A moderately low phosphate intake may provide health benefits analogous to those conferred by UV light - a further advantage of vegan diets

Elevated phosphate activates N-ras and promotes cell transformation and skin tumorigenesis

Recent results suggest a paradigm shift from viewing inorganic phosphate as a passive requirement for basic cell functions to an active regulator of cell behavior. We have previously shown that elevated concentrations of phosphate increased cell proliferation and expression of protumorigenic genes such as Fra-1 and osteopontin in a preosteoblast cell line. Therefore, we hypothesized that elevated phosphate concentrations would promote cell transformation in vitro and tumorigenesis in vivo. Supplementation of medium with phosphate increased anchorage-independent transformation and proliferation of BALB/c mouse JB6 epidermal cells, activation of N-ras, ERK1/2, and activator protein-1, and increased gene expression of Fra-1, COX-2, and osteopontin in a dose-dependent manner. These in vitro results led to the hypothesis that varying the levels of dietary inorganic phosphate would alter tumorigenesis in the mouse model of skin carcinogenesis. Female FVB/N mice were treated with 7,12-dimethylbenz(a)anthracene/12-O-tetradecanoylphorbol-13-acetate and fed high- or low-phosphate diets (1.2% versus 0.2% of the diet) for 19 weeks. The high-phosphate diet increased skin papilloma number by approximately 50% without changing feed intake and body weights. High dietary phosphate increased serum concentrations of phosphate, parathyroid hormone, and osteopontin and decreased serum concentrations of calcium. Thus, we conclude that elevated phosphate promotes cell transformation and skin tumorigenesis partly by increasing the availability of phosphate for activation of N-ras and its downstream targets, which defines reducing dietary phosphate as a novel target for chemoprevention.

Can moderate elevations of parathyroid hormone acutely increase risk for ischemic cardiac arrhythmias?

There is suggestive evidence that chronic elevations of parathyroid hormone (PTH), associated with poor vitamin D status or low calcium intake, can increase risk for insulin resistance, weight gain, hypertension, and left ventricular hypertrophy, while stimulating production of acute phase reactants. New evidence that elevated PTH is prognostic for increased vascular mortality in very elderly subjects, prompts an examination of the possible impact of PTH on risk for arrhythmias. The cardiac effects of PTH are mediated by G protein-coupled receptors that activate phospholipase C (PLC). Catecholamines, angiotensin II, and endothelin have been shown to be arrhythmogenic for ischemic myocardium in animal studies; the receptors mediating this effect are all likewise linked to activation of PLC. Thus, it is reasonable to presume that a sufficient concentration of PTH can be arrhythmogenic in the ischemic heart. The extent to which this effect can be evoked by the high-normal PTH levels prevalent in many elderly subjects, can be assessed in epidemiological studies.

The association of calcium and vitamin D with risk of colorectal adenomas

The Polyp Prevention Trial (PPT) was a multicenter randomized clinical trial designed to determine the effects of a high-fiber, high-fruit and vegetable, low-fat diet on the recurrence of adenomatous polyps in the large bowel. Detailed dietary intake and supplement use data were collected at baseline and at each of 4 annual study visits. Adenoma recurrence was ascertained by complete colonoscopy at baseline and after 1 and 4 y. Recurrence was found in 754 of the 1905 trial participants. We evaluated the association between calcium and vitamin D intake and adenomatous polyp recurrence after adjusting for intervention group, age, gender, nonsteroidal anti-inflammatory drug use, total energy intake, and the interaction of gender and intervention group. Vitamin D models were also adjusted for the location of the clinic site. Dietary variables were adjusted for total energy intake via the residual method. There were no overall significant associations between adenoma recurrence and dietary calcium intake [odds ratio (OR) for the 5th compared with the lowest quintile = 0.91; 95% CI = 0.67-1.23; P-trend = 0.68], total calcium intake (OR = 0.86; 95% CI = 0.62-1.18; P-trend = 0.20), or dietary vitamin D intake (OR = 0.93; 95% CI = 0.69-1.25; P-trend = 0.43) averaged over follow-up. Total vitamin D intake was weakly inversely associated with adenoma recurrence (OR = 0.84; 95% CI = 0.62-1.13; P-trend = 0.03). Supplemental calcium and vitamin D use during follow-up also were inversely associated with adenoma recurrence (OR for any compared with no use = 0.82; 95% CI = 0.68-0.99; and OR = 0.82; 95% CI = 0.68-0.99; for calcium and vitamin D, respectively). Slightly stronger associations were noted for the prevention of multiple recurrences. Our analyses did not suggest a significant effect modification between total calcium and total vitamin D intake (P = 0.14) on risk for adenoma recurrence. This trial cohort provides some evidence that calcium and vitamin D may be inversely associated with adenoma recurrence.

Secondary hyperparathyroidism promotes the acute phase response – a rationale for supplemental Vitamin D in prevention of vascular events in the elderly

Parathyroid hormone (PTH) promotes IL-6 secretion by osteoblasts, and may also up-regulate IL-6 production in the liver and adipose tissue; this may explain why serum IL-6 is markedly elevated in primary hyperparathyroidism, and low in hypoparathyroidism. IL-6 is the chief stimulus to hepatic production of many acute phase reactants, notably fibrinogen and C-reactive protein (CRP). Mild secondary hyperparathyroidism is common in elderly people, particularly at high latitudes during the winter, owing to poor vitamin D status. This may rationalize evidence that acute phase proteins show seasonal variations and are typically elevated in the elderly, whereas leisure physical activity is associated with a reduction in these proteins. In a recent clinical trial targeting elderly chronically ill patients, administration of vitamin D reduced serum levels of both CRP and IL-6; further such studies should assess the impact of physiologically meaningful doses of vitamin D on acute phase reactants in elderly subjects likely to have poor vitamin D status. Since elevations of CRP and fibrinogen may increase risk for thromboembolic vascular events, these considerations may help to explain the excess of coronary mortality observed during winter months, and suggest a role for supplemental vitamin D in preservation of vascular health. Moderate alcohol intake is associated with reduced serum PTH as well as decreased levels of CRP and fibrinogen; conceivably, modulation of PTH mediates, at least in part, the favorable impact of moderate drinking on the acute phase reactants.