What are the consequences of vitamin D deficiency. How can you recognize the symptoms of low vitamin D levels. What are the best food sources of vitamin D. How can you safely increase your vitamin D intake.

Understanding Vitamin D: The Sunshine Vitamin

Vitamin D is a crucial fat-soluble nutrient that plays a vital role in maintaining overall health. Often referred to as the “sunshine vitamin,” it is unique because our bodies can produce it when our skin is exposed to sunlight. However, despite its importance, vitamin D deficiency has become increasingly common in recent years.

The National Institutes of Health reports that nearly 25% of U.S. adults have insufficient vitamin D levels. This widespread deficiency has led to increased screening and awareness among healthcare professionals.

Why is Vitamin D Important?

Vitamin D serves several essential functions in the body:

• Promotes calcium absorption for strong bones and teeth
• Supports immune system function
• Helps regulate mood and mental health
• Aids in muscle function and strength
• Plays a role in cell growth and differentiation

Given its wide-ranging impact on health, maintaining adequate vitamin D levels is crucial for overall well-being.

Recognizing the Signs: 9 Symptoms of Vitamin D Deficiency

While many individuals with vitamin D deficiency may not experience noticeable symptoms, some people may develop various signs indicating low levels. It’s important to be aware of these potential indicators:

1. Persistent fatigue and low energy
2. Bone pain or aches, particularly in the back and legs
3. Muscle weakness or difficulty climbing stairs
4. Mood changes, including depression or feelings of sadness
5. Impaired wound healing or frequent infections
6. Hair loss or thinning
7. Sleep disturbances or insomnia
8. Decreased appetite
9. Pale or ashen skin tone

If you experience any combination of these symptoms, it’s advisable to consult a healthcare professional. They may recommend a blood test to measure your vitamin D levels and determine if you have a deficiency.

How is Vitamin D Deficiency Diagnosed?

Vitamin D status is typically assessed through a blood test measuring the level of 25-hydroxyvitamin D. Generally, a concentration above 30 ng/mL (75 nmol/L) is considered sufficient for most individuals. However, optimal levels may vary depending on individual health factors and recommendations from healthcare providers.

The Silent Epidemic: Who’s at Risk for Vitamin D Deficiency?

Certain groups are more susceptible to developing vitamin D deficiency. Understanding these risk factors can help individuals take proactive steps to maintain adequate levels:

• People with darker skin tones: Melanin reduces the skin’s ability to produce vitamin D from sunlight
• Older adults: Aging skin is less efficient at synthesizing vitamin D
• Individuals with limited sun exposure: Those who spend most of their time indoors or live in northern latitudes
• People with obesity: Excess body fat can bind to vitamin D, reducing its availability
• Individuals with malabsorption disorders: Conditions like celiac disease or inflammatory bowel disease can interfere with vitamin D absorption
• Those with osteoporosis: Low bone density is often associated with vitamin D deficiency

Recognizing these risk factors can help individuals and healthcare providers identify potential vitamin D deficiencies early and implement appropriate interventions.

Bridging the Gap: 10 Vitamin D-Rich Foods to Boost Your Intake

While sunlight exposure is the most efficient way to produce vitamin D, dietary sources can also contribute significantly to maintaining adequate levels. Here are ten foods that can help increase your vitamin D intake:

Naturally Rich Sources:

1. Fatty fish (salmon, mackerel, tuna)
2. Cod liver oil
3. Egg yolks
4. Beef liver
5. Wild mushrooms (exposed to UV light)

Fortified Food Options:

6. Fortified milk (dairy and plant-based alternatives)
7. Fortified orange juice
8. Fortified breakfast cereals
9. Fortified yogurt
10. Fortified tofu

Incorporating these foods into your diet can help increase your vitamin D intake. However, it’s important to note that dietary sources alone may not be sufficient for individuals with severe deficiency or those at high risk.

