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By Rob Verkerk MSc DIC PhD FACN
Founder, executive and scientific director
As summer draws to a close in the northern hemisphere, you’d imagine most people will feel satisfied that they’ve benefited from the elevated levels of the ‘sunshine vitamin’. The truth is rather different. Study after study, whether in children, pregnant women or the elderly, reflects the pandemic nature of vitamin D deficiency.
If you’ve got yourself out in the summer sunshine with large parts of your body exposed for 5 to 30 minutes, a couple of times or more a week, you might have got your circulating 25-hydroxy (25[OH]) vitamin D levels into the optimal range (100-150 nmol/L [40-60 ng/ml]).
But for many that won’t have happened. And even if it has, you’re about to plunge into the autumn and winter and your levels are set to decline further.
That makes you susceptible to increased risk of common cancers, osteopenia, osteoporosis, fractures, autoimmune diseases, hypertension, infectious diseases and muscle weakness (in older people). Vitamin D deficiency may also increase your risk of insulin resistance and type 2 diabetes.
Why is maintaining adequate vitamin D blood levels so tough?
There are many reasons why so many people find it hard to optimise their vitamin D levels. Here’s just a few reasons:
- They’ve been told to wear sunscreens when exposed to the sun to reduce the risk of skin cancers. What they’re not told is that lower blood levels increase your risk of other cancers, and skin cancer risk generally only increases among those who are repeatedly over-exposed to the sun (sunburned) and have a susceptible skin type.
- Their lifestyle, age or customs don’t allow them to have sufficient skin exposure to the sun
- They consume little or no dietary sources of vitamin D (e.g. fish liver oils, fatty fish such as salmon, tuna, and mackerel, eggs from hens that have been fed vitamin D, fortified milk products; and other fortified foods such as breakfast cereals)
- They don’t take high dose vitamin D supplements regularly or use indoor tanning services
- They’re elderly so the amount of vitamin D synthesis in the skin, the gastrointestinal absorption of vitamin D from foods and the conversion (hydroxylation) of 25(OH)D to 1,25(OH)2D (calcitriol), a process tightly regulated by parathyroid hormone, is lower
- They’re young, asthmatic and have been put on corticosteroid drugs (asthma inhalers) that reduce circulating vitamin D levels
- You’ve got genetic variations (polymorphisms) in your vitamin D receptors (VDR) that affect your response to vitamin D supplementation or intake.
What about fortification?
Once we accept that vitamin D deficiency is pandemic, how do we resolve it? Getting more sun or going to tanning salons isn’t a solution for everyone – although it’s likely the way nature intended us to make most of our vitamin D.
If it’s the wrong time of year, the angle of the sun is too low, it’s not culturally acceptable, or your skin type requires you need more sun exposure to produce vitamin D (i.e. those with darker skin types), it’s hardly the solution anyway.
That’s why fortification and supplementation are getting more and more air time following the results of comprehensive studies.
That latest study, on fortification and supplementation, conducted at the University of Birmingham in the UK, shows clear health benefits and cost effectiveness for wheat flour fortification, especially when coupled to supplementation. The modelling study that looked at the effects of fortification and supplementation over a 90-year period suggested that 10 million new cases of vitamin D deficiency in England and Wales would be prevented and the NHS would save £65m (~€71m) - over the next 90 years.
As governments, with the limited exception of folate for preconceptual and pregnant women, have generally failed to endorse supplementation as a viable strategy for reducing nutrient deficiencies, it’s interesting that fortification continues to be viewed as more acceptable.
Drawbacks of fortification
In our view it’s got 2 big drawbacks that seldom get mentioned:
- It is dependent on people eating the fortified foods. In the case of fortified wheat flour, not only is it an allergen, it’s also often delivered in ultra-processed form which in turn is directly linked to the increased prevalence of obesity and type 2 diabetes;
- It’s difficult to control the dosage. One thing we’ve learned a lot about over the last couple of decades is that optimising circulating 25(OH)D and the hydroxylated active form, 1,25(OH)D, through dietary intake of vitamin D demands that different people consume highly variable amounts of vitamin D. If governments continue to restrict high dose vitamin D (over 4,000 IU or 100 mcg dose rates), that becomes challenging.
