U.S. TASK FORCE'S RECOMMENDATIONS STOKE DEBATE OVER CALCIUM AND VITAMIN D SUPPLEMENTS

Healthy Women Advised Taking Low Dose Calcium & Vitamin D Will Not Help Prevent Fractures But These Supplements Still Have Other Health Benefits

The United States Preventive Services Task Force, a panel of experts in health prevention, recently concluded that low doses of calcium (1000mg or less) with vitamin D (400 IU or less) do not help to prevent fractures in healthy postmenopausal women, and, thus, recommended against these women taking a low dose of calcium and vitamin D.   This recommendation applied only to healthy post-menopausal women not at increased risk for low bone density, osteoporosis, or a history of fractures.  The National Osteoporosis Foundation recommends that people with the bone disease consume at least 1,200mg of calcium and 800-1,000 IUs of vitamin D daily through food or supplements.

The task force’s new recommendations add more fervor to the ongoing debate about the benefits associated with these popular supplements.  In response to the task force’s statements, numerous experts expressed concerns that the recommendations were misleading and potentially dangerous. Dr. Susan Ott, a bone specialist noted that “they ignored a lot of people who are getting very little calcium in their ordinary diet."  She said that she fears "for the millions of women who feel perfectly healthy yet are in fact deficient in calcium or vitamin D, and who erroneously think as a result of the task force recommendations that they are in the clear."   The Institute of Medicine estimates that 75% of American women do not get the recommended 1,000-1,200 mg of calcium from their food every day.  Certainly, adequate intake of calcium from food sources is rare unless a person consumes a lot of dairy.  For example, to get the recommend amount one would have to drink 3-4 cups of milk or eat 16-20 cups of cooked broccoli daily.

Also, while the task force concluded that supplementing with 400 IU of vitamin D does not prevent fractures, a growing body of evidence suggests that higher levels of supplementation in fact do improve fracture rates.  Indeed, the same task force recently advised that, to prevent falls in older adults, there is significant evidence that supplementing with 800 IU of vitamin D, and participating in physical therapy and/or regular activity can reduce the risk of falls by 13-17%.  And, in a recent Swiss study, researchers found that taking more than 800 IU of vitamin D daily could reduce the risk of hip fractures in older women by 30%.  Similarly, a recent study that followed more than 3,000 people between the ages of 70 and 79 for six years, found that those with the lowest vitamin D levels at the start of the study, had nearly a 30% increased risk of a mobility limitation and almost twice the risk of a mobility disability compared to those with the highest levels of vitamin D.

Also, in addition to vitamin D and calcium’s role in bone health, they have many other important roles in the body.  The heart, muscles, and nerves cannot work properly without calcium.  Vitamin D is crucial in part because it helps the body absorb calcium from food but it also appears to be important for proper functioning of the endocrine and immune systems.  These two nutrients have even been implicated in controlling appetite.  Persons that are low in calcium and/or vitamin D appear to be more likely to overeat.  In a recent study Dr. Erin LeBlanc and her team found that women over 65 with higher blood vitamin D levels gained less weight over time than women with lower vitamin D levels.  And, a recent review of multiple clinical trials concluded that older adults who take vitamin D and calcium supplements may live a bit longer than their peers.  Researchers found that older adults who were given vitamin D and calcium supplements were 9% less likely to die over three years than those given placebo pills.

What to do:  Certainly, it is always best to get necessary nutrients from food.  To get adequate calcium be sure to consume plenty of lowfat/nonfat dairy, foods that contain bones such as sardines, and/or foods fortified with calcium.  The body makes vitamin D when exposed to sunlight but it is difficult and possibly puts one at risk for skin cancer to get adequate sun exposure.  Vitamin D is not widespread in the food supply.  Only fatty fish liver oil and foods containing bones are very good natural sources though now many foods are supplemented with vitamin D including milk and cereals.  Vitamin D levels can be reliably tested with routine bloodwork.  Supplementation is still advised for those with bone disease or at high risk for bone disease.  And, for others who do not get adequate calcium and vitamin D from their diet, a supplement of 500mg of calcium and 500 IU of vitamin D taken 2-3 times daily is likely to have some health benefits, but to determine if you should be taking a supplement, talk to your primary care physician or dietitian about what level of supplementation best suits your health needs.      

