V

ITAMIN

D By: Jennie Simpson, RD, LD, CDE Alaska Regional Hospital

W HAT IS V ITAMIN D

 Fat soluble vitamin  Hormone  Regulated by parathyroid hormone, calcium and phosphate  Present in very few foods  Produced in skin from sunlight

I MPORTANCE

 Promotes calcium absorption in gut and maintains adequate serum calcium  Immune function  Cells  Growth   Proliferation Differentiation  Inflammation

T YPE OF V ITAMIN D

 D2-Ergocalciferol- photosynthesized in plants, mushrooms and yeast  Sometimes used in food fortification  D3-Cholecalciferol- formed upon exposure to UVB  25-hydroxyvitamin D- calcidiol  Storage form  1,25-dihydroxyvitamin- calcitriol- active form

F OOD S OURCES

Food Source

Cod Liver Oil Salmon (sockeye) Tuna Fish (canned in water) Fortified Orange Juice Fortified Milk Sardines (canned in oil) Beef Liver Egg yolk Fortified ready to eat cereal Swiss Cheese

Serving Size IUs per serving

1 tbsp 1,360 3 oz 3 oz 8 oz 8 oz 447 154 ~137 115-124 2 sardines 46 3 oz 1 large 1 oz 41 41 varies 6

O THER S OURCES

 Sun exposure  Season, time of day, length of day, cloud coverage, smog, skin melanin content, sunscreen  Dietary Supplement   D2 and D3 are equivalent Both raise serum 25 (OH) D levels, cure rickets  D2 is less potent at high doses *supplementation is based on your levels *take with Calcium

R ECOMMENDED D AILY (RDA) A LLOWANCE

Age

0-12 months 1-70 years of age >70 years of age Pregnancy/ Lactation

RDA

400 IU (10 mcg) 600 IU (15mcg) 800 IU (20mcg) 600 IU (15mcg)

T OLERABLE U PPER L IMIT (U LS )

Age

0-6 months 7-12 months 1-3 years of age 4-8 years of age >8 years of age Pregnancy lactation

UL

1,000 IU (25 mcg) 1,500 IU (38 mcg) 2,500 IU (63mcg) 3,000 (75 mcg) 4,000 IU (100 mcg) *OTC- max dose 5,000 IU

D EFICIENCY

 Rickets-failure of bone tissue to properly mineralize causing soft bones and skeletal deformities  Osteomalacia- weak bones * Caused by dietary inadequacy, impaired absorption and use, increased requirement or increase secretion

G ROUPS AT R ISK FOR D EFICIENCY

 Breastfed infants  Older adults  Limited sun exposure  People with dark skin  IBS or other fat malabsorption  Obese  Gastric Bypass Surgery  Use of certain medications (steroids, orlistate, cholestyramine, anti-seizure)

H EALTH R ISK FOR V ITAMIN E XCESSIVE D

 Non specific symptoms- anorexia, wt. loss, polyuria and heart arrhythmias  Raise blood levels of calcium  Kidney stones in post menopausal women  Excessive sun exposure does not lead to excessive vitamin D  Toxicity is mainly caused through over supplementation

B EYOND B ONES



Osteoporosis



Cancer



Diabetes



HTN



Glucose Intolerance



Multiple Sclerosis

Y OUR L EVELS

Serum 25-Hydroxyvitamin D Concentrations and Health

nmo l/L <30 <12 30 50 Ng/m L Health Status Associated with vitamin D deficiency (leading to rickets/ osteomalacia) 12-20 Inadequate for bone and overall health > 50 > 20 > 125 > 50 Adequate for bone and overall health Potential adverse effects w/ emerging evidence

P UT IT ALL T OGETHER

 Only supplement based on your levels  Talk to your provider about supplementing if needed  If supplementing take with Calcium  Follow a healthy diet

Q UESTIONS

R EFERENCES  National Institute of Health  http://ods.od.nih.gov/factsheets/vitaminD-HealthProfessional/  Linus Pauling Institute at Oregon State University  http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/  National Cancer Institute  http://www.cancer.gov/cancertopics/factsheet/prevention/vitamin-D/