Healthy People Wont Reduce Their Fracture Risk By Taking Calcium And Vitamin D Supplements Sarah Leyland
We know that healthy people living in the community wont reduce their fracture risk by taking calcium and vitamin D supplements, Leyland says. However, people who may not be getting enough such as those who are housebound or live in sheltered accommodation can benefit from these supplements.
Still, researchers havent found clear evidence of that, either. One meta-analysis examining the prevention of fractures in community, nursing home and hospital inpatient populations concluded that vitamin D alone is unlikely to prevent fractures in the doses and formulations tested so far in older people. And some evidence suggests that high doses can actually result in an increased number of fractures and falls. One randomised study found that high-dose monthly vitamin D supplements increased the risk of falls among the elderly population by 20-30% compared to those on a lower dose.
D for disease
There is also conflicting research on the relationship between vitamin D and other diseases, even ageing.
One main claim is that vitamin D supplements will boost the immune system. Adrian Martineau, professor of respiratory infection and immunity at The London School of Medicine and Dentistry, Queen Mary University of London, who leads a research group on the effects of vitamin D on health, has found that vitamin D plays a role in improving respiratory infections.
One study found that vitamin D helps decrease the risk of respiratory infections though only slightly
Can You Get Enough Vitamin D From The Sun Alone
Some people will be able to get enough vitamin D just from sunlight. However, it depends on where in the world they live, the time of year, the time of day, and their skin color.
People who live nearer the equator get more sun exposure. In the Northern Hemisphere, a person may not get sufficient vitamin D from sunlight during the winter.
The sun is usually strongest between 11:00 a.m. and 3:00 p.m. In the summer, a person does not need to be out in the sun for very long during this period to make enough vitamin D.
The amount of melanin a persons skin contains affects how much vitamin D they can make. Less melanin results in lighter skin, which does not protect as well against harmful ultraviolet rays.
People with more melanin in their skin have better protection from the sun, but take longer to make vitamin D. In the United States, the Centers for Disease Control and Prevention found that Mexican-Americans and non-Hispanic black people are more likely to have vitamin D deficiency.
These varied factors make it difficult to recommend how much sunlight a person should get to make the vitamin D that their body needs.
The Vitamin D Council gives some examples:
- At noon during summer in Miami, someone with a medium skin tone would need to expose one-quarter of their skin to sunlight for 6 minutes.
- At noon during summer in Boston, someone with a darker skin tone would need to expose one-quarter of their skin to sunlight for 2 hours.
- egg yolk
- beef liver
Does Being A Man Or A Woman Affect How Much Vitamin D You Need
Yes and no. Body size is more influential than sex when it comes to vitamin D intake recommendations, Foroutan says. On average, men weigh more than women. However, the relative amount of body fat an individual has may be more pertinent, since vitamin D is stored in body fat.
A study published online in November 2014 in PLoS One aimed to analyze the effect that body mass index may have on vitamin D dosing targets. Findings suggested that participants who were obese needed 2 to 3 times more vitamin D than their normal-weight counterparts.
But men and women are at different risks for various chronic conditions, which means adjusting your vitamin D target may be helpful for managing symptoms or delaying disease progression.
For example, women may be more likely than men to develop both thyroid disease, per the Department of Health and Human Services Office on Womens Health, and osteoporosis, and a vitamin D deficiency is associated with both, other research suggests. If you live with a chronic disease that is associated with your sex, your doctor may factor in vitamin D as part of your personal management plan.
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Vitamin D Supplements: How To Take Them Safely
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Please read this document in full before you decide whether to opt in and before you start taking the vitamin D supplements that have been provided to you.
How Much Vitamin D Do You Really Need
How much vitamin D do you need to ensure strong, healthy bones? Unfortunately, there isnt an easy answer.
Its incredibly controversial, says Neil Binkley, MD, a UW Health geriatrician and internationally recognized researcher who leads the UW Osteoporosis Clinical Research Program. The experts in the field are quite polarized. I try to be somewhere in the middle because I really believe that we simply dont know.
Why all the controversy about the sunshine vitamin? Doctors determine whether an individuals vitamin D level is normal, insufficient or deficient by measuring serum 25-hydroxyvitamin D in the blood. But the measurement has historically been problematic and difficult to standardize, and experts dont agree on the optimal level.
Another problem: Randomized trials of vitamin D supplementation havent required that participants start with low levels, so its difficult to draw clear conclusions from such research. Additionally, there is substantial variation in 25-hydroxyvitamin D increase after individuals begin vitamin D supplementation.
Heres what we do know about this controversial vitamin:
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What About Sun Exposure
The DRIs for vitamin D are set based on the assumption of minimal sun exposure. This was necessary because of public health concerns about skin cancer due to ultraviolet radiation from the sun. Currently, there is a lack of information about whether sun exposure may be experienced without increasing risk of cancer.
