Tuesday, August 14, 2012

Supplements: Overview and Vitamin D3

A good and balanced paleo inspired diet should in theory provide all nutrients. But reality does not meet the theory very well. There are several issues because of which we may not get enough nutrients. In this article we will just discuss the general reasons and Vitamin D.

Digestion may not be very good
Many people these days have bad digestion. Bad digestion results in incomplete absorption of nutrients. Bad digestion normally occurs due to impaired gut flora, which provide some of the important nutrients, Biotin and Vit K. We should improve the digestion, but while we get it fixed it would be best to get some extra nutrients in the form of supplements.

Food restrictions
Many people in India are vegetarians. Vegetarians need to eat enough ghee and curd. Unfortunately its very difficult to get very good quality of either easily in the present environment. This results in reduced Vit B12, Zinc, and Fat soluble vitamins like K2 and A.

Reduced nutrient content in food
This is by far the major reason for malnutrition. These days fruits and vegetables have undergone modification, via breeding, Genetic Modifications, enforced mutations, etc. These are done in most cases for increasing production. A breed that provides a larger fruits and vegetables or in a significantly increased quantity will have a much lowered nutrient content. Plants are also bread for blander and sweeter fruits and vegetables, further reducing the nutrient contents.

Consumption of refined foods, salt and water
People these days are eating refined flours, refined sugars, refined salts, and purified water. These might be prudent in some cases, but overall affect the nutrient intake. Refined flours, white rice are not a problem if the intake is not significant. Sugars are bad even if not refined and should be avoided. Refined salts are created to remove the problematic magnesium chloride, which is hygroscopic, and makes the salt absorb water. Unfortunately it is difficult to find unrefined salt. In Bangalore it was easier, but in Delhi I haven't been able to source it. Purified water is mostly a necessity because of the chlorination process that goes in the potable water, but it also removes important nutrients like magnesium.

Lack of Sunlight or Vitamin D3 (Cholecalciferol) deficiency
Vitamin D is generally very low in people, because we are living in houses, and work in offices, both confined spaces, with no exposure to sun. Contrary to popular belief, sunlight does not cause damage to the skin, as you can observe in people working the whole day under the sun. The problem normally is bad nutrition, and very occasional sunlight exposure. UVB component of Sunlight is used by the skin to create vitamin D. This vitamin/hormone is a very important nutrient. It is required for the proper functioning of the immune system. It is required by the liver for handling toxic chemicals. It is also required for absorbing Calcium from food.

The best way to get vitamin D is from the sun. If you are fair skinned, an hour or two of morning sun in the summers in Delhi would be enough to produce enough vitamin D. But for darker skinned people the whole day in winters in Delhi may not be adequate to meet the demand. The skin color is mostly determined based on the vitamin D requirement, sun and genetics.

It is also possible to get Vitamin D from Fish and fats of animals that have been exposed to sunlight most of their lives.

Majority of the people are deficient in Vitamin D, with values less than 20ng/ml. The best values are somewhere between 30ng/ml and 50ng/ml. There is quite a controversy regarding what is the healthy range. Read Chris Masterjohn's post on the subject if you want to get more technical information. He is of the opinion 30ng/ml - 35ng/ml is the best range. Vitamin D can have some significant negative effects, if attempted to increase by exogenous intake. Many people handle it well though.

Normal bad reactions are increase in serum calcium, if there are issues with excretion (ie impaired kidneys), or increase in calcium deposition. Serum calcium increase is easy to detect if you are aware and mindful of the symptoms. Calcium deposition is much more probable and difficult to determine.

Calcium absorbed by Vitamin D requires several cofactors to utilize it. Some of them are Vitamin K2, Vitamin A and Magnesium. These nutrients should also exist to prevent calcium deposition.

Cod liver oil is the most natural way of getting extra vitamin D. It contains Omega3s, Vitamin A, Vitamin E, and some other good things as well. In India Seacod sells cod liver oil in 100ml bottles. They also sell capsules. Each capsule contains only 300mg of the oil. This is quite less. A person can consume 1 to 2 tea spoons, ie 5-10ml of the oil. If you wanted to get that much oil from caps you would need to consume 10-30caps. Clearly, excessive. Another issue is that taste can tell you whether the oil has gone bad. This is not possible with caps. Each 5ml of Seacod contains.

EPA - 333ml
DHA - 500ml
Vit A - 4700 IU
Vit D - 470 IU

It does not contain a lot of vitamin D, but it is a very good supplement. You will see your immunity improve a lot with it.

Seacod unfortunately prefers selling the capsules, so we had quite a bit of trouble finding the real values. Kudos to Raj Ganpath for finally nailing someone there to provide sensible numbers.

The fresh cod liver oil will have very little fishy smell. Unfortunately it is difficult to find it very fresh. So try to find as fresh as you can, and store them in fridge or even in freezer for longer term storage. If it tastes very bad, its better to throw it.

One important point is that never supplement calcium along with Vitamin D. Vitamin D supplementation is already has dangers of calcium deposition, adding more calcium to the mix can only be worse. An aside, milk is not required for calcium, as many cultures which can't handle milk have shown (asians are an example). There is plenty of calcium in green vegetables and tubers. Pastured full fat dairy is ok as it contains enough K2 to handle extra calcium. It would be better to avoid reduced fat dairy, when supplementing with Vitamin D.

Gelcaps are the best way to get extra vitamin D (over and above cod liver oil), because they are filled with an oil to improve absorption. NOW foods has a very reasonably priced 5000IU, with 240caps in a single bottle. I have used this almost exclusively.

Where to get Vitamins and Minerals
iHerb and Swanson Vitamins are good online stores in the US. I have used them. The trouble is with the shipment and customs part. I personally never faced any issues with the shipment and customs, but my brother has faced problems. The cost of supplements in the US is very low. The shipment and customs can add quite significant costs to the supplements. This option may still be quite a bit cheaper if the cost of supplements being ordered is at least a couple of hundred USDs.

If you cannot get someone to bring them for you and you want to order only a few items, then you may want to check out local companies. There are two online shops in India, which are selling supplements, Healthkart and Biovea. I haven't tried these yet.


  1. Few important points to remember:
    1. Excess vitamin D levels are also associated with reduced bone mineral density.
    2. Vitamin D level is difficult to monitor because after saturation it shoots rapidly.
    3. Calcification is difficult to detect and is not easily reversible.
    4. Taking regular cod liver oil improves immune system even if your Vitamin D level is low.

  2. Thank you for this informative post. I am actually taking vitamin d3 supplements right now. This is for me to stay healthy and strong since I'm a very busy person. Thanks my doc and to people like you who knows how to give people the right knowledge that they should not taken for granted.

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  4. Dear Perfect health Monitor,

    I think in India specially in Kolkata people can also use online medicine store known as Sastasundar

    They claim that they supply only real medicines and people can also find generic medicine too

  5. Thanks for this great post Anand. Vitamin D is very important in anyone's life. It helps us to increase our immunity, Before, i was not taking all this seriously but now I have start taking Vitamin D supplements. :)