D*action

The Total, per our Scientists’ Call to Action, is recommended to be between 40-60 ng/ml (100-150 nmol/L) for best overall health. If you are in that range, keep up the good work! If not, a couple of things to keep in mind:

Vitamin D sources are primarily sun and, for most people, supplements. If you choose to supplement, the D*calculator provides an estimate of an amount of daily supplementation sufficient for 50% of people to raise their vitamin D serum level from what it is currently to their target serum level. Knowing that some individuals will require more, it also provides an estimate of the amount that would be needed for 90% of people to make the same change. For example, for a 150 pound person who is taking 1000 IU supplemental vitamin D3 to go from 20 to at least 40 ng/ml would require a new average of 4000 IU vitamin D3 per day; individual results may vary. Experts recommend re-testing vitamin D serum levels after 6 months (or a minimum of 3 months) to determine how your serum level is adjusting to a new supplement dose.

The D*calculator was created using data from the GrassrootsHealth D*action Study, which provided supplement dose and serum level data from over 7000 individuals.

The latest Institute of Medicine (IOM) report, 2010, indicates 10,000 IU/day is considered the no observed adverse effect level (NOAEL); 4000 IU/day is considered a safe upper intake level for adults aged 19 and older. The observed cases of vitamin D toxicity started at total levels of 200 ng/ml per J. Hathcock, Am J. Clin Nutr. 2007;85:6-18.

GrassrootsHealth is solely providing information and is not acting as your healthcare provider. Please talk with your healthcare provider about what is best for you.

We appreciate your participation in this program to help eliminate the vitamin D deficiency epidemic. Please don’t hesitate to contact us with any questions.

Director
GrassrootsHealth
A Public Health Promotion Organization
[email protected]
760-579-8141

MORE INFORMATION ABOUT THE AA:EPA RATIO

Experts recommend an AA:EPA Ratio of 3 or less to reduce levels of chronic inflammation and diseases related to chronic inflammation.

There are two fatty acids included in the AA:EPA ratio – arachidonic acid (AA, 20:4n-6) and eicosapentaenoic acid (EPA, 20:5n-3). To change your AA:EPA ratio, simply change what you eat and/or the supplements you take. Raising the intake of EPA+DHA from sea foods and/or omega-3 supplements will likely decrease the AA:EPA ratio. Everyone responds differently to these changes so the only way to know how your blood levels respond is to re-test. We recommend re-testing every 3-6 months to confirm you are getting the right mix of fats in your diet.

A lower AA:EPA ratio correlates with a higher Omega-3 Index. Many studies have shown that people with higher (vs. lower) Omega-3 Index levels are at decreased risk for a variety of diseases. These include heart disease, stroke, dementia, and depression to name a few. These people may even live longer than those with lower levels. Lowering your AA:EPA ratio and keeping it down could help reduce your risk of these conditions.

Omega-3 fatty acids are found primarily in fish, especially “oily” fish. The two most important omega-3 fatty acids are EPA and DHA.

It should be noted that omega-3 fatty acids from flaxseed oil (alpha-linolenic acid, or ALA) will have little to no effect on your Omega-3 Index and AA:EPA Ratio. Therefore, ALA is not an effective substitute for EPA and DHA.

To make sure your AA:EPA ratio remains in the target range you should re-check it every 3-6 months.

† These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. Rather it is a wellness test to assess nutritional status. You are encouraged to discuss these results with your healthcare provider.

