Complications Of Vitamin D Deficiency
Vitamin D deficiency can lead to loss of bone density, which can contribute to osteoporosis and easy fractures .
Severe vitamin D deficiency in children can cause rickets.
Rickets is a rare disease that makes bones soft and bend.
In adults, severe vitamin D deficiency causes osteomalacia.
Osteomalacia causes weak bones, bone pain, and muscle weakness.
Researchers are studying vitamin D for its potential links to several medical conditions, including diabetes, high blood pressure, cancer, and autoimmune diseases such as multiple sclerosis.
They need to do more research and studies before they can judge the effects of vitamin D on these conditions.
Impact Of Vitamin D Levels On Disease Activity In Rrms: Observational Studies
In a prospective longitudinal study from the Netherlands, 25D was measured every 8 weeks for a mean of 1.7 years in 73 patients with RRMS . Fifty-eight patients experienced a total of 139 exacerbations during the study period. Relapse risk was significantly reduced in those with medium and high serum vitamin D levels compared to those with low levels . For each doubling of serum vitamin D concentration from baseline of 10, 20, 30, MS relapse risk decreased by 27%. Although this suggests a beneficial effect of vitamin D on MS, it must be noted that there is also a possibility that conditions associated with MS relapse had an effect on serum vitamin D levels .
Fig. 4
Reprinted with permission from Wiley Company
Association of vitamin D and relapse risk in MS. The graph shows risk of relapse according to 25D levels, adjusted for age and month of serum measurement. Size of points is proportional to the inverse of the variance .
Cytokines And Nitric Oxide
The cellular effects of 1,25-2D include effects on production of immunoregulatory molecules such as cytokines and NO. 1,25-2D decreases the production of pro-inflammatory cytokines IL-2, IFN- and TNF- in vitro and in vivo , and IL-12 in vivo . On the other hand, it promotes the in vivo production of anti-inflammatory cytokines such as IL-4 and TGF- . An increase of TGF-1 expression in lymph nodes at the periphery may explain the beneficial effect of 1,25-2D in EAE and has been re-emphasized in MS . In contrast, TGF-1 increase was not found in the rat CNS , suggesting that the effects of 1,25-2D in EAE are due to effects on the peripheral immune system rather than on local immune suppression. 1,25-2D triggers the production of inducible nitric oxide synthase by a human macrophage cell line in vitro , but decreases iNOS expression during rat EAE . The macrophage enzyme iNOS is required for the inducible production of NO by macrophages. The role of NO in EAE and MS is not yet fully clarified, but several studies indicate a worsening effect due to NO production in the brain . Others indicate that NO has an immune-downregulating effect in EAE .
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Other Ms Risk Factors Are Still Important To Consider
Its important to note that most of the research on vitamin D and MS risk has focused on non-Hispanic white populations, and it might not apply to people of color, who generally produce less vitamin D in their skin. In fact, the 2006 study of U.S. military personnel found no relationship between vitamin D and MS development in Hispanic or black people, and a recent report from Mexico also found no association in that population.
Low vitamin D is also not the only risk factor identified for MS. MS is definitely multifactorial, says Sharon Stoll, DO, an assistant professor of neurology at the Yale School of Medicine in New Haven, Connecticut, citing other known risk factors like smoking and infection with Epstein-Barr virus.
But, Dr. Stoll says, Vitamin D deficiency can set someone up who already has genetic components to develop multiple sclerosis, and supplementation could prevent that.
Vitamin D And Obesity
Obesity is defined as an excess amount of body fat and represents a significant health problem worldwide. High prevalence of vitamin D deficiency in obese subjects is a well-documented finding, most probably due to volumetric dilution into the greater volumes of fat, serum, liver, and muscle, even though other mechanisms could not completely be excluded, as they may contribute concurrently.Vitamin D deficiency is common, and testing and supplementation is increasing. Serum vitamin D is lower in obese people it is important to understand the mechanism of this effect and whether it indicates clinically significant deficiency. Recent findings: Vitamin D is fat soluble, and distributed into fat, muscle, liver, and serum. All of these compartments are increased in volume in obesity, so the lower vitamin D.Vitamin D deficiency D) < 25-30 nmol/l) and sub-optimal status D < 50-100 nmol/l) are increasingly associated with unfavourable metabolic phenotypes, including insulin resistance, type 2 diabetes and CVD conditions also commonly linked with overweight and obesity.
