Vitamin-d-the-sunshine-vitamin

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28
Jul
2015

Vitamin D - The Sunshine Vitamin

Kim graduated from London's Institute for Optimum in 2008 and has worked in the field of and health for over ten years.


We’re constantly warned of the damaging and ageing effect of the sun’s rays on our skin, but in avoiding sun exposure, could we be doing ourselves more harm than good?


Exposure to UVB radiation the mechanism for more than 90% of the vitamin D in most individuals (Norval M, 2009) but wearing a with an SPF as low as eight reduces the skin's production of D by an 95% (Reichrath J, 2008).


Why Is Vitamin D So Essential?


Despite its name, vitamin D is actually a prohormone and is for numerous functions throughout the body. It plays a key role in calcium making it integral to bone health. (DeLuca HF, 2004). It’s also for healthy neuromuscular, and immune function, respiratory system function and cognitive function ( S, 2013). Vitamin D is also vitally important to skin health as it is directly involved the and of keratinocytes. If adequate amounts of D are not available, epidermal cells cannot differentiate optimally. ( K, 1991)


Deficiency – It’s More Common Than We Think


Vitamin D deficiency is more common than previously believed. The Centers for Disease Control and reported that the of adults with sufficient D levels (defined by 25(OH) D of at least 75 nmol/L) significantly between 1994 – 2001. Between , 60% of Americans has vitamin D levels, this to approximately 30% in and from approximately 10% to 5% in during this same time (Kennel KA, 2010). This means that from , an 70% of Americans and 90-95% of African Americans were to have insufficient vitamin D levels.


For a long time, we have been aware of the impact of severe D deficiency which manifests as rickets. Rickets is a childhood characterised by growth retardation, deformities of the legs, bending of the spine, knobby projections of the ribcage, and weak and toneless (Holick MF, 2006). A of the 19th Century, rickets was virtually half a ago as diets improved in Britain, however, there has been a of the disease in recent years. In January 2011 Dame Sally Davies, the government's chief officer, recommended all aged six months to five should be given vitamin D supplements, especially during winter months when the opportunity for sun is reduced. Advice for to wear a high factor and remain covered up while is partly felt to be behind the reason for the of rickets (Lowdon J, 2011)


Aside from rickets, epidemiologic evidence links vitamin D deficiency to disease, cancer, disease, depression, dementia, infectious diseases, musculoskeletal decline, and more (Haines ST, 2012). Common manifestations of D are symmetric lower back pain, muscle weakness, muscle aches, and bone pain elicited by pressure over the or tibia (Bordelon P, 2009).


More subtle signs of D may include and susceptibility to however an individual may be completely asymptomatic and still be deficient.


In addition to reduced sun exposure, being pregnant or can increase the risk of D deficiency, as can very covering clothing and/or a lot of time indoors. Babies and young children under the age of five and older people aged 65 years and over are also at increased risk.


 


Vitamin D and Skin Type


An interesting point to note is that the darker a person’s skin type, the lower their to Vitamin D. D3 is produced in skin through ultraviolet irradiation of 7-dehydrocholesterol. It is biologically inert and must be metabolized to 25 D3 in the liver and then to 1alpha,25 D3 in the kidney before function (DeLuca HF, 2004).


An extract from the in 1967 states: In northern latitudes, there is a selection for white skins that allow maximum of 7 into vitamin D at low intensities of radiation. In latitudes, there is a selection for black skins able to prevent up to 95% of the incident ultraviolet from the deeper layers of the skin where D is synthesized. (Loomis WF, 1967)


In a modern world where is common, people whose skin type has adapted to excess vitamin D in their native, sunny environment are particularly prone to a deficiency when living in a such as the UK. My client list comprises a diverse ethnic background. Muslim women who cover themselves for religious are often found to be Vitamin D deficient. My Asian with Fitzpatrick IV-V skin type are also deficient. That said, I have also seen plenty of Fitzpatrick Type I clients with low, or vitamin D levels. Most of us spend a significant proportion of our time meaning that regardless of skin type, anyone can be affected.


 


How Do We Assess Vitamin D Levels?


Vitamin D levels can be easily using a simple blood test. Ingested and cutaneously vitamin D is quickly converted to 25(OH)D, but in serum, only a small fraction of 25(OH)D is to 1,25(OH)2D, its active metabolite. Therefore the total 25(OH)D level is the best test to assess levels of vitamin D (Kurt A. Kennel).


I test my client’s 25(OH)D levels through The Doctor’s (TDL) but a number of offer this . It can be done or as part of a more vitamin and screen. When possible I prefer to run a comprehensive micronutrient panel and then retest the nutrients at two to three months post .


