What Vitamin D Supplement Should I Take

What Vitamin D Supplement Should I Take

Vitamin D is essential for good health, and cholesterol plays a role in producing vitamin D from sunlight. Most of us don't get enough vitamin D but it's possible to get more from supplements and sunlight.

Why we need vitamin D

Vitamin D helps you absorb calcium and phosphorus from your diet and use these minerals to keep your bones, teeth and muscles strong. This helps prevent falls as you get older.

Vitamin D may have other roles in the body's immune system and heart health too.
A lack of vitamin D can cause bone problems such as rickets (which causes bowed legs) in children and muscle weakness and painful or tender bones in adults.

How we make vitamin D

We get a little vitamin D from food, but we get most of it from sunlight. The sun acts on chemicals under the skin and helps turn them into vitamin D. In winter in the UK, we don't get enough of the right type of sunlight to make enough vitamin D.

Not getting enough vitamin D

We don't need vitamin D from food or sunlight every day. But if you don't get enough over a longer period of time, you won't have enough vitamin D for good health – known as vitamin D deficiency. This is very common in the UK – around one in five adults and one in six children don't have enough vitamin D.

Some people are more likely to have a vitamin D deficiency than others. Supplements and eating foods which contain vitamin D can help.

Vitamin D and cholesterol

Vitamin D is linked to cholesterol because we need cholesterol in our skins cells to make vitamin D from sunlight. The vitamin D is later transformed again in the liver and kidneys, but cholesterol is needed for the first step.

Vitamin D and statins

There has been some debate around whether statins could stop us making enough vitamin D – because statins lower cholesterol. In reality, we have more than enough cholesterol to make vitamin D, even if you take statins. It's more important to make sure you're getting enough time in sunlight or getting enough vitamin D from foods or supplements.

Muscle problems that are thought to be caused by statins

It's possible that muscle aches and pains that are often thought to be caused by statins are actually caused by a lack of vitamin D. Too little vitamin D can cause muscle weakness and tenderness in the bones – these muscle problems seem very similar to the ones linked to statins.

Because a lack of vitamin D is so common, it's likely that many people who are taking statins don't have enough vitamin D.

Your doctor can check if you have enough vitamin D in your blood using a simple blood test.

How much vitamin D is enough?

Adults and children over the age of one need 10mcg (micrograms) of vitamin D per day. This is the same for everyone, including people at risk of vitamin D deficiency and women who are pregnant or breastfeeding.

Babies up to one year old need 8.5-10mcg of vitamin D per day. Find out more about how you can reach this from the NHS.

How to get enough vitamin D

Getting vitamin D from sunlight

To make vitamin D, you need sunlight on your skin. From April until the end of September it's possible to get enough vitamin D by spending time outside.

For most people, you only need to be outside for short periods of time, for example around 20-30 minutes. Although the exact time isn't known because it's different for different people. If you have dark skin, for example if you're of south Asian, African or African Caribbean origin, you will need longer in the sun.

You need to have some skin exposed, for example, your forearms, hands and lower legs. But you can still make vitamin D even if you sit in the shade.

Sitting inside by a sunny window doesn't count because glass filters out the UVB rays – the type of light that is needed to make vitamin D.

In the UK, we don't get enough vitamin D from sunlight between October and March, because the light doesn't contain enough UVB rays. During this time, we need to rely on getting enough vitamin D from food, and possibly supplements.

The guidelines in the UK are that everyone should consider taking a vitamin D supplement in the winter, especially if you're more like to have a deficiency.

Protecting your skin

Suntan lotions protect your skin from the sun but they also prevent your skin from making vitamin D.

If you are going to sit in strong sunlight for some time, or if your skin is sensitive, then you will need to protect your skin so it doesn't burn. Wear sunscreen and a hat in summer if you're out for a long time and avoid mid-day sun on hot summer days. Find out more about your skin type and avoiding sunburn from Cancer Research UK.

Getting vitamin D from food

Most foods don't contain much vitamin D so it's hard to get enough vitamin D from food alone.

Foods which contain vitamin D include:

• oily fish – such as salmon, sardines, mackerel, trout
• red meat
• liver and fish liver oil
• egg (yolks)
• foods with vitamin D added – such as most fat spreads, some breakfast cereals and some plant-based alternatives to milk. Check the labels.
• infant formula – which has vitamin D added to make sure babies get enough.

As most of these foods are animal products, it's harder to get vitamin D from food if you are vegan or vegetarian. Plant-based sources of vitamin D include sun-exposed mushrooms and fortified foods such as vegetable spreads, breakfast cereals and plant based dairy alternatives.

In the UK, cows' milk is generally not a good source of vitamin D because it isn't fortified, as it is in some other countries. There are some yoghurts which have been fortified, but check the label as they can also be high in saturated fat and so should be avoided.

