Vitamin D and Calcium Supplementation to Prevent Fractures in Adults
Tuesday, April 29, 2014
U.S. Preventive Services Task Force Recommendation Statement
The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific clinical preventive services for patients without related signs or symptoms.
It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.
The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.
Summary of Recommendations and Evidence
The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men (I statement).
The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1,000 mg of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women (I statement).
The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women (D recommendation).
The USPSTF has previously concluded in a separate recommendation that vitamin D supplementation is effective in preventing falls in community-dwelling adults aged 65 years or older who are at increased risk for falls (B recommendation).
Rationale
Importance
Fractures, particularly hip fractures, are associated with chronic pain and disability, loss of independence, decreased quality of life, and increased mortality (1). One half of all postmenopausal women will have an osteoporosis-related fracture during their lifetime.
Appropriate intake of vitamin D and calcium are essential to overall health. The Institute of Medicine has published recommended dietary allowances (Table). However, the benefits and harms of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1,000 mg of calcium to prevent fractures are not clearly understood.
Benefits of Preventive Medication
In premenopausal women and in men, there is inadequate evidence to determine the effect of combined vitamin D3 and calcium supplementation on the incidence of fractures. In postmenopausal women, there is adequate evidence that daily supplementation with 400 IU of vitamin D3 combined with 1,000 mg of calcium has no effect on the incidence of fractures. However, there is inadequate evidence regarding the effect of higher doses of combined vitamin D and calcium supplementation on fracture incidence in noninstitutionalized postmenopausal women.
Harms of Preventive Medication
Adequate evidence indicates that supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium increases the incidence of renal stones. The USPSTF assessed the magnitude of this harm as small.
USPSTF Assessment
Noninstitutionalized, community-dwelling postmenopausal women. The USPSTF concludes that evidence is lacking about the benefit of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1,000 mg of calcium for the primary prevention of fractures, and the balance of benefits and harms cannot be determined.
The USPSTF concludes with moderate certainty that daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium has no net benefit for the primary prevention of fractures.
Men and premenopausal women. The USPSTF concludes that evidence is lacking about the benefit of vitamin D supplementation with or without calcium for the primary prevention of fractures, and the balance of benefits and harms cannot be determined.
Vitamin D Supplementation Improves Muscle Efficiency
Friday, March 14, 2014
New research shows for the first time a link between vitamin D levels and muscle efficiency. Vitamin D supplementation may also be effective in improving skeletal muscle function. This study is presented today at the Society for Endocrinology annual conference in Harrogate, UK. The findings may explain the physical fatigue commonly experienced by patients with vitamin D deficiency, with broad implications for a large section of society
Vitamin D is a hormone produced in the skin using energy from sunlight, and to a lesser extent derived from dietary sources. Vitamin D deficiency is a significant public health problem as diagnosed cases are on the rise and the hormone is essential for good bone health. Alongside poor bone health, muscle fatigue is a common symptom in vitamin D deficient patients. This fatigue could be due to a problem in the mitochondria: the power stations within each cell of the body. Mitochondria use glucose and oxygen to make energy in a form that can be used to run the cell (an energy-rich molecule called ATP). Muscle cells need large amounts of ATP for movement and they use phosphocreatine as a ready and available energy source to make ATP. The mitochondria also replenish this phosphocreatine store after muscle contraction. Measurement of the time taken to replenish the phosphocreatine store is a measure of mitochondrial efficiency: better mitochondrial function is associated with shorter phosphocreatine recovery times.
Researchers from Newcastle University, led by Dr Akash Sinha who also works within the Newcastle upon Tyne Hospitals NHS Foundation Trust, investigated phosphocreatine recovery times in patients with vitamin D deficiency. They employed a non-invasive magnetic resonance scan to measure phosphocreatine dynamics in response to exercise in the calf muscles of 12 patients with severe vitamin D deficiency before and after treatment with vitamin D. This is the first time a study of this kind has been conducted.
