What Is Vitamin D Deficiency
Vitamin D deficiency means you dont have enough vitamin D in your body. It primarily causes issues with your bones and muscles.
You can get vitamin D in a variety of ways, including:
- Sun exposure on your skin .
- Through the food you eat.
- Through nutritional supplements.
Despite all these methods to get vitamin D, vitamin D deficiency is a common worldwide problem.
Recommendations For Supplementation In Vitamin D
Supplementation in vitamin D-deficient patients depends on your patients 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
*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.
Why Is Vitamin D So Important
Vitamin D is one of many vitamins your body needs to stay healthy. It plays a crucial role in maintaining the balance of calcium in your blood and bones and in building and maintaining bones.
More specifically, you need vitamin D so your body can use calcium and phosphorus to build bones and support healthy tissues.
Both hypocalcemia and hyperparathyroidism, if severe, can cause symptoms, including muscle weakness and cramps, fatigue and depression.
To try to balance calcium levels in your blood , your body takes calcium from your bones, which leads to accelerated bone demineralization .
Osteomalacia and osteoporosis put you at an increased risk for bone fractures. Rickets is the same as osteomalacia, but it only affects children. Since a childs bones are still growing, demineralization causes bowed or bent bones.
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Statistical Analysis Of The Beef Data
Statistical analysis of the data was conducted using SPSS for Windows, version 20.0 . Distributions of all variables were tested via KolmogorovSmirnov tests. Descriptive statistics were determined for all variables. The beef fat content was normally distributed. The vitamin D3, vitamin D2, 25D3, 25D2, and total vitamin D activity of beef were nonnormally distributed. A log transformation of total vitamin D activity achieved a near-normal distribution, whereas various transformations of vitamin D3, vitamin D2, 25D3, and 25D2 did not improve the normality. A 1-factor ANOVA followed by Tukey’s test were used to compare the mean total vitamin D activity and fat content of beef steaks from the 4 different sampling points, whereas KruskalWallis tests followed by MannWhitney tests were used for comparison of vitamin D3, vitamin D2, 25D3, and 25D2 contents of the meat.
Beef fat has been shown to have a higher content of vitamin D3, and possibly 25D3, than lean beef meat therefore, in an additional analysis, differences in fat content of the striploin steaks sampled from different seasons were accounted for in a regression model. The exploration of whether vitamin D2 and/or 25D2 was evident in Irish meats other than beef was guided by the presence of contents above the LOD for these compounds, and not subjected to statistical testing.
What Causes Vitamin D Deficiency
In general, the two main causes of vitamin D deficiency are:
- Not getting enough vitamin D in your diet and/or through sunlight.
- Your body isnt properly absorbing or using vitamin D.
There are several specific causes of vitamin D deficiency, including:
- Certain medical conditions.
- Weight loss-surgeries.
- Certain medications.
Several different biological and environmental factors can also put you at a greater risk of developing vitamin D deficiency, such as older age and the amount of melanin in your skin.
Medical conditions that can cause vitamin D deficiency
Medical conditions that can cause vitamin D deficiency include:
- Cystic fibrosis, Crohn’s diseaseand celiac disease: These conditions can prevent your intestines from adequately absorbing enough vitamin D through supplements, especially if the condition is untreated.
- Obesity: A body mass index greater than 30 is associated with lower vitamin D levels. Fat cells keep vitamin D isolated so that its not released. Obesity often requires taking larger doses of vitamin D supplements to reach and maintain normal levels.
- Kidney disease and liver disease: These conditions reduce the amount of certain enzymes your body needs to change vitamin D to a form it can use. A lack of either of these enzymes leads to an inadequate level of active vitamin D in your body.
Weight-loss surgeries and vitamin D deficiency
Medications that can cause vitamin D deficiency
Certain medications can lower vitamin D levels, including:
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How Can You Get Vitamin D2 Naturally
Vitamin D is found in plants and animals, but it can also be obtained simply by spending time outside. During the summer months, you will be able to get much more vitamin D. You may need to spend more time in direct sunlight if you are deficient or if you have a dark complexion.
Children need less vitamin D than adults, but vitamin D is much more important during adolescence than it is in adulthood. You should try to get your daily intake of vitamin D through healthy eating habits as well as maintaining an active outdoor lifestyle.
The New York Times has reported that sunscreen may actually prevent people from getting the vitamin D that they need to promote bone health.