People most at risk of vitamin D deficiency

Some people don't have enough vitamin D. This could be because their skin isn't exposed to enough sunlight, or because of health problems or higher needs for vitamin D.

For example, if:

• you don't go outdoors often, for example if you are housebound, in hospital or are disabled and less able to get about
• you wear clothes which cover most of your skin when you go outside
• you have dark skin, for example if you're from an African, African-Caribbean or south Asian background – as you need more sunlight to make enough vitamin D
• you wear sunscreen most or all of the time
• you need more vitamin D, babies, young children and pregnant and breastfeeding women need more vitamin D
• you are an older adult, as older people can't make as much vitamin D
• you have a health problem or you're taking certain medications which change the way vitamin D is controlled in the body, such as Crohn's disease, coeliac disease, and some types of liver and kidney disease.
• you are very overweight, a there is some evidence to suggest that people who are very over weight are more likely to lack vitamin D
• you eat very few foods that contain vitamin D.

Taking supplements

Any one at risk of not getting enough vitamin D should take a vitamin D supplement – especially during the winter months but ideally all year round.

Adults and older children will need a daily supplement which contains 10mcg of vitamin D. This will sometimes be written as 400IU (international units).

There are special vitamin drops available for babies and children under 5. These may be available free of charge for some families. If you are pregnant and breastfeeding you may also be able to claim free vitamin D tablets.

If you are not in one of the groups above and you simply want to make sure you're taking enough, you can consider taking a vitamin D supplement during the winter, when the levels of vitamin D in our blood usually drops.

You can't get too much vitamin D from sunlight, but it is possible to take too much vitamin D if you take a supplement that has a high dose, and you take it for a long time. This can cause a build-up of calcium in the body, which can damage your bones, heart and kidneys.

So, if you are taking supplements, then 10mcg each day should be enough. More is not necessarily better. Don't go over 25mcg a day for adults unless your doctor advises you to. If in doubt, check the advice about the dose on the pack or speak to your doctor about what's right for you.

Find out more about vitamin D and how to get enough, including the guidelines for pregnant women and babies, from the NHS.

Learn about dark chocolate and cholesterol

What Vitamin D Supplement Should I Take

Source: https://www.heartuk.org.uk/low-cholesterol-foods/vitamin-d

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Vitamin D Mood

Vitamin D Mood

Overview

Symptoms of vitamin D deficiency

What is vitamin D deficiency?

Vitamin D deficiency means that you do not have enough vitamin D in your body. Vitamin D is unique because your skin actually produces it by using sunlight. Fair-skinned individuals and those who are younger convert sunshine into vitamin D far better than those who are darker-skinned and over age 50.

Why is vitamin D so important?

Vitamin D is one of many vitamins our bodies need to stay healthy. This vitamin has many functions, including:

• Keeping bones strong: Having healthy bones protects you from various conditions, including rickets. Rickets is a disorder that causes children to have bones that are weak and soft. It is caused by a lack of vitamin D in the body. You need vitamin D so that calcium and phosphorus can be used to build bones. In adults, having soft bones is a condition called osteomalacia.
• Absorbing calcium: Vitamin D, along with calcium, helps build bones and keep bones strong and healthy. Weak bones can lead to osteoporosis, the loss of bone density, which can lead to fractures. Vitamin D, once either taken orally or from sunshine exposure is then converted to an active form of the vitamin. It is that active form that promotes optimal absorption of calcium from your diet.
• Working with parathyroid glands: The parathyroid glands work minute to minute to balance the calcium in the blood by communicating with the kidneys, gut and skeleton. When there is sufficient calcium in the diet and sufficient active Vitamin D, dietary calcium is absorbed and put to good use throughout the body. If calcium intake is insufficient, or vitamin D is low, the parathyroid glands will 'borrow' calcium from the skeleton in order to keep the blood calcium in the normal range.

What are the health effects of vitamin D deficiency?

Getting enough vitamin D may also play a role in helping to keep you healthy by protecting against the following conditions and possibly helping to treat them. These conditions can include:

• Heart disease and high blood pressure.
• Diabetes.
• Infections and immune system disorders.
• Falls in older people.
• Some types of cancer, such as colon, prostate and breast cancers.
• Multiple sclerosis.

What are the sources of vitamin D?

You can get vitamin D in a variety of ways. These can include:

• Being exposed to the sun. About 15-20 minutes three days per week is usually sufficient.
• Through the foods you eat.
• Through nutritional supplements.

What does sunlight have to do with getting enough vitamin D?

