Prevent Fractures From Falls With Vitamin D Supplementation

News reports have picked up the story about a recent meta-analysis on vitamin D, and headlines have read: “Vitamin D doesn’t aid the prevention of Osteoporosis.” A meta-analysis (Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis) conducted by researchers at the University of Auckland in New Zealand and published in The Lancet earlier this month looked at 23 vitamin D studies. The studies totaled 4,082 generally healthy people (92 percent female) with an average age of 59 years. Bone mineral/density was studied at one to five sites in each study, with the sites being lumbar spine, femoral neck, total hip, femur, total body or forearm. Participants took 500-800 International Units (IUs) of vitamin D per day. Results of the meta-analysis showed a small benefit at the femoral neck in bone density, but no other areas. The lead author of the study, Dr. Ian R. Reid, said “for healthy people focused on osteoporosis prevention, vitamin D does not make a positive contribution.”

While this meta-analysis didn’t find vitamin D to be helpful in managing osteoporosis, the study doesn’t review vitamin D levels and the potential for falls. In May, 2012, the U.S. Preventive Services Task Force (USPSTF) recommended exercise or physical therapy and vitamin D supplementation to prevent falls in community dwelling adults 65 years or older who are at increased risk for falls.

Falls are the leading cause of injury in community dwelling adults 65 years or older, and 30-40 percent of adults 65 years or older fall at least once per year! Fractured bones are the result of approximately 5 percent of these falls, and two meta-analyses have found that vitamin D prevents fractures. Low vitamin D levels increases fracture risk. It has been estimated that as many as half of the older adults with hip fractures could have vitamin D levels below 30 ng/mL. (Optimal vitamin D is 30-100 ng/mL; suboptimal is 20-29 ng/mL and lower than 20 ng/mL is insufficient. Dr. Cooper likes to see levels 40-60 ng/mL in patients.)

Adult Cooper Complete multivitamins contain 2,000 IU vitamin D, and a standalone 1,000 IU Vitamin D tablet for individuals who need higher supplementation to get to an appropriate level.

Since falling is such a risk for older adults, it makes sense to stay aware of vitamin D levels through an annual blood test and to supplement as appropriate to get levels where they need to be. In addition, as Dr. Cooper has long advocated, it makes sense to commit, at every stage of life, to move and exercise like your life depends on it.

For our latest recommendations subscribe to our free e-newsletter The Cooperized here.

Introducing the New Cooper Complete Supplement: MVP

By Vitamin Expert Todd Whitthorne

Imagine this: It’s a beautiful sunny day–perfect baseball weather. You’re in the batter’s box facing Texas Rangers pitcher Yu Darvish. Nerves aside, you’re wondering what type of pitch will be hurled your way. Will it be a 97 mile-an-hour fastball or a 64 mile-an-hour curve ball? Since it takes a mere half-second for a pitch to reach home plate, your decision to swing will be made in the blink of an eye.

In that fraction of time, your eyes must evaluate the speed, direction and anticipated path of the pitch. That visual “data” is passed through the optic nerve, into the brain, which then sends a signal through your nerves to your muscles to immediately react to the information being processed. This all hinges on your hand-eye coordination which can mean the difference between a game-winning base hit or game-ending strikeout. The start of this entire process is obviously highly dependent on vision.

He Did What?
On a recent trip to Brazil I met with “Professor” Oscar Erichsen, the head trainer of Atletico Paranaense, one of the country’s premier soccer teams. He recalled in great detail a moment during the 1970 World Cup in Mexico City. Pele, arguably the best soccer player in history, took a shot on goal from midfield. The shot sailed wide but the mere fact that Pele had even attempted such a feat sent shock waves throughout the soccer world. Professor Oscar explained that the shot attempt was significant for two reasons. One was the obvious leg strength that it took to launch such a blast. The other was more subtle.

Pele had an incredible ability to constantly evaluate data while in the throes of competition. For instance, how were his teammates positioned in comparison to the competition? How fast was Defender A compared to Defender B? How did the length of the grass and the direction of the wind impact the flight of the ball? On this particular play, Pele sensed the defenders nearest him were out of position and that the opposing goalie had drifted away from the net. In an instant he made the decision to take a shot that, despite being off-line, fans still talk about over 40 years later.

Scientifically this ability to read one’s external environment is known as “exteroception” and Professor Oscar said no one has ever had it better than Pele. This is similar to what we hear about great point guards, “He has eyes in the back of his head,” or about outstanding quarterbacks, “The game just seems to slow down for them.”

See Stronger with Cooper Complete MVP
Vision is a key performance factor in just about every sport. The ability for an athlete’s eyes to adapt to varying light conditions, whether from artificial indoor light or bright sunshine outside, has a direct impact on performance.

