Vitamin D basics

Maddy Draper, APRN, a health care provider at OSF OnCall, says vitamin D is a nutrient our body needs to produce calcium. Calcium helps create strong teeth and bones. So logically, not having enough vitamin D leads to brittle bones (a risk for greater injury after a fall), plus muscle aches and pains. Others with a vitamin D deficiency may not show symptoms. Either way, a provider may order a blood test to confirm the issue and then may advise you to take a supplement. This is usually in pill form and can be prescribed or bought over the counter by itself or as part of a multivitamin.

“Or the provider may just talk about vitamin D-rich foods first before starting a supplement,” Draper says. “High fat fishes, egg yolks, some cheeses and mushrooms.”

Draper adds that pregnant women, babies (especially babies who are breastfed), the elderly and people with darker skin often lack vitamin D.

On the flip side, Draper says it’s rare, but a person can get too much vitamin D. Symptoms include nausea, vomiting and heart palpitations (feeling like your heartbeat is fast, pounding or otherwise irregular). You may also suffer kidney damage.

Summer sun

Here’s advice to commit to memory: Draper says research shows 10 to 15 minutes of sun exposure three times a day can get you a healthy amount of vitamin D.

“You want to protect your skin while doing that,” Draper adds. “Sunscreen and protective clothing like a hat and sunglasses. There’s not any research showing that sunscreen or clothes will prevent you from getting the vitamin D you need.”

Experts say your sunscreen should have a sun protection factor (SPF) of 30 or higher, and you should reapply every two hours. Clothing should be lightweight and light colored (Dark colors absorb more sunlight, leading to quicker heat illness.) Stay hydrated, and watch for redness and blisters from sunburns and suspicious moles that may be skin cancer. See a provider right away if you have issues from getting too much sun.

Another thing to note: Experts say a specialized lamp can help with seasonal affective disorder, a mental health condition often seen in the winter due to decreased daylight. The same logic does not apply for vitamin D. You need natural, not artificial light to get the vitamin D you need.

The bottom line

Draper says most people don’t have to worry about getting too much or too little vitamin D.

“The average person will get it through the sun,” Draper says. “If you live in a cold and dark environment, you’re at higher risk for vitamin D deficiency. People farther away from the equator are higher risk.”

If you have symptoms of too much or too little vitamin D or just have a concern, talk to your primary care provider.

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Jeanna Brouwer, an outpatient oncology dietitian with the OSF HealthCare Cancer Institute, says understanding your vitamin D levels is one of the first steps in supporting your overall health during treatment. She emphasizes that vitamin D, a fat-soluble vitamin, helps support bone health, immune function and recovery, making it a crucial part of cancer care.

"It's a pre-hormone, or a precursor to a hormone, that is like a 'master key in our body,'" Brouwer says, adding it helps regulate many important processes inside of you.

There are two forms of vitamin D: D2 and D3. Brouwer says the body utilizes vitamin D3 more efficiently than vitamin D2. Vitamin D3 is naturally found in animal-based foods, including fatty fish, and is generally more effective than vitamin D2 at raising and maintaining vitamin D levels.

Why vitamin D is important during cancer treatment

Brouwer says vitamin D is almost always a beneficial part of a person's cancer journey. If someone hasn't had a recent vitamin D blood test, she recommends having one ordered so a baseline can be established before determining whether a supplement is needed.

"When we're deficient, our body isn't functioning to the ideal level that we need it to," Brouwer says. "We don't have the ideal immune system that can help us during cancer treatment. So, if we're deficient, we want to start there and bring it up to a healthy level."

Brouwer also says studies show an association between adequate vitamin D status and better outcomes in certain cancers.

For some people, supplementation becomes even more important depending on their diagnosis and treatment plan.

"So, for example, prostate cancer patients; if you get put on something called ADT therapy, where it's blocking testosterone, that's going to alter our bone health. So, anybody put on that medication oftentimes (recommended by their oncology team) start supplementing with vitamin D and calcium," Brouwer says.

Supplementation can also help protect against osteopenia and osteoporosis.

People with pancreatic cancer can face a different challenge. Brouwer says pancreatic insufficiency can prevent the body from properly breaking down fat, leading to malabsorption. Because vitamin D is a fat-soluble vitamin, traditional vitamin D supplements may be less effective for some patients.

Choosing a supplement

Although sunlight helps the body produce vitamin D, Brouwer says supplements are an excellent way to get the nutrient without spending long periods of time in the sun, which can increase the risk of skin damage and skin cancer.

She also understands that choosing the right supplement can be overwhelming.

In general, Brouwer recommends choosing vitamin D3 over D2. She says products containing vitamin K2 can also help direct calcium into the bones more effectively.

