Many Americans Fall Short on Their Vitamin D

This is not exclusive to Americans. With reduced exposure to the sun, we are seeing much higher rates of people deficient in vitamin D.

http://www.healthday.com/Article.asp?AID=625331

Many Americans Fall Short on Their Vitamin D
Recommended levels in foods need to be increased, experts say

By Steven Reinberg
HealthDay Reporter

MONDAY, March 23 (HealthDay News) -- Over the course of two decades, vitamin D levels have dramatically decreased among Americans, a new study finds.

Low levels of vitamin D have been associated with rickets in children and lower bone mineral density in adults. Recent research has also linked insufficient vitamin D to cancer, heart disease, infection and poorer health overall. Optimal levels range from 30 nanograms per milliliter to 40 nanograms per milliliter, the researchers said.

"We found a marked increase in vitamin D deficiency over the past two decades," said lead researcher Dr. Adit Ginde, an assistant professor of surgery at the University of Colorado Denver School of Medicine. "Over three out of every four Americans now have vitamin D levels below what we believe is necessary for optimal health. African-Americans and Hispanics are at particularly high risk -- nearly all have suboptimal levels."

The report was published in the March 23 issue of the Archives of Internal Medicine.

For the study, Ginde's group collected data on vitamin D levels in 18,883 people collected between 1988 and 1994, and 13,369 people collected between 2001 and 2004. All the data came from the Third National Health and Nutrition Examination Survey.

The researchers found that average vitamin D levels were 30 nanograms per milliliter from 1988 to 1994, but decreased to 24 nanograms per milliliter between 2001 and 2004. Moreover, vitamin D levels of less than 10 nanograms per milliliter increased from 2 percent to 6 percent over the study period. There were also fewer people with vitamin D levels of 30 nanograms per milliliter or higher (45 percent vs. 23 percent).

The greatest drops in vitamin D levels were seen among blacks, where levels of vitamin D of less than 10 nanograms per milliliter rose from 9 percent to 29 percent, and levels of more than 30 nanograms per milliliter or higher dropped from 12 percent to 3 percent, the researchers found.

"Increases in vitamin D deficiency in the population may have reduced the overall health of the population," Ginde said. "Since sunlight is the body's major source of vitamin D, increases in sunscreen, sun avoidance, and overall decreased outdoor activity, while successful in reducing skin cancers, has probably reduced vitamin D levels in the population."

Ten minutes of sunlight on exposed arms and legs two to three times per week would significantly improve vitamin D production, but must be weighed against the risk for skin cancer, Ginde noted. Vitamin D supplementation is another way to increase levels. However, current recommended doses of vitamin D supplements are outdated and inadequate, he added.

Right now, recommended levels of vitamin D supplements are 200 international units per day from birth to age 50, 400 international units (IU) per day from age 51 to 70, and 600 international units per day for adults aged 71 and older. These recommendations are primarily for improving bone health.

"Vitamin D is an important and underappreciated public health issue and may be responsible for some racial differences in health outcomes," Ginde said. "Most Americans could use more vitamin D. Higher doses of vitamin D supplementation than currently recommended, at least 1,000 to 2,000 IU daily, are likely needed to raise vitamin D levels for many people."

Another report in the same journal highlights the importance of vitamin D for bone health. In the study, Swiss researchers conclude that 400 IU of vitamin D supplements per day are associated with a reduced risk of fractures in older adults.

"Given the frequency, severity and cost of non-vertebral fractures, everyone age 65 and older should take vitamin D in a dose close to 800 IU per day," said lead researcher Heike A. Bischoff-Ferrari, an assistant professor at the University of Zurich.

To reach their conclusion, Bischoff-Ferrari and colleagues reviewed the findings of 12 clinical trials of looking at the benefits of vitamin D supplements in reducing fractures in adults aged 65 and older. In all, the trials involved 42,279 participants.

