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Why you are probably NOT getting enough vitamin D...

Posted Sep 17 2008 12:48am 1 Comment

What vitamin do we need in amounts up to 25 times higher than the government recommends for us to be healthy?

What vitamin deficiency affects over half of the population, is almost never diagnosed, and has been linked to many cancers, high blood pressure, heart disease, diabetes, depression, fibromyalgia, chronic muscle pain, bone loss, and autoimmune diseases like multiple sclerosis?

What vitamin is almost totally absent from our food supply?

What vitamin is the hidden cause of so much suffering that is so easy to treat?

If you guessed vitamin D, you're right!

You might be familiar with vitamin D from my recent article in Parade Magazine ( http://www.parade.com/livelonger/pages/Nutrigenomics_piece ). But I think this topic is so important that I want to go into it in even more depth here.
 
Over the last 10 years of my practice, my focus has been to discover what the body needs to function optimally. And I have become more interested in the role of specific nutrients.  

Over the last 3 years, I have tested almost every patient in my practice for vitamin D deficiency -- and been shocked by the results.

Even more amazing?

What happens when my patients' vitamin D status reaches optimal levels!

There's no doubt about it: Vitamin D is an incredible asset to your health.

First, it reduces cellular growth (which promotes cancer) and improves cell differentiation (which puts cells into an anti-cancer state). That makes vitamin D one of the most potent cancer inhibitors -- and explains why vitamin D deficiency has been linked to colon, prostate, breast and ovarian cancer. 

What's even more fascinating?

How vitamin D actually regulates and controls genes.

It acts on a cellular docking station called a receptor that then sends messages to our genes.   That's how vitamin D controls so many different functions -- from preventing cancer, reducing inflammation, boosting mood, easing muscle aches and fibromyalgia, and building bones. 

Those are just some examples of the power of vitamin D.

So why are so many of us deficient in it?

There isn't just one reason.

For one thing, your body makes vitamin D when it's exposed to sunlight. In fact, 80 to 100 percent of the vitamin D we need comes from the sun. The sun exposure that makes our skin a bit red (called 1 minimum erythemal dose) produces the equivalent of 10,000 to 25,000 international units (IU) of vitamin D in our bodies.

So what's the problem?

First, sunscreen helps protect against skin cancer -- but it also blocks a whopping 97 percent of your body's vitamin D production.

If you live in a northern climate, you're not getting enough sun (and therefore vitamin D) to begin with, especially during winter. And you're probably not eating enough of the few natural dietary sources of vitamin D -- that's fatty wild fish like mackerel, herring, and cod liver oil -- either.

Plus, aging skin produces less vitamin D -- the average 70 year-old person creates only 25 percent of the vitamin D that a 20 year-old does.

And skin color makes a difference, too. People with dark skin also produce less vitamin D. And I've seen very severe deficiencies in Orthodox Jews and Muslims who keep themselves covered all the time.

With all these causes of vitamin D deficiency, you can see why getting enough of this vitamin is so important. But are you being told the right amount of vitamin D to take?

Yes -- and NO!

The government recommends 200 to 600 IU of vitamin a day. It's true that we only need that amount to prevent rickets, a disease of vitamin D deficiency.

But the real question is, how much vitamin D do we need for OPTIMAL health? How much do we need to prevent autoimmune diseases, high blood pressure, fibromyalgia, depression, osteoporosis, and even cancer? 

And the answer is, "Much more than you think!"

Recent research by vitamin D pioneer Dr. Michael Holick, Professor of Medicine, Physiology and Dermatology at Boston University School of Medicine, recommends intakes of up to 2,000 IU a day -- or enough to keep blood levels of 25 hydroxy vitamin D at between 75 to 125 nmol/L (nanomoles per liter). Sounds high, but it's still safe: Lifeguards have levels of 250 nmol/L without toxicity. 

Our government currently recommends 2,000 IU as the upper limit for vitamin D -- but even that may not be high enough for our sun-deprived population!

In countries where sun exposure provides the equivalent of 10,000 IU a day and people have vitamin D blood levels of 105 to 163 nmol/L, autoimmune diseases (like multiple sclerosis, type 1 diabetes, inflammatory bowel disease, rheumatoid arthritis, and lupus) are uncommon.

And don't be scared that amounts that high are toxic: As an example, one study of healthy young men receiving 10,000 IU of vitamin D for 20 weeks showed no toxicity.

So how can you get the right amounts of vitamin D?

Unless you're spending all your time at the beach, eating 30 ounces of wild salmon a day, or downing 10 tablespoons of cod liver oil a day, supplementation is essential! 

The exact amount needed to get your blood levels to the optimal range (100 to160 nmol/L) will vary depending on your age, how far north you live, how much time you spend in the sun, and even time of the year. But once you reach optimal levels, you'll be amazed at the results.