Adapted from articles at:

http://www.scientificamerican.com/article.cfm?id=calcium-vitamind-supplement-debate

http://www.nlm.nih.gov/medlineplus/news/fullstory_126935.html

http://www.nlm.nih.gov/medlineplus/news/fullstory_126347.html

http://www.nlm.nih.gov/medlineplus/news/fullstory_126659.html

http://www.nlm.nih.gov/medlineplus/news/fullstory_126205.html

http://www.nlm.nih.gov/medlineplus/news/fullstory_125688.html

http://www.nlm.nih.gov/medlineplus/news/fullstory_125812.html

http://www.nytimes.com/2012/06/13/health/calcium-and-vitamin-d-ineffective-for-fractures-us-preventive-services-task-force-says.html?

http://www.nejm.org/doi/full/10.1056/NEJMoa1109617

Research sources include:

http://bit.ly/LaoDDQ Journal of Clinical Endocrinology & Metabolism, online May 17, 2012. http://bit.ly/K7kSAx Annals of Internal Medicine, online June 12, 2012.  

http://bit.ly/L9cPi0 Annals of Internal Medicine, May 28, 2012

Kaiser Permanente, news release, June 26, 2012

Heike Bischoff-Ferrari, M.D., Dr.P.H., the Center on Aging and Mobility at the University of Zurich and Wald City Hospital, Zurich; Anna Lasak, M.D., clinical director of the department of rehabilitation, and the women's physical medicine and rehabilitation program, Montefiore Medical Center, New York City; July 5, 2012, New England Journal of Medicine.

U.S. Preventive Services Task Force. Vitamin D and Calcium Supplementation to Prevent Cancer and Osteoporotic Fractures in Adults: Draft Recommendation Statement. AHRQ Publication No. 12-05163-EF-2. http://www.uspreventiveservicestaskforce.org/draftrec3.htm.

Denise Houston, Ph.D., R.D., nutrition epidemiologist and assistant professor, Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, N.C.; Jessica Shapiro, M.S., R.D., C.D.N., associate wellness dietician, Montefiore Medical Center, New York City; May 2012, Journal of Gerontology: Medical Sciences, online

LOW-GLYCEMIC DIET HEALTHIEST OPTION FOR MAINTAINING WEIGHT LOSS

When researchers compared a low-fat diet, a very low-carbohydrate diet, and a low-glycemic-index diet among persons trying to maintain weight loss, they found that the low-glycemic diet proved to be the best option; supporting the body’s calorie burning rate while also being heart healthy.

In this study, Dr. David Ludwig and his colleagues at Boston Children’s Hospital examined which diets best support health and metabolism after weight loss. Each of the study's 21 adult participants (ages 18-40) first had to lose 10-20% of their body weight, and after weight stabilization, completed all three of the following diets in random order, each for four weeks at a time. The low-fat diet, emphasized whole grain products and a variety of fruits and vegetables and was composed of 60% of calories from carbohydrates, 20% from fat, and 20% from protein.   The low-glycemic index diet treatment was made up of minimally processed grains, vegetables, healthy fats, legumes and fruits, with 40% of calories from carbohydrates, 40% from fat and 20% from protein. Low-glycemic-index carbohydrates digest slowly, helping to keep blood sugar and hunger hormones stable after meals.   The third diet treatment, a low-carbohydrate diet modeled after the Atkins diet, was composed of 10% of daily calories from carbohydrates, 60% from fat, and 30% from protein.

Researchers then measured how many calories participants on each of the diets burned. They found that persons on the low card diet burned about 150 more calories than those on the low-glycemic diet and nearly 300 more than those on the lowfat diet. 

