Experts review vitamin D advice

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24 January 2012 Last updated at 12:19 GMT Concerns over vitamin D deficiency - A quarter of toddlers affected

The chief medical officer for England, Dame Sally Davies, is to contact medical staff about concerns young children and some adults are not getting enough vitamin D.

Government guidelines recommend some groups, including the under-fives, should take a daily supplement.

However, recent research found that many parents and health professionals were unaware of the advice.

There has been an increase in childhood rickets over the past 15 years.

According to Dr Benjamin Jacobs, from the Royal National Orthopaedic Hospital, links to heart disease and some cancers are also being investigated.

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It is important to raise awareness of this issue, and I will be contacting health professionals on the need to prescribe and recommend vitamin D supplements to at-risk groups”

End Quote Dame Sally Davies Chief medical officer for England The consultant paediatrician told BBC Breakfast that the hospital saw about one severe case a month of rickets - softening of bones through lack of vitamin D in childhood.

He said: "There are many other children who have less severe problems - muscle weakness, delay in walking, bone pains - and research indicates that in many parts of the country the majority of children have a low level of vitamin D."

The Feeding for Life Foundation report, published in October last year, suggested one in four toddlers in the UK is vitamin D deficient.

However, this may be an underestimate as only vitamin D from food was included, and not any vitamin D obtained through sun exposure.

Vitamin D supplements are recommended for all people at risk of a deficiency, including all pregnant and breastfeeding women, children under five years old, people aged over 65, and people at risk of not getting enough exposure to sunlight.

Vitamin D is mainly obtained from sunlight. However, too much sun exposure increases the risk of skin cancer.

According to one recent study, nearly three-quarters of parents and more than half of health professionals are unaware of the recommendations.

The Department of Health has asked the Scientific Advisory Committee on Nutrition to review the issue of current dietary recommendations on vitamin D.

Dame Sally Davies: "We know a significant proportion of people in the UK probably have inadequate levels of vitamin D in their blood. People at risk of vitamin D deficiency, including pregnant women and children under five, are already advised to take daily supplements.

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"Our experts are clear - low levels of vitamin D can increase the risk of poor bone health, including rickets in young children.

"Many health professionals such as midwives, GPs and nurses give advice on supplements, and it is crucial they continue to offer this advice as part of routine consultations and ensure disadvantaged families have access to free vitamin supplements through our Healthy Start scheme.

"It is important to raise awareness of this issue, and I will be contacting health professionals on the need to prescribe and recommend vitamin D supplements to at-risk groups."

It has long been known that vitamin D prevents rickets and children were once given food supplements like cod liver oil.

However, this practice was stopped in the 1950s because it was thought unnecessary.

In the last 10 years, doctors have been seeing more cases of vitamin D deficiency, leading to a debate over the use of food supplements and concern that many medical staff are unaware of the problem.

Source BBC

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Steroid medications tied to vitamin D deficiency

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NEW YORK | Fri Oct 28, 2011 12:12am EDT

NEW YORK (Reuters Health) - People who use oral steroid medications may be at greater-than-average risk of a serious vitamin D deficiency, a new study suggests.

The findings, reported in the Journal of Clinical Endocrinology & Metabolism, do not prove that the drugs themselves are the cause.

But they do suggest that people on the medications should have their doctors check their blood levels of vitamin D, researchers say. And that may be especially important for children.

Steroid medications help control inflammation and are used for a number of medical conditions -- including asthma, certain types of arthritis such as rheumatoid arthritis and autoimmune diseases like Crohn's disease, lupus and multiple sclerosis.

In the new study, researchers found that among nearly 23,000 Americans in a government health survey, those using oral steroid medications were twice as likely as non-users to have a severe vitamin D deficiency.

Overall, 11 percent of those on steroids had a vitamin D level below 10 ng/mL -- which is considered too low to keep your bones, or the rest of you, healthy. That compared with five percent of study participants not on steroids.

Vitamin D levels that low can lead to a serious softening of the bones or muscle pain. Blood levels of about 20 ng/mL or above are considered sufficient for health.

"When doctors write that prescription for steroids and they're sending the patients for lab tests, they should also get the vitamin D level measured," lead researcher Dr. Amy L. Skversky, of Albert Einstein College of Medicine in New York, said in a news release from the university.

Skversky's team based their findings on a national health survey done between 2001 and 2006. It included 22,650 U.S. adults and children who had blood samples taken and reported on their medication use.

