Vitamin D deficiency divides the medical community

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With summer just around the corner, sunscreen is becoming a controversy instead of a must.

All of us produce plentiful supplies of vitamin D, also known as the “sunshine vitamin,” when our bodies are exposed to direct sunlight.But sunscreen, windows and other shields from the sun may prevent vitamin D absorption and lead to deficiencies that even a good diet can't overcome. But, although direct sun exposure is the best way to increase vitamin D levels, a longstanding debate continues in the medical community about the benefits versus the dangers of sun exposure.Dermatologists, physicians and dietitians disagree about using sunscreen for people with a vitamin D deficiency. Brittany Farb/MEDILL.Dermatologists, physicians and dietitians disagree about using sunscreen for people with a vitamin D deficiency. Brittany Farb/MEDILL.

Chicago-based dietitian Erin McCarthy recommends a wide range of therapies for vitamin D deficient patients.

“It depends on the level of the deficiency,” she said. “If it’s not as severe, I suggest dietary changes and increased sun exposure. If it’s severe, supplements in addition to diet and sun are needed.”

Vitamin D exists in two forms: vitamin D2 and D3. Vitamin D2 is synthesized by plants and available in a vegetable-rich diet. Vitamin D3 is created with exposere to ultraviolet rays. Both forms are vital to human health and protect against osteoporosis, hypertension, several cancers and autoimmune diseases.

McCarthy stressed the importance of monitoring vitamin D levels through routine blood tests. A long list of health problems result from vitamin D deficiencies including rickets, skeletal deformities, osteomalacia, weak bones, and urinary incontinence.

Normal levels of vitamin D fall between 30 to 100 nanograms/milliliter of blood. A simple blood test can confirm the level and low levels cause fatigue as well as increased risk of more serious ailments.

“Most physicians do take vitamin D levels when you go to doctor,” she said. “It’s important to test before things come about.”

Wisconsin resident Nicole Winkelmann, 27, was diagnosed with a vitamin D deficiency after a blood test at her physician’s office in January. Her doctor recommended a supplement and instructed her to revise her diet, increase her sun exposure and regularly spend time in tanning beds with vitamin D face tanners.

“After about the third week, I could notice a huge difference in how I felt physically and mentally and the amount of energy I had,” she said. “It’s just been getting better as the weeks go by.”

Winkelmann said she has made a conscious effort to revamp her daily lifestyle.

“I have changed my diet,” she said. “I wasn’t really drinking milk at all so I have greatly increased that, increased yogurt and increased a lot of fresh vegetables and fresh fruits.  I haven’t done the tanning beds because it has actually been getting sunny here again so I make sure I’m out at least 15 minutes in the sun each day.”

Barbara Goodkin, 59, of St. Louis, was diagnosed with a vitamin D deficiency in her early 50s. Unlike Winkelmann, Goodkin's physician recommended only a supplement that solved her problem with changes in diet. She avoids the sun, she said.

“My doctor’s opinion was that a change in diet and sun would not be enough,” she said. “I also have had skin cancer so I totally steer clear of the sun now.”

McCarthy said vitamin D deficiencies show up “all across race groups” but according to the Mayo Clinic, high-risk groups include “the elderly, obese individuals, exclusively breastfed infants, and those who have limited sun exposure. Also, individuals who have fat malabsorption syndromes or inflammatory bowel disease are at risk.”

McCarthy said it is recommended to get sun exposure without sunscreen five to 10 minutes a day.

“If you don’t have sunlight, you won’t get adequate exposure,” she said. “The recommendations state that sunscreen use reduces vitamin D3 synthesis.”

Dr. Marisa Pongprutthipan, a dermatologist at Northwestern University, disagrees and said increased sun exposure without sunscreen should never be prescribed regardless of vitamin D levels.

“Sunscreen will not block 100 percent of the UVB,” Pongprutthipan said. “Some UVB rays will penetrate the sunscreen. The worst thing for dermatologists is skin cancer, so we first try to protect them from skin cancer. We don’t want to recommend them to go out in the sun or to tanning beds.”

The position of  the American Academy of Dermatology on vitamin D is “an adequate amount of vitamin D should be obtained from a healthy diet.”

Instead, Pongprutthipan advises patients to incorporate vitamin D rich foods into their diets such as milk, fish, eggs, cheese and fortified cereal and take supplements if needed.

Despite the debate, Winkelmann advises those with a deficiency to seek a doctor’s advice and she credits her physician for her rejuvenation and recovery from a deficiency.

“Do everything your doctor suggests,” she said. “The increase in vitamin D intake and sun exposure has made a huge difference in my life.”

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