Vitamin D – Should We?

By Dr. Laura Cloukey, Medical Director, The Villages Health Pinellas Care Center

Every year there seems to be a vitamin of interest and this year, we are focused on Vitamin D. Much confusion surrounds this vitamin, which is considered a hormone rather than a vitamin, as it has receptors on virtually every cell in the human body. Deficiency in Vitamin D is seen in over one billion people worldwide (Holick, 2007). People greater than age 70 years are at advanced risk so it is this population that we will focus on.

Vitamin D Deficiency and Insufficiency

Vitamin D insufficiency is diagnosed when there is 20-30 ng/mL of circulating vitamin in the body. Vitamin D deficiency is when there is < 20 ng/mL in the body. Deficiency in Vitamin D affects bone metabolism, cell growth modulation, neuromuscular and immune function, and inflammation reduction. It remains debatable if healthy levels of Vitamin D can help reduce the risk of non-skeletal diseases. Additional research is underway to address the role of Vitamin D in disorders such as multiple sclerosis, autoimmune disorders, infections, respiratory disease, cardiometabolic disease, cancer, and fracture risk.

Sources-of-Vitamin-D Evergreen Wellness

Sources of Vitamin D

How does Vitamin D enter the human body? Vitamin D is produced when the skin is exposed to sunlight. A pre-vitamin D3 is made and transformed into Vitamin D3. This then binds to protein and is transported to the liver where the vitamin undergoes hydroxylation. It then becomes Vitamin D, 25, which is the level that is measured when blood is taken and analyzed. The vitamin then is transported to the kidneys where it then becomes a 1,25 Vitamin D, which is the most active form of the vitamin but is not commonly measured as its half-life is very short, and thus not as good of a measure as Vitamin D, 25 is. Vitamin D also comes from dietary sources. Foods such as fatty fish (salmon, tuna, sword, sardines), egg yolks, portabella mushrooms, and fortified cereals and milk are rich in Vitamin D. People who have malabsorption conditions that affect the gastrointestinal tract such as Crohn’sceliac, chronic kidney and liver disease, diabetes, and cirrhosis, may be at particular risk of Vitamin D deficiency

Vitamin D has also been shown to be a fat-soluble vitamin and may reside in adipose (fat) tissues. Researchers measured serum Vitamin D, 25 in 3890 third-generation participants of the Framingham Heart Study without cardiovascular disease and diabetes, and found that the greater the body mass index (a factor of height & weight), the lower the Vitamin D (Pfotenhauer and Shubrook, 2017). Further research is underway to help explain this relationship and mechanism.

Should you be screened?

Who should be screened for a Vitamin D level? The 2013 US Preventative Services Task Force guidelines and the 2011 Endocrine Society guidelines recommended screening only for those at risk for the deficiencyVillagers who are of advancing age, use SPF protection on their skin and who have an elevated BMI, diabetes (and possibly other disease states), should be screened. Remember: a serum Vitamin D level of < 20ng/mL puts a person at risk for increased fracture, bone pain, and muscle weakness.

Vitamin D Getting-Treated Evergreen Wellness

Getting treated

So what should a person take to treat a low Vitamin D? Most people, aged 1-70, should take 600 IU/tablet of Vitamin D per day. People older than 70 may need 800 IU/tablet or more, depending on the amount of sun exposure and on other medical conditions. Vitamin D may be taken once a week, as a larger dose, or daily as a smaller dose. Either dosing regimen is acceptable. The Endocrine Society suggests even higher doses for ages 70 and older, recommending 1500-2000 IU/tablet (Holick, 2007). It is best to speak with your primary care provider to help you decide what is right for you.

For now, remember, Vitamin D – Should We? The answer is yes, but taking a Vitamin D supplement alone is not enough to avoid fragility fractures. Weight-bearing exercise, some sunshine, a diet rich in Vitamin D, and possibly a supplement will help keep your body healthy for years to come.

 

References

Holick, M. F. (2007). Vitamin D Deficiency. New England Journal of Medicine, 357(3), 266-281. doi:10.1056/nejmra070553

Pfotenhauer, K. M., & Shubrook, J. H. (2017). Vitamin D Deficiency, Its Role in Health and Disease, and Current Supplementation Recommendations. The Journal of the American Osteopathic Association,117(5), 301. doi:10.7556/jaoa.2017.055

Last updated: 06.06.2018
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Written byDr. Laura Cloukey

Laura Cloukey, DO is Medical Director of The Villages Health® Pinellas Care Center in The Villages®, Florida. Hailing from her hometown of Waltham, Massachusetts, Dr. Cloukey attended the University of Massachusetts for her undergraduate studies and received her medical degree from the University of New England College of Osteopathic Medicine. She did her internship and residency at Carney Hospital and Boston University. She is certified by the American Board of Internal Medicine and has been in practice for more than 20 years. Prior to coming to Florida, Dr. Cloukey was at the Beth Israel Deaconess Hospital system in Boston, which is an affiliate of Harvard Medical School. She relocated to The Villages to join The Villages Health to help build a novel and superior health care system that promises patient-centered care, while delivering informed, relevant care plans and better outcomes.

Coach Image

Written by Dr. Laura Cloukey

Laura Cloukey, DO is Medical Director of The Villages Health® Pinellas Care Center in The Villages®, Florida. Hailing from her hometown of Waltham, Massachusetts, Dr. Cloukey attended the University of Massachusetts for her undergraduate studies and received her medical degree from the University of New England College of Osteopathic Medicine. She did her internship and residency at Carney Hospital and Boston University. She is certified by the American Board of Internal Medicine and has been in practice for more than 20 years. Prior to coming to Florida, Dr. Cloukey was at the Beth Israel Deaconess Hospital system in Boston, which is an affiliate of Harvard Medical School. She relocated to The Villages to join The Villages Health to help build a novel and superior health care system that promises patient-centered care, while delivering informed, relevant care plans and better outcomes.

The Villages, The Villages Health, America’s Healthiest Hometown, and their associated logos are trademarks of Holding Company of The Villages, Inc., and are used with permission.

Disclaimer: This content is for informational purposes only and it is not meant to be relied on as medical advice, diagnosis, or treatment. Consult your physician before starting any exercise or dietary program or taking any other action respecting your health. In case of a medical emergency, call 911.

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