Vitamin D Deficiency
Vitamin D Deficiency
The other day I was examining a young patient for knock knees, a thought occurred to me that a surprisingly vitamin D deficiency has been affecting our society for many years. Awareness has been spreading among common people about nutritional deficiencies. Vitamins are essential for healthy living. Vitamin D deficiency is a common vitamin deficiency that causes issues with bones and muscles. It most commonly affects people over the age of 65 and people who have darker skin. It’s preventable and treatable.
How common is vitamin D deficiency?
Vitamin D deficiency is a common global issue. About 1 billion people worldwide have vitamin D deficiency, while 50% of the population has vitamin D insufficiency.
Vitamin D is an essential vitamin that body uses for normal bone development and maintenance. Vitamin D also plays a role in nervous system, musculoskeletal system and immune system.
Why is vitamin D so important?
Vitamin D is one of many vitamins body needs to stay healthy. It plays a crucial role in maintaining the balance of calcium in blood and bones and in building and maintaining bones.
With chronic and/or severe vitamin D deficiency, a decline in calcium and phosphorus absorption by intestines leads to hypocalcemia (low calcium levels in blood). This leads to secondary hyperparathyroidism (overactive parathyroid glands attempting to keep blood calcium levels normal).
Both hypocalcemia and hyperparathyroidism, if severe, can cause symptoms, including muscle weakness and cramps, fatigue and depression.
To try to balance calcium levels in blood (via secondary hyperparathyroidism), body takes calcium from bones, which leads to accelerated bone demineralization (when a bone breaks down faster than it can reform).This can further result in osteomalacia (soft bones) in adults and rickets in children.
Osteomalacia and osteoporosis put body at an increased risk for bone fractures. Rickets is the same as osteomalacia, but it only affects children. Since a child’s bones are still growing, demineralization causes bowed or bent bones.
What are the signs and symptoms of vitamin D deficiency?
Severe lack of vitamin D in children causes rickets.
Symptoms of rickets include:
Incorrect growth patterns due to bowed or bent bones,muscle weakness,bone pain,deformities in joints.This is very rare. Children with a mild vitamin deficiency may just have weak, sore and/or painful muscles.Lack of vitamin D isn’t quite as obvious in adults.
Signs and symptoms might include:
Fatigue,bone pain,muscle weakness, muscle aches or muscle cramps,mood changes, like depression.
However, may have no signs or symptoms of vitamin D deficiency.
What causes vitamin D deficiency?
In general, the two main causes of vitamin D deficiency are:
A.Not getting enough vitamin D in diet and/or through sunlight.
B. Body isn’t properly absorbing or using vitamin D.
There are several specific causes of vitamin D deficiency, including:
Certain medical conditions,Weight loss-surgeries,Certain medications
Several different biological and environmental factors such as older age and the amount of melanin (pigment) in skin.
Medical conditions that can cause vitamin D deficiency include:
Cystic fibrosis, Crohn’s disease and celiac disease: These conditions can prevent intestines from adequately absorbing enough vitamin D through supplements, especially if the condition is untreated.
Obesity: A body mass index greater than 30 is associated with lower vitamin D levels. Fat cells keep vitamin D isolated so that it’s not released. Obesity often requires taking larger doses of vitamin D supplements to reach and maintain normal levels.
Kidney disease and liver disease: These conditions reduce the amount of certain enzymes (hepatic enzyme 25–hydroxylase from liver and 1-alpha-hydroxylase from kidneys) body needs to change vitamin D to a form it can use. A lack of either of these enzymes leads to an inadequate level of active vitamin D in body.
Weight-loss surgeries that reduce the size of stomach and/or bypass part of small intestines, such as gastric bypass surgery, make it difficult for your body to absorb sufficient quantities of certain nutrients, vitamins and minerals.
Certain medications can lower vitamin D levels, including:
Laxatives, Steroids (such as prednisone), Cholesterol-lowering drugs (such as cholestyramine and colestipol), Seizure-preventing drugs (such as phenobarbital and phenytoin), Rifampin (a tuberculosis drug), Orlistat (a weight-loss drug)
DIAGNOSIS AND TESTS
How is vitamin D deficiency diagnosed?
