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Why Would A Doctor Prescribe Vitamin D

Healthy People Wont Reduce Their Fracture Risk By Taking Calcium And Vitamin D Supplements Sarah Leyland

Titan Medical Center’s instructional video on how to inject Doctor Prescribed vitamin D

We know that healthy people living in the community wont reduce their fracture risk by taking calcium and vitamin D supplements, Leyland says. However, people who may not be getting enough such as those who are housebound or live in sheltered accommodation can benefit from these supplements.

Still, researchers havent found clear evidence of that, either. One meta-analysis examining the prevention of fractures in community, nursing home and hospital inpatient populations concluded that vitamin D alone is unlikely to prevent fractures in the doses and formulations tested so far in older people. And some evidence suggests that high doses can actually result in an increased number of fractures and falls. One randomised study found that high-dose monthly vitamin D supplements increased the risk of falls among the elderly population by 20-30% compared to those on a lower dose.

D for disease

There is also conflicting research on the relationship between vitamin D and other diseases, even ageing.

One main claim is that vitamin D supplements will boost the immune system. Adrian Martineau, professor of respiratory infection and immunity at The London School of Medicine and Dentistry, Queen Mary University of London, who leads a research group on the effects of vitamin D on health, has found that vitamin D plays a role in improving respiratory infections.

One study found that vitamin D helps decrease the risk of respiratory infections though only slightly

Manifestations Of Vitamin D Deficiency

Vitamin D deficiency causes bone to demineralize. In children, bones soften over time and become deformed, leading to growth retardation, enlargement of the epiphyses of the long bones, and leg deformities.9 Adults with osteomalacia may experience global bone discomfort and muscle aches, often leading to a misdiagnosis of fibromyalgia, chronic fatigue syndrome, or arthritis. Because vitamin D receptors are present in skeletal muscle, deficiency may also lead to proximal muscle weakness an increased risk of falls global bone discomfort, often elicited with pressure over the sternum or tibia and low back pain .8,10 Common manifestations of vitamin D deficiency are listed in Table 3.1,4,810

Bone discomfort or pain in low back, pelvis, lower extremities
Increased risk of falls and impaired physical function
Muscle aches
Symmetric low back pain in women

Why Are Doctors Reluctant To Accept Vitamin D

  • Myth: Excess vitamin D will turn the human body into marbleUntil recently medical students were told that > 2,000 IU of vitamin D could cause Calcium problemsIt is difficult to unlearn something. It is typically much easier to learn something totally newSee Myth for 50 years: 2000 IU of vitamin D is toxic – still taught as fact in 2010
  • Williams Syndrome mistaken diagnosis
  • Would require reversal of position on supplements.Medical societies first supported, then reversed themselves on the need for supplementsDoctors got burned by first telling patients to take supplement X then later having the patients stop taking supplement XDoctors are reluctant to endure yet another supplement reversal
  • Risk being sued if exceed guidelinesIncrease risk of being sued for Malpractice if exceed current medical guidelinesExample: prescribe 6,000 IU of vitamin D during pregnancy instead of the 400 IU in most guidelines
  • Experts do not agreeThere is a worldwide agreement that 400 IU of vitamin D is needed to prevent Rickets, but little else is agreed upon
  • and taking vitamins was even trivialized by some as a great way to make expensive urine.Vitamin D is arguably the most complex supplement – the amount needed varies with: Weight, Skin color, Latitude, Season, Co-factors, Current meal, Recent surgery/trauma, Neighborhood, etc. see also Why isnt nutrition a bigger part of conventional medical school education? Question at Research Gate 2013 with > 400 responses
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    What Is Vitamin D

    Vitamin D is a fat soluble vitamin that is needed for calcium to be absorbed into your bones, says Dr. Inna Lukyanovsky, Pharm.D., functional medicine practitioner and the author of The Crohns and Colitis Fix.

    Chirag Shah, MD, co-founder of Push Health, elaborates: Vitamin D is a type of molecule known as a secosteroid. Vitamin D is biologically active in the body and helps increase the absorption of electrolytes, including calcium and magnesium, from the gastrointestinal tract.

    In other words, your bones cant absorb calcium without vitamin D. Thats why most cows milk sold in U.S. grocery stores is fortified with vitamin D. No matter how much of that great calcium you get from foods, your bones will be soft and brittle unless you also take in enough vitamin D to process it.

    Does A Lack Of Vitamin D Cause Rickets


    A vitamin D or calcium shortage will result in rickets in youngsters and soft bones in adults over time. The skin is the only site through which vitamin D can be absorbed into the body. Sunlight is needed for the skin to make its own vitamin D. Without enough sunlight, people become deficient in vitamin D.

    People are becoming less likely to get sunburn these days because they use sunscreen, wear long-sleeved shirts, and don’t go out in the sun for very long periods of time. This could put them at risk for vitamin D deficiency. Although milk products contain some vitamin D, most people need to eat foods such as salmon, shrimp, tuna, tofu, and eggs to get sufficient amounts. Some manufacturers include vitamin D in dietary supplements and medications. However, not all forms of vitamin D are safe and interactions with other medications may occur.