People should keep in mind that the amount of vitamin D found in many calcium supplements or multivitamins is often not enough to meet their daily needs.

Most people need between 1,000 and 2,000 international units (IU) of vitamin D each day, Brouwer says. Reaching that amount through food alone can be difficult. For example, it would take about 10 glasses of milk a day to provide that much vitamin D, which is not recommended.

For people taking multiple medications, pill burden is a real concern. Brouwer says liquid-filled or gel capsules are often easier to swallow. Vitamin D also comes in gummies which are more palatable for some people.

Some formulations may also improve absorption. Liposomal supplements contain fat, which helps the body absorb vitamin D more effectively. For people who have difficulty absorbing vitamin D through the digestive tract, such as some pancreatic cancer patients, liquid drops may be a better option.

"Doing a sublingual bypass anything in the gut area. You hold the liquid under your tongue for 30-60 seconds, and it's going to absorb into the tissue in the oral cavity," Brouwer says. "So, if you get drops that are liposomal, best of both worlds."

Look for third-party testing

Because dietary supplements are not regulated by the U.S. Food and Drug Administration (FDA), Brouwer encourages people to look for products that have undergone independent, third-party testing.

She recommends looking for certifications such as USP (U.S. Pharmacopeia) or NSF (National Sanitation Foundation) on the label to help verify a supplement's quality and contents.

Before starting any vitamin D supplement, talk with your oncology care team or health care provider. There are scenarios, such as high calcium levels caused by cancer, where taking supplemental vitamin D can be problematic. A simple blood test can determine whether you're deficient and help identify the supplement and dosage that's right for you.

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Author's note: this is part one of a two part story on staying healthy during summer vacations. Click here for part two.


Summer means getaways to de-stress and make memories. But the last thing you want is to catch a cold or worse, especially if you’re halfway across the world where health care resources might be different or scarce.

It's not too late to make some quick preparations, says Jennifer Whitfill, APRN, a family nurse practitioner at OSF HealthCare.

• Stop by the doctor’s office: Whitfill says if you haven’t seen your primary care provider for a physical exam in a while, make an appointment before vacation to address any lingering health issues. This could include getting vaccines depending on your health and where you’re going. Whitfill says typhoid fever (seen in southern Africa, Asia, Central America and South America), yellow fever (Africa), hepatitis A (remote or underdeveloped areas) and rabies are ailments to protect yourself against.
   
• Stock up on over-the-counter medication.
  
  “It’s important to be prepared,” for when these medications are needed, Whitfill says. “Consider packing Tylenol or ibuprofen, anti-allergy medicines like Claritin, Zyrtec and Benadryl. Dramamine is a good one for motion sickness or nausea. Some people reach out to their provider if they’re going on a cruise. There’s a prescription called a scopolamine patch that you can put behind your ear. It’s good for three days and helps offset motion sickness.

“Eyedrops are good if you have seasonal allergies. Over-the-counter saline or Pataday drops,” Whitfill adds. “Creams like hydrocortisone and triple antibiotic ointment are good to have.”

For outdoor trips like camping, essentials including a first aid kit, sunscreen and bug spray are must-haves, too. Know if you’re on a medication, such as certain acne creams and menstrual cycle medications, that makes you more prone to sunburn.

And regardless of what you pack, Whitfill says flyers should check the Transportation Security Administration guidelines about what can come on a plane. She says to leave medicines in their original packaging when preparing airport luggage.

• Medicine, part two – before you go: You might hear travel bloggers say to boost your immune health before traveling to reduce your risk of catching something. Is the advice overblown?
  
  Whitfill says no. She says elderberry, vitamin C and D and zinc are all good supplements to take before a trip. Start three to four weeks before departure, if you can. And if you have concerns about supplements interacting with prescription medication, talk to your provider.
   
• Check the U.S. Centers for Disease Control and Prevention website for travel advisories about disease outbreaks, civil unrest and more.

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• Teeth issues, such as cavities and discoloration. Loose teeth (not baby teeth that are intended to come out) are also a red flag.
   
• Gum issues, such as redness, bleeding or swollen or sore gums.
   
• Chewing and swallowing issues, whether from pain or a diagnosed disorder.
   
• Chemotherapy can also negatively impact oral health, Dr. Splaingard says. So if you’re going through cancer treatment, keep a close eye for changes in your mouth.
   
• And while we can’t control our age or gender, Dr. Splaingard says to be aware: poor oral health and the poor bone health that could come with it are more common as you age. He adds that women who have reached menopause are especially at risk.

Prevention

Having good oral health is no secret. Think back to what your parents told you as kids.

• Brush and floss regularly. The American Dental Association recommends brushing twice per day and flossing once per day. If you have questions about frequency, talk to your dentist.
   
