By: Phyllis J. Molnar, R.D., L.D. 

Reducing the pain from osteoarthritis in our knees and preventing falls are two important concerns for seniors. Research indicates that vitamin D may help with both.

Arthritis pain

In a recent study, adults with low blood levels of vitamin D were shown to have significantly more osteoarthritis knee pain than adults with healthy vitamin D levels.

Aging and carrying extra weight are prime factors in knee osteoarthritis pain.  When researchers increased the study participants’ vitamin D levels to normal, they experienced significantly less osteoarthritis knee pain—in spite of the fact that they were older and overweight.

Those with higher vitamin D levels were also better able to walk, had better balance and had an easier time getting up from a chair than participants with low vitamin D levels.

Preventing falls

Falls are the major cause of injury mortality in Americans over 65 years of age. 

Studies have shown that persons with low serum (blood) levels of vitamin D of less than 30 ng/mL (75nmol/L) have increased balance problems, more muscle weakness and an increased rate of falling.

Whereas, participants having an average vitamin D level greater than 30 ng/mL (75nmol/L) experienced significantly fewer falls and bone fractures.

Source of information: The American Geriatrics Society’s 2014 consensus statement, “Vitamin D for Prevention of Falls and Their Consequence in Older Adults.”

Vitamin D sources

Achieving a vitamin D level greater than 30 ng/mL (75nmol/L) can be difficult without taking a vitamin D supplement –especially for seniors.

Foods alone cannot provide sufficient vitamin D. Sunshine is the best source of vitamin D.  Studies have found that persons who spend most of their day indoors have low levels of vitamin D.

And as we age, our skin cannot produce vitamin D as efficiently from the sunlight and our kidneys are less able to convert vitamin D to its active form.

Therefore, most seniors need a vitamin D supplement to achieve optimal vitamin D blood levels.

Vitamin D supplements

Only your doctor can determine the correct dose of vitamin D for you based on your current vitamin D level, daily sun exposure, age, weight, medical conditions and medications.

Obesity increases the amount of vitamin D needed. Persons with malabsorption conditions such as Crohn’s disease, celiac disease, cystic fibrosis and other inflammatory bowel diseases need larger doses of vitamin D.  Medications that block fat absorption, such as cholestyramine and others, also increase the need for vitamin D.

Increasing vitamin D absorption

Vitamin D is a fat soluble vitamin, so we need fat to help absorb it. Studies have shown that taking a vitamin D supplement with a meal containing significant fat or oil increases its absorption by 32 percent.

Many people take their vitamins with breakfast. A breakfast of cereal, fruit and milk contains little fat. Thus, little vitamin D will be absorbed. Instead, take a vitamin D supplement with a meal containing more fat such as supper or lunch. Never take vitamin D with water between meals.

Facts about Vitamin D

• In northern Ohio, we can only make vitamin D from the sun during the late spring, summer and early fall.
• Vitamin D is made from the sun’s ultraviolet (UV) B rays.
• Complete cloud cover reduces UVB exposure by 50 percent.
• Shade (including that produced by severe air pollution) reduces it by 60 percent.
• UVB rays do not penetrate through clothing, glass windows or sunscreens with a sun protection of 8 or more.
• The skin may produce approximately 20,000 IU vitamin D in response to 20 to 30 minutes of unobstructed summer sun exposure.  The body can store vitamin D.
• You cannot get too much vitamin D from excessive sun exposure.  Sustained heat on the skin degrades (breaks down) vitamin D.
• Persons who are obese typically have lower blood vitamin D since vitamin D gets trapped in body fat and is unavailable for use. 
• One 8 ounce glass of milk contains only 100 IU of added vitamin D.
• Yogurts and most cheeses are made with milk which is not fortified with vitamin D.
• Few foods naturally contain vitamin D, with the exception of canned salmon (processing with heat removes some water, concentrating the vitamin D).

Salmon Tetrazzini

4 ounces spaghetti

1 can (14.75 ounces) salmon

Low-fat milk (about 1 ½ cups)

2 Tbsp. canola oil

2 Tbsp. flour

¼ tsp. salt

Dash of pepper and nutmeg

2 Tbsp. red wine

Sliced mushrooms (1 small can or 4 fresh), optional

Topping:

2 Tbsp. dry bread crumbs mixed with 2 Tbsp. grated Parmesan cheese

Preheat oven to 350 degrees.

Cook spaghetti according to package directions and drain. Set aside.

Drain canned salmon reserving liquid in a 2 cup measuring cup.

Add enough milk to make 2 cups of liquid.

In a bowl, break up salmon into large pieces and crush bones. (Do not discard bones)

In a large saucepan, heat oil. Using a whisk, stir in flour, salt, pepper and nutmeg.

Add salmon-milk liquid all at once.

Cook over medium heat stirring constantly until mixture thickens and is bubbly.

Add 2 Tbsp. wine. Stir in cooked spaghetti, mushrooms and salmon.

Pour into 1 quart casserole dish. Top with bread crumb-Parmesan cheese mixture.

Bake for 35 to 40 minutes.

Nutrition note:  Fresh fish is significantly lower in vitamin D. During the heating process of canning, water is evaporated, concentrating the amount of vitamin D per serving in the fish.

By Phyllis J. Molnar, R.D., L.D. 

Registered Dietitian

Elyria City Health District