Sunshine Never Tasted So Good
While vitamin D3 has been called “sunshine in a bottle,” your patients have probably thought it was a pretty humdrum supplement. That’s about to change with a new, chocolate-flavored chewable version from Integrative Therapeutics.
Whenever we’re exposed to sunlight, our skin cells synthesize vitamin D3. Unfortunately, for many – especially the elderly – vitamin D3 from sunlight alone just isn’t enough.
Vitamin D and bone health†
Historically, vitamin D has been associated with bone health.† It’s critical for healthy skeletal development and bone mineralization.†1
Since most of the calcium in the body is found in the bones, it’s crucial that dietary calcium intake is put to good use by getting there in the first place. Vitamin D helps make sure this happens by supporting calcium (and phosphorus) absorption through the intestinal tract, and reducing the excretion of calcium through the kidneys.†1 Vitamin D intake seems to make a big difference – and many clinical trials have demonstrated the benefits of vitamin D to support bone strength and density.†
- In women with low serum levels (a mean of 50 nmol/L) of vitamin D, increasing vitamin D3 intake has shown to increase intestinal calcium absorption by up to 65%.†2
- In the actual bone tissue, vitamin D stimulates bone turnover, while at the same time, it exerts a protective effect on osteoblasts - bone building compounds.†3
- Supplementation with vitamin D3 at dosages of 700-800 IU daily or higher has been associated with a 23-26% improvement in bone health, especially for older adults.†4
- Another recent study demonstrates supplementation with an even higher dosage level - 5000 IU of vitamin D3 - is associated with healthy bone density in older adults.†5
Not just necessary for older adults
While it sounds hard to believe in 21st century America, a 2004 case review found 166 cases of children with rickets reported in the United States between 1986 and 2003.6 This classic bone disease associated with vitamin D deficiency is characterized by bowed legs, a bent spine, and weak, toneless muscles. It was thought to be a disease of the past.
Vitamin D and immune health†
Even if your patients have heard about vitamin D and bone health, it’s very likely they haven’t made the connection between vitamin D and immune system support.†
However, epidemiological studies have found a link between vitamin D and immune function.† As new research makes the mechanics of the process better understood, it seems that vitamin D helps regulate cellular proliferation, differentiation, apoptosis, and angiogenesis.†7,8
Many cells, including breast, brain, prostate, and colon tissue, as well as immune cells, have receptors which can be activated by the hormonal form, 1,25-hydroxyvitamin D. –known to your patients as vitamin D3.†9
Cell studies have shown that vitamin D3, in the form of cholecalciferol, supports normal prostate cell replication and division, a real “selling point” to mention to your male patients.†10
Additionally, vitamin D is a potent immunomodulator, and has been shown to stimulate human macrophage cell activity – something that anyone who comes to your practice can appreciate – especially given current headlines.†11
Vitamin D intake and dosage levels – time for a change?
Dosage levels are probably not what they should be. For older adults – especially those in institutions with already limited mobility and sun exposure, approximately 38-60% have been found to be lacking in vitamin D intake (depending on the time of year tested).12,13
This may be due to both a failure to gain exposure to adequate amounts of sunlight and because the vitamin D synthesis process becomes less efficient with aging.14
However, this concern isn’t limited to the elderly. In a study of women living in Michigan, with an age range of 21 to 65 years, (average around 48 years old), 67% were lacking in vitamin D.15
Ethnic differences in vitamin D levels
As it breaks out ethnically, non-Caucasians were 3 times more likely than Caucasians to have low vitamin D levels, indicated by circulating 25-hydroxyvitamin D levels of less than 50 nmol/L. Study participants with less than 400 IU per day from their diet and supplementation were 10 times likely to have low vitamin D levels than others meeting or exceeding that level.15
A study of pregnant women living in the northern United States found that 83% of African American mothers were either deficient or had insufficient levels of vitamin D, while 47% of Caucasian mothers were either deficient or had insufficient levels (from less than 37.5 nmol/L to 37.5-80 nmol/L).16
All of this points to current daily Adequate Intake. For adults (19 – 50 years old) the Institute of Medicine (IOM) has set the recommendation at 200 IU. They have also set the tolerable upper intake levels (UL) at 2000 IU daily, based on serum levels of vitamin D associated with hypercalcemia.17
However, not everyone feels this is correct.
