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Thanks for watching!

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Hey everyone, it's Mikki here. You're listening to a mini Mikkipedia on a Monday and this Monday I want to chat about Vitamin D, specifically as it relates to menopause and post-menopausal women. Now, before you switch off and think I'm not in that age bracket, I'm not female, this is really useful information regardless of your age and your sex because if you're

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you probably know are females. So this just highlights the role of such an important nutrient slash hormone that is often overlooked, particularly in a country like New Zealand. And some context with that statement is that a vitamin D test is very simple to get, yet it's overlooked in the GP's office, and this isn't the fault of the GP, and I'm certainly not sort of coming down on doctors or anything.

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it's just not funded by the public health system. And so what I hear from doctors is that well it's not funded, people therefore have to pay for it to be measured. We already quote unquote know that you're going to be deficient in vitamin D so here's a script and so we'll just give you a vitamin D booster. Now this isn't necessarily a problem but it's just that it it's not a nuanced approach I suppose to looking at someone's overall health and in fact

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what I've just described is probably best case scenario because in other instances, and this is actual clients reporting back to me, that their doctors will dismiss the idea that they're vitamin D deficient so they won't either order a test or prescribe a script for vitamin D. And comments such as, we know you're going to be low, everyone's low, it's fairly normal, which tells me that they are mistaking what is normal for what is common.

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just because something is common doesn't necessarily mean that it is normal. So I think that's something that is just worth remembering. And equally, I don't know, like some people just want to be proactive about their health. And if they go to a doctor and they say to them, I'm really interested in understanding more about my vitamin D status, can I get a blood test done? And then there are comments such as, well, the vitamin D number doesn't really tell you much anyway. You sort of need a parathyroid hormone test to really uncover.

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much vitamin D your body is actually using. This is all very expensive. You don't need to worry about that. And again that way of thinking isn't that helpful for someone who's trying to be proactive. And whilst it is absolutely true that serum vitamin D and the vitamin D level that you might get measured might not necessarily reflect what your body can use because we do have vitamin D receptors which are either good or not that good at uptaking vitamin D.

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sort of the best we have and it's the most easily accessible and I do think that there is value in getting your vitamin D level tested to understand whether or not you have a sufficient level and by sufficient that if you look at a blood test or a serum test on vitamin D you will see that there is a range with which you fall into with which you'd be considered deficient or what

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anywhere under 50 nanomoles per liter, you would be considered deficient in vitamin D and requiring a vitamin D supplement. Anywhere over 50, you were considered optimal. And 50 as a cutoff is based on bone metabolism research and is kind of outdated with regards to, as we understand, vitamin D now. And vitamin D has so many more roles in the body and it isn't just related to bone metabolism. I'm gonna be talking through the roles of vitamin D.

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as it pertains to sort of menopause in a minute. But just know that the experts that look at research and do research on vitamin D, they recommend that vitamin D levels should be around 100 to 120 nanomoles per liter. And if you are North American based, these numbers relate to, or firstly, below 50 would be below 20 nanograms.

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per milliliter. So that's your reference sort of unit and suggesting that anywhere below 30 nanograms per milliliter are actually below normal. So that equates to about 75 nanomoles per liter here in New Zealand. So, I mean, it's pretty easy to go online and use a converter calculator to establish how these numbers sort of interchange. But for the US and sort of North American population,

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As I understand it, around 50 to 80 would be pretty ideal. And here in New Zealand, around 100 to 120 would be considered ideal as well. So just have a think about those numbers when you're next going to your doctor. And if you are, for example, ordering a vitamin D test, have a look to see what your numbers actually are. Because I see so many people with numbers well below that. Like it's December and their numbers are 60.

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whereas I've just said optimal would be 100 to 120. So it's almost less than half of where you would like it to be. Anyone with an autoimmune condition might have a higher, well does have a higher requirement for vitamin D and often their vitamin D is lower as well. And I've seen people with vitamin D levels in the 20s and 30s and that's in nanomoles per liter, which the sort of cutoff for deficient would be considered 50, which again is probably too low.

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Just a little bit of background context for vitamin D. I do wanna go into, of course, the topic which is around menopause. But first, just a reminder, vitamin D is a fat soluble vitamin. It comes in two forms, both D2 and D3. Now vitamin D2 is derived from plants. Well, vitamin D3 is produced in human skin when exposed to sunlight. So the D3 is then converted from sunlight into its active form.

