Wednesday, July 2, 2008

Low Vitamin D Levels Common in Fat Folk

At times, I will be blogging to raise awareness of certain health conditions, ones that may be more common among people of size....and especially ones that people of size may not know to look for.

One such condition is low vitamin D levels. Several recent studies have suggested that at least 50%......HALF!!!....of all "obese" folks may have low vitamin D levels.....levels low enough to significantly affect their health, both now and in the future.

Yeah, that vitamin D. Vitamin D, as is in the stuff you get from exposure to the sun. Vitamin D, as in the stuff that's added to milk or some types of orange juice. Vitamin D, as in the stuff that's important for bone health, but may also be related to high blood pressure, diabetes, heart disease, multiple sclerosis, musculo-skeletal pain, colon cancer, breast cancer, prostate cancer, and early death.

Fat people, people of color, those living at more northern latitudes, those who are insulin-resistant, older folks, and those who follow "fully covered" clothing traditions are at a higher risk for low Vitamin D levels. So are those folks who have fat-absorption or intestinal issues, like cystic fibrosis, Crohn's Disease, or those who have had gastric bypass. But make no mistake......even skinny white folk living in sunny areas may have low Vitamin D levels. It seems to be that common now.

Rickets used to be a serious problem in the past. But because milk is fortified with Vitamin D now, many medical professionals assumed for years that Vitamin D was not an issue anymore. But in this age where we are encouraged to slather on the sunscreen liberally, low Vitamin D levels may be increasing.

What's clear is that low Vitamin D levels seem to be associated with a number of health conditions. What is less clear is whether supplementation with Vitamin D (either through vitamin supplements or through increased sun exposure) is able to treat or prevent these health conditions. Furthermore, too much sun exposure may lead to skin cancer. So it's hard to know exactly what to do about low vitamin D levels.

But the first step is to find out WHAT your vitamin D levels are, especially if you have one or more of the risk factors listed above. It's best to test for this during the wintertime when your sun exposure is at its lowest level (and what you do get is not absorbed very well). If you test in the summertime and are borderline at all, be sure to re-test again in the wintertime.

When you are tested, be sure to ask for your exact results AND the scale that was used to determine "normal." One thing I have noticed in looking at this issue online is that different sources define "low" vitamin D levels differently (and different sources use different units of measurement). Some doctors define "low Vitamin D" levels so conservatively that hardly anyone qualifies; some define it so liberally that lots of people qualify. So get your exact results, see how it compares to the lab's range of "normal," and then find out how their "normal" compares to online measures. Get some perspective on how much room for concern there really might be.

If your Vitamin D levels do turn out to be low, you can increase your intake of Vitamin D-rich foods, like eggs and fatty fish, or Vitamin-D fortified foods like milk or some orange juices. This is probably not the best way to correct a significant deficiency, but when possible, getting nutrients from real foods instead of supplements is usually optimal.

Many healthcare practitioners currently recommend Vitamin D supplements (vitamin D3, cholecalciferol), though how much is needed is hotly debated. Current recommendations are about 200 international units, and most multivitamins typically contain about 400 international units........but many providers believe this to be far too low. About 1000-2000 international units seems to be considered relatively safe, and some healthcare practitioners recommend up to 4000 units for those who are Vitamin D-deficient. Some practitioners recommend even more, while others dispute the safety of larger doses. Research on optimal dosing is urgently needed, and on whether D supplements actually help or hurt health.

Another controversial issue is sun exposure. Many doctors are now recommending that people get about 15 minutes of sun exposure (no sunscreen) every day or two so that the body can synthesize its own Vitamin D from the sun, which is the most efficient source of all. 15 minutes sounds pretty minimal; some healthcare providers recommend more, while others balk even at suggestions of 15 unprotected minutes.

The best course for sun exposure has yet to be determined, but personally, it makes sense to me that if we evolved in an area of high sunlight intensity (Africa), we were made to need regular sunlight exposure. Covering up so much (hats, long sleeves, sunscreen everywhere at ALL times) seems a bit extreme to me. I agree we shouldn't overdo sun.....but it seems to me like the pendulum on sun exposure has swung too severely to one side. How about a happy medium? One that takes into account your geographic area, your skin color, your health status, etc.? Might some limited sun exposure be reasonable and even helpful for some people?

At this point, I don't think that scientists have fully proven their case about low Vitamin D levels. It may be that low D levels is just the latest scientific "fad" explanation for all the ills of the world. We need more research to prove their point. On the other hand, at this point evidence suggests that low D levels are associated with a number of health conditions. Whether low D levels are simply a symptom of something else or are the actual cause of health problems remains to be seen, as does whether supplementation or increased sun exposure decreases/prevents these health risks.

At this point, it's hard to know what is best to do. However, because many "obese" people tend to be insulin-resistant and have particularly low vitamin D levels, it may be most prudent for us to get tested, and to consider either supplements or modestly increased sun exposure if the tests show a Vitamin D deficiency.

Post Script:

It's interesting how vitamin D levels bring out subtle size biases.

When I was diagnosed with severely deficient levels last fall, my provider asked me if I thought the deficit was because I wasn't getting enough sun. Implication: You must be a couch potato and therefore you probably rarely get out in the sun. Even friends asked me if I thought this was the real cause.

Come on, people! Research shows that the decreased levels of Vitamin D in obese people is not due to lower intakes of calcium/vitamin D foods, nor is it due to low sun exposure. So there!!


Sheathen said...

I gotta be fine, I'm rocking my "Irish tan" (otherwise known as a liberal swathe of freckles) from sweating off the sunscreen while on my bike.

Anonymous said...

I would like to know exactly what the level of D deficiency is in non-fat people in the same geographic area. In other words, 50% sounds like a lot but if non-fat people sit at 45% or 48%, or something, then it's not really a big DIFFERENCE. (But still a concern for all, of course.)

Anonymous said...

Maybe I'm just say low vitamin D levels in fat people are NOT due to lack of sun exposure or to low intake of vitamin-D-rich-foods...but we should consider treating it by increasing those things? What? How does that work?

Christaupnorth said...

Implication: You must be a couch potato and therefore you probably rarely get out in the sun.

See, I didn't even THINK of that. I thought perhaps it was because many obese people feel the need to cover up more than thin people because of how they are judged. I know some fat people who refuse to wear shorts, refuse to wear tank tops, even refuse t-shirts.

bellygirl said...

well thanx for this, i learn something everytime i come here:)

what you said at the end about how people assume it's b/c you must be a couch potato, it's the same as when i had to have my gall bladder out. people assumed it was b/c i must be eating too many fried foods. ie. it's a fat persons thing. i thought that was quite funny considering most of the womeni knew who have had theirs taken o/ are thin!

Anonymous said...

I have had a few health concerns including thyroid, feeling weak and a bit depressed. I tested with canaryclub and found that many of my issues were lack of vitamin D - (sitting at the computer all day with little sun time) Suppliments have me back in the gym and feeling much much better. Evidentally it is easy to confuse thyroid and D. Judith