Diseases, Drugs and Vitamin D deficiency

Vitamin D Deficiency, diseases and drugs

Vitamin D is needed by almost every tissue in the body, so the harm from deficiency isn’t surprising. The majority of research on vitamin D deficiency and depression found a correlation between the two, but a few studies didn’t. In one such study, “Low vitamin D status is associated with more depressive symptoms in Dutch older adults,” (E.M. Brouwer-Brolsma, et al, in European Journal of Nutrition, 2016, 55:1525-1534) supplementing those with depression with vitamin D for two years didn’t lead to any improvement. Is there some other benefit from sun exposure apart from vitamin D synthesis that improves mood?

Vitamin D is needed to absorb calcium. It also helps regulate this mineral in the body. So, it isn’t surprising that vitamin D deficiency is associated with weak even deformed bones in children. A lack of this vitamin can also lead to seizures and heart failure. In adults, vitamin D deficiency can lead to hypertension, coronary artery disease, and heart failure. In one study of patients with heart failure, 87% were found to be significantly deficient in vitamin D. Muscle weakness is common with a shortfall of the vitamin, so it isn’t surprising that falls and fractures are more common in those with a lack of it.

It has long been known that vitamin D is needed by many of the immune system cells and those that are deficient in t have a much higher risk of developing autoimmune disorders such as type 1 (juvenile) diabetes as well as multiple sclerosis. A country in northern Europe started giving infants vitamin D every day for their first year and after twenty years of this practice, the rates of type 1 diabetes fell by over 80%! Resent research shows a link between a lack of vitamin D and type 2 (adult onset) diabetes. The immune system is more able to fight infections if the blood level of vitamin D are normal.

Vitamin D appears to boost the body’s cancer-fighting ability. Those with metastatic colon cancer may have a longer life expectancy if they maintain adequate levels of it. This isn’t surprising given the way it supports immune system functioning.

Some medications have been found to be linked to vitamin D deficiency. This information comes from “Vitamin D deficiency as adverse drug reaction? A cross sectional study in Dutch geriatric outpatients.” (A.C.B. van Orten-Luiten, et al, in European Journal of Clinical Pharmacology, 2016, 72:605-614). The following are those uncovered thus far:

  • metformin for type 2 diabetes
  • loop diuretics such as furosemide and potassium-sparing diuretics like spironolactone
  • digoxin used for heart failure and atrial fibrillation
  • warfarin, a medication that decreases blood clot formation
  • ACE inhibitors such as lisinopril and
  • SSRI antidepressants such as sertraline.

See your health care provider if you are taking one of these medications and ask if a vitamin D supplement may be recommended. Those needed to avoid sun exposure may want to ask about this as well.


Vitamin D Deficiency and Diabetes

Vitamin D Deficiency and Diabetes

While vitamin D deficiency has long been linked with bone disorders such as rickets, a large number of research studies have found evidence that it may increase a person’s risk for autoimmune disorders, particularly type 1 diabetes. More recent studies have found that a lack of vitamin D may also increase the risk of type 2 diabetes. Conversely, having consistently adequate levels seems to offer protection from colon cancer, as well as infections. This may seem like a pretty broad effect but studies have uncovered some facts that may explain that.

According to the article “Role of Vitamin D in Insulin Resistance,” by C. Sung, et al (Journal of Biomedicine and Biotechnology, volume 2012, article ID 634195) vitamin D has been found to be involved in tempering both the adaptive immune and inflammatory responses. It is also involved in managing cell proliferation and differentiation. That translates to helping the body attack foreign invaders but keeping it from attacking its own tissues. Autoimmune disorders are caused by the immune cells attacking the body’s tissues. Many immune cells have vitamin D receptor so it isn’t surprising that immune cells damaged by a vitamin D deficiency would be more likely to do that.

