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Vitamin B Combination Plus Folic Acid May Reduce Risk of Age-Related Vision Loss

CHICAGO -- February 23, 2009 -- Taking a combination of vitamins B[6 and B12 and folic acid appears to decrease the risk of age-related macular degeneration (AMD) in women, according to a study published in the February 23 issue of Archives of Internal Medicine.
William G. Christen, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, and colleagues conducted a randomised, double-blind trial involving 5,442 women aged 40 years and older who already had heart disease or at least 3 risk factors. Of these, 5,205 did not have AMD at the beginning of the study.

In April 1998, the women were randomly assigned to take a placebo or a combination of folic acid 2.5 mg per day, vitamin B6 50 mg per day, and vitamin B12 1 mg per day. Participants continued the therapy through July 2005 and were tracked for the development of AMD through November 2005.

Over an average of 7.3 years of treatment and follow-up, 137 new cases of AMD were documented, including 70 cases that were visually significant (resulting in a visual acuity of 20/30 or worse). Of these, 55 AMD cases -- 26 visually significant -- occurred in the 2,607 women in the active-treatment group, whereas 82 of the 2,598 women in the placebo group developed AMD, 44 cases of which were visually significant.

Women taking the supplements had a 34% lower risk of any AMD and a 41% lower risk of visually significant AMD. "The beneficial effect of treatment began to emerge at approximately 2 years of follow-up and persisted throughout the trial," the authors wrote.

"The trial findings reported herein are the strongest evidence to date in support of a possible beneficial effect of folic acid and B vitamin supplements in AMD prevention."

Because the findings apply to the early stages of disease development, these supplements appear to represent the first identified way -- other than not smoking -- to reduce the risk of AMD in individuals at an average risk. "From a public health perspective, this is particularly important because persons with early AMD are at increased risk of developing advanced AMD, the leading cause of severe, irreversible vision loss in older Americans," wrote the authors.

Beyond lowering homocysteine levels, potential mechanisms for the effectiveness of B vitamins and folic acid in preventing AMD include antioxidant effects and improved function of blood vessels in the eye, the authors noted.

SOURCE: Archives of Internal Medicine

Some Stress Reducing Foods

What fruits and vegetables should you buy organic and which ones does it not matter
The Environmental Working Group (EWG, a nonprofit, nonpartisan organization) has identified 15 fruits and vegetables that are least likely to be contaminated with pesticide residuesAsparagus
EWG also identified 12 fruits and vegetables that are most likely to have higher trace amounts of pesticides.

About E. coli in salad(spinach)
By OLIVIA MUNOZ, Associated Press WriterTue Sep 19, 2:44 AM ET
On its way to supermarket shelves, bagged spinach passes from field to packing plant to store, with several opportunities along the journey for it to become contaminated with deadly E. coli bacteria.
This complex chain is making it hard to identify the precise source of the outbreak that has killed one person and sickened at least 113 others around the country.
From the time spinach leaves first poke out of the ground, the greatest threat comes from human and animal waste, the most common sources of E. coli.
Food health experts say the germ can be spread a multitude of ways — by manure, by contaminated irrigation water, by farmhands relieving themselves in the field, by inadequate washing by processors, by insufficient refrigeration that promotes the growth of bacteria in sealed bags of salad greens.
The Food and Drug Administration has linked the outbreak to fresh spinach from Salinas-based Natural Selection Foods LLC, the country's largest grower of organic produce. The company has recalled 34 brands of fresh spinach sold at stores around the country.
Experts say there are several points of vulnerability on which public health investigators are focused:
THE FIELD: To keep spinach safe where it grows, the most basic precaution is preventing cattle and other farm animals from walking through the fields, said Kathy Means, a spokeswoman for the Produce Marketing Association and a co-author of the FDA's guidelines on the safe handling of leafy greens.
It is neither standard practice nor in accordance with federal guidelines to use raw animal manure on spinach. FDA guidelines allow composted manure if the decaying organic matter reached a high enough temperature to kill any disease-causing germs.
Also, bacteria thrive in water, and past E. coli outbreaks have been traced to contaminated water in the Salinas Valley, so farmers must make sure that water for crops is not drawn from sources that could contain runoff from cattle pastures.
Drip hoses along the ground are preferred to water sprayed from overhead, because they keep water from coming into contact directly with spinach leaves, Means said.
Farm workers also must keep their equipment clean, use bathrooms and wash their hands with soap and water. California agricultural regulations require that toilet and handwashing facilities for farmworkers be located within one-quarter mile or a five-minute walk from the work site, with one toilet per 20 employees of each gender.
But pressure from farmers may keep workers from using those facilities, said Marc Grossman, spokesman for the United Farm Workers union.
"Farmers do what are called 'speed-ups,' where they push workers to work faster and harder. Sometimes the workers feel under pressure to get that day's job done and don't take their bathroom breaks, especially if the facilities are far away from where they're working," Grossman said.
Employers whose workers use fields instead of the bathrooms can face fines of up to several thousand dollars, said Dean Fryer, a spokesman for the state Occupational Safety and Health Administration.
THE FACTORY: After harvesting, spinach goes to a packing plant, where it is washed and bagged.
The water used to clean the spinach should contain chlorine or a similar disinfectant, Means said, but those chemicals are not designed to kill bacteria already on the leaves. Instead, she said, the chlorine merely keeps water that touches a contaminated plant from passing bacteria on to other plants.
Studies have shown that the structure of spinach leaves make them especially hard to rid of germs, even when washed with treated water.
"It has a lot of places for them to hide," said Trevor Suslow, a food safety researcher at the University of California, Davis.
THE DISTRIBUTOR: Refrigerated trucks and warehouses must keep spinach cold to prevent germs from flourishing, especially in sealed bags.
Yet whatever precautionary measures are in place, industry watchers say you can only do so much to control nature.
"You can have a field out in the middle of nowhere grown with filtered water and filtered soil and be completely clean, and have a flock of birds fly over, and birds do what birds do, and the field then becomes contaminated," said Rochell Dornatt, spokeswoman for Rep. Sam Farr (news, bio, voting record), D-Calif., whose district is home to Natural Selection Foods.
"We know that our producers will do whatever it takes to make sure that their product is safe, but we don't know what's causing this contamination, so until we find out what that is, we're not sure what to do."

Dakota Growers Rolls Out Low-Carb Pasta
Fri Apr 30, 2:55 PM ET  Add Health - AP to My Yahoo!
By DALE WETZEL, Associated Press Writer
BISMARCK, N.D. - Trying to buck an anti-carbohydrate trend that has hammered pasta sales, a North Dakota company is unveiling a new brand of pasta it hopes will appeal to dieters who have been shunning noodles and spaghetti. The Dakota Growers Pasta Co. product, called Dreamfields, is joining an assortment of new, reduced-carbohydrate offerings on the nation's grocery shelves. Dreamfields' developers say its flavor is virtually indistinguishable from regular pasta. It is made mostly from semolina, a granular flour that is used to make conventional pasta, with a patented fiber blend added to block digestion of most of the product's carbohydrates. "We think we have an edge, because along with being low-carb, it is authentic pasta. This is the real deal," said Jack Hasper, Dakota Growers' vice president for marketing.Dakota Growers is part of a group of four businesses, which formed a separate company to develop and market the pasta. It got its formal introduction Thursday at a news conference at Tavern on the Green, a restaurant in New York City's Central Park. It includes spaghetti, elbows, penne rigate and linguine shapes, and will be sold through grocery stores, discount outlets and Dreamfields' Web site. A one-pound box will sell from $2.39 to $2.69, compared to 79 to 99 cents a pound for regular pasta, Hasper said. Dreamfields is advertised as having only 5 grams of digestible carbohydrates for each 2-ounce serving. Dakota Growers' regular product has about 42 gramsJon Anfinsen, a biochemist and one of the project's business partners, says Dreamfields' fiber blend blocks digestion of most carbohydrates, causing the colon to treat them as dietary fiber.In human tests, the product did not have a laxative effect, Anfinsen said. Blood sugar testing confirmed the pasta's low levels of digestible carbohydrates, said Dr. John Abernethy, owner of a medical clinic in Gainesville, Fla., where testing has been conducted for six months. "We've done hundreds of test meals with several dozen subjects," Abernethy said. The Food and Drug Administration (news - web sites) currently does not regulate claims about foods' carbohydrate content. The agency is considering three requests to define the meaning of some terms, including low- and reduced-carbohydrate, a spokeswoman said. The petitions were brought by ConAgra Foods Inc., Kraft Foods Inc. and the Grocery Manufacturers of America. Tim Dodd, Dakota Growers' president, said Dreamfields initially should appeal to two large customer groups — dieters who favor low-carbohydrate meals, and people with diabetes. Starchy foods can cause a diabetic's blood sugar levels to rise quickly. Rick Mendosa, an Aptos, Calif., writer who maintains a Web site with a comprehensive trove of diabetes information, tried the Dreamfields pasta recently over several days. It caused minimal increases in his blood-sugar levels, said Mendosa, who posted test results on his site,
"Some people have weaned themselves off pasta because it is so high in carbs generally, but I think there will be a big market, a huge market in this for people with diabetes," Mendosa said in an interview.
He has heard from other diabetics who experienced big jumps in their blood-sugar levels after eating Dreamfields, but that may have happened because they were extremely resistant to insulin, Medosa said. Insulin regulates how the body uses blood sugar, which is extracted from carbohydrates. Laurie Kuntz, chief executive officer of LowCarbiz, a Denver-based newsletter, magazine and Web site that tracks low-carbohydrate products, said the lack of scientific information about Dreamfields so far has bred skepticism about its benefits."I know that in the diabetic world, there are a number of people who have been showing insulin spikes, so they're not believing what they are reading on the label," she said. Anfinsen said he had expected some disbelief. The pasta brand's Web site will feature extensive research information on the product for consumers to examine, he said. "What we have here is something that is very good. It is good for the health of the population," he said. The number of low-carbohydrate foods has mushroomed in recent months. Kuntz estimates there are 1,300 products that advertise themselves as low-carb, and the number is rising. "There are chips, salad dressings, hot cereals, bars, pasta, pancake mix, cereals, ketchup, jellies, ice cream. You name it," she said.

