This Issue

Vitamin D A dose of sunshine goes a long way

The man to see on vitamin D

Calcium and vitamin D: The dynamic duo

Where’s the calcium?

So many choices

Who’s at risk?

• African Americans – melanin reduces the skin’s ability to make vitamin D

• Those with limited exposure to sunlight

• Breastfed infants – mother’s milk does not contain enough vitamin D

• Elderly – less able to convert vitamin D to its active form

• Vegetarians that follow a strict plant-based diet

• People with certain intestinal problems, such as celiac disease

• Obese people – excess fat impedes the circulation of vitamin D

Q & A

A closer look

Who’s at risk?

Want to know the score?


The 25-hydroxy vitamin D test measures the level of vitamin D in the body.

Vitamin D Status

Deficient

Insufficient

Sufficient

Value

Less than 20 nanograms/milliliter (ng/mL)

20 to 29 ng/mL

30 ng/mL or more


The Vitamin D Council recommends a minimum reading of 50 ng/mL


For more information, click here


Links to low levels

Weak bones cause the spine to collapse
National Institute of Arthritis & Musculoskeletal & Skin Diseases

Several studies suggest that normal levels of vitamin D are required to reduce the risk for many chronic illnesses, such as:

• Rickets

• Osteomalacia (adult rickets)

• Osteoporosis

• Fractures and falls

• Osteoarthritis

• Bone and muscle pain

• Muscle weakness

• Heart disease

• Heart failure

• Stroke

• Hypertension

• Depression

• Schizophrenia

• Multiple sclerosis

• Asthma

• Flu

• Obesity

• Inflammatory diseases

• Breast cancer

• Colon cancer

• Prostate cancer

• Autoimmune diseases

• Diabetes 1 and 2

• Fibromyalgia

• Chronic fatigue syndrome

• Metabolic syndrome


Links to low levels



So many choices


Calcium can also be obtained through supplements, but the trick is to determine which one. There are many choices — carbonate, citrate, lactate, gluconate. Here are some helpful tips.

• Calcium carbonate contains the most calcium per pill (40 percent), but should be taken after meals.

• Calcium citrate contains less calcium per pill (20 percent), but does not need to be taken with food.

• Determine the amount of “elemental calcium” — the amount available for the body to absorb and what’s counted in the recommended daily dose of calcium. If not specified, check the Nutrition Facts label. The amount of elemental calcium will be listed in milligrams (mg) according to “serving size” — generally one or two tablets.

• Gluconate and lactate contain low content of elemental calcium, and would require several tablets to meet the calcium requirement.

• Avoid dolomite, oyster shell and bone meal calcium. They might contain metals and lead.

• Look for USP (United States Pharmacopeia) symbol on the package, which designates standards for quality and purity.

• If the symbol is not listed, you can test the quality of pill by dissolving it in clear vinegar. Stir occasionally. If the pill dissolves within 30 minutes, it will also dissolve in your stomach.

For more information, click here

Looking for vitamin D?

How to get
your D

Want to know the score?

Where’s the calcium?



Calcium is found in dairy products including yogurt, cheeses and milk; to reduce fat intake try skim milk or low fat products.
Dark, leafy green vegetables such as spinach, kale, collard greens, and broccoli are all good sources of calcium. These foods are great in salads, stir-fries or even on their own.


Seafood like sardines, pink salmon, ocean perch, blue crab, clams and rainbow trout can be a tasty way to up your intake.

Select foods, including cereal and orange juice, are often fortified with calcium and can be good sources.

 

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A closer look



Vitamin D deficiency and insufficiency are common in young people. So much so that rickets, or bone weakness, has made a comeback. Rickets is seen more frequently in black children often due to less time playing outdoors and low consumption of dairy products particularly in those who are lactose intolerant. Teens who favor soft drinks and iced teas over fortified milk and cereal are also hard hit. The American Academy of Pediatrics recently revised its guidelines and now recommends a minimum daily intake of 400 IU of vitamin D beginning soon after birth and continuing through adolescence.

The man to see on vitamin D

Because of weakness in his legs, Douglas Fairhurst was unable to ride his bike. After several months of a prescription of vitamin D, he’s back in form.

Of all Douglas Fairhurst’s medical problems, the most bewildering were his weakening muscles. An avid bicyclist, Fairhurst, 74, could barely lift his leg much less pedal a bike. “I could hardly walk,” he said.

That’s when Fairhurst turned to Dr. Douglass Bibuld, the medical director of Mattapan Community Health Center.

