Vitamin D Deficiency

Vitamin D deficiency: All you want to know

Vitamin D deficiency is a pandemic (Present all over the world) with more than half of the world’s population suffering from it. Vitamin D is necessary for optimal bone and muscle health. Adequate vitamin D level also decreases the risk of many cancers, heart disease and auto immune disease.

What are vitamin D2 and vitamin D3:

Vitamin D2 is obtained from plant sources like mushrooms and fortified soya milk, almond milk etc. It is less effective than vitamin D3 which is most active form and obtained from sunlight exposure and animal sources like meat, egg, milk, etc. The most important vitamin D metabolite in the blood is the 25-hydroxyvitamin D (25-OHD). Most of the laboratory values are based on its level in the blood.

Vitamin D deficiency causes:

There is no consensus on the normal serum concentration of 25-OHD (or Vitamin D) but blood level below 20 ng/ml is considered deficient. Although regular sunlight exposure is all that is required to maintain blood level of vitamin D; however even in sunny countries, studies have shown that vitamin D deficiency is highly prevalent. This may be due to customary clothing, seasonal variation(less vitamin D synthesis in winters), dietary habits, high latitude, old age, obesity, dark skin color, sunscreen use and avoidance of sun exposure. Application of sunscreen with SPF 15 can block 99% vitamin D synthesis in skin. Vitamin D is stored in the fat so obese individual requires more vitamin D to have the equivalent blood level increase as compared to thin individual.

Elderly people (above 60-70 years) are particularly deficient in vitamin D due to the process of ageing by itself leads to a decrease in the skin’s ability to produce vitamin D because of the diminution of the amount of 7-dehydrocholesterol which is a precursor for vitamin D synthesis.

Signs and symptoms of vitamin D deficiency:

Vitamin D deficiency may occur in children, adults, old persons of both sexes.In adults symptoms of vitamin D deficiency include tiredness, generalized body ache, Joint pain of legs, back pain, muscle cramps, thighs and/or calves pain, difficulty in walking/running etc. Children deficient in vitamin D develops rickets which commonly present as bow legs (inward curving of legs) in toddlers. Severe deficiency in adults who remain confined to house with inadequate sun exposure may lead to osteomalacia. Common feature in osteomalacic females is pain at inner and upper side of thigh due to stress fractures of thigh bone.

Sources of vitamin D:

Sunlight exposure is the best available source. Other dietary sources include meat, fish, milk, egg, cheese, mushroom, etc. It’s also found in fortified foods like breakfast cereals. Daily recommended dose of vitamin D for adult is 400-600 IU.

Treatment:

If any of above features is troubling your health get vitamin D level checked. If it is less than 20-30 nmol/liter then you need vitamin D supplementation. Vitamin D3 is 2 to 3 times more effective in increasing blood levels of 25(OH)D than the equivalent dose of vitamin D2. Children below age 5 and older persons above 60-70 years are also vulnerable for vitamin D deficiency. Vitamin D deficiency is particularly more prevalent during winters and autumn. Severe deficiency (<10 nmol/lt) should be treated with vitamin D doses ( single shot of 6 lacs units injection into muscle or oral doses of 60 k units per week for 8 weeks) Daily doses of 1000 units for 3 months are also effective.