In 1997, several nutrition scientists challenged these ULs. They feel that the minimum recommended intake needs to be raised, pointing to newer clinical trials in healthy adults that support a UL as high as 10,000 IU per day.18-20
And, although extremely high levels of vitamin D intake have been associated with hypercalcemia, toxicity of vitamin D has not been reported in dosages up to 10,000 IU daily.
Supplementation is sensible
However, if your patients have balked at the idea of taking a single-ingredient supplement in the past, recommend that they try the new Chocolate Flavored Vitamin D3 2000 IU supplement from Integrative Therapeutics™. Proper vitamin D intake is more important than they may realize.
Supplementation with the same form that our bodies produce naturally, that actually tastes good, may make it something they actually look forward to adding to their regimen. It’ll add sunshine to your patients’ lives, especially on those days when getting out in the sunlight just isn’t an option.
References:
- Grant WB, Holick MF. Benefits and requirement of vitamin D for optimal health: a review. Altern Med Rev. 2005;10:94-111.
- Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr. 2003;22:142-6.
- Montero-Odasso M, Duque G. Vitamin D in the aging musculoskeletal system: an authentic strength preserving hormone. Mol Aspects Med. 2005;26:203-19.
- Izaks GJ. Fracture prevention with vitamin D supplementation: considering the inconsistent results. BMC Musculoskelet Disord. 2007;8:26.
- Mocanu V, Stitt PA, Costan AR, Voroniuc O, Zbranca E, Luca V, Vieth R. Long-term effects of giving nursing home residents bread fortified with 125 microg (5000 IU) vitamin D(3) per daily serving. Am J Clin Nutr 2009;89:1132-7.
- Weisberg P, Scanlon KS, Li R, Cogswell ME. Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003. Am J Clin Nutr. 2004;80(6 Suppl):1697S-705S.
- Li H, Stampfer MJ, Hollis JB, et al. Prospective Study of Plasma Vitamin D Metabolites, Vitamin Receptor Polymorphisms, and Prostate Cancer. PLoS Med. 2007;4:e103.
- Murillo G, Matusiak D, Benya RV, Mehta RG. Chemopreventive efficacy of 25-hydroxyvitamin D3 in colon cancer. J Steroid Biochem Mol Biol. 2007;103:763-7.
- Pendás-Franco N, González-Sancho JM, Suárez Y, et al. Vitamin D regulates the phenotype of human breast cancer cells. Differentiation. 2007;75:193-207.
- Tokar EJ, Webber MM. Cholecalciferol (vitamin D3) inhibits growth and invasion by upregulating nuclear receptors and 25-hydroxylase (CYP27A1) in human prostate cancer cells. Clin Exp Metastasis. 2005;22:275-84.
- Chandra G, Selvaraj P, Jawahar MS, Banurekha VV, Narayanan PR. Effect of vitamin D3 on phagocytic potential of macrophages with live Mycobacterium tuberculosis and lymphoproliferative response in pulmonary tuberculosis. J Clin Immunol. 2004;24:249-57.
- Liu BA, Gordon M, Labranche JM, Murray TM, Vieth R, Shear NH. Seasonal prevalence of vitamin D deficiency in institutionalized older adults. J Am Geriatr Soc. 1997;45:598-603.
- Gloth FM, Gundberg CM, Hollis BW, Haddad JG, Tobin JD. Vitamin D deficiency in homebound elderly persons. JAMA. 1995;274:1683-6.
- Vitamins A, D, E and K. In: Wardlaw GM, Insel PM. Perspectives in Nutrition. 2nd ed. St. Louis, Missouri: Mosby; 1993:358.
- Kakarala RR, Chandana SR, Harris SS, Kocharla LP, Dvorin E. Prevalence of vitamin D deficiency in uninsured women. J Gen Intern Med. 2007;22:1180-3.
- Bodnar LM, Simhan HN, Powers RW, et al. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr. 2007;137:447-52.
- Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press;1997:250-287.
- Vieth R. Why the optimal requirement for Vitamin D3 is probably much higher than what is officially recommended for adults. J Steroid Biochem Mol Biol. 2004;89-90:575-9.
- Viljakainen HT, Palssa A, Kärkkäinen M, Jakobsen J, Lamberg-Allardt C. How much vitamin D3 do the elderly need? J Am Coll Nutr. 2006;25:429-35.
- Hathcock JN, Shao A, Vieth R, Heaney R. Risk assessment for vitamin D. Am J Clin Nutr. 2007;85:6-18.
Published December 22, 2010