Wednesday, June 30, 2010

Sunshine of Your Love Part 6: Multitasking Your Needs

Doesn't this fish just look inquisitive?  That or hungry...

Today, we further delve into the intricacies of vitamin D by answering the question: Can you meet multiple needs through one source?  

If you remember from our previous installments, vitamin D can be had from different sources:
  • the sun
  • food (especially fish), and
  • supplementation
Supplementation is a slippery slope.  First, we tell you NOT to ingest processed foods, and THEN we say that our current nutritional milleau is insufficient to meet our needs, even if we eat whole foods.  So we are left with a conundrum: eat whole foods and risk deficiencies or eat whole foods and add supplements to meet our evolutionarily-derived needs.

One example of our need for supplementation is with omega-3 fatty acids.  Our ancestors had whole foods raised naturally on unpolluted, richly fertilized earth.  Whole foods of that caliber are increasingly hard to come by and in our modern world you can bet on oil being part of the process, whether to fertilize that soil, process the goods, or transport them.  Our plants and animals are entirely different beings than those we evolved upon.  We've domesticated plants into sugar factories, animals into fat (and thereby fat soluble toxin) delivery systems, and we stripe our foods of their nutrients during processing.  The problem (besides all that reliance on oil, a very finite natural resource) is that our bodies haven't caught up with modernity yet.  They still need a lot of what we can't naturally give them.  One of those things is omega-3 fatty acids.  We thrive on having our omega-3s about equal with our omega-6 fatty acids.  The problem is that while omega-6 fatty acids have become more and more ubiquitous as we consume nuts, seeds, and their oils and processed, grain-fed meats daily, the same can't be said for omega-3s that reside mostly in fish and meat from animals raised as if they were wild.  And even if we only consume the right meats, most of us thrive when given even more omega-3 fatty acids (but the same can NOT be said of omega-6 fatty acids, despite the fact that they are also essential).  So we supplement our omega-3 fatty acids with fish oil, thereby reducing systemic inflammation, improving our heart health, and accelerating recovery to exercise and the rigors of modern life (ex. stress).

The same story exists for vitamin D.  While our equatorial ancestors had no problem getting the sun they needed to produce their vitamin D, we mucked up the process by moving to places not really fit for our skin color, staying inside, covering up, and bathing too much and now most of us don't see midday sun anywhere near the duration we need to get the vitamin D we need from the sun alone.  Most of us can't meet our vitamin D needs from the sun alone, year round.  Okay, so we can eat fortified foods and whole foods that are sources of vitamin D, you say.  That makes two more problems: 1) fortified foods are processed and often don't contain the animal-based vitamin D3 we need and 2) even the whole food sources of vitamin D are a drop in the bucket to meet our needs.  We can't meet our vitamin D needs from food alone.  So what's left? Supplementation or replacement to get the vitamin D we need to thrive.  What are our options?  Well, we can take vitamin D3 gel caps, tablets along with fat, or in liquid form.

Another option exists.  We know we need fish oil for omega-3 supplementation, and we know fish are a good source of vitamin D--so put two and two together and you have the ultimate choice, right?  Not really.  Let me explain.

What About Cod Liver Oil?

Cod liver oil has been named the "Number One Superfood" by the Weston Price Foundation.  Why?  It contains bountiful omega-3 fatty acids, vitamin D, vitamin A (important for vision amongst other things), and small amounts of vitamin K (key in maintenance of bone and blood) in the most concentrated natural source. 

Balancing your fish oil needs with your vitamin D needs is tricky business, especially since those fish oil sources high in vitamin D are also high in vitamin A, which adds another layer to our risk of toxicity.  I love multitasking, but creating a trifecta balance of omega-3, vitamin D, and vitamin A might be more trouble than it is worth.  In fact, cod liver oil has created one heck of a debate in the medical community, polarizing those for and against its use.

