Posts Tagged Breast Cancer

Vitamin D Deficiency is Common

Vitamin D Deficiency is Common


In Brief

  • Vitamin D deficiency is common in Australia
  • In many cases Australians do not receive adequate vitamin D from casual sun exposure
  • Vitamin D is essential for healthy, strong bones and is protective against cancer
  • Postmenopausal are at greatest risk of osteoporosis and vitamin D deficiency significantly increases the risk
  • Many women I see in my clinic have low levels of vitamin D
  • All adults should be checked routinely for vitamin D deficiency, particularly those in the high risk groups discussed below
  • Vitamin D supplementation may be necessary



What is vitamin D?

Vitamin D is a fat soluble vitamin, also called calciferol and sunlight vitamin. Although small amounts of Vitamin D can be obtained from some foods (see below), the majority of our vitamin D is produced by the body when UV radiation in sunlight hits our skin and reacts with a cholesterol-like substance in the skin. It is the only vitamin that is manufactured in body and is also considered a hormone. After being produced in the skin vitamin D enters the circulation and travels to liver and kidneys where it is synthesised into its active form.


Prevalence of vitamin D deficiency in Australia

The prevalence of vitamin D deficiency in Australia varies, however according to an article in the Medical Journal of Australia it is much higher than previously thought. Studies have shown that vitamin D deficiency is common in the elderly with up to 76% having a marginal deficiency. Other studies have shown that up to 43% of younger adults have inadequate vitamin D levels. The highest rates of severe deficiency occur in dark-skinned, veiled, and pregnant women with a deficiency incidence of up to 80%.


The importance of vitamin D

Adequate levels of vitamin D are essential for healthy, strong bones. Therefore its importance increases in menopausal and postmenopausal women, who are already at risk of developing osteoporosis due to decreased oestrogen levels.


Vitamin D is necessary for calcium absorption and for regulating calcium and phosphate concentrations in the blood, which ensure normal mineralisation of bone. Without sufficient vitamin D bones can become weak and the incidence of fracture may increase.


Ensuring healthy bones is not the only job of vitamin D. It also plays important roles in the health and functioning of the immune system, neuromuscular function and in the reduction of inflammation. In addition, vitamin D plays a role in the prevention and treatment of type 1 and type 2 diabetes, hypertension, glucose intolerance, autoimmune thyroid disease and multiple sclerosis.


Vitamin D deficiency and increased cancer risk

Vitamin D has potent anticancer properties and vitamin D deficiency may be associated with an increased incidence of a number of cancers, particularly those of the gastrointestinal tract.  According to a study published in 2008, low vitamin D status may increase breast cancer risk in post-menopausal women. 4 Vitamin D may also play a role in the outcome for cancer patients.


Vitamin D deficiency in children

In recent times vitamin D deficiency has re-emerged as a significant health issue in children. This can result in seizures (due to low calcium), limb pain, fractures and rickets.


Vitamin D deficiency in pregnant women will result in a deficiency in their infants. Therefore all women considering pregnancy should have their vitamin D levels checked before conception and during pregnancy.


What causes vitamin D deficiency?

The major cause of vitamin D deficiency is inadequate exposure to sunlight. This is a difficult issue because we also know that too much sun exposure can lead to skin cancer and malignant melanoma. It is quite ironic that scientists now believe that vitamin D is protective against skin cancer. Therefore we may be putting a little too much effort (and money) into protecting ourselves from the sun.


Although you may often read that most Australians get enough sun exposure to ensure adequate vitamin D levels, especially in the more northern parts of Australia, this is not the reality and certainly is not what I see in my clinical practice. Almost every woman I have seen who has had a blood test for vitamin D levels has either been on the low side of normal or outside the normal range, exhibiting a deficiency.


How much sun is enough (but not too much)?

It is difficult to find a definitive answer about the optimal amount of sun exposure which ensures adequate vitamin D levels without causing a risk of skin cancer etc. In actual fact the answer will be quite different for different regions of Australia and for different individuals.


Sun exposure should be limited to the early morning and late afternoon and the amount of exposure needs to suit the individual skin type. Very fair skinned people can tolerate less sun that those with olive skin or darker skin. Indeed people with fair skin actually need much less sun exposure for the production of vitamin D because the UV rays penetrate the skin much easier.


