Vitamin D – Sources & Amounts

Technology is great.  A couple taps on my phone lets me confirm medical appointments, check test results, or even communicate with my doctor.  It seems incredibly efficient for my doctor to be able to make notes when reviewing lab results and not have to task someone to make phone calls.  Just like that, I saw the note:

RECOMMEND ADDING EXTRA 1000 IU OF VITAMIN D TO DAILY REGIMEN

Since I could see the lab’s numbers, that recommendation wasn’t really a surprise.  Vitamin D might be easy to get in the tropics, but deficiency is pretty common in the rainy Pacific Northwest since the best way to get Vitamin D is from sun exposure and we don’t have a lot of sunshine.  So how do we get Vitamin D?  And how much do we need?

Vitamin D is primarily synthesized in our bodies based on exposure to sunlight. Think of it like photosynthesis for people (thankfully we don’t turn green!). Both the liver and the kidneys play a part. But if we’re missing the initial sunshine step, it’s pretty difficult for the kidneys and liver to do their part. Although it’s theoretically possible to get Vitamin D through our diet (our liver & kidneys do the same hydroxylations whether our Vitamin D is acquired through diet or sunshine), there aren’t that many dietary sources.  Foods containing vitamin D include fish, eggs, UV mushrooms, and pork. That’s a pretty short list.  I’m not counting fortified products, since the whole point is to find nutrient-dense foods instead of taking supplements.  Hiding supplements in the food doesn’t change the fact that they’re supplements instead of naturally-occurring.  Plus the fact that the foods they add Vitamin D to are mainly dairy products, ensuring that people who don’t get calcium from dairy also don’t get Vitamin D.  But if you consume dairy products, you can add that as a Vitamin D source, too.

So What Does Vitamin D Do for Us?

Vitamin D does more than just prevent rickets in growing kids. It reduces inflammation (!), modulates cell growth, helps us metabolize glucose, affects immune function, and helps build strong teeth. 

A major job of Vitamin D is to help us absorb calcium.  We can take all the calcium pills we want, but if we’re not getting enough Vitamin D, the calcium is not going to do much good – and our meds can affect things further. For instance, prednisone interferes with Vitamin D. Everyone taking DMARDs is at increased risk for osteoporosis, so metabolizing calcium is extremely important, which means that Vitamin D is important.  People taking Disease Modifying Anti-Rheumatic Drugs need to be particularly careful to get enough Vitamin D so that their calcium is properly absorbed or they could end up with soft bones.  Who needs more problems?

But there’s more.  There is a clear link between MS and low 25(OH)D levels. Will future studies show a link to other conditions?  Studies are still underway because data from previous studies is unclear. There could be a link between low Vitamin D and cardiovascular disease (which is already a risk for people with autoimmune diseases).  The data on the link between Vitamin D and cancer is conflicted, but it appears that both too little and too much might increase the risk of cancer, and that Goldilocks-right-in-the-middle amounts might decrease mortality in people who get cancer despite having good Vitamin D levels. There are also studies on a link between low Vitamin D and type 2 diabetes.  Another study seems to indicate that overweight people can increase their Vitamin D levels by losing weight, the thinking being along the lines of D getting trapped in the outer fat cells – losing that fat then makes the D available to metabolize.  It’s fascinating.

Do We Really Need 15 mcg Per Day?

There is a tidy little chart listing US Recommended Dietary Allowances that says everyone should consume 15 mcg a day until age 70, when it goes up to 20 mcg.  But then there’s the fine print.  That’s dietary Vitamin D assuming minimal sun exposure. Those getting plenty of sunshine on their skin wouldn’t need as much Vitamin D from their food. 

On the other hand, not everyone agrees with the US RDAs.  Only 10 mcg are recommended in the UK.

Labs Can Measure Blood Serum Vitamin D

The amount of dietary Vitamin D we take in doesn’t correspond directly to the amount in our bloodstream.  Doctors can order a lab test to check our levels. The reliability of that test is questionable, but we work with what we have and use the Food & Nutrition Board’s definitions of appropriate levels of Vitamin D. I note that the lab I use has slightly different definitions:

Before we get too dogmatic about those number being etched in stone, we need to recognize that the NIH fact sheet on Vitamin D tells us,

“Optimal serum concentrations of 25(OH)D for bone and general health have not been established because they are likely to vary by stage of life, by race and ethnicity, and with each physiological measure used. In addition, although 25(OH)D levels rise in response to increased vitamin D intake, the relationship is nonlinear. The amount of increase varies, for example, by baseline serum levels and duration of supplementation.”

Basically they’re saying that nobody knows for sure how much Vitamin D we truly need, but they’ve taken as good a guess as they can.

