By Joan Sumpio, RND–
Many experts are still in denial that a big number of Asians are suffering from, if not at risk of having, Vitamin D deficiency. Experts who say that it is next to impossible for Asians to have vitamin D deficiency do not have a clear picture of the way of life of Asians.
Individuals who live in a tropical country would actually often shelter themselves from the sun’s rays to keep their skin from getting darker. This practice alone already puts most Asian populations at risk of having inadequate vitamin D.
To the working Asian population, longer office hours keep them from being exposed to the sun’s rays for a reasonable time. Many would say that they leave for work before the sun rises and go home when the sun has set – another reason why many people miss the sun’s health benefits. Although it is true that many foods are now fortified with vitamin D, we cannot guarantee that this is enough. Note that a lot of foods have been fortified with vitamin A, Iron and Iodine, and yet, its deficiency is still a big public health problem.
Vitamin D is well known to be a very important bone nutrient. Its primary function is to maintain blood levels of calcium and phosphorus concentrations at a range that will support body processes, neuromuscular functions and bone building/strengthening activities. Aside from these important functions, vitamin D also acts like a hormone that stimulates maturation of cells including those of the immune system.
Vitamin D is also beneficial to our brain functions. In one study, participants with vitamin D deficiency were found to have higher risk of substantial cognitive decline by 60 percent compared to those with sufficient vitamin D levels. As we age, our cognitive performance naturally declines. With vitamin D deficiency, this decline is accelerated.
If you do not experience this accelerated decline in cognitive function, you should have regular exposure to sunlight for at least 15 minutes in day.
On days when you are most sheltered from sunlight, make sure you incorporate vitamin D food sources into your meal plans. Foods like salmon, sardines, and those fortified with vitamin D (milk, cheese/cheese spreads, breakfast cereals, pasta and margarine)are sources of vitamin D.
Presently, our recommended daily intake for vitamin D is 5ug for the general population. For those aged 50 – 64 years old there is higher recommended intake of 10ug and for those above 65 years old, a daily intake of 15 ug is recommended. Prolonged exposure under the sun does not pose any risk because the body can regulate the production of vitamin D3 from the sun; it is our exogenous intake of vitamin D that we have to watch out for as chronic excessive intake can lead to bone resorption.
If you needed another reason to moan about the Irish weather – US vitamin D specialist Dr Michael Holick is the man to talk to.
The professor of Medicine at Boston University Medical Center and author of The Vitamin D Solution believes Ireland’s lack of sunshine, needed to stimulate the production of vitamin D in the body, is making us all less healthy.
Known as the “sunshine vitamin”, it not only helps us absorb up to twice as much calcium from our food for good bone health, but Holick says it can also play a role in everything from labour pains to multiple sclerosis.
The modern lifestyles “of avoiding the sun, putting on sun screen and working indoors” is thwarting Mother Nature, something that’s further exacerbated by Ireland’s northerly latitude, says Holick.
“You get no Vitamin D in Ireland from November through March,” he says. “The sun is coming in at an angle at that time of year and the vitamin D producing rays are being absorbed by the ozone layer.”
Our summers aren’t much good either, according to Holick, particularly if we’re being sun smart. “If you go out in the early morning and late afternoon as you’ve been taught, you get no vitamin D in summer either because the sun is coming in just like winter sunlight.”
So how does he explain sunburn at these off-peak times? “UVA radiation makes no vitamin D, but it can still cause redness to the skin – it’s not UVA rays you’re after, it’s UVB and it mainly comes in from 10am to 3pm.”
Before sun-worshippers take Dr Holick’s words as carte blanche to hit the garage roof with some reflective foil and a slick of baby oil, he urges caution.
“Get out for five or 10 minutes, protect your face because it’s the most sun damaged – but exposing your arms or legs a couple of times a week won’t cause any problems and will definitely improve your vitamin D status.”
So what can the sunshine vitamin do for us? “We’ve shown that pregnant women who are vitamin D deficient in their first trimester have a higher risk of vaginal infection and of pre-eclampsia,” he says.