In 2006 the Medical Journal of Australia published information on recommended sun exposure times (at 10am or 3pm) for fair skinned individuals aged 19-50 years with 15% of their body exposed to the sun eg face, arms and hands. As you would expect exposure time varied greatly depending on locality. For example in Townsville as little as 10 minutes in summer and up to 15 minutes in winter, whilst in Hobart up to 13 minutes in summer and as much as 166 minutes in winter may be needed to ensure sufficient vitamin D levels based on current recommended daily allowances.


These recommended times are only estimations and are subject to many variations including seasonal differences in UVB levels from one year to another, altitude, skin type, level of cloud cover etc. It is also worth noting that many researchers have suggested that optimal vitamin D intake has been underestimated and that official recommendations are too low.  If this is the case recommended sun exposure times may be too short, however excessive unprotected sun exposure may increase risk of skin cancer.


The best way to ensure that you have adequate vitamin D is to have yearly or twice yearly blood tests to check your vitamin D status. Try to ensure adequate sun exposure without overdoing it. You need to be careful and take your skin type, your location, time of day and season into account. If the exposed area begins to redden slightly it is time to get out of the sun.



Those at most risk of vitamin D deficiency

Older adults

As we age the skin is less able to produce vitamin D and the kidneys are less efficient at converting it into the active form. The risk of vitamin D deficiency is increased for older people who spend most of their time indoors.


People with limited sun exposure

People who are homebound and women who wear veils and/or long robes are very likely to have vitamin D deficiency. Many people get very little or no sun exposure during winter, particularly on their working days. Vitamin D supplementation may be necessary during the winter months.


People with dark skin are also at increased risk of vitamin D deficiency because the increased pigment in the skin (melanin) reduces penetration of UV rays and the production of vitamin D.



Being overweight, particularly if you have a body mass index (BMI) of greater than 30 you are at increased risk of vitamin D deficiency. This is not because vitamin D production is decreased but because the subcutaneous fat decreases the release of vitamin D into the circulation. Even when vitamin D is taken orally through food or supplementation the amount of available vitamin D in the circulation is reduced in obese people.



Dietary sources of vitamin D

Very few foods contain significant amounts of vitamin D. The richest sources are oily fish such salmon, sardines, herring and mackerel. Other foods containing some vitamin D include milk, meat, eggs, cheese and fortified foods.


Most experts agree that it is very difficult to obtain sufficient vitamin D from foods alone and that sun exposure and/or supplementation is essential to prevent vitamin D deficiency.


Comments (2)

Breast Cancer Rates Have Declined

by Berris Burgoyne – Naturopath –
Suite 8/1177 Logan Road, Holland Park, Brisbane 4121

Breast cancer rates have declined significantly
Research presented at the 29th Annual San Antonio Breast Cancer Symposium showed a significant drop in the incidence of breast cancer in 2003 – a dramatic fall that never before has been observed in a single year. In women aged 50-69 years of age there was a 12% decline in oestrogen dependent cancers and a 4% decrease in non-oestrogen dependent cancers. It appears that the decreased use of hormone replacement therapy (HRT) may be responsible, at least in the case of oestrogen dependent breast cancers.

Another research team reporting in a recent issue of the Journal of Clinical Oncology came to similar conclusions, “Hormone therapy use dropped by 68% between 2001 and 2003, and shortly thereafter we saw breast cancer rates drop by 10% to 11% and this drop was sustained in 2004, which tells us that the decline wasn’t just a fluke”.

Why did the use of HRT decline?
The use of HRT declined significantly after the results of two long-term studies were published in 1998 and 2002. The most significant of these was the Women’s Health Initiative (WHI) study which involved almost 162,000 women between the ages of 50 and 79 years. The role of the WHI is to focus on defining the risks and benefits of treatments that could potentially reduce the incidence of heart disease, breast and colorectal cancer, and fractures in postmenopausal women.

The duration of the study was planned for 8.5 years and included assessing the benefits and risks of women using either combined HRT (oestrogen/progestin) or oestrogen alone. However, after just 5.2 years, in mid 2002 an independent monitoring board recommended stopping the combined HRT trial because they considered the risks to health of taking combined HRT outweighed any benefits.

There were a number of negative outcomes resulting from this trial and although some of the risks are relatively small, they do exist.

