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Vitamin D and Destin

Check out the video below for some great information about vitamin D!

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Forget the Flu Vaccine – Take Vitamin D!

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My most recent blog focused on the new report from the Institute of Medicine (IOM) that stated most people in North America were getting enough vitamin D.  Their research, however, focused only on vitamin D as it pertains to bone health.  Vitamin D does much more than just support healthy bones.  In my opinion, the IOM’s report was way off base and I hope it does not encourage people to stop taking their vitamin D supplements.

As further evidence to this, take this recent research that I ran across today.

A clinical trial led by Mitsuyoshi Urashima and conducted by the Division of Molecular Epidemiology in the the Department of Pediatrics at the Jikei University School of Medicine Minato-ku in Tokyo found that vitamin D was extremely effective at halting influenza infections in children. The trial appears in the March, 2010 issue of the American Journal of Clinical Nutrition (Am J Clin Nutr (March 10, 2010). doi:10.3945/ajcn.2009.29094)

The results are from a randomized, double-blind, placebo-controlled study involving 334 children, half of which were given 1200 IUs per day of vitamin D3.

In the study, while 31 of 167 children in the placebo group contracted influenza over the four month duration of the study, only 18 of 168 children in the vitamin D group did. This means vitamin D was responsible for an absolute reduction of nearly 8 percent. (www.naturalnews.com)

Only 8 percent?  Yes 8 percent!  That may not seem like a lot, but compare this the most recent research available on flu vaccines which states that they only reduce the incidence of the flu by 1%!

I hear some of you.  You’re saying, “That can’t possibly be correct. My doctor said my flu vaccine will protect me from the flu.  If I get the vaccine, I won’t get sick.”

I’ve got the data to back it up.

The Cochrane Collaboration

The Cochrane Collaboration, as described on its own website, is, “…an international, independent, not-for-profit organization of over 28,000 contributors from more than 100 countries, dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide.”

“We are world leaders in evidence-based health care,” the site goes on to say, followed by a quote from The Lancet which states, “The Cochrane Collaboration is an enterprise that rivals the Human Genome Project in its potential implications for modern medicine.” (www.naturalnews.com)

Anyone who is in health care knows about the Cochrane Collaboration and their studies.  They are some of the most trusted studies in the medical world.

Dr. Tom Jefferson, an epidemiologist, worked closely with the Cochrane Collaboration to evaluate the true effectiveness of the flu vaccines.  His findings were truly surprising to those in the traditional medical field.  You may access a great summary by the authors here for free if you are interested in reading it.  I will summarize it below.

Selection Criteria: Randomized controlled trials (RCTs) or quasi-RCTs comparing influenza vaccines with placebo or no intervention in naturally-occurring influenza in healthy individuals aged 16 to 65 years.

Main Results: A total of 50 reports were included in the review.  This included a total of about 70,000 people. They concluded that in ideal situations where the vaccine matched the virus in circulation a 4% reduction in flu rates were obtained.  This means 100 people would need to be vaccinated to prevent 4 cases of the flu.  In average conditions where the vaccine does not match the strain of flu virus there was a 1% reduction.  This means 1 case was prevented for every 100 people who get the vaccine.

Even in ideal conditions where the anticipated viral strain included in the vaccine matches the viral strain in the environment it only produced a 4% reduction!  Remember, the flu vaccine makers try to guess which strain of the flu will be most prevalent each season.  They rarely guess correctly because it’s simply not easy to predict. In fact, the Cochrane Report concluded that it is a…”relatively uncommon circumstance [that the] vaccine match[es] the viral circulating strain.”

That means most people that get the flu vaccine are only afforded a 1% reduction rate in the flu.

The Cochrane Report also warned of manipulation of data and evidence of bias on the part of the pharmaceutical industry:

This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.

They also went on to conclude:

Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited.

Optimistic?! Wow. If a 1% reduction in flu rates is optimistic, I’d hate to see what realistic is!

So back to vitamin D.  Recall that a placebo controlled study recently released in the American Journal of Clinical Nutrition found that vitamin D reduced the rate of flu in children by 8%.  That’s 800% more effective than the vaccines that are available.  I understand that this information steps on a lot of toes, but the numbers don’t lie.

