How Does Sunshine Create Vitamin D
Ever wonder how sunshine creates vitamin D? Its pretty science heavy, but heres the scoop. When ultraviolet, UVB, rays from the sun hit our skin, skin tissue starts making vitamin D3. This vitamin D3 is combined into chylomicrons, which are fat cells attached to proteins.
These chylomicrons are then absorbed into our blood and travel throughout the body. The vitamin D that is consumed or made by the skin must be transformed in the liver into a form of vitamin D called vitamin D-25-hydroxylase, and then into another form called 25-hydroxyvitamin D .
This 25-OHD form is finally turned into an active form of vitamin D that will increase calcium absorption . Whew, its quite the journey. And pretty amazing how the body works.
Calcium / Vitamin D Dosage
Medically reviewed by Drugs.com. Last updated on May 23, 2022.
Applies to the following strengths: 600 mg-10 mcg 600 mg-20 mcg 250 mg-10 mcg 600 mg-5 mcg 232 mg-200 intl units 117 mg-3.325 mcg 250 mg-3.125 mcg 500 mg-3.125 mcg 500 mg-5 mcg 315 mg-6.25 mcg 200 mg-6.25 mcg 200 mg-6.25 mcg 250 mg-5 mcg 600 mg-3.125 mcg 500 mg-2.5 mcg 500 mg-15 mcg 500 mg-10 mcg 315 mg-5 mcg 600 mg-12.5 mcg 250 mg-6.25 mcg 250 mg-12.5 mcg 105 mg-3 mcg 100 mg-3 mcg 1000 mg-10 mcg/30 mL 500 mg-12.5 mcg/5 g
Variability In Therapeutic Regimens To Correct Vitamin D Deficiency
Daily dosing vs weekly vs monthly
Relatively few studies have evaluated the comparative efficacy and safety of vitamin D treatment in daily, weekly or monthly dosing regimens.
When the same cumulative dose of vitamin D3 was given under daily, weekly or monthly regimens, the mean levels of 25D over a period of two months were similar with slightly more variability observed when given monthly .
Another prospective randomized open label multicenter 3-month study showed equal efficacy and safety of daily 1,000 IU vs either weekly 7,000 IU or monthly 30,000 IU of vitamin D3 on 64 adults with low 25D . 25D values were restored to> 20 ng/mL in all groups. Observed increases in 25D were similar without any statistically significant differences among groups .
In another recent single-center, open-label randomized 12-week study on healthy subjects with low 25 D , efficacy and safety of three different schedules of cholecalciferol were tested. All subjects rapidly and safely normalized vitamin D with similar peak 25D serum levels .
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Clinical Studies Of Vitamin D
There have been 7 studies on vitamin D alone and 13 studies with vitamin D + calcium on bone. A fundamental flaw is that none of the studies had a dose response design. As a result meta analyses have been used to examine the data.
Regarding vitamin D only studies, there are few trials in the literature where vitamin D only was compared to placebo, and these were reviewed in two meta-analyses . On low doses of vitamin D 4001,000IU there was no reduction in fractures . In two studies, one a large trial of 2256 women age 70 years who were given a single oral high dose annually of vitamin 500,000 IU there was unexpectedly a significant increase in fractures within 3 months of dosing in two separate years 1.26, CI: 1.00 1.59) . Another study of an annual injection of high dose vitamin D 300,00IU showed a significant increase in hip fractures in women but not in men . Thus, vitamin D alone in low doses has no effect on fractures and large bolus doses increase fractures.
In summary, vitamin D alone does not reduce fracture whereas calcium plus vitamin D supplementation reduces fractures by 813 percent. The results of the DIPART analysis show that vitamin D 400800IU plus 1000mg calcium is a regimen that prevents fractures. It was not possible for the authors to define a serum 25OHD level associated with efficacy.
How Much Vitamin D Do I Need
From about late March/early April to the end of September, the majority of people should be able to make all the vitamin D they need from sunlight on their skin.
Children from the age of 1 year and adults need 10 micrograms of vitamin D a day. This includes pregnant and breastfeeding women, and people at risk of vitamin D deficiency.
