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A paper published this week in Immunity, a leading research journal highlighting discoveries in immunology by Cell Press, lays the groundwork to better understand and treat Crohn’s disease, a type of Inflammatory Bowel Disease (IBD). Beneficial interactions among intestinal cell types limit the harmful effects of a dysregulated gut microbiota, which is comprised of trillions of bacteria, viruses, and other microorganisms. These cell-cell interactions are essential to maintain a healthy gut and dysregulation of this cellular “crosstalk” can predispose the development of IBD.

Pawan Kumar

Led by Pawan Kumar, BVSc, PhD, of the Renaissance School of Medicine at Stony Brook University, the research identified a new role for Interleukin-17A (IL-17A), an immune cell-derived cytokine, in promoting selective epithelial cell development as well as limiting inflammation during colitis.Although drugs that target IL-17A are highly effective against psoriasis, an autoimmune condition, the same drugs result in adverse effects when used to treat the inflammatory responses of Crohn’s. While targeting IL-17A may reduce the pathogenesis of certain inflammatory responses, it is unclear why these treatments had opposing effects in Crohn’s patients. The research team has addressed this underlying question.

“We identified a new role for IL-17A in the intestinal inflammatory process by regulating a type of stem cell (Lgr5+) and progenitor cell function,” said Kumar, Senior Author and an Assistant Professor in the Department of Microbiology and Immunology. “We found that IL-17A acts on intestinal stem cells to promote secretory cell lineage commitment. In addition, impaired IL-17A signaling to secretory cells (ATOH1+) exacerbates colitis.

”The research team tested their findings in different murine models. Upon collaborating with Ken Cadwell of New York University, they confirmed their results in human organoids. They found that IL-17A stimulated secretory cell differentiation in cystic human intestinal organoids.“Our data suggest that there is a ‘cross talk’ between immune cells and stem cells that regulates secretory cell lineage commitment and the integrity of the mucosa,” summarizes Kumar.

The authors believe their findings will help further research and lay the groundwork for future clinical studies that investigate the therapeutic potential of IL-17A and/or its downstream effector proteins.This research is supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases, the Crohn’s and Colitis Foundation, the SUNY Research Foundation and a National Science Foundation Graduate Research Fellowship.

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Photo from Town of Smithtown
Photo from Town of Smithtown
Photo from Town of Smithtown

The Town of Smithtown successfully distributed over 2000 at-home Covid test kits to the most vulnerable population within the township. On Wednesday, Feb. 9, Town staff picked up 2,552 test kits from Suffolk County at the Department of Fire, Rescue and Emergency Services. On Thursday, Feb. 10, Smithtown Officials delivered approximately 2000 tests to seniors and at-risk individuals within the community, and at the Senior Center. On Monday morning, Feb. 14, the Department of Public Safety orchestrated a distribution event, where residents could collect their at-home tests outside of the Maple Avenue building.

“I’m extremely grateful to our partners in government at Suffolk County for arranging the much needed supply to be distributed to our residents, especially those who need it most. Our community members who are retired or living on a fixed income have certainly felt the cost of inflation, and this pandemic, in ways that have severely reduced quality of life. No one should have to sacrifice nutrition or grocery budgets to purchase PPE like face masks and covid tests. We owe it to our most vulnerable to provide the resources necessary to keep everyone healthy. While I hope the latest wave of the omicron variant was the last peak of Covid-19; these test kits will go a long way towards keeping people safe while cases are on the decline,” said Supervisor Ed Wehrheim.

The At-Home Covid-19 Antigen test kit (made in the USA) which includes two tests per box, were delivered to senior living communities throughout the township, at the Senior Center and at Public Safety. Supervisor Wehrheim’s office worked alongside Legislators Kennedy and Trotta to ensure locations were not replicated with the Legislators drop off locations and distribution events, to maximize the reach. When supplies ran out late on Monday morning at Public Safety, Legislator Robert Trotta generously allotted additional kits for the remaining residents.

Suffolk County will continue to work with the Town of Smithtown to provide additional Covid-19 related resources & PPE supplies for anyone in need. Residents who may be homebound, or are unable to obtain at-home test kits may email the Supervisors office at [email protected] with requests. For additional information on future at-home test kit distribution events within the township, residents can download the Town of Smithtown Mobile App, available for free on Google Play and the App Store.

