Many of us have now assumed certain grandparenting duties with joy and pleasure, especially if we do can them without the duress of becoming the primary care giver … Apparently there have been very few studies on what this role does to our cognitive health. So I read with great interest the article that appeared in this month’s journal of the North American Menopause Society (aptly named Menopause).

The title of the article is “Role of grandparenting in postmenopausal women’s cognitive health: results from the Women’s Healthy Aging Project”. The participants included 186 Australian women from a larger prospective aging study. This portion of the study was meant to examine the disuse hypothesis, also known as ” the use it or lose it” hypothesis that proposes that decreases in activity with age results in the disuse of cognitive mechanisms, which then cause a decline in cognitive abilities. We know that as we get older, large social networks or high levels of social activities can improve cognitive function, help diminish cognitive decline and even lower the risk of developing dementia. So does grandparenting fulfill this function?

A questionnaire was administered to the participants in 2004. They were asked whether they had grandchildren, if they were currently minding their grandchildren, and, if so, how much time they spent minding their grandchildren. Participants were also asked if they felt that their children have been particularly demanding of them in the past 12 month. Cognitive tests were later administered (I won’t bore you with the types and the questions) and their verbal memory and executive function were assessed. There were 131 grandmothers in the sample and those who spent time minding grandchildren (111) were more likely to be employed than those who did not. There was no significant difference in age, number of grandchildren or education between the participants. No significant differences in performance in any of the tests were observed between grandmothers and non-grandmothers; there were also no significant differences between participants who were minding grandchildren and those who were not. The only differences that were found were that participants who spent one day a week minding their grandchildren had the highest cognitive performance in all the tests and those who did so for five days or more per week had the lowest test scores. Frequent grandparenting apparently predicted lower processing speed and working memory performance. Moreover, those who had to perform this “task” almost daily reported more feelings of resentment.

Does this mean that too much of a grandparenting role may not be good for our cognitive health? Although this article was published in a peer reviewed journal, I feel the study is too small to make that assumption. There’s no question that if one has to take care for grandchildren without a respite it can be tiring both physically and mentally. Those in the study who “minded” their grandchildren five days a week or more may have had no choice and indeed minded. Their mood and perhaps fatigue may have adversely impacted their cognitive test results.

I have to stop now and take my granddaughter to her dance class. The drive might be mind numbing but watching her perform is not. This is not a daily “task”, so I assume my cognitive abilities will remain intact.

I didn’t have a chance to discuss this in my last website and even though I’m a week late I wanted to belatedly acknowledge the International Day of the Girl which was celebrated on October 11. In honor of that day, the CDC sent an email with information that they hoped would raise awareness about the health issues that impact young girls worldwide. They chose seven topics (none, thank goodness about Ebola) that should be addressed in order to promote the health and safety of girls. I thought I would outline them this week:

Binge Drinking
The CDC noted that “alcohol is the most commonly used and abused drug among youth in the United States.” According to their statistics one in five high school girls binge drink and half of high school girls who drink alcohol report binge drinking. That means that they’re consuming four or more drinks on a single occasion. This increases their risk of behavior problems, injuries, sexually transmitted infections, unintended pregnancy and also impacts their risk of becoming addicted to alcohol and future health problems.

Human Papilloma Virus (HPV)
This type of virus causes most cases of cervical cancer as well as vaginal and anal cancer. It’s now calculated that 14 million people including teens become infected with HPV every year! But here’s the good news… We now have an HPV vaccine that protects against the HPV types that most often cause anal, cervical, vaginal, vulvar and mouth/throat cancers in women. I’ve talked to most of my patients who are mothers, as well as my younger patients, about the importance of getting this vaccine and indeed have written several articles on my website. Here is a reminder: The HPV vaccine is recommended for girls and boys when they are 11 or 12 years old. It can lower HPV infection rate for teen girls by half. Unfortunately, only 57% of girls and 35% the boys have started the HPV vaccine series. We have to do better…

Indoor Tanning
As I hope we all know, this significantly increases skin cancer risk. The risk is highest among those who start tanning at a younger age. Nearly 33% of white high school girls have tanned indoors and some start doing this as early as age 14 or younger. Indoor tanning causes melanoma which is the deadliest type of cancer. It also contributes to premature aging. We do have laws that prevent young teens from using indoor tanning salons in California but I’m not sure that they are well followed. Somehow we have to promote the slogan that untanned skin is beautiful (and will stay beautiful longer). So many of us wish we had known this years ago.

