Category Archives: Recommendations

Nutrition Fact: More than 25% of Americans are Vitamin D Insufficient

Are YOU Getting Enough Vitamin D?

It seems like Vitamin D has been the “fashionable” vitamin over the past few years mainly because there has been a trend in research suggesting vitamin D deficiency/insufficiency may play a role in various diseases other than just bone health.  Additionally, while the the Institute of Medicine (IOM) increased their recommendations and upper limits for vitamin D for optimum bone health in 2010,  other experts don’t agree with those recommendations and more and more research is showing increased intake may protect against several chronic diseases.  So, with all the controversy and inconclusive evidence out there how do you tease out what you really need to know about Vitamin D?  Let’s start by understanding what vitamin D is and where you get it from.     

What is Vitamin D? 

Vitamin D is a family of fat-soluble vitamins which functions to regulate calcium and phosphorus homeostasis.  Additional functions include:

  1.  Helps maintain bone health
  2. Aids in cell differentiation of hemotapoietic and epithelial cells
  3. Enhances immunity
  4. Helps reduce inflammation
  5. Aids in regulation of blood pressure and insulin

Aside from these known functions Vitamin D plays, new research suggests that vitamin D status may also be linked to chronic diseases including cardiovascular disease, certain cancers, cognitive decline, depression, diabetes, pregnancy complications, and some autoimmune diseases.  Although the link between Vitamin D and these chronic diseases is still inconclusive, it’s not surprising that there has been a dramatic increase in sales in Vitamin D supplements and manufactures of the vitamin dues to evidence of protection against certain chronic diseases.

Where do I get Vitamin D from? 

Vitamin D is mostly obtained through skin exposure to UV B light where it is converted to the active form for Vitamin D (D3) in our skin.   Some Vitamin D is also obtained from the diet in fortified foods such as milk, cereals, and juices as well as some natural foods such as some fish (i.e. salmon and sardines) and liver.  But more recently many have been receiving vitamin D from supplements which either come in the form of D2 or D3.

Because most of our Vitamin D supply comes from sunlight, there are certain populations that are at risk of deficiency because they convert less sunlight to Vitamin D from their skin.  This includes:

  • Those with darker skin tones.  The increased melanin reduces conversion of sunlight to Vitamin D.
  • Those that don’t expose skin in the sunlight or wear high levels of sunblock all the time.  Clothing and sunblock inhibit the conversion of Vitamin D from sunlight.
  • Those that live in geographies that have less sun exposure.
What are the recommendations for Vitamin D intake?  

The Institute of Medicine (IOM) who puts out the Recommended Daily Allowances (RDAs) for nutrients makes the following recommendations for Vitamin D:

Recommended Dietary Allowance (RDA) for Vitamin D
Set by the Institute of Medicine
Life Stage  Age  Males
mcg/day (IU/day)
Females
mcg/day (IU/day)
Infants 0-6 months 400 IU (AI) 400 IU (AI)
Infants 6-12 months 400 IU (AI) 400 IU (AI)
Children 1-3 years 600 IU 600 IU
Children 4-8 years 600 IU 600 IU
Children 9-13 years 600 IU 600 IU
Adolescents 14-18 years 600 IU 600 IU
Adults 19-50 years 600 IU 600 IU
Adults 51-70 years 600 IU 600 IU
Adults 71 years and older 800 IU 800 IU
Pregnancy all ages 600 IU
Breast-feeding all ages 600 IU

Credit: Linus Pauling Institute on Micronutrients 

The IOM also set the tolerable Upper Limits for Children 9 years and older at 4,000 IU/ day to prevent any toxicity from over consumption of Vitamin D.  It’s important to keep in mind that these are conservative recommendations based only on the IOM’s review of the research related to optimum bone health.  Many other experts are now recommending increased intake of vitamin D in light of new research linking increased Vitamin D status to lower risk of certain chronic diseases and based on data from a NHANES study showing that about 30% of Americans are Vitamin D deficient or at risk of being deficient according to IOM serum Vitamin D levels for optimum bone health.  I personally was tested two years ago and was severely deficient as well.  In order also project against some chronic diseases, some experts such as the Vitamin D Council are now recommending as much as 5,000 IU/day for adults.

SO WHAT DO I RECOMMEND?

