Vitamin D Deficiency

Our family friend, Laurie, volunteered to share a paper she wrote on the importance of Vitamin D.  As caregivers, it can be challenging simply to keep up with daily tasks let alone keeping up to date on the latest health information. 

Laurie sent this to me noting: “I was thinking about your kids getting sick a lot. They could be deficient, esp. Riley because he gets very little sun exposure and is on antiseizure meds.  I have been learning a lot lately about the fact that a lot of us don’t have enough vitamin D because we don’t spend enough time outside (getting full sun exposure for at least 30 minutes a day). I am very interested in the work of the Vitamin D Council and have contacted them to get involved in spreading the word. I have summarized what I have learned in the attached article.”

Thank you Laurie for looking out for us!

The Importance of Vitamin D Supplementation 

Vitamin D has wide ranging health benefits. It plays many important roles in the metabolism and absorption of minerals in the body. Vitamin D promotes calcium absorption in the gut, which enables normal mineralization of bone.  Low levels of vitamin D lead to the release of the parathyroid hormone, which mobilizes calcium to leave the bone. Over time, excessive loss of calcium from the bone can lead to rickets.

It has become clear that vitamin D not only plays a role in calcium homeostasis and bone metabolism, but it also interacts with the immune system in a wide variety of ways. It has been found that a sufficient amount of vitamin D is necessary for our immune system to function properly. Low vitamin D levels have been associated with cardiovascular disease, certain cancers, cognitive decline, depression, diabetes, pregnancy complications, autoimmune diseases, asthma, and respiratory infections like TB, pneumonia, bronchitis and influenza. Low levels have been linked to a 78% increase in all causes of death. There are decades of research that indicate that people die from many various diseases that are impacted by vitamin D.

Vitamin D also has far reaching effects on the body and especially the brain. There are receptors for vitamin D throughout the entire central nervous system. It helps regulate enzymes in the brain and cerebrospinal fluid that are responsible for manufacturing neurotransmitters and stimulating nerve growth. Vitamin D has also been found to protect neurons from the damaging effects of free radicals and it reduces inflammation in the body.

 Vitamin D Deficiency

Researchers have known for 20 years that there is a high prevalence of vitamin D deficiency worldwide across all age groups. It is currently estimated that over one billion people in the world may be vitamin D deficient. Over the past 20 years, there has also been increased attention given to recognizing vitamin D deficiency in children throughout the world. Childhood vitamin D deficiency in developing countries is still very prevalent, and even industrialized countries like the United States., Canada, Greece, the UK, Finland and New Zealand have a high occurrence of vitamin D deficiency in infants and children. It has been found that 1 in 10 children are significantly deficient, and 60 percent of children have levels of Vitamin D that are suboptimal for bone health and the prevention of disease.

This is a major public health concern, especially given the fact that many diseases of adulthood are rooted in childhood. Much of our life-long health is preprogrammed in childhood, and many adult diseases take root as the result of exposures, lifestyles and diet during the first decade of life.

A recent large study strongly suggests that many children are getting far too little vitamin D, especially those who do not get plenty of sun exposure throughout the year. The safety data to date has prompted experts in the field to modify the current recommendations regarding adequate vitamin D intake not only for adults but also for children.

Prolonged and untreated deficiency of vitamin D can affect multiple organs and functions, including bone growth and density, metabolism, heart and immune function. The problem is that it rarely causes overt symptoms and is frequently unnoticed in children. Vitamin D deficiency in childhood can cause skeletal deformities, rickets, growth failure, frequent fractures, brittle bones, and premature osteoporosis. Recent studies have also found a link between vitamin D deficiency and some cancers, heart disease, suppressed immunity and even premature death. These studies do not show that vitamin D deficiency causes these diseases, but do suggest that vitamin D plays a large role in the genesis of these diseases.

If a child has insufficient vitamin D, only 15% of dietary calcium is absorbed. Low calcium can, in rare cases, cause heart rhythm abnormalities and seizures. Other symptoms can manifest due to low calcium, such as poor muscle tone, insufficient dental enamel and muscle spasms. Once detected, however, the good news is that it can be corrected quickly with high level supplementation.

Risk Factors for Vitamin D Deficiency

  • limited sun exposure
  • diets deficient in vitamin D
  • breast fed infants
  • any condition that affects food absorption in the gut
  • a low fat diet
  • long-term use of anti-seizure medications

We get most of our vitamin D through exposure to sunlight, and taking vitamin D supplements. There is very little vitamin D found in foods, therefore it is impossible to meet all of our vitamin D requirements through our diet.

Vitamin D Food Sources

The few foods that contain vitamin D are:

  • The flesh of salmon, mackerel, tuna, and swordfish are the best sources
  • Beef liver, cheese, sardines and egg yolks contain small amounts
  •  Fortified milk and orange juice
  • Fortified cereals
  • Fortified yogurt
  • Fortified margarine
  • Fortified infant formula

Cod liver oil has the highest concentration of Vitamin D, but if you try to take enough to raise your vitamin D levels, you’ll get toxic levels of vitamin A, so this is not recommended.