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Causes Of Vitamin D Deficiency
For people who ensure that their food contains vitamin D, the sun is sufficient to synthesize the rest of their recommended daily dose of vitamin D. Many people who live near the equator or who maintain a lifestyle that consists of staying indoors and wearing clothing that covers most of the skin do not absorb enough vitamin D to cause vitamin D deficiency. They need to take vitamin D supplements to cover their daily intake. When exposed to sunlight, the skin of older people does not produce as much vitamin D because they have so little vitamin D in their diet. Therefore, taking vitamin D supplements at a low dose per day) will not prevent vitamin D deficiency.
Healthy, fair-skinned people who get plenty of sun can develop vitamin D deficiency, which can also occur in people who take certain medications. This can be due to subtle metabolic problems in the production and absorption of vitamin D. Some people with other risk factors for the disease may also develop vitamin D deficiency, but it is not clear why this happens.
Is Checking The Vitamin D Level And Supplementation Suggested For The Family Members Of Ms Patients
As the most of the people does not meet the minimum requirement of Ultraviolet B , vitamin D supplementation is recommended for the majority of general population. The risk of MS is only 0.20.4 % in first degree relatives. However, vitamin D supplementation is inexpensive and safe and also seems to be reasonable even from the general preventive medical point of view alone. However the panel did not reached the consensus about vitamin D level check for all family members of MS Patients. But the panel suggests serum vitamin D evaluation for first degree relatives of MS patients who are at high risk age. If serum level is < 40 ng/ml, the panel recommended the currently prescribed doses of vitamin D in clinical practice to treat hypovitaminosis . The panel recommended the currently suggested maintenance dose of vitamin D to maintain serum level of 25 D above 30 ng/ml for the family memebers of MS patients .
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Vitamin D Might Help If You Already Have Ibd
The sunshine vitamin appears to affect more than the prevalence of IBD, but also the disease activity, rate of flare-ups, and disease-related quality of life. A 2014 study set out to investigate the effect of vitamin D concentrations on health-related quality of life in IBD patients. They found that low serum vitamin D was associated with a lower IBDQ score in both Crohns disease and ulcerative colitis participants.
Another study completed in patients with Crohns disease found that after 24 weeks of vitamin D supplementation, serum vitamin D concentrations increased above 40ng/mL, and the mean IBDQ score rose significantly. This suggests that restoration of normal vitamin D levels may be helpful in the management of patients with IBD.
Although more human studies are required to confirm, clinical data suggest an association between low vitamin D concentrations and increased disease activity in ulcerative colitis and Crohns disease. Therefore, it appears that vitamin D levels should be considered to not only decrease the risk for IBD development, but also treat active IBD by reducing disease activity and improving quality of life.
Can Low Vitamin D Cause Easy Bruising
Can low vitamin d cause easy bruisingWhat Does Vitamin Deficiency Cause Easy Bruising? Deficiencies in vitamin C can cause a condition called scurvy. Scurvy causes bleeding gums, wounds that do not heal, and easy bruising. Vitamin K helps the body form clots to stop bleeding. Newborns often have very low levels of vitamin K, which are insufficient to stop bleeding.
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The Effects Of Vitamin D On The Innate And The Adaptive Immune System
Not only MS but also several other autoimmune disorders are associated with vitamin D deficiency . Accordingly, studies performed in vitro and in vivo have shown that 1,252D3 has anti-inflammatory effects by suppressing the innate as well as the adaptive immune system .
