Vitamin D Deficiency Stirs Debate
Boston University researcher Michael Holick estimates that approximately 1 billion people worldwide are vitamin D deficient. His review article “Vitamin D Deficiency” appears in the July 19, 2007, issue of the New England Journal of Medicine.
It is interesting to note that the term vitamin D is actually a misnomer. Vitamins by definition are essential nutrients that typically cannot be produced in the body and therefore must be obtained through the diet. Vitamin D is produced in skin exposed to sunlight and occurs naturally in only a few foods (butter, egg yolk, fish oil, and human milk). So vitamin D isn’t a vitamin at all, it’s a sterol. Sterols are compounds that behave like fats and are classified as lipids. Cholesterol is a well-known sterol.
The biologically active form of vitamin D, 1,25-dihydroxyvitamin D, is formed in the body from one of two biologically inactive precursors, known as vitamin D3 or cholecaliciferol and vitamin D2 or ergocalciferol. Vitamin D3 is the precursor of choice due to its greater bioactive potential. Many nutrition experts now recommend D3 over D2, and many multivitamins now contain D3.
Current U.S. recommendations issued by the Institute of Medicine (IOM) call for 200 IU (international units) per day for children and adults up to 50 years of age, 400 IU for adults 51 to 70 years of age, and 600 IU for adults 71 years of age or older.
Based on current data, Holick recommends a fourfold increase in the recommended daily intake of vitamin D in all population groups, or at least 800 IU per day.
“Unless a person eats oily fish frequently, it is very difficult to obtain that much vitamin D on a daily basis from dietary sources. (Fortified milk contains approximately 100 IU per 8 ounce serving.) Excessive exposure to sunlight, especially sunlight that causes sunburn, will increase the risk of skin cancer. Thus sensible sun exposure and the use of supplements are needed to fulfill the body’s vitamin D requirements,” said Holick.
What is sensible sun exposure?
Holick describes sensible sun exposure as the exposure of arms and legs for 5-30 minutes (depending on time of day, season, latitude, and skin pigmentation) between the hours of 10 am and 3 pm twice a week.
Given the many variables (time of day, season, latitude, and skin pigmentation) and the risks associated with too much sun exposure, quantifying the amount of sun exposure each individual needs to produce adequate vitamin D is difficult. Additionally, many pediatric care providers are reluctant to recommend sun exposure even for brief intervals.
Is there an alternative to sun exposure?
An alternative to sun exposure is daily supplementation using at least 800 IU of vitamin D3. Holick states that an intake of 1,000-2,000 IU of vitamin D3 per day is safe and that even higher levels may be appropriate for selected groups of individuals. Reports of vitamin D intoxication (too much vitamin D) are rare. While daily intake of more than 50,000 IU of vitamin D3 per day can have adverse side effects, 10,000 IU of vitamin D3 per day have not been shown to cause toxicity.
If you are pregnant or breastfeeding, talk with your health care provider about the amount of vitamin D3 supplement that is appropriate for you and your child. Human milk is one of the few foods that contains vitamin D, but the levels are typically quite low given the fact that breastmilk was never intended to be an infant’s primary source of vitamin D. Recent research shows that supplementing a breastfeeding mother with large amounts of vitamin D3 (4,000 IU per day) can achieve adequate levels of 25-hydroxyvitamin D in the mother as well as her milk.
More research is needed in this area, but the fact remains that adequate levels of vitamin D are essential to long-term health, particularly in view of vitamin D’s role in reducing the risk for a variety of chronic diseases, including cancer, autoimmune disease, osteoporosis, and cardiovascular disease.
As an added footnote, the study also concluded that tanning beds, when used in moderation, are a good source of vitamin D3.
According to Holick, “Most tanning beds emit 2 to 6% ultraviolet B radiation and are a recommended source of vitamin D3 when used in moderation.”
In addition, “Tanners had robust levels of 25-hydroxyvitamin D (approximately 45 ng per milliliter [112 nmol per liter]) at the end of the winter and higher bone density as compared with nontanners (with levels of approximately 18 ng per milliliter [45 nmol per liter]).”
These results underscore the importance of sunlight (specifically ultraviolet B radiation) in maintaining adequate levels of vitamin D.
My mom has Vit D level of 36.6ng/ml. Her medical doctor has her on 50,000 IU per week. Recently she was told to take this amount for only 3 weeks then leave off 1 week and the start back for 3 weeks. I was wondering if this amount is really high. She has history of colon cancer, nearly 8 yrs ago now. Thank you , Paula
There is a lot of controversy over how best to achieve normal levels of vitamin D. Traditionally, we relied upon the sun as our primary source of vitamin D, but a significant increase in skin cancers, particularly melanoma, has prompted physicians to modify those recommendations. I would suggest that your mother discuss your concerns and hers with her doctor. Research data show that vitamin D may decrease the risk of colon cancer, so given your mom’s history I can understand her physician’s desire to improve her vitamin D status. You might also want to access scientific articles by Holick, as he is considered by many to be one of the most knowledgeable sources on the subject.