I think it’s still too early to be recommending everyone to start taking high dose Vitamin D supplements to protect against various chronic diseases, however, there is promising research for additional benefits with increased Vitamin D coupled with the fact that many Americans are in fact not getting enough Vitamin D from sunlight or the diet so I would recommend the following to increase your intake of Vitamin D:

  1. Get tested.  Testing your Vitamin D level is a simple blood test and especially if your insurance covers it, I would recommend it.  That will give you a basis on how much Vitamin D supplements, if any you really need.  There are also tests you can do at home with a simple blood pinch that are fairly inexpensive with decent accuracy to give you some idea of your Vitamin D levels.
  2. Try consuming more Vitamin D rich foods from your diet.  Natural is ALWAYS better so make sure you’re including enough milk, salmon, and other fortified foods in your diet to help increase your Vitamin D intake.
  3. Try to expose enough skin (arms and/or legs) to at least 5-15 minutes of sunlight twice a day.  That amount of time without sunblock should provide you with more than enough Vitamin D while still minimizing risk to harmful side effects of sun exposure.  Additional plus is that you can’t get Vitamin D toxicity from Vitamin D synthesized from sunlight, only from too much supplement or intake from the diet.
  4. If you do wish to take supplements, or if your doctor recommends it, make sure you take Vitamin  D3 over D2 which research indicates may be up to three times more potent.

After I finished my prescription dose of Vitamin D to get me back to a healthy blood level,  my doctor recommends to get between 1,000- 2,000 IU/ day so I eat fortified foods and take a 1,000 IU supplement daily.  That recommendation is based on the fact that I don’t get much sun exposure living in Seattle, have darker skin, and that my levels were low.  So before you start popping 1,000 IU or 2,000 IU Vitamin D supplements per day, I would recommend you get your levels tested and try moderate sun exposure and diet before you choose supplements.  That will prevent any potential toxicity from too much Vitamin D intake and will save you money…and who doesn’t need to save money right?

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Nutrition Fact: Not All Calories are Equal, Especially Liquid Calories.

Why liquid calories are different… 

Ever heard that a calorie is a calorie and that weight loss/gain is simply a matter of calories in versus calories out?  Well, while that theoretically is true, the reality is that our bodies process calories from different sources differently, and liquid calories are no exception.  The mechanisms for controlling thirst and hunger differ in our bodies.  So while liquid calories may quench our thirst, they do very little when it comes to curbing our hunger.

One of the reasons liquid calories act differently is because they travel faster through our intestinal tract which affects the nutrient absorption rate leading to altered effects on satiety hormones.  What does this mean?  Basically that 100 calories from a soda will not curb your hunger as well as 100 calories from something like an apple or other solid foods in general.

Ok but why is this important?

  1. Liquid calories add up fast and don’t keep you full! A 12 oz of cola contains 140 calories; A 12 oz. latte made with whole milk contains 180 calories; 16 oz. ice cream milkshake has 625 calories. But because they don’t provide the same satiety as solid calories, you usually just end up consuming more calories than you need. (Remember that every 3,500 calories eaten above your needs = 1 pound of fat gained)
  2. Liquid calories can lead to increased weight gain.  A recent Harvard Nurse’s Health study of more than 50,000 women over eight years found that those who increased their intake of sugar-sweetened beverages, such as sodas or fruit punch, from one per week to one or more per day consumed an average of 358 extra calories per day and gained a significant amount of weight. And vice versa, the women who reduced their intake cut their calories by an average of 319 and gained less weight.
  3. Most liquid calories are high in sugar!  

    Drinks

    Estimated Sugar Content

    Soda (8 oz) 22 g
    Fruit Smoothie (10 oz) 34-50 g
    Sports Drinks (8 oz) 7g
    Fruit Juice (8 oz) 24 g
    Energy Drinks (12 oz) 42 g

I know when you’re working all day or on the go, you need something sweet and caffeinated right?  Grabbing a latte or soda is just the easy thing to do.  But if you want to avoid liquid calories creeping up on you, here’s a few ideas for healthy alternatives or substitutions to try in situations like that:

  • Instead of soda, try sparkling water and squeeze a slice of lemon, lime, an orange, or even add a hint of fruit juice for a lower calorie, less sugar sweet alternative.  Added bonus, sparkling water does not contain phosphoric acid like most sodas which is bad for your bones.  
  • Instead of a normal latte, use soy or non-fat milk instead for a lower calorie drink or just coffee or tea and go easy on the sugar or sweetener.  
  • If you like drinking alcoholic cocktails, try ordering a glass of wine or lite beer instead for a lower calorie alcoholic beverage
  • When it comes to smoothies, just order the smallest portion to keep calories under control.  Usually smoothies come in 16oz servings or more so go for the half portions.  
  • And remember, water is always your best option to quench your thirst.  Your body needs 8-10 glasses a day!  

So next time you’re debating whether that drink is worth it, think twice before you drink those liquid calories =)

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