The Vitamin D Deficiency Hidden Epidemic?
YOU MAY HAVE UNDIAGNOSED VITAMIN D DEFICIENCY! Keep reading…
Introduction
- Years and years of reading and researching about chronic fatigue issues led me to believe that there are many, many people who may have undiagnosed Vitamin D deficiency. Indeed vitamin D deficiency is more common than what most conventional physicians think. In more than 90% of my patients, it is I, their psychiatrist, and not their primary care physicians that discover their Vitamin D Deficiency. To think that Vitamin D can save lives or prevent so many illnesses that are not just depressing for those who are ill and their loved ones. The treatments are also very costly and not without complications. In fact, we keep hearing that hospital or medication related deaths are rising at such an alarming rate.
- Indeed, since I started checking for blood levels of Vitamin D on my patients whose clinical presentation is suspicious for Vitamin D deficiency, I have consistently seen abnormal results (indicating insufficiency or deficiency) in majority of them in the order of 80-90%.
- To my pleasant surprise my established patients with refractory depression and anxiety experienced remarkable recovery when I added Vitamin D to their treatment; and my new patients since I started doing this seem to recover faster and to a greater degree, which I have attributed to correcting the nutritional insufficiency/ies or deficiency/ies that I found (like Vitamin B12 and/or Vitamin D as confirmed by blood tests) in addition to prescribing antidepressant treatment.
- I also explore with my patients whatever may be the underlying reason/s for their malnutrition (malbasorption, etc?) and proceed to address them as well.
I concur with world-renowned Integrative Physician, Dr. Julian Whitaker of Newport Beach, CA when he made reference to Vitamin D as a “super nutrient”. Keep reading.
The following are excerpts from The NIH Vitamin D Facts Sheet (see link at the end)
My comments are in Italics
Vitamin D Is Not Just For the Bones
Clinical studies have shown the protective function ‘Vitamin D in the prevention of infectious and inflammatory conditions as well as some forms of cancer. Read more…
Food
Very few foods in nature contain vitamin D.Fortified foods provide most of the vitamin D in the American diet. Almost all of the U.S. milk supply is fortified with 100 IU/cup of vitamin D.Other dairy products made from milk, such as cheese and ice cream, are generally not fortified.
The Sun Connection
Complete cloud cover reduces UV energy by 50%; shade (including that produced by severe pollution) reduces it by 60% . The UV energy, at the northern latitude, approximately between the northern border of California and Boston is insufficient for cutaneous vitamin D synthesis from November through February. In far northern latitudes, this reduced intensity lasts for up to 6 months. Latitudes below 34 degrees north (a line between Los Angeles and Columbia, South Carolina) allow for cutaneous (skin) production of vitamin D throughout the year.UVB radiation does not penetrate glass, so exposure to sunshine indoors through a window does not produce vitamin D . Sunscreens with a sun protection factor of 8 or more appear to block vitamin D-producing UV rays.Despite the importance of the sun to vitamin D synthesis, it is prudent to limit exposure of skin to sunlight because of its carcinogenic effect. Read more…
MAKE SURE YOUR DOCTOR ORDERED THE RIGHT BLOOD TEST TO MEASURE VITAMIN D LEVEL
- Serum concentration of 25- Hydroxy Vitamin D or 25(OH)D is the best indicator of vitamin D status.
Reluctantly, my primary care physician agreed to check my Vitamin D level. She said that she saw no reason do it in my case. When I looked at the order slip, the wrong Vitamin D level was ordered, which I asked to be corrected. I hope this doctor would not give the next patients a hard time when they ask because as it turned out I had undetected Vitamin D deficiency, for which I am now taking potent Vitamin D supplement. In order to catch up, I take more than the recommended daily allowance or RDA.
Groups At Risk For Vitamin D Deficiency
- Breastfed Infants- need to be supplemented. See attached article by Dr. Julian Whittaker about increased risk of developing Type I Diabetes due to Vitamin D Deficiency in infancy.
- Older adults-Americans aged 50 and older are at increased risk of developing vitamin D insufficiency. As people age, skin cannot synthesize vitamin D as efficiently and the kidney is less able to convert vitamin D to its active hormone form . As many as half of older adults in the United States with hip fractures could have serum 25(OH)D levels <12 ng/mL
- People with limited sun exposure -living in northern latitudes.
- People with fat malabsorption- As a fat-soluble vitamin, vitamin D requires some dietary fat in the gut for absorption.Fat malabsorption is associated with a variety of medical conditions;pancreatic enzyme deficiency, Crohn’s disease, cystic fibrosis, celiac disease, liver disease.
That said, people with IBS or “leaky gut” do not just just have fat malabsorption. They have malabsorption of everything. Consequently, expect them to have multiple deficiencies including Vitamin D and B12 as I have observed in my clinical practice. Incidentally, the milk may be fortified alright and the cereals, too but without enough fat, how can Vitamin D be absorbed?
