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Vitamin D: Are You Getting Enough?
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Calcium has been in the nutrition headlines for some time. Now vitamin D is taking calcium’s place. Why? Recent studies suggest that the blood levels of vitamin D in our bodies are much lower than they should be. There are a couple of reasons for this low blood level. First, our bodies are not making enough vitamin D from the sun’s rays. Most of us spend time in our cars and indoors. When we do head outside, we’re covered in sunscreen which cuts down on vitamin D production. Normally, here’s what should happen. When you’re outside, the sun’s ultraviolet B rays penetrate into your skin’s outer layer and produce a vitamin D precursor. The liver and kidneys then process this precursor and covert it into the usable active form in your body called vitamin D3.
At the same time that we’re staying out of the sun and not producing vitamin D, we’re also not getting very much from our diet. Vitamin D is fairly difficult to get in your diet because food sources are pretty limited. Milk, fatty fish and egg yolks are three of the main sources.
We’re not getting enough Vitamin D from the sun nor our diet, but researchers are finding more and more benefits of vitamin D. You may have heard of vitamin D as being important, along with calcium, for bone health. Besides protecting your body from brittle bones, vitamin D has other great benefits:
1. Helps maintain strength and balance.
2. Helps the immune system function correctly. Did you know that vitamin D is in almost every cell in the body?
3. Helps treat psoriasis.
4. May help stop the uncontrolled growth of cancer cells including breast, prostate, and colorectal cancers.
5. May play a role in autoimmune disease. Research has found that people with higher levels of vitamin D in the body are less like to develop multiple sclerosis (MS). Diabetes is also considered an autoimmune disease since the cells of the pancreas are affected.
The current recommendation for vitamin D is between 200 and 600 international units (IU) per day depending on your age. However, many researchers now think these recommendations are too low and are pushing for them to be increased up towards 1000 IU. The 2005 Dietary Guidelines already suggested that people with darker skin, elderly or insufficient sunlight need 1000 IU daily. In fact, 1000 IU is fast becoming the suggestion of the scientific community as the daily amount that most adults need.
The less you are in the sun, the more vitamin D you need from food. Many vitamins occur naturally in a variety of foods but not vitamin D.
Natural Food sources:
Salmon, 3.5 ounces cooked: 360 IU
Tuna, 3 ounces, in oil (drained) 250 IU
Egg yolk, 20 IU
Fortified Food Sources (read the label to make sure as only milk is routinely fortified):
Milk, 8 ounces, 100 IU (doesn’t matter the fat percentage)
Orange juice, 8 ounces, 100 IU
Cereals, about 1 cup, 40 IU
Until more foods are fortified with vitamin D similar to the way we have done with calcium, supplements can be an important part of the equation. There are two forms of vitamin D that you will find in supplements, vitamin D2 and D3. You want the vitamin D3 form which is the more potent form.
So, what is a realistic game plan to increase the amount of vitamin D you get on a daily basis?
1. check your multi vitamin/mineral supplement, most have 400 IU
2. check your calcium supplement if it has D added, typically 100 IU
3. best food choices currently include milk, 100 IU per cup or yogurt (check the label), 80 IU per container, fish such as salmon or catfish
4. take the remainder as a vitamin D3 supplement
Tip: labels on fortified foods as well as supplements provide vitamin D information as a percentage of the Daily Value or DV. Since the DV for vitamin D is 400 IU currently, a food that says 50% of the DV would have 200 IU per serving.
Dr. Susan
Comments (16)
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Posted August 7, 2007 3:26 AM
Edward, I agree with everything you said however here in the United States we have to deal with the F.D.A.. I believe they are influenced or pressured by the medical industry to over react when consumers overdose with supplements. If the F.D.A had it's way all vitamins would be by doctor's prescription only! I completely agree that most of us are deficient in Vitamin D, but even a few cases of toxic levels might cause problems for the many who would benefit from this vitamin. I still find it hard to understand why we cannot buy the amino acid tryptophan after one incident involving a tainted batch, but we can still buy "Tylenlol" after similar problems? I don't want us to lose our freedom to buy these products because some people are ignorant and our governement feels it's necessary to protect us from ourselves.