Then there’s the Endocrine Society, which says that people should get as much Vitamin D as it takes to keep their serum 25(OH)D levels above 75 nmol/L (30 ng/mL).  That’s quite a bit higher than the Food & Nutrition Board’s recommendation that 50 is adequate.

Putting everyone’s guesses together, I take it to mean that ideal serum levels would be in the 75-96 range, and we need to figure out a safe way to get our Vitamin D to that level.

But we have to be careful. As with other fat-soluble vitamins, toxicity is a real possibility. Current theory tells us that 1,000 IU daily can raise the serum level by 10 ng/mL, so that much supplementation should theoretically be safe for people whose numbers are low.  The Tolerable Upper Limit for adults is 4,000 IU, so 1,000 should be perfectly safe.  Don’t take too much, though.  Toxicity sounds not just unpleasant, but dangerous: nausea, vomiting, pain, dehydration, kidney stones, renal failure, heart problems, or death.

Note that those scary results of toxicity are thought to be from supplements. Getting Vitamin D from sunshine and food is considered safe.

Which foods contain Vitamin D?

Six ounces of salmon or swordfish contain 142% of the daily Vitamin D we need.  An equal amount of halibut provides 50% of our day’s Vitamin D.  A three-ounce can of tuna provides 9%. 

Supposedly a 1-cup serving of crimini mushrooms has zero vitamin D, unless they’ve been treated with UV light, in which case they provide 122% of our daily Vitamin D.  This is most peculiar. I’m not sure if it means we should be setting our mushrooms out in the sunshine before consuming them, or what the deal is, but if I had sunshine, I could set myself in it instead of my mushrooms. 

Basically, unless you’re eating a ton of salmon every day or drinking milk, it’s nearly possible to get enough Vitamin D without taking supplements or going out in the sun.

How Much Sunshine Do We Need?

We don’t need as much sunlight as you might think. Up to one hour three times a week should be sufficient. Note that since Vitamin D is fat soluble, extra is stored (as opposed to water-soluble vitamins that are excreted if we get more than we need).  It appears that we can spend time in the sun every-other-day, not daily.

How long we should spend in the sun depends both on how dark our skin is and on how intense the sunlight is.  We just need to know the UV index – and I’ve discovered that my smart watch can provide that information. It’s also possible to check the weather forecast for the UV Index.

It’s not enough to look out the window to see if it’s sunny or not. UV index depends on other factors, including angle of the sun (ie time of day and season of the year). For instance, it’s a beautiful day here, but the sun is so low that despite the blue sky, the UV index is only 2.

Once I know the current UV index, GB Healthwatch has a handy table for looking up how much time is needed in the sun (while wearing shorts and a t-shirt). Unfortunately, they don’t document where the data came from. Nonetheless, it’s a starting point.

Conclusion

The average person needs 15 mcg of dietary Vitamin D, every day, or needs to spend up to an hour getting sunlight directly on the skin (directly, not through a window). The farther from the equator people live, the less likely they are to get adequate Vitamin D from the sun, so supplements might be needed. It’s also possible (but fairly expensive) to use a special UVB light or spend time in a tanning bed.

People with autoimmune diseases need to be especially vigilant in getting enough Vitamin D, both to help control inflammation, and to reduce the probabilities of complications such as cardiovascular disease and osteoporosis.

Wishing you well!

***** ****** ******

1 Food & Nutrition Board
2 National Academies of Sciences, Engineering, and Medicine

Resources:

*Vitamin D Fact Sheet for Health Professionals

*Vitamin D: A Rapid Review

*Get Vitamin D from Sun Exposure

*Top Ten Vitamin D Foods

Why is it politically incorrect to tell people that they’re wrong?

Recently someone posted a video, essentially saying that everyone needs to wear a mask so that she feels safe and respected. Her partner does, so the whole world should, too.

No.

First, it is incredibly selfish for one individual or group to say that the whole world needs to change to accommodate them.  Count me as one immunocompromised person who does not want everyone wearing masks. I would not dream of expecting the rest of the world to cater to me.

Second, before 2020 we already knew a lot about masks and how they do/don’t work.  More has been learned in the past few months.  If you feel safer by making everyone wear masks, then you’re not paying any attention to the facts.  If you want to wear an N95 mask to protect yourself, go for it (and I would when going to a doctor’s appointment), but the rest of the world shouldn’t have to put their health at risk just to give you a false sense of security. There are risks to wearing masks.

Telling the whole world that they need to wear a mask to accommodate your unique needs is astonishingly self-centered.  It’s not all about you.