Sexually Transmitted Infections (STI’s)
Teens and young adults between the ages of 15 and 24 account for half of all new STI’s. Clearly this is where choice of partner and condoms come into play or should I say foreplay…

Sexual Violence
The CDC reports that studies indicate that 36% to 62% of reported sexual assaults are committed against girls age 15 and younger around the world. In the United States, 40.4% of female rape victims where first raped before age 18.

Suicide
Among 15 to 24-year-olds, suicide accounts for 11% of all deaths annually!

Teen Pregnancy
In 2012, more than 86,000 teens in The United States ages 15 to 17 gave birth. As the CDC points out, this increases their medical risks and results in huge emotional, social and financial costs to the mother and her children. Becoming a teen mom affects whether the mother finishes high school, goes to college, and the type of job she will get.

I listed these alarming stats because I (and the CDC) think we should be aware of the major issues that impact the teen girls in our lives. Ignoring them will not help us address their problems. Yes, we should be celebrating the day of the young girl, but to do so, we need to make sure she stays safe and healthy.

This has been a fabulous week for me. On Monday, I was honored by the National Breast Cancer Coalition event titled “Les Girls”. Unlike most “disease dinners” this was a cabaret style stage show with television actors singing, dancing and providing fabulous entertainment to a few hundred guests who were there to raise money and awareness for this amazing organization. What made the evening so touching and rewarding for me was the fact that family, friends and patients came…

Now on to a new medical article… The Obstetrics and Gynecology Journal published an article this month on titled “Exposure to selective serotonin reuptake inhibitor’s (antidepressants) in early pregnancy and the risk of miscarriage.” This is very relevant because up to 15% of all women are affected with depressive symptoms during pregnancy. Untreated depression has been associated with preeclampsia, preterm delivery, low birth weight, and miscarriage. The question the researchers posed and sought to answer is whether SSRIs increase miscarriage rates.

In Denmark, where the study was carried out, the number of women being treated with an SSRI during pregnancy has apparently increased 16 fold from 1997 to 2010. In the United States, up to 13% of pregnant women are treated with an SSRI in the first trimester of pregnancy. Denmark, like the other Scandinavian countries, maintains amazingly detailed medical records on their entire population and these of course include statistics on pregnancy, miscarriage, procedures and prescriptions. The researchers identified 1,279,840 registered pregnancies between 1997 and 2010. Of these 71.2% ended up in live births, 17.7% in induced abortions and 11.1% in miscarriages. They also found that 1.8% of women were exposed to an SSRI during the first 35 days of pregnancy. Women exposed to an SSRI were more likely to be older, have a lower educational length, lower income and experienced more previous miscarriages compared with unexposed women. The statisticians calculated that the hazard rate of having a miscarriage in pregnancies exposed to an SSRI compared to those of unexposed women was 1.27. That means that those exposed had a 27% increase risk of miscarriage. But they also identified 1.8% of women who discontinued SSRI treatment 3 to 12 months before conception and of whom 13.8% experienced a miscarriage prepared with the 11.1% among the unexposed women. So their hazard rate for miscarriage after discontinuing treatment before conception was 1.24. In other, more understandable words, they had the same risk of miscarriage as women who continued taking SSRIs

Bottom line: It’s not the SSRI that increases risk of miscarriage but probably lifestyle factors associated with depression such as alcohol use, smoking or poor compliance for folic acid supplementation during pregnancy. Because the risk of miscarriage is elevated in both women who take an SSRI and those who stopped a few months before getting pregnant, there’s likely no benefit discontinuing the medication that helps alleviate symptoms of depression.

