Optimal Vitamin D Levels May Vary For Different Ethnic And Racial Groups
- Rutgers University
- When recommending vitamin D supplements, doctors should look at each individual patient as having different requirements and not rely on ‘one-size-fits-all’ guidelines, according to a new study.
When recommending vitamin D supplements, doctors should look at each individual patient as having different requirements and not rely on “one-size-fits-all” guidelines, according to a study by researchers at Rutgers and the University of California, San Francisco.
The study, published in the journal Metabolism, Clinical and Experimental, highlights the need to gain consensus through improved tests for vitamin D levels that are currently available.
According to the Institute of Medicine, people with less than 20 nanograms of vitamin D per milliliter of blood are deficient. The Endocrine Society set a higher threshold of 30 nanograms. Neither guideline is more definitive than the other at this time.
“Recommendations based on earlier studies using a number of different tests for vitamin D levels persist and, not surprisingly, current guidelines vary,” said author Sylvia Christakos, a professor at Rutgers New Jersey Medical School. “For example, it is not clear that the most optimal levels for vitamin D are the same for Caucasians, blacks or Asians alike. More laboratories are now implementing improved tests and efforts are being made to standardize results from different laboratories.”
Testing Your Patients For Vitamin D12
Many physicians recognize the importance of testing vitamin D levels in their high-risk patients, such as older adults and those who are dark-skinned or receive little or no sun exposure. Patients with low vitamin D levels are at risk of osteoporosis and cardiovascular disease, as well as cancer and respiratory disease. Patients who are pregnant or lactating should be tested too, since they represent another high-risk group. Deficiency in pregnancy can lead to preeclampsia, and deficiency while lactating can cause rickets in infants.
An important part of the testing process is advising patients on their vitamin D supplementation needs based on their test results. Heres what you need to know.
How To Take Vitamin D
For best results take vitamin D once a day, with a meal, because it is a fat-soluble vitamin. If you take it on an empty stomach it is unlikely to be absorbed.
You can take it in the morning or at night, but if you tend to skip breakfast, take it in the evening, just before your evening meal.
It may be best to take it early in the evening, as there is a suggestion vitamin D can interfere with the production of melatonin. However, there is no evidence to support the fact that vitamin D disrupts sleep patterns.
Make sure you drink plenty of fluids.
If you miss a dose, skip it, but take the next one on time.
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Vitamin D Level Standards
While the debate rages on among experts as to what blood vitamin D levels constitute normal, most would agree that levels of 10 ng/mL or lower suggest a real deficiency, and that people in high-risk groups should have a level above 20 to 30 ng/mL . However, integrative doctors and naturopaths say normal levels should be as high as 50 to 70 ng/mL.
The conclusion? While some experts suggest a level above 20 would be adequate, all agree that vitamin D levels could reach 60 to 100 ng/mL without posing any safety risk. So while there is no standard level, taking into consideration all opinions would result in the following vitamin D level recommendations:
- < 30: deficient
It is important to make sure that levels do not go above 100 ng/mL.
Vitamin D Food Sources
Looking for worthy foods to give you the vitamin D your body needs? Consider adding both fish and mushrooms to your diet . Other foods that naturally contain vitamin D are egg yolks, organ meats , and high-fat dairy.
- Muscle meat has some vitamin D, but the concentrations are not considerable.
- Egg yolks vitamin D concentrations are between the vitamin D values of muscle meat and organ meat.
- Milk and dairy products are normally quite low in vitamin D if they are not fortified with it. The highest natural values are reported in butter and cheese due to the high fat content. In the United States and Canada, milk is fortified with vitamin D, as are some bread products, orange juices, cereals, yogurts, and cheeses. The amount of vitamin D in fortified foods is generally around 100 IUs per serving.
Recent studies indicate that cooking may sometimes significantly lower vitamin D content. Canning and freezing fish does not alter its vitamin D much, nor does baking. Frying salmon, on the other hand, was found in one study to decrease the vitamin D by about 50 percent. The canned versions of oily fish like salmon, sardines, and mackerel can be a simple, relatively inexpensive way to get your vitamin D plus the extremely important omega-3 fatty acids EPA and DHA.
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Why Test Vitamin D Levels
Youre likely aware of the huge surge in research showing that vitamin D plays a crucial role in a plethora of physiological and preventive functions. Not only does it regulate calcium and phosphate levels, as we thought, but vitamin D also has numerous extra-skeletal effects.
Acting as a hormone, vitamin D can have a significant impact on the cardiovascular system, central nervous system, endocrine system, and immune system. Vitamin D receptors have now been found in most body cells. It is believed that when vitamin D binds to these receptors, it regulates a very large number of genes in the human genome.