Posted August 6, 2007 9:46 PM
I think we have got to get the risk of Vitamin d toxicity into perspective.
In the UK most white adults have levels between 50-75nmol/L so to reach optimal status they must average 2000iu/d more as 400iu only raises status by between 7-12nmol/L.
I use bio-tech myself but I buy their 5000iu capsules and take just one capsule every day when I know I will not be able to get outside into the sunshine. During the Winter I take just 5 x 5000iu one week and 6 x 5000iu the next to average over the fortnight, 4000iu each day.(UK milk is not fortified) Most people will only come upon suppliers of high strength Vitamin D3 from sites such as The Vitamin D Council where good evidence based advice and information is available so no one should be tempted to take more than is good for them.
I think (particularly in the UK) we have to be a bit more realistic about how much Vitamin d we actually make from Sunshine. "Effects of Above Average Summer Sun Exposure on Serum 25-Hydroxyvitamin D and Calcium Absorption" http://jcem.endojournals.org/cgi/content/abstract/87/11/4952?ijkey=4c619... shows that outdoor workers in Omaha only average 2800iu/d over the year becoming insufficient in Winter. While some people are prepared to lay naked in the sun (I personally think everyone should) but for MOST people it simply isn't an option, lack of privacy and here in the UK I doubt there are more than 30 days in the year when there is sufficient sunshine and the wind/cloud cover and chill factor are likely to make it an inviting proposition.
But bear in mind that Bruce Hollis, one of the leading Vitamin D scientists, who lives in Charleston, SC, USA says "No one should have a circulating 25(OH) D level—this is the metabolite that defines nutritional vitamin D status—less than 80 nmol. I try to keep my own level at 125 nmol minimum and consume between 2,000-8,000 IU/day depending on the season."
There is IMO a far bigger danger that more people will continue to take too little Vitamin d3 than take too much. At the moment 94% of hospital admissions are Vitamin D deficient. We have to crack this problem first before worrying about the numbers that get hospitalised with too high a Vitamin D status. We did have a case reported only last month. http://content.nejm.org/cgi/content/full/357/3/308 but at the moment it is so rare it gets headline news. But just look at how high that overdose scenario was?
Posted August 4, 2007 4:28 PM
http://www.bio-tech-pharm.com/products/d35.html, sells a bottle of 100 count 50,000IU without a prescription. All we have established is that megadose of this Vitamin is easy to obtain and many people will start to self medicate and run the risk of hurting themselves. Dr.Susan wrote a fine article meant to get people thinking about this often neglected supplement, but as we can see whether it's human nature or a problem specific to our society it will be abused. Moderation people!
Posted August 3, 2007 8:39 PM
There is an effect strength Vitamin D3 supplement available. Our company sells one product- MAXIMUM D3® . It is 10,000 IU USP PHARMACEUTICAL QUALITY CHOLECALCIFEROL 0.25mg FOR VITAMIN D SUPPLEMENTATION Patent Pending. This is the largest dose the FDA has allowed for over the counter use. Although this is sold over the counter in pharmacies, it is made as if it was a prescription product. It is approved for once a week use. We recommend that individuals obtain their D3 level prior to taking this. Packaged in a gelcap, for improved absorption, it is sold on a card with 5 capsules. It is also available on the web site www.vitd3.com along with additional information regarding D3 and our product.
Posted August 3, 2007 7:43 AM
Unfortunately missing from the spam merchants products is an effective strength Cholecalciferol Vitamin D3 supplement.
During the Summer of course we should (apart from those who are unable to go outside during the day) be getting our Vitamin D3 from sunshine.
Laying naked in the sun (if the erythemal index is above 3 and your shadow is shorter than your height) will generate roughly 1000iu per 5mins per side. So a maximum of 20 minutes will create sufficient for your daily needs.
