Vitamin D Requirement

Extreme deficiency of vitamin D can cause rickets in children and osteomalacia in adults – a skeletal demineralization especially in the spine, pelvis, and lower extremities. Signs and symptoms of osteomalacia are burning in the mouth and throat, nervousness, diarrhea, and insomnia.

However, even a moderate deficiency of vitamin D has much broader effects. A meta-analysis of 18 randomized controlled trials has found that supplemental vitamin D significantly reduces mortality from all causes.

The analysis emphasizes the medical, ethical, and legal implications of promptly diagnosing and adequately treating vitamin D deficiency.

Not only are such deficiencies common, but vitamin D deficiency is implicated in most of the diseases of civilization. Vitamin D’s final metabolic product targets more than 200 human genes in a wide variety of tissues. One of the most important genes vitamin D up-regulates is for cathelicidin, a naturally occurring broad-spectrum antibiotic.

Since vitamin D deficiency is both endemic and is associated with numerous diseases, it is one of the most important medical problems in modern society. Treatment of vitamin D deficiency in otherwise healthy patients must be individualized due to the numerous factors affecting vitamin D levels. Steps should be taken to keep patients with chronic diseases associated with vitamin D deficiency, especially internal cancers, in the higher normal range of vitamin D blood levels. [Alternative Medicine Review March 2008 ]

Average blood levels of vitamin D appear to have decreased in the United States between 1994 and 2004, according to a report in the March 23, 2009 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

 


Signs, symptoms & indicators of Vitamin D Requirement

Lab Values - Nutrients  

Low serum vitamin D



Counter Indicators
Lab Values - Nutrients  

Normal/excess serum vitamin D



Symptoms - Bowel Movements  

(Very) frequent stools or normal stool frequency



Symptoms - Head - Mouth/Oral  

(Frequent) raw throat



Symptoms - Muscular  

Tender posterior neck muscles



 

Tender calf muscles



Symptoms - Sleep  

Unsound sleep



 

Being a light sleeper




Conditions that suggest Vitamin D Requirement

Aging  

Senior Issues

In a study of 667 women in low-level care and 952 women in high-level care, vitamin D deficiency (serum 25-hydroxyvitamin D <25 nmol/1) was found in 22% of the women in low-level care and 45% of the women in high-level care, with the level of serum 25-hydroxyvitamin D being independently associated with the first time of a fall. [J Am Geriatr Soc. November 2003;51(11): pp.1533-1538]



Autoimmune  

Multiple Sclerosis / Risk

The possibility that vitamin D could help protect people from developing multiple sclerosis (MS) has been posited by researchers in recent decades, but evidence to support that link has been scant. In the first large-scale, prospective study to investigate the relationship between vitamin D levels and MS, researchers at the Harvard School of Public Health (HSPH) have found an association between higher levels of vitamin D in the body and a lower risk of MS. The study appears in the Journal of the American Medical Association, December 31, 2006.



 

Chronic Thyroiditis

As vitamin D deficiency is common in Hashimoto’s and many other forms of autoimmune diseases, patient status should be should be determined. A simple blood test can help determine whether or not you are deficient in Vitamin D.



Circulation  

Congestive Heart Failure

Various studies show that vitamin D deficiency is widespread among the critically ill and suggest that that vitamin D deficiency may contribute to the inflammatory basis of various illnesses. Early in 2004, researchers studied patients with congestive heart failure and found elevated levels of TNF, another marker of inflammation. They also found critically low levels of calcidiol [25(OH)D], the only reliable marker of vitamin D, and even found low levels of calcitriol, the active form of vitamin D that is usually low only in those who are severely vitamin D deficient.



Digestion  

IBS (Irritable Bowel Syndrome)

IBS (Irritable Bowel Syndrome) has been linked with a lack of vitamin D for the first time in a study published in the BMJ (British Medical Journal December 21, 2015). Of the 51 patients with IBS tested, 82% had insufficient vitamin D levels.



