Vitamin D Testing Determines "How Much?"

I was recently asked by a twitter follower how much vitamin D is needed, and how much is too much. This question is much more complex than can be done justice in 140 characters, so I decided to write a quick guide to determining your vitamin D needs.

You'll need to start by getting your blood D levels checked. Okay, there's lots of differing opinion on how, and what, and where, and so forth. Let's just keep things simple: Next time you are at the doctor's getting a physical, ask him or her to do a vitamin D test (serum 25-hydroxyvitamin D test). They will run the blood you are already providing them with, although my physician often forgets, requiring me to go back in for a second blood letting. Whatever--it's worth it to me.

You'll probably have to pay for the test if you live in the U.S. The last one I got cost me somewhere in the $200 range, and that was after insurance covered a minimal portion. Listen, I believe so strongly in getting blood levels of D checked, that the cost is also worth it to me. (Life Extensions Foundation endorses a $47 test that you can get by calling the 800-number in their article here).

You will get your results within a couple of days. The numbers can vary depending on the lab, but good reference points for adults are between 30-100 ng/mL for optimal levels. Levels of Serum D between 20-29 ng/mL indicate insufficiency, while anything below 20 ng/mL is a frank deficiency (that includes in children as well, although anything above 20 ng/mL is considered optimal for pediatrics).

If your blood D levels come in at 29 ng/mL or less, your doctor may prescribe 50,000 international units (IU) for a short course to bring you back up to par. After that, taking anywhere from 1,000-10,000 IUs per day is recommended to keep levels up, of course, those numbers depend on the source. The standard is that you want to bring the numbers above 30 ng/mL, but according to some, optimal levels are above 50-60 ng/mL (this is the range I'd shoot for as I trust these sources, and here).

Obviously, what you need depends on your current levels, so again, getting tested is a must. I want to emphasize that vitamin D is the sun-nutrient, and in my opinion, getting adequate sunlight is the best approach. But I do realize that parts of the world get very little sunlight at various times of the year, so I am a believer in supplementation.

So, there is no easy answer to the "how much vitamin D" question. Get tested, find where you are, and then go from there. Hope that helps.

Vitamin D Supplementation VERY Effective

More evidence showing the dangers of vitamin D insufficiency, as a large new study shows that people with low blood concentrations of the vital nutrient are at an increased risk for dying of any cause. Any cause? Yes, and even more startling was that by boosting low levels with vitamin D supplementation cut peoples' risk of dying by half.

According to the latest study, which looked at 10,899 patients at the University of Kansas Hospital, found that 70% were deficient in vitamin D and they were at significantly higher risk for a variety of heart diseases, including. D-deficiency also nearly doubled a person's likelihood of dying, whereas correcting the deficiency with supplements lowered their risk of death by 60%.

Rickets

These numbers highlight previous research that has shown many North Americans to have insufficient blood levels of vitamin D. Rickets due to vitamin D deficiency has been well understood for many years, but how much D levels play in overall health and well-being is just becoming to be understood more fully. Levels under 30 ng/ml are below what's necessary for good health.

According to the latest National Health and Nutrition Examination Survey, an estimated 25-57% of adults are vitamin D insufficient, and other studies have suggested the number is as high as 70%.  Cardiologists from the University of Kansas study found that people with deficient levels of vitamin D were more than twice as likely to have diabetes, 40% more likely to have high blood pressure and about 30% more likely to suffer from cardiomyopathy (diseased heart muscle) than people without D deficiency.

"We expected to see that there was a relationship between heart disease and vitamin D deficiency; we were surprised at how strong it was," said Dr. James L. Vacek, a professor of cardiology at the University of Kansas Hospital and Medical Center.

"It was so much more profound than we expected."

Vacek believes that so many people are deficient because we should get 90% of our vitamin D from the sun and only 10% from food. We need sunlight to make vitamin D in our bodies, so 20 minutes per day minimum exposure is necessary to maintain proper blood levels. With the fear of skin cancer looming, many have taken to using sunscreens to reduce sun exposure. 

Experts say that in the Northern United States and Canada the sun isn't strong enough during winter months to make sufficient vitamin D, even if the weather was warm enough to expose the skin for a long time. To combat this, adults should get their vitamin D levels checked by their doctors and take vitamin D supplements. 

This study comes at an opportune time as many in the medical field have dismissed previous vitamin D research as inconclusive, particularly the role supplements can play in a return to health from those deficient. I have wondered why so many doctors and medical policy stiffs have been so adamant at denying the research results on vitamin D, and the only thing I can think of is they just despise being wrong. I don't think its a pharmaceutical conspiracy like many tend to, but hanging on to old beliefs is the only way I can make sense of  the blindness in light of some pretty solid data. I mean I can understand skepticism, but previous studies have been fairly well done, and they are vast in number. 

