Shady Dealings

Lack of Sunshine Has Many People at Risk of Vitamin D Deficiency
Dr. Ken Aquilino

Dr. Ken Aquilino says ingesting foods rich in vitamin D won’t do much good unless the vitamin is triggered by exposure to the sun — which many kids aren’t getting enough of.

There are many reasons not to like the shorter days that come this time of year, ranging from the psychological to the practical.

Here’s one people might not be thinking much about. Less sunlight (not to mention less time in the sun when it is out) means less vitamin D, which is transferred to people’s bodies directly from the sun’s rays. And that can carry some health risks.

“In the winter, you don’t have much choice,” said Dr. Kenneth Aquilino, an internist at Holyoke Medical Center. “There’s less sunlight during the day, and it’s cold outside, especially in the New England area. So a lot of people are at risk of developing vitamin D deficiency.”

Vitamin D, which maintains normal levels of calcium and phosphorous, aids in the absorption of calcium, which directly affects bone health. Not getting enough, he explained, can cause rickets in children and malfused bones and bone loss in adults.

“With osteomalacia, the bone starts eating itself away, and in older adults there’s osteoporosis,” said Aquilino. “So there are some major problems and diseases associated with vitamin D deficiency.”

For many children, however, lack of adequate sunshine has become a year-round problem because they don’t spend as much time outdoors as young people from previous generations did. Several factors — including parents’ safety concerns about playing outside, the growing popularity of video games and the Internet, and increasing rates of childhood obesity due to sedentary lifestyles — have converged to keep children out of the sun, meaning they’re not getting that natural dose of vitamin D.

Even adults have increasingly drifted away from an outdoorsy lifestyle, and away from the sun — a problem that’s only exacerbated when the weather gets colder.

“In New England, because of our climate, the consensus is that very few people are getting enough sun exposure,” said Paula Serafino-Cross, a registered bariatric dietitian at Baystate Medical Center.

“In the hospital, we see lots of patients with low vitamin D levels, and people who are homebound or nursing home-bound are especially at risk,” she added. “We’re testing everybody now, at all ages, and we’re finding a prevalence of vitamin D deficiency. If we lived closer to the equator, spending more time outdoors, walking to work, it would be different.”

In this issue, BusinessWest looks at the importance of this key nutrient, how to get more into the body, and why sunlight is still the best option.

Pulling the Trigger

The term ‘vitamin D’ actually refers to several different forms of the nutrient. Two are important to people: ergocalciferol (vitamin D2), which is synthesized by plants, and cholecalciferol (vitamin D3), which is synthesized by humans in the skin when exposed to ultraviolet rays from the sun. Foods may be fortified with either vitamin D2 or D3.

The good news is that vitamin D is present in a number of foods and drinks, said Aquilino, among them milk, cereals, yogurt, egg yolks, orange juice, and some seafood, including tuna and salmon — in other words, a wide range of common items.

“The problem,” he continued, “is that we still need exposure to the sun, because that’s what activates the vitamin D and starts the process to convert it to an active form. Even if you eat plenty of vitamin D in your diet, if you don’t have sun exposure, it won’t do much good. Think of the sun as the trigger that starts the whole process. Without that switch, you can’t process the vitamin D.”

The liver and kidneys are both active in this process, he added, and people with problems with those organs are also at higher risk for deficiency. Others at risk include people with malabsorption syndromes (like cystic fibrosis) or inflammatory bowel disease (such as Crohn’s disease).

Vitamin D deficiency can exacerbate such medical issues, said Serafino-Cross, noting that gastric-bypass surgery poses a risk of malabsorption, yet many patients begin the surgery in that condition. “So surgeons are actually treating patients prior to surgery and monitoring their vitamin D levels after surgery,” she said.

In older patients, she added, an adequate intake of vitamin D might stem the incidence of hip and other bone fractures, which often trigger a permanent downward spiral in health.

Yet, even this demographic group isn’t as aware as it should be about the dangers of deficiency, said Serafino-Cross, who lectured recently at Keystone Woods in Springfield and asked a group of 30 residents if they knew their vitamin D levels.

“Only one said, ‘yes, my doctor checked my vitamin D.’ No one else knew if their levels had been checked, or if they were too low — and this carries a heightened risk in this population.”

On the other hand, Aquilio noted, while many benefits of vitamin D are well-established, others are only theoretical. “Nowadays, some studies say that people with vitamin D deficiency are prone to develop certain types of cancer, too,” he said. “Those studies are controversial, however, with little hard evidence to support those claims.”

According to the American Cancer Society, a few small-scale studies have been conducted that examine the effects of vitamin D along with standard treatments for prostate cancer. In one study of men with prostate cancer that had spread, one in four had less bone pain and one in three had stronger muscles after taking 2,000 IU of vitamin D each day for 12 weeks. However, among these 16 patients, nearly half were deficient in vitamin D at the start of the study, which could have affected the results.

Other studies have looked at the effect of vitamin D3 on blood PSA (prostate-specific antigen) levels in prostate-cancer patients, and while early results were promising, the ACS said more studies are needed to determine whether vitamin D can have a significant role in slowing the progression of the disease.

In addition, too much vitamin D can be unsafe for both children and adults; levels above what is recommended can cause nausea, vomiting, poor appetite, constipation, weakness, and weight loss. Over the long term, too much vitamin D can lead to depression, headache, sleepiness, and weakness, as well as calcium and bone loss. It can also cause the arteries and other soft tissues of the body (such as kidneys, heart, and lungs) to become hardened and lined with layers of calcium, a condition known as calcinosis.

Ray of Hope

Serafino-Cross said the medical community has already begun to increase its recommendations for vitamin D intake, and the good news is that the vitamin in supplement form remains very inexpensive, “which is a nice thing, considering the economy right now.”

More good news, for those who don’t exactly worship the sun, is that it takes only about 10 minutes of direct sunlight exposure per day, on average, to prevent the diseases caused by inadequate vitamin D. The fact that deficiency remains a problem speaks volumes about modern lifestyles, especially among children, whose bones are still growing and who especially need plenty of vitamin D.

“We live in the northern latitudes, and anywhere above Georgia, people tend to be at risk for vitamin D deficiency,” said Aquilino, due to colder temperatures during the winter months keeping people indoors. But the issue is also one of lifestyle, he reiterated, given that today’s children, even in the warmer seasons, don’t spend as much time in outdoor play as kids did, say, 20 or 30 years ago.

“Today, they’re more likely to play video games, and they do that indoors,” he said. “For whatever reason, they’re not out playing, and so they are at risk for vitamin D deficiency.”

And forget trying to have it both ways, like moving the computer next to a window. “The thing is, the sun exposure has to be outside,” said Aquilino. “Indoors, essentially getting sun through the glass, is not going to cut it.”

In other words, it’s time to power down, get outside, and power up.

Joseph Bednar can be reached at[email protected]

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