ARE YOU DEFICIENT IN VITAMIN D?

BY FRED G. ARNOLD, NMD

BACKGROUND AND PREVALENCE OF VITAMIN D DEFICIENCY
There is hardly a health magazine I read or seminar I attend where some mention of Vitamin D is not made and unless you have been taking Vitamin D on a regular basis there is a good chance you are deficient in Vitamin D (hypovitaminosis D). I am always amazed how low the Vitamin D levels are when we perform blood analysis levels on our patients. What you may also find interesting is that Vitamin D is actually not even a Vitamin, it is a steroid hormone and considered a prohormone. Vitamin D is the most abundant prohormone in the body and is also known as calcidiol and calcitriol. Vitamin D is referred to as the sunshine vitamin for ninety to one hundred percent of Vitamin D is made in the skin from cholesterol under the influence of UVB radiation from sunlight. It is said your skin can only make Vitamin D hormone, if your shadow is shorter than you. 1

The wavelength of UVB and the amount of exposure is critical to the production of Vitamin D in the body. Probably the main reason many people are low in Vitamin D is because our exposure to sunlight is greatly reduced compared to our ancient ancestors. Remember, our ancestors lived naked in the sun for several million years. Then 50,000 years ago, some of us migrated north and south to places with less sun. Then we put on clothes, started working inside and living in cities where buildings blocked the sun. Then we started travelling in cars instead of walking, or riding horses, and glass blocked even more of the UVB in the sunlight. Then, only a few years ago, we started actively avoiding the sun and putting on sun block.1 We have to expose 80% of our body to the sunlight for at least 20 minutes each day for adequate Vitamin D production. Even in the desert, very few people exposure themselves to this much sunlight.

Dependent upon the study and the definition used to define deficiency Vitamin D deficiency, it is considered to occur when blood or serum levels are less that 30ng/ml. In the blood Vitamin D is measured as Vitamin D3-25 hydroxy. It has been estimated that 1 billion people worldwide have Vitamin D deficiency. According to several studies, 40-100% of U.S. and European elderly men and women still living in the community (not in nursing homes) are deficient in Vitamin D. More than 50% of postmenopausal women taking medication for osteoporosis had suboptimal levels of 25-hydroxyvitamin D (below 30 ng/ml). 8

VITAMIN D DEFECIENCY SYMPTOMS AND DISEASES
Since the industrial revolution, a really significant reduction in sunlight exposure has occurred, just as the time diseases of civilization like cardiovascular disease, diabetes, and cancer seen to have greatly increased. According to Dr. James E. Dowd, M.D. in his book, The Vitamin D Cure, symptoms of Vitamin D deficiency can include the following: fatigue, joint pain and/or swelling, muscle pain, cramping, and /or weakness, chronic pain, uncontrolled weight gain, high blood pressure, restless sleep , poor concentration and memory, headaches, bowel problems (constipation, diarrhea, or both), and bladder problems (urgency, frequency, or both). Diseases associated with Vitamin D deficiency includes Depression, including seasonal affective disorder (SAD), Fibromyalgia, Parkinson’s disease, Alzheimer’s disease, Arthritis (osteoarthritis, gout, pseudogout, tendinitis, bursitis), Osteoporosis, Gum disease and tooth loss, Obesity, Diabetes, Heart disease, Autism and Metabolic syndrome. 3, 4 Autoimmune diseases such as multiple sclerosis, systemic lupus erythematosis, Type 1 Diabetes and rheumatoid arthritis are associated with Vitamin D intake. 7 Vitamin D protects against cancers such as colorectal, renal cell, breast, prostate and ovarian cancers and others including leukemic cells and retinoblastoma. 3

VITAMIN D AND PAINFUL CONDITIONS
There are now numerous studies that link Vitamin D deficiency to painful conditions. One such study in the British Journal of medicine found pain due to Hypovitaminosis D (low Vitamin D) to be related to painful conditions. Generally, the pain is symmetrical and starts in the lower back, then spreads to the pelvis, upper legs and ribs. It is felt mainly in the bones and muscles. With treatment involving Vitamin D and calcium complete resolution of symptoms occurred within 6-8 months. 2 According to another study conducted by the Mayo Clinic in 2003, “all patients with persistent, nonspecific musculoskeletal pain are at high risk for the consequences of unrecognized and untreated severe Hypovitaminosis D”. This article recommended screening all outpatients with persistent, nonspecific musculoskeletal pain for Hypovitaminosis D as a standard practice in clinical care. 9

