2024-08-19 00:22:16
In Spain, vitamin D levels are similar and even lower than those in Central Europe because the modernization in these countries has brought food supplements. In addition, there are many factors that can prevent the production of vitamin D, such as pollution, age or the period of time of the sun.
The presence of the hottest months of the year, in which the phenomenon of sunlight precedes, is related to the general observation that the production of vitamin D is greater because we spend more time outside and receive direct sunlight. It is true that, from a physiological point of view, skin production through the action of the sun’s ultraviolet B radiation is the main source of vitamin D (80-90-%), with the rest obtained through food. But there are many factors that can make this production difficult, especially during the sleep period. Some of these factors are: time of sun exposure, latitude and time zone where you sunbathe, exposed skin, use of sunscreens (important to avoid damage to the skin and avoid risks such as melanoma), phototype plate. (higher in pigmentation, lower production), age (older adults, less production), environmental pollution (which reduces this production) or avoidance behaviors (in the face of heat that maximum and prevention of damage). ). In addition to this is the fact that the total daily intake of vitamin D is generally not enough to maintain optimal levels of 25 (OH) D (the metabolite used to measure, as accurately as possible, how much vitamin D is in. body).
Vitamin D values are better in central Europe compared to Spain
It should be noted that the levels of vitamin D in Spain are similar (or even lower) to those in central Europe or Scandinavia, because in these countries the foods used are often supplemented with vitamin D .Various studies have shown that vitamin D deficiency is not. something exclusive to areas with little sunlight and the prevalence of hypovitaminosis D in sunny climates can be estimated.
Therefore, a study that analyzed the prevalence of hypovitaminosis D in medical students at the University of Las Palmas de Gran Canaria determined that almost two out of three students have low levels of 25-hydroxyvitamin D1.
The effect of the use of sunscreens, typical of this era, on the skin’s production of vitamin D is controversial. In this sense, the Spanish Society for Bone and Mineral Research (SEIOMM) recommends, in the Caucasian population, a daily sun exposure of 15 minutes on the face and arms between the months of March and October, with a safety margin between 15 and 30, depending on the size and intensity of the radiation. In elderly people and patients with osteoporosis, the recommended daily exposure to sunlight is 30 minutes. At the same time, for years, social health policies have been implemented to restrict exposure to sunlight. , promoting a dietary source of vitamin D to prevent the risk of skin damage (e.g. melanoma) associated with sun exposure.
Hypovitaminosis D can affect the general health status. In this sense, the incidence and severity of cardiovascular, neuropsychiatric, autoimmune diseases and bone and muscle problems can worsen in conditions of deficiency of this hormone.
“There are many factors that prevent the skin’s production of this vitamin, so the arrival of the sunny months of the year is not a guarantee that the production will be better”Esteban Jódar explained, head of Endocrinology and Nutrition service at Quirónsalud University Hospital and professor of Endocrinology at the European University of Madrid.
Medical holidays in vitamin D supplementation: is it necessary and appropriate?
A randomized clinical trial conducted in Spain has shown the effect of stopping calcifediol (treatment for vitamin D deficiency) in postmenopausal women with vitamin D6 deficiency. The main objective of the study was to evaluate the long-term effect and safety of monthly calcifediol 0.266 mg for 12 months, monthly calcifediol 0.266 mg for 4 months + placebo for 8 months or monthly cholecalciferol 25,000 IU for 12 months.
Once the optimal levels of 25-hydroxyvitamin D have been reached, after stopping treatment in 4 months, the levels fall again, once again giving a deficient state. The authors therefore conclude that, as observed with cholecalciferol, the interruption of treatment with calcifediol leads to 25(OH)D levels falling rapidly back to pre-treatment levels, indicating the need to maintain supplementation once better levels are reached. This observation is consistent with that of SEIOMM of unlimited supplementation for the population at risk of vitamin D deficiency.
For Dr. Jódar: “In clinical practice it is common for therapeutic breaks in vitamin D supplementation, not so much promoted by patients but by professionals. This is not recommended since, like any other hormonal supplement, the treatment delay leads to a decrease in the levels before the treatment, which, therefore, are deficient. A decrease in 25(OH)D levels after the cessation of vitamin D supplementation can prevent the beneficial effects of this endocrine system, both at the muscle levels and the excess levels. Patients who are most at risk when treatment is stopped are those with osteoporosis. We know that, in this situation, even when there is not much sleep or it is done with protection, vitamin D drops are the most common prevention of treatment failure for osteoporosis. Perhaps, other groups or other specialties such as neurology are in the same situation. ” MTT/LDB (SyM)
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