Vitamin D Again (or Still)

il_430xn_66592028Is vitamin D the key to a long and healthy life?  Judging simply by the number of literature citations or even the number of times Rick and I have talked about vitamin D in the last 18 months of podcasts, that sure looks to be the case.  Just as historically vitamin E, the B vitamins, and many others have had their moment in the limelight, vitamin D is currently everyone’s  darling.  Now comes a study in Archives of Internal Medicine associating low levels of vitamin D with cognitive decline and dementia.

Almost 900 participants in the InCHIANTI study, an ongoing study designed to identify risk factors for late life disability, were part of this study.  Each of them was assessed cognitively, once at baseline and again every three years.  Serum vitamin D levels were measured as well, and those subjects with the lowest vitamin D levels had the highest risk for cognitive decline and dementia.

It’s worth mentioning here that a very common instrument many of us will hear more about in coming years was used to assess cognition, the mini-mental state examination or MMSE.  And vitamin D levels were actually  serum 25-hydroxyvitamin D, abbreviated 25(OH)D.  So hopefully these won’t be meaningless mumbo-jumbo when they impact on your life.

What does this study tell us about vitamin D, and does it suggest that supplementation in those deemed to be deficient is a good idea?  Rick opines that while there is an association, there is no cause and effect, or smoking gun.  We can’t say, yes, low vitamin D levels cause cognitive problems.  And we really can’t say with certainty that supplements will ward off decline.

What we can say with certainty, as the authors of the study point out, is a very large number of people, especially the elderly, are vitamin D deficient. While estimates of deficiency span the range of 40 to 100% of community dwelling elders, the association of low vitamin D levels with fractures, other chronic conditions and mortality is much more precise.  It seems prudent, then, to test vitamin D levels and supplement those whose levels are found to be low.

How about the rest of us?  Should we supplement with vitamin D or simply try to consume a diet (think fish, eggs, fortified milk) with adequate amounts of the vitamin, and also get some sun exposure, since that’s necessary for converting to an active form of the vitamin?  In a word, yes.  While that same old song about lifestyle, diet, and exercise gets rather tedious sometimes, it remains the best way to assume a healthy life.

Other topics in this week’s podcast include a new drug for weight loss in this week’s NEJM, cholesterol screening in kids in the August issue of Pediatrics, and differences in the management of end stage renal disease around the country in JAMA.  Until next week, y’all live well.

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