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Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.
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Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.
Katherine Zeratsky and Jennifer Nelson
Jennifer K. Nelson, M.S., R.D., L.D., C.N.S.D.
Jennifer Nelson is your link to a better diet. As specialty editor of the Food & Nutrition Center, she plays a vital role in bringing you healthy recipes and meal planning."Nutrition is one way people have direct control over the quality of their lives," she says. "I hope to translate the science of nutrition into ways that people can select and prepare great-tasting foods that help maintain health and treat disease."
A St. Paul, Minn., native, she is certified by the National Board of Nutrition Support Certification, has been with Mayo Clinic since 1978, and is director of clinical dietetics and an associate professor of nutrition at Mayo Clinic College of Medicine.
She leads clinical nutrition efforts for a staff of more than 50 clinical dietitians and nine dietetic technicians and oversees staffing, strategic and financial planning, and quality improvement. Nelson was co-editor of the James Beard Foundation Award-winning "The New Mayo Clinic Cookbook." She has been a contributing author to and reviewer of many Mayo Clinic books, including "Mayo Clinic Healthy Weight for EveryBody," "The Mayo Clinic Family Health Book" and "The Mayo Clinic/Williams Sonoma Cookbook." She contributes to the strategic direction of the Food & Nutrition Center, which includes creating recipes and menus, reviewing nutrition content of various articles, and answering nutrition questions posed to Ask a Specialist.
Katherine Zeratsky, R.D., L.D.
As a specialty editor for the Food & Nutrition Center, Katherine Zeratsky helps you sort through the facts and figures, the fads and the hype to learn more about nutrition and diet.A Marinette, Wis., native, she is certified in dietetics by the state of Minnesota and the American Dietetic Association. She has been with Mayo Clinic since 1999.
She is active in nutrition-related curriculum and course development in pediatrics at Mayo Clinic Rochester and nutrition education related to the physiology and recommended intakes for premature infants.
Other areas of interest include breast milk and formula safety, neonatal feeding, and nutrition for breast-feeding mothers.
She graduated from the University of Wisconsin-Madison, served a dietetic internship at the University of Iowa Hospitals and Clinics, and worked as a registered dietitian and health risk counselor at ThedaCare of Appleton, Wis., before joining the Mayo Clinic staff.
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Jan. 8, 2009
Shedding light on vitamin D
By Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.
It's winter in the Northern hemisphere and for many that means sunshine is in short supply. As a result, your vitamin D levels may be on the decline. Should you be worried? How much vitamin D do you really need? What's the best way to get it? Several studies published in the December 2008 issue of the American Journal of Clinical Nutrition attempt to shed light on these questions.
One of the studies found that vitamin D levels appear lower among Americans today than 15 to 20 years ago. Researchers attributed the decline to the following factors: increasing weight, declining milk consumption, and increasing use of sun protection.
On a brighter note, another study demonstrated that fortifying foods, such as milk, with vitamin D does improve vitamin D status in adults.
A third study looked at vitamin D levels in the winter months. The study showed that people who get less sun in the summer need slightly higher vitamin D supplementation in the winter to maintain recommended levels. Interestingly, the top dose in the study was 600 international units, which is higher than the 400 international units of vitamin D generally found in multivitamins.
So what does this all mean? The data we have seems to tell us that:
- Although 10-15 minutes of daily sun in non-peak hours can provide adequate vitamin D, people who use sun protection (which should be most of us) need to look for other sources of vitamin D.
- Fatty fish, egg yolks, and fortified foods are good dietary sources of vitamin D. And toxicity from fortified foods is rare.
- Vitamin D supplements at currently recommended doses can increase vitamin D levels in the body.
Some questions still remain. What happens if you take more vitamin D than the current recommendation? Is there an upper limit beyond which you are harmed rather than helped?
What are your thoughts? For those of you who don't take a multivitamin or vitamin D supplement, will these studies change your mind? For those of you who take a supplement, how much are you taking? What changes have you noticed as a result?
To your health,
Katherine
44 comments posted
November 5, 2009 9:59 a.m.
