Vitamin Information Center

EAGLE COUNTY, Colorado — Vitamin D deficiency is now recognized as an epidemic throughout the United States. And as the dark winter clouds descend upon the Vail Valley to obscure the warm Colorado sunshine, things will only get worse.

A growing body of research has begun to demonstrate the importance of vitamin D, known as the “sunshine” vitamin. Historically vitamin D has been associated with skeletal growth and strong bones. This association arose early in the 20th century when it was shown that rickets, a childhood disease characterized by improper development of bones, could be prevented by a fat-soluble “factor D” in the diet or body exposure to ultraviolet light. Therefore, any compound with curative action on rickets was designated as vitamin D.

Our current understanding of the vitamin is now much more far-reaching, but still far from complete. We know that almost every cell in the human body has a receptor for vitamin D. Thousands of studies have confirmed that vitamin D can improve mood, prevent colds and flu’s, prevent autoimmune disease, build bone mass, increase strength in the elderly, significantly reduce risk of cancer, decrease chronic pain and systemic inflammation and the incidence of heart disease, and much more. With such broad effects on health, scientists are saying that vitamin D might be the most important hormone in the body.

We know that vitamin D is found in small quantities in milk, milk products, fatty fish, sun-dried shiitaki mushrooms, fortified cereals, and a good multivitamin. But the best and most reliable source is sunlight exposure. Every inch of your skin is covered with a cholesterol derivative called 7-dehydrocholesterol, which is converted to vitamin D when exposed to sunlight (or more specifically, the invisible form of sunlight that causes sunburn known as ultraviolet-B). Interestingly, sunscreen with an SPF of 8 will decrease vitamin D synthesis by 92.5 percent, and an SPF of 15 will decrease it by 99 percent. In light of this fact, most naturopathic doctors are beginning to recommend sensible exposure to sunshine. Fifteen to 20 minutes of exposure to midday summer sun on the forearms and face is usually sufficient to raise vitamin D in the blood to healthy levels. And because most tanning beds emit 2 to 6 percent UVB radiation, some docs are even recommending tanning beds for the treatment and prevention of vitamin D deficiency during the wintertime — in moderation of course and for 30 to 50 percent of the time recommended for tanning.

Many doctors once scoffed at vitamin D deficiency, but testing has become more routine and is now covered by most health insurance plans. In Seattle, which is infamous for dark and excruciating long winters, most hospitals and clinics are routinely checking 25-hydroxy vitamin D levels on patients. In my experience, after living and working in Seattle for the past seven years, approximately 80 to 90 percent of Seattleites are proving to be deficient in this essential nutrient!

Even in sunny Colorado it seems that vitamin D deficiency may be the rule rather than the exception. This is especially true during the winter months, when Colorado is furthest from the sun and located at such an angle to the sun’s radiation that makes it impossible to allow for adequate vitamin D production in the skin. You can literally stand outside naked for eight hours a day during the winter and still not increase your vitamin D levels. This naked truth — in conjunction with widespread sunscreen use in the summertime, the rise in obesity (which causes the body to sequester the vitamin in fat cells), the high prevalence of various malabsorption syndromes (including wheat and dairy sensitivities), and the use of certain medications (that destroy or block the absorption of vitamin D into the bloodstream) — suggests that many of us are unknowingly deficient in this important nutriment.

Most experts believe that without adequate sun exposure, children and adults require 1,000 to 2,000 IU of vitamin D3 per day. In cases of frank deficiency, much larger doses are often required to reestablish healthy levels. But be mindful that it is possible to go overboard with supplements. Because vitamin D is fat soluble and can build up in the body, it does have the potential to trigger dangerous calcium deposits in the kidneys and blood vessels. Therefore, it is advised to work closely with a doctor to promptly diagnose and effectively treat vitamin D deficiency. Your heath just might depend on it.

Nick Bitz is a naturopathic doctor at the Riverwalk Natural Health Clinic in Edwards. To reach the clinic, call 970-926-7606. E-mail comments about this column to cschnell@vaildaily.com.

