By Gerald (“Jerry”) Simons, PA-C
You have all heard it before: Stay out of the sun, use 30 SPF sunblock, and apply copious amounts of it.
For the most part, I do encourage patients to avoid excessive exposure to the sun; the risks of skin cancers, premature skin aging, and wrinkles are a real threat. On the other hand, I also deal with how the lack of sunlight affects patients on a daily basis.
Many forget the vital role that the sun plays in vitamin D production. Vitamin D3 (cholecalciferol) is produced in the skin under the effects of ultraviolet radiation, This is the active form that our body utilizes in order to carry out many important metabolic processes, including proper calcium absorption for bone health. Vitamin D2 (Ergocalciferol) is found in some plant products and is completely inactive in our bodies.
I became interested in the role of vitamin D after reading an article in The New England Journal of Medicine by Dr. Michael F. Holick, Ph.D., M.D. He points out the importance of vitamin D, and how many problems can be caused by a lack of it. He notes that vitamin D deficiency is one of the most commonly unrecognized medical conditions, and estimates that there are over one billion people worldwide at risk for vitamin D deficiency, with 30-50% of children and adults in the United States at high risk for this potentially life-threatening condition. When I originally learned about vitamin D at Cornell Medical School, we were told that just daily exposure to the sun provided adequate vitamin D for optimal health…how times have changed!
Interesting findings about vitamin D:
- Vitamin D sufficiency is more important for bone health than high calcium intake. If Vitamin D status is sufficient, calcium intake levels of more than 800mg/day may be unnecessary.i
- High circulating levels of vitamin D are associated with a lower risk of multiple sclerosis. 25-OH Vitamin D between 90-100nmol/L were considered optimal in this study.ii
- Vitamin D from diet or sun may lower breast cancer risk. Overall, participating in any outdoor work at any point in life resulted in about a 40% reduction in breast cancer risk.iii
- Women with 25 OH Vitamin D levels less than 50ng/mL were six times more likely to develop breast cancer than those with levels greater than 50.iv
- High maternal Vitamin D intake in pregnancy may help protect children from asthma and wheezing during early childhood. This protection came from vitamin D from diet or nutritional supplements v
- Vitamin D was found to be protective against melanoma relapse. vi
- Vitamin D supplementation in infancy has a strong protective effect against the autoimmune disease Type 1 Diabetes. vii
- Oral Vitamin D supplementation reduces the risk of hip and non-vertebral fractures in elderly patients. viii
Know your vitamin D level!
Vitamin D can be easily and accurately measured in the blood. I encourage you to know your serum level! Ask for a 25-Hydroxy-vitamin D test to be done the next time you are due for blood work. The minimum acceptable serum level is 25-35, but for optimal health, I recommend a level of 50 to 100.
While there are some foods that provide vitamin D3 (fish liver oil, egg yolks, fatty fish), the quantities are often insufficient. Optimal vitamin D-3 supplementation dosage depends on the individual and is best determined by your physician based on blood results. Common dosing for vitamin D-3 is 1000 iu daily, but if a person is very deficient, we may recommend up to 5000iu daily. Consult your physician before supplementing with vitamin D.
I would encourage you to do the following to improve your bone health:
1. Request a vitamin D blood test the next time you are having blood work done.
2. Get a bone density study. I recommend all women get their first bone density between the ages of 40-45, and men get a bone density in their early 60s.
3. If your vitamin D levels are not sufficient (less than 50), ask your health care provider whether you should add to get the maximum effect from your calcium.
4. Keep healthy with regular weight-bearing, aerobic exercise
6. Speak to your healthcare provider before taking vitamin D, if you have a history of kidney stones or a parathyroid gland imbalance.
If you have any additional questions or thoughts on Vitamin D, please submit them in the comments section below or on our Facebook page.
This article does not establish a practitioner-patient relationship. Consult with your health provider on how supplements may affect your current condition or medications.
Gerald Simons, PA-C
The Morrison Center
i Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G. Relationship Between Serum Parathyroid Hormone Levels, Vitamin D Sufficiency, and Calcium Intake. JAMA. 2005;294(18):2336-2341. doi:10.1001/jama.294.18.2336.
ii Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-Hydroxyvitamin D Levels and Risk of Multiple Sclerosis. JAMA.2006;296(23):2832-2838. doi:10.1001/jama.296.23.2832.
iii Bertone-Johnson ER, Chen WY, Holick MF, Holis BW, Colditz GA, Willett WC, Hankinson SE. Plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D and risk of breast cancer. Cancer Epidemiol Biomarkers Prev. 2005 Aug;14(8):1991-7.
iv Lowe LC, Guy M, Mansi JL, Peckitt C, Bliss J, Wilson RG, Colston KW. Plasma 25-hydroxy vitamin D concentrations, vitamin D receptor genotype and breast cancer risk in a UK Caucasian population. European Journal of Cancer. 2005(41):1164-9.
v Wendling, P. Maternal Vitamin D Affects Children’s Asthma Risk. Family Practice News. May 1, 2006.
https://www.nhlbi.nih.gov/news/2016/asthma-prevention-study-suggests-vitamin-d-supplementation-pregnant-women-might-affect. Accessed June 9, 2015.
vi Walsh, N. Vitamin D Supplements Shown to Protect Against Melanoma Relapse. Family Practice News.
December 15, 2006. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897580/.
Accessed June 9, 2015.
vii Hyppönen E1, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001 Nov 3;358(9292):1500-3.
viii Bischoff-Ferrari HA1, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005 May 11;293(18):2257-64.