Vitamin D Deficiency
What are the symptoms of vitamin D deficiency?
There is no clear pattern of symptoms. In fact many people remain
asymptomatic despite low levels. But here are the more common symptoms
- General muscle pain and weakness
- Muscle cramps
- Joint pain
- Chronic pain
- Weight gain
- High blood pressure
- Restless sleep
- Poor concentration
- Bladder problems
- Constipation or diarrhea
What diseases are associated with Vitamin D deficiency?
Vitamin D deficiency has been shown to play a role in almost every major disease.
- Osteoporosis and Osteopenia
- 17 varieties of Cancer (including breast, prostate and colon)
- Heart disease
- High blood pressure
- Metabolic Syndrome and Diabetes
- Autoimmune diseases
- Multiple sclerosis
- Rheumatoid arthritis
- Infertility and PMS
- Parkinson’s Disease
- Depression and Seasonal Affective Disorder
- Alzheimer’s Disease
- Chronic fatigue syndrome
- Chronic Pain
- Periodontal disease
VITAMIN Deficiency. D3-2500 contains 2,500 IU of the most important single vitamin
to supplement - Vitamin D3. Everyone recognizes the central role Calcium
plays in bone health, yet few are aware that without Vitamin D, Calcium
cannot be absorbed and utilized. In short, Vitamin D is just as
important as Calcium for bone health. That should be enough to encourage
everyone to consume extra Vitamin D, but it’s the other benefits that
are making headlines and has experts seeking to drastically raise the
recommended levels of Vitamin D. The body can produce small amounts of
Vitamin D when exposed to sunlight (UV radiation), but our reduced sun
exposure, increased use of sunscreens, as well as aging makes our
internal production of Vitamin D extremely limited and unreliable.
Moreover, Vitamin D is not readily available in food, being present in
only small amounts in some fish and eggs. As a result, for over 30
years, we have always provided extra Vitamin D in all our multivitamins
and Calcium products. An enormous amount of recent research confirms the
wisdom of consuming extra Vitamin D and, best of all, with our Vitamin
D3-2500, it is a pleasure to use, since it comes in a small, soft,
easy-to- swallow capsule that is guaranteed gentle even to sensitive
It is estimated that anywhere from 30 to 100% of Americans, depending
upon their age and community living environments, are deficient in
Vitamin D. More than half of all American children are vitamin
deficient. Supposedly almost 3/4s of pregnant women are vitamin D
deficient, predisposing their unborn children to all sorts of problems.
Worldwide, it is estimated that the epidemic of vitamin D deficiency
affects one billion people. In my practice over 80% of patients whose
vitamin D levels I check are deficient.
No one is exactly sure why this is happening apart from the fact that
we spend too much time indoors and when we go out into the sun, we
lather sunscreen on ourselves. I think it must be more than that. But
whatever the reason, the reality is we have a major epidemic on our
How much vitamin D do I need?
How much vitamin D you need varies with age, body weight, percent of
body fat, latitude, skin coloration, season of the year, use of sun
block, individual variation in sun exposure, and – probably – how ill
As a general rule, old people need more than young people, big people
need more that little people, fat people need more than skinny people,
northern people need more than southern people, dark-skinned people need
more than fair skinned people, winter people need more than summer
people, sun block lovers need more than sun block haters, sun-phobes
need more than sun worshipers, and ill people may need more than well
What I and many of my colleagues around the country are finding is
that even people spending what we thought was adequate amount of time in
the sun, are still showing up with low blood vitamin D levels. I am not
sure why at this stage but there is an easy and cheap solution…vitamin D
Here are some guidelines:
- If your blood level is above 45ng/ml and for maintenance,
I recommend 2,000-4,000 IU daily depending on age, weight, season, how
much time is spent outdoors, where one lives, skin color and obviously
blood levels. In other words if you are older, larger, living in the
northern latitudes during the winter, are not getting sun and have dark
skin, I recommend the higher maintenance dose.
- If your blood level is 35-45 ng/ml, I recommend you
correct it with 5,000 of vitamin D3 a day for 3 months under a doctor’s
supervision and then recheck your blood levels.
