Are You Taking Vitamin D?
If you're not taking vitamin D, have you wondered if you should be?
The short answer is ... yes, you should.
Some facts...
There’s a worldwide problem with vitamin D insufficiency (not enough) and outright deficiency (health risk) - even in hot, sunny countries like India (and Bermuda, where I live) - but especially in northern latitudes where the sunlight in winter months is dim.
People who are overweight and those with darker skin tone have been shown to have lower circulating levels of vitamin D.
As are older adults! Women (and men) over 50 don’t make vitamin D as efficiently on their skin and tend to have lower levels. That would be us.
If you live in a winter-y climate, you’re bundled up for 6 to 8 months of the year, getting little or no sunshine on your skin.
Canadians and those living in the northern half of the USA (and similar latitudes in the UK and Europe) are at particular risk.
Statistics tell us that the average vitamin D level for Canadians aged 3 to 79 is in the insufficient range. And 70% of Americans are reported to be vitamin D deficient.
How many of you can say that you get 10 to 20 minutes of unprotected sunlight on bare arms and legs during the hours of 10 am to 3 pm every day?
It should be easy here in Bermuda, but even when the sun is shining brightly outside, I don’t get this kind of exposure because I work indoors all day, and when I go out to exercise on weekends, it’s usually early morning before the sun is high in the sky. Most people who have day jobs would share this experience.
And on top of that, we use sunscreen and sun-blocking clothing which also block vitamin D formation on the skin.
So, you can see that for some or all of these reasons, your risk of having low vitamin D is probably quite high.
In fact, the reason I’m updating you on the latest on vitamin D, is because I’ve found so many people in my practice, of all shapes, sizes and skin tones, shockingly low in vitamin D. Therefore, I spend a significant amount of time during their visits discussing the results of their tests, then explaining why they need to supplement with vitamin D.
Here are the questions I am most commonly asked:
What is Vitamin D?
Vitamin D is a fat-soluble vitamin that’s stored in the liver and fatty tissues. It’s actually a prohormone, which means that it can be converted into an active hormone in the body. It’s been put into the vitamin category because it’s an essential nutrient that the body doesn’t make on its own - it must be synthesized on the skin during sun exposure, or absorbed in the gut from food or supplements.
Because it’s a fat-soluble vitamin, it needs fat to be present in the diet to be absorbed. But note, for the same reason, body fat has the ability to absorb vitamin D and hold on to it, keeping it from being released for use in the body. Something to think about.
Why is vitamin D important?
When I was in medical school, I learned only of the importance of vitamin D in bone health - its role in the absorption and use of calcium by the bones. That was 20 years ago.
Since that time, there have been numerous studies that have shown that vitamin D receptors are present on almost every cell type in the body.
Vitamin D has the following health-promoting effects:
maintains the health of bones and teeth
supports the health of the immune system, brain, and nervous system
regulates insulin levels and aids diabetes management
supports lung function and heart health
protects against certain cancers
and we're finding out more all the time!
Vitamin D deficiency is correlated with an increased risk of developing breast, prostate and colon cancer, autoimmune diseases such as multiple sclerosis, inflammatory bowel disease, rheumatoid arthritis and diabetes, and of hypertension, heart disease and various infectious diseases.
And also...aging! We need vitamin D to help generate an anti-aging enzyme in the kidney which protects against skin shriveling, thinning bones, weak blood vessels, and memory and hearing loss. It actually regulates genes related to health span, which means it helps to delay the chronic diseases of aging.
Enough said!
Can’t I get all the vitamin D I need from the sun?
You can get some vitamin D from the sun, and it’s still the best way to top your levels up. But it will it be enough?
Vitamin D is synthesized on the skin by the ultraviolet rays in sunlight, but humans the world over seem to be doing a poor job of getting the amount needed solely from the sun.
Several reasons have been suggested:
We don’t expose ourselves to sun at the right time of day for the right length of time
We wear sunscreen and cover up with clothing
Pollution in urban areas is blocking bright sunlight
We may get enough, but environmental toxins (pesticides and heavy metals) may be playing a role in inhibiting conversion to the active form of vitamin D in our kidneys
There is a new theory, yet to be proven, that we may actually be washing off skin oils containing newly-made vitamin D precursors by showering with soap shortly after sun exposure
Can I get vitamin D from dietary sources?
Yes, but again...will it be enough? Due to reports of a billion people globally who are insufficient, I think it's unlikely we can get all we need from our diets. But we can try!
