30-44 ng/ml).
• Fall Prevention - the risk of falling was reduced by 19% when vitamin D was consumed at doses of 700-1,000 IU per day, while lower doses did not reduce the risk of falls.  Optimum fall prevention was observed when blood levels of vitamin D were between 75-100 nmol/L.
• Non-Skeletal Endpoints - data collected and analyzed from studies on the impact of vitamin D on cancer, heart health, hypertension, and overall mortality suggest that optimum benefits were achieved with a blood level of vitamin D around 100 nmol/L.
• Safety - Elevated calcium levels are typically used to measure vitamin D toxicity.  According to this new report, vitamin D intake up to 100,000 IU per day or blood levels up to about 640 nmol/L had no effect on average blood calcium levels.  While a handful of individual case reports of elevated calcium were identified, all the relevant cases occurred at vitamin D blood levels higher than 500 nmol/L.

This is an important study that might well influence new dietary recommendations for vitamin D.   According to these study results, an optimum blood level of vitamin D for a range of health benefits is between 70-110 nmol/L.  The study investigators indicated that this level can be obtained by consuming between 1,800-4,000 IU vitamin D per day.  This daily consumption amount is substantially higher than the current upper limit of 2,000 IU per day as set by the Institute of Medicine.  However, based on the data from this study, doses much higher than this had no toxicity.  In those cases where elevated calcium was observed, blood levels of vitamin D were 4 to 5 times higher than the optimum levels.  Based on these study results, consuming 1,800-4,000 IU per day appears to have numerous health benefits with little or no risk of toxicity.

In addition to the health endpoints examined in this study, a previous study has suggested that vitamin D might support weight loss. In this study, a vitamin D blood level of 30 ng/ml was associated with a weight loss of about 12 pounds.  A blood level of 30 ng/ml is equivalent to 75 nmol/L and is thus within the optimum range defined by the latest study.

According to this latest study, consumption of 400-800 IU per day leaves about 50% of the adult population with below-optimum blood levels of vitamin D.  It will be interesting to see if the Institute of Medicine changes their recommendation for vitamin D intake and if so to what level. 

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Eat Your 'Whole Grains'!

The Dietary Guidelines for Americans 2005 recommend that we consume 3 or more 1-ounce servings of whole grains per day to help reduce the risk of several chronic diseases and potentially support healthy weight control.  Interestingly, there was not an official definition of 'whole grains' until one was issued by the U.S. Food & Drug Administration in February 2006.  According to the FDA, whole grains include cereal grains that consist of the intact and unrefined, ground, cracked or flaked fruit of the grains whose principal components, the starchy endosperm, germ and bran, are present in the same relative proportions as they exist in the intact grain. Despite having a better understanding of what constitutes 'whole grains', little information exists on how much whole grain we eat as a population and how it impacts our overall nutrient intake.

A new nutrition research study published in the current issue of the Journal of the American Dietetic Association used data collected in the National Health and Nutrition Examination Survey (NHANES) from 1999 - 2004 to determine the link between consumption of whole grains and diet quality, including nutrient intake.  Data was collected from 7,039 survey participants between 19 - 50 years of age and 6,237 participants 51 years of age or older.  The survey participants were divided into four groups based on their whole grain consumption habits: (1) zero to less than 0.6 servings/day, (2) between 0.6 - 1.5 servings/day, and (3) between 1.5 - less than 3 servings/day, and (4) 3 or more servings/day.  Analysis of whole grains consumption, dietary quality, and nutrient intake showed that:

• When looking at the study population overall, individuals between 19 - 50 years of age only consumed 0.63 servings of whole grains per day on average, while adults over 51 years of age ate an average of 0.77 servings of whole grains per day.
• In adults consuming the most servings of whole grains daily, diet quality and intakes of fiber, polyunsaturated fatty acids (healthier fats), and total energy were substantially higher.
• Micronutrient intake, except vitamin B12 and sodium, was higher in adults consuming the most servings of whole grains.
• Adults eating the highest levels of whole grains consumed significantly smaller amounts of total sugar, added sugar, saturated fatty acids, monounsaturated fatty acids, and cholesterol.

The results of this dietary consumption analysis provide us with a couple of important take-home messages.  First, it is clear that eating recommended amounts of whole grains dramatically improves our diet quality.  This was clear by the increase in the consumption of healthier dietary components like fiber, polyunsaturated fats, and higher amounts of most vitamins and minerals.  Additionally diet quality was improved by the reduction in the amounts of less healthy dietary components like saturated fat, added sugar, and cholesterol.  Secondly (and unfortunately), this new study makes it very clear that the vast majority of us eat no where close to the amount of whole grains that we should.  This lack of whole grains in our diets has a serious negative impact on our overall diet quality.  Based on these study results if we wanted to make one quick and easy dietary change to improve the quality of our diet, it would be to start consuming 3 or more servings of whole grains every day.

How much whole grains do you eat each day?

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Children's School Lunch Choices Need to Improve

It is abundantly clear that there is a childhood obesity problem that appears to stem from a wide variety of issues.  As I mentioned in a previous blog, children utilizing the school lunch program appear to be at an increased risk for becoming obese.  While this might be partly due to the food choices provided to the children, the choices children make while in line at the school cafeteria also plays a part in this growing problem.

