Their answers to these vitamin D questions will help you personalize recommendations for diet tweaks, supplements, and more.
In this article, you’ll …
- Learn how to personalize vitamin D recommendations for every client
- Identify crucial vitamin D questions to better assess clients’ levels
- Find out what might be preventing your clients from optimal vitamin D absorption
- Get the tools you need to have better conversations about vitamin D sources
- Easily attract clients, get referrals and reconnect with old clients using The Better Nutrition Program’s evaluations to show them the power of personalization
By Meghan Rabbitt
These days, most people know about the importance of getting enough vitamin D—and the downsides of having a deficiency. Otherwise known as the sunshine vitamin thanks to the body’s ability to synthesize it after exposure to sunlight, vitamin D is actually a hormone that makes multiple systems in the body work optimally. It’s needed to manage blood sugar levels and to support the cardiovascular and immune systems. It helps the body absorb calcium, making it essential for bone health. And your clients are likely also reading about D’s link to weight, with research showing a connection between vitamin D deficiency and obesity.
Another reason more people are wondering about their vitamin D levels is because vitamin D deficiency is in the news. An estimated 1 billion people around the world have inadequate amounts of vitamin D in their blood no matter how old they are or where they live, according to one study published in the New England Journal of Medicine. And we’re learning more and more about the link between vitamin D deficiency and the novel coronavirus. One recent study found low levels of D raises the risk of testing positive for COVID-19 and another study discovered that more than 80 percent of patients diagnosed with COVID-19 were vitamin D deficient. Still more research found that high vitamin D levels may protect against COVID-19, especially for Black individuals: The researchers found that Black people with vitamin D levels of 30 to 40 ng/ml had a nearly three times higher risk of testing positive for COVID-19 than those with levels of 40 ng/ml or greater.
And while you can get some vitamin D from a handful of foods (like some fish, eggs, mushrooms, and from some vitamin D-fortified foods), getting adequate amounts is extremely challenging, says Ashley Koff, RD, CEO of The Better Nutrition Program. “Not only that, but trying to get enough vitamin D via fortified foods or from the sun is downright unhealthy,” she says. “Nobody should be drinking six to eight glasses of vitamin D-fortified milk every day or skipping sunblock just to load up on vitamin D.” These are just some of the reasons why it’s crucial to assess your clients’ vitamin D status and help them get—and keep—better vitamin D levels.
To help you do just that, here are five crucial questions that’ll help you assess your clients’ vitamin D levels as well as personalize your recommendations for getting more of the sunshine vitamin.
5 Crucial Questions to Ask Your Clients to Personalize Vitamin D Recommendations
The best way to start a conversation about vitamin D is to give prospects or existing clients The Better Nutrition Program’s Vitamin D Evaluation. It asks these crucial questions to help you get a clearer picture of your clients’ vitamin D status and tee you up to help them get (and keep!) optimal vitamin D levels. It helps you show them the different factors that impact their current status. This makes it easier to personalize your recommendations!
Question No. 1: Where do you live?
Numerous studies have found that no matter where you live and how much exposure to sunlight you get, there’s a good chance you’re deficient. That said, the further away from the equator you live, the less UVB light you’ll be exposed to—and the less vitamin D you’ll produce as a result. For example, those who live in Boston make little (if any) vitamin D from November through February. What’s more, wearing sunscreen prevents vitamin D production the same way it prevents sunburn: by blocking vitamin D-producing UVB rays.
The bottom line: If your client lives north of the line that runs from Los Angeles to the northern border of Florida, there’s a good chance he or she isn’t getting enough sunlight exposure most months of the year to optimize vitamin D levels—which means supplementing is a good idea. (The daily recommendation for adults is 400-800 IUs or 10-20 mcg per day. More on this later.)
Question No. 2: What foods & beverages do you choose most often?
It can be tempting to think that diet doesn’t play a huge role in vitamin D levels because after all, very few foods naturally contain vitamin D. In fact, fortified foods provide most of the vitamin D in the Standard American Diet—and most people don’t eat enough fatty fish (like trout, salmon, tuna, and mackerel), beef liver, eggs, and mushrooms to get adequate amounts.
