Vitamin D pills' effect on healthy bones queried

Dr Laura TripkovicUniversity of SurreyI'm not surprised they didn't find any evidence of the effects of vitamin D on bone density because there are so many other factors involved...”
Fair-skinned people who are prone to sunburn may need to take supplements to ensure they get enough vitamin D, say experts.
It appears that those with pale skin, while not deficient, may still be lacking in the essential vitamin that the body makes from sunlight.
The Cancer Research UK-funded team say that even with a lot of sun exposure, those with fair skin may not be able to make enough vitamin D.
And too much sun causes skin cancer.
Clearly, for this reason, increasing sun exposure is not the way to achieve higher vitamin D levels in the fair-skinned population, say the researchers. But taking supplements could be.
Their work examined 1,200 people.
Of these, 730 were found to have "lower than optimal" vitamin D levels - and many of these were people with very pale, freckled skin.
Extra boostEnd Quote Prof Julia Newton-BishopFair-skinned individuals who burn easily are not able to make enough vitamin D from sunlight and so may need to take vitamin D supplements”
Supplements are already recommended for groups at higher risk of deficiency. This includes people with dark skin, such as people of African-Caribbean and South Asian origin, and people who wear full-body coverings, as well as the elderly, young children, pregnant and breastfeeding women and people who avoid the sun.
Based on the latest findings, it appears that pale-skinned people should be added to this list.
Vitamin D is important for healthy bones and teeth.
A level less than 25nmol/L in the blood is a deficiency, but experts increasingly believe that lower than 60nmol/L are suboptimal and can also be damaging to health.
Most people get enough vitamin D with short exposures to the sun (10 to 15 minutes a day). A small amount also comes from the diet in foods like oily fish and dairy products.
But people with fair skin do not seem to be able to get enough, according to Prof Julia Newton-Bishop and her team at the University of Leeds.
Part of the reason might be that people who burn easily are more likely to cover up and avoid the sun.
But some fair-skinned individuals also appear to be less able to make and process vitamin D in the body, regardless of how long they sit in the sun for.
Prof Newton-Bishop said: "It's very difficult to give easy advice that everyone can follow. There's no one-size-fits-all.
"However, fair-skinned individuals who burn easily are not able to make enough vitamin D from sunlight and so may need to take vitamin D supplements."
Hazel Nunn, of Cancer Research UK, said: "It is about striking a balance between the benefits and harms of sun exposure.
"People with fair skin are at higher risk of developing skin cancer and should take care to avoid over-exposure to the sun's rays.
"If people are concerned about their vitamin D levels, they should see their doctor who may recommend a vitamin D test."
She said it was too soon to start recommending supplements, but said most people could safely take 10 micrograms a day of vitamin D without any side-effects.
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The NHS should consider checking pregnant women's vitamin D levels to protect babies from the "Victorian" bone disease rickets, an expert says.
A Journal of Medical Screening article suggests rickets was returning, with many women not getting enough vitamin D, which comes mainly from sunlight.
People with dark skin, and women who cover up for cultural or religious reasons, are at particular risk.
The Department of Health is reviewing the evidence on vitamin D screening.
The editorial was by Dr James Haddow, a US expert in pre-natal screening.
Breastfeeding mothersHis article described cases of seizures, heart failure and rickets in children whose mothers were vitamin D deficient.
Dr Haddow said it was time to look at screening pregnant women with a blood test, focusing initially on those most at risk.
"Any strategy aimed at avoiding symptomatic vitamin D deficiency in offspring would logically include assuring adequacy of maternal vitamin D during pregnancy.
"Attending to this aspect of maternal and child health has added significance for mothers who breastfeed."
A recent study in inner-city Birmingham found that almost one in two Asian women were vitamin D deficient.
End Quote Dr Jonathan Berg City Hospital, BirminghamScreening in selected populations is currently the way forward”
The level was one in three in the wider Asian community, one in four in the black population and one in eight among Caucasians.