I just think the old guard will never accept that they were wrong about supplementation from the start, no matter how well-intentioned they might have been; and I think many are wrong to advocate minimal sun exposure for the masses. Some increases in skin cancer can be from chronic pharmaceutical use, particularly those that are immunosuppressive. 

It was easy to blame the sun, but that was also wrong. The sun is the most life-giving source in the solar system. Avoiding it is just unwise. This latest vitamin D study is simply more evidence supporting the principle.

Oral Steroids Linked to Vit D Deficiency

People that take oral steroid medications, particularly children, could be at an increased risk for serious vitamin D deficiency. So says a recent study published in the Journal of Clinical Endocrinology & Metabolism.  Some conditions people take these drugs for are asthma, certain types of arthritis such as rheumatoid arthritis and autoimmune diseases like Crohn's disease, lupus and multiple sclerosis.

Researchers looked at nearly 23,000 Americans in a government health survey, and found that those using oral steroid medications were twice as likely as non-users to have a severe vitamin D deficiency. Eleven percent (2,530 people) of those on steroids had a vitamin D level below 10 ng/mL--far below the minimum requirement to remain healthy. That compared with five percent (1,150 people) of study participants not on steroids.

Blood levels of vitamin D lower than 10 ng/mL:

associated with the most severe deficiency diseases: rickets in infants and children, and osteomalacia in adults. A concentration above 15 ng/ml (37.5 nmol/L) is generally considered adequate for those in good health. Levels above 30 ng/ml (75 nmol/L) are proposed by some as desirable for achieving optimum health, but there is not yet enough evidence to support this. ~ Wikipedia (as of 10/31/11)

The link was especially strong among children. Steroid users younger than 18 were 14 times more likely to have a vitamin D deficiency than kids not taking the medications.

The authors of the study point out the findings do not prove causality, but this should alert doctors and parents to keep an eye on vitamin D levels of the children taking these drugs.  Something else parents can do is make sure their children are out in the sun as much as possible. Some parents may inadvertently keep their asthmatic kids indoors, but I think this is a mistake. Lots of sunshine is necessary for the production of vitamin D. At the very least, the inhaler should be countered each time with a good vitamin D supplement.

As the severity of vitamin D insufficiency in North America is dismissed, data showing its pervasiveness continues to accumulate.  The smart reader will continue to get plenty of sun-screen free sun, and supplement if necessary (not so for those getting sun daily). And making sure that if you or your child are on oral steroids, you get your blood vitamin D levels checked.

Vitamin D Insufficiency Linked to HBP

Wow!  More out of the vitamin-D-has-greater-importance-than-we-ever-thought camp: Low vitamin D levels in the blood lead to unhealthy blood vessels.  You heard right, new research shows a link between vitamin D concentrations and cardiovascular health.

A study conducted by researchers from the Emory/Georgia Tech Predictive Health Institute showed that participants with the lowest D levels had an increased blood pressure, and thus increased risk of heart disease and stroke.  Even more amazing is that when the participants increased their blood levels of vitamin D, their blood pressure went down.  Amazing...

Here's how they found out: The 554 participants in the study were Emory or Georgia Tech employees with an average age of 47 and in general good health.  Blood levels of vitamin D were measured.  The average concentration of 25-hydroxyvitamin D (a stable form of the vitamin reflecting diet as well as that produced in the skin) in participants' blood was 31.8 nanograms per milliliter.  In this group, 14% had 25-hydroxyvitamin D levels considered deficient (less than 20 nanograms per milliliter), and 33% had levels considered insufficient (less than 30 nanograms per milliliter).

Researchers monitored the blood vessels' ability to relax by using a blood pressure cuff.  To allow blood to flow back into the arm, blood vessels must relax and enlarge--a change measured by ultrasound.  The researchers also examined the resistance to blood flow imposed by the arteries.

After controlling for factors like age age, weight and cholesterol, people with lower vitamin D levels still had stiffer arteries and impaired vascular function.  Lead author Ibhar Al Mheid, MD, a cardiovascular researcher at Emory University School of Medicine said,

"We found that people with vitamin D deficiency had vascular dysfunction comparable to those with diabetes or hypertension."

The researchers believe that vitamin D acts to strengthen the endothelial cells and muscles that surround blood vessels.  Al Mheid also believes that it could be reducing levels of angiotensin, a hormone that drives increased blood pressure, or regulating inflammation.  Wow, I wonder what these results mean for the overuse of statins?