I'm age 71. I've had moderately high blood pressure, depression, and significant arthritis pain for about 10 years, and I take blood pressure meds, an antidepressant, and an NSAID. My doctor ordered a vitamin D blood test. He says that on a scale of 33-100, mine is at 8! I don't get out in the sun very much because walking is/was diffiuclt with the arthritis. I don't eat dairy products anymore because it make arthritis flare up. I don't drink fortified orange juice because it seems to acidic now. Doctor gave me samples of therapeutic vitamin D from a high-quality manufacturer (10,000 IU per capsule). I'm to take one capsule per day for 7 days, then one capsule per week thereafter. I will be retested in about 6 months. Amazing! After a week, my mood has lifted! The blood pressure went down to 100/63, so I am to stop taking the BP meds for a couple of days and check the BP to see if indeed it is back to normal, and the arthritis pain is now manageable. Earlier this year my bone scan showed that I have osteopenia, so I am on Fosamax, which I will continue unless directed otherwise. My doctor, an M.D., is well educated on this; shared info from some respected journals (I didn't ask for citations). It is amazing that such a small thing can have such bad symptoms -- and that it easily "fixable." Even people without medical resources can get more sunshine and/or eat more Vitamin D foods. What a nice way to alleviate some of our personal "health care crises.&q
- Paula
October 28, 2009 1:24 p.m.
Check out these sources of information: www.grassrootshealth.org Look in the Documenttation section for the: 1. Definitive statement and "Call to action" from 16 eminent scientists 2. Disease Incidence Prevention Chart www.ucsd.tv Search for "Vitamins" Start with presentations by Carole Baggerly & Frank Garland www.direct-ms.org Go to Information / Presentations Watch the presentation "Prospects for Vitamin D Nutrition". The speaker is Professor Reinhold Vieth who states that 50,000 IU of Vitamin D3 in a single dose is not a problem and 10,000 per day is OK. After that ask your doctor to test your blood for "25 hydroxy-vitamin D" Then make your own decisions about how much Vitamin D to take, as your doctor may nut be as well educated about it as you are.
- Rufus
October 27, 2009 12:15 p.m.
I find it most disturbing that current medical and lay literature sources are bursting at the seams with convincing evidence of the far-reaching benefits of the hormone we call vitamin D, and yet the FNB and the NIH have not updated their recommendations for daily vitamin D supplements since the one they published in 1997. That recommendation was for 200, 400, or 600 i.u. daily, depending on one's age. In fact, the NIH held a conference of experts in August this past summer, but won't share the decisions made at that meeting until next spring. In the meanwhile, an uninformed public will likely pay the consequences of their "thumb-twiddling". After a good bit of study on this topic during the past 2 years, it's my opinion that an adult should receive a MINIMUM of 2000 i.u. vitamin D daily, and 4000 to 5000 i.u. is probably closer to their real need for optimal health outcomes.
- Russ
October 20, 2009 4:45 p.m.
After 8 weeks of the prescription dose of 50000 ius/week & 6 weeks of 1000 ius daily, my D levels are still only 16. & I have always eaten alot of dairy & a fair amount of fish & am in the sun daily for my work. Makes no sense. If it's an absorption problem why isn't there a patch or sublingual tablets? I don't absorb B12 either so I take a sublingual tab for that. We need help!
- cb, socal
October 9, 2009 12:05 p.m.
My D level was tested at 17. After 12 weeks of 50,000 units, once a week, it only went up to 24. My sister was on the same dose/time and her level tripled. Any thoughts on why my body's response was so minimal?
- Wendy
October 6, 2009 3:31 p.m.
It doesn't matter how much vitamin D-3 you take. The key is never let your level fall below 40, should be 50-80. I found out how important this was AFTER I had breast cancer, I tested at 19. So do what you have to to maintain this level it is so very important to know your number, keep track and don't listen to anyone who tells you that 40 or less is okay. The older you get the less your skin will allow the sun to absorb. Also gelcaps only.
- Betty
September 17, 2009 12:16 a.m.
I ran into a woman friend the other day who said she is on 3,000 IU daily of Vit. D. Here's the thing: she looked tan! She has beautiful skin, but was always very pale. Now she looks "sun-kissed" - seriously, she looked just radiant! Said she hadn't been this tan since she was a child. Can Vit. D make you look tan?
- Marianne
September 13, 2009 9:35 a.m.
I just was listening to talk radio, to a doctor promoting his vitamin D + omega 3 supplement together and he said we adults need the two together. he added that we should take 5,000 I.U. daily of Vit. D, which I thought was a toxic level, even for living in a midwestern state. He also said our blood tests should be taken and we should be at around 50-60 (20-100 is the normal range), not in the 30 range. I am a Medical Assistant and work for a very busy and well esteemed practice in the community and the doctors in general do not want their patients to go beyond 2-3,000 I.U. daily. What do you believe to be accurate?
- Wendy
August 2, 2009 10:45 a.m.
Ihad my Vitamin D level checked and it 6, the lowest my Dr. had seen. I felt fatigued all the time, muscle aches, muscle weakness, even too tired to walk up a flight of stairs. would sleep for 8 hours and want to take a nap after being awake for 2 hours. I was put on 50, 000IU for two weeks. After two days I felt so much better. Actually got through a day without a nap. More energy and now muscle achiness. After two weeks put on 2,000IU a day and syptoms started coming back after three days. Having bloodwork this week and a Dr. visit the following week. Hope they increase my Vitamin D dose.