Here is the gist of it:

The Vitamin D Council's Dr. Cannell cautioned against cod liver oil since some varieties have such high levels of vitamin A, which can be toxic when you get close to its tolerable upper intake of 10,000 IU for adults (see reference) and leads to birth defects when taken in high dosage by pregnant women.  He contends that our regular diet already generates our vitamin A needs through the carotenoids in our diet (brightly colored veggies).  Finally, excess vitamin A messes with the activation of vitamin D, making it less effective because the two compete for each other's function.  Here is his story.  Bottom line:
As the prevalence of vitamin A deficiency in the United States is apparently much lower than the prevalence of subclinical vitamin A toxicity, we cannot recommend cod liver oil for either adults or children. 
The Weston A. Price Foundation has countered that the levels of vitamin A aren't toxic (until closer to 30,000 IU) because of the natural balance between vitamins A and D in natural food sources, like cod liver oil (especially fermented kinds), and it is only when people are deficient in vitamin D that they run the risk of vitamin A toxicity.  Here is their side of the story.  Their recommendations for vitamin A run 2-5 times greater than the US RDA for children, eight times greater for pregnant women, and four times greater for adults, making their recommended dosage equal to the current upper limit of 10,000 IU.  Their rationale (see article for the citations):
While some forms of synthetic vitamin A found in supplements can be toxic at only moderately high doses, fat-soluble vitamin A naturally found in foods like cod liver oil, liver, and butterfat is safe at up to ten times the doses of water-soluble, solidified and emulsified vitamin A found in some supplements that produce toxicity.(1) Additionally, the vitamin D found in cod liver oil and butterfat from pasture-raised animals protects against vitamin A toxicity, and allows one to consume a much higher amount of vitamin A before it becomes toxic.(1-3) 
Furthermore, according to this summary of the controversy, the problem is not with natural sources of cod liver oil that are relatively unprocessed; instead, the problem arises when the oil is processed and the vitamins are added back in at unnaturally potent levels, which can be toxic at high dosage.  

But is even natural cod liver oil safe?  

How Much Do You Need?

To evaluate that, let's do the math.  Here is a handy Whole 9 fish oil calculator that applies Robb Wolf's fish oil recommendations to your personal parameters (body weight and health status) and your fish oil's DHA and EPA stats to generate how much you need to take maintain or improve your health.  It takes less than a minute to find out your personalized dosage.  If you are curious why you need fish oil, read Whole 9's introduction page to the calculator and click on all the links from reputable sources like Robb Wolf, Barry Sears, Poliquin, and Berardi.  The consensus is that you need your fish oil.

However, there are potential side effects as with anything.  The same potential problems from omega-3 supplementation now apply to supplements for omega-3 and vitamin D.  One of these is problems with blood clotting since fish oil naturally thins the blood.  There are precautions not to take fish oil two weeks before surgery and one week after to avoid bleeding complications.  Obviously, don't couple fish oil with blood thinning medication.

Okay, let's play with the calculator and compare some brands to see if they can meet your omega-3 AND vitamin D needs while keeping vitamin A below the National Institutes of Health Tolerable Upper Intake Level of 10,000 IU (yeah, I know, some say it can go much higher, but I'll take the conservative road on this one).  For your vitamin D goals, let's say you don't get outside much and want to follow the 5,000 IU a day for 2-3 months recommendation of the Vitamin D Council.  For your omega-3 needs, let's calculate for a 200lb individual (the default of the calculator) and a 140lb individual using the modifier for "Healthy: Training smart, sleeping well, eating no sugars, grains, dairy or legumes" (i.e. paleo-eaters) (NOTE: if you aren't fully paleo or if you are injured/recovering from an injury, the dosage will be even higher).  Here are some results:

Nordic Naturals Omega-3D Liquid (their product with the highest omega-3 concentration):
EPA: 825 mg
DHA: 550 mg
D3: 1,000 IU
Vitamin A: none
Minimum dosage for Healthy 200lb paleo-eaters: 7 tsp/day; for 140lb paleo-eaters: 5 tsp/day
Conclusion?  EXCEEDS our optimal vitamin D for 200lb paleo-eaters by 2000 IU but MEETS the needs for 140lb-er

