Vitamin D: Are You Getting Enough?

There has been a lot of recent research on vitamin D. Some has focused on its known benefits, notably its crucial role in working with calcium to keep bones strong. But many studies have looked at its potential to reduce the risk of everything from some common cancers and multiple sclerosis to diabetes, hypertension, and age-related muscle weakness. The research is promising.

Much of this research has linked the potential benefits to high blood levels of vitamin D—levels higher than most Americans and Canadians have. Thus, some prominent researchers recommend that people have their blood levels of D measured so that, if necessary, they can take enough supplemental D to get their levels into the "desirable" range. Some doctors have started testing many of their patients. Should you be tested? First, some basics about this special vitamin.

D basics
Vitamin D is unique in that your skin manufactures it just by being exposed to sun. The amount made depends on the time of day, season, how far north you live, skin pigmentation (darker skin makes less D), how much of your body is exposed to the sun, and your age (older people produce less D from sun exposure). Because D is fat soluble, the body can store it for the days or even months when you don’t get any sun or consume any D.

Few foods supply vitamin D. Milk is fortified with D and is the major dietary source, with 100 IU (international units) per cup. Some soy milks, orange juice, margarines, and breakfast cereals are also fortified. Fatty fish, such as salmon, tuna, and sardines, are naturally rich in D. But it’s hard to get adequate D from food alone. Thus, supplements are often necessary (see below).

Many people are deficient in vitamin D, especially those who are over 60, live at northern latitudes, have darker skin, or are rarely outdoors. In the northern U.S. and in Canada, blood levels drop markedly in the winter, when days are shorter, the sun is weaker, and we wear more clothes and spend less time outside. Many young people also have low blood levels of D, according to some recent studies. Obesity is associated with reduced blood levels.

Many of the foods we eat have no naturally occurring vitamin D. Fish such as salmon, swordfish, or mackerel is one big exception -- and can provide a healthy amount of vitamin D in one serving. Other fatty fish such as tuna and sardines have some "D," but in much lower amounts. Small amounts are found in egg yolk, beef liver, and fortified foods like cereal and milk. 

The case for testing
A recent meta-analysis in Archives of Internal Medicine of 18 studies found that people taking D supplements (usually 400 to 800 IU a day) had a 7% reduction in total mortality rates. In an accompanying editorial, Dr. Edward Giovannucci of Harvard concluded: "Given the high probability of benefit for at least some of the many conditions that have been associated with vitamin D deficiency, and the low likelihood of harm, it seems prudent that physicians measure serum 25-hydroxyvitamin D in their patients." That’s the form of D in the blood measured by the preferred test.
Among those advocating routine vitamin D testing is Dr. Bruce Hollis of the Medical University of South Carolina, who has been doing vitamin D research for 30 years. "Everyone needs to know his or her level of 25-hydroxyvitamin D," says Dr. Hollis, because of its potentially protective effect against chronic diseases. The amount of D in a multivitamin (usually 400 IU) and/or from exposing your face and arms to the sun for short periods may not be enough to reach desirable blood levels. An intake of even 800 to 1,000 IU a day won’t be enough for some people, he says. The body’s ability to make and utilize D varies from person to person. That’s why testing can be important.

Blood levels: what’s desirable
Most experts now agree that blood levels of at least 30 to 40 ng/ml (nanograms per milliliter of blood) of 25-hydroxyvitamin D are desirable. It’s often hard to achieve such levels via current recommended intakes of D and a little sun exposure. Many people, especially those over 60 and during the winter, have levels of 20 ng/ml or below. There is some debate, however, about what the optimal blood levels are. Dr. Hollis believes that 50 to 60 ng/ml is a better goal.

Exposing your arms and legs or your full body to the midday sun without sunscreen (and not in winter in the northern half of the U.S. or in Canada) can produce high blood levels of D, but can cause skin cancer. That leaves supplements as the best option, unless you know your blood level is in the desirable range.

Practical matters
If you ask for the blood test for vitamin D, your doctor may well say it isn’t necessary. It costs about $100, and insurance may not pay for it unless you have osteoporosis or another condition potentially related to vitamin D deficiency. And if the test shows low D levels and you start taking higher doses of D, you should repeat the test to make sure you’re getting into the desirable range. Keep in mind, too, that blood levels of D vary markedly by season—with the lowest readings in late winter and early spring. A result of 25 ng/ml may be okay for late winter, for instance, but is low for late summer.

Bottom line: It’s too early to recommend vitamin D testing for everyone. The large, long-term clinical studies that would justify routine screening have not yet been done. But talk to your doctor about testing, especially if you are over 60, for instance, or have low bone density. In any case, consider taking 800 to 1,000 IU of supplemental D a day. For most people, that should raise blood levels to the desirable range (above 30 ng/ml) or at least close to it.

How much D to take
The official recommended daily intakes for vitamin D, devised by the Institute of Medicine, are 200 IU (international units) for people 50 and younger, 400 IU for those 51 to 70, and 600 IU for those 71 and older. Most people don’t consume that much D, unless they drink lots of milk and/or take a multivitamin. However, many researchers believe those guidelines are too low, and that a better goal for everyone, especially those over 60 and/or with darker skin, is 800 to 1,000 IU a day. Some people with low blood levels of D may need even higher intakes to reach the desirable range.
Thus, fifteen leading nutrition experts last year urged the Institute of Medicine to increase its recommended intakes of D. Meanwhile, the Canadian Cancer Society now advises all Canadian adults to take 1,000 IU of D a day during fall and winter, and older and darker-skinned people to take this much year round. That is good advice for most Americans as well.

