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Vitamin D in Preparing for Pregnancy and Living in Sun Drenched Australia

Answered on September 12, 2014
Created February 23, 2012 at 5:03 AM

We are going to try to get pregnant towards the end of the year. I had a blood test recently which said I was deficient in Vitamin D. My level was 65 and it is supposed to be a minimum of 75 at the least. My doctor wants me to start supplementing with vitamin D starting right now. However I don't love the idea of supplements - especially synthetic ones.

I know you all want to shout out 'sit in the sun'! Well a lot of you are in the states and maybe don't realise how bloody strong the sun is in Australia! I can stand outside and get burnt within 10 minutes (my skin is quite fair). The other thing is that I am an archaeologist and consequently spend a lot of time outdoors - I am always covered up and using sunscreen - perhaps I could expose myself a little more. But I am also living through the experience of my father who has developed melanoma's all over his back from excessive sun exposure during the no-one knew better 70s. Hence Sisson's chapter on sun exposure freaked me out a little.

I am wondering if fermented cod liver oil would help? Or is D3 different to just D? Or if there are any other suggestions. Including any information on safe levels for the lead up to and during pregnancy.

F4d04667059bc682540fdfd8b40f13a7

on February 25, 2012
at 02:31 AM

I agree, I always cover up rather than wear slimey sunscreen!

94a4a87e3d2e1e9160b6ed77678b4bea

(1311)

on February 23, 2012
at 09:39 PM

Interestingly my doctor was aware of VitD lit because she herself is deficient (much more so than myself actually) - and she was happy to cite studies from all over Australia - including some of the hottest parts - where VitD deficiency is still as large a problem as in the colder and less sunnier areas. She basically said that the scientific community probably still has a lot to learn about the issue.

94a4a87e3d2e1e9160b6ed77678b4bea

(1311)

on February 23, 2012
at 09:36 PM

Thanks - I actually hate wearing sunscreen and mostly just try to cover up where i can instead - it makes my normally nice skin go bleugh. I'm in Melbourne so it is a little cooler - but not when working outside in summer!

94a4a87e3d2e1e9160b6ed77678b4bea

(1311)

on February 23, 2012
at 09:35 PM

Thank you - I will be reading your blog!

286a4ff7c362241c5c4b020df4972212

(1288)

on February 23, 2012
at 07:43 AM

FYI lots of the derms in Aust are now thinking that Melanoma is now caused by a weak immune system caused by lack of Vita D - the slip slop campaign has done nothing but increase Melamoma rates. I am not saying go sit in the sun and you wont get it - just food for thought though!

94a4a87e3d2e1e9160b6ed77678b4bea

(1311)

on February 23, 2012
at 05:21 AM

Thanks Daz - to my rescue again - I had no idea about the conversions.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on February 23, 2012
at 05:15 AM

For the non aussies; the units used in Australia for serum 25ohD are nmol/L. For ng/ml, divide by 2.48, Therefore 65 nmol/L = 26 ng/ml (and 75 nmol/L = 30 ng/ml).

Af3e3615beba642bcafd0f21d64d74f7

on February 23, 2012
at 05:08 AM

Fermented cod liver oil will help, as well as organ meats and eggs. D3 is utilized by the body better than D2. As well as natural pre-natals, which can be taken if trying to get pregnant, not just when you get pregnant. You can get minimum exposure to the blistering sun, and gradually not get burnt as easily. To produce vit D via sun you would have to expose a good range of bare skin in as little as 15 minutes is all that is needed to start producing vit D.

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8 Answers

2
7d01d86c539003eed77cf901bf037412

(1076)

on February 24, 2012
at 06:11 AM

Gidday from New Zealand, where the ozone layer is even thinner. I've noticed since going more into full-on paleo and eating a lot of beef and lamb fat and butter and coconut oil that I burn a lot less easily. Eg, I sat outside at 1 pm yesterday for about an hour and a half in mild-overcast to sunny conditions (eating a delicious fatty steak I might add). No sunburn today. Four or five years ago I would have got burnt in about 20 minutes. I do have a pretty classic farmer's tan at this point I have to admit.

