Spreads with vitamin D

[johnhemming]

IU are more useful for vitamins as they attempt to compare the strength of different chemical formulae. The problems with comparing the mass is that the mass of different formulae vary even if the efficacy is the same.

[Bouleversee]

So why do you suppose so many of the supplements are denominated in ug/mcg and IIRC the NHS website refers to the latter rather than iu? All the ones I have been prescribed are in iu which I find simpler.

[johnhemming]

no idea

[DrBunsenHoneydew]

When you get an NHS prescription for "Vitamin D" you get it prescribed by the actual type of vit D using the precise chemical name, and each of which are manufactured and dispensed in either weight or units measure (or both!):
Alfacalcidol (1-alpha) by weight
Calcitriol (1,25 di-hydroxy) by weight
Colecalciferol (D3) by units
Dihydrotachysterol by weight
Ergocalciferol (D2, a.k.a. Calciferol) by both weight or by units (25 micrograms = 1000 units)
Paracalcitol by weight
Some types of vit D are prescribed as a combination with various Calcium salts (carbonate, phosphate, lactate - by weight)

[Bouleversee]

Mine was Fultium D3, the active ingredient being colecalciferol.

[prowisehealthcare]

Vitamin D is a fat-soluble nutrient and is found in Cod liver oil, vitamin D-fortified foods, egg yolks, and butter. However, the majority of vitamin D in the body is created during a chemical reaction that starts with sunlight exposure to the skin. This is why vitamin D is often referred to as the sunshine vitamin.

Unfortunately due to concerns about skin cancer many of us don’t get the safe sun exposure we need to generate sufficient vitamin D. In fact, during the months of October to April those in the UK need to supplement with vitamin D as at this time of year the sunlight we do get is at the wrong frequency to stimulate vitamin D production. As a general rule of thumb if your shadow is taller than you then no vitamin D is being produced.

[AsleepInYorkshire]

Since reading this from the British Nutritional Foundation:

According to national surveys in the UK, across the population approximately 1 in 5 people have low vitamin D levels (defined as serum levels below 25 nmol/L). Low vitamin D levels are associated with a higher risk of poor musculoskeletal health such as rickets, osteomalacia, falls and poor muscle strength.

- and bearing in mind my own circumstances - I've been taking a Vitamin D supplement every day. I buy them from Amazon and they cost me about £12 a year.

RC

I completely agree with the need for everyone in the UK to supplement if they are not exposed to strong direct sunlight between 10am and 3.30pm. I've taken Vitamin D as a supplement for nearly a decade now. I take 4,000 iu's per day. With B12 I find they both help keep my "mood" out of my boots.

I completely disagree with the NHS/NICE minimum levels as do the USA and Japan. It should in my opinion be double that stated by NICE.

AiY

[Bouleversee]

It's also in oily fish and mushrooms but supplements are still needed. I understand 15 mins. exposure in the sun at midday provides enough in the summer months but don't know whether that would create a risk of skin cancer though I should have thought not.

I think someone posted on here that one should not take a Vit D supplement with one's evening meal. Can anyone remind me why not? I sometimes forget to take it at lunchtime.

I can't help thinking it would save the NHS a fortune if milk was fortified with Vit D, as in the USA.

[vrdiver]

I think someone posted on here that one should not take a Vit D supplement with one's evening meal. Can anyone remind me why not? I sometimes forget to take it at lunchtime.

I read that too. It was to do with vitamin D interfering with your sleep if taken later in the day.

VRD

[Nocton]

Much better to eat a tin of sardines, piece of salmon, smoked mackerel or similar oily fish a week.

Almost every study on the use of supplements have found they don't work or worse. [Supplements started with high dose Vit C which had a big following as Linus Pauling, the promoter, was a Nobel prize winner, but of course not in medical science. It continued with the idea that extra anti-oxidants like tocopherols and carotenes protected against heart disease - that trial, like many others since, had to be stopped because people taking the supplements were dying sooner.]
There was one similar negative dietary trial reported in the press a few days ago, but I can't immediately locate it. Here is one from 2019: https://directorsblog.nih.gov/2019/04/16/study-finds-no-benefit-for-dietary-supplements
Re Vitamin D I quote:

There was also evidence that people who took supplemental vitamin D at a dose exceeding 10 micrograms (400 IU) per day without a vitamin D deficiency were more likely to die from cancer.

[vrdiver]

Much better to eat a tin of sardines, piece of salmon, smoked mackerel or similar oily fish a week.

Almost every study on the use of supplements have found they don't work or worse.

Here is one from 2019: https://directorsblog.nih.gov/2019/04/16/study-finds-no-benefit-for-dietary-supplements
Re Vitamin D I quote:

There was also evidence that people who took supplemental vitamin D at a dose exceeding 10 micrograms (400 IU) per day without a vitamin D deficiency were more likely to die from cancer.