Did You Know?

Residential households in the U.S. can order one set of four (4) free at-home tests through the US Postal Service. You can obtain a free at-home test kit by visiting covidtests.gov or by calling 1-800-232-0233 (TTY 1-888-720-7489).

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Organic Krush, an organic eatery with locations in Connecticut, New York and Virginia, has announced a partnership with Stony Brook University Athletics which includes a unique opportunity to fuel the athletes within the athletic arena, giving them direct access to healthy organic meals pre-and post workout. 

Krush worked directly with George Greene, Associate Athletic Director of High Performance and Competitive Success at SBU, to create the program, working together to select dishes based on macro-micro nutritional value, satiety and calories as well as variety, ultimately providing the athletes fueling options that reduce their body burden and allow then to train efficiently.

“Healthy clean eating is the wave of the future for athletes” said Michelle Walrath and Fran Paniccia, co-founders of Organic Krush. “As moms and parents of college athletes, we know the importance of food as fuel. Access to great tasting organic and plant based food can be difficult for college athletes. We started Organic Krush to make healthy food accessible to all. Our partnership with SBU Athletics gives us the opportunity to showcase the benefit of healthy eating to young athletes!”

“Organic Krush is the perfect partner for our athletes” said Greene. “Our goal is to keep our athletes healthy and strong on the field, court, track, and pool. Giving our athletes healthy balanced meals and uniting the passionate fans of SBU with the power of Organic Krush is a slam dunk for us! We are excited to welcome a partner that shares our commitment to improving the lives of our student-athletes as well as in the local community.”

Krush recently opened its 10th store around the corner from the Stony Brook University campus at 1111 Route 25A.

The partnership will kick off with a “Fuel Up with Krush” campaign echoing the importance of eating well for performance. Digital activations and event integrations spotlighting Organic Krush during games and events as well as a community-based summer fun run are planned.

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Do the benefits outweigh the risks?

By David Dunaief, M.D.

Dr. David Dunaief

Statins are one of the most commonly prescribed medications in the United States. First approved in the U.S. in 1987, they are still the “unpredictable uncle” at the pharmaceutical family table nearly 35 years later. 

Many in the medical community still disagree about who should be taking a statin and for what purpose; some believe that more patients should be on this class of drugs, while others think it is overprescribed. This is one of the most polarizing issues in medicine — probably rightly so.

The biggest debate is over primary prevention with statins. Primary prevention is treating people with high cholesterol and/or inflammation who may be at risk for a first cardiovascular event, such as a stroke or heart attack. Currently, recommendations of the American College of Cardiology and the American Heart Association do not align with those of the U.S. Preventive Services Task Force, which is currently reviewing its own recommendations because of data updates.

Most physicians agree that statins have their place in secondary prevention — treating patients who have had a stroke or heart attack already or who have coronary artery disease.

We will examine benefits and risks for the patient population that could take statins for primary prevention. On one side are those who point to statins’ benefits: reduced cancer risk, improved quality of life and lowered glaucoma risk. On the other, we have those who note statins’ side effects: increased diabetes risk, fatigue and cataracts, to name a few. Let’s look at some of the evidence.

Cancer studies

A study published in The New England Journal of Medicine involved 300,000 Danish participants and investigated 13 cancers. It showed that statin users may have a 15 percent decreased risk of death from cancer (1). As you can imagine, this news was greeted with excitement.

However, there were major limitations with the study. First, researchers did not control for smoking, which we know is a large contributor to cancer. Second, it was unknown which of the statin-using population might have received conventional cancer treatments, such as radiation and chemotherapy. Third, the dose of statins did not correlate to risk reduction. In fact, those who took 1 to 75 percent of prescribed statin levels showed more benefit in terms of cancer mortality risk than those who took more. We need a better-designed trial to determine whether there is really an effect.

Another study, a meta-analysis of 13 observational studies, showed that statins may play a role in reducing the risk of esophageal cancer. This is important, since esophageal cancer, especially adenocarcinoma that develops from Barrett’s esophagus, is on the rise. The results showed a 28 percent risk reduction in this type of cancer. The authors of the study surmise that statins may have a protective effect (2).

Although there is an association, these results need to be confirmed with randomized controlled trials. Aspirin has about the same 30 percent reduction in colorectal cancer, yet is not recommended solely for this use because of side effects.