But again, the best part: Those study participants with low blood vitamin D levels that then increased their concentrations by either supplementing or spending more time in the sun, were rechecked after six months and showed improvement to their vascular health measures and lowered their blood pressure.  Booyah!  Forty-two participants with vitamin D insufficiency whose levels later went back to normal had an average drop in blood pressure of 4.6 mmHg.  The study's findings were reported at this year's annual American College of Cardiology meeting in New Orleans.

What can I say other than "heck yes!"  Why should I care about these results?  Because it makes the universe more understandable to me.  I know with certainty that human health operates within universal laws.  I know that the increased incidence of high blood pressure today is not due to a lack of statin medication.  I also know that health is not random (genetics), and that vitamin D insufficiency is epidemic in North America.  Furthermore, it is not lost on me that blood vitamin D levels are low in many people at a time when dermatologists have scared people out of the sunshine and into big hats and SPF5000.

Here is just some more evidence that sun energy is essential to human health.  Everybody needs unprotected sun exposure on a daily basis, period.  Supplementation helps, but nothing--and I mean nothing--beats the healing energy of our life-giving sun.

Sun Me

Last post I discussed vitamin D insufficiency resulting from too little sun, and I'm not holding back knocking dermatologic scare tactics keeping people out of the sun. The addition of sunscreen lotions to our moisturizing products and makeup has become pervasive. Aside from keeping us from getting our necessary vitamin D, sunscreens have a direct effect on our health.

As a recap, we need sun exposure; sunlight causes the production of vitamin D in our skin. Vitamin D is necessary for many functions, and being low in vitamin D can cause a bevy of problems. I'm not going over all of them here. I've written plenty of posts on vitamin D insufficiency; they are all here (here, here, and here). I also recommend reading my article on vitamin D--it'll direct you on how to get tested and find out your vitamin D levels. Vitamin D insufficiency is epidemic today, and people are developing chronic illness as a result. Educate yourself on the dangers, get tested, take supplements and get sun, that simple.

What I want to discuss is the direct danger of using sunscreen. This product has been so ingrained into our lifestyle that people accept it's safety as if it were soap. I encourage you to think twice. Let's look:

Melanin, the brown pigment that is released when skin is exposed to sunlight, absorbs UV radiation and dissipates the energy as harmless heat, blocking the UV rays from damaging skin tissue. It is nature's amazing photoprotectant--more than 99.9% of these molecules repel photon energy. Compare this to some ingredients in popular sunscreens--the most effective only repelling 81% photon energy, and some as low as 10%.

Because of its poor dissipation of photon energy, sunscreens actually allow more free radical formation. My regular readers know what these damaging chemicals are, but for those of you who don't, free radicals oxidize molecules and tissue potentially leading to cancer and other degenerative diseases including premature aging.

Not only are sunscreens poor photoprotectants, but some of their ingredients have been implicated as increasing the concentration of reactive oxygen species (ROS), which can also cause oxidative damage to DNA, cells and tissues leading to inflammatory diseases and premature aging. In one study, the sunscreen acted as a protector for the first twenty minutes; after 60 minutes, however, it increased the number of ROS in the skin.

Some studies (also here and here) have even implicated sunscreen as increasing the risk of developing malignant melanoma, the deadliest of all skin cancers. However, two meta-analyses (and here) failed to show a causal effect of sunscreen use on melanoma development, despite the correlation found in the other studies. So the jury is still out on whether sunscreen increases the skin cancer risk.

What is pretty clear, though, is the health risk posed by some of the synthetic compounds found in sunscreens. From Wikipedia:

In 2007 two studies by the CDC highlighted concerns about the sunscreen chemical oxybenzone (benzophenone-3). The first detected the chemicals in greater than 95% of 2000 Americans tested, while the second found that mothers with high levels of oxybenzone in their bodies were more likely to give birth to underweight baby girls.

Finally, there has been some concern over nanoparticles used in many sunscreens. Nanoparticles could increase rates of certain cancers or diseases similar to those caused by asbestos.

With all the potential dangers linked to using sunscreens, along with their blocking our vitamin D producing capacity (as well as studies showing sun exposure lowering death rates of cancer patients), why the heck would anybody continue using them regularly? Like I said last post--I'm done. I'm getting my daily sun sans sunscreen. If I go to the beach, I'll put some on after about twenty minutes, then I'll get under my umbrella. Short bouts of sun, that's it. That's how I'm doing it. How 'bout you?