Exposure to sunlight

Our bodies are designed to produce vitamin D when bare skin is exposed to ultraviolet B rays in sunlight. There are a number of factors that affect how much vitamin D is produced when we are exposed to sunlight. These factors include:

  • The time of day when you are in the sun- the middle of the day is best
  • The amount of skin that you expose- the more skin that is exposed to the sun, the more vitamin D is produced
  • The color of your skin- lighter the skin type, the more vitamin D will be absorbed
  • Your age- the older we are, the harder it is for our bodies to produce vitamin D
  • If you use sunscreen- sunscreen blocks most vitamin D production
  • Where you live- the higher the altitude, the more vitamin D you will produce. If you live in an area with high pollution- pollution soaks up the ultraviolet B rays (UVB), or reflects it back into space.
  • How much time you spend indoors- glass blocks all UVB rays, so little vitamin D is produced

Most people get some of their vitamin D needs through exposure to sunlight. However, it is important to limit sun exposure because it has been linked to squamous and basal cell carcinoma.

Some research suggests that while sunscreen protects against squamous cell carcinoma, it does not appear to protect against basal cell carcinoma. Therefore, the Vitamin D Council recommends covering the skin with clothing, seeking shade, and using sunscreen, after a little bit of sun exposure. Infants under 6 months of age should not be exposed to direct sun because their skin is so delicate and burns easily.

The rule of thumb with sun exposure for children and adults to get the vitamin D they need is to be in the sun for half of the time it takes for the individual’s skin to turn pink and start to burn.

Vitamin D Supplements

Vitamin D supplementation is a relatively simple intervention that might decrease the incidence of many infections, thereby preventing illness and death.

It’s hard to get daily full body sun exposure, therefore the Vitamin D Council recommends that on the days that you can’t get full sun exposure, taking a vitamin D supplement is an effective way to get the vitamin D your body need

To prevent vitamin D deficiency (breast milk contains very little vitamin D) the American Academy of Pediatrics recommends that all breast fed babies are to be supplemented with a minimum of 400 IU/day after the first few days of life.

Different organizations recommend different daily intakes. Here are recommendations from three different organizations in the United States:

 

Recommended daily intakes from various organizations

Vitamin D Council  Endocrine Society              Food and                                                                                                      Nutrition Board

Infants                       1,000 IU/day           400-1,000 IU/day              400 IU/day

Children (1-18)       1,000 IU/day           600-1,000 IU/day              600 IU/day

Per 25 lbs of                                                                                                                                                body weight

Adults                        5,000 IU/day           1,500-2,000 IU/day          600 IU/day

800 IU/day

For adults 70 and over

Different organizations have different interpretations of the scientific data currently available. The Vitamin D Council is considered the authority on Vitamin D recommendations, as some of the leading experts and researchers of vitamin D are on this council. The Vitamin D Council is in the high range for supplementation, based on what they believe to be true. The Endocrine Society is mid-range and the U.S. Government Food and Nutrition Board is the most conservative. The bottom line is whatever amount of supplementation it takes to get your blood levels where they need to be for optimal health is how much you need to take. Most experts agree on where the blood levels need to be.

 

Upper safe limits set by various organizations

                        Vitamin D Council              Endocrine Society              Food and Nutrition Board

 

Infants                       2,000 IU/day           2,000             IU per day    1,000-5,000IU/day

Children                    2,000 IU/day           4,000 IU/day           2,500-3,000 IU/day

Per 25 lbs of body weight

Adults                        10,000 IU/day        10,000 IU/day        4,000 IU/day

Vitamin D Toxicity

Vitamin D is a fat soluble vitamin, so toxicity can occur, but it is very rare. The Vitamin D Council recommends taking no more than the upper limit of 10,000 IU/day for adults. The main consequence of taking too much calcium is a buildup of calcium in your blood. Symptoms of toxicity include nausea, vomiting, weakness, frequent urination and even kidney problems may occur. Treatment includes stopping vitamin D supplementation. Taking huge doses of 40,000-50,000 UI over several months has been shown to cause toxicity.

While these doses may seem like a lot, the body can produce 10,000-25,000 IU’s of Vitamin D after just a little bit of full body sun exposure. Vitamin D toxicity, where Vitamin D is harmful, usually happens if 40,000 IU’s per day are taken for several months.

The Vitamin D Council recommends taking Vitamin D3. This is the type of Vitamin D that your body makes with sun exposure. Vitamin D3 can be taken in the form of capsules, tablets or liquid drops. It doesn’t matter which form. It is easily absorbed by the body and can be taken any time of the day. It doesn’t matter whether it is taken with food or not.

Optimal Levels Recommended

The literature suggests that that conventional medicine is not at all up to date in implementing what science knows about vitamin D to prevent disease and promote health. Recent reviews by prominent vitamin D researchers concluded that a blood level of 30ng/ml should be the minimum sufficient level for bone health. It is estimated that about 50% of North Americans have blood levels less than 30ng/ml.