The research associates vitamin D deficiency with many acute and chronic illnesses, including autoimmune diseases , cancer , type 2 diabetes and insulin resistance , infectious diseases , cardiovascular disease , cognitive decline , and more.
While more research is needed, many vitamin D researchers and physicians, including Boston Universitys Dr. Michael Holick, PhD, MD, one of the one of the worlds most prominent vitamin D researchers, disagree with the JAMA authors stance on staying with low-dose vitamin D. Instead, they support the idea of increasing vitamin D levels through high-dose supplementation.
Prevalence Of Vitamin D Deficiency
Vitamin D receptors are traced throughout the brain explaining the role of vitamin D in psychosomatic disorders, and it was found to have an equivocal call for vitamin D deficiency and depression going hand in hand .
Vitamin D insufficiency/deficiency is a worldwide problem, affecting all ages and races. Optimal 25 vitamin D concentrations for skeletal health are > 30 ng/ml. Serum 25 vitamin D concentrations are generally lower in blacks than in whites and people who avoid exposing them to the sun. The increased use of sunscreens is hypothesized to increase the prevalence of vitamin D deficiency. Older adults, as a result of hyperparathyroidism related to renal insufficiency, tend to require more vitamin D to achieve adequate levels of 25 vitamin D. As a result of the change in the definition of adequate concentrations, the prevalence of vitamin D deficiency is higher than previously thought. The prevalence of vitamin D deficiency among older men and women living in the United States and Europe ranges from 40100%. The National Health and Nutrition Examination Survey from 2000 to 2004 found that ~25% of men > 50 years of age and 3035% of women > 50 years of age had 25 vitamin D concentrations < 0.001. Two studies performed in Colorado and Georgia found that despite reported consumption of more than the required daily intake of vitamin D , the prevalence of vitamin D insufficiency among community-dwelling older adults ranged from 36.7 to 74.0% .
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Effect Of Vitamin D On Mood And Cognition
Vitamin D receptors and the 1-hydroxylase enzyme have been isolated and found in the regions of the cerebral cortex and cerebellum, suggesting the conversion of calcifediol into an active form of vitamin D, i.e., calcitriol in the brain for a local cellular response . Several studies discuss the deficiency of vitamin D in the body at its targeted ligand binding sites due to less sunlight exposure or sun blockage, vitamin D receptor mutation causing phenotypic-conformational changes at the ligand binding site, and insufficient vitamin D-fortified diet, all causing major or minor mood disorders and illustrate the effectiveness of vitamin D or sunlight therapy , gene therapy, or supplemented vitamin D diet therapy for the treatment of depression and other mood disorders, demonstrating the associations between 25 vitamin D concentrations and mood alone or mood and cognition in adults of all ages, including pregnant women, older adults, and targeted vitamin D-deficient population globally .
Based On Years Of Patient Testing And Data Analysis We Have Updated Our Laboratory Report Reference Range To Reflect That Values Between 20
This raises the issue: is normal the same thing as optimal? Not necessarily. The Vitamin D Council places the ideal level between 40 and 80 ng/mL with levels below 20 ng/mL as deficient. The Endocrine Society has a Clinical Practice Guideline on the evaluation, treatment, and prevention of vitamin D deficiency. This guideline recommends a minimum vitamin D level of 20 ng/mL, but to guarantee sufficiency they recommend between 30 and 50 ng/mL for both children and adults. In contrast, the Vitamin D Council states that even levels between 30 and 40 ng/mL are still not quite sufficient. On the other end of the spectrum, results that fall between 80 and 100 ng/mL are not achievable naturally that is, they are only reached with some form of vitamin D supplementation. So, while they are not harmful levels, they are instead reflective of supplementation and therefore not what would be detected in a “normal” patient population.
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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.
Maintaining Your Vitamin D Blood Levels With Good Foods Is Difficult Nowadays As Many Foods Are Now Contaminated So Take A Supplement That Is Free From Toxins And Contaminants And Has Selected Specific Vitamin Elements
Some supplement brands are manufactured synthetically or from food sources and wont give you more vitamins and minerals.
Such brands contain lesser amounts of vitamins than specific supplements that contain selected specific vitamin elements.
Also, it would be best if you increase your intake of plant compounds that have significant health benefits, along with fiber.
But the issue, as usual, is getting organic produce, which is expensive.
Choose a supplement based on a price that gives an optimum dose so that you get the maximum health benefits WITHOUT leaving you at risk.
It stands true, as we have seen, dietary supplements, as well as vitamin D brands, are contaminated with heavy metals like lead, cadmium, arsenic, and other toxins.
As discussed, in some cases, you are paying a high price for poor-quality products with contaminants that cause harm to your health.
It also stands true that there are many other brands in all the different categories of supplements that also contain contaminants.
Poor-quality supplements will remain on the market if the supplement industry is not regulated, including whole powder supplements.
