The female-centric 411 on this essential nutrient
by Ashley Jordan Ferira, PhD, RDN
Vitamin D research and daily news headlines are ubiquitous. PubMed’s search engine contains over 81,400 articles pertaining to vitamin D.1 Information abounds on vitamin D, but the vetting and translation of that information into pragmatic recommendations is harder to find. Evidence-based takeaways and female-centric recommendations are crucial for healthcare practitioners (HCPs), their female patients and consumers alike. Women are busy, multi-tasking pros, so practical, personalized takeaways are always appreciated. In other words, women need the “411” on vitamin D. Merriam-Webster defines “411” as “relevant information” or the “skinny”.2 So for all of you busy women, here’s the skinny on vitamin D. Let’s explore common questions about this popular micronutrient.
Q: Is vitamin D more important for younger or older women?
A: All of the above. Vitamin D plays a critical role in women’s health across all life stages, from fertility/conception, to in utero, childhood, adolescence, adulthood, older adulthood, and even in palliative care. Vitamin D is converted by the liver and kidneys into its active hormone form: 1,25-dihydroxyvitamin D. This dynamic hormone binds nuclear receptors in many different organs in order to modulate gene expression related to many crucial health areas across the lifecycle, including bone, muscle, immune, cardiometabolic, brain, and pregnancy to name a few.3
Q: I am a grandmother. Are my vitamin D needs different than my daughter and granddaughter?
A: Yes, age-specific vitamin D recommendations exist. As an essential fat-soluble vitamin, women need to achieve adequate levels of vitamin D daily. Age-specific Recommended Dietary Allowances (RDA) from The Institute of Medicine (IOM),4 as well as newer clinical guidelines from The Endocrine Society,5 provide helpful clinical direction for daily vitamin D intake and/or supplementation goals.
The IOM RDAs4 are considered by many vitamin D researchers to be a conservative, minimum daily vitamin D intake estimate to support the bone health of a healthy population (i.e. prevent the manifestation of frank vitamin D deficiency as bone softening: rickets and osteomalacia):
Infants (0-1 year): 400 IU/day
Children & Adolescents (1-18 years): 600 IU/day
Adults (19-70 years): 600 IU/day
Older Adults (>70 years): 800 IU/day
The Endocrine Society’s clinical practice guidelines5 recommend higher daily vitamin D levels than the IOM, with a different end-goal: raising the serum biomarker for vitamin D status [serum 25-hydroxvitamin D: 25(OH)D] into the sufficient range (≥ 30 ng/ml) in the individual patient:
Infants (0-1 year): At least 1,000 IU/day
Children & Adolescents (1-18 years): At least 1,000 IU/day
Adults (19+ years): At least 1,500 – 2,000 IU/day
Q: I am a health-conscious woman who eats a nutritious, well-rounded diet. I should not need a vitamin D supplement, right?
A: Not so fast. Daily micronutrient needs can be met via diet alone for many vitamins and minerals. Vitamin D is one of the exceptions, which is why an alarming number of Americans (93%) are failing to consume the recommended levels from their diet alone.6-7 Very few foods are endogenous sources of animal-derived vitamin D3 (cholecalciferol) or plant-derived vitamin D2 (ergocalciferol). Some natural vitamin D sources include certain fatty fish (e.g. salmon, mackerel, sardines, cod, halibut, and tuna), fish liver oils, eggs (yolk) and certain species of UV-irradiated mushrooms.8 In the early 20th century, the US began fortifying dairy and cereals with vitamin D to help combat rickets, which was widespread. For example, one cup (8 fluid ounces) of fortified milk will contain approximately 100 IU of vitamin D.
Even though some food sources do exist, the amounts of these foods or beverages that an adult would need to consume daily in order to achieve healthy 25(OH)D levels (> 30 ng/ml) is quite unrealistic and even comical to consider. For example, you would need to toss back 20 glasses of milk daily or 50 eggs/day to achieve 2,000 IU of vitamin D! In contrast, daily vitamin D supplementation provides an easy and economical solution to consistently achieve 2,000 IU and any other specifically targeted levels.
Q: I enjoy the outdoors and get out in the sun daily, so I should be getting all of the vitamin D that I need, correct?
