Eric Madrid, MD
Physicians and scientists are starting to realize the numerous health benefits of sunshine exposure and vitamin D supplementation. Most doctors know severe vitamin D deficiency causes rickets. Since rickets is rarely seen today, it is incorrectly assumed that vitamin D deficiency is nonexistent.

Fallbrook and Temecula medical providers have diagnosed hundreds of patients with vitamin D deficiency, or about 90 percent of all patients tested. Nine out of 10 people reading this story likely suffer from vitamin D deficiency.

Why should you have your vitamin D level checked? Studies have shown that those with lower levels of vitamin D in their blood have a higher risk of developing breast cancer, ovarian cancer, colon cancer, prostate cancer, type 1 diabetes, multiple sclerosis and heart disease. One study showed greater than a 60-percent reduction in breast cancer in those with the highest levels of vitamin D in their blood.

In addition, senior citizens who have lower levels of vitamin D in their blood are at higher risk of falls, osteoporosis and bone fractures. Those who suffer from chronic pain and fibromyalgia also have lower levels of vitamin D.

Vitamin D levels are checked by a simple blood test. Treatment usually requires supplementation with vitamin D3 as opposed to the more commonly sold over the counter vitamin D.

Vitamin D is also made from moderate daily sun exposure to the arms and legs. Caution must be taken to prevent sun burning. Many sunscreens will block out UVB, which is the type of sunlight needed for skin to make vitamin D. Those with darker pigment are higher risk of deficiency, which may explain the higher incidence of diseases in certain ethnic populations.

To check your vitamin D level, contact your physician or call (951) 676-4193 for an appointment.

Eric Madrid MD is a family physician with Rancho Family Medical Group, which has offices in Fallbrook and Temecula. See www.ranchofamilymed.com.

Oily fish: Mackerel is a good source of vitamin D

Vitamin D may offer protection against the most common form of diabetes.

New research shows that, in particular, men with the highest blood level of the vitamin were 72 per cent less likely to develop type 2 diabetes.

There was a reduced effect among women.

Scientists in Finland monitored several thousand people, aged 40 to 74, for 22 years, during which time 412 developed the disease.

Results showed that those with higher levels of vitamin D had the lower risk of diabetes.

It is thought that low levels of vitamin D affect the body’s ability to produce insulin.

Diabetes type 2 is a growing health problem.

There are 1.9 million adults in the UK with diagnosed diabetes, and it is estimated there are another 589,000 unidentified sufferers.

Risk increases with age - less than one per cent of people under 34 have diagnosed diabetes compared with 10 per cent aged 75 and over.

A friend recently told me about how his uncle had heard that garlic could help lower his high blood pressure. So the uncle generously added garlic salt to his diet.

A little knowledge can kill you.

A similar misunderstanding appears to be spreading about vitamin D. More and more people are realizing that they are lactose intolerant. So they eliminate milk from their diets.

People also are worried about sun exposure and skin cancer, so they slop on sunscreen whenever they go out or otherwise avoid direct sunlight. And mercury is scaring folks away from eating fish.

As a result, some people are losing all sources of vitamin D. For the first time in a century, doctors are seeing a resurgence in rickets, that bone-deforming disease once endemic to wobbly-kneed child laborers in the Victorian era who never saw the light of day.

Pediatricians in Philadelphia have reported more than 150 new cases in the past three years, up from about zero. Washington, D.C., and other areas with large African-American populations are reporting the similar increases.

No formal studies have found the precise cause of the rickets — be it less milk consumption, less sun exposure, or other factors — but it does appear that Americans in general aren’t getting enough vitamin D.

Vitamin Q and A

Vitamin D is a complicated essential micronutrient. The National Institutes of Health convened a panel of experts last September to establish nutritional guidelines. As revealed in the official meeting proceedings, published in the August 2008 issue of the American Journal of Clinical Nutrition, they couldn’t come to any consensus. The published overview is essentially a collective shrug of the shoulders.

Vitamin D is crucial for calcium metabolism — namely, the making of strong bones — and likely for immune function, heart health, cell proliferation and cancer and diabetes protection, at a minimum. An independent study from Johns Hopkins University, published in the current issue of the Archives of Internal Medicine, associated lower levels of vitamin D in the blood with a higher risk of death.

Yet the experts couldn’t agree to any details. The current recommendation is to get 400 IU of vitamin D daily. Many say this isn’t enough, but no one knows how much more is too much.

Complicating issues further is the fact that vitamin D is the only nutrient that can be made entirely in the skin upon exposure to sunlight, yet this varies greatly with skin color and latitude. It’s hard to assess your daily dose. Few foods other than fish contain vitamin D. Milk is fortified with it, but you need four glasses to get 400 IUs.