Nordic Naturals Arctic-D Cod Liver Oil
EPA: 410 mg
DHA: 625 mg
Vitamin A: 650–1500 IU
Vitamin D: 1000 IU
Minimum dosage for Healthy 200lb paleo-eaters: 10 tsp/day; for 140lb paleo-eaters: 7 tsp/day
Conclusion?  EXCEEDS our optimal vitamin D for both weight classes (by 5000 IU and 2000 IU respectively) and vitamin A for 200lb-ers (by 5000 IU, using the highest possible vitamin A)

Carlson's Cod Liver Oil with Low Vitamin A
EPA: 110 mg
DHA: 110 mg
Vitamin A: 250 IU
Vitamin D: 100 IU
Minimum dosage for Healthy 200lb paleo-eaters: 45 pills/day; for 140lb paleo-eaters: 32 pills/day
Conclusion?  DOESN'T MEET our optimal vitamin D for either weight class (totals: 4500 and 3200 respectively) and EXCEEDS the upper limit of vitamin A for 200lb-ers (by 1250 IU), and that is a metric crap-ton of pills to take in a day!

EPA: 500-590 mg
DHA: 400-500 mg
Vitamin A: 800-1200 IU
Vitamin D: 2000 IU
Minimum dosage for Healthy 200lb paleo-eaters: 11 tsp/day; for 140lb paleo-eaters: 8 tsp/day
Conclusion?  EXCEEDS the optimal vitamin D for both weight classes (by 17000 IU and 11000 IU respectively--Yikes!) and vitamin A for 200lb-ers (by 3200 IU, using the highest possible vitamin A)

Dr. Ron's Blue Ice Fermented Cod Liver Oil (recommended by the Weston A. Price Foundation as one of the best cod liver oil sources) 
EPA: 150 mg
DHA: 100 mg
Vitamin A: 2500 IU
Vitamin D: 250 IU
Minimum dosage for Healthy 200lb paleo-eaters: 40 pills/day; for 140lb paleo-eaters: 28 pills/day
Conclusion?  EXCEEDS the optimal vitamin D (by 5000 IU and 2000 IU respectively) and vitamin A for both weight classes (by 90,000 IU and 60,000 IU respectively)--OMG!

Looking at the ingredient labels of the other recommended brands shows the same results: too high vitamin A and vitamin D while much too low omega-3, at least according to our calculator.  According to the Weston Price Foundation, cofactors in cod liver oil increase the uptake and usage of vitamins A and D so it's more potent than other sources and you don't have to take as much to get the same results.  That still leaves out omega-3 fatty acids, though, and leads to greater potential for toxicity by the already high levels of vitamins A and D.  Perhaps you don't need as much supplemental omega-3 when your diet is full of pastured, wild-caught, grass-fed animals and fish.  Perhaps you can take some supplemental vitamin A in your diet without adverse side effects.  Perhaps, perhaps, perhaps...  To me, it's a little too iffy.  

Thus, if you are going to get your vitamin D from cod liver oil, you have to make damn sure the ratio of vitamin A to vitamin D does NOT exceed 10:1 and take into account what dosage you need to meet your vitamin D and omega-3 needs--is the vitamin A at that dosage exceeding the tolerable upper intake of 10,000 IU for adults?  Remember, if you are eating plenty of brightly colored veggies, eggs, occasional liver, and good sources of meat and fish, you are likely meeting your vitamin A needs, so keep it's level by supplement as low as possible.  

Bottom line: If you are going to multitask your omega-3 and vitamin D needs, you just might be jumping into the deep end of the pool without your water wings.  

Next up, let's discuss more about supplementation sources:
Sunshine of Your Love Part 7: Supplementation Source

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, and formulate your OWN plan.