- If your blood level is less than 35 ng/ml, I
recommend you correct it with 10,000 of vitamin D3 a day under a
doctor’s supervision and then recheck your blood levels after 3 months.
It takes a good 6 months usually to optimize your vitamin D levels if
you’re deficient. Once this occurs, you can lower the dose to the
maintenance dose of 2,000 – 4,000 IU a day.
What about vitamin D toxicity?
It is impossible to generate too much vitamin D in your body from
sunlight exposure: your body will self-regulate and only generate what
it needs. Although very rare, it is possible to overdose and become
toxic with supplementation as vitamin D is a fat soluble vitamin and
therefore stored in the body for longer periods of time. Therefore if
you are taking 5,000 IU or more daily, you should have your blood levels
monitored approximately every 3 months.
What blood test should I have to check my vitamin D levels?
The only blood test that can diagnose vitamin D deficiency is a
25-hydroxy-vitamin D (25 OH vitamin D). Unfortunately, some doctors are
still ordering the wrong test, 1,25-dihydroxy-vitamin D. In fact a
common cause of high 1,25-dihydroxy-vitamin D is a low 25(OH)D or
vitamin D deficiency. So when doctors see the 1,25-dihydroxy-vitamin D
is normal or high and tell their patients that they are OK, they are
often vitamin D deficient.
Your doctor should do this test for you. Unfortunately even some of the labs
, in particular Qwest, have had problems with correct results, usually giving erroneously high results.
If you don’t want to go through your doctor, the ZRT lab
does a blood spot test that you can order without going through a doctor.
What is the ideal blood level of 25 hydroxy vitamin D?
The current ranges for “normal” are 20 to 55 ng/ml. These are much
too low!!! They may be fine if you want to prevent rickets or
osteomalacia, but not for optimal health. The ideal range for optimal
health is 50-80 ng/ml.
How often should I have a 25 hydroxy vitamin D blood test?
At least once a year especially at the beginning of winter. If you
are supplementing, I suggest you monitor your vitamin D levels
approximately every 3months until you are in the optimal range. If you
are taking high doses (10,000 IU a day) your doctor must also check your
calcium, phosphorous, and parathyroid hormone levels every 3 months.
This statement has not been evaluated by the Food and
Drug Administration. This product is not intended to diagnose, treat,
cure or prevent any disease.
Many of my colleagues and I believe that the current RDA of vitamin D
(200 IU), which was set in 1997, may be too low to accommodate our
current lifestyles. No sooner did we all utter those words than a new
Institute of Medicine (IOM) report was issued increasing the RDA to 600
IU, and 800 IU for people over 70 years of age. Frankly, many doctors
and scientists felt that the recommendation is still too low.
Vitamin D is one of the fat-soluble vitamins (e.g. A, D, E, K).
Make sure to eat some fat-containing food (e.g. nuts, low-fat dairy)
for optimal absorption. There are two main forms of the vitamin: D2
(ergocalciferol) and D3 (cholecalciferol). Catching ultraviolet B rays
will increase your D3 levels. Fatty fish, mushrooms, eggs and meat are
rich in D, as well as foods specifically fortified with D. Vitamin D is
essential for the proper absorption of calcium and phosphate. That’s why
vitamin D is so critical for bone health.
What you may not know is that recent research has also shown
that adequate vitamin D levels are necessary for optimal immune, brain,
nerve, and muscular function and control of genes that can influence our
tendency toward certain diseases. Research in these areas is still
How does someone become vitamin D deficient? Remember the
age-old recommendation to get your 15 minutes of daily sunshine? Well,
as it turns out, that may not be enough. A study of young Hawaiian
skateboarders and surfers found that over 50% of them had vitamin D
levels lower than average. Slathering on sunscreen could be an issue in
blocking adequate absorption. What was really interesting was that the
vitamin D levels of these tropical sun-bathing folks were compared to
levels among Wisconsin residents who were taking vitamin D supplements
and who aren’t riding waves or boogying down the sidewalk on their
boards. Guess who had better levels? Yep, it was the pale-skinned
Midwesterners. Apparently outdoor training and recreation wasn’t cutting
it for maintaining adequate vitamin D levels.