There are health benefits of sunlight. Vitamin D is produced when your skin is exposed to sunshine, or rather, the ultraviolet B (UV-B) radiation that the sun emits. The amount of vitamin D that your skin makes depends on such factors as:

• The season: This factor depends a bit on where you live. In areas such as Cleveland, OH, the UV-B light does not reach the earth for six months out of the year due to the ozone layer and the zenith of the sun.
• The time of day: The sun's rays are most powerful between 10 a.m. and 3 p.m.
• The amount of cloud cover and air pollution.
• Where you live: Cities near the equator have higher ultraviolet (UV) light levels. It is the UV-B light in sunlight that causes your skin to make vitamin D.
• The melanin content of your skin: Melanin is a brown-black pigment in the eyes, hair and skin. Melanin causes skin to tan. The darker your skin, the more sun exposure is needed in order to get sufficient vitamin D from the sun.

What does your diet have to do with getting enough vitamin D?

Vitamin D doesn't occur naturally in many foods. That's why certain foods have added vitamin D. In fact, newer food nutrition labels show the amount of vitamin D contained in a particular food item.

It may be difficult, especially for vegans or people who are lactose-intolerant, to get enough vitamin D from their diets, which is why some people may choose to take supplements. It is always important to eat a variety of healthy foods from all food groups. The vitamin content of various foods is shown in the following table.

Vitamin D content of various foods

Food	Vitamin D content in International Units (IUs) per serving
Cod liver oil, 1 tablespoon	1360
Swordfish, cooked, 3 ounces	566
Salmon (sockeye) cooked, 3 ounces	447
Tuna, canned in water, drained, 3 ounces	154
Orange juice fortified with vitamin D, 1 cup	137
Milk, vitamin-fortified, 1 cup	115-124
Yogurt, fortified with 20% of the daily value of vitamin D, 6 ounces	80
Sardines, canned in oil, drained, 2 sardines	46
Liver, beef, cooked, 3 ounces	42
Egg yolk, 1 large	41
Cereal, fortified with 10% of the daily value of vitamin D, 1 cup	40
Cheese, Swiss, 1 ounce	6

Source: Vitamin D. Health Professionals. Dietary Supplement Fact Sheet. National Institutes of Health. Office of Dietary Supplements. August 7, 2019.

It is important to check product labels, as the amount of added vitamin D varies when it is artificially added to products such as orange juice, yogurt and margarine.

How much vitamin D do you need?

In healthy people, the amount of vitamin D needed per day varies by age. The chart below shows the often-cited recommendations of the Institute of Medicine, now the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine. It is important to know that these are general recommendations. If your doctor is checking your blood levels, he or she might recommend higher or lower doses based on your individual needs.

If you have osteoporosis, your doctor might suggest a blood test of your vitamin D levels. The amount of vitamin D supplement can be customized for each person, based on the results. For many older patients, a vitamin D supplement containing anywhere between 800 to 2000 IUs daily, which can be obtained without a prescription, can be both safe and beneficial. It is important to speak with your doctor about your individual needs.

People by age	Recommended dietary allowance (IU/day)	Upper level intake (IU/day)
Infants 0-6 months*	400	1,000
Infants 6-12 months*	400	1,500
Children 1-3 years old	600	2,500
Children 4-8 years old	600	3,000
People 9-70 years old	600	4,000
People over 70 years old	800	4,000
Females 14-50 years old, pregnant/lactating	600	4,000

*refers to adequate intake vs recommended dietary allowance of the other age groups.

Symptoms and Causes

What causes vitamin D deficiency?

Vitamin D deficiency can be caused by specific medical conditions, such as:

• Cystic fibrosis , Crohn's disease, and celiac disease : These diseases do not allow the intestines to absorb enough vitamin D through supplements.
• Weight loss surgeries. Weight loss surgeries that reduce the size of the stomach and/or bypasses part of the small intestines make it very difficult to consume sufficient quantities of certain nutrients, vitamins, and minerals. These individuals need to be carefully monitored by their doctors and need to continue to take vitamin D and other supplements throughout their lives.
• Obesity : A body mass index greater than 30 is associated with lower vitamin D levels. Fat cells keep vitamin D isolated so that it is not released. Vitamin D deficiency is more likely in obese people. Obesity often makes it necessary to take larger doses of vitamin D supplements in order to reach and maintain normal D levels.
• Kidney and liver diseases: These diseases reduce the amount of an enzyme needed to change vitamin D to a form that is used in the body. Lack of this enzyme leads to an inadequate level of active vitamin D in the body.

What other factors can lead to vitamin D deficiency?

• Age: The skin's ability to make vitamin D lessens with age.
• Mobility: People who are homebound or are rarely outside (for example, people in nursing homes and other facilities) are not able to use sun exposure as a source of vitamin D.
• Skin color: Dark-colored skin is less able to make vitamin D than fair-colored skin.
• Human breast milk: A woman's breast milk only contains a small amount of vitamin D. Often infant formulas also only include a small amount of D also. Therefore infants are at risk of not receiving enough vitamin D. This is especially true for infants who are only fed breast milk.