The official "Upper Limit" for D, set many years ago, is 2,000 IU a day. It’s possible to get that much, or more, if you consume milk, other fortified foods, and fatty fish, and also take a multivitamin and combined calcium/D supplement. However, a review article in the American Journal of Clinical Nutrition last January concluded that D is not toxic up to 10,000 IU a day. We don’t recommend that much, but you needn't worry if you get somewhat more than 2,000 IU.

Calcium and D may help burn fat

Overweight women who take supplements of calcium and vitamin D may be able to lose more body fat, but only if they weren’t getting much calcium before. Researchers writing in the British Journal of Nutrition gave 63 overweight women a calcium and D supplement and tracked them for 15 weeks while they followed a low-calorie diet. In the study group as a whole, the supplement didn’t help people lose more body fat, but women who started with low levels of calcium seemed to lose more weight and fat. When watched eating at a buffet, those women also ate less fat than they did during a meal at the beginning of the study. Women with low calcium levels at the beginning of the study who got the supplements lost an average of 13 pounds, compared to 3 pounds for those on placebos.

Why Should I Care If I'm Sufficient or Deficient in Vitamin D?

I know, it sounds like snake-oil. How can Vitamin D possibly have an effect on so many chronic diseases and conditions?

Simple--every cell and tissue in the body has a Vitamin D receptor--and all of them depend upon D for optimal health. Here's just a sampling of the bad things that can happen if you aren't getting enough.

• Cardiovascular disease - increase risk of heart attack 142% if under 15 ng/mL
• Cancer - if you live in a northern latitude you have a higher risk of colorectal, breast, & prostate cancers. Projected 50% risk reduction with over 1000 IUs a day. Adequate Vitamin D actually inhibits cancer cell growth.
• Autoimmune Diseases
• Osteoporosis/fractures - study after study shows the necessity of Vitamin D to absorb calcium & build strong bones. With sufficient Vitamin D you'll absorb 30% of the calcium in your diet. Without Vitamin D, the absorption rate drops to 10-15%. Although Dr. Holick recommends a Vitamin D level of 50 as the optimal number to prevent osteoporosis, Dr. Heike A. Bischoff-Ferrari concluded that the optimal level of vitamin D to prevent hip and nonvertebral fractures in older adults should be at 75 nmol/l. ("Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes" inSunlight, Vitamin D and Skin Cancer, edited by Jorg Reichrath, 2008)
• Respiratory infections & flu - Yes, believe it! Your immune system hums with D. Cytokine & immunoglobulin production is regulated by Vitamin D. 2009 Archives of Internal Medicine article shows the higher the Vitamin D, the lower the risk of upper respiratory tract infections.
• Osteomalacia - generalized & isolated bone pain - it can vanish with adequate Vitamin D
• Arthritis - both rheumatoid & osteoarthritis
• Multiple sclerosis -risk increases the further one gets from the equator. Studies show the risk is reduced for outdoor workers, and in people with higher levels of Vitamin D.
• Schizophrenia - risk diminished in infants supplemented with D in first year of life.
• Type 1 Diabetes - Finnish study showed an 80% reduction in developing Type 1 diabetes for infants receiving adequate Vitamin D supplementation.
• Dementia - both vascular and Alzheimer's
• Fibromyalgia is often a misdiagnosed Vitamin D deficiency causing generalized muscle aches & pains.
• Type 2 diabetes. May exacerbate type 2 diabetes & impair insulin production. Obesity, associated with type 2 diabetes, prevents adequate Vitamin D absorption.

Why Are So Many of Us Vitamin D Deficient & What Gets in the Way of Absorbing Adequate Vitamin D?

• We're Indoors & Wear Sunscreen. We spend most of our time indoors & when we're outside we're slathered in sunscreen, or mostly covered up with clothes. Dermatologists have been telling us to wear sunscreen & avoid the sun for almost 40 years. An SPF 15 reduces Vitamin D absorption by 95-99%
• No Mid-day Sun. To get adequate Vitamin D from the sun you would have to be exposed to the sun in the peak hours of 10 am to 3 pm.
• It's a Vitamin D Deficiency Epidemic! Vitamin D deficiency (a level under 30 ng/mL) is epidemic in adults over 50 (over 70% of us); 50% of children are deficient; 42% of young adults are deficient; and Vitamin D deficiency even exists in California, Florida, Arizona, and Saudi Arabia. Personally, I don't know a single friend who wasn't deficient when they were first tested.
• It's an Age Thing. Age decreases the ability of the skin to make Vitamin D. A 20 year old makes 3 times more Vitamin D than a 70 year old.
• Dark Skin Color. African-Americans need to be out in the sun 5-10 times longer to get enough Vitamin D. They are walking around with a natural SPF of 15. Many researchers believe that the excessively low levels of D in African Americans may be responsible for their higher rates of prostate cancer, hypertension, and diabetes. 
• Obesity. The more you weigh, the less Vitamin D is getting into your blood stream. Obese people can only utilize 50% of their Vitamin D--because it ends up in their body fat & can't get into their blood stream. They need to get 2-3 times as much Vitamin D from the sun or supplements to bring their levels up to normal.
• Kidney disease & Liver Damage. Either one will impair the body's ability to activate circulating Vitamin D.
• Certain Drugs Inhibit Absorption of Vitamin D. Like anticonvulsants, bile acid sequestrants (for cholesterol), Tagamet, corticosteroids, and heparin.

How Do I Find Out What My Level of Vitamin D Is?