Harnessing the Sun: Safe Ways to Boost Vitamin D Production

Sunlight exposure remains the most efficient way for our bodies to produce vitamin D. However, it’s crucial to balance the benefits of sun exposure with the risks of skin damage and cancer. Here are some guidelines for safe sun exposure:

• Aim for 10-30 minutes of midday sun exposure several times per week
• Expose larger areas of skin, such as arms and legs
• Be mindful of your skin type and adjust exposure time accordingly
• Use sunscreen after initial exposure to prevent skin damage
• Consider your geographical location and time of year, as UV intensity varies

Remember that factors like cloud cover, pollution, and sunscreen use can affect vitamin D production. If regular sun exposure is not feasible, alternative methods of supplementation may be necessary.

Supplementation: A Safe and Effective Solution?

For many individuals, vitamin D supplements can be an effective way to maintain adequate levels, especially when sunlight exposure and dietary sources are limited. However, it’s essential to approach supplementation with caution and under the guidance of a healthcare professional.

Types of Vitamin D Supplements

Vitamin D supplements come in two main forms:

• Vitamin D2 (ergocalciferol): Derived from plant sources
• Vitamin D3 (cholecalciferol): Derived from animal sources or lichen

Research suggests that vitamin D3 may be more effective at raising and maintaining blood levels of vitamin D. Therefore, many healthcare providers recommend D3 supplements when supplementation is necessary.

Recommended Dosages

The recommended dietary allowance (RDA) for vitamin D varies by age and life stage:

• Infants (0-12 months): 400 IU (10 mcg)
• Children and adults (1-70 years): 600 IU (15 mcg)
• Adults over 70 years: 800 IU (20 mcg)
• Pregnant and breastfeeding women: 600 IU (15 mcg)

However, individuals with deficiency may require higher doses under medical supervision. It’s crucial to consult with a healthcare provider to determine the appropriate dosage based on your specific needs and vitamin D levels.

Safety Considerations

While vitamin D toxicity is rare, it can occur with excessive supplementation. Symptoms of vitamin D toxicity may include:

• Nausea and vomiting
• Confusion and disorientation
• Excessive thirst and frequent urination
• Kidney stones
• Calcium buildup in the blood (hypercalcemia)

To avoid potential complications, always follow recommended dosages and consult with a healthcare provider before starting any new supplement regimen.

Beyond Bone Health: The Far-Reaching Impact of Vitamin D

While vitamin D is primarily known for its role in bone health, research has uncovered numerous other potential benefits associated with maintaining adequate levels:

Immune Function

Vitamin D plays a crucial role in modulating the immune system. It helps activate T cells, which are responsible for detecting and destroying foreign pathogens. Some studies suggest that adequate vitamin D levels may help reduce the risk of autoimmune diseases and improve the body’s ability to fight infections.

Mental Health

There is growing evidence linking vitamin D deficiency to an increased risk of depression and other mood disorders. The vitamin D receptor is present in brain areas involved in mood regulation, suggesting a potential role in mental health. While more research is needed, maintaining adequate vitamin D levels may contribute to overall mental well-being.

Cardiovascular Health

Some studies have suggested a potential link between vitamin D deficiency and an increased risk of cardiovascular diseases. Vitamin D may help regulate blood pressure, reduce inflammation, and improve overall heart health. However, more research is needed to fully understand the relationship between vitamin D and cardiovascular health.

Cancer Prevention

While the evidence is mixed, some studies have suggested that adequate vitamin D levels may be associated with a reduced risk of certain cancers, including colorectal, breast, and prostate cancer. Vitamin D is involved in regulating cell growth and differentiation, which may explain its potential protective effects.

Muscle Function

Vitamin D plays a role in muscle strength and function. Adequate levels may help reduce the risk of falls, particularly in older adults. This is especially important for maintaining mobility and independence as we age.

While these potential benefits are promising, it’s important to note that more research is needed to fully understand the extent of vitamin D’s impact on various aspects of health. Maintaining adequate vitamin D levels through a combination of sun exposure, diet, and supplementation (when necessary) remains a crucial aspect of overall health and well-being.