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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What Is The Vitamin D 25
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Symptoms And Health Risks Of Vitamin D Deficiency
Symptoms of bone pain and muscle weakness can mean you have a vitamin D deficiency. 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
Cancer 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 sclerosi.
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Vitamin D2 Vs Vitamin D3 Supplements: How Much Is Enough
Both D2 and D3 are available as dietary supplements. The relative efficacy of D2 vs D3 in humans continues to be debated, although both appear to be effective for preventing or treating disease, provided that an adequate total 25D blood level is obtained. The variable efficacy of D2 vs D3 may relate primarily to differences in serum half-life and is clinically relevant for dosing and monitoring frequency. A single dose of 50,000 IU of D2 or D3 produces a similar increase in the total 25D concentration, but the apparent longer half-life of D3 suggests that less frequent dosing may be needed.19 A daily dosing study of 1000 IU of D2 vs D3 showed no difference in any resulting vitamin D level .20 However, a recent study comparing 1600 IU of D2 once daily vs 1600 IU of D3 once daily vs 50,000 IU of D2 once monthly vs 50,000 IU of D3 once monthly suggested that D3 is superior in that it showed slightly higher levels of 25D3 at the end of 1 year. An important caveat of this study was that the mean total 25D level at the beginning of the study was already in the reference range , and those with hypovitaminosis D may respond differently.21 We recommend the use of D3, particularly if dosing is infrequent . One situation in which D2 may be preferred is a vegetarian or vegan diet. It is recommended that both D2 and D3 be taken with a meal containing fat to ensure maximum absorption.
What Are The Signs And Symptoms Of Vitamin D Deficiency
Severe lack of vitamin D in children causes rickets. Symptoms of rickets include:
- Incorrect growth patterns due to bowed or bent bones.
- Muscle weakness.
- Bone pain.
- Deformities in joints.
This is very rare. Children with a mild vitamin deficiency may just have weak, sore and/or painful muscles.
Lack of vitamin D isnt quite as obvious in adults. Signs and symptoms might include:
However, you may have no signs or symptoms of vitamin D deficiency.
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Eat Foods High In Vitamin D
Although vitamin D only occurs in a few foods naturally, its often added to others.7 Adding these foods to your dietor adjusting how frequently you eat themis a good way to increase your vitamin D levels naturally.
Foods including fatty fish, fish liver oil, egg yolks, and mushrooms naturally have high levels of vitamin D.7 Other foods, especially dairy and plant-based milks, are frequently fortified with vitamin D.7
Below are foods that are good sources of vitamin D.
While it is helpful to know which foods are a good source of vitamin D, actually incorporating them into your diet can be a bit more tricky. Heather Shannon at UCI Health has put together a list of six recipes that are high in vitamin D to help get you started.
What Do The Results Mean
Your test results may be reported in different ways. It may give you a total vitamin D result, or it may include separate results for vitamin D2 and vitamin D3. These two types of vitamin D work about the same in your body. Your total vitamin D level is the sum of these two types. The total vitamin D number is the important number.
If your total vitamin D level shows a vitamin D deficiency or insufficiency, it may mean you:
- Dont get enough vitamin D from your diet and/or exposure to sunlight
- Have trouble absorbing vitamin D in your food, which may be a sign of a malabsorption disorder
- Have trouble changing vitamin D into a form your body can use, which may be a sign of kidney or liver disease
The treatment for low vitamin D levels is usually supplements and/or dietary changes. This is usually safer than getting more sun, which may cause skin cancer.
If your total vitamin D level shows you have too much vitamin D, it is most likely from getting too much from supplements. This is very uncommon, but if it happens, youll need to stop taking these supplements to reduce your vitamin D levels. Too much vitamin D can cause serious damage to your organs and blood vessels. If you take vitamin D supplements, ask your provider what dose is right for you.
To learn what your vitamin D test results mean, talk with your provider.
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Measurement Of The Vitamin D Content Of Meat
The vitamin D3, 25D3, vitamin D2, and 25D2 contents of the meat samples were analyzed using a modification of a sensitive LC-tandem MS method, as described in detail elsewhere . The extraction procedure for the analysis was a modification from a previously published method , which included an overnight saponification and solid phase extraction followed by 4-phenyl-1,2,4-triazoline-3.5-dione derivatization. The method’s limit of detection for vitamin D3, vitamin D2, 25D3, and 25D2 was 0.007, 0.009, 0.003, and 0.007 g/100 g, respectively. The National Institute of Standards and Technology standard reference material no. 1546a: Meat Homogenate was analyzed for the 4 vitamin D compounds so that a comparison could be made with its reference vitamin D3 and certified 25D3 values.