Eye disease studies: mixed results

In two common eye diseases, glaucoma and cataracts, statins have vastly different results. In one study, statins were shown to decrease the risk of glaucoma by five percent over one year and nine percent over two years (3). It is encouraging that the longer the duration of statin use, the greater the positive effect on preventing glaucoma.

Statins also help to slow glaucoma progression in patients suspected of having early-stage disease at about the same rate. This was a retrospective study analyzing statin use with patients at risk for open-angle glaucoma. We need prospective (forward-looking) studies. With cataracts, it is a completely different story. Statins increase the risk of cataracts by over 50 percent, as shown in the Waterloo Eye Study (4). Statins exacerbate the risk of cataracts in an already high-risk group, diabetes patients.

Quality of life and longevity studies: a mixed bag

In a meta-analysis involving 11 randomized controlled trials, statins did not reduce the risk of all-cause mortality in moderate to high-risk primary prevention participants (5). This study analysis involved over 65,000 participants with high cholesterol and at significant risk for heart disease.

However, in this same study, participants at high risk for coronary heart disease saw a substantial improvement in their quality of life with statins. In other words, the risk of a nonfatal heart attack was reduced by more than half and nonfatal strokes by almost half, avoiding the potentially disabling effects of these events.

Fatigue side-effect study

Some of my patients who are on statins complain of fatigue. A randomized controlled trial published in the Archives of Internal Medicine reinforces the idea that statins increase the possibility of fatigue (6).

Women, especially, complained of lower energy levels, both overall and on exertion, when they were blindly assigned to a statin-taking group. The trial had three groups: two that took statins, simvastatin 20 mg and pravastatin 40 mg; and a placebo group. The participants were at least 20 years old and had LDL (bad) cholesterol of 115 to 190 mg/dl, with less than 100 mg/dl considered ideal.

In conclusion, some individuals who are at high risk for cardiovascular disease may need a statin, but it is likely that statins are overprescribed in primary prevention. Evidence of the best results points to lifestyle modifications, including diet and exercise shifts, with or without statins.

References: 

(1) N Engl J Med 2012;367:1792-1802. (2) Clin Gastroenterol Hepatol. 2013 Jun; 11(6):620–629. (3) Ophthalmology 2012;119(10):2074-2081. (4) Optom Vis Sci 2012;89:1165-1171. (5) Arch Intern Med 2010;170(12):1024-1031. (6) Arch Intern Med 2012;172(15):1180-1182.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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Pixabay photo

Over the last month, the pandemic trends continue to improve in Suffolk County and in the country.

After a rocky start to the New Year, brought on by an omicron variant that was more contagious than either the original strain of the virus or the delta variant, the percentage of positive tests in Suffolk County continues to decline.

As of Feb. 7, the percentage of positive tests over a seven-day average in Suffolk County was 4.9%, according to the New York State Department of Health. That is down from 14% on Jan. 21 and 27% on Jan. 7.

The trends on Long Island are following similar patterns in other parts of the world that experienced the omicron infection earlier.

South Africa “experienced the omicron wave first,” Dr. Gregson Pigott, health commissioner of the Suffolk County Department of Health Services, wrote in an email. “Almost as steeply as cases rose, they fell.”

Indeed, at Port Jefferson’s St. Charles Hospital, Dr. Sunil Dhuper, chief medical officer, said there has been a “significant” drop in the number of patients hospitalized and in the number of Emergency Room visits, while the use of monoclonal antibodies to treat patients in the early stages of an infection has also dropped dramatically.

“We are not seeing the kind of volume we were seeing a few weeks ago,” Dhuper added.

The Department of Health for the country reported that the reinfection rate, which reached a peak in the last week of December and first week of January, has also been declining.

The number of hospitalizations throughout the country has fallen enough that Dr. Anthony Fauci, the chief medical adviser to President Joseph Biden (D), recently said in an interview with the Financial Times that the country is almost past the “full-blown” pandemic phase. While he didn’t offer a specific timetable, he suggested that virus restrictions could be lifted within a matter of months.

Area doctors suggested that vaccinations and more mild symptoms among those who contracted the virus helped alleviate the strain on the health care community.