The team found that phosphocreatine recovery significantly improved after the patients took a fixed dose of oral vitamin D for 10-12 weeks (average phosphocreatine recovery half time decreased from 34.4sec to 27.8sec, p<0.001). All patients reported an improvement in symptoms of fatigue following supplementation. In a parallel study, the group demonstrated that low Vitamin D levels were associated with reduced mitochondrial function (r=-0.41, p=0.009).
The research shows for the first time that vitamin D levels are correlated with muscle efficiency, and that muscle aerobic metabolism improves with Vitamin D supplementation. Whilst this is a small study, it establishes clear proof of principle and (for the first time) a link between vitamin D and mitochondria in man. The mechanisms underpinning this effect are an avenue for future research by the group, who also aim to establish whether vitamin D supplementation could alleviate frailty in the elderly or improve the exercise capacity of athletes.
Study leader Dr Akash Sinha, Clinical Research Fellow at Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust said: "This is the first time a link has been shown between vitamin D status and muscle aerobic function. To do so we used a non-invasive scan to get a unique biochemical perspective on muscle mitochondrial metabolism during exercise: a window into what is really going on in the muscle as it works
"Patients with vitamin D deficiency often experience symptoms of muscle fatigue. Our findings in a small group of patients with very low vitamin D levels show that muscle efficiency significantly improves when vitamin D status is improved.
"Well need further research in more patients to work out how this is happening and whether non-deficient patients can benefit from this too."
Omega 3 Fat Supplementation Can Prevent Depression in the Elderly
Monday, February 24, 2014
Creatine supplementation
Sunday, February 9, 2014
Creatine supplementation is popular among athletes. It is a combination of amino acids ( arginine, glycine and methionine ) which are formed in the liver , pancreas and kidney . Phosphocreatine (PC ) is used for immediate energy in the muscle that keeps the level of ATP (energy source of the cell) necessary for muscle contraction. Creatine is found naturally in herring, pork, beef, salmon, tuna and cod.
Theoretical justification of creatine supplementation .
During short and explosive type , a biochemical reaction that forms the adenosine triphosphate ( ATP ) that is determined by the amount of creatine phosphate which has been stored in the muscle occurs . When reserves of creatine phosphate (CP ) start to run low, the performance deteriorates rapidly due to the inability to resynthesize ATP at the required pace.
Thus, creatine supplementation increases the total amount of creatine in muscle and PC content . Increasing the availability of PC ATP levels increase during intense exercise and the rate at which ATP is resynthesized after exercise of high intensity and short duration accelerates.
Composition of creatine supplements .
Creatine supplements can be found in your presentation, in several ways:
Pure creatine monohydrate .
Creatine monohydrate with simple sugars ( glucose, dextrose, etc . )
Creatine Monohydrate with fast sugars and lipoic acid.
Creatine monohydrate added to protein / carbohydrate .
Positive effects after taking creatine :
Increases total creatine in muscle by 10-20 %.
Increases in total PC muscle by 20-40 %.
Accelerates the rate at which ATP is resynthesized after high intensity exercise :
- Efforts explosives .
- High intensity exercises .
- Repetitive exercises maximum or submaximal exercise .
Increases anaerobic threshold and maximum oxygen consumption ( bodys ability to transport oxygen to the muscles at submaximal and maximal efforts ) .
Glucose intake with creatine increases the concentration of insulin ( anabolic hormone ) which counteracts cortisol ( catabolic hormone ) .
Although no toxicity should not be consumed in huge quantities. Before training (20-30 ` ) on an empty stomach , the recommended dose is:
Loading Phase : 20-25 gr / day ( in divided doses ) for 7 days.
Maintenance phase: 10 g / day in divided doses ) for 60 days.
Break phase: 30 days without drinking.
There are cases that taking creatine does not produce improvements in athletic performance .
When less than 20 g / day for 5 days ingested or when 2-3 g / day ingested during training ( with or without a loading phase ) .
In less than 5 weeks of usage periods.
When the recovery time is too long or short between sets.
In aerobics.
Effects of creatine intake on body composition .
Increases total muscle mass
- Retains fluids ( causing an increase in total weight).
- Increase the amount and quality of training.
- Increases protein synthesis promoting strength gains .
Side effects due to the intake of creatine.
Weight gain caused by water retention .
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