Optimal Vitamin D Supplementation Levels For Cardiovascular Disease Protection
David R. Thickett
1School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, Centre for Translational Inflammation Research , University of Birmingham Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
Abstract
First described in relation to musculoskeletal disease, there is accumulating data to suggest that vitamin D may play an important role in cardiovascular disease . In this review we aim to provide an overview of the role of vitamin D status as both a marker of and potentially causative agent of hypertension, coronary artery disease, heart failure, atrial fibrillation, stroke, and peripheral vascular disease. The role of vitamin D levels as a disease marker for all-cause mortality is also discussed. We review the current knowledge gathered from experimental studies, observational studies, randomised controlled trials, and subsequent systematic reviews in order to suggest the optimal vitamin D level for CVD protection.
1. Vitamin D Introduction
Vitamin D is a fat-soluble vitamin that functions as a steroid hormone. In the skin, ultraviolet light causes photochemical cleavage of 7-dehydrocholesterol into previtamin D3, which spontaneously isomerises to form vitamin D3 . Vitamin D2 is a plant-derived form of vitamin D through exposure of yeast to UV light. Skin synthesis of vitamin D3 accounts for about 80% of vitamin D dietary sources include fish oils, egg yolks, mushrooms, dairy products, and fortified cereals.
Why 50 Ng/ml Is The Vitamin D Goal For Life
So if 30 ng/ml really doesn’t cut it if you want to best support your health and well-being, what vitamin D levels should you strive to achieve and maintain?
“As an endocrinologist, I know that achieving optimal serum 25D levels in the 50+ ng/ml range is imperative for immune health, bone health, and more,” Henderson says. “This is the average or median level at which most association studies show various benefits, including immune health, balanced mood, and more.”
And the tool to achieve that level of 50 ng/ml is clearly vitamin D3 supplementation, according to Henderson’s clinical expertise with hundreds of patients, plus the collective D science to date.*
While hitting 30 ng/ml is a start , it’s not the goal.
“We are consistently undertreating patients when we stop at 30 ng/ml,” Henderson continues. “Our population is heavily vitamin D deficient and targeting an optimal level of 50 ng/ml has an enormous impact on all aspects of human health.”
Ferira adds this analogy, “Aiming for 30 ng/ml is like signing up and paying for four years of college but never attending any classes, taking any tests, or graduating. It’s a bad investment, aims too low, and is going to hurt eventually.”
How To Actually Hit 50 Ng/ml
If you think relying on food and sun alone will help you reach that 50 ng/ml mark , newsflash for you: It’s just not possible and unwise .
Ready for a little math? Ferira breaks it down for us: “Pharmacokinetic research shows that it takes 100 IU of vitamin D to increase a normal-weight adult’s serum D levels by about 10 ng/ml. So, that means that in order to achieve 50 ng/ml, you need 5,000 IU of vitamin D per day.”
Considering a 3-ounce serving of trout only offers 645 IU and that a number of factors prevent most people from getting significant amounts of vitamin D from the sun, you’re left with one stellar option: a high-quality, high-potency vitamin D supplement.*
That means vitamin D3, which is the body’s preferred form.* “The formulation of vitamin D3 is the most important variable,” says Henderson. “It has to be packaged as highly bioavailable or it just won’t work!”
Specifically, “since vitamin D is a fat-soluble vitamin, it is important that it be packaged with fats for maximal absorption,”* she adds. And, remember, you’ll need 5,000 IU per day to hit that 50 ng/ml mark.
Not many supplements check all of these boxes, which is why mbg formulated vitamin D3 potency+ to provide 5,000 IU of vitamin D3 , plus a trio of healthy organic fats from extra-virgin olive, flaxseed, and avocado oils.*
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How Vitamin D Levels Are Measured
First things first, a quick breakdown of how doctors and researchers measure vitamin D levels in the body. When you ask your doc to test your vitamin D, they perform a blood test to measure your serum total 25-hydroxyvitamin D, or 25D, for short, explains mbg’s director of scientific affairs Ashley Jordan Ferira, Ph.D., RDN.
Quantified in nanograms per milliliter units, Ferira explains that, “your 25D level is a biomarker that reflects your whole-body vitamin D status from circulating blood levels. Vitamin D is the starting vitamin input, and that essential micronutrient is hydroxylated in your liver to 25D to travel around the body, available to your various organs for a variety of critical health functions.”*
She goes on to say, “Some people track their blood pressure as an indication of cardiovascular health. I’m one of those people, but I also track my 25D level at least annually to inform my vitamin D health state. It’s that important.”
