Post your response to the discussion board.

Then, comment on the posts of at least two

classmates in 200-300-word responses who were focused on a different vitamin D sub-topic.
Compare the evidence they have provided to what you have found to begin to understand the
difficulty in setting strict vitamin D limits. Address areas of limitation in either focus, and discuss
future directions for research to address these limitations. 

My response to the discussion board: Across the board, it is recommended that

women take prenatal vitamins as soon as they know they are expecting, if they are trying to
conceive, during the pregnancy, and during breastfeeding months (Equilis and Hewison, 2010).
This is to ensure the healthy development of the fetus, as well as maintain optimum health levels
of the mother’s own well-being. However, it is unlikely that prenatal vitamins provide enough
Vitamin D. It is suspected that women taking vitamin D with a daily dosage of 4,000 IU receive
the most considerable benefits in preventing birth issues, infections, and preterm labor (Morales,
et al., 2012). However, while studies have confirmed that these levels of vitamin D are the safest
and recommended, more research is still needed to support the exact level of enough vitamin D
levels and how to best deliver them through supplements (Locas, Xiang, Ponson, 2013).

While research is still ongoing to figure out the exact specifications, vitamin D is still proven to
support healthy immune function, stellar bone health, and healthy cell division during gestational
periods (2013). These benefits continue after birth, as well as vitamin D, is necessary for the
metabolism and absorption of calcium and phosphorous (Morales, et al., 2012). Women should
take vitamins, in conjunction with prenatal vitamins and other recommended health routines
during their pregnancy, as an investment in the well - being of their child. Deficiency is linked to
dangerous conditions, including preeclampsia, which could result in the death of both mother
and child during labor/the birthing process (2012). It has been shown that almost 60% of the
United States population is vitamin D deficient - these numbers include pregnant women or
women trying to conceive (Equilis and Hewison, 2010). Factors that have been stacked against
pregnant women preventing their absorption of vitamin D, without supplements, include where
they live, time spent in the sun without sunscreen, age, obesity, and more.

 References

Equils, O., & Hewison, M. (2010). A Role for Vitamin D in Pregnancy. The American
Pregnancy Association, 201(12).

Lucas, R., Xiang, F., & Ponson, A. (2013). Vitamin D sufficiency in pregnancy: Better evidence
is required to establish optimal levels and need for supplementation. BMJ: British Medical
Journal, 346. 7902.

Morales, E., Romieu, I., Guerra, S., Ballester, F., Rebagliato, M., Vioque, J., . . . INMA Project.
(2012). Maternal Vitamin D Status in Pregnancy and Risk of Lower Respiratory Tract Infections,
Wheezing, and Asthma in Offspring. Epidemiology, 23(1), 64-71.

The response post that has to be replied to: Vitamin D has been associated
with bone mineral density (BMD). (Gropper & Smith, 2018) This is specifically important in
preventing injury for athletes. Some studies have compared bone density levels between athletes
participating in various sports. Findings showed that those participating in sports with higher
impact tended to have higher BMD levels than those in a no impact sport. These sports include
soccer or basketball and cross-country or crew for high-impact and no impact respectively.
(Tenforder et al., 2018) Vitamin D helps with the absorption of calcium which in turn helps
increase bone strength. (Whitney & Rolfes, 2019, p 342) Furthermore, vitamin D as Calcitriol
has a vital role in maintaining serum calcium homeostasis. In turn, when low blood calcium
signals the parathyroid gland, the result is the release of calcium from the bone into the blood,
which can cause adverse effects to the bone. (Gropper & Smith, 2018, p 393-396).

In association with athletes, specifically those in the trial, it was found that BMI had a positive
correlation with low BMD results. (Tenforder et al., 2018) This provides explanation to non-
impact sports, such as cross country, where BMI levels are relatively low among this population.
This could be for many reasons, one being the ability to replenish caloric deficit appropriately
may be absent. For adults 15 micrograms per day is the recommended dietary allowance. There
is no differentiation for athletes, so collegiate athletes would fall under this category.
Furthermore, vitamin D can be absorbed through the skin from exposure to direct UV lights.
(Gropper & Smith, 2018, p 398) This makes it complicated to put a proper amount on intake
through food, especially since no RDA has been recognized through exposure to sunlight.
(Whitney & Rolfes, 2019, p 346) For athletes who fall under the category of a lower BMI or
participate in a non- or low-impact sport, attention to consumption of foods that provide a
substantial amount of vitamin D may be advised. These recommendations may be to consume
more shitake mushrooms or swordfish or expose arms to direct sunlight for about 15 minutes a
day between 10am and 3pm (spring, summer, & fall). (Gropper & Smith, 2018) This could
propose that athletes whose sports are performed predominately outside would have less
deficiencies than those who play inside. One other factor that could inhibit the ability to absorb
enough calcium in the bones to keep them healthy is the deficiency of protein. Since sports like
cross country and crew are endurance sports, glycogen and fat energy could be used up relying
on protein. Since protein would be used for energy in these scenarios, the transport proteins used
to carry vitamin D, among other nutrients, would be unavailable or limited. In conclusion, in
order to prevent deficiency of vitamin D among athletics, diet and recovery should be carefully
considered.

Resources

Gropper, S.S., & Smith, J.L. (2018). Advanced Nutrition and Human Metabolism (7th ed.).
Boston, MA: Cengage Learning.