Breaking the Silence

As I read with distress the politicizing of healthcare in the U.S., I sometimes wonder how long it will be before our system collapses. No political arguments here, just a pondering of what arthritis patients will do. Thus, my investigation into whether there’s any merit to the claims of some that diet can have an impact on disease symptoms.  To date, the reports of people going into remission due to dietary modifications are anecdotal, but it turns out that doctors are starting to recommend that people try an AIP diet, and they’re even starting to do some research to see if science backs up the anecdotes. One of the bloggers who writes about using diet to treat autoimmune diseases was a medical researcher until her second child was born.  Another is a clinical nutritionist. Maybe there’s something to this.

One week of AIP suppers:

Second week of AIP suppers:

I’ve been experimenting with autoimmune protocol since last spring and feel enough better that I will continue eating this way.  I love the delicious recipes! The drawback is that the planning can be extremely time-intensive (thus no time for blogging) — until you figure out what you’re doing. After a while, I am happy to report, it gets easier. It still takes a lot of time, but it’s worth it since I feel better.

But I confess that changing the whole way you eat is a bit of an adjustment. What I find the most challenging is that the rest of my family is not on board with eating nutritious food.  My husband has eaten a particular way his whole life and sees no problem occasionally snacking on corn chips instead of sitting at the table for a real meal! This is what I’m dealing with!  My solution has been to continue to introduce nutritious offerings, keeping note of which ones my family likes and which ones they don’t care for.

After my wonderful husband exclaimed, “I don’t need to be experimented on!” I started trying my new recipes at lunchtime or days he works late. The big winners then get repeated at dinner on a different day 🙂

For me, keys to making it work include:

  1. …fixing my food first.  I try to have everyone eat the same thing, but sometimes I eat different food than my family.  One example is rice. I do much better if I don’t eat rice. Fortunately, I discovered that a vegetable I hated as a kid actually tastes pretty good as a rice substitute. Unfortunately, the rest of my family doesn’t like the nutritious alternative. If I prepare everyone else’s meal first, sometimes I’m too tired to make mine and just end up eating what they’re eating. Then I end up regretting it, so I discovered that I can make mine first, and the problem is solved.
  2. …planning. This is essential.  I have to know what I’m going to eat before it’s time to fix the meal. Otherwise, it’s too easy to just grab anything, and that’s rarely a good option.  Once the plan is made, you can make a grocery list and go shopping.
    I made this process easier by subscribing to Real Plans (no, they didn’t pay me to advertise for them, I just think it’s fantastic) and added upgrades for extra AIP recipes. I might write a whole separate post on how I use Real Plans, so I won’t say any more about it now.
  3. …having good substitutes.  Who doesn’t love spaghetti? But AIP says no nightshades (spaghetti sauce is made from tomatoes, which is a nightshade – a kind of plant, not, as my son thought, something to cover the windows) and no grains (pasta is made from grains).  But I found nomato sauce and zoodles, which I admit sounded very odd when I first heard of it. In the spirit of Dr. Seuss’s Sam-I-Am, I decided to give it a try and was pleasantly surprised.  I cook up a huge batch of sauce, divide it into small containers, and freeze it. Then when I cook regular spaghetti for my family, I can easily grab an AIP-friendly version for myself. I’ve served this twice to company with positive comments both times.
  4. …having breakfast options in the freezer.  I posted previously some of the breakfast recipes I found. But they take a while to prepare, and I don’t always have time to cook in the mornings. Or I might have time, but be too hungry to wait.  Instant food is the solution.  A few of the recipes I found freeze very well. I cook up a big batch, divide it into individual servings, and stick all those individual containers in the freezer. This worked especially well when we took child #4 to college and spent two weeks on the road.  Hubby sees such a difference in how I feel that he made space for an ice chest so that I could pack food for the trip! The hotels were all pretty good about putting my stuff in their big freezer overnight.
  5. …keeping a record. Being able to look back at what I’ve eaten lets me make connections between symptoms and specific foods. It also helps with planning new menus.
  6. …cleaning the pantry.  I would prefer to completely toss out the potato chips, but there are other adults in my house who buy them and want to eat them with other junk foods. I really struggled with this for a while, because every time I opened the pantry door, these awful things masquerading as food were staring me in the face.  I emptied the entire pantry, then reserved a small section at the back for the family’s snack foods. Granola bars and little things like that are in a plastic tote where people can get them easily if they want them, but they’re not so easy to grab that I’ve ever been tempted to make the effort to climb up on the step-stool and open the tote.  Most of the pantry is mine, with real ingredients for preparing real food. The snacks are there, and available, but no longer calling my name.

If your symptoms are not 100% under control, I’d encourage you to do some reading about AIP and see if it’s something you might want to try. You’re eating anyway, so why not experiment with some new recipes? 🙂  There is quite a bit of talk among AIP people about “leaky gut” and I’m not convinced that’s a real thing, but the recipes are delicious, and I’m not having any joint pain.