That said, understanding someone’s diet is still super important because several nutrients are crucial for adequate vitamin D levels. For example, if someone’s not getting enough magnesium, they might not absorb the vitamin D they’re eating or taking in supplement form, says Koff. (One study published in The American Journal of Clinical Nutrition found that magnesium not only helped people absorb vitamin D and raise levels, but it even reduced levels in study participants whose vitamin D was too high!) Considering upwards of 80% of Americans are deficient in magnesium, following the vitamin D evaluation, assess your clients’ magnesium levels with The Better Nutrition Program’s Magnesium Evaluation. Calcium intake also impacts vitamin D, says Koff, making it just as important to use The Better Nutrition Program’s Calcium Evaluation as well.
Also, keep in mind that excess body fat absorbs vitamin D, and studies have found that being obese is correlated with low vitamin D levels. “Carrying excess body fat may affect the bioavailability of vitamin D,” says Koff. “With a full assessment of your clients’ diet, you’ll be able to see where there are opportunities to add more nutrients and minerals to optimize vitamin D levels irregardless of supplementation.”
Question No. 3: Do you need a digestive tune-up?
This is a crucial question to ask all clients you work with no matter what you’re evaluating! But, it’s especially important when you’re considering vitamin D levels and how to fix a deficiency. There’s some evidence that vitamin D regulates gastrointestinal inflammation, and it has even been shown to affect the gut microbiome.
“We know that better digestion is key to better health, and that includes better vitamin D levels,” says Koff. “The Better Digestion Evaluation serves as an excellent starting point to assess your clients’ digestion and help you make better recommendations for supplementing.” For example, vitamin D is a fat-soluble nutrient, which means it requires fat to be absorbed. If a client isn’t eating enough healthy fats, the vitamin D she’s being exposed to via sunlight or taking via supplement may not be doing anything for her health. “Understanding someone’s diet as well as their digestive health is absolutely crucial if you want to help optimize their vitamin D,” says Koff.
Question No. 4: What is your current vitamin D level?
If your client can’t answer this question, you need to help them. It is a great opportunity to connect with their doctor to have a vitamin D test done (it’s called vitamin D 25-OH). What’s more, clients should understand that repeating that test every six months to a year is also a good idea, because it’ll help you understand if your strategies for optimizing vitamin D are working, adds Koff. “As practitioners, we can’t just tell people to supplement without knowing their starting point,” she says. “nor can we know if our recommendations are effective without repeat testing.”
That’s why Koff likes to retest after 6 weeks if possible. (Though it’s important to note that insurance companies typically reimburse for vitamin D testing just once or twice a year. At home-tests may be an option depending on patient resources.) “If you see D levels increasing, you’ll know the recommendations are working,” she says. “If D levels are still suboptimal, it’s a sign we might need to optimize your digestive health or make sure you’re getting enough other nutrients, like magnesium, calcium, or vitamin K, to optimize your vitamin D.”
Question No. 5: Are you already taking a vitamin D supplement?
If the answer is yes, it’s important to know additional information. How much and how often is your client is taking their supplement? Are they taking it with food or other supplements? How long have they been taking this or any vitamin D supplement? And you still want to review labs per the above to see if their current supplementation is sufficient to maintain healthy levels.
While these are the current daily suggestions from the National Institutes of Health (NIH), in practice, Koff shares this is often insufficient to address a deficiency and for many to maintain healthy levels, especially in those with other health issues:
- Children up to 12 months: 400 IU
- People age 1 to 70 years old: 600 IU
- People age 71 and older: 800 IU
- Pregnant and breastfeeding women: 600 IU
What’s your better next step to effectively personalize vitamin D recommendations for each client?
Use these questions as a starting point and assess (and reassess!) your client’s vitamin D levels via their labs, you’ll be a true partner in figuring out how much vitamin D your clients need and can create personalized plans that’ll help everyone you see achieve optimal—and lasting—health.
Considering how many variables must be considered when it comes to reaching and maintaining adequate levels of vitamin D, your clients will undoubtedly have more success when they work with you on optimizing their levels. You need to use your toolkit tools to show them this when they are evaluating working with you and remind them of it ongoing. You also want to let other practitioners know you have a proven system to personalize vitamin D levels for their patients!