Archive August 2015

Vitamin D for chronic inflammatory rheumatic diseases (CIRD)?

Researchers studied a cross-section from the baseline visit of the CARMA (cardiovascular in rheumatology) project, a 10 year prospective study evaluating the risk of cardiovascular events in rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) patients, and non-CIRD patients who attended rheumatology outpatient clinics from 67 hospitals in Spain. 2,234 patients were assessed. Non-CIRD group was frequency matched by age with the joint distribution of the three CIRD groups included in the study. The aim was to evaluate the association between vitamin D status (25(OH)D) and the clinical characteristics of patients with CIRD. Deficiency was defined as 25(OH)D levels <20 ng/ml. Patients with CIRD had lower 25(OH)D levels than those form the non-CIRD controls. Globally, vitamin D deficiency was detected in 40.5% of patients with RA, 39.7 % of patients with AS, 40.9 % of patients with PsA, and 26.7% of those with non-CIRD. Overall, researchers found that RA patients have a high risk of vitamin D deficiency, in spite of presenting low-to-moderate disease activity. They concluded that clinicians must monitor the levels of vitamin D at baseline and during follow-up and supplement vitamin D if any deficiency is detected.

A. Urruticoechea-Arana, et al. Vitamin D deficiency in chronic inflammatory rheumatic diseases: results of the cardiovascular in rheumatology [CARMA] study. Arthritis Research & Therapy Aug 15, 2015

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Vitamin D for Reduced Breast Density in Premenopausal Women!

High breast density has been identified as a strong risk factor for breast cancer. Researchers tested the association between vitamin D intake, but not circulating vitamin D levels, and mammographic breast density among women. They conducted a cross-sectional study of 165 screening mammography patients at Nashville General Hospital’s Breast Health Center. Dietary and total (dietary plus supplementation) vitamin D, and calcium intakes were estimated by the AFFQ and blood samples were analyzed for 25(OH)D3. Average percent breast density for the left and right beast combined was estimated from digitized films. After statistical adjustment for age, race and body mass index, the result revealed there were significant trends of decreasing breast density with increasing vitamin D and calcium intake among premenopausal (but not postmenopausal) women.

AM Fair, et al. Increased vitamin D and calcium intake associated with reduced mammographic breast density among premenopausal women. Nutrition Research. Published online July 31, 2015

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Melatonin for GERD?

Melatonin is a hormone produce by the pineal gland and enterochromaffin cells which control sleep and gastrointestinal motility. Low melatonin levels lead to gastroesophageal reflux disease (GERD). Most patients with GERD have a sleep disorder, and low melatonin levels are a main cause of insomnia. It has an inhibitory action on gastric acid secretion and seems to control the lower esophageal sphincter.(1) Additionally, melatonin has been found to protect the gastrointestinal mucosa from oxidative damage caused by reactive oxygen species in different experimental ulcer models, where is has been shown to prevent acute ethanol-induced gastric injury from ethanol-induced via its antioxidant activity.(2) Another clinical study showed oral melatonin has a role in the prevention of GERD, and is effective in relieving epigastric pain and heartburn.(3)

1) J Dulce, et al. Which is the best choice for gastroesophageal disorders: Melatonin or proton pump inhibitors. World J Gastrointest Pharmcol Ther. 2010 Oct 6, 1(5): 102-106
2) D.Bilici, et al. Melatonin Prevents Ethanol-Induced Gastric Mucosal Damage Possibly Due to Its Antioxidant Effect. Digestive Diseases and Sciences. Apr 2002, Vol. 47, Issue 4. Pp 856-861.
3) TS Kandil, et al. The potential therapeutic effect of melatonin in Gastro-Esophageal Reflux Disease. BMC Gastroenterol. 2010 Jan 18;10:7. doi: 10.1186/1471-230X-10-7.

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Vitamin D for gut microbiome and GI function?

Vitamin D is known for its effects on bone mineralization, inflammatory processes and immunomodulatory properties, which positively influences human health, but in-vivo data on its effects on human gut microbiome are missing. Researchers conducted an open-label, interventional pilot study to investigate the effects of oral vitamin D3 on the human mucosa-associated and stool microbiome as well as CD8+ T cells in healthy volunteers. Sixteen participants were endoscopically examined to access a total of 7 sites, and researchers sampled stomach, small bowel, colon, and stools before and after 8 weeks of vitamin D3 supplementation. Weeks 1-4 participants took a weekly dose representing 140 IU/Kg body weight per day up to a max of 68,600 IU/week (9,800 IU/day). The following 4 weeks they took half the amount (70 IU/Kg body weight per day up to 34,300 IU/week (4,900 IU/day). Supplementation changed the gut microbiome in the upper GI tract (gastric corpus, antrum and duodenum). Researchers found a decreased relative abundance of Gammaproteobacteria including Pseudomonas spp., Escherichia/Shigella spp. and increased bacterial richness. No major changes occurred in the terminal ileum, appendiceal orifice, ascending colon, and sigmoid colon or in stool, but the CD8+ T cell fraction was significantly increased in the terminal ileum. They concluded that vitamin D3 modulates the gut microbiome of the upper GI tract which might explain its positive influence on GI diseases such as inflammatory bowel disease or bacterial infections. Local effects demonstrate pronounce regional differences in the response of the GI microbiome to external factors.

M Bashir, et al. Effects of high doses of vitamin D3 on mucosa-associated gut microbiome vary between regions of the human gastrointestinal tract. Eur J Nutr. 2015 Jul 1. [Epub ahead of print]

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