The Latest Research On Vitamin D Supplements
Vitamin D supplements have long been touted as important to bone health. The problem is that several studies have found that they dont live up to the hype. Vitamin D supplementation doesnt prevent fractures or falls, or have any effect on bone mineral density that is clinically meaningful, according to large review of over 81 clinical trials published in October 2018 in The Lancet Diabetes and Endocrinology. 30265-1″ rel=”nofollow”> 4)
Nor was vitamin D supplementation found to reduce the risk of cancer, heart attack, stroke, or cardiovascular death in a randomized, controlled clinical trial involving over 25,000 participants that was published in January 2019 in The New England Journal of Medicine. Yet researchers found that those who developed cancer had a 25 percent lower death rate when they were taking vitamin D. The findings also included a possible reduction in cancer risk for African Americans, which researchers wrote warrants further study.
Meanwhile, though observational studies have suggested a link between low vitamin D levels and the risk of developing type 2 diabetes, a randomized, controlled clinical trial published in June 2019 in The New England Journal of Medicine did not support that conclusion. Vitamin D3 supplementation at a dose of 4,000 IU per day did not result in a significantly lower risk of diabetes compared with a placebo.
Still, before you dispose of your supplements, speak with your doctor.
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Editorial Sources And Fact
Good Sources Of Vitamin D
From about late March/early April to the end of September, most people should be able to make all the vitamin D they need from sunlight.
The body creates vitamin D from direct sunlight on the skin when outdoors.
But between October and early March we do not make enough vitamin D from sunlight. Read more about vitamin D and sunlight.
Vitamin D is also found in a small number of foods.
- fortified foods such as some fat spreads and breakfast cereals
Another source of vitamin D is dietary supplements.
In the UK, cows’ milk is generally not a good source of vitamin D because it is not fortified, as it is in some other countries.
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Are Vitamin D Supplements Safe
Taking vitamin D supplements is safe so long as you stick to the recommended adult dose of 400 IU per day.
This dose is likely to achieve a blood level of vitamin D, in the region of 30 ng/ml.
There is generally no need to have blood tests if you want to take a vitamin D supplement. However, it is possible if you have specific health concerns, to see your GP and request a vitamin D blood test.
This can be done before you start, as a baseline, and then be repeated 3-6 months after starting treatment.
How Is A Vitamin D Deficiency Diagnosed
Your doctor can order a blood test to measure your levels of vitamin D. There are two types of tests that might be ordered, but the most common is the 25-hydroxyvitamin D, known as 25D for short. For the blood test, a technician will use a needle to take blood from a vein. You do not need to fast or otherwise prepare for this type of test.
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So Who Should Be Screened For Vitamin D Deficiency
Dr. Finkelstein and his colleagues published a study of over 2,000 perimenopausal women who had been followed for almost 10 years, and they found that vitamin D levels less than 20 were associated with a slightly increased risk of nontraumatic fractures. They concluded that because few foods contain vitamin D, vitamin D supplementation is warranted in women at midlife with levels less than 20 ng/mL. “For perimenopausal women or other groups of people with higher fracture risk, certainly a level of 20 or above is ideal,” and he adds: “For the vast majority of healthy individuals, levels much lower, 15, maybe 10, are probably perfectly fine, and so I would say I agree with what the authors of the New England Journal perspective article are saying.”
All that said, most experts, including Dr. Finkelstein, agree we should be checking vitamin D levels in high-risk people those most at risk for a true deficiency. These include people with anorexia nervosa, people who have had gastric bypass surgeries, who suffer from other malabsorption syndromes like celiac sprue, or who have dark skin, or wear total skin covering . In addition, certain populations will require that vitamin D level of 20 ng/ml or higher. This can include perimenopausal women, people diagnosed with osteopenia and osteoporosis or other skeletal disorders, as well as pregnant and lactating women. All of these groups should be screened and treated as appropriate.
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Can You Ever Have Too Much Vitamin D
Yes. You can get too much vitamin D if you overdo the supplements. Interestingly, you cannot get too much vitamin D from the sun. Vitamin D toxicity is, thankfully, quite rare but can lead to hypercalcemia and together the symptoms can include:
- Confusion.
- Ataxia .
Do not take higher-than-recommended doses of vitamin D without first discussing it with your doctor. However, your doctor might recommend higher doses of vitamin D if he or she is checking your blood levels and adjusting your dose accordingly. Also, be cautious about getting large doses of vitamin A along with the D in some fish oils. Vitamin A can also reach toxic levels and can cause serious problems.
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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.