One of the authors, Dr Jonathan Berg, director of pathology at City Hospital, Birmingham, says some local GPs are already screening pregnant women from the Asian community, although there is no formal protocol.
The trust also offers a vitamin D blood-test for those who are not in at-risk groups, for £20. Dr Berg says a lot of people were having the check.
"Screening in selected populations is currently the way forward, but clearly it is very difficult for the NHS to test everyone. We are seeing a big increase in demand from the 'worried well'."
Free supplements
A consultant paediatrician at Ealing's hospital, Dr Colin Michie, says the increased use of high-factor sun-cream means a lot of women who are not in at-risk groups are also vitamin D deficient.
He says the idea of screening is interesting, but he argues that providing free vitamin D supplements for all pregnant women would be cheaper and easier.
He believes this would lead to healthier babies and would save the NHS money.
A spokesman for the Department of Health in England said: "All pregnant women are advised to take vitamin D supplements.
"Our priority is to ensure health professionals provide consistent advice and implement the current recommendations."
The department has asked the scientific advisory committee to review the evidence on vitamin D requirements for different population groups.
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Soy appears to do nothing to relieve the symptoms of menopause, scientists say, despite the high hopes of many.
A controlled study involving nearly 250 US women going through "the change" found soy tablets did not abate hot flushes or bone density loss.
The tablets were no better than placebo over the two-year-long investigation, Archives of Internal Medicine reports.
But experts said other studies have shown soy can ease menopause symptoms.
The dose given in the latest trial was twice that normally ingested by people with soy-rich diets.
Soy products like tofu contain natural plant oestrogens and experts have suggested that these might help women going through the menopause whose own oestrogen levels are dwindling.
'Not a candidate'Many women are already offered oestrogen in the form of hormone replacement therapy or HRT to help with menopausal symptoms.
End Quote Lead researcher Dr Silvina LevisMy advice would be that women should reconsider taking these products for menopausal symptoms”
But following reports that prolonged use of HRT may carry a very small increased risk of other conditions, like breast cancer and stroke, some do not want to go on HRT and look for alternatives.
The researchers from the University of Miami say their work suggests soy is not a candidate, although they stress that they only looked at soy isoflavone tablets rather than other dietary sources of soy.
They recruited 248 menopausal women to take part in their study and randomly allocated them to one of two groups: soy or placebo.
The soy group received 200mg of soy isoflavone tablets daily for two years, while the women in the placebo group were given dummy pills.
During the follow-up, no significant differences were found between the two groups regarding changes in bone loss - a common side effect of the menopause.
Menopausal symptoms such as sleep disturbances affected both groups to similar degrees, although the soy group did appear to experience more hot flushes than the placebo group overall.
Lead researcher Dr Silvina Levis said: "My advice would be that women should reconsider taking these products for menopausal symptoms. We found soy isoflavone tablets did not provide any benefit.
"We did not look at soy foods but I suspect these too would probably not be helpful."
Dr Malcolm Whitehead, a menopause expert at King's College Hospital in London, said: "I'm not at all surprised by the findings. In my clinical experience, women say this doesn't work for them."
He said HRT could be a safe and effective treatment for most women.
A spokesperson from the charity Women's Health Concern said that other studies had shown soy could be helpful for treating symptoms of the menopause.
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Cases of the crippling children's bone disease rickets are being seen in Cardiff, BBC Wales has learned.
Caused by a lack of vitamin D, the disease can lead to deformities like bowed legs and stunted growth, but it largely disappeared last century.
Eye on Wales has learnt health professionals working in communities in south Cardiff are reporting incidents.
Public Health Wales does not hold statistics on the number of cases as rickets is not a notifiable disease
Dr Elspeth Webb, a reader in child health at Cardiff University, spends half her time working as a paediatrician within Splott and Tremorfa in the city.