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which is 125-dihydroxy vitamin D3. And this is through processes in the liver, the kidneys, and the mitochondria, which just bear that in mind because there are sort of three different organs or two organs in the mitochondria that the vitamin D you're exposed to has to go through in order to be converted to the form that we need. So just because you go out into the sunlight doesn't necessarily mean you're going to have adequate vitamin D levels.

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Anyway, so vitamin D primarily helps in regulating calcium and phosphorus metabolism, which is essential for bone growth, as I sort of mentioned, but recent research has also highlighted its significant role beyond bone health, which includes immune function regulation, cell growth, and reducing oxidative stress and tissue damage. And deficiency in vitamin D has been linked to several health conditions, such as cardiovascular disease, metabolic syndrome, cancer,

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and immune system disorders. And let's not go into the COVIDs, but there is a significant relationship between vitamin D deficiency and severity of COVID outcomes. The Institute of Medicine has its, that's the IOM where people often look to for sort of clinical ranges with different vitamins and minerals in terms of their status, with vitamin D a level below 50.

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or 20 nanograms per milliliter, so 50 nanomoles, is considered deficient. However, there's no consensus among various institutions about the ideal level of the vitamin. So the endocrine system would suggest that it should, in fact, no one should be below 75 nanomoles. So that's a significant jump up from that 50. And as I said, vitamin D researchers would suggest that 100 to 120 would be optimal.

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And it is estimated that around the world, one billion people suffer from vitamin D deficiency, which is significant. And this deficiency is particularly prevalent in menopausal women. It affects about 50 to 80% of them. So this is a significant number. In these women, the efficiency of skin and kidneys in producing the active form of vitamin D decreases. And the absorption in the intestines is also reduced,

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levels of vitamin D in the body. And this is in relationship to the reduction in estrogen because there is that strong association between vitamin D uptake and estrogen at that cellular level. The risk of osteoporosis also increases with age, particularly in menopausal women. And this is partly due to decreased estrogen and the reduction in estrogen leads to lower calcium absorption in the small intestine, resulting in that decrease in bone density.

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Vitamin D plays a crucial role in bone health by enhancing the absorption of calcium and phosphorus from the small intestine, aiding in new bone formation and calcification, and it regulates parathyroid hormone to maintain blood calcium and phosphorus levels. So the function of vitamin D here is essentially in preventing or treating osteoporosis. I would also say that in addition to vitamin D, like looking at vitamin K2 is another

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really important vitamin in terms of bone metabolism and vitamin D being able to do its job in this role. So when vitamin D levels are low, it can cause the secondary hyperparathyroidism which alters bone metabolism. That leads to reduced bone mass and an increased risk of osteoporotic fractures. So vitamin D receptors have been found in muscle tissue and vitamin D is also involved in regulating muscle cell growth and differentiation.

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So this can significantly improve muscle strength and function, enhancing balance and reducing muscle related issues like myalgia, decreased muscle strength and altered muscle morphology in vitamin D deficient patients. So if you have low levels of vitamin D and you are resistance training, you are not going to be able to make the same lean mass gains as someone else would if they were vitamin D sufficient. So,

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Not only is it harder to accrue muscle and bone mass as we age and hold onto it, it is even more difficult if you are vitamin D deficient, which makes it really important to know where your status is so you can supplement accordingly. Interestingly, a study focusing on 54 postmenopausal women revealed that vitamin D levels of 20

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are linked to better lower limb muscle function and strength, and combining calcium with vitamin D has been shown to reduce bone loss in perimenopausal and postmenopausal women. An 18 year study of over 72,000 postmenopausal women found that adequate vitamin D intake was associated with a lower risk of osteoporotic hip fractures as well. And the thing is, and we've discussed this before, I've talked about this with other

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biggest causes of early mortality for people over 60 is falls. And it is because we lose bone mass and muscle mass as we age through the decades. And then if we're in our forties and we trip, we are actually able to up ourselves and able to correct the trip so it doesn't become a fall because we've got our muscles are strong enough, we've got that proprioception.

