Ask the Nurse

I can’t tolerate any kind of dairy and from what I noticed Vitamin D (sunshine) either. Symptoms include swelling of my lips and the corners of my lips crack open. Also, the area between my vagina and my rectum gets a rash and cracks open. Another symptom is that I get auras and almost black out if I eat dairy. I stopped all dairy and avoided most sunshine to try to keep my symptoms minimal. Since I have practiced avoidance it’s much better, but there aren’t many things I can eat. I have been to a lot of different doctors who mostly say just avoid dairy, but that isn’t what I would like to do if I don’t have to. I need vitamin D since I already have osteopenia and am high risk for osteoporosis. Thank you in advance for any thoughts you may have.

Vitamin D is an essential nutrient that plays an important role in calcium regulation and bone health. Having adequate levels of vitamin D have been associated with a reduced risk in certain cancers, such as colon and breast, and have also been shown to help with mood, memory and in preventing falls in the elderly. Deficiencies in vitamin D can lead to osteopenia or osteoporosis. The main sources of vitamin D (which is NOT a vitamin but a prosterol hormone) are from our diet and from sunlight. Foods rich in vitamin D include:

  • cod fish
  • catfish
  • salmon
  • eggs

You should aim to eat fish two times per week if you are not allergic.

Since sunlight can also lead to some skin cancers and solar aging and wrinkly, we recommend getting your vitamin D from supplements, which can be bought over the counter at your local drug store. Ask your doctor to check your levels to see if you are very low. Otherwise, it is a good idea to start taking 1,000 iu 2,000 units per day (and the maximum you may take without advice and monitoring from a physician is 5,000 units.)

Another source of vitamin D is specialized vitamin D lamps. They are specifically used for those with severe deficiencies in absorbing vitamin D, such as individuals diagnosed with cystic fibrosis or other malabsorption syndromes. These lamps are generally not recommend as first line but are an option for folks who cannot tolerate vitamin D supplements and who are deficient. They should only be used under the guidance of a supervising physician and can be purchased on-line.

Everyone should aim to maintain a daily total calcium intake of 1000 mg, or up to 1200 mg in women older than age 51. Calcium is best received from our diets. You can only absorb about 300-500mg of calcium at one time so you need to ingest some calcium with every meal.

There are many people who either can’t tolerate dairy or who choose to avoid dairy that can look for other sources of dietary calcium, including:

  • Almond and coconut milk are good ’milk’ alternatives and are high in calcium.
  • Almonds and Brazilian nuts are good sources to take in moderation.
  • Spinach
  • Broccoli
  • Oatmeal
  • Salmon
  • Beans

Remember, calcium is best absorbed by the body and used only when there is enough vitamin D in your system, so maintaining good levels of Vitamin D are essential to maintaining good levels of calcium. Only if you feel you are not getting enough calcium from your diet should you talk to your doctor about calcium supplements, as calcium supplements have some unwanted side effects such as constipation and upset stomach in certain individuals. Use the online calculator to determine if you may need more calcium in the form of supplements or rather “bone-up” on calcium with calcium rich foods in your diet.

All my best,
Speaking of Women's Health Nurse

August 26, 2014 at 3:57pm