Can medications cause a vitamin D deficiency?

Yes. Vitamin D levels can be lowered by certain medications. These include:

• Laxatives.
• Steroids (such as prednisone).
• Cholesterol-lowering drugs (such as cholestyramine and colestipol).
• Seizure-control drugs (such as phenobarbital and phenytoin).
• A tuberculosis drug (rifampin).
• A weight-loss drug (orlistat).

Always tell your doctor about the drugs you take and any vitamin D supplements or other supplements or herbs/alternative health products that you take.

What are the signs and symptoms of vitamin D deficiency?

Severe lack of vitamin D causes rickets, which shows up in children as incorrect growth patterns, weakness in muscles, pain in bones and deformities in joints. This is very rare. However, children who are deficient in vitamin D can also have muscle weakness or sore and painful muscles.

Lack of vitamin D is not quite as obvious in adults. Signs and symptoms might include:

• Fatigue.
• Bone pain.
• Muscle weakness, muscle aches, or muscle cramps.
• Mood changes, like depression.

Diagnosis and Tests

How is a vitamin D deficiency diagnosed?

Your doctor can order a blood test to measure your levels of vitamin D. There are two types of tests that might be ordered, but the most common is the 25-hydroxyvitamin D, known as 25(OH)D for short. For the blood test, a technician will use a needle to take blood from a vein. You do not need to fast or otherwise prepare for this type of test.

What do vitamin D test results mean?

There are some differing opinions about what levels of vitamin D work the best for each person. Laboratories might use different numbers for reference. Please discuss your results with your doctor.

How often do you need to get your vitamin D levels checked?

Doctors do not usually order routine checks of vitamin D levels, but they might need to check your levels if you have certain medical conditions or risk factors for vitamin D deficiency. Sometimes vitamin D levels can be checked as a cause of symptoms such as long-lasting body aches, a history of falls or bone fractures without significant trauma.

Management and Treatment

How is vitamin D deficiency treated?

The goals of treatment and prevention are the same—to reach, and then maintain, an adequate level of vitamin D in the body. While you might consider eating more foods that contain vitamin D and getting a little bit of sunlight, you will likely be told to take vitamin D supplements.

Vitamin D comes in two forms: D2 and D3. D2, also called ergocalciferol, comes from plants. D3, also called cholecalciferol, comes from animals. You need a prescription to get D2. D3, however, is available over the counter. It is more easily absorbed than D2 and lasts longer in the body dose-for-dose. Work with your doctor to find out if you need to take a vitamin supplement and how much to take if it is needed.

Can you ever have too much vitamin D?

Yes. You can get too much vitamin D if you overdo the supplements. Interestingly, you cannot get too much vitamin D from the sun. Vitamin D toxicity is, thankfully, quite rare but can lead to hypercalcemia and together the symptoms can include:

• Nausea.
• Increased thirst and urination.
• Poor appetite.
• Constipation.
• Weakness.
• Confusion.
• Ataxia (a neurological condition that may cause slurring of words and stumbling).

Do not take higher-than-recommended doses of vitamin D without first discussing it with your doctor. However, your doctor might recommend higher doses of vitamin D if he or she is checking your blood levels and adjusting your dose accordingly. Also, be cautious about getting large doses of vitamin A along with the D in some fish oils. Vitamin A can also reach toxic levels and can cause serious problems.

Prevention

How can I help prevent vitamin D deficiency?

The goals of treating and preventing the lack of vitamin D of treatment and prevention are the same—to reach and keep an adequate level of vitamin D in the body. Your healthcare provider will let you know if you need to take or keep taking vitamin D supplements. If so, they will also let you know how much you should take. You might also want to consider:

Eating more foods that contain vitamin D: See the vitamin D food sources table included in this article. Keep in mind that foods alone usually don't meet the daily recommended levels of vitamin D.

Getting some exposure to sunshine—but not too much: Exactly how much sun exposure is needed isn't clear. 10 to 15 minutes of sun exposure two to three times a week to the face, arms, legs or back may be all that is needed to absorb a suitable amount of vitamin D. You might need more sun exposure (especially in early spring and late fall) if:

• You are older.
• You have a darker skin color.
• You live in northern climates.

The use of sunscreen, and standing behind a window, prevents vitamin D from being produced in the skin. However, you should remember that too much sunshine increases the risk of skin cancer and ages the skin. That is why taking an appropriately dosed D supplement is far safer than intentionally getting routine sun exposure.

Vitamin D Mood

Source: https://my.clevelandclinic.org/health/articles/15050-vitamin-d--vitamin-d-deficiency

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