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We've got our ligaments and tendons are working as they should be. However, this does decline with age. And if you're not taking care of yourself from resistance training and nutrient intakes, then come 60, we're not as lucky. And that trip does become a fall. And with the fall, we lose our active time. We become sedentary and inactive. And with that,

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we drastically reduce our muscle mass and our bone mass. And I talked to Brendan Egan about this in a podcast that you can lose pretty much 10 years of muscle in 10 days of bed rest, which is pretty significant. Actually, that sounds like a lot to me. So do fact check that, but I know it is a lot. Make sure that in addition to your resistance training, which I know you will be doing, that you've got your vitamin D sorted as well. So estrogen,

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On another thing that diminishes as we age, obviously, as we go through those menopause years, it's beneficial for heart health, and estrogen helps regulate lipid metabolism in the liver and reduces LDL levels by increasing LDL receptors. And it also boosts high-density lipoprotein by enhancing the activity of lipoprotein lipase. So lipoprotein lipase is an enzyme and it...

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acts on the vascular endothelial surface of our cells and it's anchored to our capillary walls and it's predominantly found in adipose tissue, muscle and heart tissue, but it's not in the liver. And lipoprotein lipase functions to convert triglycerides to fatty acids and glycerol. So it breaks down fatty acids and turns it into fuel. However,

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Menopause often leads to weight gain and changes in body fat distribution in women, mainly due to the decreased estrogen levels and the impact this has on fat deposition, carbohydrate handling, the decrease can disrupt lipid metabolism as well and result in abnormal fat distribution, contributing to metabolic syndrome, which then leads to cardiovascular disease, type 2 diabetes, and of course, dyslipidemia.

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And vitamin D can play a role in this increased risk of cardiovascular disease and metabolic disease also because you've got things like inflammatory factors such as tumor necrosis factor alpha, TNF alpha, and adipocytokines, which are cell signaling molecules produced by our adipose or fat tissue that play a role in energy and metabolic status of the body with inflammation and obesity, et cetera.

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And research has been exploring the impact of vitamin D on the sort of non-traditional pathways related to inflammation. And it's known for regulating immune functions and its anti-inflammatory and antioxidative effects. So all of this to say that vitamin D can also lead to immune dysfunction and increase the risk of cardiovascular and metabolic disease because of its roles in the immune system.

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So studies have shown that lower vitamin D levels are linked with higher fasting glucose levels, higher insulin, and higher C-Peptide in postmenopausal women with type 2 diabetes. Vitamin D that is present in the cardiovascular system can inhibit the renin angiotensin system, which is responsible for blood pressure, can increase nitric oxide production in endothelial cells, which helps with our vasodilation.

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and it can help prevent atherosclerosis. Vitamin D also enhances insulin secretion, improves insulin sensitivity, and reduces systemic inflammation. Thereby, it does ameliorate insulin resistance. And if you recall, and I'm sure we've talked about this before here on the minis, but also in previous conversations on Micropedia, insulin resistance is a common...

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in women through perimenopause that can last into those menopausal years. And this is influenced by your vitamin D status. What we will say is that the relationship between vitamin D and cardiovascular disease in menopausal women is not fully clear. So there's a lot of mechanistic relationship and data, but it hasn't been laid out in these human clinical trials to date.

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However, because vitamin D deficiency is common in postmenopausal and menopausal women, it makes sense that vitamin D should be considered as part of therapy or help when looking at factors related to menopause. Now another area where vitamin D is important is in the genitourinary tract. So

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Genitourinary Syndrome of Menopause or GSM is a condition which affects postmenopausal women and is characterized by symptoms like vaginal dryness, pain during intercourse, difficulty urinating, and frequent and urgent urination. These are really common actually and the symptoms are primarily due to the decline in ovarian function and decreased estrogen levels.

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thinning of the epithelium, lowered glycogen content, increased vaginal pH, and a higher incidence of bacterial vaginosis infections due to that increased pH. Estrogen therapy can alleviate a lot of these symptoms in postmenopausal women, but I would say there is still probably some controversy around its use.

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just with patients with a history of breast and endometrial cancers. It has led to an interest in finding safe and effective alternatives that help women with their genitourinary syndrome. And vitamin D, known for its role in regulating cell growth and differentiation, may be particularly effective in the vaginal epithelium. So supplementation with vitamin D can promote the maturation proliferation

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and differentiation of vaginal mucosal cells, helping to restore the vagina's physical barrier. Studies have shown promising results. There have been a number of studies where vitamin D vaginal suppositories improved vaginal dryness and lowered pH in women with vaginal atrophy, and there was a double-blind placebo-controlled trial indicating that 40,000 IU of vitamin D, given weekly, significantly improved the vaginal maturation index.

