More Vitamin D

Vitamin D Survey

We’re asking all readers to answer two questions in the comment section below:

1)   Have you ever been tested for vitamin D, yes or no.

2)   If so, can you share the test result (in ng/mL, the usual form).

Thank you very much; we’ll share the result in the next post.

Health and Quilting

The beautiful wife wishes my Word of Wisdom Living posts were shorter, perhaps 600 words.  I try, but the last post on vitamin D, a critical health topic, ran 1220 words.  And I didn’t even cover all the important points, like how to optimize vitamin D from sunshine.  So here are a few more words about the vitamin that’s more like a hormone, and is sometimes called the immunity steroid.  For more on the benefits of vitamin D, see this article by Dr. Jack Kruse, a neurosurgeon.

Before we get too passionate about vitamin D, please remember one thing:  WOWL seeks a balanced view of nutrition and health; we try to stay above the fads that come and go.  It helps to think of your health as a quilt comprising 52 patches, which we address with our weekly Healthy Changes.  Most people act on perhaps a half-dozen or so health topic, dominated by those most recently in the news.   A PhD nutritionist might be aware of a thousand, or so, an impossibility for the average person.  We attempt to increase your vision and practice to cover 52—a boost that just might save the life of someone you care for.

The Seasonal Cycle

Vitamin D and omega-3 fats work together in the body.  (We'll talk about omega-3 fats in two weeks.)  Both are essential to brain function, for example.  So it shouldn’t surprise they have harmony in Nature.  The green plants of spring and early summer deliver the most omega-3 fats, just as the sun restores our vitamin D by shining brighter and longer. 

The pattern of spring is reversed in the fall.  The fall harvest—more brown than green—is low in omega-3 and high in omega-6, which seems to prepare us for winter.  Vitamin D levels decline also—as the sun drops low in the sky and the days grow shorter, we produce less D.  There's likely a good reason for these seasonal variations but until more is known, it seems wise to keep vitamin D within the optimum range.

Best Sources of Vitamin D

Studies suggest Americans have too little vitamin D and this is getting worse.  Two big reasons are 1) we've been taught (by weathermen, the clowns of TV) that sunshine is bad, and 2) the modern American diet (MAD) may be making things worse.  For example, the MAD is low in omega-3 fats and excessive in omega-6.  There's evidence this combination inhibits the body's ability to produce vitamin D, even if you get enough sunshine.  If you get plenty of sun but have low serum vitamin D, take a look at your diet.

There are other reasons for low vitamin D production:  If you're older things just slow down (but you do have more time to sit in the sun).  If you're overweight or obese your vitamin D supply can be trapped in permanent fat tissue and unavailable. (Fat cells are the winter storage depot for vitamin D.)  A darker complexion is rich in melatonin, which protects the body from the sun, but slows down vitamin D production.  And there are always the genetic differences. 

What is the best way to increase your vitamin D?  Dr. John A. McDougall, an advocate of disease prevention through diet and lifestyle, gives his opinion in this article.  Basically, he favors 1) regular sensible sun, if possible, 2) the safe use of tanning booths in winter, and 3), as the last resort, vitamin D pills.  There are also dietary sources of vitamin D that shouldn't be overlooked.

Dietary Vitamin D

As you move away from the equator, people get less vitamin D producing sunshine.  But the consumption of meat increases and animal (as well as human) fat is a storehouse for vitamin D.  So you get some D from animal fat (as well as the organ meats).  Then there’s your internal supply:  If the fat you add in the fall actually disappears in the winter, you’re releasing some vitamin D. 

Cold-water fish are another source of vitamin D, in addition to omega-3 fats.  Wild salmon have a lot of D, 600-1000 IU per serving; farmed salmon contain about 1/4^th as much.  Herring, sardines, tuna and shrimp also contain vitamin D, as well as omega-3 fats. If you’re eating fancy, oysters and caviar are a good D source.  Remember the tradition about eating fish in the months with an ‘r’?  Isn’t it nice that these are the months with the least sunshine? 

The sun-starved folks in New England traditionally ate a lot of cod.  Cod liver oil is uniquely rich in both omega-3 and vitamin D.  (Cod liver oil has 1300 IU of D in just 1 tbsp.)  Nature does provide.

