The most common vitamin deficiency worldwide, under-diagnosed, but easy to treat
Not getting enough vitamin D can cause serious health problems in adults and children.
There are many types of research that include Vitamin D. Only firmly established connection is between vitamin D and bone health. Some researchers are advising the following health problems are linked to Vitamin D deficiency:
- some cancers, including prostate cancer and breast cancer
- severe kidney damage
- autoimmune diseases (where your immune system attacks your own cells)
- type 2 diabetes
- heart disease
- high blood pressure
- infections, and
- weak bones and teeth.
Who is at risk?
For many people, consuming vitamin D-fortified foods and exposing themselves to some sunlight are essential for maintaining a healthy vitamin D status. However, some groups might need dietary supplements to meet their vitamin D requirements.
The following groups are among those most likely to have inadequate vitamin D status:
- Breastfed infants – as it is advised to keep infants younger than 6 months out of direct sunlight
- Older adults – because skin’s ability to synthesize vitamin D declines with age
- People with limited sun exposure
- People with dark skin – pigment melanin in the epidermal layer of the skin results in darker skin and reduce the skin’s ability to produce vitamin D from sunlight.
- People with conditions that limit fat absorption – Because vitamin D is fat-soluble, its absorption depends on the gut’s ability to absorb dietary fat. Fat malabsorption is associated with medical conditions that include some forms of liver disease, cystic fibrosis, celiac disease, Crohn’s disease, and ulcerative colitis.
- People who are obese – greater amounts of subcutaneous fat sequester more of the vitamin
- People who have undergone gastric bypass surgery – In this procedure, part of the upper small intestine, where vitamin D is absorbed, is bypassed.
Remember too much sun increase skin cancer risk – the little sun is good for you but doesn’t get burned!
Spending 30 minutes on direct sunlight from 10 am until 3 PM with 40% exposed skin (face, neck, arms without shoulders, lower legs) will provide you 2000 IU of Vitamin D
Vitamin D from food:
Most foods contain little or no vitamin D. And even foods that are rich in vitamin D, or ‘fortified’ with extra vitamin D, wouldn’t give enough of it from a normal diet.
Some food rich in Vitamin D:
- fatty fish, such such as trout, salmon, tuna, and mackerel and fish liver oils – one of the best sources
- calves’ liver
- cheese
- egg yolks.
What are the symptoms?
Mild vitamin D deficiency probably won’t cause any symptoms. But that doesn’t mean it’s not a problem. Having even a mild vitamin D deficiency means you are more likely to get one of the conditions listed above.
Serious deficiency might have more noticeable symptoms. In children, it is a condition called rickets. Rickets is more common in poorer countries and where there is a low level of education about nutrition. In children with rickets, the bones become weak and can bend under pressure. This can cause bow-leggedness and deformed bones in the forearms. These bone problems usually appear when the child is between 6 months and two years old.
Children with rickets or severe vitamin D deficiency might also:
- grow more slowly than healthy children
- have pain in their bones
- be irritable, probably because of the pain in their bones
- struggle or fail to do the physical things that healthy children of their age do, such as walking and running, moving easily, and using their hands for certain tasks
- have delayed tooth development and other dental problems
- have cramps, weakness, or numbness in their muscles
- have spasms or seizures.
Adults don’t usually have the bone deformities that can occur in children. But they might have other symptoms in their bones:
- bone pain
- pain in the hips, which can cause a ‘waddling’ gait when they walk
- tiredness and a general feeling of being unwell (this is called malaise).
The main health problems caused by vitamin D deficiency in adults are weak bones, which can lead to falls and fractures, and kidney damage.
How to diagnose?
Laboratory blood tests will show how much Vitamin D is available in your body. In some cases, the doctor might request for X-ray or bone densitometry to check the condition of your bones.
What treatments work?
Treating vitamin D deficiency is usually simple. Sensible sun exposure and vitamin D supplements are usually all that’s needed. In children, treating the deficiency will help bones to grow normally and become strong. In adults, the bones will become stronger and less painful.
The amount of vitamin D you need for good health depends on a variety of things, including:
- your age -older people might need more vitamin D
- how severe your deficiency is
- whether you are taking any medicines that can affect how your body absorbs vitamin D
- whether you have a medical condition that stops you from absorbing vitamin D properly. These include coeliac disease, cystic fibrosis, liver failure, and Crohn’s disease. If you have had bariatric (weight-loss) surgery you will also be less able to absorb vitamin D
- your body weight – people who are very overweight might need to take more vitamin D.
Some people who don’t absorb supplements well might need to use a sunbed or injections of Vitamin D. Too much sunbed use can cause sunburn and increase your chance of getting skin cancer. Your doctor will also recommend calcium supplements, as calcium is essential for strong bones.
Is it possible to have too much vitamin D?
Yes. You should not take more vitamin D than your doctor recommends. Taking too much vitamin D in the form of supplements can cause serious health problems, including heart and kidney problems.
What to expect?
Treatment of vitamin D deficiency has good results. Most bone problems in children get better after treatment, usually within 6 months. And the earlier they get treatment, the better the outlook. Adults also have great improvements in bone strength and other symptoms within a year or two.
People treated for a severe vitamin D deficiency will probably need to take vitamin D supplements for the rest of their lives.
Reference:
- https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#en70
- https://bestpractice.bmj.com/
- Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.
- Chalcraft JR, Cardinal LM, Wechsler PJ, Hollis BW, Gerow KG, Alexander BM, et al. Vitamin D synthesis following a single bout of sun exposure in older and younger men and women. Nutrients 2020; 12, 2237; doi:10.3390/nu12082237
- Pappa HM, Bern E, Kamin D, Grand RJ. Vitamin D status in gastrointestinal and liver disease. Curr Opin Gastroenterol 2008;24:176-83.
- Silva MC, Furlanetto TW. Intestinal absorption of vitamin D: A systematic review. Nutr Rev 2018;76:60-76.
- Photos are prom Pixabay – profiles: JillWellington, PublicDomainPictures, sasint, ID 632240, Monfocus and stux.
