Those Who Live Farther Away From The Equator
Countries close to the equator get plenty of sunlight all year round. Conversely, countries farther away from the equator get less sunlight all year round.
This can cause low blood vitamin D levels, especially during winter months when there is even less sunlight.
For instance, a study of Norwegians discovered that they dont produce much vitamin D3 from their skin during the winter months of October to March .
If you live far from the equator, then you need to get more vitamin D from your diet and supplements. Many experts believe that people in these countries should consume at least 1,000 IU daily .
Signs And Symptoms Of Vitamin D Deficiency
Adults with a vitamin D deficiency may experience fatigue, thinning hair, aches or cramps, changes in mood, depression, or weakness.
In addition, a low vitamin D level may also be associated with an increased risk of certain health conditions like bone weakness and heart disease.
In children, a chronically low vitamin D level may lead to rickets. Rickets is a rare disorder that causes bone pain, joint deformities, and muscle weakness. Besides rickets, children who are deficient in vitamin D may experience sore, painful, or weak muscles.
What Does Vitamin D Do
Most people know that vitamin D is good for calcium absorption and bone health, but vitamin D is also important for many other vital bodily processes.
A lack of vitamin D has been associated with:
- An impairment in memory and thinking skills in older adults
- Bone, back, or muscle pain
- Cancer
- Severe asthma in children
- Skin wounds that take a long time to heal.
Research also suggests low vitamin D may be a factor in several other conditions such as diabetes, high blood pressure, and multiple sclerosis.
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The Zrt Laboratory Blog
If you have ever had your level of Vitamin D tested, depending on which lab you used, your report showing whether your level is low, normal, or high might have left you scratching your head. In fact, there are multiple agencies all with slightly different opinions on what levels are deficient, insufficient, sufficient, high, or toxic.
When testing with ZRT, you will receive a result that is reflective of your total 25-Hydroxy Vitamin D status in blood. This is the storage form of vitamin D, which is converted by the kidneys to the biologically active form, 1,25-dihydroxycholecalciferol.
Vitamin D3 is involved in numerous biological processes such as immune system modulation, insulin sensitivity, hormone and neurotransmitter homeostasis, and is essential for ensuring calcium absorption in the bones. Dietary sources of vitamin D include foods such as cows milk, fish, egg yolk, and pork. Sunlight exposure and supplements are two other main sources of vitamin D that will contribute to reaching an optimal vitamin D status for health. Those of you who are not living in a sunny climate year-round will be hard-pressed to maintain a healthy level of vitamin D by relying on sunlight alone.
Reference Range
What Research Gaps Were Identified
The IOM expert committee identified areas where further research would help improve the determination of reference values in the future. A total of 22 major research needs were identified and are summarized in Table 9-1 of the report. The general categories of information gaps are:
- Data on the physiology and metabolism of calcium and vitamin D
- Data on health outcomes and adverse effects related to calcium and vitamin D
- Data on dose-response relationships between intakes of calcium and vitamin D and health outcomes
- Evidence to judge independent effects of calcium and vitamin D
- Information on the impact and role of sun exposure relative to vitamin D
- Standardized and consistent data on calcium and vitamin D intakes
- Exploration of methodologies for synthesizing evidence
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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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Vitamin D And Diabetes
Type 2 diabetes is a condition in which the body does not use insulin properly and blood sugar levels can rise above normal. Researchers are looking into whether vitamin D can help regulate blood sugar levels. In addition, vitamin D helps with the absorption of calcium, and calcium helps manage sugar in the blood. Studies have found people with vitamin D deficiency have a higher risk of developing type 2 diabetes later in life, but the link is not conclusive. More research is needed to determine if vitamin D supplementation can help people with type 2 diabetes.
