Vitamin D Council Recommendations

Vitamin D Council Recommendations

Why does the Vitamin D Council recommend 5,000 IU/day?

Posted on December 10, 2013 by John Cannell, MD

Where did the Vitamin D Council get its recommendation that adults take 5,000 IU/day of vitamin D3 for the rest of their life? The Institute of Medicine's Food and Nutrition Board say 600 IU/day is enough for adults and the Endocrine Society says 2,000 IU/day is enough for most adults.

We think the safest thing to do while all the research is going on is to maintain natural vitamin D levels. By natural, we mean those levels obtained by those with natural sun exposure, such as lifeguards, some roofers and gardeners, and others who work in the sun and expose a lot of skin to sunshine. This is how our ancestors behaved throughout our evolutionary history.

The best study that examined the vitamin D levels of people who get plenty of sun exposure was published last year. Researchers discovered that free-living hunter gatherers living around the African equator (where humans evolved) have average vitamin D levels of 46 ng/ml (115 nmol/L).

• Luxwolda MF, Kuipers RS, Kema IP, Dijck-Brouwer DA, Muskiet FA. Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/l. Br J Nutr. 2012 Nov 14;108(9):1557-61.

Most people will not have their blood tested unless their doctor recommends it. So we needed a recommended dose that:

• Is easy to obtain at most pharmacies.
• Will get at least 97% of people above 30 ng/ml.
• Will get most people above 40 ng/ml, and close to around 50 ng/ml.
• Will not cause anyone to get toxic levels.

When we decided on a recommendation with the four goals above in mind, we also had to take into account body weight. Besides genetics, body weight is the single biggest determinate of vitamin D levels. The more you weigh, the more vitamin D you need to take.

Professor Robert Heaney of Creighton University details in the study below just how high vitamin D supplementation/input needs to be to reach the vitamin D level goals above.

• Drincic AT, Armas LA, Van Diest EE, Heaney RP. Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity (Silver Spring). 2012 Jul;20(7):1444-8. doi: 10.1038/oby.2011.404.

Together with his coauthors, Professor Heaney stated that for a normal weight adult, 5,000 IU/day of total input was needed to obtain a vitamin D level of 40 ng/ml. Of course the final vitamin D level obtained by any dose depends on baseline level, sun exposure and genetics. But he was speaking of the average adult.

For those who want a more careful calculation, he stated his data showed that 70-80 IU/day/kg of body weight total input is needed to obtain a 25(OH)D of 40 ng/ml. That works out to about 35 IU/day/pound. So a 100 pound woman would need 3,500 IU/day of total input but a 300 pound lineman would need 10,500 IU/day. Keep in mind this is total input, which includes sunlight, diet and supplements.

Taking all these factors into account, we conclude a recommendation of 5,000 IU/day is about right for the average adult.

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• Low cost cofactors for vitamin D Cofactors are vital when taking > 3,000 IU of vitamin D
• Vitamin D3 for Vegans
• Low Cost vitamin D - including liquid and bulk
• Patients older than 65 needed 5,000 IU vitamin D – May 2010
• USANA recommended 5,000 IU to achieve 50 ng/ml with graph
• Vitamin D Recommendations around the world - IU and ng which has the following chart

Response to Vitamin D: summary chart of 8 studies – March 2013 shows 5,000 IU dose would get avg of 60 ng

Is 50 ng of vitamin D too high, just right, or not enough has

Chart from GrassRootsHealth shows that response to 5,000 does not vary much with the form

• Amazon US 400+ listings for 5,000 IU of vitamin D as of Dec 2013: Capsule, liquid, gummy bear, Kosher, Halal, etc.
• D3Plus: The only Vitamin D on the market endorsed by the Vitamin D Council
  5,000 IU vitamin D + 8000 ug Vitamin K + 225 mg Magnesium + 12 mg Zing + 3 mg Boron (3 capsules/day due to the Magnesium)
  comment by VitaminDWiki - excellent combination of D with cofactors

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Vitamin D Council Recommendations

Source: https://vitamindwiki.com/5%2C000+IU+recommended+by+Vitamin+D+Council+-+Dec+2013

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Signs Of Low Calcium And Vitamin D

Signs Of Low Calcium And Vitamin D

• Definition
  • What Is Vitamin D Deficiency?
• Symptoms
  • What Are Symptoms of Vitamin D Deficiency?
• Causes
  • What Causes Vitamin D Deficiency?
• Diagnosis
  • How Is Vitamin D Deficiency Diagnosed?
• Treatment
  • What Is the Treatment for Vitamin D Deficiency?
• Complications
  • What Are Complications of Vitamin D Deficiency?
• Prevention
  • How Do You Prevent Vitamin D Deficiency?
• Guide
  • What Happens When Your Vitamin D Is Low? Topic Guide

What Is Vitamin D Deficiency?

Vitamin D deficiency can cause weakness, bone pain, fatigue and even cancer in some cases. Luckily, vitamin D supplements are cheap and common and can cure the condition in many cases.

Vitamin D is a fat-soluble vitamin that helps the body absorb dietary calcium and phosphorus from the intestines and suppresses the release of parathyroid hormone, a hormone that causes bone resorption. This serves to keep the bones healthy. Vitamin D is also believed to improve muscle and immune function.

Vitamin D is made in the skin when it is exposed to sunlight. Vitamin D is also naturally occurring in certain foods such as fatty fish, cod liver oil, and eggs. It is also found on fortified foods such as cow's milk.

Low levels of vitamin D are referred to as vitamin D deficiency.

What Are Symptoms of Vitamin D Deficiency?

Symptoms of vitamin D deficiency include:

• Bone pain
• Muscle weakness
• Muscle aches or cramps
• Fatigue
• Cognitive impairment in older adults
• Severe asthma in children
• Cancer

What Causes Vitamin D Deficiency?

