Sunday, May 04, 2008

Are you deficient in Vitamin D? The odds are good and the risk is high... Read on!

Vitamin D, a fat soluble vitamin, is known to be malabsorbed in patients with celiac disease and gluten intolerance. Despite being one of the most crucial components of healthy bones, a protector against cancer and diabetes, and a valuable component of the immune system, vitamin D has gone largely unnoticed as an important deficiency in the American public.

Dr. Michael F. Holick is a vitamin D researcher at Boston University's Medical Center and the author of “The UV Advantage”. Dr Holick has done some of the recent seminal work in this area.

Vitamin D has a multitude of effects, the principal of which is the development and maintenance of bone health. In people who are vitamin D deficient, you will see a wide variety of bone disorders, such as osteoporosis, osteopenia and osteomalacia -the inability to mineralize bone, causing pain and weakness.

But while its effect on bones may be most commonly known, vitamin D also has many other very important functions. For example, it reduces the risk of diabetes and certain forms of cancer including ovary, breast, colon and prostate; it has been shown to improve hypertension; help psoriasis; and it drastically reduces the risk of heart disease. There are even some studies that link Alzheimer's disease, depression and multiple sclerosis to low vitamin D levels.

In terms of the immune system, vitamin D has extremely important, yet subtle effects. For example, studies have shown that people at higher latitudes have a higher rate of multiple sclerosis (MS) - possibly due to deficiency in vitamin D. In fact, several animal studies have shown that animals that can be induced with MS will not get MS if treated with vitamin D beforehand. Another study in Finland found that proper levels of vitamin D actually reduce the occurrence of Type 1 diabetes in children by about 80%.

Vitamin D is critically important for maintaining normal calcium levels in the blood and for bone health. Not only that, but research by Dr Holick has shown that if blood levels of vitamin D are good, it reduces the rate of colon cancer by about 50%. In short, vitamin D plays a crucial role in many metabolic functions as well as nerve, cardiac and muscle function.

In children, vitamin D is critically important. Without it, you'll have growth retardation, rickets and other skeletal deformities. In fact, rickets - once considered a disease from a hundred years ago is on the rise. Why? There is not enough vitamin D in breast milk. Children in particular need to get more vitamin D.
Sunlight is a crucial factor in maintaining proper levels of vitamin D. It's so important that our skin makes vitamin D when exposed to UVB radiation from the sun. Studies have shown that between 80% and 100% of the daily requirement for vitamin D comes simply from being in sunlight for about 15 minutes a day. One problem with that is that we are worried about sun exposure because of the risk of skin cancer. We stay indoors more often and wear sunscreen that doesn’t allow us to get the proper amount of sun to manufacture Vitamin D.

Few foods actually contain any appreciable level of vitamin D naturally. Certain fish, like mackerel and salmon have some, as do oils from fish like cod, shark and tuna. Meats and egg yolks also have some vitamin D in them, but very little. Of course fortified milk has vitamin D, but the amounts in every container are highly variable and insufficient to provide what the average person requires.

Research has shown that certain types of low pressure lamps used in tanning beds supply UVB radiation-which is exactly what you need to make vitamin D. But not all tanning salons use that particular type of lamp, so you would need to check.

While anyone who doesn't get enough exposure to sunlight or supplement their diet with Vitamin D is at risk, studies from the Center for Disease Control (CDC) have shown that African Americans suffer from vitamin D deficiencies the most. As many as 42% of all African Americans ages 15 to 45 have low levels of vitamin D. In fact, they need five to ten times more exposure to make the same amount as a Caucasian because the melanin in their skin acts as a sunscreen.

People who live at higher latitudes are also at high risk for being deficient. A study in Boston showed that 36% of young adults ages 18 to 29 had insufficient levels of vitamin D. The subjects were local medical school students and hospital residents whose work or studies limited their exposure to sunlight. The bottom line is that people - especially if they live in the north or spend most of their time indoors either need to find ways to get outside or replenish their levels of vitamin D with supplementation.

Other studies show that >30% of the general population is deficient, with >60-90% showing insufficient or suboptimal levels of Vitamin D. People with chronic conditions and inflammation frequently are Vitamin D deficient.

Symptoms associated with Vitamin D deficiency:
hypertension, heart disease
diabetes
arthritis
most cancers
malabsorption (as seen in Celiac and gluten intolerance)
migraines
Multiple Sclerosis
asthma, allergies
periodontal and gingival disease
obesity
osteoporosis, osteopenia
musculoskeletal pain, fibromyalgia
psoriasis
chronic wounds
seizure disorders
dementia, depression, and mental illness

Get a blood test to determine your Vitamin D levels. Look at the chart below to determine where you fall regarding deficiency.