The animated diagrams here http://www.uvguide.co.uk/vitdpathway.htm detail the process. If you scroll down the page to the second diagram you will see that the process is self limiting and further heat converts the D3 to suprasterols that are not usable by the body. It follows that if you want to build up your vitamin D reserves for Winter or correct an insufficiency situation, you need to cover up, go inside, let your skin cool down and then repeat the 20minutes or so later in the day. Sunblock and sunscreen of course block UVB and therefore will prevent Vitamin D synthesis.
There is a NATURAL daily maximum of 10,000iu/d (the main reason this was selected as the proposed as the new SUL, toxicity occurs above 40,000iu/d so there is a wide safety margin ) your body produces from sun exposure, so there really is no point in trying to spend all day in the sun. That is the way to sunburn and skin cancer. REGULAR, LIMITED sessions will harden the skin against UV, prime the skin against cancer, http://www.sciencentral.com/articles/view.php3?type=article&article_id=2... and create maximum Vitamin D status.
Posted August 2, 2007 6:21 PM
Hello Frank, Cori and Edward,
Thank you for your very interesting dialogue and you have brought up some terrific points. Frank, we do tend to be a nation who says that if a little is good, more must be better. Vitamin D in a 50,000 IU pill crosses the line in my opinion from a supplement to a drug. Current articles on vitamin D in the Nutrition and Action Health Letter and Eating Well magazine condense the latest evidence based research from peer reviewed journals. Currently, the thinking is that the upper limit of safety for vitamin D intake is somewhere between 2000 IU and 10,000 IU. This may change as additional research comes in.
What's important for everyone to remember is that this upper limit is NOT your daily need. Yes, there is an abundance of information on vitamin D on the Internet along with every other nutrition topic you can think of but just because it's on the Internet doesn't make it accurate or evidence-based. The savvy reader has to look at the information with a wary eye.
According to Eating Well, Creighton University's Robert Heaney suggests that a blood level should be 50-60 ng/ml and the blood test should be done in midwinter when your blood levels are most likely to be at their lowest. As always, any time you make the decision to take supplements such as vitamin D, be sure and discuss your plan with your doctor and how it affects your personal health. Every person is different.
Dr. Susan
Posted August 2, 2007 9:34 AM
Sorry forgot my link to the latest Vitamin D conference presentations
http://app2.capitalreach.com/esp1204/servlet/tc?cn=asbmr&c=10169&s=20343...
Posted August 2, 2007 9:31 AM
Anyone who is concerned about the safety of Vitamin D3 should study this Risk assessement for Vitamin D. http://www.ajcn.org/cgi/content/abstract/85/1/6
If you still have any doubts then you may like to listen to Vieth presenting a summary of the research findings here at the Contemporary Diagnosis and Treatment of Vitamin D-Related Disorders conference. Session 4: Vitamin D and Population Health you may want to use the arrows by the slide preview to fast forward to the Reinhold Vieth, Ph.D. session. Pay particular attention to slide 76 that shows both the recent research producing no adverse events and plots the levels at which toxicity through accidental overdose has been recorded.
While eventually the RDA will be raised those wanting to benefit from the latest scientific understandings need to appreciate just how much Vitamin D our body naturally uses daily. http://www.ajcn.org/cgi/content/full/77/1/204 and learn more about how it affects our body's functions. http://www.uvadvantage.org/CONTENT/NEJournalofMedicine.pdf
When purchasing Vitamin D you also need to be aware of the difference between D2 Ergocalciferol and D3 Cholecalciferol. http://www.ajcn.org/cgi/content/abstract/84/4/694 The case against ergocalciferol (vitamin D2) as a vitamin supplement
There is, in society, a myth that Prescribed medicines are always more effective than over the counter supplements. In this case everyone with a Vitamin D prescription should be aware they are probably being scammed with a less effective, more expensive, synthetic, product that is not absorbed by many third age users.