Inflammation  

Chronic Inflammation

Researchers found that vitamin D deficiency is associated with increased inflammation in otherwise healthy people. Increased inflammation in the body can increase the risk of chronic inflammatory conditions, including coronary heart disease (CHD) and diabetes. Further, the researchers found that inflammation was lowered by the use of vitamin D. [

QJM 2002 Dec;95(12):787-96]



Musculo-Skeletal  

Muscle Pains (Myalgia)

A was conducted on 150 patients with nonspecific musculoskeletal pain. Researchers measured their calcidoiol levels, an indicator of vitamin D ingestion, and found every patient to be vitamin D deficient.

The study screened 83 immigrants and 67 non-immigrants, of both sexes who ranged from 10 years to 65 years of age, from six broad ethic groups. The researcher’s results found that 100% of the Black, Hispanic, East Africa and American Indian were vitamin D deficient. Both the non-immigrant and immigrant groups were both equally deficient. Out of the 150 patients, 28% had severely deficient vitamin D levels, 55% of who were younger than 30 years.



 


 

Muscle Cramps / Twitching

Vitamin D is necessary for absorption of calcium. A vitamin D deficiency can result in muscle cramping. Even one dose has helped in some cases of chronic muscle cramping.



Nervous System  

Neuritis/Neuropathy

Research published in the American Medical Association “Journal of Internal Medicine” suggests that vitamin D therapy can facilitate nerve growth and regulate nerve functioning which can benefit patients suffering from neuropathy symptoms.



Pain  

Low Back Pain / Problems

In a study conducted in Saudi Arabia, researchers found vitamin D deficiency in a group of 360 chronic back patients. All the patients were given physiological doses of cholecalciferol for three months, which improved the chronic pain. Even though the doses they were given (5,000 to 10,000 IU) are said to be toxic (the American institute of Medicine says 3,800 IU is toxic) all the patients normalized their calcidiol levels. [Mayo Clinic Proceedings December, 2003]

Taking vitamin D with vitamin A has been reported to be helpful in treating some cases of sciatica pain.



Risks  

Cancer / Risk - General Measures

It has been known for many decades that there is an inverse correlation between sun exposure and cancer deaths. It has also been observed that there is a direct association between skin cancers and sun exposure and an inverse association between skin cancers and internal cancers. Some even thought that development of skin cancer brought immunity against various internal cancers. It is now understood to be a function not of immunity, but of vitamin D concentrations. The important point here is that cancer prevention can be provided not by additional sun exposure (increasing the risk of melanoma) but by the use of supplemental vitamin D.

Calcitriol, the activated form of vitamin D, has been shown to induce cell differentiation and to control cell proliferation. People with a low vitamin D level are less able to make calcitriol in an amount sufficient to exert the controls over cell proliferation that are needed to reduce cancer.




Risk factors for Vitamin D Requirement

Childhood  

Sweaty head as a child



 

Sensitive hair during childhood

This is symptomatic of a childhood vitamin D deficiency which may in turn indicate a vitamin D dependency throughout a person’s life.



 

Easily-tired legs as a child

This is symptomatic of a childhood vitamin D deficiency which may in turn indicate a vitamin D dependency throughout a person’s life. A dependency is a greater than average requirement, requiring greater intake and/or sun exposure. If there is no indication of vitamin D deficiency as an adult then the historical problem is no longer an issue.



 

Childhood rocking or head-rolling

This is symptomatic of a childhood vitamin D deficiency which may in turn indicate a vitamin D dependency throughout a person’s life. Vitamin D testing should be considered if there is any doubt about a deficiency.



 

Growing pains in childhood



Digestion  


Lab Values - Chemistries  

Hypocalcemia



Lab Values - Nutrients  

Past vitamin D deficiency



Organ Health  

Consequences of Gallbladder Surgery

Bile is needed to enhance the absorption of fat soluble vitamins like Vitamin A, D, E and K.



Personal Background  

African ethnicity

Deeply pigmented people essentially have a major screen on their skin that effectively blocks a high percentage of UV-B radiation, which generates vitamin D in the skin. Vitamin D is a necessary nutrient to staying healthy, and vitamin D deficiency may be a contributing factor in the increased occurrence of prostate cancer among black men.