The researchers found that vitamin D supplements decreased the risk of non-vertebral fractures by 14 percent and of hip fractures by 9 percent. In trials where people were given doses of more than 400 IUs a day, fractures were reduced by 20 percent and hip fractures by 18 percent.

In addition, for people taking high doses of vitamin D, calcium supplements did not appear to have any additional protective effect against fractures, the researchers reported.

"At the higher dose, this benefit is not restricted to frail older individuals, but is also present in community-dwelling older individuals," Bischoff-Ferrari said. "In the subgroup of community-dwelling older individuals, vitamin D at the higher dose reduced non-vertebral fractures by 33 percent."

Dr. Michael F. Holick, director of the Vitamin D Laboratory at Boston University, noted that the recommended levels of vitamin D are under review and likely to be increased.

"An Institute of Medicine panel is planning to have new recommendations out by mid-2010," Holick said. "It's pretty clear that you need a minimum of 1,400 and up to 2,000 IU a day, and if you are obese, you probably need at least one and a half to two times as much, because the fat sequesters the vitamin D," he said.

Holick said people are drinking less milk and staying out of the sun, which are the main reasons for the decreasing vitamin D levels in the population.

One way to combat the problem is to increase vitamin D supplementation in foods, Holick said. New recommendations that increase vitamin D levels will let the food industry increase vitamin D levels in foods and add vitamin D to more foods, he said.

"We are in desperate need to have a marked increase in the adequate intake recommendation, and hopefully, that will be 1,000 to 2,000 IUs per day and raise the safe upper limit to at least 10,000 IUs a day," Holick said. "The plan would be to increase the amount per serving and increase the number of foods fortified with vitamin D."

More information

For more on vitamin D, visit the U.S. National Library of Medicine.



SOURCES: Adit Ginde, M.D., M.P.H., assistant professor, surgery, University of Colorado Denver School of Medicine; Heike A. Bischoff-Ferrari, Dr.P.H., assistant professor, University of Zurich, University Hospital, Zurich, Switzerland; Michael F. Holick, M.D., Ph.D., director, Vitamin D Laboratory, Boston University; March 23, 2009, Archives of Internal Medicine

Copyright © 2009 ScoutNews, LLC. All rights reserved.

It may prove to be far more important to take adequate vitamin D than it is to take calcium for bone health. Yes, you do need calcium but without vitamin D, it does little good. Also, please note that darker skinned people have higher deficiencies in D. The darker the skin, the more sun that is needed to provide enough vitamin D. Thalassemics have an even higher need for vitamin D. Do not ignore this key part of nutrition.

Thanks for the info Andy,Viatmin D sure seems like a wonder vitamin.

Zaini.

This news comes from USA. So I will post it here. I hope it is ok

New Measurement Standard For Vitamin D May Lead To Better Bone Health
26 Mar 2009   

In a development that could help improve the prevention and treatment of osteoporosis, rickets, and other bone diseases, government chemists are reporting an advance in developing an accurate, reliable set of standards for measuring vitamin D levels in blood. Their findings could affect the health of millions of people worldwide, particularly children, women, and the elderly, who suffer from or are at risk of these debilitating diseases. The study will be presented here at the American Chemical Society's 237th National Meeting.

The advance comes in the midst of a growing awareness that many children and adults are not getting enough vitamin D. New studies also link vitamin D deficiency to a higher risk of diseases ranging from cancer to cognitive impairment in the elderly. Everyone needs ample vitamin D not just to absorb calcium and maintain bone strength but to promote good overall health.

People produce the vitamin naturally when sunlight shines on their skin. Concerns about skin cancer, however, have reduced exposure to sunlight. Likewise, declines in consumption of certain dairy products have reduced intake of another natural source of vitamin D. The vitamin also is available as a dietary supplement.

Despite concerns about adequate vitamin D intake, there is no standard laboratory test for measuring vitamin D levels in humans, and no universal agreement on what are considered "normal" or "optimal" vitamin D levels. To understand vitamin D's role in health and disease, and use that knowledge in everyday medicine, laboratories need better measurement standards, the scientists say.