Deficiency is defined as a serum 25(OH)D level of less than 50 nmol per L. is defined as a serum 25(OH)D level of 50 to 75 nmol per L ( P, 2009). Of the last 20 clients that I have tested, six were deficient, six had suboptimal levels and just eight had optimal levels. Those with optimal levels were usually either supplementing or spent a significant amount of time abroad. Two of those who tested deficient had levels below 10nmol per L.


 


How Should We D?


The dosing for D from that for most other nutrients. Normally we take a �[https://www.consultingroom.com �little] and often approach, whilst also dietary sources. However, with D, the dosing strategy is different. For individuals with vitamin D deficiency, treatment may include oral supplementation of one 50,000 IU dose per week for eight weeks. After D levels normalise, a daily of 800 to 1,000 IU of D3 is usually . (Bordelon P, 2009) Academy of recommends that and children at least 400 IU per day from diet and in order to prevent .


D supplements are available in two forms: D2 (ergocalciferol) and D3 (cholecalciferol). D3 is the type that most experts agree should be used in practice. Humans synthesise vitamin D3 in response to sunlight and therefore it is the most form to supplement. Vitamin D3 is more and significantly more effective at blood levels of D than Vitamin D2 ( U, 2013). A review published in The American Journal of Nutrition stated: that vitamin D2 should no longer be regarded as a appropriate for or fortification of foods (Houghton LA, 2006).


 


Vitamin D in the Diet


Despite contributing minimally to our vitamin D levels, we should not forget to mention sources. Unfortunately, there are few good quality, sources of vitamin D. Oily fish – such as wild salmon, and mackerel and eggs provide D but otherwise, most other food come in the form of highly processed foods such as margarine and cereals which I do not recommend.


 


Safe Sun Exposure


There’s no doubt that most of us could from spending a little less time indoors and a little more time outside. Making a conscious effort to tear ourselves away from a screen and get out for a short daily walk could our health and in many ways. NICE, in their 2011 report stated that: "Exposure to the sun has a number of benefits. For example, it increases people's sense of wellbeing, allows them to synthesise vitamin D and provides opportunities for physical activity" (Lowdon J, 2011)


As with many things in life, the key to safe, sun exposure is moderation. The NHS the following: ‘Short daily of sun exposure without sunscreen during the summer months (April to October) are enough for most people to make enough vitamin D. that the most effective time of day for vitamin D is between 11 am and 3 pm.


A short period of time in the sun means just a few minutes – evidence suggests that about 10 to 15 minutes is enough for most people – and is less than the time it takes you to start going red or burn'
That said, we often (quite rightly) the daily use of as part of a skincare regime and in doing so could be reducing our client or patient’s to vitamin D from the sun. Therefore a daily vitamin D3 supplement, especially during the winter months, is something you might wish to consider.


 

Summary

In summary, when your clients or patients on D, consider the following:



References


P, Ghetu MV, Langan RC. (2009)
and management of vitamin D deficiency.
Am Fam . 80(8):841-6.


S, Hewison M, Gardner DG, et al (2013)
Vitamin D: beyond bone.
Ann N Y Acad Sci. 1287:45-58.


DeLuca HF (2004)
Overview of general physiologic and functions of vitamin D.
Am J Clin Nutr. 80(6 Suppl):1689S-96S.


Feldman D, Pike JW, Adams JS. (2011)
Vitamin D, Third
Elsevier Press


Haines ST, Park SK. (2012)
Vitamin D supplementation: what's known, what to do, and what's needed.
Pharmacotherapy. 32(4):354-82


Holick MF (2006)
of D and rickets
J Clin Invest. 116(8): 2062–2072


LA and Vieth R (2006)
The case against (vitamin D2) as a vitamin supplement
Society for Clinical . 84 (4)


Lehmann U, Hirche F, Stangl GI, et al (2013)
Bioavailability of D(2) and D(3) in healthy volunteers, a placebo-controlled trial.
J Clin Metab. 98(11): .


Loomis WF. (1967)
regulation of in man.
Science. 157(3788):501-6.


Lowdon J. (2011)
Rickets: concerns over the .
J Fam Health Care. 21(2):25-9


Kennel KA, Drake MT, Hurley DL (2010)
Vitamin D Deficiency in Adults: When to Test and How to Treat
Mayo Clin Proc. 85(8): 752–758


K, Azuma Y, Kiyoki M, et al (1991)
of endogenously 1,25 D-3 in the growth and differentiation of human keratinocytes.
Acta. 1092(3):311-8.


Norval M, Wulf HC. (2009)
Does sunscreen use reduce vitamin D to insufficient levels?
Br J . 161(4):732-6.


J, Nürnberg B. (2008)
Solar UV-radiation, vitamin D and skin cancer in organ recipients (OTRs).
Adv Exp Med Biol. 624:203-14. 


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