Eggs contain vitamin D also, about 20-37 IU.  Some breakfast cereals have been fortified with vitamin D (40-140 IU per serving): milk contains 100 IU of D, added by irradiation.  Though these are synthetic forms of D, you can get 300 IU or so with a hearty breakfast.  Mushrooms contain D and this is increased if you place them in the sun for a few hours.

This Week’s Recipe

In the 52 Breakthrough Recipes we plan to post this year, we’ve included five salads.  THe Healthy Change implied a recipe with vitamin D so the beautiful wife suggested a Classic Seafood Salad recipe, which we included in this week’s menu.  Here’s our recipe:

Classic Seafood Salad

Ingredients (feeds 4):

• 8-12 oz. of cooked shrimp
• 4 cups dark greens, washed
• 4 green onions, chopped
• 4 eggs, hard-boiled and quartered
• 2 medium tomatoes, cut into sections
• 1 avocado, sliced

Directions:

1)   This is too easy but always a treat; it can be the only dish if accompanied with bread.  We ate it this week with cheese quesadilla.  Simply arrange the ingredients on a salad plate, artfully.  You can add about any produce you have on hand.  This salad works with almost any seafood; canned tuna is easy on the budget, but we also buy crab when the price is right.

2)   Serve the dressing at the table.  The beautiful wife makes a 1000 Island dressing by combining our homemade chili sauce with ketchup and mayonnaise. 

Please Comment:  Per the request at the top of the page, please tell if you’ve been tested for vitamin D (yes or no), and share the test result, if you don’t mind. 

Let The Sun Shine

The quick answer:  Aside from a healthy diet and exercise, the next best thing you can do is to get enough sunshine to maintain a healthy serum vitamin D level.  It’s good for your mood and can help prevent a long list of diseases.

_____________________________________________________________________________________________

About Vitamin D

It’s essential to eat vitamin-rich food because the body can’t produce them, with one exception:  With a little sunshine, the body can make it’s own vitamin D.  Unfortunately, the weathermen and dermatologists have scared us out of getting enough sunshine.  Ever had your vitamin D level tested?

Sufficient D is essential to good health; vitamin D receptors are found in cells all through your body.  The growing list of conditions where vitamin D deficiency is a risk factor includes seasonal affective disorder (SAD), osteoporosis, muscle and joint pain including back pain, certain cancers (breast, ovarian, colorectal, and prostate), obesity and diabetes, stroke or heart attack, G.I. diseases like inflammatory bowel disease (IBD) or Crohn’s disease, and immunological diseases such as MS and Parkinson’s disease.  It’s a long list. 

Vitamin D deficiency increases as you move away from the equator.  In the Sunbelt you can get adequate D year around, though it takes longer in winter.  But if you live above the 40^th latitude parallel, roughly a line through Portland, OR, Salt Lake City, and New York City, you can ski all winter in your bathing suit and not get enough D.

There’s an annual cycle to your vitamin D level.  For most, our D level peaks in the last sunny days of summer, then hits rock bottom as winter turns to spring.  This is the point when you feel the blues, lack energy, or suffer muscle aches.  Because spring just started, your D is likely at its annual low-point (unless you’ve just back from sunbathing on a beach in Costa Rica). 

IOM Report

Americans love to take pills.  Maybe it’s because we’re in a rush and taking a pill is a quick fix, but we eat a lot of pills, including vitamin pills.  We get into vitamin fads—remember the vitamin C and E eras?   Usually these end badly; the hoped-for benefit proves elusive, or side effects present.  Because of the growing interest in vitamin D, the Institute of Medicine, perhaps the world’s most prestigious scientific body, was asked to study the vitamin D issue lest we run off on another pill fad.

The IOM report, issued in late 2010, disappointed many because of its cautiousness.  Basically, if you set the minimum level for serum vitamin D at 20 nanograms/mL, most people are OK.  But if you set the level at 30, as some labs do, then up to 80% are deficient.  Some doctors argue that 40-50 is a good range but the IOM couldn’t find sufficient evidence to support a target higher than 20-30.  (The IOM report also looked at calcium supplements and found little support, with the exception of girls in their teens.)

