In Post-Menopausal Women, 'the Sunshine Vitamin' is One to Watch

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By: , SparkPeople Blogger
1/25/2012 10:00 AM   :  23 comments   :  13,709 Views

Vitamin D is a hot topic in nutrition, and one that's become a focus in menopausal bone health.  There are two forms of the vitamin, D2 and D3 (cholecalciferol), with D3 the form best metabolized by the body. Vitamin D is found in foods such as fish, eggs, fortified milk and the old remedy, cod liver oil. 

Although this nutrient is found in foods, the greatest source for obtaining vitamin D is through the skin.  When bare skin is exposed to ultraviolet light, it synthesizes vitamin D3 that is then stored in the liver.  You only need 10-15 minutes of sun exposure during peak sun hours (between 10 a.m. and 2 p.m. in most locations) during the summer months to produce up to 10,000 IUs of the nutrient.  After that short exposure you can continue with safe sun habits and slather on a broad-spectrum sunscreen. 

How much vitamin D do you need? According to SparkPeople's resident dietitian, Becky Hand: In the last few years, many experts and health organizations urged the Institute of Medicine to revisit the DRI set for vitamin D and re-evaluate the latest research. After a thorough review, the recommendations for vitamin D did go up by two or threefold in some age groups. The current Recommended Dietary Allowance for vitamin D (as of November 2010) is:
  • Ages 1-70: 600 IU (International Units) daily
  • Ages 71 and older: 800 IU daily
  • Tolerable Upper Intake Level: ages 9 and up: 4000 IU daily
 
Read more: How to Get Your Daily Dose of Vitamin D

Current research on vitamin D and its role in health suggests that there may be a correlation between low blood levels of this nutrient and the development of diseases such as osteoporosis, some cancers, diabetes, cardiovascular disease, hypertension and even obesity and depression.  There are estimates that up to one half of all Americans are deficient in this vitamin, with an increased risk of deficiency in people who have one or more of these risk factors:
  •  Dark skinned
  •  Live in northern latitudes
  •  Over the age of 50
  •  Post-menopausal
  •  A diet low in foods containing vitamin D
  •  Fat malabsorption syndromes
  •  Obesity
  •  Inflammatory bowel disease
This fat-soluble vitamin plays an essential role in the regulation of calcium and phosphorus metabolism and a deficiency can affect bone strength and remodeling.  When calcium levels in the body are deficient, the body draws from bone stores, resulting in an increased risk of osteopenia or osteoporosis in adults.  In children, a deficiency of vitamin D can result in rickets, a disease that affects the growth of bones.

Postmenopausal women should determine their vitamin D blood level by having their healthcare provider order the 25-hydroxy vitamin D test.  If your test level is under 32 mg per milliliter (some healthcare providers consider numbers higher that this to be in the low/deficient range), you are considered deficient and supplementation of the vitamin and follow up testing is needed.

There's conflicting medical discussion regarding what constitutes a deficient, low or normal level of vitamin D, as well as what is a safe and effective supplement dose.  Many healthcare providers feel that the current guidelines for what constitutes normal 25-hydroxy vitamin D level and recommended daily intake are outdated and need revision. 

A prospective cohort study of 72,000 post-menopausal women in the U.S. reported that the women who took in at least 600 IU/day of vitamin D3 (via diet and supplement) had a 37% decreased risk of osteoporotic hip fracture than the women who consumed less than 140 IU/day. 

The data increasingly suggests that the threshold level of vitamin D3 daily intake needs to be at least 700-800 IUs, with several studies finding similar threshold levels needed for bone protection.  Of interest, when vitamin D3 supplements were discontinued in study participants, bone density gains were lost within two years.
The steps to determining your optimal daily vitamin D requirement are:
  • Have your 25-hydroxy vitamin D tested.
     
  • Discuss your results and treatment options with your healthcare provider.
     
  • Follow up with additional testing if you tested low and modify your vitamin D intake if your test level hasn't increased to recommended levels.
Currently it's recommended that postmenopausal women get at least 800 IUs of vitamin D each day, along with adequate calcium intake (both are needed for bone health).   There are many supplements that provide both nutrients in liquid or pill form. My favorite brand is the Bluebonnet liquid supplement.  Two tablespoons a day provide 1,200 mg calcium citrate, 800 IUs of vitamin D3 and 600 mg magnesium citrate.  It's a great way to get your daily doses, especially if you find swallowing pills difficult.

Do you track your vitamin D intake? (You can easily track it on the SparkPeople Nutrition Tracker.) Do you know if you're getting an adequate amount of vitamin D? Have you ever been tested? 