Just under one percent of the group said they'd used oral steroids in the past month -- which would translate to 2.1 million Americans likely taking the drugs nationwide.

The steroid users in the study were twice as likely to have a vitamin D deficiency, even after researchers accounted for several other factors that affect D levels -- including obesity, milk intake and vitamin D supplement use.

The link was especially strong among children. Steroid users younger than 18 were 14 times more likely to have a vitamin D deficiency than kids not taking the medications.

It's not clear that the medications themselves were to blame, or fully to blame. It's likely, according to Skversky's team, that the conditions the drugs treat contribute to low vitamin D levels.

Some of those disorders can lead to poor nutrient absorption, for example, or limit people's physical activity -- which may mean more time indoors, away from the sunlight that triggers the body's natural ability to make vitamin D.

On the other hand, there is evidence that steroid medications may lead to vitamin D deficiency, possibly by boosting an enzyme that curbs the vitamin's activity in the body.

The bottom line, according to Skversky, is that patients and doctors should be aware of the higher risk of vitamin D deficiency linked to oral steroids.

The latest recommendations from the Institute of Medicine, an advisory body to the U.S. government, are for most children and adults to get 600 IU of vitamin D per day. Adults older than 70 are advised to get 800 IU.

There are no special recommendations for people on steroid medication.

The sun is the major natural source of vitamin D. Food sources are relatively few and include fatty fish like salmon and mackerel, as well as dairy products and cereals that have added vitamin D. Multivitamins also contain vitamin D.

Not all steroids are taken orally. The study did not look at inhaled steroids, like those often used by people with asthma, so it's not clear if the findings would apply to those medications.

SOURCE: bit.ly/rLA1t2 Journal of Clinical Endocrinology & Metabolism, online September 28, 2011.

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Worried about vitamin safety? Experts offer advice

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In this Thursday, Oct. 13, 2011 photo illustration, multivitamins are poured from a bottle in Philadelphia. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) In this Thursday, Oct. 13, 2011 photo illustration, multivitamins are poured from a bottle in Philadelphia. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) The nutritional label of a box of multivitamins is photographed in Philadelphia on Thursday, Oct. 13, 2011. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) The nutritional label of a box of multivitamins is photographed in Philadelphia on Thursday, Oct. 13, 2011. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); Two studies this week raised gnawing worries about the safety of vitamin supplements and a host of questions. Should anyone be taking them? Which ones are most risky? And if you do take them, how can you pick the safest ones?

Vitamins have long had a "health halo." Many people think they're good for you and at worst might simply be unnecessary. The industry calls them an insurance policy against bad eating.

But our foods are increasingly pumped full of them already. Even junk foods and drinks often are fortified with nutrients to give them a healthier profile, so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit.

"We're finding out they're not as harmless as the industry might have us believe," said David Schardt, a nutritionist at the consumer group Center for Science in the Public Interest.

This week, a study of nearly 40,000 older women found a slightly higher risk of death among those taking dietary supplements, including multivitamins, folic acid, iron and copper. It was just an observational study, though, not a rigorous test.

Another study found that men taking high doses of vitamin E — 400 units a day — for five years had a slightly increased risk of prostate cancer.

As many as one-third of Americans take vitamins and nearly half of people 50 and older take multivitamins, surveys suggest. Americans spent $9.6 billion on vitamins last year, up from $7.2 billion in 2005, according to the Nutrition Business Journal. Multivitamins top the list, at nearly $5 billion in sales.

Yet there is no clear evidence that multivitamins lower the risk of cancer, heart disease or any other chronic health problems. No government agency recommends them "regardless of the quality of a person's diet," says a fact sheet from the federal Office of Dietary Supplements. And vitamins aren't required to undergo the strict testing required of U.S.-approved prescription medicines.

Some fads, such as the antioxidant craze over vitamins A and E and beta-carotene, backfired when studies found more health risk, not less. And studies that find more disease in people with too little of a certain vitamin can be misleading: Correcting a deficiency so you have the right daily amount is different from supplementing beyond recommended levels.

The best way to get vitamins is to eat foods that naturally contain them, said Jody Engel, a nutritionist with Office of Dietary Supplements. "Foods provide more than just vitamins and minerals, such as fiber and other ingredients that may have positive health effects."

Schardt adds: "It's virtually impossible to overdose on the nutrients in food."

Some folks may need more of certain nutrients and should talk with their doctors about supplements:

— Postmenopausal women regarding calcium and vitamin D to protect bones.

— Women planning on pregnancy regarding folate, or folic acid, to prevent birth defects.