Babies up to the age of 1 year need 8.5 to 10 micrograms of vitamin D a day.
A microgram is 1,000 times smaller than a milligram . The word microgram is sometimes written with the Greek symbol followed by the letter g .
Sometimes the amount of vitamin D is expressed as International Units . 1 microgram of vitamin D is equal to 40 IU. So 10 micrograms of vitamin D is equal to 400 IU.
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What Should Ones Vitamin D Level Be
This question has been hotly, hotly debated. At this time, it depends on whom you ask.
The Institute of Medicine believes a blood level of 20-40 ng/mL should be adequate. The Endocrine Society, the American Geriatrics Society, and some other expert groups recommend a level of at least 30 ng/mL.
As noted above, the party line which I consider reasonable is that most people dont need their vitamin D level checked. In the absence of certain health problems, a low vitamin D level is unlikely in someone who takes a daily supplement.
Why Is Vitamin D Important
Vitamin D helps with a variety of bodily functions. It helps fight infectious, aids in muscle movement, nerve function, cell growth, and reduces inflammation .
Vitamin D also promotes the absorption of calcium which is important for bone health. When there is enough calcium absorbed in the body, the bones can mineralize rather than become thin or brittle .
Vitamin D is also suspected to play a role in prevention and treatment of autoimmune disease, chronic pain, and depression. Though, at this time there is no definitive proof of results through clinical trials. The Institute of Medicine states that by itself, vitamin D, has few wide-ranging health benefits .
However, in combination with other supplements, like calcium and phosphorus, vitamin D can maintain normal immune system functions and reduce the risk of bone- and muscle-related illnesses, like osteoporosis, multiple sclerosis, and osteomalacia in older adults. Without vitamin D, the body only absorbs 10-15% of calcium and 60% of phosphorus .
While there is still a lot we dont know, science will continue to provide answers. In the meantime, we do know enough that this is an important nutrient for the elderly.
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Vitamin D: Recommended Dosage For Seniors
The recommended vitamin D dose for adults up to 70 years of age is 15mcg per day.
Adults aged 71 and older are recommended 20mcg per day.1
As you can see, the older an individual gets, the higher the recommended dose.
While most people can get their recommended intake from a combination of sunlight and food, this isnt always possible to achieve consistently.
This is why a vitamin D supplement is recommended, particularly through the winter months.
Symptoms Of Vitamin D Deficiency
Symptoms of vitamin D deficiency may include muscle weakness, changes in mood and cognitive function, fatigue, and stress fractures. Weakened muscles and bones from low vitamin D can increase the risk of falls and fractures, which can be fatal for the elderly.
Since vitamin D regulates immune function and the release of neurotransmitters in the brain, like serotonin and dopamine, its deficiency can also cause changes in mood and cognitive function .
Long-term effects of vitamin D deficiency include osteoporosis and osteomalacia. Osteoporosis occurs when the body loses too much bone or makes too little bone. The bones become weak and are more likely to break during a fall, or even minor bumps in extreme cases.
Although a lack of calcium plays the main role in the development of osteoporosis, vitamin D works in conjunction with calcium and can help reduce the risk of developing the disease.
On the other hand, osteomalacia is the softening of the bones, and it is the result of a severe vitamin D deficiency. This can lead to fractures or joint pain if left untreated.
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People With Medical Conditions That Reduce Fat Absorption
Because vitamin D is fat-soluble, it relies on the guts ability to absorb fat from the diet.
Thus, people who have medical conditions that reduce fat absorption are prone to vitamin D deficiencies. These include inflammatory bowel disease , liver disease and also people who have had bariatric surgery (
Summary: Those who need the most vitamin D are older people, people with darker skin, those who live farther from the equator and people who cant absorb fat properly.
What Is The Correct Dosing For Vitamin D
Dr. Kenneth Madden
What I did before
Every year, one-third of older adults experience one or more falls.1 One therapy with the potential to reduce both falling and fractures is vitamin D supplementation, possibly due to a direct stimulation of vitamin D receptors on muscle tissue.2 Often the patients that would most benefit from vitamin D have swallowing issues that make swallowing large vitamin pills difficult. Since there is no correct dose and it is only a vitamin I often administered larger doses to make administration easier for patients with swallowing issues.
