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.
Vitamin D is an essential vitamin that your body uses for normal bone development and maintenance. Vitamin D also plays a role in your nervous system, musculoskeletal system and immune system.
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.
Provide Relief For Symptoms Of Autoimmune Conditions
Researchers have long been fascinated with the potential effect that vitamin D may have on autoimmune disorders because of the nutrients role in regulating the immune system, according to Harvard University. But as is the case with much of the research on vitamin D, more study is needed.
A 2016 review of clinical trials and molecular studies published in Frontiers in Immunology concluded, Based on the current data on the effect of vitamin D supplementation, it is still not possible to draw conclusions about the added value for the treatment of autoimmunity.
Vitamin D Side Effects Due To Drug Interaction
Often particular medication is not considered suitable for everyone. Therefore, individuals undergoing specific medical treatments should abstain from vitamin D supplements. People taking the following medicines should consult a doctor before taking vitamin D supplements:
- Steroids
- Phenobarbital and phenytoin
- Orlistat
- Cholestyramine
Some medications might adversely impact the sensitivity of the supplements and the medical conditions. Therefore, people with the following ailments must contact a doctor before taking the supplements:
- Primary hyperthyroidism
- Tinnitus
- Pancreatitis
- Gastric ulcers
- Coma
More often than not, these problems have passive effects such as weight loss or weight gain, mood fluctuations and changes in behavioural patterns.
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Depression And Vitamin D Deficiency
For most people, low vitamin D levels tend to be more of a problem. Deficiency can have a number of health effects, including poor bone health, but it can also impact brain development and functioning. Low levels of vitamin D have been associated with mental health conditions, including seasonal affective disorder, depression, and schizophrenia.
However, that does not mean that boosting vitamin D can always cure depression. One randomized controlled trial found insufficient evidence to support the use of vitamin D supplementation as a treatment for depression.
If you are experiencing symptoms of depression, whether or not it’s seasonal, talk to your doctor before you try to self-medicate with a supplement like vitamin D. Your doctor can assess your health and determine if vitamin D might help or if some other treatment would be more appropriate.
Vitamin D And Impact On Overall Health
For a printable version of the November CE Story and test go HERE or to take test online go HERE. For more information, visit the Continuing Education tab.
LEARNING OBJECTIVES
Upon completion of this article, the reader will be able to:
1. Discuss how vitamin D is metabolized.
2. Describe vitamin D metabolites and their role in overall health and testing for levels of vitamin D.
3. Describe the testing technologies used to measure levels of vitamin D and testing rates worldwide.
4. Describe the potential medical complications of vitamin D deficiency.
Vitamin D is an essential nutrient that is well known for its role in maintaining bone health. Additionally, vitamin D is important in immune function and has been recognized for other health benefits, including reducing the risk of chronic diseases. The most important role of vitamin D is to regulate two key players in bone mineralization calcium and phosphorus but it also plays a critical role in many biological functions. Because vitamin D deficiency is associated with numerous increased health risks, the Endocrine Society continues to recommend vitamin D screening for at-risk groups. Understanding the prevalence of vitamin D deficiency and the impact of vitamin D status on overall health can help clinicians provide the appropriate patient care. 1-6
Numerous metabolites are created when Vitamin D is activated.
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Alopecia And Hair Loss
Women with female pattern hair loss had significantly lower levels of vitamin D than those without hair loss, a 2013 study in Skin Pharmacology and Physiology found. The vitamin is crucial for hair cycling, and helps push hair from its resting phase to the growing phase. Turkish researchers found that patients with alopecia areata, an autoimmune disease that attacks follicles and can cause hair loss all over the body, had significantly lower levels of 25-hydroxy vitamin D than folks without the condition, according to a 2014 study in British Journal of Dermatology. Researchers also noted, the lower their D levels, the more severe their disease.
Impact Of Vitamin D Status On Overall Health
Even though vitamin D deficiency has been associated with many diseases, the data are conflicting. In many clinical trials, 25D measurements at baseline or after supplementation are not taken, which confounds outcome analysis on the effects of supplementation on vitamin D deficiency.4 Importantly, vitamin D is a nutrient, and unlike a drug, it is difficult to control in randomized controlled trials because confounders such as habitual intake and sun exposure exist.22 Thus, even though the disease association with vitamin D may exist, cause-effect relationships have been difficult to show. The importance of vitamin D sufficiency may be in early prevention. Studies that analyze available data on the general population and that focus on productivity, healthcare costs, hospitalization, or mortality, independent of specific disease states strongly suggest that subjects with adequate levels of vitamin D show less absenteeism,22 have lower health care costs,24-26 and lower mortality. 27, 28
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Vitamin D Deficiency May Be Linked To Several Conditions From Depression To Cancer
We get vitamin D from a great source: the sun. But it’s still possible to not get enough vitamin Dwhich can lead to negative health consequences. According to the National Library of Medicine, vitamin D deficiency can lead to a loss of bone density, which can contribute to osteoporosis and fractures . Severe vitamin D deficiency can also lead to other diseases. And researchers are studying vitamin D for its possible connections to several medical conditions, including diabetes, high blood pressure, cancer, and autoimmune conditions such as multiple sclerosis.
