by Craig Weatherby
Q: What do 19th century London-dwellers and conservative Muslim women living in 21st century Scandinavia have in common?
A: Both display a tendency toward vitamin D deficiency.
Historical accounts indicate that rickets was common in 19thcentury English cities, probably because coal smoke was so thick it hid the vitamin D-producing midday sun (Rickets is a disease in which developing bones soften and curve because they aren't receiving enough calcium, uptake of which into bones requires adequate vitamin D.
Modern research suggests that the traditional head covering called the hijab leaves Islamic women living in already sun-lacking northern latitudes prone to substantial vitamin D deficiency, which can promote cancer, depression—and osteoporosis.
Vitamin D and bone health
You can't build bone without calcium, and you can't absorb and utilize calcium without vitamin D. This is why vitamin d was first identified as an essential anti-rickets nutrient (Omega-3s are also associated with better bone health).
People with severe osteoporosis often exhibit low body levels of vitamin D, and taking calcium and vitamin D supplements—or eating foods rich in calcium and vitamin D—can slow down or even reverse osteoporosis.
Vitamin D deficiency is fairly common among the house- or institution-bound elderly, who often receive less sun exposure. It is also common among seniors and adolescents in northern latitudes who do not eat oily, vitamin D-rich fish or milk fortified with smaller amounts of vitamin D. Aside from osteoporosis, the consequences of this deficiency include increased risk of hypertension, and several common types of cancer.
Millions face fractured futures
An estimated 1.5 million Americans—mostly elderly—suffer an osteoporosis-related bone fracture every year. Almost half of Caucasian women (i.e., women of European extraction) age 50 or older will experience a hip, spine, or wrist fracture, while about 15 percent of Caucasian men will suffer a similar fate. While the lifetime risk for non-Caucasian women is less, it seems to be rising among Hispanic women.
Fractures can have catastrophic consequences. For example, the risk of death is three to four times greater than normal among hip fracture patients during the first three months after the fracture. And fractures often initiate a downward spiral that devastates quality of life, with many victims becoming isolated and depressed. Spinal fractures, which are not diagnosed and treated as easily, can disfigure and cause chronic pain.
Osteoporosis is the most important underlying cause of fractures in the elderly. Some 10 million Americans over age 50 have osteoporosis, while another 34 million suffer from low bone mass (osteopenia) of the hip, which puts them at risk for fractures and attendant complications.
Getting enough D?
According to a 2004 report by the U.S. Surgeon General, “Relatively few individuals follow the recommendations related to the amounts of physical activity, calcium, and vitamin D that are needed to maintain bone health.”
Dietary supplements are often inferior to food, in terms of the effectiveness of their vitamin D. Instead of the D-3 form used by the body, and found in fish, most mass market brands contain 400 IU of the D-2 form, which is biologically inefficient. In other works, it takes much less D-3 to equal the health effects of a given amount of D-2.
The distinction between D-2 and D-3 is similar to the difference between the "short-chain" or plant-source omega-3 called ALA, only 5-15 percent of which the body can convert to the long-chain forms it needs (e.g., EPA and DHA), and "long chain" omega-3s which are found only in fish and fish oil supplements.
In addition, many multivitamins also contain vitamin A, which interferes with the body's ability to absorb vitamin D.
The evidence concerning the effects of combined calcium-vitamin D supplements on bone density and fracture risk is mixed. One study found that among 295 men and women 65 years of age or older, taking 500 mg of calcium plus 700 IU of vitamin D3 per day reduced bone loss in the neck, spine, and total body moderately over a three-year period, and reduced the incidence of non-vertebral fractures. (The U.S. RDA for people aged 51-70 or older is 400 IU.)
However, other studies, including two recent ones from the UK, indicated that calcium and vitamin D supplements had fairly little impact on risk of fractures in the elderly. These mixed results suggest the possibility that, for unknown reasons, whole foods are better sources.
Fatty fish to prevent fractures
As we noted in our last issue, the best food sources of vitamin D—by far—are fish rich in oil (and omega-3s), such as salmon, sardines, sablefish, and tuna. (An eight-ounce glass of fortified milk provides only 100 IU.)
Sardines shine when it comes to bone health, because they provide both calcium and vitamin D. A one-quarter cup (2.2 oz.) serving of Vital Choice Sardines (one-half of one 4-3/8 oz. can) provides 234 mg of calcium (20 percent of the RDA), and about 285 IU of vitamin D3 (70 percent of the RDA for adults).
And, a standard 3.5 oz. serving would provide even more: about 375 mg of calcium (30 percent of the RDA), and about 460 IU of vitamin D3 (115 percent of the RDA).
A single 3½ ounce serving of salmon provides 360 IU of vitamin D, while a serving of tuna provides a bit more than half the RDA (233 IU).
It's nice to know that one food group—fatty fish—offers two of the most important health-enhancing nutrients: omega-3s and vitamin D!
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