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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Walking Promotes Normal Memory Health

Physical activity is a vitally important part of a healthy lifestyle, particularly moderate-intensity exercise, which has been linked to a number of health benefits.  Moderate-intensity exercise can be achieved in a number of ways, including something as simple as taking a brisk walk.  One proposed benefit of walking is an improvement in brain function; however, long-term studies showing the true benefit have been lacking.

A new research study explored the effect of walking on brain size, specifically gray matter size, and memory health in 299 older adults (average age of 78 years).  To determine the impact of physical activity on brain and memory function, the study investigators measured the number of blocks walked over a 1 week period, scanned the volunteers brains 9 years after measuring physical activity, and measured memory function after 13 years.  According to the study summary and related press release, the study results indicated that:

• The amount walked over a 1 week period ranged from 0 to 300 blocks with an average of about 56 blocks.
• Brain size was greater after 9 years in individuals who walked at least 72 blocks (about 6 - 9 miles) per week (or about a mile per day) compared to individuals who walked less than 72 blocks per week.
• After 13 years, walking 72 blocks per week reduced the risk of memory loss by 2-fold.

This is excellent news.  Exercise, including walking, has been linked to numerous health benefits.  This new research indicates that walking about one mile per day might reduce the risk of memory impairment, the stage of memory loss before dementia.  This reduced risk of memory loss was linked to greater brain size in individuals who walked about one mile per day.  Aging has been linked to a reduction in brain size, but this new research suggests that a moderate-intensity exercise like walking can help protect against a loss of brain volume.  According to the Centers for Disease Control and Prevention, "if you're doing moderate-intensity activity you can talk, but not sing, during the activity. If you're doing vigorous-intensity activity, you will not be able to say more than a few words without pausing for a breath".  While we all know that walking is a great part of any weight loss program, this new research also suggests that walking can help promote normal memory health.  So get out and walk whenever possible!

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Dim The Lights?

We all understand that obesity is the result of many factors, with the best known factors being a lack of physical activity and the consumption of too much food.  However, other factors are known to have additional effects on a person's risk for becoming obese.  While some of these factors appear to be genetic, others appear to be environmental.  For example, a lack of adequate amounts of sleep has been linked to one's risk for obesity and can impact dieting success.  A potentially related nighttime phenomenon, "light at night", has recently been suggested to impact body weight.

A new obesity research study examined the potential relationship between nighttime light exposure (or "light at night") and body mass in male mice.  The obesity researchers housed mice under different lighting conditions (standard light/dark cycle, dim light, or bright light) over the 8-week study period and measured changes in body weight, food intake, physical activity, and metabolism.  The study investigators reported:

• Mice housed in bright light and dim light showed an increase in body weight as early as the first week of the study compared to mice housed in a normal light/dark cycle.
• The increase in body weight was at least partly due to an increase in fat mass in the mice exposed to light at night.
• Total daily physical activity and food intake was not different between mice housed in different lighting conditions; however, differences were noted in the timing of eating.
• Mice housed in dim light consumed about 55% of their food during the light phase, which is a shift in the normal eating habits of nocturnal mice.  The mice housed in normal light conditions consumed only about 36% of their food during the light phase.
• Limiting food consumption of mice housed in dim lighting conditions to only normal eating times prevented weight gain.

This is a fascinating study that suggests even low amounts of light at night, about equivalent to twilight with a clear sky, alters metabolism, alters the timing of regular food consumption, and promotes weight gain.  While these are interesting results, it will be more interesting to see if this holds true in human beings.  Our internal body clock helps to determine many of the schedules we keep including when we eat and when we sleep.  Because the hormone melatonin is closely involved in our internal clock and is affected by light exposure, changes in melatonin might be partly responsible for this disruption in normal metabolism and eating behaviors.  As a population, we are typically exposed to high amounts of light at night from computers, television, and other artificial sources of light.  While watching television and sitting in front of a computer can increase our chances of gaining weight due to a lack of physical activity, these results imply that exposure to their artificial light might negatively effect our dietary habits.  However, much more research will be needed to clarify this relationship as well as the level of impact it might have.

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Structured Weight Loss Programs Promote Healthy Weight Loss

If you watch any amount of television at all, you are bound to see advertisements for the many, many weight loss programs, all telling you that their program will help you lose weight.  Despite what these programs tell you in their commercials, few of them have actually conducted clinical research studies to test their effectiveness.  Two new weight loss studies, published online in the Journal of the American Medical Association and free to download, examined the effectiveness of structured weight loss programs in different groups of volunteers.

