Thursday, June 17, 2010

Sunshine of Your Love Part 4: Supplementation

Okay after a brief hiatus, now for the another installment of our vitamin D saga.  If you missed parts 1-3, please check them out:
Our conclusions were:
  • Go natural with the sunscreen--it pays to look into the ingredients just as you do your food.  If you don't want to eat chemicals, don't put them on your skin either.  
  • Regular sun exposure up to pink gets you the vitamin D you need.  BUT it is HIGHLY unlikely that you can get all the vitamin D you need from the sun alone.  
  • Why?  Because geographical location, time of year, time of day, duration of exposure, age, and skin color all must be in perfect alignment for you to meet your requirements.  And you must be as close to the Full Monty as possible--sorry, naked hands and face are NOT going to cut it.  AND you can't bathe or wash it off for at least an hour (some reports say up to 48 hours! See Dr. Mercola) after exposure to absorb it from the surface of your skin.  
    • Bottom line: I would love for more people to get some sun exposure if they safely can.  There is a LOT more to gain from regular sunning than just vitamin D--like photoproducts we hardy know anything about for one (read newly released The Vitamin D Solution by Michael Holick, one of the Vitamin D Council doctors).  Unfortunately, it is also a reality that most of us find it difficult (perchance even impossible) to get outside as much as we should to meet our vitamin D requirements.    
  • What are the requirements?  50-80 ng/ML of 25(OH)D in your blood according to the Vitamin D Council.  Keep reading for other recommendations given below.  
  • And NO, you can't get all the vitamin D you need from whole food sources since those with the highest concentrations still only have a drop in the bucket, and you probably don't want to eat fish at every single meal.  
  • NO, fortified foods aren't the answer either because they are processed and we are trying to move away from laboratory creations to eat real food again, you know: plants and animals.  
  • Oh and still eating grains, other refined carbohydrates, and sugar?  Clean up your diet first.  Grains, especially wheat, contain nasties that muck up absorption.  Gluten gets its sticky hands all over nutrient, vitamin, and mineral absorption.  To add insult to injury, carbohydrate overload makes you store fat, which stores more of your vitamin D (fat-soluble, remember?) than it allows to circulate AND since you are in storage mode, you can't use that vitamin D because you aren't using your fat (NO you are NOT feeling the burn) (ref: Health Correlator).  Therefore, getting your vitamin D in check if you are a refined carbohydrate- or sugar-eater requires a heck of a lot more finagling.   
So if we can't meet our vitamin D needs from the sun alone or from food alone, what are we left with?  Supplementation (or as Dr. Harris from PaNu likes to call it: replacement, since we are just trying to get it back up to where it should be from the significant portion of our evolutionary past spent in the sun).

Here is a cute video from those fantastic Paleo in a Nutshell peeps over at Pay Now, Live Later.  Great summary of the sunshine topic thus far in our quest:

Vitamin D from Supplementation

Here are the guidelines:

1.  Take vitamin D as a liquid or gel/liquid capsule.  The tablets do NOT work unless you have them with fat.  Keep that liquid refrigerated to avoid oxidation (gel caps probably don't need to be, but I wouldn't leave them out in warm places or in clear containers, just in case).

2.  Take vitamin D3 from an animal source (usually fish or wool (lanolin)) NOT vitamin D2 from plants (it is NOT the same and is much less efficiently processed in your body).  You want cholecaliferol, which is also the form your skin makes naturally.  Nerdy interlude: The animal source for vitamin D3 is often wool since fur or feathers make animal vitamin D just as our skin does for us.  Furred and feathered animals get their vitamin D from grooming.  Unlike them, we don't have to lick our skin to ingest our vitamin D (but I guess you could...mmmnnn salty); we simply absorb it if we don't bathe or swim for at least an hour after sun exposure, if not more (try up to 48 hours more recommended by some sources, like Dr. Mercola).  Bring on the funk!

