I've recently noticed a lot of articles about the importance of Vitamin D, a nutrient that many doctors claim we are all deficient in. I knew we could get Vitamin D from the sun and from certain foods, but how much is enough? Even if you spend a lot of time outdoors, you may not be getting enough Vitamin D. To help us make some sense of all the Vitamin D hype, we turned to the highly respected New York City nutritionist Stephanie Middleberg, founder of Middleberg Nutrition. Here she offers guidance to pregnant women and breastfeeding moms on the importance, and sources, of Vitamin D.
Why do you need vitamin D?
Vitamin D has been getting a lot of press. A huge reason is because it is believed that 40 to 60 percent of the American population is deficient in it. Vitamin D helps the body absorb calcium and phosphorus, supports your immune system, maintains strong bones and supports a healthy thyroid function. Vitamin D has also been shown to prevent various autoimmune diseases, cancers, gum disease, and high blood pressure. However, remember that nothing is a cure-all, so don’t go out and start overdosing on Vitamin D (or any other vitamin for that matter).
What is your opinion about the best ways to get Vitamin D?
First answer is always through real food. But Vitamin D is one of the trickier vitamins…so unless you’re out in the sun for at least 20 minutes every day, or eating 30 ounces of wild salmon, it is really hard to get enough “naturally.” The exact amount needed varies depending a lot of factors like age, body weight, where you live, time of year, how much sun you get, etc. so there really isn’t a one-size-fits-all recommendation. That’s why there is so much discussion for the right amount. And because it is a fat-soluble vitamin, you can overdo it, and it can be toxic (although this is rare). By the way, you cannot reach toxic levels by sun exposure alone. There are recommendations from anywhere between 400iu—10,000IU a day. I recommend between 1,000IU-2,000IU/day, especially for those who avoid the sun, but am always sure to look at a client’s bloodwork. I highly recommend that once you start supplementing, have your levels checked every three months by your MD. I don’t like over-supplementing.
What foods are high in Vitamin D?
There are unfortunately not many foods that are great sources, especially healthy ones. There is a discussion with the difference between D3 sources and D2 (vegan) sources in regards to its efficacy. Many feel that D2 is less potent, and therefore requires higher doses and longer time to see results versus D3 forms. Regardless, most agree that it is difficult to meet your Vitamin D needs through diet alone. My preferred food sources are oily fish like wild salmon, sardines and eggs. Now there are fortified foods like milk, cereal, margarine (bleh) and juices that contain Vitamin D but they a)contain the less potent form and b)you need to eat large quantities for it to make an impact. Plus, it’s not naturally reccuring, so the jury’s still out as to its effectiveness. Mushrooms are a natural source of Vitamin D, especially when exposed to sunlight during their growing process.
What brand supplements do you recommend for getting Vitamin D?
Just like you are particular about the quality of food (as you should be), I recommend clients focus on the quality of their supplement, especially if you are taking it daily. Look for the word “gamma" on the label. Some of my favorite supplements are: New Chapter, Deva Vegan Vitamin D, Nordic Naturals Vitamin D3 and Prothera Vitamin D3.
If you are breastfeeding, how much vitamin D should you take in supplement form? I know there are various dosages.
There doesn’t seem to be one right answer of the exact right amount. The Institute of Medicine recommends that pregnant women get 600 IU of Vitamin D/day and not to exceed 4,000 IU/day. However, many recommend most sun-phobic, pregnant and breastfeeding women who live in northern latitudes (especially during winter) take 1,000 IU/day, and others recommend as high as 5,000IU. Be sure to have a discussion with your RD or MD, and monitor your blood levels to ensure you are in the optimal range.
Do you have any recommendations for Vitamin D supplement drops for infants?
I actually don’t have a favorite supplement. I would need to do more research. This really depends on mom’s Vitamin D3 supplement intake and sun exposure. “The American Academy of Pediatrics recommends that breastfed infants receive a daily supplement of 400 units until they are weaned and consuming a quart or more each day of fortified milk or formula.” Some others feel that if the mom is taking adequate levels, the infant doesn’t need to supplement. Speak to your healthcare provider for more information.
Do you have any nutritionist favorites for foods high in Vitamin D?
Yes! My favorites are wild salmon and sardines. The next best is pasture-raised eggs (preferable to cage free) and mushrooms. I highly recommend the brand Vital Choice (www.vitalchoice.com) for sustainable wild salmon and sardines. The wild canned options (with bones) are also a fantastic source of calcium. Tuna is a good source but concerns about mercury make it a less preferred option, especially for pregnant woman. Another good source is ricotta cheese. I recommend spreading it on a high-fiber cracker or adding some pomegranates or cherries and pistachios as a great breakfast or snack. You can also add it to eggs with some veggies for a great omelette. Yogurt and milk aren’t a great source, but if you do consume these products, I highly recommend selecting 2% vs. fat free. You need fat to help your body absorb fat-soluble vitamins (like Vitamin D).