
Are You Vitamin D Deficient? (Infographic) - cwan
http://www.informationisbeautiful.net/2010/vitamin-d/
======
arithmetic
As a person living in Seattle (rains a lot!) who is of a darker skin color
because of my race, I get told every now and then that I must be very lucky
because I'm never going to be Vit D deficient.

I'm surprised that people think having darker skin color means I already have
oodles of Vit D, when it's quite the opposite - people with dark skin color
synthesize less Vitamin D on exposure to sunlight. I probably need lot more of
that big ass star :)

------
MikeCapone
I take 4,000 UI of Vitamin D each day in gelcap form (Vitamin D is fat-
soluble, so much better absorbed that way than with dry tablets -- this
information is based on blood tests that the cardiologist at the Heart Scan
Blog did <http://heartscanblog.blogspot.com/> ). Living in Canada and working
inside most of the day, that seems to be a minimum for me. I could probably up
the dose to 6,000 UI this winter...

Here's the kind I get: [http://www.vitaminlife.com/product-
exec/PNAME/Vitamin_D_2000...](http://www.vitaminlife.com/product-
exec/PNAME/Vitamin_D_2000_IU/product_id/35147)

I also take 3 grams of omega 3 (adding up to 1800 mg of EPA/DHA), 500 mg of
Vitamin C, and a multivitamin.

~~~
evolvingstuff
You might consider switching to a D3 supplement that includes some K2; they
play nicely together.

~~~
MikeCapone
I'm not familiar with K2. I'll do some Googling around, but if you have good
sources, I'd appreciate it if you shared them. Thanks.

~~~
evolvingstuff
As far as I understand it, higher levels of vitamin D3 greatly increases
absorption of calcium from the gut, and the K2 is necessary to ensure that the
calcium gets deposited in the right places.

Sorry, I don't have an existing set of references for this, but here are a
couple things I found:

From
[http://www.drjessicaseaton.com/Chiropractic_in_West_Los_Ange...](http://www.drjessicaseaton.com/Chiropractic_in_West_Los_Angeles/Vitamin_D3_%28and_K2%29.html)

"Increased levels of vitamin D require increased levels of vitamin K,
especially of vitamin K2 (menaquinone). Without enough vitamin K2 there is an
increased risk of hardening of the arteries and other soft tissues."

From <http://en.wikipedia.org/wiki/Vitamin_K>

"...high intakes of vitamin D but low intakes of vitamin K were suggested to
pose an increased risk of hip fracture."

~~~
fubari
evlovingstuff - I think you'll like this article about K & D interaction:

[http://www.lef.org/magazine/mag2010/sep2010_Brittle-Bones-
Ha...](http://www.lef.org/magazine/mag2010/sep2010_Brittle-Bones-Hardened-
Arteries_01.htm)

Here is the summary: "The remarkable discovery that blood vessel cells can
transform into bone-forming cells confirmed the little-known link between
atherosclerosis and osteoporosis. At the core of this connection is
insufficient D and K intake. These vital nutrients operate in synergy to
optimize bone mineralization and prevent calcium deposits in vascular tissue.
Low vitamin D is linked with arterial disease and bone loss, while vitamin K
stimulates bone formation and modifies specific proteins (Gla) that help
protect against arterial calcification.

Vitamin D taken in higher doses (5,000-10,000 IU/day) has become popular over
the last two years based on findings showing that this potency is required to
achieve optimal blood levels (over 50 ng/mL of 25-hydroxyvitamin D).
Relatively few supplement takers, however, understand the critical need for
aging humans to also take a daily vitamin K supplement. Fortunately, Life
Extension members were informed in 1999 about the critical need of including
vitamin K in their supplement regimen."

~~~
evolvingstuff
Thanks fubari, great information!

------
_delirium
Man, this is a terrible infographic imo, though this sort of thing gets
linkshared around the internet like wildfire, so I must be in the minority on
that. Some parts of it are fine, like the map, but some parts would be a lot
more straightforward as a few sentences or some normal bullet points, instead
of that confusing mess of flow-chart-esque lines in the "Vitamin D - ESSENTIAL
FOR / INFLUENCES / SUSPECTED EFFECT" section. And the graphics in the "D-Day"
section aren't really telling me much at all.

Also, why does the whole thing have to be one giant image?

