Tuesday, April 20, 2010

Time for some Vitamin D (Part 1—with FLAN FAIL!)

Fiesta!  Time to celebrate!  I’m done with classes in medical school and just hanging out until graduation on May 16.  This includes some much needed sun in Mexico (we leave on Sunday) with my best friend from high school. 

When I went home last month to visit my mom, I had a skirt on to honor springtime.  She was aghast the pastiness of my white legs.  We went on a walk that night and my two stumps were aglow in the moonlight.  

While this complaint of lack of sun seems vain, it elucidates the negligible amount of time I’ve spent in the sun in the past three years.  Not only have I lived in Cleveland, voted by Forbes to have the worst winter weather in America, but seemingly, for the past two summers, I have done my absolutely hardest rotations during peak summer sun hours.  Going into the hospital before the sun’s up and catching only the twilight zone at the end of the day just does not help. 

Even though basking in the sun puts people at increased risk for deadly skin cancers, one benefit from our favorite burning ball of gas, besides sanity, is that the skin reacts with sunlight to produce vitamin D.  Vitamin D, if you haven’t noticed, is all the rage right now.   A quick literature search reveals research blaming vitamin D deficiency for everything from heart disease to diabetes, low birth weight babies, chronic pain, pelvic floor disorders and neurologic deficiencies. 

Obviously this is a rapidly growing area of interest, but is the hype real?  Even three years ago in my first year of medical school I was taught the vitamin D deficiency was quite rare and remember the lecturer saying that “only some old lady who doesn’t eat anything and is locked up in her bedroom all year” could lack this essential nutrient. 

Vitamin D deficiency is actually much more prevalent than once previously thought.  When I did an endocrinology rotation all of the fellows who are young and healthy tested their vitamin D blood levels.  They were all insufficient.  In the National Health and Nutrition Examination Survey from 2001-2004 of 6275 nationally represented children from ages 1-21, 9% were deficient and 61% were insufficient [1].  A study of 2500 mothers and infants in urban Boston showed that 58% of infants and 35.8% of mothers were severely deficient [2].  People of darker skin color and colder climates are at the highest risk.

In the next post, I’ll discuss the role of vitamin D in the body, and review some of the literature about the health effects of deficiency.  I’m sure you’re wondering how you can boost your own vitamin D levels.  Get outside and get some sun.  Supplemental tablets  (the Institute of Medicine is about to release new dosage guidelines) and foods with vitamin D such as fortified milk products, eggs and fish, are also good sources. 

To prepare for my Mexican adventures and to boost all of our vitamin levels with eggs and milk in a sweet way, I tried to make some cinnamon infused flan.  I just love anything custardy.  In fact, my very first memory wasn’t of my parents or our cats but of custard that our neighbor made.  And the donuts we ate at the beach.  I’ve been a life-long food lover, and now I want to share it with you. 

Well, you see, I wrote this post and had a FLAN FAIL!  It looked great until I tried to flip it and it turned into a puddle of soupy caramel egg mush.  So, for the next post, I’ll try a new recipe that is guaranteed to succeed.  For now, I give you my stages of flan grief. 

1.  Kumar, J., et al. “Prevalence and Associations of 25-Hydroxyvitamin D Deficiency in US Children: NHANES 2001-2004.” Pediatrics, 2009.
2. Merewood, A., et al. “Widespread vitamin D deficiency in urban Massachusetts newborns and their mothers.” Pediatrics, v. 125 issue 4, 2010, p. 640-7.


  1. Very informative post! I am going to check with my daughter's neo specialist to see if some vitamin D could help her (29 weeks-6 weeks on bed rest)..I know I get very blue during the winter month's; so I took vitamin D all winter this year and I did feel better..I also heard there is a lot of vitamin D in potato skins..so I always leave the skin on now even for mashed!

  2. Hey, looks tasty anyway. Looking forward to Vit D. post the sequel. I've been meaning to sit down with the Vit D literature and separate hype from reality for a while. Glad you're doing it instead! :)

  3. Amy, glad you're looking forward to it...but don't have too high of expectations. I mean, you are the queen of finding BS in science papers!

  4. Sorry about the flan! I recently had a similar experience with reduced sugar gluten free peanut butter cookies. They were perfect the first time, but flopped the next 2 times I made them. Frustrating.

    I swear by vitamin D. Running my own little experiment where the hubby doesn't take any...he will get sick and I won't (and I have the immune system of a gnat with full blown AIDs and a side of Ebola). The toddler had 6 or 7 URIs in a row, I only caught one (of course that was the one that landed me in the ER for the first time in 4 years but c'est la vie).

    My mom got sick-- she did better when I gave her some of my vitamins (including D). When she got lazy about it, her symptoms got worse.

    I hope they keep studying D3, I really do think there's merit to it. I'm a fan!

    Even with all the supplementation I do, my D level is a surprisingly low normal and I've been using it for a few years now.


  5. qué te apuesto que estaba rico IGUAL!!!
    están excelentes las fotos, amigaaaaaaaa!!!
    te adoro!

  6. "Supplemental tablets (the Institute of Medicine is about to release new dosage guidelines) and foods with vitamin D such as fortified milk products, eggs and fish, are also good sources. "

    Check out the Vitamin D Council at www.vitamindcouncil.org. The new recommendations tend to be 5000 IU per day for adults.

    Vitamin D is actually a hormone, and the blood levels for optimal health are on a continuum without a sharp cut-off point. It affects so many functions in the body that a high level is needed for optimal health.

    But milk has D2, which is worthless, and eggs and fish are only "good sources" relative to most other foods, but do not have nearly enough to get people into the optimal range. The only food I know of that has a really significant amount of vitamin D is cod liver. In Scandinavia this is relatively easy to get in cans or fresh.

    Vitamin D helps to prevent and repair skin cancer, so staying out of the sun is not helpful. The highest rates of skin cancer are among office workers relative to people who work outdoors and probably get more vitamin D. Get some sunshine! A vast majority of the population would benefit from more sun and not less.