The good news? It’s relatively easy to get enough vitamin D. Certain foods, including fatty fish, can help you increase your levels, as can sunlight. Specifically, 15 minutes of sunlight on your hands and face each day can do the trick, Donald Ford, MD, a family medicine doctor at Cleveland Clinic, told Health.
Here are 26 reasons you should consider spending more time outdoors if your doctor mentions that your vitamin D levels are low.
How Much Vitamin D Should A Person Take
A persons daily vitamin D requirement several individual factors, such as age, sex, and health status.
Doctors consider vitamin D levels if a person has at least 20 nanograms of the vitamin per milliliter of blood. If levels rise above 50 ng/mL, a person may experience adverse side effects.
Below are some of the most serious side effects of over-supplementing vitamin D.
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Vitamin D Intoxication And Hypersensitivity
Vitamin D intoxication is rare and usually only occurs at very high supplementation doses . However, various mutations in vitamin D metabolizing enzymes that may lead to increased sensitivity to standard vitamin D supplementation or even endogenous vitamin D intoxication with hypercalcemia, hypercalciuria, and nephrocalcinosis/chronic renal insufficiency have been described . Typically, these mutations affect CYP24A1, the enzyme that catabolizes 1,25OHD2 to the inactive metabolite 24,25OHD2. Therefore, a diagnosis can be made by using the ratio of 24,25:25 D and does not necessarily require genetic testing.
This condition has been termed idiopathic infantile hypercalcemia, but due to the greatly varying clinical phenotypes, patients may well become symptomatic only in adulthood. Currently, no causal treatment is available, but avoidance of a high-calcium diet, UV-B exposure, and vitamin D or calcium supplements is advised.
Uv Levels In Victoria
From mid-August to the end of April, average UV levels in Victoria are 3 and above for much of the day so sun protection is recommended.
Sensible sun protection measures should not put people at risk of vitamin D deficiency.
From May to mid-August, average UV levels in Victoria are typically low . During this time sun protection is not recommended unless you work outdoors, are near highly reflective surfaces , or are outside for extended periods.
Overexposure to UV is never recommended, even for people who have vitamin D deficiency.
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Help Protect Against Heart Disease And Stroke
Is vitamin D heart-healthy? A prior review of 19 studies linked adequate vitamin D to a reduced risk of heart disease, stroke, and heart failure. Yet the VITAL study, a large, randomized clinical trial study involving more than 25,000 participants and published in January 2019 in the New England Journal of Medicine, found no risk reduction for strokes, heart attacks or cardiovascular deaths in people who took 2,000 IU supplements daily.
What Other Drugs Will Affect Cholecalciferol
Certain medications can make it harder for your body to absorb vitamin D. If you take other medications, take them at least 2 hours before or 2 hours after you take cholecalciferol.
Other drugs may affect cholecalciferol, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.
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Vitamin D Supplement Safety
Your body produces vitamin D when exposed to the sun, but many people may not get enough due to a variety of factors. Because of this, people often turn to vitamin D supplements. Unfortunately, it isnt uncommon for people to overdo it.
A 2017 study published in The Journal of the American Medical Association found that between 1999 and 2014, there was an increase in the number of American adults taking daily vitamin D supplements of 1,000 IU or more. Of these, 18% exceeded 1000 IU each day and 3% took more than 4,000 IU per day, which may place them at a higher risk of experiencing some adverse effects related to excessive vitamin D.
In most cases, you can get all of the vitamin D you need naturally without supplementation through sun exposure and diet. A 15-minute walk outside each day with your extremities exposed can boost vitamin D production. .
Eating foods that are naturally high in vitamin D or are fortified with the nutrient can help. Foods you can eat to boost your vitamin D levels include:
- Egg yolks
- Fortified milk, yogurt, or juice
- Cheese
- Fatter fish such as tuna or salmon
- Cod liver oil
If you do decide to take a vitamin D supplement to correct a deficiency or because you are unable to get an adequate amount through sunlight and diet, always follow your doctor’s guidelines and do not take more than recommended amounts.
Epidemiology Of Vitamin D Inadequacy
Several studies showed that 40 to 100% of U.S. and European elderly men and women still living in the community are deficient in vitamin D . It has already become a largely unrecognized global epidemic. Vitamin D inadequacy can be seen in young adults as well as healthy children. For example, 48% of white preadolescent girls in a study in Maine and 52% of Hispanic and black adolescents in a study in Boston are vitamin D deficient . In Europe, where very few foods are fortified with vitamin D, children and adults would appear to be at especially high risk . A study of middle aged British adults showed that 60% are vitamin D insufficient, and the number rose to 90% during winter and spring .