High doses of vitamins are dangerous, UK report
The UK is set to radically lower the levels of vitamins currently available in supplements and will probably ban the mineral chromium picolinate from shelves, following advice from experts who cite health risks from vitamin overdoses and even cancer.
The report, commissioned by the UK’s Food Standards Agency (FSA), is set to shake up the natural health industry, with changes to dosages of some of the most commonly used vitamins and minerals, including vitamin C and iron.

The FSA warns that levels of vitamin C above 1000mg/day could cause abdominal pain and diarrhoea. In some supplements, vitamin C is available at up to three times this amount. Doses of calcium above 1500mg/day and iron above 17mg/day may also result in similar symptoms in some people, said the report. However the symptoms are not permanent and should disappear once people stop taking the supplements.

The report also finds that chromium in the form of chromium picolinate may have the potential to cause cancer. The Expert group highlighted a study showing that chromium picolinate - a synthetic chromium compound - has caused DNA damage in mammalian cells, and others associating it with renal failure. Consumers are therefore being advised not to take chromium in this form and the FSA is consulting on a proposal to ban its use in the manufacture of food supplements from July next year. Despite this, the Agency confirms that 10mg daily or less in total of chromium in other forms is unlikely to cause any harm.

Other substances under review include beta-carotene, which is thought to increase the risk of lung cancer in smokers and those exposed to asbestos when taken at high doses. Nicotinic acid, zinc, manganese (especially for older people) and phosphorus, are also thought to produce irreversible harmful effects if taken for long periods at the highest supplemental doses, said the FSA.

Current advice on vitamin B6 is also being re-emphasised. The Agency warns against taking more than 10mg/day of vitamin B6 from dietary supplements unless acting on medical advice. It warns that high intakes taken over a long period of time can lead to a loss of feeling in the arms and legs.

Further advice is given on biotin, folic acid, pantothenic acid, riboflavin, niacin, thiamin, vitamin B12, vitamin D, vitamin E, vitamin K, boron, cobalt, copper, iodine, molybdenum, nickel, selenium, tin, magnesium, potassium, and silicon.

Commenting on the safety advice, Sir John Krebs, chair of the Food Standards Agency, said: “We are using an extremely thorough independent expert review of the scientific evidence on the safety of vitamins and minerals as the basis for new advice to help consumers make informed choices. In addition, the Board of the Food Standards Agency will be considering what further action we would wish the supplements industry to take.”

The report has prompted widespread industry and consumer reaction. Children’s charity The Birth Defects Foundation (BDF) warns that pregnant women could put the health of their unborn children at risk following the FSA advice on folic acid - in older people it can conceal the symptoms of B12 deficiency, according to the report. The charity said it has received a flood of calls to its nurse-run helpline, with future mothers questioning the safety of taking folic acid supplements during pregnancy.

Sheila Brown, chief executive of BDF, which funds research into the cause and prevention of defects in the unborn child, said: "There is a great deal of research currently being carried out into the effects of vitamin supplements on both adults and children but folic acid is medically proven to be save and even essential to the health of the unborn child. I am concerned that some mum's-to-be could be deterred from taking folic acid as a direct consequence of the FSA's report.”

A report in The Times yesterday said that Ralph Pike, of the National Association of Health Stores, which represents 12,500 health shops in the UK, was incensed by the 'meddling' of the FSA.

"Where are the dead bodies? There has not been one death anywhere in the world from people taking a legitimate vitamin supplement. The authorities just don’t like people taking control of their own health and they want everyone to abrogate responsibility for their lives to the nanny state," he is quoted as saying.

The global natural health industry has suffered a number of attacks recently. In the US, a report in the New York Times last week calling vitamins useless will have a considerable effect on consumer purchasing, while in Australia, the country's leading supplement maker has been involved in a major product recall. The industry is under increasing pressure to promote the safety and efficacy of its goods.

The FSA Board is currently working on recommendations to the supplement industry for dose reductions and/or label warnings for some high dose food supplements.

The report was carried out by the Expert Group on Vitamins and Minerals (EVM), which makes recommendations on 31 vitamins and minerals. A draft of the report was issued in September last year.

Most carbohydrates come from plant-based foods—fruits, vegetables, grains, and legumes (beans, peas, and lentils). Dairy products are the only animal-derived foods with lots of carbs. There are two general types of carbohydrates:
• Simple carbohydrates are sugars—glucose and fructose from fruits and some vegetables, lactose from milk, sucrose from cane or beet sugar, and others. Table sugar is pure sucrose. Much of the simple carbs we eat are sugars added to processed foods such as sodas, cookies, etc. These added sugars are the main reason why sugar now accounts for 16% of all calories consumed by Americans; 20 years ago, it supplied 11%. Soda alone supplies about one-third of this added sugar.
• Complex carbohydrates, which are chains of simple sugars, consist primarily of starches as well as the fiber that occurs in all plant foods. Starch is the storage form of carbohydrates in plants. Foods rich in complex carbs include grains and grain products (such as bread and pasta), beans, potatoes, corn, and some other vegetables.

