I have written before about the dosage of vitamin D that I should be taking, and the toxicity of vitamin D, but here is a new study from the University of Kentucky that indicates that levels of vitamin D that are too low may be associated with brain damage.

The researchers studied animals, so it remains to be seen whether the same effects would be seen in humans. However, I do know that I feel better when I have been able to spend at least some time in the sunshine, so maybe there is a bit of truth here?

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I saw today that the World Congress on Sleep Apnea is holding it’s tenth congress in Rome. They only meet every 3 years, so don’t look for one next year. The last one was in Seoul, Korea, but that web site is no longer active.

I am not going, as I am not a physician, and do not work in the sleep apnea world – I just live in it as a patient. I was particularly interested in a couple of items on the agenda for discussion on Rodshealth.

1. Philips Respironics is organizing a symposium on CPAP compliance. Participants are going to be hearing about the rationale for using CPAP, with the question of how much is enough being asked. They are also going to hear about interventions that will improve CPAP compliance from a PR person, then something about the role of behavioral interventions in improving CPAP compliance.

   I wonder if they will address what seems to be a frequent mantra of those who work in this area that the straps should be pulled as tight as possible? Getting the patient set up right at the start of their treatment is extremely important for improving adherence to the treatment program (I prefer adherence to compliance because I choose to follow the treatment). 
    

2. In the introduction to the Congress, Dr. Christian Guilleminault notes that sleep disordered breathing is responsible for many health-related problems, especially cardiovascular diseases. There will be no arguments from those who have sleep apnea that inattention, daytime sleepiness, systemic inflammation, and grinding of the teeth are associated with sleep apnea – they were in my case.

   Dr. Guilleminault goes on to note that sleep apnea “is induced or enhanced by obesity leading to fat deposition within the tongue and neck.” As pointed out, which comes first is not easy to identify.

The last point raises a question that I have often seen in the forums – will my sleep apnea be cured if I lose weight? My own opinion is that it all depends on which came first. I am not obese, although I am overweight. As a child I was definitely not overweight – almost the opposite, in fact. Yet I had symptoms that I now recognize as being possibly related to sleep apnea. There is no way to confirm that I had sleep apnea that long (50+ years!), but the possibility of being able to stop using the CPAP through weight loss is intriguing.

This looks like a scientifically very interesting meeting, and I hope I will be able to go through the abstract book over the next few months and highlight some of the interesting studies. Meantime, I will continue to work on my exercise program, my diet, and taking good quality vitamins to support my diet and exercise program.

Vitamin D is found everywhere in the body. It is essential for many body functions. It has been shown to be important in helping to

• Avoid complications of pregnancy
• Avoid Parkinson’s disease
• Maintain cognition (this may help reduce the effects of Alzheimer’s disease)
• Prevent cancer of several types
• Prevent type 1 diabetes, especially in babies
• Increase the risk of heart attacks and stroke
• Increase the body’s ability to fight Clostridium difficile infections (that is a nasty infection that is resistant to many antibiotics. Help avoid it by making sure you wash your hands frequently when visiting someone in hospital)
• Increase your response to exercise
• Increase the chances of migraine (possibly)
• Increased risk of fibromyalgia (a painful condition that has sometimes been linked to chronic fatigue syndrome)

There are probably many other health problems possibly associated with not enough vitamin D in the body. Autism has been suggested by some experts as being related to lack of vitamin D, but there needs to be a lot more research done to confirm the link – it might be that the lack of vitamin D is actually the result of something else.

The problem with all of these possible ill effects of not enough vitamin D is that it takes a long time to show the effects of supplementation with vitamin D on the health problem. There is also disagreement over the type of vitamin that should be used for supplementation.

So, how much vitamin D do I need?

Unfortunately, that is not possible to answer in a post – it all depends. How much vitamin D do you actually have in your body? How much sun to you allow to reach your skin (without sun blocker or clothes)? How dark is your skin? How far north (or south) of the equator do you live (the higher the latitude, the less effective sun exposure is in increasing vitamin D levels). How old are you (older people make less vitamin D)? How much vitamin D do you get in your food?

The answer to the last question is actually easy – not much. The only way to know how much vitamin D you need is to have a health care provider request a lab test for you. Once you know the levels, then you can plan for getting more vitamin D. The majority of people in the higher latitudes do not have enough vitamin D, so I can be fairly certain that you will need more.

Options for increasing vitamin D levels

Really, there are only two ways to increase vitamin D levels:

• More sun exposure
• Supplementation

The sun exposure can be difficult – you need about 15-20 minutes of full sun exposure every day during. As I write this post there has been no sun all day! In doing this, you have to be careful to avoid burning your skin. You may need to increase the time if you are dark skinned, and as you get older. See how difficult it is? The amount of vitamin D you can get from food is limited. Maybe a bit from calcium and vitamin D that is added to some orange juice or milk, but that is not a reliable amount.

Supplementation is easier, but you need to work with your health care provider to determine the dose. You don’t need to use a prescription form of vitamin D. What you can buy at the health food store is usually enough. Just make sure you buy a good brand, and have your vitamin D levels checked. Probably at the beginning and end of winter.