The human body is an amazing factory, with all kinds of parts working together to make chemicals necessary for good health. But one thing it can’t make on its own is vitamin D. Research shows that defect can be troubling, especially among children.

To create vitamin D, which plays an important role in bone health and development, the body needs exposure to sunlight. As some countries move into autumn, the days get shorter and colder and exposure to sunlight decreases, making the colder months of the year a crucial time to watch vitamin D intake. Supplements can play an important role but one question is, how much?

Most of a child’s bone mass is built up early. A vitamin deficiency can prevent a child from building adequate bone mass now, and they won’t be able to make it all up later.

Although a study released this week found that vitamin D deficiencies are common in children around the world, there is minimal data on how much supplementation is necessary or safe.

Vitamin D is a fat — soluble vitamin directly or indirectly involved in several key body processes: regulating calcium and phosphorus levels in the blood, promoting bone formation and mineralisation, restricting parathyroid hormone secretion and promoting anti-tumour activity.

A review of medical literature on the vitamin published last year in The New England Journal of Medicine found that vitamin D is also associated with a reduced risk of type 1 diabetes in children, and may inhibit future hip fracture.

The main source of vitamin D is sunlight, which the body uses to convert vitamin D into a useable form. It’s also found naturally in eggs and fatty fish like salmon or tuna, and milk and some breakfast cereals are fortified with the vitamin.

The Institute of Medicine recommends that children get 200 IUs of vitamin D daily, but some experts say that up to 800 IUs is better.

The new study found that high doses of the vitamin were safe for children, whether taken over the short-term or for a longer period of time, and helped increased bone mass in 10 to 17 year olds.

A study released this summer found that even children who are otherwise healthy can have low levels of vitamin D, resulting in low levels of bone mineral content.

The risk for low vitamin D levels begins in infancy —breast milk, like cow’s milk, is naturally low in vitamin D. And if a mother doesn’t have enough vitamin D, her breast milk won’t either.

A vitamin D deficiency can affect bone growth even if there are no obvious problems.

A bottle of vitamin supplements
The American Academy of Paediatrics says that rickets, bone softening that can lead to fractures and deformity, in infants due to low vitamin D intake is seen in several US states.

The agency recommends that breast-fed infants receive vitamin D supplement drops.

Children at risk
“It is recommended that all infants, including those who are exclusively breastfed, have a minimum intake of 200 IUs of vitamin D per day beginning during the first two months of life,” said a clinical report for the health agency done by Dr Lawrence Gartner and Dr Frank Greer.

“In addition, it is recommended that an intake of 200 IUs of vitamin D per day be continued throughout childhood and adolescence, because adequate sunlight exposure is not easily determined for a given individual.”

The risks to bone health don’t end in infancy.
A Canadian study released last year found that despite guidelines for its prevention, vitamin D-deficiency rickets in childhood is still seen in the country, with an annual incidence of 2.9 cases per 100,000.

Children living in countries where exposure to sunlight is low had the highest incidence, and most of the affected children had medium to dark skin tones and had been breast fed.

“Since there were no reported cases of breast-fed children having received regular vitamin D (400 IU/d) from birth who developed rickets, the current guidelines for rickets prevention can be effective but are not being consistently implemented,” the study concluded.

Adequate vitamin D levels in the blood are important because the body can’t absorb dietary calcium without vitamin D, so in its absence it steals calcium from the bones, which increases the risk of rickets, osteoporosis and fractures.

This also places teenagers at risk because they have weaker bones that are more likely to fracture.

Children at particular risk include infants who are breast-fed exclusively and don’t receive supplementation, children who use sunscreen in summer, children who don’t use sunscreen in the summer but spend less than 15 minutes a day in direct sunlight, children who receive no supplementation in the winter, and children with chronic diseases that affect fat malabsorption, such as cystic fibrosis or celiac disease, according to the Hospital for Sick Children.

TORONTO (Reuters) - The human body is an amazing factory, with all kinds of parts working together to the make the chemicals necessary for good health. But one thing it can’t make on its own is vitamin D. Research shows that defect can be troubling, especially among children.