Out of Africa

Lighter skin is more efficient at producing vitamin D. So African-Americans are at a double disadvantage for synthesizing vitamin D from sunlight — in the United States. Their darker skin blocks the ultraviolet light that triggers this chemical reaction. In their native lands, closer to the equator where sunlight is more direct, their darker skins would have enough sun exposure to synthesize vitamin D.

Peoples in high northern latitudes, such as Europeans, slowly developed lighter skin over tens of thousands of years to adapt to the weaker sunlight to generate enough vitamin D to survive. African-Americans forced migration from Africa occurred over a period of only a few hundred years.

Also, most African Americans — and most of the world, actually — are lactose intolerant and cannot digest cow milk well. So many do not drink enough milk. Natural sources of vitamin D include cod liver oil (as if anyone can stomach this, let alone find it outside their great-grandmother’s cupboard) and salmon and mackerel (tasty, but expensive).

In Philadelphia many rickets cases involve children of Black Muslims, and the culture of conservative clothing likely played a role.

Yet doctors wonder whether the African-American communities are providing a warning call for all of America, as kids of all races drink less milk, the primary albeit artificial source of vitamin D for most clothed, non-farming residents of North America.

Killer rays

More sunlight isn’t the answer. Humans evolved to frolic naked in the sun but also to live about 30 years or so in Africa. Take your fair skin better suited for Scandinavia and place it in Miami for several summers, and you’re going to get skin cancer.

Regardless, for latitudes north of New York City, and considering how people bundle up during winter, there’s not enough sunlight year-round to satisfy the daily vitamin D requirement.

Milk fortification works well. But all vitamin D supplementation and fortification is essentially created equal. Look for new vitamin D recommendations later this year that try to make sense of the ambiguous NIH report.

Mothers everywhere probably will not be surprised to hear that they were right. Drinking your milk is, of course, good for you. Not only is milk chock-full of calcium, most milk has been fortified with vitamin D — and both nutrients are necessary for good bone health, among other things. And in recent years, a growing body of research has caused experts to conclude that many adults, particularly those over 50, are not getting enough calcium or vitamin D, says Dr. Michelle Germain, a part-time faculty member in the Department of Gynecology and Division of Urogynecology at Greater Baltimore Medical Center.

What is vitamin D?

Vitamin D is a fat-soluble vitamin. It is absorbed from food through the GI [gastrointestinal] tract and also is made by the body. The body needs it because it helps with absorption of calcium and phosphorus, both of which the body needs for bone health.

You said that, in addition to absorbing vitamin D from food, the body also manufactures it. How does the body make vitamin D?

The skin manufactures the vitamin D with the help of ultraviolet rays from the sun. So you need sun exposure to make it. Once we have vitamin D in our bodies, the liver and the kidneys convert the vitamin D into the active form that is used for bone health.

What foods contain vitamin D?

Cod-liver oil is the best way to get vitamin D, but we don’t see many people taking that these days. So other really great sources of vitamin D are fish, such as salmon, mackerel and tuna, and vitamin D-fortified foods, such as dairy products and cereals.

What happens if we don’t get enough vitamin D?

You can become vitamin D-deficient. Children can develop “rickets,” in which the bone doesn’t properly mineralize, and the children develop very soft bones and deformities of their skeleton. In adults, too little vitamin D can lead to osteoporosis. [Too much vitamin D, on the other hand, can make the intestines absorb too much calcium.]

How pervasive is rickets?

In developed countries like the United States, it is pretty uncommon because we fortify so many foods with vitamin D. But there has been a resurgence of rickets in African-American infants and children in poorer states, especially in the South such as Tennessee and Mississippi. The resurgence is being caused by poverty and poor nutrition. It also has to do with darker pigmentation of the skin, which converts sunlight less effectively into vitamin D.

Rickets also is more prevalent in immigrants from Africa, the Middle East and Asia because of their diets before they arrive in the United States and because they may not have enough money to afford good nutrition once here. Again, if they have darker skin, they are not converting UV rays into vitamin D as effectively as people with lighter skins.

Are there other populations for which vitamin D is particularly important?

Older women. If older women are vitamin D-deficient then they are at increased risk for osteoporosis. This is of special concern for menopausal women because once their estrogen levels drop, they begin to lose bone. The vitamin D is necessary to absorb calcium and utilize it in bone formation. And people who have any kind of gastrointestinal illness like Crohn’s disease or celiac disease or any kind of liver disease also are at increased risk for vitamin D deficiency.

