Institute Of Medicine Vitamin D Deficiency

Institute Of Medicine Vitamin D Deficiency

Overview

Symptoms of vitamin D deficiency

What is vitamin D deficiency?

Vitamin D deficiency means that you do not have enough vitamin D in your body. Vitamin D is unique because your skin actually produces it by using sunlight. Fair-skinned individuals and those who are younger convert sunshine into vitamin D far better than those who are darker-skinned and over age 50.

Why is vitamin D so important?

Vitamin D is one of many vitamins our bodies need to stay healthy. This vitamin has many functions, including:

• Keeping bones strong: Having healthy bones protects you from various conditions, including rickets. Rickets is a disorder that causes children to have bones that are weak and soft. It is caused by a lack of vitamin D in the body. You need vitamin D so that calcium and phosphorus can be used to build bones. In adults, having soft bones is a condition called osteomalacia.
• Absorbing calcium: Vitamin D, along with calcium, helps build bones and keep bones strong and healthy. Weak bones can lead to osteoporosis, the loss of bone density, which can lead to fractures. Vitamin D, once either taken orally or from sunshine exposure is then converted to an active form of the vitamin. It is that active form that promotes optimal absorption of calcium from your diet.
• Working with parathyroid glands: The parathyroid glands work minute to minute to balance the calcium in the blood by communicating with the kidneys, gut and skeleton. When there is sufficient calcium in the diet and sufficient active Vitamin D, dietary calcium is absorbed and put to good use throughout the body. If calcium intake is insufficient, or vitamin D is low, the parathyroid glands will 'borrow' calcium from the skeleton in order to keep the blood calcium in the normal range.

What are the health effects of vitamin D deficiency?

Getting enough vitamin D may also play a role in helping to keep you healthy by protecting against the following conditions and possibly helping to treat them. These conditions can include:

• Heart disease and high blood pressure.
• Diabetes.
• Infections and immune system disorders.
• Falls in older people.
• Some types of cancer, such as colon, prostate and breast cancers.
• Multiple sclerosis.

What are the sources of vitamin D?

You can get vitamin D in a variety of ways. These can include:

• Being exposed to the sun. About 15-20 minutes three days per week is usually sufficient.
• Through the foods you eat.
• Through nutritional supplements.

What does sunlight have to do with getting enough vitamin D?

There are health benefits of sunlight. Vitamin D is produced when your skin is exposed to sunshine, or rather, the ultraviolet B (UV-B) radiation that the sun emits. The amount of vitamin D that your skin makes depends on such factors as:

• The season: This factor depends a bit on where you live. In areas such as Cleveland, OH, the UV-B light does not reach the earth for six months out of the year due to the ozone layer and the zenith of the sun.
• The time of day: The sun's rays are most powerful between 10 a.m. and 3 p.m.
• The amount of cloud cover and air pollution.
• Where you live: Cities near the equator have higher ultraviolet (UV) light levels. It is the UV-B light in sunlight that causes your skin to make vitamin D.
• The melanin content of your skin: Melanin is a brown-black pigment in the eyes, hair and skin. Melanin causes skin to tan. The darker your skin, the more sun exposure is needed in order to get sufficient vitamin D from the sun.

What does your diet have to do with getting enough vitamin D?

Vitamin D doesn't occur naturally in many foods. That's why certain foods have added vitamin D. In fact, newer food nutrition labels show the amount of vitamin D contained in a particular food item.

It may be difficult, especially for vegans or people who are lactose-intolerant, to get enough vitamin D from their diets, which is why some people may choose to take supplements. It is always important to eat a variety of healthy foods from all food groups. The vitamin content of various foods is shown in the following table.

Vitamin D content of various foods

Food	Vitamin D content in International Units (IUs) per serving
Cod liver oil, 1 tablespoon	1360
Swordfish, cooked, 3 ounces	566
Salmon (sockeye) cooked, 3 ounces	447
Tuna, canned in water, drained, 3 ounces	154
Orange juice fortified with vitamin D, 1 cup	137
Milk, vitamin-fortified, 1 cup	115-124
Yogurt, fortified with 20% of the daily value of vitamin D, 6 ounces	80
Sardines, canned in oil, drained, 2 sardines	46
Liver, beef, cooked, 3 ounces	42
Egg yolk, 1 large	41
Cereal, fortified with 10% of the daily value of vitamin D, 1 cup	40
Cheese, Swiss, 1 ounce	6

Source: Vitamin D. Health Professionals. Dietary Supplement Fact Sheet. National Institutes of Health. Office of Dietary Supplements. August 7, 2019.