In a week in which we’re supposed to get ready to ask to be written during Yom Kippur “in the book of life” there’s been a lot of news about death, especially Ebola….All the medical journals are now publishing articles about this devastating disease. As a trustee on the board of Save The Children, I’ve been appraised almost daily about the epidemic in the three countries in West Africa where we already have significant programs. Caroline Miles, our CEO has traveled to Liberia where Save the Children and other NGOs are establishing Ebola diagnostic centers, isolation centers and Ebola treatment centers. The consequences of not becoming involved in attempts to treat, contain and hopefully prevent further spread of this disease will have devastating country-wide and global consequences.

But I’m not going to report on Ebola or other diseases in this week’s website. The media is finally doing a good job (especially the New York Times) and so I looked for some novel, not completely medical news to report. I found it in good old JAMA.

In the past, physicians have tended to be Republican. I assume this was for mostly for monetary reasons. (I would try to avoid political discussions with many of my colleagues because I knew we disagreed, especially about their economic woes, which are perhaps currently more valid.) My good news is that the growing ranks of women in the medical profession are shifting political allegiances toward the left.

Women now account for roughly 1/3 of the US physician workforce and happily that proportion is growing. A new study analyzed donations from physicians to national political campaigns between the 1991-1992 election cycle through the 2011-2013 election cycle. Physician campaign contributions increased during this time. But those made to Republicans declined between the mid-1990s and 2012. It was reported that the majority of male physician contributors still backed Republicans but only 31% of female physician contributors supported that party. My take is that this is due to the lack of the official Republican Party’s support of women’s reproductive rights, immigration reform, and funding for causes so many women, especially those involved in health care, care about.

Finally some news that made me smile…May the Jewish New Year bring improved health, governance and stability to all of us.

The incidence of BRCA1 and BRCA2 mutations is higher in the Ashkenazi Jewish population and hence studies on population screening have initially been done in Israel. This week we celebrate the Jewish New Year…and the latest JAMA article on population based screening for these mutations was most timely.

The article published in the September 17 JAMA is based on the 2014 Lasker Award. This award in medical science was presented to Dr. Mary-Clair King to recognize and honor her “for bold and imaginative contributions to medical science and society – exemplified by her discovery of a single gene BRCA1 that causes a… form of hereditary breast cancer…” The article both describes the application of this discovery and suggests that population-based screening of women for BRCA1 and BRCA2 should become a routine part of clinical practice.

Just to remind you: BRCA1 mutation carriers have a combined risk of developing either breast or ovarian cancer of 60% by age 60 and 83% by age 80. For BRCA2 mutation carriers, risk is 33% by age 60 and 76% by age 80.

A recent study in Israel recruited more than 8000 healthy Ashkenazi Jewish men. The men were tested as a gateway to families for breast and ovarian cancer. (The men were unaffected by breast-cancer themselves but if they were positive, it would enable researchers to identify female mutation carriers, not based on their personal or family history of cancer.) 175 men were identified as carriers of the mutation and genetic testing was offered to all of their female relatives. Surprisingly, 50% of families found to harbor BRCA1 or BRCA2 mutation had no history of breast or or ovarian cancer that would have triggered clinical attention. However, female mutation carriers from these theoretically low-cancer- incidence families had similar cancer risks to female carriers from families with high cancer incidence. Low-cancer-incidence families were simply smaller with fewer females and hence were less likely to exhibit a significant breast or ovarian cancer history.

The authors of the article point out that without population-wide screening, women with BRCA1 or BRCA2 mutation from such families would not have been identified until they developed cancer; a failure of cancer prevention. This study has significant implications for preventive care in Israel which has a large population of Ashkenazi Jews. But in another study, it was found that only 35% of families with high incidence of breast or ovarian cancer had even previously been referred for genetic counseling, despite common knowledge of the increased risk due to BRCA1 and BRCA2 in the Ashkenazi Jewish population and the availability in that country of free testing and counseling.