Addressing Vitamin D Deficiency: A Multifaceted Approach

Combating vitamin D deficiency requires a comprehensive strategy that considers individual needs, lifestyle factors, and potential barriers to adequate intake. Here are some key steps to address vitamin D deficiency:

1. Regular Screening

Routine vitamin D testing can help identify deficiencies early, especially for individuals at higher risk. Healthcare providers may recommend periodic blood tests to monitor vitamin D levels and adjust interventions as needed.

2. Lifestyle Modifications

Simple changes to daily routines can significantly impact vitamin D status:

• Spending more time outdoors, especially during midday hours
• Engaging in outdoor activities or exercise when possible
• Incorporating vitamin D-rich foods into the diet
• Considering UV exposure through safe sunbathing or the use of UV lamps (under medical supervision)

3. Dietary Adjustments

Working with a registered dietitian can help individuals develop meal plans that incorporate more vitamin D-rich foods. This may include:

• Increasing consumption of fatty fish
• Choosing fortified dairy or plant-based milk alternatives
• Incorporating egg yolks and mushrooms into meals
• Selecting fortified breakfast cereals and other fortified foods

4. Targeted Supplementation

For individuals unable to achieve adequate vitamin D levels through sun exposure and diet alone, supplementation may be necessary. Healthcare providers can recommend appropriate dosages based on individual needs and deficiency severity.

5. Addressing Underlying Health Conditions

In some cases, vitamin D deficiency may be a symptom of underlying health issues. Treating conditions that affect vitamin D absorption or metabolism, such as celiac disease or kidney problems, may help improve vitamin D status.

6. Education and Awareness

Increasing public awareness about the importance of vitamin D and the risks of deficiency can help individuals take proactive steps to maintain adequate levels. This may include:

• Community health programs focused on vitamin D education
• Workplace wellness initiatives that promote sun safety and vitamin D awareness
• School-based programs that teach children about the importance of vitamin D for growth and development

7. Seasonal Considerations

In regions with significant seasonal variations in sunlight, individuals may need to adjust their vitamin D strategies throughout the year. This could involve:

• Increasing supplementation during winter months
• Taking advantage of outdoor activities during summer months
• Using light therapy devices during periods of limited sunlight (under medical supervision)

By implementing a comprehensive approach that addresses individual needs and risk factors, it’s possible to effectively manage and prevent vitamin D deficiency. Regular consultation with healthcare providers can help ensure that strategies are tailored to each person’s unique circumstances and health goals.

The Future of Vitamin D Research: Emerging Trends and Potential Breakthroughs

As our understanding of vitamin D’s role in health continues to evolve, researchers are exploring new avenues and potential applications. Here are some exciting areas of ongoing research:

Genetic Factors Influencing Vitamin D Metabolism

Scientists are investigating how genetic variations affect vitamin D metabolism and utilization. This research could lead to more personalized approaches to vitamin D supplementation and deficiency prevention.

Vitamin D and Immune Function

The COVID-19 pandemic has sparked renewed interest in vitamin D’s role in immune function. Researchers are exploring whether vitamin D supplementation could help reduce the severity of respiratory infections or improve vaccine efficacy.

Novel Delivery Methods

Scientists are developing new ways to deliver vitamin D, such as fortified foods, transdermal patches, or extended-release formulations. These innovations could improve absorption and make it easier for individuals to maintain adequate levels.

Vitamin D and Chronic Diseases

Ongoing studies are investigating the potential role of vitamin D in preventing or managing chronic diseases such as diabetes, multiple sclerosis, and certain cancers. While more research is needed, early findings suggest promising avenues for future exploration.

Optimal Dosing Strategies

Researchers are working to refine vitamin D dosing recommendations for different populations and health conditions. This could lead to more targeted and effective supplementation strategies.

Vitamin D and Brain Health

Emerging research is exploring the potential link between vitamin D and cognitive function, including its possible role in preventing age-related cognitive decline and neurodegenerative diseases.

As these areas of research continue to develop, our understanding of vitamin D’s importance in overall health will likely expand. This ongoing scientific inquiry promises to yield new insights and strategies for addressing vitamin D deficiency and optimizing health outcomes.

9 vitamin D deficiency symptoms (and 10 high vitamin D foods)

Vitamin D is a fat-soluble vitamin essential for health. It keeps your bones strong, can improve your mental health and helps you sleep.

