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]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Nair R, Maseeh A. Vitamin D: The “sunshine” vitamin. J Pharmacol Pharmacother. 2012 Apr;3(2):118-26. [PMC free article: PMC3356951] [PubMed: 22629085]

2.

Holick MF. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J. 2005 Oct;98(10):1024-7. [PubMed: 16295817]

3.

Czernichow S, Fan T, Nocea G, Sen SS. Calcium and vitamin D intake by postmenopausal women with osteoporosis in France. Curr Med Res Opin. 2010 Jul;26(7):1667-74. [PubMed: 20446889]

4.

Naeem Z. Vitamin d deficiency- an ignored epidemic. Int J Health Sci (Qassim). 2010 Jan;4(1):V-VI. [PMC free article: PMC3068797] [PubMed: 21475519]

5.

Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM, Prince RL, Finkelstein JS. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998 Mar 19;338(12):777-83. [PubMed: 9504937]

6.

Gröber U, Kisters K. Influence of drugs on vitamin D and calcium metabolism. Dermatoendocrinol. 2012 Apr 01;4(2):158-66. [PMC free article: PMC3427195] [PubMed: 22928072]

7.

Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev. 2015 Apr;16(4):341-9. [PubMed: 25688659]

8.

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]

9.

Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: when to test and how to treat. Mayo Clin Proc. 2010 Aug;85(8):752-7; quiz 757-8. [PMC free article: PMC2912737] [PubMed: 20675513]

10.

Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014 Oct;144 Pt A:138-45. [PMC free article: PMC4018438] [PubMed: 24239505]

11.

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]

12.

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]

13.

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]

14.

Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med. 2007 Sep 10;167(16):1730-7. [PubMed: 17846391]

15.

Bolland MJ, Grey A, Gamble GD, Reid IR. Calcium and vitamin D supplements and health outcomes: a reanalysis of the Women’s Health Initiative (WHI) limited-access data set. Am J Clin Nutr. 2011 Oct;94(4):1144-9. [PMC free article: PMC3173029] [PubMed: 21880848]

16.

Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91. [PubMed: 17556697]

17.

Jolliffe DA, Greenberg L, Hooper RL, Mathyssen C, Rafiq R, de Jongh RT, Camargo CA, Griffiths CJ, Janssens W, Martineau AR. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials. Thorax. 2019 Apr;74(4):337-345. [PubMed: 30630893]

18.

Gani LU, How CH. PILL Series. Vitamin D deficiency. Singapore Med J. 2015 Aug;56(8):433-6; quiz 437. [PMC free article: PMC4545131] [PubMed: 26311908]

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.