Vitamin D
For the past several years the data in support of increasing vitamin D intake for every living human has been mounting. This week the American Journal of Clinical Nutrition features a collection of new research articles addressing the trends in vitamin D status and optimal dose recommendations.
This week’s take home lesson: While current research indicates we should be getting more vitamin D than is presently recommended, as a whole our vitamin D levels appear to have decreased in the past 15 years. The best way to combat this deficiency is with vitamin D supplements.
Vitamin D is a fat-soluble prohormone and essential nutrient produced when ultraviolet radiation (UVB) contacts our skin. It is probably best known for its role in bone metabolism (it has been shown to be more important than calcium for maintaining bone health), however recent studies indicate that vitamin D is essential for other physiological process as well.
Low blood levels of vitamin D have now been associated with many different chronic diseases including cancer, coronary heart disease, multiple sclerosis, Alzheimer’s disease, tuberculosis, depression, hypertension, periodontal disease, schizophrenia, seasonal affective disorder and type 1 diabetes.
In light of these findings, many nutrition researchers have argued for increasing recommended levels of vitamin D intake, but making population-wide recommendations have proved difficult for world health agencies because of large variability and uncertainty in vitamin D requirements.
There are several things to consider when evaluating vitamin D status in an individual. Latitude (sun exposure) is probably the single best predictor of vitamin D status. Anyone living in San Francisco or further north cannot get enough sun exposure to achieve sufficient vitamin D status, particularly during the winter months.
Because vitamin D is fat-soluble, it is retained in body tissues for several months after sun exposure. For this reason, people living at far north latitudes are particularly vulnerable to vitamin D deficiency because they frequently do not store up sufficient vitamin D during the summer to sustain their needs during the winter.
To further complicate matters, it is incredibly difficult to obtain vitamin D through dietary sources. Fatty fish and eggs are the only natural sources of vitamin D, though they are probably insufficient to achieve optimal status. Milk and soy products are typically fortified with vitamin D, as are some juices.
Skin pigmentation, sun avoidance and body composition (high body fat) are all associated with vitamin D deficiency. Darker skin tones do not convert sunlight to vitamin D as easily as lighter skin tones. Sunscreen blocks virtually all vitamin D synthesis. Body fat reduces bioavailability of vitamin D tissue stores.
This week’s study by Anne Looker et al, suggests that increased body mass as well as awareness of skin cancer risk and use of sunscreen have contributed to a significant decline in vitamin D levels in north America in the past decade.
The good news is that supplementation does appear to be effective at improving vitamin D status. Though there is still some disagreement on what the optimum blood levels of vitamin D are, it is generally agreed that they are much higher than currently recommended by any world health organization. One of the principle motivations of the present studies is to inform new vitamin D recommendations.
Kevin Cashman et al offers estimations of dietary requirements of vitamin D for healthy adults. They performed a randomized, placebo-controlled study testing the effects of different vitamin D doses and how they effect blood vitamin D levels.
The absolute minimum amount of vitamin D supplementation recommended by the study is 8.7 ug/day, or approximately 400 IU. This was to maintain blood serum levels greater than 25 nmol/L, and is double the current FDA recommendation for people under age 50. However, this suggestion is only sufficient to avoid deficiencies associated with bone loss and not other chronic diseases.
“The data from the present study clearly show that vitamin D tissue stores, developed during summer via exposure of skin to sunshine, were not sufficient to maintain serum 25(OH)D concentrations of greater than 25 nmol/L in most of the population [during winter], and that dietary vitamin D is an absolute requirement to maintain status above this minimum threshold.”
But the recommendations do not stop here. To maintain blood serum levels of greater than 50 nmol/L–a range more consistent with lowering risk of chronic disease–the study recommends 28 ug/day or 1100 IU of vitamin D. To keep blood serum above 80 nmol/L (from all I have read this is what I would recommend), 41 ug/day or 1650 IU is needed.
Remember this is most important if you are overweight, live north of San Francisco, get little sun exposure or have darker skin. Very rarely do I recommend vitamin supplements (they are not usually effective and are sometimes dangerous), but in this case the evidence is unequivocal.
Vitamin D supplements are easier to find than in the past, but they are usually packaged with calcium and are insufficient in dosage. Men should be wary of excess calcium supplementation since it is associated with an increased risk of prostate cancer.
I will continue looking for a good vitamin D supplement and will post when I find one I am happy with. If you have any recommendations, please share them with us.
Look for supplements where vitamin D is in the form of cholecalciferol, or vitamin D3.
