Vitamin Information Center

Everywhere you look this month, someone seems to be talking about Vitamin D. Good Morning America, Parenting Magazine, and numerous news organizations have focused on the possible benefits of the vitamin your body produces itself, yet most people seem to lack.

All this attention has led to some confusion. South Jersey Healthcare outpatient dietitian Deborah Stump helped shine some light on vitamin D last week by answering more than a dozen questions submitted to The Daily Journal’s Healthline.

“It’s a big topic right now,” said Stump. She added that recent studies have linked vitamin D to everything from diabetes to cancer prevention.
What is it?

Vitamin D helps the body absorb calcium and form bone. It also strengthens the immune system.
How do I get it?

Getting vitamin D is as easy as going outside. Your skin turns UVB rays from sunlight into vitamin D. It also is found in most multi-vitamin supplements, stand-alone supplements, and in “fortified” foods such as milk and some fruit juices and cereals.

So, if it’s so easy to get, why are more than half of children and some 65 percent of adults not getting enough?

Turns out, according to Stump, some generally-accepted, healthy habits have had the unintended consequence of restricting vitamin D. The first: sunscreen.

“You need 10-20 minutes of sun exposure three times a week,” she said, adding that the exposure should come between 11 a.m. and 3 p.m., when the sun is strongest. Sunscreen, of course, blocks those rays.

And yes, you have to go outside.

“One question asked if you can get sunlight through glass,” Stump said. “Glass lets about 78 percent of UVA rays through,” she said, “but it blocks all but about 5 percent of the important UVB rays. So, you have to get outside.”

Stump added that people should spend a little more time outside during the winter months, when the sun is not as strong.

Vitamin D took another hit as people moved away from eating saturated fats.

“As people started eating more poly and unsaturated fats, we saw a decrease in vitamin D,” she said.
How much do I need?

This was the most common Healthline question.

The Dietary Reference Intake for vitamin D is 200 International Units per day for kids and adults up to age 50, but that is being hotly debated. The American Academy of Pediatrics recommends 400 IU per day, and a quick check of a bottle of One-A-Day vitamins says that 400 IU covers 100 percent of my daily requirement.

Stump said even that may not be enough.

“There is a lot of research supporting 800-1,000 IU of Vitamin D per day,” she said.
What’s the use?

So why so much interest in vitamin D? Well, besides forming bone and helping the immune system, Stump said there is an association between vitamin D deficiency and Type 1 and 2 diabetes. Also, there is evidence that vitamin D can fight prostate, breast, and colon cancers as well as fight depression and improve cardio-vascular health.

Dr. Robert Heaney, professor of internal medicine at St. Louis University School of Medicine, says 40 percent of his patients get too little vitamin D. He fears the condition could result in health problems as people age.

That corresponds with the 40 percent of Americans and more than 500 million worldwide who get too little vitamin D to stay healthy, according to the World Health Organization.

Vitamin D is known as the “sunshine vitamin” because people normally would get most of what they need from exposing their skin to the sun. UVB rays turn cholesterol in the skin into vitamin D.

And that’s the snag. As scientists find that vitamin D helps conditions from bones to heart health, physicians are rethinking the guidelines for sun exposure — to the chagrin of doctors who believe that’s an invitation to more skin cancer.

Fish oils, fish and fortified dairy products are the main vitamin D sources in food. “But you can eat fish every day of the week and be deficient in vitamin D,” Heaney says. “Vitamin D is difficult to get from food.”

Indeed, the American Vitamin D Council cites research that 10 to 15 minutes in the sun makes up to 12,000 IU (international units) of vitamin D. A sunburn can make up to 50,000. A multivitamin may have 400 IU, which is the recommended daily amount of vitamin D for adults, according to the National Institutes of Health.

Dr. John Cannell, founder of the American Vitamin D Council, says vitamin D is much more valuable than a tool to build bones and teeth. Researchers say vitamin D affects more than 1,000 genes, including ones that resist illness such as colds and even cancer.

“We never put together before that we get colds in the winter and not in the summer when we get more vitamin D in the summer,” Cannell said.

THE SNAG

Doctors who fight skin cancer fear that young people will start sunbathing — and sunburning — again, or use tanning beds to up their dose of vitamin D.

Dr. Susan Bayliss, professor of dermatology at the Washington University School of Medicine, recommends food supplements over increased sun

exposure. UVB and UVA sun rays remain culprits for skin cancer.

“The dilemma is that if you have really fair skin and red hair and freckles, it’s probably better to take your vitamin D in by mouth and put your sunscreen on,” says Bayliss, who also is director of pediatric dermatology and practices at St. Louis Children’s Hospital and the Center for Advanced Medicine.

People with more pigment (melanin) in the skin can tolerate more sun, she says.

