18 April 2012

Heart failure and vitamin D. But what about sunlight?

Supports Chapter Eleven: Our irrational fear of sunlight

Vitamin D, just like all other vitamins, is essential not just to our health, but to life itself. Vitamin D is actually not really a vitamin, because our bodies can synthsize it from cholesterol in our skin with the action of the ultra-violet end of the spectrum of sunlight. But as the specific wavelength - UVB - is attenuated by the atmosphere, there is no point in sunbathing when the sun is low in the sky. We have to be in the sun, with as little clothing on as possible, and no sunscreen, when the sun is so high in the sky that our shadow is no longer than we are. In other words, in the middle of the day. But that is exactly what we are told by the 'experts' not to do!

There is very little food which contains vitamin D.
And vitamin D is one of the four fat-soluble vitamins (the others are A, E, and K). But fat is 'bad for us', isn't it! So the incompetent 'experts' also advise us to shun the only foods which can help.

It should come as no surprise, therefore, that severe vitamin D deficiency is a widespread health problem throughout the industrialised world.

Now a study just published in the European Journal of Heart Failure points out a growing serious health issue caused by this misguided advice. The Abstract of that study is below:

Israel Gotsman, Ayelet Shauer, Donna R. Zwas, et al. Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome. Eur J Heart Fail (2012) 14 (4):357-366.doi: 10.1093/eurjhf/hfr175


Aims Vitamin D deficiency is a highly prevalent, global phenomenon. The prevalence in heart failure (HF) patients and its effect on outcome are less clear. We evaluated vitamin D levels and vitamin D supplementation in patients with HF and its effect on mortality.

Methods and results 25-Hydroxyvitamin D [25(OH)D] levels were evaluated in HF patients from a health maintenance organization (HMO), and compared them with those of the rest of the members of the HMO. Patients with HF (n = 3009) had a lower median 25(OH)D level compared with the control group (n = 46 825): 36.9 nmol/L (interquartile range 23.2–55.9) vs. 40.7 nmol/L (26.7–56.9), respectively, P < 0.00001. The percentage of patients with vitamin D deficiency [25(OH)D <25 nmol/L] was higher in patients with HF compared with the control group (28% vs. 22%, P < 0.00001). Only 8.8% of the HF patients had optimal 25(OH)D levels (≥75 nmol/L). Median clinical follow-up was 518 days. Cox regression analysis demonstrated that vitamin D deficiency was an independent predictor of increased mortality in patients with HF [hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.21–1.92, P < 0.001] and in the control group (HR 1.91, 95% CI 1.48–2.46, P < 0.00001). Vitamin D supplementation was independently associated with reduced mortality in HF patients (HR 0.68, 95% CI 0.54–0.85, P < 0.0001). Parameters associated with vitamin D deficiency in HF patients were decreased previous solar radiation exposure, body mass index, diabetes, female gender, pulse, and decreased calcium and haemoglobin levels.

Conclusions Vitamin D deficiency is highly prevalent in HF patients and is a significant predictor of reduced survival. Vitamin D supplementation was associated with improved outcome.

Note the last sentence. "Vitamin D supplementation" improves survival. So they only consider treating the problem after it has been caused. What's wrong with advising people to get out in the sun more?

Incidentally, I do get out in the sun as much as possible. It doesn't need a lot: half an hour a day at midday is sufficient. I had my serum vitamin D checked a couple of weeks ago. It was 150.8nmol/L. And I aim to keep it that way.


Serdna said...

Great! It is a very interesting data point, given the supposed declining in vitamin D generation capacity with age. Perhaps a good and balanced diet (high fat and high cholesterol) is behind your intact capacity of vitamin D production.
Cheers, Andrés.

Anonymous said...

Back in the fifties my brother and I
used to have 'sunlight treatment' sessions along with a group of other children from similar poor backgrounds . How come vitamin D was recognised as important all those years ago and somehow that knowledge forgotten in the intervening years? I just wonder sometimes if our basic medical knowledge ( the sort that doesn't lead to huge profits ) has purposely been thrown away. No doubt the big food companies and 'health stores' will be charging premium rates for 'food' with added vitamin D and not forgetting the tablets and capsules of course. Vitamin D is there for all for free. Just get out in the sun WITHOUT that expensively bought sunscreen and enjoy!!!!

Anonymous said...

I agree with above comments that perhaps people should get more sun. Unfortunately however, it is more complex than just blaming the food companies...
Exposure to the sun has its issues as well, specifically skin cancer which can be fatal as well as skin aging. You need to be cautious with a recommendation regarding sun exposure that has finite risks.
In addition, even sun exposure perhaps is not enough, as elderly people have a reduced capacity for vitamin D production from sun exposure.
I think that the appropriate recommendation would be to recommend some increase in sun exposure with additional supplementation in those people with vitamin D deficiency.
With regard to prevention, there is no direct data besides epidemiological data to suggest that vitamin D supplementation can prevent systemic diseases such as heart disease. Such recommendations should be backed by direct evidence before recommending supplementation to the whole population.

Barry Groves said...

Anonymous (2)

There are three types of skin cancer. Only one of them, malignant melanoma, is fatal.

As I explained in Chapter 11, although sun exposure is blamed for the recent increase of melanoma, it only appears to do so in people who eat polyunsaturated vegetable cooking oils and margarines.

If you eat a natural diet, the evidence is against sunlight causing any disease. In fact many trials have shown, not only that vitamin D from sunlight reduces the risk of melanoma, it also slows the progression of melanoma if you already have it.

There is some debate about whether regular exposure to sunlight ages the skin. Some studies have shown the opposite - that it protects the skin from aging. And in 76 years, many of which I have spent in the sun as a resident of Singapore and as a naturist, I have noticed that my skin is not as aged as I would have expected by comparing it with others of my age.

But, even if it did age the skin, isn't that preferable to any of the cancers that vitamin D has been shown to reduce the risk of?


Anonymous said...

I despair sometimes. Since when did ' ageing' become a disease? I'm sick of reading articles telling women in particular to keep out of the sun as it causes ' premature ageing ', 'pigmentation' 'wrinkles' and other such horrors. If this is the price I have to pay for living as natural a life as I can, so be it. There's NOTHING as uplifting as relaxing for an hour in full sun. Obviously as with everything you have to use your common sense but if you sunbathe naturally without sunscreen you will feel when your body has had enough. Wearing sunscreen just encourages the wearer to stay in the sun much longer than is beneficial .I personally think it's criminal that sunscreen allows you to 'burn' without burning, if you know what I mean. Now THAT could well be dangerous.

Anonymous said...

These days we women are even being told to wear sunscreen in winter and to cap it all I've even seen sunscreen in night cream! The sun is being treated like a toxic entity instead of a life giving blessing. As far as I'm concerned these sun skin cancer warnings belong in the same bin as the global warming and the current drought myths .( the nearby river has just broken its banks and still the hose pipe ban stays in place )Come on people,do your own homework and think for yourselves

Newspaper Article said...

vitamin d is good for skin's healthy. its from sunlight

Anonymous said...

Hi Barry
Please could you advise me on the use of sunbeds? I'm ow they're not a replacement for natural sunlight as such, but living in the UK, what are the alternatives??
Many thanks

Barry Groves said...

Hi Lynn

I sympathise with you about the opportunities for sunbathing in the UK's current weather!

To answer your question, I have no qualms about sunbeds, but my preference is for vitamin D3 capsules. But that's only because sunbeds are so expensive - and take up a lot of space.

Anonymous said...

Thanks Barry
With regards