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 best way to prevent an infection

The best way to prevent infections

Since we’re living in an era when there isn’t an antimicrobial drug for every infection, prevention is critical. Although there have been a lot of advances in medicine, proper hand washing is the best way to prevent picking up or spreading an infection. Proper in italics because this is key, and I would venture to say most people don’t do that. That changed after reading Dr. Frederic Saldmann’s Wash Your Hands! (New York: Weinstein Books, 2008).

It’s no secret that hands carry a lot of germs, and not just those that cause skin infections or gastroenteritis. We cough into our hands, touch computers and elevator buttons, shake hands, touch our face, grab onto the handrails of stairs, touch toilet seats and sink faucets, touch our face, pick up fruits and vegetables at the grocery store, touch our face, and then do a split-second wash that may be giving the germs just the chance they need to start a very big family and also get free housing.

Proper hand washing includes washing every part including the space between fingers and cuticles. In the article “Implementing Infection Prevention and Control Precautions in the Community” by Deborah Ward (British Journal of Community Nursing, March 2017, vol. 22, #3) it’s noted that fingernails and fingertips have the highest number of organisms. The author adds that rings and other jewelry can also be a reservoir for germs. She also notes that alcohol-based sanitizers don’t kill the germs that cause the pseudomembranous colitis, a serious lower GI infection.

Drying is just as important because, per Dr. Saldmann’s book, moist hands carry five hundred times as many pathogens as dry hands! Yet another study found that about a third of hand washers don’t dry their hands. And using a damp towel can contaminate washed hands. The most startling news is that using a warm-air dryer actually leads to a significant increase in the number of germs on hands compared with the number before washing them!

After shaking hands with someone that had a recent trip to the bathroom and didn’t wash their hands, there’s a 33% chance you’ll get some of the bacteria from their feces in your mouth within a couple hours. If you think it’s rare for someone to not wash their hands after using the restroom, guess again. In one study, almost half of the research subjects didn’t wash their hands then if they were alone; that’s five times the rate of those who are in the bathroom with other people around. Proper hand washing takes less than a minute – a worthy investment!

Antibiotic Resistance – A very real Danger

Antibiotic Resistance – A very real danger

The emergence of bacteria that are resistant to various antibiotics has been deemed a major public health threat. This sobering judgment if from an article in the Health and Human Services and Centers for Disease Control’s Morbidity and Mortality Weekly Reports. The article, “Elements of Outpatient Antibiotic Stewardship” by G. Sanchez, et al (MMWR for November 11, 2016, Vol. 65, number 6), was written for prescribers but the message is applicable to everyone.

We are all stakeholders in the use of antibiotics. Health care providers may be tempted to give a patient a prescription for an unnecessary antibiotic course because they are rushed or in an effort to please survey-writing patients. It is much easier to do that than to take the time to explain why an antibiotic isn’t needed and to describe other things that may speed recovery from a viral infection or help the person feel better.

Patients encourage the inappropriate use of antibiotics when they visit a health care provider when they have a cold or allergies, imagining that antibiotics will help. Furthermore, if the provider hedges about prescribing the coveted antibiotic, the patient may ignore the providers experience- and education-based decision and continue to push. It can get to the point where the provider senses a negative and damaging comment from the patient may result, or just feel too tired or rushed to bother with more education.

It may not seem like a big deal, this overuse of antibiotics, but the research and statistics reveal how damaging this situation is. Bacteria that are resistant to many antibiotics contribute to an estimated 23,000 deaths in the U.S. each year. They are also responsible for some 2 million infections every year. Although antibiotics can be life-saving, inappropriate prescribing and use of antibiotics is the major reason why there are disease-causing bacteria that aren’t killed or kept from increasing in number.

Bacteria reproduce so quickly, it isn’t surprising that mutations develop. Mutations are abnormalities in an organism’s genes that develop because of exposure to a mutagen (a vague name for anything that instigates the error in DNA). Usually mutations don’t give the affected cells an advantage. Indeed, mutations usually make for weaker organisms, but because some mutated bacteria aren’t harmed by an antibiotic they were exposed to, they increase in number and spread, causing infections that are hard to treat.

Antibiotic resistance develops when antibiotics kill, or keep from reproducing, some bacteria in the body, but not all bacteria. Those that survive increase in number because the antibiotic has destroyed much of the competition. These bacteria can easily be spread to others and can also spread their mutated genes to other bacteria so that they’ll also be resistant to the same antibiotics.

The best way to stop antibiotic resistance isn’t with new antibiotics but with careful and appropriate use of the ones we have. In a November of 2015 article in Reader’s Digest, “When to Say No To an Antibiotics Prescription,” (reproduced from a Consumer Reports on Health), people are encouraged to not push for antibiotics for viral infections such as influenza, colds, acute bronchitis or sinus infections when there are no serious symptoms. If someone is unsure about what constitutes “serious symptoms” or signs, they should contact their health care provider. As with all information on this website, readers should not substitute it for the advice and care of their health care provider.