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com Supplement Your Knowledge of Vitamin D Here's the Scoop on Vitamin D, From Fun in the Sun to the Debate Over Dosage By Daniel J. DeNoon WebMD Health News Reviewed by Louise Chang, MD May 19, 2008 -- The big news hit last week: Women who are deficient in vitamin D when they get breast cancer have a much higher chance of dying from their cancer. That's surprising news. But just as surprising is the fact that many women -- and many men -- are deficient in vitamin D or have insufficient blood levels of this important vitamin. How many? Data suggest many of us don't get the vitamin D we need. For example, a 2007 study of childbearing women in the Northern U.S. found insufficient vitamin D levels in 54% of black women and in 42% of white women. WebMD's FAQ addresses these questions: * Why do I need vitamin D? * How can I get enough vitamin D? * Which foods contain vitamin D? * How much vitamin D do I need? * Can I get too much vitamin D? * What kind of vitamin D is best? * Does vitamin D interact with other medications? Why do I need vitamin D? Your body must have vitamin D to absorb calcium and promote bone growth. Too little vitamin D results in soft bones in children (rickets) and fragile, misshapen bones in adults (osteomalacia). You also need vitamin D for other important body functions. Vitamin D deficiency has now been linked to breast cancer, colon cancer, prostate cancer, heart disease, depression, weight gain, and other maladies. These studies show that people with higher levels of vitamin D have a lower risk of disease, although they do not definitively prove that lack of vitamin D causes disease -- or that vitamin D supplements would lower risk. The Vitamin D Council -- a scientist-led group promoting vitamin D deficiency awareness -- suggests vitamin D treatment might be found helpful in treating or preventing autism, autoimmune disease, cancer, chronic pain, depression, diabetes, heart disease, hyperparathyroidism, high blood pressure, flu,

neuromuscular diseases, and osteoporosis. However, there have been no definitive clinical trials. The best known benefit of vitamin D is its role in helping calcium build strong bones. But that's far from the whole story. Vitamin D helps regulate the immune system and the neuromuscular system. Vitamin D also plays major roles in the life cycle of human cells. Vitamin D is so important that your body makes it by itself -- but only after skin exposure to sufficient sunlight. This is a problem for people in northern climates. In the U.S., only people who live south of a line drawn from Los Angeles to Columbia, S.C., get enough sunlight for vitamin D production throughout the year. Dark skin absorbs less sunlight, so people with dark skin do not get as much vitamin D from sun exposure as do light-skinned people. This is a particular problem for African-Americans in the northern U.S. How can I get enough vitamin D? Five to 30 minutes of sun exposure to the face, legs, or back -- without sunscreen -at least twice a week should give you plenty of vitamin D. But this much direct sun exposure might also expose you to potentially dangerous levels of cancer-causing UV radiation. And unless you live in the South or Southwest, you probably don't get enough sunlight during the winter months. It's probably a better idea to get vitamin D from foods or from supplements. Which foods contain vitamin D? Surprisingly few foods contain vitamin D -- unless it's added to the food. Food sources of vitamin D include: * Cod liver oil * Salmon * Mackerel * Tuna or sardines canned in oil * Milk, regardless of whether it's whole, nonfat, or reduced fat * Egg yolks * Beef or calf liver * Cheese Nearly all milk in the U.S. is fortified with vitamin D. So are many brands of orange juice, yogurt, margarine, and ready-to-eat breakfast cereals. How much vitamin D do I need?

The current recommended daily dose of vitamin D is 200 IU for people up to age 50, 400 IU for people aged 51 to 70, and 600 IU for people over age 70. That's not enough, Boston University vitamin D expert Michael Holick, MD, PhD, tells WebMD. Holick recommends a dose of 1,000 IU a day of vitamin D for both infants and adults -- unless they're getting plenty of safe sun exposure. In 2008, the American Academy of Pediatrics recommended that breastfed infants receive 400 IU of vitamin D every day until they are weaned and drink at least 1 liter of vitamin D-fortified formula or whole milk each day. The AAP also recommends 400 IU/day of vitamin D for children and teens who drink less than a liter of vitamin D-fortified milk per day. The Vitamin D Council recommends that healthy adults take 2,000 IU of vitamin D daily -- more if they get little or no sun exposure. A simple blood test -- the 25(OH)D or calcidiol test -- can tell your doctor whether your vitamin D level is low. The Vitamin D Council recommends that 25(OH)D levels be between 40 and 65 ng/mL. The U.S. National Institutes of health notes that 25(OH)D levels over 30 ng/mL are optimal, and that there is "insufficient data" to support recommendations for higher levels. Can I get too much vitamin D? Too much of any good thing is a bad thing. Too much vitamin D can cause nausea, constipation, confusion, abnormal heart rhythm, and even kidney stones. It's nearly impossible to get too much vitamin D from sunlight or from foods (unless you take way too much cod liver oil). Nearly all vitamin D overdoses come from supplements. Can I get too much vitamin D? continued... How much vitamin D is too much? That's controversial. According to the National Institutes of Health, the maximum upper limit for vitamin D is 25 micrograms (1,000 IU) for children up to age 12 months and 50 micrograms (2,000 IU) for everyone else. But some recent studies suggest that healthy adults can tolerate more than 10,000 IU of vitamin D per day. John Jacob Cannell, MD, executive director of The Vitamin D Council, notes that the skin makes 10,000 IU of vitamin D after 30 minutes of fullbody sun exposure. He suggests that 10,000 IU of vitamin D is not toxic. According to the National Institutes of Health, 25(OH)D levels that are consistently over 200 ng/mL are "potentially toxic." What kind of vitamin D is best?

The recommended form of vitamin D is vitamin D3 or cholecalciferol. This is the natural form of vitamin D that your body makes from sunlight. Supplements are made from the fat of lambs' wool. Many supplements contain vitamin D as vitamin D2 or calciferol. It's derived from irradiated fungus. Because this is not the form of vitamin D naturally made by your body, WebMD nutritionist Kathleen M. Zelman, MPH, RD, recommends using the D3 form for those taking vitamin D supplements. Because of its potency, different forms of vitamin D are used in prescription medications. If you have a prescription for one of these medications, do not switch to another form of vitamin D without checking with your doctor. Does vitamin D interact with other medications? Yes. Steroid medications such as prednisone can interfere with vitamin D metabolism. If you take steroid drugs regularly, discuss vitamin D with your doctor. The weight loss drug orlistat -- brand names include Xenical and Alli -- may cut absorption of vitamin D. So does the cholesterol-lowering drug cholestyramine (sold as Questran, LoCholest, and Prevalite). People taking these drugs should discuss vitamin intake with their doctors. The seizure drugs phenobarbitol and Dilantin (phenytoin), affect vitamin D metabolism and affect calcium absorption.