How Ethnicity May Affect Your Need For Vitamin D
People who live in colder climates generally need more vitamin D than those who live closer to the equator, but among all geographic locations, people with darker skin tones often need more of the vitamin than those with lighter skin. Indeed, people with highly pigmented skin who live in cold climates are considered to be at a particularly high risk of vitamin D deficiency, according to a study published in June 2017 in the Journal of the American Academy of Dermatology. 31404-4/fulltext” rel=”nofollow”> 13)
Observationally, weve seen that people of African descent and people of Middle Eastern descent also need more vitamin D to achieve optimum levels, Foroutan says.
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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.
How Is Vitamin D Made By Our Body
The synthesis of active vitamin D is quite complex but involves sunlight, a specific type of cholesterol present in our skin, and modification first by our liver and then our kidneys.
Within our skin is a type of cholesterol called 7-dehydrocholesterol. When UVB rays of the wavelength range 290 to 315nm touch 7-dehydrocholesterol, they convert it into previtamin D3. This is then converted into cholecalciferol so that it can be transported to our liver for hydroxylation into calcidiol . Further hydroxylation happens in the kidneys to make 1,25D which is the active form of vitamin D3.
The whole process of converting 7-dehydrocholesterol into active D3 is quite efficient and it has been reported that it takes 10 minutes of summer sun on the hands and face to generate 10 micrograms of vitamin D3 which is considered the daily requirement.
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What Are The New Dris For Calcium
The DRIs for calcium are based on evidence related to bone health, largely from the results of calcium balance studies. Calcium balance, which can be positive, neutral or negative, compares total calcium intake with urinary and fecal excretion of calcium. It is used to determine the accumulation and level of bone mass.
The DRIs for calciumFootnote 1, which can also be found in the DRI tables, are as follows:
The DRIs for calcium| 2500 mg |
| Adequate Intake rather than Recommended Dietary Allowance. |
The IOM report states that there are no additional health benefits associated with calcium intakes above the level of the new RDA.
Total calcium intake should remain below the level of the new UL to avoid possible adverse effects. Long-term intakes above the UL increase the risk of adverse health effects, such as kidney stones.
What Foods Provide Calcium
Calcium is found in many foods. You can get recommended amounts of calcium by eating a variety of foods, including the following:
- Milk and milk alternatives such as yogurt, cheese, and fortified plant-based beverages
- Dark green vegetables such as broccoli, kale and spinach
- Fish with soft bones that are eaten, such as canned salmon or sardines.
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What Is A Normal Vitamin D Level
The question that you REALLY want to know is,what are OPTIMAL Vitamin D levels. Every laboratory has a reference range that is unique and depends upon many different factors. Often they take a range of healthy individuals and create an average range after excluding a certain percentage from the low range and the high range.Voila, they determined the normal Vitamin D level.
But in the Symptoms of Vitamin D Deficiency page, you learned that a very high percentage of the population, has a low Vitamin D level either from simply not getting enough, from poor Vitamin D Absorption, or not having the proper cofactors.
“Vigilance of ones vitamin D status by the yearly measurement of vitamin d 25 hydroxy level should be part of an annual physical examination.”-Michael F. Holick, ‘The Vitamin D Epidemic and its Health Consequences’
So, if you take a blood test for Vitamin D and get an average number for a group of people who are Vitamin D deficient, then you have numbers that are on the low side, right? One study summed this up very well by saying,
Historically, a ‘normal’ nutritional vitamin D status has been defined as just about any circulating level of vitamin d 25 hydroxy in asymptomatic subjects.
Vitamin D: The Healthy Aging Dose
Confused by all the back and forth in the media about vitamin D?
Dont be. Theres actually a pretty easy and straightforward approach that most older adults can take.
In this post, Ill explain what I recommend to most of my older patients, and why.
Ill also address the following frequently asked questions:
- Which type of Vitamin D should I take?
- Do I need to have my vitamin D blood level checked?
- What should ones vitamin D level be?
- Will vitamin D really prevent falls or fractures?
- Will vitamin D prevent dementia, cancer, and/or premature death?
- I am outside a lot. Do I need a vitamin D supplement?
- I heard that a higher level of vitamin D is better for you. How much is too much?
