Self Care Pharmacy Blog

Posts Tagged ‘vitamin d’


The Truth about Calcium That May Leave Supplement Companies in Pandemonium

Monday, November 9th, 2015

By: Caleb Tang

Calcium is an essential mineral and contributor to bone health that helps keep bones strong. In fact, 99% of the body’s calcium is found in bon
e.1 The human body is continually removing calcium from bone so that it can be used to aid in blood clots, muscle movement, and nerve messaging. Dietary calcium actually replenishes these losses and prevents bones from becoming weak. So why wouldn’t increasing the amount of calcium intake positively affect bone health? Imagine that your car is low on gas. Wouldn’t it obviously make sense to go to the nearest gas station and fill up your tank? In the case of bone health, the answer is not that cut and dry. Yes, calcium is an important factor, but increasing intake alone will not directly improve bone health.7

800px-500_mg_calcium_supplements_with_vitamin_DJust three weeks ago, the New York Times published an article titled, “Calcium Doesn’t Improve Bone Density, Analysis Finds”. This surprising claim was made by Nicholas Bakalar of the New York Times. He based his claim on two articles published by the British Medical Journal (BMJ) just this summer. The results from articles review made a bold claim that completely defies common household knowledge.  Aside from the fact that the two BMJ articles came to the same conclusion, the two were eerily related. Both were published on the same day (September 29, 2015) and both were associated with the University of Auckland and the University of Otago in New Zealand.

It seems illogical that increasing consumption of a crucial mineral for bone strength would not actually improve bone strength. The apparent paradox lies within biology and culture.9 It is important to realize that one simple dietary change will not affect bone strength. Consuming more calcium means nothing if the body doesn’t absorb it.1,6 Vitamin D increases calcium absorption from the small intestine, into the bloodstream, and finally to the bones. Other factors that positively affect bone health are as follows: weight-bearing exercise, tobacco avoidance, moderate alcohol intake.1

The effectiveness of calcium supplementation on bone mineral density varies according to two factors:  dietary calcium intake and stage of life.8,9 Compared to Western cultures, Asian cultures do not commonly incorporate high-calcium level foods (such as milk, cheese and other dairy products) into the everyday diet.10-12 A study in elderly Thai women found that calcium supplementation of at least 500mg/day for 2 years resulted in noticeable changes in BMD (bone marrow density) at several skeletal study points. The study’s conclusion was this: “Calcium supplementation might be crucial in people who have low calcium intake at baseline”.9 In cases like these, supplementation may be needed, but the first choice is to consume calcium from foods.8

Another important factor that plays a role in the effectiveness of calcium supplementation is the stage in life of the patient, especially if that patient is a woman. Elderly postmenopausal women experience loss of “beneficial effects of estrogen on the stimulation of intestinal calcium absorption and reduction of renal calcium excretion as well as an increase in bone turnover rate.”9 In this case, vitamin D calcium supplementation would actually help to prevent early postmenopausal bone loss.6,9

The human body surely requires at least some calcium, but currently, there is no reliable method to determine an optimal amount of daily calcium intake based on criteria such as age, gender, height, and weight.4 Even in a study where the mean calcium intake was well above the daily recommended amount (1,200mg/day), hip fractures were still evident.4 This seemingly counterintuitive finding begs that further studies explain why meeting or even exceeding a healthy limit will produce a high incidence of hip fractures.

In light of these recent scientific findings, one shouldn’t rely on calcium supplements to prevent BMD complications. Furthermore, patients who currently have osteoporosis or a high risk of fracture should never replace prescription medication with calcium supplementation. Until further evidence surfaces, people of all ages hoping to prevent later development of osteoporosis should continue to strive for a balanced diet containing adequate protein, fruits, vegetables, calcium, and vitamin D.8 Would you still consider taking a calcium supplement for the insignificant increase in bone strength it provides?


