New England Health Advisory

By Inger Pols

This is part five of a series on the supplements I think every adult should take. Previous issues focused on whole-food based multivitamins, ubiquinol, fiber and omega 3. You can read them by clicking here.

The final supplement on the list is vitamin D, which is made in our bodies through sun exposure. But today, we simply don’t get enough direct exposure to sunshine, without sunscreen, to make the vitamin D we need.

Vitamin D helps with bone health by facilitating calcium absorption. It also plays an important role in many other healthy body functions. Vitamin D has been shown to improve immune health and heart health, protect against cancer, autoimmune diseases, depression and a host of other conditions.

Vitamin D deficiency is a major cause for concern as it affects multiple systems in our bodies. Vitamin D deficiency is far more pervasive than previously believed, with research now indicating virtually all adults and children have lower than optimal vitamin D levels.

The only way to know how much vitamin D you need on a daily basis is to get your levels tested a couple of months after you begin to supplement. You want to see levels of 125-200 nmol/L, or nanomoles per liter. (Sometimes test results are reported in nanograms per milliliter or ng/ml. It’s the same test, just a different measurement: Like miles per hour versus feet per second. If your test results are in ng/ml, you will want to see at least 50 ng/ml for optimal vitamin D function.)

Estimates now suggest that 5,000 International Units, or IU, of vitamin D a day or 35 IU per pound for kids or heavier people is appropriate. But some of us need more: I was recently listening to a renowned brain expert say that as a physician, he was shocked when he found out after vitamin D testing that his body required 10,000 IU a day to function at its optimal level since he lives in southern California and is exposed to sunshine all year.

My whole food multivitamin contains 5,000 IU of vitamin D3 and I get plenty of daily summer sunshine, so I don’t take a supplement in summer. But most multivitamins have shockingly low levels of vitamin D3. So even if you are taking a good whole-food multivitamin, you’ll most likely need to add some D3, unless you get time outside without sunscreen every day. And even though my multivitamin provides a good baseline, I still find that I need to supplement with an additional 1,000-2,000 IUs of vitamin D3 during the long New England winters. Unless you are in a warm weather climate, you probably will too.

If you haven’t read my full article on vitamin D, you should check it out. Before we leave the topic of supplements, I want briefly mention three other supplements that did not make my top five list that you may want to consider: collagen, probiotics and DIM.

Collagen

If you read my article on bone health, you know how important collagen is to avoiding bone fractures. You can and should get your collagen from eating good collagen-rich foods like dark green leafy vegetables. But if you find—like many—that you may not be eating enough collagen and you are not taking a good whole-food multivitamin, you may want to consider collagen supplementation.

As I shared in an earlier article, in order to maintain my weight and to prevent blood sugar issues, I try to eat small amounts of protein, healthy fats (omegas 3s) and fiber at every meal or snack. If I am ever in a situation where I am not consuming protein, I will take a collagen supplement (and a fiber or omega 3 supplement if needed) for balance. While not nearly as good as eating the right foods, in a pinch, it’s better than taking in carbohydrates (sugar) without any having protein to balance it out since carbs ingested without a protein counterbalance are stored as fat in the body.

Probiotics/Digestive Enzymes

We’ve all heard of antibiotics: They kill off or inhibit the growth of bacteria. But antibiotics also kill off the healthy bacteria in our digestive tract and inhibit our ability to digest food and to absorb nutrients. Probiotics contain the beneficial flora that your digestive system needs and digestive enzymes that work in your stomach to help break down foods. Both can be damaged by illness, poor diet and antibiotics, so if you have experienced any of those and have not taken a course of probiotics and enzymes afterward, your digestive system is likely not operating at top capacity.

Probiotics and digestive enzymes are also a must if you have digestive concerns such as cramps, constipation, diarrhea, gas or bloating or Irritable Bowel Syndrome. If you struggle with allergies or asthma, food sensitivities such as sugar or gluten, yeast infections or urinary tract infections, rosacea, acne or skin conditions, headaches or migraines, chronic bad breath (halitosis), PMS or hormonal imbalance, or achy joints, you should consider probiotic supplementation.