What changed my practice
Unfortunately, a closer look at the issue revealed the appropriate dose of vitamin D necessary to safely reduce fall and fracture risk remains controversial. A recent meta-analysis of all studies done to date3 demonstrated that high dose vitamin D reduced falls by 23 percent when high dose was defined as 700 to 1000 IU per day. Lower doses had no effect on fall risk. The effects of doses higher than 1000 IU had not been examined previously to the publication of this meta-analysis. It is also important to remember that large doses of vitamins are not necessarily benign the increase in mortality with high-dosage vitamin E4 should serve as a cautionary example.
What I do now
Notes from the BC Guidelines
Population at Risk
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Vitamin D Is Referred To As The Sunlight Vitamin How Much Sunlight Exposure Do I Need To Receive An Adequate Amounts Of Vitamin D
When skin is exposed to sunlight cutaneous 7-dehydrocholesterol is converted to previtamin D-3 which is then metabolized in the body to the active form. However, relying on sunlight to meet our vitamin D requirements is controversial due to the well-known skin damage that results from even small amounts of exposure to sunlight. It has been suggested by some vitamin D researchers that approximately 530 min of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen usually leads to sufficient vitamin D synthesis.2 However, numerous factors can reduce the skin’s ability to convert vitamin D including time of day, inclement weather or dark skin color. As well, conversion is less efficient in the skin of older persons and some individuals, such as those who are home-bound and get little to no sun exposure.3 Sunlight exposure through glass is ineffective in producing vitamin D because glass filters out the ultraviolet light necessary for that conversion.2
Sunscreens with a sun protection factor or higher may block vitamin D-producing ultraviolet waves. However, people generally do not apply sufficient amounts of sunscreen to all sun-exposed skin and/or do not reapply it regularly so skin likely synthesizes some vitamin D even when it is protected by sunscreen as typically applied.2
Variability In The Form Of Vd That Is Needed For Specific Situations
Use of calcidiol versus calcitriol
Calcitriol is the most active metabolite of vitamin D. Alfacalcidol is a synthetic calcitriol analogue which is 25-hydroxylated in the liver into calcitriol, avoiding the need for enzymatic conversion by the renal 1alpha-hydroxylase enzyme . Not surprisingly, therefore, alfacalcidol increases calcitriol levels independently of renal function. The effects on intestinal calcium absorption and on bone turnover of oral or parenteral administered calcitriol and alfacalcidol are very similar . In general, the use of 1-alpha-hydroxylated forms is hampered by the higher risk of developing hypercalcemia and/or hypercalciuria . However, the biochemical safety of calcitriol and alfacalcidol is similar. Alfacalcidol has been shown to prevent falls and fractures in women with postmenopausal osteoporosis and also in elderly individuals of both sexes . Some possible differences on vertebral fracture risk between calcitriol and alfacalcidol may be related to the populations enrolled in the trials .
When to use active vitamin D analogues versus 25D versus vitamin D-alone or in various combinations
Manifestations Of Vitamin D Deficiency
Vitamin D deficiency causes bone to demineralize. In children, bones soften over time and become deformed, leading to growth retardation, enlargement of the epiphyses of the long bones, and leg deformities.9 Adults with osteomalacia may experience global bone discomfort and muscle aches, often leading to a misdiagnosis of fibromyalgia, chronic fatigue syndrome, or arthritis. Because vitamin D receptors are present in skeletal muscle, deficiency may also lead to proximal muscle weakness an increased risk of falls global bone discomfort, often elicited with pressure over the sternum or tibia and low back pain .8,10 Common manifestations of vitamin D deficiency are listed in Table 3.1,4,8–10
|Bone discomfort or pain in low back, pelvis, lower extremities|
|Increased risk of falls and impaired physical function|
|Symmetric low back pain in women|
Vitamin D Helps Prevent Cancers And Infections
Seniors who want to be proactive about their health should turn to vitamin D. Scientists cite the important nutrient as a preventive treatment for everything from colon cancer to the flu.
