Thursday, October 13, 2016

Vitamin D, and what I've learned

There's a lot about vitamin D that I was never fully aware. Most of us know that vitamin D is needed for bone health. But more and more research is pointing to the need for vitamin D in prevention and treatment of depression, as well as possibly relief from some of the pain and fatigue in fibromyalgia, both of which are on my mind these days.

Seattle is a hot spot for vitamin D deficiency. It isn't just that we're well-known for our cloud cover, many days of the year. Some summers, the sun doesn't make its appearance until early July, no joke. But, also, we are way up here, in the far northern corner of PNW USA. Hello, down there, can anybody hear me? The sunlight that we do receive in winter isn't strong enough for our skin's production of vitamin D. Vitamin D screening/testing is becoming commonplace, here, as a result.


The best source of vitamin D is prudent sun exposure. That was the original design. Some of us don't live where adequate sun abounds. For others, use of sunblock is a health necessity. And still for others, skin pigmentation prevents adequate production of vitamin D in the body. Finally, (something I don't relish thinking about), but as we age, our bodies become less efficient at using sun exposure for our vitamin D supply.

So, for those of us needing supplementation, this is what I've learned. (And if you don't know whether you need more vitamin D or not, your medical professional can run a blood test, to check your serum vitamin D levels.)


D2 & D3
There are different types/sources of vitamin D for supplementation. I don't know where D1 comes from, if it still exists, or what it is. But commonly in supplement form, you'll see labels on packages or vitamin bottles with D2 and D3.

D2 is vitamin D made from ergosterol, from fungi and protozoa. Vitamin D3 is made from cholecalciferol, which comes from an animal source (from sheep's wool, I believe). From what I've read, vitamin D3 is more like what our bodies form from sun exposure than vitamin D2. There is some evidence that suggests D3 is taken up by the body more easily than D2. That doesn't mean that D2 is completely useless, though.

There's also a D4 and a D5, but I've never seen either listed on any package label, or referred to as needed for health, in a medical article.

Reading labels
When reading food packages or vitamin bottle labels, check for ergocalciferol and/or cholecalciferol. Vitamin D without a subscript can refer to either D2 or D3, or even both. Together, they are known as calciferol.

While most commercial milk (and many brands of yogurt) is fortified with vitamin D, many other dairy products, such as cheese and ice cream, are not fortified with vitamin D.

Supplement forms of vitamin D Vitamin D as a supplement comes in liquid, gel caps (filled with liquid) and tablet (compressed solids, as in a stand alone vitamin D, or a daily multi-vitamin tablet, containing vitamin D). 

There is also some evidence that vitamin D3 may be taken up via transdermal application (which is very helpful for elderly, who may not receive adequate sun exposure or supplements by mouth). This form is available as a patch, and as a cream.

The digestive system absorbs vitamin D as a liquid or gel cap, more easily than a solid/tablet. Some people have reported, anecdotally, that they feel better on the liquid drops than either gel caps or tablet. My own doctor didn't feel there was any efficacy benefit from the drops vs the gel caps, however.

Vitamin D is fat soluble. That means, it needs fat in the digestive system to absorb it's nutrient value. 
Vitamin D in liquid form is also sold in a preparation of a liquid fat, to be taken regardless of whether you've just eaten some fat or not. This is very beneficial for those individuals who for one reason or another have an extremely limited diet, or can't take much by mouth.

I've read the advice to take vitamin D supplements with your heaviest meal meal of the day. 

The human body benefits from adding Vitamin K, when supplementing vitamin D and calcium. Vitamin K is also a fat-soluble vitamin. There are a few forms of vitamin K. K1 and K2 are the natural sources. K1 is what is found in leafy green vegetables. The human body converts K1 to K2, with, but not limited to, the help of gut flora. Deficiency of vitamin K has been found in individuals with malabsorption issues, due to disease of the digestive system or extensive use of broad spectrum antibiotics.

Vitamin K2 is thought to be the main storage form of vitamin K, in animals. Food source-wise, K2 is found in animal livers and bacteria-fermented foods, including hard cheeses.

It is recommended to get both sources of vitamin K in your diet on a daily basis. Although vitamin K is fat-soluble, it doesn't appear to be stored long-term (like vitamin D), in the body. 

Most of us have heard that vitamin K helps in blood coagulation. It also plays a key role in the body when paired with vitamin D. In a nutshell, if I recall correctly, vitamin D helps the body absorbs calcium, and vitamin K2 helps direct that calcium away from soft tissue (like arteries) and into the bones.

What I've observed with D2. 
Alternative milks, like soy milk and almond milk, are mostly supplemented with vitamin D2, not D3. My guess is that alternative milks are not only market-targeted to those with dietary issues regarding lactose, but also to the vegetarian/vegan share of the market. D2 being from a non-animal source fits with that marketing model. Just something to be aware of, as some experts say that D2 is not taken up as easily by the body as D3.