Another plus to vitamin D is that its effectiveness does not rely on matching viral strains and guessing which virus is going to be most prevalent.  It works by regulating your immune system.

Also recall that the IOM says people are getting “enough” vitamin D as long as they are getting 600IU per day.  But this recent study has found added benefit for vitamin D at 1200IU?  Curious.  I think the IOM should reevaluate their stance.

This flu season consider an alternative to the flu shot.  The numbers show that it is not terribly effective.  You’d be better off by eating healthy, exercising and taking a little extra vitamin D.  For adults in the winter I recommend 4,000IU per day.  This will take care of your daily needs as well as protect you from the flu.

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Are we getting enough Vitamin D?

The Institute or Medicine (IOM) says we are.  They say we might even be getting too much.  Their recent report released on November 30th states that most Americans are getting enough vitamin D from their diet and supplementation is unnecessary.  In fact their conclusion to the report states “the committee emphasizes that, with a few exceptions, all North Americans are receiving enough calcium and vitamin D.”  I couldn’t disagree more.

The IOM examined over 1,000 studies and reports to make their conclusions that people need no more than 600IU of vitamin D per day.  They concluded that people are getting enough vitamin D.  However, this blanket statement only applies to one health factor – bone health.

It is my fear that people will see the headlines on the news and assume they are getting enough vitamin D.  The headlines inevitably will read “Americans Getting Enough Vitamin D.”  They will not tell people this refers only to bone health.  Vitamin D does so much more than protect your bones.

The IOM says the evidence, at this point, is insufficient to say that vitamin D has a protective benefit in any other area of health.  Research, however, has shown it improves cancer rates, reduces the incidence of MS, decreases cardiovascular disease rates and many more.

So why the conflict?

Part of the problem is that the IOM based it’s conclusions on what it takes to maintain bone health and since 2000 the research for vitamin D has exploded.  Many studies, published in some of the world’s most respected peer-reviewed journals, have concluded in direct conflict with what the IOM has said.

The IOM has said the studies that were done that drew conclusions on vitamin D’s other health benefits were either poorly designed or were insufficient to conclude vitamin D is good for anything but bone health.  These studies that they dismissed were good enough to be published in many of the best journals in the world.  I guess the IOM does not agree.

Below is a graph of the disease reduction rates by serum levels of vitamin D.  As serum levels rise, the rates of many diseases are reduced.  For example, breast cancer levels are reduced by 30% when vitamin D levels are at 34ng/ml or higher.  The X’s represent reasonable extrapolations based on the research but is beyond existing data.

 

Vitamin D reduces the rates of all of these diseases. It is NOT just for bone health as the IOM has concluded. The references are listed above as well.

The IOM report readily admits that people do not get enough vitamin D by saying:

“While the average total intake of vitamin D is below the median requirement, national surveys show that average blood levels of vitamin D are above the 20 nanograms per milliliter that the IOM committee found to be the level that is needed for good bone health for practically all individuals.”

If you look at the graph above you will see that the research is consistent with that statement.  At 20 ng/ml of serum vitamin D 99% of cases of rickets is prevented.  This is a disease of soft bones in children.  But what about all of the other wonderful, researched benefits of vitamin D? The IOM has seemingly missed the boat.

The graph above would suggest that a level of 60 ng/ml is optimal to protect a person from the diseases listed.  This is a serum level that cannot be obtained by current diets.  A person must supplement to reach this level and the IOM’s recommendation of 600IUs per day obtained from diet is exceptionally low.

I recently tested a patient who was under my care and was taking 4,000IUs per day as I had recommended.  Her serum vitamin D level came back at 18ng/ml.  By any current laboratory’s standard this patient was deficient in vitamin D.  And that’s after taking 4,000IUs per day for 2 months!  How can the IOM say 600IUs is enough for everyone.  It makes absolutely no sense whatsoever.

The IOM’s own report concluded that the average intake is below the median requirement but that blood levels were above the 20ng/ml required for healthy bones according to the quote above in gray.  How could that be possible?  Perhaps the 20ng/ml of serum vitamin D is too low as well.  This would make much more sense.  Instead of making that conclusion the IOM simply concluded that people must somehow be getting enough vitamin D.

I couldn’t disagree more.