— People over age 50 and vegans who may need vitamin B12. "As we get older, a number of us no longer produce enough acid in the stomach to extract the B12 in food," Schardt explained.

— Pregnant women, who may need extra iron.

— Breastfed infants and possibly other infants concerning vitamin D.

Vitamin D is a nutrient many of us may need to supplement. Last fall, the Institute of Medicine, a panel of scientists who advise the government, raised the recommended amount but also warned against overdoing it. People ages 1 to 70 should get 600 international units a day, older folks 800 units.

If you do need a supplement, beware: Quality varies. Consumerlab.com, a company that tests supplements and publishes ratings for subscribers, has found a high rate of problems in the 3,000 products it has tested since 1999.

"One out of 4 either doesn't contain what it claims or has some other problems such as contamination or the pills won't break apart properly," said company president Dr. Tod Cooperman.

For example, one gummy bear calcium product had 250 percent of the amount of vitamin D claimed on the label. Another liquid product made with rose hips had just over half the amount of vitamin C listed.

"You don't have to pay a lot. Price is not necessarily linked to quality," he said. "The quality doesn't really relate to where you're buying it. I know many people are surprised by that or don't want to believe it, but that is the case. We find good and bad products in every venue."

Mark Blumenthal, executive director of the American Botanical Council, suggests looking for "seals of approval" or certifications of quality from groups that spot-test supplements such as the USP, or United States Pharmacopeia; NSF International and NPA, the Natural Products Association.

Experts offered this advice:

— Keep it simple. The more ingredients there are in a supplement combo, the more chance that one of them will not be the right amount, Cooperman said.

— Consider a supplement combo tailored to your gender and age, the Office of Dietary Supplements suggests. Multivitamins often contain little iron, and ones for seniors give more calcium and vitamin D than products aimed at younger adults.

— Take vitamin D with dinner. A study found significantly more absorption of that nutrient when it was consumed at the largest meal, which tends to have more fat, than at breakfast, Cooperman said.

— Watch out for vitamin K — it promotes clotting and can interfere with common heart medicines and blood thinners such as warfarin, sold as Coumadin and other brands.

— Current and former smokers are advised to avoid multivitamins with lots of beta-carotene or vitamin A; two studies have tied them to increased risk of lung cancer.

— For cancer patients, "vitamins C and E might reduce the effectiveness of certain types of chemotherapy," Engel said.

— People having surgery should know that some vitamins can affect bleeding and response to anesthesia.

With any supplement — ask your doctor.

__

Online:

Vitamin facts: http://ods.od.nih.gov/factsheets/list-VitaminsMinerals

and http://ods.od.nih.gov/factsheets/MVMS-HealthProfessional

FAQs: http://ods.od.nih.gov/Health_Information/ODS_Frequently_Asked_Questions.aspx

Dietary advice: www.dietaryguidelines.gov

Vitamin E and prostate study: http://jama.ama-assn.org/content/306/14/1549

Video interview with author: http://jama.ama-assn.org/content/306/14/1549/suppl/DC1

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Vitamin E May Increase Risk of Prostate Cancer

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Adding to the evidence that regularly taking dietary supplements may do more harm than good, researchers at the Cleveland Clinic have found that men taking vitamin E are not protected from prostate cancer, and may even be at higher risk for disease, compared with men not using the supplements.

The new study is only the latest blow to E, a popular supplement that has been touted as a powerful way to prevent everything from prostate and breast cancer to heart disease, vision loss and Alzheimer's. In recent years, however, in-depth studies have broken vitamin E's healthy spell, finding that people who take it are no better off than people who don't.

Still, based on animal studies and early population studies, scientists had believe that vitamin E supplementation could be a smart and inexpensive way to prevent prostate tumors, given that the vitamin's antioxidant effects may combat potentially damaging changes to the DNA in prostate cells.

"This finding was surprising, because all the evidence previously suggested that vitamin E may be protective against prostate cancer," says the Cleveland Clinic's Dr. Eric Klein, lead author of the new study published in the Journal of the American Medical Association.

MORE: Multivitamins, Dietary Supplements Linked to Death in Older Women

The current study is a follow-up to one of the first rigorous studies of the effects of vitamin E and selenium on prostate cancer risk, published by Klein and colleagues in 2008. That study, in which men were randomly assigned to take either supplement, or both together, or a placebo, Klein and his team found no difference in cancer risk among any of the groups, suggesting that vitamin E offered no protective anticancer benefit. Based on those results, the study was stopped. Additional analysis revealed that vitamin E may even boost risk of developing tumors.

