Sunday, April 25, 2010

Time for some Vitamin D (part 2) Que FLAN-TASTICO!

In my last post, I admitted that I’m not only pale, but a failure.  Well, these two things are about to change.  Sun is coming my way, and my second attempt at flan unveiled a beautiful, creamy delight.  In the last post, I also discussed how vitamin D deficiency and insufficiency are much more common than previously thought.

So what is vitamin D anyway? And why could deficiency affect your health?  Vitamin D, a hormone, can be formed in skin exposed to sunlight or through ingestion.  Vitamin D is involved in an intricate hormonal pathway that helps the body absorb calcium and phosphorus in the gut.  Metabolic derivatives of vitamin D also increase kidney absorption of calcium and promote bone formation. 

Vitamin D is a hot topic in research right now.  Vitamin D is very important in bone health and deficiency is thought to contribute to low bone mineral density and osteoporosis.  Recent studies, including a meta-analysis by the Cochrane review show that supplementation of vitamin D alone cannot prevent fractures in postmenopausal women, but vitamin D taken with calcium can have an effect in preventing bone breaks [1].  A recent randomized control trial of post-menopausal women who were given dietary supplementation of calcium and vitamin D rich foods had less frequent bone breaks than those who were not part of the intervention [2]. A study of women given vitamin supplementation of calcium and vitamin D had decreased bone fractures compared to those untreated [3].

Other effects of vitamin D seem to be less well supported by well designed, randomized controlled trials.  Vitamin D, along with bone health, is although thought to be associated with pain control, muscle health and strength [4].  The Cochrane Review of effects of vitamin D in chronic pain shows that most research is inconclusive [5].  As for muscular integrity, in a small, retrospective study of pelvic floor disorders (urinary incontinence and organ prolapse) in post-menopausal women, those with pelvic floor disorders had a significantly higher rate of vitamin D deficiency, even when controlled for age, race and number of babies born [6].  The proposed mechanism for this finding is related to muscular health. 

There is an incredible amount of research looking at vitamin D deficiency and its effects on various diseases.  It will definitely be an interesting field to follow, so keep your eyes open!  As for my opinions on this, I think little harm can come from increasing vitamin D and calcium intake and supplementation can improve general health, especially if you live somewhere cold.   Eggs and milk are a great way to get some vitamin D, and this flan which I copied exactly from Julia Child has LOTS of both.  I went straight for the fat after my attempts at a healthier, less lipid laden attempt at flan that was ugly and boring and broke like stink.  So, if you want a yummy flan, don’t cut corners, just cut little pieces and share with lots of friends. 

Que Flan-tastico ! Julia Child’s Flan from The Way to Cook with an Elizabethan kick

(left my cookbook back in Cleveland so these are my abbreviated instructions)

For caramel sauce
¾ cups sugar
3 tbsp water

For flan
6 whole eggs
5 egg yolks
¾ cups sugar
4 cups whole milk
1 cinnamon stick
½ vanilla bean scraped and added to milk
1 tsp ground cinnamon
¼ tsp ground nutmeg
Pinch salt

Preheat oven to 350.  For caramel sauce. Over low heat in heavy bottomed sauce pan, swish around pan without stirring until sugar is dissolved.  Once sugar is dissolved, increase heat to medium high, cover and cook until sugar is dark, about 5 minutes.  In 4 inch deep dish or soufflĂ© pan, add half of caramel sauce to bottom of dish and swirl around bottom and sides until coated.  To other half of caramel sauce, add ¼ cup water and reserve for top of flan. 

In saucepan, over medium heat up milk with vanilla bean, cinnamon and nutmeg until steaming.  In large bowl, mix together eggs and sugar until well mixed but not foamy.  Slowly add milk to egg mixture, and whisk until mixed.  Strain mixture over dish.  Put dish in casserole dish in oven and add boiling water to about halfway up the flan dish.  Bake for about 1 hour to 1 hour 15 minutes or until flan is formed but still wiggles in the middle.  Remove from water and allow to cool.  Run sharp knife around edge of flan and invent carefully onto a large plate.  Serve with extra sauce and enjoy!!

1. Avenell, A.; Gillespie, WJ.; Gillespie, LD.; O'Connell, D. “Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis.” Cochrane Database Syst Rev, issue 2, 2009, p. CD000227.

2. Moschonis, G.; Katsaroli, I.; Lyritis, GP.; Manios, Y. “The effects of a 30-month dietary intervention on bone mineral density: The Postmenopausal Health Study.” British Journal of Nutrition,, 2010, p. 1-8.

3. K, et al. “Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65-71 years: a 3-year randomized population-based trial (OSTPRE-FPS).” Osteoporosis International,, 2010.

4. Venning, G. “Recent developments in vitamin D deficiency and muscle weakness among elderly people.” BMJ: British Medical Journal, v. 330 issue 7490, 2005, p. 524-6.

5. Straube, S.; Derry, S.; Moore, RA.; McQuay, HJ. “Vitamin D for the treatment of chronic painful conditions in adults.” Cochrane Database Syst Rev, issue 1, 2010, p. CD007771.

6. Badalian, SS.; Rosenbaum, PF. “Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey.” Obstetrics and Gynecology, v. 115 issue 4, 2010, p. 795-803


  1. "Eggs and milk are a great way to get some vitamin D..."

    I like the way you mix the science and the cooking, but consider the following.


    The case against ergocalciferol (vitamin D2) as a vitamin supplement1,2

    Lisa A Houghton and Reinhold Vieth
    1 From the School of Nutrition and Dietetics, Acadia University, Wolfville, Canada (LAH); the Department of Nutritional Sciences, University of Toronto, Toronto, Canada (RV); and the Mount Sinai Hospital, Toronto, Canada (RV)

    Supplemental vitamin D is available in 2 distinct forms: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Pharmacopoeias have officially regarded these 2 forms as equivalent and interchangeable, yet this presumption of equivalence is based on studies of rickets prevention in infants conducted 70 y ago. The emergence of 25-hydroxyvitamin D as a measure of vitamin D status provides an objective, quantitative measure of the biological response to vitamin D administration. As a result, vitamin D3 has proven to be the more potent form of vitamin D in all primate species, including humans. Despite an emerging body of evidence suggesting several plausible explanations for the greater bioefficacy of vitamin D3, the form of vitamin D used in major preparations of prescriptions in North America is vitamin D2. The case that vitamin D2 should no longer be considered equivalent to vitamin D3 is based on differences in their efficacy at raising serum 25-hydroxyvitamin D, diminished binding of vitamin D2 metabolites to vitamin D binding protein in plasma, and a nonphysiologic metabolism and shorter shelf life of vitamin D2. Vitamin D2, or ergocalciferol, should not be regarded as a nutrient suitable for supplementation or fortification.

    Vitamin D2, which is the vitamin D added to milk, is worthless. So the assumption that milk provides any vitamin D is false. Eggs and seafood and almost any other food have very low quantities of vitamin D relative to the need. The food exception is cod liver and cod liver oil.

    So vitamin D is essential, and around 5000 IU is needed, but do not count on food unless it is cod liver or cod liver oil. People are supposed to get sunshine, which produces plenty of vitamin D.

    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.

  2. Flan is amazing, and yours looks very much tastier than the Vit D pill I just ate at dinnertime!