Depending on how long and how strong your course of antibiotics was, or how severe your digestive concerns are and what your diet is like (if it is very acidic), you may want to stay on probiotics for a while to ensure balance is restored and maintained. At a minimum, you’ll want to take probiotics and digestive enzymes while taking antibiotics and for several weeks afterward. A two to three month supplementation cycle is great for restoring balance and digestive health after any significant stress to your digestive system. Eating yogurt can help, but your body most likely needs more help than yogurt alone can provide.

Even if you haven’t had antibiotics lately or faced a digestive health concern, your system could still be imbalanced from a concern long ago. Probiotics can help restore balance if you have a heavily acidic diet that promotes yeast and causes other imbalances in your digestive pathway. I recommend a month (or two) of probiotic and digestive enzyme supplementation every year to help ensure your digestive system has everything it needs to maximize the nutrient absorption of the food you are eating.

There are many different probiotic strains and each works differently in the body, so you may need to experiment with more than one brand to find the right one. If you are facing a specific issue, research your condition to find the best strains. The right probiotic should make a difference within the first week or two. If you don’t see improvement after two weeks, try another brand with different strains of bacteria. If you are just looking to restore balance annually with no specific concerns, choose a highly rated probiotic that has bifidobacteria and lactobacillus acidophilus in the billions.

DIM or Diindolylmethane

Diindolylmethane, or DIM, promotes healthy hormonal balance through beneficial estrogen metabolism. DIM is a naturally occurring phytonutrient found in cruciferous vegetables (like broccoli, cabbage or collards), which we know are good for us, but do not eat nearly enough of. DIM can balance estrogen by blocking “bad” estrogen and promoting good or beneficial estrogen in our bodies.

For women, healthy estrogen metabolism prevents breast, cervical and uterine cancers; for men, it is required for prostate health. (Men, you have estrogen in your bodies and are exposed to it in foods and the environment as well, so it’s just as important for you!) We are going to be talking more about DIM and prostrate health in Friday’s issue.

Not everyone needs DIM, so it didn’t make my top five list. But if you’re concerned about hormonal balance, fibers, tumors or reproductive cancers or prostate health, DIM is a supplement you should consider taking daily. (I found it quiets my hot flashes.) Generally speaking, unless cancer runs in your family, you are perimenopausal and/or you are already struggling with reproductive issues like fibroids or hysterectomy, it’s something you can wait to take until you’re in your 50s.

Research has shown that most DIM supplements cannot be absorbed; they require microencapsulation. Only one company, BioResponse, has a patented microencapsulation with extended release naoparticles, ensuring predictable absorption. This company is the only brand being used in all the published clinical trials, including those sponsored by the National Cancer Institute, so it’s the one I take and recommend.

To your health!

Inger Pols
Editor of New England Health Advisory

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By Inger Pols

Today we’re starting a five-part series: The five supplements I think every adult should take. The first one is a whole-food based multivitamin.

A recent article in Reader’s Digest called vitamins a scam and said that taking them is a waste of money. It cited a study of 160,000 mid-life women that showed no difference in health with respect to the big diseases like cancer, heart disease and stroke, from taking a multivitamin. But as with all studies, you need to dig deeper—in this case because not all vitamins are created equal. (I am always suspect when a magazine whose advertising is largely from pharmaceutical companies says vitamins are worthless.)

The article challenges the benefits of certain individual supplements, such as vitamins A or E, which will likely have little, if any, effect when taken in isolation without proper co-factors. The article does recommend one standalone vitamin that should be taken by everyone: vitamin D. We’ve already discussed the importance of vitamin D and the rampant deficiency among children and adults today, so I couldn’t agree more. (Click here for more on vitamin D.) Vitamin D3 can stand on its own and I take it daily; most other vitamins need to be taken together as part of a complete nutritional package.

Eating a whole food and plant-based diet will go a long way toward staying healthy and I strongly recommend we do both. We cannot eat too many dark leafy green vegetables and we should be eating the rainbow (fruits and vegetables that cover every spectrum of color from white to orange, red, green and purple.) But I also take a whole food multivitamin and a whole food raw green superfood powder, because the truth is, it is very difficult to get the nutrients we need from our modern food supply.