I’m very excited that we have added a new product to our Cooper Complete line of nutritional supplements: Cooper Complete MVP (Maximum Vision & Performance). This product is scientifically formulated to improve tolerance to glaring light by 58% and reduce glare recovery time by 5 seconds performance, as well as improve contrast sensitivity–the ability to distinguish a white ball against a blue sky. The ingredients in MVP are pure, potent and supply the proper nutritional levels that research shows are most beneficial to athletes of all levels looking for a competitive edge.

I encourage you to visit our website to learn more or purchase Cooper Complete MVP.

Podcast: Jorn Dyerberg, MD, the Father of the Omega-3 Movement, Interviewed

Jorn Dyerberg, MD
Father of the Omega-3 Momvement

Todd Whitthorne interviews Jorn Dyerberg, MD, the father of the omega-3 movement. Dr. Dyerberg was studying the Eskimos, who ate a high fat diet, and had very low rates of heart disease, and discovered the protective effects of omega-3 fatty acids (EPA and DHA) in marine sources. Dr. Dyerberg talks about advances in the science of omega-3 fatty acids from 1970 to present day, and a bit about the 25,000 studies that have been conducted during this time period. Once studied primarily for cardiovascular health, researchers have also studied the impact of omega-3 fatty acids on inflammatory disorders, brain health, eye health, etc. Dr. Dyerberg discusses the protective effects of omega-3 fatty acids, and how much of the nutrients we need for optimal health.

Dr. Dyerberg is also the co-author (with Richard Passwater and Cheryl Hirsch) of  the book The Missing Wellness Factors: EPA and DHA: The Most Important Nutrients Since Vitamins?

Click here to listen to the interview.

Are you Getting Enough Vitamin D?

By Todd Whitthorne,  Vitamin Expert

Today’s Healthy Living Section of the Dallas Morning News featured a story on healthy ways to make your face more beautiful, which included protecting your skin from the sun’s UV rays. As a guy that works at Cooper and oversees our vitamin and nutritional supplement line, I spend a great deal of time following the literature on this topic.

I obviously agree that the sun can do tremendous damage (aging and increased risk of skin cancer). But I also I think it’s always important to remind folks that when it comes to sun screen you should be careful “not to throw the baby out with the bath water.” That same UVB light that accelerates aging and increases cancer risk is also the same light that generates vitamin D.

We have a vitamin D deficiency epidemic in this country. An article published in the 2009 Archives of Internal Medicine found that 77 percent of U.S. adults and adolescents were insufficient in vitamin D (90 percent of Mexican-Americans and 97 percent of all non-Hispanic blacks). At Cooper Clinic we have been measuring vitamin D levels in our patients since 2006, and we find approximately 80 percent of our first time patients have levels lower than we like to see (<40 ng/ml).

Dr. Ed Giovannucci, a highly respected researcher from Harvard, wrote in the Journal of the National Cancer Institute in 2006 that “sunlight might prevent 30 deaths for each one caused by skin cancer. I would challenge anyone to find an area or nutrient or any factor that has such consistent anti-cancer benefits as vitamin D. The data are really quite remarkable.”

Of course, then the question comes up of whether physicians prefer that their patients get vitamin D through supplementation, as opposed to directly from the sun. That really depends on whom, and what type of doctor, you ask. Most of the research indicates that there is really very little difference between the two.

Most physicians feel supplements are the most logical choice because of ease, cost, accuracy of dosing, etc. Dermatologists clearly like to steer folks away from the sun. However a few, including Dr. John Cannell, Founder of the Vitamin D Council, feel that the sun is the preferred method since that’s the way we were “designed” to get vitamin D (listen to a podcast with Dr. Cannell).

Obviously no one, including Dr. Cannell, recommends getting a sun burn, but for most folks 10-15 minutes of unprotected sun exposure seems to be a logical, and safe, dose. The problem is how often do most people go out in a bathing suit, or shorts and a tank top, between 10 a.m. and 2 p.m. when the UVB light is most available? Clearly if the weather is gloomy and overcast that wouldn’t be practical.

Something else to keep in mind is that there is a huge variability in how much vitamin D we synthesize from the sun, or absorb from supplements. There clearly is no such thing as “one size fits all.” Cooper Clinic physicians recommend starting with 2000 international units (IU) of vitamin D-3 per day and go up in dose as needed. The ideal method to determine how much vitamin D you need is to get a blood test. But from a practical standpoint, most people aren’t going to take the time or spend the money to do that. 2000 IU per day may not get them to an “optimal” blood level, but for most individuals it will at least help them avoid “deficiency” (less than 20 ng/ml).

Even though I run and ride my bike outside quite a bit, I have found that I need to take 5000 IU of Vitamin D-3 per day for me to maintain a blood level of 60 ng/ml (my ideal target). But remember, everyone is different. The main takeaway is to make sure to get your vitamin D. Whether it’s from the sun or supplements….just get it.