The N. Y. Times ran an article on the IOM report, repeating the message that vitamin D and calcium pills may not be indicated for most.  The article unleashed a torrent of reader comments, many from thoughtful people in the Northeast, the region with the least sunshine for vitamin D.  Readers expressed real anger that there wasn’t better guidance on the optimum vitamin D level, or on the best methods to maintain vitamin D in the winter.  This is a common problem in nutrition—after the billions spent on research, we have these basic questions without a clear answer.

The Vitamin D Solution

The best book I’ve seen on vitamin D is The Vitamin D Solution, written by Dr. Michael Holick, PhD, MD.  Holick suggests a 3-step solution of 1) testing, to know where you are, 2) sensible sunshine, and 3) safe supplementation when sunshine isn’t available. 

The book makes two remarkable statements about vitamin D and cancer:

First, on the benefit of getting sensible sunshine: “vitamin D could be the single most effective medicine in preventing cancer, perhaps even outpacing the benefits of . . . a healthy diet”.  We hear all the time that we should avoid avoid sunshine to prevent skin cancer, which brings us to the second point.

Second, the book quotes Dr. Edward Giovannucci on the benefits of sunshine for vitamin D versus the risk of skin cancer:  sufficient “vitamin D might help prevent 30 deaths for each one caused by skin cancer”.    I like those odds: 30 better outcomes at the risk of one bad outcome.

I recently saw my dermatologist.  She’s a charming woman who cares about her patients.  We talked about the trade-off between getting enough vitamin D the natural way—by sunshine—versus the risk of skin cancer.  The good doctor pointed out that in southern California, you could get sufficient vitamin D with 15 minutes of sunshine on most days.  Of course you have to show a little skin, so I do my workouts outdoors around noontime, wearing shorts and shirts without sleeves (except when it’s cold).  When no one’s around I take off my shirt, but I try to avoid the “pinkness” that’s the first stage of a sunburn. 

I’ve got a physical check-up scheduled that includes a test for vitamin D.  I’ll let you know how it comes out.  I’ll be happy if I have a serum level of 30 ng/mL, the upper range recommended by the IOM.  A number of people have told me their vitamin D levels—I’m forward about asking—and I’ve yet to meet anyone with a value of at least 30.  Per the IOM, this is a big problem, which brings us to this week's Healthy Change:

Please note the term "a little" sunshine, sun that burns or turns the skin pink may be harmful and should be avoided.  (If you live in the northern latitudes, don’t tolerate the sun, or are concerned about your vitamin D, consult your doctor.)

Please comment:  Want to share your experience with vitamin D, or how you tested?  Do you live in the northern latitudes?  If so, what do you do in winter to maintain vitamin D.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

The Vitamin Era

Food traditions are important to families, especially at Easter.  Our observance started Saturday morning, with the children’s Easter egg hunt.  Dozens of children scrambled to find hidden eggs, while the morning sun competed with a refreshing ocean breeze to relax the adults.  Afterwards, we had a family breakfast.  On Sunday we worshipped in the morning and gathered for family dinner in the afternoon.  We didn’t have ham this year, there were already two ham bones in our freezer.  The menu featured slow-roasted brisket of beef, Skip’s scalloped potatoes (recipe to follow), peas, green salad, and orange rolls.  Yes, deviled eggs too.  After dinner we took a sunset stroll back to the park so the grandchildren could find the last of the hidden eggs, and then returned home for strawberry shortcake (using a new, healthier recipe). And we started a new tradition, a game to see who had the toughest Easter egg.  Our best Easter ever?  Yes, and our saddest.

Our daughter called Saturday evening in tears: long time friends had lost an exceptional daughter to an auto accident as she traveled home for Easter.  You have ties to this family too, in a way, for the mother is the source of our featured recipe: Beth’s Vegetarian Enchiladas.  Our daughter hurried to the home to offer condolences.  She couldn’t help but notice how the family table, carefully prepared for the next day’s Easter dinner, included a place setting for the daughter who would not come this way again.

The second death was a person with whom we had worshipped for years; she passed away on the day known as Good Friday.  She was 62 and had never married.  A decade before she had declined surgery for an ovarian cancer, because she had not given up her dream of marriage and motherhood.   A woman risking her life for a dim chance of creating life?  The idea is at once irrational yet deeply moving. 