Vitamins with natural forms of food elements are better, without contaminants. However, remember that all supplements are harmful in too high a dose.
For example, you would need 1.6 IU of vitamin E in a synthetic form, compared to the natural food source, in which case youd need 1.1 IU. So, vitamin E in a natural state would be better.
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Measuring Pigmentation Using Reflectometry
Melanin content was measured in the inner upper arm using a narrow band reflectometer during the initial visit . Measurements taken on the upper inner arm represent constitutive skin pigmentation . The Dermaspectrometer estimates the amount of melanin in the skin from the amount of light reflected back to the machine in the red and green wavelengths of the light spectrum . Skin color is primarily influenced by two pigments: hemoglobin and melanin, with hemoglobin showing a large optical absorption peak in the green wavelengths and a sharp drop off in the red wavelengths , while melanin shows absorption of light at all wavelengths . Based on the differences in the spectral curves of the two pigments, Diffey et al. suggested that the reflectance of light in the red spectrum would generate an estimate of the melanin content of human skin, following the equation, Melanin = log10 . Melanin Index values calculated using the Dermaspectrometer range from the low 20s to more than 100, with individuals with the lightest skin pigmentation having the lowest values and those with the darkest pigmentation having the highest .
Research Spotlight: Health Coaching And Nutrient Deficiencies
Web-Based Nutrition Intervention Improves Nutrient Biomarkers
In-person coaching approaches have demonstrated efficacy for improving patient health and motivation for change in previous clinical trials. However, one-on-one coaching sessions are financially unrealistic for many people. Until recently, it was uncertain whether these interventions could be administered on a large scale and still produce health benefits. A 2018 study assessed the effects of a web-based intervention on health biomarkers, including several markers for common nutrient deficiencies.
This research indicates that an online health coaching platform is useful for promoting diet and lifestyle behaviors that restore healthy vitamin D and iron status in deficient individuals. These findings suggest that personalized nutrition can be made more accessible through web-based health coaching programs that serve a large group of people.
While this study used an automated system to deliver appropriate interventions to subjects based on their respective biomarkers, a health coach could interact with clients on a more supportive, empowering level, along with the invaluable human aspect that is absent in fully automated coaching programs.
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Causes Of Vitamin D Deficiency
Vitamin D deficiency can occur for a number of reasons:
You don’t consume the recommended levels of the vitamin over time. This is likely if you follow a strict vegan diet, because most of the natural sources are animal-based, including fish and fish oils, egg yolks, fortified milk, and beef liver. Here are the best vitamin d foods for vegetarians.
Your exposure to sunlight is limited. Because the body makes vitamin D when your skin is exposed to sunlight, you may be at risk of deficiency if you are homebound, live in northern latitudes, wear long robes or head coverings for religious reasons, or have an occupation that prevents sun exposure. Duirng the winter, vitamin D deficiency can be more prevalent because there is less sunlight available.
You have dark skin. The pigment melanin reduces the skin’s ability to make vitamin D in response to sunlight exposure. Some studies show that older adults with darker skin are at high risk of vitamin D deficiency.
Your digestive tract cannot adequately absorb vitamin D. Certain medical problems, including Crohn’s disease, cystic fibrosis, and celiac disease, can affect your intestine’s ability to absorb vitamin D from the food you eat.
What Are The Signs And Symptoms Of Vitamin D Deficiency
Severe lack of vitamin D causes rickets, which shows up in children as incorrect growth patterns, weakness in muscles, pain in bones and deformities in joints. This is very rare. However, children who are deficient in vitamin D can also have muscle weakness or sore and painful muscles.
Lack of vitamin D is not quite as obvious in adults. Signs and symptoms might include:
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When Vitamin D Testing And Treatment Is A Waste Of Time And Money
Its important to be clear that the task force is highlighting uncertainty around screening and treating asymptomatic people who dont have real signs of illness, such as broken bones, or other illnesses that can cause vitamin deficiencies, like liver disease or multiple sclerosis.
For healthy individuals, if youre tired and weak, but its nondescript, this is a really tempting thing to do: measure vitamin D and then treat, Dr. Rosen, who is based at the Maine Medical Center Research Institute, warned. But there just isnt enough evidence it does anything.
So, for example, if you were feeling a little low this winter and you ask for a vitamin D test, then find out your levels are hovering around 20 or 30 ng/mL, you can go on supplements. And theres no doubt that those supplements will raise your vitamin D levels, since researchers have found they are absorbed by the body very efficiently. Doctors just dont know whether that change actually has any health benefit.
Rosen also cautioned that the biggest misconception about vitamin D is the association between low vitamin D levels and disease risk. Theres this idea, if we treat you, not only will some of your symptoms get better but also your long-term health benefit will be enhanced, he said. Again, theres no good evidence that thats the case.