To create vitamin D, which plays an important role in bone health and development, the body needs exposure to sunlight. As we move into autumn, the days get shorter and colder and our exposure to sunlight decreases, making the colder months of the year a crucial time to watch vitamin D intake. Supplements can play an important role but one question is, how much?

Most of a child’s bone mass is built up early. A vitamin deficiency can prevent a child from building adequate bone mass now, and they won’t be able to make it all up later. Although a study released this week found that vitamin D deficiencies are common in children around the world, there is minimal data on how much supplementation is necessary or safe.

Vitamin D is a fat-soluble vitamin directly or indirectly involved in several key body processes: regulating calcium and phosphorus levels in the blood, promoting bone formation and mineralization, restricting parathyroid hormone secretion and promoting anti-tumor activity. A review of medical literature on the vitamin published last year in The New England Journal of Medicine found that vitamin D is also associated with a reduced risk of type 1 diabetes in children, and may inhibit future hip fracture.

The main source of vitamin D is sunlight, which the body uses to convert vitamin D into a useable form. It’s also found naturally in eggs and fatty fish like salmon or tuna, and milk and some breakfast cereals are fortified with the vitamin. The Institute of Medicine recommends that children get 200 IUs of vitamin D daily, but some experts say that up to 800 IUs is better.

This week’s study found that high doses of the vitamin were safe for children, whether taken over the short-term or for a longer period of time, and helped increased bone mass in 10-17-year olds.

Vitamin D deficiency is particularly a problem for North Americans, research shows, due in part to the higher latitudes at which they live. As well, because of concerns about skin cancer, many people now wear sunscreen, which inhibits the body’s ability to use sunlight to make the vitamin. The Hospital for Sick Children in Toronto says that sunscreen with an SPF above 8 blocks all vitamin D production through the skin. And darker-skinned individuals living in Canada and the United States may be at particular risk because they have more melanin in their skin, which means they need more sunlight than a lighter-skinned person to make the same amount of vitamin D.

A study released this summer found that even children who are otherwise healthy can have low levels of vitamin D, and resulting low levels of bone mineral content. More than 12 percent of the 400 kids studied by researchers at the Children’s Hospital in Boston had levels of vitamin D in their blood low enough to qualify them as deficient, and 40 percent of the children had less than the recommended level
The risk for low vitamin D levels begins in infancy - breast milk, like cow’s milk, is naturally low in vitamin D. And if a mother doesn’t have enough vitamin D, her breast milk won’t either.

A vitamin D deficiency can affect bone growth even if there are no obvious problems. The American Academy of Pediatrics says that rickets (), bone softening that can lead to fractures and deformity, in infants due to low vitamin D intake is seen in several U.S. states. The agency recommends that breast-fed infants receive vitamin D supplement drops.

“It is recommended that all infants, including those who are exclusively breastfed, have a minimum intake of 200 IUs of vitamin D per day beginning during the first 2 months of life,” said a clinical report for the health agency done by Drs. Lawrence Gartner and Frank Greer. “In addition, it is recommended that an intake of 200 IUs of vitamin D per day be continued throughout childhood and adolescence, because adequate sunlight exposure is not easily determined for a given individual.”

The risks to bone health don’t end in infancy. A Canadian study released last year found that despite guidelines for its prevention, vitamin D-deficiency rickets in childhood is still seen in the country, with an annual incidence of 2.9 cases per 100,000. Children living in the northern part of the country, where exposure to sunlight is the lowest, had the highest incidence, and most of the affected children had medium to dark skin tones and had been breast fed.

“Since there were no reported cases of breast-fed children having received regular vitamin D (400 IU/d) from birth who developed rickets, the current guidelines for rickets prevention can be effective but are not being consistently implemented,” the study concluded.

Adequate vitamin D levels in the blood are important because the body can’t absorb dietary calcium without vitamin D, so in its absence it steals calcium from the bones, which increases the risk of rickets, osteoporosis and fractures. This also places teenagers at risk because they have weaker bones that are more likely to fracture.

