Nutrition for the Aging: Vitamin D

A few weeks ago, my doctor told me that I was highly deficient in Vitamin D. She added that this wasn't unusual for someone in my age group (over 65). About 70% of us don't have enough Vitamin D in our systems! Vitamin D helps us to keep strong bones and muscles. This is especially important with LB D, where falls are common. It also improves immunity and helps to fight infections, another issue LBD caregivers deal with continually.

Vitamin D deficiency caused loss of bone and muscle strength appears to be recoverable with adequate Vitamin D. However, extended deficiencies may result in some loss of cognitive ability--which may or may not be improved with better Vitamin D levels. Oh, yes! I need to increase my Vitamin D right away!

For anyone over 65 and anyone who is infirm, the DV (Daily Value) is 800 IU. (This has increased from 400IU for all adults.) The best, and usually, the easiest, source of this vitamin is from the sun. Sensible sun exposure (5-10 min of exposure of the arms and legs or the hands, arms, and face, 2 or 3 times per week) allows the absorption of Vitamin D without much danger of cancer.

However, several issues interfere with this. The first three apply to everyone:

• Anyone living as far north as Boston or San Francisco is at risk for Vitamin D deficiency, especially from October to April.
• Anyone of darker skin, living in a non-tropical location, is at risk for Vitamin D deficiency.
• A justified fear of cancer has led to the use of sun-block. The problem is that the same UV rays that cause cancer are also the ones that deliver the Vitamin D. Leaving the sun block off for the first few minutes, time depending on the intensity of the sun, can alleviate this issue.

Even if a person lives where there is an abundance of sun, aging can cause other problems.

• The elderly tend to be out in the sun less, especially if they are mobility challenged.
• Elderly bodies tend to be less efficient at absorbing the Vitamin D, at both skin and intestinal level, and one absorbed, turning it into a usable nutrient. Therefore, we need more than our younger relatives do.

Since getting enough Vitamin D from the sun is probably not going to happen, we need to get it from other sources. There are only a few good food sources:

• Cod liver oil. One tablespoon = 1,300 IUs of Vitamin D. Our grandmothers knew what they were doing when they made their children choke down cod liver oil every spring! Now, it comes easier to take capsules. However, cod liver oil is that is also high in Vitamin A. Taking enough to satisfy your daily Vitamin D needs may put you well over Vitamin A's upper limit of 10,000 IU. If you choose to use take the capsules, read the labels carefully.
• Fatty fish, such as swordfish, salmon, tuna, or sardines have high levels of Vitamin D, but not enough to get your full daily allowance unless you eat a LOT of fish. A three oz. portion of baked wild salmon meets the DV. The same amount of farm salmon provides only half that and if you fry either one, you lose about 50%. Few of us can afford to eat salmon everyday, especially wild salmon. But canned tuna is almost as good. A 4 oz can of white albacore tuna also meets the DV. Do include some fatty fish in your weekly diet.
• Some milk, yogurt, orange juice and cereals are fortified with Vitamin D. Read the labels. Make a habit of reading labels and choosing those of these products that are fortified even if they cost more.

Since few people, and especially the elderly, get enough Vitamin D from food, most doctors prescribe Vitamin D supplements for their elderly patients. Supplements may start as low as the former DV of 400IU/day and go up to 50,000IU taken one to three times a week. When my doctor prescribed a large dose for me to take once a week, I asked about the safety of this. After all, Vitamin D is a fat-soluble vitamin and therefore, the excess isn't secreted in the urine. Apparently, large doses are absorbed better than many small doses and when the need is great, large doses are better. Sigh. I guess I'll just have to deal with having to remember to take that weekly capsule--or I may not be able to remember!

However, there may be a downside for the elderly who are already at risk for falls--a group that often includes PwLBD. A new clinical trial found that these higher doses of Vitamin D may increase falls in this group. This report makes it even more important to monitor and maintain Vitamin D levels so that they don't get so low that the larger doses are needed.

References:
http://www.drweil.com/drw/u/QAA400033/Cod-Liver-Oil-for-Vitamin-D.html http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698592/
http://www.jwatch.org/fw111030/2016/01/05/high-doses-vitamin-d-associated-with-increased-fall-risk?

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a physician's advice.