AUSTRALIA’S DILEMMA

Heaney says that Australians, who have the highest rate of skin cancer in the world, years ago heeded the word about skin cancer and got out of the sun. But in only a few years, the rate of rickets — a disease of softened bones and bowed legs caused by vitamin D deficiency — increased.

Physicians who advocate more sun say vitamin D made with sunshine never reaches toxic levels. “Vitamin D gets to the useful level, then the sunshine destroys the surplus,” he says.

ELSEWHERE

As health experts wonder what to do with the new findings, they are examining vitamin D intake standards.

For example, the one-size-fits all approach is obsolete. Vitamin D intake recommendations change the closer you live to the equator. People who live in St. Louis don’t get the same amount of sun as southern neighbors, but we do get more sun that our northern states.

The Canadian Cancer Society, for example, last year raised its recommendation for daily vitamin D supplement intake to 1,000 IU per day, more than twice the 400 IU recommended daily for U.S. adults.

SUNSHINE

For some, getting more sun is a back-to-basics measure.

Dr. John Morley, head of geriatrics at St. Louis University, says, “In our nursing homes, people are supposed to be on 800 IU a day,” he said. Still, “about 40-50 percent are vitamin D deficient by the criteria you have to measure the vitamin D. For people 25, that’s not so important and can be corrected. But at 60 or 65 you’re more likely to have falls and deterioration in your functional status, more injuries, hip fractures.”

Nursing homes where he consults now put residents in the sun about 30 minutes a day. The policy led to fewer falls and fractures as well as better health and mood.

“Even with lousy sunlight, if you get people out a half-hour a day, and they’re not covered up and they get some sun, they’ll do OK,” Morley says. “Since we’ve been doing that, we’ve noticed a marked decrease in fractures in the nursing homes, and we now have a rule in the nursing homes, you have to check the vitamin D and make sure the people get (the vitamin) and calcium at an appropriate level.

“But so many people don’t get any sunlight, and that’s particularly true with older people.”

SAFE STEPS

Physicians agree on some issues:

– Vitamin D is essential and needs to be maintained and monitored.

– Sunbathing for a long time in direct summer sun is still a bad thing. “You can get outside, even wearing a hat and expose the arms,” says Dr. Veronica McGregor, an endocrinologist with St. John’s Mercy Medical Center in West County. “About 10 to 15 minutes two or three times a week. It doesn’t take much sun to get adequate vitamin D.”

– Check food labels on supplements because not all vitamin D is the same, Heaney says. You’ll find two types. The best is “cholecalciferol,” the form that occurs naturally and exists mainly in fish oils. It can be synthesized. The second type, “ergocalciferol, is an inexpensively produced vitamin D but may be only 30 percent as effective as the other form. A label that doesn’t specify is probably the lesser form, Heaney says.

– Cod liver oil is the best single source of vitamin D besides sunshine. One tablespoon can deliver 340 percent of the daily recommended vitamin D.

– Don’t rely on fortified dairy products. “Those levels were established (decades ago) to address problems with rickets in children,” Heaney says. “They don’t supply enough for an adult.”

– Tanning beds aren’t the answer. They may not be balanced properly between UVB and UVA rays. Too much UVA is not beneficial.

– Talk to your doctor about a vitamin D test. People most likely to have deficiencies are people who get little sun and anyone who has a family history of bone-density problems.
Source: St. Louis Post-Dispatch

The benefits of vitamin D have long been known. It’s central for healthy bones and preventing some cancers.

A recent study boosted D’s profile, saying people with a moderate vitamin D deficiency had a 60-percent increased risk of cardiovascular problems, and those with a severe deficiency a almost 100-percent risk.

Since we get vitamin D from the sun along with food, it seemed great news for those who like to catch some rays. But not so fast, says Judy Dowd, a physician’s assistant with Cotton-O’Neil Dermatology. She says one source says all you need is five to 10 minutes of sun exposure on the hands, arm and face, two to three times a week, to get enough sun exposure to get the vitamin D you need and metabolize it usefully.

That’s about a half hour total. Other health officials said up to two hours total a week is what’s needed. But you also get vitamin D from food. Dowd says it is milk, cereals, breads and other foods are fortified with it and it’s also in eggs and liver.

Dowd advocates minimal sun exposure, so that you get enough vitamin D without adding to the risk sun exposure poses. She says it can cause early signs of aging, like wrinkles. It can also impact the immune system and cause skin cancers.

Dowd says it’s projected there’ll be 1.3 million new cases of skin cancer in the next couple years. She says many health experts attribute this to the increased use of tanning beds. As for tanning beds and vitamin D, she says we get vitamin D from UVB rays, not UVA rays, and most tanning beds use only UVA rays.