Tuesday, June 22, 2010

Sunshine of Your Love Part 5: Toxicity

 Image courtesy of wikipedia
In fact, living in America today while worrying about vitamin D toxicity is like dying of thirst in the desert while worrying about drowning. --Dr. Cannell, The Vitamin D Council

Read The Whole Series:

What about toxicity?

Have you heard the stories?  They are pretty scary.  Bones dissolve, people pass painful kidney stones, kidneys fail, soft tissues turn to bone--fun stuff!

This fear is why the National Institutes of Health recommends "adequate intake" levels of only 600 IU (from food AND supplement) daily, which "represents a daily intake that is sufficient to maintain bone health and normal calcium metabolism in healthy people."  Their recommended blood level of 25(OH)D of only 15 ng/mL is "generally considered adequate for bone and overall health in healthy individuals."  Their established "tolerable upper intake level" is 2,000 IU (which is LESS than a bunch of us take each day in supplement!) saying "long-term intakes above the UL increase the risk of adverse health effects." However, short-term high dosages of up to 50,000 IU per week for eight weeks are considered safe.  In short, they are VERY concerned about toxicity.

Compare those conservative recommendations with the Vitamin D Council's for 5,000 IU daily for two to three months (if sunlight exposure is inadequate) before testing 25(OH)D levels to achieve a 50-80 ng/mL level year-round.  And the Vitamin D Council is not as concerned about toxicity--hence, the above quote.

What should we believe?  Is the government's conservatism warranted?  Well, in their favor: there isn't much evidence that high dosages (greater than 10,000 IU daily) are safe for prolonged periods of time, so you probably don't want to exceed that number by supplementation.  However, if you get some sun, you likely WILL exceed that number since your skin can make the equivalent to ingesting 10,000 IU in less than an hour (I know, I know, it all depends on age, skin color, latitude, time of day, etc.--but you get the picture).  Another however: your skin has a turn off valve once it reaches enough vitamin D (about 20,000 IU): the UV starts to degrade the vitamin D, never allowing overproduction.  Neat huh?

Unfortunately, we don't have the same turn off value internally when we ingest vitamin D, so there is a potential risk of toxicity.  BUT there is another however: there isn't much evidence that levels up 10,000 IU daily are harmful.  There is little to no basis for that 2,000 IU upper limit.  This literature review from 1999 in the American Journal of Clinical Nutrition concludes that there is very little data on moderate dose toxicity and NO data on 10k IU dosage being toxic.  Okay, so that is ten years old.  Let's look more recently.   

How about 2009?  This journal article published in the Annals of Epidemiology reports that prolonged 10k IU dosage is safe, up to a blood level of 25(OH)D of 88 ng/mL.

More specifically, the "lowest observed adverse effect level" (the upper, upper limit) currently set at 4,000 IU by medical standards is safe to use long-term, according to Vieth, author of the 1999 review and coauthor of this commentary in the Canadian Medical Association Journal from 2002.  Hypercalcemia (see next section), the symptom of toxicity, has only been shown to rear its bony head at blood concentrations of 25(OH)D in excess of 150 ng/mL, so the current upper limit of 100 ng/mL is safe, as concluded by a 2008 article in the American Journal of Clinical Nutrition.  

This gives us a few options:
  1. If you don't get adequate sun daily, you might want to think about supplementing, but keep it below 10,000 IU a day.  This is great for the winter too.  Best bet: Get Tested!
  2. If you do get some good sun, reduce your supplementation on those days or the days following exposure (vitamin D sticks around up to three weeks in your body). 
  3. If you regularly get some sun, but not enough, supplement on the conservative side and get tested to figure out how to reach your goals.  
  4. If you really think you get enough sun to meet your needs, get tested to confirm that.  Remember, it is highly unlikely even in the sunshine state!
What is hypercalcemia?

