Vitamin D

[Guest guest]

I just discovered that I am vitamin D deficient, and I take well over 1000 IU

of vitamind D

a day. However, I am allergic to the sun, so I never go into the sun for more

than a minute

or two.

Here's a site:

Roni

Diet, nutrition & weight loss

Preventing vitamin D deficiency — the new breakthrough? by Marcelle Pick,

OB/GYN NP

I just returned from a conference where everyone was discussing vitamin D.

It’s been a hot topic in both conventional and alternative medicine lately

because vitamin D deficiency seems to be related to so many health concerns:

depression, heart disease and stroke, cancer, osteoporosis, parathyroid

problems, immune function — even weight loss.

Practitioners from both sides of the aisle are seeing more cases of vitamin D

deficiency — one colleague reported that 85–90% of his patients don’t get enough

D. And that’s consistent with what we see at Women to Women.

How can this be happening? And what should you do about it for you and your

family? The answer isn’t as simple as drinking more fortified milk.

We’ve been testing and treating patients for vitamin D deficiencies for

several years, and I know there are effective, natural strategies that work in

most cases. In others, vitamin D therapy is needed and can bring wonderful

results. So let’s explore vitamin D’s role in your health and how to determine

what you should do.

What does vitamin D do for the body? This essential nutrient is called a

vitamin, but vitamin D is actually a precursor hormone — the building block of a

powerful steroid hormone in your body called calcitriol. It’s been known for

many years that vitamin D is critical to the health of our bones and teeth, but

our deeper insight into D’s true role in our health is quite new.

Vitamin D works in concert with other nutrients and hormones in your body to

support healthy bone renewal — the ongoing process of mineralization and

demineralization that when awry shows up as rickets in children and osteomalacia

(“soft bones”) in adults.

Researchers are discovering that D also promotes normal cell growth and

differentiation throughout the body, a key factor in maintaining hormonal

balance and a healthy immune system. It appears that calcitriol actually becomes

part of the physical composition of cells, assisting in the buildup and

breakdown of healthy tissue — in other words, the process that keeps you well.

What’s more, evidence from studies that track the prevalence of disease by

geography and nationality shows links between vitamin D deficiency and obesity,

insulin resistance, heart disease, certain cancers, and depression. I test all

of my patients and have been surprised to find that 85% come up with a vitamin D

deficiency.

Your body can’t create vitamin D on its own. Instead, it’s designed to make it

through sun exposure. In theory, you can make an ample supply of vitamin D with

as little as a couple of hours per week in the sun. You can also ingest D

through food, especially eggs and certain fish. So vitamin D deficiency should

be an easy problem to solve, right? But the truth is we’re just not getting

enough.

Vitamin D requirements The growing awareness of how much our bodies rely on

vitamin D has raised concern that the dietary recommended daily intake values

(DRI’s) are obsolete — 200 IU (International Units) a day for adults 19–50 years

old, 400 IU for those 51–70, and 600 IU for those over 70. Many experts now

agree that the DRI’s for vitamin D are way too low, particularly for people who

don’t get sufficient sun exposure. It’s also important to note that we lose some

of our ability to absorb vitamin D as we age. Some studies have shown that

adults can metabolize up to 10,000 IU per day without side effects. The European

Union’s Scientific Committee on Food lists 2000 IU per day as the safety

cut-off, as does the US Food and Nutrition Board, but until we have more

complete information on who needs how much, general wisdom has put the tolerable

intake level at 1000 IU per day.

Vitamin D supplementation appears beneficial throughout our lifespan, from in

utero to advanced age. A recent long-term study indicates that we are at less

risk of developing osteoporosis later in life if our mothers had adequate stores

on board while pregnant. Another age group needing ample vitamin D is teenage

girls living in northern climates who cannot get enough sunlight to make enough

vitamin D naturally. Optimal bone growth and accumulation during puberty may be

a factor in preventing osteoporosis later on in life, and a new daily

recommendation for teenage girls of 400-600 IU — up from 200 IU — would be wise,

particularly in winter.

The elderly, who are at increased risk of falls and fractures, also stand to

benefit. Some studies in the US indicate that supplementation with vitamin D and

calcium significantly reduces bone loss and incidence of nonvertebral fractures

in women 65 and over. Even in sunny Australia, a two-year study conducted among

the elderly showed that supplementation with vitamin D reduced incidence of

falls and fractures. Yet all these studies have their limitations, and it’s a

misconception to think that supplements alone are enough to protect your bones

for life.