Interview with Cooper Clinic Head of Cardiology Dr. Nina Radford about Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events

Dr. Nina Radford, Cooper Clinic

Todd Whitthorne talked with Dr. Nina Radford, about the systematic review and meta-analysis Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events published in the JAMA September 12, 2012, Vol 308, No 10 issue. Click here if you would prefer to listen to the interview.

Todd:  Hello once again this is Todd Whitthorne with another healthy living podcast and I’m joined today by Dr. Nina Radford, the Head of Cardiology for the Cooper Clinic and we’re going to talk about a recent article in JAMA that discussed a meta-analysis of omega-3 as it relates to the cardiovascular benefits.  So Dr. Radford, this can be a rather complicated topic because we’re talking about statistics and scientific research, but I do know we have a very educated and inquisitive listening audience, so let’s walk through this paper because the headlines we’ve seen in the newspapers or heard on the radio basically came out and said that “omega-3, or fish oil, did not show benefit for cardiovascular health.” Can we dig a little deeper and explain really what this paper was investigating, and what the results showed?

Dr. Radford: Absolutely! I’m just delighted to discuss this with you because as we both know, sometimes these very important papers get condensed into a single, simple sentence or headline that may peak an individual’s attention but doesn’t always tell the whole story…, and this paper I think is a good example of that.

So this paper is a meta-analysis, and what that means is it is combining information from multiple studies, and why would you want to do that? Well, if you combine studies together your population will grow, so for example in this meta-analysis they combined the data from 20 studies so it included almost 69,000 patients.  When you have a larger patient population, it’s easier to see small effects that may occur that may be statistically significant. The problem with combining studies is that all studies are a little bit different… the ages of the patient may be different; the formulation of the omega-3 being used may be different; they time they use the omega-3 may be very different; it may be in a different country where native foods are very different for example, from the United States. So, one of the problems is that when you combine studies that are very different, and you reach conclusions from them, your house is sort of built of rickety wood, so you have to be careful in terms of how you interpret it. That being said, what we have are this combination of 20 studies. The median age is 68, and I’ll remind you median means that 50% or below that age, and 50% are above, and in these studies the age range was 49 to 70. In these studies, the median dose of omega-3 was about a gram, and that’s probably less than most people consider taking daily today.

Todd:  I’m sorry. That’s a gram of EPA plus DHA, not a gram of fish oil, correct?

Dr. Radford: That’s correct. And the range was from .53, so half a gram, which most of us would consider on the lower side, to 1.8 grams per day. The treatment duration was about two years and spanned from one to six, and the important thing about these studies is that 13 of the 20 were secondary prevention studies.  What that means is those participants had already been diagnosed with heart disease. They had heart attack, bypass, heart failure, sudden death, stents, but they were not people who were taking it to prevent the first event. Rather, these were people who were put on fish oil to prevent a second cardiovascular event or death. Four of the studies were mixed primary secondary, you couldn’t really sort out which was which, and three of the studies had to do with preventing sudden death in people who had implantable cardiac defibrillators (those are the internal defibrillators that shock you if you have a potentially life-threatening heart rhythm abnormality). So again, these are patients who are older, they have known heart disease, and they’re taking EPA plus DHA at a median of a gram for about two years.

Now, one of the things that we have to remember in all of this is that there’s pretty good reason to think that fish oil may help when we look at basic science. There have been studies that suggest it lowers blood pressure, lowers triglycerides, may stabilize heart rhythms, may reduce the stickiness of the blood to form to form blood clots, so there’s some good rationale from which these studies were conducted, and that’s always sort of reassuring to know there’s some basic science that underlies these. So in this analysis, they looked at five major outcomes  – all cause mortality (that’s the risk of dying of anything); cardiac death (dying of heart attack); they looked at sudden death (which is a heart rhythm abnormality); rather than having a heart attack and then having heart failure, for example; having a nonfatal heart attack; or stroke.

When we look at whether or not a result is statistically significant, we look at something called the P value, and the P value helps us decide if this result that could happen by chance, or is this the result that can withstand rigorous statistical testing? And we rely on that P value as readers of medical science, to let us know yes, that’s statistically significant, or no it’s not.  We don’t just rely on the number that we see, we have to rely on the statistics to back it up, so in this population is that meaningful.

Now, in most studies that I read, a P value of significance is a P value less than 0.05. When you know that the P value is less than that, you know it’s statistically significant. And when we look at that range of P value in this study, there was actually a demonstrated benefit in terms of reducing cardiac death. It reduced it by about 9 percent. Now, what’s made this somewhat controversial is these authors have decided to make a much more limited P value of .0063, and that’s rather usual, and that requires that the effect be more robust if you will, in order to prove that it’s present.