~~~
adolph
The map seems pretty bad too: What about areas south of -42° latitude during
their winter?

~~~
RK
The population south of 42°S is pretty small. Also, they may have lower ozone
levels that allow more UV through.

------
alec
This infographic suggests taking 2,000 IUs/day. Both the Mayo Clinic and WebMD
say that more than 2,000 IUs/day can be toxic:
[http://www.mayoclinic.com/health/vitamin-d/NS_patient-
vitami...](http://www.mayoclinic.com/health/vitamin-d/NS_patient-
vitamind/DSECTION=dosing) [http://www.webmd.com/vitamins-lifestyle-
guide/supplement-gui...](http://www.webmd.com/vitamins-lifestyle-
guide/supplement-guide-vitamin-d)

~~~
MikeCapone
This is from memory, I don't have my sources right now, but most of what I've
read is that the body can deal very well with too much Vitamin D. What it
doesn't do well is a deficiency.

A few of my pharmacist friends told me about how some people are being
prescribed doses of 50,000 UI, and I've read somewhere that below 14,000 UI a
day over extended periods, no toxicity was found. So I kind of doubt that
2,000 UI is an upper bound, unless you have a very specific condition. Just
spending a day on the beach probably gives you a MUCH higher dose than this.

But as I said, this is from memory. Take this with a grain of salt and do your
own research. Personally, I'll keep taking my 4,000 UI/day, something that
I've been doing for about 4-5 years (and while this is anecdotal, I've seen
improvements in seasonal mood changes and the number of times I'm sick per
year).

~~~
dasil003
IU

~~~
MikeCapone
I'm not sure if I wrote it like that because I used to writing the acronym for
"user interface" or because in French, my native language, they write it as
"UI" (unités internationales). But thanks for the correction.

------
stretchwithme
Most guides to getting Vitamin D make blanket statements about how much
ultraviolet light is available. The amount of sun varies throughout the winter
and by time of day, as well as latitude. You can probably get more UVB at high
noon in December than you can at 3pm in October.

I'd love to see a guide that shows you how long you need to be out at a
specific time, date, latitude and skin color.

------
FluidDjango
I found the wikipedia entry useful in citing specific interesting studies
(e.g., suggesting >50,000 IUs/day (orally) may be needed for toxicity). Plus a
clarification of the 'how' of sunlight-produced D self-limiting:

<http://en.wikipedia.org/wiki/Vitamin_D>

------
organicgrant
As tech people, we need to remember that our glorious LED backlit Macs just
aren't as important as that big ass star holding us all together.

Here's my infographic: [go outside everyday!]

~~~
randallsquared
_our glorious LED backlit Macs just aren't as important as that big ass star
holding us all together._

Hey, let's not go overboard! Can we agree that both Macs and the Sun are
important? Hrm?

------
evolvingstuff
Shameless plug of my dad's website on vitamin D:
<http://www.vitamindwiki.com/tiki-index.php>

------
hugh3
I feel like I should be offended about the Northern Hemisphere-centric nature
of the plot. What about the lack of sunlight below 42 S from May to July?

(Admittedly that only includes half of New Zealand's South Island, the tip of
Tasmania, and part of Patagonia. Plus all of Antarctica, but I assume if
you're wintering in Antarctica you're probably well aware of Vitamin D
deficiency.)

------
jodrellblank
10 minutes outside in summer? Does that address our alledged reduced ability
to make vitamin D with age? Does it address that vitamin D is made from
cholesterol and lots of people are on an anti-cholesterol crusade? Does it
address that UVA hinders the reaction which UVB encourages, and therefore
sitting in the sun behind glass might undo some of the benefit? (hint: no).

Does the daily recommended amount for supplementation address which kinds of
Vitamin D are useful and which aren't? Which kinds are more easily absorbed?
That different people absorb different amounts? That it's possible to
overdose? (hint: no).

These skirt around the real point which is to raise some particular blood
level of a specific kind of Vitamin D. If you aren't getting that,
specifically, measured then whatever else you do in terms of sunlight or
supplementation is winging it and hoping for the best (and risking overdose)
or merely assuaging some guilt that you should be healthier by doing
"something".

~~~
dnsworks
Does this mean that vegans are more likely to be Vitamin D deficient (and
vegetarians to a certain degree)?

~~~
wazoox
Vegans are extremely likely to have many deficiencies anyway.

------
RK
I have a lot of physician friends who say that testing vitamin D levels is the
latest "fad", so to speak.

I got tested out of curiosity and was in the intermediate range (30-40 ng/ml)
(technically not "normal" (>40ng/ml), but not "low" (<30 ng/ml)).

Amazingly, I had higher levels than anyone else I talked to who had been
tested. My friend said it was the highest level he could remember (of his
patients). My doctor still suggested that I take 1 or 2 2000 IU D3 capsules
per day.

If you're curious, get tested. I did have to convince my doctor that I wanted
to know the number. He said, "trust me, it will be lower than it should be."