    The best way to avoid developing deficiencies in these vitamins is by including them in your daily diet. If you aren’t getting enough vitamin D from your current intake, it’s easy to take action to fix the problem. Just making sure you get enough calcium and vitamin D together in your diet should be enough to keep your bones healthy.

    Recommended Reading: What Vitamins Are Needed Daily

    Where Do We Get Vitamin D

    Vitamin D is obtained from few food sources in any significant quantity , says Arielle Levitan, MD, co-founder of Vous Vitamin and author of The Vitamin Solution. It can be obtained from exposure to the sun.

    But a lot of people dont get enough vitamin D from food or sun exposure. If thats the case, they might need to take a vitamin D supplement. Sometimes people can get what they need from an over-the-counter supplement, but many people need a prescription from their doctor. You can find generic vitamin D supplements in pharmacies and drugstores as well as brand-name supplements such as Drisdol and Calciferol.

    Q: Should People Consider Vitamin D Supplements

    A: If the level of vitamin D in your blood is less than 20 nanograms per milliliter, your doctor may recommend taking a supplement. Many women already take calcium and vitamin D supplements together for bone health because vitamin D can help in calcium absorption, and they work best when taken together. Ask your doctor if supplements are right for you.

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    Epidemiology And Risk Factors

    Vitamin D deficiency in adults was previously thought to be limited to older persons living in institutions, but recent evidence suggests otherwise.5 A group of international experts concluded that approximately 50 percent of persons 65 years and older in North America and 66 percent of persons internationally failed to maintain healthy bone density and tooth attachment because of inadequate vitamin D levels.3

    Risk factors for vitamin D deficiency are listed in Table 2.4,5 A common cause of deficiency is medication use, such as anticonvulsants or glucocorticoids, which can increase catabolism and actively destroy vitamin D.1 However, approximately one third of persons with known deficiency have no identifiable risk factors.5 For example, in a study of 142 healthy persons, most of whom consumed milk and supplements, participants 18 to 29 years of age with no risk factors for deficiency were found to have the lowest levels of vitamin D.6

    Age older than 65 years
    Breastfed exclusively without vitamin D supplementation
    Dark skin
    Medication use that alters vitamin D metabolism
    Sedentary lifestyle

    A Test Usually Does Not Improve Treatment

    Boston doctor discusses link between vitamin D deficiency and severe COVID-19

    Many people have low levels of vitamin D, but few have seriously low levels. Most of us dont need a vitamin D test. We just need to make simple changes so we get enough D. We need to get a little more sun and follow the following advice.

    Even if you are at risk for other diseases, like diabetes and heart disease, a vitamin D test isnt usually helpful. The test results are unlikely to change the advice from your doctor. It is much more important for you to make lifestyle changes firstto stop smoking, aim for a healthy weight and be physically active. And, like most other Americans, you should try to get enough vitamin D from sun and foods. And talk to your doctor about supplements.

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    Q: Whats The Link Between Vitamin D And Heart Health

    A: That isnt entirely clear. We know that low vitamin D levels are a risk factor for heart disease, but at this time, we do not know whether treating low vitamin D with supplements can prevent a heart attack. There are a number of large clinical trials studying this now. Part of the problem with finding the answer is accounting for the many factors involved in heart disease. For example, maybe people who develop heart disease are also getting less physical activity outdoors. It may not be low vitamin D levels causing the heart disease.

    Will a Daily Vitamin Help Keep Your Heart Healthy?

    Why Is Vitamin D Important

    Also called the sunshine vitamin, this nutrient is critical for building strong bones and maintaining a healthy immune system. Deficiency in this vitamin has been linked to depression, muscle weakness, high blood pressure, and the risk of certain cancers. Especially in areas of the country that regularly have overcast weather, vitamin D deficiency can be a common problem.

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    Who Is At Risk

    Vitamin D deficiency is more common than many people realize. Around 1 billion people worldwide are deficient in the nutrient. People who are at risk of vitamin deficiency include those who live in climates that dont get a lot of sun and people who eat a diet low in the nutrient, such as a vegan diet. At-risk patients can also include those who have health conditions that prevent proper nutrient absorption. Older patients and those with dark skin pigmentation are also in the high-risk group.

    Is A Prescription Required For Vitamin D


    Depending on the strength of vitamin D2 or D3 youre looking for, you may not need a prescription. Formulations that are available over-the-counter come in the following doses, which are measured in international units :

    • 400 IU

    • 2000 IU

    • 5000 IU

    If someone has low vitamin D levels in their blood, their provider may recommend taking a more concentrated supplement for a short period of time to get their levels back up to a normal range.

    While both vitamin D2 and D3 pills are available in this strength, many providers prescribe D2 because it is more readily available and easier to find. Interestingly, the same dose of D3 can be purchased without a prescription. But most pharmacies do not carry it, and many companies will only sell it to a licensed healthcare provider.

    It is also important to know that while these extra high doses are sometimes used intermittently to boost vitamin D levels, it is a controversial approach. This is because there has never been strong evidence to show they are any more effective than smaller, more conservative doses.

