Tuesday, February 16, 2010
Is more vitamin D good for your diet?
Dr. Michael Camardi
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About Dr. Michael Camardi
Dr. Michael Camardi is a geriatrician at Carilion's Center for Healthy Aging. Age Matters is his new Roanoke Times column, appearing the third Tuesday of every month.
Camardi has been with Carilion for about three years and was one of the experts who reporter Beth Macy spoke to for her series, “Age of Uncertainty.” He wanted to start this column to help answer questions he’s often heard as part of his job.
Camardi was founder and past medical director of the geriatric liaison program for Jacobi Medical Center (Albert Einstein College of Medicine) in Bronx, N .Y.
Camardi trained at Winthrop University Hospital (Stony Brook University Medical School), where he was chief medical resident. He has received numerous commendations for his contributions to education, patient advocacy, community relations and hospital administration.
If you have questions for Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014, or e-mail them to extra@roanoke.com with “Age Matters” in the subject line.
Dear Dr. Camardi,
I've had the same doctor for 20 years and the only time we ever talked about vitamins was when he'd ask me if I took any.
Well, I go to see him last week for my yearly and he must have gone on for 20 minutes on how important this vitamin D thing is. I don't get it. Why now after never caring about it before?
I take vitamins, but he made it sound as if I've been walking around without enough of this stuff forever. I know it's a vitamin, but what does it do? Am I OK if I just take a pill?
I'm really confused. Is this something new?
-- Roanoke
I never thought in the modern practice of medicine that in America, the vitamin epicenter of the world, that we would be facing a vitamin deficiency. And not just in select patient populations but as a widespread health issue affecting up to, by some estimates, 40 percent of the population.
Studies have shown that we have to manage the need for increased doses of vitamin D in our daily routines. The need is especially important for the geriatric patient, who more than likely has suffered through the deficiency of this key vitamin for decades, never realizing the implications.
Current work suggests that inadequate amounts of vitamin D (the additional need for calcium will be discussed in another article) may be linked to many diseases including breast cancer, prostate cancer, bowel cancer, anxiety, depression and cardiovascular disease.
Our need for vitamin D has always been based upon the observation that it helps the normal growth and development of bones.
The key role vitamin D plays in our lives is that the body produces it just upon exposure to sunlight. Therein lies a problem: Most of us -- either in our busy lifestyles of morning-to-night office work or choosing not to increase our risk for skin cancer -- do not receive sufficient vitamin D from sunlight. We could get it with only 30 minutes of exposure two to three times per week.
Given the above, how do we know if we have a deficiency?
A simple blood test called 25-hydroxyvitamin D (just ask for a 25-OHD test) will do the trick. There is general agreement from the National Institutes of Health that we would like the level to be above 30ng/ml ("ng" stands for nanograms, which really means a very small amount is all we need) with levels above 200 ng/ml as being excessive.
How do we get to this level? Well, just about all the milk we consume is fortified with vitamin D, which extends to cheese and yogurt as well as orange juice, mushrooms, tuna, sardines, egg yolk, calf's liver, mackerel and salmon.
However, the vast majority of us would much rather simplify our shopping habits and take a simple vitamin pill. As we look to pick an appropriate general vitamin for our needs, the current thinking is that people 50 to 70 years of age should be taking 400 IU (IU stands for international unit) per day of vitamin D and that people 70 and older should be taking 600 IU per day.
Now I am willing to bet that this may be subject to change, and I am eagerly awaiting the report of the NIH's Food and Nutrition Board in May, of which I will report upon in this space.
When you read the vitamin label, you may see the vitamin listed as vitamin D2 (the type found in foods) or D3 (the type formed by sun exposure).
Studies from 2007-09 suggest that D2 is as effective as D3, however not all investigators agree on this. Most line up on the D3 side of the argument.
As always, whenever there is any change in what you do or what you ingest, please talk it over with your health care provider as it may interact with other medications.
The key here is to begin the dialogue with your provider. You should ask for the blood test to gauge your need for this key aspect of your overall health.
If you have questions for Dr. Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014 or e-mail them to extra@roanoke.com with "Age Matters" in the subject line.
Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging. His column runs monthly in Extra.