Here are the food sources of vitamin D:
Salmon (wild-caught)
Herring, sardines, halibut and mackerel
Cod liver oil (more of a supplement than a food!)
Canned tuna (eat 6 oz or less per week to prevent mercury buildup)
Oysters
Shrimp (wild-caught)
Wild mushrooms
Egg yolks
Fortified foods (milk, cereals, orange juice, soy milk - these are foods I don’t eat and don’t recommend mostly because they're processed foods, and many people avoid dairy)
Should I take a vitamin D supplement?
Yes! Vitamin D3 (D2 for vegans) is one of the daily vitamin supplements I recommend, along with a good multivitamin, Omega 3s and probiotics. The reason for taking these vitamins together is that they all work together, like an orchestra, supporting absorption and strengthening each other's effects.
For example, vitamin D needs minerals such as magnesium for proper functioning, and in return, plays a role in the absorption of essential elements such as calcium, magnesium, iron, phosphate, zinc and copper. Omega 3 fatty acids work with vitamin D in the brain to increase serotonin levels, improving mood. And probiotics help keep the gut healthy so that optimal absorption of nutrients can take place.
We also have some new information that vitamin K2 is important for optimal use of the calcium that vitamin D makes available to the body - so that it is deposited in bone and not in tissue such as heart vessels.
When shopping for your vitamin D, look for a good quality brand in capsule or drops form. They often come formulated in olive oil (or other oils), which is helpful as there is fat already present to aid in absorption. Don't settle for less expensive drug store brands.
How much should I take?
With increased scientific study and recognition of the importance of vitamin D for health, it's been easier for doctors to request the test and have it covered by our patients’ insurance plans.
Ask your physician to test your vitamin D level and then discuss recommendations for daily doses as necessary for you.
Normal blood levels are 30 to 100 ng/ml. (Canadians note that your units will be in nmol/L. Convert to ng/ml here)
Optimal levels for prevention of disease are felt to be above 50 ng/ml
Be aware that your physician may default to the US Endocrine Society or Health Canada recommended daily allowance of 600 - 1000 IU, which studies indicate to be too low to prevent disease.
Know you can safely take the recommendation below - both organizations set the safe upper limit at 4000 IU daily.
If you don’t know your vitamin D level, or if you're told that it's below 40 ng/ml (low normal), take 2000 - 4000 IU daily with a fatty meal.
Get 10 to 30 minutes (based on your skin tone) of unprotected sun exposure to arms, hands, and legs per day, when you can, during the months of June to September.
Always use sunscreen on your face to prevent photo-aging (wrinkles and sun damage).
When you shower or bathe after being in the sun, use soap only in armpits and groin area to preserve vitamin D-rich oils on skin.
What I do
My vitamin D level is 49.6. That’s after a summer in Bermuda with lots of sunny days, beach and swimming. I regularly walk, cycle, and run outdoors with no sunscreen on my arms and legs, but always wear at least SPF 50 on my face.
So you can see it takes some work for me to get my D level up over 50 ng/ml. But I'm on it!
My new supplement routine is to take Vitamin D plus K 5000 IU (made by Life Extension) daily, and try to get 20 minutes of unprotected sun on my skin whenever I can. I also take a good multivitamin, Omega 3 fish oil, and a daily probiotic.
I eat salmon and other cold water fish, eggs, tuna and wild mushrooms, when I can get them. I eat organic as much and as often as possible. And I often skip the soap on my limbs - it dries the skin, anyway.
I have a feeling that vitamin D is of key importance optimal cellular function, period. So I’m going to keep working to get my levels up in the 50-60 ng/ml range. This is a safe range, and appears to produce the prevention and health effects shown in recent research.
Bottom Line
Take vitamin D, eat your fish, and soak up some sun today, wherever you are. Consider eating organic. And while we're waiting for conclusive evidence...could it hurt not to use soap every time you bathe?
Get your vitamin D level added to your annual blood tests so you'll know your number and can track your progress.
Note: I make recommendations to patients based on a combination of the latest scientific literature, the Precautionary Principle, and my education and lifetime of experience. I use all of the above to guide my own health decision-making as well.
The Precautionary Principle in medical and health care decision-making guides providers and patients as they discuss therapies that either have a long history of beneficial use, or have preliminary studies done but may not yet have strong evidence for benefit. However, there may be good evidence for safety, and if so, can be considered for use sooner rather than later.
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