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Vitamin D could protect against auto immune diseases

MD-FM Thursday March 21, 2013




GENERIQUE
Carillon
 
Sarah:
MD FM — Medical News from around the world with Peter Goodwin.
 
P1

PETER:
Hello. And with me is Sarah Maxwell.

To begin with: further insights into the key role vitamin D plays in health have been discussed in several papers over the last few days…

SARAH:
Yes, first off: the link between ultraviolet B and rheumatoid arthritis has been looked at using data from the famous Nurses’ Health Study with 200,000 women in America — published in the Annals of Rheumatic Diseases. Elizabeth Arkema and her group from Boston compared published records of UV-B from sunshine in different states, with the incidence of RA in two groups of women of different ages:

Bob- ELIZABETH ARKEMA 01
IN:  We found that a higher average UV-B exposure was associated with a 21% decreased risk of rheumatoid arthritis in an older cohort of women — so women born before 1946 —  but not in the younger cohort.  And we believe that this could be due to the fact that the older women might have had different sun-avoidance behaviors than the younger women. And this is the first UBV study to see this association”

SARAH:
The study followed earlier evidence that the incidence of auto-immune diseases like multiple sclerosis has been related to latitude. So there’s long been a belief that sun-light is involved, and the new study hypothesises that this is because it helps us make vitamin D:


Bob- ELIZABETH ARKEMA 02
IN: “Vitamin D has been shown to be an immunomodulator.  We actually produce vitamin D subcutaneously 90 per cent of the vitamin D we get is through sunlight exposure.  The other 10 per cent is from foods, so UBV is our best acquirement of vitamin D. But we actually did not measure vitamin D but that’s the hypothesis: that through  UBV exposure we have more increase of vitamin D in the blood, and that — kind of — calms down the immune system perhaps. And it’s been shown from cell studies and lab studies, but this is the first to show this in an epidemiological study”

SARAH:
Dr Elizbeth Arkumma, from the Brigham and Women’s Hospital in Boston Massachusetts, talking to us on the phone from the Karolinska Institute in Stockholm where she’s now working.

P2

PETER:
And vitamin D seems to be a hot topic at the Karolinska, where another group reported that; patients with idiopathic inflammatory myopathies had low serum vitamin D levels — which fits in with the idea that being deficient in vitamin D could affect your risk of developing auto-immunity.

SARAH:
Also in the Annals of Rheumatic Diseases — Professor Maurizio Cutolo from Italy wrote an article weighing up evidence that; vitamin D influences both the risk and prognosis of auto-immune rheumatic disease by acting on the endocrine-system. When we called him up in Genoa he explained that vitamin D helps form hormones essential for the body’s protection against infection:

Bob- MAURIZIO CUTOLO 01 (calcium channels in common)
IN: “Vitamin D and glucocorticoids exert almost the same action — are endogenous immunosuppressive and anti inflammatory agents — so when you get good concentration of the hormone as well as endogenous production of glucocorticoids you observe this modulation of the immune response and keep the auto-immunity factor under control”

SARAH:
Professor Cutolo recommended doctors everywhere to be vigilant in looking for signs of 25-hydroxy vitamin D deficiency among patients and to consider giving supplements, especially in winter months:

Bob- MAURIZIO CUTOLO 02
IN:  “Please consider the levels of 25 hydroxylated [vitamin D] that is one of the most reliable precursors when it’s winter time in your patients or in your people, because if the levels are lower – 20 or 15 this is the range to speak of deficiency  – try to integrate with at least 1 000 unit of 25 analogues and in this way for three or four months with a cycle of administration: that means fifteen or twenty days a month for three or four month you try to keep the serum levels or the precursor levels in a god quantity.”  

SARAH:
Maurizio Cutolo, Director of Rheumatology at the University of Genoa in Italy.

VIRGULE MUSICALE

P3

PETER:
The vexed issue of hormone replacement therapy now. It’s become a less popular treatment for menopausal symptoms recently, since worries about cancer risks have emerged. But, could it be time for change?

SARAH
Well you could say that, as studies attributing breast cancer risk to HRT have been flawed, according to Professor Samuel Shapiro from the University of Cape Town. In a review of evidence from the big studies on breast cancer risks from menopausal hormone therapy, he points out that some facts to be explained:

Bob- SAMUEL SHAPIRO 01
IN:  “The incidence of breast cancer started to decline before the use of HRT dropped.  Then there were many other problems, and if that weren’t enough, subsequent studies that have been done have not shown the decline of incidence to be uniform in all countries where HRT dropped. And in all ethnic groups in which HRT dropped and in all areas in which HRT dropped. Then the final thing is that they had no information for critically important factors such as what is happening to mammography: the more common mammography is the more otherwise silent clinically undeclared breast cancers are detected, and this changes over time, and women who stop using HRT may stop having mammograms as well. And really the secular trend data neither support nor rebut the hypothesis that HRT increases the risk of breast cancer.”
 