Education, education, education – still not working
The other thing that continues to astound us given the robust nature of the evidence of a vitamin D pandemic, is that educational efforts are still not delivering information to the people who need it most.
This has just been reinforced by a new UK study that shows that most parents, even those from white-British ethnic backgrounds, didn’t know much about the importance of vitamin D, nor about how supplementation or vitamin D fortified foods could go a long way to resolving deficiency in their children.
Get with the 5-step D programme!
So let’s get smarter about vitamin D – before more and more suffer unnecessarily.
Here are 5 steps to help you optimise your vitamin D levels:
- Get your blood levels tested at least twice a year, using an accredited lab. End of summer or winter (yes, now!) are good times to run tests to see where you might be, at your highest or lowest levels. Whichever country you live in, put “vitamin D blood test” into your search engine and you’ll find an increasing array of services that measure your blood levels based on a blood spot that you produce yourself with a pinprick. Everything you need is supplied to your home and you’ll get your results a few days after you’ve sent your bloodspot to the lab by post.
- If your blood levels of 25(OH)D are below 100 nmol/L (40 ng/ml), take high dose vitamin D3 supplements (4000 IU [100 mcg] or more daily) to bring yourself back into range. Ideally test again 3 months after starting supplementation. The rate at which you optimise will vary greatly in different people. If in doubt, seek the support of a suitably qualified and experienced nutritional practitioner. You may need to increase your intake (via food or supplements) of additional nutrients and/or enzymes to enhance absorption.
- If you struggle to optimise your vitamin D levels, you may wish to have a genetic test to check for vitamin D polymorphisms, something that your nutritional practitioner can help arrange for you.
- Let’s be less fearful of the sun and skin cancer risk – let’s simply avoid getting burned. Don’t slap that sunscreen on the kids before they’ve had a chance to be in the sun – but also don’t let them get burned. We need to get sun smart again – it’s what we’ve done for millennia.
- If you can consume oily fish, fish liver oil and fortified foods, these can help boost your levels, but typically, the levels are not high enough to remedy severe deficiency. These fortified foods (e.g. dairy, wheat) may also contribute to other health problems.
Comments
your voice counts
Helena Pike
28 August 2019 at 9:57 pm
Not to forget to supplement with Vitamin K2 which is necessary as a co-factor with Vitamin D supplementation.
Ian Aitchison https://primalfoodstore.com
29 August 2019 at 7:45 pm
Unfortunately there are many GP's who refuse to give Patients a Vitamin D blood serum test, saying Rickets is no longer a problem in today's society! They have no understanding of the role this 'super-hormone' plays in many important functions within the body. It begs the question; what exactly do Doctors learn at Medical School? How about adding an extra year or two on to their course that would maybe focus on important topics like this.
Vanessa
28 August 2019 at 10:58 pm
Don't forget to mention the importance of adequate magnesium in order to ensure that vitamin D is activated in the body. It seems that many people have a magnesium deficiency these days too (exacerbated by 'stress') which may also be behind the D deficiency being seen:
"Abstract
Nutrients usually act in a coordinated manner in the body. Intestinal absorption and subsequent metabolism of a particular nutrient, to a certain extent, is dependent on the availability of other nutrients. Magnesium and vitamin D are 2 essential nutrients that are necessary for the physiologic functions of various organs. Magnesium assists in the activation of vitamin D, which helps regulate calcium and phosphate homeostasis to influence the growth and maintenance of bones. All of the enzymes that metabolize vitamin D seem to require magnesium, which acts as a cofactor in the enzymatic reactions in the liver and kidneys. Deficiency in either of these nutrients is reported to be associated with various disorders, such as skeletal deformities, cardiovascular diseases, and metabolic syndrome. It is therefore essential to ensure that the recommended amount of magnesium is consumed to obtain the optimal benefits of vitamin D."
https://jaoa.org/article.aspx?articleid=2673882
Just to say also that many elderly people in care homes are being denied the opportunity to sit in the sun to help their vitamin D levels - my late mother-in-law was smothered in sun screen by the staff any time she was outside (which was rare). When I asked about this, they said that's what they'd been trained to do. Obviously no knowledge of the importance of vitamin D in the elderly, from many aspects - bone density, dementia, diabetes etc.
