Vitamin D - OLE Opportunities for Lifelong Education

Vitamin D - OLE Opportunities for Lifelong Education

VITAMIN D By: Jennie Simpson, RD, LD, CDE Alaska Regional Hospital WHAT IS VITAMIN D Fat soluble vitamin Hormone Regulated by parathyroid hormone, calcium and phosphate Present in very few foods Produced in skin from sunlight IMPORTANCE Promotes

calcium absorption in gut and maintains adequate serum calcium Immune function Cells Growth Proliferation Differentiation Inflammation TYPE OF VITAMIN D D2-Ergocalciferol- photosynthesized in plants, mushrooms and yeast Sometimes used in food fortification D3-Cholecalciferol- formed upon exposure

to UVB 25-hydroxyvitamin D- calcidiol Storage form 1,25-dihydroxyvitamin- calcitriol- active form FOOD SOURCES Food Source Serving Size IUs per serving Cod Liver Oil

1 tbsp 1,360 Salmon (sockeye) 3 oz 447 Tuna Fish (canned in water) 3 oz 154 Fortified Orange Juice 8 oz

~137 Fortified Milk 8 oz 115-124 Sardines (canned in oil) 2 sardines 46 Beef Liver

3 oz 41 Egg yolk 1 large 41 Fortified ready to eat cereal Swiss Cheese varies 1 oz

6 OTHER SOURCES Sun exposure Season, time of day, length of day, cloud coverage, smog, skin melanin content, sunscreen Dietary Supplement D2 and D3 are equivalent Both raise serum 25 (OH) D levels, cure rickets D2 is less potent at high doses *supplementation is based on your levels *take with Calcium RECOMMENDED DAILY ALLOWANCE

(RDA) Age RDA 0-12 months 400 IU (10 mcg) 1-70 years of age 600 IU (15mcg) >70 years of age 800 IU (20mcg)

Pregnancy/ Lactation 600 IU (15mcg) TOLERABLE UPPER LIMIT (ULS) Age 0-6 months 7-12 months 1-3 years of age 4-8 years of age >8 years of age Pregnancy lactation *OTC- max dose 5,000 IU UL

1,000 1,500 2,500 3,000 4,000 IU (25 mcg) IU (38 mcg) IU (63mcg) (75 mcg) IU (100 mcg) DEFICIENCY Rickets-failure of bone tissue to properly mineralize

causing soft bones and skeletal deformities Osteomalacia- weak bones *Caused by dietary inadequacy, impaired absorption and use, increased requirement or increase secretion GROUPS AT RISK FOR DEFICIENCY Breastfed infants Older adults Limited sun exposure People with dark skin

IBS or other fat malabsorption Obese Gastric Bypass Surgery Use of certain medications (steroids, orlistate, cholestyramine, anti-seizure) HEALTH RISK FOR EXCESSIVE VITAMIN D Non specific symptoms- anorexia, wt. loss, polyuria and heart arrhythmias Raise blood levels of calcium Kidney stones in post menopausal women Excessive sun exposure does not lead to excessive vitamin D

Toxicity is mainly caused through over supplementation BEYOND BONES Osteoporosis Cancer Diabetes HTN Glucose Intolerance Multiple Sclerosis YOUR LEVELS Serum 25-Hydroxyvitamin D Concentrations and Health nm Ng/

Health Status ol/L mL <30 <12 Associated with vitamin D deficiency (leading to rickets/ osteomalacia) 30- 12-20 Inadequate for bone and overall health 50 > > 20 Adequate for bone and overall health 50 > > 50 Potential adverse effects w/ emerging 125 evidence PUT IT ALL TOGETHER Only

supplement based on your levels Talk to your provider about supplementing if needed If supplementing take with Calcium Follow a healthy diet QUESTIONS REFERENCES National Institute of Health http://ods.od.nih.gov/factsheets/vitaminD-HealthProfessional/ Linus

Pauling Institute at Oregon State University http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/ National Cancer Institute http://www.cancer.gov/cancertopics/factsheet/prevention/ vitamin-D/

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