While the Atkins-type diet stimulated the greatest calorie burn, it had negative effects on chronic disease risk factors including an increase in stress hormones and inflammation. Indeed another recent study by Swedish researchers found that women who regularly follow an Atkins-style diet have a 28% increased risk for heart disease and stroke.

The results of this article have been widely reported as ground breaking in the media.  However, in an editorial accompanying the publication of these results, Dr. George Bray stressed caution in interpreting the results from this short-term relatively small study. "There are some interesting physiological responses in this study, but translating this information for possible long-term results is difficult to do.  Adherence is an important element. If a diet helps you adhere better, that will help you to manage your weight, but, in longer-term studies none of these diets has proven better than any other at weight management over the long-term."  In a recent New York Times interview, highly respected longtime obesity researcher Dr. Jules Hirsh pointed out that while there is evidence that proteins take somewhat more energy to digest, fats require less energy to be stored as fats.  And, because high fat and high protein diets cause initial water losses, the findings that calorie burning was higher in these diets was likely an artifact of how these values were assessed rather than actual differences in metabolic rates while on the diets of different macronutrient composition.

What to do: This study’s results support a diet higher in fat than is traditionally recommended but actually in line with what persons following a healthy diet usually achieve.  While substituting fats (which do not effect blood sugar), for carbohydrates helps to moderate blood sugar increases after a meal, it is also important to choose heart healthy fats and not increase total caloric intake. In this study caloric intake was carefully controlled so that even with a relatively high fat intake, total caloric intake did not increase.  However, in real world situations, this can prove tricky as gram per gram fats have more than twice as many calories as carbohydrates and proteins.

Overall, any diet that eliminates fat, carbohydrates, or protein is inherently unbalanced.  A mixture of all the macronutrients is needed to nourish our bodies and feel satisfied. Modern diets tend to be high in refined carbohydrates such as sugar and white flour as well as unhealthy meat and dairy fats.  While being mindful of caloric intake it is important to choose foods high in nutritional quality including whole food carbohydrates, healthy fats from plant and fish sources, and proteins that are low in fat or from oily fish.  

SOURCES:

Cara B. Ebbeling et al. Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. JAMA, June 27, 2012 DOI: 10.1001/jama.2012.6607

Pagona Lagiou et al.  Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study.  BMJ. 2012; 344: e4026. doi:  10.1136/bmj.e4026

http://www.nytimes.com/2012/07/10/health/nutrition/q-and-a-are-high-protein-low-carb-diets-effective.html

Adapted from articles available at: http://consumer.healthday.com/Article.asp?AID=666110, http://www.nlm.nih.gov/medlineplus/news/fullstory_126664.html, http://www.sciencedaily.com/releases/2012/06/120626163801.htm

EAT YOUR VEGGIES!

A diet rich in vegetables has many health benefits.  Vegetables are rich in fiber, vitamins, minerals, and beneficial plant compounds such as antioxidants.  Studies reveal diets rich in non-starchy vegetables support better blood pressure and blood sugar levels and a reduced risk of heart disease, stroke, some cancers, vision problems, and digestive problems.  Diets rich in vegetables are also associated with lower total calorie consumption and better weight management.  

The Dietary Guidelines for Americans recommends that most adults get at least 3 cups of vegetables each day.  Which are the best vegetables?  Choose a variety of non-starchy vegetables kinds and colors including dark leafy greens, cooked tomatoes, and anything that's a rich yellow, orange, or red color. Starchy vegetables (such as potatoes, yams, and plantains), though rich in vitamins and minerals are higher in calories and carbohydrates so do not count these as vegetable servings and instead substitute helpings of the starchy vegetables for grain items such as bread, rice, and pasta.  To fit more vegetables in your meals, follow these simple tips. It is easier than you may think.

