Medicine For People!

July 2011: Shingles Vaccine, Vitamin D, Walking, The Loan


Vitamin D Update

Regular readers have been following the vitamin D story in our newsletter since 2004. In December 2010 we published a story to correct massive media distortion of the Institute of Medicine's very narrow analysis and recommendations regarding vitamin D. As a result of the Institute's report, many people stopped taking vitamin D and many doctors stopped testing for vitamin D deficiency. After all, this prestigious national institution said

"Therefore, the committee assumed minimal sun exposure when establishing the DRIs for vitamin D, and it determined that North Americans need on average 400 International Units (IUs) of vitamin D per day (see table for the Recommended Dietary Allowances - values sufficient to meet the needs of virtually all persons)." Report Brief

This conclusion does not match what we see in our office, so we reviewed fifty consecutive vitamin D levels from our patients. Four we ignored as they were people taking vitamin D for previously diagnosed deficiency, to ensure they were on the proper dose. Of the 46 remaining, 27 people (59 percent) were low by the generally accepted standard of 32 ng/ml, and 12 people (26 percent) were low by the Institute of Medicine (IOM) standard (20 ng/ml). I believe the IOM standard to be unrealistically low, but even by their standard, 25 percent of people we tested were deficient! At the February 2011 meeting of the American Society for Nutrition, several researchers emphasized that, contrary to the IOM report, vitamin D deficiency does cause harm not just the bones but also to the immune system and much else. Unless you're about to move to a very sunny climate, you need to find out if you are vitamin D deficient. For more information see your December newsletter.

Shingles Vaccine

You still ask us about the shingles vaccine. Here's a recent analysis titled "Real-world Effectiveness of Herpes Zoster Vaccine" by Thomas L. Schwenk, MD. He points out that in a study of some 300,000 people around the age of 60, followed for about a year and a half, the annual risk of developing herpes zoster (shingles) was 1.3 percent for the unvaccinated compared to 0.64 percent for those who were vaccinated. The annual risk of hospitalization for herpes zoster for vaccinated adults was about one-third what it was in the unvaccinated. Schwenk summarizes: "According to these findings, 1 case of herpes zoster would be prevented during 3 years of follow-up for every 70 people vaccinated." Our economic analysis of this vaccine in our December 2006 newsletter showed that the benefit of this vaccine, while clear, accrues to just a small proportion of those vaccinated, and at a substantial cost (currently $150 to $200 per vaccination).

Walking and Weight: We Get mail

Following our newsletter on walking, reader Gwen Evans writes, "Thanks for this! I have never owned a car and have walked everywhere since I was a kid growing up in North Seattle where there wasn't good bus service. I have relied on public transportation and my own feet for the better part of my sixty years. When visiting Paris or New York where almost no one owns or relies on a private vehicle, one notices many fewer obese people, undoubtedly due to the fact that people walk daily. I think nothing of walking 8-10 miles at a stretch in those cities and average at least 3 miles a day here at home. Walking is the best, thanks for sharing…"

Thank you for writing, Gwen!

Thought for the Day: Appreciate What You Have been Loaned

Recently a man in the office with his terminally wife told me "You almost have to be in denial to enjoy the day at all."

It struck me how true this is for all of us. We know we will die, that what we have given our lives to is but temporary. The beauty around us, the cycle of seasons, the sun's rise in the east, those will continue. But we will not. Our children will not.

Still, we behave as if we would live forever. We tell ourselves we "own" this or that, but in reality we do not. Even our own bodies are a loan, and though the interest rate is generous and term of the loan is indefinite, the termination of the lease in inevitable.

We cannot live our lives in fear of death. We must live them in love of life. Denial can serve us well when it allows us to let go of that we cannot hold.

We at the clinic wish you a happy and healthy summer. We appreciate your trust in us and appreciate you recommending us to your friends.



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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.