  1. National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation, 2010;1–56.
  2. Bolland MJ, Leung W, Tai V, et al. Calcium intake and risk of fracture: Systematic review.BMJ. 2015;351. doi: 10.1136/bmj.h4580.
  3. Tai V, Leung W, Grey A, Reid IR, Bolland MJ. Calcium intake and bone mineral density: Systematic review and meta-analysis.BMJ. 2015;351. doi: 10.1136/bmj.h4183.
  4. Cho K, Cederholm T, Lökk J. Calcium intake in elderly patients with hip fractures.Food & Nutrition Research. 2008;52:1-5.
  5. Cosman F, de Beur ,S.J., LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis.Osteoporos Int. 2014;25(10):2359-2381.
  6. Kärkkäinen M, Tuppurainen M, Salovaara K, et al. Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65-71 years: A 3-year randomized population-based trial (OSTPRE-FPS).Osteoporos Int. 2010;21(12):2047-2055.
  7. Kling, Juliana M.Clarke, Bart L.Sandhu,Nicole P. Osteoporosis prevention, screening, and treatment: A review.Journal of Women’s Health (15409996). 2014;23(7):563-572.
  8. Nieves JW. Skeletal effects of nutrients and nutraceuticals, beyond calcium and vitamin D.Osteoporos Int. 2013;24(3):771-786.
  9. Rajatanavin R, Chailurkit L, Saetung S, Thakkinstian A, Nimitphong H. The efficacy of calcium supplementation alone in elderly thai women over a 2-year period: A randomized controlled trial.Osteoporosis Int. 2013;24(11):2871.
  10. Kim HS, Kim JS, Kim NS, Kim JH, Lee BK (2007) Association of vitamin D receptor polymorphism with calcaneal broadband ultrasound attenuation in Korean postmenopausal women with low calcium intake. Br J Nutr 98:878–881
  11. Lau EM, Woo J, Lam V, Hong A (2001) Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. J Bone Miner Res 16:1704–1709
  12. 12. Chee WS, Suriah AR, Zaitun Y, Chan SP, Yap SL, Chan YM (2002) Dietary calcium intake in postmenopausal Malaysian women: comparison between the food frequency questionnaire and three-day food records. Asia Pac J Clin Nutr 11:142–146

Vitamin D: A New Option in the Fight Against Asthma?

Monday, October 27th, 2014

By Charles Snyder, PharmD Student Cedarville University

Most people are either affected by asthma or know of someone close to them who struggles with the condition, which has increased in prevalence in America an estimated 25% every decade since 1960.[1] Asthma is a chronic disease that affects the airways of the body, leading to increased sensitivity, soreness, and swelling of these inner airways and ultimately less air into the lungs. Common symptoms include but are not limited to; wheezing, cough, tightness of the chest and difficulty breathing. Since there is currently no cure for asthma, the goal of treatment is to relieve these chronic symptoms. This is achieved by avoiding common things that can trigger asthmatic attacks such as exposure to pollen, dander and other allergens and by taking inhaled medications. Inhaled corticosteroids, such as Advair®, are aimed at preventing inflammation and swelling of the airways in a long-term capacity. Other anti-asthmatic medications are inhaled at the time of an asthmatic flare up, with a goal of immediately reducing symptoms.[2] As a whole, the current treatments for asthma are fairly effective; however, many patients still struggle to manage their chronic asthmatic symptoms on a day to day basis.

Fox news recently highlighted a new research study that suggests taking vitamin D may have an influence in combating the chronic effects of asthma. [3] The idea that vitamin D levels can affect asthma is a fairly common one. Rates of asthma incidence are statistically higher in northern regions, so it appears that there could be a connection between the northern environment and asthma. Many researchers suspect that the decreased sunlight in these regions, which is responsible for producing the majority of the body’s vitamin D, is leading to the increased asthma rates.[4] It is hypothesized that vitamin D helps to protect against asthma by regulating the immune system. This is accomplished by reducing the number of inflammatory cells (Helper T cells) that produce the symptoms of asthma. These inflammatory cells are also thought to produce another negative effect by reducing the effect of inhaled steroids.[5]

The study was performed by Dr. Saba Arshi at the Medical University of Tehran. This study involved one-hundred and thirty children and adults who were diagnosed with mild to severe asthma. The participants were divided into two groups. One group received treatment for their asthma using a dry powder inhaler, the control group, while the other group was treated with both the dry powder inhaler as well as high doses (100,000 units initially and then 50,000 units per week) of vitamin D for six months. After 28 weeks the researchers conducting the study measured the amount of air that patients could exhale. They found that the group who received the vitamin D, along with the inhaler, had improved by about twenty percent, while the dry powder inhaler only group had improved by seven percent.

