As we move into Spring and in the UK, with temps raising the mercury in the summer ( heres hoping!), I thought it was time I talked about how important the sun is in terms of how it creates the right environment for this specific hormone to work its magic in the body.  The reason I’m talking about this now is that the rays you gathered from when the clocks go forward, will have the desired effect you need to help all sorts of processes in your body come Autumn and Winter.

Over the years vitamin D has hit the headlines many times, and with empirical data evidencing the importance of it in the body, it has widely been accepted and embraced by the medical community and as such it’s no coincidence that in the UK GPs are now testing routinely for this and prescribing it to everyone from little ones to the elderly. Vitamin D is also on my mind as headlines last year look at how the right levels can help asthma.

Our main source of Vitamin D comes from our absorption of sunlight that mixes with saturated fats in our bodies, to create Vitamin D.

As the year progresses and we enter spring, the sun gets higher in the sky and therefore produces more intense UV rays, and its the UVBs that we all need!

With more intense sunlight we get more exposure to the rays, and therefore more opportunity to manufacture this important nutrient.

For those of us in northern hemisphere we are often plunged into often up to 8 months of the year of low rays, making it almost impossible to get enough sunlight, something we all need. Sunlight is so important for us a species and as UK peeps wait and watch, many summers in the past just haven’t cut it, and due to this there have been huge health consequences. This has promoted scientists to look into issues with long term health – a few summers ago there were children presenting in doctors surgeries with aches and pain and getting all sorts of illness, this was also linked to cases of rickets, https://www.theguardian.com/society/2017/dec/23/poorer-children-disproportionately-need-hospital-treatment  which is shocking to hear, but just shows how important it is to get outdoors when we have any sun and stop covering kids up with sun factor 50 in the summer!

It amazes me every summer when I start to feel the heat of the sun on my body, just how far away it is and yet it can make a huge impact on us and even cause sun burn! Sadly as the ozone layer began to thin and places like Australia and New Zealand were reporting cases of sun cancer as early as 1980s the campaign and worldwide demonization of the sun began.

I understand with skin cancer on the rise why the sun is so vilified to some extent. But we could not have evolved past single cells organisms without it – we’ve forgotten that photosynthesis supports most of the food chain on this planet.  And as mammals we use photosynthesis to make vit D as our first stop, instead of ‘fortified foods’.  The ‘skin Cancer’  message has been loud and clear, and has hit parents hugely. Even in places like the UK parents are slapping factor 50 on their little ones ( don’t get me started on parents using what can only be described as ‘ scuba suits’ for kids when they actually do go to hotter climates ( apart from Australia where you do need this!) No wonder there is a childhood epidemic of low vitamin D levels and Doctors force feeding drops down poor kids neck!  As much as I like supplements, the real deal is so much better!

More relevantly and as I get to the point  – the sun is vital for fertility.  Studies have looked into peak conception rates and this can be traced back to the summer month, not surprisingly when the sun is in full force! https://www.sciencedaily.com/releases/2017/05/170523084302.htm

There are many reasons for this, but new research highlights vitamin D as a key to higher conception rates.

Vitamin D is often referred to as a vitamin, it is in fact a steroid hormone and is important for good overall health and particularly to help build strong and healthy bones. It’s also an important factor in making sure your muscles, heart, lungs and brain work well and that your body can fight infection. We have vitamin D receptors in loads of areas of our bodies and some of us even have mutations on these receptor ( I’m one of them and I found this out by looking into my genes at 23andme )

Recent research has alluded to ways in which Vitamin D can cause issues with our health including a role in chronic diseases like diabetes, obesity and autoimmune conditions as well as cardiovascular disease and cancer.  https://www.ncbi.nlm.nih.gov/pubmed/26068917

Vitamin D status affects different cells in our body and more specifically organs. It does this as it actively turns on and off genes, which can mean cell growth or death.

Your body can make its own vitamin D from sunlight. You can also get vitamin D from supplements and a very small amount comes from a few foods you eat.