Children at particular risk include infants who are breast-fed exclusively and don’t receive supplementation, children who use sunscreen in the summer, children who don’t use sunscreen in the summer but spend less than 15 minutes a day in direct sunlight, children who receive no supplementation in the winter, and children with chronic diseases that affect fat malabsorption, such as cystic fibrosis or celiac disease, according to the Hospital for Sick Children.

Because natural sources are so rare, it’s difficult to get adequate vitamin D in the diet. One tablespoon of cod liver oil has 1,360 IUs, a serving of cooked salmon has 360, a cup of fortified milk has 98 and a whole egg has 20. Fifteen minutes of direct sunlight is enough for many people to reach their needs for vitamin D, but darker-skinned people need longer exposure and because winter sunlight in North America is indirect, supplementation may be recommended.

Do you supplement with extra vitamin D? Let us know: HealthMatters@reuters.com

NEW YORK (Reuters Health) - Softening of the skull bones in normal-appearing newborns is tied to a vitamin D deficiency in the womb, according to Japanese researchers.

They suggest that breast-fed infants with this condition may need vitamin D supplements.

Soft skull bones, also known as craniotabes, in normal newborns is usually regarded as no cause for alarm, but Dr. Tohru Yorifuji at Kyoto University Hospital and colleagues dispute this in their report in the Journal of Clinical Endocrinology and Metabolism. They point to evidence that the condition is associated with type 1 diabetes, reduced bone mass during childhood, and lowered immunity.

In their study, the researchers screened 1120 normal infants at 5 to 7 days of age. Craniotabes was considered present when “the skull bones reversibly bended by application of pressure by the examiner’s fingers.”

They found that 246 babies, or 22 percent, had craniotabes. The highest rate occurred among infants born in April and May, and the lowest in those born in November.

Vitamin D production in the body is triggered by sunlight, and Yorifuji’s team points out that the rate of craniotabes “was influenced by the daylight hours approximately 4 months prior to delivery.” They say this strongly suggests that “the condition is associated with vitamin D deficiency in utero.”

Low vitamin D levels and other abnormalities at 1 month of age were more common in babies who were breast-fed than in those who were fed formula at least part of the time, the investigators found.

They therefore recommend “treating breast-fed infants with craniotabes with vitamin D, or preferably, treating all pregnant women with vitamin D.”

SOURCE: Journal of Clinical Endocrinology and Metabolism, online February 12, 2008.

It takes more than drinking milk to strengthen our bones. Milk is certainly a good source of calcium, but it is only one option to prevent or retard osteoporosis, the disease that affects one out of every two women over the age of 50.

Bone density begins its slow decline between the ages of 25 and 30. By the age of 70, women can lose up to 30 percent of that density. By age 75, osteoporosis becomes as common in men as it is in women.

Osteoporosis means “porous bones” and is considered the third-leading health issue in our country, after cardiovascular and cancer problems. The most threatening areas for fractures to occur are in the spine, hips and wrists.

When bones become weak and brittle, actions as easy as bending over or even coughing can cause fractures. While hip fractures usually are a result of a fall, many fractures occur without involving any falls.

Compression fractures can develop when bones in your back simply become too weak, resulting in a stooped posture. This will increase pressure around your spine, eventually causing more compression fractures.

Three of the major risk factors for osteoporosis that we can control are lack of regular exercise, too little calcium intake and an inadequate amount of vitamin D, which is essential for calcium absorption.

People who have been physically active in their younger years have an advantage over their non-active friends: While the active types may lose some bone as they age, their chances of suffering fractures from having brittle bones are greatly reduced.

It never is too early or too late to begin strengthening the muscles and the bones. Exercise can improve muscle strength, bone density, posture and balance, all of which will help prevent falls.

If you already have osteoporosis, exercising can help maintain your bone mass. You should replace any high-impact exercise that could place stress on your spine (such as jogging) with more gentle weight-bearing exercises (walking).

Similarly, bending and twisting movements at the waist (such as in golf, tennis and situps) should be avoided, because they could cause the already weakened spinal bones to compress and possibly fracture.

