Vitamin D

Nov 16, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Look. I understand too little too late. I realize there are things you say and do in life that you can never take back. But what would you be if you didn't even try. You have to try. So, after a lot of thought, I'd like to reconsider. Please. If it's not too late. Make it a ... cheese burger." I love the lyrics from the song "Here I am" by Lyle Lovett and His Large Band. You think he is going to a dark place, but surprises you with a light ending.

Dauphin is somewhere else that the light is ending. And as our daylight is slipping away from us, our bodies are less able to make Vitamin D. In fact, many would argue we should all take Vitamin D supplements for the long dark days of winter.

What is Vitamin D? There are different forms of Vitamin D, but the most potent form is called calcitriol. The type of Vitamin D your body makes is called Vitamin D3 (or cholecalciferol). The formation is complicated, but it goes something like this. A Pre- Vitamin D3 is converted to Vitamin D3 in the skin with the help of sunlight (UV Radiation). Vitamin D3 is converted to a second form in the liver called calcidiol. The calcidiol is converted to calcitriol by the kidney. Again calcitriol is the most active form. So you can get Vitamin D3 from taking pills, having your skin make it from sunshine or eating things like fish. Then you hope your kidneys are healthy enough to convert the Vitamin D3 to calcitriol. There is another form of Vitamin D called Vitamin D2 . It is formed by plants and it can be converted to calcitriol in your body as well. There are those that argue that Vitamin D2 doesn't form calcitriol as well at Vitamin D3.

Why do we care about Vitamin D? The most important thing about Vitamin D is still that it helps your gut absorb calcium. We know this because young children who don't get enough Vitamin D develop rickets. Rickets is a condition characterized by bone deformities and "soft bones" which don't have enough calcium. If we treat these children with Vitamin D and/or sunlight, their bones get better. This is why we give breast fed babies a Vitamin D supplement. We assume that the newborns aren't put in the sun (mostly because we told the mothers not too) and the mothers aren't in the sun either. Once the babies go onto formula or milk, they don't need the Vitamin D supplement anymore.

We need Vitamin D to absorb calcium. That isn't a new recommendation. But there are other things about Vitamin D you probably haven't thought of. First, we are all probably getting less Vitamin D than we did before. We are using more sunscreen which is good for preventing skin cancer, but it reduces the Vitamin D our skin can produce. We spend less and less time outdoors, and as people age their bodies are less good at absorbing Vitamin D from their diet. The second thing is the recommendations for how much Vitamin D we need keeps going up. It used to be 400 IU of Vitamin D was fine. Now we don't think 400 IU of Vitamin D will prevent fractures in adults. The recommendations are for at least 400 IU if you are healthy and less than 50. If you are over 50, you should consider 800 to 1000 IU. Vitamin D is generally considered safe up to 4000 IU per day in healthy adults.

Another reason that Vitamin D seems to be in the news more is that it is inexpensive, relatively safe and every time we turn around it seems to do another good thing for us. Let's look at some of the health claims for Vitamin D.

Vitamin D has been shown to prevent falls. In the February 2008 issue of the Journal of the American Geriatric Society there was a study that said nursing home patients on 800 IU of Vitamin D fell less than ones on less Vitamin D or on placebo. There are still researchers who aren't sure if Vitamin D reducing falls is a real effect or not. But since many elderly are not in the sun anyway, Vitamin D supplements still seem like a good idea.

The Canadian Cancer Society now recommends 1000 IU of Vitamin D during the fall and winter. There is some evidence that Vitamin D prevents some cancers, especially colorectal cancer and breast cancer. Of course, there are conflicting studies saying Vitamin D doesn't decrease cancer risk. And there are other studies that say if you have cancer, Vitamin D may help you stop dying from it. But even with the mights and maybes, I'll take the bet that Vitamin D might help with cancer.

Multiple Sclerosis and Vitamin D may have a relationship, but that relationship is unclear. The further you live from the equator, the more likely you are to get MS. Is that because you get more sun and thus more Vitamin D near the equator? Maybe. Studies have shown people with high levels of Vitamin D in them have a lower risk of getting MS, but giving people with MS Vitamin D hasn't shown much success. Recently researchers in Canada and the UK found that if you have a defective gene that normally converts Vitamin D to the active form you are more likely to get MS. So, the complicated dance continues.

Vitamin D is probably good for you, especially in dark cold Canada where we are covered up much of the year. But beside helping your bones, exactly what good things Vitamin D does for you is unclear. To paraphrase Mr. Lovett, "If Ford is to Chevrolet, what Dodge is to Chrysler, what Corn Flakes are to Post Toasties, what the clear blue sky is to the deep blue sea, what Hank Williams is to Neil Armstrong, can you doubt you and Vitamin D were made for each other?"

As always if you have any questions or concerns about these products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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Lyle Lovett and His Large Band - "Here I Am" :


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