The total vitamin D activity of meat was defined as . The conversion factor of 5 is applied to the 25D3 content on the basis of efficacy data from a randomized controlled trial with oral vitamin D3 and 25D3 in healthy adults , and is a factor commonly used in a number of food composition tables . It should be noted, however, that equivalent data do not exist for vitamin D2 and 25D2, so we assumed a conversion factor of 5 in our calculation of the total vitamin D activity of meat .
How Much Does The Test Cost
The cost of vitamin D blood testing depends on where you have the test taken, whether other tests are performed at the same time, and whether you have health care coverage.
The costs of testing may include an office visit, a blood draw fee, and charges from the laboratory analyzing your blood sample. These costs are usually covered by insurance when the test is ordered by your health care provider. However, you may wish to check with your health insurance company to learn whether you are responsible for a deductible or copay.
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How To Increase Vitamin D Levels
People can get at least some of their daily vitamin D from exposure to sunlight.However, as light levels vary, depending on location and the time of year, a person may not be able to get all the vitamin D they need from sunlight.
A 2019 study in Switzerland found that only 1015 minutes of sun exposure per day was enough to provide 1,000 IU of vitamin D in spring and summer. However, getting this amount in fall and winter was unrealistic, requiring someone to spend over 6 hours a day outdoors.
This suggests that people who live in colder climates, or who spend most of their time indoors, may benefit from vitamin D supplements. However, a person should talk to their doctor before taking vitamin D, as it can interact with some medications.
Sunlight can also cause skin damage and sunburn, so it is essential to use sunscreen when spending time outside.
A study on Australian office workers found that applying sunscreen meant people could spend more time outdoors, leading to higher vitamin D levels overall.
People can also get some of their vitamin D from food. According to the , food sources of vitamin D include:
- oily fish, such as mackerel, tuna, and trout
- beef liver
So Who Should Be Screened For Vitamin D Deficiency
Dr. Finkelstein and his colleagues published a study of over 2,000 perimenopausal women who had been followed for almost 10 years, and they found that vitamin D levels less than 20 were associated with a slightly increased risk of nontraumatic fractures. They concluded that because few foods contain vitamin D, vitamin D supplementation is warranted in women at midlife with levels less than 20 ng/mL. “For perimenopausal women or other groups of people with higher fracture risk, certainly a level of 20 or above is ideal,” and he adds: “For the vast majority of healthy individuals, levels much lower, 15, maybe 10, are probably perfectly fine, and so I would say I agree with what the authors of the New England Journal perspective article are saying.”
All that said, most experts, including Dr. Finkelstein, agree we should be checking vitamin D levels in high-risk people those most at risk for a true deficiency. These include people with anorexia nervosa, people who have had gastric bypass surgeries, who suffer from other malabsorption syndromes like celiac sprue, or who have dark skin, or wear total skin covering . In addition, certain populations will require that vitamin D level of 20 ng/ml or higher. This can include perimenopausal women, people diagnosed with osteopenia and osteoporosis or other skeletal disorders, as well as pregnant and lactating women. All of these groups should be screened and treated as appropriate.
Image: Kras1/Getty Images
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Vitamin D Testing In Children
Vitamin D deficiency and insufficiency can be a problem in infants and children. Vitamin D deficiency can cause a serious disease called rickets that affects bone development. Rickets may result in skeletal deformities, impaired growth, short stature, and dental problems.
Vitamin D deficiency in childhood is more common in countries where a large portion of the population is malnourished. However, certain risk factors that increase the chances of vitamin D deficiency can occur in infants and children in any country and include:
- Exclusive breastfeeding since breast milk has low vitamin D content
- Lack of sunlight exposure, darker skin pigmentation, and sunscreen use
- Diets that limit intake of vitamin D-fortified foods
Health care providers may order vitamin D testing for infants and children with symptoms of vitamin D deficiency, such as skeletal changes. Some health providers will also screen young patients without symptoms, such as exclusively breastfed infants, children whose skin is darkly pigmented who live in areas with low sun exposure, and children whose diets are low in vitamin D.