“We did a study of 400 women to see if vitamin D levels had an effect on the numbers requiring C-section – we found a 400 per cent reduced risk of a C-section if they simply were vitamin D sufficient at the time they gave birth.”
Holick says a deficiency of the vitamin in utero and in the first year of life brings a higher risk of eczema and wheezing disorders and also impairs growth.
He says “there’s no food that naturally contains vitamin D other than oily fish. It’s mainly in foods especially fortified with vitamin D, like milk.”
For pregnant women, he advises pre-natal vitamins containing vitamin D and two glasses of D-fortified milk a day.
There are also benefits for teens, he says. “There’s data in the US that teenagers who are D deficient have over twice the risk of having high blood pressure and four times the risk of having type 2 diabetes.”
Holick claims vitamin D can also have a powerful effect on multiple sclerosis (MS) and again draws a parallel between our geographic location and the disease.
“We know that if you live north of Atlanta Georgia, so basically all of northern Europe, for the first 10 years of your life, you have a 100 per cent increased risk of getting MS for the rest of your life,” he says.
Holick agrees that he gets a certain amount of criticism from skin cancer lobbyists for his pro-sun advice.
“I do get criticism, but I can tell you that 40 per cent of Australians are vitamin D deficient – it turns out the ‘Slip, Slop, Slap!’ campaign has caused a major epidemic in vitamin D deficiency.
“Even the Australian Cancer Council and the Australian Dermatology Association have now recommended some sensible sun exposure.”
This wonder vitamin might just be good for government coffers too, according to Holick. He believes that Ireland’s annual healthcare budget could be decreased by up to 25 per cent if we all had higher levels of vitamin D.
Let’s hope for a fine summer then.
A recent study on the relationship between cognitive impairment (thinking disorders) and vitamin D levels came to some very interesting conclusions. Dr. David Llewellyn, the lead researcher, stated the following: “Compared with those patients with sufficient levels of vitamin D, those participants who were very vitamin D deficient had a 6-fold higher risk for cognitive impairment, with a doubling of risk still for those who were considered deficient (>25 to <50)”” Dr. Llewellyn also stated that “low levels of vitamin D are just genuinely bad for the brain.”
Vitamin D research continues to amaze. The evidence mounts that vitamin D deficiency has a profound negative influence on the function of the brain. Previously, I wrote of the compelling evidence that autism is a vitamin D deficiency disease and also presented research indicative of a role of vitamin D in reducing depression, elevating mood and increasing happiness. I also came across a small study of 17 psychiatric patients. Of these patients, two were borderline deficient and 15 were deficient. Seven had such low levels that blood tests could not produce an accurate reading. Encouragingly, the researchers recommended that mental-health inpatients receive adequate exposure to sunlight. In my book, I documented the critical importance of sunlight/vitamin D to the development and health of the brain:
1. Prenatal vitamin D deficiency in animals profoundly alters brain development. ] Dr. Darryl Eyles and his colleagues state, “rats born to vitamin D-deficient mothers had profound alterations in the brain at birth.” The cortex was longer but not wider, the lateral ventricles were enlarged, the cortex was proportionally thinner and there was more cell proliferation throughout the brain… Our findings would suggest that low maternal vitamin D(3) has important ramifications for the developing brain.”
2. Rats born to vitamin D-deficient mothers also have permanently damaged brains into adulthood and exhibit hyperlocomotion (excessive movement from place to place) at the age of ten weeks. Could this relate to hyperactivity in our children? Such rats also show impairment in learning and memory skills.
3. People hospitalized for bipolar disorder, and who are exposed to sunlight daily, are able to leave the hospital almost four days earlier than those who are not exposed, and people hospitalized for seasonal affective disorder (SAD) also have shorter stays when they are placed in rooms on the sunny side of the hospital.
4. Two studies of mice with abnormal vitamin D receptors (VDR) in the brain found an increase in anxiety, aggression, poor grooming, maternal pup neglect and cannibalism.  Abnormal VDR cause a situation similar to vitamin D deficiency; the vitamin D that is available cannot properly stimulate the genes that prevent the anxiety, cannibalism, etc.