Vitamin D deficiency may be caused by:

• Low levels of vitamin D in the diet along with inadequate sun exposure
  • Human breast milk contains low levels of vitamin D, and most infant formulas do not contain adequate vitamin D
  • Older adults often do not eat enough vitamin D-rich foods, and when they do, absorption may be limited
  • Exposure to the sun is not recommended as a source of vitamin D for infants and children because of the potential risks of skin cancer
• Certain conditions that result in an inability to absorb vitamin D from the intestines
  • Celiac disease
  • Crohn's disease
  • Cystic fibrosis
• Surgery that removes or bypasses portions of the stomach or intestines such as gastric bypass
• An inability to process vitamin D due to kidney or liver disease
• Certain medications
  • Laxatives
  • Steroids
  • Weight loss medications
  • Cholesterol-lowering drugs
  • Anti-seizure medications
  • Tuberculosis medication

SLIDESHOW

Vitamin D Deficiency: How Much Vitamin D Is Enough? See Slideshow

How Is Vitamin D Deficiency Diagnosed?

Vitamin D deficiency is diagnosed with a blood test called 25-hydroxyvitamin D or 25(OH)D (OH = hydroxy, D = vitamin D).

What Is the Treatment for Vitamin D Deficiency?

Treatment for vitamin D deficiency includes:

• Vitamin D supplements
  • Ergocalciferol (vitamin D2)
  • Cholecalciferol (vitamin D3) - vitamin D3 is usually recommended because it is the naturally occurring form of the vitamin and it may raise vitamin D levels more effectively
• The recommended dose of vitamin D depends upon the nature and severity of the vitamin D deficiency
• Additional supplements
  • Calcium - 1000 mg of calcium per day for premenopausal women and men and 1200 mg per day for postmenopausal women

Foods that are good sources of vitamin D include:

• Seafood
• Trout
• Salmon
• Sardines
• Tuna
• Meat and poultry
• Beef liver
• Chicken breast
• Ground beef
• Vegetables
• Mushrooms – white and portabella
• Dairy products
• Milk, vitamin D fortified
• Cheddar cheese
• Other
• Cod liver oil
• Plant-based milks (e.g. soy, almond, oat), vitamin D fortified
• Eggs
• Ready-to-eat cereals, vitamin D fortified

Exposure to sunlight is also another source for vitamin D but too much sun exposure can lead to sunburns, premature skin aging, eye damage, heat exhaustion or heat stroke, or skin cancer. Talk to your doctor about how much sun exposure you may need and how to get exposure safely.

What Are Complications of Vitamin D Deficiency?

Complications of vitamin D deficiency include:

• Low blood calcium (hypocalcemia)
• Low blood phosphate (hypophosphatemia)
• Rickets (softening of the bones during childhood)
• Osteomalacia (softening of the bones in adults)
• Decreased bone density (osteopenia or osteoporosis)
• Elevated parathyroid hormone (which accelerates bone resorption)
• Increased risk of falls that may result in fractures

How Do You Prevent Vitamin D Deficiency?

Prevention of vitamin D deficiency depends upon a person's skin color, sun exposure (which can be affected by the season and where a person lives), diet, and underlying medical conditions.

• Adults may be advised to take a supplement of 800 IU (20 micrograms) of vitamin D daily. Older people confined indoors may need higher doses.
• Infants and children may be advised to take a vitamin D supplement containing 400 IU (10 micrograms) of vitamin D, which included in most nonprescription infant multivitamin drops.
• Exposure to sunlight is also another source for vitamin D. Talk to your doctor about how much sun exposure you may need and how to get exposure safely.

Reviewed on 8/31/2020

References

Medscape Medical Reference

Signs Of Low Calcium And Vitamin D

Source: https://www.emedicinehealth.com/what_happens_when_your_vitamin_d_is_low/article_em.htm

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Inj Vitamin D Dose

Inj Vitamin D Dose

Photo Courtesy: Justin Paget/DigitalVision/Getty Images

Vitamin D is important for maintaining a healthy body, primarily because it helps you fully maximize your body's absorption and utilization of calcium, an important mineral that we all need. When paired with calcium, vitamin D helps regulate bone remodeling and growth, ensuring healthy, strong bones. Vitamin D can also help protect older adults from osteoporosis, which occurs due to excess bone loss from aging.

Furthermore, this nutrient boosts your immune system and reduces inflammation within your body, potentially warding off future medical conditions in the process. It also plays a vital role in cell growth, neuromuscular functions and protein encoding. Studies have shown that a regular, healthy vitamin D intake can also serve as an antidepressant and make people feel generally happier. But that's not all you'll want to know about vitamin D.

Vitamin D is naturally found in certain foods and now appears in many more foods that have been fortified with added nutrients. The best sources of naturally occurring vitamin D are oily fish such as salmon, tuna, cod, sardines and mackerel. Fish liver oils are another good source of vitamin D. Small amounts of the nutrient are present in beef liver, cheese, egg yolks and mushrooms.

Photo Courtesy: Alexander Spatari/Moment/Getty Images

Commonly, vitamin D-fortified foods include whole milk, orange juice, margarine and breakfast cereals. It's important to look at the label and nutrition facts to verify that vitamin D is in a particular food you're considering. Because dairy products are often fortified with vitamin D, lactose intolerant or vegan individuals should keep an eye on their diets to ensure they get enough of the vitamin.

Sun exposure is another method of naturally obtaining vitamin D, as our bodies can create their own vitamin D upon exposure to ultraviolet (UV) rays from the sun. However, it's difficult to gauge exactly how much sun exposure can generate sufficient vitamin D, as overexposure can be harmful, too. UV rays are also known to trigger free radicals, which can lead to skin cancer if left unchecked.

It's been suggested that getting approximately 15 minutes of sun exposure between 10 a.m. and 3 p.m. at least twice a week to your face, arms, legs or back will help your body synthesize enough vitamin D. It's important to note that you can't cover the exposed area of your body with sunscreen if you choose to get vitamin D naturally. The SPF blocks UV rays and can hinder your body's ability to create vitamin D. If you're in the shade or behind a window, the rays will not get through. If the climate where you live is primarily cloudy, it's important to get your recommended amount of vitamin D via other means.

Dietary supplements are also an excellent way of obtaining vitamin D. Supplements come in two forms: vitamin D3 (cholecalciferol), which is identical to the form your body makes when exposed to sunlight, and vitamin D2 (ergocalciferol), which differs slightly from D3 in its chemical side-chain structure. There's some evidence that vitamin D3 increases and maintains overall levels slightly better than vitamin D2.

Side Effects of a Vitamin D Deficiency

Vitamin D deficiency occurs when you don't adequately absorb the nutrient or when your kidneys can't convert the nutrient to its active form. This deficiency can result in medical conditions, two of which are called rickets and osteomalacia.