Another consideration is that not all forms of vitamin D are the same — some

are more usable (bioavailable). Our bodies can naturally synthesize more than

20,000 IU of vitamin D in just 20 minutes of sun exposure without ill effect.

That’s because we have a natural check-and-balance mechanism that shuts off the

synthesis when we get enough. This doesn’t happen when we eat sources of vitamin

D — the same 20,000 IU of vitamin D taken as an oral supplement could be toxic.

Most milk suppliers fortify their products with vitamin D in the form of

ergocalciferol (also called D2). Some orange juice makers are doing the same,

and like many food fads, you can soon expect to see lots of other products

claiming to be good for you because they’re fortified with vitamin D. While the

amount in these beverages is enough to ward off malnutrition, you’d have to

drink four or five glasses a day to reach optimal levels; that’s just too much

milk or juice for most adults.

But let’s not write off vitamin D-fortified foods altogether. It’s interesting

that a bakery here in the US had to test their new vitamin D bread in Europe

because of the high amount of vitamin D it contained. The bread also contained

calcium carbonate and was reported to increase lumbar bone mineral density in

the elderly patients consuming it.

The bottom line is, we still don’t really understand the mechanism behind

vitamin D — we just know our bodies rely on a certain amount and that many of us

aren’t getting enough. The truth is that adequate levels are probably highly

individualized and depend on a variety of factors. To know whether you’re

D–deficient, you need to get a blood test from your healthcare practitioner.

Why the lack of vitamin D? Awareness of vitamin D first took center stage in

the early part of the 20th century, although it was described in medical

writings as early as the 17th century. Children with vitamin D deficiency

developed rickets, a condition in which the body fails to mineralize bone. This

led to a movement to fortify milk and cereal with vitamin D. By the 1960’s,

rickets had become a relatively rare disease.

As we now know, sun exposure is critical to sufficient vitamin D. Until modern

times, human beings spent a great deal of time outdoors. The origin of our

species was subtropical, meaning we naturally got enough sun exposure to

generate vitamin D. But as Homo sapiens migrated to less temperate climes this

changed. The shift from an agrarian-based society to an increasingly industrial

society also meant less time in the sun.

Today many of us work in sealed buildings with glazed windows, and we wear

sunblock and drive everywhere in cars instead of walking outdoors. Any sunblock

with an SPF above 8 will block the UV rays necessary for vitamin D conversion.

If you live in a region above latitude 40 (a horizontal line that runs from

just below New York City west to northern California), then the sun is only

strong enough to trigger the vitamin D conversion between May and September.

This means that a large percentage of the population is at risk much of the year

for vitamin D deficiency. On the other hand, don’t just assume that because you

live in New England, for example, that you are deficient. You really need to see

your practitioner and have your vitamin D levels tested before upping your

supplemental dose.

Vitamin D deficiency symptoms Vitamin D deficiency may be characterized by

muscle pain, weak bones/fractures, low energy and fatigue, lowered immunity,

depression and mood swings, and sleep irregularities. Women with renal problems

or intestinal concerns (such as IBS or Crohn’s disease) may be vitamin D

deficient because they can neither absorb nor adequately convert the nutrient.

Vitamin D, menopause and osteoporosis As we age, our bodies slowly lose the

ability to mobilize vitamin D, a process that lowers our calcium absorption

rates. This creates a higher risk of osteoporosis, particularly in

post-menopausal women.

We’re not sure how sex hormones affect vitamin D conversion, but women seem to

have a harder time stimulating the mechanism that builds bone tissue when their

estrogen levels are reduced.

Calcium is clearly an important co-factor to vitamin D, and may lose efficacy

if vitamin D is deficient or estrogen levels are low, as vitamin D appears to be

the more critical factor in bone health. A recent study by scientists at the

University of Massachusetts found that a diet rich in calcium and vitamin D can

help control some symptoms of PMS, such as tearfulness, anxiety, and

irritability.

What does this mean? No one knows for sure, but it is more evidence that all

the systems of the body are connected and we can’t look for easy answers in one

place.