Magnus A. L. Mulliner www.mtenergie.com
29 August 2019 at 7:49 am
Many thanks for the reminder about how vitally important Cholecalciferol/D3 is.
I take Liposomal D3 with K2 during the Autumn & Winter - ca 5000-1000iu daily. Blood testing is essential, however also remember our body requires enough Magnesium (Mg). Without enough Mg your body (in the liver) will be challenged at utilising this life enhancing pro-hormone.
I steam cruciferous vegetables like my local organic greens - Broccoli, cabbage, Cavolo Nero, Curly Kale, etc and I also take a Transdermal Magnesium Chloride Hexahydrate spray called - Magnesium Calm/Rapid Recovery. I spray after my shower and before bed – ca 1000mg daily in total.
It doesn't make me itch and it's absorbed immediately, bypassing our gut.
Another healthy tip bit - Only apply to your biggest organ (Skin), if you'd consume it! I personally don’t mind the taste, but this spray is meant to be topical!
Other important factors to consider.
When out in the sun, certainly don’t burn yourself, but remember that UVB strikes our skin and with the help of cholesterol is eventually absorbed (can take ca 48hrs) and processed in our liver.
Showering it all off will not help it absorbed, so wash essential bodily parts but don’t use organic soap or gel and wash it all off your skin, simply rinse in cold water. As an addendum, I also highly recommend people have a cold shower each morning! That will align many wonderful neurotransmitters and wake you up optimally.
Ensure you sleep in a completely dark room at night so that the vitamin absorption can be effective and of course turn off your Wi-Fi. We cabled our home so no ‘dirty electricity’.
I could go on… Keep having fun
Vanessa
30 August 2019 at 11:10 am
I used to tell people not to shower or bath straight after being out in the sun for the reasons you state, and was 'shouted down' on one FB page where they said it wasn't proven to be true. However, I still think there may be some truth in it because people these days are so obsessed with being 'clean' and often shower daily with various products, which may be exacerbating the vitamin D deficiency epidemic.
Rufus Greenbaum www.vitaminduk.com
29 August 2019 at 11:10 am
I totally endorse and support this 5-step Vitamin D programme
The UK government advice is only designed to avoid the bone and muscle problems of being totally deficient in Vitamin D.
It is not designed to achieve an optimum level of Vitamin D, which will give you better health in so many ways
Here are some places to learn more about the health benefits of optimum Vitamin D
https://vitamindwiki.com ( read it in 50+ languages )
https://www.vitamindcouncil.org ( see "Health Conditions" )
https://www.grassrootshealth.net ( download their Call-To-D*Action )
http://www.vitamindassociation.org/events ( watch videos of top experts explaining why we need Vitamin D )
https://is.gd/howmuchD ( read the blog "How Much Vitamin D Do I Need ?" )
http://vitamindtest.org.uk ( Vitamin D blood test by post from an NHS laboratory )
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Vanessa
30 August 2019 at 11:06 am
Yes, it was exactly a consequence of the lack of nutritional education that spurred Dr Rangan Chatterjee to learn about it and Functional Medicine in general, as his son nearly died as a result of a vitamin D deficiency. I think there is a movement going on, started by Cambridge Uni medical students, to provide more education regarding nutrition. There is also a lack of understanding of how nutritional deficiencies can be the cause, or trigger, of mental health problems, but most psychiatrists don't want to know!
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