1. V ITAMIN D By: Jennie Simpson, RD, LD, CDE Alaska Regional Hospital

2. W HAT IS V ITAMIN D Fat soluble vitamin Hormone Regulated by parathyroid hormone, calcium and phosphate Present in very few foods Produced in skin from sunlight

3. I MPORTANCE Promotes calcium absorption in gut and maintains adequate serum calcium Immune function Cells Growth Proliferation Differentiation Inflammation

4. T YPE OF V ITAMIN D D2-Ergocalciferol- photosynthesized in plants, mushrooms and yeast Sometimes used in food fortification D3-Cholecalciferol- formed upon exposure to UVB 25-hydroxyvitamin D- calcidiol Storage form 1,25-dihydroxyvitamin- calcitriol- active form

5. F OOD S OURCES Food SourceServing Size IUs per serving Cod Liver Oil1 tbsp1,360 Salmon (sockeye)3 oz447 Tuna Fish (canned in water)3 oz154 Fortified Orange Juice8 oz~137 Fortified Milk8 oz115-124 Sardines (canned in oil)2 sardines46 Beef Liver3 oz41 Egg yolk1 large41 Fortified ready to eat cerealvaries Swiss Cheese1 oz6

6. O THER S OURCES Sun exposure Season, time of day, length of day, cloud coverage, smog, skin melanin content, sunscreen Dietary Supplement D2 and D3 are equivalent Both raise serum 25 (OH) D levels, cure rickets D2 is less potent at high doses *supplementation is based on your levels *take with Calcium

7. R ECOMMENDED D AILY A LLOWANCE (RDA) AgeRDA 0-12 months400 IU (10 mcg) 1-70 years of age600 IU (15mcg) >70 years of age800 IU (20mcg) Pregnancy/ Lactation600 IU (15mcg)

8. T OLERABLE U PPER L IMIT (U LS ) AgeUL 0-6 months1,000 IU (25 mcg) 7-12 months1,500 IU (38 mcg) 1-3 years of age2,500 IU (63mcg) 4-8 years of age3,000 (75 mcg) >8 years of age Pregnancy lactation 4,000 IU (100 mcg) *OTC- max dose 5,000 IU

9. D EFICIENCY Rickets-failure of bone tissue to properly mineralize causing soft bones and skeletal deformities Osteomalacia- weak bones * Caused by dietary inadequacy, impaired absorption and use, increased requirement or increase secretion

10. G ROUPS AT R ISK FOR D EFICIENCY Breastfed infants Older adults Limited sun exposure People with dark skin IBS or other fat malabsorption Obese Gastric Bypass Surgery Use of certain medications (steroids, orlistate, cholestyramine, anti-seizure)

11. H EALTH R ISK FOR E XCESSIVE V ITAMIN D Non specific symptoms- anorexia, wt. loss, polyuria and heart arrhythmias Raise blood levels of calcium Kidney stones in post menopausal women Excessive sun exposure does not lead to excessive vitamin D Toxicity is mainly caused through over supplementation

12. B EYOND B ONES Osteoporosis Cancer Diabetes HTN Glucose Intolerance Multiple Sclerosis

13. Y OUR L EVELS Serum 25-Hydroxyvitamin D Concentrations and Health nmo l/L Ng/m L Health Status <30<12Associated with vitamin D deficiency (leading to rickets/ osteomalacia) 30- 50 12-20Inadequate for bone and overall health > 50> 20Adequate for bone and overall health > 125 > 50Potential adverse effects w/ emerging evidence

14. P UT IT ALL T OGETHER Only supplement based on your levels Talk to your provider about supplementing if needed If supplementing take with Calcium Follow a healthy diet

15. Q UESTIONS

16. R EFERENCES National Institute of Health http://ods.od.nih.gov/factsheets/vitaminD-HealthProfessional/ Linus Pauling Institute at Oregon State University http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/ National Cancer Institute http://www.cancer.gov/cancertopics/factsheet/prevention/vitamin-D/