According to the National Institutes of Health, almost 1 in 4 U.S. adults are considered low in vitamin D. Symptoms depend on how severe the deficiency is and the person. 

Vitamin D deficiency has become more common over the past several years. The University Health Center occasionally screens for this condition in patients struggling with fatigue, depressive symptoms and bone issues.

Health center provider Sarah Wallingford, PA, shares what vitamin D deficiency looks like – and three ways to overcome it. 

Symptoms when vitamin D is low

Most people with vitamin D deficiency are asymptomatic. However, if you’re exhausted, your bones hurt, you have muscle weakness or mood changes, that’s an indication that something may be abnormal with your body.

Symptoms of vitamin D deficiency may include:

1. Fatigue
2. Not sleeping well
3. Bone pain or achiness
4. Depression or feelings of sadness
5. Hair loss
6. Muscle weakness
7. Loss of appetite
8. Getting sick more easily
9. Pale skin

If these symptoms sound familiar, it’s time to see a medical professional. They may do a blood test to check your vitamin D levels to see if they are within normal range.  

Get vitamin D from food

5 foods naturally high in vitamin D:

• Fatty fish like salmon, trout, tuna and mackerel
• Canned fish like herring and sardines
• Egg yolks
• Beef liver
• Fish liver

5 vitamin D fortified foods:

• Breakfast cereals 
• Milk 
• Almond milk
• Soy milk
• Orange juice 

Since there aren’t a lot of naturally occurring vitamin D foods, many products are enriched with vitamin D. Always check the nutrition label to  ensure there’s vitamin D added.

Get vitamin D from sunlight

When your skin is exposed to ultraviolet rays from the sun, your body creates vitamin D.

Make time daily to get out in the sun. If you don’t have classes, work or commitments scheduled that require you to go outside for the day, set aside a few minutes to take a quick walk, even if it’s just around your residence hall or the block. Remember to wear sunscreen, even on cloudy, gloomy days.

If you don’t get regular sunlight, you may need to increase your dietary intake or take a vitamin D supplement.

Take a vitamin D supplement

Most people should be taking a vitamin D supplement, Wallingford says.

Vitamin D has two main forms: D2 and D3. You can absorb both types in your body. Still, studies have shown that vitamin D3 raises your levels more effectively than vitamin D2. For this reason, Wallingford recommends over-the-counter supplements that contain vitamin D3 or taking a cod liver oil supplement. Vitamin D3 supplements can be purchased at the University Health Center pharmacy.

The recommended dietary allowance of vitamin D for young adults is 600 international units. A doctor may prescribe  a prescription-strength dose of vitamin D if your levels are severely low.

Are vitamin D supplements safe?

Yes. A vitamin D supplement doesn’t cause many adverse effects at recommended doses. What you don’t use, your body usually urinates out, so it’s difficult to overdose on vitamin D unless you are taking massive doses.

Extremely high vitamin D levels are harmful and can cause nausea, vomiting, confusion, excessive thirst and kidney stones. Vitamin D supplements can interact with certain medications, so check with your doctor before starting one.

Who is more at risk for vitamin D deficiency?

People with darker skin are much better protected from UV rays but also need to spend more time in the sun than people with lighter skin to produce the same amount of vitamin D. Non-Hispanic Black people generally have higher rates of vitamin D deficiency. The darker your skin, the less vitamin D you make from sunlight exposure. People who are obese, those with osteoporosis, and people with malabsorption disorders like celiac disease or inflammatory bowel disease are also at risk for vitamin D deficiency.

If you are concerned you have low vitamin D levels and would like to talk to a doctor about it, schedule an appointment at the University Health Center by calling 402.472.5000.