To further understand what was going on, Klein continued the study with the majority of participants, who had stopped taking supplements but had agreed to continue providing information on their prostate cancer status for an additional 18 months.

In that time, Klein and his team found that even after the men had stopped taking vitamin E, their risk of prostate cancer remained higher than that of men who had originally been assigned a placebo. "The effect seemed to continue even after the supplements stopped," he says, suggesting that vitamins have powerful effects on body systems that may have lasting consequences. "People have to get out of the idea that taking vitamins is innocuous, and that their effects stop when they stop taking them."

Klein doesn't know exactly how vitamin E may increase the risk of prostate, but is hoping that his biobank of tissue samples from participants in the trial, which contains their starting levels of vitamin E and selenium, might provide some clues. By accounting for these baseline levels of the vitamin, he or others hope to determine whether it's vitamin E itself, or whether it's the dose of the vitamin, that may be contributing to prostate cancer. For example, people who are deficient in vitamin E may be able to take supplements safely and may even benefit from some anticancer effect, while those who are already getting enough of the vitamin may, by taking extra doses, trigger some as-yet unknown mechanism that prompts prostate cancer cells to grow abnormally.

MORE: Eating Fruits and Veggies May Outwit Bad Heart Genes

So, it's still possible that vitamin E supplements may help prevent some disease. So far, the most promising results are with Alzheimer's patients. In some studies, people with early signs of dementia show slower rates of cognitive decline if they take vitamin E than if they don't. But even here, the evidence isn't strong enough for doctors to recommend that those on the road to Alzheimer's take E to ward off their disease.

Overall, it seems, the growing consensus is that unless you need supplements to treat a specific deficiency, nutrients and vitamins are best obtained through a healthy diet. And that goes for E as well, says Klein, since it won't help you avoid cancer. "There doesn't seem to be much benefit to taking vitamin E if you are otherwise healthy," says Klein.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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Vitamin E pills linked with prostate cancer risk

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In this Monday, Oct. 10, 2011 photo, Joe Latina, 71, is shown on his porch at his home in Ashtabula, Ohio. Latina participated in a study involving vitamin E pills. Vitamin E pills are linked with an increased risk for prostate cancer, according to follow-up data from a study aiming to see if the supplements could prevent the disease but halted when there were signs of possible harm. Men who had been randomly assigned to take vitamin E were 17 percent more likely to get prostate cancer than those given dummy pills, the follow-up report found. (AP Photo/Tony Dejak) In this Monday, Oct. 10, 2011 photo, Joe Latina, 71, is shown on his porch at his home in Ashtabula, Ohio. Latina participated in a study involving vitamin E pills. Vitamin E pills are linked with an increased risk for prostate cancer, according to follow-up data from a study aiming to see if the supplements could prevent the disease but halted when there were signs of possible harm. Men who had been randomly assigned to take vitamin E were 17 percent more likely to get prostate cancer than those given dummy pills, the follow-up report found. (AP Photo/Tony Dejak) In this Monday, Oct. 10, 2011 photo, Joe Latina, right, 71, walks with his wife, Rita, along the shores of Lake Erie in Ashtabula, Ohio. Joe Latina participated in a study involving vitamin E pills. Vitamin E pills are linked with an increased risk for prostate cancer, according to follow-up data from a study aiming to see if the supplements could prevent the disease but halted when there were signs of possible harm. Men who had been randomly assigned to take vitamin E were 17 percent more likely to get prostate cancer than those given dummy pills, the follow-up report found. (AP Photo/Tony Dejak) In this Monday, Oct. 10, 2011 photo, Joe Latina, 71, is shown on his porch at his home in Ashtabula, Ohio. Latina participated in a study involving vitamin E pills. Vitamin E pills are linked with an increased risk for prostate cancer, according to follow-up data from a study aiming to see if the supplements could prevent the disease but halted when there were signs of possible harm. Men who had been randomly assigned to take vitamin E were 17 percent more likely to get prostate cancer than those given dummy pills, the follow-up report found. (AP Photo/Tony Dejak)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); CHICAGO (AP) — There is more evidence that taking vitamin E pills can be risky. A study that followed up on men who took high doses of the vitamin for about five years found they had a slightly increased risk of prostate cancer — even after they quit taking the pills.

Doctors say it's another sign that people should be careful about using vitamins and other supplements.