Photo Courtesy: RealPeopleGroup/E+/Getty Images

Rickets, a disease characterized by a failure of bone tissues to get enough minerals, can result in abnormal, soft bones and skeletal deformities. It's most common in children. Fortunately, it isn't permanent, and kids can consume as few as 1 to 3 teaspoons of cod liver oil a day to reverse the condition.

With the help of fortified foods today, rickets is almost obsolete in the United States. Osteomalacia, characterized by soft and weak bones, is usually present in adults. It's commonly treated with an intense regimen of vitamin D replacement under the care of a physician.

Vitamin D and Other Health Conditions

Vitamin D deficiency has been linked to cardiovascular disease, and people with lower levels of vitamin D appear to be at an increased risk of having a heart attack or stroke. However, the exact relationship isn't clear, and there appears to be no benefit to cardiovascular risk in taking a vitamin D supplement.

Photo Courtesy: PixelsEffect/E+/Getty Images

Research is also ongoing to find if there's a link between vitamin D and multiple sclerosis (MS). It appears that vitamin D deficiency is linked to the development of MS, and people with MS and higher levels of vitamin D appear to have reduced disease activity.

Low vitamin D has been linked to an increased risk of contracting respiratory illnesses such as influenza A. It appears that people with low vitamin D levels are at greater risk of severe novel coronavirus (COVID-19) infection. It's not clear yet if routine vitamin D supplementation would reduce this risk.

Because vitamin D is a fat-soluble substance, it can stay in your body for several days. Thus, vitamin D poisoning is possible if you supplement too much vitamin D over a period of a few months. Symptoms of vitamin D overdose include dehydration, vomiting, decreased appetite, irritability, constipation and fatigue. If left unaddressed, vitamin D poisoning can lead to anorexia, over-calcification of the bones and internal organs, kidney stones and hypertension (high blood pressure). It's important to note that vitamin D poisoning usually only occurs with excessive intake of dietary supplements. It's highly unlikely to occur as a result of normal dietary intake and sun exposure.

Daily Dosage Recommendations

The recommended dietary allowances for vitamin D vary depending on your age and other health and life circumstances, such as pregnancy. For infants under 12 months, the recommended intake is 400 international units (IU) or 10 micrograms (mcg). For individuals under 70 years old, the recommended intake is 600IU (15mcg). For individuals over 70 years old, the intake increases to 800IU (20mcg).

Photo Courtesy: katleho Seisa/E+/Getty Images

If you have a pre-existing medical condition or other medical concerns, it's best to talk to a healthcare professional about determining your recommended dietary allowance for vitamin D. This way, you can be sure the vitamin doesn't interact negatively with your condition or medication.

Resource Links:

https://medlineplus.gov/vitamind.html

https://ods.od.nih.gov/factsheets/VitaminD-Consumer/

https://www.hsph.harvard.edu/nutritionsource/vitamin-d/

https://medlineplus.gov/druginfo/meds/a620058.html

https://bestpractice.bmj.com/patient-leaflets/en-gb/pdf/3000049/Vitamin%20D%20deficiency.pdf

https://bestpractice.bmj.com/topics/en-gb/641

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf

https://www.covid19treatmentguidelines.nih.gov/adjunctive-therapy/vitamin-d/

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Inj Vitamin D Dose

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Does Vitamin D Help Blood Circulation

Does Vitamin D Help Blood Circulation

Photo Courtesy: Michael Godek/Getty Images

Are you getting enough sun? In many parts of the world, that might prove difficult during the winter months — and it can impact more than your sunny disposition.When exposed to sunshine, our bodies produce vitamin D, something our bodies need to maintain healthy bones and teeth; support our immune and cardiovascular systems; and stave off certain diseases, like type 1 diabetes. Some reports suggest that roughly three-quarters of American teens and adults might not be getting enough vitamin D. So, how can you turn that number around?

The National Institutes of Health (NIH) makes recommendations for what one's daily intake of vitamin D should be based on age, gender and other factors. The recommendations, in micrograms (mcg), can be summarized as follows:

Photo Courtesy: Sean Gladwell/Getty Images

• Infants (up to 12 months): 10 mcg daily
• Children (1 to 13 years): 15 mcg daily
• Teens (14 to 18 years): 15 mcg daily
• Adults (19 to 50 years): 15 mcg daily
• Older adults (51 to 70 years): 15 mcg daily
• Seniors (70+ years): 20 mcg daily

So, how can you supplement your vitamin D intake if all that basking in the sun isn't cutting it? Thanks to the Dietary Guidelines for Americans, we've rounded up 10 healthy foods that can help you reach those daily vitamin D goals.

Salmon

Salmon comes in quite a few different varieties — canned sockeye salmon, smoked chinook salmon, canned pink salmon, cooked sockeye salmon, cooked pink salmon and even cooked wild coho salmon — and all of them are chock-full of vitamin D. All of these options will help you hit your goals. After all, a three-ounce serving of canned sockeye salmon contains 17.9 mcg of vitamin D, while a three-ounce portion of cooked sockeye salmon contains 11.1 mcg of vitamin D.

Photo Courtesy: Justin Ong/Getty Images

Smoked Whitefish

Want to change up that salmon intake? Whitefish can help with that. While whitefish are a species of fish, the term also refers to a cluster of types of fish, all of which have a mild, slightly sweet flavor. Some of the most popular "whitefish" include pollock, bass, cod, halibut, grouper and haddock. On average, a standard three-ounce serving of smoked whitefish contains an impressive 10.8 mcg of vitamin D.

Photo Courtesy: Bohemian Nomad Picturemakers/Getty Images

Swordfish

If you're looking for a terrific source of vitamin D, and to break up all that whitefish and salmon, try swordfish. These creatures can grow to be a whopping 1,400 pounds — and nearly 15-feet in length. While you wouldn't want to tangle with one of these in the ocean, encountering it as a nice, grilled steak is a treat. Best of all, a three-ounce portion will provide you with 14.1 mcg of vitamin D.

Photo Courtesy: Shawn Miller/Getty Images

Tilapia

Tilapia is a cluster of fish species that aren't found in nature. That is, tilapia is a farmed fish, which makes it pretty inexpensive. This mild species is the fourth most common type of seafood eaten by Americans, in part because of its versatility. We recommend a nice herb-and-parmesan crust, but, any way you slice it (or season it), a three-ounce portion will provide you with 3.1 mcg of vitamin D.