Vitamin D Deficiency – StatPearls

Continuing Education Activity

Vitamin D is a fat-soluble vitamin used by the body for normal bone development and maintenance by increasing the absorption of calcium, magnesium, and phosphate. A circulating level of 25-hydroxyvitamin D greater than 30 ng/mL is required to maintain a healthy level of vitamin D. Vitamin D deficiency can lead to an array of problems, most notably rickets in children and osteoporosis in adults. The fortification of milk with vitamin D in the 1930s was effective in eradicating rickets in the world. However, vitamin D deficiency is now more prevalent than ever and should be screened in high-risk populations. Many conflicting studies are now showing an association between vitamin D deficiency and cancer, cardiovascular disease, diabetes, autoimmune diseases, and depression. This activity reviews the evaluation and management of vitamin D deficiency and explains the role of the interprofessional team in improving care for patients with this condition.

Objectives:

• Review the etiology of vitamin D deficiency.

• Discuss the pathophysiology and epidemiology of vitamin D deficiency.

• Review evaluation and management of vitamin D deficiency.

• Outline the role of the interprofessional team in evaluating and managing patients with vitamin D deficiency.

Access free multiple choice questions on this topic.

Introduction

Vitamin D is a fat-soluble vitamin that plays an important role in calcium homeostasis and bone metabolism. Vitamin D deficiency can lead to osteomalacia and rickets in children and osteomalacia in adults. The fortification of milk with vitamin D in the 1930s was effective in eradicating rickets in the world. However, subclinical vitamin D deficiency is still widely prevalent in both developed and developing countries with a worldwide prevalence of up to 1 billion. [1]  This subclinical vitamin-D deficiency is associated with osteoporosis, increased risk of falls and fragility fractures. Many conflicting recent studies are now showing an association between vitamin D deficiency and cancer, cardiovascular disease, diabetes, autoimmune diseases, and depression.[2]

Etiology

Dermal synthesis and dietary intake (fatty fish livers, fortified food) are the major sources of ergocalciferol (D2) and cholecalciferol (D3), both of which are converted to 25-hydroxy-vitamin D2 (25-OH-D2) and 25-hydroxy-vitamin D3 (25-OH-D3) respectively in the liver by the enzyme hepatic enzyme 25–hydroxylase. Both 25-OH-D2 and 25-OH-D3 are then converted to the most active form of vitamin D (1,25 dihydroxyvitamin D) by the enzyme 1-alpha-hydroxylase in the kidneys. This active 1,25 dihydroxyvitamin D increases intestinal absorption of calcium and bone resorption and decreases renal excretion of calcium and phosphate. Vitamin D deficiency can result from several causes.

1. Decreased dietary intake and/or absorption.

Certain malabsorption syndromes such as celiac disease, short bowel syndrome, gastric bypass, inflammatory bowel disease, chronic pancreatic insufficiency, and cystic fibrosis may lead to vitamin D deficiency. Lower vitamin D intake orally is more prevalent in the elderly population. [3]

2. Decreased sun exposure.

About 50% to 90% of vitamin D is absorbed through the skin via sunlight while the rest comes from the diet. Twenty minutes of sunshine daily with over 40% of skin exposed is required to prevent vitamin D deficiency.[4] Cutaneous synthesis of vitamin D declines with aging. Dark-skinned people have less cutaneous vitamin D synthesis. Decreased exposure to the sun as seen in individuals who are institutionalized, or have prolonged hospitalizations can also lead to vitamin D deficiency. [5] Effective sun exposure is decreased in individuals who use sunscreens consistently. 

3. Decreased endogenous synthesis.

Individuals with chronic liver disease such as cirrhosis can have defective 25-hydroxylation leading to deficiency of active vitamin D. Defect in 1-alpha 25-hydroxylation can be seen in hyperparathyroidism, renal failure and 1-alpha hydroxylase deficiency. 

4. Increased hepatic catabolism.

Medications such as phenobarbital, carbamazepine, dexamethasone, nifedipine, spironolactone, clotrimazole, and rifampin induce hepatic p450 enzymes which activate degradation of vitamin D.[6]

5. End organ resistance.

End organ resistance to vitamin D can be seen in hereditary vitamin D resistant rickets.

