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VITAMIN D: ARE YOU GETTING ENOUGH?

Vitamin D is a fat soluble vitamin that your body needs to absorb calcium and plays an important role in maintaining muscle strength. This vitamin is unique in that your skin manufactures it just by being exposed to the sun (caution: too much exposure to ultraviolet rays can lead to skin damage and/or cancer). The amount made depend on the time of day, season, how far north you live (most people in Syracuse are vitamin D deficient), how much of your body is exposed to the sun, and your age (older people produce less vitamin D from sun exposure).
Many people are deficient in vitamin D -which can put them at an increased risk for fractures- especially those who are over 60, have darker skin, live in the northern latitudes, are rarely outside, individuals with malabsorption syndromes (i.e. Crohns or celiac disease), or individuals taking medications that interfere with absorption (i.e. steroid use ≥ 3 months, certain seizure and cholesterol lowering medications).  Many young people also have low blood levels of D, according to recent studies. Obesity is also associated with reduced blood levels of vitamin D.
Vitamin D is fat soluble; therefore, the body can store it for days or even months when you are not able to get into the sun or take any supplements.
Sources:
Few foods supply vitamin D. Some of the foods that do include:
·         Milk fortified with vitamin D3 (100 IU per cup)
·         Some soy milk, orange juice, margarines, yogurts, and breakfast cereals are fortified with vitamin D3
·         Fatty fish (i.e. salmon, tuna, and sardines) are naturally rich in vitamin D
·         Fish oils
·         Organic free ranged eggs
Blood levels and why testing is important
The amount of D in a multivitamin and/or exposing your face and arms to the sun for periods of time may not be enough to reach desirable blood levels. The body’s ability to make and utilize D varies from person to person, this is why it is important to get a serum 25-hydroxyvitamin D (the type of vitamin D found in the blood) level checked by your physician. Most experts agree that blood levels at least 30 to 40 ng/ml are desirable and others believe that at least 50 to 60 ng/ml is a better goal –consult with your physician to determine your ultimate vitamin D goal.
If your test shows a low D level your doctor will recommend a dosage which may need a prescription. After the desired treatment has been completed it will be necessary to recheck your levels to make sure the treatment was effective at raising your D to a sufficient level.
There has been a lot of recent research on vitamin D. The most notable focus on the crucial role in working with Calcium to keep bones strong. Other studies have looked at its potential to reduce the risk of common cancers, multiple sclerosis, diabetes, hypertension, and age related muscle weakness. A recent study done by Archives of Internal Medicine showed a 7% reduction in total mortality rate of people taking vitamin D supplements.
It is difficult to get a sufficient amount of vitamin D from food alone so often supplements are necessary.


Recommendations from the Institute of Medicine
Age Dosage in international units (IU)
50 or younger 200
51-70 400
71 or older 600
Recommendations from the National Osteoporosis Foundation
Age Dosage in international units (IU)
50 or younger 400-800
51 or older 800-1000
  
Some people with low levels of D may need an even higher intake up to 50,000 IU (prescribed by a physician) for up to eight weeks to elevate his/or her vitamin D to an adequate level.
The Canadian Cancer Society recommends that all Canadian adults take 1,000 IU of D a day during fall and winter, and older and/or darker-skinned people to take this much year round. The University of California, Berkley believes this is good advice for most Americans as well. 
Tips for shopping for vitamin D
·         Read the fine print
·         Look for D3 (cholecalciferol) which is more potent than D3 (ergocalciferol)
·         Do not take Cod liver oil for its high level of D, since it is rich in Vitamin A (retinol) which weakens bones
·         Eat fatty fish (rich in vitamin D but not in vitamin A)
There is evidence that the intake of adequate vitamin D along with Calcium (see Meeting your Calcium Needs) may reduce the risk for falls (by increasing muscle strength) AND reduce the risk for fracture in postmenopausal women and older adults. As adults age the need for vitamin D increases; it is a good idea for all adults to speak to their healthcare provider about their individual recommendations for vitamin D.  
 
References:
New York State Osteoporosis Prevention and Education Program “Vitamin D”. © 2004-2009 NYSOPEP. www.nysopep.org.
University of California, Berkely Wellness Letter –The Newsletter of Nutrition, Fitrness, and Self-Care. “Vitamin D: are you getting enough”. February 2008.
American Academy of Dermatology Vitamin D Factsheet




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