Lost in the effort to improve global vitamin D awareness is that to date, we actually don’t have very good data on best methods to educate on vitamin D. We know what we want in spreading awareness. We want to educate people to make sure they’re getting enough vitamin D, to make sure they’re not deficient in vitamin D. At minimum, we reduce the incidence of falls and fractures. Some might say we even know what the optimal vitamin D level is, and after we educate, we want people to raise their levels into that range. At maximum, if research pans out, we reduce the incidence of cancer, cardiovascular disease and more.
What’s missing is research that shows how to best educate to meet these goals. You’ll see some individuals and organizations recommend easy things, like “take a supplement,” “get more sun exposure,” or “increase fish consumption.” And you’ll see some individuals and organizations recommend entire protocols, like “Test your vitamin D level, figure out the dose you need, test again, adjust your regimen, repeat.”
Unfortunately, we don’t really have the data to know which works best on a population scale. For example, there is no data on whether recommending a supplement, recommending sun exposure or recommending both – on a population scale – is best to try and raise vitamin D levels. We don’t know if a one-size fits all recommendation, like “Take 5,000 IU/day,” is better than a formulaic recommendation tailored to the individual, i.e. “Take 1,000 IU per 25lbs of body weight,” in efforts to raise an entire population’s vitamin D levels.
And again, we really don’t know if we should be giving people simple directions to get more vitamin D, like “Take a supplement,” or if we should be teaching the end-goal, like “Aim for a level 50 ng/ml, learn how to get there and then off you go.”
At the Vitamin D Council, since there is a lack of data on best education methods for vitamin D, we do our best to educate using all of these angles. We try to layer the presentation of our information, making simple steps accessible first, then if the individual wants to learn more, provide more in depth recommendations and regimens to go by.
We know our methodology works okay by a combination of in-person usability testing and web analytics tracking, the latter which tells us whether people are reading the pages or if they’re deciding to go elsewhere, how long they’re staying on the page, etc. That being said, we don’t have the budget to more rigorously put our information to the test, and we’re still not sure how well we’re meeting our end-goal question: Are we maximally decreasing the percentage of people deficient in vitamin D?
We receive many emails from people saying we should change content, or we should educate in XYZ manner. While we take feedback very seriously and always add it to our list of things to consider, you can’t justify putting education methods into practice unless they are backed by research or they pass through usability testing or something similar. As much as you might be tempted to put common sense into practice, common sense doesn’t always pan out into best-evidence or best-methods.
At this point, you’ve probably taken a gander at what I’m getting at: We really need academia to step up and start looking into best methods to educate on vitamin D.
There have been a few trials that show that traditional counseling from a dietician doesn’t work for vitamin D, where a nutritionist sits down with a client/patient and discusses how to incorporate more vitamin D into the diet. This doesn’t decrease prevalence of vitamin D deficiency for obvious reasons, in that we can’t get much vitamin D from our diet.
How about sun exposure? If we recommend sun exposure, will people actually go get sun exposure? And will they get enough so that they actually raise their vitamin D levels?
In the most recent journal Molecules, researchers out of Saudi Arabia finally looked at this question.
Doctors had 95 patients enroll into their study, of which only 47 completed. The participants were overweight Saudis.
The doctors told the patients that their vitamin D levels were low, and to improve them, they needed to get 5 to 30 minutes of sun exposure twice per week.
And it worked, to a certain extent. After one year, vitamin D levels rose from 30 nmol/l to 37 nmol/l, and the percentage of people with a severely deficient level of less than 25 nmol/l decreased from 44% to 27%.
Unfortunately, the doctors made a huge error in recommending sun exposure only before 10am or after 3pm, well before and past times of peak UVB.
The limitation in the study is the 50% dropout. While the authors didn’t mention why this was, the other half that didn’t complete the study could have easily not gotten much sun exposure at all, as they demonstrated a general lack of compliance, which could well represent the general public. This shortfall in the study is a big enough limitation, where, in my opinion, there is still quite a bit of doubt whether a doctor simply telling his patient to get more sun exposure actually works.
In conclusion, I think it’s important to recognize that we don’t know best-methods to educate on vitamin D. We do take our best guess and try to make up for the lack of research in the area through usability testing, analytics and general principles in providing patient friendly information. This is an area where we need more research, and we hope to see more in the next few years.
Until then, it’s probably best to simply recommend sun exposure and supplements, and if people want to know more, then you can really delve into vitamin D levels and tailoring recommendations.