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Signs Of Deficiency And Toxicity
Deficiency
Vitamin D deficiency may occur from a lack in the diet, poor absorption, or having a metabolic need for higher amounts. If one is not eating enough vitamin D and does not receive enough ultraviolet sun exposure over an extended period , a deficiency may arise. People who cannot tolerate or do not eat milk, eggs, and fish, such as those with a lactose intolerance or who follow a vegan diet, are at higher risk for a deficiency. Other people at high risk of vitamin D deficiency include:
- People with inflammatory bowel disease or other conditions that disrupt the normal digestion of fat. Vitamin D is a fat-soluble vitamin that depends on the guts ability to absorb dietary fat.
- People who are obese tend to have lower blood vitamin D levels. Vitamin D accumulates in excess fat tissues but is not easily available for use by the body when needed. Higher doses of vitamin D supplementation may be needed to achieve a desirable blood level. Conversely, blood levels of vitamin D rise when obese people lose weight.
- People who have undergone gastric bypass surgery, which typically removes the upper part of the small intestine where vitamin D is absorbed.
Conditions resulting from prolonged vitamin D deficiency:
Toxicity
Symptoms of toxicity:
- Weight loss
- Irregular heart beat
- Hardening of blood vessels and tissues due to increased blood levels of calcium, potentially leading to damage of the heart and kidneys
Heart Attack And Irregular Heartbeat
As per a 2012 study, high calcium content in the blood can reduce the ability of the heart cells to perform. As a result, a person with a high concentration of phosphate and calcium develops deposits in the heart valves and arteries. It leads to severe heart health issues. The symptoms of heart complications caused by Vitamin D are:
- Chest pain
- Irregular heartbeat
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Q: Why Is Vitamin D Important
A: Research I have done in this area has found that people with low blood levels of vitamin D have a greater risk of a heart attack, heart failure, stroke, diabetes or high blood pressure later in life. In pregnant women, low vitamin D levels are linked to pre-eclampsia, gestational diabetes and adverse pregnancy outcomes. No matter your age or stage of life, having adequate vitamin D levels is important.
Advice For Infants And Young Children
The Department of Health and Social Care recommends that babies from birth to 1 year of age should have a daily supplement containing 8.5 to 10 micrograms of vitamin D throughout the year if they are:
- breastfed
- formula-fed and are having less than 500ml of infant formula a day, as infant formula is already fortified with vitamin D
Children aged 1 to 4 years old should be given a daily supplement containing 10 micrograms of vitamin D throughout the year.
You can buy vitamin D supplements or vitamin drops containing vitamin D at most pharmacies and supermarkets.
Women and children who qualify for the Healthy Start scheme can get free supplements containing vitamin D.
See the Healthy Start website for more information.
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Why Does Vitamin D Deficiency Occur
There are several reasons for an adult to have reduced vitamin D levels, including:
- Increasing age the skin’s ability to produce vitamin D declines over time
- Reduced exposure to the sun your body only produces vitamin D when your skin is exposed to sunlight
- Having darker skin skin tone affects the amount of vitamin D produced when in the sun, with fair-colored skin producing it easier than darker skin
- Lack of vitamin D in the diet although very few foods naturally contain vitamin D, many are fortified with it
- Health conditions that affect how well your body absorbs or processes vitamin D, including Crohn’s disease, celiac disease, ulcerative colitis, cystic fibrosis, obesity and chronic kidney or liver disease
- Some medications and medical procedures, such as laxatives, steroids, drugs taken to treat high cholesterol, seizures or tuberculosis, as well as gastric bypass surgery
“It’s important to address low vitamin D levels, but doing so requires working with your doctor to develop an effective, safe treatment plan. While reduced exposure to the sun can be a source of lower vitamin D levels, increasing sun exposure is not recommended as a source of vitamin D since this can increase your lifetime risk of developing skin cancer,” warns Dr. Brown.
Additionally, he points out that overdoing it and taking in too much vitamin D can also be harmful to your health.
Gum Disease And Tooth Loss
Because vitamin D helps your body absorb calcium, it’s essential for healthy teeth and gums, says the National Library of Medicine.
When vitamin D levels are unregulated, it weakens your teeth, making you susceptible to cavities, fractures, and decay. A 2020 study in the journal Oral Diseases looked at over 4200 US adults and found that vitamin D levels are significantly associated with the occurrence of cavities.
Additionally, a 2020 study published in the Journal of Periodontal Research found lower vitamin D levels are linked with an increased risk of periodontitis, possibly because of its connection to the immune system. Vitamin D seems to positively impact inflammation and mineralization effects on the tissue surrounding your teeth.
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What To Look For
Vitamin D is not found naturally in many foods and if you have limited sun exposure, you may want to consider a vitamin D supplement. Before deciding on a supplement, it is a good idea to have your levels checked by a healthcare professional so you know if your vitamin D status is deficient or sufficient. Based on your level, your healthcare provider can determine the appropriate dose for your needs.
You can find a supplement in pill, chewable, liquids, or gummy form. Chewables, liquids, or gummies may contain added sugar. Make sure to look for a supplement that contains D2 or D3. Both forms are effective, but vitamin D3 increases levels higher for longer. Additionally, look for a supplement with a third-party certification such as NSF International, ConsumerLab, or U.S. Pharmacopeia.
