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Vitamin D Products - When Are They Useful?

What should I look out for when using vitamin D?

Basically, the DGE recommends that an adequate supply of vitamin D is best achieved through the body's own production through exposure to the sun and through diet. Only if this is not sufficient should vitamin D supplements in the amount of the reference value (20 µg / day) be taken. For people who live in nursing homes, the BfR recommends a general supplementation with vitamin D at 20 µg / day.

- If you do not belong to one of the risk groups (see below) - you should first have a blood test (usually an IGe service that is subject to a fee) to determine whether you actually have an inadequate supply and whether an improvement in supply is neither due to a cheaper choice of food can be achieved through the body's own vitamin D production through increased exposure to the sun.

However, you should discuss taking a vitamin D product with your doctor. If there is a real deficiency, he or she may be able to prescribe suitable finished medicinal products for you based on the results of the blood test.

You can find out which costs are covered by the health insurance here.

According to the German Nutrition Society, it makes sense to take a vitamin D preparation (up to 20 µg or 800 I.U. per day) to ensure a vitamin D supply for people belonging to the risk group. Nevertheless, to be on the safe side, you should speak to your doctor beforehand if possible.

You belong to one of the risk groups, If you:

  • are older than 65 years, because the self-production of vitamin D decreases with age. It has not yet been clarified why older women in particular are more likely to be undersupplied than older men. The causes could be the naturally higher body fat percentage of women, the avoidance of sunlight by looking for shady areas, the more extensive coverage of the body outdoors, the more frequent use of sunscreens and skin creams with sun protection factor or the inadequate consumption of foods rich in vitamin D.
  • to the very old seniors include: Difficulties in providing care can arise especially if you are restricted in your mobility and can no longer be in the sun (e.g. if you are bedridden).
  • never go into the sun with your skin bare, for example, because you have a strong sun allergy or because you only go outside under cover for religious reasons.
  • a have dark skin tone, because the UVB rays of the sun are more strongly blocked by the increased melanin content in the skin.


Vitamin D poisoning is not possible through excessive sunbathing, but rather just by oral delivery. The Federal Institute for Risk Assessment recommends a maximum daily amount of 20 µg vitamin D (= 800 i.E.) in food supplements. Before use, it makes sense to have the blood serum level checked by a doctor in order to clarify any need.

A daily intake of vitamin D supplements with doses of 50 µg or 100 µg is not necessary from a nutritional point of view. However, the BfR currently considers health impairments to be unlikely if such high-dose preparations are only consumed occasionally. However, if you were to take high-dose vitamin D supplements on a daily basis over the long term, the current study situation indicates an increased health risk.

Under no circumstances should more than 100 micrograms (= 4000 i.E.) total (including food) be consumed per day: Headache, nausea and loss of appetite, vomiting, constipation, reduced muscle tone in the worst case even kidney calcification and kidney stones up to a decrease in kidney function. could be the result. Serious damage to health occurs time and again, especially with significantly higher dosed products from the Internet. Note that this overdose can also occur gradually, as vitamin D can be stored in the body for a long time and gradually adds up. Here you will find a report from the everyday life of a family doctor.

Interactions with medication are possible: Caution should be exercised when taking, among other things Cardiac glycosides commanded. An increased calcium level caused by vitamin D can increase the effects of these drugs and lead to cardiac arrhythmias. If you need to take any medication, it should be discussed with your doctor or pharmacist before buying any dietary supplement. He can tell you whether there is a risk of reciprocal effects and how you can avoid them, if necessary, through time intervals.


Note:
These vitamin D compounds are approved in food supplements in Germany and other EU countries (in accordance with EU Directive 2002/46 / EC, Annex II (version of 05.07.2017)):

  • Cholecalciferol (D3)
  • Ergocalciferol (D2)
     

According to an expert commission (BVL / BfArM), products can only be classified as dietary supplements up to a daily dose of 20 micrograms of vitamin D (= 800 i.E.). Higher dosed preparations are to be regarded as medicinal products.


 
Dietary supplements are offered with vitamin D3 (animal) and vitamin D2 (vegetable). Vitamin D2 is obtained from yeast by UV irradiation of ergosterol (vitamin precursor). It is therefore vegan, but is not absorbed quite as well by the body. Vitamin D3 for food supplements is usually obtained from wool fat (lanolin). In vegan products that are offered with vitamin D3, the vitamin comes from certain lichens. Genetically engineered carriers for this vitamin are possible.
 

Tip:

  • Go in the sun for some time every day (e.g. walk at lunchtime) and thus stimulate your body's vitamin D production.
  • However, make sure you have adequate sun protection when sunbathing for long periods.
  • Fatty sea fish such as salmon, mackerel, sardines as well as eggs, mushrooms and margarine, which are fortified with vitamin D, also provide valuable vitamin D.
  • An adequate calcium intake, physical activity and sport also strengthen muscles and bones.


How is the supply situation in Germany?

According to the DGE, the frequency of an inadequate supply of vitamin D is high in Germany. Especially in the winter months in our latitudes, UVB radiation is not sufficient for vitamin D synthesis in the skin (but it still takes place). During this time, the body draws on the vitamin D stores in fat and muscle tissue as well as in the liver, which are hopefully well filled by the spring and summer sun. This supply is usually enough to get through the winter without deficiency symptoms.

Nevertheless, the majority of Germans do not achieve the optimal vitamin D blood level of 50 nmol / l, especially in winter, which is measured using the "25-hydroxyvitamin D" marker etc. (see below: covering daily requirements). This value is considered to be desirable in terms of bone health by the German Nutrition Society, which is based on the classification of the US Institute of Medicine (IOM) (see table).

But most of them are far from a clinical vitamin D deficiency, which also has health effects. The Robert Koch Institute speaks of 15.2% of adults (18-79 years) and 12.5% ​​of children and adolescents. According to the IMO classification, a vitamin D deficiency is present at a "25-hydroxyvitamin D" concentration below 30 nmol / l.

The vitamin D status is determined by measuring 25-hydroxyvitamin D (short 25 (OH) D.) in the blood serum. It can be in the units nmol / l or ng / ml (to convert nmol / l to ng / ml, divide the value by 2.5). The laboratory methods are still not standardized, however.

25 (OH) D.
in nmol / l

25 (OH) D.
in ng / ml

Interpretation according to IMO classification (source: RKI)

<30

<12

Inadequate care places an increased risk of diseases such as rickets, osteomalacia and osteoporosis.

30-<50

12-<20

Sub-optimal supply with possible consequences for bone health.

50 -<75

20-<30

Adequate care related to bone health.

75-<125

30-<50

Adequate care in terms of bone health with no additional health benefits.

≥125

≥50

Possible oversupply, which can have negative health consequences for the body, for example hypercalcemia, which can lead to cardiac arrhythmias or kidney stones.