• See a dentist regularly. Twice per year is a good starting point, but some people who need extra attention could go four times per year.
   
• In between those appointments, watch your teeth and gums and let your dentist know if something doesn’t seem right.
   
• Avoid smoking.
   
• Eat a healthy diet that’s low in cavity-causing sugar and high in beneficial things like calcium.
  
  “Calcium and vitamin D deficiencies can affect calcium balance in the bones,” Dr. Splaingard adds
   
• And if you are diagnosed with osteoporosis, follow the medication plan outlined by your health care provider.

Learn more

Read more about how to maintain good oral health on the OSF HealthCare website.

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If you’ve been feeling a little off and not yourself lately, you’re not alone. You might be experiencing seasonal affective disorder (SAD). To make matters worse, we turn the clocks back Sunday, November 2, as part of daylight saving time, which means it’s going to get darker one hour earlier.

“Seasonal affective disorder is also known as seasonal depression. It's a form of depression that occurs during different seasons,” says Erin Wojewodzki, APRN, a nurse practitioner with OSF HealthCare. “There's winter onset seasonal affective disorder, which typically begins during the fall months. And then there's a summer depression, where symptoms develop during spring and summer.”

In the United States, approximately 5% of adults experience SAD. It’s typically diagnosed between the ages of 18 to 30, and it's more common in women. People with a family history of mental health challenges or depression are more likely to experience SAD. And so do people who live in areas farther away from the equator and experience more cloudier days including Alaska, Vermont and New Hampshire.

There are a range of symptoms that come with SAD, from feeling a little anxious to much more serious issues that could require medical attention.  

“The symptoms of the winter onset SAD include symptoms such as depression, feelings of guilt, and a lack of desire to do those things that you typically love doing,” says Wojewodzki. “There's a carbohydrate craving, it can impact sleep, and there can be feelings of suicidal ideation or thoughts.” 

Experts aren’t sure what causes SAD. Most theories revolve around a lack of sunlight and sun exposure. 

“We have this biological clock within us that's used to so much sunlight in the wintertime – that changes,” says Wojewodzki. “It gets darker earlier, and that can impact our mood, our sleep, our hormones, and lead to some of these symptoms.” 

Another issue is vitamin D deficiency. Sunlight helps boost vitamin D, which helps improve serotonin levels. Serotonin is the hormone in charge of boosting mood. Low levels of serotonin can lead to depression.

Finally, melatonin is another hormone that impacts our sleep. When you lack sunlight it can affect your melatonin, which makes us sleepier and groggier, which is easy to do when it turns dark by late afternoon.

Talk to your health care provider 

There is no blood test or scan to diagnose SAD. Instead, your health care provider will discuss family history, review symptoms and may make a referral to a psychologist. Health care providers also use a patient questionnaire called PHQ-9, a tool that assesses degrees of depression.

“We look at things like, are you having symptoms of depression?” says Wojewodzki. “Are those symptoms of depression occurring during a specific time of the year, every year, and have those symptoms occurred two or more times during a specific season where you've experienced these feelings?” 

A treatment plan is tailored specifically for each patient. Wojewodzki says that plan might include light therapy that can boost serotonin. Getting outside as often as possible can help. Your provider may recommend taking Vitamin D supplements or prescribe antidepressant medications until spring arrives. Medication called selective serotonin reuptake inhibitors (SSRIs) can improve mood by managing serotonin levels in your body. Finally, spend time with people you enjoy, which can boost your mood.

Dealing with changes that winter brings can be tough on anyone, especially those who suffer from SAD. But by sticking to your treatment plan, caring for yourself and planning ahead, Wojewodzki says malaise feelings can be overcome.

“If you are feeling symptoms of depression, isolation, sleep issues, gaining weight, not yourself, and especially feeling like harming yourself, I want you to reach out to your health care provider,” she says.  “We can discuss different options to you, whether that's medication or non-medication options to help you through this hard time.”

For more information on SAD or other behavioral health issues, visit the OSF HealthCare website. 



 

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If you’ve read anything on the importance of vitamin D, you know that its many benefits range from making your teeth and bones strong, to supporting your muscles, nerves and immune system.

And now new research published in the Journal of the Endocrine Society has found that vitamin D supplements may lower blood pressure in older adults with obesity.

The study followed 221 older people who are considered obese taking vitamin D supplements at either 600 international units a day or 3,750 units a day, for an entire year. They found that the supplements decreased their blood pressure and that the higher doses of vitamin D did not provide additional health benefits.

It’s difficult to draw a conclusion from the study without knowing certain variables, such as where these people live and what their diet consists of. But there’s little doubt that vitamin D can affect blood pressure in several ways, according to Dipti Sabharwal, DO, a family practice physician with OSF HealthCare.

