Who is at risk for Vitamin D deficiency? Exclusively breast-fed infants, dark skin, aging, northern climate dwellers, city-dwellers, those who cover their heads when outside, sunscreen users, lactose intolerance, s/p gastric bypass, cystic fibrosis patients, gallbladder disease, IBS, obesity, women.
Diseases associated with vitamin D deficiency: osteoporosis, breast, colon and ovarian cancer; autoimmune disorders such as multiple sclerosis, rheumatoid arthritis and diabetes; Seasonal Affective Disorder (depression during winter months), cardiovascular disease and hypertension, Alzheimer’s Disease.
Osteoporosis progression slows at 32 ng/mL ; goal of therapy should be 50 – 80 ng/mL to decrease cancer risks
Sources of Vitamin D: sun, food, supplements
Sun block SPF 8 or greater reduces conversion of Vitamin D in the skin by 95% If using sunscreen, apply after sun exposure for twenty minutes
Adequate sun exposure: Bikini-wearing, 10:00 a.m. – 3:00 p.m., 2-3 x per week Everybody living North of 37 degrees latitude (basically, North of line extending across the U.S. from Atlanta, GA to Los Angeles, CA) should take supplements (2000 IU daily) from October through March
Dietary sources of vitamin D include: wild-caught, fatty fish, dairy products, fortified cereals, fortified orange juice, egg yolks and cod liver oil
Take Vitamin D supplements during meals with fatty foods
Vitamin D3 is better than Vitamin D2 for supplementation (except prescription strength only comes in D2)
Children should receive 400 IU Vitamin D3 daily
Lab to order: 25-hydroxy-Vitamin D [AKA: 25(OH)D]
Definitions: “deficiency” <> 32 ng/mL
Too much vitamin D in the system: > 200 ng/mL
Treating vitamin D deficiency when measuring 25(OH)D : <>: Vitamin D2 50,000 IU weekly x 1 year 21-31 ng/mL: Vitamin D2 50,000 IU weekly x 12 weeks then Vitamin D3 2000 IU daily; recheck in 1 year 32 ng/mL: Vitamin D3 2000 IU daily
Who should not take Vitamin D without supervision? Individuals with impaired kidney function
Food sources Vitamin D (IU) Pink salmon, wild caught, 3 oz 530 Sardines, 3 oz 231 Tuna, canned, 3 oz 200 Cow’s milk, 8 oz 100 Fortified O.J., 8 oz 100 Fortified cereal, 1 cup 40-50 Eggs (Yolk), 1 oz 30 Cod Liver Oil, 1 oz 1, 360
Adequate serum levels of Vitamin D have been associated with decreased risk of several cancers, including breast cancer. Why? Some studies have shown vitamin D inhibits the formation of malignant breast cells. Regardless of the mechanism, KD Crew and associates recently published an abstract on line that indicates vitamin D levels are inversely related to breast cancer risk.
This population-based, case-controlled study compared vitamin D plasma levels of 1,026 women diagnosed with breast cancer between 1996 and 1997 with vitamin D plasma levels of 1,075 women who lived in the same area of Long Island, New York.
The authors found:
Plasma vitamin D levels were inversely related to breast cancer risk
All women with vitamin D levels greater than or equal to 40 ng/mL were 46% less likely to have breast cancer than women with vitamin D levels less than 20 ng/mL
Postmenopausal women benefited most with a 54% reduction of breast cancer risk if their serum vitamin D level was greater than or equal to 40 ng/mL
These results add to a growing body of evidence that adequate vitamin D stores may prevent breast cancer development. It is known that circulating vitamin D levels of more than 32 ng/mL are associated with normal bone mineral metabolism; this data suggest that the optimal level for breast cancer prevention is greater than or equal to 40 ng/mL. More clinical trials are urgently needed to evaluate the role of vitamin D supplementation on breast cancer prevention.
What I tell my patients
It is unknown, as of yet, the optimal plasma level of 25-hydroxyvitamin D. Evidence continues to mount that our previous perception of "normal" levels of vitamin D falls short. Many experts now believe that a range of 40 to 80 ng/mL is an optimal range to protect us from many chronic and debilitating illness. However, many labs still report a 25-hydroxyvitamin D level as "normal" when it falls in the range of 20 - 100 ng/mL. Have your levels tested. Ask your doctor what your 25-hydroxyvitamin D level is. I recommend a level of 52 - 80 ng/mL to my patients (colon cancer risk is cut in half at 52 ng/mL).
