In the last article I talked about some of the questions that I typically receive from patients when we talk about Vitamin B12. Vitamin D is another nutrient that I discuss with patients very frequently. Below is a hypothetical conversation that I might have with a patient who has questions about Vitamin D.
Laura is a 50 year old women who has come in to see me for her lower back pain. During the examination she has questions about vitamin D:
Laura: I wanted to ask you about my vitamin D levels. I know at my age I need to be sure that I am getting enough vitamin D because I think it helps my bones, is this right?
Dr. Rybicki: Yes, Vitamin D is a vitamin that helps the intestines absorb calcium from your food. Vitamin D deficiency can cause decreased calcium levels in the body. This can result in less calcium in the bones causing conditions such as osteoporosis, or thinning of the bones.
Laura: How do I know if I am getting enough Vitamin D?
Dr. Rybicki: If there is a concern about your Vitamin D intake, we can do a simple blood test to check for the levels in your body.
Laura: I read that there are several different types of vitamin D that can be checked in the blood. Which test is the best?
Dr. Rybicki: The main test that has been used the longest is one called 25-hydroxyvitamin D. There are other vitamin D particles, called metabolites, that can be measured. The importance of checking these metabolite levels is the subject of a lot of disagreement these days. For now I usually just depend on the 25-hydroxyvitamin D measurement to check the blood levels.
Laura: What happens if my blood levels are low? I read that this can also affect the muscles, heart and immune system. I also read that low vitamin D levels may be associated with cancer and multiple sclerosis.
Dr. Rybicki: Again, there is currently a lot of debate about all of these other systems that Vitamin D may affect. The experts don’t seem to agree on what effects low vitamin D may have on these other systems. There are not any good scientific studies that prove the effect of low vitamin D on these conditions.
Laura: What blood level of vitamin D should I have?
Dr. Rybicki: The usual reports show the vitamin D levels in “nanograms per milliliter”. Most experts like this value to be above 20 to 30.
Laura: How can I get enough vitamin D?
Dr. Rybicki: Vitamin D is actually made in the skin after it is exposed to sunlight. The Ultraviolet B rays in sunlight causes a chemical reaction in the skin which forms vitamin D. Unfortunately we need to be careful to avoid too much sunlight due to the risk of skin cancer. Sunblock effectively blocks ultraviolet rays and decreases the skin’s synthesis of vitamin D. Vitamin D supplements work very well. I usually recommend Vitamin D3.
Laura: How much Vitamin D3 should I take?
Dr. Rybicki: Again, there is a lot of debate about exactly how much to take. Many doctors have recommended very high amounts in the past few years, but recently these recommendations have dropped some. It depends upon what your blood levels are, but I usually recommend 1000 to 2000 units per day if someone is low. I like to try this for a few months and then re-check the blood levels.
Laura: Are there foods I can eat that will help?
Dr. Rybicki: Sure, many dairy products are fortified with Vitamin D. Milk and Eggs are good sources of Vitamin D. Other foods that have vitamin D are raw fish, such as salmon, mackerel, herring, and oil packed tuna. Cod liver oil also contains a high level of Vitamin D. The easiest way to get extra vitamin D is still supplement tablets.
Laura: Is there a special type of vitamin D supplement? Is there a natural, or organic form of Vitamin D3?
Dr. Rybicki: There are companies that make natural or organic vitamins, but it seems as though any Vitamin D3 that you can buy over the counter in the U.S. are sufficient to help boost the body’s levels of vitamin D