Because of vitamin Ds ability to manage immune cells, taking the recommended dose of vitamin D for seniors can of colon cancer and blood cancers, specifically. Recent research from the University of Eastern Finland also suggests reduced mortality among some cancer patients treated with vitamin D.
In addition to fending off life-threatening and chronic diseases, vitamin D can help boost a seniors immune system to defeat more everyday illnesses like colds, the flu, and other respiratory conditions. A global study incorporating 25 clinical trials reported that vitamin D promotes natural antibiotic-like substances in the lungs.
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Vitamin D Promotes Bone Health In The Elderly
Osteoporosis, a condition that causes bones to become brittle and weak, affects 16% of all seniors, according to the Centers for Disease Control. The condition carries serious health risks, potentially leading to fallsand other dangerous home safety situations. The clear connection between vitamin D and bone health in the elderly helps seniors defend against bone softening.
For added effectiveness, older adults should pair the recommended vitamin D dosage for seniors with calcium. A 2019 American Medical Association analysis of 49,000 participants found that seniors who combined adequate vitamin D levels with sufficient calcium intake reduced their risk of hip fractures by 16%.
Strengthens The Immune System
Vitamin D has a variety of important functions, including promoting the immune system’s strength and performance. It promotes T-cell growth and aids in the immunological response to viral illnesses such as the common cold, influenza, and other community-wide diseases caused by viruses, bacteria, and fungus.
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Vitamin D Dosing Considerations In Covid
William Simonson PharmD, BCGP, FASCP
I commonly share my bi-monthly pharmacy columns with friends and colleagues after I submit them to Geriatric Nursing for publication. The most recent article, which appeared in the May/June, 2020 issue reviewed the role of Vitamin D in COVID-19 infections, generated a number of questions about the vitamin, especially with respect to dosing.1 I decided to address some of these questions in this issue’s column. As always, space limitation prevents an in-depth review so the reader is referred to a Vitamin D Fact Sheet for Health Professionals for those who would like more detailed information as well as the other references that I cite below.2,3, 4, 5, 6, 7, 8
Some People Are Overdoing It In Search Of Better Health
Vitamin D is having its day in the sun. In recent years, research has associated low blood levels of the vitamin with higher risks of everything from heart disease, diabetes, and cancer to mood disorders and dementia. The findings have not gone unnoticed. Vitamin D supplements and screening tests have surged in popularity.
“Vitamin D testing is one of the top Medicare lab tests performed in the United States in recent years,” says Dr. JoAnn E. Manson, the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School. “This is really surprising for a test that is recommended for only a small subset of the population.”
Unfortunately, this vitamin D trend isn’t all blue skies. Some people are overdoing it with supplements. Researchers looking at national survey data gathered between 1999 and 2014 found a 2.8% uptick in the number of people taking potentially unsafe amounts of vitamin D that is, more than 4,000 international units per day, according to a research letter published in the June 20 issue of The Journal of the American Medical Association . And during the same time period there was nearly an 18% increase in the number of people taking 1,000 IU or more of vitamin D daily, which is also beyond the dose of 600 to 800 IU recommended for most people.
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Will Vitamin D Prevent Dementia Cancer And/or Premature Death
Several studies have identified an association between vitamin D deficiency and diagnoses such as Alzheimers disease and cancer. In other words, people with these conditions tend to have low vitamin D blood levels.
But an association isnt the same thing as causation, so its not yet known whether vitamin D deficiency causes these diseases. Its also not yet known whether taking vitamin D supplements will reduce ones chance of developing these diseases.
To date, most randomized studies of vitamin D to improve health outcomes have been negative.
Although its possible that low vitamin D levels might be a factor in developing certain diseases, its probably a small effect. Cancer and Alzheimers, after all, generally seem to be the result of lots of little factors genetics, epigenetics, stress, immune function, nutrition, inflammation, toxins interacting over time.
In 2010, the Institute of Medicine concluded: This thorough review found that information about the health benefits of vitamin D supplementation beyond bone healthbenefits often reported in the mediawere from studies that provided often mixed and inconclusive results and could not be considered reliable.