She told the programme: "We're still seeing rickets in children in Cardiff in the 21st Century - which a lot of people might be very shocked and surprised by, thinking of it as a Victorian illness. But no, it's not.
"You get women living in certain communities that perhaps don't go out much because of religious, cultural traditions.
"They're covered up when they do. They don't get enough access to sunlight. So they get vitamin D deficient."
End Quote Dr Elspeth Webb Cardiff UniversityYou don't see rickets in rich, advantaged, educated, middle-class South Asian people”
"Every pregnancy, you use up your vitamin D stores and if you're not making enough to replenish them, you gradually get more and more depleted.
"By your third or fourth child, that child is born already without enough vitamin D."
"So they'll be presenting with rickets at around 18 months."
While her experience suggests that rickets is confined within certain communities in south Cardiff, Dr Webb says that poverty and poor access to services are also reasons why the disease is occurring.
"You don't see rickets in rich, advantaged, educated, middle-class South Asian people. So it's a mixture of religious, cultural practices with poverty."
'Quite startling'As co-ordinator of the Butetown Communities First project, Nathan Evans has been involved in the response to rickets and believes progress can be made towards eradicating the disease.
"For me this is something from the past. This is something that is alive and kicking in the 21st Century? This was quite startling for me."
End Quote Prof Gareth Williams Cardiff University School of Social SciencesWithin Cardiff you've got quite dramatic contrasts between the northern area of Cardiff and the old docks area where life expectancy is considerably lower”
"But then some of the remedies surrounding it are around that up-take of Vitamin D. So it's around diet, it's around lifestyle."
"The Local Health Board have this big drive around vitamin up-take. This has proved quite successful locally."
"As long as active promotion of where people can access vitamins, how they can maybe modify their behaviour in order to attract more sunlight into their lives then I believe this is something that can be reversed."
The cases of rickets serve to highlight the health inequalities - and differences in life expectancy - that exist within Wales' capital city.
Those differences have always existed, but Gareth Williams - a professor of sociology at Cardiff University - said the gap was widening, not shrinking.
"Within Cardiff you've got quite dramatic contrasts between the northern area of Cardiff and the old docks area where life expectancy is considerably lower. There's a 10-year life expectancy difference."
"Everyone's life expectancy is getting better. The life expectancy of people in poor communities has been getting better very slowly.
"Whereas the life expectancy of people in wealthier places is getting better quite quickly."
Earlier this month, First Minister Carwyn Jones committed the Welsh Government to passing a Public Health Bill to deliver improved life expectancy and reduce health inequality within the life of this assembly.
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New health advice recommends short spells in the sun - without suncream and in the middle of the day.
Seven organisations have issued joint advice on vitamin D, which the body gets from natural sunlight.
The nutrient keeps bones strong, and protects against conditions like osteoporosis.
The guidance was drawn up because it is thought fears about skin cancer have made people too cautious about being in the sun.
Cancer Research UK and the National Osteoporosis Society are among the bodies which agree that "little and frequent" spells in summer sunshine several times a week can benefit your health.
The experts now say it is fine to go outside in strong sun in the middle of the day, as long as you cover up or apply sunscreen before your skin goes red.
'Too negative'End Quote Professor Peter Johnson Cancer Research UKA good diet and sensible sun exposure will be adequate for most people to minimise their cancer risk.”
Professor Rona Mackie, from the British Association of Dermatologists, said: "Total sun protection with high factor suncream on all the time is not ideal, in terms of vitamin D levels.
"Even Australia has changed its policy on this. They're now producing charts showing parts of Australia where sun protection may not be required during some parts of the year.
"Some of the messages about sun exposure have been too negative. UK summer sunshine isn't desperately strong. We don't have many days in the year when it is very intense.
"What's changed is that we're now saying that exposure of 10 to 15 minutes to the UK summer sun, without suncream, several times a week is probably a safe balance between adequate vitamin D levels and any risk of skin cancer."