• Ask your doctor to order a simple, low cost 25-hydroxyvitamin D test for you. It's the only way to know what your baseline is. Then follow-up a few months later if you are deficient.
• For optimal health aim for Dr. Holick's goal of 50 ng/mL. Absolutely get yourself up to 30 ng/mL. You're safe up to 100 ng/ML. And it's impossible to get too much Vitamin D from the sun--the body will regulate it. With supplements you would have to take over 10,000 IUs/a day, for six months to have Vitamin D intoxication. Lifeguards wearing no sunscreen have been tested--they have super-high levels, and no intoxication.
• Every 100 IUs of Vitamin D you take, you can figure it will raise your Vitamin D level by 1 point, assuming you are not obese--which necessitates increasing the level by 50% or more.
• For those who are very low in Vitamin D, under physician guidance, you may need to take 50,000 IUs of Vitamin D2 (yes, D2--is now confirmed to be just as good as D3) once a week for 8 weeks, then 50,000 IUs every 2 weeks "forever" after, according to Holick.

How Much Vitamin D Can I Get Naturally From the Sun? What's Safe?

• You can get your Vitamin D from the sun, from April-September if you live north of Atlanta, Georgia, and it is the best source of Vitamin D.
• If you are sunbathing mid-day on Cape Cod in the summer, wearing a bathing suit, without sunscreen, and you have fair skin, you will get 10,000-20,000 IUs of Vitamin D in just 15 minutes of exposure. Do that 2-3 times a week and you'll build up a healthy storehouse.
• The body is able to store the Vitamin D it gets from the sun far longer than it can store the Vitamin D it gets from supplements.
• Mother Nature has designed the body to store the Vitamin D we get from the sun in our body fat, and release it when we aren't "making" any more.
• Our Vitamin D levels peak in the summer--but in you are barely Vitamin D sufficient at the end of the summer (a level of 30 ng/mL) you will deplete those stores in one month. By the end of the winter, you will be severely Vitamin D deficient, unless you are taking a supplement.
• Sensible sun exposure. Here's what Dr. Holick advocates. 10-15 minutes of exposure on arms & legs in the peak sun hours of 10 am - 3 pm, two or three times a week. Use a sunscreen on your face, and after 10-15 minutes get out of the sun or slather up. Overexposure can increase non-melanoma skin cancer. 10-15 minutes is not overexposure.
• To get exact guidance on how long you would need to stay in the sun to get enough Vitamin D, based on where you live, your skin type, the time of day, & the time of year--take a look at Dr. Holick's book, The UV Advantage, or try Dr. James Dowd's online sun exposure calculator.
• Vitamin D from the sun & depression. Although Vitamin D is known to lessen depression and boost the mood--unfortunately, only the natural kind from the sun has this effect.

What About Skin Cancer? I Thought It Was Risky to Be Out in the Sun Without Sunscreen?

• The American Academy of Dermatologists is still not recommending that we go out in the sun without sunscreen for any amount of time. They are recommending we take supplements and eat fish. But remember, Dr. Holick is only recommending short sun exposure with the face protected by sunscreen, and the truth of it is--melanoma, the most dangerous of skin cancers, is usually found in the unexposed parts of the body that never see sunlight.
• Interestingly, occupational sun exposure decreases the risk of malignant melanoma and lifetime sun exposure is associated with a lower risk for malignant melanoma.
• The Dermatological & Cancer Societies of Australia have recently changed their position on sun exposure. Now that studies have shown that 30-50% of Australian's are Vitamin D deficient because the sunscreen campaigns have been so successful, the Aussies are rethinking "their sunscreen message". Their new message: Get sensible sun exposure. Enough to get adequate Vitamin D, not too much to increase cancer.

Any Special Recommendations for Pregnant Women & Infants?

• Vitamin-D deficient infants will never attain their genetically preprogrammed bone density or height. That's one scary thought!
• A Boston study looked at 40 mother-infant pairs--the moms took the recommended 400 IU/day Vitamin D in their prenatal vitamin and drank 2.3 glasses of milk a day--at birth, 76% of moms were Vitamin D deficient--81% of newborns were deficient.
• All pregnant women need get 1000 IUs a day in addition to the Vitamin D in their prenatal vitamin, and an additional 200 IUs from their diet, according to Holick.
• Higher Vitamin D levels decreased the likelihood of preeclampsia, and reduced the need for C-sections.
• Moms who got adequate Vitamin D during pregnancy reduced the risk of wheezing disorders in their children by 61%.
• Breast-feeding moms need to be vigilant that their babies are getting enough Vitamin D. The breast milk of moms who are not getting enough Vitamin D has a paltry 25 IUs of Vitamin D per liter (1 quart, 2 ounces). Not even close to the 400 IUs their babies need. It would take 4000-6400 IUs/a day for a breast-feeding mom to get enough Vitamin D into her breast milk to meet the baby's requirement of 400 IUs a day. But according to Holick, until more studies are done, "it's not something we're recommending." Hopefully, we'll be able to in the near future." In the meantime--breast-feeding moms need to make sure their babies are getting 400 IUs/a day of a Vitamin D supplement.

What Kind of Supplementation Does Dr. Holick Recommend?

• 1000-1500 IUs/a day for most children
• 1500-2000 IUs/a day for adults
• All pregnant women need get 1000 IUs a day in addition to the Vitamin D in their prenatal vitamin, and an additional 200 IUs from their diet.
• The American Academy of Pediatrics now recommends 400 IUs/a day for infants.
• In August 2009 Dr. Holick participated in an Expert Panel convened by the Institute of Medicine to work on new recommendations for Vitamin D--in light of all the research that has come out recently. Expect new standards sometime around the Spring of 2010.

Can You Get Enough Vitamin D from Diet Alone? Not Likely!

• The only food that contains Vitamin D, is oily fish, like wild (not farmed) salmon--clocking in at 500-1000 IU a serving. See a Boston University breakdown of Vitamin D for various fish here.
• Cod Liver Oil is an OK source.
• Some foods are fortified, but at a typical 100 IUs a serving that's about 10 glasses of milk a day.

