In the past few days, a few articles on vitamin D have come out. Spring is the perfect time to talk about vitamin D, since most of us are getting more sun exposure now than we did in the winter.
What did the articles say:
The first one patients will be talking about, because it is being talked about on everything from NPR to USA Today. It found that Americans don’t get enough vitamin D (actual study in the Archives of Internal Medicine). Several commentators have brought up that the data is older and other journals have found fault with the assay technique.
Another was published on WebMd, so patients may see it too. It found that vitamin D lowers cut bone and said that perhaps the RDA needed to be raised.
Current standards set by the Institute of Medicine are 200 IU per day for children up to age 13, 200 IU per day for men and women aged 14-50, 400 IU per day for men and women aged 51-70, and 600 IU per day for men and women aged 71 and older. The study used 770 IU daily, but the WebMd article suggests somewhere between 1,000 and 2,000 units daily.
What Pharmacists Should Know:
I do believe that Americans don’t get enough vitamin D, but I think the Annals article has been misinterpreted by the media (imagine that) in a way that could be harmful to patients. Many of the articles that talk about the study mention the blocking effects that clothing and sunscreen have on vitamin D.
It is true that sunscreen and clothing block vitamin D formation, but they also protect against skin cancer. It’s the “dangerous” UV-B rays that form vitamin D. There’s no getting around the exposure.
We need to tell patients that wearing sunscreen is essential if they will be swimming, sunning or anything for a long period of time.
Sources vary on how much sun exposure you need for adequate vitamin D formation. It also varies based on climate, cloud cover, time of day, skin tone . . . there is no one size fits all. The low number I found referenced was 10 minutes of exposure three times a week for a person with light skin in southern latitudes.
One presentation found that, in higher latitudes, sunning yourself in the morning or late afternoon causes burning before you get adequate vitamin D production. Sunning between 10 am and 2 pm during summer months (or winter months in southern latitudes) for 20-120 minutes, depending on skin type and color, will form adequate vitamin D before burning occurs. (Vitamin D Production by Natural and Artificial Sources).
Another caveat: eighty-five percent of your body needs to be exposed to the sun before you can make adequate vitamin D. Not hard for those strutting string bikinis, but for most of us, exposing 85% of ourselves to the sun is an issue.
Bottom line: You probably are not going to get enough vitamin D from the sun before you expose yourself to increased skin cancer risks or a severe sun burn.
Vitamin D From Food
I know I’m a pharmacist and I should be recommending people take a vitamin D tablet, and that can be a great alternative, but I prefer to get nutrients from food whenever possible. That’s the way our ancestors did it.
Recommend people eat more fish, especially fish like salmon, mackerel, tuna, sardines and herring. Fish is almost a miracle food, lean, high in omega 3s for joints, your heart, your brain. Everyone should eat more of it. Most milk and dairy products have been fortified with vitamin D. Vitamin D is found in egg yolk, some fortified cereals and animal organs like liver (which our ancestors at a lot).
Take Home
These findings are believable, but do not mean that we should all strip down and run around with no sunscreen. Eating sensibly is a far more effective way to get your vitamin D. If you cannot or will not eat a variety of vitamin D sources, taking a tablet is a viable alternative.
If you want to learn more about vitamin D than any one human needs to know, you can check out The Miracle of Vitamin D, which is a great and well referenced article on vitamin production and utilization. I also found a nice visual aid about how vitamin D is made by the skin and one more study (J Steroid Biochem Mol Biol. 2007 March; 103(3-5): 631–634) that showed even the sun drenched Hawiians can use supplementation.
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