Blood levels of vitamin D

Blood levels should ideally be kept above 15 ng/ml (37.5 nmol/L), but less than 200 ng/ml (500 nmol/L) according to the Office of Dietary Supplements. My physician recommends keeping my levels closer to the lower level to avoid side effects. I take 1000 units per day, but some people may need 10,000 units/day, at least for a short time. It is important to work with your health care provider to determine YOUR correct level of supplements.

I often see questions on various forums and in news articles questioning the value of multivitamins.  There is a lot of evidence in the literature that in some cases individual vitamins have been shown to have this or that effect. Often, there is no effect, although in some cases it another vitamin is beneficial. Other times we read that a combination may show some benefit. Calcium and vitamin D is one example. Why should this be?

There are a couple of reasons why we need to look closely at what vitamins we are taking. Firstly, we need to make sure that they are high quality, that they undergo some kind of testing where the results are publicized, so that we can depend on actually getting what the label says we are getting. The FDA does not routinely inspect the places where vitamins are manufactured. They are concerned with whether those herbal remedies contain some form of the drug contained in Viagra, but under the Dietary Supplement Health and Education Act (DSHEA) of 1994, there is no prelaunch approval process for supplements similar to the process for pharmaceutical drugs. FDA will only act if there are problems reported with a supplement; and usually only if there are a lot of problems reported. Particularly if people have died.

The second reason we need to look closely at the vitamins we are taking is that some of them will only work if they are taken together. Like calcium and vitamin D, that I mentioned above. Several of the B vitamins work best if they are taken with other B vitamins. This is a problem with clinical trials – if the trial is of a single vitamin taken alone, how do we know that it will be used effectively by the body? We don’t.

Good combinations of vitamins are quite ‘expensive’ in money terms. However, we can read that the food that we eat is of lower nutritional quality than it was 30 years ago (I did a few weeks ago). This means that we have to replace some of that quality with a good nutritional supplement. Also known as multivitamins. These are different from the herbal ‘dietary supplements’. The manufacturing quality can be controlled to ensure that the amount of each vitamin is close to the amount stated on the label. Did you know that there are manufacturing tolerances for pharmaceutical drugs as well?

So, to ensure that we are getting ‘good’ vitamins, we should pick a company that carries out research into the optimal combinations of vitamins, and manufactures the resulting combinations with as much care as a pharmaceutical company does. That way, we can be sure we are getting value for money.

Do I take vitamin and mineral supplements? Yes. As a result, my blood pressure is lower than the ‘standard’ pressure for my age, I do not have diabetes, and I only rarely visit a doctor other than for check-ups. Could this be the result of eating a healthy diet and exercising? Yes, it probably could. Could it be something in my genes? Sure, but unless I get genetic testing, I am not going to know for sure. Could it be luck? Maybe, but don’t we all create our own ‘luck’ by working hard and eating right? I just prefer the additional insurance that taking vitamins gives me, maintaining Rodshealth at an excellent level.

Think about it.

I posted before that I have sleep apnea. Since the diagnosis, I have learned a lot about the disorder – both from reading about it, and from living with it.

My wife tells me that my snoring scared her when we got married (nearly 16 years ago). At that time she knew nothing about sleep apnea, and there were probably not many doctors that knew much about it, either. So she put up with it. I didn’t know that I snored that much, but I did find that I was getting very tired during the day. I thought that was normal for the kind of work I was doing – sedentary, office-type work. I would try and do some exercise, but then I found I was getting even more tired. Weight was becoming a big problem.

There are many effects of sleep apnea – none of them nice. They include  high blood pressure; greater risk of heart attack and stroke; heart rhythm changes; waking up in the night to use the bathroom (I was lucky, only once a night); headaches (including migraine); daytime sleepiness, even after a ‘good’ night’s sleep; memory and concentration problems; weight gain;  possibly seizures; possibly diabetes; gastric reflux disease; sweating during the night; depression; anxiety; pain; impotence; relationship and job issues; and so on. Enough already? The real danger is that some people fall asleep during the day – the person not moving when the traffic signal has changed to green may have sleep apnea. They need sympathy and education, not an angry blast on the horn.

I have been using my CPAP machine for nearly a year now  and have seen a lot of improvement in my health. I don’t snore, and I am no longer needing to nap during the afternoon at work (a very good thing when the boss is around). I still get tired, but I don’t have the ‘brain fog’ that I used to have. I wake up before the alarm some mornings, and I no longer want to sleep late (after 7-8 AM) on a Sunday morning. I do find that I need to go to bed a little after 9:30 PM, but that is because I get up at 5:00 AM on days when I have to go to work.

The CPAP machine is amazing technology. It is just a little fan that blows air through a hose and into my nose through a mask. These masks are often called interfaces because they can cover the whole face (think Darth Vader), just the nose (a little bit like the masks that come down if there is a loss of cabin pressure in a plane), or just sit under the nose so that there is very little contact with your nose (called nasal pillows).

My personal favorite mask is the nasal pillows. They don’t make my nose sore, and are normally very quiet. They do get a bit noisy when they are not adjusted properly and air is leaking out of the sides.

The air pressure is something people get worried about. It is measured in centimeters of water. Why, I don’t know. If they talked about pounds per square inch (in the US, where I live), the numbers would be very small. Nothing that would blow up a balloon. I got used to the pressure I was prescribed very quickly – it was only 8, although I did have to have it increased to 10 after a couple of months because I was still snoring a bit.

So, sleep apnea is a scary thing – the treatment is not.