The IOM has taken an exceptionally conservative stance on this.  Their stance on this is equivalent to saying that people shouldn’t exercise more than 10 minutes a day because any more than that might lead injury.

I recommend my patients get at least 2,000IUs per day of vitamin D.  I myself take 8,000IUs per day.  The benefits of taking vitamin D far outweigh any perceived “risks” associated with it.  Vitamin D is very safe and I hope this report doesn’t persuade any physicians into thinking it’s not.

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“I’m destined to get (insert disease here) because my parents did.” – Maybe Not.

The field of genetics has rapidly evolved over the last 15-20 years.  The latest push in genetics is trying to figure out why some people with specific genes express them and why some do not.  For example, a very well-known gene is the “breast cancer” gene called BRCA.  This gene is known to increase the risk of developing breast cancer, but it’s not an absolute.  Just because you have the gene does not mean you are going to get breast cancer.  So why the difference?  Why would one woman with the gene get breast cancer and the next not?

Well some new research on vitamin D may help us find out.  It is clear that vitamin D is a potent genetic regulator.  The reduction in cancer rates and the rates of other diseases drops sharply with adequate vitamin D levels.  Most people, however, do not have adequate levels of vitamin D.

Vitamin D is considered a vitamin, but it’s really a hormone.  It is best obtained from direct sunlight but dietary sources do exist and include fortified milk, eggs and oily fish.  Vitamin D is probably best known for helping people build and maintain strong bones.  While it is essential for that, the story for vitamin D only begins there.

Vitamin D is believed to have a role in controlling genes linked to major diseases such as certain types of cancers, dementia, and autoimmune disorders, new research has found.

“Through large scale studies, we now have a good idea of the genes involved in common complex diseases such as type 1 diabetes, multiple sclerosis and systemic lupus erythematosus,” wrote lead author, Dr. Sreeram Ramagopalan of the Wellcome Trust Centre for Human Genetics at Oxford University.

Scientists from University of Oxford, The London School of Medicine and Dentistry and Simon Fraser University in Canada identified 2,776 gene positions occupied by the vitamin D receptor and 229 genes that changed in response to vitamin D.  That’s right, thousands of genes respond to vitamin D.  To put this in perspective, the human genome has an estimated 23,000 genes.  That means vitamin D has a direct effect on over 12% of our genes. It doesn’t get more important than that!

What I want to stress is that if you are concerned about a part of your family’s health history as it relates to you (and who isn’t) taking vitamin D is good insurance.  It may just offset your genetic potential for disease by controlling your genes and keeping the bad ones turned off and the good ones turned on.

How much should I take?

I always recommend that my patients have their serum vitamin D checked.  It has become a very routine test for physicians to order and just about every person who comes to see me walks out of my office with a lab requisition to check vitamin D.

Taking vitamin D is simple.  Most people, even ones in sunny climates, can benefit from taking vitamin D.  Here in the Northeast I recommend my patients take 4,000-6,000 IUs per day for maintenance.  If we are working to significantly raise serum levels a dose of at least 10,000 IUs per day is necessary.  The point is check your blood levels.  Shoot for a level of between 55 and 65 ng/ml.  Once you reach that level you must maintain it to continue to get all the benefits that vitamin D provides.

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1 in 100 Children have Autism…Find Out Why

My recent studies have focused very much on vitamin D and all of its wonderful benefits.  A quick perusal of the other articles on our blog will confirm this!  Recently, I came across information that was too good not to share with all of you.  A link between Autism and vitamin D deficiency has been established.  As some of you know, we see many children at The Vreeland Clinic for interventions with autism.  We provide nutritional and neurological rehabilitation programs to further assist in the development of the brains of these children.  In this article I would like to share with you groundbreaking information regarding vitamin D and autism.

Autism now affects 1 in 100 children in the U.S.

Autism statistics are staggering.  Twenty-five years ago an autism diagnosis was a 1 in 10,000 chance.  Today, 1 in 100 children will be diagnosed with autism.  Many researchers point to the increase in diagnosis as nothing more than more accurate methods and increased awareness.  They believe that the number was always about 1 in 100, but it was not reported.  Although there is some truth to more accurate diagnosis, it does not account for such a meteoric rise.  What’s more likely is that there has been some change in our environment over the last 20 to 25 years that, in combination with a more accurate system of diagnosis, has caused the number of autistic children to rise to epidemic proportions.