5. Another vital function of vitamin D is in inducing the production of nerve-growth factor (NGF), a protein that is essential for proper development of nerve cells in the brain and elsewhere.  It is obvious that if vitamin D is not present, nerve cells will simply not develop as they should in the central nervous system and brain, leading to the mental disorders we discuss here.
Can it be that the Powers of Darkness (the “sunscare” promoters) are partially responsible for the widespread depression, negativism, anxiety and psychological disorder that plague our society to a greater extent each year? Their efforts, coupled with modern indoor lifestyles, are leading to increases in a plethora of diseases, some of which are disorders of the brain. I believe it will be only a matter of time until vitamin D deficiency in pregnant women will be correlated to abnormally low IQ in the children they bear. In another blog, I have already discussed autism as a vitamin D deficiency disease, and there is an indication that women who conceive in the fall and winter tend to bear more dyslexic children, as well as children with other learning and reading disabilities.   The nervous system’s critical time to develop neural connections is in the first months after conception. If the pregnant woman is low in vitamin D during that time, it could affect the development of the fetal brain.Activated vitamin D is a potent hormone that is essential for proper brain development.
As a society and as parents, we cannot wait for more research before acting on the crying need for optimal vitamin D levels. Our mental and physical health, as well as that of our children, depends on regular, non-burning exposure sunlight, or other sources of vitamin D.
 Susan Jeffery, Low Vitamin D Levels Associated With Increased Risk for Cognitive Impairment Medscape Today, July 13,2010.  Tiangga, E. et al. Psychiatric Bulletin 2008;32:390-93  Eyles, D. et al. Vitamin D3 and brain development. Neuroscience 2003;118:641-53.  McGrath, J. et al. Vitamin D3-implications for brain development. J Steroid Biochem Mol Biol 2004;89-90:557-60.  Feron, F. et al. Developmental vitamin D3 deficiency alters the adult rat brain. Brain Res Bull. 2005 Mar 15;65(2):141-8.  Burne, T. et al. Transient prenatal Vitamin D deficiency is associated with hyperlocomotion in adult rats. Behav Brain Res 2004;154:549-55.  Benedetti, F. et al. Morning sunlight reduces length of hospitalization in bipolar depression. J Affect Disord 2001;62:221-23.  Beauchemin, K. et al. sunny hospital rooms expedite recovery from severe and refractory depressions. J Affect Disord 1996;40:49-51.  Kalueff, A. et al. Increased anxiety in mice lacking vitamin D receptor gene. Neuroreport 2004;15:1271-74.  Kalueff, A. et al. Behavioral anomalies in mice evoked by Tokyo disruption of the vitamin D receptor gene. Neurosci Res 2006;54:254-60.  Kiraly,S et al. Vitamin D as a neuroactive substance: review. Scientific World Journal 2006;6:125-139.  Carlson, A. et al. Is vitamin D deficiency associated with peripheral neuropathy? The Endocrinologist 2007;17:319-25.  Livingston, R. et al. Season of birth and neurodevelopmental disorders: summer birth is associated with dyslexia. J Am Acad Child Adolesc Psychiatry. 1993;32:612-6.  Badian, N. Reading Disability in an Epidemiological Context: Incidence and Environmental Correlates. J Learn Disabil. 1984;17:129-36.  Martin, R. Season of birth is related to child retention rates, achievement, and rate of diagnosis of specific LD. J Learn Disabil 2004;37:307-17 – See more at: http://www.sunlightinstitute.org/sunlight-vitamin-d-and-brain-disorders-if-you-want-stay-smart-get-some-sunlight#sthash.JzZjCaNl.dpuf
Their study of 3,000 people, published in Archives of Neurology, found people with the lowest levels of the sunshine vitamin had a three-fold higher risk.
Vitamin D could be helping to protect the nerve cells gradually lost by people with the disease, experts say.
The charity Parkinson’s UK said further research was required.
Parkinson’s disease affects several parts of the brain, leading to symptoms like tremor and slow movements.
The researchers from Finland’s National Institute for Health and Welfare measured vitamin D levels from the study group between 1978 and 1980, using blood samples.
