The Scoop on Vitamin D

Dear Patients, Friends, Family & Community Members

A month or so ago I attended a webinar for health care practitioners that was designed to bring everyone up to speed on the latest research related to Vitamin D. The presenter, Dr. David Seaman, was a researcher from Florida.

I love these new webinars. I don't have to travel anywhere. From the comfort of my office (or home) I can sit back and listen to top researchers like Seaman. I can even fire off questions. The best part is that the presentations are archived and can be accessed at any time for review.

Vitamin D is a hot topic. Over the past several years there was some shocking research that had/has scientists taking a hard look at Vitamin D. They had to review its relationship to certain symptoms and diseases. Those initial studies sparked some great new research and they have come up with new recommendations for adequate intakes related to that vitamin. There is some very compelling evidence that we have been sorely inadequate in our intake of this amazing vitamin.

As usual, there are hundreds of opinions out there as to what to do with Vitamin D. Some will tell you that it is toxic and you have to be careful. Others will tell you that you can get all you need in your diet. Others will say that you need to take lots - but they all have different opinions as to how much is adequate.

In this blog I am going to use the scientific literature to help bring you up to speed and clear the confusion concerning Vitamin D. Like my Discovering Wellness Workshops, I will present the science - you draw the conclusions!

There is a lot of information in this blog. If you are the type that just wants the answers and don't want the reasons, please cursor to the end for a summary. If on the other hand you want to learn and understand the how and why of the answers, please read on. Most of you know I like to stand up on my soap box and talk about important health and wellness issues.

What started all the interest in vitamin D?

Let's go back to that shocking research. Turns out, the vast majority of people in developed countries like Canada, England, the USA, etc., are deficient in our blood levels of Vitamin D. The normal range of Vitamin D in your blood for good health should be between 32-100 ng/mL (80-250 nmol/L). Don't worry about what that means, just remember that this is the normal range.

One study listed the blood levels of Vitamin D from various areas around North America. Some examples from Canada:

• Toronto, ON - subjects were young women - in the summer their Vitamin D peaked at 30.4 and in the winter they dropped to 23.2. This is shockingly low.
• Calgary, AB - subjects were men and women ages 27-89 - in the summer their average Vitamin D peaked at 28.6 and in winter dropped to 22.9. Again, shockingly low.

These low numbers went on and on right across North America¹. Other studies from other parts of the world showed the same trend^2,3,4.

As the studies began coming in, researchers realized that we had a BIG problem. In the past, in more primitive societies, people obtained most of their Vitamin D from sunshine. In the summer time, blood levels of Vitamin D would increase towards 100 ng/mL and during the winter, because of decreased sunshine, the blood levels would slowly decline towards the 30 ng/mL mark. By the time the blood levels declined, spring time would arrive and the cycle would repeat.

In our modern society we shun sunlight. Like vampires, afraid we will melt, we avoid the sun. We were told that sun exposure causes skin cancer and ages our skin. So we avoid it. Unfortunately, that has led to Vitamin D levels that are below minimum values for health. The amount of Vitamin D available from the average North American diet is far below that required to maintain even minimum levels. Those of you who have attended our Discovering Wellness Workshop will remember that adequate sunshine is considered essential for overall good health - it was good for our paleolithic ancestors and a little is good for us too.

What happens if we don't get enough Vitamin D?

Low Vitamin D levels are associated with a multitude of different types of disease including: breast cancer, prostate cancer, ovarian cancer, colon cancer , kidney cancer, endometrial cancer, non-Hodgkins lymphoma, Type I Diabetes, Type II Diabetes, Multiple Sclerosis, Heart Attacks, Osteoporosis, Osteoarthritis, Fractures, Hyper Tension (high blood pressure), Metabolic Syndrome, Epilepsy, etc. It has even been implicated in such diverse things as fibromyalgia, mood disorders, back pain and viral infections such as cold and flu^{5,6,7 8,9,10,11,12,13,14,15,16,17,18}.

Why is a Chiropractor interested in Vitamin D?

As a Wellness Chiropractor there are three things about Vitamin D that interest me.

1. Overall health and wellbeing of my patients.
2. The association of low blood levels of Vitamin D with back pain, overall muscle and joint pain and fibromyalgia.
3. Its relationship with preventing colds and flu or at least reducing the severity and duration of symptoms.