Photo Courtesy: Mike Kemp/Getty Images

Canned Tuna

Not into canned food? Well, canned fish should probably be your exception. In fact, canned tuna, in addition to being readily available and inexpensive, can make an abundance of tasty meals, from tuna salad and melts to casseroles. Best of all, a three-ounce serving of light tuna canned in oil contains about 5.7 mcg of vitamin D.

Photo Courtesy: LauriPatterson/Getty Images

Mushrooms

The five fish options we've listed above might not have surprised you, but this one might. Many varieties of mushrooms — including portabella, cremini, morels, chanterelles, maitake, and even your basic white button mushrooms — are excellent sources of vitamin D. In fact, half a cup of grilled portabella mushrooms delivers an impressive 7.9 mcg of vitamin D.

Photo Courtesy: Robert Lowdon/Getty Images

Eggs

Eggs — and, in particular, egg yolks — are one of the easiest, cheapest and quickest ways to nab some vitamin D. However, they may not be the food of choice for folks with high cholesterol. If your diet allows, whip up two scrambled eggs and enjoy getting 5% of your recommended daily intake of vitamin D first thing in the morning.

Photo Courtesy: valentinrussanov/Getty Images

Milk

Milk is more than just a great source of calcium. In fact, vitamin D is among its significant nutritional benefits. When it comes to a 16-ounce serving of cow's milk, the vitamin D content varies based on the milk's composition. For example, whole milk contains 6.3 mcg of vitamin D, while 2%, 1% and skim milk all contain 5.9 mcg. Even soy and dehydrated (powdered) milk will help you reach your goals by providing 5.8 mcg and 3.4 mcg of vitamin D respectively.

Photo Courtesy: JW LTD/Getty Images

Yogurt

Milk is not the only dairy product capable of delivering some serious vitamin D benefits. Of course, the nutritional value of yogurt changes depending upon the variety. For example, Greek-style yogurt contains more protein and less sugar than other types of yogurt. Nonetheless, you can still expect anywhere from 2 to 3 mcg of vitamin D per eight-ounce serving, regardless of the variety of yogurt.

Photo Courtesy: Westend61/Getty Images

Pork

So far, you've seen lots of fish and dairy options. You might be wondering, Where's the meat? Well, generally speaking, beef and chicken are not great sources of vitamin D. In fact, if you're a meat lover in search of some vitamin D, pork is your best bet. The nutritional value of pork varies depending upon the cut, method of preparation and more, but you're likely to find between 0.2 to 2.2 mcg of vitamin D in a standard three-ounce serving of pork.

Photo Courtesy: EasyBuy4u/Getty Images

Resource Links:

• The U.S. Department of Health and Human Services and Department of Agriculture's Dietary Guidelines for Americans
• The National Institutes of Health (NIH)

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Calcium 600 Mg Plus Vitamin D

Calcium 600 Mg Plus Vitamin D

Methodist Debakey Cardiovasc J. 2019 Jul-Sep; 15(3): 207–213.

Vitamin D and Calcium Supplements: Helpful, Harmful, or Neutral for Cardiovascular Risk?

Amir S. Heravi

JOHNS HOPKINS SCHOOL OF MEDICINE, BALTIMORE, MARYLAND

Erin D. Michos

JOHNS HOPKINS SCHOOL OF MEDICINE, BALTIMORE, MARYLAND

This article has been cited by other articles in PMC.

Abstract

Vitamin D has traditionally been known as the "bone vitamin". However, a large body of observational data has also linked low concentrations of serum 25-hydroxyvitamin D (25[OH]D), the primary storage form of vitamin D, to an increased risk of incident cardiovascular disease (CVD) and mortality, garnering public excitement about the purported nonskeletal benefits of vitamin D. Despite this, more recent meta-analyses and randomized clinical trials have failed to find a beneficial effect of vitamin D supplements on CVD and cancer outcomes. These findings, along with the lack of consensus on optimal serum 25(OH)D concentrations, have dampened some of the initial enthusiasm for vitamin D supplements. Residual confounding or reverse causation may explain some of the discrepancy between the observational and trial results. At this time, vitamin D supplements should not be prescribed for the primary purpose of CVD prevention. Adding to this complexity is the fact that many adults take vitamin D and calcium supplements together for bone health, and there is some concern (albeit inconclusive) related to calcium use and increased CVD risk. In this light, it may be best to achieve the recommended daily allowances of calcium intake through food and reserve calcium supplementation only for those at risk for calcium intake deficiency, with the smallest dosage needed after dietary modifications have been exhausted. In this review, we discuss vitamin D and calcium supplementation and how they may affect cardiovascular health.

Keywords: vitamin D, calcium, supplements, cardiovascular risk

INTRODUCTION

Vitamin D has been known as the "bone vitamin" ever since its discovery as the unknown factor in cod liver oil that cures rickets and osteomalacia. Through the past century, this label was cemented through numerous discoveries that further linked vitamin D to bone physiology, pathways of calcium homeostasis, and sunlight exposure (the other identified cure for rickets).1 However, newer discoveries suggest a broader role for vitamin D.2 Activated vitamin D receptors, which act as transcription factors, could influence the expression of hundreds of genes, including genes crucial in cell-cycle regulation, differentiation, and cancer pathology.2 Most importantly, low serum concentrations of 25-hydroxyvitamin D (25[OH]D), the primary storage form of vitamin D, have been associated with increased morbidity and mortality from an expansive list of diseases, including the two leading causes of death in the United States—cardiovascular disease (CVD) and cancer. This has sparked much public enthusiasm for the potentially protective effects of supplementation.3

However, the pendulum may be swinging the other way, as more recent meta-analyses and randomized clinical trials have failed to find a beneficial effect of vitamin D supplements on CVD and cancer outcomes.4–7 These findings, along with the lack of consensus on optimal serum concentrations,8,9 have dampened some of the initial enthusiasm of vitamin D as a potential "do-it-all" vitamin. To add to this conundrum, many adults take calcium supplements along with vitamin D, and there are some concerns (although inconclusive) regarding calcium supplements and increased CVD risk.10–12

In this review, we will discuss vitamin D and calcium supplementation and how they may affect cardiovascular health.