SARAH
Samuel Shapiro, who’s written up his conclusions in the Journal of Family Planning and Reproductive Health Care looking at data from: the Women’s Health Initiative, the Million Women Studies, and the Surveillance, Epidemiology and End Results — or SEER — study among others. He concluded there’s no clear evidence that the decline in the use of HRT has caused the fall in new cases of breast cancer.

The commentary on his paper was written by consultant gynaecologist, Nick Panay from London, who shares the reservations:
 
Bob- NICK PANAY:  01
IN: “The view that I have — and this is shared by the British and international menopause societies — is that there were severe limitations with the studies that have been performed. And in our clinical experience and looking at other data over the last 20 or 30 years HRT seems to be a very safe preparation and the benefits far outweigh the risks.”
 
SARAH:
And Mr Panay pointed out that there are clear practical messages now which should reassure doctors and patients:

Bob- NICK PANAY:  02
IN: “I think the clinical implications are that the studies have shown us that there is some doubt as to the potential risks and if there are risks they are very small and these risks need to be put into the context of the benefits to women which can be immense — not only to their quality of life and ability to function on a day-to-day basis but also potential benefits for osteoporosis, cardiovascular disease and also longer term issues: cognitive functioning.”

SARAH:
Mr Nick Panay, from Queen Charlotte’s and the Chelsea and Westminster Hospitals, in London, and Chairman of the British Menopause Society. And there’s a great review of the whole area in the latest Journal of Clinical Endocrinology and Metabolism, by Dr Lobo from Columbia University in New York.


VIRGULE MUSICALE
 
P4

PETER:
We’re learning from a number of sources that cancer risks and cardiovascular risks seem to go hand in hand…

SARAH
Yes, and measures for reducing heart disease also bring benefits in cutting the risk of cancer, according to an article published in the American Heart Association’s journal: Circulation.

PETER:
Hmm, and that also fits in with a report presented at the St Gallen conference on Early Breast Cancer — in Switzerland — a few days ago doesn’t it:

SARAH
Yes. Rowan Chlebowski from Los Angeles — who’s long been associated with powerful studies of health risks — delivered his latest verdict on diet and exercise in cancer prevention and therapy. He told us there isn’t enough evidence to implicate particular diets in either, but…

Bob- ROWAN CHLEBOWSKI:  02
IN: “For breast cancer risk it really looks like there’s very strong association with obesity and also with physical activity.  And interestingly the physical activity doesn’t have to be intense [it] has to be walking three or four hours, regular pace, per week — almost everybody should be able to do that.”

SARAH:
Also in his talk at the St Gallen meeting Dr Chlebowski discussed the effect obesity has on the choice of hormonal adjuvant therapy in breast cancer. Despite the advantages that aromatase inhibitors have shown over tamoxifen in some patients, in the case of patients who are obese, it seems, you have to choose your AI carefully:

Bob- ROWAN CHLEBOWSKI:  02
IN: “There’s data suggesting that anastrazole is not better than tamoxifen in women who are overweight or obese in this big ATAC trial. And in the BIG 198 trial letrozole was better than tamoxifen in women who were overweight or obese. That’s simplifying the whole area, but letrozole also suppressed — as was pointed out — estrogen levels greater than anastrazole so in the absence of further data I think letrozole is the safer bet for women who are overweight or obese although questions still remain.”

PETER:
Dr Rowan Chlebowski from UCLA Harbor Medical Center in California.


BREVE 1 -Sur fond musical
 
PETER:
Finally, in brief:

For adults with treatment-resistant depression, atypical antipsychotic medications — not originally intended for depression — can reduce symptoms. That’s according to a meta-analysis — in PLos Medicine — that looked at randomized trials comparing four different adjunctive drugs with placebo: aripiprazole, olanzapine/fluoxetine combination, quetiapine, and risperidone. All four had statistically significant impacts on remission, but authors advise caution as the benefits were modest.

And...
 
BREVE 2

For women with breast cancer, having radiotherapy increased the incidence of major coronary events in a population-based, case–control study from Scandinavia — in the New England Journal of Medicine. It looked at over 2000 women, and found the more ionizing radiation the heart was exposed to during breast cancer therapy, the higher the risk. And for women with preexisting cardiac risk factors, the increase was even greater.

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then, from me Peter Goodwin, goodbye!
 
JINGLE FIN    
 

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Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
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