It is important to check product labels, as the amount of added vitamin D varies when it is artificially added to products such as orange juice, yogurt and margarine.

How much vitamin D do you need?

In healthy people, the amount of vitamin D needed per day varies by age. The chart below shows the often-cited recommendations of the Institute of Medicine, now the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine. It is important to know that these are general recommendations. If your doctor is checking your blood levels, he or she might recommend higher or lower doses based on your individual needs.

If you have osteoporosis, your doctor might suggest a blood test of your vitamin D levels. The amount of vitamin D supplement can be customized for each person, based on the results. For many older patients, a vitamin D supplement containing anywhere between 800 to 2000 IUs daily, which can be obtained without a prescription, can be both safe and beneficial. It is important to speak with your doctor about your individual needs.

People by age	Recommended dietary allowance (IU/day)	Upper level intake (IU/day)
Infants 0-6 months*	400	1,000
Infants 6-12 months*	400	1,500
Children 1-3 years old	600	2,500
Children 4-8 years old	600	3,000
People 9-70 years old	600	4,000
People over 70 years old	800	4,000
Females 14-50 years old, pregnant/lactating	600	4,000

*refers to adequate intake vs recommended dietary allowance of the other age groups.

Symptoms and Causes

What causes vitamin D deficiency?

Vitamin D deficiency can be caused by specific medical conditions, such as:

• Cystic fibrosis , Crohn's disease, and celiac disease : These diseases do not allow the intestines to absorb enough vitamin D through supplements.
• Weight loss surgeries. Weight loss surgeries that reduce the size of the stomach and/or bypasses part of the small intestines make it very difficult to consume sufficient quantities of certain nutrients, vitamins, and minerals. These individuals need to be carefully monitored by their doctors and need to continue to take vitamin D and other supplements throughout their lives.
• Obesity : A body mass index greater than 30 is associated with lower vitamin D levels. Fat cells keep vitamin D isolated so that it is not released. Vitamin D deficiency is more likely in obese people. Obesity often makes it necessary to take larger doses of vitamin D supplements in order to reach and maintain normal D levels.
• Kidney and liver diseases: These diseases reduce the amount of an enzyme needed to change vitamin D to a form that is used in the body. Lack of this enzyme leads to an inadequate level of active vitamin D in the body.

What other factors can lead to vitamin D deficiency?

• Age: The skin's ability to make vitamin D lessens with age.
• Mobility: People who are homebound or are rarely outside (for example, people in nursing homes and other facilities) are not able to use sun exposure as a source of vitamin D.
• Skin color: Dark-colored skin is less able to make vitamin D than fair-colored skin.
• Human breast milk: A woman's breast milk only contains a small amount of vitamin D. Often infant formulas also only include a small amount of D also. Therefore infants are at risk of not receiving enough vitamin D. This is especially true for infants who are only fed breast milk.

Can medications cause a vitamin D deficiency?

Yes. Vitamin D levels can be lowered by certain medications. These include:

• Laxatives.
• Steroids (such as prednisone).
• Cholesterol-lowering drugs (such as cholestyramine and colestipol).
• Seizure-control drugs (such as phenobarbital and phenytoin).
• A tuberculosis drug (rifampin).
• A weight-loss drug (orlistat).

Always tell your doctor about the drugs you take and any vitamin D supplements or other supplements or herbs/alternative health products that you take.

What are the signs and symptoms of vitamin D deficiency?

Severe lack of vitamin D causes rickets, which shows up in children as incorrect growth patterns, weakness in muscles, pain in bones and deformities in joints. This is very rare. However, children who are deficient in vitamin D can also have muscle weakness or sore and painful muscles.

Lack of vitamin D is not quite as obvious in adults. Signs and symptoms might include:

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

Diagnosis and Tests

How is a vitamin D deficiency diagnosed?

Your doctor can order a blood test to measure your levels of vitamin D. There are two types of tests that might be ordered, but the most common is the 25-hydroxyvitamin D, known as 25(OH)D for short. For the blood test, a technician will use a needle to take blood from a vein. You do not need to fast or otherwise prepare for this type of test.

What do vitamin D test results mean?

There are some differing opinions about what levels of vitamin D work the best for each person. Laboratories might use different numbers for reference. Please discuss your results with your doctor.

How often do you need to get your vitamin D levels checked?