So our thoughts on Easter morning, stirred by the music of the day, were about the preciousness of life.  We eat well not to live forever, but to live well.  And vitamins are very much a part of living well.  I apologize for this unusual introduction to vitamins, but the events of the weekend have given new meaning to old truths. 

New Knowledge

The discovery of vitamins in the first half of the past century created a sensation.  As vitamins are exogenous, meaning not produced by the body, we must get them in our diet.  People were fascinated at the power of microscopic quantities of chemicals to cure dreaded deficiency diseases like scurvy (vitamin C), beriberi (B1), and rickets (D).  The first discoveries (there are 13 known vitamins) were made in Europe but World War I intervened and American science gained prominence.  With the discovery of vitamins, the idea began to grow that we knew just about everything that could be known of nutrition.  In America, anything that fascinates soon becomes a business and vitamins were no exception.  In our next post we’ll take a closer look at the business of vitamins.

The discovery of vitamins illustrates the problem of nutrition done the American way—new knowledge rather than helping often has the opposite result of making thing worse.  There is that saying, you know, “a little knowledge can be a dangerous thing.”  When we cured the vitamin deficiency diseases with synthetic vitamins, we began to believe that manufactured molecules could heal whatever ailed us.  Futurists speculated that a meal could someday be taken in a single pill, a great labor and time saver.  There was a corresponding loss of respect for the sanctity of natural foods.  Fortunately, this is being rediscovered.

The best vitamin factories are plants, or the creatures that eat plants.  The picture above shows natural sources for vitamins (I was surprised at the concentration of B complex vitamins and vitamin E in sunflower seeds).  This is the traditional and optimum way to get our vitamins—through a variety of colorful whole foods.  Because much of the standard American diet consists of food-like, factory-made concoctions, we now live in a state of sub-clinical vitamin deficiency.  Sub-clinical means the consequences aren’t serious enough to notice.  This low-level deficiency is referred to as insufficiency.  Long-term vitamin insufficiency is a little-studied medical condition but is suspected to play a role in the development of chronic disease.  In the richest of nations, vitamin insufficiency is widespread.  What are our most serious vitamin insufficiencies today?  Here are three:

Vitamin D:  There is controversy (previously reviewed here) regarding the optimum level.  Bottom line is we don’t know for sure, but some argue that higher levels are protective of a number of diseases.  If they’re right, most Americans are deficient or at least insufficient and this is a risk factor for a number of chronic diseases.  In northern latitudes wintertime vitamin D deficiency can be a health problem.

Folate: Previously discussed here, folate is the preform of Vitamin B9 (folic acid is a synthetic form), and is a common deficiency that raises the risk of neural tube birth defects.  The 2010 Dietary Guidelines for Americans strongly urges women capable of becoming pregnant to supplement as needed to get 400 mcg folic acid daily.

Vitamin B12:  B12 is vital to building red blood cells, to DNA formation, and nervous system health.  Insufficiency is a risk factor for anemia, fatigue, irritability, depression, cognitive loss, mental disorders, stroke, elevated homocysteine (a cause of atherosclerosis and heart disease), and may be a cause of Alzheimer’s disease.  Add infertility and recurrent fetal loss to the list.  The nature of these conditions makes diagnosis difficult so B12 deficiency is often overlooked.  Long-term vegans are at risk for B-12 deficiency but insufficiency is widespread, especially among the elderly.  The Framingham Study found 40% of adults 26-83 years of age to be insufficient and 9% were outright deficient.

________________________________________________________________________________________________

Bottom line:  In the U.S. there is widespread vitamin insufficiency due to the spread of processed foods.  The solution is to eat a diet rich in natural sources of vitamins.  John A. and Leah Widtsoe understood this back in 1937 when they wrote their book, The Word of Wisdom, and stated:  “Let this be emphasized: one is much safer in taking vitamins and minerals from natural foods than from artificially prepared drug products.”

Please add comments and from your vitamin experience.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Nutrition Book #2

In the post “Let The Sunshine In” we looked at the recent dustup over vitamin D.  Vitamin D, more hormone than vitamin, is more crucial to health than previously appreciated. As promised, in this post we review the book, The Vitamin D Solution by scientist Michael F. Holick, PhD, MD. (Another good book is The Vitamin D Cure, by James E. Dowd, MD.) 