~~~
quicksilver03
Fad or not, get tested for vit D and calcium absorption.

I was a rugby player at amateur level until 3 years ago, when I fractured
twice my left wrist in 8 months. Seeing that the second fracture was due to a
pretty light contact, I asked to get tested and I was diagnosed with
osteoporosis. This is quite rare for a 36 years old male such as myself, I
understand it may not be so rare in the next years.

------
kadavy
I remember Dr. Weil saying that if you live north of, say, Atlanta, there
isn't enough UV exposure for to get sufficient vitamin D from the sun during
winter months. He recommended sardines as a natural source of vitamin D.

source - somewhere in his interview with Kevin Rose:
<http://www.youtube.com/watch?v=t7wSp7Y4bFM>

------
nodata
Nice infographic.

Needs to add symptoms of Vitamin D deficiency to fit the headline though.

------
adammichaelc
Quick note on the infographic. It is extremely important to _not take_ cod
liver oil as your vitamin D source. The problem with cod liver oil is that it
contains toxic levels of vitamin A, which acts as an antagonist against
vitamin D. They use the same receptor and so when there is too much vitamin A
in the blood, even moderate toxicity, the good effects of vitamin D will be
greatly diminished.

Also, if you are going to take a multivitamin, make sure it is 100% beta
carotene, as other forms of vitamin A (eg. retinol, the kind of vitamin A that
cod liver oil contains) cannot be flushed out of the system and will lead to
toxicity -- therefore you cancel out any benefit you would have gotten from
the D. Below is a more thorough commentary on the latest research:

Dr. John Cannell, MD. via Vitamin D Council

 _"Although activated vitamin D and vitamin A signal through common cofactors,
they compete for each others function. Retinoic acid antagonizes the action of
vitamin D and its active metabolite. In humans, even the vitamin A in a single
serving of liver impairs vitamin D's rapid intestinal calcium response. In a
dietary intake study, Oh, et al, found that a high retinol intake completely
thwarted vitamin D's otherwise protective effect on distal colorectal adenoma,
and they found a clear relationship between vitamin D and vitamin A intakes,
as the women in the highest quintile of vitamin D intake also ingested around
10,000 IU/d of retinol." [1a, 1b, 1c]

"Furthermore, the consumption of preformed retinol even in amounts consumed by
many Americans in both multivitamins and cod liver oil may cause bone toxicity
in individuals with inadequate vitamin D status. Women in the highest quintile
of total vitamin A intake have a 1.5-times elevated risk of hip fracture." [2]

"Indeed, a recent Cochrane Review found that vitamin A supplements increased
total mortality rate by 16%, perhaps through antagonism of vitamin D." [3]

"Another recent Cochrane meta-analysis concluded that although vitamin A
significantly reduced the incidence of acute lower respiratory tract
infections in children with low intake of retinol, as occurs in the Third
World, it appears to increase the risk and/or worsen the clinical course in
children in developed countries." [4]

"As early as 1933, Alfred Hess, who discovered that sunlight both prevented
and cured rickets warned about vitamin A consumption, concluding, ...as to a
requirement of thousands of units of vitamin A daily, the unquestionable
answer is that this constitutes therapeutic absurdity, which, happily, will
prove to be only a passing fad (p 662)."

"Unfortunately, Hess's prophecy of a passing fad proved premature and
Americans continue consuming multivitamins and/or cod liver oil containing
small amounts of vitamin D but undesirable quantities of vitamin A. For
example, multivitamins, until recently, had small amounts of vitamin D (200 to
400 IU) but high amounts of preformed retinol (5,000 to 10,000 IU). This pales
in comparison to a tablespoon of modern cod liver oil, most of which contains
sub-physiological amounts of vitamin D (400 to 1200 IU) but supra-
physiological amounts of completely preformed retinol (5,000 to 15,000 IU or,
in some cases, 30,000 IU)." [5, 6]

"Clinical lore holds that Vitamin A is an anti-infective. We suggest that lore
exists because of old cod liver oil studies. Semba reviewed early literature
on vitamin A, usually given as cod or halibut liver oil, as a successful anti-
infective. For reasons that are not entirely clear, fish liver oils of the
time contained much higher amounts of vitamin D then does modern cod liver
oil, perhaps because modern processing removes the vitamin D during
distillation and then replace it at lower doses. Furthermore, a meta-analysis
concluded that vitamin A, when given alone, increases the incidence of
respiratory tract infections. If vitamin A increases the risk of respiratory
infections, its high content in modern cod liver oils will only mask the full
benefit of adequate vitamin D nutrition."