Vitamin D toxicity from excess supplementation is rare and primarily happens in individuals with specific other medical conditions, such as hyperparathyroidism. But it can still happen. So mega-dosing isn't advised. (Just because a little is good doesn't mean that a lot is better.)

***None of this is to be read as medical advice. These are all things I didn't know about vitamin D until recently. Some of this information may be new to you, and I encourage you to do your own research and consult with your doctor/medical care professional about your nutritional needs. You already know this, but I have to say it -- I am not a medical professional, and I've never played one on TV.

Now, this is what I have chosen to do.
  • I had vitamin D2 in my cabinet when I began this research. Although it is not as available to the body as D3, it's not useless. I didn't want throw it out, of course. But I also didn't want to rely on it as my only source of vitamin D supplementation. So, to use it up (and not have wasted money on something),  I alternated the D2 with D3, every other day. I don't get any vitamin D from animal milk. Even if I tried drinking more milk, with lactose intolerance, it's been suggested that my body wouldn't be able to absorb all the nutrients, anyways, due to a compromised digestive system when I consume milk.
  • I don't eat much fish, either. So, most of my vitamin D needs to come from supplements for most of the year.
  • After finishing my D2, I settled on a liquid form of vitamin D3, in drops, to be taken on my tongue. The drops may be taken up by my body better than other forms. But also, I like them because they're very easy to take, with no extra pills to swallow.
  • I take my vitamin D, twice each day, immediately after eating a spoonful of natural-style peanut butter. or handful of nuts with my breakfast., and right after lunch. I would take vitamin D with dinner (as that's my heaviest meal of the day), but I get so busy and tired at that hour that I forget.
  • I don't count the vitamin D2 that is in the soy milk that I use, daily, towards my RDA for vitamin D.
  • I've added a vitamin K2 supplement to my diet, as I don't eat enough sources of K2 on a regular basis. I do eat plenty of leafy greens, but I also have some nutrient absorption issues, and have taken more than my share of broad spectrum antibiotics, unfortunately.
If you think you need extra vitamin D, this is a good discussion to have with your doctor. Many doctors now routinely test for serum vitamin D levels.

(This is a lot of information. Sorry to have gone on so long.) 

20 comments:

  1. Thank you for sharing your experiences with vitamin d. An acute deficiency was uncovered when I broke my arm. Normal levels start at 25 thru 80. I was at 11. I continue with got d 3 supplements, and constant blood tests to monitor, tweaking aka increasing my doses as needed. I feel significantly better when my levels are higher, especially as regards fatigue. My brother and SIL are pharmacists, both recommend only Nature Made for consistent quality. CVS often has BOGO sales. I pay for these with my Has funds.

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    1. Hi Carol,
      I'm hoping my fatigue begins to diminish as my D levels go up. I'm glad yours have. Good to know about the Nature Made.
      have a great day, Carol!

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  2. I stay on the low end of normal for the vitamin D test range, but my doctor would like it to be higher, so I take over the counter supplements. However, my husband and son are usually low enough that they take prescription D supplements to get to the normal range. I wonder if there is some inheritance working in their situations.

    I want to add, as you said, Vit D should be monitored by your doctor. That's the only way you can know what your levels are. And while it is rare, you can overdose on Vit D because it is a fat souble vitamin. (Meaning you don't pee the extra out like you do with water soluble vitamins.)

    You are so disciplined in taking your vitamin. I have a hard time establishing a habit taking what I need. In fact all of the house stuff has gotten my regular schedules off kilter and I haven't had any supplements for a while. This post is a good reminder for me to get back on track. I need all the energy I can find these days.

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    1. Hi live and learn,
      I wonder, too, about the genetic factor. Definitely, about seeing a doctor. OTC vitamin D now comes in such high doses, that it would be possible to take too much.

      I find that I'm more likely to be consistent with the liquid drops, than the gel caps. One of my daughters does well to have hers in a daily pill box. I guess it's a matter of finding the way that you will most likely be consistent. But then again, your life is rather out of the ordinary, right now. So it's no surprise that consistency is difficult, for the moment.

      Have a great day, live and learn!

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  3. You've done your research! Good for you! I also had to do it several years ago when diagnosed with osteopenia after my DEXA scan. After much tweaking and trying various supplements over the years, I've personally settled on Thorne D drops with K as they are in the right ratio. Also, I supplement with magnesium in an easily-absorbed form, as well as silicon. My last DEXA showed my bones back to "normal", thankfully. I do hike as my primary form of exercise, and where we hike it is often a full-body workout (pulling up on boulders for instance, working the upper arms).