METABOLISM AND MEASUREMENT

Vitamin D is the collective of two physiologically inactive precursors to the active 1,25-dihydroxycalciferol (1,25(OH)₂D or calcitriol) steroid hormone: vitamin D2 (ergocalciferol), which is obtained from plants, and vitamin D3 (cholecalciferol), which is produced after the skin is exposed to UVB radiation.13 While both D2 and D3 can be obtained as dietary supplements, the classification of "vitamin" could be considered a misnomer since the body can produce its required vitamin D3 in the skin when enough sunlight is available. However, this endogenous production is often insufficient, and augmentation with dietary intake is required. Since few foods are naturally rich in vitamin D, and farmed varieties contain lower concentrations, artificially fortified foods and supplements are appealing.13

Vitamins D2 and D3 are hydroxylated in the liver to form 25(OH)D, which is the primary circulating form of vitamin D. 25(OH)D reflects both endogenous and exogenous sources and is considered the best marker for assessing vitamin D status. To generate the physiologically active form of vitamin D, 25(OH)D undergoes hydroxylation by the 1α-hydroxylase enzyme in the kidneys to produce 1,25(OH)₂D (calcitriol). However, identification of extra-renal forms of 1α-hydroxylase and the presence of vitamin D receptors in nearly all nonskeletal tissue—including cardiomyocytes, arterial wall cells, and immune cells—have led to speculations of autocrine and paracrine functions for vitamin D in many organ systems, including the cardiovascular system.2 Currently, circulating 25(OH)D concentrations continue to be the marker of choice for assessing auto/paracrine vitamin D activity, even in the study of nonskeletal effects of vitamin D.14

Assays of calcitriol concentration are not useful in assessment of vitamin D reserves since serum concentration of calcitriol is considerably lower than 25(OH)D and tightly regulated by the parathyroid hormone, such that it could be normal or even elevated in vitamin D-deficient individuals. Conversely, this assay is used in the differential diagnosis of hypercalcemia, parathyroid disorders, granulomatous diseases (which are associated with unregulated activation of vitamin D, causing toxicity),15 and when pathologic inability to activate 25(OH)D into calcitriol is suspected as the cause of phenotypic vitamin D deficiency despite adequate reserves (eg, which could occur in individuals with chronic kidney disease).16

ADEQUATE LEVELS OF VITAMIN D INTAKE

Cutaneous vitamin D production depends on many geographical factors such as latitude, season of the year, ambient pollution, and weather conditions as well as individual factors such as age, time spent outdoors, choice of clothing, skin pigmentation, and sunscreen use.13 Most scientific research sidesteps this quantification problem by studying serum 25(OH)D. As a downfall, few studies relate dietary vitamin D directly to health measures, and most organizations base their guidelines on establishing a sufficient serum 25(OH)D concentration and define adequate dietary intake as the amount of vitamin D intake that would maintain such serum levels with minimum sun exposure.8

To our knowledge, all relevant guidelines concede that evidence for nonskeletal benefits of vitamin D are lacking and instead use optimal bone health as the benchmark. Most guidelines agree that serum 25(OH)D concentration < 12 ng/mL (multiply by 2.496 for nmol/L) constitutes frank deficiency and 12 to 20 ng/mL is typically insufficient for optimal bone health. However, establishing an optimal serum 25(OH)D concentration has proven more controversial. Among the two most cited guidelines, the Institute of Medicine (IOM) guidelines chose 20 ng/mL as sufficient for 97.5% of the population and argue that higher levels do not confer additional benefits,8 while the Endocrine Society classified > 30 ng/mL as satisfactory and 20 to 30 ng/mL as insufficient.9

To link these serum concentrations to dietary vitamin D intake, the IOM used a nonlinear dose-response relationship based on results of studies from Antarctica and Northern Europe in winter. To err on the side of caution, the IOM then rounded up the calculated results and recommended a daily intake of 600 IU for individuals between ages 1 and 70 years old and 800 IU for individuals older than 71 years.8 A notable subtlety of this indirect process is that these values are not calculated so that 97.5% of the population achieves serum 25(OH)D concentrations of 20 ng/mL; rather, they are expected to result in a mean concentration of 20 ng/mL, which is meant to suffice for 97.5% of the population. Hence, it would be expected that significantly more than 2.5% of adherent adults would be classified as deficient (< 20 ng/mL) when tested. Discussions about this subtlety and its appropriateness are other points of controversy.

VITAMIN D AND CVD IN OBSERVATIONAL STUDIES

The earliest reports of an association between vitamin D and CVD were ecologic studies in which mortality from CVD was found to differ based on an individual's distance from the equator and seasonal changes, such that less sunshine exposure was associated with higher cardiovascular risk.17,18 In NHANES III, participants with the lowest quartile of 25(OH)D (serum concentrations < 17.8 ng/mL) were found to have 26% higher all-cause mortality compared to the highest quartile after adjustment for other risk factors (RR 1.26; 95% CI, 1.08–1.46).19 Subsequent prospective community-based cohort studies have linked low serum 25(OH)D concentrations to increased risks of incident coronary heart disease (CHD), stroke, heart failure, and total CVD. 20–24

In a large meta-analysis of cohort studies from Europe and the United States, concentrations of serum 25(OH)D in populations experiencing all-cause mortality, cardiovascular mortality, and cancer mortality all showed an inverse dose-response relationship (~50% increase in cardiovascular death in the lowest quintile compared to the highest quintile).25 Several other studies and meta-analyses have found both low and high serum 25(OH)D to confer increased risk.19,24,26,27

Of course, observational studies are innately limited in establishing causality and cannot predict the effects of intervention. In the case of vitamin D, there were at least two other possible explanations for these observations (Figure 1):

There are many possible pathways that could explain how low 25(OH)D and poor cardiovascular outcomes can be correlated, but only a causal relationship would mean that vitamin D supplementation can improve outcomes for cardiovascular disease (CVD). Unaccounted confounding and reverse causation can also result in associations in observational studies, but this would mean that improving vitamin D status through supplementation does not improve cardiovascular health. These correlative relationships aren't necessarily mutually exclusive, and even all can be present at the same time, making them hard to control for in observational settings and reinforcing the need for randomized controlled trials to establish causal effect.