- People who are obese- greater amounts of subcutaneous fat sequester more of the vitamin and alter its release into the circulation.
The 2000-2004 NHANES(National Health and Nutrition Examination Survey) provided the most recent data on the vitamin D nutritional status of the U.S.
Depending on the population group,
- 1-9% had serum 25(OH)D levels <11 ng/mL ,
- 8-36% had levels <20 ng/mL, and
- the majority (50-78%) had levels <30 ng/mL-
To think that MOST primary care docs DO NOT routinely check Vitamin D levels. Even after various docs like Dr. Oz have been calling the attention of the public about this. In January 2009 alone, he was at a morning talk show, at Oprah’s show and Larry King Live on the same week asking people to have their Vitamin D levels checked.
Quest Diagnostics defines <30 as “insufficient and <20 “deficient. Most integrative or holistic health professionals consider 40-70 as the level that is compatible with optimal health, as Dr. Whittaker would consistently note in his monthly newsletter. In n my practice I tend to see Vitamin D levels of < 30ng/ml in majority of my patients.
Among adults in the United Kingdom, nationally representative data collected between 1992 and 2001 show that
- 5-20% in most age groups on average had serum 25(OH)D levels <10 ng/ml;
- the prevalence of deficiency was greater (range 20-40%) for older people >65 years of age in residential care homes and among women >85 years.
- Among all adults, 20-60% had levels ≤20 ng/ml and
- 90% had levels ≤32 ng/ml. (Even worse!). Read more…
Possible causes:
- lntake is lower than recommended
- Exposure to sunlight is limited
- Kidneys cannot convert vitamin D to its active form,
- Absorption of vitamin D from the digestive tract is inadequate.
- Vitamin D-deficient diets are associated with milk allergy, lactose intolerance, and.strict vegetarianism
Symptoms:
- Classical: In children - Rickets ( soft bones and skeletal deformities); in adults- Osteomalacia
In adults, vitamin D deficiency can lead to osteomalacia, resulting in weak muscles and bones . Symptoms of bone pain and muscle weakness can indicate inadequate vitamin D levels, but such symptoms can be subtle and go undetected in the initial stages.
According to world renowned Integrative Physician, Dr Julian Whittaker and Chronic Fatigue and Fibrromyalgia expert Dr. Teitelbaum, Osteomalacia may sometimes be mistaken for Fibromyalgia pains which may or may not be co-existing with Osteomalacia. If both are present, both conditions MUST be treated for fully effective pain management. Dr Whittaher also opines that unnecessary back surgeries may have been prevented if Vitamin D Deficiency was identified and treated beforehand.Is it just me, or are we really seeing alarming rate of injuries among our young people; some get even when or while not engaged in contact sports.ARE WE RAISING KIDS NOWADAYS WITH WEAKER MUSCLES AND BONES?
Read more…
Vitamin D and Health
Efforts are underway to standardize the quantification of 25(OH)D to measure vitamin D status. No wonder I noticed that the normal values differ from lab to lab.
In March 2007, a group of vitamin D and nutrition researchers published a controversial and provocative editorial contending that the desirable concentration of 25(OH)D is ≥30 ng/mL . They noted that supplemental intakes of 400 IU/day of vitamin D increase 25(OH)D concentrations by only 2.8-4.8 ng/mL and that daily intakes of approximately 1,700 IU are needed to raise these concentrations from 20 to 32 ng/mL.
Two years ago I started checking Vitamin D levels on my patients, especially if they have treatment refractory depression or anxiety associated with chronic gut issues, allergies or food sensitivities and sinus issues. in 8 to 9 out of 10 the levels are <30 and more than half of them have levels <20ng/ml.
More than 25 million adults in the United States have or are at risk of developing osteoporosis, a disease characterized by fragile bones that significantly increases the risk of bone fractures. Osteoporosis is most often associated with inadequate calcium intakes (generally <1,000-1,200 mg/day), but insufficient vitamin D contributes to osteoporosis by reducing calcium absorption.Although rickets and osteomalacia are extreme examples of the effects of vitamin D deficiency, osteoporosis is an example of a long-term effect of calcium and vitamin D insufficiency.The authors of a recent evidence-based review of research concluded that supplements of both vitamin D3 (at 700-800 IU/day) and calcium (500-1,200 mg/day) decreased the risk of falls, fractures, and bone loss in elderly individuals aged 62-85 years. Read more…
Vitamin D emerged as a protective factor in some clinical studies:
- 3,121 adults aged ≥50 years (96% men) who underwent a colonoscopy:Those with the highest vitamin D intakes (>645 IU/day) had a significantly lower risk of these lesions-
- 1,179 postmenopausal women residing in rural Nebraska found that subjects supplemented daily with calcium (1,400-1,500 mg) and vitamin D3 (1,100 IU) had a significantly lower incidence of cancer over 4 years compared to women taking a placebo.