What should your vitamin D level be? Here’s the rub. The IOM
panel recommends 20 ng/mL as a sufficient level, while some vitamin D
advocates, including the Endocrine Society and the International
Osteoporosis Foundation, note that 30 ng/mL is necessary for optimal
bone health. Can you have too much? Evidence suggests that levels above
50 ng/mL may pose an increased cancer risk. But that’s not the problem
for most of the population. Not having enough D on board is the critical
The good news is that emerging information about vitamin D’s
potential has prompted excellent new research studies. For instance, the
National Institutes of Health has initiated a study to include 20,000
men and women over 60 years old to study whether 2,000 IU of vitamin D,
omega-3 fatty acids from fish oil, or placebo will lower the risk of
heart disease. Stay tuned!
Meanwhile, what should you do?
1. Get your vitamin D level checked. This is especially
important for those people who are getting little sun, are at risk for
osteoporosis, may have inadequate dietary intake, and are either taking
no vitamin supplements or are taking them sporadically. It’s just good
to get a baseline. Knowledge is power.
2. Discuss your vitamin D status and supplements with your medical
team. Because there is controversy surrounding the IOM report regarding
what is a normal D level and supplement intake, you need to talk with
your medical professional about your individual situation. Your gender,
age, level of physical activity, nutrition intake, bone status,
osteoporosis risk, and sun exposure are all factors that must be
considered. Then add to this your D level and you can have a
comprehensive discussion about next steps to optimize your D status.
3. Add up your daily D. Just for grins, whip out your supplements and
add up how much D you’re actually consuming. Multivitamins contain D at
varying levels, while calcium supplements are usually fortified with D.
Check out how much D you’re consuming from foods sources including
fortified dairy and cereals. This will help you monitor your total
intake. And it will be helpful to share this information with your
medical team when you’re deciding how much D you need on a daily basis.
4. Soak up a few rays. Even though we now know that 15 minutes in the
sun is probably not enough to bump your D levels sky high, it’s still
good to get outdoors to reap whatever benefit you can from the sun, as
well as enjoy your external environment while staying physically active.
Just remember to smooth on that sunscreen after 15 minutes of exposure
or you’ll never hear the end of it from your dermatologist.
5. Eat D-licious foods. You saw the laundry list of natural food
sources for vitamin D. If you eat salmon, try to get the wild (not
farmed) type, as it has fewer contaminants. I’m increasing my egg
consumption and integrating more mushrooms into my daily salads and side
Michael Holick, MD, PhD, and colleagues from the Boston University
School of Medicine report that eating mushrooms with vitamin D2 can be
as effective at increasing vitamin D status as taking vitamin D2 or D3.
The researchers randomized 30 healthy adults to take either 2000 IU
capsules of traditionally-made vitamin D2, 2000 IU vitamin D3 or 2000 IU
of vitamin D2 made from irradiated mushrooms. The mushrooms were then
finely chopped and placed in capsules. The participants supplemented
once daily for 12 weeks during winter months.
The authors found that baseline 25(OH)D levels were not significantly
different among the different supplementation groups. Vitamin D status
among the 3 groups gradually increased for 7 weeks when levels plateaued
and remained stable for the remaining 5 weeks.
“These results provide evidence that ingesting mushrooms which have
been exposed to ultraviolet light and contain vitamin D2, are a good
source of vitamin D that can improve the vitamin D status of healthy
adults. Furthermore we found ingesting mushrooms containing vitamin D2
was as effective in raising and maintaining a healthy adult’s vitamin D
status as ingesting a supplement that contained either vitamin D2 or
vitamin D3,” said Dr Holick.
The authors also report that they were able to determine how
mushrooms make vitamin D2. They explain that the process is fairly
similar to what occurs in human skin after sun exposure. They also
report that mushrooms have the ability to produce not only vitamin D2,
but also vitamin D3 and D4.
Note that despite these findings, the Vitamin D Council still recommends use of vitamin D3 over vitamin D2