The Other Big D (as in Vitamin D)

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Today, our D"Mine columnist and correspondent Wil Dubois takes a real close look at an essential component of our health that most of us never think about.

“But I spend a lot of time outdoors,” I told my endo.

She fixed me with a steely gaze. “And are you totally naked when you are outside?”

“Uh… sometimes…” I hedged.

“Well unless you are fully naked in the sun for at least two hours every day, you’re not going to get the vitamin D that you need.” She waved the script in front of my face, “Just take the damn pills, Wil.”

Yeah. My lab tests showed I was low on the other D -- you know, Vitamin D.

That made me ask a bunch of questions and set out to investigate the answers: Just what is this vitamin D? What does it do? What happens when we have too little? Can you have too much? And certainly, what’s the connection between the two big-Ds: Diabetes and vitamin D?

This is what I learned.

Vitamin D’s Job

Vitamin D is the body’s air traffic controller for calcium. It’s a fat-soluble vitamin that allows absorption of calcium in the gut and maintains the proper levels in the blood to promote proper bone health and growth.

At least, that’s vitamin D’s day job. It also has roles to play in cell growth, inflammation control, and immune function.

If you don’t have enough D, your bones can become thin and brittle. In kids that’s called rickets and in adults it’s called osteomalacia, or in plain English: Soft bones. But wait, there’s more. Seventeen types of cancers have been linked to low D, as have other health scourges from cardiovascular disease to lowly gum disease.

Dangerously low D is defined by the Institute of Medicine as a serum concentration of less than 30 nmol/L on a blood test. Between 30 and 50 is classified as “inadequate” for overall bone health, and over 50 is the desired level. At least up to 125, where the guidelines note that “emerging evidence links potential adverse effects to such high levels.”

OK, so where do we get D and how come many of us are low on it?

The Vitamin D Sun Connection

You have more in common with plants than you thought. Plants create energy through photosynthesis: Converting sunlight to food. In a similar way, your skin can synthesize vit-D3, a.k.a. cholecalcirerol, from ultraviolet light. The problem is that in this modern age, most of us aren’t out in the sun long enough to produce the levels we need. And how much time would that be? Well… it’s complicated. Complicated by the type of skin you have, what your age is (older folks tend to make less), where on the globe you live, what your altitude is, how polluted the air is, what season it is, how cloudy it is on any given day, and how fond of sunscreen you are.

Entire books have been written on how to calculate the exposure needed, but the consensus seems to be that most people need between 15 minutes and two hours with arms, legs, and the bulk of your trunk exposed (despite what my endo said, being totally naked is apparently optional), every day, at mid-day. The largest variable in determining how much time you need in the sun is your skin color. Apparently a china-skinned redhead might squeak by with 15 minutes, whereas someone with beautiful dark skin might need a couple of hours.

A handy guideline for white folks is to get daily sun exposure equal to half the time it takes to turn your skin pink. According to the Vitamin D Council, the body can produce between 10,000 to 25,000 IUs of vit-D per day in this period of time. But a sunset walk with your sweetie won’t cut it. At low sun angles the earth’s atmosphere filters out the vitamin D making UV rays.

So how do you know if the sun is too low? Apparently, the Shadow Knows. If your shadow is longer than your height, you aren’t making D. And unless you live at the equator, you probably won’t be able to make vit-D in the winter. Even at noon, the sun is at too steep an angle for the UV to get through the atmosphere.

One thing is clear: Most of us can’t get that much skin exposed, to that kind of sun, that often, which may be why low D is at epidemic levels.

Vitamin D in Food?

Apparently, there’s not too much vitamin D in food, and experts agree that it’s not possible to get enough dietary D to meet your body’s needs. You have to get some from the sun and or from supplements. That said, naturally occurring vitamin D is found in cod liver oil (yuck!), swordfish (yum!), sockeye salmon, tuna, sardines… are you seeing a pattern here? On dry land, vitamin D is found in beef liver and egg yokes.

Of course, most milk sold in America is “fortified” with vitamin D, as is most orange juice.

On Diabetes and Vitamin D

In the U.S., low vitamin D is estimated to affect 41.6% of people overall, with the rate being highest in darker-skinned ethnic groups. It’s even higher for people with diabetes. One study out of India found that among recently diagnosed young people with type 2 diabetes, 91.1% of them had low vitamin D, compared to a 58.5% rate in the “healthy” controls. Similar numbers are seen in the type 1 community.

So does diabetes make vitamin D levels lower, or is something more sinister going on?

Some researchers believe that low D is actually a causative factor in both type 1 and type 2 diabetes. In type 1s, the smoking gun seems to be vitamin D’s role in immune system regulation, and it’s been pointed out that type 1 is more common in higher latitudes, where getting enough sunlight for adequate vitamin D synthesis is problematic. And on another cheery note, once you have type 1, having low D seems to increase your risk of dying prematurely.

In type 2s, there’s evidence that low levels of D reduces insulin secretion and increase insulin resistance. Further, in people who already have established diabetes, low D hinders glycemic control.

Double the D, Not Double the Fun

It’s easy enough to get your D levels checked. Given all manner of ills that low D causes, both diabetes-specific, and to your health globally, perhaps a healthy vitamin D level is nearly as important as a good A1C level is. And so much easier to achieve. All you have to do is party naked in the sun, or pop a supplement.

But not having access to Hugh Heffner’s swimming pool, I guess I’ll have to take the damn pills. And you should too.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn"t adhere to Healthline"s editorial guidelines. For more information about Healthline"s partnership with Diabetes Mine, please click here.

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