Regarding the innate immune system, after phagocytosis of microbes through macrophages, Toll-like receptors are activated, resulting in an up-regulation of VDR and CYP27B1 expression in macrophages and monocytes . In macrophages, 1,252D3 then activates cathelicidins, which are antimicrobial peptides . Another anti-inflammatory mechanism of action of 1,252D3 is exerted through its various effects on glucocorticoids, including an increased stimulation of monocytes by glucocorticoids to produce mitogen-activated kinase phosphatase 1, which reduces the pro-inflammatory activity of mitogen-activated protein kinases .
Addressing immune cells, which are part of the innate and the adaptive immune system, 1,252D3 increases the differentiation of hematopoietic stem cells into natural killer cells and inhibits the function of the dendritic cell line . Regarding the dendritic cell line, 1,252D3 inhibits the differentiation of monocytes into dendritic cells, the maturation of dendritic cells, the production of pro-inflammatory cytokine IL-12, the expression of the major histocompatibility complex class II, and the presentation of antigens . Furthermore, dendritic cells are induced to undergo apoptosis .
Signs And Symptoms Of Vitamin D Deficiency
Vitamin D deficiency isnt typically associated with noticeable symptoms unless the deficiency is severe, so most people dont know theyre deficient until they have a blood test. However, prolonged, severe deficiency can result in the following symptoms (
- dental abnormalities
- heart problems
If you recognize any of the above symptoms, make sure to discuss them with your healthcare provider to rule out a vitamin D deficiency.
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Why Do I Need Vitamin D And How Do I Get It
Vitamin D helps your body absorb calcium. Calcium is one of the main building blocks of bone. Vitamin D also has a role in your nervous, muscle, and immune systems.
You can get vitamin D in three ways: through your skin, from your diet, and from supplements. Your body forms vitamin D naturally after exposure to sunlight. But too much sun exposure can lead to skin aging and skin cancer, so many people try to get their vitamin D from other sources.
Can Vitamin D Help People With Ms
Another group of Australian scientists based in Melbourne, led by Dr Steve Simpson-Yap, has been exploring whether people with MS feel better after taking vitamin D.
Dr Simpson-Yap surveyed 1,401 people with MS about their sun exposure levels and whether they took vitamin D supplements, along with standardised questions to determine peoples physical and mental quality of life.
They found that self-reported vitamin D supplement use, sun exposure, and wearing sun-related attire were associated with higher physical and mental quality of life. This study shows that vitamin D supplementation is well tolerated, and people do feel better for it. Of course, this study wasnt blinded , which may induce a placebo effect. The study did not examine why people feel better or whether it was associated with a physical change.
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Immune System And 125
The active form of vitamin D, 1,25-2D, is a potent regulator of the immune system . Here we focus on the autoimmune animal model for MS EAE. The preventive and curative effects of vitamin D-related treatment on the clinical course of EAE are described . The effects on the cellular level, which are relevant for EAE, and may have implications for MS and other autoimmune diseases, are summarized. The possible actions of vitamin D metabolites on immune cells relevant for EAE are portrayed in . Finally, the influences of vitamin D metabolites on the production of cytokines and nitric oxide , and on the BBB are described.
Table 1 Preventive and curative effects of vitamin D-related treatment of EAE Administration of
What Are The Signs And Symptoms Of Vitamin D Toxicity And How It Should Be Managed In Ms Patients
Like other essential micronutrients, vitamin D intake has a U curve regarding adverse effects due to deficiency and toxicity. Vitamin D toxicity from dietary source is unusual. However, signs of toxicity might appear as a result of high dose vitamin D supplementation .
According to endocrine society guideline maintenance dose of < 4000 IU/day does not resulted in any notable adverse effects . Consumption of maintenance dose of 4000 IU per day might increase the likelihood of hypercalcemia . According to the results of Burton et al. study, large replacing dose for short duration did not result in hypercalcemia. As shown in Table they prescribed 40,000 IU/d for 28 weeks to MS patients . Also studies recommended 50,000 IU vitamin D/week for 812 to treat hypovitaminosis . Only annual large dose exceeding 300,000 IU vitamin D2 was reported to be associated with an increased risk of hip/femur/wrist fracture in elderly women and greater number of falls .
