Vitamin D, Hormone Replacement, and Fish Oil, One Size Does Not Fit All

Be careful interpreting recommendations and research findings.

My 9th grade marine biology teacher once told me: “Only believe half of what you see and nothing of what you hear.” Keep this in mind when you hear news reported about recent research findings or read  recommendations given by the government and medical organizations.

 I’ve had a few patients ask questions recently about conversations they have had with their primary care doctors or recent articles they have seen in the newspaper. My suggestion is always to do as I do, interpret carefully, use common sense, and remember the bell curve. The knee jerk reaction to many published studies is to apply the results to the entire population even though in most cases, research is narrowly focused on a small population and age range. In addition, research does not always examine other factors that can affect the outcome of the study.

 Female hormone replacement is a classic example. The Women’s Health initiative study, released in 2002, studied the risks and benefits of female hormone replacement and because of the results led many medical organizations to issue the opinion that all hormone replacement treatment was dangerous and that the risk of treatment outweighed the benefit. The knee jerk reaction in the medical community was to take all women off of hormone replacement and discourage its use other than in the most extreme of cases. The problem with this is the study was conducted using synthetic estrogen derived from the urine of pregnant horses (premarin®) or the combination of this equine estrogen with synthetic progesterone (prempro®). Additionally, the patient populations were largely over 65 and half of them were smokers. What is also not reported is that the branch of the study that used estrogen alone is still ongoing, the branch that was stopped prematurely, because of the increased incidents of blood clots, breast cancer, and heart attacks, used the combination of equine estrogen and synthetic progesterone.

 Looking closely at the data, many in the medical community believe that the true culprit in this picture is the synthetic progesterone. In addition, the fact that we make blanket recommendations about all hormone replacement based on a study done on animal hormones given to humans, doesn’t pass the common sense test. Can you really apply findings of this study to say, a healthy 40 year old woman who eats healthy, doesn’t smoke and exercises daily? To date there has not been a study that has shown that bioidentical hormones (those that are the identical chemical produced in your body and not animal derived) have the same risks. In fact there are numerous studies that suggest a protective effect in many areas including heart disease, stroke, osteoporosis, and breast cancer. 1

 Another question concerning new recommendations by the IOC (Institute of Medicine) for vitamin D intake was recently making the rounds on the news. They increased the recommendations for daily supplementation, but in the process put out warning statements about taking too much vitamin D and, in the opinion of many in the anti-aging world, fell woefully short on the recommendations they have made. It seems they are following the RDA’s antiquated approach to nutritional recommendations by recommending the minimum amount of a nutrient to prevent disease. Granted, there is risk in taking too much vitamin D and you should have your levels checked before taking larger doses, but recent research reveals that 75% of our population is deficient in this important nutrient. Other recent studies suggest deficiencies in Vitamin D increase your risk of many cancers including colon and breast cancer, two of the most common types of cancer in the US. Their recommendation of keeping vitamin D3 levels above 20 (the lower threshold of normal) is simply dumbfounding. My patients take 5000 IU of vitamin D3 per day until levels reach 50 – 60 and then we drop them down to 2000 IU daily for maintenance. I take into account the recommendations but treat my patients as I would treat my wife. Vitamin D is not a nutrient you want to be deficient in based on the research that I have reviewed and do you really want your standard to be meeting the lower threshold of anything? View my prior blog on vitamin D for further information on this important nutrient

 Finally, you may have seen reports on a recent study that revealed that fish oil showed little benefit in preventing recurrent Atrial Fibrillation, a common heart rhythm abnormality. In this 24 week study of 663 patients taking, “high doses of fish oil,” (4 grams daily) there did not appear to be a benefit in terms of preventing a recurrence of the abnormal heart rhythm. Other similar studies have shown mixed results the effect of fish oil on A-Fib and multiple studies have shown marked benefit for other health conditions as well as mortality in general.2,3,4,5,6  Prior blogs address fish oil as well.

 Research is a good thing. We must continue to question and test old assumptions if we are to continue to improve patient care and health but we must also use our big picture goggles when it comes to practical application. I will do my best to keep you informed of the most recent research and the recommendations but will also try to give you the practical take home message after I examine them through my own common sense and big picture goggles.

 

 Until next time, stay healthy and live well… Dr. Mike

  1. Postgraduate Medicine, 2009; vol 121, issue 1
  2. Circulation, 2002; 105:1897-1903
  3. JAMA vol 287. No. 14 p 1815.
  4. N Engl J Med. 2002 346:1113-1118
  5. Br J Nutr. 2002;87:281-289
  6. Lancet. 2001;3571764-1766
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Dr. Michael Heim

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