Local paleo guru Jamie Scott argues that Vitamin D is actually protective against sunburn -- an unfortunate paradox, eh?

http://thatpaleoguy.com/2010/04/21/vitamin-d-protective-against-sunburn/

http://thatpaleoguy.com/2011/01/25/the-good-the-bad-and-the-ugly-of-sunscreens/

http://thatpaleoguy.com/2011/12/10/more-sun-science/

Anyway, as your levels come up and as you increase the saturated fat in your diet, you might want to try judiciously extending your sun exposure.

2
Ce41c230e8c2a4295db31aec3ef4b2ab

(32556)

on February 23, 2012
at 09:49 AM

I'm a pregnancy coach & you can read my blog post on the topic, (includes the Vitamin D council's newsletter.)

94a4a87e3d2e1e9160b6ed77678b4bea

(1311)

on February 23, 2012
at 09:35 PM

Thank you - I will be reading your blog!

2
286a4ff7c362241c5c4b020df4972212

on February 23, 2012
at 07:45 AM

10 min in the sun between 10 and 2pm 5 days a wk is enough to up your levels - I am good for a few wks then forget to get out there - just reminded me to go take some!

2
121a16aded2bed8dca492d3c9662ef4c

on February 23, 2012
at 06:55 AM

If you are reluctant to go into the sun, then you really have no other option than to supplement. Especially if you are planning to get pregnant, you simply won't be able to meet your needs via diet (cod liver oil is enough to prevent rickets, but that's about it).

I'd be with your doctor on this one. The fact that (s)he ordered the test is a sign (s)he is up on the literature.

During pregnancy, your body's vitamin D demand will rise dramatically, and its ability to provide the required substrate will determine your risk for gestational hypertension and preterm birth. In a randomized, controlled safety trial, Hollis and Wagner tested 4000 IU/d, 2000 IU/d, and 400 IU/d in pregnant women and found that 4000 IU/d was both safe and associated with the greatest effect on plasma 25(OH)D levels:

  1. Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J. Bone Miner. Res. 2011;26(10):2341???2357.
  2. Robinson CJ, Alanis MC, Wagner CL, Hollis BW, Johnson DD. Plasma 25-hydroxyvitamin D levels in early-onset severe preeclampsia. Am. J. Obstet. Gynecol. 2010;203(4):366.e1???6.

You can use either the sun or supplements to get your levels in the range between 100 and 150 nmol/L, which is the level associated with lowest risk of complications. You'll want to maintain this level when breastfeeding as well, since you've got to supply baby, too (although if your doc is awake, (s)he'll prescribe a neonatal supplement also).

D3 is the natural form of vitamin D (cholecalciferol), D2 the synthetic (ergocalciferol). There's a fierce debate raging over whether there is a difference, but it's hard to argue against the natural form, especially as there's some evidence that it's more potent.

94a4a87e3d2e1e9160b6ed77678b4bea

(1311)

on February 23, 2012
at 09:39 PM

Interestingly my doctor was aware of VitD lit because she herself is deficient (much more so than myself actually) - and she was happy to cite studies from all over Australia - including some of the hottest parts - where VitD deficiency is still as large a problem as in the colder and less sunnier areas. She basically said that the scientific community probably still has a lot to learn about the issue.

1
543a65b3004bf5a51974fbdd60d666bb

(4493)

on February 24, 2012
at 05:52 AM

On sun exposure: It's UVB exposure you are after. And you want to minimise/avoid UVA exposure.
more details and info here: http://www.vitamindcouncil.org/health-conditions/cancer/melanoma/ and http://www.vitamindcouncil.org/about-vitamin-d/how-to-get-your-vitamin-d/uvb-exposure-sunlight-and-indoor-tanning/

On D2 vs D3: Here are some recent studies, No surprises; natural vitamin D3 is better (than synthetic D2):
http://blog.vitamindcouncil.org/2011/11/16/meta-analysis-looks-at-efficacy-of-d2-vs-d3/
http://jcem.endojournals.org/content/96/3/E447.abstract
http://www.ncbi.nlm.nih.gov/pubmed/21735411

On fermented cod liver oil: I would say it is fine to take fermented cod liver oil (fclo), but take it for its Vitamin A, not for its Vitamin D & watch your dose.
What i mean by that is, if you dose your FCLO to get a "good serve" of Vitamin D you will almost certainly (imo) end up with a high (excessive, too high?) dose of Vitamin A.