The vitamin D that you get in your skin from sunlight, and the vitamin D from supplements, has to be changed by your body a number of times before it can be used. Once it’s been converted the vitamin D receptors (VDR) in your body use it to manage the amount of calcium in your blood, bones and gut and to help cells all over your body to communicate properly.

Vitamin D is linked to so many issues:

Vitamin D is a natural antibiotic that assists White Blood Cells in clearing infections. It does this by stimulating immune cells.  This does not happen well in our gut, but works really well in our skin with UV rays as the catalyst. Many of my clients have issues with Natural Killer Cells, and I could almost bet their Vitamin D levels are low in this instance, which is what maybe the ‘ heightened’ immune response is all about!

There is also a school of though that looks at vitamin D and chronic inflammation and illness. There are some clinicians studying Vitamin D and as mentioned above its always best to look at both markers of active and stored vitamin D as systemic inflammation may cause an alteration in that dynamic. https://link.springer.com/article/10.1007%2Fs00011-014-0755-z

Age will decrease your skin’s ability to make vitamin D3 from sunlight and cholesterol. As we go from 20 to 60 years old, we lose the ability to convert Vitamin D hugely. So as we age, we need more sun or supplementation.

If we have  autoimmune diseases, we need much higher levels of Vitamin D from sunshine. Autoimmune conditions that are often associated with vitamin D deficiencies. Issues like endometriosis, PCOS https://www.ncbi.nlm.nih.gov/pubmed/?term=vitamin+D+and+PCOS  and thyroid issues, which in these cases will mean  you need a higher amount of Vitamin D, for your bones, muscles, oestrogen and immunity to work in the way it was designed to do. https://www.ncbi.nlm.nih.gov/pubmed/25407646

A report in the European Journal of Endocrinology mentioned a few key facts in relation to vitamin Ds importance in women.

One that is often overlooked by many IVF clinics is that vitamin D has an impact in terms of Invitro fertiliation (IVF) outcome and a quick scout around pubmed typing in IVF and Vitamin D will show up lots of published studies on this!

Anecdotally I haven’t ever had a client with PCOS without dangerously low levels of Vitamin D. In terms of the endocrine system and hormones, the root of all fertility, vitamin D is important to boost levels of progesterone and oestrogen, which regulate menstrual cycles and improve chances of conception.

Both genders require Vitamin D for different things in the body. In men, vitamin D is essential for the healthy development of the nucleus of the sperm cell, and it supports semen quality and count. Vitamin D also increases levels of testosterone needed for sperm development and sex drive.

Vitamin D is always hitting the headlines for all sorts of issues. In 2008, Australian fertility specialist Dr. Anne Clark found almost one-third of the 800 infertile men included in her study had lower than normal levels of vitamin D. She also looked at folate levels in conjunction with Vitamin D. When men made adjustments to lifestyle with dietary and supplement changes, fertility markers were dramatically improved.

If you’re Struggling with Infertility, it may not be the overall reason for fertility issues, as it is never just one things as we are complex beings, however it won’t harm you to do some checking under the hood, so I would speak to a practitioner to get Your Vitamin D Levels checked.

Vitamin D is so crucial to health that as a practitioner its in all my initial test grade panel! Doctors commonly use vitamin D which in clinical terms is  25(OH)D  However, this is not the final picture, and a truly knowledgeable physician would look at the Parathyroid Hormone level ( PTH) and  25(OH)D, together with  1,25(OH)2D  to get a true picture, as well as bone density as a third marker of how well the sunshine vitamin is being utilized in your body.

Vitamin D and skin colour

Many practitioners will tell you vitamin D is often seen as more important the darker your skin. However if you do live in a sunny climate ( and get out in the sun) you need to be careful drawing conclusions about a simple lab test that only show 25(oh) d levels.  Tribally when tested many massai warriors in African had a borderline level of 25(OH)D and great bone density. Showing possibly that its not as black and white as just looking at one marker, as living with so many hours of sunlight, logically we would assume a higher amount of Vitamin D! This may mean that that ethnicity and where we live may also change this picture and we naturally adjust to what levels we need when living in sunny climates and outdoors a lot.

What will show a true picture of this important hormone?