Want to learn more?

Listen to Dr. Holick and Dr. James Dowd on the People's Pharmacy

The American Academy of Pediatrics updated Vitamin D guidelines for infants & children

The Audio-Digest Family Practice Summary of "Vitamin D: the Vital Vitamin". 57(12): Mar. 28, 2009

NPR Transcript from the Living on Earth broadcast of "Skin Color and Vitamin D"

Why Is Vitamin D My Favorite Vitamin? Let Me Count the Reasons

"Institute of Medicine Studies a Boost In Vitamin D". AMA News April 20, 2009

Gretchen Reynolds. Phys Ed. Can Vitamin D Improve Your Athletic Performance? New York Times Sept. 23, 2009

Vitamin D may boost heart health during weight loss

Supplements of vitamin D may improve cardiovascular health during weight loss, without impacting on how many pounds are shed, suggests a new study.

Writing in this month’s issue of the American Journal of Clinical Nutrition, German researchers report that a daily dose of vitamin of 83 micrograms per day had lower levels on triglycerides and markers of inflammation like tumour necrosis factor-alpha (TNF-alpha).
"The results indicate that a vitamin D supplement of 83 micrograms/d does not adversely affect weight loss and is able to significantly improve several cardiovascular disease risk markers in overweight subjects with inadequate vitamin D status participating in a weight-reduction program," wrote the authors, led by Armin Zittermann from the Clinic for Thorax and Cardiovascular Surgery in Bad Oeynhausen.

With obesity rates still high – not only in developed countries but also, increasingly, in newly wealthy emerging markets, there is considerable attention to ways to trim down waistlines. The results of the new randomised, double-blind, placebo-controlled trial indicate that vitamin D supplements may be useful as a means of boosting heart health during weight loss.

The details on D

Vitamin D refers to two biologically inactive precursors - D3, also known as cholecalciferol, and D2, also known as ergocalciferol. The former, produced in the skin on exposure to UVB radiation (290 to 320 nm), is said to be more bioactive.

While our bodies do manufacture vitamin D on exposure to sunshine, the levels in some northern countries are so weak during the winter months that our body makes no vitamin D at all, meaning that dietary supplements and fortified foods are seen by many as the best way to boost intakes of vitamin D.

In adults, it is said vitamin D deficiency may precipitate or exacerbate osteopenia, osteoporosis, muscle weakness, fractures, common cancers, autoimmune diseases, infectious diseases and cardiovascular diseases. There is also some evidence that the vitamin may reduce the incidence of several types of cancer and type-1 diabetes.

On the downside, the researchers noted that participants receiving the vitamin D supplements did experience an average 5.4 per cent increase in their levels of LDL-cholesterol.

Source for Vitamin D?
Vitamin D is measured in international units (IUs); most adults should get between 600 and 800 IUs per day. So, what foods are best for vitamin D? Most foods don’t contain much vitamin D—the best source for vitamin D is actually sunlight. You only need about 10 to 15 minutes of sun exposure a few times a week to reap the benefits.  You can supplement your vitamin D intake with these foods:

• Swordfish: 566 IUs per serving
• Salmon: 447 IUs
• Canned tuna: 154 IUs
• Fortified orange juice: 137 IUs
• Fortified milk: 115 to 124 IUs
• Eggs: 41 IUs

Vitamin D and Mental Health

Vitamin D does play a role in mental illness based on these reasons from the Vitamin D Council's website:

1. 1. Epidemiological evidence shows an association between reduced sun exposure and mental illness.
2. 2. Mental illness is associated with low 25-hydroxyvitamin D [25(OH)D] levels.
3. 3. Mental illness shows a significant comorbidity with illnesses thought to be associated with vitamin D deficiency.
4. 4. Theoretical models (in vitro or animal evidence) exist to explain how vitamin D deficiency may play a causative role in mental illness.
5. 5. Studies indicate vitamin D improves mental illness.

Here's even more details, according to the Vitamin D Council:

* Mental illness has increased as humans have migrated out of the sun.

* There is epidemiological evidence that associates vitamin D deficiency with mental illness. Two small reports studied the association of low 25(OH)D levels with mental illness and both were positive.

* Depression has significant co-morbidity with illnesses associated with hypovitaminosis D such as osteoporosis, diabetes, heart disease, hypertension, multiple sclerosis, and rheumatoid arthritis.

* Vitamin D has a significant biochemistry in the brain. Nuclear receptors for vitamin D exist in the brain and vitamin D is involved in the biosynthesis of neurotrophic factors, synthesis of nitric oxide synthase, and increased glutathione levels--all suggesting an important role for vitamin D in brain function. Rats born to severely vitamin D deficient dams have profound brain abnormalities. 

When NOT to Take Extra Vitamin D

 

 

 Dr. Eric Berg explains in this video

Vitamin D to end hair loss?

No matter your gender or age, hair loss can be traumatic to anyone. However, with new research, it appears that we’re inching closer and closer to stopping hair loss in its tracks. Recently, scientists discovered that vitamin D seems to reactivate hair follicles that shut down in hair loss. So what does that mean for you?

“We do believe that for that reason vitamin D does play a significant role in the hair growth cycle,” says Miami dermatologist Dr. Janice Lima-Maribona. “We do know that at the follicular level there are receptors for vitamin D, and a lot of people do claim that after taking vitamin D they notice a significant improvement with hair growth and quality.”

That said, when doctors treat hair loss, they typically recommend taking a full spectrum of vitamins along with other treatments to see results. Another factor that comes into play when treating hair loss is the reason behind it.