In the United States, the number of carriers of mutations in the BRCA1 and BRCA2 genes is estimated to be between 1 in 300 and 500 women or between 250,000 and 450,000 adult women for whom breast and ovarian cancer is both highly likely and potentially preventable. Wide scale population genetic counseling and screening should go on our medical wish list. But at present, the US Preventive Services Task Force (USPSTF) supports BRCA1 and BRCA2 testing based on family history and ancestry, but not for the entire female population. Unfortunately only 19% of US primary care physicians accurately assess family history for BRCA1/BRCA2 testing. This is clearly unacceptable.

The author states at the end of the article that “population wide screening will require significant efforts to educate the public and to develop new counseling strategies, but this investment will both save women’s lives and provide a model for other public health programs in genomic medicine…. Women should have the choice to learn if they carry an actionable mutation in BRCA1 or BRCA2.” We have much to learn and do…

Since I tend to report on aspects of my personal life, I want to announce some personally exciting news: My daughter and her two small children moved to LA for a year. Not only are they living three minutes away…the children are in my temple school. I am delighted!

I have also become involved with a terrific organization, the National Breast Cancer Coalition (NBCC) which sponsors and supports the research that will help us prevent, diagnosis and effectively treat breast cancer. They are holding their annual event in LA on October 6. It will be a phenomenal French style review of dancing and singing titled “Les Girls” with performances by many of your favorite TV and theater stars and will be hosted by Allison Janney (who, I might add just won two Tonys). I am somewhat embarrassed to add that the NBCC board decided to present me with an award that evening and I am truly honored.

So if you think you would like to come to a fun evening and contribute to an important cause you can download details HERE.

Now onto the medical subject of this week’s website….Weight Loss

The September 3 issue of JAMA was dedicated to this weighty subject. As you know, one third of Americans are overweight or obese. It truly is an American epidemic. (And by the way, risk for a majority of cancers is significantly increased or just plain caused by obesity.) Multi billions of dollars are spent on branded weight loss programs, foods, diets, lifestyle recommendations and “come-on books” that suggest a secret way to lose pounds quickly, now and forever… A meta-analysis of 48 unique, randomized trials was published in that issue of JAMA and after many tables and graphs concluded that both low-carbohydrate and low-fat diets were associated with more weight loss than no dietary intervention over a 12-month period and that behavior support and exercise enhanced weight loss. (So far, I think we all knew this.) What made this article unique and caused it to create a stir was the fact that the statisticians found that weight loss differences between individual diets were small and likely of little importance. Their suggestion: if you want to lose weight adhere to any diet that you can stay on be it low-carb or low-fat.

The last article in the JAMA issue discussed two drugs, now on the market, that may aid and albeit weight loss: lorcaserin (Belviq) and Qsymia (Vivus). These new products are FDA approved for use in obese patients with body mass index (BMI) equal to or greater than 30 or overweight patients (BMI over 27) who also have at least one weight- related risk factor such as hypertension, abnormal lipids or type 2 diabetes.

In short: Belviq activates a serotonin receptor (type 2C to be exact) and is thought to suppress appetite. It can, however, cause headache, nausea and dizziness and in trials was discontinued 36 to 50% of the time. In the first year of one major trial, patients lost somewhat more that 5 % of their body weight but regained a quarter of it back during the second year of therapy. Qsymia combines phentermine and Topamax, a drug used for epilepsy. ( In the past phentermine was combined with fenfluramine (“phe-fen”) and caused heart valve problems…hence it was discontinued and now a new combination has been formulated, and felt to be heart valve safe.) Weight loss of 5% or more in the first year occurred in 45 to 70 % of patients depending on the dose and those who continued the medication for two years had an average weight loss of 10% compared to 1.8% in those on placebo. Side effects that occurred in more than 5% of patients included dry mouth, constipation, numbness and in the higher doses, insomnia. There were also reports of difficulties in concentration and memory.