FDA Consumer magazine  May-June 2000
by John Henkel
Vegetarians and health enthusiasts have known for years that foods rich in soy protein offer a good alternative to meat, poultry, and other animal-based products. As consumers have pursued healthier lifestyles in recent years, consumption of soy foods has risen steadily, bolstered by scientific studies showing health benefits from these products. Last October, the Food and Drug Administration gave food manufacturers permission to put labels on products high in soy protein indicating that these foods may help lower heart disease risk.
As with health claims for oat bran and other foods before it, this health claim provides consumers with solid scientific information about the benefits of soy protein and helps them make informed choices to create a "heart healthy" diet. Health claims encourage food manufacturers to make more healthful products. With soy, food manufacturers have responded with a cornucopia of soy-based wares. (See "The Soy Health Claim.")
No sooner had FDA proposed the health claim regulation, however, than concerns arose about certain components in soy products, particularly isoflavones. Resulting questions have engulfed the regulation in controversy.
This came as no surprise to Elizabeth A. Yetley, Ph.D., lead scientist for nutrition at FDA's Center for Food Safety and Applied Nutrition . "Every dietary health claim that has ever been published has had controversy," she says, "even the relationship of saturated fat to a healthy diet."
While the controversy may seem confusing to the consumer giving it casual consideration, a careful review of the science behind the rule reveals a strict divide between what FDA allows as a health claim based on solid scientific research and related issues that go well beyond the approved statements about health benefits of soy protein.
What's known is that all foods, including soy, are complex collections of chemicals that can be beneficial for many people in many situations, but can be harmful to some people when used inappropriately. In that simple fact lies much of the scientific dilemma--when do data show a food is safe and when do they show there could be problems?
Scientists agree that foods rich in soy protein can have considerable value to heart health, a fact backed by dozens of controlled clinical studies. A yearlong review of the available human studies in 1999 prompted FDA to allow a health claim on food labels stating that a daily diet containing 25 grams of soy protein, also low in saturated fat and cholesterol, may reduce the risk of heart disease.
"Soy by itself is not a magic food," says Christine Lewis, acting director of the Center for Food Safety and Applied Nutrition's Office of Nutritional Products, Labeling and Dietary Supplements. "But rather it is an example of the different kinds of foods that together in a complete diet can have a positive effect on health."
Much of the research to date has examined dietary soy in the form of whole foods such as tofu, "soymilk," or as soy protein added to foods, and the public health community mostly concurs that these whole foods can be worthwhile additions to a healthy diet. The recently raised concerns, however, focus on specific components of soy, such as the soy isoflavones daidzein and genistein, not the whole food or intact soy protein. These chemicals, available over the counter in pills and powders, are often advertised as dietary supplements for use by women to help lessen menopausal symptoms such as hot flashes.
The problem, researchers say, is that isoflavones are phytoestrogens, a weak form of estrogen that could have a drug-like effect in the body. This may be pronounced in postmenopausal women, and some studies suggest that high isoflavone levels might increase the risk of cancer, particularly breast cancer. Research data, however, are far from conclusive, and some studies show just the opposite--that under some conditions, soy may help prevent breast cancer. It is this scientific conundrum, where evidence simultaneously points to benefits and possible risks, that is causing some researchers to urge caution.
Unlike the controversy surrounding soy isoflavones, available evidence on soy protein benefits is much clearer. That's why FDA limited its health claim to foods containing intact soy protein. The claim does not extend to isolated substances from soy protein such as the isoflavones genistein and daidzein.
"The story's not all in yet," says Margo Woods, D.Sc., associate professor of medicine at Tufts University, who has studied soy's effects in postmenopausal women. "There's a lot of emerging data and it's confusing. In the meantime, we should be cautious." She says her concerns are centered mainly on isoflavone supplements and that she's "much more comfortable" recommending soy as a whole food. "There are probably hundreds of protective compounds in soy [foods]. It's just too big a leap to assume that a pill could do the same thing."
Daniel Sheehan, Ph.D., director of the Estrogen Knowledge Base Program at FDA's National Center for Toxicological Research, also urges caution in consumption of soy isoflavones. In formal comments submitted to the public record of his own agency while FDA was reviewing the health claim, Sheehan, along with colleague Daniel Doerge, Ph.D., wrote, "While isoflavones may have beneficial effects at some ages or circumstances, this cannot be assumed to be true at all ages. Isoflavones are like other estrogens in that they are two-edged swords, conferring both benefits and risks."
As a science-based agency, FDA recognizes that research information evolves with time and that some of the existing confusion will be resolved as new studies are completed. "We continue to monitor the ongoing science," Yetley says. "As new data warrants, we make adjustments in our position and the advice we give to the public. We take this responsibility very seriously."
Soy Benefits
Soy protein products can be good substitutes for animal products because, unlike some other beans, soy offers a "complete" protein profile. Soybeans contain all the amino acids essential to human nutrition, which must be supplied in the diet because they cannot be synthesized by the human body. Soy protein products can replace animal-based foods--which also have complete proteins but tend to contain more fat, especially saturated fat--without requiring major adjustments elsewhere in the diet.
While foreign cultures, especially Asians, have used soy extensively for centuries, mainstream America has been slow to move dietary soy beyond a niche market status. In the United States, soybean is a huge cash crop, but the product is used largely as livestock feed.
With the increased emphasis on healthy diets, that may be changing. Sales of soy products are up and are projected to increase, due in part, say industry officials, to the FDA-approved health claim. (U.S. retail sales of soyfoods were $.852 billion in 1992 and are projected to rise to $3.714 billion in 2002. See attached chart.) "We've seen this before with other claims FDA has approved," says Brian Sansoni, senior manager for public policy at the Grocery Manufacturers of America. "It brings attention to products; there are newspaper and TV stories and information on the Internet."
To qualify for the health claim, foods must contain at least 6.25 grams of soy protein per serving and fit other criteria, such as being low in fat, cholesterol, and sodium. The claim is similar to others the agency has approved in recent years to indicate heart benefits, including claims for the cholesterol-lowering effects of soluble fiber in oat bran and psyllium seeds.
FDA determined that diets with four daily soy servings can reduce levels of low-density lipoproteins (LDLs), the so-called "bad cholesterol" that builds up in blood vessels, by as much as 10 percent. This number is significant because heart experts generally agree that a 1 percent drop in total cholesterol can equal a 2 percent drop in heart disease risk. Heart disease kills more Americans than any other illness. Disorders of the heart and blood vessels, including stroke, cause nearly 1 million deaths yearly.
FDA allowed the health claim for soy protein in response to a petition by Protein Technologies International Inc., a leading soy producer that tracks its origins to soybean studies sponsored by Henry Ford in the early 1930s. The company was acquired by E.I. du Pont de Nemours & Company (DuPont) in 1997. In considering the petition, FDA reviewed data from 27 clinical studies submitted in the petition, as well as comments submitted to the public record and studies identified by FDA. The available research consistently showed that regular soy protein consumption lowered cholesterol to varying degrees.
One of the studies, conducted over nine weeks at Wake Forest University Baptist Medical Center and reported in the Archives of Internal Medicine in 1999, found that soy protein can reduce plasma concentrations of total and LDL cholesterol but does not adversely affect levels of HDL, or "good" cholesterol, which at high levels has been associated with a reduction in heart disease risk. Another often-quoted study, published in the New England Journal of Medicine in 1995, examined 38 separate studies and concluded that soy protein can prompt "significant reductions" not only in total and LDL cholesterol, but also in triglycerides, another fat linked to health problems when present at elevated levels.
Other studies hint that soy may have benefits beyond fostering a healthy heart. At the Third International Symposium on the Role of Soy in Preventing and Treating Chronic Disease, held in late 1999, researchers presented data linking soy consumption to a reduced risk of several illnesses. Disorders as diverse as osteoporosis, prostate cancer, and colon cancer are under investigation.
Soy's Many Faces
Though soy may seem like a new and different kind of food for many Americans, it actually is found in a number of products already widely consumed. For example, soybean oil accounts for 79 percent of the edible fats used annually in the United States, according to the United Soybean Board. A glance at the ingredients for commercial mayonnaises, margarines, salad dressings, or vegetable shortenings often reveals soybean oil high on the list.
But the health claim only covers the form that includes soy protein. This form can be incorporated into the diet in a variety of ways to help reach the daily intake of 25 grams of soy protein considered beneficial.
While not every form of the following foods will qualify for the health claim, these are some of the most common sources of soy protein:
Tofu is made from cooked puréed soybeans processed into a custard-like cake. It has a neutral flavor and can be stir-fried, mixed into "smoothies," or blended into a cream cheese texture for use in dips or as a cheese substitute. It comes in firm, soft and silken textures.
"Soymilk," the name some marketers use for a soy beverage, is produced by grinding dehulled soybeans and mixing them with water to form a milk-like liquid. It can be consumed as a beverage or used in recipes as a substitute for cow's milk. Soymilk, sometimes fortified with calcium, comes plain or in flavors such as vanilla, chocolate and coffee. For lactose-intolerant individuals, it can be a good replacement for dairy products.
Soy flour is created by grinding roasted soybeans into a fine powder. The flour adds protein to baked goods, and, because it adds moisture, it can be used as an egg substitute in these products. It also can be found in cereals, pancake mixes, frozen desserts, and other common foods.
Textured soy protein is made from defatted soy flour, which is compressed and dehydrated. It can be used as a meat substitute or as filler in dishes such as meatloaf.
Tempeh is made from whole, cooked soybeans formed into a chewy cake and used as a meat substitute.
Miso is a fermented soybean paste used for seasoning and in soup stock.
Soy protein also is found in many "meat analog" products, such as soy sausages, burgers, franks, and cold cuts, as well as soy yogurts and cheese, all of which are intended as substitutes for their animal-based counterparts.
Since not all foods that contain soy ingredients will meet the required conditions for the health claim, consumers should check the labels of products to identify those most appropriate for a heart-healthy diet. Make sure the products contain enough soy protein to make a meaningful contribution to the total daily diet without being high in saturated fat and other unhealthy substances.
Are Consumers Warming Up to Soy?
Although it's clear that Americans are increasing their consumption of soy products, the soybean has a long way to go before it becomes a staple in the average pantry. According to a 1999 survey by the United Soybean Board, two-thirds of consumers surveyed believe soy products are "healthy," up from 59 percent in 1997. While the public may think it's good for them, only 15 percent eat a soy product once a week.
The reason for the disparity appears to be a problem of perception. "Americans are not prepared to make massive lifestyle changes in order to get healthy foods into their diet," says chef and soy cookbook author Dana Jacobi. "Many people have negative attitudes toward soy products due to their misconception of, or their experiences with, taste and texture. But in fact, there are so many ways to work soy into your diet." (See "Adding Soy Protein to the Diet.")
Industry figures show that in some cases, the popularity of soy foods is increasing dramatically. For example, in 1998, sales of soymilk grew 53 percent in mainstream supermarkets and 24 percent in health food stores over the previous year, according to data from Spence Information Services, a San Francisco sales tracking firm. Another research firm, HealthFocus, reports that 10 percent of shoppers in 1998, versus 3 percent in 1996, said they are eating more soy specifically because they believe it will reduce their risk of disease.
According to the Soyfoods Association of North America, three factors are responsible for driving soy's upward trend:
Baby boomers are more enlightened about, and more interested in, longevity and good health than previous generations.
The double-digit growth in Asian populations in the United States has fueled demand for traditional soy foods. Americans also are eating more Asian foods, which often include soy.
Young people are choosing more plant-based foods. A food industry survey found that 97 percent of colleges and universities now offer meatless entrées on their menus.
Mainstream grocery stores also have been prominently displaying soy products amid traditional foods. Soy-based burgers and sausages are often found in the freezer case next to other meats. Some stores offer refrigerated soymilk alongside cow's milk products. And it's not unusual to see tofu, along with soy cheese and cold cuts, in a store's fresh fruit and veggie department. "We expanded our line of soy products in the produce section even before [FDA approved] the health claim," says Paulette Thompson, nutritionist for Giant Food, a large East Coast grocery chain. "But soy is still rather mysterious to many consumers, so it's important to educate them." She says her company is offering information about soy in its Sunday newspaper supplements and its quarterly consumer magazine. It also plans a special "healthy products" promotion that will trumpet the benefits of soy and other diet components.
For consumers reluctant to try soy foods because they fear a bad taste, food manufacturers are creating new lines of soy-based products that contain enough soy to meet the claim requirement but are developed specifically to taste good. "Soy's major stumbling block has been its taste, real or perceived," says Meghan Parkhurst, spokeswoman for Kellogg Co. She says the company plans to introduce in several western states a granola-like soy cereal that got high marks for taste in consumer trials.
Examining the Controversy
While the existing scientific data strongly support the value of increasing soy protein as described in the health claim, questions have been raised about individual components of soy, especially when consumed as concentrated supplements by some segments of the population.
"FDA continues to monitor the debates about the relative safety of these individual soy components and the scientific research that will eventually resolve them," says the Center for Food Safety and Applied Nutrition's Lewis, "If new results suggest an increased risk, the agency will modify or refine its policies in light of the new information."
A number of studies already are under way or in the planning stages now. In one study, Barry Delclos, Ph.D., a researcher at FDA's National Center for Toxicological Research (NCTR), is overseeing a long-term, multigeneration study in rats of the soy component genistein. Early data using rats suggest that genistein alone may prompt undesirable effects such as the growth of breast tissue in males. The study will analyze the relationship between dosage and any adverse outcomes.
The National Institutes of Health is sponsoring a long-term follow-up study on the safety of soy infant formula. The study is a "longitudinal retrospective epidemiological" assessment in which young adults who consumed soy formula as infants will be compared with young adults who consumed milk-based formulas as infants. They will be evaluated for any adverse effects from infancy into their childbearing years.
NCTR's Sheehan says research is needed in this area because an earlier study, published in 1997 in the medical journal The Lancet, showed that infants consuming soy formula had five to 10 times higher levels of isoflavones in their blood serum than women receiving soy supplements who show menstrual cycle disturbances. He says these levels may cause toxicological effects. "Infants receive higher doses of soy and isoflavones than anybody because it is their only food and they are consuming it all the time." The American Academy of Pediatrics, however, has published guidelines showing that in some cases, soy protein-based formulas "are appropriate for use in infants" when cow's milk cannot be tolerated.
Sheehan also expresses concern about the effects soy may have on the function of the thyroid gland. Animal study results, some of which date back to 1959, link soy isoflavones to possible thyroid disorders, such as goiter. A 1997 study in Biochemical Pharmacology identified genistein and daidzein as inhibitors of thyroid peroxidase, which data suggest may prompt goiter and autoimmune disorders of the thyroid. Critics of these studies suggest that iodine deficiency may be a factor that needs to be considered when evaluating study results.
Though the research community has varying degrees of concern about a possible "dark side" to soy consumption, one thread runs consistently through its messages: the need for more research for new uses of soy components. The health claim, however, focuses on uses of soy protein that are generally accepted among health professionals as useful for heart-healthy diets.
Sales of soy foods probably will continue to rise steadily for the foreseeable future, says Sansoni of the Grocery Manufacturers of America. "We're seeing a 'buzz' with soy products that intrigues people and they want to try them," he says. "But I don't believe soy is a fad. It's a continuing trend that's here for the long haul."
With the rising interest, the health claim for soy protein appears to have succeeded. It has provided specific guidelines to help the public improve the heart-healthiness of its diet and has stimulated the industry to produce new food products high in soy protein. These trends, in the end, should be good for those trying to lower their risk of heart disease.
John Henkel is a member of FDA's public affairs staff.

