Vitamin D3 — we all need it

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Vitamin D3 is a fat-soluble vitamin that most of us are lacking. It is made in the skin, or consumed in the diet, processed in the liver, then converted in the kidneys to calcitriol, its active form, which is actually a hormone with far-reaching benefits in the body.

Who is at risk?

Many South Africans, in spite of our plentiful sunshine, are found to have low levels. There are several reasons why this is so.

  • Applying sunblock with an SPF of 15 will reduce the amount of Vitamin D3 manufactured in the body by about 99%.
  • Many of us spend a lot of time working indoors.
  • Those with darker skins require 10x more exposure to make the same amount of Vitamin D3.
  • As you age, your efficiency for producing vitamin D3 decreases. The elderly make about 30% less than when they were young.
  • Fat absorbs vitamin D3, so obese people need more to maintain an adequate level.

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What does vitamin D3 do?

Classically Vitamin D3 is known for its important role in regulating calcium uptake into bones, but it has recently been shown to prevent many chronic diseases including cancers, especially colon and breast cancers. It directly affects cell growth and differentiation. It is also an immune system modulator, thus having an important effect in auto-immune diseases, and in fighting infections. As a hormone itself, it is an important regulator of other hormones. It reduces hypertension, atherosclerotic disease, heart attacks and strokes. It up-regulates a multitude of genes, which control many metabolic processes in the body. It also has an important role in preventing neurologic diseases such as epileptic seizures, migraines, multiple sclerosis and depression.

Benefits of optimal levels

It is important to have a blood test to determine your vitamin D3 level. The range of optimal level is controversial and not all authorities are in agreement on this. The Institute of Functional Medicine recommends that Vitamin D3 optimally should be between 50-80 ng/ml. The local pathology laboratories recommend anything above 30ng/ml as optimal, but this appears to be based on outdated research.

Below are conditions that have been associated with vitamin D levels:
< 10 ng/mL = Severely deficient

  • < 15 ng/mL Risk of rickets [i]
  • < 20 ng/mL 75% greater risk of colon cancer [ii]

< 30 ng/mL = Deficient

  • Increased calcium loss from bones, osteoporosis [iii]
  • Poor wound healing [iv]
  • Increased muscle pain [v]
  • Increased joint and back pain [vi]
  • Greater risk of depression [vii]
  • Increased risk of type 1 and 11 diabetes [viii]
  • Increased polycystic ovarian syndrome [PCOS]
  • Increased epileptic seizures
  • Increased schizophrenia [ix]
  • Increased migraines [x]
  • Increased autoimmune disease (lupus, scleroderma) [xi]
  • Increased allergies
  • Increased preeclampsia [xii]
  • Increased inflammation

30–50 ng/mL = Suboptimal levels

  • < 34 ng/mL Twice the risk of heart attack [xiii]
  • < 36 ng/mL Increased incidence of high blood pressure [xiv]
  • < 40 ng/mL Three times the risk of multiple sclerosis [xv]

50–80 ng/mL = Optimal levels

  • > 50 ng/mL 50% reduction in breast cancer, decreased risk of all solid cancers [xvi]
  • 80–100 ng/mL Slowing of cancer growth in patients with cancer [xvii]

> 100 ng/mL = Increased risk of toxic symptoms (hypercalcemia) [xviii]

Now the controversy

Many studies have shown the association between a low level of vitamin D3 in the blood and diseases. The questions we have to ask here are:

  • “Is the low level of Vitamin D3 a result of the illness, or the cause of the illness?”
  • “Will supplementing vitamin D3 improve the outcome of the disease or not?”

Some studies demonstrate improvement in the condition with supplementation, and others do not. Much research still needs to be done to clarify these issues. Some authorities, supported by a recent study [xix], assert that the low vitamin D3 level is an indicator of poor health, which needs to be addressed more holistically than by merely taking a supplement. The inflammatory processes of chronic disease appear to suppress the levels of vitamin D3. Poor diet, with excessive intake of animal proteins, fats and inflammatory foods such as refined oils, sugars and refined grains may contribute to low vitamin D3 levels.

Natural sources

The best way to raise your vitamin D3 level naturally is by exposure to sunlight. With arms and legs exposed [without sunblock] your skin will make about 10 000units of vitamin D3 in about 15 minutes. The time may vary depending on your age, skin tone or colour. Generally you should expose your skin until it just turns pink, which is about half the time it would take to burn. Sunlight also produces many other photo-chemicals in the skin, including nitrous oxide which lowers blood pressure. The vitamin D produced by sunlight has a self-regulating effect in the body, unlike supplements which may have a suppressive effect.

You can also obtain small amounts of vitamin D3 from oily fish and egg yolks, and vitamin D2 from plant foods. Although Vitamin D3 and D2 are metabolised in the same way, it seems vitamin D2 is less efficiently metabolised.

Supplementation and balance

If you really cannot increase your sun exposure enough, then you will have to consider supplementation. Ensure that you are not deficient in magnesium by requesting a red blood cell magnesium blood test [this provides a more accurate reflection of your body stores of magnesium than the conventional serum magnesium level]. Replenishing magnesium is often enough to raise vitamin D3 levels. Adequate calcium intake is important for healthy vitamin D levels. Also adequate Vitamin A protects the blood vessels from calcium build-up due to excess vitamin D levels. Serum calcium levels should be periodically monitored; too high a level may indicate excessive vitamin D3 supplementation.

Vitamin K2 also has a protective effect on calcification of blood vessels, by activating osteocalcin, which drives calcium into the bones. It probably should be supplemented [100-150ug] if you are taking high doses [< 10 000iu] of vitamin D3 daily. It is derived naturally from some fermented foods such as natto and sauerkraut, cheeses such as Edam, Brie and Gouda, eggs, organ meats, seafoods and the fat from grass-fed beef.

Which form of supplement is best?

Although more research needs to be done, it is thought that Vitamin D3 in oil has a better effect at raising the blood level than the tablet form. Research shows that daily or weekly doses have a similar effect, and both can be used to raise the levels quickly when initiating treatment.

The bottom line

If your vitamin D3 level is low, don’t just rush to take a supplement. Consider this to be a warning sign of ill health; make improvements in your diet, check your magnesium level, address silent inflammation in the body, and get out into the sun.


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