“The vast majority of those hospitalized for respiratory or other COVID-type illnesses have not been vaccinated,” Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, explained in an email.

While the overall number continues to decline, the county, and the country, need to make continued progress in reducing the overall infection rate before the all-clear signal.

Sean Clouston, associate professor in the Program in Public Health and the Department of Family, Population and Preventive Medicine at the Renaissance School of Medicine at Stony Brook University, suggested that the current number of infections still leaves room for improvement.

A positivity rate above 5% which was the figure earlier this week, is “still extremely high,” Clouston explained in an email. “Currently, the [Centers for Disease Control and Prevention] would recommend that no one in the globe travel to Long Island, which doesn’t seem like we ourselves see this as safe objectively.”

Health care providers highlighted the difference between the reported and the actual infection numbers.

When the pandemic started in March of 2020, Dhuper estimates that the ratio of reported to actual cases was close to 1 to 10. With Delta, that number likely dropped to closer to 1 to 5, and with omicron, that’s probably about 1 to 3 or 4.

With the increase in at-home testing, the numbers “we see are more of a sampling, showing the approximate prevalence of COVID-19 virus circulating in the population,” Pigott explained.

Nachman added that Stony Brook is following guidelines from the Food and Drug Administration and the Centers for Disease Control and Prevention when it comes to vaccinations for people who tested positive for COVID-19.

These public health authorities generally recommend a booster dose after people feel well, which is usually 10 days to two weeks after an illness.

Doctors said they are monitoring a new version of the omicron variant, called BA.2

The new variant seems a “bit more” contagious” than the original omicron, Dhuper said. Vaccines, however, have a “reasonable level of protection to prevent hospitalizations and death.”

Dhuper said he continues to “keep an eye” on that variant.

Nachman suggested that the available vaccines continue to help.

“Right now, the [two omicron variants] do not seem to be radically different,” she suggested, as both have a short incubation period and people are protected by the vaccine.

With the number of people contracting the virus and developing more severe symptoms declining, Dhuper said the demand for the effective monoclonal antibody treatment continues to fall.

Dhuper said a recent New England Journal of Medicine study indicated that the antiviral treatment remdesivir, manufactured by Gilead Sciences, was effective at treating mild to moderate illnesses on an outpatient basis over a three-day period.

“Given under controlled conditions, (remdesivir) could be one of the best alternatives that we have,” Dhuper said.

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SBU Mall Walkers returns

Stony Brook University has announced the return of the Mall Walkers, a fun and easy free exercise program co-sponsored by Stony Brook University Hospital and Smith Haven Mall in Lake Grove, that meets on the last Wednesday of the month at 10 a.m. 

Members walk around the inside of the mall at their own pace, and after their workout enjoy a complimentary light snack and the opportunity to socialize. Membership includes monthly talks on a variety of health and wellness topics offered by experts from Stony Brook Medicine.

The Mall Walkers meet nine times a year (there will be no meeting in July, August and December). Walking dates for 2022 are February 23, March 30, April 27, May 25, June 29, September 28, October 26 and November 30. For more information, contact Stony Brook Medicine at 631-444-4000.

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From left, David D’Agate, DO, St. Francis Heart Center cardiologist; Jie Jane Cao, MD, St. Francis Heart Center cardiologist; and Joshua P. Bozek, DO, St. Catherine of Siena Hospital emergency medicine physician. Photo from St. Catherine of Siena Hospital/Michelle Pipia-Stiles

Catholic Health is expanding with its newly opened,  award-winning St. Francis Heart Center (SFHC) at St. Catherine of Siena Hospital (SCSH) in Smithtown. Here, St. Francis cardiologists will provide prompt, expert assessments and treatment of acute chest pain.

“In bringing St. Francis Heart Center to St. Catherine, we’re giving residents of Suffolk County’s north shore access to lifesaving treatment for patients with acute chest pain,” said SCSH President James O’Connor. “Residents can have confidence in knowing that they have access to St. Francis’ cardiovascular care close to home.”

Led by a team of nationally-renowned cardiologists, the St. Francis Heart Center at St. Catherine is specifically for those who present with acute chest pain. Patients will be seen quickly by a physician and receive an EKG within minutes. The individual’s condition will be evaluated using the H.E.A.R.T. scoring method: History, Electrocardiogram (ECG), Age, Risk factors and levels of Troponin, ensuring customized, efficient and effective treatment.