Adding Soy Protein to the Diet
For consumers interested in increasing soy protein consumption to help reduce their risk of heart disease, health experts say they need not completely eliminate animal-based products such as meat, poultry, and dairy foods to reap soy's benefits. While soy protein's direct effects on cholesterol levels are well documented, replacing some animal protein with soy protein is a valuable way to lower fat intake. "If individuals begin to substitute soy products, for example, soy burgers, for foods high in saturated fat, such as hamburgers, there would be the added advantage of replacing saturated fat and cholesterol [in] the diet," says Alice Lichtenstein, D.Sc., professor of nutrition at Tufts University. Whole soy foods also are a good source of fiber, B vitamins, calcium, and omega-3 essential fatty acids, all important food components.
The American Heart Association recommends that soy products be used in a diet that includes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and lean meats. The AHA also emphasizes that a diet to effectively lower cholesterol should consist of no more than 30 percent of total daily calories from fat and no more than 10 percent of calories from saturated fat.
Nowadays, a huge variety of soy foods is on shelves not only in health food stores, but increasingly in mainstream grocery stores. As the number of soy-based products grows, it becomes increasingly easy for consumers to add enough soy to their daily diets to meet the 25-gram amount that FDA says is beneficial to heart health. According to soybean industry figures, the numbers add up quickly when you look at the protein contained in typical soy foods. For example:
Four ounces of firm tofu contains 13 grams of soy protein.
One soy "sausage" link provides 6 grams of protein.
One soy "burger" includes 10 to 12 grams of protein.
An 8-ounce glass of plain soymilk contains 10 grams of protein.
One soy protein bar delivers 14 grams of protein.
One-half cup of tempeh provides 19.5 grams of protein.
And a quarter cup of roasted soy nuts contains 19 grams of soy protein.
Though some consumers may try soy products here and there, it takes a sustained effort to eat enough to reach the beneficial daily intake. This is especially true for those who have elevated cholesterol levels. "Dietary interventions that can lower cholesterol are important tools for physicians," says Antonio Gotto, M.D., professor of medicine at Cornell University, "particularly since diet is usually prescribed before medication and is continued after drug therapy is begun." He emphasizes that in order to succeed, such diets must have enough variety that patients don't get bored and lapse back into old eating habits. He says his experience with patients suggests that it's important to learn how to "sneak" soy into the diet painlessly.
"People think it's challenging to get a high concentration of soy into your diet," says chef and cookbook author Dana Jacobi. "But it's actually easy to consume 25 grams [of soy protein], once you realize what a wide range of soy products is available." For those new to soy, she recommends what she calls "good-tasting" soy foods such as smoothies, muffins made with soy flour, protein bars, and soy nuts.
The American Dietetic Association recommends introducing soy slowly by adding small amounts to the daily diet or mixing into existing foods. Then, once the taste and texture have become familiar, add more.
Because some soy products have a mild or even neutral flavor, it's possible to add soy to dishes and barely know it's there. Soy flour can be used to thicken sauces and gravies. Soymilk can be added to baked goods and desserts. And tofu takes on the flavor of whatever it is cooked in, making it suitable for stews and stir-fries. "Cook it with strong flavors such as garlic, crushed red pepper, or ginger," says Amy Lanou, a New York-based nutritionist. "One of my favorites is tofu sautéed with a spicy barbecue sauce." She also suggests commercial forms of baked tofu, which she says has a "cheese-like texture and a mild, but delicious, flavor." For soy "newbies," she also recommends trying a high-quality restaurant that really knows how to prepare soy dishes--just to see how professionals handle soy.
Soy chefs and nutritionists suggest the following further possibilities for adding soy to the diet:
Include soy-based beverages, muffins, sausages, yogurt, or cream cheese at breakfast. Use soy deli meats, soy nut butter (similar to peanut butter), or soy cheese to make sandwiches. Top pizzas with soy cheese, pepperoni, sausages, or "crumbles" (similar to ground beef). Grill soy hot dogs, burgers, marinated tempeh, and baked tofu. Cube and stir fry tofu or tempeh and add to a salad. Pour soymilk on cereal and use it in cooking or to make "smoothies." Order soy-based dishes such as spicy bean curd and miso soup at Asian restaurants. Eat roasted soy nuts or a soy protein bar for a snack.

The Soy Health Claim
In October 1999, FDA approved a health claim that can be used on labels of soy-based foods to tout their heart-healthy benefits. The agency reviewed research from 27 studies that showed soy protein's value in lowering levels of total cholesterol and low-density lipoprotein (LDL, or "bad" cholesterol).
Food marketers can now use the following claim, or a reasonable variation, on their products: "Diets low in saturated fat and cholesterol that include 25 grams of soy protein a day may reduce the risk of heart disease. One serving of (name of food) provides __ grams of soy protein." To qualify for the claim foods must contain per serving:
6.25 grams of soy protein
low fat (less than 3 grams)
low saturated fat (less than 1 gram)
low cholesterol (less than 20 milligrams)
sodium value of less than 480 milligrams for individual foods, less than 720 milligrams if considered a main dish, and less than 960 milligrams if considered a meal.
Foods made with the whole soybean, such as tofu, may qualify for the claim if they have no fat other than that naturally present in the whole bean.

The extraordinary berry.
Adding berries to your diet may help you stay sharp to a ripe old age. Studies have shown nutrient-rich berries may diminish the cognitive decline associated with aging. Berries are powerful antioxidants.Raspberries have as much antioxidant power as spinach -- strawberries have even more, and blueberries have twice as much. 

Here are five good reasons it just might be  lentils. 1) Lentils, a fine source of plant protein, don't take hours to cook, unlike other dried beans. 2) Lentils are rich in soluble fiber, which helps control blood cholesterol. 3) Lentils provide some calcium, iron and other trace minerals. 4) Lentils are one of the best sources for folic acid, a B vitamin critical for preventing neural tube defects. 5) Lentils may protect against some types of cancers and lower heart disease risk.

Can eating  peas save your eyesight? Peas are also an excellent source of lutein, which is believed to help fight macular degeneration, the leading cause of blindness in people age 65 and older. It may surprise you to learn peas are not vegetables -- they're actually legumes. Either way, a 2/3-cup serving contains about 5 grams of protein, or about 10% of the daily protein needs of a 130-lb. person. Like other legumes, peas are rich in B vitamins, minerals and soluble fiber. While it's a treat to eat fresh peas in late spring and early summer, shucking them is tedious. Frozen peas are just as nutritious as fresh. Add them to pilafs, bean salads and soups.

Parsley isn't just pretty on the plate -- the green herb may help keep you in the pink. Parsley is rich in potassium, vitamins C and A, folic acid, iron and copper. It also contains phytochemicals that may have cancer-fighting and heart-protective properties. Research into these potential health benefits is in its infancy, however, and there's no data directly relating parsley consumption and lowered disease risk. To wash fresh parsley, dunk the leaves in a large bowl of cold water. Shake off the excess, wrap in paper towels and refrigerate in a plastic bag. It'll keep for several days. Add larger quantities to pilafs, potatoes, egg dishes and vegetable sautes shortly before you finish cooking for a nutritious boost that's not just cosmetic.

Strawberries, Raspberries Halt Cancer in Rats

BOSTON (Reuters Health) - If animal studies are correct, black raspberries and strawberries may be "very, very powerful" inhibitors of cancer growth, an Ohio researcher reported here this month at the American Chemical Society's annual meeting.

People should make berries one of their daily fruit servings, or at least try to eat berries two or three times a week, Dr. Gary D. Stoner of Ohio State University told Reuters Health.

Animal studies by Stoner and his colleagues found the berries were potent inhibitors of cancer development in rodents given cancer-promoting chemicals. The team is now planning studies in people to investigate the effect of berries on both esophageal and colon cancer.

Stoner and his team are studying squamous cell carcinoma (SCC) of the esophagus, which makes up 95% of cases of esophageal cancer worldwide. Overall, survival is very poor, with 10% of patients living 5 years after diagnosis.

Esophageal SCC is particularly common in China, Japan, the Transkei region of South Africa, Iran, France and Puerto Rico. Men are more likely than women to develop the disease, and African Americans also face an increased risk compared with whites.

Smoking, alcohol, salt, and hot and spicy foods are known to promote the development of esophageal SCC. Fungal toxins and chemicals called nitrosamines--both found in the Chinese diet--and vitamin and mineral deficiencies have also been implicated.

To investigate strategies for blocking esophageal SCC growth, Stoner and his team fed rats two types of cancer-promoting nitrosamine chemicals. While chemicals called isothiocyanates proved to be the best way to stop tumors from forming in the first place, strawberries and black raspberries from an Ohio farm worked best for preventing tumors from growing.

Isothiocyanates are found in many foods, including cruciferous vegetables like broccoli and wasabi, a pungent Japanese condiment.

Rats that consumed 5% to 10% of their diet as freeze-dried black raspberries and strawberries showed dramatic reductions in the growth of precancerous cells and tumor progression, the researchers found. And in other animal tests, Stoner told Reuters Health, the berries reduced colon cancer growth by 80%.