"No one really knows what methods or assays are correct at this point," says Mary Bedner, Ph.D., an analytical chemist with the National Institute of Standards and Technology (NIST) in Gaithersburg, Md. "Right now, you can send a blood sample to two different labs and get completely different results for vitamin D."

About three years ago, NIST, the Federal Government agency that sets measurement standards, began efforts to develop a standard for measuring vitamin D in collaboration with the National Institutes of Health's (NIH's) Office of Dietary Supplements. Later this year, after much consultation with experts and extensive laboratory testing, NIST scientists plan to unveil their standard to the public in a development that promises to lead to a better understanding of vitamin D in health and disease.

The most commonly used indicator of a person's vitamin D status is the measurement of 25-hydroxyvitamin D in the blood. But several different forms of this vitamin exist in the blood including 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 that are of clinical significance and would be overlooked by scientists focusing on total 25-hydroxyvitamin D alone.

To account for these other forms of vitamin D, NIST developed Standard Reference Material 972 (SRM 972). The material is composed of four different pools of human blood serum obtained from a wide cross-section of blood donors. Each of the four pools contains different amounts of 25-hydroxyvitamin D2 and D3 to represent vitamin D profiles normally seen in a clinical setting. All were carefully measured using a combination of state-of-the-art liquid chromatography and mass spectroscopy highly sensitive analytical chemistry tools.

One pool represents "normal" serum, which contains mostly 25-hydroxyvitamin D3. The second pool, which represents vitamin D deficient individuals, contains about half as much 25-hydroxyvitamin D3 as the "normal" pool. The third represents the blood profile of someone taking vitamin D supplements and contains elevated levels of 25-hydroxyvitamin D2. Finally, the fourth pool contains high levels of 3-epi-25-hydroxyvitamin D3, or the "epi" form of vitamin D, which is typically found in the blood of small children.

By using these four blood samples as reference points, clinical laboratories can calibrate their instruments and measurement techniques to assure more accurate and reliable vitamin D measurements for blood samples so doctors can make the right treatment decisions. As a result, testing based on this standard can more reliably tell patients whether they're getting enough vitamin D and provide information about what forms of vitamin D they need to take to stay healthy, the researchers say.

"Accuracy is key," Bedner says. "We need to provide a reference material that other people can trust."

The researchers plan to make their reference standard commercially available within the next year. NIST and NIH funded the research.

The American Chemical Society is a nonprofit organization chartered by the U.S. Congress. With more than 154,000 members, ACS is the world's largest scientific society and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. Its main offices are in Washington, D.C., and Columbus, Ohio.

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Article URL: http://www.medicalnewstoday.com/articles/143753.php

Main News Category: Bones / Orthopaedics

Also Appears In:  Nutrition / Diet,  Conferences, 

Thanks for this Dore.  I really believe that vitamin D has a significant impact on overall health. 

Sharmin

Ten minutes of sunlight on exposed arms and legs two to three times per week would significantly improve vitamin D production,
    Hi Guys well the weather here in kuwait now is arround 75F and it will increase slowley withen few days my point is if any body need a real sun and can cook some egg over the street he will be very welcome in kuwait ,,, i have my sweming pool also some fresh drink...  ( you can make it as invitation for any body)   
                                   khalifa
                            state of kuwait

We should have a file about vitamin D.

This is what I found:

Vitamin D May Have Key Role In Helping Brain Work Well In Later Life

[Association between 25-hydroxyvitamin D levels and cognitive performance in middle-aged and older European men J Neurol Neurosurg Psychiatry 2009; doi 10.1136/jnnp.2008.165720]

Vitamin D may have a key role in helping the brain to keep working well in later life, suggests research published ahead of print in the Journal of Neurology Neurosurgery and Psychiatry.

Previous research indicates that inadequate vitamin D intake may be linked to poorer mental agility in the ageing brain, but the results have been inconsistent.

