The multi-center study included 957 people in South Korea with benign paroxysmal positional vertigo who had undergone canalith repositioning maneuvers—head movements that shift displaced calcium carbonate crystals in the inner ear. The intervention group included patients who received 400 IU vitamin D and 500 mg calcium carbonate twice daily for 1 year when their baseline serum vitamin D level was below 20 ng/mL along with patients who had higher baseline levels and took no supplements. An observation group had no baseline testing or interventions.
The supplements significantly reduced the annual vertigo recurrence rate by 24%. There were 0.83 recurrences per 1 person-year in the intervention group compared with 1.10 in the observation group. Patients with greater vitamin D deficiencies at baseline derived the most benefit.
BPPV = benign paroxysmal positional vertigo. The original study in Neurology and the JAMA summary both use the word “prevent” in their respective titles. I think reduce is a more apt description. Semantics aside a 24% reduction in recurrent BPPV episodes is significant.
And yet another example of nutritional deficiencies underlying another disease.
This article provides an overview of the clinical evidence on the poorer clinical outcomes of COVID-19 infection in patients with diabetes versus patients without diabetes, including in specific patient populations, such as children, pregnant women, and racial and ethnic minorities.
In the article above the researchers reviewed nearly 90 studies.
Type 2 diabetes (T2D) is defined by a single metabolite, glucose, but is increasingly recognized as a highly heterogeneous disease, including individuals with varying clinical characteristics, disease progression, drug response, and risk of complications. Identification of subtypes with differing risk profiles and disease etiologies at diagnosis could open up avenues for personalized medicine and allow clinical resources to be focused to the patients who would be most likely to develop diabetic complications, thereby both improving patient health and reducing costs for the health sector. More homogeneous populations also offer increased power in experimental, genetic, and clinical studies. Clinical parameters are easily available and reflect relevant disease pathways, including the effects of both genetic and environmental exposures. We used six clinical parameters (GAD autoantibodies, age at diabetes onset, HbA1c, BMI, and measures of insulin resistance and insulin secretion) to cluster adult-onset diabetes patients into five subtypes. These subtypes have been robustly reproduced in several populations and associated with different risks of complications, comorbidities, genetics, and response to treatment. Importantly, the group with severe insulin-deficient diabetes (SIDD) had increased risk of retinopathy and neuropathy, whereas the severe insulin-resistant diabetes (SIRD) group had the highest risk for diabetic kidney disease (DKD) and fatty liver, emphasizing the importance of insulin resistance for DKD and hepatosteatosis in T2D. In conclusion, we believe that subclassification using these highly relevant parameters could provide a framework for personalized medicine in diabetes.
Not just potential for personalized medicine in the treatment of diabetes but perhaps a framework for better risk stratification and selection in life insurance.
Intakes of Folate, Vitamin B6, and Vitamin B12 in Relation to Diabetes Incidence Among American Young Adults: A 30-Year Follow-up Study
RESULTS During 30 years (mean 20.5 ± 8.9) of follow-up, 655 incident cases of diabetes occurred. Intake of folate, but not vitamin B6 or vitamin B12, was inversely associated with diabetes incidence after adjustment for potential confounders. Compared with the lowest quintile of total folate intake, the multivariable-adjusted hazard ratios (95% CI) in quintiles 2–5 were 0.85 (0.67–1.08), 0.78 (0.60–1.02), 0.82 (0.62–1.09), and 0.70 (0.51–0.97; Ptrend = 0.02). Higher folate intake was also associated with lower plasma homocysteine (Ptrend < 0.01) and insulin (Ptrend < 0.01). Among supplement users, folate intake was inversely associated with serum C-reactive protein levels (Ptrend < 0.01).
CONCLUSIONS Intake of folate in young adulthood was inversely associated with diabetes incidence in midlife among Americans. The observed association may be partially explained by mechanisms related to homocysteine level, insulin sensitivity, and systemic inflammation.
Intakes of Folate, Vitamin B6, and Vitamin B12 in Relation to Diabetes Incidence Among American Young Adults: A 30-Year Follow-up Study — Diabetes Care 2020 Oct; 43(10): 2426-2434. https://doi.org/10.2337/dc20-0828
Folate is a B vitamin that occurs naturally in foods such as green leafy vegetables, citrus fruit, and beans. So eat your greens and beans. Taking a supplement can’t hurt either. My multivitamin has plenty of folate.
Vegetarian diets have been associated with atherosclerosis protection, with healthier atherosclerosis risk profiles, as well as lower prevalence of, and mortality from, ischemic heart disease and stroke. However, there are few data concerning the possible cardiovascular effects of a vegan diet (with no meat, dairy or egg products). Vitamin B-12 deficiency is highly prevalent in vegetarians; this can be partially alleviated by taking dairy/egg products in lact-ovo-vegetarians. However, metabolic vitamin B-12 deficiency is highly prevalent in vegetarians in Australia, Germany, Italy and Austria, and in vegans (80%) in Hong Kong and India, where vegans rarely take vitamin B-12 fortified food or vitamin B-12 supplements. Similar deficiencies exist in northern Chinese rural communities consuming inadequate meat, egg or dairy products due to poverty or dietary habits. Vascular studies have demonstrated impaired arterial endothelial function and increased carotid intima-media thickness as atherosclerosis surrogates in such metabolic vitamin B-12 deficient populations, but not in lactovegetarians in China. Vitamin B-12 supplementation has a favourable impact on these vascular surrogates in Hong Kong vegans and in underprivileged communities in northern rural China. Regular monitoring of vitamin B-12 status is thus potentially beneficial for early detection and treatment of metabolic vitamin B-12 deficiency in vegans, and possibly for prevention of atherosclerosis-related diseases.
Metabolic vitamin B-12 deficiency is prevalent in vegetarians and, in particular, in vegans. Those subjects with normal or relatively high salt intake may be associated with unhealthy early vascular changes in function and structure, which have not been well documented in the past. In individuals with subnormal vitamin B-12 status, vitamin B-12 supplementation may significantly improve such vascular changes. Regular monitoring of vitamin B-12 profile may thus be beneficial for early detection and treatment of metabolic vitamin B-12 deficiency, and possibly prevention of atherosclerosis-related diseases.
You can download a copy of the full study at this link.
It’s not easy to overcome confirmation bias. So my research often takes me to studies and articles that challenge my firmest held beliefs. This literature review study does confirm one of my longest held beliefs. Some of the sickest people I see are the shoppers in health food stores.
Conclusions: Use of DSs among older adults continues to be high in the United States, with 29% of users regularly taking ≥4 DSs, and there is a high concurrent usage of them with prescription medications.
These supplements have been linked to dozens adverse health events reported to the FDA such as increased blood pressure, racing heart, liver damage, stroke, seizure and death. During 2014, the agency issued seven recalls and more than 30 public notifications about these products. It also maintains an online list of tainted weight-loss products.
Researchers analyzed registry data from some 800 patients with liver injury either from medications excluding acetaminophen or herbal and dietary supplements. In the first 2 years of the registry, 7% of cases were due to herbal and dietary supplements, a proportion that increased to 20% a decade later. Hepatotoxicity from non-bodybuilding-related supplements required liver transplantation more often than injury from conventional drugs 13% vs. 3%; there were no cases of liver transplantation associated with bodybuilding supplements.