Levels can be checked if patients have certain medical conditions or risk factors for vitamin D deficiency and/or have symptoms of it.
Blood test is done to measure levels of vitamin D. There are two types of tests, but the most common is the 25-hydroxyvitamin D, known as 25(OH)D.
MANAGEMENT AND TREATMENT
How is vitamin D deficiency treated?
The goals of treatment and prevention for vitamin D deficiency are the same: to reach and then maintain an adequate vitamin D level in body. While eating more foods containing vitamin D and getting more sunlight, recommend taking vitamin D supplements.
Vitamin D comes in two forms: D2 and D3. D2 (ergocalciferol) comes from plants. D3 (cholecalciferol) comes from animals. You need a prescription to get D2. D3, however, is available over the counter. body more easily absorbs D3 than D2. need a vitamin supplement and how much to take, if needed.
PREVENTION
Who is most at risk for vitamin D deficiency?
Biological and environmental factors that put someone at an increased risk of vitamin D deficiency include:
Age: skin’s ability to make vitamin D decreases with age, so people over the age of 65 years are especially at risk for vitamin D deficiency. Infants are also at risk of not receiving enough vitamin D. This is especially true for infants who are only fed breast milk, as it contains only a small amount of vitamin D.
Skin color: It’s more difficult for dark-colored skin to make vitamin D from sunlight than light-colored skin, so people with darker skin are at a higher risk for vitamin D deficiency.
Mobility: People who are homebound or rarely go outside (for example, people in nursing homes and other facilities) aren’t able to use sun exposure as a source of vitamin D. Thus, they’re at a higher risk for vitamin D deficiency.
How to prevent vitamin D deficiency?
The best way to prevent vitamin D deficiency is to ensure body is getting enough vitamin D in diet and/or through sun exposure. But be careful about being in the sun for too long without sunscreen. Excessive sun exposure puts body at an increased risk for skin cancer.
The amount of vitamin D you need each day depends on your age. The average daily recommended amounts are listed below in micrograms (mcg) and International Units (IU).
Age / Life Stage Recommended Amount
Infants up to 12 months old 10 mcg (400 IU)
People 1 to 70 years old 15 mcg (600 IU)
Adults 71 years and older 20 mcg (800 IU)
Pregnant and breastfeeding people 15 mcg (600 IU)
There are a few foods that naturally have some vitamin D like fatty fish such as salmon, tuna and mackerel and sardines, rainbow trout, mushrooms, Egg yolks, Cod liver oil. Vitamin D can be found from fortified foods. Foods that often have added vitamin D include: Cow’s milk and soy, almond and oat milk, breakfast cereals, orange juice, other dairy products, such as yogurt
Vitamin D is in many multivitamins. There are also vitamin D supplements.
What are the possible complications of vitamin D deficiency?
The most serious complications of vitamin D deficiency include:
Low blood calcium levels (hypocalcemia)
Low blood phosphate levels (hypophosphatemia)
Rickets (softening of bones during childhood)
Osteomalacia (softening of bones in adults)
All of these conditions are treatable. While rickets is a treatable and often curable disease, treating it as soon as possible is important. When not treated, milder cases of rickets can result in long-term bone damage that can keep bones from growing properly. Severe cases that aren’t treated can lead to seizures, heart damage and death
Too much vitamin D?
Body can get too much vitamin D if too many supplements are taken. Interestingly, body can’t get too much vitamin D from the sun. Vitamin D toxicity is rare, but it can lead to hypercalcemia symptoms of which can include:
Nausea, Increased thirst and urination, Poor appetite, Constipation, Weakness, Confusion, Ataxia (impaired balance or coordination), Dysarthria (unclear speech)
Higher-than-recommended doses of vitamin D shouldn’t be taken. Vitamin D is an important vitamin body needs to be healthy. If anyone has risk factors for developing vitamin D deficiency or are experiencing symptoms, a blood test can be done.
To conclude, Vitamin D deficiency is a common vitamin deficiency that causes issues with bones and muscles. With some awareness and test, it can be identified, prevented and treated.
Leave a Reply