Crackdown on Vitamin D Fortification is Troubling
Douglas Andersen, DC, DACBSP, CCN
Volume 21, number
20, 9/24/03, page 17
Includes discussion on how we make vitamin D and the risk factors for
deficiency and the recent decision to remove it form many vitamin fortified
protein bars and powders.
A few months ago I noticed
vitamin D was removed from my vitamin- and mineral-enriched protein powder.
Since I tend to be a label reader, when I started looking at other brands,
I noticed that they, too, began to remove vitamin D. I also noticed this
in many of the protein and carbohydrate bars in the health food store. I
called the manufacturer to ask why they eliminated vitamin D from their
product, and was told that the government forced them to do so.
On April 1, 2003, the Revised Code of Federal Regulations was released.
In Title 21, volume 3, part 184, subpart B, section 184.1950, vitamin D
is discussed. In that section, the law states that only the following foods
may be fortified with vitamin D.
Milk and milk products
Grain products and pastas
The restrictions on vitamin D fortification to food are troubling due to
the fact that there is less vitamin D in foods than any other vitamin. The
best sources are fatty fish. Vitamin D is also found in egg yolks, butter,
cream, and liver. Of the food groups where fortification is allowed, only
milk (100 IU/8 oz – 25% US RDA) is a significant source.
In many western countries, including the United States, populations are
aging. In the US, consumption of milk, butter, and eggs is decreasing. People
are also using more sunscreen and trying to stay out of the sun. All of
this contributes to vitamin D deficiency, which is a growing problem and
an important factor in the increasing rates of osteoporosis. See
Tables 1, 2, and 3.
Table 1 – Risk
Factors for Vitamin D Deficiency
Persons concerned about skin wrinkles and skin cancer who avoid sun exposure
Living in temperate to higher latitudes
Persons with dark skin
Indoor occupations and living
The elderly (two-thirds less 7-DHC is produced in the skin)
Fall and winter
Table 2 – Causes
and Effects of Inadequate Vitamin D
hormone (PTH) is increased.
is resorbed from the bones
is elevated; bone density decreased
Table 3 – Vitamin
D and Calcium
Vitamin D stimulates calcium absorption from the gut
Vitamin D stimulates calcium reabsorption from the kidney
Vitamin D stimulates calcium resorption from bone (when dietary calcium
Many scientists do not consider
vitamin D to be a true vitamin, since man can synthesize it internally.
See Table 4, How We Make Vitamin D.
Table 4 – How
We Make Vitamin DUltraviolet light converts
7-DHC to cholecalciferol (D3)
Sebaceous oil glands in the skin secrete 7-dehydrocholesterol (7-DHC)
to the skin surface
the liver, enzymes convert D3 to 25-hydroxycholecalciferol (25-D3)
the kidneys, 25-D3 is converted to 1,25-dihydroxycholecalciferol (1,25-D3)
1,25-D3 is the active form of vitamin D
Most of the companies that
sell supplements to chiropractors are concerned about hypervitaminosis
D and use low levels of vitamin D, even in their bone-building formulas.
In my personal experience, I have seen scores of patients with vitamin
D deficiency. See Table 5.
Table 5 – Vitamin D Deficiency Statistics, 3
25-D3 is the most accurate lab measurement.
50% of non-Caucasian women had deficiency in a South Wales study
75% of adolescent girls needed 800 IU/day in the winter just to maintain
normal levels in a Finnish study
50% or more of nursing home patients are deficient
35% of adults over age 50 that were admitted to Massachusetts General Hospital
for any reason were vitamin D deficient
· The farther north you live from the equator the less vitamin D
you make. If you live in cities such as Boston, Milwaukee, or Boise you
will not make vitamin D from November to February, even if you are in the
sun all day. Go further north to Edmonton and you will not make vitamin
D from mid October to mid April.
Conversely, I have never had
a case of hypervitaminosis D in my practice. I have found one brand of
multivitamin that contains 2000 IU of vitamin D per 3 tablet serving.
I have used this successfully with the above-mentioned low vitamin D bone-building
formulas in many patients who want to increase bone density. See
Table 6 – Hypervitaminosis
Extra vitamin D from sun exposure is destroyed by the body
At least 2000 IU/day for 18 months is required for toxicity
2000 IU/day is the current no-adverse-effects level (NOAEL)
A recent paper states that NOAEL should be 10,000 IU/day
The reason why vitamin D deficiency
is so often overlooked is that there are often no symptoms of deficiency
until levels are severely depressed. See Table 7, Vitamin
D Deficiency Signs and Symptoms.
Table 7 – Vitamin
D Deficiency Signs and Symptoms 2,3
Ricketts in children and infants (knock knees, enlarged joints, pigeon chest,
bulging forehead, pot belly, and bowed limbs)
Osteomalacia in adults
Muscle twitching and convulsions (tetany)
Low serum calcium
Gnawing bone pain
Increased risk to breast, prostate, and colon cancer
Increased risk of falling
Conversely, by taking a dietary
history and analyzing supplements, vitamin D toxicity is much easier to
catch. See Table 8, Vitamin D Toxicity.
Table 8 –
Vitamin D Toxicity Signs and Symptoms8
High serum calcium
Nausea and vomiting
Alternating diarrhea and constipation
1. Code of Federal
Regulations, Title 21, Volume 3, Part 184, 2003.
2. Plehwe, W.E. Vitamin D Deficiency in the 21st Century: An Unnecessary
Pandemic? Clinical Endocrinology. 2003; 59: 22-24.
3. Liebman, Bonnie. Vitamin D Deficiency: The Silent Epidemic. Nutrition
Action. 1997; 24(8): 1-6.
4. Boik, John. Natural Compounds in Cancer Therapy. Oregon Medical Press.
5. Vieth, R. Vitamin D Supplementation, 25-hydroxyvitamin D Concentrations
and Safety. Am J Clin Nutr. 1999; 69(5): 842-56.
6. Malabanan, A.O., Holick, M.F. Vitamin D and Bone Health in Postmenopausal
Women. J Women’s Health. 2003; 12(2): 151-6.
7. Studzinski, G.T., Moore, D.C. Sunlight – Can it Prevent As Well
As Cause Cancer? Cancer Research. September 15, 1995; 55: 4014-22.
8. Ensminger, A.H., Ensminger, M.E., Konlande, J.E., Robson, J.R. Encyclopedia
of Foods and Nutrition. CRC Press: Boca Raton, FL. 1995.
E. Imperial Hwy.
Brea, CA. 92821
2004, G. Douglas Andersen, DC, DACBSP, CCN, 916 E. Imperial Hwy, Brea,
CA 92821, (714) 990-0824