In conclusion, the article states that either drug, taken as an addition to diet and exercise “may be affective in increasing weight loss in the first year of use, but much less so in the second year. Qsymia appears to be more effective than lovaserin, but may cause more troublesome adverse effects.”

A lot of information…I (or your other physicians) will be happy to discuss all of this in your next visit.

And I hope to see some of you (not in the office) October 6….

The media has been recently focused on this (at least when not reporting on ISIS). It’s likely that many of you have heard about the report that came out comparing mortality rates for three types of surgery for breast cancer: bilateral mastectomy (both breasts), unilateral mastectomy (single) or lumpectomy with radiation. The article that the media has been quoting was published in the September 3 issue of JAMA.

The reported study included 189,734 California women who were diagnosed with breast cancer in stages 0 to 3 between January 1998 and December 2011. The researchers reviewed the types of treatments they received, their follow up and the death certificates of those who died during the follow up. They excluded those women who were diagnosed after 2010 because of incomplete mortality data. If appropriate records were not available they also eliminated some of the patients, so basically, the final analysis included 174, 917 women whose medium follow up time was 89.9 months. (I am not sure you wanted all these numbers but I thought I would try to be as exact as possible,at least at the beginning of this website article.)

What they found was that the rate of bilateral mastectomy increased from 2% in 1998 to 12.3% in 2011 and this represented an annual increase of 14.3%. Women younger than 40 were most likely to have an increased rate of bilateral mastectomy which went from 3.6% in 1998 to 33% in 2011. This procedure was more often used by non-Hispanic white women, those with private insurance and those who received care at a National Cancer Institute (NCI) designated cancer center (8.6% among NCI cancer center patients versus 6% among non-NCI cancer patients). Unilateral mastectomy (obviously on the side diagnosed with breast cancer) was more often used by racial/ethnic minorities and those with public/Medicaid insurance (up to 52%). Breast conserving surgery with radiation was done in about 55% of all patients but again varied according to age, insurance and tumor size.

The important conclusions of the study was that compared with breast conserving surgery (lumpectomy) with radiation that had an overall ten-year mortality of 16.8%, unilateral mastectomy was associated with a higher all-cause mortality and a ten-year mortality rate of 20.1%. There was no significant mortality difference between lumpectomy and radiation and bilateral mastectomy (in which the ten-year mortality rate was 18.8%).

I know these mortality rates seem high. But there was a huge variability in cancer stage between zero and stage III, so the rates included the higher stage cancers. The study was not randomized and treatment was dependent on a lot of other factors including size of the tumor, tumor features that suggested a poor prognosis as well as lymph node metastases, receptor status and genetic changes which could worsen the prognosis. And as new reconstruction procedures were developed (which look better and allow symmetry), it was likely that some women would choose to have bilateral rather than unilateral mastectomy. Finally, younger women who have a longer period of time for risk of recurrent or new cancer or have a higher probability of carrying genetic mutations were more likely to chose to have surgery on both breasts.

The conclusion of the authors was that although the use of bilateral mastectomy increased throughout California through 2011, overall it was not associated with lower mortality than that achieved with breast conservativeness surgery and radiation. Unilateral mastectomy was actually associated with higher mortality than the other two surgical options.

I want to add my own take on this… it is an important study, but the fact that so many stages of breast cancer were lumped together and prognostic features were varied, there are significant drawbacks. Today with MRI, genetic tumor analysis and profiling, the prognosis of a woman’s breast cancer is more defined, allowing therapy to be targeted and of course improved. When deciding on the course of surgery, considerations of family history, ability to follow up with therapy and surveillance as well as complications of radiation and/or extensive surgery warrant careful consideration. Insurance status is an issue and is unfortunate; hopefully in the future no woman will be denied appropriate care. Every woman who has a diagnosis of breast cancer should carefully consider all choices of therapy with her physicians. Taking a few weeks to consider these will not make a difference in the outcome. This study should be part of the discussion.