The Ohio Department of Agriculture supported the research Stoner presented at the meeting.

Eating berries could be a way to help people at risk of esophageal SCC protect themselves from the disease, Stoner said.

But there are obstacles. For one, he pointed out, berries are a seasonal food in most of the world, which has also made it difficult to conduct epidemiological studies of their effects on cancer. And in some countries where esophageal SCC is a major problem--like China--people rarely eat berries. Finally, berries are expensive.

One way to get around these problems, Stoner said, might be to use extracts of the freeze-dried berries. He and his colleagues have been able to develop some potent berry extracts, he added.

Stoner and his team have completed Phase I trials to investigate the toxicity of the berries and whether berry components reach the bloodstream. People who ate two large bowls of berries a day showed no toxic effects, and many fruit components were absorbed into the blood, according to Stoner.

The researchers, in partnership with a food company, are now launching Phase II clinical trials to investigate whether berries have a cancer-protecting effect on esophageal cancer among people in China and the US. They also plan to investigate the effect of berries on colon cancer.

Peanut Butter as Health Food
Fri Aug 23,11:50 PM ET
(HealthScoutNews) -- Good news about a convenient, tasty kid food: peanut butter. It can help protect against two serious health threats -- heart disease and obesity -- reports Clarian Health Partners, an affiliate of Indiana University. Recent studies show that diets rich in peanuts and peanut butter appear to protect against heart disease by lowering levels of bad LDL cholesterol and controlling body weight, benefits that older children and teens need more than ever. Just don't let the kids overdo it.
And remember to follow this important caveat: The American Academy of Pediatrics suggests that parents wait until their children are at least 2 years old before introducing them to peanut butter. Hold off until age 3 if either parent has any type of allergy.
Start with just a little bit, spread thin on a cracker. And wait until age 4 before serving chunky peanut butter, to guard against choking.
Discourage eating peanut butter right from the spoon. It can cause choking in both children and adults.

Vitamins and Minerals
Although vitamins are a small part of our diets, they are absolutely essential to life. This is true because the human body can only produce Vitamin D; all other vitamins must be taken into your body by foods you eat. This sometimes poses a problem to people who are trying to limit the amount of food they eat.
Vitamin A
Vitamin A can only be found in animal products, including butter, eggs, oils and fish liver. However, there is a yellowish substance in plants called "carotene" which can be changed to Vitamin A in animals. The RDA (Recommended Daily Allowance) for an adult is about 1.5 mg (5,000 IU.)
Vitamin A is necessary to maintain the epithelial cells of the eyes, skin and the digestive and respiratory tracts. Vitamin A deficiency causes the cells to become flat and less resistant to infection. Sometimes Vitamin A (well deserving) is called the "anti-infection vitamin."
Vitamin B Complex
Vitamin B Complex used to be known as the "anti-beriberi factor," but now the Vitamin B Complex has been separated into other materials with different biologic effects. Liver, and yeast are prime sources for Vitamin B.
Vitamin B1 (Thiamine)
Vitamin B1 is the first part which is separated from the rest of the complex. Thiamine helps prevent beriberi. Although this vitamin can now be synthetically prepared, it can be found in Liver, port, yeast, nuts, and some grains. An average adult requires 2 to 3 grams of Vitamin B1. Breads, flour and cereals are now enriched with thiamine so there is no longer a worry of deficient Vitamin B1 intake, which would cause beriberi.

Vitamin B2 (Riboflavin or G)
Riboflavin, as it is generally called, is also found in liver, yeast, in addition to wheat germ, eggs, and cheese. Riboflavin helps in the metabolism of glucose and amino acids. An average adult requires 1 to 2 grams of riboflavin.

Vitamin B6 (Pyridoxine)
Vitamin B6 can be found in nuts, meats, eggs and whole grains and beans. Vitamin B6 helps in the metabolism of some amino acids.

Vitamin B12 (Cobalamin), Folic Acid, Choline, and Ionistol
All of these are necessary to prevent anemia. They also play a key role in the metabolism of certain substances involved in the synthesis of amino acids.
Vitamin C
Vitamin C is mainly found in oranges, lemons, and other citrus fruits. The RDA of Vitamin C is from 75 to 100 mg for an adult. A lack of Vitamin C can cause scurvy, a common disease suffered by sailors who were on long sea voyages. A combination of deficient protein, vegetable and Vitamin C intakes can cause scurvy. Nowadays, scurvy has been virtually obliterated by modern packaging techniques. Ascorbic acid was found to be the vitamin which prevented scurvy. Vitamin C takes a part in cellular oxidation.

Vitamin D
Vitamin D can be found in butter, eggs, milk and some oils. Vitamin D is necessary for normal absorption of calcium and phosphorus from the intestine. Adults and children only need about .02 mg per day.

Vitamin E
Studies on rats, chicks and ducks have shown that Vitamin E is necessary to prevent sterility. When absent, the male animals became sterile and the females were unable to complete the pregnancy process. It is not been proven that Vitamin E deficiency can cause sterility, but it is a possibility. However, experiments that pertain to humans have shown that deficiency of Vitamin E has caused progressive deterioration of the muscles and paralysis.
(Biology, Villee, Fourth Edition)

Vitamin K
Vitamin K helps in the normal clotting of blood. A recommended amount is 1 to 5 mg a day.

Niacin (Nicotinic Acid)
Niacin is present in yeast, meat, beer and fresh vegetables. Niacin help maintain the epithelia of the skin cells and digestive tract. The RDA is 20 to 25 mg. for an adult.

There are 15 essential minerals, some include: sodium chloride, potassium, magnesium, phosphorus, calcium, iron, copper, manganese, iodine, zinc, and cobalt. Zinc, manganese and cobalt are only needed in trace amounts.

Pantothenic Acid
Pantothenic Acid helps in the normal maintenance of nerves and skin. Sources include, eggs, meats, and some nuts.

Antioxidants Battle Inflammation
Source: American Diabetes Association
Publication date: 2002-07-09
Heart Disease Weekly
July 14, 2002
High-fat meal raises blood's proinflammatory factors; vitamins E and C counter that response
In a series of studies designed to define the role of dietary macronutrients in the initiation of arterial inflammation that predisposes a person to atherosclerosis, University at Buffalo researchers have found that a high intake of glucose, or eating a high-fat, high-calorie, fast-food meal causes an increase in the blood's inflammatory components.
However, they also have shown that the antioxidant vitamins E and C can nullify this inflammatory response.
Results of the research were presented in San Francisco, California at the June 2002 annual meeting of the American Diabetes Association. "A meal high in calories and fat caused an increase in inflammatory markers that lasted 3-4 hours," said Paresh Dandona, MD, professor of medicine, head of the University of Buffalo School of Medicine and Biomedical Sciences' Division of Endocrinology, and senior author on the studies.
"We think the influx of macronutrients may alter cell behavior and that genes are activated to produce more powerful enzymes and mediators that are potentially more damaging to the lining of blood vessels. Obese persons may have an ongoing abnormality of the white blood cells and the lining of blood vessels.
"On the other hand, we found that one way to render an 'unsafe' meal 'safe' is to include antioxidant vitamins," Dandona said. "The proinflammatory effect of glucose is stopped if right at the outset you give vitamins E and C."
The "meal" study was conducted with nine normal subjects who ate a 900-calorie breakfast - an egg-and-ham sandwich and hash browns from a fast-food restaurant - after an overnight fast. Blood samples were taken before eating and at 1, 2 and 3 hours after eating to determine the concentration of oxygen free radicals, which can begin the inflammation cascade by injuring blood vessel linings, and of several blood mediators of inflammation.
Results showed a mean increase of free radicals over baseline of 129%, 175% and 138% at the three sampling times, respectively. Levels of several proinflammatory indicators also increased significantly, while the level of a factor that inhibits inflammation was reduced.
Four additional studies further defined the proinflammatory cascade initiated by an influx of glucose alone and of an infusion of fatty acids. These studies also showed that both sugar and fat caused a reduction in the ability of vessels to expand and contract in response to changes in blood flow, actions crucial for maintaining healthy blood pressure and blood flow to vital organs.
In yet another study, eight subjects took 1200 I.U. of vitamin E and 500 mg of vitamin C before a glucose challenge, and on a subsequent occasion, took only glucose. Blood samples were taken before the challenges and at 1, 2, and 3 hours after.
Results showed that levels of oxygen free radicals and two proinflammatory markers increased when glucose was taken alone, but did not increase when accompanied by the two antioxidant vitamins.
This article was prepared by Heart Disease Weekly editors from staff and other reports.
Publication date: 2002-07-09
© 2002, YellowBrix, Inc.

