February 17, 2016

Director's Letter

Carole Baggerly

Director, GrassrootsHealth

As highlighted in our newsletter at the beginning of the month, February is American Heart Month. One of the major risk factors for cardiovascular disease is diabetes - a disease known to be associated with vitamin D status. While the association has been documented for many years, including a 2008 analysis showing a connection to latitude, we were recently able to use your D*action data to help isolate the range of vitamin D status that appears to be most closely associated with type 2 diabetes!

The GrassrootsHealth diabetes paper, published using YOUR Data, shows a full 60% lower rate of incidence of type 2 diabetes in the D*action group with a median serum level of 41 ng/ml vs. a median of 22 ng/ml from a group representing national health status (NHANES). Another very significant finding was that the data were consistent with previous data we have published showing a sigmoidal (S-shaped) response curve with the serum level, and not a straight line:

there is a flat (no) response for people under 10 ng/ml
between 10 ng/ml and 30-35 ng/ml, there is a very definite positive clinical response and
no additional effect above 30-35 ng/ml

A very significant addition to the field with the GrassrootsHealth data is that we actually have enough people above 35 ng/ml to demonstrate this plateau. Prior to this publication, it was not clear.

Onwards!

Carole Baggerly

Director, GrassrootsHealth

A Public Health Promotion & Research Organization

Moving Research into Practice NOW!

More than 50% Lower Incidence of Diabetes with Vitamin D

Where is the data from?

GrassrootsHealth data is collected from at-home 25(OH)D blood tests from people of all ages, health status, and geographic locations. Along with each blood test participants also complete a questionnaire which includes a series of health questions. We ask that participants complete a new test and questionnaire every 6 months for 5 years so that we can get long-term data. (Anyone who wishes to continue beyond 5 years is certainly welcome to do so.)

For this study on diabetes, the GrassrootsHealth data was compared to data from the National Health and Nutrition Examination Survey (NHANES). NHANES, run by the National Center for Health Statistics, combines interviews and physical examinations to assess the health and nutritional status of people in the United States. To match the data from the two data sets for comparison, GrassrootsHealth data was limited to participants 20 years and older residing in the United States who had not had a history of diabetes more than a year before enrollment.

A 60% lower incidence rate of type 2 diabetes?

Yes! Our cohort has a median 25(OH)D level of 41 ng/mg vs. NHANES with a median of 22 ng/ml. When comparing the number of cases seen in each population group in the study period, the GrassrootsHealth cohort has a full 60% lower incidence rate of diabetes.

Want to know more?

The paper describes the scientific method that was used and both cohorts in detail. It also has a very detailed table, table 1, recounting facts and figures from both cohorts.

What is an S-shaped curve?

The way the body responds to most nutrients can be described by an 'S' shaped curve, or sigmoidal response curve, such as in the chart below. Understanding this curve is important to be able to define the appropriate amount of the nutrient that reduces risk.

Most nutrients are multi-functional, with different response curves in different systems (such as skeletal vs. immune), meaning the amount of a nutrient needed for a response in one system may be different than the amount of the same nutrient for a different system. Also, the usefulness or benefit of a nutrient will vary based on the initial nutrient status, the amount of nutrient added (dose/intake), and system-specific sensitivity.

A few key points to consider:

The benefit rises as intake rises up to a certain point (away from deficiency and before toxicity).
Within the curve are null response regions; too low will not be enough to produce a response, and too high will not produce any further response (response has been maximized).

Click to Expand

GrassrootsHealth Research Director, Dr. Robert Heaney, explains this curve in minutes 12:12- 15:20 of his webinar, Nutrition and Medicine - The Troubled Relationship. If you continue listening you will also hear him explain how both calcium and vitamin D trial results were misinterpreted because of where the trials started and finished along this curve.

Another key point to understand is that the same dose may produce a significant response in one system and a null response in another. The graph below shows three different theoretical nutrient response curves ('A', 'B', and 'C'). Each curve represents response in a different physiological system. To maximize benefits it is important to choose a dose that produces positive results in all systems.

Click to Expand

GrassrootsHealth disease incidence prevention chart illustrates this point, as you can see that some diseases respond favorably to lower amounts of vitamin D (20-30 ng/ml) - but to cover all disease prevention we recommend 40-60 ng/ml.

Participant Story

Treating Heart Disease with Vitamin D

Many of you are at the leading edge of medicine. You are using vitamin D sufficiency to improve your lives. This story is one of a 66 year-old D*action participant from South Florida. Much of her life she did not go to a doctor because she is generally very healthy. She learned about vitamin D from being in a research study, and she suspects she was in the control group (no extra D). She credits her current health to daily supplementation of 4000 or 2000 IU which she started after the study ended.

In her own words - heart disease, really?

In August 2014 when for the first time (at 64 years of age) I got insurance I not only discovered that my D, as suspected, was low (19 ng/ml) but I was diagnosed with severe aortic valve stenosis. Oddly enough I had absolutely no symptoms and so no clue. My cholesterol was elevated at 211 and I also needed to lose a bit of weight (25lbs). Around that same time the Vitamin D study finished and they gave me a vitamin D supplement (Biotics Research - Bio-D-Mulsion Forte^R) which I have been taking religiously since September 2014.

In March, 2015 I went back after 6 months to see the heart specialist and have another echocardiogram. Unfortunately, the blood work he asked for did not include vitamin D. My blood profile was excellent with cholesterol now at 167 as well as a weight loss of 25 lbs. But the really interesting thing is that according to the echo the specialist is

now diagnosing me with 'moderate aortic stenosis' when 6 months ago the diagnosis was 'severe.' Further the ejection fraction was 55% and now it is 60 -65%. I wonder if my vitamin D values could possibly have had anything to do with the improved outcome of the stenosis diagnosis. I have been exercising regularly and the tingling in the tips of my toes has completely disappeared. The cardiologist down-graded my severity and asked me to come back in 12 months.

Note: She ordered her own vitamin D test through D*action April 2015, just after her cardiology appointment, and found her 25(OH)D to be 36 ng/ml - a big improvement from 19 ng/ml.

Editor's Letter

Susan Siljander

Marketing Director, GrassrootsHealth

This issue is packed with great information about how to fight disease with vitamin D. We have papers you can read, a customer story, and a webinar you can listen too.

I want to re-iterate the importance of the 'S'-shaped curve. As you become a spokesperson for vitamin D people will inevitably point out studies where vitamin D showed no improvement for a disease or condition. If you understand this nutrient response curve you can read the study parameters and inevitably you will find out they either 1) gave too little vitamin D (no change along the bottom of the S-curve, 2) did not have people with D-levels at the right level (participants already were sufficient, > 30 ng/ml), or the most popular... 3) the dose was not regular enough (we recommend daily).

Dr. Heaney does a great job explaining this - starting at minute 12 of his webinar. He explains this curve and why some studies don't yield positive results.

Thank you,

Susan Siljander

Marketing Director, GrassrootsHealth

A Public Health Promotion & Research Organization

Moving Research Into Practice NOW!

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Paper of the Week

Incidence rate of type 2 diabetes is >50% lower in GrassrootsHealth cohort with median serum 25-hydroxyvitamin D of 41 ng/ml than in NHANES cohort with median of 22 ng/ml

Sharon L. McDonnell, MPH

Leo L. Baggerly, PhD

Christine B. French, MS

Robert P. Heaney, MD

Edward.D. Gorham, PhD

Michael F. Holick, PhD, MD

Robert Scragg, MD, PhD

Cedric F. Garland, Dr PH FACE

July, 2015

Read Paper