Tenforde, A. S., Carlson, J. L., Sainani, K. L., Chang, A. O., Kim, J. H., Golden, N. H., &
Fredericson, M.(2018). Sport and Triad Risk Factors Influence Bone Mineral Density in
CollegiateAthletes. Medicine & Science in Sports & Exercise, 50(12), 2536–2543. doi:
10.1249/mss.0000000000001711

Whitney, E., & Rolfes, S. R. (2019). Understanding Nutrition (15th ed.). Boston, MA: Cengage
               Learning, Inc.
The response post that has to be replied to: Vitamin D has a role in cognition
that is not fully understood, however the vitamin has been suggested to improve cognition,
especially in elderly populations. The RDA for vitamin D is 15 mcg (600 IU) per day for most
people, and 20 mcg (800 IU) per day for individuals older than 70, while the UL is 100 mcg
(4000 IU) per day through adulthood. (Gropper & Smith, 2013) Few studies have been
performed on humans with cognitive impairment, for example, those with dementia or
Alzheimer’s disease. (Petterson, 2017) And those few studies that have been performed in
humans have not shown significant results due to the short length of time of the studies. It is
suggested that effects of vitamin D supplementation can take up to 16 weeks. (Petterson, 2017)

Some studies have shown that increased serum vitamin D levels are positively associated with
better cognition in humans based on results of Mini-Mental State Examinations (MMSE), Pattern
Recognition Memory Task (PRM), Paired Associates Learning Task (PAL), and/ or Symbol
Digit Modalities Test (SDMT). 

One study performed on elderly Korean participants who resided within a community aged ≥ 65
years, measured cognitive impairment with MMSE with independent variables of physical
fitness and serum vitamin D levels. The MMSE scores range from 0 – 30, with 30 reflecting
better cognition and a score of ≤ 23 reflects cognitive impairment. (Jeong-Deok & Hyunsik,
2015) The study found that those with higher serum vitamin D levels had better cognition than
those who had lower serum levels of vitamin D. It also showed that those who participated in
exercise also had better cognition. The study in Koreans was performed due to the increasing
amount of vitamin D deficiency in the Korean population, showing perhaps supplementation
may be needed, especially in the elderly population. (Jeong-Deok & Hyunsik, 2015)

Another study was performed in the United Kingdom on healthy individuals varying in age
groups supplemented with vitamin D3 with one group on 4000 IU/ day (high dose) and another
group on 400 IU/ day (low dose) for 18 weeks. (Petterson, 2017) Serum levels increased in both
groups. There were no significant differences in cognition at baseline between the groups. The
participants’ cognition was measured based on the results of cognitive testing including PRM,
PAL, and SDMT. The most significant of the results showed that the high dose group had
considerable improvement in visual memory but not in other tests, such as verbal memory. The
low dose group had improvements in verbal memory and verbal fluency. (Petterson, 2017) These
are important findings, but leaves the reader questioning how much vitamin D they should
consume to maintain or improve cognitive function.

It has been suggested that Leucine (an amino acid involved in the synthesis of muscle), vitamin
D3, and medium-chain triglycerides (MCT) can improve strength and cognition in frail elderly
adults. (Sakiko, et al., 2017) A study performed on frail elderly participants living in a nursing
home was conducted using three supplement groups over a period of 12 weeks. One group had a
supplement of Leucine (1.2g), vitamin D3 (20 mcg), and medium-chain triglycerides (MCT – 6
g), while another group had a supplement of Leucine (1.2 g), vitamin D3 (20 mcg), and long-
chain triglycerides (LCT – 6 g). The control group was not given supplements. The MCT group
had significant improvements on MMSE and in Nishimura geriatric rating of mental status, while
the other two groups showed a decrease in both assessments. (Sakiko, et al., 2017)
These studies show a positive association with vitamin D and cognition, but they have not
suggested or defined a specific recommendation for each type of individual. Vitamin D is also
synthesized by sun exposure, therefore how much vitamin D can be recommended on an
individual basis? This was not addressed in either of the studies. It is easy to see that there could
be varied recommendations within the RDA and UL. Should these recommendations increase as
more individuals are spending less time in the sun due to business conducted in an office setting,
or for elderly living in nursing homes, or for Koreans who are deficient in vitamin D?

 Reference List

Gropper, S. A. S., & Smith, J. L. (2013). Advanced nutrition and human metabolism. Belmont,
CA: Wadsworth/Cengage Learning.

Jeong-Deok Ahn, & Hyunsik Kang. (2015). Physical Fitness and Serum Vitamin D and
Cognition in Elderly Koreans. Journal of Sports Science & Medicine, 14(4), 740-746. 

Pettersen, J. A. (2017). Does high dose vitamin D supplementation enhance cognition?: A

randomized trial in healthy adults. Experimental Gerontology, 90, 90–97. doi:
10.1016/j.exger.2017.01.019

Sakiko, A., Osamu, E., Motohisa, S. (2017). Medium-Chain Triglycerides in Combination with

Leucine and Vitamin D Benefit Cognition in Frail Elderly Adults: A Randomized Controlled
Trial. Journal of Nutritional Science and Vitaminology, 63(2), 133-140.
https://doi.org/10.3177/jnsv.63.133

Additional Instructions: 1 full page per discussion response. I can provide textbook
information if needed. APA FORMAT. No more than 25 % Plagiarism. Provide source to
research.