* Try to include vegetables in at least two meals and one snack per day.  Try filling half your plate with vegetables at meals.  Serving up salads, stir fries, or vegetable-rich soups makes it easier to reach this goal. Vegetables also make great, filling, low-calorie snacks.

* Discover fast ways to cook.  Cook fresh or frozen vegetables in the microwave for a quick-and-easy dish to add to any meal. Steam green beans, carrots, or broccoli in a bowl with a small amount of water in the microwave for a quick side dish or a healthy low-calorie addition that can be mixed into entrees.

*  Be ahead of the game.  Cut up a batch of bell peppers, carrots, cucumbers, celery, or cauliflower. Pre-bag them to use when time is limited.  Enjoy them on their own or have them ready to add to salads, sandwiches, and omelets.   Buy ready-to eat baby carrots, cherry tomatoes, and sugar snap peas.  Use vegetables as dippers for hummus, nonfat dressing, or nonfat yogurt dip (for an easy creamy option, try combining nonfat Greek yogurt with your favorite variety of dry dip flavoring packet).

*  Check the freezer aisle.  Frozen vegetables are quick and easy to use and are just as nutritious as fresh veggies. Try adding green beans, spinach, sugar snap peas, broccoli, cauliflower, and many more to some of your favorite dishes or eat as a side dish.  Experiment with stir-fry ready frozen vegetable mixes.  

*  Stock up on veggies.  While some vegetables such as lettuce do not keep long, others such as cabbage and carrots can keep for some time.  Using canned and frozen is another way to keep vegetables on hand without risk of spoilage.  With canned vegetables, look for those labeled “no salt added” and “low sodium”, and rinse those with added salt. 

*  Start your meals with a salad or vegetable soup.  Filling up on vegetables first allows you to comfortably reduce your portions of higher calorie items.  Make your salad eye-catching using a rainbow of vegetables.

* Heat it and eat it. Enliven canned soups and frozen meals by adding frozen vegetables and/or tomato sauce to these items.  This makes ready-to-eat items healthier, more filling, and tastier.  (Note: Because soups and frozen meals are often high in salt, check labels for sodium content to make a healthy choice.)

* Try something new.  You never know what you may like. Choose a new vegetable—add it to your recipe or look up how to fix it online.  Some delicious vegetables that sometimes get overlooked include artichokes, asparagus, chayote, Brussels sprouts, Swiss chard, broccoli rabe, and kohlrabi.

EXPLORE CREATIVE WAYS TO ADD MORE VEGETABLES TO MEALS

*  Fire up the grill - Try grilling mushrooms, carrots, peppers, cherry tomatoes, zucchini, and onions on a kabob skewer. Marinate or brush with oil to keep them from drying out.

*  Expand the flavor of your casseroles - Mix vegetables such as sautéed onions, garlic, tomatoes, and mushrooms into your favorite dish for that extra flavor.

*  Planning something Italian?  Add extra vegetables to your pasta, pizza, or lasagna dish. Slip some peppers, zucchini, onions, and/or cherry tomatoes into your traditional preparations.

*  Get creative with your salad - Toss in both raw and lightly steamed vegetables of a variety of colors.  Experiment with different greens as your salad base including mesclun mixes, spinach, endive, frisee, kale, arugula, cabbage, watercress, romaine, and escarole. 

*  Mix it up with stir-fries - Stir-fry your veggies—like broccoli, carrots, sugar snap peas, mushrooms, or green beans—for a quick-and-easy addition to any meal.

*  Add them to your sandwiches - Whether it is a sandwich or wrap, vegetables make great additions to both.  Try sliced tomatoes, shredded carrots, spinach, sprouts, and/or avocado on your everyday sandwich or wrap for extra flavor.  Consider replacing the slice on top of your sandwich with a leaf of romaine or making a lettuce wrap to create lower calorie options.

*  Liven up an omelet - Boost the color and flavor of your omelet or egg scramble with vegetables. Try combining different vegetables, such as mushrooms, spinach, onions, or bell peppers.