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Clinician’s Corner: Vitamin-D

As we continue our review of the fat-soluble vitamins, let’s discuss Vitamin-D, the one fat soluble vitamin most of us should be taking.  Living in Central Pennsylvania, especially this time of year we don’t get much sunlight on our bare skin.

Sources: very few foods contain natural Vitamin-D:  fish liver oils, egg yolk, fortified milk, synthesized in skin exposed to UV light.

Function: acts as a hormone and plays a role in calcium balance.

Deficiency:  More adults are deficient in vitamin D for the following reasons:

  • increased use of sunscreens
  • spending more time indoors
  • and less efficient vitamin D absorption as people age
  • Darker skin and living at higher latitudes also increase risk.
  • Kidney failure and some drugs cause Vitamin-D deficiency.
  • Consider testing for patients who are likely to be deficient such as house bound elderly, especially in a nursing home.

Rickets:  still common in tropical countries even though adequate skin exposure.  Soft bones in children become easily deformed.  These patients see low calcium and phosphate levels in the blood.

DOSE: adults recommend 800-2000iu per day. Your Thompson Pharmacist can recommend up to 2000iu of Vitamin-D without doing a blood test.  Most evidence from studies suggests that to prevent falls, a dose of at least 800 IU per day is required for our elderly patients.

Do I have to swallow a capsule, what about drinking milk, or exposure to sunshine?

Dairy Products: It takes about 5 quarts of milk, to equal 2000iu in a capsule…. not to mention over 2750 calories!

Sun Exposure: Sun Exposure (Ultraviolet-B) 2 to 3 times a week during mid-day. Bare arms & legs for10-15 minutes per session is usually adequate. The effect of sunlight exposure and vitamin D synthesis is reduced in individuals with darker skin pigment. Effective use of a sunscreen does block Vitamin-D formation in the skin. Middle aged and elderly persons who use sunscreens daily have significantly lower Vitamin-D levels.  However, the benefits of using a sunscreen, far outweigh the disadvantages of a decrease in Vitamin-D. A local dermatologist told me “it is easier to treat Vitamin-D deficiency than it is to treat skin cancer…so use a sunscreen.”

What about Infants & children?

  • Recommended daily intake of vitamin D is 400 IU per day in all infants (beginning in the first few days of life), children, and adolescents.
  • Breastfed and partially breastfed infants should begin vitamin D supplementation beginning in the first few days of life.

Excessive dose: Side effects with excessive use may include nausea, anorexia, weight loss, constipation, polyuria, polydipsia, hypertension, weakness, and muscle aches or stiffness.

New Vitamin-D labeling:

To convert Vitamin D:     From IU to mcg: IU/40 = mcg

INTERNATIONAL UNITS

(old labeling)

MICROGRAMS

(new labeling)

400iu 10mcg
800iu 20mcg
1000iu 25mcg
2000iu 50mcg
5000iu 125mcg
50,000iu   Rx only 1250mcg= 1.25mg

With 41% of the population being vitamin D deficient, especially in these latitudes, we need to be recommending this Vitamin a whole lot more.  Drinking milk and sun exposure is not the answer to correcting this wide scale deficiency. People low in vitamin D who take a supplement may be less likely to fall. That makes sense, given that vitamin D plays a key role in keeping bones and muscles strong.  Ask your Thompson Pharmacist for a Vitamin-D recommendation.  At Thompson Pharmacy it’s all for YOU.