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    1. Hi Cat,
      Thorne Labs comes up time after time for a variety of supplements, when I'm reading. They can be more expensive, but the quality sounds like it's excellent. I'm so glad for you that your bones have returned to a healthy state! That's really great news!

      Have a great day, Cat!

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  4. My Vitamin D levels run low. However, neither my doctor, pharmacist, nor I have been able to find a supplement I can take due to allergies. Even the prescription gels have peanut oil. Has anyone found one that doesn't?

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    1. You might check out the Thorne brand drops I mentioned above. I also have a peanut allergy.

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    2. Hi Busy Bee,
      In addition to checking Thorne Labs, as Cat suggested, have you checked vitamin D patches? They're kind of expensive at $20 for 30 days (5000 IU D3, 200 mcg K2, 250 mg magnesium all in one, through patchmd.com). But vitamin D can be dosed not just daily, but every other day, if the 5000 IUs is too high, and that brings the per day cost of the patch down. Best of luck finding a solution, Busy Bee.

      Have a great day!

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  5. Excellent research, Lili :)

    I don't think I have issues about vitamin D, however I do wonder about calcium supplementation. My OBGYN nurse practitioner long ago advised I take calcium supplements for osteoporosis prevention. But I stopped that since my husband suggested it may not be a good idea hearing that it may encourage plaque formation in vessels. You've mentioned vitamin K2's role in directing calcium away from vessels. I didn't know this, but it makes sense since vitamin K is essential for clotting.

    I know there are challenges to getting sufficient vitamins and minerals, but I think only in very deficit situations is it advisable to supplement. My thoughts are there are hidden catalysts in foods that are not known but are essential for optimum bioavailability of nutrients, likewise, taking too much of one nutrient without the essential catalysts can be harmful in my opinion, and I suspect calcium is one of those nutrients. I think, while getting calcium in green vegetables for example is good (vegetables are good sources of vitamin K), supplementation is bad. Just last week I started taking calcium supplements against my better judgement because I read that calcium and vitamin D might help prevent colon cancer (my latest big fear), and serendipitously I purchased a soon to expire 60 tab bottle for .25 after coupon. But after that bottle, I think I am going to stop.

    Kudos to you for doing your research when you suspect a deficit with a particular nutrient because you are not eating enough foods that are good sources. And thank you for sharing your research.

    Have a great day!!

    YHF

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    1. Ha...I need to do my research on vitamin K2. Thanks for pointing this vitamin out, I am not understanding the difference with K1, but I see there is. Is it really an "essential" vitamin, that your body cannot produce?

      YHF

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    2. Hi YHF,
      Your body converts K1 to K2 using digestive flora, if you don't have any digestion issues. It's the K2 that drives calcium away from arteries, and into the bones. The reason K2 is important with vitamin D, is D makes calcium more available to the body, so more calcium could, in theory, be deposited in the arteries, if it weren't for the K2. This doesn't appear to be a problem with dietary calcium.

      K2 is also found in fermented foods, which you might already eat. Something called natto, a fermented soy product is very high in K2. The other thing that you, in particular, have going for you is you eat a lot of fish. You should be getting some vitamin D in the fatty fish. The best way to know, though is to have your D levels checked with your blood work. Many doctors are already doing this, routinely, in my area. Just something to look at on your lab report the next time you have an appointment, and if it isn't routine, there, maybe talk with your doctor about whether this testing would be beneficial for you.

      And if you take blood thinners, then taking vitamin K is not advised.

      I agree on foods being the very best sources of our nutrients. It seems that there is always a "new" nutrient, unknown before, that is being discovered in the foods we eat. Taking a bunch of pills, then eating junk, would miss all of those micronutrients.

      Have a great day, YHF!

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    3. Yes, I read about natto being a very good source of Vitamin K2. I pointed it out to my husband since I read it might prevent prostate cancer according to studies. He told me to tell you the best way to eat natto is adding soyu and chopped green onions, mixing well until very slimy (they have fun twirling the beans with their chopsticks), and eating with fresh hot rice. My husband and daughter love that stuff, but I have never tried it. Just the smell and looks of it freaks me out, but I think now for health reasons I'll give it a good try.

      YHF

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    4. YHF, I heard that natto is an acquired taste! I'm not sure I could be persuaded to try it. But maybe in an itty bitty amount? Good luck with it!

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  6. Holy Kazoli! Another fabulous and well researched post! I've never had my vitamin D levels checked, should probably do that. I've taken a fairly low dose D3 supplement for years, and spending lots of time on my bike here in sunny CO, I figure I probably get plenty of sun exposure.