Posted August 1, 2007 4:19 PM
Cori, the site was very educational. My point was to get people thinking to prevent doing themselves harm. The fact that Vitamin D is available in a 50,000IU pill gives me concern. The F.D.A. would like to regulate vitamins which would only drive up the cost. Remember the scare associated to the amino acid Trytophan? A tainted batch from I believe Japan, lead to the banning of this harmless protein. I expect the R.D.A. of Vitamin D will change but until then there will probably be a lot of debate over healthy limits. There is sure no shortage of information on the Internet. I hope this does not become the latest "coral calcium" panacea. I respect your approach of proper testing and appropriate dosing. We are a nation of excess which leads to problems in many areas of life not just food consumption.
Posted August 1, 2007 1:59 PM
Hi Susan and Frank
We're still laboring under a misconception about Vitamin D's toxicity that we inherited a long time ago.
Let's be scientific about this and really find out what the dosage should be for each person instead of setting a slightly higher but still insufficient upper level. Better yet, everyone should get tested and aim for an optimal level of 45-50ng/ml or 115-128nmol/L...summertime lifeguard level. The fact that we make tens of thousands IU in one short sun exposure should be considered pretty essential information.
Dark-skinned people are much more deficient, suffer much higher rates of cancer and other vitamin D associated diseases and need from 5-20 times more time in the sun than light-skinned people.
Check out the Vitamin D Council's website for the cutting edge science in Vitamin D toxicity.
http://www.vitamindcouncil.com/vitaminDToxicity.shtml
Posted August 1, 2007 11:30 AM
Dr. Susan, a few weeks ago my eighty one year old mother was told she was severely deficient in Vitamin D and the doctor prescribed a month long course of daily 50,000 unit pills. I have read up on vitamins and supplements for years and never heard of such a high dose, but after researching on the Internet I have a better understanding. I myself began adding one 1000 unit Vitamin D tablet to my daily supplement regimen. You mentioned all the valid reasons for supplementing, but people need to be cautious and not overdo this vitamin. Many people do not take the time to educate themselves and will assume if a little of this is good for them , then more will be better. Vitamin D as with some other supplements can be toxic at certain levels. Let's hope everyone follows your advice and doesn't get carried away. Thanks.
Posted August 19, 2007 10:37 PM
recently was perscribed Vitiam D, 1000 daily, 50000 once weekly. The Dr referred to D2 and D3, which didn't compute for two pharmcist. Are these the same using 100 0 and 50000 units even tho the numbers are not used on the vitiman containers-thank you if this is of interest-bud
Posted August 20, 2007 2:16 PM
You really do have to insist that you buy/use only Vitamin D3 Cholecalciferol. You can get it mail order from one of the several suppliers listed at The Vitamin D Council Website links page. "The Case Against Ergocalciferol(Vitamin D2) as a Vitamin Supplement" explains the reasons why D2 is less effective, less reliable and shorter lived. (it's also more expensive)
50,000iu/D3 once a week for 8 weeks is a good way of boosting your status quickly.It averages at around 7000iu/d which is 3000iu more than you actually need daily. You can get 100X 50,000iu from those same suppliers on the Vit d council pages. I have some at hand which I keep with the idea that I may try STOSS therapy should avain flu ever appear locally. I also like to have them available to boost my friends/relatives status when I discover they may be a bit short. BUT they should NOT be used daily or for extended periods. These are a medicinal strength and if you used them daily for several months you WILL GET HYPERCALCEMIA. You are taking in more than your body uses daily and therefor you levels will rise day after day and you will eventually top 350nmol/L and thus be in DANGER of adverse events.
While 1000iu/daily of D3 may be a suitable amount for people who are able to get regular daily full body exposure to sunlight, if you have been tested and found to need a major dose level to raise your status it would be a fairly major life style change to get sufficient Vitamin D from sunlight. Heaney found that OUTDOOR workers in Omaha averaged only 2800iu/d over the year so became insufficient in the Winter.