The bad news –
• Increased risk of breast cancer
• Increased risk of ovarian cancer
• Increased risk of heart disease
• Increased risk of stroke

• Increased risk of blood clots/deep vain thrombosis (DVT)
• Increased risk of pulmonary (lungs) embolism
• Increased risk of dementia
• Possible increased risk of cognitive decline
• Increased risk of urinary incontinence

In relation to breast cancer the WHI trial found that relatively short-term combined oestrogen/progestin use increased breast cancers, which were diagnosed at a more advanced stage compared with placebo use.

The good news –
• Decreased risk of fracture (osteoporosis)
• Decreased risk of bowel cancer

Despite the early termination of the WHI oestrogen plus progestin trial, the oestrogen-alone trial was continued with ongoing careful scrutiny by the monitoring board. However, in February 2004 the National Institutes of Health (NIH) decided to terminate the oestrogen-alone trial after 6.8 years, rather than allowing it to run the full 8.5 years. They determined that oestrogen therapy did not offer significant benefits compared with the possible risks.

As with combined HRT, oestrogen alone therapy also reduced the risk of fracture although it did not have the same protective effect against bowel cancer that combined HRT appeared to offer.

So, what does this mean for you?
There are a number of different reasons why women either choose to take HRT or are prescribed HRT by their doctor. Each individual woman has to decide, with the help of a health care professional, how important the use of HRT is for her.

HRT has been traditionally prescribed not only to alleviate the symptoms of menopause but also to protect against conditions such as heart disease, dementia and osteoporosis. We now understand from extensive clinical trials that HRT does not carry the protective effect previously assumed for heart disease and dementia. In fact, the use of HRT (particularly combined HRT) increased the risk of these conditions.

For some women however, HRT may be important to help prevent or reduce the occurrence of osteoporosis. This is particularly the case where there is a strong family history of the disease and the woman has a significant number of risk factors. For example, slight build, therefore less bone mass; little weight bearing exercise; sedentary life style; diet high in salt and caffeine, (which leach calcium from the body); history of eating disorders such as anorexia or bulimia; and drugs such as corticosteroids.

Are there effective alternative treatments for menopausal symptoms?
The answer is a very big YES. In most cases menopausal symptoms are extremely easy to treat with natural therapies and women have a significant improvement in a relatively short period of time. The type of treatment used depends on the individual woman, her lifestyle and the symptoms experienced.

Is it possible to stop HRT?
Yes it is definitely possible to stop taking HRT, however it is not a good idea to do so suddenly. We have had a lot of experience at helping women wean off HRT and the best way is to do so gradually. However, before making the decision to stop HRT, it is important to consider the reason that HRT was initially prescribed and how relevant it is to your long-term health and wellbeing.

It is important to understand that the uncomfortable symptoms of menopause are caused by the reducing levels of female hormones, particularly oestrogen. By taking HRT it is really only delaying the inevitable. If HRT is stopped suddenly, particularly without any other support being offered, the body once again has to go through the withdrawal process, producing the original symptoms.

It is the adrenal glands that produce oestrogen after menopause therefore it is important to improve adrenal function prior to starting to reduce the dose of HRT. When we consider this function of the adrenals it is hardly surprising that so many women experience symptoms during the perimenopausal and postmenopausal time. The number one factor that depletes the adrenals is stress, particularly over a long period of time.

There is a very fundamental difference between HRT and herbal medicine for the treatment of menopausal symptoms. It needs to be remembered that menopause is not a disease process but a natural occurrence in the life of all women who reach a certain age. Herbal medicines provide the support for the body to do what it should naturally be doing. That is, produce hormones in the adrenal glands. HRT does just the opposite. By putting hormones into the body you actually shut down this natural process in the body.

There are a number of herbal medicines and nutritional factors that quickly improve adrenal function so that the body can increase the natural production of female sex hormones. Depending on the continued level of stress, we will often prescribe herbs that help the body deal with stress and generally tonify the nervous system, which further takes the load off the adrenals.

Once adrenal function has improved the dose of HRT can gradually be reduced until it is no longer required. What this means is that we have restored the body to a natural state of health.

During this process we also use herbal medicines that are specific for any symptoms that may arise during the weaning off period. Where necessary we support the nervous system because stress is a major cause of adrenal depletion.

So, you can see, it is easy to come off HRT if desired. All you need to do is take it slowly and use the appropriate herbs and nutrients for each stage of the process.

If you are using HRT and are not sure if you wish to continue, why not give us a call.

Leave a Comment