Are there any symptoms of vitamin D deficiency that might occur before bone loss?

Unfortunately, there are really no symptoms of it until you are diagnosed with osteoporosis.

What do you tell your patients about vitamin D?

Children and young adults need to consume a diet that is rich in vitamin D-fortified foods. At least 15 minutes of exposure to sunlight twice a week should be adequate to make sufficient amounts of vitamin D. But I also tell them that if you put on sunscreen with an SPF greater than 8, it can interfere with making vitamin D, so diet is very important. Particularly in winter, they should concentrate on eating a diet with plenty of vitamin D-rich foods.

What do you tell adults?

If a woman has osteoporosis, she should ask the doctor if she is potentially vitamin D-deficient. Very often, after a woman has a hip fracture, we check her vitamin D level, and it turns out to be ridiculously low. So, if you have osteoporosis or a fracture, ask about your vitamin D level.

How much vitamin D do we need?

Last year, the National Osteoporosis Foundation released new recommendations about vitamin D. The National Institutes of Health also are due to release this spring new guidelines. According to the National Osteoporosis Foundation, adults under age 50 need 400 to 800 IU [International Units] of vitamin D3 daily. [Also called cholecalciferol, vitamin D3 is the kind of vitamin D that best enhances healthy bones.] And menopausal women and adults over the age of 50 need 800 to 1,000 IU of vitamin D3 daily.

Whilst avoiding the harsher elements of direct sunlight is not only wise but is necessary, avoiding the sun all together and as the result, not getting enough direct sunlight on our skin, is even more problematic. So, let’s examine the benefits of healthy sun exposure without getting burnt or promoting sun damage.

Did you know that according to a June 2007 study (1), not getting enough direct sunlight increases our chances of cancer by at least 70%? Why? Because our bodies need natural sunlight to synthesize adequate amounts of vitamin D in order to keep our bones strong and healthy, as well as support the immune system.

What is Vitamin D?

Vitamin D, in the form of calciferol (vitamin D3) is a fat-soluble vitamin. It is found in food, but also can be made in your body after exposure to ultraviolet rays from the sun. Vitamin D exists in several forms, each with a different function. Some forms are relatively inactive in the body, and have limited ability to function as a vitamin. The liver and kidneys help convert vitamin D to its active hormone form known as calcitriol; so, in actual fact, vitamin D technically is sunlight derived pro-hormone calcitriol. Vitamin D in its active pro-hormone form of calcitriol is important in determining how our cells express themselves and is vital in the production of various hormones and neurotransmitters (messengers in the brain). For the purpose of more clarity and understanding we will refer to calcitriol as vitamin D.

The major biological function of vitamin D is to maintain normal blood levels of calcium and phosphorus. Vitamin D helps us absorb calcium, and thus helps to form and maintain strong bones and teeth. It regulates bone mineralization in unison with a number of other vitamins, minerals, and hormones. In short, without vitamin D, bones start to become thin, brittle, soft, or misshapen. Vitamin D prevents rickets in children, osteoporosis and osteomalacia in adults.

What does the latest research on Vitamin D offer us?

It offers us practical advice in preventing some serious health issues.

Exciting new research conducted at the Creighton University School of Medicine in Nebraska has revealed that supplementing with vitamin D and calcium can reduce your risk of cancer by at least 60 percent. This includes breast cancer, colon cancer, skin cancer and other forms of cancer. This research provides strong new evidence that vitamin D is the single most effective medicine against cancer, far outpacing the benefits of any cancer drug known to modern science.

The Nebraska 4-year placebo-controlled study has revealed that the group receiving the calcium and vitamin D supplements showed at least 60 percent decrease in cancers. Note that these astonishing effects were achieved on what many nutritionists consider to be a low dose of vitamin D. Exposure to sunlight, which creates even more vitamin D in the body, was not tested or considered, and the quality of the calcium supplements was likely not as high as it could have been (it was probably calcium carbonate and not high-grade calcium aspartate, oratate or citrate).

So what is the bottom line of all this?

The bottom line is that if you take good-quality calcium supplements (for better health avoid pasteurized milk) and get adequate natural sunlight exposure or supplement with a good source of vitamin D (such as high quality cod liver oil), you could easily improve on the 60 percent reductions recorded in this study… but why is it better to get vitamin D from the sun?

Vitamin D, as calciferol (D3) is found in the foods listed below. Most people would not eat these foods on a daily basis all year round and, for this reason would need to get the active form of vitamin D with careful exposure to ultraviolet rays from the sun. Please note it has to be ultraviolet rays of the sun (UV) as these are the only ones that actually trigger the synthesis of vitamin D in our body. So if you rely on solariums or sun tan beds to get your natural sunlight, check if they radiate some ultraviolet rays.