Vitamin D and weight loss I’m sure many of you have seen the new “diet with

dairy” ads launched by the American Dairy Council. Some studies have shown that

weight loss does occur with an increase in calcium intake, while others appear

to refute this. Since vitamin D is directly involved in calcium absorption, it

stands to reason that vitamin D is also a factor in how the body regulates

weight.

Moreover, people who have a reduced capacity to mobilize vitamin D often weigh

more and have more body fat than those with full capacity. In the past 20 years

multiple studies have shown a correlation between higher blood levels of vitamin

D and leaner body mass.

Again, vitamin D seems to be very important in regulating our weight, but we

don’t yet understand the mechanism involved or how it relates to our environment

and individual biochemistry. Still, there may be a correlation between rising

rates of obesity and vitamin D deficiency. If you are having difficulty with

weight gain — or can’t keep the pounds off once you lose them — you may want to

have your vitamin D levels checked by your healthcare practitioner.

Vitamin D and cancer Evidence is mounting that vitamin D may protect against

some cancers, particularly breast cancer, prostate cancer, and colorectal

cancers. In fact, over 60 years of research have shown vitamin D supplementation

or sunlight-induced vitamin D conversion to be associated with lower incidence

of cancers.

There is also a higher incidence of breast cancer in northern climates, but

whether that is associated with lower levels of vitamin D is still speculation.

Vitamin D deficiency most certainly affects your immune system because

calcitriol actually helps regulate cell division, so adequate levels may help

sustain normal cell growth. And stress and other physiological markers can

disrupt the function of vitamin D receptors, among others, making us more

susceptible to unusual cell activity.

Vitamin D and depression Another area of vitamin D research is its

relationship to depression. Seasonal affective disorder, or SAD, is a

situational mood disorder brought on by decreasing daylight in the winter months

(for more see our article on antidepressants). High doses of vitamin D during

these months have proven to be a very effective natural remedy for SAD, leading

most practitioners to believe that normal neurotransmitter function depends in

part on adequate vitamin D synthesis.

Vitamin D levels are inversely related to those of melatonin, another

mood-regulating hormone. Melatonin helps modulate your circadian rhythms, with

darkness triggering melatonin secretion by the pineal gland within your brain,

bringing you down gently at night for sleep. Insomnia, mood swings and food

cravings are influenced by melatonin. Sunlight shuts melatonin production off,

while triggering release of vitamin D — that’s why doctors recommend getting

outdoors as a remedy for jet lag.

Most of us can sense the positive influence of sunlight in our own lives by

the immediate lift we get from taking a walk outdoors on a beautiful sunny day.

Now there may be many factors at work that brighten our mood in such cases, but

sun exposure is almost certainly a critical piece. Soaking in the warmth of the

sun is one of the most relaxing activities we share with all living creatures —

just watch a cat dozing in a beam of sunlight.

Healthy sunbathing — is it possible?

Our bodies are remarkably efficient. During the summer months, even as little

as 15 minutes in the sun (without sunblock!) in the early morning and late

afternoon is enough for most light-skinned individuals to create an ample supply

of vitamin D. Skin with more pigment (melanin) may require up to 40 minutes.

But you could say we are trading our longer lifespan for an increased risk of

skin cancers, so don’t throw away your sunblock! It’s important to protect your

skin, particularly on your face and scalp, during the sun’s peak hours (11 AM –

2 PM) by using a lotion with SPF–15 or more, preferably PABA–free. Melanoma is a

serious condition, and I’m not in favor of increasing your risk with unhealthy

sun exposure.

This means you should not be out in the sun unprotected for more than 15

minutes, twice a day, early in the morning and late afternoon. If you begin to

turn red before 15 minutes, cover up completely or go inside. It is never a

healthy practice to burn your skin. It is also not safe to use tanning beds as a

source of vitamin D. Please click here to learn more about tanning beds and

vitamin D.

I do believe from what I see in my patients here in Maine that the problem is

on the rise. But it just makes good “body sense” to allow your skin to do what

it already knows how — produce vitamin D with sunlight. What’s more, unlike with

supplements, it’s impossible to get a vitamin D overdose from sun exposure.