References:

1. Block RC, Harris WS, Reid KJ, Sands SA, Spertus JA. EPA and DHA in blood cell membranes from acute coronary syndrome patients and controls. Atherosclerosis. 2007;197:821-828

2. Siscovick DS, Raghunathan TE, King I, Weinmann S, Wicklund KG, Albright J, Bovbjerg V, Arbogast P, Smith H, Kushi LH, et al. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA. 1995;274:1363-1367

3. Albert CM, Campos H, Stampfer MJ, Ridker PM, Manson JE, Willett WC, Ma J. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. The New England journal of medicine. 2002;346:1113-1118

4. Otsuka R, Tange C, Nishita Y, Kato Y, Imai T, Ando F, Shimokata H. Serum docosahexaenoic and eicosapentaenoic acid and risk of cognitive decline over 10 years among elderly japanese. European journal of clinical nutrition. 2014;68:503-509

5. Tan ZS, Harris WS, Beiser AS, Au R, Himali JJ, Debette S, Pikula A, Decarli C, Wolf PA, Vasan RS, Robins SJ, Seshadri S. Red blood cell omega-3 fatty acid levels and markers of accelerated brain aging. Neurology. 2012;78:658-664

6. Pottala JV, Yaffe K, Robinson JG, Espeland MA, Wallace R, Harris WS. Higher rbc epa + dha corresponds with larger total brain and hippocampal volumes: Whims-mri study. Neurology. 2014;82:435-442

7. Kulzow N, Witte AV, Kerti L, Grittner U, Schuchardt JP, Hahn A, Floel A. Impact of omega-3 fatty acid supplementation on memory functions in healthy older adults. Journal of Alzheimer’s disease : JAD. 2016;51:713-725

8. Johnston DT, Deuster PA, Harris WS, Macrae H, Dretsch MN. Red blood cell omega-3 fatty acid levels and neurocognitive performance in deployed u.S. Servicemembers. Nutr Neurosci. 2013;16:30-38

9. McNamara RK, Welge JA. Meta-analysis of erythrocyte polyunsaturated fatty acid biostatus in bipolar disorder. Bipolar disorders. 2016;18:300-306

10. Hawkey E, Nigg JT. Omega−3 fatty acid and adhd: Blood level analysis and meta-analytic extension of supplementation trials. Clinical Psychology Review. 2014;34:496-505

11. Lin PY, Chiu CC, Huang SY, Su KP. A meta-analytic review of polyunsaturated fatty acid compositions in dementia. J Clin.Psychiatry. 2012;68:140-147

12. Merle BM, Benlian P, Puche N, Bassols A, Delcourt C, Souied EH. Circulating omega-3 fatty acids and neovascular age-related macular degeneration. Investigative ophthalmology & visual science. 2014;55:2010-2019

13. Mozaffarian D, Lemaitre RN, King IB, Song X, Huang H, Sacks FM, Rimm EB, Wang M, Siscovick DS. Plasma phospholipid long-chain omega-3 fatty acids and total and cause-specific mortality in older adults: A cohort study. Annals of internal medicine. 2013;158:515-525

14. Pottala JV, Garg S, Cohen BE, Whooley MA, Harris WS. Blood eicosapentaenoic and docosahexaenoic acids predict all-cause mortality in patients with stable coronary heart disease: The heart and soul study. Circ.Cardiovasc.Qual.Outcomes. 2010;3:406-412

15. Kleber ME, Delgado GE, Lorkowski S, Marz W, von Schacky C. Omega-3 fatty acids and mortality in patients referred for coronary angiography. The ludwigshafen risk and cardiovascular health study. Atherosclerosis. 2016;252:175-181

16. Flock MR, Skulas-Ray AC, Harris WS, Etherton TD, Fleming JA, Kris-Etherton PM. Determinants of erythrocyte omega-3 fatty acid content in response to fish oil supplementation: A dose-response randomized controlled trial. Journal of the American Heart Association. 2013;2:e000513

17. Dewell A, Marvasti FF, Harris WS, Tsao P, Gardner CD. Low- and high-dose plant and marine (n-3) fatty acids do not affect plasma inflammatory markers in adults with metabolic syndrome. The Journal of nutrition. 2011;141:2166-2171

18. Katan MB, Deslypere JP, van Birgelen AP, Penders M, Zegwaard M. Kinetics of the incorporation of dietary fatty acids into serum cholesteryl esters, erythrocyte membranes, and adipose tissue: An 18-month controlled study. Journal of lipid research. 1997;38:2012-2022

In an analysis limited to participants aged 65 years and older (17% of all participants):

• 11% experienced a fall in the 6 months prior to their first test.
• Our data did not show a difference in falls based on serum levels; there was no difference in serum levels between those who fell in the prior 6 months and those who didn’t.
• The median serum level was 44 ng/ml for both those who fell and those who didn’t.