Two key questions remain unsettled by science and Dr. Holick gives his input:

•   What is the optimum blood level of vitamin D?  Dr. Holick recommends staying above 30 ng/mL; the Institute of Medicine (IOM), more cautious, used 20 ng/mL in their report.  This is a big deal: the IOM, using “20”, didn’t see a big vitamin D deficiency in America.  If you use Holick’s “30”, there is a widespread deficiency. Others use higher targets, up to 50 ng/mL. Take your pick.    

•   What is the best way to get vitamin D (pills or sunshine)?  Dr. Holick and Dr. Dowd put more emphasis on sunshine, but suggest complementing with pills as needed, especially in northern latitudes.  Food contributes vitamin D also. The vitamin D from sunshine lasts twice as long in your blood according to Holick, and there are 5-10 other molecules also produced by the skin which science is just beginning to study. 

The importance of vitamin D is shown by the diseases it can prevent or help cure, according to Dr. Holick. The cause of these diseases is not fully understood, thus not all agree with Dr. Holick. Because the broad role of vitamin D is a more recent discovery, the passage of time should fill in some of the blanks. Right now, vitamin D looks like a wonder drug; it just might be but we should be careful not to go overboard.  In the meantime we all must decide how to protect our families and ourselves. Below is a partial list of diseases helped by vitamin D:

•   Cancer: breast, prostate, colorectal, ovarian, and pancreatic cancer risk can be reduced up to 30-50% by maintaining your vitamin D, which helps regulate cell growth. Dr. William B. Grant, a vitamin D researcher, has projected 155,000 less internal cancers each year if people get adequate (vitamin D-producing) sunshine.

•   Heart disease: you can reduce your risk of high blood pressure, heart attack or stroke by up to 50%.

•   Fertility: adequate vitamin D improves fertility, reduces risk of C-section, shortens labor, and makes for a healthier baby. 

•   Osteoporosis: the essential role of vitamin D is well known.

•   Autoimmune disease: vitamin D reduces your risk of rheumatoid arthritis, or multiple sclerosis, by up to 40%. Holick also proposes that the epidemic of fibromyalgia in some cases may actually be vitamin D deficiency.

•   Depression: the active form of vitamin D stimulates production of serotonin, essential to good mood.  (Is that why I enjoy the beach so much?)

•   Insomnia: yes, sufficient vitamin D helps you sleep better also.

•   Overweight: vitamin D is necessary for proper production of leptin, which regulates appetite so you don’t eat too much. 

Finally, remember that most dermatologists caution against too much sunshine without noting that some is needed. I like the sunshine but try to avoid getting burned, or even “pink”. Holick must have a sense of humor for he told of a survey for vitamin D levels among dermatologists in Australia: 82% were vitamin D deficient! That will teach them. I saw my own dermatologist the other day and asked why I didn’t see her down at the beach last summer.  She didn’t blink, said her baby was young and tries to eat the sand.  She’s a great doctor.

Let the sunshine in

The quick answer:  Aside from a healthy diet and exercise, the next best thing you can do is to get enough sunshine to maintain a healthy serum vitamin D level.  It’s good for your mood and can help prevent a long list of diseases.

_____________________________________________________________________________________________

About Vitamin D

It’s essential to eat vitamin-rich food because the body can’t produce them, with one exception:  With a little sunshine, the body can make it’s own vitamin D.  Unfortunately, the weathermen and dermatologists have scared us out of getting enough sunshine.  Ever had your vitamin D level tested?

Sufficient D is essential to good health; vitamin D receptors are found in cells all through your body.  The growing list of conditions where vitamin D deficiency is a risk factor includes seasonal affective disorder (SAD), osteoporosis, muscle and joint pain including back pain, certain cancers (breast, ovarian, colorectal, and prostate), obesity and diabetes, stroke or heart attack, G.I. diseases like inflammatory bowel disease (IBD) or Crohn’s disease, and immunological diseases such as MS and Parkinson’s disease.  It’s a long list. 