Doctors do not usually order routine checks of vitamin D levels, but they might need to check your levels if you have certain medical conditions or risk factors for vitamin D deficiency. Sometimes vitamin D levels can be checked as a cause of symptoms such as long-lasting body aches, a history of falls or bone fractures without significant trauma.

Management and Treatment

How is vitamin D deficiency treated?

The goals of treatment and prevention are the same—to reach, and then maintain, an adequate level of vitamin D in the body. While you might consider eating more foods that contain vitamin D and getting a little bit of sunlight, you will likely be told to take vitamin D supplements.

Vitamin D comes in two forms: D2 and D3. D2, also called ergocalciferol, comes from plants. D3, also called cholecalciferol, comes from animals. You need a prescription to get D2. D3, however, is available over the counter. It is more easily absorbed than D2 and lasts longer in the body dose-for-dose. Work with your doctor to find out if you need to take a vitamin supplement and how much to take if it is needed.

Can you ever have too much vitamin D?

Yes. You can get too much vitamin D if you overdo the supplements. Interestingly, you cannot get too much vitamin D from the sun. Vitamin D toxicity is, thankfully, quite rare but can lead to hypercalcemia and together the symptoms can include:

• Nausea.
• Increased thirst and urination.
• Poor appetite.
• Constipation.
• Weakness.
• Confusion.
• Ataxia (a neurological condition that may cause slurring of words and stumbling).

Do not take higher-than-recommended doses of vitamin D without first discussing it with your doctor. However, your doctor might recommend higher doses of vitamin D if he or she is checking your blood levels and adjusting your dose accordingly. Also, be cautious about getting large doses of vitamin A along with the D in some fish oils. Vitamin A can also reach toxic levels and can cause serious problems.

Prevention

How can I help prevent vitamin D deficiency?

The goals of treating and preventing the lack of vitamin D of treatment and prevention are the same—to reach and keep an adequate level of vitamin D in the body. Your healthcare provider will let you know if you need to take or keep taking vitamin D supplements. If so, they will also let you know how much you should take. You might also want to consider:

Eating more foods that contain vitamin D: See the vitamin D food sources table included in this article. Keep in mind that foods alone usually don't meet the daily recommended levels of vitamin D.

Getting some exposure to sunshine—but not too much: Exactly how much sun exposure is needed isn't clear. 10 to 15 minutes of sun exposure two to three times a week to the face, arms, legs or back may be all that is needed to absorb a suitable amount of vitamin D. You might need more sun exposure (especially in early spring and late fall) if:

• You are older.
• You have a darker skin color.
• You live in northern climates.

The use of sunscreen, and standing behind a window, prevents vitamin D from being produced in the skin. However, you should remember that too much sunshine increases the risk of skin cancer and ages the skin. That is why taking an appropriately dosed D supplement is far safer than intentionally getting routine sun exposure.

Institute Of Medicine Vitamin D Deficiency

Source: https://my.clevelandclinic.org/health/articles/15050-vitamin-d--vitamin-d-deficiency

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How Much Vitamin D Supplement For Deficiency

How Much Vitamin D Supplement For Deficiency

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Vitamin D is essential for a range of bodily functions. Dietary sources provide some vitamin D, but most comes from exposure to sunlight. After the body takes in vitamin D, it needs to convert it to its active form.

Deficiencies can arise if a person does not take in enough vitamin D or their skin has an impaired ability to synthesize it from the sun. A person can also become deficient if the body is not able to absorb the vitamin or convert it to its active form in the liver and kidneys.

Low vitamin D levels can lead to a range of problems, especially relating to the bones and muscles.

Some people have an annual blood test to check for a vitamin D deficiency. The result will show serum vitamin D levels in nanomoles/liter (nmol/l). Healthy levels of serum vitamin D are between 50 nmol/l and 125 nmol/l.

In this article, we look at how to detect the signs of vitamin D deficiency and how to treat it.

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A person may experience vitamin D deficiency if they do not get exposure to enough sunlight.

Vitamin D is a fat-soluble vitamin that the body produces when the skin gets exposed to sunlight.

It is present in a small number of foods, including fortified products.

When vitamin D enters the body, it is not in an active form.

To use it, the body needs to convert it to an active form called 25-hydroxyvitamin D [25(OH)D] or calcidiol.

How much is a deficiency?