The researchers base their current findings on just over 3000 European men between the ages of 40 and 79, who were all part of the international European Male Ageing Study, drawn from eight different cities across Europe.

Their mental agility was assessed using a range of tests, designed to measure memory and speed of information processing as well as mood and physical activity levels, both of which affect mental agility.

Blood samples were then taken to measure circulating levels of vitamin D, which is obtained through dietary sources and by exposure to sunlight.

High circulating vitamin D levels were associated with high scores on the memory and information processing tests, but after adjusting for mood and physical activity, the association remained for only one of the two information processing tests.

Low vitamin D levels were associated with poor scores, with levels of 35 nmol/litre or under marking the threshold of poorer performance.

Experimental data point to the biological plausibility for an association between low circulating levels of vitamin D and poorer mental agility, but exactly how the two might be connected is not clear, say the authors.

Possible suggestions include vitamin D's role in increasing certain hormonal activity or the protection of neurones and chemical signalling pathways.

The findings show that the magnitude of the association between vitamin D level and mental agility was comparatively small, say the authors.

But if it were possible to stave off the effects of ageing on the brain with vitamin D supplements, then the implications for population health could be quite significant, they contend, because many people, particularly in older age, are vitamin D deficient.

Source
Journal Of Neurology Neurosurgery And Psychiatry

Before this whole new episodes with pain started I already made I list of things I wanted to discuss with my doctor. #1 was about vit D. I wanted to ask of it was not a clever idea to put me on a higher dose of vit D in stead of waiting for the DEXA-scan of summer 2010. I was already told that I probably should start in summer 2010 with taking biophates (sp??). 

We heard the importance of Vitamin D at the NY conference. Here is something that i read today, which might be interesting to those like me living in a place where the sun exposure is very small. Ellen Fung at the conference mentioned the level of sunlight we get here (in northeast parts of USA) falls well below the level a person should get.

http://www.boston.com/news/health/articles/2009/10/26/many_people_dont_get_enough_vitamin_d/

Q. Does vitamin D prevent the swine (H1N1) and seasonal flu, or the common cold?
A. It’s not clear whether vitamin D specifically protects against H1N1, a novel virus, but there’s growing evidence that it does protect against a number of respiratory infections - and that many Americans do not get enough of the vitamin.

One study showed that people taking supplements containing 2,000 international units of vitamin D a day suffered fewer respiratory infections than those not taking supplements. Another study showed the obverse - that people with low blood levels of vitamin D were somewhat more likely to have had a recent upper respiratory tract infection than people with higher levels (24 percent vs. 17 percent). Vitamin D boosts the activity of a gene that makes cathelicidin, a natural antimicrobial compound that is part of the body’s defenses against infections, says Dr. Carlos A. Camargo, an associate professor of medicine and epidemiology at Harvard Medical School.

When there’s lots of sunshine, people make vitamin D naturally. But in New England, most people have low levels of vitamin D, especially in winter. The problem is a national one as well: A study being published today in Pediatrics shows that about 20 percent of children ages 1 to 11 have suboptimal levels of vitamin D.

You can get a blood test to determine your vitamin D level. People with darker skin are at extra risk because highly pigmented skin requires more sun exposure to obtain a healthy level.

The vitamin has so many benefits - including lowering the risk of osteoporosis, heart attacks, and colon cancer - that “I am encouraging everyone to increase their vitamin D intake, especially children,’’ says Dr. Michael F. Holick, a professor of medicine, physiology, and biophysics at Boston University. He suggests that children take a minimum of 400 IUs a day and preferably 1,000. “Adults should take at least 1,000 IUs and preferably 2,000 IUs a day,’’ he says.

Daniel Perlman, a senior scientist at Brandeis University, says 2,000 IUs a day is safe: “In the summer sun, the body itself is known to produce far higher levels.’’