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    How Should This Medicine Be Used

    Cholecalciferol comes as a capsule, gel capsule, chewable gel , tablet, and liquid drops to take by mouth. It is usually taken once or twice daily depending on the preparation, your age, and your medical condition. Cholecalciferol is available without a prescription, but your doctor may prescribe cholecalciferol to treat certain conditions. Check with your doctor or pharmacist before taking a cholecalciferol supplement. Take cholecalciferol at around the same time every day. Follow the directions on your product label or doctor’s instructions carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take cholecalciferol exactly as directed. Do not take more or less of it or take it more often than recommended by your doctor.

    Cholecalciferol liquid drops may be added to your child’s food or drink.

    Cholecalciferol supplements are available alone and in combination with vitamins, and in combination with medications.

    What Protects From Fractures

    For older patients at risk of vitamin D deficiency, supplements can have a major impact. They can prevent osteomalacia, a softening of the bone that makes fractures more likely.

    A University of Auckland meta-study reported that vitamin D supplements had little effect on bone density.

    We would not expect vitamin D supplements to have a large impact on bone density unless the deficiency was severe, he says. Then their impact could be significant.

    Improving bone density is not the only way to prevent fractures especially in older patients. Vitamin D can also have huge benefits for muscle function, cognition and falling.

    One study found no evidence that vitamin D supplements reduced mortality, or prevented falls or fractures. A different study found no evidence that vitamin D supplements reduced overall mortality. Drilling down into the type of supplement taken, however, vitamin D3 significantly reduced mortality while vitamin D2 slightly increased mortality.

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    Most Basic Suggestions Advise Individuals To Complement With 400

    Additionally known as the sunshine vitamin, this nutrient is crucial for constructing robust bones and sustaining a wholesome immune system. Older sufferers and people with darkish pores and skin pigmentation are additionally within the high-risk group. Particular circumstances

    some well being circumstances are straight linked to a nutrient deficiency. For instance, one examine confirmed that individuals who had enough ranges of the vitamin have been at a 62% decrease threat of growing a number of sclerosis. An excessive amount of vitamin d can result in lack of urge for food, nausea, vomiting, fatigue, dizziness, extreme thirst, and frequent urination. Discover out extra

    although vitamin d deficiency is frequent, all sufferers ought to seek the advice of with a healthcare supplier earlier than beginning a complement. A healthcare supplier can check a affected persons present nutrient ranges and supply suggestions for remedy.

    What Is Vitamin D And How Do I Get It

    Ask the Doctor Clip 705a: What is Vitamin D and Why Does the Body Need It?

    Vitamin D is an important ingredient in many different cellular processes in the body. It is well-known for keeping our bones strong, but it also plays a role in other functions, including:

    • Muscle strength

    • Calcium and glucose metabolism

    There are two natural sources of vitamin D:

    1) Food: There are only a small number of foods that naturally contain vitamin D. Some of the best sources include:

    • Liver

    • Mushrooms

    • Egg yolks

    It is more common to find foods that are artificially fortified with vitamin D, like cereals and milk.

    2) Sunlight: Our body can actually make its own vitamin D! When we are exposed to ultraviolet light from the sun, our skin uses the sunlight to make the vitamin from scratch.

    Most people have adequate levels of vitamin D through these two sources. After all, it takes only 5 to 30 minutes of sun exposure a day for your body to make enough of it. But some people choose to take supplements to keep their vitamin D levels at a normal level especially if they have or are at risk for low levels of it.

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    What You Can Do Now

    If youre concerned about vitamin D deficiency, ask your doctor to check your vitamin D level, says Dr. Deal. If the level is low and your provider starts you on supplements, you need repeat testing in eight to 12 weeks to make sure the level is not too high or too low.

    If testing shows your vitamin D level is normal, you need repeat testing every two to three years unless you have major changes in your overall health.

    Different diseases need different doses of vitamin D. If you have chronic kidney disease or parathyroid disease, ask your kidney specialist or endocrinologist about the type and dose of vitamin D you need.

    If youre pregnant or breastfeeding, Dr. Deal recommends you keep taking vitamin D supplements as long as your doctor prescribes them. The supplement is linked to healthy development for you and your baby.

    For bone health, be sure to stay active and remember to eat a calcium-rich diet. Consult with your doctor frequently to make sure youre taking the right steps to current bone health.

    Do I Need Vitamin D Supplements

    There are many different reasons that someone might take vitamin D supplements. The most common reason of course, is having low levels of vitamin D.

    People can have low vitamin D levels for a variety of reasons:

    • Low dietary intake: Most people do not have a diet rich in liver and mushrooms. Young infants are particularly at risk for low vitamin D levels because of low dietary intake.

    • Low sunlight exposure: This is common in winter months and climates and latitudes where sunlight is limited. Otherwise, people whose lifestyles involve more time indoors are also at risk for low vitamin D levels.

    • Darker skin: People with high levels of skin pigmentation make less vitamin D with sun exposure.

    People with certain medical conditions also commonly take vitamin D supplements, often as a preventative measure to help strengthen their bones. Some examples include:

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