Foods that contain Vitamin D3 and the amount in International Units (IU):

* 1 Tablespoon Cod Liver Oil - 1,360 IU

* 100gr Salmon, cooked - 360 IU

* 100gr Mackerel, cooked - 345 IU

* 100gr Sardines, canned in oil, drained - 270 IU

* 250ml Milk, nonfat, reduced fat, and whole, vitamin D fortified - 98 IU

* 1 whole Egg soft boiled, (vitamin D is present in the yolk) - 25 IU

Source: (http://healthlink.mcw.edu/article/982088787.html)

It is interesting to note here that one would need to drink at least a litre of milk a day to get the minimum requirements of vitamin D, which is around 400 IU. If we were to expose at least 20% of our skin to sunlight all year round for up to 10 minutes a day without any SPF, then we would ensure adequate amounts of vitamin D. The fairer your skin the less direct exposure is needed to activate vitamin D synthesis. For people with very fair skin, just a short burst of sunshine on their skin would also be enough.

As we know the liver and kidney help convert vitamin D to its active hormone form. If anyone has impaired liver or kidney functions then they would require more vitamin D synthesis either from direct sunlight or good quality supplements.

It is imperative to have a simple blood test that a General Practitioner can request, to check your current levels of vitamin D before considering any supplementation. This is because over supplementing with vitamin D could have serious consequences, such as bone resorption (breaking down of the calcium) and soft tissue calcification (hardening). It is very important to know this before considering taking any cod liver oil or other vitamin D supplements. It is very wise to have your vitamin D levels checked 3-4 months after initial supplementation to see if a deficiency is still present.

Deficiency or insufficiency of natural sunlight and vitamin D has been associated with the following conditions:

* adrenal insufficiency

* Alzheimer’s

* allergies

* autoimmune disorders including multiple sclerosis and rheumatoid arthritis

* cancers of the colon, breast, skin and prostate

* depression, seasonal affective disorder (SAD)

* diabetes, Type 1 and 2

* gluten intolerance, lectin intolerance

* heart disease, hypertension, Syndrome X

* infertility, sexual dysfunction

* learning and behavior disorders

* misaligned teeth and cavities

* obesity

* osteopenia, osteoporosis, osteomalacia (adult rickets)

* Parkinson’s

* PMS

* psoriasis

source: Krispin Sullivan (http://www.sunlightandvitamind.com)

Here is an overview of some obvious health related issues from Vitamin D deficiency

* Vitamin D and Bone Health: Having adequate levels of vitamin D in your body helps keep your bones strong and helps prevent osteoporosis. Vitamin D deficiency (which often masquerades as calcium deficiency) has been associated with greater incidence of hip fractures. A greater vitamin D intake from diet and supplements has been associated with less bone loss in older women. Since bone loss increases the risk of fractures, vitamin D supplementation may help prevent fractures resulting from osteoporosis.

* Diabetes: Vitamin D deficiency has been associated with insulin deficiency and insulin resistance. In fact it was shown in a 2001 study (2) that vitamin D deficiency is likely to be a major factor contributing to the onset of type 1 diabetes in children, as human milk often lacks vitamin D.

* Infertility and PMS: Infertility is associated with low vitamin D, and PMS has been completely reversed by the addition of calcium, magnesium, boron and vitamin D.

* Fatigue and Depression: Activated vitamin D as calcitriol, in the adrenal gland regulates tyrosine hydroxylase, the rate limiting enzyme necessary for the production of dopamine, adrenaline and noradrenaline. The adrenal glands pump these hormones to help us cope with daily stress. Hence, when adrenals have been pumping these powerful hormones for some time our bodies begin to experience constant exhaustion which leads to chronic fatigue. Not having adequate levels of vitamin D may contribute to chronic fatigue and depression.

* Syndrome X: Vitamin D deficiency has been clearly linked with Syndrome X – fat gain around the middle section (3). Syndrome X results from insulin resistance (the inability to properly deal with dietary carbohydrates and sugars), abnormal blood fats (such as elevated cholesterol and triglycerides), overweight, and high blood pressure. Syndrome X condition requires a complete lifestyle and dietary change, focusing on reducing stress levels, which activate these adrenal hormones and promote weight gain, for improvement and long term management.

Vitamin D and Steroids

Steroids, like prednisone, are often prescribed to reduce inflammation related to a variety of medical problems. These medicines may be essential for a person’s medical treatment, but they have potential side effects, including decreased calcium absorption.