Most men lose hair due to genetics and male pattern baldness, but women tend to have reactive hair loss. That means that their hair is being lost because of a reaction to outside causes such as a crash diet, divorce or surgery. “These things that are a shock to the body create stress, and the hair reacts and starts falling out,” says Dr. Lima-Maribona.

According to a study we reported in the past, marital status is the second biggest cause of hair loss in women. The study examined twins that were genetically programmed to experience hair loss and found that "if one twin loses more hair than the other, it is related to external factors,” says Cleveland plastic surgeon Bahman Guyuron, MD, American Society of Plastic Surgeons Member Surgeon and co-author of the study.

Other things that can cause hair loss are reactions to different hair treatments and products, as well as frequent trauma to the hair from heat styling. The best way to determine the cause of your hair loss and find a treatment is to visit a board-certified dermatologist or hair loss specialist.

In power of vitamin D, hope for a new disease fighter

In a Newark laboratory, researchers watch as mice stricken with multiple sclerosis suddenly walk. They peer into microscopes and see the growth of breast cancer cells dramatically slowed.


They are examining, up close, the power of vitamin D.

"We're believers," said Sylvia Christakos, a longtime vitamin researcher at UMDNJ-New Jersey Medical School.

Many others are following. A spate of provocative studies shows the potential health benefits of vitamin D on everything from breast, prostate and colon cancer to auto- immune disorders such as Type I diabetes, rheumatoid arthritis, lupus and multiple sclerosis.

The so-called "sunshine vitamin" may even protect the heart.

Some researchers, citing widespread vitamin D deficiencies among Americans, call current federal guidelines outdated and argue most people need far more of the nutrient than they get from food, multi-vitamins and the sun.

Others say more research is needed before Americans start downing supplements or exposing unprotected skin to height-of-the- day sun, whose ultraviolet rays help create the vitamin.

Few researchers, however, have studied the nutrient more closely than Christakos.

"There is finally more of a recognition of the value of vitamin D to prevent various diseases," she said. "But it's cheap and over-the-counter so you won't turn on the television and see commercials pushing vitamin D."

In a review scheduled for publi cation this week in the online Journal of Cellular Biochemistry, Christakos and her team conclude proper blood levels of vitamin D can protect people from multiple sclerosis. The review said the nutrient may help maintain balance in the immune system.

The team looked at MS in mice, and found those treated early with an active form of vitamin D improved dramatically. The stricken mice, once paralyzed, were able to walk, though Christakos said that does not mean the same will happen for people with MS.

The lab has gone a step further to show how vitamin D may work on a genetic level. Working with researchers from Stanford University, they showed how vitamin D likely inhibits a key inflammatory response involved in MS.

The data on vitamin D is accumulating. For example:

A Canadian study found women with breast cancer were nearly twice as likely to see their cancer spread, and far more likely to die, if deficient in the vitamin.

A 2007 study in the American Journal of Clinical Nutrition concluded improving calcium and vitamin D levels substantially reduces all cancer risk in post-menopausal women.

In last year's New England Journal of Medicine, researcher Michael F. Holick of Boston University School of Medicine cited a study that found elderly French women given 1,200 mg of calcium and 800 international units (IU) of vitamin D daily for three years reduced their risk of hip fracture by 43 percent.

Holick cited another study that found women who took more than 400 IU of vitamin D had a 42 percent reduced risk of developing multiple sclerosis. Another study found that 10,366 Finnish children who were given 2,000 IU of vitamin D per day during their first year of life and were followed for 31 years had their risk of developing Type I diabetes reduced by 80 percent.

Holick said Americans should take at least 1,000 IU of vitamin D daily as well as a multivitamin with another 400 IU. Christakos said vitamin D supplements are especially important for those at risk of immune disorders, such as siblings of people with Type I diabetes or MS.

Government guidelines, however, recommend just 200 IU for those under 50; 400 for those 51-70; and 600 for those over 70.

Jennifer Koentop, a spokeswoman for the U.S. Department of Health and Human Services, said the government is negotiating with the Institute of Medicine, a national advisory organization, to review the vitamin D guidelines.

Humans once routinely absorbed vitamin D from the sun, but when jobs and society moved in doors exposure to sunlight dropped. Holick estimates half of all Americans are vitamin D defi cient. Deficiency rates among African-Americans may be higher.

Reinhold Veith, a researcher at the University of Toronto, said people can safely put on a bathing suit and expose much of their skin, without sunscreen, for as little as five minutes several times a week to obtain vitamin D.

Most dermatologists disagree, however. The American Academy of Dermatology, on its website, said people who want additional vitamin D should use supplements to prevent skin cancer and damage.

Debate continues over supplements, too. Laura Byham-Gray, associate professor of nutritional sciences at the UMDNJ-School of Health Related Professions, does not recommend higher doses.

"What we consider a vitamin D deficiency is still under debate," she said. She cites the hype that once surrounded vitamin E, which researchers later learned actually increased mortality.

Vitamin D proponents said as much as 10,000 IU daily will not cause toxicity.

"Policy makers want a high level of evidence before committing themselves," Veith said. "But all the accumulating evidence on vita min D has been like a slow rising sun. When do you call it daytime?"

Low vitamin D means fatter, weaker muscles

Insufficient blood levels of vitamin D may be associated with the accumulation of fat in muscle tissue, leading to lower muscle strength, says a new study.

A study with 90 young women aged between 16 and 22 found that almost 60 per cent were vitamin D insufficient, and that muscle fat levels were higher in these women, compared with women with normal vitamin D levels, according to findings published in the Journal of Clinical Endocrinology and Metabolism.