It is a little more complicated how vitamin D deficiency may promote the development of type 2 diabetes. What we do know is that there are receptors for vitamin D on pancreatic cells and the vitamin protects the insulin-producing beta cells in the pancreas from harmful immune cell attacks. It also improves beta cell functioning.

Insulin receptors are found on skeletal muscles, fat cells and in the liver. When insulin fits in these receptors, it causes the cells to allow glucose to enter so that the cells can make energy. But those receptors don’t work very well in those with type 2 diabetes. It is significant that vitamin D improves insulin receptor functioning, or, as it is often called, insulin sensitivity. If the vitamin protects insulin producing cells in the pancreas and enhances the functioning of the insulin receptors, it isn’t surprising that it lowers the risk of type 2 diabetes.

Since vitamin D is a fat-soluble vitamin, it is difficult for the body to get rid of excess vitamin D. The recommended intake for adults up to age 71 is 600 IU/day, and for those 71 and older its 800 IU/day. The upper limit is 4,000 IU/day. In The Clinical Advisor for August 2017, a study of vitamin D intake noted that people are taking more of it (“High-dose vitamin D supplements and adverse events”). 3% in the study exceeded that amount. It is too soon to say what the harmful effects are from too much vitamin D, but there doesn’t seem to be any benefit from exceeding that upper limit. This information isn’t intended to replace consultation with your health care provider and their recommendations.


The Power of Pumpkin

You really can’t judge a book by its cover, or a food by its outward appearance. Pumpkin may look like a blank canvas of autumn artists or an iconic Thanksgiving star but it deserves better. Here are some of the benefits of pumpkin:

  • High in fiber (5 grams per half cup serving)
  • Low in calories (83 calories in one cup)
  • Rich in alpha- and beta-carotene which the body converts to vitamin A

The carotenes in pumpkin make it particularly powerful. Beta-carotene has been extensively studied. One benefit of it that

scientists have discovered is that this antioxidant helps prevent oxidation of cholesterol, and this effect keeps arterial plaque from getting larger. Carotenes also have an anti-inflammatory property.

What diseases can the nutrients in pumpkin help prevent?

  • Arterial diseases that lead to a stroke or heart attack
  • Cataracts and macular degeneration
  • Lung, colon, bladder, cervical, breast and skin cancer
  • Population studies suggest it may also protect from esophageal, stomach, prostate and laryngeal cancer as well
  • Recent research offers hope that it may support the insulin-producing cells in the pancreas, helping to prevent diabetes, or, if its developed, slow the progress of type 2 diabetes

In Jean Carper’s The Food Pharmacy (New York, 1988), pumpkin seeds have also been found to have some cancer-fighting powers. This book includes some interesting information on the correlation between regular pumpkin intake and lower lung cancer rates in smokers and those exposed to cigarette smoking on a regular basis.

Another advantage of pumpkin is that it is inexpensive. Pumpkin season has just ended so fresh pumpkin isn’t as widely available. In Steven Pratt, MD, and Kathy Matthews’ book SuperFoods Rx (New York, 2004), canned pumpkin is just as nutritious as fresh pumpkin. It doesn’t contain the seeds but it is convenient and fairly inexpensive. Avoid canned pumpkin pie filling since it has sugar added to it and that is one food that not only doesn’t prevent disease but can cause it.

Medications used to treat type 2 diabetes

Oral Medications for Diabetes

There are two major types of diabetes, type 1 which was once called juvenile diabetes, and type 2 diabetes – previously referred to as adult-onset diabetes. Type 1 affects about 1 in 100 Americans “Diabetes Medications:  The next Generation of Oral Agents, Insulin and more” by Donna Ellis in MedSurg Nursing, July/August 2013, volume 22, issue #4); it is usually diagnosed in children, thus its original name. It starts with the body’s immune system attacking and destroying the cells in the pancreas that make insulin. Because insulin is needed to allow glucose to move into muscle and fat cells, without it those cells burn fat for energy and the pH level of the blood drops dramatically. This is an emergency. Those with this type of diabetes require insulin replacement and the oral diabetes medication would not help them.