The results of a serum vitamin D blood test may show the following:

• Too high and possibly harmful: 125 nmol/l or more
• Sufficient: 50–125 nmol/l
• At risk of inadequacy: 30–49 nmol/l
• At risk of deficiency: 30 nmol/l or less

Functions of vitamin D

Vitamin D has many important functions, including:

• supporting bone health by enabling the absorption of calcium
• promoting muscle health
• modulating the immune system
• aiding cell growth
• reducing inflammation, which helps prevent diseases such as rheumatoid arthritis and psoriasis
• regulating blood pressure and supporting cardiovascular health

Low vitamin D and diabetes

Some experts have suggested that vitamin D may help prevent type 2 diabetes.

However, in a 2019 study, 2,423 people at risk of type 2 diabetes took either a vitamin D supplement of 4,000 international units (IU) a day or a placebo.

Vitamin D levels increased in those who took the supplement. However, taking the supplement did not appear to reduce the risk of diabetes developing.

Learn more about the health benefits of vitamin D.

Vitamin D deficiency can happen when a person:

• does not consume enough vitamin D
• is unable to absorb or metabolize the vitamin D
• does not spend enough time in ultraviolet B (UVB) sunlight

Risk factors

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A person's diet may contribute to vitamin D deficiency.

Various factors can increase the risk of a deficiency.

Diet: People who do not eat enough vitamin D-rich foods, including fortified dairy products and cereals, may have low levels of vitamin D.

Lifestyle factors: Some people spend little time outdoors due to work, ill health, a lack of outdoor space in their neighborhood, or other factors. These people have less opportunity to expose their skin to sunlight. Those who wear clothes that cover all of their body, whether to protect it from the sun or for cultural or religious reasons, may also have a higher risk of a deficiency.

The Office of Dietary Supplements (ODS) recommend that people who use a lot of sunscreen or wear clothing that covers the body should include sources of vitamin D in their diet.

Geographical factors: People living in certain parts of the word — Northern Canada and Alaska, for example — may have less access to the sun's UVB rays, especially in winter. People who live in a hot climate may also be at risk, as they often try to avoid the heat and strong sunlight by staying indoors.

Pollution: Particles in the air can block UVB rays and prevent them from reaching the skin. People who live in highly polluted areas may also be more likely to avoid spending time outside.

Absorption problems: Crohn's disease, celiac disease, and other conditions can affect how the intestines absorb nutrients, including vitamin D.

Medications: Some drugs reduce the body's ability to absorb or synthesize vitamin D. These include steroids and some drugs for lowering cholesterol, among others.

Smoking: Levels of deficiency appear to be higher among smokers. Some experts have suggested that smoking may affect the gene that activates the production of vitamin D-3 in the body.

Obesity: Research has found lower vitamin D levels in people with obesity, or a body mass index (BMI) of 30 or more. This link may be stem from the ways in which body fat affects vitamin D absorption. Some people with obesity may spend less time outdoors due to mobility issues. Those who have undergone bariatric surgery may also have absorption problems. Conversely, people whose BMI of 25–29.9 classified them as overweight appeared to have a lower risk of a deficiency than those who were not overweight. The authors suggest that dietary factors are responsible for this difference.

Skin type: People with darker skin need more sunlight exposure to produce vitamin D than those with lighter skin. People with pale skin or a history of skin cancer may avoid sun exposure to protect their skin from damage.

Age: The ability to convert vitamin D to calcitriol may decline with age due to decreased kidney function. As a result, calcium absorption will fall.

Kidney and liver health: People with liver disease and kidney disease tend to have lower vitamin D levels. These diseases can affect the body's ability to synthesize vitamin D or turn it into its active form.

Pregnancy: The need for vitamin D may increase during pregnancy, but experts remain unsure whether supplements are a good idea. The authors of a 2019 Cochrane review concluded that taking supplements during pregnancy may reduce the risk of preeclampsia, gestational diabetes, low birth weight, and severe bleeding after delivery. However, it may also increase the risk of preterm birth, which is birth before 37 weeks. The authors called for further research.

Breastfeeding infants: Human milk is low in vitamin D, which means that breastfeeding infants are at risk of a deficiency. The Centers for Disease Control and Prevention (CDC) recommend giving a vitamin D supplement to all breastfeeding infants from the first few days of life until they consume 1 l or more of formula milk each day. Supplementation becomes unnecessary at this point because formula milk contains added vitamin D.

Groups with a higher risk

A major study in the United States from 2001–2006 found that 24% of the population were at risk of low vitamin D levels, while 8% were at risk of a deficiency. On the other hand, 1% of the population had levels of vitamin D that were so high that they could be harmful.

In 2019, experts published a report on data from 2011–2012. They looked at how vitamin D deficiencies affect specific populations in the U.S. The findings suggested that African American adults have the highest risk of a deficiency, followed by Hispanic people.