Based on the patient’s score, St. Francis physicians will determine the level of criticality and treatment options. In some cases, a cardiac CT scan will be performed to better assess a patient’s heart and locate heart disease. The images will be read by St. Francis Heart Center’s dedicated cardiac imaging team. If a patient requires a catheterization, precision angioplasty will be performed onsite with the level of excellence that has made St. Francis Heart Center a recognized national leader in cardiology. Upon the patient’s discharge, the team will schedule follow-up appointments within 24 hours with a St. Francis-affiliated cardiologist, or the patient’s own cardiologist.

“Timely diagnosis and treatment of patients with acute chest pain is vital to successful outcomes,” said Catholic Health and St. Francis Hospital Chairman of Cardiology Richard Shlofmitz, MD. “When a person has a heart problem, it has to be taken care of right away. You don’t want to walk into an urgent care center and then have to drive to a hospital emergency room and wait hours before receiving therapy. Time is valuable, and we want to save you time by bringing St. Francis closer to you. With the opening of the St. Francis Heart Center at St. Catherine, patients will receive the same quality of care and expertise St. Francis is known for worldwide.”

The St. Francis Heart Center has already expanded its nationally recognized cardiovascular expertise to Good Samaritan Hospital in West Islip and Mercy Hospital in Rockville Centre.

For more information on the cardiology services offered at Catholic Health, click here or call (866) MY-LI-DOC. To view a video about the new St. Francis Heart Center at St. Catherine, click here.

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Photo from Town of Huntington

Huntington Town Supervisor Edmund J. Smyth, the Huntington Town Board, in their role as the Community Development Agency (CDA), and CDA Director Leah M. Jefferson will launch the distribution of  COVID-19 at-home test kits at Manor Field Park, East 5th Street, Huntington Station on Monday, February 7 at 11 a.m.

The Huntington Community Development Agency will be distributing over 10,000 over-the-counter (OTC) COVID-19 test kits to Town of Huntington residents funded by the 2020 CARES Act Community Development Block Grant Coronavirus (CDBG-CV) program.  

 Pre-registration is required. Recipients must be Town of Huntington residents and each household is eligible to receive up to four (4) OTC Rapid Result COVID-19 test kits. Apply online at huntingtonny.gov/covid-test-kits. 

Hours of operation will be Mondays, Tuesdays, and Thursdays from 9am to 2pm, Wednesdays from 3pm to 7pm, and Fridays from 1pm to 4pm, while supplies last. The distribution site will not be open on Federal holidays. 

 The Huntington Community Development Agency is also partnering with Value Drugs of Greenlawn to provide approximately 2,000 Town of Huntington residents an opportunity to receive a free onsite Rapid Results Antigen COVID-19 test. Onsite testing is available now to pre-registered residents. Apply at huntingtonny.gov/valuedrugscovid19testing to receive a voucher for a free test. Once approved, residents can schedule their appointment with Value Drugs. Tests will be made available on a first-come, first-served basis. 

Huntington CDA Chairman Ed Smyth stated, “These at-home test kits will provide Huntington families peace of mind that it is safe to gather and visit with at-risk family members.” 

 “Due to the recent spike in coronavirus cases, and with the demand of test kits outpacing the supply, the Town of Huntington and the Community Development Agency felt it was imperative that we address the issue,” said Leah M. Jefferson, Director of the Community Development Agency. “The Town has faced enough difficulties during the pandemic, and we are grateful for the generosity of Value Drugs which has allowed us to meet the demand for rapid testing, and ultimately keep our community safer.” 

 In September 2020, the Town of Huntington was awarded funding in the amount of $1,869,925 from the Department of Housing and Urban Development (HUD) to prepare for, respond to, and prevent the spread of coronavirus. This funding was made available through the Community Development Block Grant- Coronavirus (CDBG-CV) program.  To date, this funding has been made available to businesses and individuals in the community who have been directly impacted by the Coronavirus pandemic, and to those community agencies that provide direct assistance to the residents of Huntington.   

 At their February 1 Community Development Agency meeting, the CDA Board authorized the distribution of 10,080 COVID-19 over-the-counter rapid tests to residents of the Town of Huntington purchased with $151,200 in CDBG-CV funds awarded in response to the COVID-19 pandemic. 