I’m often asked this and as mentioned above, its never one marker that determines the truth in the body, as we just aren’t as simple as this! As a practitioner I recommend working with someone more closely, who can work through your bio individual situation. They should test initially 25(OH)D and with  1,25(OH)2D  to get a true picture.  if the 25(OH)D  is lower than 50, then you need to look at Parathyroid levels PTH. If PTH is less than 30, you may not need to supplement as the Parathyroid gland is adequately using vitamin D in the body.  If PTH is under 20 then by all means all systems go for higher supplementation and UV exposure!  ( or splash out on a holiday! ( practitioners orders! 😉

If your levels of the stored Vitamin D are over 60 then then you don’t need extra vit D supplement. If your Test shows a 25(OH)D  of over 70, adjust diet take out supplements with over 1000Ius and stay indoors a little! Too high a levels is just as damaging as too low!  Also another word of caution – I would be vary of blindly going out and buying supplements with over 3000ius as vitamin d, as it can build up, so it’s only wise to supplement if your know the true picture.

Speaking for supplements can I get Vitamin D from a supplement, or is it better to get it from food?

There are very few foods that actually have therapeutic levels of vitamin D naturally and even fortified foods don’t contain enough vitamin D to support your body. However for those in areas like Australia where the ozone layer is very thin, its vital you do make sure your skin is not exposed for even a short time. Even 5 mins in the 11am sun can do harm. I experienced this myself in 2004 when I visited. Its funny as it really is a totally different experience in regards to the sun in Over in Aus and NZ.   My flight arrived early in February the height of their summer, and my room wasn’t ready. So I sat on Manley Beach in Sydney and the only thing that wasn’t covered was one foot! Ouch! 5 mins in and my foot was burnt for the full 3 week holiday! My advice here is that its good to build up your vitamin D levels in spring in this part of the world and only for a short amount of time and not in the full swing of summer!

How long you need to stay in the sun varies massively  depending on the factors below:
Antioxidant level and diet
Age
Skin Colour/ tan level
Latitude and altitude
Ozone Layer
Use of sunscreen
Season
Cloud Cover
Surface reflexion

Sun cream is also another tricky one… What to go for?

In the UK factor 50 isn’t necessary despite it going up to 30 degrees c this year. With a  SP factor as high as 50 you are blocking your ability to get any vitamin D. I would opt for a sun screen that ranges from 15 – 30 SPF. There are some amazing ranges out there at present, including ranges for children such as Oganii, Biosolis and Green People as these are some camps that argue that the chemicals in the sun cream are a contributing factor to disease, including hormone disruption! The above are free from all sorts of nasties, so at least you know you aren’t going down this route.

Diet is an interesting one, If you can’t get access to the sun then diet is the only option. Here are some sources

Cod liver oil
Tuna.
Sardines
Beef or calf liver.
Egg yolks

But if you have low levels, to get them up quickly – you only really only have one option if you want to raise your levels and that is to take a vitamin D supplement. As a general guideline,  after testing – if  your levels are 50ng/ml then I would take 1000-3000 IUs for one month and see what your levels are like after 1-2 months of this level. I’m not a fan of huge 1 week 20,000IU doses. Its also likely that if you have issues digesting food, or are overweight and have had a gall bladder removed, you may have issues with fat and assimilating it, so this type of approach won’t help, and in the long term could possibly lead to kidney stones as your parathyroid tries to cope with this amount!  If you do opt for a vitamin D supplement, please remember that you also need to boost your intake of  vitamin K2 through food and/or a supplement, as well as Magnesium. If you’re getting your vitamin D from the sun, this isn’t necessary. ( however its always good to get some leafy greens in right?)

Like anything all vitamins need  to be balanced out (as they would in nature)  so if you are getting less than optimal sun and have to resort to supplements, make sure you are supplying your body with the means to self regulate with enough vitamin A, K and other minerals’ such as calcium and magnesium, zinc, boron.

That way you will be winning in the Vitamin D stakes and have one less thing to worry about in regards to fertility.