3. Do NOT rely on fish oil for your vitamin D unless it specifically says it contains vitamin D and even then, there is some controversy (ex. vitamin A toxicity with high dosage).  Read What about cod liver oil? in an upcoming installment.

4.  Do NOT compromise with additives.  Check ingredients so you don't sell your soul to get your D along with grain or soy or unpronounceable chemicals.

5.  Get the dosage YOU need.  How do you find this?  Get TESTED (We'll tackle how and where to get tested in another installment--it deserves its own time in the sun).  For now, I'd stick with the Vitamin D Council's suggestion to start supplementing if your sun exposure is inadequate and then test your vitamin D levels in two to three months.  For more details: read What We Recommend at the bottom of the linked page on the Vitamin D Council website.  If you do know your current vitamin D level and need to raise it, keep in mind that about 1,000 IU of D3 supplement for 3-4 months will raise your ng/mL count by 10.  Check out the information below on recommended levels and supplementation amounts.

6.  Take your vitamin D on schedule.  Most sources advise morning or daytime supplementation so that you aren't kept awake at night.  You can choose to take a large dose every other day or a daily dose, but I have seen some mixed reviews on the megadose-once-a-week plan.  It is skirting with toxicity (we'll delve into that another day).  To be safe, NEVER take more than 10,000 IU a day for any prolonged period.  For me, I like the routine of having my vitamin D with my morning fish oil--I'd probably forget if it wasn't ritual.

Dosing the D

Dosage recommendations vary and most advisors would rather you use a combination of sun, food, and supplementation/replacement.  If you have darker skin, you need to supplement (see this recent Journal of Nutrition article).  NOTE: it takes a good few weeks to months for supplementation to have its maximum effect on your blood levels of 25(OH)D--that is how vitamin D levels are measured--so be patient and, again, get TESTED and RETESTED.

NOTE: Some people are hypersensitive to vitamin D, but full blown toxicity cases are rare if you stick to supplementation guidelines.  Read what the Vitamin D Council has to say about toxicity and hypersensitivity here.

