Symptoms And Health Risks Of Vitamin D Deficiency
Symptoms of bone pain and muscle weakness can mean you have a vitamin D deficiency. However, for many people, the symptoms are subtle. Yet, even without symptoms, too little vitamin D can pose health risks. Low blood levels of the vitamin have been associated with the following:
- Increased risk of death from cardiovascular disease
- Cognitive impairment in older adults
- Severe asthma in children
Research suggests that vitamin D could play a role in the prevention and treatment of a number of different conditions, including type1 and type 2 diabetes, hypertension, glucose intolerance, and multiple sclerosis.
Beyond Vitamin D: The Many Benefits Of Sunlight
Vitamin D is really just the tip of the iceberg when it comes to the benefits of sunlight. A recent 20-year study following 29,518 subjects found that those individuals avoiding sun exposure were twice as likely to die from all causes . While this study did not assess vitamin D levels, findings from other epidemiological studies suggest that this cannot be accounted for by the increase in vitamin D production alone.
Indeed, humans make several important peptide and hormone photoproducts when our skin is exposed to the UVB wavelength of sunlight . These include:
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- Calcitonin Gene-Related Peptide: a vasodilator that protects against hypertension, vascular inflammation, and oxidative stress
- Substance P: a neuropeptide that promotes blood flow and regulates the immune system in response to acute stressors
- Adrenocorticotropic Hormone: a polypeptide hormone that controls cortisol release by the adrenal glands, thus regulating the immune system and inflammation
- Melanocyte-Stimulating Hormone: a polypeptide hormone that reduces appetite, increases libido, and is also responsible for increased skin pigmentation
What Causes Vitamin D Deficiency Symptoms
These are the most common causes of vitamin D deficiency symptoms:
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Recommendations For Supplementation In Vitamin D
Supplementation in vitamin D-deficient patients depends on your patient’s age and medical history. Use this table as a guide to help you advise your patients on recommendations for supplementation:
Recommendations for supplementation in Vitamin D-deficient patients
Obese Patients / Patients with malabsorbtion syndromes / Patiens taking certain medications
*After achieving 25D levels > 30 ng/mL.
Specific supplementation guidelines are not available for pregnant and lactating women. Both groups should be advised to supplement if tests show low levels of vitamin D.
What To Do If Your Vitamin D Level Is 37
- Increase your consumption of vitamin D-rich foods like salmon, herring, canned tuna, eggs , and fortified foods like milk, yogurt, and breakfast cereals
- Get 10â30 minutes of unprotected midday sunlight most days
- Take a vitamin D supplement. How much you should take depends on your level of deficiency. For a level of 37, you will likely need to take 2,000-5,000 IU daily for several months to significantly improve your vitamin D status.
- If levels do not improve after 3 months, review your supplements with an expert or talk to your doctor.
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For Patients Who Cant Wait
While awaiting that data, clinicians still need an answer for patients tempted to take large doses of vitamin D. Th ree endocrinologists interviewed for an Endocrine News article on osteoporosis in the April issue all aimed for levels of at least 30 ng/ml with an eye toward maximizing bone health in at-risk patients.
Holick believes that maintaining a level of 40 to 60 ng/ml is desirable in the general population and a level up to 100 ng/ml is perfectly safe.
Others urge caution about going above 50 ng/ ml. Th e data are not clear cut, but some evidence of toxicity has been associated with levels above 50 ng/ ml, including hypercalcemia and kidney stones, says Cliff ord Rosen, MD, director of clinical and translational research at the Maine Medical Center Research Institute, who worked on the IOM guideline.
But even a level of 50 ng/ml leaves a lot of leeway above the IOMs deficiency level of 20 ng/ml and the Endocrine Societys sufficiency level of 30 ng/ml. And it leaves a lot of leeway for taking supplements the IOM guideline found that intakes as high as 4,000 IU/day should be safe for adults, although longterm risks of such high intakes are unknown.
Seaborg is a freelance writer based in Charlottesville, Va. He wrote about male reproduction and EDCs in the September issue.
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People With Medical Conditions That Reduce Fat Absorption
Because vitamin D is fat-soluble, it relies on the guts ability to absorb fat from the diet.
Thus, people who have medical conditions that reduce fat absorption are prone to vitamin D deficiencies. These include inflammatory bowel disease , liver disease and also people who have had bariatric surgery (
Summary: Those who need the most vitamin D are older people, people with darker skin, those who live farther from the equator and people who cant absorb fat properly.
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Can You Take Too Much Vitamin D
While it is possible to take too much vitamin D, toxicity is very rare.
In fact, you would need to take extremely high doses of 50,000 IU or more for a long period of time .
Its also worth noting that it is impossible to overdose on vitamin D from sunlight .