These days, to offset the bad fats and processed food sugars we consume and to restore balance within our bodies, we need more vegetables than ever. We are not just eating to fuel our bodies, we are eating to heal our bodies from the inflammation and oxidation of our processed diets. It’s getting harder to get the nutrients we need because in addition to the packaged and prepared foods in our diets, our fresh food supply is not as vitamin rich as it used to be. Soil has been depleted of nutrients, food is sprayed with chemicals and pesticides or is genetically modified to grow bigger or to resist disease, and then it is transported hundreds or thousands of miles to get to our tables.

If you go to a farm or a market and buy fresh produce, you know that after a few days on your counter, it will begin to go bad. Now think about the grapes or tomatoes you are buying from the opposite coast or from South America. They were picked, packaged and then shipped (sometimes by barge) to the U.S., sent out by truck across the country to your local market, displayed on the shelf for several days and then finally taken home.

For the produce to survive that trip looking fresh and beautiful and without bruising, it is heavily sprayed with chemicals, and picked before it is ripe and allowed to mature along the way. Once the fruit leaves the vine, it doesn’t get the sun and the nutrients any longer, it doesn’t fully develop the enzymes and phytonutrients that are usually present in mature fresh picked local produce.

(I’m going to talk about organic versus local and making better food choices soon, but you should also know that many chemicals and pesticides banned in the U.S. are used freely in the foreign countries from which we buy produce.)

Studies estimate more than 50% of nutrient value is lost in the journey from farm to table. So even if you are doing your best to eat a lot of good fruits and veggies, unless you have access to a local farm, it is hard to get food with the nutritional profile you need for health. Then you’d have to eat a lot of it, and how many of us can sit down and eat a bunch of tomatoes or a basket full of kale. You’ll feel full long before you can finish, especially if you paired it with a big piece of meat protein or dairy.

While I fantasize about growing my own food, here in New England, with a long, cold winter and a busy life with two kids and work, it’s not possible at the moment. I do my best to shop at local farmers’ markets for fresh produce, and I buy flash frozen organic produce when I can’t. But despite my best efforts, I do not believe that I can get the nutrition I need without taking a multivitamin (my kids take one too).

But there is a big difference among multivitamins. There are natural organic whole food based products that when manufactured correctly leave the integrity of the whole food intact.

When looking for a good whole food supplement, keep in mind that whole foods are just that: whole foods. Look for ingredients such as carrots, spinach, wheat grass, spirulina, kale, celery etc. There will be vitamins listed as well but their sources will also be present: The original foods from which they were derived. When the ingredient list reads more like a science report than a grocery list, and there are no food sources included just isolated chemicals, it’s typically comprised of manmade synthetic compounds.

Because synthetic vitamins are created in a lab to simulate the real thing, they are often not identical in the way they interact with or are absorbed by the body. They are often missing minerals, nutrients and other requisite co-factors for assimilation. In addition, they often contain cheap fillers and binders from ingredients like sand and titanium dioxide, dibasic calcium phosphate and microcrystalline cellulose, they are ingredients that our bodies cannot absorb and that may even be harmful to us. Many common over-the-counter vitamins are passed through the stool whole and intact. (Centrum is famous for this).

Taking a multivitamin that includes a broad spectrum of vitamins, minerals and nutrients can make a difference, but only if it is bioavailable and bioabsorpable; in other words your body can actually break down and absorb the nutrients. That is not possible with synthetic vitamins. I prefer a whole food-based product that is as close to what I should be eating as possible, and made from the real thing, not created to imitate it.

Interestingly the Readers Digest article’s main argument against taking multivitamins said, “These days, you’re extremely unlikely to be deficient if you eat an average America diet, if only because many packaged foods are vitamin enriched.”

Think about that for a moment.

Food manufacturers strip out all the vitamins that exist in the food during the manufacturing process. Then they “enrich” them, by adding back cheap lab-created imitations. They want us to believe that these created versions are the same as the original, but research shows they are not: You cannot duplicate naturally occurring nutrients from synthetic ingredients. In addition, they will be missing enzymes and cofactors required for assimilation. When I see “enriched” on a food label, I know to stay away.