The findings are said to be the first to show a clear link between Vitamin D levels and the accumulation of fat in muscle tissue, and add to an ever growing body of science supporting the benefits of maintaining healthy vitamin D levels.

In adults, it is said vitamin D deficiency may precipitate or exacerbate osteopenia, osteoporosis, muscle weakness, fractures, common cancers, autoimmune diseases, infectious diseases and cardiovascular diseases. There is also some evidence that the vitamin may reduce the incidence of several types of cancer and type-1 diabetes.

Vitamin D refers to two biologically inactive precursors - D3, also known as cholecalciferol, and D2, also known as ergocalciferol. The former, produced in the skin on exposure to UVB radiation (290 to 320 nm), is said to be more bioactive.

While our bodies do manufacture vitamin D on exposure to sunshine, the levels in some northern countries are so weak during the winter months that our body makes no vitamin D at all, meaning that dietary supplements and fortified foods are seen by many as the best way to boost intakes of vitamin D.

The Endocrine Society issued the guidelines in response to the possible health risks associated with vitamin D deficiency. Among the group's recommendations:

• People who are considered at high risk should be routinely screened for vitamin D deficiency.
• People who are diagnosed with a vitamin D deficiency should be treated with either a vitamin D2 or vitamin D3 supplement.

To maximize bone health and muscle function, people considered at high risk for a deficiency should adhere to the following guidelines for dietary intake of vitamin D:
Infants up to 12 months of age require at least 400 international units (IU) a day.

• Children older than 1 year and adults from 19 to 70 years old, including pregnant and lactating women, should consume at least 600 IU daily.
• People older than 70 years should get a minimum of 800 IU a day.

The task force stressed that in order to raise the blood level of vitamin D consistently above 30 nanograms per milliliter, a significantly higher intake of vitamin D may be required. The group also noted that vitamin D screening is not necessary for people who are not considered at risk for the deficiency. And, it said there is no evidence supporting use of vitamin D supplements for benefits other than bone health.

Extra Vitamin D and Calcium Aren’t Needed, Report Says

The very high levels of vitamin D that are often recommended by doctors and testing laboratories — and can be achieved only by taking supplements — are unnecessary and could be harmful, an expert committee says. It also concludes that calcium supplements are not needed.

The group said most people have adequate amounts of vitamin D in their blood supplied by their diets and natural sources like sunshine, the committee says in a report that is to be released on Tuesday.

“For most people, taking extra calcium and vitamin D supplements is not indicated,” said Dr. Clifford J. Rosen, a member of the panel and an osteoporosis expert at the Maine Medical Center Research Institute.

Dr. J. Christopher Gallagher, director of the bone metabolism unit at the Creighton University School of Medicine in Omaha, Neb., agreed, adding, “The onus is on the people who propose extra calcium and vitamin D to show it is safe before they push it on people.”

Over the past few years, the idea that nearly everyone needs extra calcium and vitamin D — especially vitamin D — has swept the nation.

With calcium, adolescent girls may be the only group that is getting too little, the panel found. Older women, on the other hand, may take too much, putting themselves at risk for kidney stones. And there is evidence that excess calcium can increase the risk of heart disease, the group wrote.

As for vitamin D, some prominent doctors have said that most people need supplements or they will be at increased risk for a wide variety of illnesses, including heart disease, cancer and autoimmune diseases.

And these days more and more people know their vitamin D levels because they are being tested for it as part of routine physical exams.

“The number of vitamin D tests has exploded,” said Dennis Black, a reviewer of the report who is a professor of epidemiology and biostatistics at the University of California, San Francisco.

At the same time, vitamin D sales have soared, growing faster than those of any supplement, according to The Nutrition Business Journal. Sales rose 82 percent from 2008 to 2009, reaching $430 million. “Everyone was hoping vitamin D would be kind of a panacea,” Dr. Black said. The report, he added, might quell the craze.

“I think this will have an impact on a lot of primary care providers,” he said.

The 14-member expert committee was convened by the Institute of Medicine, an independent nonprofit scientific body, at the request of the United States and Canadian governments. It was asked to examine the available data — nearly 1,000 publications — to determine how much vitamin D and calcium people were getting, how much was needed for optimal health and how much was too much.

The two nutrients work together for bone health.

Bone health, though, is only one of the benefits that have been attributed to vitamin D, and there is not enough good evidence to support most other claims, the committee said.

Some labs have started reporting levels of less than 30 nanograms of vitamin D per milliliter of blood as a deficiency. With that as a standard, 80 percent of the population would be deemed deficient of vitamin D, Dr. Rosen said. Most people need to take supplements to reach levels above 30 nanograms per milliliter, he added.

But, the committee concluded, a level of 20 to 30 nanograms is all that is needed for bone health, and nearly everyone is in that range.

Vitamin D is being added to more and more foods, said Paul R. Thomas of the Office of Dietary Supplements at the National Institutes of Health. Not only is it in orange juice and milk, but more is being added to breakfast cereals, and it now can be found in very high doses in supplement pills. Most vitamin D pills, he said, used to contain no more than 1,000 international units of it. Now it is easy to find pills, even in places like Wal-Mart, with 5,000 international units. The committee, though, said people need only 600 international units a day.

To assess the amounts of vitamin D and calcium people are getting, the panel looked at national data on diets. Most people, they concluded, get enough calcium from the foods they eat, about 1,000 milligrams a day for most adults (1,200 for women ages 51 to 70).

Vitamin D is more complicated, the group said. In general, most people are not getting enough vitamin D from their diets, but they have enough of the vitamin in their blood, probably because they are also making it naturally after being out in the sun and storing it in their bodies.

