Monday, November 1, 2010

Health Care and the Big D (Vitaminlicious)

All children know that they need to drink milk. They are told from a very early age that drinking milk gives them healthy, strong bones and bright, white teeth. Is this an urban legend, an old wives' tale, or truth in healthcare? Well, according to, vitamin D was once known as simply a bone builder. It's true that vitamin D works with calcium to help keep bones strong. You can't absorb calcium without vitamin D. And, vitamin D may affect inflammation and gum health, which could lead to tooth loss - independent of bone density. But new and emerging research suggests vitamin D may be far more versatile, offering an array of wellness benefits. Some preliminary research suggests vitamin D helps regulate the immune system and helps support heart health, normal blood pressure, healthy blood sugar and healthy aging. And, ongoing research continues to explore the potential connection to certain diseases, including some cancers.

According to the National Institutes of Health (NIH), vitamin D is a fat-soluble vitamin that is naturally present in very few foods, added to others, and available as a dietary supplement. It is also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation, first in the liver and then in the kidneys.  Vitamin D is essential for promoting calcium absorption in the gut and maintaining adequate serum calcium and phosphate concentrations to enable normal mineralization of bone and prevent hypocalcemic tetany. It is also needed for bone growth and bone remodeling by osteoblasts and osteoclasts. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from osteoporosis. Vitamin D has other roles in human health, including modulation of neuromuscular and immune function and reduction of inflammation. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D.

To repeat, vitamin D is essential for strong bones and a healthy immune system, according to While a limited amount of vitamin D can be obtained from exposure to the sun’s ultraviolet (UV) radiation, the health risks of UV exposure — including skin cancer — are great. Instead, The Skin Cancer Foundation suggests you get your recommended daily 1,000 IU (international units) of vitamin D a day from food sources like oily fish, fortified dairy products and cereals, and supplements. Because vitamin D is vital to good health, many foods have been enriched with the vitamin. However, it is naturally present in very few foods, and vitamin D supplements may be necessary to ensure adequate intake. But an excellent natural source of vitamin D does exist: oily fish.

Oily, or fatty fish, contain about 15 percent healthy fat, whereas white, or non-oily, fish contain less than two percent. Which oily fish are at the head of the class? A 3.5-ounce fillet of cooked salmon contains 360 International Units (IUs) of vitamin D, essentially a full day's adequate intake (AI) for anyone under age 70; the same amount of mackerel has 345 IUs; and 1.75 ounces of sardines contain 250 IUs. For a full list of oily fish, see below.
•Mackerel* (High in Mercury)
•Tuna (fresh)* (High in Mercury)
•Swordfish* (High in Mercury)
•Jack fish
•Orange roughy

Unfortunately, not all fish are safe to eat. Mercury, a naturally occurring metal, is also released into the air by pollution. When it reaches water, bacteria transform mercury into soluble, toxic methylmercury, which fish absorb. When you eat fish high in methylmercury, the toxin accumulates in the bloodstream and can endanger the nervous systems of unborn babies and young children as well as the cardiovascular and neurological systems of adults. Nearly all fish contain trace amounts of methylmercury. The FDA and the Environmental Protection Agency (EPA) recommend that pregnant women, those who may become pregnant, nursing mothers, and young children completely avoid the large, predatory, oily king mackerel and swordfish, and the non-oily shark and tilefish. These long-lived fish have had time to accumulate high levels of methylmercury in their bloodstreams.Women not of childbearing age and men should also limit their consumption of these fish to no more than eight ounces per month. There is some concern about the safety of tuna. If you are pregnant, you may want to avoid both canned and fresh tuna; otherwise, consume no more than six ounces per week. Bluefin, yellowfin (ahi), and albacore ("white") tuna have higher levels of mercury than skipjack.

Rickets and osteomalacia are classic vitamin D deficiency diseases, according to the Mayo Clinic. In children, vitamin D deficiency causes rickets, which results in skeletal deformities. In adults, vitamin D deficiency can lead to osteomalacia, which results in muscular weakness and weak bones. Populations who may be at a high risk for vitamin D deficiencies include the elderly, obese individuals, exclusively breastfed infants, and those who have limited sun exposure. Also, individuals who have fat malabsorption syndromes (e.g., cystic fibrosis) or inflammatory bowel disease (e.g., Crohn's disease) are at risk.  Dosing instructions for vitamin D supplements can be found here: .

According to the Food Nutrition Board at the Institute of Medicine of The National Academies, which created the Dietary Reference Intakes (DRIs), people should be intaking the following amounts of vitamin D if nothing is being synthesized (no sunlight exposure):
--Children up to 13 years - 5 mcg (200 IU).
--14-18 years - 5 mcg (200 IU).
--19-50 years - 5mcg (200 IU).
--51-70 years - 10 mcg (400 IU).
--71+ years - 15 mcg (600 IU).

The American Academy of Pediatrics recommends that exclusively or partially breastfed babies should receive supplements of 400 UI per day shortly after birth, and when they are weaned they should consume a minimum of 1,000 mL/day of vitamin D fortified formula or whole milk. Non-breastfed infants consuming less than 1,000 mL/day of vitamin D-fortified formula or milk should receive a vitamin D supplement of 400 IU per day. It also recommends that older children and adolescents who do not get 400 IU per day through vitamin D fortified milk and foods should take a 400 IU vitamin supplement each day.

It appears that Vitamin D is an essential part of helping your immune system and other body functions in good working order, including bone and teeth health. If you need a supplement, visit your family physician for recommended dosage. Also, find out from your pharmacist what the most highly efficient brands are in his store for you to purchase that are safe and comply with your doctor's suggestion. And, if you aren't lactose intolerant, there's nothing like a big class of ice cold milk every day to help out. While your at it, throw in a big toll house chocolate chip cookie for good measure.

Until next time. Let me know what you think.

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