The truth is that enriched foods do not add vital nutrients to our bodies, nor will synthetic vitamin pills. The best way to get what we need is from the whole food source. Nature intended us to eat vitamins, minerals, trace minerals and phytonutrients together as they work synergistically. When whole food supplements are made the right way, they maintain a multitude of the plants original components and the integrity of the food source. So eat as much good stuff as you can. Buy local when you can, organic if possible. But know that even then, most of us will still need to supplement with a whole food-based supplement to bridge the gap for long term health and wellness.

To your health!

Inger Pols
Editor of New England Health Advisory

P.S. As I mentioned at the top of today’s issue, we are always eager to hear from readers. Besides commenting on our articles, you can also connect with New England Health Advisory on Twitter and Facebook. “See” you there!

The A, B, C’s of Vitamin D

Too Much of a Good Thing?

Not Your Grandmother’s Cod Liver Oil

Winter can be long. Thankfully, here in New England, we do get bright sunny days. (Unlike Detroit where I spent several gray winters craving sunshine due to “lake effect.”) But the days are short and it is hard to get out and experience sunlight if you work a traditional schedule.

I took my kids on vacation for school break this February and it was amazing how much better we all felt once we had some time in the sun. It was not just about being away and relaxing; I felt noticeably better–physically and emotionally -after experiencing the sunshine on my skin.

Vitamin D, the sunshine vitamin, has been getting a lot of press lately, and for good reason. While we have always known it helps with bone health as it facilitates calcium absorption, new research is proving that higher levels of the vitamin have an impact on immune health and protect against cancer, heart health, autoimmune diseases, depression, periodontal disease, diabetes and a host of other conditions.

While adequate levels are shown to be protectors against many conditions, low levels, or deficiencies, are now linked to concerns with these same systems and conditions. Studies now show that vitamin D deficiency is rampant and far more pervasive than previously believed.

Many experts say increasing your vitamin D levels may be the single most important thing you can do to improve your health.

What is Vitamin D?

Interestingly, vitamin D is not really a vitamin; it’s actually a group of prohormones. The two major forms are known as vitamin D2, known as ergocalciferol, and vitamin D3, known as cholecalciferol. Vitamin D is one of the four fat-soluble vitamins, which means it is absorbed with the help of lipids (fats) in the intestinal tract. This means that without adequate fat present, the body will not absorb vitamin D. It also means that unlike water-soluble vitamins, which are not readily stored, excess vitamin D can be stored in fat and muscle tissue for future use.

The vitamin D the body receives from food, supplementation or sun exposure is inert and undergoes two reactions in the body in order to become active. The metabolic product created from this process, calcitrol, is a hormone that is said to target over 2,000 genes. That is about 10% of all human genes; no wonder some call it the miracle cure!

A Return to Rickets

Vitamin D deficiency is so rampant now that a recent report in the British Medical Journal revealed the return of a condition common in Victorian times known as rickets. Rickets is a disease affecting growing children whose bones do not harden or set appropriately due to insufficient vitamin D. This once common condition disappeared in developed countries upon discovery that minimal levels of vitamin D would prevent it, but it has now returned.

A new study recently published in the journal Pediatrics here in America revealed that as many as two-thirds of all children are deficient in vitamin D. Among darker-skinned populations the deficiency is even more rampant, with as many as 92% of black children being deficient and as many as 80% of non-black Hispanic children being deficient.

These numbers are based on the new target minimum of 75 nanomoles per liter (nmol/L).
(Until recently, the standard minimum had been considered 50 nmol/L but many researchers have recently suggested that level be raised.)

According to the Vitamin D Council, however, the recommended minimum vitamin D dosage is actually much higher. They cite recent research that indicates that below 100 nmol/L, the body uses vitamin D up as quickly as it is created. At between 100 and 125 nmol/L, some people begin to store vitamin D, but others do not. At 125 nmol/L, virtually everyone begins to store excess vitamin D in fat and muscle tissue.