Although 4,000 IU is set as the maximum amount of vitamin D you can take safely, several studies have shown that taking up to 10,000 IU daily wont cause side effects (
Vitamin D: Whats The Right Level
- By Monique Tello, MD, MPH, Contributor
Many of my patients who come into the office for their physical exams ask to have their vitamin D levels checked. They may have a family member with osteoporosis, or perhaps they have had bone thinning themselves. Mostly, they want to know that theyre doing everything they can to keep their bones strong. Vitamin D is critical for healthy bones. But when we check that blood level, how to act on the result is the subject of great controversy in medical-research land.
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How Much Vitamin D Should We Take
If everyone took 2,000 units of vitamin D a day, it could shift the curve from average blood levels in the mid-50s to about a 110 nmol/L , which some estimate could add years to our life expectancy. Data derived from randomized clinical trials have convinced some influential experts, such as Harvards Chair of Nutrition, that we should shoot for this kind of range, levels that about nine out of ten people fail to reach because it may necessitate taking 1,800 to 4,000 units of vitamin D a day.
The Institute of Medicine , however, considered blood levels of 50 nmol/L to be sufficient and therefore recommended only 600 to 800 units a day for those with little or no sun exposure. Why so low? Because the IOM was only considering bone health. Even if we cared just about our bones and not our lifespan, wed still probably want to shoot for a 75 nmol/L threshold, because theres evidence from hundreds of autopsies of people who died in car accidents, for instance, showing osteomalacia, or softening of the bones, in 18 to 39 percent of people who reach the IOM target of 50 nmol/L, but failed to make it to 75 nmol/L.
Causes Of Vitamin D Deficiency
Vitamin D deficiency can occur for a number of reasons:
You don’t consume the recommended levels of the vitamin over time. This is likely if you follow a strict vegan diet, because most of the natural sources are animal-based, including fish and fish oils, egg yolks, fortified milk, and beef liver. Here are the best vitamin d foods for vegetarians.
Your exposure to sunlight is limited. Because the body makes vitamin D when your skin is exposed to sunlight, you may be at risk of deficiency if you are homebound, live in northern latitudes, wear long robes or head coverings for religious reasons, or have an occupation that prevents sun exposure. Duirng the winter, vitamin D deficiency can be more prevalent because there is less sunlight available.
You have dark skin. The pigment melanin reduces the skin’s ability to make vitamin D in response to sunlight exposure. Some studies show that older adults with darker skin are at high risk of vitamin D deficiency.
Your digestive tract cannot adequately absorb vitamin D. Certain medical problems, including Crohn’s disease, cystic fibrosis, and celiac disease, can affect your intestine’s ability to absorb vitamin D from the food you eat.
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Your Value Is Between 0
This value indicates severe vitamin D deficiency and represents significant risk to health. This low vitamin D level means that calcium cannot be sufficiently absorbed into the blood, which may lead to osteomalacia. This may also affect muscle strength and motor coordination.
If your vitamin D blood level is e.g. 25 ng/ml or higher and you want to increase them, you can take the following amount of vitamin D :
To reach the mentioned value.. take this vitamin D Dose per day:
20 ng/ml ..1000 IU 30 ng/ml ..2200 IU 40 ng/ml ..3600 IU 50 ng/ml ..5300 IU 60 ng/ml ..7400 IU 70 ng/ml ..10100 IU
The Health Benefits Of Vitamin D
I could write an entire book on the benefits of Vitamin D.
Here I will provide just a few reasons why you should optimize your levels.
Lowers Antibodies Across the Board
Autoimmune conditions such as Hashimoto’s, Graves’, Celiac, Chron’s, Lupus, Rheumatoid Arthritis and Multiple Sclerosis are all improved when vitamin D levels are optimized.
For example, a recent study found that 83% of patients with Hashimoto’s who were given 1200-4000 IU of Vitamin D3 for 4 months, experienced 20.8% drops in TPO antibodies
In addition, it is a well known fact that patients with any of the above mentioned autoimmune conditions are chronically low in vitamin D.
New Research from Autoimmunity Research Foundation shows that the vitamin D receptors get down regulated by pathogens compromising the uptake of vitamin D.
These pathogens can be the primary causes of autoimmunity.
So increasing vitamin D levels and/or supplementation, is key in managing an autoimmune condition.
Builds Stronger Bones
Vitamin D is a precursor hormone for a powerful steroid hormone in your body called calcitriol.
Calcitriol is essential for bone strength and cell regeneration which is central to slowing down the aging process!
You absolutely have to have optimal levels of Vitamin D in order to absorb minerals such as calcium, magnesium and potassium.
Vitamin D also suppresses parathyroid hormone which breaks bone down. This helps slow down the softening of bones in both children and adults.