"People tend to think of vitamins as innocuous substances, almost like chicken soup — take a little and it can't hurt," said lead author Dr. Eric Klein of the Cleveland Clinic. The study shows that is not true.

"If you have normal levels, the vitamin is probably of no benefit, and if you take too much, you can be harmed," Klein said.

Men randomly assigned to take a 400-unit capsule of vitamin E every day for about five years were 17 percent more likely to get prostate cancer than those given dummy pills. That dose, commonly found in over-the-counter supplements, is almost 20 times higher than the recommended adult amount, which is about 23 units daily.

The results mean for every 1,000 men who took vitamin E, there were 11 additional cases of prostate cancer, compared with men taking dummy pills.

The study was actually launched to try to confirm less rigorous research suggesting vitamin E might protect against prostate cancer. Overall, about 160 of every 1,000 U.S. men will develop prostate cancer in their lifetime.

Risks increase as men age. Detection can be tricky since symptoms such as frequent urination can also be caused by harmless conditions, and doctors disagree about the benefits of screening tests. Treatment is also complex since some slow-growing prostate cancers are not deadly but some procedures, including surgery, can damage sexual function and cause incontinence.

Just last week, a government-convened panel of experts recommended against routine PSA screening for prostate cancer. That draft advice is open for public comment.

What should vitamin E users do, given the new study results? About 13 percent of American men take it, according to a supplement trade group.

Dr. Otis Brawley, chief medical officer for the American Cancer Society, says they should stop taking large doses and talk to their doctors about risks and benefits from prostate cancer screening. Smaller doses, typically found in multivitamins, are probably fine, said Brawley, who was not involved in the research.

Vitamin E is found in foods such as nuts, seeds and vegetable oils. The nutrient helps nerves, muscles, blood vessels and the immune system function.

Vitamin E supplements have long been promoted for disease prevention, but scientific research has disproven many claims and suggested they might increase risks for some conditions, including heart failure.

Brawley noted that the study echoes previous thinking on beta-carotene, which once was thought to protect against cancer but more recently has been linked with increased risks for lung cancer, especially in smokers.

"There should be a global warning that ... excessive use of vitamins has not been proven to be beneficial and may be the opposite," Brawley said.

Experts generally agree that foods are the best sources for vitamins.

The new research appears in Wednesday's Journal of the American Medical Association. The National Cancer Institute and National Center for Complementary and Alternative Medicine paid for the multimillion-dollar study.

Joe Latina, a cabinet shop owner in Aurora, Ohio, was among study participants. He said researchers gave him pills they said "might slow down prostate cancer." Now 71 and cancer-free, he says he doesn't know whether he was given vitamins or dummy pills.

Latina said he "was kind of surprised" by the study results, but is not stressing out over the possibility that he still might get cancer.

"I'm a positive thinker," he said. "I'm not walking around saying, 'Oh my God, the other shoe is going to drop. I don't think I have any way to control it."

The study involved more than 35,000 healthy men aged 50 and older, from the United States, Canada and Puerto Rico. They were randomly assigned to take daily vitamin E or selenium supplements, both pills or dummy pills. The study was halted after about five years when there were signs of no benefit and a possible increased risk for prostate cancer in vitamin E users. The researchers continued tracking the men even after they stopped taking pills.

The follow-up found that a potential link between selenium and diabetes was a false alarm, but it confirmed signs of a vitamin E-prostate cancer link. Over a total of about seven years, there were 76 cases of prostate cancer diagnosed per 1,000 men, versus 65 cases in men given dummy pills.

"The implications of our observations are substantial," the study authors said.

The results suggest that extra risks associated with taking relatively high doses of vitamin E continue even after supplements are stopped. The researchers said it is unclear how vitamin E would harm the prostate.

There was no increased risk for men who took both vitamin E and selenium, suggesting that selenium might somehow counter the harmful effects of vitamin E, the study authors said.

Duffy MacKay of the Council for Responsible Nutrition, a supplement makers' trade group, said the study shouldn't be interpreted as questioning the benefits of vitamin E as an essential nutrient, and he said there is evidence that many Americans don't get enough.

___

Online:

JAMA: http://www.jama.ama-assn.org

National Cancer Institute: http://www.cancer.gov

PSA recommendations: http://www.ahrq.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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Vitamin pills 'may shorten life'

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11 October 2011 Last updated at 00:57 GMT By Michelle Roberts Health reporter, BBC News A healthy diet should provide enough nutrients without the need for supplements, experts advise When it comes to vitamins, it appears you could have too much of a good thing, say researchers who report a link between their use and higher death rates among older women.

