by Dr. Leah Holland
Are You Vitamin D Deficient?
Despite living in the sunny south, you may actually be Vitamin D deficient. Research finds that the majority of those living above the 35th parallel are deficient in Vitamin D(1). This means if you are living in most of North Carolina, any part of Tennessee, Virginia, Kentucky or even further north, you are at risk for having a Vitamin D deficiency. Additionally, it has been found that 52% of post-menopausal women are Vitamin D deficient(2). With increasing age, our skin becomes thinner, and it not able to utilize Vitamin D from the sun as it did when we were younger. The American Academy of Pediatrics has also found that 7% of children are Vitamin D deficient. This is not surprising based upon poor food choices and the amount of hours spent in front of the television watching or playing video games. Vitamin D levels have also been found to be much lower in patients that are uninsured(3). So whether you are younger or older, it is possible that you aren’t just feeling down. You may in fact be Vitamin D deficient.
Why is Vitamin D So Important?
Vitamin D is a fat-soluble vitamin and is stored within our bodies during times of little light or inadequate dietary Vitamin D(4). Our bodies cannot produce Vitamin D, therefore it must come from the sun, from our food, or through supplementation. Vitamin D works similar to a hormone, therefore it has a potent affect on our mood, metabolism, and endocrine system.
Vitamin D is stored in the liver, bone, brain, and skin. It assists with muscle contractions, and therefore it affects physical performance. It also specifically helps with mineralization of bone and has been used therapeutically to prevent rickets, osteoporosis, and fractures. Clinically, it has also been found to assist with psoriasis, polycystic ovarian syndrome, viral infections, multiple sclerosis, tuberculosis, autoimmune diseases, and fibromyalgia(5). Vitamin D protects against cancer because it encourages cell differentiation and works with the immune system to regulate T and B cells (inherited and acquired immunity)(5,6).
Vitamin D deficiencies are correlated not only with cancer but also heart disease, type 1 and II diabetes, recurrent respiratory infections, obesity, stroke, dementia including Alzheimer’s disease, low or high blood pressure (hypotension/hypertension), and abnormal insulin production (insulin resistance) (5-13). Thus Vitamin D supplementations have been gaining vast popularity among physicians and researchers due to its importance in addressing various health-related conditions.
What are symptoms of Vitamin D Deficiency?
There are many signs and symptoms of Vitamin D deficiency. They can include fatigue, muscle pain, depression, bone pain, restless leg syndrome, weakness, poor memory, brain fog, mood fluctuations, ovarian cysts, recurrent infections, abnormal blood pressure, or blood sugar imbalances.
How Do I Find Out If I Am Deficient?
The best option to find out if you are Vitamin D deficient or insufficient is to speak with your primary care physician, ob/gyn, or nurse practitioner. He or she will run a blood test known as 25(OH)D. It is important to have your vitamin D level checked prior to supplementation. If supplementation is recommended, the dose and frequency will be based on your age and current medical condition. In general, most labs have identified 50-75ng/ml as optimal, >30ng/ml as adequate, 20-29ng/ml as insufficient, and <20 is deficiency. However, recent research is now showing that 75-110ng/ml is the most optimal level for Vitamin D without increasing health risks(14). Each patient’s physical condition, vitamin levels, and history are unique. Your health care practitioner will give you the best recommendation for supplementation if your levels are not optimal.
What To Do If You Are Deficient
There are three ways to improve your Vitamin D levels. Once Vitamin D levels return to normal, it is important to do follow-up maintenance throughout the fall and winter and also avoid toxic doses. Again, follow-up care with your physician is vital.
Get outside daily for 15-20 minutes without sun block. Vitamin D toxicity does not occur from the sun; however, sunburn is not the goal and in fact causes skin damage that can lead to skin cancer.
Publisher’s Note: Like most things in life, it is about moderation. So research the dangers of tanning beds before choosing that route.
Eat a diverse diet that includes Vitamin D foods such as shrimp, halibut, shiitake mushrooms, fortified cereals, some rice or soy milks, lamb, eggs, beef, butter, and sardines.
