Since the end of December 2014, I set myself a project of writing a journal article on the value of Vitamin D. I knew it was important for many areas of health but I wanted to understand more of the “why” and decided I would write the article with a focus towards nursing education. I graduated from my Bachelor of Science (Nursing) in 1988 and then Post Graduate Certificate in Preventive Medicine in 2007, and in neither of those courses do I remember receiving much focus on the biochemical importance of vitamins and minerals. We studied biochemistry but not with an emphasis on deficiencies or excesses of vitamins and minerals. So, I knew it was well past time that I did some research. I thought the article may take about a month to complete and now it is mid March and although it is well on the way to completion – there is more to do to make it a readable and useful document.
Probably the biggest lesson I have learned to date through writing the article is how we have been taught a simplified way of thinking of our physical health. Even back in the mid to late 80’s we were being taught to practice holistic nursing – look at the patient as a whole – but this always seemed to me (back then) to be more about the patient’s relationships, environment and just a little bit about their diet. Let me use Vitamin D as an example of how complex things can get!!
To make active vitamin D we must either have unprotected exposure to direct sunlight – optimally in the middle of the day – and/or ingest foods containing the inactive form [7-DHC]. This inactive form of vitamin D from sunlight and food is then transported to the liver for conversion to another inactive form [25(OH)D3] and then is transported to the kidneys for the final conversion to active Vitamin D [1,25(OH)2D3]. But here comes the if, buts and provisos!
If you have insufficient magnesium then each stage of the conversion process cannot occur (at the skin, liver and kidneys).
If you have insufficient zinc then the vitamin D receptors will not be able to carry the vitamin D through the conversion process and at the cellular level.
If you have insufficient vitamin K2 then your vitamin D cannot perform the function of calcium being transported to the target sites (eg bones).
If you have insufficient vitamin A then vitamin D cannot read the DNA code
And, if you have insufficient Boron then vitamin D cannot effectively play it’s role in mineral metabolism, hormone synthesis and brain function.
So yes, vitamin D is really important – but it just isn’t as simple as supplementing your diet with vitamin D because the other co-factors have to be in adequate supply for the whole process to work! Not one is more important than the other.
So let us extend our minds to taking this one step further to add to the complexity! Each of those co-factors also has a set of co-factors!!
If you look at zinc as an example, it can be blocked from absorption by copper, cadmium, mercury, aluminium and antimony. If you don’t have adequate stomach acidity then you cannot absorb zinc and if you don’t absorb zinc then you can’t make stomach acid! If your diet is high in sugars (including starch carbohydrates) or you are taking medication that raises your stomach acid pH (making your stomach less acidic) then you cannot make or absorb zinc and this means you cannot absorb vitamin D. (That’s just one nasty story about inadequate stomach acid and would equate to more than one article).
To be told you only have to eat a healthy diet is not helpful. You really need to know that you are eating what you need to be and that you are getting the nutrient value out of your meals. Know that Western Australian soils are extremely depleted in necessary minerals for our health and so the only way to ensure you are ingesting what you need is through supplementing. But as I have pointed out already – this is not as simple as taking a supplement but needs a well qualified naturopath/nutritionist that understands the biochemical implications of a vitamin and mineral excess or deficiency to guide you to avoid a biological problem in the form of disease. Also – only use quality supplements. Do not buy your supplements from the supermarket – supplements in some forms can actually be harmful and these are usually the cheaper brands. The best place to purchase supplements other than a naturopath/nutritionist is at a health food shop or a pharmacy that has a resident naturopath/nutritionist. Not all supplements are created equal so get your advice from the professional that has actually studied or been taught the information you are needing.
The bibliography that follows is from my journal article. I will post the article on this site once it is completed.
Australian Government. (2015). Ultraviolet (UV) Index Forecast. Retrieved from Bureau of Meteorology: www.bom.gov.au/wa/uv/index.shtml
Balch, P. (2010). Prescription for Nutritional Healing. New York: Penguin.
Binkley, N., Novotny, R., Krueger, D., Kawahara, T., Daida, Y., Lensmeyer, G., . . . Drezner, M. (2009). Low vitamin D status despite abundant sun exposure. The Journal of Clinical Endocrinology & Metabolism 92(6), 2130-2135.
