Vitamin D deficiency an epidemic.

Vitamin D has dominated the health headlines lately.

• "People with a vitamin D deficiency are twice as likely to die."

• "Lack of vitamin D rampant in infants, teens."

• "Breast cancer patients deficient in vitamin D."

• "Vitamin D protects against heart attacks in men."

• "Vitamin D deficiency increases chances of getting influenza."

• "Prostates protected by vitamin D."

• "Ensuring levels of vitamin D never get low could be a way of protecting against cancer."

• "Vitamin D to boost mood in older adults."

These studies are only from within the last two months.

Why so much press? Vitamin D deficiency is officially considered an epidemic in the United States as well as in many other countries.

Rickets from vitamin D deficiency was common well into the twentieth century. Although antirichatic procedures (first cod liver oil and then adding vitamin D to milk) were routine in Northern countries in the 1940's, the practice waned in the 1950's and 1960's. Subsequently, a rise in rickets ensued until vitamin D milk fortification was once again implemented in the late 1970's. So why are we now seeing so many diseases, including an upswing in rickets, from vitamin D deficiency even though the vitamin fortification policy is unchanged? Several explanations are believed to be contributing:

1. Lack of unencumbered sun exposure -
   Exposure to ultraviolet rays from the sun prevents deficiency, but public skin cancer policy has scared many of us away from sufficient sun exposure. This is why we are seeing deficiencies even in sunny climate populations. Many people can make enough vitamin D in the summer to last them through the winter months, but current lifestyle does not promote adequate outdoor time.
   
   
2. Recommended Daily Allowance (RDA) for Vitamin D needs to be revised -
   Besides the vitamin D in fortified milk and milk substitutes, which is usually 400IU, the Western Diet contains little vitamin D. Fortified milk (and milk substitutes) may stave off a rickets epidemic, but it is now apparent that humans need much higher amounts of vitamin D to prevent chronic disease and it is time for the FDA as well as the WHO to make changes to their recommendations.
   
   
3. Mothers of breast-fed infants are often nutrient depleted and infants are exposed to very little sunlight -
   This could be easily remedied if mother's like the ones we counsel are on the proper nutrient and dietary regimen. Unfortunately, until very recently, little attention has been paid to prenatal, pregnant, and nursing women. All pregnant and nursing women should have a minimum of 400IU of vitamin D in their prenatal. In addition, when a nursing infant is six months old, 400IU of vitamin D3 should be added to their diet. It is also imperative for infants to be exposed to some sun without sunscreen. The fifteen minutes of sun should apply to infants and young children as well as adults. which is sufficient enough even if they did not want to expose their infants to the sun.
   
   The deficiencies are not limited to just breast-fed children. A recent Archives of Pediatrics and Adolescent Medicine study found that 40% of infants, toddlers, and adolescents, many of which were not breast-fed, were vitamin D deficient.
   
   
4. The elderly, who are indoors almost exclusively, are probably at greatest risk for vitamin D deficiency. Especially when living in assisted living facilities, the diets of the elderly are often nutrient-poor, increasing their chances of developing chronic and acute diseases.
   
   
5. Milk consumption in some individuals has been eliminated due to intolerance and allergy.
   Often in these cases, the vitamin D is not being replaced by milk substitutes, vitamin D-rich foods, and/or supplements. Very little vitamin D is naturally present in our food. Oily fish, including salmon, mackerel, and herring; cod liver oil; and sun-dried mushrooms typically provide 400-500IU of vitamin D per serving. The major foods that are fortified with vitamin D in the United States include milk, milk substitutes (such as rice milk, soy milk, and nuts milks), orange juice, cereals, and some breads.
   
   
6. Most health care professionals have ignored the evidence for vitamin D deficiency.
   According to the Journal Nutrition and American Journal of Clinical Nutrition, it is estimated that the body requires daily 3000-5000IU of vitamin D for optimum functioning. The reason for this is that essentially every tissue and cell in the body has a Vitamin D receptor and therefore has a requirement for vitamin D. When health care professionals do not consider diet a major factor in diagnosing health issues, of course vitamin D deficiency is going to be overlooked.
   
   

BONNIE'S PUBLIC HEALTH POLICY TO ADDRESS THE VITAMIN D EPIDEMIC

• Attitude Must Change Regarding Sun Exposure.
  Sensible sun exposure in the spring and summer, and education of the public about the beneficial effects of some limited sun exposure to satisfy their body's vitamin D requirements should be implemented. Exposure to sunlight for usually no more than 15 minutes daily (between 10 AM and 3 PM) on arms and legs or hands, face and arms, provides the body with its required 1000IU of cholecalciferol. After the limited exposure, this should be followed by the application of a broad spectrum sunscreen with an SPF of at least 15 to prevent damaging effects due to excessive exposure to sunlight and to prevent sun burning. In the absence of sun exposure, 1000IU of cholecalciferol (vitamin D3) through food and supplements should be the minimum required daily for both children and adults.
  

• Vitamin D Blood Test Should be Standard for Physicals.
  Vitamin D status has such important health implications that, while we have always recommended much higher doses of supplemental vitamin D than the RDA, we now are asking that a measurement of 25(OH)D be part of your routine physical examination for children and adults of all ages. The measurement of the major circulating form of vitamin D, 25(OH)D, is the gold standard for determining the vitamin D status of a patient. The normal range is typically 25-37.5 nmol/L (10-15 ng/mL) to 137.5-162.5 nmol/L (55-65 ng/mL) by most commercial assays. The measurement of 1,25(OH)2D provides no insight about the vitamin D status of a patient. It is often normal or on occasion elevated in vitamin D deficient patients.
  

• 1000IU of Total Vitamin D3 Daily.
  In the absence of any sun exposure, 1000IU of cholecalciferol a day is necessary to maintain a healthy blood level of 25(OH)D. Dietary sources and vitamin D supplements can satisfy this requirement. Cod Liver Oil and Multivitamins typically contain 400IU of vitamin D3. Vitamin D3 supplements alone are available in dosages ranging from 400-10,000IU. To date, the only pharmaceutical preparation of vitamin D in the United States is vitamin D-2. Although it is only 20-40% as effective as cholecalciferol (D-3, widely available as a dietary supplement) in raising blood levels of 25(OH)D. It is only effective in high doses (usually 50,000IU doses taken once weekly), which would translate to about 2857IU per day absorption-wise.
  
  
• Toxicity.
  For years, physicians and nutritionists were taught that because vitamin D is fat soluble and must be processed in the liver, excess oral vitamin D could be toxic. This fear has not been borne out. People who have taken the pharmaceutical megadoses for years have shown no adverse effects. However, self-medicating with long-term oral doses over 2000IU daily is not recommended unless prescribed by a licensed health professional. This is also why the sun is so beneficial. The stored vitamin D derived from the sun does not have to be processed by the liver!

CONCLUSION
Now that we marked out a clear path of what needs to be done to ameliorate the vitamin D epidemic, please pass the information along to friends, loved ones, and work colleagues. You can have a hand in changing public health policy for the greater good. Who knows, maybe the FDA and WHO will finally catch on?