“The main role of vitamin D is it helps with calcium homeostasis. So that's maintaining your calcium levels in the body,” she says. “Calcium has many roles. It helps contract your blood vessels, and then it helps relax them as well. If we have normal amounts of vitamin D, then the calcium is working well, so the muscles can continue working normally.”

Dr. Sabharwal adds that vitamin D also helps with the renin-angiotensin-aldosterone system (RAAS), a hormone system that helps in regulating blood pressure.

Past research has found that vitamin D deficiency can cause an increased risk of falls in older adults, bone fractures, a risk of cardiovascular disease, some autoimmune diseases including Type 1 diabetes and even depression.  

“So very commonly, we use it for patients who have seasonal affective disorder or depression, especially during the winter months,” says Dr. Sabharwal. “We give them photo therapy or light therapy to help with the vitamin D levels in the body, and that has also shown to help with depression.”

The recommended daily amount of vitamin D varies, but Dr. Sabharwal says healthy adults should get between 600-800 international units per day. For people with a deficiency or experiencing osteoporosis, a doctor might recommend a higher dose. But too much isn’t always a good thing.

“If you have a lot of calcium, it can increase the risk of kidney stones. It can cause constipation and belly pain," says Dr. Sabharwal. "Those are some common side effects.”

Dr. Sabharwal says the first step is getting a blood test to find out if you are low in vitamin D and following your doctor’s advice regarding dosage, especially if you are older or obese.

Additionally, any supplements should be used in combination with a healthy diet, exercise and weight management. Foods rich in vitamin D include fatty fish, fortified dairy products and eggs. Sun exposure is another good way to absorb vitamin D, but that’s not always possible in the Midwest with its unpredictable winters.

One thing to keep in mind is that vitamin D supplements alone are not going to help lower blood pressure,” says Dr. Sabharwal. “It's really exercise and diet. Those are the two things that someone can do on their own to help lower blood pressure naturally.”

The bottom line, she adds, it’s better to take control of your blood pressure now before it becomes a problem down the road.

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You see the phrase as you browse the grocery aisle: helps lower cholesterol.

But have you looked into what that means for you? And more importantly, is this something my children need to worry about?

The answer to the second question is yes, says Tricia Herman, a cardiac rehabilitation registered nurse at OSF HealthCare in Danville, Illinois. And it’s a perfect time to change lifestyles to avoid cholesterol problems as we enter a holiday eating season where you may be chowing down on unhealthy food.

What is cholesterol?

Herman says cholesterol is a fatty, waxy substance that’s responsible for building cells in our body. It also helps produce hormones and vitamin D.

“When we have our cholesterol checked, it’s not just total cholesterol that we’re really looking at. We’re looking at three different levels,” Herman says.

“The bad cholesterol is LDL [low-density lipoprotein]. You can consider it lousy. The good cholesterol is HDL [high-density lipoprotein]. And triglycerides is another level that we take a look at.”

LDL values should be less than 100 milligrams per deciliter. HDL should be greater than 60 milligrams per deciliter. And triglycerides should be less than 150 milligrams per deciliter.

Be proactive at all ages

The average person doesn’t need to memorize those numbers. Herman recommends that when you get your yearly physical, get a blood test to measure cholesterol as well. You’ll need to fast for 12 hours before the test, so Herman says to do it first thing in the morning if possible.

After the results come in, your health care provider will come up with a course of action, if necessary. That may involve follow up lab work or medicine.

What you should think about daily: a healthy lifestyle.

For kids, try for 60 minutes of exercise per day. That could be as simple as walking, Herman says.

And cut down on less healthy food choices like fried or fatty foods, sweets and red meat.

Or as Herman puts it: don’t brake and hit the drive thru because it’s the quick and easy option. Keep your foot on the gas.

“Eating habits are the hardest thing for a lot of people,” Herman says. “It’s the way we were brought up. What was served at our table when we were younger become habits we grow up with.”

Instead, try lean meats like fish or poultry. Bake, grill or broil your meat instead of frying it. Use whole grain bread instead of white bread.

“Create a meal plan for your child that has lots of fruits and vegetables,” Herman says. “Don’t have them eat on the go. Have them sit down and eat so it’s more meaningful and thoughtful.”

The consequences

High cholesterol leads to plaque building in arteries of the heart, brain or legs.

“You’re at risk for stroke if it’s happening in your brain or even in your carotid arteries [in your neck],” Herman says. “You’re at risk for heart disease if it’s happening in your heart. And peripheral artery disease if it happens in your legs.”

Herman notes that high cholesterol often doesn’t come with symptoms until it’s too late. So talk to your primary care provider if you have concerns.

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