The number of skin cancers continues to climb and successful treatment means catching it early. The Cotton-O’Neil Cancer Center will have free skin cancer screenings Saturday, April 26th. It’s free, but you do have to register for an appointment by calling HealthConnections at 785-354-5225.

The days are finally getting longer, but the cold and wind have kept us indoors through much of this winter. Even if we were outside on a regular basis, our skin would produce very little, if any, vitamin D. While the sun is closest to the earth in winter, the sun’s rays are entering at such an oblique angle (zenith angle) the solar ultraviolet B (UVB) rays are blocked by the ozone layer — and it is this solar UVB radiation that stimulates vitamin D production. But even in the summer, in the early morning and late afternoon, the zenith angle of the sun’s rays is so oblique that very little vitamin D is produced in the skin.

Why is this important? Vitamin D is recognized as the sunshine vitamin, and if we get little UVB radiation, we produce very little vitamin D. More than 90 percent of the vitamin D we need comes from casual exposure to sunlight.

But production decreases sharply with increased skin pigmentation (racial or seasonal), advancing age and use of sunscreens. Other important factors include the season and even the time of day. As a result, dark skinned individuals and the elderly may suffer from vitamin D deficiency, especially during the winter months.Vitamin D is assumed to be plentiful in a healthy diet but, in truth, very few foods naturally contain it and only a few are fortified with it. Moreover, recommended intakes of vitamin D are not sufficient to prevent deficiency. This, together with the widespread use of sunscreens and an overall lack of sunshine exposure, is the reason vitamin D deficiency is now epidemic in the United States.

Adults with vitamin D deficiency absorb calcium poorly and are at increased risk for osteoporosis and related fractures. If this deficiency is not corrected, extreme degrees of deficiency may ensue, leading to the painful bone disease of osteomalacia.

Other consequences of vitamin D deficiency include impaired neuromuscular function with poor balance, decreased muscular strength and increased falls. Individuals may complain of deep aching bone pain, weakness and muscular discomfort. Such patients are often misdiagnosed with fibromyalgia, chronic fatigue, myositis or other nonspecific conditions. It has been estimated that 40 to 60 percent of patients with fibromyalgia may have some component of vitamin D deficiency and osteomalacia. Vitamin D deficiencies have been demonstrated to increase the risks of many autoimmune diseases including Type 1 diabetes, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease and psoriasis. Another action of vitamin D is thought to be important in keeping cell growth in check, and preserving normal cellular proliferation and differentiation, thus preventing cells from developing into unregulated cancers. Deficiency of vitamin D is now felt to contribute to several major cancers, notably

prostate, colon and breast.

So what can be done to prevent vitamin D deficiency? First, it’s important to recognize that it exists, that it is epidemic and that it may affect you since no age group is immune. Even teenagers and children are at risk. Second, get sensible sun exposure — 5 to 10 minutes at a time, two to three times per week between the hours of 10 a.m. and 3 p.m. in the spring, summer, and fall. (It is equally important to avoid chronic, excessive exposure to sunlight which increases the risk of nonmelanoma skin cancers.)

Increased dietary and supplemental vitamin D intakes of 800 to 1000 international units (IU) per day are reasonable and safe.

Maintaining a normal vitamin D status should be a high priority for all of us, with the help of our doctor.

– Dr. James Maddy practiced internal medicine and endocrinology in Casper for more than 30 years before retiring in 2004.

Much of the research for this article was take from the works and publications of Dr. Michael Holick, Boston University Medical Center, and Dr. Robert Heaney, Creighton University, in Omaha, Neb.

With More Than 50 percent of Americans Vitamin D Deficient, Dr. Karl Gruber
  Says the Sun is the Best Solution - but for Only 10 Minutes Weekly; Wear
Sunscreen With UVA and UVB Protection to Avoid Melanoma and Premature Aging

    CHARLESTON, S.C., March 4 /PRNewswire/ -- As many as half of all U.S.
children and adults are vitamin D deficient and new evidence shows a link
between low vitamin D levels and cancer, autoimmune and infectious
diseases, according to experts. Researchers and doctors say the vitamin D
problem can be solved if people spend more time outside on a sunny day.

    Karl Gruber, M.D., a South Carolina-based surgical pathologist and CEO
of LUCA Sunscreen, providing the highest UVA rating available, agrees that
the sun can help people reap the benefits of vitamin D, but not without
precaution.

    "There's no doubt the sun is the quickest way to obtain important
vitamin D," says Dr. Gruber. "However, to simply prescribe sunshine without
prescribing sunscreen is irresponsible. It's imperative that people
understand that ample vitamin D is produced with finite limited amounts of
UVB rays, but there are no beneficial effects from the more dangerous UVA
rays. People need to block the UVA rays with sunscreen everyday -- even
when trying to obtain vitamin D from the sun."