The American Society for Bone and Mineral Research and other groups applauded the report. It is “a very balanced set of recommendations,” said Dr. Sundeep Khosla, a Mayo Clinic endocrinologist and the society’s president.

But Andrew Shao, an executive vice president at the Council for Responsible Nutrition, a trade group, said the panel was being overly cautious, especially in its recommendations about vitamin D. He said there was no convincing evidence that people were being harmed by taking supplements, and he said higher levels of vitamin D, in particular, could be beneficial.

Such claims “are not supported by the available evidence,” the committee wrote. They were based on studies that observed populations and concluded that people with lower levels of the vitamin had more of various diseases. Such studies have been misleading and most scientists agree that they cannot determine cause and effect.

It is not clear how or why the claims for high vitamin D levels started, medical experts say. First there were two studies, which turned out to be incorrect, that said people needed 30 nanograms of vitamin D per milliliter of blood, the upper end of what the committee says is a normal range. They were followed by articles and claims and books saying much higher levels — 40 to 50 nanograms or even higher — were needed.

After reviewing the data, the committee concluded that the evidence for the benefits of high levels of vitamin D was “inconsistent and/or conflicting and did not demonstrate causality.”

Evidence also suggests that high levels of vitamin D can increase the risks for fractures and the overall death rate and can raise the risk for other diseases. While those studies are not conclusive, any risk looms large when there is no demonstrable benefit. Those hints of risk are “challenging the concept that ‘more is better,’ ” the committee wrote.

That is what surprised Dr. Black. “We thought that probably higher is better,” he said.

He has changed his mind, and expects others will too: “I think this report will make people more cautious.”

Vitamin D

It's suddenly one of the most popular vitamins on the planet, and for good reason. This nutrient has wide-ranging health impacts: More than 1,000 human and lab studies indicate that vitamin D is not only essential for calcium absorption (the two are often paired together for this reason) but may also ward off breast, colorectal, ovarian, and other cancers. 

And getting too little vitamin D could cause premature death from heart disease, according to a recent study. Not to get too laundry list-y, but more research shows that D may also regulate immunity, relieve backaches, lower diabetes risk, and even fight depression.

However, up to 53% of us may not get enough vitamin D from sources such as direct sunlight or food (fish and fortified dairy, for example), reports the National Institutes of Health--and current guidelines have recently been dismissed by experts as insufficient.
How to get it:
Nicknamed the sunshine vitamin, D is the only vitamin our body produces on its own with 10 to 15 minutes of sunlight exposure. But since it's tough to get enough from food and sunlight (especially during non-summer months and if you wear sunscreen), take a supplement to achieve optimal levels.
Vitamin D is found in multivitamins or stand-alone supplements; it's also commonly coupled with calcium.

Good food sources

Fish such as salmon, herring, and sardines; fortified milk and cereals; veal; beef; and egg yolks.
Dosage: Current government guidelines call for 200 IU daily for women under age 51, 400 IU for women ages 51 to 70, and 600 IU for women age 71 and older, but this is a hotly debated area of science right now. Many researchers believe we may need 1,000 IU or more for optimal health.
Precautions: Because vitamin D is stored in the body (what's known as being "fat soluble"), it can potentially reach toxic levels and cause high blood pressure and kidney damage, if you take super-high doses for a long time. People who take estrogen or diuretics may get D from medication side effects, so ask your doctor before starting a supplement. People who take antacids, certain blood pressure meds, and some other drugs may get too little D and require additional supplements.

Did you know...

You can reduce your risk of developing colon, breast, and esophageal cancers by 30 to 50% just by getting enough vitamin D.

Eggland’s Best Eggs

Eggland's Best, Inc. (EB), New York, NY, has increased the nutritional value of all its egg varieties (large, extra large, jumbo, cage-free and organic), which now contain four times more vitamin D and three times more omega-3 compared to ordinary eggs, according to the company. EB eggs also contain high levels of vitamin B12 and vitamin E, and are a “good source” of vitamin A and vitamin B2. Additionally, they contain 25% less saturated fat.

As part of a healthy diet, recent studies indicate increased Vitamin D consumption can help prevent diabetes.[1] Additionally, a low level of Vitamin D has also been linked to obesity in study participants and individuals experiencing chronic pain.[2] Ongoing research also shows a diet rich in Omega-3 can help reduce one’s risk of high cholesterol and cardiovascular disease.[3]

“After extensive testing and development, we have successfully increased the nutritional value of Eggland’s Best eggs without sacrificing EB’S great taste or increasing the price,” said Charlie Lanktree, CEO of Eggland’s Best. “EB eggs have always been the better eggs and now they are even more nutritious.”

When incorporated into a healthy diet, EB eggs can provide a simple way to increase the nutrient intake of several nutrients most Americans lack in their diet. “One of the major barriers to healthy eating is lack of convenience,” said registered dietitian Julie Upton, MS, RD, co-author of Energy to Burn: The Ultimate Food and Nutrition Guide to Fuel Your Active Life. “With increased amounts of Vitamin A, B2, B12, D and Omega-3 plus several other vitamins and minerals, Eggland’s Best eggs are a convenient nutrient booster. As a healthy breakfast or snack, EB eggs provide the nutrition and energy to help you stay nourished and active all day long.”