There is some evidence that steroids may also impair vitamin D metabolism, further contributing to the loss of bone and development of osteoporosis associated with steroid medications. For these reasons, individuals on chronic steroid therapy should consult with their physician or nutritionist about the need to increase vitamin D intake through carefully monitored dietary supplements.

The World Health Organization states that 70% of all cancers are easily preventable through dietary and lifestyle changes. The latest Nebraska research shows us that sunlight and calcium supplements can reduce cancer risks by 77% in women. The question is why won’t conventional medicine embrace this low-cost, safe and highly effective method for preventing cancer?

Another question we might ask is why do we not hear as much about the importance of vitamin D as we hear about calcium? The reasons for this, as most would already know, there are no profits in promoting natural sunlight, not for the cancer council or for the pharmaceuticals industry.

In conclusion of the safest way of ensuring adequate vitamin D, getting at least some early morning direct sunlight is very beneficial for all of us. The best sun exposure during summer would be 10 minutes approximately of early morning sun before 9 am or late afternoon after 5 pm.

If planning to stay out longer then applying some natural, chemical-free SPF 15 + sunscreen (you can find these in some health food stores as they are becoming more popular) would be safe for your skin. During winter, 20 minutes of direct sun even during the day on hands, neck, feet, and legs would be ideal. If direct sunlight is not possible in the winter then carefully supplementing with cod liver oil, only if the blood tests reveal a vitamin D deficiency would be beneficial. It is important to understand that the darker your skin, the more sunlight is needed to activate vitamin D synthesis.
For the albino population (people with very sun sensitive skin as they lack pigment), the good news is that less direct sun is required, even a short burst of early morning sun would be enough to stimulate vitamin D activation in their system.

In addition, having a diet high in antioxidants - the good guys that prevent premature ageing (antioxidants from super-foods like Wolfberries, blueberries and pomegranates) - is known to help protect the skin from rapid sunburn and premature ageing. In fact, some natural chemical-free sun tan lotions contain fair amounts of antioxidants such as vitamin A and E. The amount of antioxidants that we would require daily would be quite high and probably unachievable for most people. The ideal amount would be more than just a punnet of blueberries; more like 3 or 4 punnets of organic blueberries daily. Yet, if we take super-foods such as Ningxia wolfberries then we might get closer to the ideal antioxidant intake. So, enjoy some fun in the sun and ensure that you have adequate amounts of Vitamin D in your system all year round for optimum health, vitality and longevity.

References:

1. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91.

2. Ortlepp JR, Lauscher J, Hoffmann R, Diabet Med. 2001 ct;18(10):842-5

3. Henendez C, Lage M, Peino R, J Endocrinol. 2001 Aug;170(2):425-31

McMichael AJ, Hall AJ. Multiple sclerosis and ultraviolet radiation: time to shed more light.Neuroepidemiology. 2001 Aug;20(3):165-7.

Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000 Sep;72(3):690-3)

(http://sunlightandvitamind.com/Main.htm)

About the author

Teya Skae M.A., B.A.,Dip Health Sciences, Dip Clinical Nutrition
Kinesiologist/Nutritionist/Writer
Health/Life Coach and Educator
Teya is the founder of Empowered Living
www.empowered-living.com.au
specialising in Neurologically Balancing busy people for chronic fatigue, corporate burnout, physical/emotional stress, Emotional Freedom Technique to resolve energy blocks, Metabolic Typing Nutrition and Results Fat Loss. Teya writes article for various publications and runs empowering educational courses in the area of balancing your health, physical body,emotions, and how to have more energy to enjoy your Life!

Lisa Bell, Know Your Numbers

Vitamin D is the only vitamin you don’t have to get from food, because it is also a hormone.

You need at least 200 IUs of vitamin D each day.

You can eat it, take a supplement, or let your body manufacture it when you are in the sun, but however you get it, you need vitamin D for strong muscles, bones, and teeth.

Doctors say it is just as important as calcium, because without D, your body can’t absorb the calcium.

If you are under 50 years old, you need 200 IU’s every day — 400 if you’re 50 to 70 years old and 600 if you’re over 70.

A little bit of sun or fortified dairy products are the easiest ways to get your vitamin D.

Unless you are lucky enough to live in a location that enjoys year-round sunshine and mild temperatures, you are likely to experience a drop in your Vitamin D levels during the winter. Getting direct sun on your skin is one of the chief ways in which you get vitamin D. With the colder weather, we spend less time outdoors and when we are outdoors, we try to cover as much skin as possible.
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