 At the same meeting, the CDA Board also approved the execution of a contract with Value Drugs for the purpose of administering rapid COVID-19 tests to the residents of the Town of Huntington onsite at the Value Drugs at 106 Broadway in Greenlawn.

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Above, medical and quartermaster corps men in connection with the United States Army Hospital in Fort Porter, New York. Public domain photos

By Daniel Dunaief

[email protected]

At the end of World War I, Spanish Influenza caused the world to focus on the same kinds of measures that people have been using to protect themselves, including wearing masks and social distancing.

Back then, pharmaceutical companies couldn’t produce vaccines and boosters for the H1N1 flu virus which killed 50 million people worldwide, including 650,000 people in the United States.

A family and their cat during the Spanish Flu pandemic in 1918.
Public domain photo

History professors at Stony Brook University described a decidedly different period over 100 years ago and the reaction by the American people to the public health crisis.

The armistice to end the war was signed in the middle of the pandemic, said Nancy Tomes, distinguished professor in the Department of History at Stony Brook University.

“Our noble dough boys were coming back after having saved Western Civilization,” Tomes said. There was no finger to point to blame someone for the coming hardship. The American public recognized that this was an “ailment our brave boys brought home. It’s your obligation to take care of these soldiers.”

People who didn’t do their part to help heal members of the military and reduce the threat were considered “slackers.” When public health officials in New York asked workers to stagger the times they took the subway, people “were not supposed to kick up a fuss because this is war,” Tomes said.

During the Spanish Influenza, people didn’t express partisan politics about public health issues.“The idea was that there’s an epidemic and it’s all hands-on deck,” she added.

Contrast that with modern times, when an anti-federal government ideology has been developing for decades, said Paul Kelton, professor and Gardiner chair in American History at Stony Brook.

“That’s been brewing since the 1980s,” Kelton said. The COVID pandemic happened at a time when this distrust toward the federal government “reached its peak.” Today, “we have a national media culture where we focus on the federal government” and, at the same time, the country has an anti-federal government ideology that’s animating a large portion of the American population,” he said.

Kelton, whose expertise includes the study of Native American history, suggested that several tribes have embraced the opportunity to get the vaccine, in part because of the encouraging response among tribe leaders.

The Navajo, for example, who have a well-earned skepticism toward the federal government, have a high rate of vaccination because the tribal government has taken charge of this public health effort.

“When people are empowered at the state and local level, rather than the federal government coming in and doing it, it makes a difference,” Kelton said.

Indeed, the communities that have resisted vaccines and public health measures during the current COVID crisis include areas with high rural white populations.

To be sure, historians recognize that the specifics of each pandemic, from the source of the public health threat to the political and cultural backdrop against which the threat occurs, vary widely.

Recalling a saying in the field of public health, Kelton said, “if you’ve seen one pandemic, you’ve seen one pandemic.” That suggests that the lessons or experiences amid any single public health threat don’t necessarily apply to another, particularly if the mode of transmission, the symptoms or the severity of the threat are all different.

“The lesson from history is to expect the unexpected when you’re dealing with germs,” said Kelton. “Novel germs are hitting populations in different circumstances. We are living in different conditions than in the past.”

What pandemics generally do, Kelton said, is expose fissures in society.

Part of what the study of other pandemics suggests is the need for opportunities to live healthier lives among those who are impoverished or are feeling disenfranchised.

“If nothing changes and health care access [remains as it is],we are going to repeat that again,” Kelton said.

Basic access to better nutrition can help fight the next pandemic, reducing the disproportionate toll some people face amid a public health threat, he said.

“Things like making sure that homeless people can get into a homeless shelter and not infect each other, the nuts and bolts of keeping people healthy, we neglected,” added Tomes.

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Pixabay photo
The focus is on absorption and blood levels

By David Dunaief, M.D.

Dr. David Dunaief

With the recent storms, the cold temperatures and the not-quite-so-short, but still short days, it’s likely you’re not spending a lot of time outside in the sunshine with your skin exposed these days.

Here in the Northeast, this is the time of year when many reach for vitamin D supplements to compensate for a lack of vitamin D from the sun. Let’s explore what we know about vitamin D supplementation.