Symptoms of vitamin D overdose or toxicity Vitamin D is fat soluble, meaning

it is stored in your fat cells. It is not excreted daily like many other

essential nutrients and can build up to unhealthy levels. And once you overdo it

on vitamin D, it’s not an easy situation to rectify. That’s why it’s absolutely

vital that you approach vitamin D supplementation only under the care of a

medical professional.

Vitamin D overdose leads to calcium toxicity, which can cause nausea,

vomiting, decreased appetite, constipation, weakness, and weight loss. It raises

levels of blood calcium and can create a confused mental state and heart

arrhythmia. Too much calcium and phosphorous can cluster in your body’s soft

tissues and disrupt kidney function (remember, calcium and vitamin D work

together). It can also cause kidney stones and hardening of the arteries, or

atherosclerosis.

Understanding your own individual needs and levels of tolerance for vitamin D

are important parts of healthy self-care. Don’t just assume that because you

live at a far northern (or southern) latitude, or work indoors and don’t get

much sun exposure that you’re vitamin D deficient and need supplements. To fully

answer that question you must see a medical professional and get a blood test.

What you can do to prevent vitamin D deficiency

Vitamin D deficiency may be a pervasive problem — one that we treat with

specific therapies at our medical practice — but the best way to protect

yourself from any deficiency is to build your health from the bottom up and let

your body balance itself. We acknowledge the controversy over whether our

primary source of vitamin D should be the sun, diet, or supplements. Which

combination is best for you depends on many variables, including your age,

nutritional status, and geographic location. In a world where so many of us are

at risk of vitamin D deficiency, we recognize each of these sources as valuable.

With this in mind we recommend the following steps to prevent vitamin D

deficiency:

Eat a diet rich in whole foods and complex carbohydrates. Nutrient-dense,

fatty fish like mackerel and sardines are good sources of vitamin D. Eggs,

fortified organic milk and other dairy products, and some organ meats (like

liver) are also good natural sources of D. Because vitamin D is still somewhat

of a mystery, we’re not sure which co-factors are important, but we know they

are most fully present in wholesome food.

Take a top-quality multivitamin every day to fill in any nutritional gaps,

preferably one that includes fish oil. Your supplement should have a minimum

dose of 200 IU of vitamin D. To be on the safe side, it should not exceed 1000

IU, to avoid vitamin D overdose. (We’ve designed our own multivitamin that we

can offer our patients with confidence. Click here to read about our Essential

Nutrients.)

Allow yourself limited, unprotected sun exposure in the early morning and

late afternoon (no more than 15 minutes for light-skinned individuals, 40

minutes for darker skin) — particularly between May and September if you live in

northern regions.

Check with your healthcare professional about vitamin D testing. If you think

you may be suffering from vitamin D deficiency, get a blood test and ask for the

results. I like to see an optimal value of 50–100 ng/mL. A conventional doctor

might think anywhere from 20–50 ng/mL is normal, but that recommendation will

soon change as the newest research becomes incorporated into the standard of

conventional care. Discuss adding a vitamin D supplement to your diet during the

winter months or if you get inadequate sun exposure. This is especially

important for women over 50. Then be sure to get follow-up testing to monitor

your response.

And keep in mind that in the end, optimal health is never about just one

thing. Vitamin D is just one component of an ever-changing picture — your health

is a work in progress that needs your consistent attention and support.

It may turn out that vitamin D is the key everyone’s been looking for, or more

likely an important part of a much larger mechanism. But what matters most is

how you feel and what works for you. I encourage you to investigate your

personal vitamin D level with your medical practitioner as part of a

comprehensive approach to your whole health.

Our Personal Program is a great place to start The Personal Program promotes

natural hormonal balance with nutritional supplements, our exclusive endocrine

support formula, dietary and lifestyle guidance, and optional phone

consultations with our Nurse-Educators. It is a convenient, at-home version of

what we recommend to all our patients at the clinic.

To learn more about the Program, go to How the Personal Program Works.

To select the Program that’s right for your symptoms, go to Choose the plan

that works for you.

To assess your symptoms, take our on-line Hormonal Health Profile.

If you have questions, don’t hesitate to call us toll-free at 1-800-257-1541.

We’re here to listen and help.

We’re always happy to welcome new patients to our medical clinic in Yarmouth,

Maine, for those who can make the trip. Click here for information about making

an appointment.

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