And when we look at studies – for example you may remember testing hormone replacement, and did hormone replacement reduce the risk of death for example? In all of those studies the P value is 0.05. If you look at whether statin medications reduce the risk of dying from heart disease, the P value is 05. So the use of this very, very small P value, is a little unusual and not everybody is accepting it when we look at this study. So certainly, what I would conclude from this study, based on a P value I think is reasonable, is that there is likely a small reduction in cardiac death in the studies of patients who are older and already had advanced heart disease.

One of the things I think is very interesting in this paper is that they provide sort of a chronologic history. They start with studies done in the mid- 1995’s and they go through the studies that were published more recently in 2012.  And what’s interesting is in the studies that were published in the in the mid-to-late 90s until 2005, there was a benefit of omega-3 in terms of all cause mortality. But when you look at the most recent studies that were published in 2010 or 2012 you did not see that effect. So does that mean that the studies that were done early on were wrong? Absolutely not!  What we see is an effect of improving medical science and improving technology. Compared to 1995, patients who are treated after a heart attack today are treated with much more sophisticated medications. Their lipids are much more aggressively lowered compared to patients in 1995, so if I add a therapy like omega-3 fatty acids, which have a small benefit compared to those other therapies, it may be hard to see that benefit unless you have an extraordinarily large number of patients in the trial. And so, I don’t see this as being a call to throw away all your fish oil.  Rather, I see this as a recommendation that there is likely is benefit, but it’s small, compared to the other known therapies that we have for patients treated after a heart attack.  Now let me be very clear that this has no bearing on patients who haven’t heart disease yet; who haven’t had their first heart attack yet. Maybe they have high cholesterol.  Maybe they have a strong family history of developing heart disease and they want to prevent their first event.  This paper doesn’t address population all.

Todd:  Clearly, what’s interesting about omega-3, is that there are literally thousands of studies that have been done looking at the various and assorted benefits and in a variety of areas, but in particular cardiovascular disease.  So for someone healthy, someone that is just looking to improve their overall cardiovascular risk profile, omega-3 still make sense from your perspective as a cardiologist?

Dr. Radford: I think that they definitely ought to be offered to patients. I think that they definitely may have some benefits in terms of reducing death from cardiovascular disease. I think compared to their other therapies, like statin medications or low dose daily aspirin, that effects may be small, but every little bit helps if we’re talking about reducing your risk of dying of heart disease.

Todd:  And that main benefit as we hear so much about inflammation, that seems to be the benefit of omega-3, as an anti-inflammatory?

Dr. Radford: And there may be benefits well beyond that, that we simply don’t have enough knowledge about.

Todd:  Very good. Well Dr. Radford, as always I appreciate your insight.  It’s like going to Paul Harvey for the rest of the story, to break it down and simplify something that is very, very complex, so we appreciate it.

Folks, if you want more information, you can sign up for The Cooperized Newsletter. As always, we’ll keep you updated with whatever we can here on the podcast and on the website. Until next time, this is Todd Whitthorne. Have a great day. Be healthy.

Podcast: Gretchen Vannice, MS, RD, author of Omega-3 Handbook, A Ready Reference Guide for Health Professionals, is interviewed

In this episode, Gretchen Vannice, MS, RD, author of Omega-3 Handbook, A Ready Reference Guide for Health Professionals, is interviewed by Todd Whitthorne. A registered dietitian, Gretchen explains what types of omega-3 fatty acids are most beneficial, and how to determine the type of omega-3 in different foods. The ways our body stores and uses EPA and DHA are also explained. Gretchen also reviews the intake recommendations for omega-3 fatty acids for different populations.

Listen to the complete podcast here.

Dr. Cooper Encourages Proper Supplementation

By Jill Turner, VP of Operations, Cooper Complete Nutritional Supplements

Since 1997 Kenneth H. Cooper, MD, MPH, founder and chairman of Cooper Aerobics, and an advisory board of respected experts from four leading universities have been studying nutritional supplements and what role they play in health and preventive medicine. That research led to the development of Cooper Complete® Nutritional Supplements. Our philosophy with supplements is that they work as an insurance policy to help fill in the gaps of what we most likely are not getting through our daily diet.

Dr. Cooper has long advocated that proper supplementation starts with a balanced diet. While it is always best to receive vitamins and minerals through food, in reality most people are unable to get the proper amount of vitamins and minerals through diet alone. Men and women should review their supplementation needs with a physician who knows them and their general health.

Our recommendation for proper supplementation remains the same despite a recent study in the Archives of Internal Medicine regarding vitamins. To read our statement regarding this news, please click here.

For more information on Cooper Complete Nutritional Supplements, visit our website.