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vaginal pH and symptoms of vaginal dryness in postmenopausal women. So that certainly is worth a look in. Postmenopausal women also face recurrent urinary tract infections. And it's a problem exacerbated by decreased estrogen levels leading to a reduction in those antimicrobial peptides and barrier proteins. So it increases the permeability of the bladder's urinary epithelium or cells, which raises the risk of infections. Vitamin D has been found to induce tight

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junction proteins like Oglodin and Chlordin-14, you don't really need to know those names do you? In bladder maturation surface cells. So it enhances that adhesion of the cells and it promotes that epithelial integrity so it won't allow for infections to get in. And in part the effectiveness of vitamin D is due to the presence of vitamin D receptors in the basal cell layer of the vaginal tissue.

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And the effectiveness of vitamin D in these roles is partly due to the presence of these vitamin D receptors, which you find in the basal cell layer of vaginal tissue. Vitamin D, as I said, is known to regulate those intercellular junctions. And it's not only has a protective effect against vaginal atrophy in postmenopausal women, but it is also relatively inexpensive and it doesn't have adverse effects. So using oral or vaginal vitamin D supplements,

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in addition to topical estrogen, potentially, obviously with the help of your doctor, because these are things that you would talk to your doctor about, but it can be effective for reducing GSM-related symptoms in postmenopausal women. And lastly, let's think about mood and vitamin D. So if we think about it, we spend one third of our lives as females in a postmenopausal state, or for some women, it might even be closer to 40%.

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So during this time, due to the loss of ovarian function and lower estrogen levels, we are more susceptible to depression and anxiety disorders. And menopausal women often experience a variety of vasodilatory symptoms in the short and medium term, such as the hot flushes, palpitations, night sweats, and cold hands and feet. Now, because research indicates pro-inflammatory cytokines can induce depression-like behaviors,

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There's been an increase in the potential of nutrients like vitamin D to improve mental health in women. Depression is often associated with a reduced physical activity and spending more time indoors, which can lead to lower vitamin D levels. Vitamin D receptors are found in brain regions involved in emotional processing, and low levels of vitamin D have been linked with depression. Supplementation with vitamin D, therefore, could show promise in improving mood and by

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pro-inflammatory cytokines and activating that stress response in a good way. And vitamin D's role in mental health could extend to cognitive function as well. And there have been studies that have reported vitamin D insufficiency is associated with cognitive impairment. Vitamin D might have a protective and regulatory effect on the brain's dopamine system. So it does suggest similarities to antidepressants.

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And in a study involving over 81,000 participants from the Women's Health Initiative, they discovered that consuming around 400 IU, which is the daily recommended dose, it's very low actually, from food sources reduced the risk of depressive symptoms by 20% in the third year, compared to 100 IU from food sources. So in a third year of menopause, you had a reduction in depressive symptoms by 20%. That's pretty remarkable.

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Furthermore, vitamin D deficiency has been associated with pelvic organ prolapse and stress urinary incontinence in postmenopausal women. And there was a case control study which found significantly lower vitamin D levels in women with the pelvic organ prolapse compared to those without. So there may be a relationship there. So you can see then that there is just this multifaceted role of vitamin D in the health of postmenopausal women.

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We've got bone health, we've got brain health, we've got muscle health, we've got immune function, we've got our urinary tract, and we've got pelvic floor prolapse. So it is a significant issue if you are vitamin D deficient, of which many people are. So my advice to you, regardless of age, although I'd say particularly if you are headed into perimenopause and menopause, is check your vitamin D status.

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go to lab tests, get it done, about $65, see where you're at. And this is something to do in winter and in summer. In summer, the UVB rays are strong enough to help us synthesize that vitamin D3 into its active form. In winter, you have to be outside for a significant length of time for that to occur because those UVB rays just aren't strong enough. So this is where supplementation throughout winter is almost, I would say, mandatory.

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Whereas you could still require one in summer, depending on your overall health status, the level with which you were able to maintain across winter months. And of course, if you know your vitamin D receptors, the state of your vitamin D receptors. So I know that was a little bit in the sort of science books for you because it did come from a review paper, but hopefully you at least got something from that. If not, at the very least, that vitamin D is important

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number of reasons outside of what you might have considered. So let me know, flick me a message, you can find me on facebook @mikkiwillidenutrition over on instagram, threads and twitter @mikkiwilliden. Head to my website mikkiwilliden.com, book a consult and we'll talk about your vitamin D. Alright team, you have a great week, see you later.