I was recently diagnosed with vitamin D deficiency. I know the normal range is 30-80 and mine was 5. My doctor put me on 50,000 IU per week. My question, “Is this the correct amount for me, and how long does it take to start working, as I am suffering with the majority of deficiency symptoms?” Thank you for your response. Also my age is 48.
There are no established guidelines for supplementation as it varies greatly with each individual. I would ask you doctor what information he/she is using to determine your supplement needs. I would also discuss safe sun exposure, given the difficulty in getting adequate vitamin D through supplements alone.
I am a 55 year old Registered Nurse. In October of 2006 I had Breast Cancer and underwent, Surgery, Chemo Therapy and Radiation. Last Spring my Oncologist wanted to see what my Vitamin D level was, because of the new research on Vitamin D Deficiency and Breast Cancer, and because I live in Washington State and we have few Sunny days. I had 3 tropical vacations the year before and wasn’t concerned although, I took no Supplements at all. When she tested it in March of 2008 it was 10ng/ml, I had left to go to Mexico for a week before I got those results back, and when I got back she wanted me to start with the 50,000 Unit pill every week, but before I started that I had her test again after the week of snorkeling in Mexico and it had gone up to 22.5 still too low, but up 12.5 in one week. Then I started the supplement of 50,000 units (Vit D2) and using a tanning bed with UVB Rays 3 times a week and it took another 6 weeks to bring it up to 29, clearly the sun was more effective than the supplements, or the tanning beds. Not that I’d recommend that much sun at one time. The other interesting thing that happened is that once my Vitamin D level reached 29.9 my seasonal allergies went away entirely, and I had suffered from them since I was 14, 2 years after moving to Washington State. I just brought in Hay for my horse yesterday and that always entailed a mask and wheezing and antihistamines and itchy areas on my arms where the grass hay touched them, and there was none of that. I have been reading every research article out there, and I’m amazed at the amount of diseases that could be helped by simply bringing our Vitamin D levels up above 32 ng/ml. But getting the word out to the medical profession has been a bit of a challenge, Dr’s don’t always see a need to test even when there are risk factors, or illnesses like Osteoporosis, Cancers, MS, and Fibromyalgia. If it can cure my seasonal allergies, what else can it Do?
I was diagnosed with a 15.5 ng/ml deficiency 3 weeks ago. My doctor put me on 50,000 IUs weekly. I’m feeling slightly better after 3 weeks’ dosage, but wanted to know when most people begin to see improvement? I still have significant aches. Thanks.
Unfortunately, I have little experience with vitamin D supplementation. Your doctor is your best source for information. But if I were guessing, I would guess that it might take weeks or months before you see a difference.
Vitamin D is a secosteroid hormone. It is not a nutrient. This is what is being forced down peoples’ throats, all based on poor science. Most studies reporting “low” Vitamin D levels (based solely on the inactive form 25 hydroxyvitamin-D) in ill patients do not measure the active metabolite 1,25 dihydroxyvitamin-D. It’s been found that people with chronic illnesses have a tendency toward “low” 25-D levels and elevated 1,25-D levels. Ingesting more “Vitamin D” is fueling the disease because “low” D is not the cause of disease, it’s the result of it. Read the following:
http://trevormarshall.com/BioEssays-Feb08-Marshall-Preprint.pdf
http://bacteriality.com/2007/09/15/vitamind/
The entire food chain is fortified with Vitamin D. A percentage of the population is popping Vitamin D supplements like it were candy. Never has a population ingested so much Vitamin D and, yet, chronic disease is on the rise. It just doesn’t add up.
I just found out two weeks ago that my level was only 4 I Never new vitaim d was so important. What I would like too know how long it took me too get this low I AM only 40 years old, And how long will it take me too get back on tract exspeaily get rid of the pain, and be able too do noramal thing again. I thought most of my sysmptems were from just working i work at night and I am over weight. But now I KNOW what has been causing my problems’ I found this out from getting blood work because I AM going too get the Relize band done in about 5 months or less.
Is 50,000 IU too much to replace a deficency?
What is the daily amount of vitamin D needed to maintain a good serum level?
What are the risks taking vitamin D?
The amount of vitamin D required each day to maintain a good serum level varies depending on your vitamin D stores and your sun exposure. The current recommendation is that adults take 800 IU a day, perhaps more if you live in areas of the world where the sun exposure is less. I have seen reports of people taking as much as 50,000 IU a day in an effort to correct a deficiency but it’s important that you be under a doctor’s care while doing so, so that you can be monitored for adverse effects. Vitamin D is a fat soluble vitamin, so it can be stored in the body. Theoretically, this allows for someone to develop toxicity when excessive amounts are taken, however, vitamin D toxicity is quite rare. The importance of vitamin D is only beginning to be understood, which explains why physicians are eager to help people achieve normal serum levels.