There is a precancerous condition that can lead to esophageal cancer called Barrett’s esophagus. When we complain of the heartburn symptoms that can be due to GERD (gastroesophageal reflux disease) most physicians (and those ubiquitous TV ads) suggest an antacid or a PPI (protein pump inhibitor such as Nexium and Prevacid). There is a concern however, that if reflux symptoms continue, long term use of the PPI’s or antacid may cause us to ignore the warning sign that Barrett’s esophagitis or even esophageal cancer has developed. (Note PPI’s have patient instructions that they should be used for just 14 days and if longer use is needed a physician should be consulted.) Over the last few weeks my reflux has returned and indeed I started a PPI… so my interest was piqued when I read the review article in the New England Journal of Medicine on Barrett’s esophagus. Here are some of the highlights:

It is estimated that 5.6% of adults in the United States have Barrett’s esophagus. This is a condition in which the cells lining the esophagus undergo injury or metaplasia due to damage from reflux of gastric acid produced in the stomach. The metaplastic cells are then more likely than normal cells to undergo malignant changes. This can result in development of esophageal adenocarcinoma which is considered a deadly tumor. Unfortunately, the incidence of this cancer has increased seven fold in the US during the past four decades The diagnosis of Barrett’s esophagus requires a biopsy of the abnormal mucosa cells via endoscopy, a procedure done under anesthesia.

There are both risk factors and protective factors for Barrett’s esophagus and esophageal adenoma carcinoma and I thought it would be interesting to list them.

Risk factors include:

  • Older age
  • White race
  • Male sex
  • Chronic heartburn
  • Age under 30 at onset of GERD symptoms
  • Hiatal hernia
  • Obesity with abdominal fat distribution
  • Metabolic syndrome (obesity, hypertension, prediabetes, high triglycerides etc.)
  • Smoking
  • Family history of GERD, Barrett’s esophagus or esophageal adenocarcinoma
  • Obstructive sleep apnea
  • Low birth weight
  • Consumption of red meat or processed meat
  • HPV infection
  • Protective factors:
  • Use of statins
  • H. pylori infection
  • A diet high in fruits and vegetables
  • Breast feeding (for the mother)
  • Tall height

So look at this list and calculate if you are at risk. If you have ongoing GERD symptoms and especially if you also have significant risk factors, you should consider an endoscopy. There are new therapies for Barrett’s in which the abnormal cells are ablated or destroyed. This has been shown to diminish the risk of esophageal cancer. So talk to your doctor or ask for a referral to a gastroenterologist. Barrett’s is not an esophageal friendly disease.

And if my symptoms don’t go away in the near future I may have to do this… Just so you know, I do follow most of the medical advice I give. I had an endoscopy a number of years ago; thank goodness it was clear.

Most of us watched with amazement (at least I did) during the World Cup as the soccer players used their heads and feet to make goals. (I will not discuss the Brazil team.). We have also been bombarded with information about concussions, especially in male football players. I suppose that butting the ball with one’s head in soccer is not brain protective. An article in the clinical review of JAMA at the end of August caught my attention. It was titled “Concussion and Female Middle School Athletes”. There were definitions of concussion, a list of health implications of concussion and statistics that I thought were highly informative for many of us as we watch our daughters and the daughters of our friends and family engage in this “getting more popular” sport.

A concussion in sport is defined as a process that affects the brain as a result of traumatic forces. (Well that part is clear.)

There are five features that characterize a concussion:
1. A direct blow to the head a blow to the body that transmits and “impulsive” force to the head.
2. This results in a rapid onset of short lived neurologic impairment that resolves spontaneously.
3. The clinical symptoms may or may not include loss of consciousness.
4. No abnormalities are seen on imaging studies.
5. The symptoms may be prolonged in a small percentage of cases.

Among high school athletes, concussion rates are highest in boys football and girls soccer. And in similar sports girls have higher rates of concussions then boys. Apparently female sex is a risk factor, so is prior concussion, young age and a history of migraine headaches. Symptoms include headache, dizziness, mental fogginess, difficulty concentrating and remembering and fatigue. Loss of consciousness occurs in less than 10% of concussions and the typical recovery time for an adolescent athlete is 7 to 10 days. (But the article noted that for some individuals, recovery may take weeks or months.)