Type 2 diabetes is much more common, affecting about 10% of Americans (Ellis, 2013). It develops much more slowly and there is often a long period before diagnosis when the pancreas makes too much insulin. This occurs because the insulin receptors, molecules on fat and muscle cells that the insulin fits into to have its effect, are not working properly. This abnormality in the receptors is called insulin resistance.  The extra insulin helps get the glucose into cells and prevents the buildup of glucose in the bloodstream where too much glucose can damage arteries and other tissues. The high levels of insulin make it difficult to lose weight since insulin enhances fat storage.

When the pancreas can no longer keep up with the excess insulin production, the blood glucose (also called blood sugar) level rises. It is at this point that diabetes can be diagnosed. Treatment may include diet changes, weight loss, and exercise. Medications can be started to help lower the blood sugar level.

One group of medications used is the sulfonylureas. These medications increase production of insulin by the pancreas. They have been used for years but the newer, second generation sulfonylureas are most often used. Because they increase insulin secretion, they can cause hypoglycemia, an abnormally low blood sugar. This is a dangerous situation because the brain relies on the glucose in the blood. Not surprising, many of the symptoms of hypoglycemia are caused by the lack of glucose in in the brain such as headache, irritability, shakiness, and even confusion if it gets severe, confusion. It has to be treated quickly with something high in sugar such as orange juice or regular soda. Per an article in Diabetic Medicine (C. L. Edridge et al, March 2015) about hypoglycemia caused by diabetes medications, in a one month period more than 50% of those with type 2 diabetes had an episode of hypoglycemia in the month before the study was conducted.

Sulfonylureas can also contribute to weight gain. Because of these side effects and the way these drugs can advance pancreatic beta cell burnout, some recommend the use of sulfonylureas (“A dynamic duo for T2DM” by C. Winter, in Nurse Practitioner Perspective, July/August 2015).

Biguinides in another class of oral medications for diabetes. This has become first-line treatment. It lowers the blood glucose level by decreasing the breakdown of the storage form of glucose in the liver. Because it doesn’t increase insulin production, it doesn’t cause hypoglycemia. It can cause diarrhea, especially when treatment is started at a high dose.

Glitazones are medications that make the insulin receptors more sensitive to insulin. They can cause the body to retain fluids and this can potentially worsen heart failure.

Alpha glucosidase inhibitors decrease the breakdown of complex carbohydrates like bread into simple sugars like glucose. These drugs are particularly helpful in decreasing the after meal rise in blood sugar. Side effects they can cause include flatus and diarrhea. They don’t lower the average blood sugar as much as the other oral diabetes medications. This is measured by a test called a hemoglobin A1C. It measures how much glucose is attached to red blood cells and the level goes up the more glucose the cells are exposed to so it is much better at gauging diabetes management.

Adherence is a common issue for the treatment of many chronic illness. In “Failure to Reach Target Glycosylated A1C Levels Among Patients with Diabetes Who Are Adherent to Their Antidiabetic Medication” by D. Juarez, et al (Population Health Management, Volume 17, number 4, for 2014) the compliance rate for diabetes medication use ranges from 67 to 85%. This article studied the records of thousands of patients that were deemed adherent to their medication regime. Adherence was assessed based on patients getting their medications refilled. 56.1% of such compliant patients were deemed to have poor control of their diabetes. This was quantified as having a hemoglobin A1C of >7%. One of the responses to this low rate of success was that diet, weight management and/or exercise were not being fully attended to. There are certainly other possibilities, some of which they suggested. But, as was noted in C. Winter’s article, diet and exercise can lower the glycosylated hemoglobin (hgb A1C) by 1 to 2%. This is a significant decrease and perhaps an area that needs to be emphasized.

This article is not intended to replace your health care provider. The intent is to make important information about medications available.