Vitamin E May Help Keep People Sharp in Old Age
Wed Jul 17,10:41 AM ET
By Melissa Schorr
NEW YORK (Reuters Health) - Vitamin E intake in food and supplements may help slow decline in mental functioning among older people, according to the results of a study.
"High amounts of vitamin E from foods appears to be protective from cognitive decline," lead author Dr. Martha Clare Morris, assistant professor of internal medicine at Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois, told Reuters Health.
The researchers theorized that vitamin E, an antioxidant, may counteract the damage done to brain cells by free radicals, which are byproducts of normal body processes that can damage tissue and have been linked to disease. Previous research has suggested that people who consume more vitamin E retain mental function and are less likely to develop Alzheimer's disease ( news - web sites).
To investigate, the researchers studied more than 2,800 US men and women aged 65 to 102. Each was given an initial battery of mental function tests and followed for an average of 3 years, during which they were retested two or three times. They were also asked to fill out a food questionnaire assessing how much of various nutrients they received in their diets and from supplements.
The investigators took into account factors that may influence mental function such as age, gender, education, smoking and drinking.
According to the findings, published in the July issue of the Archives of Neurology, 61% of the study participants showed some decline in their mental function during the course of the study, while 39% had no decline or even improved. The group who reported the highest intakes of vitamin E had a slower decline in mental function than those whose vitamin E intake was lowest.
"There was a 36% reduction in the rate of decline for people in the highest fifth of intake of vitamin E compared to those in lowest fifth of intake," Morris said, referring to intake of the vitamin in both food and supplements.
And those with the highest intake of vitamin E in food had a 32% reduction in their rate of mental decline, compared to those with the least vitamin E in their diets, she said.
For those who took vitamin E supplements, the effect on mental skill was only seen among those who received little vitamin E from their diet, but not in those who already received lots of the vitamin in their diet. "There may be a ceiling effect, and if you taking more, it's not helpful," Morris noted.
However, because the number of people taking supplements during the study doubled, possibly in response to cognitive decline, it was hard for researchers to draw conclusions about whether supplement use was effective on its own in maintaining the brain.
By contrast, vitamin C seemed to have only a limited effect on mental function. "We also don't feel that our data on vitamin C was definitive," Morris said. "The association wasn't consistent."
The team recently reported similar findings for vitamin E and Alzheimer's disease. High intake of the nutrient was linked to a 70% reduction in the risk of developing the disease during a 4-year period. Together, Morris noted, the studies strongly suggest that vitamin E has some protective effect on the brain.
Vitamin E is found in green, leafy vegetables as well as corn, nuts, olives and vegetable oils.
SOURCE: Archives of Neurology 2002;59:1125-1132

Any Way You Slice It, Pizza High in Calories, Fat
Fri May 17, 5:42 PM ET
NEW YORK (Reuters Health) - Pizza, that long-time staple of dorms, conference rooms and Friday-night dining tables, is helping to fuel rates of obesity and heart disease in America, a consumer health group said Friday.
Just two slices of plain cheese pizza can pack enough calories, fat and sodium to last an entire day. Add toppings such as pepperoni or meat and you might as well get reverse liposuction, according to the Washington, DC-based Center for Science and the Public Interest (CSPI).
The report, based on an independent analysis of pizza bought from 36 big and small pizzerias in three American cities, found pizzas that combine multi-meat toppings with a stuffed crust, or pack cheese into the crust, contain the most calories, fat and sodium. Two slices of Pizza Hut's Stuffed Crust Cheese pizza contain nearly 900 calories, 20 grams of saturated fat and more than 2,000 milligrams (mg) of sodium, for instance.
"You need cheese stuffed into a pizza crust like you need reverse liposuction to force more fat under your skin," Jayne Hurley and Bonnie Liebman write in the report.
Two slices of The Big New Yorker Sausage Pizza at Pizza Hut contain more than 1,100 calories, 3,200 mg of sodium and 66 grams of fat--28 of which are saturated, the study found. At Domino's, a similar serving of beef pizza contains from 11 to 18 grams of saturated fat.
"Add beef to your pizza at your own risk," warns the report, published in the June issue of the group's Nutrition Action Healthletter.
Side orders such as bread sticks, Buffalo wings and cheese bread only make matters worse. Each piece of Double Cheesy Bread from Domino's contains 140 calories and two grams of saturated fat, according to the analysis.
But for many people, pizza serves as a quick and easy meal. Americans order about 3 billion pizza pies a year, boosting annual sales of pizza to roughly $30 billion.
So what's a harried and hungry person to do?
Rather than going cold turkey, pizza lovers should skimp on the cheese and load their pie with vegetable toppings. While menus may not inform consumers that they can request less cheese, the authors note, the kitchen is often happy to oblige since it is less expensive.
Alternatively, some restaurants offer cheese-less pizzas. At California Pizza Kitchen, consumers can feast on a "salad pizza" in which arugula, radicchio, red-leaf lettuce, diced tomatoes and shaved Parmesan replace the traditional melted mozzarella.
For meat lovers, chicken and ham are lower in calories and fat than pepperoni, sausage, pork and beef. And ordering a salad can help diners cut down on the number of pizza slices they consume.
CSPI, known for its exposes on Chinese food and movie theater popcorn, reported its findings at a press conference in Washington, DC Friday.

Study Finds Likely Carcinogen in Many Foods
Fri May 17, 3:17 PM ET
By Sharman Esarey
LONDON (Reuters) - Britain's food watchdog said on Friday it had confirmed a Swedish study which found a substance that may cause human cancer is widespread in foods, but it advised people against changing their diets or cooking habits.

The Food Standards Agency (FSA) found acrylamide, which has been shown to cause cancerous tumors in rats, in a range of high-carbohydrate foods including packets of chips, crispbreads and fresh potatoes once they had been cooked.
The FSA said acrylamide, used to treat municipal water supplies and as an aid to papermaking, may be present in many cooked and prepared foods, but there is little knowledge of what, if any, effect eating such foods would have on human health.
"We are advising people they should not change either their food or cooking and that they should eat a balanced diet (particularly) fruits and vegetables," said Dr. Andrew Wadge, head of Chemical Safety and Toxicology at the FSA.
The study is the first to confirm Swedish research that last month sparked a global food scare on evidence that acrylamide is formed in very high concentrations when carbohydrate-rich foods such as rice or cereals are fried or baked.
But the scientists said acrylamide was likely present in other foods as well as a result of cooking other than boiling. It may have been part of the human diet for thousands of years.
Overcooking raises acrylamide levels even further, the study found. The FSA said they knew of no current research on the effects of microwaving food.
"On the basis of the evidence, acrylamide is formed naturally in (cooking)," said Steve Wearne, head of Chemical Contaminants at the FSA. "It's likely acrylamide will be present in any fried, baked, roasted or grilled food."
Any risks would arise from long-term exposure.
The FSA did not estimate the amount of acrylamide in the British diet, but said the Swedish study pointed to a diet that is 1,000 times less toxic than levels that are proven to cause harm.
Scientists across the globe, alarmed by the study's findings, are planning further research to help guide consumer choices. The World Health Organization (news - web sites) will meet on June 25-27 to study the issue.
In a joint statement, the British Retail Consortium and the Food and Drink Federation said that they would work with the FSA and internationally to establish the significance of the finding for public health and to reduce consumers' exposure.
Until then, there is little consumers can do to avoid acrylamide.
"Eating is not a completely risk-free activity. Acrylamide is one of many things we are exposed to in food that may be detrimental to our health, including immediate risks such as food poisoning from not cooking food thoroughly," the FSA said in a briefing note.
"There are no practical ways it can be avoided

Leading Food Sources of potassium:

What if you don't eat dairy foods?

Every day, choose a variety of foods from the Food Sources of Calcium list on the following Food Sources of Calcium table. Plan your food choices carefully. If you find it difficult to get the recommended amounts of calcium and vitamin D from foods, a combination of food sources and supplements is recommended.
Food Sources of Calcium (milligrams)

Dairy Foods Portion mg
Milk, with added calcium  1 cup  420
Milk, whole, 2%, 1% skim  1 cup 300
Yogurt, low fat, plain  ¾ cup 300
Cheese, processed slices  2 slices 265
Yogurt, fruit bottom ¾ cup 250 
Processed cheese spread  3Tbsp 250
Cheese, hard  1 oz 240
Milk, evaporated  ¼ cup 165
Cottage cheese  ¾ cup 120
Frozen yogurt, soft serve  ½ cup 100
Ice cream  ½ cup 85
Beans and Bean Products  Portion mg
Soy cheese substitutes 1 oz  0-200
Tofu, firm, made with calcium sulphate  3 ½ oz  125
White beans  ½ cup 100
Navy beans  ½ cup  60
Black turtle beans  ½ cup 50
Pinto beans, chickpeas  ½ cup 40
Nuts and Seeds Portion mg
Almonds, dry roast  ¼ cup 95
Whole sesame seeds (black or (white) 1Tbsp 90 
Tahini(sesame seed butter)  1Tbsp  63
Brazil, hazelnuts  ¼ cup 55
Almond butter  1Tbsp 43 
Meats, Fish, and Poultry  Portion mg
Sardines, canned  3 ½ oz/ 8 med 370 
Salmon, canned with bones  3 oz 180
Oysters, canned  ½ cup 60
Shrimp, canned  ½ cup 40
(all measures for cooked vegetables)  Portion mg
Turnip greens  ½ cup 95
Okra, frozen  ½ cup 75 
Chinese cabbage/bok choy ½ cup 75
Kale  ½ cup 50
Mustard greens  ½ cup 50
Chinese broccoli (gai lan)  ½ cup  44
Rutabaga  ½ cup 40 
Broccoli  ½ cup  35
Fruit Portion mg
Orange  1 med  55
Dried figs  2 med 54
Non Dairy Drinks  Portion mg
Calcium enriched orange juice  1 cup  300
Fortified rice beverage  1 cup 300
Fortified soy beverage 1 cup 300 
Regular soy beverage  1 cup  20 
Grains  Portion mg
Amaranth, raw  ½ cup 150
Whole wheat flour  1 cup  40
Other  Portion mg
Brown sugar  1 cup 180
Blackstrap molasses 1Tbsp 170 
Regular molasses  1Tbsp 40
Asian Foods  Portion mg
Sea cucumber, fresh  3 oz  285
Soy bean curd slab, spiced, semisoft  3 oz  269 
Shrimp, small, dried  1 oz 167
Dried fish, smelt  2Tbsp 140
Seaweed, dry (hijiki)* 10 gram 140 
Seaweed, dry (agar)  10 gram 76
Lily flower, dried  ¼ cup 70
Soy bean milk film, stick shape  3 oz 69 
Fat-choy, dried  ¼ cup 50
Oyster, dried  3 45
Soy bean milk film, dried  3 oz  43
Boiled bone soup  ½ cup  negligible
*Laver, nori, and wakame seaweeds are low in calcium 
Native Foods  Portion mg
Oolichan, salted, cooked 3 oz  210 
Fish head soup  1 cup  150
Indian ice cream (whipped soapberries)
½ cup 130 

The below listings are based on a 100 gram serving of each (the equivalent of 3.53 ounces), listed in a descending order from the highest amount of calcium to the lowest amount of calcium. We ended the table at "Milk, Human" (breast milk) as this is the only natural source of milk-based calcium for humans, which of course is intended for our infancy.