Autism involves poor social and verbal functioning accompanied by a host of other issues that range from poor digestion to fixed and repetitive behaviors.  Also included in the Autistic Spectrum Disorders is a series of problems with fine or gross motor control, all of which can have a devastating effect on a family.  The range is so broad in fact that many scientists and healthcare professionals often do not agree on a diagnosis.  What is presently known is that this condition can cause subtle developmental delays or profound issues that can require long-term care is specialized facilities.  The dichotomy is obvious, but there seems to be a link between the two.  This link is vitamin D.

There are many proposed causes of autism.  Most agree that there is some genetic predisposition.  This has been suggested because of the increased frequency of autism that tends to occur in families and in studies of identical twins.  Although there is a genetic link, it is also accepted that some environmental trigger must occur to cause autism.  The majority of scientists have come to a consensus that identifies both genetic and environmental factors as being relevant in the cause of autism.  Many theories have focused on environmental toxins, especially heavy metals, as a culprit in autism.  Another theory is low levels of vitamin D during pregnancy and infancy.

Many times when speaking about autism people are very confused by the recent rise in autism diagnoses.  Most times,

A link between Autism and vitamin D deficiency has been found

people rightly point out that a purely genetic theory makes no sense because our genes certainly are not any different than they were 20 years ago.  They also make the point that our environment, while different, is not significantly different than it was 20 years ago.  If both of these previous statements are true, and I believe they are, then what could possibly be causing the rise in the diagnosis of autism?  Dr. John Cannell, a leading researcher in vitamin D has a theory.  He agrees that genetically we are the same today as we were 20 years ago and that the environment, while altered, is not so significantly altered to cause an epidemic of autism.  He argues that our behavior with regard to our environment has changed.  He states that these changes have had an effect on our nervous systems that can and does account for a rapid rise in autism diagnoses.

Our understanding of what vitamin D does in our body has exploded in recent years.  Although most physicians know that vitamin D is critical for healthy bones, most do not know about its other benefits.  Vitamin D is critical for a healthy heart.  It has been shown that it is critical in preventing many forms of cancer.  We know that it regulates the immune system by keeping it prepared but also keeping it from overreacting.  Vitamin D is a potent anti-inflammatory.  It has also been shown that the active form of vitamin D, called calcitriol, is an important neurosteroid hormone.  A neurosteroid hormone is a compound that is extremely important for brain development and behavior.  Calcitriol is a potent neurosteroid that controls brain cell growth and acts on brain cells from the time of conception.  Recent research has suggested that vitamin D offers “neuroprotection, antiepileptic effects [antiseizure effects], immunomodulation, impact on several brain neurotransmitter systems and hormones as well as regulation of behaviors.”  The last statement makes it very obvious that vitamin D is critical for pregnant mothers, newborns and children alike.

The question remains, however.  What could have possibly changed so greatly in the past 20 years that it would account for the rapid rise in autistic cases?  Dr. Cannell believes it is a simple answer.  He believes that in an effort to reduce our risk for skin cancer we have created a very serious deficiency in vitamin D.  Remember, it is through the sun’s UV rays that most of our vitamin D is produced in the body.  By lathering up with sunscreen every time we go out side, we block those UV rays from ever reaching our skin, thus preventing synthesis of the all important vitamin D.  Dr. Cannell also believes that because we have become a much more sedentary society that we do not get outside nearly as much as we used to.  And is this so hard to believe?  Twenty years ago marks the real beginning of home video game systems.  Cable television was still in its infancy 20 years ago.  The iPod did not exist and hand held electronic games were not nearly as popular and complex as they are today.  So this, in combination with sunscreen, creates a dangerous, yet easily overlooked scenario.

Our unfounded fear of the sun has lead to an epidemic of low vitamin D levels - even in sunny climates.