Epidemiology

Vitamin D deficiency is a global public health issue.  About 1 billion people worldwide have vitamin D deficiency, while 50% of the population has vitamin D insufficiency.[1] The prevalence of patients with vitamin D deficiency is highest in the elderly, obese patients, nursing home residents, and hospitalized patients. The prevalence of vitamin D deficiency was 35% higher in obese subjects irrespective of latitude and age.[7] In the United States, about 50% to 60% of nursing home residents and hospitalized patients had vitamin D deficiency. [8][9] Vitamin D deficiency may be related to populations who have higher skin melanin content and who use extensive skin coverage, particularly in Middle Eastern countries. In the United States, 47% of African American infants and 56% of Caucasian infants have vitamin D deficiency, while over 90% of infants in Iran, Turkey, and India have vitamin D deficiency. In the adult population, 35% of adults in the United States are vitamin D deficient whereas over 80% of adults in Pakistan, India, and Bangladesh are Vitamin D deficient. In the United States, 61% of the elderly population is vitamin D deficient whereas 90% in Turkey, 96% in India, 72% in Pakistan, and 67% in Iran were vitamin D deficient.[10]

Pathophysiology

Vitamin D plays a crucial role in calcium homeostasis and bone metabolism. With chronic and/or severe vitamin D deficiency, a decline in intestinal calcium and phosphorus absorption leads to hypocalcemia leading to secondary hyperparathyroidism. This secondary hyperparathyroidism then leads to phosphaturia and accelerated bone demineralization.  This can further results in osteomalacia and osteoporosis in adults and osteomalacia and rickets in children.

History and Physical

The majority of patients with vitamin D deficiency are asymptomatic. However, even mild chronic vitamin D deficiency can lead to chronic hypocalcemia and hyperparathyroidism which can contribute risk of osteoporosis, falls and fractures especially in the elderly population. Patients with a prolonged and severe vitamin D deficiency can experience symptoms associated with secondary hyperparathyroidism including bone pain, arthralgias, myalgias, fatigue, muscle twitching (fasciculations), and weakness.  Fragility fractures may result from chronic vitamin D deficiency leading to osteoporosis. In children, irritability, lethargy, developmental delay, bone changes, or fractures can be symptoms of vitamin D deficiency.

Evaluation

It is not recommended to screen asymptomatic individuals for vitamin-D deficiency. High-risk individuals shall be evaluated. Vitamin D sufficiency or deficiency is evaluated by the measurement of serum 25-hydroxyvitamin D. Optimal serum levels of 25-hydroxyvitamin D is still a matter of controversy.  There are substantial differences in mineral metabolism amongst different races.  African Americans, for example, have higher bone density and low fracture risk compared to other races.  Further, the effects of calcium and vitamin-D supplementation in the non-Caucasian population have not yet been completely evaluated or reported.  The International Society for Clinical Densitometry and International Osteoporosis Foundation recommend minimum serum levels of 25-hydroxyvitamin D of 30 ng/mL to minimize the risk of fall and fractures in older individuals.  [11] There is insufficient data about the maximum safe up her level of serum 25-hydroxyvitamin D, however, at high levels such as above 100 ng/mL, there is a potential risk of toxicity due to the secondary hypercalcemia. In patients where vitamin-D deficiency has been diagnosed, it is important to evaluate for secondary hyperparathyroidism and levels of parathyroid hormone and serum calcium shall be checked.

Treatment / Management

Several preparations of vitamin D are available. Vitamin D3 (cholecalciferol), when compared with vitamin D2 (ergocalciferol), has been shown to be more efficacious in achieving optimal 25-hydroxyvitamin D levels, thus favoring vitamin D3 as a treatment of choice. [12]

Prevention of Vitamin D deficiency

Adults less than 65 years of age who do not have year-round effective sun exposure shall consume 600 to 800 international units of vitamin D3 daily to prevent deficiency. Older adults 65 years of age or more shall consume 800 to 1000 international units of vitamin D3 daily to prevent deficiency and to reduce the risk of fractures and falls.

Management of Vitamin D deficiency

The amount of vitamin D required to treat the deficiency depends largely on the degree of the deficiency and underlying risk factors.