The Vitamin D Council considers numbers below 125 to indicate “chronic substrate starvation” and recommends a range of 125-200 nmol/L. (Using these numbers as a baseline, I would venture a guess that virtually everyone tested in that study would be deficient.)

Vitamin D is used to support the immune system and protect against so many conditions that the presence of any health concerns in the body may well warrant a need for an increase in availability. If your body is fighting cancer or heart disease, or looking to recover after a strenuous workout, how much more vitamin D might you need? We don’t yet know those answers, but we can certainly imagine that there might be cases where the body needs much more.

Whether you choose to follow the recommendations of the Vitamin D Council or to be more conservative and follow more traditional guidelines, it is likely that you need to raise your vitamin D levels.

How do I measure my Vitamin D levels?

The only way to reliably know how deficient in vitamin D you might be is to have a simple blood test performed called a 25 hydroxyvitamin D test or a 25 (OH)D. Your doctor can do this easily and most insurance plans should cover it. Many doctors will still consider significantly lower numbers to be acceptable (keeping up with the emerging research can be a full-time job and your doctor already has a full-time job); if so, it will be up to you to share information and partner with your physician to find the right level for you.

If your physician will not test you for vitamin D, you can order a test from the Vitamin D Council on its Web site. You complete the test and mail it back for accurate results (in all states but New York, which prohibits testing of specimens collected in or mailed from New York and prohibits data transmission from the lab to New York physicians or residents.) The test costs $65–or $220 for four if you want to test periodically or test more than one family member.

The tests will tell you your current levels, but from there you will need to figure out how much supplementation you require to get you to where you want to be.

How much vitamin D do I need?

Generally speaking, we know that the darker your skin, the bigger you are and the less daily sunshine you receive, the more you will need.

While current FDA guidelines suggest a vitamin D level of 400 International Units, or IUs, per day, many researchers and physicians have increased their suggested optimal adult vitamin D level to around 5,000 IUs per day. I have also seen a formula used that indicates a body needs 35 IUs per pound of body weight, which allows for variance for children and heavier people.

Supplementation at the 5,000 IU level has been shown to bring vitamin D into the desired nmol/L range for many people. But because vitamin D is used to fight cancer, regulate the immune system and myriad other functions, there can be a need for much more depending on what is going on in your body. Some studies have revealed that certain individuals need as much as 25,000 to 30,000 IUs just to reach a consistent rate of 125 nmol/L!

Vitamin D needs are individual and must be customized. That’s why it is recommended that you test in order to be sure your supplementation is adequate for your own body’s needs.  It is recommended that you begin supplementation first and consume vitamin D regularly for two to three months before you have your levels tested in order to see how effective your dosing is for you. (If you feel more comfortable testing first, that’s fine. Just know that you may need to test several times in the process.)

Unless your climate remains constant year round, you will probably want to test in summer and in winter to get a sense of the shifts in your body and how the season changes affect your dosage levels. People who avoid the sun as well as those with darker skin pigmentation will likely need to increase their dosage, especially in winter.

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Too Much of a Good Thing?

According to the Vitamin D Council, even at the new recommendation of 125-200 nmol/L (much higher than most doctors will be familiar with), those ranges are still very conservative. But because excess Vitamin D is stored in fat and muscle tissue, there have been concerns about toxicity from over consumption.

While we should always be aware of such possibilities–and that is yet another reason to work with your doctor and get tested regularly–the risk of toxicity is much less than previously believed. Because the body is geared to produce very high levels of vitamin D from our daily sun exposure, we have the capacity to absorb very high levels.

Typical summer sun exposure of 20 minutes (without sunscreen and with face, arms and legs uncovered) yields 20,000 IU of vitamin D. We didn’t have sunscreen until recently; our bodies were built to be in sunlight for much of the day (building up our sun exposure to prevent burning of course.) So we are engineered to produce and absorb very high levels of vitamin D. And we also have a built-in safety mechanism: After the body produces about 20,000 IUs of vitamin D, the sunlight, begins to break it down, preventing the body from excess. And once we are tan, the body naturally adjusts and makes less, producing only about 10,000 IUs.