From the literature, it seems that instead of being overly concerned about toxicity, we should be more concerned about deficiency because it is so rampant.  Think that might be overly dramatic?  Try nearly 3 out of every 4 adolescents and adults in the US and nearly all non-Hispanic blacks and Mexican-Americans according to a report published in the Archives of Internal Medicine on data collections from 1988-2004.  Unfortunately, a big contributor to our deficiency is the inadequacy of our medical standards.  A growing consensus in the medical community has deemed the standards for vitamin D intake and blood levels epically inadequate for most people.  Here is the standard right now:
  • Dietary Supplement Fact Sheet: Vitamin D from the Office of Dietary Supplements and National Institutes of Health (our current medical standards):
    • Dosage: 200 IU for children to age 50, 400 IU for ages 51-70, and 600 IU for ages 71+ with a safe upper limit of 2,000 IU for adults (1,000 IU for infants)
    • Blood levels of 25(OH)D: less than or equal to 15 ng/mL is "adequate" but less than 10-15 ng/mL is considered "inadequate" and greater than 200 ng/mL is "potentially toxic"  
    • Testing: Testing?  Um, didn't find this even mentioned.  
And here is what some influential dissenters recommend (numbers given are for adults unless stated otherwise):
  • Vitamin D Council
    • Dosage: 5,000 IU a day for 2-3 months if you don't get regular sun
    • Blood levels of 25(OH)D: 50-80 ng/mL is optimal 
    • Testing: after 2-3 months of supplementation
  • Marks Daily Apple
    • Dosage: 4,000 IU a day to supplement (if you can't get adequate sun)
    • Blood levels of 25(OH)D: 50-60 ng/mL levels recommended
    • Testing: before supplementation and again in two months
  • The Heart Scan Blog
    • Dosage: 6,000 IU a day for most people (because you likely can NOT get your D from the sun, especially if you are over 40 years old)
    • Blood levels of 25(OH)D: 60-70 ng/mL levels are optimal 
    • Testing: every six months (summer and winter)
  • Animal Pharm (and Track Your Plaque):
    • Dosage: 2,000 to 10,000 IU daily (in the morning or daytime) (Track Your Plaque more specifically states: typically 4,000-5,000 for females, 5,000-6,000 for males but a range of 1,000-24,000 depending upon blood levels)
    • Blood levels of 25(OH)D: 60-70 ng/mL goal 
    • Testing: every six months of 25(OH)D (vitamin D), calcium, magnesium, and parathyroid hormone once optimal levels are reached (summer and winter testing)
  • Dr. Mercola:
    • Dosage: 5,000 IU daily but only after you've ruled out his preferred source: sun exposure 
    • Blood levels of 25(OH)D: 50-70 ng/mL ideally
    • Testing: before you begin and at regular intervals once supplementing 
  • Dr. Miller, Cardiac Surgeon and Professor of Surgery:
    • Dosage: 5,000 IU a day without sun exposure
    • Blood levels of 25(OH)D: 50-99 ng/mL
    • Testing: unclear frequency but especially if mixing high supplementation levels with sun exposure
  • PaNu:
    • Dosage: 4,000 IU daily in general, but see the quote that follows for more specificity
    • Blood levels of 25(OH)D: above 50 ng/mL is optimal
    • Testing: at least yearly and both vitamin D and ionized calcium should be measured
Ideally, get your 25(OH)D level and ionized calcium measured, and if it is less than 40 ng/ml, take 8000 iu/day for two months and measure it again. If  40-50, take 6000 iu/day. Any day you get full-dose sun, skip the oral dose. If still below 50 ng/ml, add 2000 iu/day with each two month increment until your interval two month reading is above 50 ng/ml. Once you are stabilized above 50ng/ml, check your levels annually
A Little More Conservative:
    • Weston A. Price Foundation (see specific references listed at the end of this post): 
      • Dosage: 1,000-2,000 IU cod liver oil to supplement vitamin D from other sources (sun and food)
      • Blood levels of 25(OH)D: 40-50 ng/mL is optimal     
      • Testing: seasonally if possible, especially if getting large dosages from any sources 
    • Primal Wisdom:
      • Blood levels of 25(OH)D: 40-60 ng/mL instead of higher levels (click on the link for his cautions)
    • Dr. Weil, MD, Arizona Center of Integrative Medicine 
      • Dosage: 2,000 IU daily and most people need to supplement
      • Blood levels of 25(OH)D: 30-74 ng/mL
      • Testing: not stressed
    This is NOT medical advice to take vitamin D or any other supplements.  Consult your doctor (and try to educate him/her with this information), do some research, get tested, and formulate your OWN plan.

    In addition to all the references already cited, here are some more specific ones from the Weston A. Price Foundation:
    From Seafood to Sunshine: A New Understanding of Vitamin D Safety

    And two more excellent resources:
    Gibson Research Corporation's Vitamin D collection
    SpectraCell Laboratories links to Vitamin D journal articles

    Stay tuned for more yet to come on the Big D!  Here is the next installment:
    Sunshine of Your Love Part 5: Toxicity


    1. What a wonderful summary! I've just added your blog to my short list of paleo blogs worth visiting.

    2. Thanks, Don! I appreciate it! I love your blog as an excellent resource for all things paleo. Keep it up!

    3. Kristy,

      Phenomenal multi-part series on vitamin D! I've been planning a post of my own, but there's just way too many already-done posts and awesome resources like yours. What I WILL do is a compilation of where-to-go for vitamin D info---and your series will be first and foremost.

      Well Done!

    4. Thanks, Mike! You are awesome! I can't wait to read your compilation! Feel free to post the link here so my readers can find it too. Thanks!

    5. Great information...supplementation is something I always MEAN to do and I last for a little while before the habit drops off. I need to start setting out my vitamin D and fish oil on the counter so it becomes part of my morning ritual. Thanks for sharing!