Official government advice already recommends vitamin D supplements for pregnant women and children aged under five.
But the experts who wrote the joint statement say mothers often are not made aware of this recommendation. They suggest women consult their GP.
Winter levels of vitamin D can be helped by a break in the tropical sun - or by eating oily fish, liver and fortified margarine.
'Complex area'Cancer Research UK's chief clinician, Professor Peter Johnson, said: "A good diet and sensible sun exposure will be adequate for the great majority of the UK population to minimise their cancer risk.
"The area of vitamin D and cancer is complex.
"There's some evidence, which is strongest in bowel cancer, that low levels of vitamin D in the blood correlate with the risk of developing cancer.
"But that doesn't mean those low levels cause bowel cancer.
"We think overall that low levels of vitamin D are unlikely to be major contributors to the chances of developing cancer in the UK population."
The joint statement also highlighted questions about vitamin D that warrant further research.
These include finding out the optimal levels of vitamin D, and more detail about the role of dietary sources and supplements.
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More than 20% of children tested showed signs of the bone disease rickets, Southampton University Hospitals NHS Trust said.
Consultant orthopaedic surgeon Prof Nicholas Clarke checked more than 200 of the city's children for bone problems caused by a lack of vitamin D.
He was astonished by the results, which, he said, were "very reminiscent of 17th Century England".
Prof Clarke works for Southampton General Hospital.
He said vitamin D supplements should be more widely adopted to halt the rise in cases.
The crippling bone disease can lead to deformities like bowed legs as well stunted growth and general ill-health.
A lack of vitamin D can be caused by poor diets and insufficient exposure to sunlight, which helps the body synthesise the vitamin.
Prof Clarke said: "A lot of the children we have seen have got low vitamin D and require treatment.
'Middle class and leafy'"In my 22 years at Southampton General Hospital, this is a completely new occurrence in the south that has evolved over the last 12 to 24 months and we are seeing cases across the board, from areas of deprivation up to the middle classes.
"There is a real need to get national attention focused on the dangers this presents."
He added that the "modern lifestyle, which involves a lack of exposure to sunlight, but also covering up in sunshine" had contributed to the problem.
"The return of rickets in northern parts of the UK came as a surprise, despite the colder climate and lower levels of sunshine in the north, but what has developed in Southampton is quite astonishing," said Prof Clarke.
"We are facing the daunting prospect of an area like Southampton, where it is high income, middle class and leafy in its surroundings, seeing increasing numbers of children with rickets, which would have been inconceivable only a year or so ago."
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Taking vitamin E could slightly increase the risk of a particular type of stroke, a study says.
The British Medical Journal study found that for every 1,250 people there is the chance of one extra haemorrhagic stroke - bleeding in the brain.
Researchers from France, Germany and the US studied nine previous trials and nearly 119,000 people.
But the level at which vitamin E becomes harmful is still unknown, experts say.
The study was carried out at Harvard Medical School, Boston, and INSERM in Paris.
Haemorrhagic strokes are the least common type and occur when a weakened blood vessel supplying the brain ruptures and causes brain damage.
Researchers found that vitamin E increased the risk of this kind of stroke by 22%.
The study also found that vitamin E could actually cut the risk of ischaemic strokes - the most common type of stroke - by 10%.
Ischaemic strokes account for 70% of all cases and happen when a blood clot prevents blood reaching the brain.
Experts found vitamin E could cut the risk, equivalent to one ischaemic stroke prevented per 476 people taking the vitamin.
Lifestyle checkHowever, they warned that keeping to a healthy lifestyle and maintaining low blood pressure and low cholesterol have a far bigger effect on cutting the risk of ischaemic stroke than taking vitamin E.
More than 111,000 people have a stroke every year and they are the third biggest cause of death in the UK.
End Quote Study authorsIndiscriminate widespread use of vitamin E should be cautioned against."”