Vitamin D deficiency increases as you move away from the equator.  In the Sunbelt you can get adequate D year around, though it takes longer in winter.  But if you live above the 40^th latitude parallel, roughly a line through Portland, OR, Salt Lake City, and New York City, you can ski all winter in your bathing suit and not get enough D.

There’s an annual cycle to your vitamin D level.  For most, our D level peaks in the last sunny days of summer, then hits rock bottom as winter turns to spring.  This is the point when you feel the blues, lack energy, or suffer muscle aches.  Because spring just started, your D is likely at its annual low-point (unless you’ve just back sunbathing on a beach in Costa Rica). 

IOM Report

Americans love to take pills.  Maybe it’s because we’re in a rush and taking a pill is a quick fix, but we eat a lot of pills, including vitamin pills.  We get into vitamin fads—remember the vitamin C and E eras?   Usually these end badly; the hoped-for benefit proves elusive, or side effects present.  Because of the growing interest in vitamin D, the Institute of Medicine, perhaps the world’s most prestigious scientific body, was asked to study the vitamin D issue lest we run off on another pill fad.

The IOM report, issued in late 2010, disappointed many because of its cautiousness.  Basically, if you set the minimum level for serum vitamin D at 20 nanograms/mL, most people are OK.  But if you set the level at 30, as some labs do, then up to 80% are deficient.  Some doctors argue that 40-50 is a good range but the IOM couldn’t find sufficient evidence to support a target higher than 20-30.  (The IOM report also looked at calcium supplements and found little support, with the exception of girls in their teens.)

The N. Y. Times ran an article on the IOM report, repeating the message that vitamin D and calcium pills may not be indicated for most.  The article unleashed a torrent of reader comments, many from thoughtful people in the Northeast, the region with the least sunshine for vitamin D.  Readers expressed real anger that there wasn’t better guidance on the optimum vitamin D level, or on the best methods to maintain vitamin D in the winter.  This is a common problem in nutrition—after the billions spent on research, we have these basic questions without a clear answer.

The Vitamin D Solution

The best book I’ve seen on vitamin D is The Vitamin D Solution, written by Dr. Michael Holick, PhD, MD.  Holick suggests a 3-step solution of 1) testing, to know where you are, 2) sensible sunshine, and 3) safe supplementation when sunshine isn’t available. 

The book makes two remarkable statements about vitamin D and cancer:

First, on the benefit of getting sensible sunshine: “vitamin D could be the single most effective medicine in preventing cancer, perhaps even outpacing the benefits of . . . a healthy diet”.  We hear all the time that we should avoid avoid sunshine to prevent skin cancer, which brings us to the second point.

Second, the book quotes Dr. Edward Giovannucci on the benefits of sunshine for vitamin D versus the risk of skin cancer:  sufficient “vitamin D might help prevent 30 deaths for each one caused by skin cancer”.    I like those odds: 30 better outcomes at the risk of one bad outcome.

I recently saw my dermatologist.  She’s a charming woman who cares about her patients.  We talked about the trade-off between getting enough vitamin D the natural way—by sunshine—versus the risk of skin cancer.  The good doctor pointed out that in southern California, you could get sufficient vitamin D with 15 minutes of sunshine on most days.  Of course you have to show a little skin, so I do my workouts outdoors around noontime, wearing shorts and shirts without sleeves (except when it’s cold).  When no one’s around I take off my shirt, but I try to avoid the “pinkness” that’s the first stage of a sunburn. 

I’ve got a physical check-up scheduled that includes a test for vitamin D.  I’ll let you know how it comes out.  I’ll be happy if I have a serum level of 30 ng/mL, the upper range recommended by the IOM.  A number of people have told me their vitamin D levels—I’m forward about asking—and I’ve yet to meet anyone with a value of at least 30.  Per the IOM, this is a big problem, which brings us to this week's Healthy Change:

Please note the term "a little" sunshine, sun that burns or turns the skin pink may be harmful and should be avoided.  (If you live in the northern latitudes, don’t tolerate the sun, or are concerned about your vitamin D, consult your doctor.)

Please comment:  Want to share your experience with vitamin D, or how you tested?  Do you live in the northern latitudes?  If so, what do you do in winter to maintain vitamin D. 

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.