An expert on vitamin D, Dr. Bibuld was well aware of the benefits that accrue from the aptly named “Sunshine Vitamin.” Received primarily from the sun’s ultraviolet rays, vitamin D is known for its ability to maintain healthy bones.

But given the fact that almost every cell is equipped to interact with vitamin D, Dr. Bibuld is convinced that the benefits extend far beyond bone health and includes protecting the immune system and preserving muscle strength.

Equally important, Dr. Bibuld was aware of the prevalence of inadequate levels of vitamin D among older blacks — a deficiency that scientists attribute to increased risks for several life-threatening diseases and debilitating conditions.

It didn’t take long before Dr. Bibuld prescribed a heavy dose of vitamin D for Fairhurst — and that appeared to at least restore a barely adequate level.

The 25-hydroxy vitamin D test is the most accurate way to measure how much vitamin D is in the body. A reading below 20 nanograms per milliliter (ng/mL) is deficient; scores between 20 and 29 are considered insufficient. Scores of 30 or more are considered sufficient. Fairhurst’s reading was 32 — and that was after the heavy doses.

And therein lies one of the problems now under serious debate within the medical community: Just what level of vitamin D in the blood is required for optimal health?

The Vitamin D Council, a California-based non-profit established to increase awareness about vitamin D deficiencies and its related diseases, recommends a reading of 50 to 80 ng/ml for everyone all year round.

According to the Council, at levels below 50, the body uses vitamin D as quickly as it is made. Above 50, the body begins to store it for future use.

A related debate swirls around the recommended daily allowance for vitamin D. The Academy of Pediatric Medicine recently increased its recommendations from 200 International Units (IU) to 400 IU a day for children and adolescents.

The Institute of Medicine (IOM), a non-profit organization that provides advice on health issues, recommends 400 IU a day for adults up to the age of 60 and 600 IU for those over 60. But even the Institute has doubts and is revising its recommendations.

Douglass Bibuld, MD
Medical Director
Mattapan Community
Health Center

Vitamin D specialists, such as Dr. Bibuld and Boston University School of Medicine’s Dr. Michael Holick, argue that 600 IU are barely enough and contend that at least 1,000 IU are needed to allow vitamin D to perform all of its functions.

Don’t get Dr. Bibuld started on the current recommended daily allowance of 400 IU. “That’s way too low,” he said.

He recommends 4,000 IU a day for blacks — and much more for those who are deficient.

The Mattapan Community Health Center is squarely behind Dr. Bibuld on vitamin D. The Center is now part of a collaboration with the American Public Health Association to develop a national policy on vitamin D.

From what the Center has seen, the numbers are alarming in the black community. With the assistance of Dr. Holick, they found that in 2007, 85 percent of their patients tested for vitamin D levels had scores of below 20 ng/mL — well below the recommended minimum of 30, and, worse, the average score was about 13 in the winter months.

Dr. Bibuld understands part of the problem — at least among blacks — is that higher levels of melanin makes it more difficult to process ultraviolet B rays. Melanin tends to block rather than absorb the sun. That process is worse for the elderly whose bodies are unable to produce vitamin D as easily as in their younger days.

Dr. Bibuld believes that everyone should have a baseline test and go from there. For the most part, it’s easy to get a good dose of vitamin D and it doesn’t cost a dime — at least in the summer. Just five to 10 minutes of sun twice a week — or thirty minutes for those of darker skin is enough. It’s possible to make over 10,000 IU in that short period of time. Supplements and fatty fish can complement the sun when necessary.

And don’t worry. According to Dr. Holick, it’s impossible to overdose on vitamin D from the sun. The body stops making the vitamin when it has ample supply. Even overdoses from supplements are basically unheard of.

Dr. Bibuld well recognizes the implications of vitamin D and its potential impact on health. “You can’t correct health disparities overnight,” he acknowledged. “But think of what this could do to health care costs and the impact on the cost of the insurance industry. It’s huge.”

Just ask Fairhurst.

At a subsequent doctor’s appointment, Fairhurst put on a performance.

“Look,” he proudly proclaimed as he held up his leg.

At first Dr. Bibuld missed the point. He thought that Fairhurst wanted his leg examined. But then he realized that Fairhurst’s strength had returned. More important, Fairhurst boasted, he was able to walk without difficulty.

Fairhurst admits he had never heard of vitamin D before meeting Dr. Bibuld and had no understanding of its impact on the body. But he does now. For him, the evidence is clear.

“I can ride my bike again,” he said.