So what evidence links autism with vitamin D deficiency?  Is it more that just a coincidence?  Calcitriol acts as a molecular switch in brain tissue that turns on favorable genes that facilitate brain development.  In fact, there are about 1,000 genes already known that are targets of calcitriol.  Vitamin D is unique in that is it the only vitamin that relies on the sun for its production rather than dietary intake.  Because pregnant women are getting into the sun less and less they require more and more to be taken orally.  Unfortunately, the prenatal vitamins that most women take are far too low in vitamin D to be of any benefit.  From an evolutionary perspective, our bodies are not used to getting the majority of our vitamin D from a pill.  It is used to getting massive amount from the sun.  The skin’s production of vitamin D is far more effective than ingesting it orally.  Take the following into consideration; in just 10-40 minutes of sunbathing by a fair skinned adult about 20,000 IUs of vitamin D will be produced over the next 24 hours.  It is important to note that the FDA claims 400 IUs per day through diet is sufficient for health.  There is quite a difference between 20,000 and 400.  Now consider this; in order to get 20,000 IUs from diet, one would have to drink 200 glasses of milk or take 50 prenatal multivitamins.  Obviously neither of those is a viable option.

Dr. Cannell points out that people have been avoiding the sun for the past 20 years.  It is exactly in the last 20 years that we have noticed a rapid rise in the diagnosis of autism.  Now, just because the rise in autism parallels a decrease in sun exposure in industrialized nations does not necessarily mean it is a cause and effect relationship.  There are other astounding biochemical reasons this theory makes sense.  A very large amount of animal studies have shown just how crucial calcitriol is to brain health.  In rats, it has been shown that the offspring of vitamin D deficient mothers had abnormal cell growth, structure and functions in their brains and alterations in learning and memory.  A group of French researchers found that 36 important brain proteins are disrupted when vitamin D is deficient during fetal development.  We discussed earlier that vitamin D is a potent anti-inflammatory.  Often in autism, children have problems with immune function similar to those affected by vitamin D – including increased inflammatory cytokine levels.  These high levels of inflammatory cytokines cause oxidative stress in the brain and are known to cause cognitive impairment.  Vitamin D reduces this oxidative stress on the brain.  Calcitriol also helps increase levels of glutathione in the brain.  Glutathione is a critical antioxidant for detoxification.  This may explain the link between heavy metals and autism.  Without the calcitriol, children cannot actively detoxify the small amounts of heavy metals that accumulate in their body on a daily basis.  In time, this results in a toxic load that retards brain development.  As we can see, there are many reasons why vitamin D is important for proper brain function.  It serves to regulate nerve cell growth, it regulates protein structure, it regulates the immune system and it regulates oxidative stress that may damage brain cells.

So now the question is, how much vitamin D do I need?  This is a good question.  Most people cannot obtain enough vitamin D through diet.  Ideally, a good blood level of vitamin D is 50-60 ng/mL.  This can be measured through a simple test.  In order to get to that number most people will have to supplement their diet with a quality form of vitamin D.  Generally speaking, we start adults on at least 2,000 – 4,000 IUs per day and recheck the levels in 2-3 months.  Recent research indicates that even that might not be enough (remember we are told the standard for Americans for adequate health is 400 IUs).  Children over 1 year of age can safely take at least 1,000 IUs but we usually start at 800 IUs and check the levels in 2-3 months.  Vitamin D is very safe to take and as a matter of fact, the risk of not having enough far out weighs the risk of vitamin D toxicity.  In fact, if vitamin D is taken responsibly, the risk of toxicity is virtually zero.  Should you have any questions regarding vitamin D supplementation, please contact you health care professional and talk to them about vitamin D.

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Finally, “modern” medicine catches up a little…

I have been touting the benefits of vitamin D for years.  A multitude of studies have shown that it is beneficial for many things, not just for healthy bones.  Now a new study, published in Pediatrics, shows that even infants need to supplement with vitamin D.

New research has shown that a significant portion of mothers and therefore infants are deficient in this life saving nutrient.  A second study in Pediatrics reports that 58% of newborns and 36% of mothers were deficient in vitamin D, according to blood tests. Although taking prenatal vitamins helped, more than 30% of moms who took them were still deficient. Getting lots of sunlight helped raise vitamin D levels in moms, but not in their newborns.

I always recommend extra vitamin D to my pregnant patients in addition to their regular prenatal vitamin.  Although prenatal vitamins are beneficial, they are entirely too low in vitamin D.  The fact that 30% of moms taking prenatals are still low in vitamin D proves it.