Vitamin D is routinely provided in tablet, capsule or oil based liquid forms. I find that the oil based liquid forms are best absorbed and raises serum levels the fastest. Also, there are observed and reported benefits of transdermal Vitamin D Cream. Conditions that respond to transdermal Vitamin D cream include acute and post-herpetic neuralgia, certain cases of RSD (CRPS II), osteoarthritis of the fingers, plantar fasciitis, acute sprains and strains, chronic pain, 1st degree burns, itch from sandfly bites, and contact dermatitis. According to Dr. John Lyftogt, a pain management doctor in New Zealand, the recommended dosage of transdermal Vitamin D3 cream is 40,000 IU applied to the affected area twice a day. 8

VITAMIN D TOXICITY
Serum Vitamin D is measured as Vitamin D3, 25-OH and since Vitamin D is a fat soluble vitamin, there has been concern regarding toxicity levels in the body. Dr. Reinhold Vieth, PhD is one of the worlds most prominent Vitamin D scientists and feels this concern regarding toxicity is unwarranted, bordering on hysteria and rampant in the medical profession. The American Board of Veterinary Toxicology (ABVT) calculates that toxicity occurs if a 110-pound adult takes 176,000,000 IU or 440,000, 400 IU Vitamin D capsules. Dr. Vieth reports that human toxicity probably begins to occur after chronic daily consumption of approximately 40,000 IU/day.10 According to Dr. Michael F. Holick MD, PhD, “Vitamin D intoxication is observed when serum levels of 25-hydroxyvitamin D are greater than 150 ng/ml. Furthermore, he reports that doses of 10,000 IU of Vitamin D per day for up to 5 months do not cause toxicity. 5 According to Dr. Vieth, “if there is published evidence of toxicity in adults from an intake of 10,000 IU per day, and it is verified by the concentration, I have yet to find it.” 10

Vitamin D overdose causes excess calcium in the blood and the main symptoms of Vitamin D overdose are those of hypercalcemia (excess calcium): anorexia, nausea, and vomiting, frequently followed by excessive urine, excessive thirst, weakness, nervousness, itching, and ultimately, renal failure. 10

VITAMIN D OPTIMAL LEVELS AND DOSES
Although many experts agree that Vitamin D deficiency occurs when serum levels are less than 30ng/ml, there is no consensus on the optimal healthy levels of Vitamin D measured in the blood as Vitamin D3, 25 Hydroxy or the recommended daily dose of Vitamin D3 levels measured in IU’s. In my professional opinion, a daily intake of Vitamin D up to 10,000 IU is a reasonable dose while monitoring physical signs, subjective symptoms, serum calcium and Vitamin D3 25-OH levels. I have not seen toxicity at this dose and when serum Vitamin D3, 25-OH levels less than 100 ng/L. When taking Vitamin D, it is important to check your serum levels after 3-4 months and then periodically to monitor your maintenance dose.

CONCLUSION
Vitamin D deficiency or Hypovitaminosis D is epidemic and world wide , especially in modern societies where clothes are worn on a regular basis and is related to a variety of health condition. Serum Vitamin D testing should be an integral part of each health evaluation and screening to help identify, treat and prevent numerous health conditions linked to Vitamin D deficiency and practically when treating painful musculoskeletal conditions with prolotherapy.

References:

1. Cedric F. Garland, Dr PH, FACE, Edward D. Gorham, MPH, PhD, Sharif B. Mohr, MPH, Frank C. Garland, PhD, Vitamin D for Cancer Prevention: Global Perspective, Annals of Epidemiology Volume 19, Issue 7, Pages 468-483 (July 2009)
2. deTorrente de la Jara G, Pecoud A. Favrat B., Musculoskeletal pain in female asylum seekers and hypovitaminosis D3, BMJ, 2004:329:156-157, Clinical Review
3. Dowd, James E. M.D., Diane Stafford, The Vitamin D Cure, John Wiley & Sons, Inc., 2008
4. Goepp, Julius MD, The Link Between Autism and Low Levels of Vitamin D, Life Extension, April, 2009, pp. 79-87.
5. Holick, Michael F., M.D., Ph.D, Vitamin D Deficiency, The New England Journal of Medicine, Vol. 357-266-281, July 19, 2007.
6. Lappe, Joan M., Travers-Gustafson, Dianne, Davies, Michael K., Recker, Robert R., and Heaney, Robert P., Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial, American Journal of Clinical Nutrition, Vol. 85, No. 6, 1586-1591, June 2007
7. Lucas, R., Ponsonby, Al, Der mey, Ivan, Vitamin D, UVR and three autoimmune diseases: an update, Photochem Photobil 81(6):1267-75.
8. Lythogt, John MD, Vitamin D Hormone, ProloNeural Therapy Seminar, Seattle, Wa, 2010
9. Plotnikoff, G.A., Quigley, J.M., Prevalence of severe hypovitaminosis D in Patients with persistent, nonspecific musculoskeletal pain, Mayo clin Proc, 2003, Dec;78(12):1463-70.
10. Vieth, Reinhold, American Journal of Clinical Nutrition, Vol 69, No. 5, 842-856, May 1999