Vitamin D Response Curve

Ever wonder why your friend exercises as much as you, but they are leaner? Or how you can eat less than them, and yet you are heavier? Well, the same can be true with vitamin D supplementation.

Using data from our D*action population (7,324 people, 18 years and older) we found that there is a wide variability with response to supplementation.

What does that mean?

Two people could both take 4,000 IU/day, they both measure their vitamin D levels and one could be below the recommended value at 10 ng/ml (25 nmol/L), while another could be way above – at 120 ng/ml (300 nmol/L) – a 10-fold variation in response to the same supplementation dose of 4,000 IU/day. When measuring vitamin D blood serum levels, supplementation response varies greatly person-to-person.

It is important to test, not guess.

A panel of 48 international scientists recommend vitamin D levels of 40-60 ng/ml (100-150 nmol/L), but without measuring, you can’t know what your level is!

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In an analysis of the GrassrootsHealth cohort (total number of participants at the time 10,909) it was found that:

• 78% of participants take vitamin D supplements.
• The average intake amount among supplement takers is 4000 IU/day.

Past analyses have looked further at factors, such as age and latitude, that may affect intake levels among participants.

Age

• The percent of participants taking vitamin D supplements increased as age increased (from 69% for those 15-34 years to 91% for those 65 years and older).
• The median vitamin D intake amount increased as age increased (from 3500 IU/day for those 15-34 years to 4300 IU/day for those 65 years and older).

Latitude

• The median latitude for the GrassrootsHealth cohort is +/- 40 degrees.
• Supplement intake is consistent across latitude with approximately 80% of participants taking vitamin D supplements.
• The median intake is the same across latitude (4000 IU/day).

Percent Outdoor Occupation

• A majority (79%) of D*action participants perform <10% of their occupation outdoors.
• As the percentage of work performed outdoors increased, the percentage of participants taking supplements decreased (from 82% for those who perform none of their occupation outdoors to 71% for those who perform >50% of their occupation outdoors).

First Test vs Second Test

• For participants’ first test, the annual average vitamin D intake amount was 1600 IU/day.
• For those who tested at least twice, the annual average intake amount for the second test was 4000 IU/day.

Vitamin D plays a large part in overall bone health and bone strength, and optimizing vitamin D status can increase bone strength and help prevent a break. The analysis referenced above was limited to participants aged 65 years and older (17% of all participants, N=1659) since that age group is most likely to experience the effects of bone health. Within this group, 2% experienced a broken bone in the 6 months prior to their first test. Of those who broke a bone, the average number of breaks was one and the most common bones were in the feet and hands. The most common reasons were falling, tripping and running into furniture/wall.

When comparing vitamin D serum levels to the incidence of broken bones:

• Those who broke a bone were more likely to have a serum level <40 ng/ml than ≥40 ng/ml.
• Those with serum levels <20 ng/ml had 3 times the risk of breaking a bone compared to those ≥40 ng/ml.

Note:
Calcium, vitamin D, protein and magnesium are several co-factors that work together to maintain strong and healthy bones. When any or all nutrients are below the optimal level, bone status is impaired at the level of the lowest – the most limited nutrient. Because vitamin D deficiency is so prevalent, it is often the nutrient leading to bone status impairment. However, if one were to focus on optimizing vitamin D, without also optimizing Ca, protein, Mg, or one of the other important co-factors, no change in bone status would be observed, leading to a false conclusion that vitamin D does not affect bone status.

Because the nutrients interact in the maintenance of bone health, the effects of a single nutrient may be overlooked if intake of others is not sufficient.

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Chart Date 4/24/15
© 2016 GrassrootsHealth
Preliminary data, not yet published

• 33% of D*action participants experienced a cold and 10% experienced the flu during the 6 months before their most recent test.
• Participants with vitamin D levels greater than 40 ng/ml (100 nmol/L) reported 41% fewer cases of the flu and 15% fewer colds than participants with levels <20 ng/ml.