If you do use FCLO, make sure its all natural, i know most of the non-fermented CLO these days contains synthetic vitamins.

From my readings, all the issues with Vitamin A are associated with supplementation of the synthetic form only. Natural Vitamin A is fine, as long as you don't go overboard, 2,500 IU to 5,000 IU per day from all sources seems to be the normal sort of amount you expect to get from food sources (i do not know what is recommended during pregnancy).

The thing with cod liver oil is that most CLO these days is not 100% natural, the vast majority of CLO products on the market have synthetic Vitamins A and D added during production. This is why they can tell you exactly how much Vits A & D you get per dose. If its all natural CLO, its probably labelled as a 'Food' product & may not even tell you the A & D content, & if it does it will be a variable range & generally lower than that you see in CLO using synthetics. For some more info you can go here http://www.westonaprice.org/cod-liver-oil

1
F4d04667059bc682540fdfd8b40f13a7

on February 23, 2012
at 05:51 AM

Hi MayaBee! I'm in Australia too! Highly recommend you read the Vitamin D Solution by Michael F. Holick Ph.D. M.D. In Australia there's an Aussie version of the book, with all of the relevant tables showing how much sun you live based on your skin type and exactly where in Aus you live!

I don't like taking supplements, but do take a very high quality Vitamin D3.

Burning isn't good, but some of the sunscreens have got terrible ingredients - make sure you get a good one!

94a4a87e3d2e1e9160b6ed77678b4bea

(1311)

on February 23, 2012
at 09:36 PM

Thanks - I actually hate wearing sunscreen and mostly just try to cover up where i can instead - it makes my normally nice skin go bleugh. I'm in Melbourne so it is a little cooler - but not when working outside in summer!

F4d04667059bc682540fdfd8b40f13a7

on February 25, 2012
at 02:31 AM

I agree, I always cover up rather than wear slimey sunscreen!

0
B8592e62f9804ddabae73c1103d6bcb9

(1956)

on February 25, 2012
at 06:00 PM

I would say 75nmol/L (30ng/ml) is too low still, 50ng/ml (124nmol/l) is much better. 30ng/ml maximises calcium absorption, but you need higher blood levels for the anti-cancer effects.

http://www.topicalinfo.org/forum/uploaded/dan/201044232733_VitaminDanddiseases.jpg

http://freetheanimal.com/2012/01/more-clues-toward-determining-optimum-vitamin-d-levels.html

http://www.vitamindwiki.com/tiki-index.php?page_id=62

0
A03f0d03067a43c61786481d91e5d3a0

(1078)

on February 25, 2012
at 02:40 AM

Last weekend I decided to sunbathe here. Turns out I forgot how sunburns work - I was expecting I'd know when I'd spent too much time in the sun. I spent less than an hour in the sun but the following day my chest was all red. Interestingly enough, my arms weren't red, not were my legs, probably because they've seen more sun than my chest, which has seen very little.

Transitions from cave-level sunlight to paleo-appropriate sunlight levels need to be gradual. Start with 1 minute in the sun, then 2 minutes a few days later, then 3, and so on. Everyone's skin can tan to some extent; if your diet is paleo and you're really so incapable of spending time in the sun, how do you think your ancestors did it?

I look at my feet and I see just how gradual a process tanning is: my feet have weird tan lines from my previous pair of Vibram Fivefingers which I stopped wearing over a month ago. So it takes longer than a month for skin to adapt.

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