- Megan
July 15, 2009 1:20 a.m.
To throw an extra ball into the game re vitamin D, I am an equine scientist from Australia. Where tropical grasses grow profusely, oxalic acid in the grass "binds" the 'free' calcium in the blood stream. This leads to an urgent call on the calcium in the bones and cartilage, and subsequently can lead to death. Equine veterinarians in Australia refer to this condition as 'hyperparathyroidism', which is totally the opposite of the clinic's terminology, which I believe to be right. We treat horses suffering from skeletal calcium depletion with large doses of D3 (colecalciferol), with excellent results. Re absorbing vitamin D from the sun...there is ample documentation that various races of people are more able than others to do so. There may be a correlation between vitamin D and ability to respond to viral infection.
- John
June 24, 2009 6:19 a.m.
Vitamin D levels is still a question in my mind. Have they increased the levels when testing? I came up low- 19- on the vitamin so was told by one doctor to take 5000 IU a day... for 2 months then go to 2500 a day. This was an integrative medicine doctor. When returning to my regular doctor and told her what I was taking she said to stop taking that amount as it was toxic to the liver. Now I take 1200IU a day. Plus I am drinking more milk and eating yogurt. I will be retested in a month to see where my levels are. Do I notice any difference in my health...no. I take Vitamin D3 in a capsule, powered form. I had always taken extra Viamin D and cod liver oil so was surprised to find my levels were low. I do live in a state which has low sunlight in the winter months and use a sunscreen. Have never been a sun worshiper. J in Oregon
- josephanne
June 22, 2009 5:37 p.m.
My gynocologist had me on fosomax for osteopenia, which had not helped....so she ordered blood work to check for a deficiency of vit. D.......found that I needed it and also had an abnormal protein. That led to a diagnosis of smoldering myeloma. Now I'm REALLY interested in calcium absorption and vit D as a help for cancer......my confusion is about whether we need D2 or D3
- B in Texas
June 18, 2009 4:01 a.m.
My doctor discovered my D deficiency a few years ago. My level didn't even register and she said if I were a child I would be in the hospital on IVs and diagnosed with ricketts! Have many food allergies, etc. and have been struggling with D supplements. Prescription green gel caps not doable. Currently having it compounded into olive oil syringe for oral. Still gives me stomach pain, headache and gastric problems and limits any leaving the house for 3-4 days! DEXA Scan worse than previous-suggested I try RECLAST. After checking it out I will pass on it and also Fosamax,etc. Am going to try accupuncture to help with the constant pain. She also suggested the sunlight and have a box I am going to try. She does express concern @ skin cancer, but I'm going to give it a try. Don't know why vitamin D is so difficult on digestive system. Wish SOMEONE would figure out how to get this into a patch!
- D in Montana
May 30, 2009 3:16 p.m.
Here's a true story that just happened here on my block. A buddy of mine, his x-wife just had a severe episode of, basically, paranoid dementia. It was scary so I won't describe it for you! When they finally got her reeled in to a psych doctor he did some blood tests, whaddya know, off scale low on vit D, no other problems detected by the blood test. They put her on Vit D, now she seems ok and this is only a few days later. I asked her yesterday what level she tested at and she didn't remember the number, but I will try to find out. She and I both feel that it is very strange that the medical community has been so slow to recognize that low vitamin D is a widespread serious problem, and that the traditional dosages recommended (RDA) are so far off. People must have been having these problems for a long time, but the doctors seem to have only just gotten the message in the last few months. By the way I like my doctor and I think he is doing a great job. Blame it on the insurance companies?
- G in Seattle
May 30, 2009 2:55 p.m.
Update to my previous 2 posts: I have been taking 1000 IU per day in the morning, every day since my April 29 post. That amount is no problem for me and I have not tried to ramp up my dosage yet. I am getting very noticeable benefits from it. My energy is better . My evening depressions are, well, usually I don't have any now, only if I am extremely tired and behind on sleep. Other things have improved that I would not have guessed. For instance now I can take the amount of thyroxin (thyroid hormone) that my doctor wants me to take. Before vit D, I was sensitive to thyroxin pills and could only take them in tiny amounts, so I was getting nowhere with my low thyroid problem. So now I am getting somewhere with that and my TSH is actually down to 4.5 now. I am also able to take my other vitamins and pills much more easily now, before they would either bother my stomach or would cause brain fog. Pretty soon I am going to try taking COQ10 again, which I haven't been able to take for years because it started to cause brain fog. These interelated effects are very strange. I am very happy that Vitamin D seems to be having such wide ranging benefits. I do still have a big problem getting up early in the morning and I still seem to need about 8.5 hours of sleep per day. But, major progress overall.