Confounding: Many risk factors for CVD and poor health outcomes are also risk factors for vitamin D deficiency and poor vitamin D bioavailability. For example, vitamin D is fat soluble and is sequestered in the adipose tissue of obese individuals, leading to lower available levels in the serum.28 Obesity can also indirectly contribute to low serum 25(OH)D because heavyset individuals may be less likely to participate in outdoor physical activities. Similarly, smoking has been shown to correlate with vitamin D status and calcium metabolism independent of lifestyle factors such as age, sex, dietary intake, and physical exercise.29 Hence, confounding and effect modification by known and unknown risk factors could alter both vitamin D status and health outcomes, resulting in a misleading association.

Reverse causation: Instead of low vitamin D being the driving factor for poor health, unhealthiness could cause a decrease in vitamin D reserves by affecting the diet, time spent outdoors, and the ability to absorb and metabolize nutrients. This culminates in a subpopulation that has both low 25(OH)D concentrations and an increased risk of disease.

EFFECTS OF VITAMIN D SUPPLEMENTATION ON CARDIOVASCULAR DISEASE

Until recently, randomized clinical trials (RCTs) studying vitamin D had focused on bone health as the primary outcome, and their findings regarding CVD were mixed and unconvincing. In the past few years, data from two completed major trials have provided high-quality evidence, and another large RCT in Australia (D-Health) is still ongoing.4,5,30

The Vitamin D Assessment (ViDA) study was a double-blind placebo-controlled trial in New Zealand,5 where more than 5,000 community residents aged 50 to 84 years were given placebo or vitamin D3, with an initial dose of 200,000 IU followed by monthly doses of 100,000 IU for a median of 3.3 years. Median deseasonalized 25(OH)D concentration at baseline was 26.5 ng/mL, and 1,270 participants (24.9%) were deficient in vitamin D. Compared to placebo, the treatment regimen increased serum 25(OH)D by more than 20 ng/mL but had a nonsignificant hazard ratio of 1.02 (95% CI, 0.87–1.20) for cardiovascular events. Similar results were seen for participants with baseline 25(OH)D deficiency.5 The high-dose monthly supplementation regimen used in that study may also affect its generalizability since daily supplementation at doses less than 2,000 IU per day is more common in the general public, and it is unclear if pharmacokinetic differences between these dosing methods could affect outcomes.

The Vitamin D and Omega-3 Trial (VITAL) is the most definitive RCT to date to investigate the effects of vitamin D supplementation on cardiovascular events and cancer in the general population.4 VITAL was a double-blind placebo-controlled trial that recruited healthy participants throughout the United States with intentional oversampling of African Americans. A total of 25,871 participants (5,106 African Americans) including men aged ≥ 50 years and women aged ≥ 55 years were randomized to receive either a 2,000 IU daily dose of vitamin D or a placebo, and primary CVD end points of myocardial infarction (MI), stroke, and death from cardiovascular causes were tracked for a median of 5.3 years. Baseline serum 25(OH)D concentrations were measured in 15,787 participants and demonstrated a 12.7% prevalence of deficiency (25[OH]D < 20 ng/mL). More than 40% of the participants personally used vitamin D supplements, but supplementation with > 800 IU/day was an exclusion criterion. VITAL found no significant benefits in CVD outcomes, with a statistically insignificant hazard ratio of 0.97 (95% CI, 0.85–1.12) for cardiovascular events in the treatment group compared to the placebo. These findings were independent of race. Even for the subgroups found to be deficient at baseline—those with serum 25(OH)D < 20 ng/mL or below the median < 31 ng/mL—no cardioprotective effects with supplementation were noted.4 These results were in line with and complementary to results from the Women's Health Initiative Calcium and Vitamin D Trial (WHI CaD), which found no cardiovascular benefits with 400 IU daily vitamin D supplementation.31 A recent meta-analysis of vitamin D RCTs confirmed the consistency of these findings across different trials and the lack of benefit from vitamin D supplements for the prevention of cardiovascular events.32

SAFETY OF VITAMIN D SUPPLEMENTATION

Acute vitamin D toxicity is theoretically life threatening (eg, along with anticoagulants, vitamin D3 is the most commonly used active ingredient in rodenticides). However, it hardly ever occurs with supplementation and requires extremely high doses.33 Vitamin D toxicity is associated with hypercalcemia and low serum parathyroid hormone levels. Because hypercalcemia is the primary issue, patients could present with clinical signs of "stones, groans, thrones, muscle tone, and psychiatric overtones" for nephrolithiasis, abdominal symptoms such as pain, anorexia and nausea/vomiting, polyuria and polydipsia, hypotonicity and hyporeflexia, and neuropsychiatric issues.34 Hypercalcemia can also affect cardiovascular conduction (shorten QT interval), cause arrhythmias, and even mimic acute myocardial infarction on electrocardiography.35 While vitamin D toxicity is rare (anecdotal evidence suggests > 10,000 IU/day is required for acute toxicity), some argue that high-dose supplementation could still contribute to adverse outcomes, especially in at-risk individuals.

In an RCT of 400 heart failure patients, daily supplementation with 4,000 IU vitamin D3 for 3 years was associated with secondary outcome of increased need for mechanical support (15.4% vs 9.0% on placebo; P = .03) and doubled the incidence of hypercalcemia (6.2% vs 3.1% on placebo), although the latter was not statistically significant.36 In a large RCT, vitamin D supplements were associated with an increased incidence of sessile serrated adenomas or polyps in the colon (22 events in 216 participants who received treatment vs 5 events in 201 participants on placebo; adjusted P = .02), although this effect only reached statistical significance when calcium supplements were also used.37 Interestingly, these associations had not reached statistical significance during the treatment phase of the RCT and were noted with a latency of 6 to 10 years.37 It should be noted that the previously discussed VITAL trial did not find any increase in the rate of colorectal cancer during its 5-year course and reported a generally benign side-effect profile with continued daily supplementation using 2,000 IU of oral vitamin D.

On the other hand, another recent meta-analysis of RCTs that investigated the effects of various dietary and supplement interventions on cardiovascular health found an increased risk for stroke (RR 1.17; 95% CI, 1.05–1.30) among those taking vitamin D plus calcium supplements but not vitamin D alone.38 Moreover, increased susceptibility to kidney stone formation has also been reported in several studies, especially in conjunction with calcium supplements.39 While these findings have not been universally reproduced, we encourage physicians to carefully assess the detrimental effects of vitamin D deficiency on bone health and potential side effects of supplementation on a patient-by-patient basis, taking into account any history of granulomatous diseases, nephrolithiasis, and other such risk factors.