When I earned my B.Sc., Specialist in Nutritional Sciences from U of T, it was considered dogma that no one should ever supplement with more than 400 International Units (IU) of Vitamin D per day. They argued that any more would risk possible toxicity, even though there were no scientific trials to support that view. It was assumed that since Vitamin D was a fat soluble vitamin, it could be toxic like Vitamin A, if over utilized. Indeed, even today, almost all vitamin supplements contain no more than 400 IU of Vitamin D per daily dose. The new research shows these fears are very overblown.

With all the new research out there a lot of patients come to me and say they have heard about Vitamin D and want to know how much they should take? Some are told by their MD's that their blood levels are low and that they need to take Vitamin D - usually prescribed 1000-2000 IU / day - is that adequate? Some patients are told by their MD's that they have osteoporosis and that they need to take Calcium with Vitamin D - how much should they take?

How much should I take?

There is a great article published in the refereed journal Alternative Medicine Review, Volume 13, Number 1, 2008 by John J. Cannell, MD and Bruce W. Hollis, PhD entitled 'Use of Vitamin D in Clinical Practice'¹⁹. These two are among the worlds leading vitamin D researchers. In the article they give some recommendations based on the latest research.

• Breast fed infants (800 IU/day)
• Formula fed infants (400 IU/day)
• Toddlers over the age of one and young children (1,000-2,000 IU/day) depending on weight.  In the summertime, if the child is getting lots of sun exposure without sunscreen you can discontinue supplementation during that time.
• Lactating women (7,000 IU/day).  Babies of women supplementing with this amount of Vitamin D do not need supplementation themselves.  The breast milk will be rich with Vitamin D.
• Adolescents and Adults (between 3,000 to 10,000 IU/day), [1,000 IU /day for every 15 kg of body weight.].
• Pregnant or women thinking of becoming pregnant should have their blood levels of Vitamin D checked every three months - target range 40 -70 ng/ml.  Typically this requires 5,000 IU/day.

The numbers listed above should result in a blood level of 40 to 70 ng/ml (considered the optimum range, right in the middle range of normal).

The authors recommend that you have your blood levels checked occasionally to see where you are. They recommend you try for at least the midrange of normal. You can ask your MD to requests the appropriate lab work (which would cost you nothing) or you can do it at home. You can order the tests from good reputable labs that will ship you the necessary things to take the finger prick blood sample and send it in to them for an accurate analysis.

I thought Vitamin D could be toxic?

Every one wonders about toxicity from too much Vitamin D intake. Although it is possible to overdo it, the research at present argues that you would have to reach blood levels of 150 to 200 ng/ml or higher in order to suffer symptoms of Vitamin D toxicity. That's well above the normal range^{20,21,22,23,24}. To put that into perspective, Dr. Seaman lives in Florida. He is a sun worshiper and always has a deep tan. He takes 10,000 IU of Vitamin D every day and has done so for 2-3 years. When he gets his blood levels checked, they are never over 82-89 ng/ml. That is well within the normal range. Sharon and I personally take 5,000 IU every day in spring, summer and fall. In the winter we increase our intake to 8,000-10,000 IU per day.

You may wonder why we increase our Vitamin D intake in the winter? Have you ever noticed that there are fewer colds or flu in the summer? The argument goes like this. In the summer months we get far more sunshine than in the winter months. More sunshine means more Vitamin D. In the winter with less and less sunshine our Vitamin D levels drop. With lower Vitamin D levels we become more vulnerable to viruses like colds and flu. As an example, remember how grey and dreary our summer was? This summer also had unusual summer viral illnesses (lower sunshine levels - lower Vitamin D levels). Also, without the summer sunshine our winter cold and flu season started very early this year (we started the fall with lower than ever Vitamin D levels). Therefore, to help counter the lack of sunshine in the winter we need to increase our Vitamin D intake.

Can I get my Vitamin D from my diet?

Vitamin D is hard to come by with our present dietary preferences. The major natural source of Vitamin D is salmon and other cold water fish. Unfortunately, fish is a very small part of our diet and we do not eat enough to meet our Vitamin D requirements. There is some Vitamin D in fortified milk, orange juice and cereals but they only supply minimal amounts. Good old fashioned Cod Liver Oil supplies about 1,300 IU per tablespoon - meaning that you would require three or more tablespoons a day to meet your requirements. This would be unacceptable, not because of the vitamin D but because Cod Liver Oil also contains Vitamin A, which can be toxic if you ingest too much.

