Watching Women's Health

Vitamin D may reduce risk of urinary incontinence

The medical community's growing realization that many Americans are low in Vitamin D has led to an explosion of interest in this vitamin's effects on bones, muscle, pregnancy outcomes, cancer risks and other medical concerns. 

Vitamin D is a fat-soluble vitamin that aids the absorption of calcium from the GI system. In addition to helping mineralize bone, calcium is important in neuromuscular and immune system function.

Vitamin D is produced in skin that is exposed to sunlight. It naturally occurs in only a few foods, fatty fish and cod liver oil (a hardy few consider cod liver oil to be a food). According to the most recent National Health and Nutrition Examination Survey (NHANES), only 17% of US women get enough vitamin D from food alone.

Most health-conscious women protect their skin from the sun and obtain vitamin D from supplements and vitamin D fortified foods. Recently, I have been including serum vitamin D levels in blood work at annual exams, and have found many of my patients have low vitamin D levels, despite our ongoing discussions about adequate calcium and vitamin D intake.

Other risk factors for vitamin D deficiency besides low sun exposure include being over 50, having darker skin pigmentation and being overweight. Breastfed infants have also been found to be at risk, as adequate vitamin D can't be obtained from human milk alone.

A new paper in the gyn literature looked at how vitamin D levels relate to women's risks for pelvic floor disorders — urinary and rectal incontinence and pelvic organ prolapse. In the NHANES data, results from 1,881 women 20 and older included information on pelvic floor disorders and vitamin D.

The mean age of the surveyed women was 47.9 and more than 80% had suboptimal vitamin D levels. 23% reported symptoms of a pelvic floor disorder. Higher vitamin D levels were associated with a lower rate of pelvic floor disorders. The strongest inverse association was in women over 50 with urinary incontinence.  The authors conclude

Given the increase in the number of patients with pelvic floor disorders, further evaluation of the role of vitamin D is warranted, particularly future research to assess the relationship between vitamin D levels and pelvic muscle strength in women of all ages and racial/ethnic groups. Our findings suggest that treatment of vitamin D insufficiency and deficiency in both premenopausal and postmenopausal women could improve pelvic muscle strength, with a possible reduction in the prevalence of pelvic floor disorders including urinary incontinence.

It is encouraging to think that the hugely annoying problem of urinary incontinence could be improved by something as simple as supplementing vitamin D. If you have not had your vitamin D level checked, it is worth doing at your next annual exam. If you have problems with urinary incontinence, it may be worthwhile having it checked sooner.

Multivitamins - take or toss?

Researchers continue to mine valuable information from the Women's Health Initiative (WHI). This US  study involved more than 160,000 postmenopausal women and ran from the middle 1990's through 2005.

The most recent WHI report analyzed whether taking multivitamins protected older women against cancer or heart disease. It also looked at whether taking multivits led to a longer lifespan.

Alas, the answer is no to all three questions.

Just over 40% of women studied took multivits. After approximately 8 years of follow-up, their rates of common cancers, cardiovascular disease and death were compared to those of women who did not take multivits. No significant differences were found.

This information comes not long after convincing evidence that vitamin C and E supplements do not protect against heart disease and may actually add risk. Yet many people continue to take these and other vitamins in hopes of doing something good for themselves.

It is likely that many older women will still take multivits despite this new report.

Why are we Americans so interested in vitamins and supplements? For one thing, it seems like an easy and inexpensive way to make up for dietary and lifestyle lapses. And, deciding to take supplements gives a sense of personal autonomy that feels different from taking a prescribed medication.

I recently wrote about vitamin D which has few natural food sources and appears to be best obtained through fortified foods or supplements. Also, many older women do not get adequate calcium through their diets and need to supplement that as well.

But the scattergun approach to vitamin supplementation appears to be of little value. Taking a multivit almost certainly does not make up for poor eating habits. This is hard to study, however, because food diaries are notoriously inaccurate.

The average American diet, however imperfect, is still replete with basic nutrients. Other lifestyle habits, such as exercise and tobacco use, also have a huge impact on our health.

I have been taking a multivit myself and still have most of a large bottle. Do I toss it or take the rest of the pills?

I think I'm going to toss it and delve deeper into the produce section of my grocery store.