CALCIUM SUPPLEMENTATION

Per the IOM, the recommended daily intake for calcium is 1,000 mg/day for women aged 19 to 50 years and men aged 19 to 70 years and 1,200 mg/day for women aged ≥ 50 and men aged ≥ 70 years.8 It is best to achieve this amount of calcium through food sources, but approximately 40% of the US population also ingest calcium in the form of supplements.40

Due to their interlinked physiology, vitamin D and calcium supplements are often used in conjunction, especially in individuals with increased risk of bone loss, such as the elderly or postmenopausal women. However, the same population is also at increased risk of CVD, which leads to concerns about the effects of supplementation on the cardiovascular system since use of calcium supplements has been suggested to increase cardiovascular risk and mortality. This topic generated concern after a meta-analysis by Bolland et al. in 2010 found a 27% increase in the risk of MI in women taking calcium supplements.11 Those findings proved controversial and led to many other publications challenging its methods and generalizability. The debate generated more controversy when Bolland et al. re-analyzed data from the WHI CaD study and reported that the calcium-naïve subpopulation had a 22% increased rate of MI during the trial, arguing that the effect was masked by a high prevalence of baseline calcium supplement users in the original analysis.12

This concern was further bolstered by observational analyses in which calcium supplement use was found to be associated with an increased risk of incident coronary artery calcium assessed by cardiac computed tomography and incident MI.10,41 Interestingly, this trend was exclusive to supplementary calcium and was not observed with dietary calcium from natural sources.10,41

To our knowledge, no RCTs have investigated a link between calcium supplement use and cardiovascular events as the primary outcome. However, a recent meta-analysis by Jenkins et al. found a trend for increased risk of cardiovascular events with calcium supplementation, although it was not statistically significant.6 As mentioned above, another recent meta-analysis of RCTs found an increased risk of stroke when calcium supplements were used in combination with vitamin D.38 The mechanism for these observations is incompletely understood. However, it may be that a transient elevation in serum calcium concentration following ingestion of calcium supplements—which are often taken in larger doses in a single setting than when calcium is ingested from food—can affect nonskeletal calcium pathways, such as thrombotic pathways and vascular calcium deposition. As mentioned above, calcium supplements in RCTs have been linked to an increased risk of kidney stones and colon polyps, perhaps through decreased gut motility.37,39 Therefore, even though the association with CVD outcomes is inconclusive, calcium supplements may not be entirely benign for other health outcomes.

FRACTURES, FALLS, AND MUSCULOSKELETAL OUTCOMES

While this review focuses on vitamin D and calcium supplements with regard to their effects on cardiovascular outcomes, most individuals take these supplements primarily for bone health, not cardiovascular health. In this context, however, it important to note that even their role in fracture reduction has been questioned in recent studies.39,42,43 This led to the US Preventive Services Task Force giving only an "Insufficient" recommendation for the use of calcium and vitamin D supplements for fracture prevention among community dwelling adults.44 So despite their widespread use, calcium and vitamin D supplements may not be indicated broadly for fracture reduction in the general population. An RCT examining whether vitamin D supplementation can reduce falls in older adults is currently ongoing.45

CONCLUSION

In sum, despite an association between serum 25(OH)D deficiency and higher mortality and incidence of CVD, supplementation with vitamin D has not shown observable CVD benefits in RCTs. Therefore, 25(OH)D concentrations should not be routinely tested, and vitamin D supplements should not be prescribed or recommended for the purpose of preventing cardiovascular events. Instead, we would recommend a healthy diet and active lifestyle as the optimal way to improve vitamin D status and promote cardiovascular health. However, since there is no convincing evidence of cardiovascular harm from vitamin D supplementation, the lack of benefit for CVD outcomes should not hinder their use for other indications.

While inconclusive, the current evidence for calcium supplementation is concerning for increased CVD risk. In this light, we suggest that the recommended daily allowances of calcium be achieved through dietary sources when possible, and that the smallest effective supplemental doses be considered in populations at risk of osteoporosis only after dietary modifications have been exhausted.

KEY POINTS

• For optimal bone health, the recommended dietary intake of vitamin D is 600 IU/day for adults aged 19 to 70 years and 800 IU/day for adults aged > 70 years. The recommended dietary intake of calcium is 1,000 mg/day for adults aged 19 to 50 years and for men aged 51 to 70 years and 1,200 mg/day for women aged ≥ 51 years and for all adults > 70 years.

• Large randomized controlled trials have shown no cardiovascular benefits conferred by vitamin D supplementation even in the case of insufficiency (< 20 ng/mL), suggesting that previously seen associations were due to confounding/reverse causation.

• Vitamin D testing/supplementation aimed solely at improving cardiovascular health is not recommended.

• There is some concern that calcium supplements (but not food sources) could increase the risk for cardiovascular events, but the evidence is inconclusive.

Footnotes

Conflict of Interest Disclosure:

The authors have completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and none were reported.

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Calcium 600 Mg Plus Vitamin D

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822648/

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Vitamin D Tanning Lotion

Vitamin D Tanning Lotion

Photo Courtesy: Justin Paget/DigitalVision/Getty Images

Vitamin D is important for maintaining a healthy body, primarily because it helps you fully maximize your body's absorption and utilization of calcium, an important mineral that we all need. When paired with calcium, vitamin D helps regulate bone remodeling and growth, ensuring healthy, strong bones. Vitamin D can also help protect older adults from osteoporosis, which occurs due to excess bone loss from aging.

Furthermore, this nutrient boosts your immune system and reduces inflammation within your body, potentially warding off future medical conditions in the process. It also plays a vital role in cell growth, neuromuscular functions and protein encoding. Studies have shown that a regular, healthy vitamin D intake can also serve as an antidepressant and make people feel generally happier. But that's not all you'll want to know about vitamin D.

Vitamin D is naturally found in certain foods and now appears in many more foods that have been fortified with added nutrients. The best sources of naturally occurring vitamin D are oily fish such as salmon, tuna, cod, sardines and mackerel. Fish liver oils are another good source of vitamin D. Small amounts of the nutrient are present in beef liver, cheese, egg yolks and mushrooms.

