You Asked

Q: What is the risk to my health from Japan's nuclear disaster?

People around the world are understandably concerned about the health hazards the nuclear plume from Japan's Fukushima nuclear accident may pose. In particular, people on the west coast of USA and Canada are getting anxious, worried and even panicky. This fear has led to a run on Potassium Iodide (KI), Kelp and other sources of iodine. Many feel unsafe and vulnerable because they could not get KI tablets. Some are willing to pay any price for these miraculous KI tablets, which obviously has created an opportunity for huge profits for many vendors on the internet.

In order to assess the situation accurately, we need to be free of fear. Only then can we use logic and take necessary actions. Here are some facts about radiation and cancer risk that we learned from the Chernobyl nuclear accident.

1. There was a long-term slightly increased risk of leukemia and cataracts in rescue workers at the nuclear accident site. Besides that, thyroid cancer was the only cancer attributable to radiation exposure from the nuclear accident.

2. Radioactive Iodine, mainly Iodine-131 isotope from the nuclear accident, caused more than 6000 cases of thyroid cancer over a period of 20 years in those individuals who were children or teenagers under the age of 18 at the time of the nuclear accident and lived in Ukraine, Belarus and the Russian Federation (all within a 100 mile radius of the Chernobyl nuclear accident). In the rest of Europe and around the globe, there was no increase in the risk of childhood thyroid cancer, although the nuclear plume flew all over the world.

3. The risk for thyroid cancer was directly proportional to the dose of radioactive Iodine, an estimated relative risk of 5.25 per Gy of radiation exposure.

4. Children and adolescents who were iodine deficient were three times more likely to suffer from thyroid cancer, compared to those who were iodine sufficient.

Please note the Chernobyl accident was level 7 on the scale of severity and the Fukushima accident is currently determined to be level 5.

Reality Check:

The chances of the radiation plume from Japan carrying large amounts of radioactive Iodine 5000 miles across the ocean to the west coast of USA and Canada are miniscule.

Actually, worrying can significantly increase your risk for many health problems including autoimmune thyroid disease. Isn't it worthwhile to pay attention to risk factors which are under our control, such as obesity, cigarette smoking and vitamin D deficiency that not only increase your risk for cancer, but a host of other diseases as well?

Practical Recommendations:

If you are still very much concerned about the risk the radiation plume may pose, you may consider the following practical recommendations:

Avoid milk, dairy products and fresh vegetables over the next one month. Why? Because when radioactive material falls on the ground, cows ingest it with grass and it then appears in their milk. Why one month? Because the half life of Iodine-131 is 8 days. In about one month, it should be down to a miniscule dose.

Minimize your outdoor activities for about one month, because you could inhale radioactive Iodine as well as Cesium, the other harmful radioisotope from nuclear accidents.

Make sure you are not iodine deficient (which you shouldn't be, anyway). You can ask your doctor to run a urine test if you want to check your iodine level. Sea food, iodized salt and commercially baked bread are some good sources of iodine in everyday life.

Potassium iodide (KI) when given to individuals exposed to radioactive iodine, can effectively reduce the risk of thyroid cancer development. This is how it works:

Iodine is the substrate thyroid gland uses to manufacture thyroid hormone. KI ( and other iodine sources such as Lugol's iodine, kelp, contrast dyes, iodine containing cough syrups, etc) provides more than enough substrate to the thyroid gland, which then seals off its gate to any more iodine entry. Therefore, radioiodine cannot get in.

In addition, KI dilutes the level of radioactive Iodine in the blood.

Remember, KI is not without any risk either. It can cause gastrointestinal upset, bad taste, skin rash and severe allergic reaction. If taken on a chronic basis, it can cause goiter formation and underactive thyroid (hypothyroidism) in people with Hashimoto's thyroiditis. It can interfere with Anti-thyroid drugs such as methimazole (Tapazole) and propylthiouracil (PTU). Therefore, you should check with your physician if you are on any of these drugs or have an underlying thyroid condition.

Q: Is there a connection between Type 2 diabetes and menstrual irregularities?

A: Yes, there is a connection between Type 2 diabetes and menstrual irregularities. The connection is insulin resistance, the underlying disease process for type 2 diabetes. It also gives rise to "Polycystic Ovary Syndrome".

However one should also keep in mind other causes for irregular menses, such as a menopause, emotional trauma, thyroid disorder and chronic illness etc.

Sometimes, a woman may have a vaginal bleeding years after she has gone thru her menopause. This type of bleeding is of concern and must be evaluated by a gynecologist.

Click here to learn about Polycystic Ovary Syndrome.

Q:Is there a connection between Vitamin D and Diabetes?

A: yes. There is a strong relationship between vitamin D deficiency and diabetes, both Type 1 as well as Type 2. Let me explain in detail.

The Relationship Between Vitamin D Deficiency and Type 1 Diabetes

Type 1 diabetes develops due to malfunctioning of the immune system. Mounting scientific evidence indicates that vitamin D plays a vital role in the normal functioning of the immune system and vitamin D deficiency can lead to the malfunctioning of the immune system. Consequently, your own immune system starts to attack and kill your own insulin producing cells in the pancreas, reacting as if they are invading viruses that must be destroyed. Once you are unable to produce insulin, you develop Type 1 diabetes.

Evidence for the Link Between Vitamin D Deficiency and Type 1 Diabetes.

Researchers have investigated the level of vitamin D in patients with Type 1 diabetes and found it to be low in the vast majority of these patients.

In a recently published study in the Journal of Pediatrics, researchers from the Joslin Diabetes Center noted that the vast majority of their Type 1 diabetic patients were low in vitamin D. The study was done in children and teenagers.