- 16,618 participants in NHANES survey:colorectal cancer mortality was inversely related to serum 25(OH)D concentrations; levels >80 nmol/L were associated with a 72% risk reduction than those <50 nmol/L.. As I said my patients invariably have much lower than 50nmol/L Read more..
A growing body of research suggests that vitamin D might play some role in the prevention and treatment of type 1 and type 2 diabetes hypertension, glucose intolerance , multiple sclerosis , and other medical conditions.
NIH warned that these claims were based only on in vito studies, but go to the link to read the BBC News articles that cited clinical studies to support the above.In case you are interested, you will find the link to those articles at the end of this letter.(BBC Articles: Vitamin D as Protection and/or Treatment Against SeriousIllnesses like cancer, diabetes, chronic lung problems, etc).
NIH did note that Vitamin D supplementation lowered overall mortality rate for any reason
“A recent meta-analysis found that use of vitamin D supplements was associated with a reduction in overall mortality from any cause by a statistically significant 7% . The subjects in these trials were primarily healthy, middle aged or elderly, and at high risk of fractures; they took 300-2,000 IU/day of vitamin D supplements”. Read more…
Health Risks from Excessive Vitamin D
A serum 25(OH)D concentration consistently >200 ng/mL is considered to be potentially toxic . In an animal model, concentrations ≤400 ng/mL were not associated with harm .
Vitamin D toxicity can cause nonspecific symptoms such as nausea, vomiting, poor appetite, constipation, weakness, and weight loss.More seriously, it can also raise blood levels of calcium, causing mental status changes such as confusion and heart rhythm abnormalities. That is why I tell my patients that blood levels need to be taken before starting supplementation at higher dose and need to be monitored.
Calcium/Vitamin supplementation was associated with a 17% increase in the risk of kidney stones over 7 years in the Women’s Health Initiative. Maybe they took the calcium carbonate kind, from LIMESTONE!!! I take Coral Calcium, myself which Integrative docs and practitoners like myself highly recommend.This particular product that I use has the proper ratio of Calcium, Magnesium and Vitamin D for good absorption and optimal benefits.
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- Steroids- can just exacerbate the effect of Calcium and Vitamin D deficiencies leading to more bone loss.
- Both the weight-loss drug orlistat (brand names Xenical® and alliTM) and
- the cholesterol-lowering drug cholestyramine (brand names Questran®, LoCholest®, and Prevalite®) can reduce the absorption of vitamin D and other fat-soluble vitamins
- Both phenobarbital and phenytoin (brand name Dilantin®), used to prevent and control epileptic seizures, increase the hepatic metabolism of vitamin D to inactive compounds and reduce calcium absorption .
Vitamin D A Super Nutrient??? Dr. Julian Whittaker Thinks So…Click here to read more
Source of the article Office of Dietary Supplements, National Institute of Health
http://ods.od.nih.gov/factsheets/vitamind.aspVitamin D and Healthful Diets
According to the 2005 Dietary Guidelines for Americans, “nutrient needs should be met primarily through consuming foods. Foods provide an array of nutrients and other compounds that may have beneficial effects on health. In certain cases, fortified foods and dietary supplements may be useful sources of one or more nutrients that otherwise might be consumed in less than recommended amounts. However, dietary supplements, while recommended in some cases, cannot replace a healthful diet.”
The Dietary Guidelines for Americans describes a healthy diet as one that
- Emphasizes a variety of fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.
Milk is fortified with vitamin D, as are many ready-to-eat cereals and a few brands of yogurt and orange juice. Cheese naturally contains small amounts of vitamin D.
- Includes lean meats, poultry, fish, beans, eggs, and nuts.
Fish such as salmon, tuna, and mackerel are very good sources of vitamin D. Small amounts of vitamin D are also found in beef liver and egg yolks.
- Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
Vitamin D is added to some margarines.
- Stays within your daily calorie needs.
Source: Office of Dietary Supplements
http://ods.od.nih.gov/factsheets/vitamind.asp
National Institutes of Health
Bethesda, Maryland 20892 USA
Web: http://ods.od.nih.gov
E-mail: ods@nih.gov
Click here to read the full article. Below are the links to the the topics found in in the article
Click on the link below to read any particular topic of interest
Vitamin D is Not Just For the Bones
Groups At Risk For Vitamin D Deficiency
- Vitamin D Deficiency and Osteoporosis (low Calcium is just one part of the problem)
- Vitamin D and Cancer
- Vitamin D Deficiency And Other Conditions
Health Risks from Excessive Vitamin D
Vitamin D A Super Nutrient???Dr. Julian Whittaker Thinks So
Click here to view the Vitamin D3 (Cholecaliferol) products featured here.
Related Topics:
- “Alkalize or Die”