THE CASE FOR VITAMIN D

Hylton I Lightman, MD, DCH (SA), FAAP

Israel.  Miami.  Acapulco.  Vail.

The Orthodox Jewish world is revving up for Yeshiva or Winter Vacation Week.  No matter the destination, people are in pursuit of sun and sunshine.  There’s much confusion about sunlight and the production of Vitamin D.  People think just because the sun is up and they’re outside, they’re getting sufficient Vitamin D.  This is not true.

So let’s speak about Vitamin D, its importance and the unfortunate almost universal lack of it in our lives.

Why is Vitamin D important? 

The body requires Vitamin D to absorb calcium and to promote healthy bone growth and maintain healthy bones.

In fact, Vitamin D is essential for calcium flowing through the bloodstream and being absorbed into bones.  Too little Vitamin D results in soft bones in children (rickets) and fragile, misshapen bones in adults (osteomalacia).

Vitamin D is also needed for other important body functions.  Low levels of Vitamin D have been associated in death of adults from cardiovascular disease, cognitive impairment of older adults, severe asthma in children, and different types of cancer as well as fatigue.

There is a scientist-led group called the Vitamin D Council which promotes awareness of Vitamin D deficiency.  This council suggests Vitamin D treatment might be found helpful in treating or preventing autism, autoimmune, chronic pain, depression, diabetes, heart disease, high blood pressure, influenza, neuromuscular diseases and osteoporosis.  To date, there have been no definitive trials conducted.  Yet the prevailing medical sentiment is Vitamin D constitutes an important part of a health regimen.

Vitamin D is also known as the “sunshine vitamin” because the body produces it in response to the skin being exposed to sunlight.  It is also occurs naturally in a few foods — including some fish, fish liver oils, and egg yolks — and in fortified dairy and grain products.

The angle of the sun and Vitamin D production are interrelated.  In order for the sun to stimulate one’s Vitamin D production the sun’s angle needs to be at a minimum of 50 degrees or greater above the horizon; 90% would be directly overhead.

Most people in the Northeastern United States have low Vitamin D.  Years ago, when I first found many children and young adults with low Vitamin D levels in my practice, I speculated it’s because we dress modestly, covered up so that the sun never touches our skin.  Even in the summer.  And during the school months, our children spend most of their days indoors.

Dr. Michael Vitale, Chief of Pediatric Spine and Scoliosis Surgery at New York-Presbyterian/Morgan Stanley Children’s Hospital, informs that he no longer tests his patients for low Vitamin D because his statistics have shown that well over 50% of all children and adolescents today need Vitamin D supplements.  I respect Dr. Vitale but nonetheless still test many of my patients for Vitamin D on routine exams.

What’s a parent to do?

Eat healthy.  Exercise.  And take a multivitamin that has Vitamin D and calcium in it.  Children older than 1 year of age need 600 IU, or 15 mcg, a day. Your child doesn’t have to get enough Vitamin D every day. Instead, aim to get the recommended amount as an average over the course of a few days or a week.  Calcium supplementation is especially important as too many women are learning the hard way as they become older.  The need for increased calcium acquisition and storage begins very early in life – especially in the pre-adolescent years.  Speak to your pediatrician or schedule an appointment today with Total Family Care.

Of course, there’s a double-edged sword here.  As much as we need the Vitamin D from the sun, we also need to protect ourselves from the sun damage.  Even if you’re producing Vitamin D, too much exposure will cause your body to stop producing it.

It has been estimated that 15 minutes of sun in the middle of the day in the summer several times weekly is sufficient to produce one’s complete Vitamin D needs.  This is for people with fair skin in ideal conditions.  Darker-skinned people may need longer exposure time.  Factors that impact Vitamin D production and absorption here include the time of day (midday has the highest potential to stimulate Vitamin D production), altitude (the higher, the more production), time of day (midday is best), and cloud cover and pollution (take away from Vitamin D production).  There are websites and phone apps that will help you calculate Vitamin D production.

Please note:  The longer you’re in the sun, the more skin damage you will sustain.  Give your unprotected skin the minimum amount of sun exposure without protection and then please, please use sunscreen.  You’ll never regret this last step.  Click TFC DR Lightman Vitamin D Sunscreen Jan 19 2018  to see Dr. Lightman in Miami!

As always, daven.