Bowker, N. (2010). Understanding Vitamin D. Retrieved from You Tube: www.youtube.com/watch?v=onSPZ0aBUKM
Chen, T., Chimeh, F., Lu, Z., Mathieu, J., Person, K., Zhang, A., . . . Holick, M. (2006). Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Archives of Biochemistry and Biophysics, Vol 460, Issue 2, , 213-217.
Epilepsy Action Australia. (2011, Jan). Seizure Smart. Retrieved from Epilepsy Action Australia: http://www.epilepsy.org.au
Grober, U., & Kisters, K. (2012, April/May/June). Influence of drugs on vitamin D and calcium metabolism. Retrieved from Dermato-Endocrinology Vol4 Issue 2: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427195/pdf/de-4-158.pdf
Helmer AC, & Jensen, C. (1937). Vitamin D precursors removed from the skin by washing. Studies Inst Divi Thomae, 207-216.
Holick, M. (2004). Vitamin D: importance in the prevention of cancers. American Journal of Clinical Nutrition, p362-371.
Holick, M., & Jenkins, M. (2003). The UV Advantage. New York: iBooks.
Johnson, J., Maher, J., DeMaria, E., Downs, R., Wolfe, L., & Kellum, J. (2006). The long-term effects of gastric bypass on Vitamin D metabolism. Retrieved from Annals of Surgery: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570540/
Lucas, R., & Neale, R. (2014). What is the optimal level of vitamin D. Australian Family Physician Vol 43, No 3, 119-122.
Moorthy, D., Cappellano, K., & Rosenburg, I. (2008). Nutrition and Crohn’s disease: an update ofprint and Web-based guidance. Retrieved from Nutrition Reviews: www.nutritionreviews.oxfordjournals.org/content/66/7/387
National Institutes of Health. (2014). Vitamin D – Fact sheet for Health Professionals. Retrieved from US Department of Health & Human Services: http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
Nowson, C., McGrath, J., Ebeling, P., Halkerwal, A., Daly, R., Sanders, K., . . . Mason, R. (2012, June 18). Clinical Focus: Vitamin D and health in adults in Australia and New Zealand: a position statement. Retrieved from The Medical Journal of Australia 196 (11): https://www.mja.com.au/journal/2012/196/11/vitamin-d-and-health-adults-australia-and-new-zealand-position-statement
NPS Medicinewise. (2012). Retrieved from NPS Medicinewise: http://www.nps.org.au/
NPS Medicinewise. (2014, November). Vitamin D Tests Fact Sheet. Retrieved from NPS Medicinewise: www.nps.org.au
Oh, S. (2011, Sep). Proton pump inhibitors – Uncommon adverse effects. Retrieved from RACGP Reprinted from Australian Family Physician Vol 40, No 9: http://www.racgp.org.au/download/documents/AFP/2011/September/201109oh.pdf
Ontometrics. (no date). D minder. Retrieved from Ontometrics: www.dminder.ontometrics.com
Osiecki, H. (no date). The Nutrient Bible 8th Edition. Australia: AG Publishing.
Rheaume-Bleue, K. (2013). Vitamin K2 and the Calcium Paradox: How a little known vitamin could save your life. Ontario, Canada: John Wiley & Sons.
Tabrizian, I. (no date). Visual Textbook of Nutritional Medicine – First Edition. Australia: NRS Publication Education Series.
US National Library of Medicine, NIH. (2012, Oct 8). Stomach acid test. Retrieved from MedlinePlus: http://www.nlm.nih.gov/medlineplus/ency/article/003883.htm
Vitamin D Council. (no date). How do I get the Vitamin D my body needs? Retrieved from Vitamin D Council: www.vitamindcouncil.org
Wortsman, J., Matsuoka, L., Chen, T., Lu, Z., & Holick, M. (2000). Decreased bioavailability of Vitamin D in obesity. American Journal of Clinical Nutrition, 690-693.
Yeomans, N. (2000, March). Drugs that inhibit acid secretion. Retrieved from Australian Prescriber: http://www.australianprescriber.com/magazine/23/3/57/9