What I learned about Vitamin D deficiency in prison …

My recent short term clinical nutrition assignment was in a forensic behavioral health hospital with a unit for sexually violent persons. Dietitians complete assessments to ensure the patients are not as risk for nutrition triggered syndromes or diseases. Part of the assessment is reviewing quarterly lab results. During this assignment I learned many things but one that stuck out was the all too often lab result indicating a deficiency of Vitamin D in individuals of the hospital.

There was no discrimination, big, strong looking men and obese women both had deficiency levels of Vitamin D. Being institutionalized, whether in a nursing home, behavioral health hospital or prison, is a risk factor for developing a deficiency of Vitamin D due to lack of sunlight that is inherent in these environments.

One less known connection is that of vitamin D deficiency and schizophrenia. A review of 19 studies, which included more than 2,800 participants, showed that those with vitamin D deficiency were more than twice as likely to be diagnosed with schizophrenia compared with their counterparts who were not vitamin D deficient. In addition, 65% of the patients who had schizophrenia also had lower levels of vitamin D. My short-lived assignment supports these findings.

Needless to say, I wrote many recommendations for supplementation with Vitamin D3 – more about that later.

Vitamin D deficiency or sufficiency?

Vitamin D is a conundrum for the nutritional community. Various medical associations disagree on what is considered a level of deficiency and when to start supplementation. They also disagree on how much to supplement. Study results appear to be published every week examining the connection of Vitamin D status with diseases such as Multiple Sclerosis, psychosis, Alzheimer’s, post-menopausal fractures, heart disease, cancer and even our weight. Yet not every study shows Vitamin D as the hero saving the day.

Looking at the top 4 professional organizations that set ranges of the deficiency number for vitamin D ranges from 10 to 30 nanograms per milliliter (ng/ml).  These wide ranges don’t give me comfort. As a post-menopausal woman, the boogeyman of osteoporosis is hiding under my bed. I’m just waiting for it to make its appearance. Our bodies need this vitamin to set the alarm when our calcium levels go sub-par.

Per Walter Willett, MD, DrPh, Nutrition Chair of Harvard School of Public Health, “for most people, taking a once daily multivitamin supplement that includes 800-1,000 International Units of vitamin D along with a healthy diet is sensible, and many people will probably benefit from taking more.”

The #1 under-consumed nutrient …

As a nutritional professional, with 35 years of completing nutrition assessments including reviewing people’s food records, there’s one thing I know for sure – the typical foods American’s choose to eat would seldom meet the RDA for vitamin D. The 2015 -2020 Dietary Guidelines for Americans identified Vitamin D as an under-consumed nutrient.

Vitamin D is found naturally in very few foods, mostly fish, like salmon, sardines, mackerel and tuna; and fish liver oils. Most foods that show Vitamin D on the Nutrition Label contain it as a result of fortification with found. Typically fortified foods include milks, juices and breakfast cereals.

Vitamin D has multiple personalities

Discovered in 1922, around the time that the bone softening disease rickets became common place, was the first diseases to be connected to the newly discovered vitamin. However; the exact mechanism by which this vitamin builds bones and cures rickets was not uncovered until the 1960’s.

Vitamin D has three distinct forms; two derived from plant sterols (D1 & D2) and one derived from sun exposed skin, D3. Vitamin D is found in food and created from sunlight making it the only vitamin with this ability. This is where this vitamin’s multiple personalities come from.

Even before it becomes a vitamin, it has a precursor form called Pre-Vitamin D. After going through a transformation in the liver and kidneys, this form of the vitamin takes on its two new personalities – its circulating form of Vitamin D, calcidiol and its active form of the vitamin, calcitriol, a type of hormone.

This vitamin becomes a hormone in charge of maintaining calcium levels to achieve a healthy bone structure. Virtually every tissue type in the body possesses receptors for the activated form of vitamin D. This places it as the only vitamin that meets the definition of a true hormone.

Roadblocks to production and activation

It’s estimated that there are over 200 genes that use the pro-hormone Vitamin D and over hundreds of receptors for Vitamin D throughout the human body. This is why a deficiency of this vitamin/hormone has such far reaching consequences. Unfortunately, there are factors beyond food and sunlight choices affecting this vitamin’s status.