[1] “Benefit Of Vitamin D In Diabetes And Other Chronic Diseases,” MedicalNewsToday.com. 13 Jan 2009. http://www.medicalnewstoday.com/articles/135257.php

[2] McCarthy MF, “Poor vitamin D status may contribute to high risk for insulin resistance, obesity, and cardiovascular disease in Asian Indians,” Medical Hypotheses. 2009 Jun;72 (6):647-51. Epub 2009 Feb 12.
http://www.ncbi.nlm.nih.gov/pubmed/19217213
Turner MK, Hooten WM, Schmidt JE, Kerkvliet JL, Townsend CO, Bruce BK, “Prevalence and clinical correlates of vitamin D inadequacy among patients with chronic pain,” Pain Medicine. 2008 Nov;9(8):979-84. Epub 2008 Mar 11.
http://www.ncbi.nlm.nih.gov/pubmed/18346069

The Growing Importance Of Vitamin D In Possible Cancer Prevention

A new study reports that a daily dose of vitamin D can cut the cancer risk by 25 percent.

"This is arguably the most important vitamin to all of our health in terms of preventing diseases, and actually potentially treating some existing conditions," Ashton said.

But according to one study 40 to 70 percent of Americans may be vitamin D deficient because they live in northern latitudes and/or don't spend enough time outdoors.

There are ways to get more vitamin D. She said 15 to 20 minutes of sunlight -- when you protect your hands and your face -- is considered a dose, while a daily supplement can be just as effective.

A doctor can determine vitamin D levels through a blood test. But you shouldn't overdo it: too much vitamin D can be toxic.

A blood level between 20 and 100 is ideal. Healthy adults can take 2,000 to 3,000 units a day in supplementary form, and children can take an additional 400 to 1000 units.

Some people are vitamin D deficient, including the elderly, people who are pale-skinned, overweight, dark-skinned and those who live in northern latitudes.

Another cancer headline concerning conflicting reports is whether taking antidepressant drugs like Paxil or Prozac after surviving breast cancer is a good thing.

One Medco Research study found the risk of breast cancer among survivors on antidepressants doubled the risk of having the cancer return. Another study conducted in the Netherlands did not find any increased risk.

If you are on those type of anti-depressants, check with your doctor, and see if there’s something else that can treat your hot flashes.

Calcium, vitamin D and cancer risk

In a study conducted in 2007, researchers found that women taking a combination of calcium and vitamin D supplements had a 60 percent lower incidence of all cancers than women not taking the tested supplement.

Research in the June 2007 issue of the American Journal of Clinical Nutrition has shown a reduction in cancer rates among postmenopausal women taking vitamin D combined with calcium.

This four-year, double blind, randomized placebo-controlled study involved over 1,100 postmenopausal women who were divided into three treatment groups. The first group received a supplement containing calcium and vitamin D, the second group received just calcium, and the third group received a placebo. The researchers found that the women taking the calcium and vitamin D supplement had a 60 percent lower incidence of all cancers than women not taking the supplement.

This new study takes an important step in extending several decades of research involving the role of vitamin D in health and disease. The results further strengthen the case made by many specialists that vitamin D may be a powerful cancer preventive and that it is commonly found lacking in the general population, particularly the elderly.

Source: Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial, Lappe et al, The American Journal of Clinical Nutrition 2007 June;85(6):1586-91

Vitamin D : Many Americans don't get enough of a crucial vitamin

Dr. Michael Holick is one of the foremost authorities on vitamin D. And he's also the man behind a 2007 New England Journal of Medicine article that declared: "It has been estimated that 1 billion people worldwide have vitamin D deficiency or insufficiency."

On Holick's Web site, he notes that vitamin D is "made in the skin as a result of exposure to sunlight." And it's "not a vitamin, but a hormone."

Beyond sun rays, the National Institutes of Health notes that vitamin D is present in, among other things, fatty fish and beef liver. And it's added to items such as fortified milk, juice, yogurt, margarine and ready-to-eat cereal. It also comes in supplement form.

Local nutritionist Cece Davis discovered just how important it is to prevent vitamin D deficiency or insufficiency at a recent nutritionists' conference in Boston, where Holick asked his large audience for a show of hands.

Holick wanted to know how many people in the audience had checked their vitamin D status. Once prompted, about 30 to 40 percent of the audience members raised their hands, Davis recalled. Then Holick asked, "OK, of those people, how many of you were deficient?"

They all raised their hands.

Davis was stunned. After all, these were fellow health experts and, still, they were deficient.

"I was flat amazed at several things," Davis recalled of Holick's speech. "One, how much of a problem it really is and how it is linked to many diseases."

In Holick's journal article, he wrote that vitamin D plays a role in "decreasing the risk of many chronic illnesses, including common cancers, autoimmune diseases, infectious diseases and cardiovascular disease."

Among the causes of vitamin D deficiency Holick cites in his article are inadequate sun exposure; insufficient skin pigment to absorb UVB rays; aging; living above 35 degrees north latitude; obesity and "breast-feeding without vitamin D supplementation."

To prevent vitamin D deficiency, nutrition consultant Nancy Bacon, of the Oklahoma State Department of Health, recommended taking a multivitamin that includes vitamin D, eating vitamin D-rich foods and getting 10 to 15 minutes of sunlight on one's face and arms without sunscreen twice a week. "

However, if you have a family history (of skin cancer) or you are concerned about it, I would not go that route," she said. "I would definitely talk to your physician for specific recommendations."

When it comes to figuring out if a person is vitamin D deficient, Davis said, "The best thing to do is go to the doctor and have a blood test run. ... An alternate method is to assume most of us are deficient and to go ahead and purchase a vitamin D supplement."

Holick wrote, "providing children and adults with approximately at least 800 (international units) of vitamin D3 per day, or its equivalent, should guarantee vitamin D sufficiency unless there are mitigating circumstances."

Later, Holick wrote, "Unless a person eats oily fish frequently, it is very difficult to obtain that much vitamin D3 on a daily basis from dietary sources ... Thus, sensible sun exposure (or ultraviolet B irradiation) and the use of supplements are needed to fulfill the body's vitamin D requirement."