To Your Good Health

Sunshine, tablets provide vitamin D

Q: I take a vitamin D every day, but I also put sunscreen on my exposed skin when I go outdoors. Won’t the sunscreen interfere with the effects of the vitamin D?

A: Low vitamin D is increasingly being diagnosed, and has been implicated in many conditions.

What is absolutely clear is that vitamin D is necessary for proper bone health, and many Americans — particularly those who live in the northern two-thirds of the country (and all Canadians) — are at higher risk. Darker-skinned people are also at higher risk for low vitamin D levels, and low vitamin D has been shown to be a reversible cause of weakness in the elderly.

Most people make their own vitamin D with a short period of sun exposure to their face and hands, and sunscreen does indeed prevent the skin from making the active form of vitamin D in sunlight.

Because you’re taking supplemental vitamin D (in the form of vitamin D-3), the sunlight isn't necessary.

Q: I take methotrexate and Remicade for rheumatoid arthritis. Both the doctor and the pharmacist have told me not to drink alcohol with these medications. Do you know why alcohol is prohibited?

A: The concern is damage to your liver, which is the major toxicity for methotrexate and is possible with Remicade. An occasional glass of wine (a few times a month and never more than two at a time) is unlikely to cause most people harm.

Your doctor should be monitoring your liver via blood tests, so it might be that, in your case, you already have some early signs of liver involvement from the medicines. You should ask the doctor whether a glass of wine once or twice a month would be a problem.

Q: In 2006, my husband, who was 45, had skin changes on his lower legs. The diagnosis was generalized morphea. He was placed on methotrexate; however, the skin changes have spread from just his lower legs to his upper legs and torso. In the past three years, it has gotten progressively worse. What could it end up doing to his body?

A: Morphea is related to the autoimmune disease scleroderma and is sometimes called limited scleroderma but doesn’t have the degree of internal organ involvement of systemic scleroderma. Morphea consists of areas of hardened and thickened skin.

It is difficult to treat. Ultraviolet light has been used successfully on morphea, as have vitamin D derivatives and steroids.
