October 2013: Question 3
The DRI For vitamin D has recently increased to 600 IU/day
for adults 70 years and younger and 800 IU/day for adults 71 years and older.
How would you advise someone to increase his or her vitamin D stores? How could
you explain to them the importance of increasing their vitamin D intake?
posted by Unknown @ 7:24 PM
12 comments
12 Comments:
Sarah S said...
I would definitely encourage people to get adequate sunlight when possible. I would advise people to take a supplement, especially in the winter, in order to get adequate vitamin D levels if they live in the midwest/north, as they will not get enough from the sun during this time. I would explain to them that vitamin D is very important for bone health and may have important effects on other diseases like colorectal cancer, and is being further investigated for its role in other conditions.
Like Sarah said, I would inform them that that they can get vitamin D through sun exposure. The majority of people likely have an inside job so they cannot get adequate sun exposure on a daily basis. Since it is difficult to get the appropriate amount of vitamin D through diet alone I would advise them to take a supplement.
Since in the winter we can't get adequate D from the sun, I'd suggest buying some fish oil vitamin D-3 supplements (that way they can get the added benefits of fish oil too). I'd explain that vitamin D is used for treating weak bones (osteoporosis), bone pain (osteomalacia), and bone loss in people with a condition called hyperparathyroidism. It is also used for preventing falls and fractures in people at risk for osteoporosis, and preventing low calcium and bone loss in people with kidney failure.
I would help my client identify different sources of vitamin D like fatty fish, fish oils, beef liver, cheese, and egg yolks in addition to fortified foods. I'd also share with them that vitamin D is produced within our bodies when our skin is exposed to ultraviolet rays from sunlight and that folks living in the northern hemisphere during the winter months likely do not receive enough sun exposure so it is very important that they consume adequate amounts through diet.
I would use evidence based research to justify the importance of proper Vitamin D consumption. As far as advising someone to increase their vitamin D stores, I would again go back to the physiology by educating the patient on how our bodies make and use Vitamin D as well as foods that are rich in Vitamin D. Finally, I would discuss supplementation and design a plan of action for their specific lifestyle.
This is one that I would encourage pt needing higher amounts of Vit D to take a supplement especially in the northern states that have such a long winter and less exposure to sunlight. I would also encourage vit D fortified foods and dairy products. Vit D is essential for healty bones and other physiological functions and shouldn't be ignored. I would emphasize the risk for women as they age to have bone deterioration and the importance to accommodate their Vit D needs as they age.
I like Lynetta's idea of helping the pt identify sources. Kaitlin-great idea of helping the pt with a supplement plan!
Sarah S said...
I agree with Lynetta that it would be beneficial to talk about the food sources of vitamin D, especially if the pt does not like the idea of taking a supplement and wants to get their nutrients more from foods.
I would suggest to someone who did not receive enough vitamin D from sunlight, to consume Vit-D fortified milk, fatty fish, and eggs. If the client is vegetarian or vegan, I would then suggest a supplement to ensure they are getting adequate amounts of Vit-D. This information may be important for someone of the older population, because synthesis of Vit-D reduces as we age. I would also remind them of the risk of developing osteomalacia, bone fractures, and osteoporosis when inadequate vitamin D and calcium are consumed.
I agree that providing a summary of evidence based research for the client is important. I would try to stay informed of new research to keep my clients up to date of ways to prevent diseases through diet.
I think the DRI recommendation may still be below what is necessary to achieve an optimal blood 25-hydroxy D level for health, considering how much we still don't know about vitamin D. If someone is at a high risk for osteoporosis, it might be prudent for them to get tested for this to see where they are at, and take a slightly higher dose of oral D3 if indicated. Responsible sun exposure each day can help boost the mood as well as the production of vitamin D, but in the winter time in northern states it might almost be necessary to supplement if they are unable to get adequate intake of dairy.
Everyone has brought up great points. Courtney gave great examples of fortification. Also a good point that if a person is a vegetarian their care plan might be much different than someone who eats meat.
Many brought up the importance of considering the time of year when talking to clients about vitamin D. I think it is important that if you are counseling someone during the summer months that you also emphasize how their consumption would be different in the winter.
I would suggest that they spend some time outside in the sun to increase their vitamin D production. It also helps increase mood as well, so it is an all around good practice for older individuals. During the winter months I would suggest they take a supplement since they are unable to get enough from the sun. I would also explain its important role in body and why it is key that they try to keep their levels up.
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