In a report that was published in JAMA Pediatric a study, was done between 2008 and 2012 for soccer clubs in Washington state that involved 351 elite female soccer players from 33 youth soccer teams age 11 to 14. Among these girls 59 concussions occurred within over 43,000 athletic exposure hours. This meant that the cumulative concussion incident was 13% per season and the incidence was 1.2 per 1000 athletic exposure hours. “Heading” the ball counted for 30.5% of the concussions and most players continued to play with symptoms!

Perhaps the most concerning part of the report pertained to potential long-term effects of concussion. These include persistent deficits in memory and visual processing, decline in academic performance, depression, dementia and postconcussion syndrome (the symptoms last longer than three months) as well as second impact syndrome. That means that if another concussion occurs it can cause rapid brain swelling and this can be fatal!

The good news is that there is now legislation in all 50 states requiring schools to have protocols in place for concussions. They are supposed to have educational materials and guidelines for athletes, coaches and parents and the parents and athletes have to sign informed consent acknowledging the dangers of concussion before participation in sports. Any student who shows signs of concussion must be evaluated and cleared by a healthcare professional before being allowed to return to practice. However, unlike many high schools where athletic trainers are trained (we hope) to evaluate and manage injuries, youth sports leagues rarely have any type of medical coverage on site.

Since I knew so little of this information, I thought it was worthy of being shared…my conclusion is that parents need to be aware of concussion risk and engage in discussions with their daughters’ coaches. And just perhaps, encouragement to play tennis, swim, dance or go out for track is in order…

This week passed quickly and before I knew it my Friday website was due. As I scanned the various medical journals, I found an interesting article in the Journal of the North American Menopause Society. The long but very comprehensive title of the article is “Calcium/vitamin D supplementation, serum 25-hydroxy vitamin D concentrations, and cholesterol profiles in the Women’s Health Initiative calcium/vitamin D randomized trial.”

The authors (17 of them in multiple centers in the US) wanted to evaluate whether increased levels of active vitamin D concentrations in the blood, the 25 hydroxy form (25OHD3), became elevated after calcium/Vitamin D supplementation and were associated with improved cholesterol levels in postmenopausal women.

The randomized, placebo-controlled trial included women already in the Women’s Health Initiative Study (WHI) and who had been enrolled in 1993 and 1998. The group they specifically studied included 300 white women, 200 African-American and 100 Hispanic women that were randomly selected from the larger WHI trial. They measured their serum (blood) vitamin D levels before starting the study as well as their lipid levels which included fasting triglycerides (TG), high density lipoprotein cholesterol (HDL- C) and calculated low density lipoprotein cholesterol (LDL- C) levels before and after calcium vitamin/D supplement.

After two years, they compared these blood tests for the women who took 1000 mg of elemental calcium and 400 units of vitamin D (CaD) and those who took a placebo. They found that those who took supplemental CaD significantly increased their vitamin D levels and decreased their LDL- C levels. The women with the higher vitamin D concentrations had more favorable lipid profiles including an increase in their HDL-C (the good cholesterol), lower LDL- C and lower TG.

If you want the numbers… In the study the women on CaD increased their vitamin D levels by 38% compared with those on placebo and those randomized to CaD decreased their LDL- C by 4.46 mg/DL. And if the serum concentrations of vitamin D increased significantly then all three parameters of the lipids improved.

They did add one thing… That many of the women were on hormone therapy and there is the possibility that there is a synergistic relationship between vitamin D and estrogen therapy which could have improved the impact of Vitamin D on lipid levels.

Bottom line: According to this study as well as many others, your vitamin D level is important to your health and improving it with supplements may have a positive impact on your lipid profile and ultimately (and I have to interject “a perhaps” here, since this has not been sufficiently studied) on coronary heart disease. I usually suggest that my patients follow “the one and one” rule. Make sure you get 1000 to 1200 mg of calcium through diet or supplements and take 1000 units of vitamin D.

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