There is an impressive body of scientific evidence that supports the recommendation of the Vitamin D Council that serum vitamin D levels need to be higher, between 40-60ng/ml for optimal health and the prevention of disease.  However, if a person is sick, with Parkinson’s, Alzheimer’s, emphysema or cancer, the Vitamin D Council recommends levels at the high range of normal (80-90 ng/ml).

Skin color, geographical location, time spent outside, sunscreen use age, etc. are all factors in how much vitamin D is produced in the skin, so the supplemental dose a person takes should be predetermined by a blood test, as people can differ greatly in the amount of vitamin D their body requires. The Vitamin D Council recommends a starting dose for most people to be 5,000 UI, and they have also concluded that all pregnant women take 5,000 UI during their pregnancies.

Preliminary findings of a brand new study that has not even been formally published yet indicates that it takes much more vitamin D supplementation than originally thought to achieve the recommended higher levels. It had been the rule of thumb, prior to this study, that for each 1,000 IU of vitamin D consumed, you would get a rise of about 10ng/ml. This study found that once a person reaches the age of 30, the amount of rise that you get for each dosage of oral vitamin D is considerably less than that. Between the ages of 40-50, you have to take 2,000 IU to reach a serum rise of 10ng/ml. What this means is that you will have to take a lot more. It’s is estimated that it will take supplementation of about 6,000 IU/day to get 90-95 % of the population above 40ng/ml.

Guidelines for safe and effective supplementation with vitamin D

  • Have a blood test to find out what your vitamin D level is
  • Adjust your supplementation accordingly to stay in the 40-60ng/ml range, unless you are sick, then your levels should be between 80-90ng/ml
  • If you do not yet know your vitamin D levels, a range of 2,000-5,000 UI is a reasonable dose of vitamin D to take until you get your levels checked

A note on calcium recommendations

Most of the scientific community has been in agreement that calcium recommendations have been too high. The World Health Organization recommends an intake of 500 mg daily. A recent study found that low dose calcium supplementation (500 mg) combined with vitamin D supplementation reduced osteoporosis fracture rates, but high dose calcium (1,000 mg) did not. These results suggest that high dose calcium supplementation blunts the beneficial effects of vitamin D. It also suggested that there is potential for cardiac harm from taking high doses of calcium (1,000 mg).

 

Other important research study findings:

  • A 2007 cancer study found that 77 percent of cancers could be prevented with a vitamin D level of at least 40ng/ml
  • One of the latest studies to be reported on vitamin D found that the higher your vitamin D level, the lower your risk of developing macular degeneration and cataracts
  • Low vitamin D levels have been found to exacerbate Parkinson’s disease
  • There is evidence suggesting that children are significantly protected against developing Type 1 diabetes if the mother has sufficient levels of vitamin D during pregnancy, and/or the infant receives sufficient amounts of vitamin D. Vitamin D levels should be checked during pregnancy. Prior to conception, both parents should take the necessary steps to be vitamin D sufficient. A level of 50ng/ml is adequate in healthy people.
  • Randomized, controlled trials have shown major reductions in bone fractures by getting serum vitamin D levels above 30-40ng/ml
  • There is some research that shows that vitamin D can reduce the number of asthma attacks for children with asthma. One study found that children whose mothers got the most vitamin D from their diet during pregnancy were least likely to develop asthma. In another small study, taking 1,200 IU of vitamin D per day reduced the chances of a child with asthma having an attack.
  • Pediatric researchers have found a link between low levels of vitamin D and anemia in children. Symptoms of anemia include fatigue, lightheadedness and low energy. Anemia, if severe and prolonged, can damage vital organs by depriving them of oxygen.
  • A study done over 7 years with 498 women showed that those with the highest intake of vitamin D reduced their risk of developing Alzheimer’s disease by 77 percent
  • Reports have shown a 25 percent risk reduction in cognitive decline in people with higher levels of vitamin D
  • When the mental states of 858 people were evaluated between 1998 and 2006, there was a substantial decline in mental function in those people with severe vitamin D deficiency
  • Multiple studies link low levels of vitamin D with risk for Parkinson’s and relapse in multiple sclerosis patients
  • Low vitamin D levels have long been shown to contribute to depression and even chronic fatigue. Adequate levels are needed by the adrenal glands to help regulate an enzyme necessary for the production of critical brain hormones that play a role in stress management, mood and energy

Laurie Minerva, M.S.N., C.N.S. Public Health

One Response to Vitamin D Deficiency

  1. Perfect timing…With the shorter days of day light it is important to also take vitamin D supplement to help with winter blues and low moods during this time. Thanks for the reminder to up my Vitamin D during this time.

    Hopefully I will get to my sister’s home in Estero this winter … now that is a fabulous way to get vitamin D – the sunshine way 🙂 ..hugs C. (HHL)

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