It is important to check with your physician or physical therapist before you begin exercising, because you need to find the safest and most enjoyable exercises depending on your degree of bone loss.

Exercise prevents osteoporosis

Muscles become stronger and bone density increases as you place demands upon them; bone is a living tissue that reacts positively to exercise.

Commitment to consistent exercise is essential, because once you cease exercising, bone density benefits will also cease.

For strengthening and helping to maintain healthy bones, it is recommended to do weight-bearing exercises a minimum of 30 minutes for three days per week and resistance exercises two or three times a week.

What type of exercise is best

Weight-bearing exercises require your body to work against gravity: jogging, brisk walking, stair climbing, racquet sports and dancing are good examples. Swimming and biking, while excellent for cardio workouts, are not considered a weight-bearing exercise.

However, in some stages of osteoporosis, water exercises may be used in rehabilitation. Resistance exercise (strength training) strengthens muscles and bones throughout the entire body. These exercises involve using your muscular strength to work against the weight of another object, such as using free weights, weight machines or resistance bands.

For some resistance exercises, you can even use your own body weight as the exercise load. Balance, coordination and flexibility exercises for fall prevention include standing on one leg, sitting and exercising on an exercise ball, tandem walking, stretching, dancing, tai chi and yoga.

Nutritionally speaking

According to the National Institutes of Health, people with vitamin D deficiencies absorb less than 10 percent of available calcium they ingest. Three of the leading contenders for calcium are plain low-fat yogurt, fruit yogurt and whole, low-fat or fat-free milk.

Our body’s absorb vitamin D through sunlight and vitamin D-fortified foods, such as milk. Here are a few added suggestions to fortify your 206 bones:

• Treat yourself to 15 minutes a day without any sunscreen. That is what your body needs to produce vitamin D, the “sunshine vitamin.”

• Almonds are packed with bone health. A handful counts for about 70mg of calcium.

• Studies indicate that a cup of tea a day increases bone density.

• Eat brown instead of white. Brown rice has three times the calcium than white rice.

• Try having chopped figs over yogurt for a snack; it will give you almost half the needed calcium requirements for the day.

If you are 50 or older and have not been exercising, check with your physician before beginning ANY exercise program. Sally Anderson, a trainer, is happy to hear from readers but cannot respond to individual queries. Write her in care of LifeTimes, St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731.

Hip extensions

Strengthens hips and thighs. Place one hand on a countertop. Keeping hips facing forward, slowly lift one leg out to the side, knee facing forward, as Royce demonstrates at left. Hold a few seconds, then slowly return leg to ankle, never touching the floor. Repeat 8 to 10 times. Priscilla shows the next movement: Lift leg diagonally to the back. Hold, then slowly release leg; repeat 8 to 10 times. Tips: Contract abdominals and do not lock knees. You may add ankle weights later.

Tandem walk

Develops balance. (Not shown.) Stand with fingers lightly supported on a counter or a wall. Looking straight ahead, walk, placing one foot directly in front of other foot, making sure front heel is close to back toes; aim for 15 to 20 steps. Then, if you do not have foot or ankle issues, try walking on your heels, with the balls of your feet lifted up. Tip: Walk tall, do not lean forward.

Wringing the towel

Strengthens the wrist. Hold a towel in both hands, keeping elbows close to your sides. Wring the towel out as hard as you can, extending one wrist and flexing the other wrist at the same time; do 10 to 15 repetitions. Tip: Use your wrist muscles, not your fingers.

Back extension

Strengthens shoulders, back, neck, spine and hips. Begin by lying on your stomach on a mat with arms in front of you, palms facing downward. Keeping legs on mat, lift head, arms and chest off the mat. Bend elbows, bringing them in toward your shoulders, feeling a slight pinch of the shoulder blades. Hold for several seconds, then extend arms to original position and repeat several times. Tip: Do not hold your breath.

Wringing the towel

Strengthens the wrist. Hold a towel in both hands, keeping elbows close to your sides. Wring the towel out as hard as you can, extending one wrist and flexing the other wrist at the same time; do 10-15 repetitions. Tip: Use your wrist muscles, not your fingers.