They then followed these people over 30 years to see whether they developed Parkinson’s disease.
They found that people with the lowest levels of vitamin D were three times more likely to develop Parkinson’s, compared with the group with the highest levels of vitamin D.
Most vitamin D is made by the body when the skin is exposed to sunlight, although some comes from foods like oily fish, milk or cereals.
As people age, however, their skin becomes less able to produce vitamin D.
Doctors have known for many years that vitamin D helps calcium uptake and bone formation.
But research is now showing that it also plays a role in regulating the immune system, as well as in the development of the nervous system.
Writing in an editorial in the US journal Archives of Neurology, Marian Evatt, assistant professor of neurology at Emory University School of Medicine, says that health authorities should consider raising the target vitamin D level.
“At this point, 30 nanograms per millilitre of blood or more appears optimal for bone health in humans.
“However, researchers don’t yet know what level is optimal for brain health or at what point vitamin D becomes toxic for humans, and this is a topic that deserves close examination.”
Dr Kieran Breen, director of research at Parkinson’s UK, said: “The study provides further clues about the potential environmental factors that may influence or protect against the progression of Parkinson’s.
“A balanced healthy diet should provide the recommended levels of vitamin D.
“Further research is required to find out whether taking a dietary supplement, or increased exposure to sunlight, may have an effect on Parkinson’s, and at what stage these would be most beneficial.”
By Dr. Patrick Massey
June 14, 2010
Vitamin D may be as effective as vaccination for seasonal flu.
In a recently published clinical trial, children who took a vitamin D supplement had a significantly lower risk of seasonal flu than children who took a placebo. Risk reduction with vitamin D was comparable to that seen in children who received the flu vaccine.
By Todd Neale, Staff Writer, MedPage Today April 28, 2010 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
PRAGUE — Among patients who have suffered a traumatic brain injury, vitamin D deficiency is associated with an increased likelihood of having chronic fatigue, Dutch researchers found.
Of 90 such patients, 80% who were fatigued had the vitamin deficiency, compared with 40% of those who were not fatigued (P<0.05), Jessica Schnieders, MD, of Rijnstate Hospital in Arnhem, the Netherlands, reported at the European Congress of Endocrinology in Prague.
Having a sleep disorder strengthened the association between vitamin D deficiency — defined as a level less than 50 nmol/L — and fatigue, Schnieders said in an interview.
“I think it’s important to get knowledge to the patients, the rehabilitation doctors, and the family doctors that they should look at vitamin D and sleep in these patients,” she said.
Schnieders said all of the patients who had a vitamin D deficiency were treated, and many said they felt better.
Although the study could not establish a causal relationship between low vitamin D levels and fatigue, treating the vitamin deficiency can benefit other areas, including bone health, she said.
Previous studies have shown that some patients with a traumatic brain injury have hormone deficiencies related to damage to the pituitary gland. Schnieders and her colleagues wanted to find out whether this, as well as other factors like vitamin D deficiency, might explain the fatigue commonly seen after traumatic brain injury.
The researchers randomly selected 100 former patients of their rehabilitation center to participate in the study, and 90 agreed (26 females and 64 males). It had been about 10 years since the traumatic brain injuries.
All filled out a fatigue questionnaire and provided information on emotional well-being, quality of life, attention, coping style, daily activity, and physical performance as assessed on a cycling test. The researchers also measured vitamin D levels.
Slightly more than half (51%) of the patients reported being severely fatigued. As expected, these patients had more anxiety and a lower quality of life.
Deficiency in at least one of the pituitary hormones was identified in 29%, growth hormone deficiency was found in 24%, and gonadal hormone deficiency was observed in 10%. None of these deficiencies was significantly related to fatigue.
In a multivariate analysis including hormone deficiencies, vitamin D deficiency, sleep problems, attention, body mass index, and gender, vitamin D deficiency was the only factor independently associated with fatigue (P<0.05).
It is unclear why sleep problems strengthened the negative effect of vitamin D deficiency on fatigue, but Schnieders said there is some evidence linking melatonin, which is involved in regulating circadian rhythms, and vitamin D.
