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Torrey Pines Dermatology – La Jolla
Do Vitamin D Supplements Provide the Same Benefits?
By Tyler on August 19, 2010
For decades doctors have known that Vitamin D is essential for normal bone growth and maintenance. In infants and children, for example, Vit D deficiency may cause rickets, a deformity of the long bones, and, in adults, Vit D deficiency may increase risks for osteoporosis (decreased bone density) and hip fracture. More recently, studies have documented much broader risks for Vit D deficiency. Low levels of Vit D are associated with increases in cancer – especially colon, breast, and prostate – as well as increases in juvenile diabetes, rheumatoid arthritis and multiple sclerosis. Evidence suggests Vit D supplementation reduces the incidence of these diseases, but to date, it has not been clinically proven.
Vit D is formed by the action of Ultraviolet B (UVB) on precursor molecules in the skin. From skin, these molecules travel via the bloodstream to the liver and kidneys, where they are metabolized into active Vit D. There are two major forms of Vit D – Vit D2, formed mostly in fungi, plants, and invertebrates, and Vit D3, formed in vertebrates. Vit D3 is more active in humans. In addition to the synthesis of Vit D by the action of UVB on skin, there are some natural dietary sources such as oily fish – mackerel, salmon, sardines. For vegetarians, mushrooms provide a small amount of Vit D. Several foods are fortified with Vit D, including milk, cereal, and bread.
Recent data document an “epidemic” of Vitamin D deficiency in some populations, especially breast-fed infants, housebound seniors, and darker-skinned individuals who form less Vit D in response to sunlight. For dermatologists, a serious concern is whether recommended sun protection may result in Vit D deficiency. While there is some controversy, most studies have concluded that sunscreen use is not associated with Vit D deficiency.
Current recommendations for Vit D supplementation are generally considered to be too low, and are scheduled to be revised this year. These earlier recommendations are as follows:
200 IU (international units) daily Up to 50 years old
400 IU (international units) daily Ages 51-70
600 IU (international units) daily Age 71 and older
In advance of the publication of newer guidelines, many doctors are recommending 1000 IU of Vit D supplementation daily for most adult patients. Unfortunately, it is difficult to get adequate supplementation with foods alone – an egg provides only 20 IU, a glass of milk 100 IU, and a serving of salmon 360 IU. Concerns regarding overdosing with supplemental Vit D, a fat-soluble vitamin, have been raised, but are generally unfounded with doses of 1000 IU per day. There are select circumstances, however, that require precaution: Parents of infants and small children should check with their pediatrician. Pregnant and breastfeeding women should consult their obstetrician before taking vitamin supplements. Patients with hypercalcemia or kidney disease should check with their internists before taking Vit D.
While sun exposure increases Vit D, ultraviolet rays in sunlight are a known carcinogen and the principal cause of photoaging – dry, mottled, wrinkled, old-looking skin. So the best advice in 2010 for most of us is this: use sun protection and take oral Vit D supplementation.
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