For example, one study found that vitamin D supplementation could reduce the risk of getting type 1 diabetes (an autoimmune disease) by 80 percent.  In the Nurses' Health Study (a study of more than 130,000 nurses over 3 decades), vitamin D supplementation reduced the risk of multiple sclerosis by 40 percent.

I've seen many patients with chronic muscle aches and pains and fibromyalgia who are vitamin D deficient -- a phenomenon that's been documented in studies.

What happens when these patients are treated with vitamin D? Their symptoms improve.

Finally, vitamin D has been shown to help prevent and treat osteoporosis - it's even more important than calcium. That's because your body needs vitamin D to be able to properly absorb calcium.

Without adequate levels of vitamin D, the intestine absorbs only 10 to 15 percent of dietary calcium. In fact, research shows that the bone-protective benefits of vitamin D keep increasing with the dose.

So what have my years of experience with this crucial nutrient taught me?

Here's my advice for getting optimal levels of vitamin D:

1. Get tested for 25 OH [JC1]vitamin D. The current ranges for "normal" are 25 to 137 nmol/L or 10 to 55 ng/ml[JC2].  These are fine if you want to prevent rickets -- but NOT for optimal health.  In that case, the range should be 100 to 160 nmol/L or 40 to 65 ng/ml.  In the future, we may raise this "optimal" level even higher.
 
2. Take the right type of vitamin D.  The only active form of vitamin D is vitamin D3 (cholecalciferol).  Look for this type.  Many vitamins and prescriptions of vitamin D have vitamin D2 -- which is not biologically active.

3. Take the right amount of vitamin D.  If you have a deficiency, you should correct it with 5,000 to 10,000 IU of vitamin D3 a day for 3 months -- but only under a doctor's supervision. For maintenance, take 2,000 to 4,000 IU a day of vitamin D3. Some people may need higher doses over the long run to maintain optimal levels because of differences in vitamin D receptors, living in northern latitudes, indoor living, or skin color.

4. Monitor your vitamin D status until you are in the optimal range.  If you are taking high doses (10,000 IU a day) your doctor must also check your calcium, phosphorous, and parathyroid hormone levels every 3 months[JC3].

5. Remember that it takes up to 6 to 10 months to "fill up the tank" for vitamin D if you're deficient.  Once this occurs, you can lower the dose to the maintenance dose of 2,000 to 4,000 Units a day.

6. Try to eat dietary sources of vitamin D. These include:

* Fish liver oils, such as cod liver oil. 1 TBSP (15 ml) = 1,360 IU of vitamin D
* Cooked wild salmon. 3.5 oz = 360 IU of vitamin D
* Cooked mackerel. 3.5 oz = 345 IU of vitamin D
* Sardines, canned in oil, drained. 1.75 oz = 250 IU of vitamin D
* One whole egg = 20 IU of vitamin D

You can see now why I feel so passionately about vitamin D.

This vitamin is critical for good health.

So start aiming for optimal levels -- and watch how your health improves.

Have you experienced any symptoms of vitamin D deficiency?

Do you think you are not getting enough sun?

Do you have any other suggestions for getting the optimal amount of vitamin D?

Have you experienced any health benefits from getting more sun or correcting a vitamin D deficiency you may have had?

Please let me know your thoughts by posting a comment below -- just click on the Add a Comment link.

Comments (1)
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Dr. Hyman

I am a 53 year woman who has been battling for answers for years.  Since the birth of my second child (soon to be 19 years old) I have been plagued with constant fatique and weight gain. I have  kept myself steady with my intake of food and have been told that I am tired because I am raising my two children.  Well, four years ago I had insisted on seeing an endocrinologist and actually demanded that I have enough test done to see what is really going on with me. When I given the results, I was told that there was good news and bad news.  The good was that I did not have Lupus, but the bad was that I had Hashimoto's Thyroiditis and that I was not to worry about it because it was quite common among woman.  I was given a script for Synthroid and off I went.  I was sent out into the world to enjoy my life.  However, with each passing year, I have been feeling worse and worse.  No one seems to understand why.  Just recently (very recently) I once again marched back into the endo's office and demanded again to have test done.  I was just given the results that I am Vitamin D deficient and my score is 16.1.  I was sent this information through the mail and given a script for vitamin D tabs (4 total) to be taken 1 pill per week and to retake the lab test in 3 months.  I never would have suspected that I was that low in vitamin D.  I totally agree with you when you mentioned that most physicians are not knowledgeable when it comes to nutrition. I have been searching, since my diagnosis of Hashimoto's , for a nutritional diet and have not found one yet.  Now I need it more than ever.

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