Vitamin D- l emma: Risk Factors and Strategies for Combating Vitamin D D eficiency

Vitamin D-lemma:Risk Factors and

Strategies for Combating Vitamin D Deficiency

YaQutullah Ibraheem Muhammad MS, RDN, LD

TRUE OR FALSE

Populations at risk for Vitamin D deficiency

do not include geriatric patients, women and children.

FALSE

Name three risk factors for Vitamin D deficiency:

A. Skin PigmentationB. Family historyC. DietD. Conservative attire

What are three behavioral /lifestyle strategies that can be used to

improve vitamin D levels?

A. Increasing sun exposure 15-20 minutes dailyB. Including Vitamin D fortified foods with meals and snacksC. SupplementationD. Only A and B

E. All of the above

Objectives

Identify different populations at risk

Address strategies for combating vitamin D deficiency

Review meal planning

The Sunshine Vitamin Overview

Naturally synthesized vitamin with daily exposure to sunlight.

Fat Soluble

Two forms of Vitamin D D2 is the supplemental form D3 is naturally occurring, found in foods and synthesized in the skin

with sunlight exposure.

Absorbed in the small intestine

Vitamin D Deficiency in Specific Populations Women

Multiple pregnancies Breastfeeding with little sun exposure sun

Community-dwelling geriatric patients With age, the skin doesn’t synthesize vitamin D as efficiently An increased risk for fractures

Children Infants with prolonged breastfeeding without supplementation

(AAP) (1) Children with inadequate intake of fortified foods (rickets) Children on anticonvulsant therapy for epilepsy (2)

Vitamin D Deficiency in Specific Populations

Vitamin D deficiency and Pigmentation With increased melanin pigmentation, the skin's ability to synthesize

vitamin D from sunlight is limited. African ancestry, Latino, South Asian, Aborigines and others

Lowered serum 25(OH)D levels with increased melanin It’s unclear whether lower levels of 25(OH)D in persons with darker skin

have significant health consequences. (Lower rates of osteoporosis and bone fractures when compared to counterparts)

Strategies: 15-30 minutes of midday sun exposure (without sunblock) Take measures to prevent sun damage to skin, and avoid sun burns. Spring, Summer & Fall Vitamin D from Fortified foods and supplements as needed.

Vitamin D Deficiency and Cultural Sensitivity

Conservative attire Religious Mandates: Orthodox Muslims, Jews, Christians In Northern Latitudes where sun exposure is limited and one must

wear clothing to protect against the cold for large parts of the year. Observing conservative attire that may limit sun exposure (face,

hands, arms, legs).

Strategies: Consider light/colored fabric to allow the sun to permeate the cloth

and allow your skin to absorb some of the sun’s rays. Private area to access to sunlight (patio, solarium area) Vitamin D supplements/fortified foods.

Vitamin D Deficiency in Specific Populations

Gastric Bypass Patients BMI ≥30 is associated with lower

serum 25(OH)D levels compared with non-obese individuals (3).

Developed deficiency with decreased absorption Part of the upper small intestine is

bypassed where Vitamin D is absorbed (4,5).

Strategy: An additional 800 IU to 2000 IU daily to maintain adequate serum levels along with long-term post surgical screening (6).

Certain Medical Conditions Some liver diseases, Cystic

Fibrosis, celiac disease, and Crohn's disease can result in fat malabsorption (Vitamin D is fat soluble)

Intolerance of fortified dairy products

Strategy: Exploring alternative sources of vitamin D

Vegans, Vegetarians and Vitamin D Fortified vegan products contain D2 (ergocalciferol).

Yeast, mushrooms exposed to ultraviolet light (1-2 seconds of a pulsed UV light)

Usually obtained from fortified foods and vitamin supplements made from yeast or other fungi.

Sunlight

Vitamin D in Meal PlanningFortified foods provide most of the vitamin D

in the American diet. Soy, rice and nut milks, yogurt Mushrooms exposed to pulsed ultraviolet light

384-634 IUs per cup

Meal Planning Ideas Recommended Dietary Allowances (RDAs) for Vitamin D is

600 IU or about 15 mcg for ages 1-70 yrs (3).

TOTAL: 1480 IUs USDA Nutrient Database Vitamin D Food Values

Lunch: 4 oz canned tuna

salad in oil, 8 oz fortified chocolate or

vanilla soy milk 354 IUs

Dinner: 3 oz Sockeye

salmon, mixed green salad with

1 cup grilled Portabella

mushrooms747 IUs

Breakfast: Two soft

scrambled eggs, 1 Tbsp fortified

margarine, 8 oz glass orange juice

fortified with calcium and vitamin D248 IUs

Snack: 8 oz reduced-

fat milk, 1 slice

fortified American cheese 175 IUs

Halal/Kosher/Vegan Supplementation

The majority of the commercial multivitamins supplements contain pork-based or other non-Halal/Kosher/Vegan ingredients. For ex. Gelatin capsules Questionable ingredients

A tablet or liquid supplement option

Calcium Citrate With Vitamin D

Look for Kosher/Halal/Vegan friendly options on the market and be sure to check for the certification seal.

NSF Certified Dietary Supplements USP Verified Mark

The Take Away…

Vitamin D has a protective effect against chronic conditions, including heart disease, diabetes, and some cancers.

As health professionals, we want to review Vitamin D labs in at risk patient/client populations.

Encourage adequate Vitamin D consumption, supplementation and sunlight exposure as necessary for optimal health.

Don’t over supplement as toxicity can result.

References

1. Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122:1142-1152.

2. J. Child Neurol. 2006 Mar;21(3):205-9

3. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.

4. Malone M. Recommended nutritional supplements for bariatric surgery patients. Ann Pharmacother 2008;42:1851-8.

5. Compher CW, Badellino KO, Boullata JI. Vitamin D and the bariatric surgical patient: a review. Obes Surg 2008;18:220-4.

6. Flores L, Osaba MJ, Andreu A, et al. Calcium and Vitamin D Supplementation after

Gastric Bypass should be Individualized to Improve or Avoid Hyperparathyroidism.

Obes Surg. 2010 Jun;20(6):738-43.

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Questions?