Do self-breast exams monthly. Get annual mammograms starting at age forty; sooner if advised. Get 20 minutes of sunshine (without sun block) at least 3 days per week. Eat a diet abundant in vegetables, fruit, whole grains and omega-3's. Eat organic, when possible. Exercise regularly. Limit alcohol consumption to no more than 1 drink per day. Laugh often. Enjoy nature. Practice silence. And, be your own best health advocate.
According to findings published in Diabetes Care, a study with 3,262 Chinese people aged between 50 and 70 showed that deficient levels of vitamin D may increase the risk of metabolic syndrome by 52% ....
Premenstrual syndrome (PMS) is a complex disorder that affects a woman’s emotional and physical well-being. Broadly defined, PMS is a constellation of behavioral, psychological and physical symptoms that affect a woman during the luteal phase, 7 to 14 days before the onset of the menstrual flow.Over 200 symptoms have been associated with PMS.See the table below for a list of the most common symptoms of PMS.
Common Symptoms of Premenstrual Symptoms
Behavioral symptoms: fatigue, insomnia, dizziness, changes in sexual interest, foodcravings, overeating, social isolation
Physical symptoms:headaches, breast tenderness, back pain, abdominal pain, bloating, weight gain, swelling of extremities, water retention, nausea and joint pain, acne, constipation, diarrhea, carbohydrate cravings
It is estimated that up to 85% of women between 25 and 35 years old are affected by PMS symptoms.20% to 40% suffer from PMS, defined by the American College of Obstetricians and Gynecologists (ACOG) as “the cyclic occurrence of symptoms that are of sufficient severity to interfere with some aspects of life and that appear with consistent and predictable relationship to the menses.” Two to 10 percent suffer from premenstrual dysphoric disorder (PMDD) which results in serious impairment of some aspect of their social, family, or work life.
PMS and PMDD are diagnoses of exclusion meaning that other physical and psychiatric disorders must be ruled out before either diagnosis can be made.Disorders such as anemia, diabetes, thyroid disease, endometriosis, other endocrine abnormalities and breast disease may be confused with PMS.Major depression, dysthymia (chronic low-grade depression) and anxiety disorders are among the key psychiatric disorders that also need to be ruled out.
The cause of PMS and PMDD remain uncertain.Proposed etiologies include: hormonal dysregulation, fluid and electrolyte imbalances, neurotransmitter (serotonin) deficiency, prostaglandin excess or deficiency, vitamin and mineral deficiencies, genetic risk, psychological factors and social factors.
Supplements that may help:
Calcium: A prospective, randomized, double-blind, placebo-controlled, parallel group multi-center clinical trial was conducted to evaluate the effectiveness of calcium carbonate for PMS.Women who took 1200 mg per day of calcium for three menstrual cycles had a 48% reduction in PMS symptoms (depression, water retention, pain food cravings, fatigue and insomnia), compared to a 30% reduction in the placebo group. In 1999 Annals of Pharmacotherapy published a review of studies focusing on calcium supplementation for PMS.The authors concluded that, “calcium supplementation of 1200 to 1600 mg/day, unless contraindicated, should be considered a sound treatment option in women who experience premenstrual syndrome.” Calcium may impair absorption of the following medications if taken simultaneously: tetracycline, iron, thyroid hormones and steroids.
Vitamin D:A study published in 2005 indicated that Vitamin D when taken in addition to supplemental calcium may decrease PMS symptoms. Doses of the two supplements taken in combination were: 400 IU of vitamin D3 and 1200 mg of elemental calcium.
Vitamin B6: Many studies have studied pyridoxine in the treatment of PMS. A systematic review of the 28 trials published between 1975 and 1999 showed that pyridoxine (Vit B6) was helpful in the treatment of PMS. 25 - 50 mg two-times per day is the recommended dose. Possible side effects: Neurologic changes can occur at doses greater than 100 mg/day.
Magnesium: Women with PMS may have lower serum magnesium levels. Several well done studies have evaluated the effect of magnesium supplementation on various premenstrual symptoms.One trial showed a significant reduction of fluid retention, weight gain, swelling, breast tenderness and bloating after only 2 months of treatment with 200 mg per day. Possible side effects: abdominal cramping, diarrhea, low blood pressure, irregular heartbeat, muscle weakness, nausea and change in mental status.
Other supplements that may be beneficial: Potassium, L-tryptophan, soy protein, vitamin E and krill oil. Additional studies are underway to assess their efficacy.
Highlights of Dr. Paykel's Presentation 