Source Calcium mg

Sesame seeds 975.000
Tofu, raw, firm, prepared with calcium sulfate 683.000
Winged beans, mature seeds, raw 440.000
Sesame butter, tahini 426.000
Soybeans, mature seeds, raw 277.000
Nuts, almond butter, plain, without salt added 270.000
Nuts, almonds 248.000
Beans, white, mature seeds, raw 240.000
Flax seed 199.000
Soybeans, green, raw 197.000
Beans, kidney, california red, mature seeds, raw 195.000
Milk, sheep 193.400
Turnip greens, raw 190.000
Dandelion greens, raw 187.000
Beans, french, mature seeds, raw 186.000
Nuts, brazilnuts, dried, unblanched 176.000
Beans, great northern, mature seeds, raw 175.000
Beans, small white, mature seeds, raw 173.000
Seaweed, kelp, raw 168.000
Beans, yellow, mature seeds, raw 166.000
lotus seeds 163.000
Tofu, firm, prepared with calcium sulfate and magnesium chloride 162.000
Arugula, raw 160.000
Beans, navy, mature seeds, raw 155.000
Mothbeans, mature seeds, raw 150.000
Seaweed, wakame, raw 150.000
Collards, raw 145.000
Figs, dried, uncooked 144.000
Beans, kidney, all types, mature seeds, raw 143.000
Mungo beans, mature seeds, raw 138.000
Back to the top! Calcium mg

Parsley, raw 138.000
Yardlong beans, mature seeds, raw 138.000
Kale, raw 135.000
Milk, goat 133.500
Mung beans, mature seeds, raw 132.000
Beans, kidney, royal red, mature seeds, raw 131.000
Beans, pink, mature seeds, raw 130.000
Wasabi, root, raw 128.000
Beans, cranberry (roman), mature seeds, raw 127.000
Beans, black, mature seeds, raw 123.000
Milk, nonfat 123.000
Beans, pinto, mature seeds, raw 121.000
Watercress, raw 120.000
Milk, producer, fluid, 3.7% milkfat 119.000
Sunflower seed 116.000
Nuts, hazelnuts or filberts 114.000
Tempeh 111.000
Tofu, soft, prepared with calcium sulfate and magnesium chloride 111.000
Tomatoes, sun-dried 110.000
Peanuts, spanish, raw 106.000
Chickpeas (garbanzo beans, bengal gram), mature seeds, raw 105.000
Nuts, walnuts, English 104.000
Broadbeans (fava beans), mature seeds, raw 103.000
Mustard greens, raw 103.000
Spinach, raw 99.000
Tempeh, cooked 95.600
Currants, zante, dried 86.000
Rhubarb, raw 86.000
Nuts, macadamia nuts, raw 85.000
Winged beans, immature seeds, raw 84.000
Back to the top! Calcium mg

Beans, kidney, red, mature seeds, raw 83.000
Lima beans, large, mature seeds, raw 81.000
Okra, raw 81.000
Seaweed, irishmoss, raw 72.000
Nuts, pecans 70.000
Seaweed, laver, raw 70.000
Lettuce, looseleaf, raw 68.000
Soybeans, mature seeds, sprouted, raw 67.000
Beans, adzuki, mature seeds, raw 66.000
Finfish, halibut, Atlantic and Pacific, cooked, dry heat 60.000
Quinoa 60.000
Beans, pinto, immature seeds, frozen, unprepared 58.000
Nuts, walnuts, black 58.000
Prickly pears, raw 56.000
Egg, whole, cooked, fried 55.000
Oats 54.000
Seaweed, agar, raw 54.000
Beans, pinto, immature seeds, frozen, cooked, boiled, drained, without salt 52.000
Chard, swiss, raw 51.000
Lentils, mature seeds, raw 51.000
Prunes, dried, uncooked  51.000
Egg, whole, cooked, hard-boiled 50.000
Hyacinth-beans, immature seeds, raw 50.000
Chickpeas (garbanzo beans, bengal gram), mature seeds, cooked, boiled, without salt 49.000
Egg, whole, raw, fresh 49.000
Raisins, seedless 49.000
Beans, snap, green, cooked, boiled, drained, without salt 46.000
Lotus root, raw 45.000
Nuts, cashew nuts, dry roasted, without salt added 45.000
Beans, pinto, mature seeds, sprouted, raw 43.000
Back to the top! Calcium mg

Peas, edible-podded, raw 43.000
Pumpkin and squash seed kernels 43.000
Burdock root, raw 41.000
Chicory roots, raw 41.000
Peanut butter, chunk style, 41.000
Mulberries, raw 39.000
Beans, fava, in pod, raw 37.000
Beans, snap, green, raw 37.000
Lettuce, cos or romaine, raw 36.000
Figs, raw 35.000
Lima beans, immature seeds, raw 34.000
Milk, human 32.200

This fruit contains anthocyanins and other phytochemicals,
which produce high antioxidant activity.
Blueberries also contain potassium, zinc, magnesium and fibre.
1 cup 80 calories, 1g protein, 19g carbs, 1g fat, 4g fibre.



Vitamin D3 Considerably More Potent Than D2
By David Douglas

NEW YORK (Reuters Health) Jan 12 - Recent recommendations by the US Institute of Medicine (IOM) for a daily vitamin D intake of 600 to 800 IU may be too low, researchers say.

Based on blood levels, the IOM reported that the majority of Americans and Canadians are getting enough vitamin D. But the new study by Dr. Robert P. Heaney and colleagues looked -- among other things -- not just at blood samples but at levels of vitamin D in body fat, too.

"In addition to showing once again that, unit for unit, vitamin D3 is substantially more potent than vitamin D2, this study is the first to quantify vitamin D storage in fat. It showed that, at doses of about 7000 IU/day, most of the vitamin was used by the body, and very little was left over to be stored," Dr. Heaney told Reuters Health by email.

In their December 22nd online report in the Journal of Clinical Endocrinology & Metabolism, Dr. Heaney of Creighton University in Omaha, Nebraska, and colleagues describe how they randomly assigned 33 healthy participants to receive 50,000 IU of one or the other calciferol weekly for 12 doses. That dose, they note, is what's typically given to treat vitamin D deficiency.

Compliance appears to have been 100%. Blood samples were taken every 2 weeks and again at week 17. Paired fat biopsies were obtained from nine of the subjects, at baseline and at week 12.

Vitamin D3 was 56% to 87% more potent than vitamin D2 in raising serum 25(OH)D. It was more than three times as potent in increasing fat calciferol content.

The subcutaneous fat content of D2 rose by 50 mcg/kg in the D2-treated group, and D3 content rose by 104 mcg/kg in the D3-treated group.

Total calciferol in fat rose by 104 mcg/kg in the D3 group, compared to only 33 ng/kg in the D2 group.

For neither was there evidence of sequestration in fat, however. Extrapolating the results to total body fat D3, just 17% of the administered dose was being stored, the authors said

"This had been suspected previously," Dr. Heaney said, "but without fat data, couldn't be clearly established. This fact alone shows clearly that the new IOM recommendations for vitamin D intake are low by at least an order of magnitude."

At the doses used, the researchers point out, "most vitamin D is metabolically consumed. This is the first study, to our knowledge, to have quantified this issue."

At the very least, they conclude, "Given its greater potency and lower cost, D3 should be the preferred treatment option when correcting vitamin D deficiency."

J Clin Endocrinol Metab. Posted online December 22, 2010. Abstract

Christine Gonzalez, PharmD, CHHC From U.S. Pharmacist Vitamin D Supplementation: An Update
Christine Gonzalez, PharmD, CHHCPosted: 11/11/2010; US Pharmacist © 2010 Jobson Publishing

An estimated 1 billion people worldwide, across all ethnicities and age groups, have a vitamin D deficiency.[1–3] This is mostly attributable to people getting less sun exposure because of climate, lifestyle, and concerns about skin cancer. The 1997 Dietary Reference Intake (DRI) values for vitamin D, initially established to prevent rickets and osteomalacia, are considered too low by many experts.[4] DRI values are 200 IU for infants, children, adults up to age 50 years, and pregnant and lactating women; 400 IU for adults aged 50 to 70 years; and 600 IU for adults older than 70 years. Current studies suggest that we may need more vitamin D than presently recommended to prevent chronic disease. Emerging research supports the possible role of vitamin D in protecting against cancer, heart disease, fractures and falls, autoimmune diseases, influenza, type 2 diabetes, and depression. Many health care providers have increased their recommendations for vitamin D supplementation to at least 1,000 IU.[5] As a result, more patients are asking their pharmacists about supplementing with vitamin D.

Vitamin D is a fat-soluble vitamin that acts as a steroid hormone. The body makes vitamin D from cholesterol through a process triggered by the action of the sun's ultraviolet B rays on the skin (FIGURE 1). Factors such as skin color, age, amount and time of sun exposure, and geographic location affect how much vitamin D the body makes. Vitamin D influences the bones, intestines, immune and cardiovascular systems, pancreas, muscles, brain, and the control of cell cycles.[6] Its primary functions are to maintain normal blood concentrations of calcium and phosphorus and to support bone heal
Vitamin D undergoes two hydroxylations in the body for activation. There are several metabolic products or modified versions of vitamin D (TABLE 1). Calcitriol (1,25-dihydroxyvitamin D3), the active form of vitamin D, has a half-life of about 15 hours, while calcidiol (25-hydroxyvitamin D3) has a half-life of about 15 days.[6] Vitamin D binds to receptors located throughout the body.

