Ronald D. Weiss, MD,

Medical Director, The Doctor is In, 6701 Bergenline Avenue

As the days get longer and the sun’s rays more potent it is time to think about how we can all benefit from a little bit of sunshine.  A number of years ago at The Doctor is In medical center, I began to notice widespread vitamin D deficiencies across all segments of the population.  As a result, Vitamin D testing has become as routine in our practice as checking cholesterols and blood pressures and is always included as part of a general physical.

1) What are the potential consequences of Vitamin D deficiency?

Eventually after many years, a vitamin D deficiency can cause significant health problems. Osteoporosis, or thinning and weakening of the bones as one ages, is now known to be at epidemic proportions in our society. Although there is no consensus among experts as to exactly why this disease is so prevalent, I strongly suspect that long-term vitamin D deficiency is playing the most major role. I draw my conclusions based on the following observations of many hundreds of patients with osteoporosis in our practice at The Doctor is In:

Osteoporosis

• 90% of all our women patients over the age of 60 have abnormally low bone density measurements.

• The vitamin D levels are significantly deficient in almost 100% of all the women who have osteoporosis. In the few women over age 60 whom we identify as having normal bones, not one has had a low vitamin D level.

• Early on in the practice, my colleagues and I noted a significant minority of women whose osteoporosis would inexplicably worsen each year as documented by serial bone density measurements, despite the fact that they were being treated with the standard treatment of calcium and osteoporosis drugs fosamax, actonel, and evista. Finally, we started measuring vitamin D levels in these patients and noted that they were severely deficient. After supplementing with large amounts of vitamin D for one year, repeat bone density measurements uniformly revealed dramatic improvements.

• Although it is not frequently talked about, it should be noted that large numbers of men, as they age, also have osteoporosis.

Multiple Sclerosis

• It is also interesting to note that one of the most enigmatic diseases known to man, multiple sclerosis, could also be linked with vitamin D deficiency. It has been known for many years that multiple sclerosis occurs with a strange geographical distribution across the planet, with low incidence of the disease around the equator, and progressively higher incidence in more northern and southern latitudes. We know that the sun’s rays are most strong at the equator and lessen towards the poles and that sun exposure is the major source of vitamin D for our bodies.

Cancer

• Lastly, there are recent medical studies that indicate that vitamin D may play a role in the prevention of cancer and that low vitamin D levels may be associated with the development of more aggressive tumors.

2) How do I know if I’m vitamin D deficient?

• Vitamin D deficiencies give no acute symptoms and therefore are difficult to detect unless a specific blood test is ordered measuring 25-hydroxy- vitamin D levels. Normal vitamin D levels range from 30-60 ng/ml. In our practice, the average adult patient who works in an office-type setting under artificial lighting usually has levels between 10-20 ng/ml.

3) How do our bodies obtain vitamin D?

• When ultraviolet light from the sun hits our skin a chemical reaction forms vitamin D3 which is the major source of vitamin D for our bodies. There are no significant food sources of naturally occurring vitamin D, other than fish and fish oils. Cow’s milk, soy milk and cereals are often artificially fortified with vitamin D.

4) Can I get enough vitamin D by eating food?

• Apparently not, given the widespread and severe vitamin D deficiencies we are noting in the general population.

5) Why is vitamin D deficiency so prevalent?

• I think there are multiple reasons:  Over the last two generations, our population has begun to work longer hours, indoors, away from ultraviolet light exposure. At the same time, doctors have been telling us to avoid sun exposure at any cost in order to prevent skin cancer, and to slather ourselves with protective sun block when we do go into the sun – this prevents vitamin D manufacture in the skin even when we are in the sun.

6) How much sun exposure would I need to obtain adequate vitamin D levels?

• A person living in the northern latitude of the New York metropolitan area would need to expose as much skin as possible (arms, legs, face), without sun block,  to about twenty minutes of full sunshine every day between 11 am and 3 pm, during the months of May and September, when the sun is strongest. Sun block may be applied after this twenty minute period if the person is to remain in the sun.

• Unfortunately, it is difficult for most working adults to meet this requirement. That is why I recommend supplementation.

7) What kind of vitamin D supplements should I take?

• Vitamin D3, otherwise known as cholecalciferol is preferred. The amount proscribed is based upon the level of deficiency in a given person.

8) Can Vitamin D supplements in high doses be toxic?

• Potentially yes, because D is one of the fat-soluble vitamins processed mainly by the liver. I therefore monitor vitamin D blood levels in most patients who need to supplement with vitamin D.

In our next issue, at the height of the August sun, I will discuss the dangers of sun exposure. In the meantime, for more information, please call The Doctor is In at 201-758-9100.

Ronald Weiss, MD