Hypercalcemia, or elevated calcium levels, is the first sign of too much vitamin D.  If you remember from our last installment, some recommendations were to test calcium along with vitamin D since the two go hand in hand (vitamin D regulates calcium levels).  There are other cofactors involved with vitamin D levels too, but calcium seems to be a runaway train once vitamin D levels get too high.  Since calcium is involved in bone growth and repair, too much spells overgrowth of bone and calcification of soft tissues (yeah, just like it sounds: they harden like bone).  Primal Wisdom's Don Matesz shares a personal experience of one of his patients with a salivary stone that went away once he reduced the patient's vitamin D supplementation and treated her with Eastern Medicine (herbs and acupuncture).

So how do you know you are skirting toxic waters with vitamin D supplementation?  There is a cute pneumonic for symptoms of hypercalcemia:
  • moans (nausea, vomiting, anorexia, weight loss, constipation, abdominal pain, etc.) 
  • stones (ex. kidney stones) 
  • groans (sometimes called psychic groans for memory problems, confusion, fatigue, weakness, etc.)
  • bones (bone pain, arthritis, osteoporosis, etc.)  
For more about hypercalcemia, read this article from the American Academy of Family Physicians.

How likely is toxicity?

The Vitamin D Council downplays toxicity concerns citing lack of evidence for high dosage health concerns beyond some questionable research, plant-based D2 toxicity (which is not the same as animal-based D3), and an overdose on mislabeled high dosage pills.  They point the finger at vitamin D hypersensitivity usually due to underlying conditions like hyperparathyroidism (the primary cause of hypercalcemia), some cancers, sarcoidosis, granulomatous tuberculosis, kidney disorders, and lymphoma.  If you have any of these conditions, DO NOT supplement your vitamin D without medical supervision.

Since the sun supplies us with 10,000 IU of vitamin D after a half hour of optimal exposure, it seems to follow that we can safely take up to that amount by supplement.  Heavy supplementation coupled with sun exposure could run the risk of toxicity, but according to the Vitamin D Council, this has never been reported yet.  

This article from the Weston A. Price Foundation does some good de-bunking even of their own contributing author's conservative recommendation not to exceed 800 IU of vitamin D a day from all sources without testing and medical supervision.  Their official recommendation (1-2,000 IU a day for 40-50 ng/mL levels) ends up a little less conservative than hers, but still more conservative than that of the Vitamin D Council.  More than any set-in-stone numbers to live by, they recommend you eat whole foods to keep your vitamins A, D, and K in balance.  Vitamin D toxicity is merely a relative deficiency in vitamins A and K.  We'll delve deeper into the Weston A. Price Foundation recommendations when we discuss cod liver oil in a future installment.  Stay tuned!

Primal Wisdom adds an interesting warning specific to those off the grains.  Author Don Matesz cautions those on a gluten-free diet that vitamin D might be better absorbed without gluten mucking up the process, so calcification is a potential problem for some, like his patient with the salivary stone.  There is also a connection with magnesium (surveys have shown that most Americans are only meeting half of the RDA for magnesium, while paleo dieters might be meeting their needs).  Low magnesium intake spells bone breakdown and reduces levels of activated vitamin D.  Matesz concludes:
This would mean that people who do not get adequate magnesium would show signs of vitamin D deficiency despite adequate sun exposure or vitamin D intake.  Conversely, people who consume more magnesium-rich foods, such as my paleo-dieting patient, require less vitamin D, and may more easily suffer from vitamin D excess. 
Thus, he more conservatively recommends for paleo dieters 25(OH)D levels of 40-60 ng/mL instead of 50+ as advised by the Vitamin D Council.  Magnesium is definitely a topic for another day!  

As the Weston A. Price Foundation and Primal Wisdom show, there are also some important cofactor interactions here with vitamins A, K, and minerals like zinc, magnesium, calcium, and phosphorus, so do your homework to make your OWN choices.  For more about cofactors, check out this page from the Vitamin D Council.  Most of the websites I reference in this article have tackled the cofactor issue since vitamin D does NOT exist in a vacuum and has many other interactions that are worth taking into account and researching.  But that, my friends, is a topic for another day :)

As is multitasking your fish oil and vitamin D needs through cod liver oil.
Keep reading here:

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, and formulate your OWN plan.