Table 1. Forms of Vitamin D(see table above)
Cholecalciferol (vitamin D3)

Deficiency, Blood Concentrations, and Toxicity
Risk factors for vitamin D deficiency include living in northern latitudes (in the U.S., above the line from San Francisco to Philadelphia), failing to get at least 15 minutes of direct sun exposure daily, being African American or dark-skinned, being elderly, or being overweight or obese.[5] Rickets and osteomalacia are the well-known diseases of severe vitamin D deficiency. Musculoskeletal pain and periodontal disease may also indicate a significant vitamin D deficiency.[7] Subtle symptoms of milder deficiency include loss of appetite, diarrhea, insomnia, vision problems, and a burning sensation in the mouth and throat.[7] Drawing a blood calcidiol concentration is the standard test for vitamin D status, since calcidiol has a longer half-life.[8]

A normal range of vitamin D is 30 to 74 ng/mL, but this can vary among laboratories.[8] Most experts agree that a concentration between 35 and 40 ng/mL is reasonable for preventive health. Some suggest that the optimal concentration for protecting against cancer and heart disease is between 50 and 70 ng/mL and up to 100 ng/mL. Side effects or toxicity can occur when blood concentrations reach 88 ng/mL or greater.[9] Symptoms include nausea, vomiting, constipation, headache, sleepiness, and weakness.[6] Too much vitamin D can raise blood calcium concentrations, and acute toxicity causes hypercalcemia and hypercalciuria.[6,9]

Disease Prevention
Vitamin D decreases cell proliferation and increases cell differentiation, stops the growth of new blood vessels, and has significant anti-inflammatory effects. Many studies have suggested a link between low vitamin D levels and an increased risk of cancer, with the strongest evidence for colorectal cancer. A Creighton University study found that postmenopausal women given 1,100 IU of vitamin D3 (plus calcium) versus placebo were 77% less likely to be diagnosed with cancer over the next 4 years.[10] In the Health Professionals Follow-up Study (HPFS), subjects with high vitamin D concentrations were half as likely to be diagnosed with colon cancer as those with low concentrations.[11]

Some studies have shown less positive results, however. The Women's Health Initiative found that women taking 400 IU of vitamin D3 (plus calcium) versus placebo did not have a lower risk of breast cancer.[12] Many critics have argued that this dosage of vitamin D is too low to prevent cancer. A 2006 Finnish study of male smokers found that those with higher vitamin D concentrations had a threefold increased risk for pancreatic cancer, with cigarette smoking not found to be a confounding factor.[13] A 2009 U.S. study of men and women (mostly nonsmokers) did not confirm these results, finding no association between vitamin D concentrations and pancreatic cancer overall, except in subjects with low sun exposure.[14] In this subgroup, higher versus lower vitamin D concentrations had a positive association with pancreatic cancer.[14] A definitive conclusion cannot yet be made about the association between vitamin D concentration and cancer risk, but results from many studies are promising.

Heart Disease
Several studies are providing evidence that the protective effect of vitamin D on the heart could be via the renin-angiotensin hormone system, through the suppression of inflammation, or directly on the cells of the heart and blood-vessel walls. In the Framingham Heart Study, patients with low vitamin D concentrations (<15 ng/mL) had a 60% higher risk of heart disease than those with higher concentrations.[15] The HPFS found that subjects with low vitamin D concentrations (<15 ng/mL) were two times more likely to have a heart attack than those with high concentrations (>30 ng/mL).[16] In another study, which followed men and women for 4 years, patients with low vitamin D concentrations (<15 ng/mL) were three times more likely to be diagnosed with hypertension than those with high concentrations (>30 ng/mL).[17] As is the case with cancer and vitamin D, more studies are needed to determine the role of vitamin D in preventing heart disease, but the evidence thus far is positive.

Fractures and Falls
Vitamin D is known to help the body absorb calcium, and it plays a role in bone health. Also, vitamin D receptors are located on the fast-twitch muscle fibers, which are the first to respond in a fall.[18] It is theorized that vitamin D may increase muscle strength, thereby preventing falls.[5] Many studies have shown an association between low vitamin D concentrations and an increased risk of fractures and falls in older adults.

A combined analysis of 12 fracture-prevention trials found that supplementation with about 800 IU of vitamin D per day reduced hip and nonspinal fractures by about 20%, and that supplementation with about 400 IU per day showed no benefit.[19] Researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University have examined the best trials of vitamin D versus placebo for falls. Their conclusion is that "fall risk reduction begins at 700 IU and increases progressively with higher doses."[18] Overall, the evidence is strong in support of supplementing with vitamin D to prevent fractures and falls.

Autoimmune Diseases and Influenza
Since vitamin D has a role in regulating the immune system and a strong anti-inflammatory effect, it has been theorized that vitamin D deficiency could contribute to autoimmune diseases such as multiple sclerosis (MS), type 1 diabetes, rheumatoid arthritis, and autoimmune thyroid disease. Scientists have suggested that vitamin D deficiency in the winter months may be the seasonal stimulus that triggers influenza outbreaks in the winter.[20] Numerous trials have evaluated the association between vitamin D and immune-system diseases.

A prospective study of white subjects found that those with the highest vitamin D concentrations had a 62% lower risk of developing MS versus those with the lowest concentrations.[21] A Finnish study that followed children from birth noted that those given vitamin D supplements during infancy had a nearly 90% lower risk of developing type 1 diabetes compared with children who did not receive supplements.22 In a Japanese randomized, controlled trial, children given a daily vitamin D supplement of 1,200 IU had a 40% lower rate of influenza type A compared with those given placebo; there was no significant difference in rates of influenza type B.[23] More studies of the influence of vitamin D on immunity will be emerging, as this is an area of great interest and it remains unclear whether there is a link.

Type 2 Diabetes and Depression
Some studies have shown that vitamin D may lower the risk of type 2 diabetes, but few studies have examined the effect of vitamin D on depression. A trial of nondiabetic patients aged 65 years and older found that those who received 700 IU of vitamin D (plus calcium) had a smaller rise in fasting plasma glucose over 3 years versus those who received placebo.[24] A Norwegian trial of overweight subjects showed that those receiving a high dose of vitamin D (20,000 or 40,000 IU weekly) had a significant improvement in depressive symptom scale scores after 1 year versus those receiving placebo.[25] These results need to be replicated in order to determine a correlation between vitamin D and the risk of diabetes or depression.

Only a few foods are a good source of vitamin D. These include fortified dairy products and breakfast cereals, fatty fish, beef liver, and egg yolks. Besides increasing sun exposure, the best way to get additional vitamin D is through supplementation. Traditional multivitamins contain about 400 IU of vitamin D, but many multivitamins now contain 800 to 1,000 IU. A variety of options are available for individual vitamin D supplements, including capsules, chewable tablets, liquids, and drops. Cod liver oil is a good source of vitamin D, but in large doses there is a risk of vitamin A toxicity.[26]

The two forms of vitamin D used in supplements are D2 (ergocalciferol) and D3 (cholecalciferol). D3 is the preferred form, as it is chemically similar to the form of vitamin D produced by the body and is more effective than D2 at raising the blood concentration of vitamin D.[27] Since vitamin D is fat soluble, it should be taken with a snack or meal containing fat. In general, 100 IU of vitamin D daily can raise blood concentrations 1 ng/mL after 2 to 3 months (TABLE 2).[28] Once the desired blood concentration is achieved, most people can maintain it with 800 to 1,000 IU of vitamin D daily.[28] Even though dosages up to 10,000 IU daily do not cause toxicity, it generally is not recommended to take more than 2,000 IU daily in supplement form without the advice of a health care provider.[29] Individuals at high risk for deficiency should have a vitamin D blood test first; a dosage of up to 3,000 to 4,000 IU may be required to restore blood concentrations.[29]

Table 2. Dosing and Blood Concentrations
Dosage Expected Increase in Blood Concentration
100 IU 1 ng/mL
200 IU 2 ng/mL
400 IU 4 ng/mL
800 IU 8 ng/mL
1,000 IU 0 ng/mL
2,000 IU 20 ng/mL

Drug Interactions
Vitamin D supplements may interact with several types of medications. Corticosteroids can reduce calcium absorption, which results in impaired vitamin D metabolism.[6] Since vitamin D is fat soluble, orlistat and cholestyramine can reduce its absorption and should be taken several hours apart from it.[6] Phenobarbital and phenytoin increase the hepatic metabolism of vitamin D to inactive compounds and decrease calcium absorption, which also impairs vitamin D metabolism.[6]

Future Research
While considerable research supports the importance of vitamin D beyond bone health, further trials are required before broad claims can be made about vitamin D and prevention of chronic disease. The Institute of Medicine (IOM) is reviewing the research on vitamin D and plans to report in late 2010 regarding any updates to the DRIs for vitamin D (and calcium).[30] Specifically, the IOM will consider the relation of vitamin D to cancer, bone health, and other chronic diseases.[30] An important study, the Vitamin D and Omega-3 Trial, was launched in early 2010 to determine whether 2,000 IU of vitamin D3 and 1,000 mg of EPA (eicosopentaenoic acid) plus DHA (docosahexaenoic acid) daily can lower the risk of cancer, heart disease, stroke, and other diseases.[31] This randomized trial, which will enroll about 20,000 healthy men and women, should provide more insight on vitamin D supplementation.

As the number of people with vitamin D deficiency continues to increase, the importance of this hormone in overall health and the prevention of chronic diseases is at the forefront of research. The best evidence for the possible role of vitamin D in protecting against cancer comes from colorectal cancer studies. Evidence also is strong for the potential role of vitamin D in preventing fractures and falls. At this time, further studies are needed to evaluate the role of vitamin D in protecting against heart disease, autoimmune diseases, influenza, diabetes, and depression

Cholecalciferol (vitamin D3) Naturally occurring form of vitamin D; made by the skin upon sun exposure; found in foods and most supplements
Calcidiol (25-hydroxyvitamin D3)Prehormone made directly from cholecalciferol in the liver; low biologic activity, but major form circulating in the bloodstream; concentrations measured by typical blood test for vitamin D deficiency
Calcitriol (1,25-dihydroxyvitamin D3) Activated form made from calcidiol in the kidneys and tissues; the most potent steroid hormone in the body
Ergocalciferol (vitamin D2) Made in the laboratory by radiating fungus; not naturally occurring in the body; used in prescription vitamin D (Drisdol), available in 50,000-IU capsules