Supplements and Medications  

Heparin use

Heparin may interfere with activation of vitamin D in the body. Osteoporosis has been reported in patients who received high amounts of heparin for several months. Osteopenia has been reported in women who received heparin therapy during pregnancy.



 

Past multiple vitamin supplement use



Counter Indicators
Supplements and Medications  

Multiple vitamin supplement use



 

Vitamin D supplementation



Symptoms - Environment  

Low recent sun exposure

Low levels of sunshine exposure on the skin suggest that more than just a minimal vitamin D supplement may be required to make up the difference. A 2001 study showed that consumption of the recommended amount of vitamin D from milk and supplements did not prevent low serum vitamin D (25(OH)D) levels during winter in a survey of 796 young Canadian women. [Eur J Clin Nutr 2001;55(12): pp.1091­1097]



Counter Indicators
Symptoms - Environment  

High recent sun exposure

Low levels of sunshine exposure on the skin suggest that more than just a minimal vitamin D supplement may be required to make up the difference. A 2001 study showed that consumption of the recommended amount of vitamin D from milk and supplements did not prevent low serum vitamin D (25(OH)D) levels during winter in a survey of 796 young Canadian women. [Eur J Clin Nutr 2001;55(12): pp.1091­1097]



Symptoms - Food - Preferences  

(Partial) vegetarian diet or vegan/raw food diet



Symptoms - Gas-Int - General  

Had typical/had severe gastric bypass

Vitamin D deficiency and elevated PTH are common following GBP and progress over time. There is a significant incidence of secondary hyperparathyroidism in short-limb GBP patients, even those with vitamin D levels > or =30 ng/mL, suggesting selective Ca malabsorption. Thus, calcium malabsorption is inherent to gastric bypass. Careful calcium and vitamin D supplementation and long-term screening are necessary to prevent deficiencies and the sequelae of secondary hyperparathyroidism.



 

Having had a small bowel resection

Vitamin D malabsorption reflects the extent of distal small bowel resection in Crohn’s disease patients.



Symptoms - Metabolic  

Pancreas mostly/pancreas completely removed




Vitamin D Requirement can lead to

Autoimmune  

Multiple Sclerosis / Risk

The possibility that vitamin D could help protect people from developing multiple sclerosis (MS) has been posited by researchers in recent decades, but evidence to support that link has been scant. In the first large-scale, prospective study to investigate the relationship between vitamin D levels and MS, researchers at the Harvard School of Public Health (HSPH) have found an association between higher levels of vitamin D in the body and a lower risk of MS. The study appears in the Journal of the American Medical Association, December 31, 2006.



Digestion  

IBS (Irritable Bowel Syndrome)

IBS (Irritable Bowel Syndrome) has been linked with a lack of vitamin D for the first time in a study published in the BMJ (British Medical Journal December 21, 2015). Of the 51 patients with IBS tested, 82% had insufficient vitamin D levels.



Musculo-Skeletal  


Nervous System  

Neuritis/Neuropathy

Research published in the American Medical Association “Journal of Internal Medicine” suggests that vitamin D therapy can facilitate nerve growth and regulate nerve functioning which can benefit patients suffering from neuropathy symptoms.



Risks  

Increased Risk of Prostate Cancer

Low circulating levels of 25-hydroxyvitamin D were associated with an increased risk of subsequent prostate cancer and more aggressive progression of prostate cancer, especially in men before the age of 52, in the Helsinki Heart Study. Ultraviolet radiation exposure has been shown to be protective against prostate cancer.

Men over the age of 30 should have an annual screening for 25-hydroxyvitamin D levels, especially those at higher risk such as African American men and indoor workers. Vitamin D nutrition should be maintained not only for bone health but also for the possible reduction in risk of prostate cancer and to reduce metastatic activity should prostate cancer develop. [Trends in Endocrinol Metab November 2003;14(9): pp.423-430]



 

Increased Risk of Hypertension

An Alabama researcher found that lack of enough sunshine exposure may increase risk of hypertension in blacks and other dark-skinned people. Those with greater amounts of pigment in the skin require six times the amount of ultraviolet B (UVB) light to produce the same amount of vitamin D3 found in lighter-skinned people.



