RICKETS There have been children in Juneau with it ! From Vitamin D deficiency in childhood Bones become soft, can fracture, and are painful Growth problems, muscle weakness, and spasms In adults a similar problem is called osteomalacia Even animals can get rickets
Epidemic in England in the 18 th and 19 th centuries Rare in ancient times Industrial revolution in 18 th century Agrarian population became urbanized People, including children, worked long hours Air in cities became polluted England is a low-sunlight country and is far north
JUNEAU We are indoors most of the time We often go to work in the dark and home in the dark We drive to work, not walk We live far north We are a low sunlight city with lots of cloud cover
Adequate Vit D Helps Depression SAD Resistance to pneumonia Progression of arthritis Lower blood pressure Calcium absorption Bolster your immune system Prevent colds and flu Wounds heal
INTRIGUING POSSIBILTIES Vitamin D may help suppress spontaneous food intake and burn fat It may help memory decline/cognition by its neuroprotective effects.
CHILDREN Have an increased risk of type 1 diabetes and multiple sclerosis if born in late spring or early summer Infants given 2,000 IU of vitamin D a day in their first year of life had an 80% reduced risk of being diagnosed with type 1 diabetes by age 30 Studies have found a significant relationship between maternal Vitamin D insufficiency and asthma, low bone mineral accrual, and increased fracture incidence
VITAMIN D Is a hormone (vitamins cannot be made in the body) Is made in the skin the presence of sunlight ( UVB)
UVB You can get a sunburn and still not make Vitamin D You can make Vitamin D from tanning beds UVB is the major cause of skin damage including malignant melanoma
Factors affecting Vit D production Time of year Time of day Latitude Clouds or air pollution Clothing Sunblock Aging Melanin in the skin Glass Plexiglas
SUN EXPOSURE A healthy adult in a swim suit after enough sun (in Arizona anytime or Juneau in summer) or tanning bed exposure to get a bit pink will make 10,000 to 20,000 IU of Vitamin D North of Boston-Vit D production declines after August, there is none from November through mid-March Bergen, Norway- can only make it from 11AM-4 PM April-September (with the most in June)
SUN EXPOSURE Those who live in Australia produce 3.4 times as much Vitamin D from sun exposure as people who live in the United Kingdom, and 4.8 times as much as Scandinavians.
FOOD SOURCES OF VIT D Fatty fish (mackerel, salmon, herring, tuna) - 200-350 IU in 3 oz Eggs - 20 IU per egg Fortified milk - 100 IU per cup (maybe!) Fortified food - cereal, orange juice etc.
“Adequate Intake” Set by the government 1997 There is no Recommended Daily Allowance Young children - was based on the amount needed to prevent rickets Young adults - was based on the average Vit D intake of 52 young women living in Omaha, Nebraska
“Adequate Intake” Infants to age 50 200 IU a day Adults 51-70 400 IU a day Adults over 70 600 IU a day
1997 Dietary Reference Intake Upper Limit Infants (0-12 mos) 1000 IU a day Everyone else 2000 IU a day
Intake Recommendations Canadian Pediatric Society- 2,000 IU a day for pregnant and breastfeeding mothers Canadian Cancer Society- non-white adults should take 1,000 IU daily year-round and whites take that amount in fall and winter National Osteoporosis Foundation- adults under 50: 400-800/day, Over 50: 800-1,000 IU/day
Infants and Children “Breast milk may not contain enough Vitamin D to prevent rickets.” (It typically contains 25 IU/liter or less.) The American Academy of Pediatrics recommends Vitamin D supplements for all children, and all breastfed babies, until they are drinking at least 17 oz of Vit D fortified milk a day.
Risk factors for low Vitamin D levels Little sun exposure, northern latitude etc. Obesity Kidney disease Chronic liver disease Fat malabsorption Celiac disease Cystic fibrosis Gastric bypass surgery
Blood levels of Vit D (25 OH) ng/ml nmol/L Health Implications < 20 < 50 Deficiency 20-30 50-80 Insufficiency 32-100 80-250 Sufficiency 54-90 135-225 Normal in sunny countries >100 > 250 Excess >150 > 325 Intoxication
Blood Levels of Vitamin D Below 32ng/ml calcium absorption is suboptimal Vitamin D metabolism is not normalized until levels are above 40, and often 50ng/ml If you have had cancer, some authorities recommend keeping your level at 60ng/ml or above.
Vitamin D Blood Testing Costs about $160 to $230 Insurance generally covers it for conditions such as multiple sclerosis, osteoporosis, osteopenia, and thyroid conditions. Your insurance may not cover it for general screening. It is moving slowly towards being covered for screening, such as cholesterol often is.
SUPPLEMENTS D2 (ergocalciferol) may not be as potent as D3. From plants. Often used for fortification of foods. D3 (cholecalciferol) We only absorb about 75% of Vit D taken orally.
VITAMIN D TIPS It is fat soluble so you can take it once a day, or once a month. It is stored in body fat and slowly released into your circulation. You will not absorb as much unless you have some food with fat in it in your stomach when you take it.
Oral Vitamin D Intake 400 IU a day does not raise blood levels At least 2,000 IU a day, after getting receptors saturated, is probably necessary for full disease-fighting effects (unless you are making Vitamin D from sun exposure)
Vitamin D Toxicity You cannot overdose on making Vitamin D from UVB exposure Increased calcium in your urine is the first sign of too high levels. At this point, you are beginning to calcify your organs. Elevated blood calcium levels are a late sign of toxicity
My Recommendations Get your Vit D (25 OH) blood level checked if you can. If low, discuss a high dose, short term, weekly Vit D supplement with your health care provider to get your level up. Ask him/her what daily dose they recommend you take after that. Get your level rechecked several months after you have finished the weekly supplement (wait until you have not had significant sun exposure for two months)
OR Take a vacation in Arizona, Mexico, Hawaii, Africa or somewhere sunny every 2 months and do a little sunscreen free sunbathing!
RECOMMENDED REFERENCES Vitamin D Second Edition Elsevier Academic Press, 2 vol., Edited by Feldman, Pike, and Glorieux http://www.kanthakkarate.com/docs/AJNP VitaminDArticle.pdf http://www.vitamindcouncil.com/