By the way, Im updating this post in part because I was disappointed by the recent NY Times article Why Are So Many People Popping Vitamin D?
Among other things, this article should have had a different headline. The key problem the article describes is that there are too many people being tested for vitamin D. The article does not make the case that too many people are taking vitamin D supplements.
In fact, vitamin D supplementation remains recommended by experts. And as Ill explain below, there are good reasons to believe that vitamin D supplementation is especially useful for older adults.
Now, I do agree with the article in that many people seem to have unrealistic expectations of what vitamin D can do for them.
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How Much Vitamin D Is Too Much
Vitamin D toxicity is rare, but it can happen if you take too many supplements. You cannot get vitamin D toxicity from the sun or by eating foods that contain vitamin D.
Vitamin D toxicity is said to occur at blood levels above 150 ng/ml of 25D. because vitamin D is a fat-soluble vitamin, it may take several weeks for levels to come down, even after you stop taking supplements.
Vitamin D levels are linked with calcium absorption, so early symptoms of vitamin D toxicity are caused by too much calcium in the blood and include nausea, vomiting, constipation/diarrhea, weakness, or frequent urination. If levels are left too high for too long, bone pain, headaches, drowsiness, itching and calcium stones in the kidneys may occur. Very high levels may also lead to low levels of vitamin K2 in the blood, which can, ironically, cause bone loss of calcium. There are reports that excessive levels of vitamin D have caused kidney failure.
Vitamin D toxicity can be treated by stopping vitamin D supplements and restricting dietary calcium. Fluids and other medications, such as bisphosphonates may also be prescribed.
Research has shown that taking 40,000-60,000 IU of vitamin D per day for several months can lead to toxicity. But this is significantly more than the recommended safe upper dosage of vitamin D, which is 4,000 IU/day for adults. The Recommended Dietary Allowance for most adults is 600 IU of vitamin D a day.
Always talk to your doctor before taking vitamin and mineral supplements.
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.
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What Foods Provide Vitamin D
The major sources of vitamin D are fortified foods. In Canada, cow’s milk and margarine must be fortified with vitamin D. Goat’s milk, fortified plant based beverages , and some calcium-fortified orange juices are permitted to be fortified with vitamin D. Cheese and yogurt can be made with vitamin D-fortified milk, however, the final product does not contain as much vitamin D as fluid milk alone. The only natural sources of vitamin D in the Canadian food supply are fatty fish and egg yolks.
Because it is a commonly-consumed food, fluid milk is a major dietary source of vitamin D.
How Is Vitamin D Deficiency Treated
The goals of treatment and prevention are the sameto reach, and then maintain, an adequate level of vitamin D in the body. While you might consider eating more foods that contain vitamin D and getting a little bit of sunlight, you will likely be told to take vitamin D supplements.
Vitamin D comes in two forms: D2 and D3. D2, also called ergocalciferol, comes from plants. D3, also called cholecalciferol, comes from animals. You need a prescription to get D2. D3, however, is available over the counter. It is more easily absorbed than D2 and lasts longer in the body dose-for-dose. Work with your doctor to find out if you need to take a vitamin supplement and how much to take if it is needed.
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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.
So What Exactly Does Vitamin D Do
Vitamin D is an essential vitamin and for good reason. Its necessary for a wide array of your bodys functions. Vitamin D helps support the health of your:
- Bones
- Heart, and
- Immune system2
A lack of vitamin D may also play a role in your bodys inflammatory processes. Now, keep in mind, inflammation is your bodys response to perceived threats. But chronic inflammation can actually lead to the development of serious health problems.3
Vitamin D is also famous for its partnership with calcium. Now, youre probably well aware that calcium is absolutely necessary for maintaining strong bones and preventing the onset of osteoporosis.4 Vitamin D works with calcium in a couple ways:
1. It allows your intestine to absorb calcium from dietary sources,
and
2. It helps your bones maintain a steady amount of calcium.5
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