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Vitamin D- l emma: Risk Factors and Strategies for Combating Vitamin D D eficiency

Vitamin D- l emma: Risk Factors and Strategies for Combating Vitamin D D eficiency. YaQutullah Ibraheem Muhammad MS, RDN, LD. TRUE OR FALSE Populations at risk for Vitamin D deficiency do not include geriatric patients, women and children. FALSE.

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Vitamin D- l emma: Risk Factors and Strategies for Combating Vitamin D D eficiency

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  1. Vitamin D-lemma:Risk Factors and Strategies for Combating Vitamin D Deficiency YaQutullah Ibraheem Muhammad MS, RDN, LD

  2. TRUE OR FALSE Populations at risk for Vitamin D deficiency do not include geriatric patients, women and children.

  3. FALSE

  4. Name three risk factors for Vitamin D deficiency: • A. Skin Pigmentation • B. Family history • C. Diet • D. Conservative attire

  5. What are three behavioral /lifestyle strategies that can be used to • improve vitamin D levels? • A. Increasing sun exposure 15-20 minutes daily • B. Including Vitamin D fortified foods with meals and snacks • C. Supplementation • D. Only A and B • E. All of the above

  6. Objectives • Identify different populations at risk • Address strategies for combating vitamin D deficiency • Review meal planning

  7. The Sunshine Vitamin Overview • Naturally synthesized vitamin with daily exposure to sunlight. • Fat Soluble • Two forms of Vitamin D • D2 is the supplemental form • D3 is naturally occurring, found in foods and synthesized in the skin with sunlight exposure. • Absorbed in the small intestine

  8. Vitamin D Deficiency in Specific Populations • Women • Multiple pregnancies • Breastfeeding with little sun exposure sun • Community-dwelling geriatric patients • With age, the skin doesn’t synthesize vitamin D as efficiently • An increased risk for fractures • Children • Infants with prolonged breastfeeding without supplementation (AAP) (1) • Children with inadequate intake of fortified foods (rickets) • Children on anticonvulsant therapy for epilepsy (2)

  9. Vitamin D Deficiency in Specific Populations • Vitamin D deficiency and Pigmentation • With increased melanin pigmentation, the skin's ability to synthesize vitamin D from sunlight is limited. • African ancestry, Latino, South Asian, Aborigines and others • Lowered serum 25(OH)D levels with increased melanin • It’s unclear whether lower levels of 25(OH)D in persons with darker skin have significant health consequences. • (Lower rates of osteoporosis and bone fractures when compared to counterparts) • Strategies: • 15-30 minutes of midday sun exposure (without sunblock) • Take measures to prevent sun damage to skin, and avoid sun burns. • Spring, Summer & Fall • Vitamin D from Fortified foods and supplements as needed.

  10. Vitamin D Deficiency and Cultural Sensitivity • Conservative attire • Religious Mandates: Orthodox Muslims, Jews, Christians • In Northern Latitudes where sun exposure is limited and one must wear clothing to protect against the cold for large parts of the year. • Observing conservative attire that may limit sun exposure (face, hands, arms, legs). • Strategies: • Consider light/colored fabric to allow the sun to permeate the cloth and allow your skin to absorb some of the sun’s rays. • Private area to access to sunlight (patio, solarium area) • Vitamin D supplements/fortified foods.

  11. Vitamin D Deficiency in Specific Populations Gastric Bypass Patients Certain Medical Conditions Some liver diseases, Cystic Fibrosis, celiac disease, and Crohn's disease can result in fat malabsorption (Vitamin D is fat soluble) Intolerance of fortified dairy products Strategy: Exploring alternative sources of vitamin D • BMI ≥30 is associated with lower serum 25(OH)D levels compared with non-obese individuals(3). • Developed deficiency with decreased absorption • Part of the upper small intestine is bypassed where Vitamin D is absorbed (4,5). • Strategy: An additional 800 IU to 2000 IU daily to maintain adequate serum levels along with long-term post surgical screening (6).

  12. Vegans, Vegetarians and Vitamin D • Fortified vegan products contain D2 (ergocalciferol). • Yeast, mushrooms exposed to ultraviolet light (1-2 seconds of a pulsed UV light) • Usually obtained from fortified foods and vitamin supplements made from yeast or other fungi. • Sunlight

  13. Vitamin D in Meal Planning • Fortified foods provide most of the vitamin D in the American diet. • Soy, rice and nut milks, yogurt • Mushrooms exposed to pulsed ultraviolet light • 384-634 IUs per cup

  14. Meal Planning Ideas Breakfast: Two soft scrambled eggs, 1 Tbsp fortified margarine, 8 oz glass orange juice fortified with calcium and vitamin D 248 IUs • Recommended Dietary Allowances (RDAs) for Vitamin D is 600 IU or about 15 mcg for ages 1-70 yrs (3). TOTAL: 1480 IUs • USDA Nutrient Database Vitamin D Food Values Snack: 8 oz reduced-fat milk, 1 slice fortified American cheese 175 IUs Lunch: 4 oz canned tuna salad in oil, 8 oz fortified chocolate or vanilla soy milk 354 IUs Dinner: 3 oz Sockeye salmon, mixed green salad with 1 cup grilled Portabella mushrooms 747 IUs

  15. Halal/Kosher/Vegan Supplementation • The majority of the commercial multivitamins supplements contain pork-based or other non-Halal/Kosher/Vegan ingredients. • For ex. Gelatin capsules • Questionable ingredients • A tablet or liquid supplement option • Calcium Citrate With Vitamin D • Look for Kosher/Halal/Vegan friendly options on the market and be sure to check for the certification seal. • NSF Certified Dietary Supplements • USP Verified Mark

  16. The Take Away… • Vitamin D has a protective effect against chronic conditions, including heart disease, diabetes, and some cancers. • As health professionals, we want to review Vitamin D labs in at risk patient/client populations. • Encourage adequate Vitamin D consumption, supplementation and sunlight exposure as necessary for optimal health. • Don’t over supplement as toxicity can result.

  17. References • Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122:1142-1152. • J. Child Neurol. 2006 Mar;21(3):205-9 • Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010. • Malone M. Recommended nutritional supplements for bariatric surgery patients. Ann Pharmacother 2008;42:1851-8. • CompherCW, Badellino KO, Boullata JI. Vitamin D and the bariatric surgical patient: a review. ObesSurg 2008;18:220-4. • Flores L, Osaba MJ, Andreu A, et al. Calcium and Vitamin D Supplementation after Gastric Bypass should be Individualized to Improve or Avoid Hyperparathyroidism. ObesSurg. 2010 Jun;20(6):738-43.

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  19. Questions?

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