For some perspective on vitamin D dosage, I asked Dr Vichinsky about this because I am quite deficient in D (level of only 19), and requested some advice. Dr Vichinsky told me that with the thal patients, they are now administering 50,000 IU of D weekly, because the smaller doses aren't having much impact. Interestingly, this jibes with the advice that our member Bigg has given. I am now starting on this regimen. I hope it helps because with the winter months coming, I need to correct my situation or I will be quite the depressed person, literally, because low D does also cause depression.

Andy

What is the recommended maintenance dose for children? I guess what is in the Osteocare is not enough

manal

Manal,

This will really vary on how much sun a child gets and how dark their skin is. If your son plays outdoors often, he would have little trouble maintaining his vitamin D level without supplements, just as I was able when I worked outdoors in Florida. If he doesn't get much sun, 1000 IU daily would be a good place to start. Although vitamin D was once considered something one can get too much of, I haven't heard of anyone tested anywhere close to the high optimum range. If there is a real question that he may be low, you can always get him tested.

The people having the most trouble with D levels are those who have been transplanted from warmer climates to cold climates that do not get adequate year round sun and women who cover, because they get very little exposure to the sun regardless of where they live. It may be an issue for males in many countries, also. Something I noticed in my trips to hot climates is that many of the males wear long pants and long sleeve shirts, so it may be limiting their vitamin D intake.

Thanks Andy

Ellen B. Fung in session Nutritional Deficiencies in Patients with Thalassmia did talk about the importance of Vitamin D at the conference. Here are some of the points I could note down. Sharmin - Could you add to it or correct me if there is anything incorrect below?

Vitamin D is the only nutrient that is synthesized.
Most of the cities in the northern part of US (New York, Boston for example) are below the 40 degree north latitude leading to most people in the northern part deficient in Vitamin D
For thals, Vitamin D supplement intake of > 1000 iu/day should be taken.
Factors to consider for Vitamin D are

• Clothing
• Sun Screen Use
• Latitude
• Season
• Altitude
• Time of the day - Greatest sunlight exposure from 10 am to 2 pm
• Skin Pigmentation

This was presented for patients in US, so others should consider the above factors prior to increasing their dose and talk with their doctors.

Narendra

Time of the day - Greatest sunlight exposure from 10 am to 2 pm

Isn't this the time you should avoid being exposed to the sun because of the harmful ultra-violet rays. I was always told that the best time is before 10 am or after 3 pm

manal

Manal,

You are right. That is what I always heard until now. I guess that was because this was in reference to the people in US, where the sun rays are a little weak compared to the other warm places. That is the reason, I mentioned the factors to be considered in the post above.

Hi Manal,

Lil A's doctor prescribed him and additional 1000IU of vitamin D along with the Osteocare.  He told me that at least 2000IU a day should be given to him.  

There are so many things to consider when looking at vitamin D, sunlight etc.  Whereas, the best source of vitamin D is sunlight - exposure to UV is also a risk.  My dad for example, was severly vitamin D deficient so the doctor told him to get more sunlight.  My dad takes everything to the extreme!  Although he is from India, he is very light skinned with hazel eyes.  Often I would notice that his face would be burned!  His ears would turn red and peel.  This summer he presented with macular degeneration, one eye having wet macular deneration.  He has always had perfect eye sight and doctors have never seen any defects in his eyes.  They suggested that this sudden onset may have been related to sun exposure, because he has such light eyes.  

What I mean to say is that we need everything in balance.  It is important to get sunlight, but be sure to protect your eyes when you are in the sunlight (we often neglect our eyes), be sure to have sunscreen on ears etc that are likely to burn.  Perhaps be in the sunshine for short intervals rather than extended times.  Oral supplements, higher than previously suggested may be suitable - especially for people with thal.  IV megadoses can be discussed with doctors.  

As Narendra and Manal have said, much of what we hear does refer to people in the US.   I wonder how we can all find that balance, where we can have the benefits but avoid the risks.  

Andy, do you have any ideas?

Sharmin