The observational study could not prove that vitamin D deficiency was causing the fatigue.
Schnieders said another possible explanation for the findings could be that fatigued patients are more likely to remain inside and not get enough exposure to sunlight.
“But I think it has something to do with the immunological system because both sleep and vitamin D are involved in the immunological system,” she said.
Schnieders reported no conflicts of interest.
By Jane E. Brody
The so-called sunshine vitamin is poised to become the nutrient of the decade, if a host of recent findings are to be believed. Vitamin D, an essential nutrient found in a limited number of foods, has long been renowned for its role in creating strong bones, which is why it is added to milk.
Now a growing legion of medical researchers have raised strong doubts about the adequacy of currently recommended levels of intake, from birth through the sunset years. The researchers maintain, based on a plethora of studies, that vitamin D levels considered adequate to prevent bone malformations like rickets in children are not optimal to counter a host of serious ailments that are now linked to low vitamin D levels.
To be sure, not all medical experts are convinced of the need for or the desirability of raising the amount of vitamin D people should receive, either through sunlight, foods, supplements or all three. The federal committee that establishes daily recommended levels of nutrients has resisted all efforts to increase vitamin D intake significantly, partly because the members are not convinced of assertions for its health-promoting potential and partly because of time-worn fears of toxicity.
This column will present the facts as currently known, but be forewarned. In the end, you will have to decide for yourself how much of this vital nutrient to consume each and every day and how to obtain it.
Where to Obtain It
Through most of human history, sunlight was the primary source of vitamin D, which is formed in skin exposed to ultraviolet B radiation (the UV light that causes sunburns). Thus, to determine how much vitamin D is needed from food and supplements, take into account factors like skin color, where you live, time of year, time spent out of doors, use of sunscreens and coverups and age.
Sun avoiders and dark-skinned people absorb less UV radiation. People in the northern two-thirds of the country make little or no vitamin D in winter, and older people make less vitamin D in their skin and are less able to convert it into the hormone that the body uses. In addition, babies fed just breast milk consume little vitamin D unless given a supplement.
In addition to fortified drinks like milk, soy milk and some juices, the limited number of vitamin D food sources include oily fish like salmon, mackerel, bluefish, catfish, sardines and tuna, as well as cod liver oil and fish oils. The amount of vitamin D in breakfast cereals is minimal at best. As for supplements, vitamin D is found in prenatal vitamins, multivitamins, calcium-vitamin D combinations and plain vitamin D. Check the label, and select brands that contain vitamin D3, or cholecalciferol. D2, or ergocalciferol, is 25 percent less effective.
Vitamin D content is listed on labels in international units (I.U.). An eight-ounce glass of milk or fortified orange juice is supposed to contain 100 I.U. Most brands of multivitamins provide 400 a day. Half a cup of canned red salmon has about 940, and three ounces of cooked catfish about 570.
Myriad Links to Health
Let’s start with the least controversial role of vitamin D — strong bones. Last year, a 15-member team of nutrition experts noted in The American Journal of Clinical Nutrition that “randomized trials using the currently recommended intakes of 400 I.U. vitamin D a day have shown no appreciable reduction in fracture risk.”
A Swiss study of women in their 80s found greater leg strength and half as many falls among those who took 800 I.U. of vitamin D a day for three months along with 1,200 milligrams of calcium, compared with women who took just calcium. Greater strength and better balance have been found in older people with high blood levels of vitamin D.
In animal studies, vitamin D has strikingly reduced tumor growth, and a large number of observational studies in people have linked low vitamin D levels to an increased risk of cancer, including cancers of the breast, rectum, ovary, prostate, stomach, bladder, esophagus, kidney, lung, pancreas and uterus, as well as Hodgkin’s lymphoma and multiple myeloma.
Researchers at Creighton University in Omaha conducted a double-blind, randomized, placebo-controlled trial (the most reliable form of clinical research) among 1,179 community-living, healthy postmenopausal women. They reported last year in The American Journal of Clinical Nutrition that over the course of four years, those taking calcium and 1,100 I.U. of vitamin D3 each day developed about 80 percent fewer cancers than those who took just calcium or a placebo.
