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





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.

Born and raised in Haiti, Gerda Paulissaint, 46, came to Boston about 12 years ago and a funny thing happened. She started having all sorts of aches and pains. Walking up a flight of stairs was particularly painful. “It was as if my legs were talking back to me,” she remembers.

She knew she had high blood pressure, but that didn’t explain that sort of pain or her restless sleep. She dismissed all of her symptoms as simply the result of stress. Without much further thought, she quietly went on with her work as a community health advocate at Mattapan Community Health Center.

Gerda Paulissaint, a medical advocate at Mattapan Community Health Center, attributed her aches and pains to low levels of vitamin D.

And then a light switch turned on.

Many of her patients were complaining of similar aches and pains and most of them had received blood test results showing they lacked a sufficient amount of vitamin D.

“Wait a minute,” she recalls thinking.

It finally donned on her that she too might be short on vitamin D. She didn’t wait for a test to confirm her theory. She purchased a supply of over-the-counter vitamin D supplements.

Evidently it helped. Paulissaint later requested a test to determine whether she was deficient. The test revealed a level of 38 nanograms per milliliter (ng/mL) — a number within the acceptable range, but just barely.

The lack of vitamin D is not all that uncommon. The recent National Health and Nutrition Examination Survey (NHANES), a program sponsored by the Centers for Disease Control and Prevention, found that a large portion of adults in the United States had low levels of vitamin D.

Adolescents are not immune. A 2004 study by Children’s Hospital Boston determined that the problem was common in otherwise healthy adolescents. Almost one-fourth of the patients studied were low in the vitamin and 5 percent were severely deficient.

The researchers further determined that race, diet, lifestyle and season all played a role. Vitamin D deficiency was more prevalent in black teenagers, those who consumed more soft drinks than milk and those with a high body mass index, an indicator of excessive weight.

So severe is the problem that rickets — once considered a thing of the past — has re-emerged in infants and children, particularly among blacks and those who are lactose intolerant.

Dr. Michael F. Holick, a leading authority on vitamin D and professor of medicine, physiology and biophysics at Boston University School of Medicine, is unequivocal about the importance of vitamin D and its proper levels required for optimal health.

He refers to several studies that have linked low vitamin D levels with the risk of heart disease, stroke, multiple sclerosis, type 1 diabetes, depression, asthma, many cancers and diseases of the immune system.

In the most recent issue of the Annals of Family Medicine, a study indicated that disproportionately low vitamin D levels might explain higher death rates from cardiovascular disease in blacks. The researchers concluded that vitamin D levels might be an independent — and possibly modifiable — risk factor for cardiovascular disease.

The importance of vitamin D is a subject of on-going debate. Researchers from Massachusetts General Hospital found that it may be vitamin D — not C — that keeps colds, the flu and other respiratory illnesses at bay. They noted that people with asthma and emphysema, for example, might be particularly susceptible to respiratory infections from vitamin D deficiency — an indication to some medical experts that it might also play a key role in the immune system.

Vitamin D is a bit of an enigma. For starters, it really isn’t a vitamin at all. Vitamins are organic compounds that the body needs but cannot make on its own. Rather, the body receives its vitamins from the food and liquids that we eat and drink.

Unlike other vitamins, vitamin D is made by the body, is found in very few foods, and, oddly enough, is actually a hormone.

Appropriately named the “Sunshine Vitamin,” vitamin D’s major source is the sun — ultraviolet B (UVB) rays to be exact — the same rays responsible for suntans and sunburns.

And skin cancer.

The American Academy of Dermatology warns against unprotected exposure to ultraviolet rays. The Academy declared “There is no scientifically validated, safe threshold level of UV (including UVB) exposure from the sun that allows for maximal vitamin D synthesis without increasing skin cancer risk.”

Deborah A. Scott, M.D.
Brigham and Women’s Hospital

Dr. Deborah Scott, a dermatologist at Brigham and Women’s Hospital, says the sun is an excellent source of vitamin D. But everyone — including African Americans — must guard against excessive exposure. “There’s a balance between sun exposure and vitamin D,” she said.

But where that balance lies is a bit tricky. The times of exposure — and resultant vitamin D levels — vary by person, season, city and time of day.

Processing those sunrays is a group effort among the skin, liver and kidney. But in order for the process to work, the UVB rays have to be long and strong enough to pull off the job. And they are — from the spring through early fall. But in the late fall and winter, they are too short and that explains increased deficiencies during cold months.

A major biological function of vitamin D is to help the body absorb calcium and phosphorus. Calcium is stored in bones, but is a major workhorse throughout the body. It makes the heart work and muscles contract. If vitamin D does not do its job, the body “robs Peter to pay Paul” by taking calcium from the bones and using it elsewhere. The impact on bones can be devastating.

That’s why low levels of vitamin D are associated with osteoporosis, rickets in children and osteomalacia, or soft bones in adults. Fractures and falls are common in those lacking vitamin D.

The issue of vitamin D is of particular interest to blacks. Melanin – the substance that gives skin its color – provides a barrier to UVB in the skin. That does not mean skin of darker hues cannot make vitamin D – it just takes more time. While it may take whites and people with light skin about 10 minutes to process sufficient levels of vitamin D, it may require blacks closer to an hour.

All of this was new to Paulissaint. Having enough sunshine was not a problem when she lived in Haiti. But living in Boston presented an entirely different challenge, especially considering that symptoms for Vitamin D deficiency are subtle and often unrecognized.

Aches and pains, fatigue, sleepless nights—all can be signs of the deficiency and are often dismissed as the result of aging or a stressful lifestyle. More often than not, doctors are not looking for it and seldom order up the right tests.

A true believer in the power of vitamin D, Paulissaint readily admits to back sliding once.

During a summer vacation in Haiti, she stopped taking the supplements. There was little need on a Caribbean island.

But when she returned to Boston and did not resume taking the supplements, she paid the price. A follow-up test revealed that her vitamin D level had dropped to 25.8 ng/mL — considered below the standard for healthy living. She is on a two - month prescription of 50,000 IU a week to get her numbers back up.

Paulissaint is now a vitamin D convert; there’s no turning back. “I feel way, way better,” she said.

“I’m a new woman now.”