There were, however, some limitations to this particular study. First, patients’ adherence to the medications was not measured over the course of the study. This means the regularity of the participants actually taking their assigned treatments is unknown. Second, the number of participants in the study was quite small, one hundred and thirty. Finally, the study only measured the volume of air patients were able to exhale, it did not test whether any asthma specific symptoms were improved over the course of the study.

The Fox news article had this to say about the study’s results, “I think it’s a reasonable hypothesis and their study and some other studies provide evidence it might be true. But I don’t think it’s proven yet.”3 This is a fair analysis of the study. Unfortunately, there simply has not been enough testing done on the relationship between vitamin D levels and asthma incidence to make a definitive statement. Much of the research that has been done has shown conflicting results on the topic4. A recent study published in The Journal of the American Medical Association (JAMA) provided results disagreeing with the study previously discussed. The JAMA article tested whether oral vitamin D supplements increased the effect of an inhaled corticosteroid. However, using variables similar to Dr. Arshi’s study, they found that there was no significant difference in treatment when paired with taking vitamin D.[6] Also worth noting is that a recent systematic review, produced by the Journal of Allergy, Asthma and Clinical Immunology, examined 1081 studies. Out of those studies, only three met the systematic reviews criteria and those three all had conflicting results on whether vitamin D levels played a role in Asthma development and treatment.5 This shows that there is still a lot of discussion occurring about the effect of vitamin D in asthma, and further, definitive data is still needed.

However, vitamin D has a wide range of health benefits such as treating conditions that cause weak bones, helping to raise calcium levels in the blood, and treatment of psoriasis, among others. When taken within the recommended daily dose (approximately 600 international units daily depending on age and weight),[7] there are very few side effects traditionally associated with vitamin D. The described study as well as other studies have not been able to present enough evidence to support using vitamin D to treat asthma. However I feel that vitamin D provides such a wide range of benefits, with no major side effects to asthmatics, that it would be worth trying for people struggling with asthma symptoms. Would you be willing to try vitamin D to see what benefits it could have for you or recommend it to asthma patients?

[1] Brown SD, Calvert HH, Fitzpatrick AM. Vitamin D and Asthma. Dermato-Endocrinology. 2012;2(4):137-145 Accessed September 20, 2014.

[2] National Heart, Lung and Blood Institute. How is asthma treated and controlled. Web site. Published August 4,2014. Updated 2014. Accessed September 20, 2014.

[3] Does vitamin D help with asthma? Fox News Web site. Published August 19, 2014. Updated 2014. Accessed September 20, 2014.

[4] Mason R, Sequeira V, Gordon-Thomson C. Vitamin D: the light side of sunshine Eur J Cin Nutr. September 2011;65(9):986-993. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 20, 2014.

[5] Rajabbik MH, Lotfi T, Alkhaled L, et al. Association between low vitamin D levels and the diagnosis of asthma in children: A systematic review of cohort studies. Allergy, Asthma & Clinical Immunology. 2014;10(1):1-16.

Therapeutic Research Faculty. Vitamin D. Medline Plus Web site.

[6] Castro M, King TS,Kunselman SJ, et al. Effect of vitamin D3 on asthma treatment failures in adults with symptomatic asthma and lower vitamin D levels: The Vida randomized clinical trial. JAMA. 2014;311(20):2083-2091. Accessed September 20, 2014

[7] Therapeutic Research Faculty. Vitamin D. Medline Plus Web site. Published July 30, 2014. Updated 2014. Accessed September 20, 2014.