    My concern is usually avoiding sunburn, so I'm pretty religious about using sunscreen (I use the super duper zinc oxide variety) - and on long rides on sunny days I take a PABA supplement to give me some added sun protection. Even so, I do actually have some tan lines this year. But I wonder how all of that impacts vitamin D absorption. Like is there a one to one correlation between enough sun to give you tan lines and enough sun to get vitamin D absorption. I think some research is in order...

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    1. Hi Cat,
      What I've read, (much like Thomas, below points to), is that from March to October, most of the N. Hemisphere gets adequate sun for vitamin D production, if in the sun daily for 15 minutes, full arms, legs, face and hands exposed (if you were wearing a short sleeve tee and shorts), without sunscreen. Fortunately, D3 has a long circulating half-life in the bloodstream, 15 days, I believe. And it is possible to store enough D in the body to last several weeks. The big problem comes in with the type of sun's ray that helps the skin produce vitamin D, is the same type of ray that causes skin damage, so care has to be taken with getting sunscreen on, or out of the sun, after 15-30 minutes.

      I've also read that after equinox in fall, and before the equinox in spring, the sun is not high enough in the sky, for most of the No.America. So, early in this period, your body is drawing on the stores of vitamin D. Later in this period, your vitamin D levels might be very low. It's a good thing to have checked maybe one time in early fall and again in early spring, to see how much your body hangs onto, both from sun exposure and through winter.

      The other thing I really don't know is how elevation affects vitamin D formation. I'm at seas level, basically, and you're in Denver. That's something that would be interesting to find out. Hope you discover what you need to know.

      have a great day, Cat!

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  7. Thanks for the article, Lili! This is a nice collection of information about vitamin D supplementation. Could be useful for those of us who plan on being thoroughly bundled up for most of the winter.

    For those wondering how getting vitamin D from sunlight works, the current stance the Internet takes on that seems to be as follows: The higher the sun is in the sky, the better, but it must be about 50 degrees above the horizontal or higher to trigger a useful amount of vitamin D production at all. (In most of the US, the sun doesn't even make it that high in the winter. There are a couple different online calculators out there that can tell you the altitude of the sun in any given area on different days and at different times of day.) Cloud cover hinders vitamin D production as well.

    In any case, it shouldn't take much sun exposure to produce a good amount of vitamin D. Some sources say it can take only 15 minutes, and all the ones I've read agree that there's no benefit to staying out long enough to get a sunburn.

    Thomas

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    1. Hi Thomas,
      I'm pretty bundled up from October through May, here, in sunny (ha ha ) Seattle! Thanks for the info on sunlight and vitamin D production. I'll look for those calculators online. And I've read the same thing, anywhere from 15 to 30 minutes of sun exposure, depending on skin pigmentation and age.

      Have a great day, Thomas!

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  8. I tried to post from a different computer yesterday but apparently that didn't get posted.

    Vit. D3 is something my hubby needed while recovery from hip surgery since the bottle said "bone growth" and I was confused about D3 giving more energy and helping reduce depression that sunlight would otherwise help. I was thinking that those were two such different things but after reading a lot it sounds like it does help a lot of things. I have two bottles of D3 in the cupboard since hubby doesn't need anymore D3.

    Not sure if it is wise to just take one each day and see if it helps me be less tired or if I should have a dr. input first. I am scheduled to see a dr. on the 26th so I'll ask. I also read that too much of a vitamin could actually be dangerous.

    There was a blurb on msn.com about vitamins--what is useful and what is not on the same day Lili posted this about vit. D. It got me thinking that a multi-vitamin can really capture all that a healthy person needs (for the most part). But your doctor is the best person to get advice from if you think you need more or less of something.

    Alice

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    1. Hi Alice,
      If you've been feeling fatigued, this is definitely something you should talk with your doctor about first. There are a surprising number of causes of fatigue, and your doctor can run a quick blood test for many of them. Sometimes, it isn't a matter of solving just one problem, but several. But have your D levels checked, because vitamin D deficiency is relatively common in adults, it sounds.
      It is possible to get too much vitamin D. It's rare, but at higher doses, day after day, yes you can get too much, and it can cause damage to your organs (I think it's kidneys). So, check with your doctor, first. He/she can tell you about how much you need per day, too. But get your fatigue checked out. Even before my first lab results were back, my doctor gave me some helpful tips for improving energy levels.

      About what vitamin D3 can do -- yes, it does far more than we grew up thinking. I remember when the only thing bad that most people thought of with D deficiency was rickets. But it's linked to fatigue, depression, fibromyalgia, lupus, MS, muscle weakness and pain, immune function, as well as bones. Not that it can completely fix all of these, but there's a correlation between these issues and low vit D.

      I'm sorry the other computer didn't work for posting a comment, yesterday. that's frustrating!

      I hope your day is off to a great start, Alice!

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I'm so glad that you stopped by today. Please comment, and let me know what you're thinking.