Vitamin D Deficiency

Vitamin D deficiency means you don’t have enough vitamin D in your body. It is a common vitamin deficiency that causes issues with your bones and muscles. Anyone can have vitamin D deficiency, including infants, children, and adults. It’s preventable and treatable.

IMPORTANCE

• Vitamin D is one of the fat-soluble vitamins your body needs to stay healthy.
• Vitamin D is an essential vitamin that your body uses for normal bone development and maintenance.
• It also plays a role in your nervous system, musculoskeletal system, and immune system.
• It plays a crucial role in maintaining the balance of calcium in your blood and bones and in building and maintaining bones.
• Deficiency can cause hypocalcemia and secondary hyperparathyroidism.
• Both hypocalcemia and hyperparathyroidism, if severe, can cause symptoms, including muscle weakness and cramps, fatigue, and depression.
• To try to balance calcium levels in your blood (via secondary hyperparathyroidism), your body takes calcium from your bones, which leads to accelerated bone demineralization (when a bone breaks down faster than it can reform).

SOURCES

You can get vitamin D in a variety of ways, including:

• Sun exposure on your skin (however, people with darker skin and older people may not get enough vitamin D through sunlight. Your geographical location may also prevent adequate vitamin D exposure through sunlight).
• Through the food you eat.
• Through nutritional supplements.

Despite all these methods to get vitamin D, vitamin D deficiency is a common worldwide problem.

CAUSES AND RISK FACTORS

• Having dark skin
• Being older
• Having overweight or obesity
• Not eating much fish or dairy
• Staying or working indoors.
• Working overnight shifts .
• Having chronic kidney disease, liver disease, or hyperparathyroidism
• Having a health condition that affects nutrient absorption, such as crohn’s disease or celiac disease.
• Having gastric bypass surgery.
• Using certain medications that affect vitamin d metabolism, such as statins and steroids.
• While people who often wear sunscreen outdoors are also at an increased risk of deficiency .

Medical conditions that can cause vitamin D deficiency.

• Cystic fibrosis, Crohn’s disease and celiac disease: These conditions can prevent your 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 your body needs to change vitamin D to its active form. A lack of either of these enzymes leads to an inadequate level of active vitamin D in your body.
• Weight-loss surgeries such as gastric bypass surgery that reduce the size of your stomach and/or bypass part of your small intestines, make it difficult for your body to absorb sufficient quantities of certain nutrients, vitamins, and minerals.

Medications that can lower vitamin D deficiency.

• Laxatives.
• Steroids (such as prednisone).
• Cholesterol-lowering drugs(such as cholestyramine and colestipol).
• Seizure-preventing drugs (such as phenobarbitaland phenytoin).
• Rifampin(a tuberculosis drug).
• Orlistat(a weight-loss drug).

SIGNS AND SYMPTOMS

Vitamin D deficiency can be difficult to notice because symptoms may not occur for several months or years. Sometimes, you may have no symptoms at all.

Vitamin D deficiency is typically defined as having blood levels below 20 ng/mL, while levels from 21–29 ng/mL are considered insufficient.

Severe vitamin D deficiency can cause

• In children, it can cause rickets. Rickets is a rare disease that causes the bones to become soft and bend.
• In adults, severe vitamin D deficiency leads to osteomalacia. Osteomalacia causes weak bones, bone pain, and muscle weakness.

Signs of rickets include:

• Incorrect growth patterns due to bowed or bent bones
• Muscle weakness
• Bone pain
• Deformities in joints- Since a child’s bones are still growing, demineralization causes bowed or bent bones.
• Children with a mild vitamin deficiency may just have weak, sore, and/or painful muscles.

Signs and symptoms of osteomalacia  include:

Osteomalacia and osteoporosis put you at an increased risk for bone fractures

• Fatigue.
• Bone pain.
• Muscle weakness, muscle aches, or muscle cramps.
• Mood changes, like depression.

DIAGNOSIS

Vitamin D deficiency is surprisingly common, but the symptoms are often subtle and nonspecific, so it may be hard to know whether you have a deficiency or some other health condition.

If you think you may have a deficiency, ask a healthcare professional for a blood test.

Tests for vitamin D deficiency

Vitamin D exists in your blood in two forms:

• 25-hydroxy vitamin D (25-OH D), or calcidiol
• 1,25-dihydroxy vitamin D, or calcitriol

The most common test for vitamin D deficiency is the 25-hydroxy vitamin D test. This is because 25-hydroxy, or calcidiol, has higher concentrations and stays in your blood longer, which makes it easier to detect.

Treatment for Vitamin D Deficiency

• The goals of treatment and prevention for vitamin D deficiency are the same: to reach and then maintain an adequate vitamin D level in your body.
• Treatment for vitamin D deficiency involves getting more vitamin D through diet and supplements.
• While you might consider eating more foods containing vitamin D and getting more sunlight, your healthcare provider will likely recommend taking vitamin D supplements.
• Vitamin D comes in two forms: D2 and D3. D2 (ergocalciferol) comes from plants. D3 (cholecalciferol) comes from animals. Your body more easily absorbs D3 than D2.
• The recommended dietary allowance (RDA) of vitamin D to 600 international units (IU) for everyone ages 1-70, and raised to 800 IU for adults older than age 70 to optimize bone health. The safe upper limit was also raised to 4,000 IU.

Healthcare professionals may prescribe more than 4,000 IU to correct a vitamin D deficiency.

OUTLOOK

• Vitamin D is a necessary nutrient for your body’s wellness.
• If you have risk factors for vitamin D insufficiency or are experiencing symptoms, talk to your doctor about getting a blood test to evaluate your levels.
• Increasing your sun exposure and eating more vitamin D-rich foods, such as fatty fish and fortified dairy products, can also help.
• Work with your healthcare provider to find out if you need a vitamin supplement and how much to take if needed