The new year has started off with a bang! Lots of clients who have been working with me for 3 months or more are now pregnant – Yay! As most are new mums a few have got in touch about Midwives and Drs misconceptions and concerns about vitamins and minerals, as this is where the medical community start to get involved. One of the concerns is about Vitamin A and its ability to cause birth defects; so let me respond and shed some light on this..

I have looked into this issues myself quite thoroughly and the research links I have cited below mention that the research is over 30 years old in regards to the potential causes of birth defects. I will say that again…. In time frame only 18 cases have been cited where this has caused deformities. 

I’m sure you are aware that any adverse reaction to drugs need to be reported.  All medicines are reported under the medical misuse category.

Drugs cause death and other health conditions by the hundreds of thousands annually. vitamins don’t cause death http://bit.ly/1Ogey41  We don’t have anything for supplements to report on this, but as always if anything does show ‘Teratogenicity ie potential for birth defects it has to be reported as such.

A basic look into drugs commonly used to help women conceive and to help those with sticky platelet, such as Aspirin have far more potential to cause birth defects, http://www.mayoclinic.org/drugs-supplements/analgesic-combination-acetaminophen-salicylate-oral-route/before-using/drg-20069948 and not to mention fertility drugs that many use unwittingly without looking into the small print, that can also cause deformities and also death. http://www.drugs.com/pro/clomid.html  My point here, is many of my clients are getting all wound up about something, without looking into the issues more closely, and colleagues in the medical profession are making a point of issuing notice on Vitamin A without also mentioning that drugs, many of them used in fertility circles, have far more of a chance of giving ladies birth defects,  And those were taken at the correct dosage!

Of the 18 reported cases over the last 30 years who had babies with deformities all of the women in regards to Vitamin A took over 25,000IUs of Vitamin A, which exceeds the RDA on this by an exponential amount. As always the devil is in the detail. Most  supplements will show 2 forms of Vitamin A – the one that can cause more damaging effects at high levels  is retinol only and not a mixed between Retinol and beta carotene,  which is what most supplements have in them.

It is worth noting also in this instance that Natural Vitamin A ( retinol) is found in high doses in organ meat, such as liver. Which up until the 1970s was consumed and readily available. Many children, like our parents who, were born after the war were given cod liver oil daily, to ensure they didn’t have deficiencies. This form of fish oil has a much higher form of Vitamin A.

One of the sources of this information is NHS choices website. In this website, which I find extremely unhelpful and very uniformed it says things like ‘ you should be able to get all you need nutrients from your diet and don’t need any extra vitamin A’. Also rather unhelpfully in the article they put the measurement in Mgs not IUs, which is the standard international unit used to measure Vitamin A, so right from the start shows a fundamental misunderstanding about vitamin A.  http://www.nhs.uk/Conditions/vitamins-minerals/Pages/Vitamin-A.aspx

In terms of its use in pregnancy it is vital and essential nutrient and the most important and well known role of vitamin A is in relation to eye function. Vitamin A is necessary to prevent drying of the eye ( Xerophthalmia) and corneal changes. It is also used for retina function. 500,000 people lose their site each year due to vitamin A deficiency. Vitamin A levels are also inportant in thyroid health as it is needed for the uptake of idone and is required for thyroid hormone triiodothyroxine (T3) to bind to intracellular receptors. 

Vitamin A is needed in pregnancy for:  – Growth, Immunity, epithelial tissue maintenance and during cell proliferation, ie foetal growth!
http://ajcn.nutrition.org/content/71/5/1325s.full

I work with many clients and look into deeper analysis of fertility issues and pregnancy complications and one area I am fascinated in is Epigenetics. Many people who have polymorphisms in their BCMO1 gene have an issue converting beta carotene into retinol. So I welcome the use of mixed vitamin A for them in a retinol base, as they will have a problem converting Beta Carotene in the body http://www.ion.ac.uk/blog/anonymous/tue-2014-06-17-0954/are-you-converting-enough-beta-carotene-vitamin-55-people-may-not  Many of the studies on the populations in the human genome project also had the potential for poor eye sight also so were really in need of vitamin A, should the gene express.