BUT, from the same* study:

more than half of US adults had inadequate intake for vitamin D

For vitamin D supplement use, stratified analysis revealed that supplement use was not associated with mortality among individuals with serum 25(OH)D <50 nmol/L; however, among individuals with serum 25(OH)D ≥50 nmol/L, vitamin D supplement use at >10 mcg/d was associated with an increased risk of all-cause mortality

There were some suggestions that vitamin D supplementation at >10 mcg/d might be associated with increased all-cause and cancer mortality among individuals with no vitamin D deficiency. It remains controversial whether vitamin D supplementation reduces premature death or prevents cancer. Prior meta-analysis of intervention trials suggests that vitamin D supplements may modestly reduce all-cause and cancer mortality (38) but recent trials did not support its role in preventing cancer or CVD (39–41). The most recent trial, the Vitamin D and Omega-3 Trial (VITAL), failed to detect an effect of vitamin D supplements at the dose of 2000 IU/day on reducing cancer or CVD incidence among 25,817 participants during a median follow-up of 5.3 years (42). Potential benefits or harms of vitamin D supplement use need to be further evaluated

In essence, if you are a UK resident, enjoying typical UK sunshine, you will be deficient in vitamin D for most of the year. Taking supplements may be useful, but if in doubt, it is worth checking your blood serum levels (you can but self-test kits) or talking to your doctor. In the current climate, it is worth noting the very positive outcomes that vitamin D has had w.r.t. Covid19. It's role in the efficacy of the immune system has been highlighted, as opposed to the "old" view that you just needed it to avoid rickets or loss of calcium from bones in older individuals.

Going large on salmon or other oily fish brings other issues. I've heard doctors suggesting limiting intake of top-predator fish like salmon and mackerel, as they can be a source of heavy metal and other toxins. This was general advice given to pregnant women.

VRD (who is a vegetarian, so oily fish is a non-starter anyway)

*https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736694/

[Nocton]

Nevertheless, vrdiver, the evidence has consistently tended to show that vitamin supplementation does not work and can even be bad for long-term health. A short dose of vitamin D to try to get someone's D levels back to normal is one thing - it's just like the doctor giving one a pill. But relying on supplements for life is quite different. The supplement industry has grown large on pandering to people's fears and ideas that you can't get all you need from a sensible diet.
If half of US adults have an inadequate intake of Vitamin D, then that shows that their diet is unhealthy/inadequate. Those who choose a vegan or vegetarian diet should understand that we have evolved as omnivores and if one chooses to sidestep our evolutionary ancestry then one will probably have to resort to chemical supplements and highly-processed foods - ersatz milks for example - to get an adequate diet.

Another point about getting vitamins and minerals in foods is that the foods themselves, e.g. oily fish or eggs have other good nutrients that one would otherwise miss out on.

[Bouleversee]

Nevertheless, vrdiver, the evidence has consistently tended to show that vitamin supplementation does not work and can even be bad for long-term health. A short dose of vitamin D to try to get someone's D levels back to normal is one thing - it's just like the doctor giving one a pill. But relying on supplements for life is quite different. The supplement industry has grown large on pandering to people's fears and ideas that you can't get all you need from a sensible diet.
If half of US adults have an inadequate intake of Vitamin D, then that shows that their diet is unhealthy/inadequate. Those who choose a vegan or vegetarian diet should understand that we have evolved as omnivores and if one chooses to sidestep our evolutionary ancestry then one will probably have to resort to chemical supplements and highly-processed foods - ersatz milks for example - to get an adequate diet.

Another point about getting vitamins and minerals in foods is that the foods themselves, e.g. oily fish or eggs have other good nutrients that one would otherwise miss out on.

What evidence? I don't think there is consistent evidence of that at all and apart from reading umpteen times from different reliable sources that we don't get sufficient Vitamin D from nutrition and still need a supplement in the winter, I can give you personal evidence that it does make a difference. When I asked for blood tests and a chest x-ray because I was suffering from extreme fatigue and a persistent and increasing cough a few years ago, despite always having a sensible diet and eating all the right things, I was found to have <20 nmol/l of Vitamin D (serious deficiency) and put on a crash course of 40k iu per day for a couple of weeks which restored my Vitamin D level to well within the normal range. I was then put on a maintenance dose of 1000 iu per day which I reduce in the summer as I try to expose my limbs for up to half an hour at midday in the summer, weather permitting. I practically live on oily fish (5 times so far this week), eggs and dairy and eat meat much less frequently but regular tests have shown that while a normal level is maintained by supplementation, my Vit D level is nowhere near the toxic level. I was also found to have an incurable lung disease but that was before I had taken any supplementation and according to Johns Hopkins, Baltimore, an association has been established between Vit. D deficiency and lung disease and various other diseases, including MS and diabetes though further research is needed into cause and effect. It is known that stress and grief can have a detrimental effect on the immune system and I am pretty sure that it is no coincidence that my husband died around that time, having been ill for a long time previously. It is also proven that dark-skinned people do not absorb it from sunshine as well as light-skinned and that overweight people need more because it tends to be retained in their fat rather than getting into their bloodstream and doing the necessary job.

All in all, so far as this particular vitamin is concerned, the weight of evidence would seem to be that supplementation is beneficial rather than otherwise but as with most things, one should not overdo it and levels should be monitored from time to time to ensure a sufficiently high level but also avoid toxicity.

As regards evolution, surely the whole point is that we have to adapt to changed circumstances and climate change is likely to necessitate modification of our diets willy-nilly; supplementation recommendation may also change accordingly. I haven't yet tried any of these alternatives to dairy milk but it is quite likely that at some point in the future they will become the norm.