Vitamin D seems to dampen an overactive immune system. The incidence of autoimmune diseases like Type 1 diabetes and multiple sclerosis has been linked to low levels of vitamin D. A study published on Dec. 20, 2006, in The Journal of the American Medical Association examined the risk of developing multiple sclerosis among more than seven million military recruits followed for up to 12 years. Among whites, but not blacks or Hispanics, the risk of developing M.S. increased with ever lower levels of vitamin D in their blood serum before age 20.
A study published in Neurology in 2004 found a 40 percent lower risk of M.S. in women who took at least 400 I.U. of vitamin D a day.
Likewise, a study of a national sample of non-Hispanic whites found a 75 percent lower risk of diabetes among those with the highest blood levels of vitamin D.
Vitamin D is a fat-soluble vitamin that when consumed or made in the skin can be stored in body fat. In summer, as little as five minutes of sun a day on unprotected hands and face can replete the body’s supply. Any excess can be stored for later use. But for most people during the rest of the year, the body needs dietary help.
Furthermore, the general increase in obesity has introduced a worrisome factor, the tendency for body fat to hold on to vitamin D, thus reducing its overall availability.
As for a maximum safe dose, researchers like Bruce W. Hollis, a pediatric nutritionist at the Medical University of South Carolina in Charleston, maintain that the current top level of 2,000 I.U. is based on shaky evidence indeed — a study of six patients in India. Dr. Hollis has been giving pregnant women 4,000 I.U. a day, and nursing women 6,000, with no adverse effects. Other experts, however, are concerned that high vitamin D levels (above 800 I.U.) with calcium can raise the risk of kidney stones in susceptible people.
Sharp rise in problem blamed on kids indoors playing computers and parents using too much sunscreen
By Owen Bowcott January 22, 2010
Computer-obsessed children who spend too long indoors and over-anxious parents who slap on excessive sunscreen are contributing to a sharp rise in cases of the bone disease rickets, doctors are warning.
Vitamin D deficiency, which causes the condition, could be rectified by adding supplements to milk and other food, a research team at Newcastle University suggests.
There are several hundred cases of the preventable condition among children in the UK every year, according to a clinical review paper in the British Medical Journal by Professor Simon Pearce and Dr Tim Cheetham.
“More than 50% of the adult population [in the UK] have insufficient levels of vitamin D and 16% have severe deficiency during winter and spring,” they say. “The highest rates are in Scotland, Northern Ireland and northern England. People with pigmented skin are at high risk as are the elderly, obese individuals and those with malabsorption.”
Most vitamin D is synthesised in the body by absorption of sunlight. Some comes from foods such as fish oil. People with darker skins need more sunlight to top up their vitamin D levels.
One of the main reasons for the reappearance of rickets – once considered a disease of the industrial poor in 19th-century cities – is the changing ethnic makeup of the population, Pearce explained.
The most commonly affected are people of Asian or African descent who live in northern cities. He has examined cases among young Somali speakers who live in east Newcastle. But changing lifestyles are also contributing to lowering vitamin D levels in the general population.
“Some people are taking the safe sun message too far,” Pearce said. “It’s good to have 20 to 30 minutes of exposure to the sun two to three times a week, after which you can put on a hat or sunscreen.
“Vitamin D levels in parts of the population are precarious. The average worker nowadays is in a call centre, not out in the field. People tend to stay at home rather than going outside to kick a ball around. They stay at home on computer games.”
Pearce has written to the Department of Health proposing that vitamin D is added to milk. It is already added as a supplement to artificial baby milk. He has also asked the Royal College of Paediatrics to record cases of rickets but said figures were not being collected.
“A more robust approach to statutory food supplementation with vitamin D (for example in milk) is needed in the UK,” the paper concludes.
Meanwhile, figures obtained by the Tories show the number of patients leaving hospital with malnutrition has hit record levels in the last year. Those affected are primarily elderly people. The NHS figures show that last year 175,000 people were malnourished on entry to hospital but nearly 185,500 were in a similar condition on discharge, meaning more than 10,000 patients were more malnourished after medical treatment.