Vitamin D supplements do improve bone health

Sunday, November 24th, 2013

by Jacques Allou, PharmD student

Vitamin D is a fat-soluble vitamin that is naturally present in very few foods. It is available as a dietary supplement, and is also produced inside the body when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis.1

In the past decade, wonderful claims has been made about the role of vitamin D in the prevention and treatment of conditions as varied as osteoporosis, heart disease, cancer, diabetes, dementia, neuromuscular and immune function, and reduction of inflammation.1 Reports from authoritative bodies and reviews show that there is good consensus on the role of Vitamin D in growth and development of bone. Adequate supply of vitamin D is required for efficient calcium absorption and for the maintenance of normal blood levels of calcium and phosphate that are needed for the normal mineralization of bone and bone health.1,2 Not only does vitamin D promote bone growth, it does also protect against cardiovascular disease. In a study published on June 23 in the Archives of Internal Medicine, a team of Austrian scientists revealed that low blood levels of vitamin D appear to have an increased risk of death overall and from cardiovascular.3 A recent consensus panel estimated that about 50 – 60 percent of older individuals in North America and the rest of the world do not have satisfactory vitamin D status, and the situation is similar for younger individuals. Blood levels of vitamin D lower than 20 to 30 nanograms per milliliter have been associated with falls, fractures, cancer, autoimmune dysfunction, cardiovascular disease and hypertension.3   Vitamin D was the leader in dietary supplement sales in 2009, recording 82% sales growth.4

In this recent article by Fox News, Researchers have indicated that Vitamin D may actually do very little to guard against osteoporosis, contrary to popular belief.5 The researchers from the University of Auckland in New Zealand analyzed data from 23 studies involving 4,082 healthy adults with an average age of 59.6  In these studies, bone mineral density – the measure of bone strength and the amount of bone mineral present – was examined at five different sites in the body: lumbar spine, femoral neck, total hip, total body and forearm. They found that adults who took supplements of vitamin D for an average period of two years did not see any improvements in their bone health, apart from a small increase in bone density around their femoral neck.  However, the study authors believe such a small increase is unlikely to be clinically significant.6

I was surprised to learn that. I do not agree with the article because the study has some limitations. There could be a strong possibility that bone mineral density in middle-aged women is a poor predictor of who will eventually have osteoporosis as already suggested by Dr. Clifford.7 It could be that vitamin D and calcium need to be taken together, and that they help only when a person is really low on either or both. Researchers have shown that, even though calcium is the main bone health nutrient, its absorption in the gut and use by bone tissue is dependent on vitamin D. Therefore, regardless of the adequacy of calcium intake, poor vitamin D status will limit calcium absorption.8 This explains why interventions using combinations of calcium and vitamin D produce more consistent results than interventions based on calcium alone.9 The link between vitamin D and calcium has been known for decades, so studying vitamin D alone does not make it appropriate.

My self-care recommendation will not be changed, based on the above discussed limitations. When counseling patients, I will stress that calcium and vitamin D work synergistically, and that foods and supplements containing these nutrients should be eaten or taken regularly as part of a balanced diet.

Half of all people around the world are deficient in vitamin D and therefore at increased risk for serious and potentially fatal conditions.3 What will we do as pharmacists to protect the cardiovascular and bone health of our aging patients?



  1. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.   Assessed November 12, 2013
  2. European Food Safety Authority. Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies on a request from the Association de la Transformation Laitière Française related to the scientific substantiation of a health claim on vitamin D and bone growth. The EFSA Journal (2008) 827, 1-10. Assessed November 12, 2013
  3. Dobnig H, Pilz S, Scharnagl H, et al. Independent Association of Low Serum 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Levels With All-Cause and Cardiovascular Mortality. Arch Intern Med. 2008;168(12):1340-1349. doi:10.1001/archinte.168.12.1340.
  4. Tousrounis C, Denneby C. Introduction to Dietary Supplements. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 17th Ed Washington DC, American Pharmacists Association Press; 2012: 955-956.
  5. Fox News. Vitamin D supplements do not improve bone health study finds. Fox News. Published October 14, 2013. Assessed November 1, 2013
  6. Ian RR, Mark JB, Andrew G. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. The Lancet. 2013; DOI: 10.1016/S0140-6736(13)61647-5.
  7. Shute N. More Evidence Against Vitamin D To Build Bones In Middle Age Published October 12, 2013. Assessed November 1, 2013
  8. Fleet JC, Schoch RD (2010) Molecular mechanisms for regulation of intestinal calcium absorption by vitamin D and other factors. Critical Reviews in Clinical Laboratory Sciences. 47, 4, 181-195
  9. Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. The Lancet. 2007; 370, 9588, 657-666.