If prescribed, be sure to follow your physician/practitioner’s Vitamin D supplementation recommendations. D3 is the active form of Vitamin D, whereas Vitamin D2 will need to be converted within the body. Also consider cod liver oil (1TB =1200IU). If you use fish oils, be sure to choose a reputable company that test their fish for environmental contaminates such as heavy metals and PCBs.
Vitamin D Toxicity
Toxicity can occur at high doses of supplementation. Signs and symptoms include increased calcium levels, elevated Vitamin D levels, poor appetite, nausea, vomiting, or kidney or liver damage. Toxicity does not occur from sunlight or artificial light. It is best to consult a physician to decrease your chances of toxicity and to determine appropriate dosing for you, your family, and friends.
Remember, nothing is gained if you hurt yourself while trying to improve your heath. Always talk to your doctor before self-medicating.
REFERENCES:
1. Moore, Murray & Holick. Vitamin D intakes by children and adults in the United States differ among ethnic groups. Journal of Nutrition 135:2478-2485, October 2005.
2. Holick, M. Vitamin D Deficiency, NEJM 2007;357:266-281.
3. Radhika R. Kakarala, Sreenivasa R. Chandana, Susan S. Harris, Lakshmi P. Kocharla, and Elena Dvorin. Prevalence of Vitamin D Deficiency in Uninsured Women. J Gen Intern Med. 2007 August; 22(8): 1180 1183.
4. Marz, R. Medical Nutrition, 2nd Edition. OmniPress, Portland, OR, 1999.
5. Mittelstaedt, M. Vitamin D casts cancer prevention in new light. GlobeLife Health, April 28, 2007.
6. Fleet, James. Mol Aspects Med. Molecular Actions of Vitamin D Contributing to Cancer Prevention. 2008 December; 29(6):388-396.
7. Wehr E, Pilz S, Schweighofer N, Giuliani A, Kopera D, Pieber TR, Obermayer-Pietsch B.Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome.
Eur J Endocrinol. 2009 Oct;161(4):575-82. Epub 2009 Jul 23.
8. Pittas, Lau, Hu, Dawson-Hughes. The Role of Vitamin D and Calcium in type 2 diabetes. A systematic Review and Meta-Analysis. J Clin Endocrinol Metab. 2007 June; 92(6): 20172029.
9. Buell JS, Dawson-Hughes B, Scott TM, Weiner DE, Dallal GE, Qui WQ, Bergethon P, Rosenberg IH, Folstein MF, Patz S, Bhadelia RA, Tucker KL.25-Hydroxyvitamin D, dementia, and cerebrovascular pathology in elders receiving home services.Neurology. 2009 Nov 25.
10. Mowry DA, Costello MM, Heelan KA.Association among cardiorespiratory fitness, body fat, and bone marker measurements in healthy young females. J Am Osteopath Assoc. 2009 Oct;109(10):534-9.
11. Cheng S, Massaro JM, Fox CS, Larson MG, Keyes MJ, McCabe EL, Robins SJ, O’Donnell CJ, Hoffmann U, Jacques PF, Booth SL, Vasan RS, Wolf M, Wang TJ .Adiposity, Cardiometabolic Risk, and Vitamin D Status: the Framingham Heart Study.
Diabetes. 2009 Oct 15.
12. Pilz S, Tomaschitz A, Ritz E, Pieber TR;Vitamin D status and arterial hypertension: a systematic review. Nat Rev Cardiol. 2009 Oct;6(10):621-30. Epub 2009 Aug 18.
13. Giulietti, et al. Vitamin D deficiency in early life accelerates type 1 diabetes in non-obese diabetic mice. Diabetolgia;47:3, March 2004.
14.Bischoff-Ferrari HA,Shao A,Dawson-Hughes B,Hathcock J,Giovannucci E,Willett WC. Benefit-risk assessment of vitamin D supplementation. Osteoporos Int. 2009 Dec 3. [Epub ahead of print].