In my clinical practice, I check vitamin D level in all of my Type 1 diabetic patients and find it to be low in virtually all of them.

Evidence that Vitamin D can Prevent Type 1 Diabetes.

Scientific evidence now exists to show that proper vitamin D supplementation can prevent Type 1 diabetes. One such study comes from Finland. This study began in 1966 when a total of 10,821 children born in 1966 in northern Finland were enrolled in the study. Frequency of vitamin D supplementation was recorded during the first year of life.

At that time, the recommended dose of vitamin D for infants in Finland was 2000 I.U. per day. These children were then followed for 31 years for the development of Type 1 diabetes.

Researchers made the amazing discovery that those children who received the daily recommended dose of 2000 I.U. of Vitamin D during the first year of their life, had an almost 80% reduction in the risk for the development of Type 1 diabetes compared to those children who received less vitamin D.

This is a ground breaking study! If some drug achieved this kind of results, it would hit the headlines and become the standard of care at once. Sadly, even many diabetes experts are not aware of this astounding study even though the study was published in 2001 in the prestigious British medical journal called Lancet. Investigators in the U.S. continue to spend millions of dollars in their pursuit of a “drug” to prevent Type 1 diabetes. So far, this kind of research has produced disappointing results. Amazingly, they have largely ignored the strong evidence that shows the outstanding role of vitamin D in preventing Type 1 diabetes. Vitamin D is not a drug. There is no glory or huge profits in simply telling people to take enough vitamin D.

It is interesting to note that the recommended allowance of vitamin D for infants in Finland was reduced from 2000 I.U. to 1000 I.U. per day in 1975 and then further reduced to 400 I.U. per day in 1992. (For comparison, in the U.S. it has been 200 I.U. a day). This reduction in the daily allowance had no scientific basis except the observation that this amount of vitamin D is present in a teaspoonful of cod-liver oil which has long been considered safe and effective in preventing rickets. In the last decades, the incidence of Type 1 diabetes in Finland has been climbing which is most likely related to the decrease in the daily recommended allowance of vitamin D.

As of 1999, Finland has the highest reported incidence of Type 1 diabetes in the world . In Finland, the yearly sunshine and therefore vitamin D skin synthesis is much lower compared to more southern areas. Therefore, the population in Finland is at even higher risk for vitamin D deficiency.

Not only in Finland, but in other countries as well, scientists have discovered the amazing power of vitamin D supplementation in preventing Type 1 diabetes. In one such study called EURODIAB, researchers found vitamin D supplementation during infancy can significantly reduce the risk for developing Type 1 diabetes. This study was carried out in seven centers in different countries across a variety of populations in Europe.

The Relationship Between Vitamin D Deficiency and Type 2 Diabetes.

Is there a relationship between vitamin D deficiency and development of Type 2 diabetes? The answer is yes. Life-style factors that are well known to cause Type 2 diabetes include obesity, old age and physical inactivity. It’s interesting to note that all of these factors also cause vitamin D deficiency.

Vitamin D is important for normal glucose metabolism. It acts through several mechanisms on glucose metabolism:

1. Vitamin D directly acts on insulin producing cells in the pancreas to produce more insulin.

2. Vitamin D directly acts on the muscle and fat cells to improve insulin action by reducing insulin resistance.

3. Vitamin D reduces inflammation which is commonly present in patients with Insulin Resistance Syndrome and Type 2 diabetes.

4. Vitamin D indirectly improves insulin production and it’s action by improving the level of calcium inside the cells.

Now you can understand the important role vitamin D plays in keeping blood glucose normal. Intuitively, vitamin D deficiency can lead to diabetes.

Evidence that Links Vitamin D Deficiency to Type 2 Diabetes

Is there any scientific evidence to link vitamin D deficiency to Type 2 diabetes? The answer is yes.

Numerous scientific studies have found vitamin D to be low in patients with Type 2 diabetes. One such remarkable study looked at the level of vitamin D, prevalence of insulin resistance and risk for Type 2 diabetes in the U.S. population. In this study, researchers concluded that people with a low level of vitamin D were at high risk for the development of insulin resistance and Type 2 diabetes.

Evidence that Vitamin D can Prevent Type 2 Diabetes

Is there evidence to show that vitamin D can prevent the development of Type 2 diabetes? The answer is yes.

In a study from Finland, researchers collected health data in men and women from the ages of 40 to 74. None of these individual had Type 2 diabetes at the start of the study. They followed these individuals for 22 years to see the pattern of development of Type 2 diabetes. These researchers found that people who had higher level of vitamin D were less likely to develop Type 2 diabetes. Thus vitamin D appears to have a protective effect against the development of Type 2 diabetes.

In another study from the U.S., researchers found that vitamin D and calcium supplementation were able to reduce progression from pre-diabetes to diabetes. This protective effect of vitamin D was similar in magnitude to other measures which have been shown to reduce the progression from pre-diabetes to diabetes, such as a weight reducing diet, intense exercise and use of the drug, metformin.

In summary, vitamin D has the potential to prevent Type 1 as well as Type 2 diabetes. It can also prevent the devastating complications of diabetes such as heart attacks and kidney failure. Unfortunately, most diabetics continue to be low in vitamin D. Many diabetics are on a long list of expensive medications, but unfortunately, all too often, vitamin D is not included. Sadly, most physicians don’t pay attention to the important relationship between vitamin D and the health of a diabetic patient. Isn’t it time that proper vitamin D supplementation become an integral part of diabetes management?

For an in depth, complete discussion of insulin resistance and diabetes, please refer to my book, “Take Charge of Your Diabetes.”

For complete information on vitamin D, refer to my book, "Power of Vitamin D."

This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, Endocrinology and Metabolism.

Dr. Zaidi is an assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.

DiabetesSpecialist