Definition Of Vitamin D Deficiency And Incidence In Us Population
Vitamin D adequacy is currently defined as a function of calcium homeostasis, with lower vitamin D levels resulting in reduced absorption of calcium from the gut and/or elevations of parathyroid hormone considered inadequate. Blood levels of the prohormone 25D, with a half-life of 2 to 3 weeks, are used to describe vitamin D sufficiency rather than levels of 1,252D, which has a half-life of only 3 to 4 hours., Furthermore, in early vitamin D depletion, blood levels of 1,252D can be misleading because they may rise initially in response to elevations in PTH, which is sensitive to reductions in 25D, before they begin to fall with prolonged precursor depletion.,
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Are You Getting Enough Essential Nutrients
Testing your vitamin D level regularly and taking daily steps to keep it at a target level of 40-60 ng/ml is important for all stages of health. Through GrassrootsHealth Nutrient Research Institute, you can also track your omega-3 status, inflammation levels, and levels of essential and toxic nutrients. Find out your levels today! Log on to the shop to get your tests and see for yourself if your level can be improved.
Make sure you track your results before and after, about every 6 months!
Can You Take Too Much Vitamin D
While it is possible to take too much vitamin D, toxicity is very rare.
In fact, you would need to take extremely high doses of 50,000 IU or more for a long period of time .
Its also worth noting that it is impossible to overdose on vitamin D from sunlight .
Although 4,000 IU is set as the maximum amount of vitamin D you can take safely, several studies have shown that taking up to 10,000 IU daily wont cause side effects (
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Clinical Trials To The Rescue
Th is dearth of evidence is likely to change soon for vitamin D because large, randomized clinical trials are already in the pipeline. Manson is a principal investigator of the largest one. The VITamin D and OmegA-3 TriaL is testing the effects of taking 2,000 IU in supplements per day versus placebo in almost 26,000 adults over age 50.The primary focus is on prevention of cancer and cardiovascular disease, but data will be collected on a host of other disorders, including diabetes, hypertension, cognitive decline, depression, respiratory disorders, and autoimmune diseases. Its an ongoing five-year trial, with preliminary results expected in about three years.
Another multi-year trial based at Tufts University will test whether daily supplements of 4,000 IUs will prevent or delay the onset of type 2 diabetes in people with prediabetes. Both trials are sponsored by the National Institutes of Health.
Optimal Vitamin D Status
At the present time, 25D levels in the range of 30 to 60 ng/mL are considered optimal, but higher levels up to 100 ng/mL are often seen in individuals with outdoor occupations receiving intense sun exposure without ill effects. Correlative studies of 25D with muscle strength or risk of breast or colon cancer have prompted several investigators to suggest that the optimal 25OHD target for multiple health outcomes is 40 to 50 ng/mL., Garland et al suggest that increasing 25D to a range of 40 to 60 ng/mL from the current US average could reduce risk of breast cancer by 25% and colon cancer by 27%. Intakes of at least 4,000 IU daily from all sources would be needed to maintain 25D levels of 40 to 60 ng/mL. Practically speaking, supplements of 2,000 IU daily plus some sun exposure would probably be required to maintain a 25D level of 40 to 60 ng/mL year round.
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Vitamin D Levels Computed Two Ways
When it comes to taking vitamin D levels, it’s important to know which form of vitamin D needs to be measured. Our bodies store vitamin D as a chemical called 25 vitamin D. Our bodies transform a tiny fraction of the stored vitamin D, about 0.1% every 2 to 3 hours, to an active form of the vitamin called 1,25 2 vitamin D. And for the vitamin D level to have any meaning, it’s also important to measure a substance called parathyroid hormone. This hormone transforms the storage form of vitamin D into the active form of vitamin D.
The Confusion Around Optimal Vitamin D Levels
If you’ve ever had your serum vitamin D levels tested or done a quick search online about healthy levels, you’ve probably come across the idea that 30 ng/ml is the goalbut that’s not really the case. In truth, 30 ng/ml is just the bottom cutoff for vitamin D “sufficiency.”
Ferira puts it this way: “I personally don’t like to confuse folks by even mentioning 30 ng/ml in the same breath as ‘vitamin D sufficiency.’ I prefer to think of 30 as the risk or warning zone. It’s the cutoff for inadequacy, so you don’t strive for it, you avoid it with intention.”
“This is the bare minimum level to avoid major issues known to occur with vitamin D deficiency, including bone issues and poor thyroid health,” explains board-certified endocrinologist Brittany Henderson, M.D., who specializes in hormones in her clinical practice. That said, “higher levels of serum 25D have consistently been associated with improvements in mood, enhancement of the immune system, and more.”
Unfortunately, a large chunk of the U.S. adult population is in the “warning zone” , and they probably don’t even know it. This means they are vitamin D insufficient. Another term used is hypovitaminosis D. To make it simple, not enough vitamin D.
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