This past weekend’s freak accident during the Louisville and Duke basketball game has put vitamin D back in the spotlight. How do you get enough?

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The recent freak accident during the Louisville and Duke basketball game has put vitamin D back in the spotlight. Many of us witnessed the horrific injury to Kevin Ware of Louisville when Ware, a sophomore, suffered an open fracture of the tibia and fibula after jumping to block a shot. Many claim it’s the worst basketball injury they’ve ever seen.

If you didn’t see it live or haven’t Googled the video yet, I’d only recommend looking it up if you don’t get queasy easily. Thankfully, Ware’s surgery later that night was successful and he was up and moving around on crutches the next day. Amazingly, a former sideline physician for the New York Jets, Dr. Robert Glatter, said that if Ware is generally healthy with no serious underlying medical conditions he could be back on the court within a year – maybe even as soon as three to six months if his recovery process goes smoothly.

Isn’t the body amazing?

But there’s more to this story, seemingly. It’s unlikely that a break of this nature, completely unexpected in a sport like basketball, would have happened without some underlying issues.

In a story at ABC News by Liz Neporent , Glatter said of Ware, “He came down hard, landing in an awkward way. That combined with an underlying bone issue or an existing stress fracture predisposes someone to this type of injury.”

This was certainly a freak combination of circumstances, the extreme bone break likely only possible because of these undetected bone issues. In that same ABC story, Tim Hewett, director of sports medicine research at Ohio State University suggested that Ware may have porous bones because of a diet low in vitamin D and calcium.

It’s easy to suppose that after months at indoor basketball courts and indoor classes he wasn’t getting adequate amounts of sunlight. And from what I know of the average 20-year old male’s diet, especially college athletes with generous and unsupervised meal allowances, it’s hard to imagine that Ware was eating the few dietary sources of vitamin D.

Beyond Ware, his accident highlights the fact that most adults of all backgrounds are deficient in vitamin D.

It’s hard to overstress the importance of this vitamin. Not only can a deficiency lead to increased fractures and osteoporosis, vitamin D deficiency is also a contributor to increased rates of diabetes, cancer, and cardiovascular disease.

Adequate vitamin D levels lead to fewer respiratory infections, a decreased risk of multiple sclerosis, and fewer headaches. And excess body weight is known to be linked to vitamin D deficiency.

Vitamin D frequently gets overlooked because when it comes to strong bones many think it’s all about calcium. You do need calcium to make strong bones, but vitamin D is the most significant nutrient for calcium absorption. In fact, the body can’t absorb calcium at all without vitamin D. And if you don’t have enough vitamin D to maintain your blood levels of calcium, your body may resort to stealing calcium from your bones…osteoporosis, which can happy at any age.

What else does vitamin D do? It aids in muscle contraction, nerve impulse transmission and immune-system support. It may also help prevent colon, prostate and breast cancers.

So here’s the deal: you need vitamin D. The current recommended dose is 600 IU every day, increasing to 800 IU for those over 71. That’s already higher than most people get, but functional medicine practitioners recommend much higher amounts: 35 IU’s per day per pound of body weight. For me at 170 pounds, that’s nearly 6,000 IU per day. How do you get that much?

Food sources tend to be pretty lean on vitamin D, but there are some notables. Cod liver oil (1360 IU per tablespoon), certain fish like swordfish (566 IU per 3 ounces, but can’t eat it cause of the mercury), salmon (447 IU), and tuna (154 IU, another fish you have to be very selective with), are the only significant dietary sources. Sardines, liver, and eggs are the other mentionables, but they only supply 40 – 46 IU per serving.

You might be wondering about those fortified sources – things like dairy, cereals, orange juice. I wonder about them, too, as in, why they’re still considered useful. Dairy in general, and in particular conventional store-bought dairy, has a number of concerns that keep it low on our recommended food list.

And when it comes to fortified food, the term ‘buyer beware’ applies. Unfortunately you don’t know how much you’re actually getting. Scientists at Boston University School of Medicine tested samples of milk and found 8 out of 10 samples contained either 20 percent less or 20 percent more vitamin D than the amount the label advertised — and some of the milk tested contained no vitamin D at all.

That’s not the worst of it. The vitamin D that’s used in fortification is the synthetic and highly inferior vitamin D2 (ergocalciferol). Even though vitamin D2 is less potent than the natural vitamin D3 (cholecalciferol), it becomes toxic in your body at far lower levels than the natural form. Only vitamin D3, the type of vitamin D found naturally in foods such as eggs, organ meats, animal fat, and cod liver oil, should be used for supplementation.

Studies have clearly shown that vitamin D2 should not be used for supplementation or food fortification. Too much synthetic vitamin D2 may be linked to health problems, including the irritation and thinning of the lining of blood vessels.

Continuing with the D2 bashing, it has a shorter shelf life and its metabolites don’t bind well with protein, making it less effective. Did you catch that? Vitamin D requires protein to be carried throughout the body, but vitamin D2, the kind used in fortified food, doesn’t bind well with it so it never makes its way to where it should go.

And here’s another factor. We’ve covered well the fact that Vitamin D enhances the absorption of calcium, but what is needed to absorb Vitamin D? The answer is fat! Vitamin D is a fat soluble vitamin. It binds to protein and is absorbed in the intestine. If you take away the fat (like the fortified products: skim milk, cereal, orange juice) then this chain of dependence is broken. No fat, no vitamin D absorption, no calcium absorption.

Without a doubt the best way to get the right amount and right kind of vitamin D is from sun exposure and food. Fifteen or twenty minutes of direct sun light (when the sun is high) will do it. Working indoors all day and winter, when sunshine is scarce (depending where you live), present a problem. And the darker your skin and being farther from the equator, the more difficult it is to produce adequate vitamin D levels from sun light alone.

So you can go crazy with fish, eggs, and cod liver oil, and another option is using a high-quality vitamin D supplement. Doctors offer prescriptions for vitamin D but be aware that if you receive a prescription for vitamin D from your doctor, you’re most likely receiving the inferior vitamin D2, since nearly all the prescription-based supplements contain the synthetic form.

If you choose to use vitamin D supplements make sure it is in the form of vitamin D3 (cholecalciferol), which is the same vitamin D your body makes from sunlight. When either D2 or D3 is taken, it must be converted to a more active form (calcitriol). Vitamin D3 is converted 500 percent faster than vitamin D2. Any way you look at it, it’s the best alternative between the two.

And just forget about trying to get your supply of vitamin D from “fortified” foods. Those foods are not giving you the natural, healthy type of vitamin D that generates all the benefits that have gotten lots of media love and attention recently.

Do yourself a favor. Make sure you’re getting enough of the right kind of vitamin D. Keep your bones healthy, and in one piece inside your body where they belong. We’ll be cheering on Kevin Ware, looking forward to seeing him back on the court next year, and hoping his recovery process includes a conversation about the importance of a healthy diet and plenty of vitamin D.

This post is linked to Sunday School at Butter Believer!

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