The Vitamin D Disparity

According to an article published by Cureous in June 2018 and cited by the NIH, Vitamin D deficiency is becoming an epidemic across the United States, even among groups that were not previously labeled "at-risk."¹ But now, our current situation with the pandemic, economic uncertainty, rising unemployment, and reduced access to healthcare, has exposed the problem of Vitamin D deficiency and the disparity across different populations to an even greater extent.

First, let’s understand why Vitamin D is important.

There are serious risks of Vitamin D deficiency on your health and immune system, accelerating the aging process. We have receptors for Vitamin D all over our body, allowing it to influence our cardiovascular, endocrine (hormone) and nervous systems.²Vitamin D is known as a fat-soluble vitamin, but it functions as a hormone in our body, playing a vital role in processes like stopping the vulnerability or degradation of our DNA as we age. Some specific roles Vitamin D plays is helping our bodies protect against:

Osteoporosis, poor bone health, increased risk for falls and imbalance, especially with age
Cancer
Heart disease, high blood pressure²
Diabetes
Autoimmune conditions (MS)
Cognitive decline¹
Mood disorders/depression/anxiety³
Risk for cold/flu and more severe symptoms of infection⁴

Where do we get Vitamin D?^3,5

Sunshine: We mostly get our Vitamin D from the sun. Just 15 minutes of sunshine (without sunscreen) per day is enough, in a healthy person, for the body to use the UV light to activate Vitamin D in the body. Of course, be sure to wear sunscreen the rest of the time to reduce risk of melanoma and skin cancers.

Source: Harvard Medical School

Food: Obtaining enough Vitamin D through your diet is a far less efficient way of obtaining enough for supporting your health, compared with sun exposure or supplements. While these foods also have other nutrients important for our wellbeing, like protein, Vitamin E, calcium and potassium, the Vitamin D we consume from them must first be absorbed and then activated.
- Fish like sardines, salmon, herring, mackerel
- Egg yolks
- Milk, cheese, yogurt and other dairy products
- Fortified nondairy milks, yogurts and other products
- Mushrooms
Supplements: Vitamin D is a great example of when supplements are important to consider, because it is so difficult for many people to get enough from food and sun alone. We need at least 600-800 IU per day, however, more is often needed to sustain an adequate blood level, based on individual risk factors.

Why are some people more at risk for Vitamin D deficiency than others?

Research has shown that as much as 40% of the US adult population is Vitamin D deficient. Race and age are risk factors, with a high prevalence of documented deficiency in 82% of African-Americans, 63% of Latinx adults and 46% of elderly^1,6,7,8

Why is there disparity? It’s important to consider this question from an ecosystem perspective. Meaning, it’s more of a ‘perfect storm’ of many risk factors happening all at once and compiling over time, versus a single issue. There are socio-economic, lifestyle and other factors hindering the health of our citizens, that we have the power to change if we prioritize public health policies to address the systemic issues that have contributed to these health inequities.

What are the risk factors for Vitamin D deficiency, that we know about?

AGE^1,6,9

Anywhere from 40% up to 70% of the elderly population (65+) is Vitamin D deficient, for several reasons, including:
- Our skin naturally gets thinner with age, making it harder for the body to absorb Vitamin D from the sun, which is our primary source.
- Mobility and other challenges to activities of daily living can exist in the elderly, making getting outdoors for sunshine challenging.
Frailty risk is elevated in the elderly when vitamin D deficiency is present.

SKIN COLOR, MELANIN^1,10,11

Skin cells produce melanin, a natural pigment that gives skin and hair their color. Darker skin means more melanin is produced in the body. Melanin reduces the body’s ability to produce Vitamin D.

GEOGRAPHY¹²

Living in a northern region of the world, where sunlight is less direct, many days of the year increases risk for Vitamin D deficiency.
Rates of insufficient blood levels have been reported to be as high as 73% with 8% being overtly deficient, in populations residing in northern latitude countries, such as the northern US, Canada, or Scandinavian countries.

MALABSORPTIVE GUT DISORDERS, LIKE IBD¹³

Vitamin D is a fat-soluble nutrient, requiring the body to be able to properly digest and absorb fats. Many persons with celiac, Crohn’s disease, colitis and other gut health conditions have reduced absorptive capabilities for fats. 25% of patients with Celiac disease are reported to be Vitamin D deficient.

OBESITY^1,14

Persons with a BMI > 30 have higher rates of Vitamin D deficiency (42%) compared to those with BMI < 30 (31%). There are several factors at play with how weight relates to D status. For example, persons carrying extra weight may be less likely to spend time outdoors due to mobility issues or sedentary job; fat-soluble vitamin absorption is impaired post-gastric bypass surgery. Another theory is that adipose tissue (fat cells) sequester this nutrient, making it unavailable to the blood for use around the body. However, research has yet to fully understand if having extra weight puts you at risk for low D, or if low D puts you are risk for carrying extra weight.

ACCESS^8,11

Many people living in the US don’t have access to doctors, dietitians and blood tests which can screen for and treat nutrient deficiencies.
Access to enjoying safe spaces outdoors for sunlight can be a challenge in many US cities and neighborhoods, which is even more pronounced with Covid-19 restrictions for social distancing causing reliable public spaces to remain closed.
Education and public health messaging doesn’t reach all communities equally.
Financial challenges as vitamins and healthy groceries can be expensive.

OCCUPATIONAL HAZARDS^15,16,17

Shift work has been linked to increased risk for diabetes and lower levels of Vitamin D.
Poor sleep, especially due to the stressors of working multiple jobs or balancing work with the demands of raising a family.

What can you do to help overcome this Vitamin D disparity? Here are 5 action steps:

Get tested. Even if you don’t think you’re at risk for low Vitamin D, the only way to know for sure is with a blood test. Ask your doctor to test your Vitamin D level, called the 25 OH D test, at your next visit.
Take a Vitamin D supplement. Having a blood test is the best way to know how much to take, however, if it’s going to be a while before you can get tested, it’s generally safe to start now with 2,000-4,000 IU per day. If you take medications, have health conditions or any concerns, speak with your medical provider before beginning a supplement. Don’t let cost be a barrier, shop around and if eligible, supplements can be purchased with snap benefits¹⁸
Get outdoors for at least 15 minutes a day
Eat a healthy, balanced diet and make time for exercise to reduce your risk of excess weight gain.
Get involved with local advocacy groups, community food and shelter organizations, write your congressperson to demand equal access to health care for all our citizens.

References:

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The Vitamin D Disparity

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