Experts have suspected for some time that supplements may only be beneficial if a person is deficient in a nutrient.

And excess may even harm, as the study in Archives of Internal Medicine finds.

All of the women, in their 50s and 60s, were generally well nourished yet many had decided to take supplements.

Multivitamins, folic acid, vitamin B6, magnesium, zinc, copper and iron in particular appeared to increase mortality risk.

The researchers believe consumers are buying supplements with no evidence that they will provide any benefit.

Harms v gains Continue reading the main story

Based on existing evidence, we see little justification for the general and widespread use of dietary supplements”

End Quote The study authors They are quick to stress that their study relied on the 38,000 US women who took part in it recalling what vitamins and minerals they had taken over the previous two decades.

And it is difficult to control for all other factors, like general physical health, that might have influenced the findings.

But they say their findings suggest that supplements should only be used if there is a strong medically-based cause for doing so because of the potential to cause harm.

"Based on existing evidence, we see little justification for the general and widespread use of dietary supplements," Dr Jaakko Mursu of the University of Eastern Finland and his research colleagues said.

Less is more

In the study, iron tablets were strongly linked with a small (2.4%) increased death risk, as were many other supplements. The link with iron was dose-dependent, meaning the more of it the individual took, the higher their risk was.

Continue reading the main story

Too much can be toxic and it is easy to inadvertently take more than the recommended daily amount”

End Quote Helen Bond British Dietetic Association Conversely, calcium supplements appeared to reduce death risk. However, the researchers say this finding needs more investigation and they do not recommend that people take calcium unless advised to by a doctor in order to treat a deficiency.

Drs Christian Gluud and Goran Bjelakovic, who review research for the Cochrane Database of Systematic Reviews to evaluate best evidence, said: "We think the paradigm 'The more the better' is wrong."

They say dietary supplementation has shifted from preventing deficiency to trying to promote wellness and prevent diseases, and caution: "We believe that for all micronutrients, risks are associated with insufficient and too-large intake."

Helen Bond of the British Dietetic Association said some people, like the elderly, might need to take certain supplements. For example, vitamin D is recommended for people over the age of 65.

But she said that generally, people should be able to get all the vitamins and minerals they needed from a healthy, balanced diet.

She said some took supplements as an insurance policy, wrongly assuming that they could do no harm. "But too much can be toxic and it is easy to inadvertently take more than the recommended daily amount."

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Vitamin D not tied to fibrillation

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By Linda Thrasybule

NEW YORK | Fri Sep 16, 2011 5:19pm EDT

NEW YORK (Reuters Health) - Despite some research linking low vitamin D levels to heart disease, a new study suggests that lacking D does not increase one's risk of an irregular heartbeat known as atrial fibrillation.

Researchers followed nearly 3,000 middle-aged and older adults in the long-running Framingham Heart Study for roughly 10 years and found that 425 people developed atrial fibrillation.

But, Dr. Michiel Rienstra of Massachusetts General Hospital and his colleagues found there was no difference in the likelihood of getting the condition between people with the highest vitamin D levels in their blood and those with the lowest.

Atrial fibrillation stems from a malfunction in the heart's electrical system, which causes the irregular heartbeat. That can lead blood to pool in the heart, increasing the risk of blood clots, which in turn may cause strokes. Treatment often includes blood thinners taken to prevent clots.

"I think the study was done well," said Dr. Michal Melamed, who studies vitamin D at the Einstein School of Medicine in New York and was not involved in the research. It shows that this one vitamin doesn't have an effect on all heart diseases, which is a good thing, she said.

A 2008 study of the same group of Framingham participants found that vitamin D levels were associated with an increased risk of cardiovascular disease.

"We think that low vitamin D affects the architecture of the heart, but I'm not sure that it affects the electrical system of the heart," Melamed told Reuters Health.

Published in the American Heart Journal, the study included roughly equal numbers of men and women, ranging in age between about 54 and 76.

A recent review by the U.S. Institute of Medicine concluded that most Americans get sufficient vitamin D and that there's insufficient evidence consuming much higher amounts would offer any greater health benefits.

Whether people should consider vitamin D important for their heart health is still controversial, said Dr. Emelia Benjamin of the Boston University School of Medicine, who worked with Rienstra on the new research. "There's a lot of speculation and it's still undergoing study."

SOURCE: bit.ly/niHaJQ American Heart Journal, September 2011.

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