    Vitamin D is produced by exposure to the sun's UVB rays. According to
Dr. Gruber, the SPF system rates a sunscreen's protection from these rays.
For example, an SPF 15 blocks 94 percent of the sun's UVB rays so a person
wearing an SPF 15 sunscreen will need to stay in the sun for two hours to
obtain the vitamin D benefits they would receive in eight minutes without
sunscreen protection. Although a person obtains UVB exposure while wearing
sunscreen, they increase their risk of exposure to dangerous UVA rays that
are closely linked to melanoma and premature aging.

    Dr. Gruber suggests that people concerned about getting enough vitamin
D should plan 10 minutes of sun exposure once a week on parts of the body
that are not chronically sun exposed, such as the back and stomach. During
this time, Dr. Gruber says to use sunscreen -- with a high UVA rating such
as 370nm or higher -- on the face, neck and arms or body parts chronically
in sunshine.

    "People should wear sunscreen daily on these highly exposed body parts
as a vital defense against the damaging effects of chronic sun exposure,
including solar aging and cancer," says Dr. Gruber. "I'm seeing skin cancer
in younger and younger patients and everyone needs to wear sunscreen daily
and take doing so seriously."

    Dr. Gruber created LUCA Sunscreen as a daily wear moisturizing solar
protection that is water resistant, hypoallergenic, fragrance free and
specially formulated for children and adults with sensitive skin. Featuring
breakthrough Polycrylene(R) technology, LUCA(TM) Sunscreen is better at
blocking UVA radiation than other sunscreens sold in the U.S. and it is the
first sunscreen on the U.S. market to back up its UVA protection claims
with a critical wavelength value printed on the bottle. With this unique
formulation, LUCA is effective for up to six hours in intense sunlight.

    Critical wavelength is an international rating system for UVA
protection and LUCA's critical wavelength of 383nm is the highest available
in the U.S. The FDA has not yet adopted a standard by which to measure
protection against UVA radiation, however, it considers any product with a
critical wavelength over 370nm to provide excellent UVA coverage.

    Because there are no tangible symptoms of vitamin D deficiency, people
are encouraged to ask their physicians to check their vitamin D levels
during annual check-ups. Ensuring the proper vitamin D levels will help the
body fight cancer, autoimmune and infectious diseases, according to
experts.

    Dr. Gruber says the farther you live from the equator and the less
opportunity you have for regular sun exposure, the more likely you are to
be deficient. Older adults and people who are obese or who have liver or
kidney disease also are at risk. In addition, African Americans and people
with darker skin are more at risk, because their skin is less able to
synthesize Vitamin D from the sun.

We can get the vitamins and minerals our body needs by eating a balanced, varied and colourful diet.

But there is one vitamin that we can make ourselves, simply by exposing our skin to sunlight.

Vitamin D is made in the skin after interaction with UVB rays and plays a vital role in the build up of bone density.

The importance of vitamin D extends further – it affects immune function, helping to avoid colds and flu and it protects against cancer and the development of diabetes.

A recent study by experts at Harvard Medical School has added to the evidence that a low vitamin D status is linked to an increased risk of heart disease.

Vitamin D may also help regulate blood pressure and be involved in reducing inflammation.

The amount of vitamin D made by our skin depends primarily on the amount of sunlight, which, in turn, depends on:

The latitude we live at – the south has the advantage over the north

The season – summer wins over winter

The time of day – mid-day comes out tops.

Vitamin D production also decreases as we age – it is slower in dark-skinned people and is lower in obese people as vitamin D is thought to be stored in fat, which makes it less readily available.

To ensure our vitamin D levels are kept topped up we need to get out more, whatever the weather as it doesn’t have to be bright sunshine.

By exercising at the same time we will doubly benefit our hearts.

It pays to create opportunities – walk to work, alight from the bus a couple of stops earlier, walk the kids to school, go for a lunchtime walk, get out at the weekend to garden, bike or hike.

Remember not to cover up too much, just leave some skin exposed so that you can actually restore those vitamin D levels.

As springtime sunrays strengthen, 10 to 15 minutes uncovered or with a low sunscreen factor before 11am and after 3pm could be enough to boost our vitamin D status without tanning or burning.

Sunlight is the cheapest way to top up your vitamin D but there are a few foods that contain vitamin D:

Oily fish such as sardines, fresh tuna, salmon, trout, mackerel and kippers – eating two portions of oily fish a week will also provide you with heart-healthy omega 3 fats

Eggs and shiitake mushrooms

Cod liver oil

Fortified breakfast cereals.

For more information and advice about healthy living, contact Heart Research UK on 0113 297 6206 or email lifestyle@heartresearch.org.uk