What about sunshine?

What about soaking up some sunshine? Is it safe and if so how much is safe? Researcher's opinions vary on this issue. It is natural for us to have some sun exposure. It is the way we are supposed to get our Vitamin D. They estimate that a fair skinned person having about 30 minutes of whole body sun exposure while wearing a bathing suit will produce 20,000 IU of Vitamin D¹⁹. Further, repeated sun exposure will allow the blood levels to climb to maximum but then an amazing thing happens - the body automatically starts destroying any further Vitamin D. In other words, when using the sun, your body will maximize your Vitamin D but not allow you to overdose. This automatic protection from excessive levels does not occur for people who take too much Vitamin D orally without sun exposure. Ironically, it's the sun that protects you.

The risk of cancer in association with sunlight is highly misunderstood. There are many different forms of skin cancer. Most, although potentially disfiguring and the cause of many trips to the dermatologist, are rarely deadly. The most dangerous skin cancer is malignant melanoma. There is no direct link between lifetime sun exposure and malignant melanoma. Indeed, regular sun exposure, excluding painful sunburn, actually seemed to decrease the risk of malignant melanoma. Excessive sun exposure and repeated sun burns are associated with less dangerous non-melanoma skin cancers²⁵.

In other words, being sensible about sun exposure will allow you to achieve healthy Vitamin D levels in the summer time but you have to be sensible - anything equivalent to 10 to 20 minutes of whole body exposure per day will be more than enough for fair skinned individuals. Being a senior, being obese or having dark skin all require more exposure time to reach the same levels. Tanning beds will allow your body to produce Vitamin D in large amounts if they emit UVB rays (not all beds do). By the way, sun screens - even a SPF of 6-8 will block over 90% of your skins ability to produce Vitamin D.

For most of us it's just simpler and safer, especially in the winter, to supplement. However, not all Vitamin D was created equal. There are many different types of Vitamin D on the market so be careful when shopping. The one you need is called cholecalciferol or Vitamin D3. Other forms of the vitamin are not adequate. Most commercial brands offer 500, 1,000 or 2,000 IU tablets. Some manufacturers offer a liquid form with 1,000 IU in every drop. We use Douglas Labs liquid vitamin D3. We simply add it to our omega 3 liquid and 'down the hatch it goes.'

Are there any contraindications for taking Vitamin D?

There are certain contraindications for taking Vitamin D. If you have primary hyperparathyroidism; hyperthyroidism (not hypothyroidism); malignancies such as multiple myeloma, lymphoma, etc.; granulomatous diseases such as sarcoidosis, tuberculosis, Chron's disease, etc. then you must talk with your MD before taking extra Vitamin D²⁶.

The only major group of drugs that are contraindicated for Vitamin D supplementation are the Thiazide Diuretic family: Hydroclorothiazide, Clorothiazide, etc.²⁶ If you are taking diuretics and you're not sure if they are a thiazide or not then talk with your pharmacist.

There, that's it! You are now up to date with the basics of the latest research.

In quick review:

• Virtually everyone in this country is deficient in adequate blood levels of Vitamin D.
• Vitamin D deficiency is directly associated with many forms of cancer and a large number of other diseases such as diabetes, hypertension, fibromyalgia, back pain, etc.
• The easiest and safest way to ensure adequate blood levels is with dietary supplementation.

Recommended intakes are:

• Breast fed infants (800 IU/day)
• Formula fed infants (400 IU/day)
• Toddlers over the age of one and young children (1,000-2,000 IU/day) depending on weight.  In the summertime, if the child is getting lots of sun exposure without sunscreen you can discontinue supplementation during that time.
• Lactating women (7,000 IU/day).  Babies of women supplementing with this amount of Vitamin D do not need supplementation themselves.  The breast milk will be rich with Vitamin D.
• Adolescents and Adults (between 3,000 to 10,000 IU/day), [1,000 IU /day for every 15 kg of body weight.].
• Pregnant or women thinking of becoming pregnant should have their blood levels of Vitamin D checked every three months - target range 40 -70 ng/ml.  Typically this requires 5,000 IU/day.

I've linked you to a great little website devoted to Vitamin D. Click HERE.

References click HERE

As always, feel free to respond and leave comments so you too can have a voice.

Be Well,

Dr. Paul