Normal or Suboptimal Levels of 25 hydroxy vitamin D
<10 ml=" possibly">36 ng/ml = decreased incidence of heart disease
>40 ng/ml = decreased incidence of MS
40-50 ng/ml = probably sufficient levels
>50 ng/ml = sufficient or optimum levels
>50 ng/ml = decreased incidence of cancer
80-100 ng/ml = goal for most cancer patients
>125 ng/ml = potentially toxic

Supplements are an excellent source of vitamin D. However many people only take a multivitamin and if you're already low in vitamin D, your body needs more than the 400 IU it can get from a single multivitamin. While 400 IU may be fine for some people who are not deficient, those who are need more - about 1000 -2000 IU per day to satisfy their body's requirement for vitamin D.

When supplementing, use Vitamin D3 – D2 is only 60% absorbed. Also supplement with adequate Calcium and Magnesium which is important for gluten intolerant patients anyway as those minerals are frequently malabsorbed as well. Supplementation should continue for 5-9 months for maximal benefit. Evaluate levels every 2 – 3 months and get them into the optimal range.

Note: Patients who are potentially Vitamin D sensitive are those with certain conditions such as sarcoid lymphoma, TB, renal or liver failure. These patients could get toxic taking Vitamin D and shouldn’t without doctor supervision.

In extreme cases of vitamin D deficiency, some patients will need to get a prescription to take very high doses of 50,000 IU/week for eight weeks. Because if you are extremely deficient, taking 400 or even 1000 IU a day would be insufficient to handle the deficiency. You would need to “prime the pump” with a higher amount for a period of time to efficiently handle the severe deficiency.

It’s a simple blood test to find out and a very small vitamin tablet to take if necessary. I consider this a small price to pay to handle a deficiency that can create such widespread problems.

To your good health!
Dr Vikki Petersen




5 comments:

Anonymous said...

Good afternoon! I read your article on Vitamin D deficiency on the internet. I've taken the prescription of 50,000 units of Vitamin D for 6 months, and my levels are still undetectable. I know someone how successfully treated their Vitamin D deficiency with a Vitamin D shot. Is that readily available in the USA?

Please note: I'm absorbing all other vitamins, calcium, etc Glucose, etc is normal. Only problem is Vitamin D.

Thank you!

Anonymous said...

I am a 57 yo female with a vit D level of 23 after being treated for over 2 months with 50,000 IU weekly. I am exhausted, I had over 20 hours of spinal surgery in Nov. 2009 and have been suffering from fatigue since. My Vit. D level was first drawn in April 2010 and found to be severely deficient at 18. My physician then started treatment with p.o.Vit D as above. My last blood test that resulted in 23 was drawn the evening that I had taken my weekly dose of 50,000 IU that morning.

I have a long history of surgeries and now that I am aware that I have this deficiency, I think may have contributed to my problems over the years. I had avascular necrosis of my joints and no one could determine why, I was not an alcoholic so they thought it was caused from the steroids I had been given prior to my first disc replacement surgery at age 35. I had my first hip replaced at age 43. I have been taking some antidepressant for the past 14 years as I kept complaining of fatigue and my physician believed it was depression.

I just want to know why I cannot get the Vit. D levels to stay in the normal range, what else I may be able to ask my physician to do or to look at, or if there is a specialist in this area that I could see. I live in the St. Louis metro area.

Please help me, I am so tired and so tired of the surgeries, I have had 3 on my spine, and have more discs that are affected by osteoporosis. I have tried to maintain a healthy weight and do work out when I feel well enough, I have pushed myself now to exercise, with no difference in the way I feel. I have had 2 hip replacements, and 2 closed reductions and one open reduction. I have avascular necrosis in my knees, discovered after surgery.

I have psoriasis, worse in the winter months, now I think I know why. I have had CIN and VIN III, a total hysterectomy when I was 30 and 2 surgeries to remove the VIN at ages 53 and 55.

Anonymous said...

To the 57 year-old with the stubborn levels:

- Is your doctor testing the right type of vitamin D? 1,25-hydroxy-vitamin D is regulated through homeostatic mechanisms (the level is kept within a certain range whether or not you are deficient).

Assuming the right type is being tested:

- Your intake is too low. 50,000 IU per week corresponds to 7,000 IU a day, which, if you are seriously deficient, isn't going to be enough to fill the hole.

- You are taking ergocalciferol (D2). Though it remains a matter of debate, some specialists say that D2 is not absorbed as well as cholecalciferol (D3).

- You probably have a defect in your vitamin D metabolism, which means that what applies to most people may not apply to you. It may be that you need way, way more oral vitamin D to make a difference.

In most people -- that is, people who do not have a metabolic disorder like sarcoidosis -- high-dose vitamin D supplementation is very tolerable. Have a look at this trial:

http://www.ncbi.nlm.nih.gov/pubmed/20445149

Note: the researchers measured a mean peak 25-hydroxy-vitamin D level of 413 nmol/L, which is a value believe to predict toxicity. Despite this, they found no laboratory evidence of toxicity.

You need to find a doctor in your area who is knowledgable in the subject. Try the Grassroots Health website.

Good luck!

Anonymous said...

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