A: Vitamin D is a highly unique micronutrient due to its ability to be synthesized by our skin following sufficient ultraviolet (UV) B irradiation from the sun. Many factors can result in variable UV radiation exposure, including season, latitude, time of day, length of day, cloud cover, smog, skin’s melanin content, and sunscreen use. Furthermore, medical consensus advises limiting sun exposure due to its established carcinogenic effects. Interestingly, even when dietary and sun exposure are both considered, conservative estimates approximate that 1/3 of the US population still remains vitamin D insufficient or deficient.9
Q: What factors can increase my risk for being vitamin D deficient? Are there female-specific risk factors?
A: Although the cutoff levels for vitamin D sufficiency vs. deficiency are still debated amongst vitamin D researchers and clinicians, insufficiency is considered a 25(OH)D of 21-29 ng/ml, while deficiency is < 20 ng/ml.5 Therefore, hypovitaminosis D (insufficiency and deficiency, collectively) occurs when a patient’s serum 25(OH)D falls below 30 ng/ml. The goal is 30 ng/ml or higher.
Ideally, vitamin D intake recommendations4-5 and therapy are personalized by the HCP based on patient-specific information, such as baseline vitamin D status, vitamin D receptor single nucleotide polymorphisms and other pertinent risk factors.
Common risk factors for vitamin D deficiency to look out for include:
-> Older age
-> Regular sunscreen use
-> Winter season
-> Frequent TV viewing
-> Dairy product exclusion
-> Darker skin (more melanin)
-> Not using vitamin D supplements
-> Malabsorption disorders (e.g. bariatric surgery, IBD, cystic fibrosis)
-> Liver disease
-> Renal insufficiency
-> Certain drug classes: weight loss, fat substitutes, bile sequestrants, anti-convulsants, anti-retrovirals, anti-tuberculosis, anti-fungals, glucocorticoids
-> Lastly, additional female-specific risk factors to look out for include exclusive breastfeeding while mother is vitamin D insufficient (can result in infant being vitamin D deficient) and certain cultural clothing that covers significant amounts of skin surface area (e.g. hijab, niqab).
Ashley Jordan Ferira, PhD, RDN is Manager of Medical Affairs and the Metagenics Institute, where she specializes in nutrition and medical communications and education. Dr. Ferira’s previous industry and consulting experiences span nutrition product development, education, communications, and corporate wellness. Ashley completed her bachelor’s degree at the University of Pennsylvania and PhD in Foods & Nutrition at The University of Georgia, where she researched the role of vitamin D in pediatric cardiometabolic disease risk. Dr. Ferira is a Registered Dietitian Nutritionist (RDN) and has served in leadership roles across local and statewide dietetics, academic, industry, and nonprofit sectors.
by Ashley Jordan Ferira, PhD, RDN
Autism spectrum disorder (ASD) is a complex neurodevelopmental syndrome with significant social, communication and behavioral deficits and challenges.1 No cure exists for ASD, although early interventions (birth to 3 years) can yield developmental improvements.1 ASD impacts approximately 1 in 68 children in the US and is 4.5 times more common in boys (1 in 42) than girls (1 in 189).2
Vitamin D’s extraskeletal roles are numerous, including its role as a neurosteroid, impacting both brain development and connectivity, and likely synaptic plasticity as well.3 Vitamin D is also one of the most common micronutrient deficiencies. Previous research has revealed associations between gestational and early childhood vitamin D insufficiency and ASD.4 This suggests that hypovitaminosis D represents a modifiable risk factor for ASD.4Furthermore, preliminary evidence demonstrates that gene variants related to vitamin D metabolism play a role in the pathophysiology of ASD.5 Robustly designed intervention trials have been scant.