Those who survive are frequently left with disability.
While none of the trials suggested that taking vitamin E increased the risk for total stroke, the differences were notable for the two individual types of strokes.
The authors concluded: "Given the relatively small risk reduction of ischaemic stroke and the generally more severe outcome of haemorrhagic stroke, indiscriminate widespread use of vitamin E should be cautioned against."
Previous studies have suggested that taking vitamin E can protect the heart from coronary heart disease, but some have also found that the vitamin could increase the risk of death if taken in high doses.
Dr Peter Coleman, deputy director of research at The Stroke Association, said: "This is a very interesting study that shows that the risk of haemorrhagic stroke can be slightly increased by high levels of orally taken Vitamin E, although what is a high level has not clearly been ascertained.
"More research is required to discover the mechanism of action and the level at which Vitamin E can become harmful.
"We urge people to maintain a lifestyle of a balanced diet, regular exercise and monitoring their blood pressure to reduce their risk of a stroke but would be very interested in seeing further research into this study," he said.
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New leaflets are to be handed out urging people to make sure they get enough vitamin D.
Doctors are concerned people in Scotland are not getting enough of the vitamin from sunlight and are not topping up their levels with a healthy diet.
There is increasing evidence that a lack of vitamin D could be linked to cancer and multiple sclerosis.
Doctors are also concerned about a rise in the bone disease rickets.
Rickets is a rare condition which causes the softening and weakening of bones in children.
Pregnant and breastfeeding women are particularly at risk of vitamin D deficiency, along with children under five, the elderly, the housebound and people with darker skin.
About 10 to 15 minutes a day of sunshine is considered safe.
Although the advice in these leaflets isn't new, the Scottish NHS is the only health service in Britain highlighting the dangers of vitamin D deficiency.
If you live in Scotland you'll be familiar enough with the Scottish weather to know why!
On the one hand we're always being warned about the dangers of too much sunshine, now we're being told we're not getting enough.
It's an easy balance to strike though - 10-15 minutes a day is safe and avoid the middle of the day when the sun's rays just burn you.
But in Scotland the sun is only strong enough to provide vitamin D between April and September.
If the body's reserves of vitamin D run out during the winter, they need to be topped up from oily fish, eggs, meat or a supplement.
Health Secretary Nicola Sturgeon said: "We know that in Scotland the winter sun is not strong enough to provide the minimum vitamin D needed for health - especially for those with darker skin.
"A significant proportion of the UK population has low vitamin D levels. This leaflet aims to ensure that those at risk are aware of the implications of vitamin D deficiency and know what they can do to prevent it."
She added: "Vitamin D is key to maintaining healthy bones. Young children have a high risk of deficiency and we are seeing an increase in reported cases of rickets in Scotland.
"These conditions are easily prevented by improving diet and taking a supplement if you are at risk.
"Recent research suggests that vitamin D deficiency may also contribute to a range of other medical conditions. The Scottish government are keen to continue to monitor this evidence."
The health secretary is due to speak at the Shine on Scotland conference on Tuesday, which will bring together academics from across the world to consider the possible links between vitamin D deficiency and various health problems.
The event is taking place after schoolboy Ryan McLaughlin took a petition to the Scottish Parliament which called on ministers to produce new guidelines on vitamin D supplements for children and pregnant women, along with an awareness campaign about the issue.
Ryan took up the cause after watching his mother Kirsten suffering from MS.
He said: "It's amazing that I only launched Shine on Scotland early last year and so much has happened since.
"The petition lodged at the Scottish Parliament got great support and I'm really grateful to the Scottish government for being prepared to look at this issue.
"I hope the summit is a great success and that something positive can be done for people with MS and to prevent future generations from developing it."
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End Quote Professor David Smith Oxford UniversityThese vitamins are doing something to the brain structure - they're protecting it, and that's very important because we need to protect the brain to prevent Alzheimer's”
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