Certain diseases that affect the liver and kidney interfere with the production of the active form of the vitamin.

We intentionally cover up our bodies with clothes, use SPF sunscreens, or stay home-bound for personal reason. This results in less opportunity to make that all too needed form of this vitamin (D3).

Aging. You knew this was coming.

By the time we reach 65 years we have a four-fold reduction in the capacity of the skin to produce vitamin D.

Plus, with age, the liver and kidney start to poop out. Add to this the intestine’s decreased ability to absorb vitamin D from food or supplements and you have the recipe for D-Deficiency!

Food sources: Natural and Fortified

The only foods that naturally contain Vitamin D are seafood, Shiitake mushrooms and egg yolks. There are also a number of foods fortified with the vitamin, although, the actual amount of the vitamin have been shown to differ from the labeling claim. Salmon, mackerel and tuna provide anywhere from approximately 236 to 1,000 international units (IU) for 3.5 ounces.

Mushroom’s natural plant sterol ergosterol, makes mushrooms a magic food when it comes to this vitamin. Mushroom growers have been exposing this fungi to UV light to bump up the vitamin D. One way to boost the absorption of this fat soluble vitamin is to pair it with olive oil. Boost the vitamins level even more by adding a hard boiled egg but make sure you eat the yolk, this is where the vitamin is found.

Fortified foods like dairy and non-dairy milks are poor sources weighing in with only 100 IU’s as compared to the general adult population (18 to 70 years of age) recommended amount of 600 international units and 800 international units for those over 70 years of age.

To put this into perspective, each 100 IU of vitamin D consumed causes the serum level to increase an average of one nanogram/milliliter.

When you consider that many people don’t eat fish due to taste, price, or preparation concerns, this eliminates the major natural source of this vitamin.

7 Reasons why this Dietitian takes a Vitamin D supplement daily

My belief is that food is the best source of all nutrients due to the unknown synergistic effects of multiple food components. In addition, without a regulatory oversight on nutrition supplements, we’ve seen too many cases of supplements containing more, less, or none of their claimed amounts. Therefore, I don’t recommend supplements easily but below I’ve outlined the reasons I personally take this vitamin (2000 IU’s) every day.

1. I live a sun-challenged life. The reality of a full life is that I spend most days indoors talking to clients, on the computer, whipping up new smoothie recipes in my kitchen, or working out in the gym to avoid the triple digits outside.
2. My face makeup has sunscreen and I always apply sunscreen when I go outside blocking the ability to convert the vitamin to it’s active hormone form.
3. I’m at risk for osteoporosis. Both parents were diagnosed with this “makes your bones look like Swiss cheese” debilitating bone disease.
4. I don’t eat enough of the foods that are naturally high in this vitamin on a daily basis.
5. Research showing that low levels of this vitamin are associated with weight gain in post-menopausal women.
6. History of bone loss in my teeth means I have a higher risk of losing my choppers in my advanced years.
7. My GI tract has a history of being less than optimal in absorbing nutrients because of Celiac Disease.

Bottom Line:

Research confirms that this vitamin/hormone is essential for hundreds of reactions in our body that prevents major diseases and unhealthy outcomes. The benefits of using a supplement outweigh the risk in most cases. Issues of toxicity of Vitamin D is one of the rarest medical conditions. The tolerable upper intake level is 4000 IU’s for adults. My blanket advice is to be safe and not take more than 2000 IU’s of Vitamin D3 daily.

Your Call to Action!

Are you taking a vitamin D supplement? Are you ready to find out if you need this supplement? You can ask your doctor, visit a self-referred lab, where you don’t need a doctor’s order, or contact me for the names of my favorite local and/or on-line labs.  I’d love to hear your comments!

Bonnie is a nutritionist for women looking for a seasoned registered dietitian that uses foods to re-balance hormones to create a healthier weight, increased vitality, restorative sleep, and a happier tummy. Visit https://www.B3Nutrition.com to receive a free gift from Bonnie!