In recent years, vitamin D deficiency has emerged as one of the hottest topics in medicine. This important fat soluble vitamin was initially thought to only play a role in regulating bone health. However, recent studies have demonstrated that the impact of vitamin D on the human body is much more diverse. Research has now linked vitamin D deficiency to multiple chronic health conditions such as osteoporosis, depression, chronic pain and cancer. Sure there is a lot of hype but what exactly is the story behind vitamin D deficiency?
What is Vitamin D?
Vitamin D is an important fat soluble vitamin that can be obtained through the diet but can also be synthesized by the body. Vitamin D3 is present within the skin and when exposed to sunlight is modified and transported to the liver and kidneys where it is converted into its active form, vitamin 1,25-dihydroxyvitamin D.
As previously mentioned, vitamin D plays a role in multiple processes within the body such as:
Vitamin D and Healthy Bone Production
Vitamin D is involved in the complicated process that keeps bones healthy. Its job is to increase the absorption of calcium and phosphorus, which are the building blocks of bones. This substance also stimulates osteoclasts, which are bone cells that help breakdown old, weakened bone to make room for new, stronger bone cells. Simple Vitamin D supplementation can reduce your risk of bone fractures dramatically. For patients over age 65, taking the Recommended Daily Allowance of 400 IU can reduce your risk of fracture by 20%. In addition, all breastfed babies must have vitamin D supplementation to prevent rickets.
Vitamin D Deficiency and Depression
It is well-known that many people suffer from Seasonal Affective Disorder (SAD) and major depression that worsens in the winter time. It is theorized that lack of vitamin D triggers depression in these patients. Scientific research also suggests that vitamin D related depression extends to premenstrual syndrome (PMS). Patients who receive less daily sunlight, such as the elderly, are at a higher risk for depression. Data continues to emerge and supports the use of sunlight therapy and vitamin D supplementation in treating depressive disorders in many patients. If you suffer from depression, ask your doctor if vitamin D supplementation is right for you.
Vitamin D and Cancer
Exciting new research is suggesting that lack of vitamin D places patients at higher risk for certain types of cancers. In particular, studies have shown that vitamin D deficiency may increase the risk of colon, prostate and breast cancer.
Vitamin D and Diabetes
If you are concerned about developing diabetes, be sure to get your daily intake of vitamin D. New data indicates that patients who lack vitamin D tend to have higher fasting blood glucose levels and have abnormal results on other diabetic screening tests. No direct correlation between the two have been made and it is possible that this link was discovered because people who are at risk tend to be sedentary and have poor diets, both which would place them at risk for low vitamin D levels.
Vitamin D and Mortality
Recent data supports the use of vitamin D3 supplementation and has found that patients with adequate vitamin D3 intake have a lower mortality rate. It is unknown exactly how vitamin D improves mortality but it may be due to a lower incidence of cancer, healthier lifestyle that involves outdoor activity or a healthy diet.
Causes of Vitamin D Deficiency
Lack of vitamin D is much more common than was once thought. Causes of vitamin D deficiency include:
- Too light sunlight exposure: Without sunlight exposure the body cannot produce its own vitamin D. Institutionalized people are at a very high risk for development of vitamin D deficiency.
- Digestive problems: Patients with conditions that interfere with absorption will not be able to absorb enough vitamin D from diet and supplementation.
- Breast feeding without vitamin d supplementation: Breastfed babies over the age of two months should be given vitamin D supplementation. Children with vitamin D deficiency will develop rickets, a disorder in the production of bone that results in bowing of the legs.
- Medications: Certain medications are linked to vitamin D deficiency. Anti-seizure medications and Rifampin are known to contribute to this condition.
Who is at Risk for Vitamin D Deficiency?
Risk factors for low vitamin D levels include:
- Advanced Age: Approximately 3 out of 5 elderly people who live in nursing homes are vitamin D deficient due to a combination of lack of sun exposure and inability to produce sufficient quantities of vitamin D in the skin. Research has demonstrated that elderly adults synthesize vitamin D in smaller amounts and must rely on dietary intake to obtain proper levels of vitamin D.
- Location: People who live in climates with cooler winters are at risk for vitamin D deficiency. Studies have demonstrated that, in some locations of the Northeastern United States, up to two thirds of young adults are lacking vitamin D by the end of the winter season.
- Darker Skin Pigmentation: Patients with darker pigmentation do not produce as much vitamin D because pigments in the skin interfere with the production of this vitamin in the skin.
- Breastfed Babies: Breast milk lacks important vitamin D so all breastfed babies should be given a supplement of this important vitamin to promote good bone health and to prevent rickets. Rickets is a condition where low vitamin D levels result in the formation of weak bones causing a bowing of the legs.
Vitamin D Deficiency Symptoms in Women
Vitamin D deficiency can be a silent disorder with few or no symptoms. Women with vitamin D deficiency may experience the following symptoms:
- Osteoporosis/Osteopenia
- Chronic pain
- Muscle Ache
- Fatigue
- Depression
- Hair Loss
- Premenstrual Syndrome
- Hyperparathyroidism
How to Test For Vitamin D Deficiency
Your doctor can screen you for this condition using a simple blood test that detects that amount of vitamin D circulating in the blood. A 25(OH) vitamin D level that is lower than 32 ng/ml is diagnostic for vitamin D deficiency. At this time, it is not recommended that all people get screened for vitamin D deficiency. Testing should be reserved for those who are at risk for having low levels of this important fat soluble vitamin.
Vitamin D Deficiency Treatment
Vitamin D Supplementation
If you are diagnosed with vitamin D disorder, your doctor will likely recommend that you begin taking oral supplements. Depending on the severity of your condition the dose may range from 400IU to 2000IU per day. It is important that you do not begin taking extra vitamin D without consulting your doctor because it is possible to have too much of this vitamin. In addition, patients with chronic kidney disease may be at risk for complications from too much vitamin intake.
Sunlight Exposure
It is important to understand that being out in the sun will not cause vitamin D toxicity. It is not possible to overdose from vitamin D by exposure to the sunlight because excess vitamin D that is produced this way is broken down into other substances that are not harmful to the body. Remember that sunscreen blocks harmful UV rays that cause skin cancer but it also blocks the same UV rays that are responsible for creating vitamin D! This does not mean you should skip the sunscreen. Ask your doctor how to get vitamin D supplementation naturally using the sunlight.
Vitamin D Deficiency Diet
For those that cannot spend much time outdoors or cannot synthesize vitamin D in their skin, it is important to supplement with medications and foods. Foods that contain vitamin D include:
- Salmon
- Blue Fish
- Mackerel
- Fortified foods such as milk, orange juice and cereals
- Swiss cheese
- Raw shiitake mushrooms
The research is still emerging on this important vitamin but based on current information it seems that vitamin D has many more responsibilities than was originally thought. However, if vitamin D supplementation can help prevent serious health problems such as osteoporosis, cancer and depression it is well worth studying this important topic more closely.