References in addition to those cited above:
Wikipedia entries on Vitamin D and hypercalcemia

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

    Tuesday, June 1, 2010

    Roasted Garlic Pesto

    And your bonus for being such a good listener?  A recipe!  

    Today's treat is a recipe (Finally!  I know, I talk/write way too much, but you should see me in person--I'm quiet, really!).  I made the most awesomely delicious pesto known to man.  I know, you are groaning, "Not another pesto recipe!  Dude, everybody has their own pesto recipe!"  Well, that is what you might think and if you leave now, your loss.  Seriously.  THIS pesto is worth the read and try.  And why is pesto related to our vitamin D post?  Just Because.  No, actually I'll serve it on shrimp and salmon, which if you remember, are good animals sources of vitamin D (although they will NEVER meet your vitamin D needs alone).

    Method to the Madness: Roasting

    The Garlic:  From America's Test Kitchen/Cooks Illustrated, I learned that roasted garlic tastes yummier than raw garlic in pesto.  It just adds a nuttier, richer, and less sharp, strong taste.  Since I have been buying the pre-peeled, packaged garlic (yes, convenience has done me in, just shoot me now!), I used that and roasted it in aluminum foil as I have seen other cooks do.  Don't worry, I'll go over this in the recipe.  If you have unpeeled garlic, try the America's Test Kitchen method of toasting it in a naked skillet over medium or low heat til just browning, not burning, on the outside.  If you have chopped/minced garlic, perhaps you can toast it in a skillet with some olive oil.  Whatever your method, we are after roasted garlic.  That makes all the difference here.

    The Nuts:  I roast my nuts ALL the time ;)  So this application is no different.  It makes them more digestible than raw, but if you still have trouble with nuts (not an allergy, just upset digestion), try soaking and then roasting your nuts.  If you have an allergy, well, it sucks to be you.

    The Basil:  Okay, this isn't roasted, but it has a method too.  I have read that bruised basil releases more flavorful oils than simply cutting it because more cells are ruptured to release their aromatic oils.  I suspect, but have yet to confirm, that cell processes are at work recruiting more liquid to the areas under duress, so more oil is released than during a quick chop.  Bruising herbs and letting them sit for a few minutes until you use them seems like it would lend itself to more flavor.  So I tried that with success.  Just be sure to use your bruised basil because it will not store this way.

    Roasted Garlic Pesto
    What can be more versatile than a rich, roasted garlic-infused pesto spreadable on any flat surface, pair-able with any meat, and dip-able by an array of veggies?  This classic pesto is a refrigerator staple!

    Cooking Time: zero to pesto in 15 minutes or less

    Quantity Achieved: about 1 to 1.5 cups (more is possible if you use more greens or oil)

    Storage: air-tight in the refrigerator for about a week or measure out and freeze in muffin tins, then empty frozen pesto hockey pucks into a freezer-safe container and they'll keep for months.  Simply defrost and serve! 

    You can make this with different greens and oils.  Here are two divine variations using the same basic recipe.

    Classic Basil Roasted Garlic Pesto (pictured above)

    • about 2 cups (4oz before de-stemmed) fresh basil (I used the packaged variety since it isn't in season here yet)
    • about 10-12 cloves of garlic (fits in 2T, packed), peeled (if unpeeled or minced/chopped already, read The Garlic section above) (For the peeled, sealed garlic, I used half a garlic packet per batch of pesto)
    • 1/2 cup almonds or another nut of your choice (no, not peanuts, silly)
    • 1/4 cup extra virgin olive oil (the good stuff), more if you desire a creamier consistency, + a little drizzle for the roasted garlic
    • 2T freshly squeezed lemon juice (one pithy lemon or half a juicy one--or use more to taste)
    • kosher salt
    • freshly ground black pepper
    NOTE: No cheese here and you will NOT miss it!


