Friday, March 16, 2018

Vitamin D and Fertlity

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.
Can I get vitamin D all year, even if it’s a sunny day? – In a word no. The further away you are from the equator, the less chance for your body to feel the rays.  When the clocks go back, the sun is further away and you get way less UVB, which is what you need for you to produce vitamin D. In this situation even on what feels like a sunny day,  I wouldn’t bother getting you kit off in the cold for such a miniscule amount!
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,  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!

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.

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.

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  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.

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.