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Comments

  • THEISISOFSVU
    23
    Mine was 13 at the lowest. It was partly due to genetics, inherited premature ovarian failure. I take 5000 a day and had two Reclast infusions to bring back form Osteoporosis. The article is out dated. I take 5000 with no problems. a blood level of 52 is optimum now from what I hear. 800 mils a day is nothing really. I d say 1000 to 2000 for normal post menopausal women. But then I am no Dr either. - 1/13/2013   10:10:54 PM
  • 22
    this article is outdated.... perhaps a little vitamin d research is needed... the amounts are much too low..znc it doesn't have any of the recent research for...Post-Menopausal Women... maybe change the title.. - 1/12/2013   12:02:17 PM
  • 21
    I've been taking a prescription Vitamin D pill once a month for over a year on the recommendation of my OB-GYN. - 1/28/2012   12:08:28 AM
  • GMAGEE
    20
    I haven't been tracking it, but perhaps should! - 1/27/2012   7:42:30 PM
  • COMPFC
    19
    BRENNA84- PCOS is a multifacted condition that can include obesity and insulin resistance, both risk factors for low vitamin D levels. The data on vitamin D blood test levels and pcos is not strong enough at this point to determine whether vitamin D levels contribute to pcos, or are a side effect of the condition. The upside is that you can test whether you're deficient in vitamin D, and take supplements to bring your level up to where your healthcare provider feels is appropriate. Again, it's important to work with your healthcare provider to find out whether you need to supplement, and how much is needed to bring your levels up if it's low. - 1/26/2012   4:18:52 PM
  • 18
    I have been taking Vitamin D for years to help with my bones, due to a diagnosis of osteopenia. I upped it to 6,000 last year....side effects?....I NEVER get sick! My one hip is in the normal range now.

    YES, the blood test is expensive....and I hope to see it become standard with the CBC in the future!

    I live in Arizona, and wear the best sun screen all over, which means even here LESS Vitamin D in the blood stream.

    I plan to get my levels done again, soon.... - 1/26/2012   3:15:47 PM
  • CIRANDELLA
    17
    I track it every day and rarely get any D via my food. My internist checks it regularly and has prescribed 1,000 mg./day of D; my level is now 50, and I had been quite low before. So good advice, SP! - 1/26/2012   2:38:25 PM
  • 16
    One thing they forgot to mention is pcos. women with pcos have much lower levels of vitamin d than women who don't. wish they'd have mentioned that. - 1/26/2012   1:47:41 PM
  • 15
    For more info on Vit D, take a look at what is on Wikipedia:
    wikipedia.org/wiki/Vitamin_D - 1/26/2012   12:05:18 PM
  • 14
    My doctor has been keeping an eye on my vitamin D levels. I am on 5000IU a day supplements and my levels are fine. Also, I live in Southern California and get a lot of outside time in the sun. It wasn't enough to get my levels up where they need to be. I am olive skinned, so perhaps that's a factor for me. - 1/26/2012   11:25:56 AM
  • 13
    I read a research article in a professional publication a few years ago that said the 15" rule for sunshine only works if you live south of the Mason-Dixon Line. They haven't determined the time for people who live as far north as I do.

    Your doctor can run a simple blood test to determine if you are deficient.
    I require considerably higher supplementation - based on blood tests that I had run every six months when I first started the supplements. I now get tested annually. - 1/26/2012   7:19:50 AM
  • 12
    Reading other articles, having issues with teeth and having been diagnosed with osteopenia, I requested vitamin D testing March 2011 and was surprised at the LOW level of 16 (29 to 70 is normal with 69 optimal). I followed the prescribed dose of 50000iu D2 once a week etc, and it raised the level to 25.... Though prescribed D2 again, I am opting to take 8000iu D3 once a day as D3 is absorbed better. I am using Dr. Mercola's guidance for my choices. I enjoy being in sunshine when it is available, though much of my awake time is indoors.... The point is, yes, is can be beneficial to be tested for vitamin D levels since vitamin D is useful in so many bodily functions while at the same time one doesn't want too much of it either. - 1/26/2012   5:45:25 AM
  • 11
    I've not had that particular test.....will be something I put on my list for next Doc's visit. Will depend on the expense as I have no health insurance. I do track my Vit D intake on the nutrition tracker, but would sure like to see sparkpeople break it down between D2 and D3. I'm sure it would be a royal pain if not impossible. D3 seems to be the one that the health professionals are touting these days. I usually get enough vitamin D in my diet, but it would be nice to know if I am actually getting enough D3. Good article...although it does leave a lot of questions. (Re: EMMANYC's entry) - 1/25/2012   4:06:34 PM
  • 10
    I've never been tested, but my doctor did tell me that I should take a calcium supplement with vtamin tD; however there was no mention of which vitamin D. It's curious that better information is not available through the doctor. - 1/25/2012   3:47:36 PM
  • COMPFC
    9
    EmmanyC-
    Good questions, but I do want to stress that for many people, it's unrealistic to be able to obtain adequate vitamin D from sun exposure. I focused more on vitamin D3 supplementation, since all the studies on this vitamin have used oral vitamin D supplements. The link to Becky Hand's article on vitamin D included in my blog provides more information on how to get your recommended amount from sun exposure:

    "Sunlight is an excellent source of vitamin D. It is free and abundant. The ultraviolet B (UVB) rays from the sun convert a precursor into vitamin D, which becomes 25-hydroxyvitamin D in the liver and is then activated to 1, 25-hydroxyvitamin D in the kidneys. A person sitting outside in a bathing suit in New York City gets more vitamin D in 20 minutes than from drinking 200 glasses of milk. In fact, many experts suggest getting 10 minutes of unprotected sun on the arms and face or arms and legs, three times weekly and before applying sunscreen. But getting vitamin D from the sun isn't that simple. UVB rays vary greatly depending on latitude, cloud cover, time of year and time of day. Above 42 degrees north latitude, the sunís rays do not provide sufficient D from November through February, for example. Remember too, that UVB rays do not penetrate glass or sunscreen with a sun protection factor (SPF) of 8 or more. The elderly, people who spend all or most of their time indoors, and people with darker skin also produce less vitamin D. Talk to your health care provider about unprotected sun exposure; not everyone in the scientific community thinks that even a little sun is a good idea, because of the risk of skin cancer."

    As I noted, it's difficult to obtain adequate levels of vitamin D via sun exposure during winter months in northern latitudes. If you're unable to use the guidelines of exposure of arms or legs during summer months, then the recommendation for you would be to take an oral supplement of vitamin D. There aren't any clear guidelines on how much skin exposure is needed outside of what Becky and I provided, so taking a supplement would ensure you're getting your daily requirement. - 1/25/2012   2:46:39 PM
  • JULIA1154
    8
    It's impossible for most people living north of Atlanta to get sufficient Vit. D. from the sun during the winter months. This means that for most of us supplementation is necessary to a greater or lesser extent.

    I'm an avid gardener but was very surprised to learn that my Vit. D. levels were extremely low despite time spent in the garden. After bringing them up to normal I can definitely tell the difference. - 1/25/2012   2:15:30 PM
  • EMMANYC
    7
    I'm aware of some of the studies and other recommendations that suggest that the best way to get Vitamin D is through exposure to sunlight. I wish this article provided clearer guidance on how to do that. For example, the article notes that you can get what you need from 10-15 minutes of exposure during peak hours in the summer months. But did the author mean daily exposure of 10-15 minutes, or did she mean total weekly exposure of 10-15 minutes (I think it's the latter but it would be nice if the author would confirm this.) Also, it would be helpful to point out that:

    a) How much of your body do you need to expose to direct sunlight to get the benefits? What did the subjects do in the study? Were they exposing just their faces, their arms and faces? Wearing bikinis? Naked? My doctor said it's not enough to expose just your face and neck if you're just going for 10-15 minutes once a week. He said exposing my arms (sleeveless or short sleeved shirt) or legs (shorts or knee length skirt) plus my face/neck would be about right. That's something I can do in the summer by taking a coffee break outside.

    2) But what do you do if a) it's winter; or b) it's not mid-day; or c) you don't want to expose large expanses of skin to the sun? What would be a helpful guide there? if I walk to and from work (30 minutes total per day) during daylight hours but at 8 am and 5 pm and I'm just exposing my face and neck, am I getting enough if I do this 5 days a week?

    3) And realistically, who is going to go sit outside in the middle of the day and then put on sunscreen? I put it on before I leave home, not while sitting on a park bench.

    I look to Spark to convert scientific studies into practical tips. While there are some good tips in this article (e.g., about getting tested etc), the guidance on how to get Vitamin D from sunlight isn't specific enough to be helpful. - 1/25/2012   1:38:26 PM
  • 6
    I don't track it, but I do drink a notable amount of milk (less now than before, but still). I always get the 1% with A&D. I also am out in the sun regularly enough waiting on buses or walking around, so I'm not particularly worried about it. - 1/25/2012   1:02:39 PM
  • 5
    My Dr says that it is harder for the skin to absorb vitamin D from the sun and has be taking supplements. - 1/25/2012   11:39:42 AM
  • AWESOME2012
    4
    I was tested a couple of years ago and my Dr couldn't beleive how low it was. I was already taking 1000mg a day. He ordered a bone density test right away. He said he shouldn't really say it but tanning beds will raise your levels very quickly, although a hot holiday would be ok too! Might be a thought...bring the levels up and then suppliment. - 1/25/2012   11:34:15 AM
  • 3
    I'm in menopause and have Metabolic Syndrome/Insulin Resistance and I've found reading Gary Taubes' "WHY WE GET FAT AND WHAT TO DO ABOUT IT" a total help. - 1/25/2012   11:00:13 AM
  • 2
    I've never been tested, but it is certainly something to bring up at this years checkup!!! - 1/25/2012   10:59:33 AM
  • 1
    I am post menopausal and my levels are low. I have been on 2000 mg ofor over a year, and my doctor said they are still low. I am now doubling that and going back to my doctor in three more weeks to again have it tested. BTW, I have been diaganosed with osteopenia also - 1/25/2012   10:54:54 AM

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