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Commonly, vitamin D-fortified foods include whole milk, orange juice, margarine and breakfast cereals. It's important to look at the label and nutrition facts to verify that vitamin D is in a particular food you're considering. Because dairy products are often fortified with vitamin D, lactose intolerant or vegan individuals should keep an eye on their diets to ensure they get enough of the vitamin.

Sun exposure is another method of naturally obtaining vitamin D, as our bodies can create their own vitamin D upon exposure to ultraviolet (UV) rays from the sun. However, it's difficult to gauge exactly how much sun exposure can generate sufficient vitamin D, as overexposure can be harmful, too. UV rays are also known to trigger free radicals, which can lead to skin cancer if left unchecked.

It's been suggested that getting approximately 15 minutes of sun exposure between 10 a.m. and 3 p.m. at least twice a week to your face, arms, legs or back will help your body synthesize enough vitamin D. It's important to note that you can't cover the exposed area of your body with sunscreen if you choose to get vitamin D naturally. The SPF blocks UV rays and can hinder your body's ability to create vitamin D. If you're in the shade or behind a window, the rays will not get through. If the climate where you live is primarily cloudy, it's important to get your recommended amount of vitamin D via other means.

Dietary supplements are also an excellent way of obtaining vitamin D. Supplements come in two forms: vitamin D3 (cholecalciferol), which is identical to the form your body makes when exposed to sunlight, and vitamin D2 (ergocalciferol), which differs slightly from D3 in its chemical side-chain structure. There's some evidence that vitamin D3 increases and maintains overall levels slightly better than vitamin D2.

Side Effects of a Vitamin D Deficiency

Vitamin D deficiency occurs when you don't adequately absorb the nutrient or when your kidneys can't convert the nutrient to its active form. This deficiency can result in medical conditions, two of which are called rickets and osteomalacia.

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Rickets, a disease characterized by a failure of bone tissues to get enough minerals, can result in abnormal, soft bones and skeletal deformities. It's most common in children. Fortunately, it isn't permanent, and kids can consume as few as 1 to 3 teaspoons of cod liver oil a day to reverse the condition.

With the help of fortified foods today, rickets is almost obsolete in the United States. Osteomalacia, characterized by soft and weak bones, is usually present in adults. It's commonly treated with an intense regimen of vitamin D replacement under the care of a physician.

Vitamin D and Other Health Conditions

Vitamin D deficiency has been linked to cardiovascular disease, and people with lower levels of vitamin D appear to be at an increased risk of having a heart attack or stroke. However, the exact relationship isn't clear, and there appears to be no benefit to cardiovascular risk in taking a vitamin D supplement.

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Research is also ongoing to find if there's a link between vitamin D and multiple sclerosis (MS). It appears that vitamin D deficiency is linked to the development of MS, and people with MS and higher levels of vitamin D appear to have reduced disease activity.

Low vitamin D has been linked to an increased risk of contracting respiratory illnesses such as influenza A. It appears that people with low vitamin D levels are at greater risk of severe novel coronavirus (COVID-19) infection. It's not clear yet if routine vitamin D supplementation would reduce this risk.

Because vitamin D is a fat-soluble substance, it can stay in your body for several days. Thus, vitamin D poisoning is possible if you supplement too much vitamin D over a period of a few months. Symptoms of vitamin D overdose include dehydration, vomiting, decreased appetite, irritability, constipation and fatigue. If left unaddressed, vitamin D poisoning can lead to anorexia, over-calcification of the bones and internal organs, kidney stones and hypertension (high blood pressure). It's important to note that vitamin D poisoning usually only occurs with excessive intake of dietary supplements. It's highly unlikely to occur as a result of normal dietary intake and sun exposure.

Daily Dosage Recommendations

The recommended dietary allowances for vitamin D vary depending on your age and other health and life circumstances, such as pregnancy. For infants under 12 months, the recommended intake is 400 international units (IU) or 10 micrograms (mcg). For individuals under 70 years old, the recommended intake is 600IU (15mcg). For individuals over 70 years old, the intake increases to 800IU (20mcg).

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If you have a pre-existing medical condition or other medical concerns, it's best to talk to a healthcare professional about determining your recommended dietary allowance for vitamin D. This way, you can be sure the vitamin doesn't interact negatively with your condition or medication.

Resource Links:

https://medlineplus.gov/vitamind.html

https://ods.od.nih.gov/factsheets/VitaminD-Consumer/

https://www.hsph.harvard.edu/nutritionsource/vitamin-d/

https://medlineplus.gov/druginfo/meds/a620058.html

https://bestpractice.bmj.com/patient-leaflets/en-gb/pdf/3000049/Vitamin%20D%20deficiency.pdf

https://bestpractice.bmj.com/topics/en-gb/641

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf

https://www.covid19treatmentguidelines.nih.gov/adjunctive-therapy/vitamin-d/

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Vitamin D Tanning Lotion

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Can Vitamin D Cause Fatty Liver

Can Vitamin D Cause Fatty Liver

Reader Question: I have a family history of cancer and have heard that lack of vitamin D might increase your risk. Should I take a supplement?

It can't hurt. An impressive (and growing) body of evidence supports a link between low vitamin D levels and an increased risk of developing colon cancer and breast cancer. One new study, published in the Archives of Internal Medicine, found that low levels of vitamin D were associated with an increased risk of death from any cause.

So how much D do you need? Unfortunately, we really don't know. The National Academy of Sciences currently recommends 200 IUs of vitamin D for people up to age 50 and 400–600 IUs for people older than that. (Note: These numbers include the vitamin D you get from food, and also the vitamin D your body manufactures when your skin is exposed to sunlight.) But some experts think that a higher amount (800–1,000 IUs) would offer additional health benefits. At the very least, I'd take a multivitamin that includes vitamin D. You should also ask your doctor to check your vitamin D level (it's a simple blood test) to find out where you stand. The American Medical Association is in the process of doing a comprehensive report on vitamin D, and when the results are available I'll be sure to share them with you.

I want to hear from you, so e-mail me your questions at dailywd@womansday.com.

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Can Vitamin D Cause Fatty Liver

Source: https://www.womansday.com/life/a42199/vitamin-d-cancer-5535/

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