I live at latitude 52 (UK) and I take 5000iu/daily whenever I cannot get outside into the sun. (I've a nice private summerhouse in the garden which isn't overlooked so I've no unsightly white patches) 5 minutes full body sun exposure raises 1000iu if the erythemal index is at least 3 and your shadow is shorter than your height. So a maximum of 20 minutes produces the 4000iu you use daily.
If you use 5,000iu/capsules then after you have raised your status (this should take between 60-90 days at 5000iu/d) you can drop down to 5 capsules one week and six capsules the next. That way you average 4000iu/d over the fortnight.
You may want to consider using a suntan parlour to boost your status. Bear in mind you need LOW PRESSURE TUBES (they produce more uvb)and restrict the time to around a half that stated for sunlight.
Posted August 20, 2007 9:32 PM
Hi Bud,
If your doctor wrote a prescription and it was unclear to the pharmacist, he or she should call your physician for clarification. You also want to know what the doctor prescribed for you and how/why he wants you to take the vitamin D. Nutritionally, D3 is the preferred form. At high levels, vitamins have actions similar to drugs so instead of self medicating, it is wise for anyone considering Vitamin D supplementation to discuss it with his/her doctor.
Dr. Susan
Posted August 21, 2007 9:08 AM
While I fully agree with Dr Susan's suggestion " it is wise for anyone considering Vitamin D supplementation to discuss it with his/her doctor" we do have to take some responsibility for our own health and consider carefully the quality of advice and prescriptions that our health professionals are providing.
If you click this link http://www.clinicalanswers.nhs.uk/index.cfm?question=5791
you will see the "Official NHS" answer provided to UK doctors to use as the basis of their prescribing practice.
What is wrong with this "OFFICIAL" medical advice?
Those who have studied the links I have previously provided in this thread will know why using too little of the wrong kind of Vitamin D will not achieve the intended result.
Those who have listened to the interesting series of presentations by Vitamin D researchers at Contemporary Diagnosis and Treatment of Vitamin D-Related Disorders from a conference sponsored by The American Society for Bone and Mineral Research will understand more about the issue. http://app2.capitalreach.com/esp1204/servlet/tc?cn=asbmr&c=10169&s=20343...
The talk by Robert P. Heaney, M.D. provides a graph of the rise in Vitamin d status from various dose levels of D3. It is a pity it takes so long for the findings from the most recent research to filter through the system to become common knowledge amongst our General Practitioners.
Part of the problem is that Vitamin D3 is FREE from sunlight, so no one has a financial interest in promoting it's use. It is also very cheap when in it's natural form Cholecalciferol. In the synthetic form D2 it can be sold for more money (even though it is less effective.) Research Companies are working flat out to research further analogues of Vitamin D that they can patent and charge a fortune for and hence they have a motive for trying to dissuade people from understanding or benefiting from the natural free/cheap stuff which doesn't help their profit margins.
Readers may like to read Dr Davis Heart Scan Blog entries
http://heartscanblog.blogspot.com/2007/08/vitamin-d2-belongs-in-garbage....
Vitamin D2 belongs in the garbage
If you enter "Vitamin D" into his search box you will find several articles making similar points.
Posted August 21, 2007 2:05 PM
Edward, the links you've provided are very informative and in a word "nothing's" wrong with what they advise. The problem of self medicating comes when people do not put the effort into educating themselves as you have. They do not follow the suggestions on those links which advise blood work be done when high levels of Vitamin D are administered. I'm upset with the half hearted and lazy efforts of consumers who will read just enough about this issue and start taking megadoses and then after having bad reactions place blame on the supplement community. I think many doctors are overwhelmed by their practice to stay current with all the research we may happen across. They are also in jeopardy of lawsuits and must proceed with caution when altering their protocols. I agree it's a pity such potentially beneficial research moves so slowly in reaching the public, but we live in a time of lawsuits and excesses. I've never taken anabolic steroids, but I believe if used under a doctors supervision and in small doses they are probably relatively safe, unfortunately we read about people who abuse these drugs and suffer horrific consequences. Education and responsibility does not stop with the publication of helpful research, it must continue with the general public.
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