• Initial supplementation for 8 weeks with Vitamin D3 either 6,000 IU daily or 50,000 IU weekly can be considered.[13] Once the serum 25-hydroxyvitamin D level exceeds 30 ng/mL, a daily maintenance dose of 1,000 to 2,000 IU is recommended.

• A higher-dose initial supplementation with vitamin D3 at 10,000 IU daily may be needed in high-risk adults who are vitamin D deficient (African Americans, Hispanics, obese, taking certain medications, malabsorption syndrome). Once serum 25-hydroxyvitamin D level exceeds 30ng/mL, 3000 to 6000 IU/day maintenance dose is recommended.

• Children who are vitamin D deficient require 2000 IU/day of vitamin D3 or 50,000 IU of vitamin D3 once weekly for 6 weeks. Once the serum 25(OH)D level exceeds 30 ng/mL, 1000 IU/day maintenance treatment is recommended. According to the American Academy of Pediatrics, infants who are breastfed and children who consume less than 1 L of vitamin D-fortified milk need 400 IU of vitamin D supplementation.

• Calcitriol can be considered where the deficiency persists despite treatment with vitamin D2 and/or D3. The serum calcium level shall be closely monitored in these individuals due to an increased risk of hypercalcemia secondary to calcitriol.

• Calcidiol can be considered in patients with fat malabsorption or severe liver disease.

Differential Diagnosis

• Celiac sprue

• Cystic fibrosis

Pertinent Studies and Ongoing Trials

A meta-analysis of 18 randomized controlled trials (RCT) including over 57,000 subjects found that intake of daily doses of vitamin D supplements decreased total mortality rates.[14] In the Women’s Health Initiative, calcium and vitamin D supplementation decreased the risk of total cancer, breast cancer, and colorectal cancer while not changing total mortality. [15] One RCT showed that calcium plus vitamin D substantially reduced all cancer risk in postmenopausal women.[16] In a meta-analysis study from three randomized controlled trials, vitamin D supplementation was found to reduce the rate of COPD exacerbations in patients with vitamin D levels below 25 nmol/L. [17]

Toxicity and Adverse Effect Management

Vitamin D is a fat-soluble vitamin, hence, toxicity is possible, although rarely noted. Hypervitaminosis D results from excess oral intake and not due to excessive sunlight exposure. Toxicity has been reported at a serum 25-hydroxyvitamin D level of more than 88 ng/mL. Acute intoxication can lead to acute hypercalcemia that can cause confusion, anorexia, vomiting, polyuria, polydipsia, and muscle weakness. Chronic intoxication can lead to nephrocalcinosis and bone pain.

Staging

The severity of vitamin D deficiency is divided into mild, moderate, and severe. [18]

Mild deficiency: 25-hydroxyvitamin D less than 20 ng/mL

Moderate deficiency: 25-hydroxyvitamin D less than 10 ng/mL

Severe deficiency: 25-hydroxyvitamin D less than 5 ng/mL

Enhancing Healthcare Team Outcomes

Vitamin D deficiency is often overlooked in outpatient and inpatient settings. According to the U.S. Preventive Services Task Force (USPSTF), universal screening for vitamin D levels is not recommended; however, it is important to note that screening for vitamin D deficiency in asymptomatic high-risk individuals is paramount in preventing future complications. High-risk populations include nursing home residents, elderly patients, women with osteoporosis, African American/Hispanic individuals, hospitalized patients, patients with chronic kidney disease, chronic liver disease, and patients with malabsorption syndromes.[9]

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References

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Elliott ME, Binkley NC, Carnes M, Zimmerman DR, Petersen K, Knapp K, Behlke JM, Ahmann N, Kieser MA. Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D. Pharmacotherapy. 2003 Jun;23(6):702-10. [PubMed: 12820811]

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Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, Josse RG, Lips P, Morales-Torres J, Yoshimura N. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int. 2010 Jul;21(7):1151-4. [PubMed: 20422154]

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Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, Chope G, Hyppönen E, Berry J, Vieth R, Lanham-New S. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr. 2012 Jun;95(6):1357-64. [PMC free article: PMC3349454] [PubMed: 22552031]

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Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM., Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. [PubMed: 21646368]

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Disclosure: Omeed Sizar declares no relevant financial relationships with ineligible companies.

