Since we told you last year about the need for most of us to get more vitamin D, this hormone's role in fighting disease and chronic pain continues to draw new attention.

Researchers at the Harvard School of Public Health recently found that having low serum vitamin D levels doubled heart attack risk in men.

A University of Toronto study of women newly diagnosed with localized breast cancer found that those who had healthy serum vitamin D levels when they were diagnosed had half the incidence of recurrence over 12 years, and a 75 percent higher survival rate, compared to those who were vitamin-D deficient.

Research in Boston found that colon cancer patients who'd had healthy serum vitamin D levels two years before diagnosis were 48% less likely to die during a follow-up period than those who had the lowest vitamin D levels.

A recent Australian study of type 2 diabetics found that taking 2,059 IU of vitamin D3 daily improved the pain level of their peripheral neuropathy from "distressing" to only "mild" and "discomforting."

In other research, chronic pain patients with low vitamin D levels needed double the morphine, and for almost twice as many months, compared to the patients with adequate D levels.

If you're thinking of taking vitamin D supplements, be sure to check that label: D3 (cholecalciferol) may be 20-40% more effective than D2 (ergocalciferol).

This article was published in the Vol. 24, No. 2, 2008 issue of The Health Resource Newsletter, and is presented here with permission.

References:
25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008 Jun 9;168(11):1174-80.

Giovannucci E, Liu Y, Hollis BW, Rimm EB.

Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA. egiovann@hsph.harvard.edu
BACKGROUND: Vitamin D deficiency may be involved in the development of atherosclerosis and coronary heart disease in humans.
METHODS: We assessed prospectively whether plasma 25-hydroxyvitamin D (25[OH]D) concentrations are associated with risk of coronary heart disease. A nested case-control study was conducted in 18,225 men in the Health Professionals Follow-up Study; the men were aged 40 to 75 years and were free of diagnosed cardiovascular disease at blood collection. The blood samples were returned between April 1, 1993, and November 30, 1999; 99% were received between April 1, 1993, and November 30, 1995. During 10 years of follow-up, 454 men developed nonfatal myocardial infarction or fatal coronary heart disease. Using risk set sampling, controls (n = 900) were selected in a 2:1 ratio and matched for age, date of blood collection, and smoking status.
RESULTS: After adjustment for matched variables, men deficient in 25(OH)D (or=30 ng/mL) (relative risk [RR], 2.42; 95% confidence interval [CI], 1.53-3.84; P < .001 for trend). After additional adjustment for family history of myocardial infarction, body mass index, alcohol consumption, physical activity, history of diabetes mellitus and hypertension, ethnicity, region, marine omega-3 intake, low- and high-density lipoprotein cholesterol levels, and triglyceride levels, this relationship remained significant (RR, 2.09; 95% CI, 1.24-3.54; P = .02 for trend). Even men with intermediate 25(OH)D levels were at elevated risk relative to those with sufficient 25(OH)D levels (22.6-29.9 ng/mL: RR, 1.60 [95% CI, 1.10-2.32]; and 15.0-22.5 ng/mL: RR, 1.43 [95% CI, 0.96-2.13], respectively).
CONCLUSION: Low levels of 25(OH)D are associated with higher risk of myocardial infarction in a graded manner, even after controlling for factors known to be associated with coronary artery disease.

Frequency of vitamin D (Vit D) deficiency at breast cancer (BC) diagnosis and association with risk of distant recurrence and death in a prospective cohort study of T1-3, N0-1, M0 BC. J Clin Oncol 26: 2008 (May 20 suppl; abstr 511)

P. J. Goodwin, M. Ennis, K. I. Pritchard, J. Koo, N. Hood

Abstract:
Background: Vit D acts through a nuclear transcription factor to regulate many aspects of cellular growth and differentiation. Low levels have been associated with increased BC risk. We examined Vit D levels and prognostic effects in an existing BC cohort. Methods: 512 consecutive women with newly diagnosed BC were enrolled at 3 U of Toronto hospitals between 1989 and 1995. A blood specimen obtained at diagnosis was stored at -80¡C. The Block questionnaire was used to measure diet intake. Clinical and pathology data were obtained from medical and pathology records. 25-OH Vit D was measured by radioimmunoassay. Women were followed prospectively to 2006. Results: Mean age was 50.4±9.7 yrs. 288 women had T1 tumors, 164 T2 and 24 T3/4. 356 tumors were N0. 342 were estrogen receptor (ER) positive. 73 tumors were grade 1, 202 grade 2 and 173 grade 3. 199 women received adjuvant chemotherapy (CXT) and 200 received tamoxifen. 116 women (22.7%) had distant recurrences and 106 (20.7%) died during a median follow-up of 11.6 yrs. Mean 25-OH Vit D was 58.1±23.4 nmol/L. Vit D levels were deficient (<50 nmol/L) in 192 (37.5%), insufficient (50-72 nmol/L) in 197 (38.5%) and adequate (>72 nmol/L) in 123 (24.0%). Low Vit D levels were associated with premenopausal status, high body mass index (BMI), high insulin and high tumor grade (all p<0.03). Low Vit D levels were associated with low dietary intake of retinol, Vitamin E, grains and alcohol (all p<0.02). Vit D was marginally lower when drawn in winter (Oct-Mar) vs summer (Apr-Sept) months (56.7 vs 59.5 nmol/L, p=0.07). Distant disease-free survival (DDFS) was significantly worse in women with deficient (vs adequate) Vit D levels (HR 1.94, 95% CI 1.16-3.24, p=0.02) as was overall survival (OS) (HR 1.73, 95% CI 1.05-2.86, p=0.02). Vit D associations with DDFS were independent of age, BMI, insulin, T and N stage, ER and grade (all HR >1.55 Q1 vs Q4, all p < 0.04); they were not significantly modified by ER, adjuvant CXT or tamoxifen. Vit D associations with OS were attenuated by grade and were absent in ER negative BC. Conclusions: Vit D deficiency is common at BC diagnosis and is associated with poor prognosis. This research was funded by the Breast Cancer Research Foundation.

