Vitamin D deficiency is “the most common nutritional deficiency and the most common medical problem in the world,” states Michael Holick, MD, PhD, director of physiology and biophysics at Boston University School of Medicine.
This is not just an third world country issue either. Studies suggest up to 70% of the North American population is also Vitamin D deficient.
Vitamin D is not just a vitamin. Researchers have discovered that this incredibly important nutrient acts more like a hormone on our bodies and is literally critical to function on many levels.
Patients with Vitamin D deficiencies are often misdiagnosed with fibromyalgia because of the widespread symptoms of pain and impaired neuromuscular function. In fact, I would suggest that ANY patient with a chronic pain syndrome that is not localized to just one region, be tested for this deficiency.
Vitamin D can become deficient in the body for several reasons. Lack of sunlight, use of sunscreen, more melanin pigmented skin can create this deficiency and in the case of little outdoor time and use of sunscreens/sunblocks, Vitamin D supplementation may become more critical. Certain medications and supplements can also contribute to a Vitamin D deficiency. In particular be aware that if you need to take anti-seizure medicine, glucocorticoids, Rifampin, or St John’s Wort that you should automatically be supplementing with a good Vitamin D source. While most labs say the blood levels are normal if between 30 to 80 or 30 to 100 nanograms per mL, research currently suggests that 50 to 80 is the optimal range and levels over 150 are possibly toxic. As we everything, more is not always better so when starting on this fat soluble vitamin it is good to get a blood test on your dose at the 90 day mark to establish if you are in a healthy range. Those who are older, obese, or dark skinned may need a higher dose to reach and maintain a good blood level of this critical nutrient. Higher doses may be required in the winter months. Patients being aggressively supplemented with up to 5000 IU a day should also have their serum calcium and magnesium levels monitored.
There are certain illnesses that will contribute to Vitamin D deficiencies also. Any gastrointestinal malabsorption syndromes such as Crohn’s, Celiac and Whipple’s disease, Sprue, irritable bowel syndrome, and certain non gastrointestinal issues such as fatty liver, liver disease and cystic fibrosis are illness states that all require automatically testing for and adding (when necessary) a good Vitamin D supplement.
When we get in the sun our skin takes parts of light and converts it to pro-vitamin D. Pro-vitamin D is also obtained from diet and looks exactly the same as the sunlight source. Our body then converts the pro-vitamin D in the liver (this explains why liver issues will impair our ability to have good levels of Vitamin D) to D2. Large amounts of D2 will then circulate in the blood and the kidneys will convert it to D3 with the help of parathyroid hormone and blood calcium and phosphorus. Many patients are prescribed D2 which is not helpful symptomatically. D3 is what is needed for physiological function and the prescription D2 is very large dose and will tax the kidneys badly. In some it may cause kidney damage and it should NOT be prescribed to those with any form of kidney compromise. Over the counter forms of D3 are already in usable form and the kidney is not required to work overtime converting a less user friendly form of D2 to the usable D3.
Once in the blood serum as D3, this fat soluble vitamin acts as a secosteriod, which is similar in structure to a steriod except certain bonds are made differently. It is most likely this steroidal form enables Vitamin D to function as such an effect way of modulating inflammation and pain in the body.
Vitamin D has now been found to impact a wide variety of tissues and targets more than 2000 human genes or 1/6 of the human genome. virtually every cell in the body has a vitamin D receptor. The brain, prostate, breast and colon tissues and all cells of the immune system require Vitamin D3 to regulate them. It is recognized now that Vitamin D deficiency is a huge factor in determining risk for many cancers including breast, prostate, colorectal and pancreatic cancer. In addition, deficiency of D3 is associated with coronary artery disease, heart disease, high blood pressure, asthma, insulin production in metabolic syndrome, and Type 2 adult-onset diabetes. Even obesity may, in some researchers opinions, be linked to Vitamin D deficiency (of course we are not letting diet off the hook here.)
Here is a brief summary of issues related to Vitamin D deficiency.
1) Autoimmune disease. Vitamin D deficiency has been linked to a variety of autoimmune diseases including Type 1 diabetes, Crohn’s, multiple sclerosis, rheumatoid arthritis, Behcets disease, SLE, and Hashimoto’s disease.
2) Psychiatic problems. Chronic Vitamin D deficiency has been suggested to be involved in Alzheimers, Parkinson’s, dementia, autism, depression and schizophrenia (look to B vitamins with these too as their may be concurrent issues)
3)Common illnesses. Because Vitamin D receptors are on every type of cell involved with the immune system it is not surprising that the deficient in Vitamin D are being found to be more at risk for colds/flu. In addition other common illnesses such as periodontal disease, cardiomyopathy, osteopenia, osteoporosis, osteomalacia, muscle weakness are being associated with this deficiency.
4) Vitamin D is critical for maintaining normal calcium, phosphorus, magnesium levels and for bone metabolism and for assisting with calcium function with muscle contraction and relaxation states, so chronic Vitamin D deficiencies will impact both bone and soft tissues. Fibromyalgia, muscle soreness, muscle weakness, osteopenia, osteoporosis, rickets and even osteoarthritis are being identified as having a higher incidence in those with Vitamin D deficiencies.
5) Endocrine metabolism effects. Low levels of D3 can impact parathyroid hormone and the thyroid gland function resulting in abnormal depositions of calcium in soft tissues.
The Vitamin D council advocates taking 1000 IU of Vitamin D3 per 25 pounds of body fat per day. This dose is safe for all ages, including children. For pregnant or nursing women, up to 4000 IU’s a day is recommended.
Vitamin D is contra-indicated in those with Vitamin D hypersensitivity, and in those with sarcoidosis, oat cell carcinoma, non-Hodgkins lymphoma and primary hyperparathyroidism.
Dr Jenny Crosby
Getting patients well from St Peters and St Charles in St Charles County and outlying areas for 15 years with chiropractic, traditional Chinese medicine, acupuncture, nutrition, food allergy testing, rehabilitative care and more