The first double-blind randomized controlled trial (RCT) utilizing vitamin D3 supplementation in children with ASD was published in The Journal of Child Psychology and Psychiatry in 2018.6 The study included 109 Egyptian children (85 boys; 24 girls) 3-10 years of age with confirmed ASD diagnosis. The children were randomized to receive vitamin D3drops (300 IU D3/kg/day; not to exceed 5,000 IU/day) or matching placebo drops daily for 4 months.6 Serum 25-hydroxyvitamin D (25[OH]D) levels were measured at baseline and 4-months. For ethical reasons, children who were identified to have vitamin D deficiency (25[OH]D <20ng/mL) were excluded from the study and administered vitamin D supplementation by the study authors.6 Autism symptoms were assessed using validated measures completed by two different psychologists and a senior psychiatrist.6
Four months of daily vitamin D3 supplementation at 300 IU/kg/day:6
Following 4 months of vitamin D3 supplementation, improvements (all p <0.05, most p <0.01; as compared to placebo) were demonstrated in many core manifestations of ASD, including:6
This rigorously designed RCT is the first of its kind to demonstrate safety and efficacy of vitamin D3supplementation in children with ASD.6 Two previous open-label vitamin D3 supplementation studies also demonstrated improvements in ASD symptoms.7-8 Wide-scale studies are warranted to continue to critically ascertain the effects of vitamin D on ASD.
Why is this Clinically Relevant?
Link to Article
Your Brain on DHA
What is DHA?
Docosahexaenoic acid (DHA) is a long-chain omega-3 fatty acid—the most abundant of all the fatty acids most commonly found in the brain and eyes. But like many essential nutrients, DHA’s importance is often overlooked, and many Americans fall short of the recommended daily allowance (RDA) outlined by the US Department of Health.1,2 With all the cognitive, and other, benefits DHA has to offer, ensuring you get enough through your daily dietary intake is truly a no-brainer.
What are the benefits?
Not only does DHA account for over 50 percent of omega-3 fatty acids in the brain, it also turns on your brain’s growth hormone, known as the brain-derived neurotrophic factor (BDNF). This helps support the survival and function of existing neurons and also encourages new neurons and synapses to grow.3,4 Unfortunately, BDNF circulation slows down with age and can be stunted by stress and other lifestyle factors.5 That’s why upping your DHA is so important.
Although DHA is essential at every age, it’s especially crucial during three particular stages of life:
DHA can be helpful for baby’s development as well as mom’s recovery. A study showed that mothers who supplemented with omega-3s during pregnancy saw their children score higher on intelligence tests due to enhanced cognitive performance.6
For some mothers, pregnancy also takes a temporary toll on cognitive functioning and memory. Colloquially, it’s called “baby brain,” and it’s likely due to hormonal changes and the stressors placed on a woman’s body to meet the increased needs of her unborn baby. According to research, pregnancy can sometimes shrink brain tissue and cause long-term changes to brain structure.7,8 Recovery from pregnancy-induced brain changes can take years, but increased dietary intake of DHA has been studied to help support the regrowth of cells along the way, as well as promote healthy brain development in the baby.9
Babies and young children are growing every day, so it’s hard to understate the importance of DHA on brain development during this tender season of life.9 In fact, higher levels of DHA are associated with improved learning skills, while DHA deficiency in children has been linked to cognitive and learning disorders.10 That’s why making sure babies and toddlers get their fair share (500-700 mg daily)2 is a vital part of early brain development.
The benefits of DHA are enormously promising for older adults looking to keep their brains sharp and healthy. In a study of over 1,500 men and women over the age of 65, those with the lowest levels of DHA had significantly lower brain volumes than those with higher DHA levels and scored lower on tests measuring both memory and abstract thinking skills.11 On the flip side, studies show higher levels of DHA in the body (1,600 mg RDA for those age 51 and older)2 have also been associated with a decreased risk for brain-related chronic illness.11,12
DHA & gray matter
Our brains consist partly of something called “gray matter” (neural tissue that makes up a large amount of the central nervous system). Recent studies have supported a link between intelligence and the amount of gray matter in particular parts of the brain, which shrinks steadily in the years following adolescence. Though we naturally lose some brain volume over time, a higher intake of DHA is positively associated with gray matter volume and better cognitive function, even as we age.12
Where can I get it?
You can get some of your DHA in foods like fatty fish (salmon, mackerel, tuna, herring, and sardines) as well as flaxseed, chia seeds, and walnuts. But for vegans and vegetarians, as well as those with nut allergies, obtaining DHA through diet alone can be a challenge. It’s also important to be mindful of how often you eat certain kinds of fish due to high mercury content.
Supplementing with fish oils, a mainstay in many supplement regimens, can help fill in the gaps and give you the support you need for positive brain and cognitive development.1 There are many things to look out for when choosing a fish oil supplement, so keep these tips in mind while you shop.
