Tuesday, February 12, 2008

vitamin D

Whenever I ask people about if they take vitamins....the answer is usually no or its "I take Centrum". When I ask women on osteoporosis medicine, most say they take calcium but not vitamin D. Research is being released that people who live above the geographic line that goes between virginia and san francisco have a higher episode of heart issues during winter months. The theory is that with less sunshine, skin cannot convert/make vitamin D. The only exception is the eskimos that supposedly ate alot of fatty fish (full of omega 3 and vit d).


The biggest disease most doctors know of is ricketts from the 60's. We don't see the disease as often and most of my memory comes from old pictures drawn in the illustrations of Netter. Cod liver oil used to be supplemented and but now with the advent of the supplement industry, the shelves of your local healthfood store, pharmacy, gym, herb shop....will be overflowing with choices. As stated above, the most popular choice is usually the one with the best TV commercial time (centrum). Another reason many docs would hesitate to recommend more than the old RDA (recommended daily allowance) for vit D is that due to ADEK. These are the vitamins that are fat soluble. Of all vitamins, A D E and K can bind with fat and accumulated to "dangerous levels". Best advise I can give is to get a blood test 2-3 times a year. For Chicago I recommend Xmas and 4th of July. I'm a practical guy/doc and those two holidays are easy to remember, (xmas is alittle hectic but even if the blood is done right after the holiday is fine and it also can be applied to money left over in the HSA or FSA that work has taken out of the paycheck before end of the year). There are standard tests from the hospital that are ok. Levels I have read that are good to maintain are 30-50 ng/ml (75-125nmol/L). This depends on age and which months of the year we are in.


A great test is the Spectracell test. Some of my patients with bluecross get it paid for. It takes about 4 weeks to get results but very well done and yields great information on blood levels of minerals and vitamins. (Also a great test for "fractionating" the different precursors to cholesterol so you get more risk factor analysis for heart disease)


Sometimes asking nicely from the customer service person on the back of the insurance card may get you somewhere. If not covered, it may be worth it to see what the standard blood tests from the hospital or docs office will check first.

When supplementing, look for vitamin D3, its easier to absorb than D2. Personally, I take 2000 IU daily and sometimes up to 4000 IU depending on if it's winter in Chicago. No sunlight usually means the skin is not creating vit D and I usually don't sit out in the sun except for when I do laps at the outdoor pool during the summer and even then I am sun blocked with lotion. There's new information about the association between artery plaque build up and thin bone. The thicker the plaque, the thinner the bone.


Science has yet to interpret the association but vitamin D supplementation can be useful in both. Calcium is also good but studies are coming out with limits on Ca++ since it may add to plaque build up. Read on it yourself and talk to your doc, we will soon see associations between vit D deficiency and heart disease from the NIH. For now the institute is still cautious in its recommendation.


The Saguil Approach is to utilized standard doc office to assess risks for osteoporosis and heart disease. Get a level of mineral, vitamins, antioxidants and lipids from blood twice a year. Time the blood tests to coincide with before supplementation and 2-3 months after starting to check blood level progress. Cut back on caffeine and alcohol. Cut back on high cholesterol foods, increase intake of multicolored fruits and veggies daily. EXERCISE!!! Stress reduction. Loose weight. Repeat.