- G in Seattle
May 27, 2009 10:51 a.m.
Has anyone with confirmed low D had muscle fatigue or weakness, breathlessness/exercise intolerance? I have seen many doctors for these primary symptoms (there are others, but main issue is the lack of energy - 2 months ago I could jog, ride a bike, etc. and now I get tired walking up the stairs in my house, or just working at my desk.) Tons of blood work, and the only thing that has come back abnormal is the D - at 20. Doc put me on 5,000 IU, but I felt dizzy for a couple of days, so I've cut back to 1,000 - 2,000 per day. So far, I feel better. I understand the normal/ideal range to be 50 - 80, and I see in previous posts that people have far less. For those that do, how do you FEEL?
- LMH
May 7, 2009 10:37 p.m.
My Doctor wants me to take 5,000 IUs a day of vitamin D for three months. My count of D is 16. I think from what I have read 5,000 a day is way too much. What do you think?
- Carolyn
April 29, 2009 10:13 p.m.
Update to my April 20 post: The wired feeling did get too intense and caused one sleepless night. Normally I have no trouble sleeping - can't get enough! So I took a few days off of Vit D capsules, then went on 1000 IU every other day (500/day average). Wired feeling disappeared in only a day. Then doc office called with results of my blood test. I'm at 17ng/mL. Normal range is 130 to 150! So I'm way below even the lowest number. So now I know I have to solve that wired effect and get back on vit D. Doctor says take 50,000 IU per week for 12 weeks! Ok. I know one other supplement I take contributes to wired hyper feeling. That is Mitochondrial Energy Optimizer by LEF. So I quit the MEO in order to ramp vit D back up, hopefully. Should be easy, but remember, stress disorder = throw "normal" out the window. Right now, 3 days in a row at 1000 IU per day and no wired feeling. Will go 2 more days at this level, then start ramping up the daily dosage if wired feeling does not intrude.
- G in Seattle
April 20, 2009 11:47 p.m.
I have had PTSD for 6 years and now have rising blood pressure. Recently my doctor suggested I should try taking about 1000 IU of vit D per day to combat the depression and fatigue that come with the stress disorder, and possibly help lose weight and lower BP. Amazingly, on the 2nd day and every day since, my frequent evening depressions have been replaced with a wired energy feeling almost like too much coffee. So far it has not interfered with sleep though, and it hasn't caused brain fog which has been a common problem with other supplements. My energy during the day is slightly better than before. So we'll see how it goes. I've tried a lot of things and often the initial results don't hold up. Hopefully the wired feeling will go away once my body adjusts to it? Probably will take days off here and there. I picked a brand that comes in small hypromellose capsules, they don't bother my stomach. Your mileage may vary, I'll tell you this, when you have a stress disorder EVERYTHING is different.
- G in Seattle
April 1, 2009 12:37 p.m.
Are there any guidelines for vitamin D testing?
- John
February 24, 2009 8:31 p.m.
I recently had a blood test and my vitamin D was 10. I remember as a teenager I was vitamin D deficient and the doctor told me to take tablets every week for 9 weeks and I never did. Now I am affraid I have been low on vitamin D for years and may suffer long term side effects. I also have elevated prolactin from a pituitary microadenoma which I think makes bone mass worse. Does anyone have any advice? I am now taking vitamin D 3x a week for 9 weeks then getting blood test after 4 weeks. www.fit4lyfe.webs.com
- marisa
February 7, 2009 12:25 p.m.
Recently I had a full blood work up and it showed my Vitamin D to be at 37.2 and the amount should be no greater than 32. What does this mean? should I stop consuming calcium D and just start taking straight calcium.
- Constance Lamb
January 19, 2009 8:42 p.m.
I see people advertising multi-purpose sunlight/tanning/UVA&UVB lighting systems which are supposed to boost Vitamin D levels and more. Any credibility to these systems?
- Theo
January 17, 2009 7:58 p.m.
My daughter (44)is low on Vit. D. She lives in Minnesota and works inside a large building with few windows. She is of the opinion that by sunning herself for hours in the summer she can store up enough Vit D to get her through the winter. Any comments?
- Lenny Qua
January 17, 2009 10:05 a.m.
My oral/maxillofacial surgeon recommended 4,000 IU of vitamin D3 per day, along with 1,500 mg. calcium, because I have had six failed dental implants. The failure was due to the jawbone not bonding with the implants. After four months on this regimen, I now have one new implant. Time will tell whether or not this treatment has made a difference. I live in sunny Arizona and have been meticulous about wearing sunblock. At the very least, this regimen has made me feel much better psychologically.
- Christine
44 comments posted