In the first weight loss study, investigators assigned 442 overweight or obese adult women with a BMI of 25-40 to either a center-based weight loss program, a telephone-based weight loss program or usual care.  The usual care group was provided consultation and information at the start of the study and again at 6 months.  The volunteers assigned to the center-based and telephone-based weight loss programs received pre-packaged prepared foods and all necessary program materials.  Additionally, they received in-person or telephone-based diet counseling on a weekly basis as well as access to website or message board interaction.  Study volunteers were encouraged to consume about 40-70% of their food intake from the pre-packaged meals during the first six months of the study and then transition to a mainly food-based meal plan over the remaining 18 months.  Additionally, study volunteers were asked to exercise 5 days per week for 30 minutes.  The results of this study showed that:

• Individuals in the usual care group lost about 7 pounds and 2 inches over 2 years.
• Volunteers in the center-based structured weight loss program lost about 18.5 pounds and nearly 3.5 inches over 2 years.
• Subjects in the telephone-based structured weight loss program lost about 15 pounds and 3 inches over 2 years.

In the second weight loss study, investigators examined the usefulness of a structured weight loss program for severely obese individuals (average body mass index was about 43-44).  For this study, 130 severely obese volunteers were randomly assigned to a structured weight loss program that included either exercise that began at the start of the study or exercise that didn't begin until 6 months into the study period.  The structured weight loss program consisted of a combination of group, individual, and telephone contacts over a 1 year period.  Study volunteers were asked to follow a meal plan that included 2 meal replacements per day during the first 3 months and 1 meal replacement from months 4 through 6 and were asked to briskly walk for 60 minutes 5 days per week.  The investigators reported:

• On average, volunteers that started exercising at the start of the structured weight loss program lost about 27 pounds, 4 inches off their waist, and about 17 square inches of belly fat.
• Volunteers that started walking six months into the structured weight loss program lost on average 22 pounds, 3 inches off their waist, and about 14 square inches of belly fat.
• 78% of individuals in the initial-activity group lost more than 5% of their body weight after 1 year, while 65% of the delayed-activity group lost more than 5% of their body weight.

Overall, these two weight loss studies indicate that a well-structured weight loss program can be an effective weight loss tool for adults who are overweight, obese, or even severely obese.  A structured weight loss program can make it easier for individuals to follow by offering pre-packaged meals or meal replacement bars and shakes, which helps minimize food weighing and calorie counting.  This can make it easier for individuals to stick to a diet plan.  This was clear in these studies where compliance to the diet plans was 78% in one study and 92% in the other study.  Because of the effectiveness of structured weight loss programs, the investigators of each study and the author of an accompanying editorial suggest that health care systems should consider their incorporation.  While this will likely not happen on a regular basis in the immediate future, well-structured weight loss programs are available for those interested in healthy weight loss.  Make sure to look for weight loss programs that are clinically tested, easy to follow, and provide a good diet counseling support system.

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Improve Your Dieting Success - Get Plenty of Sleep!

Sleep... we all know how important it is for our overall health.  Despite this it seems like many of us never get enough sleep.  Busy evenings after work and the need for a little 'down time' before heading to bed often result in many of us getting to sleep a lot later than we should.  Combine this with often having to get up early for work or having to get the kids ready for school, and we're lucky to get an adequate amount of sleep.

Previous research has shown us that a lack of sleep puts us at an increased risk for becoming overweight or obese.  This appears to be due to a number of factors including (1) altered metabolic hormones that effect our appetite, (2) changes in blood glucose metabolism, and (3) altered waking behaviors that lead to greater consumption of high-calorie foods and decreased exercise.  While this research clearly indicates that a lack of sleep can put us at risk for becoming overweight or obese, new research also suggests that a lack of sleep can affect our weight loss success when dieting.

A new weight loss study examined the impact of sleep restriction on body fat loss in individuals following a reduced-calorie diet.  In this small pilot study, weight loss investigators asked 10 overweight, adult volunteers to sleep in a sleep laboratory for two 14-day dieting periods.  During the first dieting period, study volunteers were allowed to sleep for 8.5 hours per night.  The volunteers were only allowed to sleep for 5.5 hours per night during the second 14-day diet period.  The weight loss researchers examined changes in body fat loss and lean tissue loss in addition to other measures.  The results of this study showed that:

• Body fat loss was greater when volunteers received 8.5 hours of sleep per night (~3 lbs) compared to when volunteers were restricted to 5.5 hours of sleep per night (~1.3 lbs). 
• Sleep restriction resulted in greater amounts of lean tissue loss (~5 lbs) compared to getting a full night's sleep (~3 lbs).
• Sleep restriction was linked to unfavorable changes in metabolic hormones resulting in an adaptation to caloric restriction, increased hunger, and reduced fat breakdown.

While this is clearly early research done in a very small group of volunteers, these fascinating research results clearly suggest that the amount of sleep we get can effect our weight loss efforts.  While the study volunteers successfully lost weight regardless of how much they slept, getting an inadequate amount of sleep appeared to cause dieters to lose more lean muscle mass than fat mass.  Additionally, a lack of sleep redued the amount of body fat lost.  Ideally, we want to lose fat mass and maintain lean muscle mass when dieting, which is one of the important reasons for exercising while dieting.  However, not getting enough sleep while dieting can make it difficult to achieve healthy weight and fat loss.