Helps with Breast Cancer
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Vitamin D: What You Need To Know
When vitamin D was discovered in the early 20th century, it was considered a breakthrough. Public-health officials armed with the new knowledge that the vitamin helps the body absorb calcium led the charge against rickets, a crippling bone disease that reached epidemic levels among infants and children in industrialized northern cities in the United States and Europe.
Based on the emerging research, doctors began recommending sun-shine and cod-liver oil for bone health, while many food and drink manufacturers started fortifying their products milk, hot dogs, even beer with vitamin D.
Since then, the medical establishment has gone back and forth on its vitamin-D recommendations. In the 1950s, British health officials blamed an outbreak of hypercalcemia, or too much circulating calcium in the body, on diets overrich in D . Several European countries subsequently banned vitamin Dfortified foods altogether. And since it takes relatively little D to keep rickets at bay, physicians largely stopped promoting it.
In the 2000s, the attitude toward vitamin D shifted again in light of the vast body of research demon-strating its vital role in overall health. Studies showed that the sunshine vitamin triggers the expression of more than 200 health-supporting genes. Additional studies suggested that D has a protective effect against chronic conditions such as cancer, osteoporosis, cardiovascular disease, diabetes, asthma, and neurodegenerative disease.
Pinpointing A Healthy Vitamin D Level Is Tricky
So, what is the current cutoff value at which people are considered “low,” and thus at risk for developing bone thinning and having fractures? Ah. This is where there is a lot of argument.
In 2010, the venerable Institute of Medicine issued a report based on lengthy examination of data by a group of experts. To sum up, they estimated that a vitamin D level of 20 ng/mL or higher was adequate for good bone health, and subsequently a level below 20 was considered a vitamin D deficiency.
In my practice, and in most, it is not uncommon to see a vitamin D level less than 20. When that happens, we tell the patient that they are deficient and recommend fairly aggressive replenishment, as well as ongoing supplementation. The majority of folks have a level between 20 and 40, in my experience, and this is corroborated by the IOMs findings in that 2010 report.
But in 2011, the respected Endocrine Society issued a report urging a much, much higher minimum blood level of vitamin D. At that time, their experts concluded: “Based on all the evidence, at a minimum, we recommend vitamin D levels of 30 ng/mL, and because of the vagaries of some of the assays, to guarantee sufficiency, we recommend between 40 and 60 ng/mL for both children and adults.”
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People Who Should Be Tested
The following should be tested for vitamin D deficiency:
- Individuals who receive therapy to prevent or treat osteoporosis
- Elderly people, especially those with minimal exposure to sunlight
- Patients with signs and symptoms of hypocalcemia or hypercalcemia
- Children and adults with suspected rickets and osteomalacia, respectively
- Patients receiving vitamin D therapy who do not demonstrate clinical improvement
Significance Of Having Vitamin D Levels Within The Normal Range
Normal vitamin D levels are markers of bone health, an indication that the body is absorbing calcium properly. Too much or too little vitamin D is bad for ones health as insufficient levels of this vitamin force the body to get calcium from the bones in an attempt to normalize the calcium level, which makes the individual more susceptible to osteoporosis. On the other hand, an overabundance of vitamin D can cause toxicity which can harm the heart, kidney and liver. Aside from bone health, a normal vitamin D level is essential for a strong immune system to help the body ward off different sorts of infection caused by fungi, virus and bacteria. It is also important for the prevention of hypertension as vitamin D helps normalize the blood pressure.
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Experts Opinion: Ideal Blood Levels Of Vitamin D
D refers to 25-hydroxyvitamin D, the form of vitamin D measured in the blood and the measurement is expressed as ng/ml.)
In 2010 Life Extension Foundation published an interview with Dr. Michael Holick, considered the worlds foremost researcher on the benefits of vitamin D. Michael F. Holick, PhD, MD, is a professor of medicine, physiology, and biophysics at Boston University Medical Center, and is also the director of the General Clinical Research Unit there. He is either directly, or indirectly, responsible for most of the studies that have shown how genetic receptors found throughout the body use vitamin D to reduce the risk of cancer, depression, diabetes, and heart disease.
In his book The Vitamin D Solution, Dr. Holick recommends that we maintain a blood level of 25-hydroxyvitamin D of between 40-60 ng/mL, the range at which most of the health benefits occur. To attain this, Dr. Holick says that he practices sensible sun exposure, when the sun provides sufficient light to make vitamin D in the skin and, as well, he takes 2,000 IU of vitamin D as a supplement, along with 400 IU from a multivitamin, and drinks 3 glasses of vitamin D fortified milk every day. This maintains his blood level of 25-hydroxyvitamin D in the range of 40-50 ng/mL.