This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues.
Food plays an important role in the development of a child’s brain. Children have very active and busy lives, now more than ever before. Their days are long and packed with schoolwork and after-school activities. The brain is constantly working to help fuel thoughts, movements, breathing, etc.; therefore, their bodies and brain need an adequate amount of fuel to stay energised and focused throughout the day. The brain consists of highly metabolically active tissue that requires a constant supply of calories and micro nutrients to meet its energy needs. What kids eat or don’t eat can impact their overall development and cognitive function.
Here are 10 foods that can help kids be sharp and get the most out of their learning and activities:
Eggs: Eggs are a great source of high-quality protein and choline.1 Adequate protein is essential for proper growth and development, whereas choline is a precursor to several neurotransmitters that help with cognitive development and memory function.1
How to serve: Eggs can be served a number of different ways—scrambled, boiled, sunny-side up, over easy, etc. Pick your child’s favorite way of eating eggs and serve with whole grain toast for a hearty breakfast or an after-school snack.
Salmon: Fish such as salmon, tuna, mackerel, etc. contain omega-3 fatty acids (EPA and DHA), essential fatty acids, which are crucial for brain growth and development.1 Including at least two servings/week of omega-3-rich food can help support cognitive function. Learn which fish pack more benefits than others.
How to serve: Introduce the kids to different types of fish early on, because eating fish/seafood can be an acquired taste for many. Try making salmon patties, tacos, or grilled sandwiches.
Green leafy vegetables: Spinach, kale, collards, etc., not only contain dietary fiber but are also packed with antioxidants and phytonutrients such as folic acid and lutein, which can help support cognitive development and memory.2
How to serve: Kids usually aren’t thrilled about eating their greens. So, you can try hiding spinach, kale, or other greens into a smoothie, quiche, pasta sauce, or omelet.
Blueberries: Blue and purple fruits and vegetables such as blueberries, purple grapes, and eggplant contain anthocyanins, a polyphenol shown to support brain health and function by positively affecting memory and focus.3
How to serve: Add blueberries to whole grain pancakes and Greek yogurt for a hearty, protein-rich breakfast.
Almonds: Almonds contain vitamin E, an important nutrient that aids with neurological functions such as balance and coordination.1
How to serve: Swapping out peanut butter in sandwiches for almond butter is a great way of incorporating almonds in their diet. Another great way of including almonds is adding them in pesto sauce instead of pine nuts and serving over whole grain pasta.
Meat: Lean meats such as beef, chicken, turkey, etc., are a rich source of vitamin B12. Vitamin B12 is required for rapid cell growth and division, especially during fetal brain development. Inadequate B12 status can impact cognitive functioning and impair brain growth.1
How to serve: Try making beef kebabs or add shredded chicken or turkey in soups, stews, chilli, or wraps.
Avocados: Avocados contain a rich supply of monounsaturated fatty acids or “healthy” fats that help support overall vascular function which can help deliver adequate nutrients to the brain.1
How to serve: Avocados are another food that can be an acquired taste. Adding avocado into a smoothie is a great way to mask the taste and add creaminess.
Beets: Beets are a good source of nitrates, which help support blood flow to the brain and promote mental performance.4
How to serve: When mixed into foods, beets can turn any food into a fun bright jewel colour that’s fun to eat. Try mixing beets into hummus, pasta sauce, or hash browns.
Dark chocolate: A small amount (1-2 ounces) of dark chocolate is a great addition to the diet due to the high content of flavonols it contains. Flavonols are phytonutrients containing anti-oxidative properties that may help support memory and brain function.1
How to serve: Rather than choosing milk or white chocolate, look for at least 70% dark cocoa when selecting chocolate. Instead of giving your children hot chocolate from a mix, create a healthier version by mixing a tablespoon of dark cocoa powder with warm almond milk.
Turmeric: Turmeric is an ancient spice that has been used for centuries in India. It contains curcumin, a polyphenol that gives turmeric its yellow colour. Curcumin contains anti-oxidative properties, which may help with cognitive function.1
How to serve: Create your version of “golden milk” by adding 1 teaspoon turmeric powder to warm almond milk.