When you need the Vitamin D supplement
Integration should not be undertaken without first ascertaining that there is an actual shortage. Actually the Vitamin D is a real hormone and like all hormones it must be integrated when missing. Just do a blood test and the dosage is clearly expressed. «Generally for insufficient sun exposure or for pathologies (celiac disease for example) or concomitant (cortisone) therapies. In our country the deficiency of this vitamin is particularly widespread as in other Mediterranean countries such as Spain and Greece, as opposed to those of Northern Europe which are much less sunny (Scandinavian paradox) where foods are fortified with vitamin D. In our country, moreover , there has been a gradual but progressive change in the increasingly indoor lifestyle (exacerbated by the lockdown). Inevitably we have gradually depleted of this hormone which is so important for our bones, but also with multiple beneficial extraskeletal effects such as those on the muscles », explains Professor Andrea Giustina.
How to choose the right supplement
«In reality, the various forms of vitamin D on the market reflect the various forms of this vitamin present in our body: the cholecalciferol is the inactive form of vitamin D produced by the skin in response to sunlight. Cholecalciferol must be transformed into calcifediol in the liver and then into calcitriol in the kidney. Only the latter is the biologically active form of vitamin D. The most widely used form is cholecalciferol which is also the most physiological, as it is identical to the one we produce after exposure to the sun.
In addition to reproducing the physiology, this form of vitamin D has the advantage of almost always avoid possible overdoses since it is the body itself that decides how much substance to metabolize to active vitamin D according to its needs. Clearly, in subjects with hepatic insufficiency, calcifediol is instead more suitable as the body is unable to metabolize cholecalciferol. Finally, calcitriol is the least used form being the most immediately active and therefore more at risk of possible overdoses, even if in some conditions such as hypoparathyroidism or renal insufficiency it is necessary to use it “, explains Professor Andrea Giustina.
How long to take vitamin D?
Vitamin must be taken continuously if it is deficient. Unless there are important changes in the conditions that caused this hormonal deficiency (for example, poor sun exposure) even if normal levels of vitamin D are reached through supplementation, the suspension of the same inevitably leads back to a deficiency condition. .
Better in the morning or in the evening?
Vitamin D must be taken during or immediately after the main meal or in any case after a meal (if for example for the patient who takes many other drugs it is more convenient in the morning, he can also take it after breakfast) because it requires a certain presence of fats in the intestine in order to be absorbed effectively.
How much Vitamin D per day?
«The generally recommended dose of vitamin D is 800-1000 International Units per day because it reflects the body’s need for the hormone. Daily intake is considered the most effective. However, since it is often a long-term supplementation, it is possible to opt for a weekly or monthly administration regimen which may be more convenient for the patient ”, explains Professor Andrea Giustina.
Special cases: obesity and cortisone therapies
“In particular patients, for example with obesity or on cortisone therapy it is often necessary to administer higher doses of vitamin to bring the hormone values back to normal.
It is the endocrinologist specialist who must always suggest the prescription and dosage of the supplement, never do it yourself », warns the expert.
Does Vitamin D Make You Fat?
“No. On the contrary! THE obese subjects have lower vitamin levels than normal-weight subjects. Our study recently published on The Journal of Clinical Endocrinology and Metabolism showed that obese subjects with low levels of the vitamin were the most exposed to a serious COVID risk. Furthermore, supplementation with this vitamin can have beneficial effects in the obese reducing low-grade systemic inflammatory state which characterizes these patients and according to some studies can also contribute in addition to diet and physical activity to weight loss by rebalancing the relationship between muscle mass and fat mass ».
What effect on cholesterol?
“This vitamin is actually a steroid hormone, meaning its synthesis comes from cholesterol. However, this has no negative impact on the body. Incidentally, several studies have suggested a virtuous link between cholesterol and this vitamin. Patients with a deficiency of this vitamin have higher levels of both total cholesterol and LDL (the “bad” cholesterol), with low levels of HDL (the so-called “good” cholesterol), compared to subjects with normal levels “, concludes the expert.