Tumors, Malignant  

Prostate Cancer

Low circulating levels of 25-hydroxyvitamin D were associated with an increased risk of subsequent prostate cancer and more aggressive progression of prostate cancer, especially in men before the age of 52, in the Helsinki Heart Study. Ultraviolet radiation exposure has been shown to be protective against prostate cancer.

Men over the age of 30 should have an annual screening for 25-hydroxyvitamin D levels, especially those at higher risk such as African American men and indoor workers. Vitamin D nutrition should be maintained not only for bone health but also for the possible reduction in risk of prostate cancer and to reduce metastatic activity should prostate cancer develop. [Trends in Endocrinol Metab November 2003;14(9): pp.423-430]




Recommendations for Vitamin D Requirement

Habits  


Lab Tests/Rule-Outs  


Mineral  

Boron

Testing in animals has demonstrated that boron enhances the efficacy of vitamin D by reducing the negative effects (especially on glucose and triglyceride metabolism) of a vitamin D deficiency. [J Trace Elem Exp Med, 1996 (9): pp.117-132]



Vitamins  


Key

Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Strongly counter-indicative
Very strongly or absolutely counter-indicative
Likely to help

Glossary

Vitamin D

A fat-soluble vitamin essential to one's health. Regulates the amount of calcium and phosphorus in the blood by improving their absorption and utilization. Necessary for normal growth and formation of bones and teeth. For Vitamin D only, 1mcg translates to 40 IU.

Rickets

Vitamin-D deficiency characterized by abnormal calcification of bone tissues.

Diarrhea

Excessive discharge of contents of bowel.

Metabolism

The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.

Endemic

Used to refer to a disease that constantly occurs in any particular geographical region.

Chronic

Usually Chronic illness: Illness extending over a long period of time.

Serum

The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.

Multiple Sclerosis

Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g., muscle weakness, loss of vision, and mood alterations.

Autoimmune Disease

One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.

Congestive

Pertaining to accumulation of blood or fluid within a vessel or organ.

TNF

Tumor Necrosis Factor. TNF-alpha is a pro-inflammatory cytokine significantly elevated in all leukemias except for AML and myelodysplastic syndromes.

Irritable Bowel Syndrome

(IBS) A condition that causes upset intestines for a long period of time. It is very unpleasant to the sufferer but tends to be harmless and usually does not lead to more serious complaints. The symptoms vary from person to person and from day to day. In order to be diagnosed with IBS, a person must have at least three of the following symptoms: pain in the lower abdomen; bloating; constipation; diarrhea or alternating diarrhea and constipation; nausea; loss of appetite; tummy rumbling; flatulence; mucous in stools; indigestion; constant tiredness; frequent urination; low back pain; painful intercourse for women.

Diabetes Mellitus

A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Calcium

The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.

Neuropathy

A group of symptoms caused by abnormalities in motor or sensory nerves. Symptoms include tingling or numbness in hands or feet followed by gradual, progressive muscular weakness.

IU

International Units. One IU is 1/40th (0.025) of a microgram (mcg).

Vitamin A

A fat-soluble vitamin essential to one's health. Plays an important part in the growth and repair of body tissue, protects epithelial tissue, helps maintain the skin and is necessary for night vision. It is also necessary for normal growth and formation of bones and teeth. For Vitamin A only, 1mg translates to 833 IU.

Sciatica

Pain in the lower back and hip radiating down the back of the thigh into the leg, often due to herniated lumbar disk.

Cancer

Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Melanoma

A life-threatening type of skin cancer that occurs in the cells (melanocytes) that produce melanin, the pigment found in skin, hair, and the iris of the eyes.

Bile

A bitter, yellow-green secretion of the liver. Bile is stored in the gallbladder and is released when fat enters the first part of the small intestine (duodenum) in order to aid digestion.

Prostate

The prostate gland in men that surrounds the neck of the bladder and the urethra and produces a secretion that liquefies coagulated semen.

Osteoporosis

A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.

ng

Nanogram: 0.000000001 or a billionth of a gram.

Distal

Anatomically located further away from a point of reference, such as an origin or a point of attachment.

Crohn's Disease

Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.

Hypertension

High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.

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