    First, dump your almonds onto one half of a baking sheet and grab a large-ish square of aluminum foil.  Place the unpeeled garlic cloves in the center of the foil, drizzle on a little olive oil, sprinkle a little salt and grind a little pepper on top.  Mix to coat evenly.  Now, take two opposite sides of foil, connect them and bend over the edge.  Continue folding the edge over itself until you have reached the garlic.  Then, take one long side and fold it up and do the same to the other side to form a nice little garlic pouch.  Isn't that cute?  Place the pouch on the other side of the baking sheet from the nuts and place the sheet in a 350 degree oven, preheating doesn't matter.  Set a timer for 5 minutes and check the nuts.

    In the meantime, prepare the basil by rinsing, drying, tearing leaves from large stems (some small stems and buds are fine), and squashing the leaves between your fingers.  Nothing too violent, just enough to bruise it.  Yeah, bruise that basil!  Bruise it good!  Isn't that a nice stress reliever?  Okay, now I am feeling mean.  Respectfully bruise that basil and tell it you'll relish every bite of its gracious contribution to your plate.  There.  Better.  

    Have you checked your nuts?  If your nuts aren't done after 5 minutes, leave them in for another five or less if you feel they're close.  Done for those almonds means slightly more brown and some looking closer to burn, but not there yet.  It is difficult to tell; they never really look all that different to me (brown to more brown isn't very obvious), but I usually wind up getting anxious about burning and notice a fragrant, nutty smell.  They should be hot and start crackling when you take them out of the oven.  I love the sound effects!  So cute!  I err on the side of perhaps not all the way roasted brown, rather than risking burnage, because I too often become it's prey.

    So once your nuts are done, put the foil pouch back in on the rack by itself, it shouldn't fall through unless you were really crazy with your folding.  Let it roast for at least 20 minutes total (don't forget the time it took the nuts to roast or the oven to preheat).  One time I let it go for 45min to an hour,  and that was an utter disaster.  So, now I err on the side of caution and say just roast until soft (you can mash them with a fork).  That varies depending upon your oven, how many times you checked your nuts, and other such unseen variables, so check the pouch (carefully unfold to look inside) after about 20 minutes and see if they are squashable.  If not, seal it back up and continue roasting another five minutes.  Watch the bottoms for browning or burning.  They are tricksy.

    Okay, now we have roasted nuts and roasted garlic.  Awesome.  Your basil is bruised and bleeding, ready to get pulverized.  Let's get this party started!  Add basil, nuts, garlic, lemon juice, and 1/8 cup of extra virgin olive oil to the food processor and pulse to chop a few times, then let 'er whirl.  Scrape down the sides periodically and see how it's going in there.  The sides will probably be a green blur.  Once it is pretty well incorporated, add the remaining 1/8 cup of extra virgin olive oil, process for a good few minutes uninterrupted, then add more oil if desired to make your ideal consistency--for me, I like a thicker, paste-like pesto I can spread, more like hummus.  Others like theirs like soup.  Your choice!

    When you are finished, add salt and pepper to taste.  Go easy with the salt--just a 1/8t to start.  One time I added a whole teaspoon and regretted it instantly.  If you don't use salt all that much, you grow much more sensitive to it!  If you do add too much salt, don't cry.  Just make another batch and now you have enough seasoning for both, or starting adding to the batch you already have.  Try some sun dried tomatoes, roasted bell peppers, more leafy greens, or if you want to be decadent, make Alton Brown's skillet mushrooms and add that.  Never heard of them?  Oh, that is a treat for another day, then!

    Variation:  Arugula Roasted Garlic Pesto (pictured on the salmon below)
    The peppery bite of the arugula pairs really well with the sweet roasted garlic, rich walnut oil, and lemon juice kick.  Delicious!