There is no question that, if you have low levels of vitamin D, replacing it is important. Previous studies have shown that it may be effective in a wide swath of chronic diseases, both in prevention and as part of a treatment paradigm. However, many questions remain.

At the 70th annual American Academy of Dermatology meeting in 2012, Dr. Richard Gallo, who was involved with the Institute of Medicine recommendations, shook things up by noting that, in most geographic locations, sun exposure will not correct vitamin D deficiencies. Interestingly, he emphasized getting more vitamin D from nutrition. Dietary sources include cold-water fatty fish, beef liver, and egg yolks. Most of us receive food-sourced vitamin D from fortified packaged foods, where vitamin D has been added.

We know its importance for bone health, but as of yet, we only have encouraging — but not yet definitive — data for other diseases. These include cardiovascular, autoimmune and skin diseases and cancer.

There is no consensus on the ideal blood level for vitamin D. For adults, the Institute of Medicine recommends between 20 and 50 ng/ml, and The Endocrine Society recommends at least 30 ng/ml.

Cardiovascular mixed results

Stock photo

Several observational studies have shown benefits of vitamin D supplements with cardiovascular disease. For example, the Framingham Offspring Study showed that those patients with deficient levels were at increased risk of cardiovascular disease (1).

However, a small randomized controlled trial (RCT) called the cardioprotective effects of vitamin D into question (2). This study of postmenopausal women, using biomarkers such as endothelial function, inflammation or vascular stiffness, showed no difference between vitamin D treatment and placebo. The authors concluded there is no reason to give vitamin D for prevention of cardiovascular disease.

The vitamin D dose given to the treatment group was 2,500 IUs. Thus, one couldn’t argue that this dose was too low. Some of the weaknesses of the study were a very short duration of four months, its size — 114 participants — and the fact that cardiovascular events or deaths were not used as study end points.

Most trials relating to vitamin D are observational, which provides associations, but not links. However, the VITAL study was a large, five-year RCT looking at the effects of vitamin D and omega-3s on cardiovascular disease and cancer (3). Study results were disappointing, finding that daily vitamin D3 supplementation at 2000 IUs did not reduce the incidence of cancers (prostate, breast or colorectal) or of major cardiovascular events.

Mortality decreased

In a meta-analysis of a group of eight studies, vitamin D with calcium reduced the mortality rate in the elderly, whereas vitamin D alone did not (5). The difference between the groups was statistically important, but clinically small: nine percent reduction with vitamin D plus calcium and seven percent with vitamin D alone.

One of the weaknesses of this analysis was that vitamin D in two of the studies was given in large amounts of 300,000 to 500,000 IUs once a year, rather than taken daily. This has different effects.

Weight benefit

There is good news, but not great news, on the weight front. It appears that vitamin D plays a role in reducing the amount of weight gain in women 65 years and older whose blood levels are more than 30 ng/ml, compared to those below this level, in the Study of Osteoporotic Fractures (4).

This association held true at baseline and after 4.5 years of observation. If the women dropped below 30 ng/ml in this time period, they were more likely to gain more weight, and they gained less if they kept levels above the target. There were 4,659 participants in the study. Unfortunately, vitamin D did not show statistical significance with weight loss.

USPSTF recommendations

The U.S. Preventive Services Task Force recommends against giving “healthy” postmenopausal women vitamin D, calcium or the combination of vitamin D 400 IUs plus calcium 1,000 mg to prevent fractures, and it found inadequate evidence of fracture prevention at higher levels (6). The supplement combination does not seem to reduce fractures, but does increase the risk of kidney stones. There is also not enough data to recommend for or against vitamin D with or without calcium for cancer prevention.

When to supplement?

It is important to supplement to optimal levels, especially since most of us living in the Northeast have insufficient to deficient levels. While vitamin D may not be a cure-all, it might play an integral role with many disorders. But it is also important not to raise the levels too high. The range that I tell my patients is between 32 and 50 ng/ml, depending on their health circumstances.

References: 

(1) Circulation. 2008 Jan 29;117(4):503-511. (2) PLoS One. 2012;7(5):e36617. (3) NEJM. 2018 published online Nov. 10, 2018. (4) J Women’s Health (Larchmt). 2012 Jun 25. (5) J Clin Endocrinol Metabol. online May 17, 2012. (6) JAMA. 2018;319(15):1592-1599.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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