I ask questions about eyesight as part of my consultations and also look at this from a family health position, as there is the potential here also to pass this on to off spring! One anecdotal thing I’m noticing much more than when I was a child is that there seems to be a huge amount of kids with glasses at a young age. I only remember a few in my whole school growing up, so I’m wondering if reduced amounts of vitamin A in pregnancy are a result of this?

WHO recommendations. More recent than 1995 http://www.who.int/elena/titles/vitamina_pregnancy/en/
American Teratology Society information on Vitamin A http://www.teratology.org/pubs/vitamina.htm

Further information on Vitamin A http://lpi.oregonstate.edu/mic/vitamins/vitamin-A#safety

On a personal note. I have used many American supplements for the last 8  years of working with women all of which have mixed vitamin A around 5000IUs and I have confidence on these levels of Vitamin A.  I have worked with hundreds of ladies and so far no issues with this, with my recommendations!

I hope this helps you to make a more informed decision about vitamin A and its use in pregnancy and preconception.

References


1.http://www.teratology.org/pubs/vitamina.htm 
2.Teratogenicity of high vitamin A intake. N Engl J Med. 1995 Nov 23 ;333(21):1369-73 
Wiegand, et al. 
3.Safety of vitamin A: recent results. Int J Vitam Nutr Res. 1998;68(6):411-6. Rothman, et al. 
4.Teratogenicity of high vitamin A intake. NEJM. 1995 Nov 23;333(21)1369-73. 3. Miller, et al.
5.Preconceptional vitamin A use. Reprod Toxicol. 1998 Jan-Feb; 12(1)75-88 
6.Tolerable levels of 10,000IUs https://umm.edu/health/medical/altmed/supplement/vitamin-a-retinol

 There is a magic formula for a healthy pregnancy: diet! You have to eat well and supplement. As in previous posts, the nine months in utero can be the most consequential in a person’s life, determining genetic predisposition, illness, and even the hard wiring of the brain. So, it makes sense to have laid the groundwork before even trying. The basic principals of healthy eating remain the same as when you were eating well and supplementing prior to trying for a baby, although nutrient needs to change a little each trimester. A few nutrients in pregnancy do deserve a special mention. Here’s what’s at the top of the list:

IRON

The recommended daily intake of iron (RDI) during pregnancy is 22-36mg (10-20mg more than in non-pregnant state). The amount needed depends on the amount of iron the mother has ‘stored’ in her body prior to pregnancy. If a woman’s iron stores are very low, she may need to get more from a supplement. I have a client at the moment carrying twins; her iron levels at first trimester are very low. Iron supplements are regularly provided for pregnant women, as its often difficult to get enough iron from food, especially in the absence of red meat. Unfortunately, iron supplements in the inorganic ‘sulphate’ format (often given by doctors) can cause constipation, so seek professional help here, and don’t routinely add iron as it builds up in the body, and too much of a good thing is no longer any good! Never self-prescribe iron as some people have a predisposition for iron build up in the body – you want to be tested regularly for your levels, preventing this from happening. More on this topic can be found here: http://healthybabycode.com/5-myths-about-pregnancy-nutrition-2-all-women-should-take-iron-during-pregnancy 

CALCIUM

The RDI of calcium during pregnancy is 1200mg per day; 300mg more than for non-pregnant women. During the third trimester of pregnancy, there is a large shift of calcium to the baby, as it starts to develop and strengthen its bones. If the mother isn’t getting enough calcium in her diet, the calcium needed by the baby is drawn from the mother’s own bones. This can have a negative impact on the mother’s bone health years later, leading to osteopenia and potentially osteoperosis, which women can already be predisposed to develop. Low calcium intake during pregnancy may also cause the baby to have weak bones, and impaired bone development. Dietary sources of calcium include: pine nuts, sesame seeds and tahini, sardines (with bones), seaweed (e.g. kombu and nori), salmon, almonds, figs, spinach and watercress. These all yield higher calcium uptake levels than milk!

ZINC

Zinc is an extremely important mineral to take across all trimesters, and should be in a good prenatal diet too. Prior to preconception, zinc is involved in over 100 enzymatic reactions in the body and vital for immunity, hormonal function, and bone development. 