Many people meet at least some of their vitamin D needs through exposure to sunlight. However, season, time of day, cloud cover, smog, skin pigmentation, and sunscreen use are all factors that can affect the amount of ultraviolet radiation received and thus vitamin D synthesis.
The DRI values have been set at levels that ensure that sun exposure is not necessary in order to obtain enough vitamin D.
What Vitamin D Dosage Is Best
Vitamin D is commonly known as the sunshine vitamin.
Thats because your skin makes vitamin D when it is exposed to sunlight .
Getting enough vitamin D is important for optimal health. It helps maintain strong and healthy bones, aids your immune system and may help protect against many harmful conditions .
Despite its importance, roughly 42% of people in the US have a vitamin D deficiency. This number rises to a staggering 82.1% of black people and 69.2% of Hispanic people .
There are several other groups of people that have higher vitamin D needs because of their age, where they live and certain medical conditions.
This article will help you discover how much vitamin D you need daily.
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What Kind Of Vitamin D Supplement Should I Take
There are two different types of vitamin D. Vitamin D2 mainly comes from plant-based foods like UV grown mushrooms, or fortified foods and dietary supplements. Vitamin D3 comes from animals and supplements. Youll get D3 from fish oil, butter, liver, and egg yolks.
Vitamin D is available in supplemental form as a liquid, tablet, or capsule. Some doctors will even give vitamin D injections. D2 typically requires a prescription to get, and D3 is commonly available for purchase over-the-counter. There is some debate about whether D2 is stronger than D3 seeking medical advice is the best way to make sure you get the right form and dosage that you need.
The best form of vitamin D to take as a supplement is D3 although, D2 is acceptable, says Tod Cooperman, MD, founder of ConsumerLab. D3 is less likely to result in errors on blood tests, and high doses may raise levels better. In terms of formulations, liquids and pills are generally both fine . My preference is liquid drops, as you can easily adjust the dose. Plus, you can put it right on food or in a beverage, which should remind you that vitamin D, which is fat-soluble, should be taken with foods that contain fats to improve absorption.
What Is The Vitamin D Status Of Canadians
Vitamin D status can be measured in two ways – vitamin D dietary intakes, and vitamin D blood levels. It is the blood level data that gives a true picture of the vitamin D status in the body. Vitamin D is unique in that there is another source besides diet and supplements, namely, sunlight. So even if dietary intakes do not appear to be adequate, overall vitamin D status may be much different.
Data on vitamin D intakes from food and supplement sources combined show a lower prevalence of inadequate vitamin D intakes, although still above 50% .
However, estimates of inadequate intakes of vitamin D must be interpreted with caution because the reference values to assess adequacy assume no vitamin D is contributed to the body by sun exposure. For this reason, data on vitamin D intakes from food and supplement sources cannot stand alone and consideration must be given to serum 25-hydroxy-vitamin-D D) levels, a well-established biomarker for vitamin D status.
Health Canada continues to recommend that people over the age of 50 years take a daily vitamin D supplement of 400 International Units .
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Vitamin D And Calcium: Updated Dietary Reference Intakes
The U.S. Institute of Medicine released its report on the review of the Dietary Reference Intakes for vitamin D and calcium on November 30, 2010. The review was jointly commissioned and funded by the U.S. and Canadian governments.
The decision to commission the IOM review reflects the government’s goal of ensuring that Canadians benefit from the most up to date health and nutritional advice.
The IOM report states that there is no additional health benefit associated with vitamin D or calcium intakes above the level of the new Recommended Dietary Allowance . Health Canada reminds Canadians that total nutrient intake should remain below the level of the new Tolerable Upper Intake Level to avoid possible adverse effects.
Study: Vitamin D Supplements May Improve Bone Health For Winter Babies
“If you follow recommendations, supplementation with at least vitamin D is going to be safe and will really help a lot of people and put them in the right range, because it’ll be difficult for them to get there without supplementing,” he said.
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Getting Vitamin D From Food
Most foods dont contain much vitamin D so its hard to get enough vitamin D from food alone.
Foods which contain vitamin D include:
- oily fish such as salmon, sardines, mackerel, trout
- red meat
- liver and fish liver oil
- foods with vitamin D added such as most fat spreads, some breakfast cereals and some plant-based alternatives to milk. Check the labels.
- infant formula which has vitamin D added to make sure babies get enough.
As most of these foods are animal products, its harder to get vitamin D from food if you are vegan or vegetarian. Plant-based sources of vitamin D include sun-exposed mushrooms and fortified foods such as vegetable spreads, breakfast cereals and plant based dairy alternatives.