I have also have mothers question why I would recommend vitamin D to them during the summer months.  The first reason is that most people don’t get outside enough to get adequate vitamin D production.  Secondly, when they do go out, modern medicine has scared them into thinking they need to rub chemical laden creams into their skin to “protect” it.  Sunscreen blocks the production of vitamin D and who knows what it does to an unborn child.

The old recommendation of 200 international units (IUs) per day is extremely low.  They have doubled the recommendation up to 400 IUs per day and in my estimation that is still far too low.  While breast feeding is always best it does not provide enough vitamin D for the baby especially if mom is also low.  The best way to increase vitamin D in your baby is to supplement with it.  It is very inexpensive and comes in liquid form.  This new recommendation, while a step in the right direction, needs to be increased even more.

How Much Should My Baby Get?

Below is a good recommendation of how much vitamin D infants and babies should obtain.

Infants and children under the age of one should obtain a total of 1,000 IU (25 mcg) per day from their formula, sun exposure, or supplements. As most breast milk contains little or no vitamin D, breast-fed babies should take 1,000 IU per day as a supplement unless they are exposed to sunlight. The only exception to this are lactating mothers who either get enough sun exposure or take enough vitamin D (usually 4,000–6,000 IU per day) to produce breast milk that is rich in vitamin D. Formula fed babies should take an extra 600 IU per day until they are weaned and then take 1,000 IU a day, as advised below.

Children over the age of 1 year should take 1,000 IU per every 25 pounds of body weight per day, depending on latitude of residence, skin pigmentation, and sun exposure. On the days they are outside in the summer sun, they do not need to take any; in the winter they will need to supplement accordingly. (From www.vitaminDcouncil.org)

These recommendations are safe and effective.  The alternative is not taking any at all and putting your child at risk for a host of diseases.  Below is the reduction rates for many diseases with adequate vitamin D levels.  These rates are all from published, peer reviewed studies.

  • 35% reduction in all cancers with serum levels of 38 ng/ml or higher.
  • 83% reduction in breast caner with serum levels of 50 ng/ml or higher.
  • 17% reduction in ovarian cancer with serum levels of 47 ng/ml or higher.
  • 60% reduction of colon cancer with serum levels of 43 ng/ml or higher.
  • 18% reduction in Non-Hodgkins Lymphoma with serum levels of 38 ng/ml or higher.
  • 66% reduction in Type I diabetes with serum levels of 53 ng/ml or higher.
  • 54% reduction in multiple sclerosis (MS) with serum levels of 55 ng/ml or higher.
  • 30% reduction in heart attacks in men with serum levels of 35 ng/ml or higher.
  • 49% reduction in kidney cancer with serum levels of 48 ng/ml or higher.
  • 37% reduction in endometrial cancer with serum levels of 51 ng/ml or higher.

The bottom line is that to gain all of the benefits of vitamin D you need to keep your serum levels between 55 and 65 ng/ml at the very least.  To achieve this level, supplementation is a must even if you live in a sunny climate.

Toxicity?

This is a question I hear a lot.  People always ask me, “But isn’t vitamin D toxic?”  While vitamin D can become toxic in extremely high doses, the fear of toxicity is completely unwarranted.  The fear of toxicity is rampant, especially in traditionally trained physicians.  These fears are unnecessary and here’s why.  I will routinely recommend 6,000-10,000 IUs per day to my patients.  The toxicity levels established and accepted are 40,000-50,000 IUs per day for several months at a time.  No one takes that much and no one is recommending people take that much.  What about if people get regular sun?  Good question.  If regular sun exposure occurs I reduce my recommendations accordingly.  Secondly, all of my patients get their serum levels checked.  If the number starts to creep too high, I reduce their recommendations.  Simple as that.

Vitamin D is a critical vitamin in the body and it does far more than anyone thought just 5 years ago.  The risk of toxicity is relatively unfounded simply because most people cannot attain enough, either from sun, supplement or food, to actually reach toxic levels.  The flip side of that is not having enough, and the dangers of that far outweigh the dangers of having too much.  Vitamin D is easy to supplement with and to reach the most beneficial levels, supplementation is necessary.

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