Zinc is also vital for male fertility, as it helps improve motility, sperm count and the morphology (structure) of the sperm. If you are low in this mineral, it can affect your mood; mothers with post-natal depression have been tested, and generally show low levels of zinc.

Zinc is also needed to help heal and repair tissues after birth, and a massive dose is taken from the mother’s own stores by the baby immediately prior to birth, leaving the mother very low.

Zinc is needed specifically by the newborns. If you have low levels when breastfeeding, this can lead to an unsettled, unhappy baby.

OMEGA-3s

A decent intake of Omega-3 fatty acids is essential in maintaining the balanced production of hormone-like substances called prostaglandins. Prostaglandins help regulate many important physiological functions including blood pressure, blood clotting, nerve transmission, the inflammatory and allergic responses, as well as the function of the kidneys, gastrointestinal tract, and production of other hormones.

Large amounts of omega-3s are needed during pregnancy to help ensure the growing foetus has enough fats to develop. omega-3s have been found to be essential for both neurological and early visual development of the baby. However, the standard western diet is severely deficient in these critical nutrients. This omega-3 dietary deficiency is compounded by the fact that pregnant women become depleted when the foetus uses fatty acids to grow its nervous system.  Omega-3s are also used after birth to make breast milk.

Research has confirmed that if pregnant women supplement their diet with EPA and DHA, it has a positive effect on visual and cognitive development of the baby. Studies have also shown that higher consumption of omega-3 fatty acids may reduce the risk of allergies in infants. Omega-3 fatty acids have positive effects on the pregnancy itself. Increased intake of EPA and DHA have been shown to prevent pre-term labour and delivery, lower the risk of pre-eclampsia, and may increase birth weight. 

FOLATE

Folate is a B-group vitamin. Insufficient folate intake during pregnancy has been linked to neural tube defects, such as spina bifida in the unborn baby, and other issues such as facial clefts. To counteract the higher levels of spina bifida pre 1990s, some governments apply a mandatory enforcement of fortification of flour with folic acid. In the UK, some food industry giants have adopted this on their own, but in countries such as the US, Canada and Costa Rica, this has been in place for some time. Australia introduced mandatory folic acid fortification in 2009. In the UK there are some concerns that folic acid on its own increases colorectal cancer, and cause B12 deficiency, so the debate continues in spite of a recent push for mandating folic acid – it has get to come into force.

Folate should be taken prior to conception, and throughout the entire pregnancy (contrary to advice!). If this is implemented it can prevent 7/10 cases of neural tube defects. Low folate intake also increases the risk of multiple births (twins). Women who are in the early stages of pregnancy (or likely to become pregnant) should take folate supplements daily, and a good prenatal should provide this.

My professional advice would be against taking folic acid or methyl-folate on its own, as this imbalances other B vitamins, but as part of a good prenatal. Important whole-food sources of folate include: leafy green vegetables (like spinach, kale and collard greens), broccoli, asparagus, legumes, nuts and avocados.

ISSUES WITH FOLIC ACID

Some people may not be able to absorb folic acid, and in many cases without knowing this, giving them the synthetic form of folate (ie folic acid) as a supplement may be detrimental to their health. About 40-60% of the population has a genetic polymorphism that impairs the conversion of supplemental folic acid to its active form, l-methylfolate. In vivo, the body converts dietary folic acid to l-methylfolate through a series of enzymatic processes. The final stage is done with enzym methyletrahydrofolate reductase (MTHFR). Those with certain polymorphisms have inadequate MTHFR activity and should opt for a methyl-folate supplement instead.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250974/

OTHER VITAMINS & MINERALS THAT ARE IMPORTANT

As well as iron and calcium, the other nutrients that should be boosted in the first and second trimesters include: vitamin C, B vitamins, vitamin D and magnesium. Vitamin D deficiency is at quite and alarming rate, particularly in the UK, so get your levels tested for this, and if low supplement with a therapeutic amount of vitamin D3 as suggested by your nutritionist or naturopath.