"As the prevalence of vitamin A deficiency in the United States is apparently
much lower than the prevalence of subclinical vitamin A toxicity, we cannot
recommend cod liver oil for either adults or children. (We exclude fish body
oil from our warning, as it contains no vitamin A or vitamin D but is a very
important source of omega-3 fatty acids.) For example, in a recent assessment
of serum retinyl esters in a group of obese individuals, four percent had
levels >10% of total retinol which usually indicates hypervitaminosis A.
Instead, a diet rich in carrots, sweet potatoes, cantaloupe, and other orange
fruits and vegetables will supply all the carotenoids the body needs to make
retinol without the potential for hypervitaminosis A, especially when
additional preformed retinol already exists in dairy products, eggs, and
fortified cereal. We wish our diet were as rich in vitamin D. With the
exception of infants on formula or toddlers drinking large amounts of milk or
fortified juice, adequate amounts of vitamin D are virtually impossible to
obtain from diet." [7,8,9] _

Sources (Gathered by Vitamin D Council
[http://www.vitamindcouncil.org/newsletter/2008-december.shtm...](http://www.vitamindcouncil.org/newsletter/2008-december.shtml)):

[1a] Calcium and vitamin D intakes in relation to risk of distal colorectal
adenoma in women. <http://www.ncbi.nlm.nih.gov/pubmed/17379616>

[1b] All-trans retinoic acid antagonizes the action of calciferol and its
active metabolite, 1,25-dihydroxycholecalciferol, in rats.
<http://www.ncbi.nlm.nih.gov/pubmed/15987844>

[1c] Vitamin A antagonizes calcium response to vitamin D in man.
<http://www.ncbi.nlm.nih.gov/pubmed/11585356>

[2] Vitamin A intake and hip fractures among postmenopausal women.
<http://www.ncbi.nlm.nih.gov/pubmed/11754708>

[3] Antioxidant supplements for prevention of mortality in healthy
participants and patients with various diseases.
<http://www.ncbi.nlm.nih.gov/pubmed/18425980>

[4] Vitamin A for preventing acute lower respiratory tract infections in
children up to seven years of age.
<http://www.ncbi.nlm.nih.gov/pubmed/18254093>

[5] The acute and chronic toxic effects of vitamin A
<http://www.ncbi.nlm.nih.gov/pubmed/16469975>

[6] Vitamin A as "anti-infective" therapy, 1920-1940.
<http://www.ncbi.nlm.nih.gov/pubmed/10203551>

[7] Vitamin A supplementation and childhood morbidity from diarrhea and
respiratory infections: a meta-analysis.
<http://www.ncbi.nlm.nih.gov/pubmed/12640379>

[8] Evaluation of vitamin A toxicity
<http://www.ncbi.nlm.nih.gov/pubmed/2197848>

[9] Retinol to retinol-binding protein (RBP) is low in obese adults due to
elevated apo-RBP. <http://www.ncbi.nlm.nih.gov/pubmed/18641048>

------
xiaoma
What a horribly unscientific infographic! UVA "ages" the skin and UVB burns
your skin but also creates vitamin D? The truth is that UVA is a longer
wavelength radiation that for the most part lacks the power to penetrate the
skin, while UVB _does_ do damage to the DNA. It's exactly that sort of genetic
damage that "ages" the skin, in the terminology of the author. It can also
lead to cancer.

Eat pretty much any fatty fish as is common in arctic cultures anyway, and
you'll be fine. Ethical vegans can eat lots of mushrooms.
<http://en.wikipedia.org/wiki/Vitamin_d#Natural_sources>

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CountHackulus
From the map it looks like all of Canada is Vitamin D deficient. Interesting,
and a bit concerning. Maybe I should be taking more supplements.

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sliverstorm
Seems like it's time to buy me some cod liver oil... I hope it's not as nasty
as I'm thinking it will be.

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dnsworks
Living in Seattle was brutal for me, it left me incredibly depressed and I
ultimate fled back to San Francisco for my sanity. Even SF is pretty rough, so
I only live in the corporate apartment complexes in SOMA where I can lay in
the sun an hour a day after swimming, it keeps me quite happy (and tan!)

~~~
estel
It would seem quite a stretch to contribute this to vitamin D, though. What
with the environment, amount of sunlight, culture, etc etc.

------
hackermom
Probably not, because we've lived up here in this "gray and cloudy"
environment for thousands of thousands of years, and we're doing just fine;
we're adapted. But we are aware that living "up here" is a problem for people
who comes from "down there".