To answer this question, we looked at the GrassrootsHealth D*action data, with over 8,000 participants. In the questionnaire that accompanies each vitamin D test, participants are asked whether they had a cold or the flu in the previous 6 months. What can we learn from this data?

• 33% of D*action participants experienced a cold and 10% experienced the flu during the 6 months before their most recent test.
• Participants with vitamin D levels greater than 40 ng/ml (100 nmol/L) reported 41% fewer cases of the flu and 15% fewer colds than participants with levels <20 ng/ml.

Serum Level vs Intake Charts

One of the most common questions we receive at GrassrootsHealth after an individual has tested their vitamin D is “How much vitamin D should I take to get my levels up?”

Based on a plot of 25(OH)D values as a function of reported vitamin D intake amounts for 7,324 D*action participants, a calculation was produced to estimate the additional daily vitamin D intake needed for 90% of adults to reach a chosen target 25(OH)D serum level (age 18 years and older, weighing an average of 150 lbs).  The charts referenced here can be used as a tool to calculate how much additional supplemental vitamin D is needed to get 90% of individuals from an initial vitamin D serum level to a desired vitamin D serum level.

Example: With a starting serum level of 20 ng/ml an additional intake of approximately 5,000 IU/day would be sufficient for 90% of adults (age 18 years and older, weighing 150 lbs) to achieve a serum level of at least 40 ng/ml (100 nmol/L).

Four versions of this chart are available in the download:

• Change in Serum Level Based on Intake (IU/day) for 90% of Adults – these charts show calculations based on an average weight of 150 lbs
  • Available in ng/ml and nmol/L
• Change in Serum Level Based on Intake (IU/lb and IU/kg) for 90% of Adults – these charts show how to calculate using an individual’s weight
  • ng/ml and nmol/L

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You may also use our D*calculator for the same calculations based on weight, starting serum level, and target serum level.

GrassrootsHealth has compared the National Health and Nutrition Examination Survey (NHANES, 2009-2010) data to look at rates and trends of vitamin D deficiency in the United States in both adults and children and how it compares to the GrassrootsHealth cohort (US participants who tested anytime in 2009 or 2010). With recent NHANES data sets, lab results from across the years have been standardized when different lab testing was used, allowing for a more accurate comparison.To note, GrassrootsHealth participants consist of individuals and, in the case of children, have parents who are generally educated about vitamin D and have tested their level at least once.

Adults

This first chart illustrates the difference between vitamin D serum levels in adults in the NHANES cohort vs the GrassrootsHealth cohort (ages 18+ years):

• Adults in the GrassrootsHealth cohort have significantly higher levels than those in the NHANES cohort
• 54% of adults in the GrassrootsHealth cohort have levels at or above 40 ng/ml compared to 11% in the NHANES cohort
• 6% of adults in the GrassrootsHealth cohort have levels below 20 ng/ml compared to 24% in the NHANES cohort
• Almost 90% of U.S. adults in the NHANES data set have a vitamin D level below the recommended range of 40-60 ng/ml, with about 25% below 20 ng/ml

Children & Teens

This next chart above illustrates the difference between vitamin D serum levels in children and teens (ages <18) in the NHANES cohort vs the GrassrootsHealth cohort:

• Children and teens in the GrassrootsHealth cohort have significantly higher levels than those in the NHANES cohort
• 60% of children and teens in the GrassrootsHealth cohort have levels at or above 40 ng/ml compared to 9% in the NHANES cohort
• 7% of children and teens in the GrassrootsHealth cohort have levels below 20 ng/ml compared to 15% in the NHANES cohort
• More than 90% of U.S. children and teens in the NHANES data set had a vitamin D level below the recommended range of 40-60 ng/ml, with about 15% below 20 ng/ml

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When downloading, both charts are included, with Adults age 18+ on page 1 and Children and Teens, ages <18 on page 2.