    Ingredients and Method:
    Same as above except use walnut oil instead of olive oil and 2 cups, packed, fresh baby arugula instead of basil (or in combination).

    Pesto Serving Suggestions:
    Damn near impossible to serve pesto wrong--it goes well on any meat I can think of (pesto bacon would be a neat one to try) and any veggie delivery device like celery or romaine.  Additionally, here are some great ways to make pesto a part of your main dish:

    Classic Basil Roasted Garlic Pesto coated Shrimp
    Pesto Shrimp
    Want to get some vitamin D in the process?  Make a pound of shrimp and add a 1/4 to 1/2 cup of pesto to them  (right after cooking so it is easier to coat them).  Serve warm or cold.  OMG delicious!

    If you don't know how to cook shrimp, here is a little primer for basic shrimp prep.  You can also grill them or saute in garlic, oil, and ginger (fan-freakin'-tastic, but perhaps not best for mixing with this pesto).
    1. Keep the tails on for more flavor, but devein them before cooking.  Rinse them and try to pat dry so they're not sopping wet.
    2. Get a skillet hot, add oil of your choice (for the pesto shrimp, I used olive oil, but I don't cook with it that often--avocado or coconut oil are better for high heat).  Then, add the shrimp.
    3. Here is the tricky part: You have to move FAST.  Get turning those little shrimps as soon as they start to turn pink and curl, which is nearly immediately.  Seriously, move FAST!  Use tongs or a fast-flipping spatula that you don't have to fuss with.  I love to cook shrimp because they are the cook's dream--they have a color changing doneness indicator! They're like little reverse Freezy Freakies (remember those? We'd store ours in the freezer).  Nice to have a clear signal for doneness visible across the room.  But you shouldn't be across the room, should you?  Get flipping!
    4. Once both sides have turned pink, immediately evacuate to a bowl or plate.  Don't wait for them to curl up into a nice little ball--just get them the hell out!  They'll continue cooking out of the pan.  I just make sure I don't see any obvious blue, see-through parts that show they're underdone.  The tails should be pink to red.  Err on underdone; they'll cook more on the plate. 
    5. Once they are out, now's your time to add the pesto.  Mix well to incorporate.
    6. Feast!
    Pesto Salmon with Arugula Roasted Garlic Pesto
    Pesto Salmon
    Want more vitamin D for your buck, how about salmon?  There are a couple ways to do this: 1) broil with pesto on top (might make the pesto a little crunchy on top--could be good or bad), 2) broil halfway, then add pesto for the remainder, or 3) add pesto after the fish is done (you might not want to use cold pesto though).  Either way, broil until just done (it turns opaque from translucent, here is a good description--flaking is too long), then let it rest before serving.  I usually use the toaster oven and it's done in less than 10 minutes.  Great lunch!  If you want to get fancy, you can cook your salmon in a parchment or aluminum foil pouch with pesto on top, like this recipe from Kalyn's Kitchen that should be DELICIOUS with my pesto.  Give it a try!

    Classic Basil Roasted Garlic Pesto smothered Roasted Turkey Breast

    Pesto Roasted Turkey Breast
    Yeah, I know, not really a great vitamin D-giver, but roasted turkey is a staple in this household.  It's super easy to prepare and gives us lunchmeat for a week when I make two at a time.  I buy the split breasts with bone in and skin on and prepare them using pesto rubbed under the skin, over the skin, inside the cavity along the tenderloin, even in slits cut into thick parts.  Basically, I want this turkey to be a pesto delivery system :)  Roast at 425, uncovered for 35-45 minutes (less if small), then check the temperature for 150 degrees (big double batches take up to an hour) and let it rest before diving in.  Makes a great meal or can be refrigerated for a week and served as lunchmeat alone or in salads.  Yum!  Here's my original Roasted Turkey Breast recipe.

    Inspired?  I hope so!  Tell me about your pesto adventures!