Circulating 25-hydroxyvitamin d levels and survival in patients with colorectal cancer. J Clin Oncol. 2008 Jun 20;26(18):2937-9.

Ng K, Meyerhardt JA, Wu K, Feskanich D, Hollis BW, Giovannucci EL, Fuchs CS.

Division of Medical Oncology, Dana-Farber Cancer Institute Boston, MA 02115, USA. kng4@partners.org

PURPOSE: Higher plasma 25-hydroxyvitamin D(3) (25(OH)D) levels are associated with a decreased incidence of colorectal cancer, but the influence of plasma 25(OH)D on the outcome of patients with established colorectal cancer is unknown.
PATIENTS AND METHODS: We prospectively examined the association between prediagnosis 25(OH)D levels and mortality among 304 participants in the Nurses' Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS) who were diagnosed with colorectal cancer from 1991 to 2002. Participants diagnosed within 2 years of blood collection were excluded. Patients were observed until death, June 2005 (NHS), or January 2005 (HPFS), whichever came first. The primary end point was overall mortality. Cox proportional hazards models were used to calculate hazard ratios (HR) adjusted for other risk factors for cancer survival.
RESULTS: Higher plasma 25(OH)D levels were associated with a significant reduction in overall mortality (P for trend = .02). Compared with the lowest quartile, participants in the highest quartile had an adjusted HR of 0.52 (95% CI, 0.29 to 0.94) for overall mortality. A trend toward improved colorectal cancer-specific mortality was also seen (HR = 0.61; 95% CI, 0.31 to 1.19). The results remained unchanged after excluding patients diagnosed within 5 years of blood collection (P for trend = .04); the multivariate HR for overall mortality comparing extreme quartiles was 0.45 (95% CI, 0.19 to 1.09).
CONCLUSION: Among patients with colorectal cancer, higher prediagnosis plasma 25(OH)D levels were associated with a significant improvement in overall survival. Further study of the vitamin D pathway and its influence on colorectal carcinogenesis and cancer progression is warranted.

Prevalence and Clinical Correlates of Vitamin D Inadequacy among Patients with Chronic Pain. Pain Med. 2008 Mar 11.

Turner MK, Hooten WM, Schmidt JE, Kerkvliet JL, Townsend CO, Bruce BK.

Department of Physical Medicine and Rehabilitation, Mayo Graduate School of Medicine, Rochester, Minnesota, USA.

Objective. Vitamin D inadequacy is associated with medication refractory musculoskeletal pain and neuromuscular dysfunction. This vitamin deficiency could subsist as an unrecognized comorbid condition among patients with chronic pain. The primary objective of this study was to determine the prevalence and clinical correlates of vitamin D inadequacy in patients seeking treatment for chronic pain.
Design. Retrospective case series. Setting. Multidisciplinary pain rehabilitation center at a tertiary referral medical center.
Patients. The study involved 267 chronic pain patients admitted from February to December 2006. Intervention. Serum 25-hydroxyvitamin D (25[OH]D) was drawn at admission.
Outcome Measures. Patients with serum 25[OH]D levels 20 ng/mL were considered to have adequate levels. Upon admission, opioid intake was documented and patients completed the Short Form-36 Health Status Questionnaire.
Results. The prevalence of vitamin D inadequacy was 26% (95% confidence interval, 20.6-31.1%). Among patients using opioids, the mean morphine equivalent dose for the inadequate vitamin D group was 133.5 mg/day compared with 70.0 mg/day for the adequate group (P = 0.001). The mean duration of opioid use for the inadequate and adequate groups were 71.1 months and 43.8 months, respectively (P = 0.023). Opioid users with inadequate levels reported worse physical functioning (P = 0.041) and health perception (P = 0.003) than opioid users with adequate levels.
Conclusion. The prevalence and clinical correlates identified in this pilot study provide the basis for the assertion that vitamin D inadequacy may represent an under-recognized source of nociception and impaired neuromuscular functioning among patients with chronic pain.

And finally, the documentation "Vitamin D as an Anagesic for Patients with Type 2 Diabetes and Neuropathic Pain" is a research letter. There is no abstract or summary online. The contact information for the lead author is: Dr. Paul Lee, Department of Endocrinology and Metabolism, Concord Repatriation General Hospital, Concord, New South Wales, Australia. pcylee@gmail.com