A new nutrition research study published in the Journal of Nutrition was conducted to determine if food choices made by school children during lunch met nutrition standards set by the School Meals Initiative (SMI) and the Institute of Medicine (IOM).  For this study, investigators measured food choices and consumption of over 2,000 4th - 6th grade children over a 3-day period using digital photography in 33 schools.  The amount of Calories, fat, saturated fat, calcium, iron, and vitamins A and C were calculated and the percent of children meeting the SMI and IOM nutritional standards was determined.  The nutrition researchers reported that:

• On average, children selected about 760 Calories worth of food, ate about 550 of those Calories and threw the remaining 210 Calories away.
• 77% of the children met the lower limit of the SMI's energy recommendation.
• In contrast, only 16% of children met the Institute of Medicine's recommended energy range with 74% of the children consuming more than the recommended amount of Calories.
• More than 70% of children consumed more than the recommended amount of saturated fat.
• Because children threw more carbohydrate than fat away, they consumed proportionally more dietary fat.
• The majority of the children in the 33 schools tested met recommendations for protein, calcium, iron, and vitamin A.

The results of this study present a mixed bag of positive and negative results.  It is great news that children using the school lunch program are meeting recommendations for protein consumption and intake of a number of vitamins and minerals.  However, these results clearly point out that grade school children are consuming too much food and too much saturated fat.  This excess food and fat consumption might well be one of the reasons why a previous study suggested that using the school lunch program increased obesity risk.   Fortunately, programs designed to improve food choices in the school lunch program are already being installed as part of the nations' fight against obesity.

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Reduce Oxidative Stress - Add More Omega-3 Fatty Acids To Your Diet

Research continues to suggest that many chronic health conditions that are so prevalent today might be due to inflammation and oxidative stress.  While our bodies naturally produce a number of chemicals that are involved in oxidative processes that are important for normal functioning, over production of these free radicals can lead to oxidative stress.  Over production of these free radicals can be due to many environmental exposures such as smoking, excess sunlight, and pollution and can result in negative health effects.

Many foods have been shown to be rich in natural chemicals with antioxidant properties that might help protect against over production of free radicals and oxidative stress.  Omega-3 fatty acids, particularly EPA and DHA, have been previously reported to have antioxidant properties and new research confirms the potential benefits of these omega-3 fatty acids.  In this new research study, investigators gave two groups of volunteers with chronic health issues one of three treatments for 6 weeks: (1) 4 grams of EPA per day, (2) 4 grams of DHA per day, or (3) olive oil (control group).  Changes in blood levels of F2-isoprostane, a marker of oxidative stress, were measured.  Compared to the olive oil control groups, the results showed that:

• EPA reduced F2-isoprostane by 24% in the first group of volunteers and 19% in the second group.
• DHA reduced F2-isoprostane by 14% in the first group and 23% in the second group of volunteers.

This new study indicates that both of these omega-3 fatty acids might help reduce the oxidative stress to which our bodies can be subjected.  While some omega-3 fatty acids can come from plant sources, EPA and DHA are found in the highest amounts in oily fish like salmon, herring and mackerel.  The amount of these omega-3 fatty acids in these kind of fish is one of the reasons for the recommendation by public health groups to consume fish at least twice per week as part of a healthy, well-balanced diet plan.

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Dietary Guidelines for Americans 2010

Dietary guidelines for American are reviewed and revised at 5 year intervals through a collaboration between the US Department of Agriculture and the US Department of Health and Human Services.  While the finalized 2010 Dietary Guidelines for Americans are not yet published, the 2010 Dietary Guidelines Advisory Committee Report, which outlines the Committee's recommendations, has been made publicly available.  Some of the points addressed and recommendations are very briefly outlined below.

The Committee Report indicates that on average Americans consume too few vegetables, fruits, high-fiber whole grains, low-fat milk products and seafood, while consuming to much added sugars, sodium, solid fats, and refined grains.  To combat this current situation, the Committee Report recommends a total diet that is energy-balanced and nutrient-dense while being flexible enough to accommodate a wide range of tastes and food preferences.  To accomplish this, the 2010 Dietary Guidelines Committee outlined several steps we can all take:

• Reduce overall calorie intake.
• Meet the 2008 Physical Activity Guidelines for Americans
• Shift food consumption patters to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, nuts, and whole grains.  As part of this shift, the Committee recommends increasing seafood and low-fat milk product consumption and eating only moderate amounts of lean meats, poultry and eggs.
• Dramatically reduce the amount of added sugars and solid fats we consume and also lower intake of sodium and refined grains.

The 2010 Dietary Guidelines Committee further indicated that more than individual efforts will be needed to achieve the necessary changes.  Rather, the Committee believes that a coordinated plan involving all sectors of society is needed to successfully change the overall food environment.  Some of the changes suggested by the Committee include:

• Improve nutritional literacy and cooking skills
• Enhance school health, nutrition, and physical education programs
• Develop financial incentives to purchase healthier foods
• Improve the availability of fresh produce
• Increase the availability of seafood to all segments of the population
• Encourage the food industry to offer health-promoting foods

It is good to see that the 2010 Dietary Guidelines for Americans is close to completion.   While the entire Committee Report is quite long, the Executive Summary provides an excellent overveiw of the Committee's recommendations including recommended changes in the dietary intake of sodium (down to 1,500 mg/day from the current 2,300 mg/day), saturated fat (less than 7% of total calories), and seafood (consume at least 2 servings per week that provide an averge of 250 mg/day of omega-3 fatty acids) among others.  It is likely that many of the recommendations suggested by the Committee will be difficult to meet both by individual Americans and the food industry; however, if these goals can be met, these recommendations have the ability to reduce future obesity incidence and lead to healthier lives for Americans.

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