In the UK, cows’ milk is generally not a good source of vitamin D because it isn’t fortified, as it is in some other countries. There are some yoghurts which have been fortified, but check the label as they can also be high in saturated fat and so should be avoided.
Did The Iom Report Make Recommendations With Respect To Serum Vitamin D Levels
Serum concentration of 25-hydroxy-vitamin-D D) is the best indicator of vitamin D status. It reflects total vitamin D input – from food, supplements, and sun exposure.
There is considerable discussion surrounding the serum concentrations of 25D associated with optimal health, and cut points have not been developed by a scientific consensus process.
However, the IOM expert committee stated that its review of the data suggests that, relative to bone health:
- People are at risk of vitamin D deficiency at serum 25D concentrations < 30 nmol/L. Some are potentially at risk for inadequacy at levels ranging from 3050 nmol/L.
- Practically all people are sufficient at levels 50 nmol/L
- There may be reason for concern at serum concentrations > 125 nmol/L
The IOM expert committee encouraged the development of evidence-based cut points for serum vitamin D measures relative to deficiency as well as excess.
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Getting More Vitamin D
Sun beds and solariumsSun beds and solariums are not recommended as they increase your risk of melanoma and other skin cancers.
You can get more vitamin D by:
- sensible sun exposure.
- choosing foods that contain vitamin D.
Some people with a high risk of vitamin D deficiency may need to take a vitamin D tablet. Talk to your GP, dietitian or lead maternity carer if youre concerned.
Supplements : Vitamin D
Vitamin D is involved in many of your bodys functions. There are two forms in the diet, D2 and D3. It can also be produced in your skin when exposed to sunlight.
Vitamin D deficiency is a problem all over the world.
However, its pervasive in young women, infants, older adults, and people who have dark skin .
About 42% of the U.S. population is vitamin D deficient. However, this rate rises to 82% in Black people and 70% in Hispanics, which systemic problems likely play a role in .
If you have access to strong sun all year, then occasional sun exposure may be enough to fulfill your vitamin D requirements.
However, if you live far north or south of the equator, your vitamin D levels may fluctuate depending on the season. The levels may go down during the winter months due to a lack of sufficient sunlight .
In that case, you may need to rely on your diet for vitamin D as well as on vitamin D thats stored in body fat (
- intensify bone loss
- increase the risk of fractures
In children, a severe vitamin D deficiency can cause delays in growth and rickets, a disease where the bones become soft.
Furthermore, vitamin D deficiency is linked with several cancers, type 1 diabetes, multiple sclerosis, high blood pressure, and thyroid problems .
Vitamin D deficiency is prevalent worldwide but occurs at higher rates in specific populations. A deficiency in vitamin D is linked to various health problems.
How much vitamin D you need depends on many factors. These include:
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Things That Impact Vitamin D Absorption
Factors like limited sun exposure, age, melanin levels, fat malabsorption, and obesity can impact vitamin D absorption. When there is limited sun exposure, there is already a significant decrease in the levels of vitamin D obtained.
As individuals age, the risk of vitamin D deficiency increases. Not only due to decreased sun exposure, but also because the skin cannot make vitamin D as efficiently as before.
Individuals with more melanin in their skin, or darker skin, absorb much less vitamin D, thus requiring more sun exposure to produce the same vitamin D as an individual with lighter skin. The greater amount of melanin also lowers the skins ability to produce vitamin D, but this can be balanced out with supplements or dietary intake.
Vitamin D is a fat-soluble vitamin, so it requires fat in the gut to be absorbed completely. If an individual cannot absorb fat as efficiently, they also may need to use supplements to obtain the recommended levels of vitamin D.
Should Elderly Persons Take A Vitamin D Supplement
To answer this question, we need to reflect on what is probably the most important principal of drug therapy which is, the possible risks of therapy must outweigh its possible benefits.
In the case of vitamin D this risk/benefit ratio is skewed far in favor of benefits. Vitamin D has many therapeutic benefits ranging from maintaining bone metabolism and strength to reducing the prevalence of colon cancer.
Toxicity can include non-specific symptoms such as anorexia, weight loss, polyuria and heart arrhythmias. The primary toxicity concern is elevated serum calcium concentration which can lead to vascular and tissue calcification with subsequent damage to kidneys, blood vessels and the heart. Risks are minimal, especially at recommended doses and most reports suggest a toxicity threshold for vitamin D of 10,000 to 40,000 International Units per day and serum concentrations of 200-240 ng/mL. for that severe toxicity to occur. Those doses and concentrations are not recommended but highlight the fact that at more reasonable doses and concentrations discussed below toxicity is not a big concern for most patients.
So, with possible benefits being great, and possible risk minimal, many elderly people are appropriate candidates for vitamin D supplementation.
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