But oral consumption is different: Can we overdose on vitamin D? While pharmacological overdoses of vitamin D2 have been documented, the same is not true for vitamin D3. Research conducted to determine toxic excess in animals revealed that the dose of vitamin D3 it takes to kill half the animals when tested in dogs was about 3,520,000 IU/kg. (Yes, sorry, they did in fact test this on animals.) That is estimated to be about 176,000,000 IUs taken by a 110-pound human.

Leading researcher Dr. Reinhold Vieth suggests that toxicity may possibly begin to occur after chronic daily consumption of 40,000 IUs a day. Clearly there is a great deal of room between the minimum guideline of 5,000 IUs and long-term daily consumption of 40,000 IUs.

Vitamin D Co-Factors

The body needs several substances to utilize vitamin D appropriately.  These co-factors include magnesium, zinc, boron, vitamin K2, genestein and a small amount of vitamin A.

I believe many people are magnesium deficient (because calcium and magnesium partner together and so many people supplement calcium but neglect magnesium–I’ll discuss magnesium more in a future newsletter) and because of that, magnesium is an important consideration in vitamin D supplementation.

If you struggle with reaching optimal vitamin D levels after supplementation, a magnesium deficiency could be the reason why. At the same time, as you supplement with vitamin D, any existing magnesium deficiency could be exacerbated.

So paying attention to the co-factors, especially magnesium, is an important component of successful vitamin D absorption.

Walking on Sunshine

The best way to increase vitamin D in your body is through sunshine. Exposed skin in summer sun for 20 minutes will give your body its daily dose. But unless you live in southern Florida, you won’t be able to get what you need year-round from sunlight alone and you’ll need to supplement, at least during winter months.

Tanning Beds

Tanning beds emit both UVA and UVB rays. However, the body is only interested in the UVB rays for vitamin D synthesis. UVB rays are shorter and affect the surface layers of the skin and as a result, can cause sunburns. The dark tans that come from tanning beds result mostly from UVA rays. Therefore, most tanning salons calibrate their beds to produce mostly UVA rays (often as high as 95% UVA) and minimal UVB.

Not Your Grandmother’s Cod Liver Oil

It is possible to get vitamin D from foods such as salmon (wild sockeye is best; not farm raised), mackerel, herring, sardines and catfish. But a standard portion of these foods will only yield about 250-350 IUs, so you’ll have to eat a lot!

Grandmother’s remedy of a tablespoon of cod liver oil is a highly effective form as well; it yields 1,360 IUs.  (Many companies now flavor the oil with lemon or orange so that the taste is not like what you might remember; my kids will even eat it and they can choose between oil and pill form.)

Choose a brand that has been tested and found to remove contaminants such as mercury and PCBs, which can be present in fish.

Cod liver oil, however, also contains vitamin A, another fat-soluble vitamin that some suggest has toxicity concerns at high doses.  I believe that in time research will show that–similar to vitamin D–high doses of vitamin A from natural sources are safe. For now, if you have concerns about excessive vitamin A, rather than quadrupling the dosage of cod liver oil to get to 5,000 IUs, you’ll want to consider D3 supplementation through pills, sprays or oils.

Studies show that vitamin D2 is only about 20%-40% as effective in supplementation as vitamin D3. Many over-the-counter vitamin D supplements–and virtually all prescription forms–contain vitamin D2. But D3 (cholecalciferol) is widely considered to be a more effective source, so read the label carefully.

And don’t be afraid of 15-20 minute breaks in the sun without sunscreen (we’ll talk about the myth that it will cause skin cancer in another newsletter). You will feel energized and renewed and many systems in your body will be thankful.

To your health!

Inger Pols
Editor of New England Health Advisory

P.S. As Inger mentioned above, cod liver oil is an excellent source of one of nature’s most important nutrients: Vitamin D. Things have changed a lot since your grandmother used to give you a tablespoon full–there’s no fishy after taste and most capsules have a pleasant lemon/lime flavor. You owe it to yourself to try this time-tested vitamin today–it can help you fight diseases and live a healthier life! Click below to find out more!

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