If you are on weight loss program or getting ready to start a diet plan, it is important to make sure you get enough sleep.  Getting inadequate amounts of sleep might reduce your weight loss success.

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Break The Vicious Circle of Overeating

Previous research studies have reported that obese individuals show differences in brain circuitry related to food reward.  Compared to lean individuals, obese individuals appear to produce less dopamine and have fewer dopamine receptors.  These differences appear to reduce the pleasure associated with eating.

A new obesity research study examined this relationship between food consumption, reward circuitry in the dorsal striatum region of the brain, and weight change.  For this study, the obesity researchers used MRI to measure brain changes in women over a 6-month study period in response to drinking either a chocolate milkshake or an unflavored milkshake.  Changes in brain function in relation to weight change over the 6 months were analyzed.  The obesity researchers reported that women who gained weight during the 6 months of follow-up showed a reduced activity in dorsal striatum in response to food consumption compared to women who did not gain weight.  The study investigators further indicated that reduced activity of the brain's reward system led to overeating and that overeating further reduced the responsiveness of the food reward circuitry.

These are fascinating study results suggesting that overeating can lead to a vicious circle of overeating and weight gain.  According to this study, overeating causes weight gain, which appears to cause a reduction in our ability to sense pleasure when eating good food, which causes us to eat even more to feel that pleasure, which leads to additional weight gain.  This is a vicious circle of overeating and weight gain that is difficult to break.

It is important to remember that food should serve to provide us with health-building nourishment.  We should never put food before our health, which in essence is what we are doing when we overeat.  Continued overeating places our minds and bodies on a direct path towards obesity and disease.  The old axiom “eat to live, don’t live to eat” is as true now as it ever has been.

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Individual Costs of Being Overweight

We have all heard that being overweight or obese puts a heavy burden on the health care industry resulting in substantial increases in medical costs for heavier individuals.  However, medical costs are only part of the additional costs paid by overweight or obese individuals.  Until recently, it was unclear how much being obese costs on an annual basis for individuals.

A new report from the George Washington University School of Public Health and Health Services Department of Healthy Policy outlines some of the individual costs linked to being overweight and obese.  While the full report is free to download and read, some of the most important revelations are briefly discussed below.

Direct Medical Costs.  Being obese costs an individual person $1,474 dollars a year in direct medical costs.  This includes $433/year inpatient costs, $458/year non-inpatient costs, and $586/year in prescription drug costs.  One study reported that costs increase with higher body weights; a moderately obese person (BMI 30 to 34.9) pays about $800 more per year than a normal weight person, while a morbidly obese person (BMI >40) pays about $2,800 more per year than a normal weight person.

Income.  Results of the analysis conducted for this new report indicated that obese female full time employees make $1,855 less per year compared to normal weight women.  Annual lost wages was only $75 for obese men compared to normal weight men.

Productivity.  According to this report, studies have shown that on average obesity causes a reduction in productivity at work.  The loss of productivity linked to obesity equaled $358 per obese employee.

Short-term Disability.  Several studies have indicated that obese workers are more likely to suffer a short-term disability than normal weight workers.  These studies suggest that an overweight employee is at a 26% increased risk for a short-disability event and that an obese worker is at a 76% increased risk for such an event.  These increased risks translated to increased costs.  The number of days lost due to illness cost an additional $55 per year for the average overweight individual and an additional $349 per year for an obese individual.  Annual costs for disability pension insurance was approximately $70 higher for obese individuals.

Personal Costs.  This new report examined two personal costs, gasoline cost and life insurance cost.  Morbidly obese individuals spent $30/year (men) and $36/year (women) more in gasoline costs than normal weight individuals.  In regards to life insurance costs, overweight individuals typically pay an additional $14/year, while obese individuals will generally pay an additional $111/year. 

Life Expectancy.  Obesity reduces life expectancy in men more so than it does in women.  In Caucasian men life expectancy is reduced by about 5 years, whereas life expectancy is reduced by 4 years in morbidly obese Caucasian women.  The value of life lost due to obesity was reported to be $3,486/year for men and $3872/year for women.

Total Costs.

1. The total reported costs for being overweight is $524 per year for women and $432 per year for men.
2. The yearly costs associated with being obese is $4,879 for women and $2,646 for men.
3. If the loss in life expectancy is included, the cost of being obese is $8365 per year for women and $6,518 per year for men.

It is clear from this new report, that being overweight or obese can have a major impact on an individuals finances.  Not counting the value associated with life span, it costs about $3,000 - $5,000 per year more to be obese compared to having a normal body weight.  While some of the costs outlined in this report are shared with employers and government institutions a number of costs come directly out of a person's pocket.  The study investigators indicated that these costs are likely to be underestimated because many other consumer-related costs like travel costs, clothing costs, automobile size, and other goods and services have not been studied.  Reducing one's body weight and maintaining a healthy body weight not only has numerous health benefits, but apparently can impact personal finances.

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