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What If Low Vitamin D Is Just Correlated With Ms But Is Not A Cause
The recent study of Finnish women, as well as previous studies with a similar observational design, can only identify correlations between variables. In other words, they can conclude that people who end up diagnosed with MS are more likely to have had low vitamin D levels earlier in life, but they cant definitively show that low vitamin D played a role in causing MS.
In epidemiology, were always concerned about that, says Munger. Are there alternative explanations, or is something else going on? For example, perhaps its not vitamin D specifically, but sun exposure, that affects MS risk.
However, Munger points to recent genetic studies, including one published in April 2017 in the journal Neurology and several more published in the last two years, that show that genes associated with lower vitamin D levels are also associated with an increased risk of multiple sclerosis.
Those studies have all suggested that there quite likely is a causal relationship between vitamin D and MS, confirming what the observational studies are showing and removing some of that doubt, Munger says.
Vitamin B12 Deficiency And Multiple Sclerosis: Symptoms And Similarities
Multiple sclerosis is a focus of much speculation and intense research today, partly because the medical field has realized that two and a half times as many people as they previously believed have developed the disease, meaning more than one million in the United States. However, with other conditions looking very much like MS, its been difficult to confirm the number. Some of the symptoms of vitamin B12 deficiency that mirror MS include:
- Weakness of the limbs and chronic fatigue
- Lightheadedness and dizziness
- Numbness and tingling in the extremities and/or limbs
- Difficulty walking and general muscle pains or aches
- Constipation or diarrhea
- Loss of vision
- Mental deficiency, such as depression, loss of memory and other cognitive issues, and behavioral or emotional changes
However, beyond the symptoms that are so similar, there is very little about a deficiency in vitamin B12 that is like multiple sclerosis, including the fact that a deficiency can be cured.
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Etiological Factors Of Ms
The etiology of MS is unknown. It is regarded as a complex multicausal disease. The etiological factors comprise genetic factors, dysfunction of the immune system , and environmental factors.
An increased family incidence and association with certain HLA allotypes suggests genetic susceptibility . The genetic epidemiology indicates that MS is not a single-gene disorder .
Autoimmune responses to myelin components may play an important role in the initiation of MS. The autoimmune character of MS is supported by the presence of numerous T lymphocytes in MS lesions and various deviating immune parameters for MS patients . Furthermore, the autoimmune animal model for MS, experimental allergic encephalomyelitis , has supported the role of autoimmunity in the pathogenesis of MS.
Levels Of Dietary Vitamin D Intake And Risk Of Msimplications For Public Health
Whether a daily dose of vitamin D or a gestational dose of vitamin D per day keeps the MS doctor away is not yet proven . Additionally, it is not known what level of serum 25D would prevent MS in a large majority of individuals. Most studies in this review reported 25D levels below 50 nmol/L in a significant proportion of their investigated populations, which is below the healthy minimum level. Indicating that establishing a target in the general population general population, pregnant women, and their offspring to achieve the minimum levels of 25D may be considered an important goal for health , according to IOM or 75 nmol/L , according to the Endocrine Society) .
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Ms Risk And Vitamin D Deficiency
MS is much more prevalent in northern latitudes, where the weather is colder and the sunlight is less intense. Vitamin D is believed to play a role in this trend in addition to dietary sources of the vitamin, the sun’s ultraviolet rays help your body produce vitamin D.
It’s thought that this contributes to the higher prevalence of MS in the Midwest and Northeast regions of the U.S., as seen below.
In addition, people who have MS tend to have lower levels of vitamin D than counterparts who do not have the condition. The reason for this association isn’t clear, but researchers have been investigating.
While it is a good idea for everyone to maintain a balanced diet, vitamin D deficiency is a common problem that many people don’t know they have.
If you have a known risk of MS, such as a family history of the condition or if you have an autoimmune disease, it makes sense to pay special attention to getting enough vitamin D.
