By Rob Verkerk MSc DIC PhD FACN Founder, executive and scientific director
As summer draws to a close in the northern hemisphere, you’d imagine most people will feel satisfied that they’ve benefited from the elevated levels of the ‘sunshine vitamin’. The truth is rather different. Study after study, whether in children, pregnant women or the elderly, reflects the pandemic nature of vitamin D deficiency.
If you’ve got yourself out in the summer sunshine with large parts of your body exposed for 5 to 30 minutes, a couple of times or more a week, you might have got your circulating 25-hydroxy (25[OH]) vitamin D levels into the optimal range (100-150 nmol/L [40-60 ng/ml]).
But for many that won’t have happened. And even if it has, you’re about to plunge into the autumn and winter and your levels are set to decline further.
Why is maintaining adequate vitamin D blood levels so tough?
There are many reasons why so many people find it hard to optimise their vitamin D levels. Here’s just a few reasons:
They’ve been told to wear sunscreens when exposed to the sun to reduce the risk of skin cancers. What they’re not told is that lower blood levels increase your risk of other cancers, and skin cancer risk generally only increases among those who are repeatedly over-exposed to the sun (sunburned) and have a susceptible skin type.
Their lifestyle, age or customs don’t allow them to have sufficient skin exposure to the sun
They consume little or no dietary sources of vitamin D (e.g. fish liver oils, fatty fish such as salmon, tuna, and mackerel, eggs from hens that have been fed vitamin D, fortified milk products; and other fortified foods such as breakfast cereals)
Once we accept that vitamin D deficiency is pandemic, how do we resolve it? Getting more sun or going to tanning salons isn’t a solution for everyone – although it’s likely the way nature intended us to make most of our vitamin D.
If it’s the wrong time of year, the angle of the sun is too low, it’s not culturally acceptable, or your skin type requires you need more sun exposure to produce vitamin D (i.e. those with darker skin types), it’s hardly the solution anyway.
That’s why fortification and supplementation are getting more and more air time following the results of comprehensive studies.
That latest study, on fortification and supplementation, conducted at the University of Birmingham in the UK, shows clear health benefits and cost effectiveness for wheat flour fortification, especially when coupled to supplementation. The modelling study that looked at the effects of fortification and supplementation over a 90-year period suggested that 10 million new cases of vitamin D deficiency in England and Wales would be prevented and the NHS would save £65m (~€71m) - over the next 90 years.
As governments, with the limited exception of folate for preconceptual and pregnant women, have generally failed to endorse supplementation as a viable strategy for reducing nutrient deficiencies, it’s interesting that fortification continues to be viewed as more acceptable.
Drawbacks of fortification
In our view it’s got 2 big drawbacks that seldom get mentioned:
It is dependent on people eating the fortified foods. In the case of fortified wheat flour, not only is it an allergen, it’s also often delivered in ultra-processed form which in turn is directly linked to the increased prevalence of obesity and type 2 diabetes;
It’s difficult to control the dosage. One thing we’ve learned a lot about over the last couple of decades is that optimising circulating 25(OH)D and the hydroxylated active form, 1,25(OH)D, through dietary intake of vitamin D demands that different people consume highly variable amounts of vitamin D. If governments continue to restrict high dose vitamin D (over 4,000 IU or 100 mcg dose rates), that becomes challenging.
Education, education, education – still not working
The other thing that continues to astound us given the robust nature of the evidence of a vitamin D pandemic, is that educational efforts are still not delivering information to the people who need it most.
This has just been reinforced by a new UK study that shows that most parents, even those from white-British ethnic backgrounds, didn’t know much about the importance of vitamin D, nor about how supplementation or vitamin D fortified foods could go a long way to resolving deficiency in their children.
Get with the 5-step D programme!
So let’s get smarter about vitamin D – before more and more suffer unnecessarily.
Here are 5 steps to help you optimise your vitamin D levels:
Get your blood levels tested at least twice a year, using an accredited lab. End of summer or winter (yes, now!) are good times to run tests to see where you might be, at your highest or lowest levels. Whichever country you live in, put “vitamin D blood test” into your search engine and you’ll find an increasing array of services that measure your blood levels based on a blood spot that you produce yourself with a pinprick. Everything you need is supplied to your home and you’ll get your results a few days after you’ve sent your bloodspot to the lab by post.
If your blood levels of 25(OH)D are below 100 nmol/L (40 ng/ml), take high dose vitamin D3 supplements (4000 IU [100 mcg] or more daily) to bring yourself back into range. Ideally test again 3 months after starting supplementation. The rate at which you optimise will vary greatly in different people. If in doubt, seek the support of a suitably qualified and experienced nutritional practitioner. You may need to increase your intake (via food or supplements) of additional nutrients and/or enzymes to enhance absorption.
If you struggle to optimise your vitamin D levels, you may wish to have a genetic test to check for vitamin D polymorphisms, something that your nutritional practitioner can help arrange for you.
Let’s be less fearful of the sun and skin cancer risk – let’s simply avoid getting burned. Don’t slap that sunscreen on the kids before they’ve had a chance to be in the sun – but also don’t let them get burned. We need to get sun smart again – it’s what we’ve done for millennia.
If you can consume oily fish, fish liver oil and fortified foods, these can help boost your levels, but typically, the levels are not high enough to remedy severe deficiency. These fortified foods (e.g. dairy, wheat) may also contribute to other health problems.