Disclosure: Swapnil Khare declares no relevant financial relationships with ineligible companies.

Disclosure: Amandeep Goyal declares no relevant financial relationships with ineligible companies.

Disclosure: Amy Givler declares no relevant financial relationships with ineligible companies.

Why vitamin D deficiency is dangerous

2

24 April

Vitamin D deficiency in the body provokes the development of pneumonia twice as often as usual.

This conclusion was made by specialists from an institute in Eastern Finland. Scientists analyzed the medical records of 1,400 Finnish residents aged 53-73 who had pneumonia and found that most patients had very low levels of vitamin D at the time of illness.

In the period from 1998 to 2001, analyzes were taken from patients to measure the level of vitamin D. The researchers also studied materials on incidence for the same period of time. It turned out that people with a lack of vitamin D were 2.5 times more likely to get pneumonia.

Earlier studies suggest that a deficiency of this vitamin seriously weakens the body’s defenses and the immune system. In addition to pneumonia, people with vitamin D deficiency often suffer from seasonal colds.

Finnish researchers note that in the northernmost countries, vitamin D deficiency is common, since in the northern hemisphere cold weather is a daily reality, and the number of sunny days a year is minimal.

Vitamin can be obtained in a “natural” way only in the warm season, and in the remaining months, doctors strongly recommend taking multivitamin complexes that can maintain the required level of trace elements and vitamins in the body. Finnish doctors, for example, recommend that all residents of their country over 60 take at least 20 micrograms of vitamin D every day to maintain immunity.

According to wherewoman.ru

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

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Why vitamin D deficiency is dangerous and how to diagnose it

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Health

WHAT IS VITAMIN D DEFICIENCY DANGEROUS AND HOW TO DIAGNOSIS IT

“For most people, vitamin D is linked to the bones – it was given to children in the form of fish oil to prevent rickets, and TV commercials recommend it to the elderly to protect them from osteoporosis. It turns out that it is valuable, not only for this.

Vitamin D regulates the absorption of calcium and phosphorus minerals, their blood levels and their entry into bone tissue and teeth. Together with vitamin A and calcium or phosphorus, it protects the body from colds, diabetes, eye and skin diseases. It also helps prevent dental caries and gum disease, helps fight osteoporosis, and speeds up the healing of fractures.

Determination of vitamin D level is used for: diagnosis of disorders of calcium metabolism (with rickets, pregnancy, malnutrition and digestion, hyperparathyroidism, osteoporosis).

Vitamin D analysis is performed to diagnose hypo- and beriberi, as well as a number of chronic diseases associated with a lack of this substance in the body. The procedure belongs to general clinical trials.

Why is it important to test for vitamin D?

Vitamin D maintains the level of inorganic phosphorus in the blood, prevents muscle weakness, improves the body’s immunity, affects the cells of the intestines, kidneys and muscles, and is involved in the regulation of blood pressure and heart function.

Vitamin D is essential for the functioning of the thyroid gland and normal blood clotting.

Vitamin D affects the absorption of calcium and magnesium, kidney function, susceptibility to skin diseases and heart disease.

Vitamin D blocks the uncontrolled reproduction of body cells, which makes it effective in the prevention of oncological diseases (cancer of the breast, prostate, colon, pancreas, esophagus, ovaries, uterus, stomach and a number of other tumors).

Main symptoms of vitamin D deficiency/overdose

Vitamin D overdose causes the following symptoms:

• weakness
• loss of appetite
• nausea
• constipation
• diarrhea
• sharp pains in the joints
• headaches and muscle pains
• fever
• increased blood pressure
• convulsions
• slow pulse
• shortness of breath
• development of osteoporosis
• bone tissue demineralization
• deposition of calcium salts in organs, impeding their functions

Vitamin D deficiency symptoms

In the early stages, vitamin D deficiency manifests itself in the form of the following symptoms:

• loss of appetite
• insomnia
• burning in mouth and throat
• weight loss
• blurred vision

Further development of osteoporosis is observed.