A vitamin D deficiency may produce no symptoms, or symptoms may take several years to appear. However, it may increase the risk of long term health problems.

In time, low levels of vitamin D can lead to:

Osteoporosis: The bones become thin or brittle. The first sign may be a bone breaking easily as a result of minor trauma. It often affects older people.

Osteomalacia: This can affect children. The bones become soft, resulting in bone deformities, short stature, dental problems, fragile bones, and pain when walking.

Researchers are looking into whether other symptoms or conditions, such as depression, bone pain, and weakness, may result from low vitamin D levels.

Can low vitamin D levels lead to hair loss? Find out here.

An individual's specific need for vitamin D will depend on various factors, including their age, UVB exposure, diet, and health status.

If a blood test shows that a person has or is at risk of a vitamin D deficiency, the doctor is likely to advise them to increase their intake.

The ODS recommend the following intake each day:

• 0–12 months: 400 IU (10 micrograms [mcg])
• 1–70 years: 600 IU (15 mcg)
• 71 years and over: 800 IU (20 mcg)

However, it is not possible to measure how much vitamin D a person obtains from sunlight.

Individuals should talk to their doctor about their vitamin D needs and how to increase their intake.

Supplements

Some people may need to take supplements, but it is best to talk to a doctor before doing so, as some can have adverse effects. The doctor will also provide advice on a suitable dosage.

Vitamin D supplements are available for purchase online.

Foods sources of vitamin D

Good dietary sources of vitamin D include:

• oily fish, such as mackerel or salmon
• beef liver
• cheese
• mushrooms
• egg yolks
• fortified foods, including some breakfast cereals, orange juice, milk, soy drinks, and margarine

What are the best dietary sources of vitamin D? Learn more here.

Exposure to natural sunlight

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Short periods spent outdoors can boost vitamin D levels.

Sunlight is important for boosting vitamin D, but inappropriate sun exposure increases the risk of skin cancer.

For safe exposure to sunlight, a person should spend a short time outdoors each day without sunscreen and with their forearms, hands, or lower legs exposed to the sun.

When to do this and for how long will depend on the time of year, geographical location, and other factors.

People should ask their doctor about safe ways to increase sunlight exposure, especially if they have fair skin or conditions that affect the skin, such as psoriasis.

How can you get more vitamin D from the sun? Get some tips here.

The best ways to prevent a vitamin D deficiency are to eat foods that are rich in this nutrient and to spend some time outside each day.

Some tips for avoiding a deficiency include:

Maintaining a healthy body weight: Cycling or walking can provide both exercise and exposure to sunlight.

Treating medical conditions: People with health conditions that affect the absorption of nutrients may find that treating the underlying condition helps boost their levels of certain nutrients, including vitamin D.

Being proactive about preventive health: People with a family history of osteoporosis or vitamin D deficiency may wish to consider speaking to their doctor about screening.

Most people can obtain the vitamin D they need from the diet and exposure to sunlight.

Anyone who is worried about their intake of vitamin D or experiences any of the symptoms of a deficiency should speak to a doctor.

How Much Vitamin D Supplement For Deficiency

Source: https://www.medicalnewstoday.com/articles/318060

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How Long To Replenish Vitamin D Deficiency

How Long To Replenish Vitamin D Deficiency

Photo Courtesy: Michael Godek/Getty Images

Are you getting enough sun? In many parts of the world, that might prove difficult during the winter months — and it can impact more than your sunny disposition.When exposed to sunshine, our bodies produce vitamin D, something our bodies need to maintain healthy bones and teeth; support our immune and cardiovascular systems; and stave off certain diseases, like type 1 diabetes. Some reports suggest that roughly three-quarters of American teens and adults might not be getting enough vitamin D. So, how can you turn that number around?

The National Institutes of Health (NIH) makes recommendations for what one's daily intake of vitamin D should be based on age, gender and other factors. The recommendations, in micrograms (mcg), can be summarized as follows:

Photo Courtesy: Sean Gladwell/Getty Images

• Infants (up to 12 months): 10 mcg daily
• Children (1 to 13 years): 15 mcg daily
• Teens (14 to 18 years): 15 mcg daily
• Adults (19 to 50 years): 15 mcg daily
• Older adults (51 to 70 years): 15 mcg daily
• Seniors (70+ years): 20 mcg daily

So, how can you supplement your vitamin D intake if all that basking in the sun isn't cutting it? Thanks to the Dietary Guidelines for Americans, we've rounded up 10 healthy foods that can help you reach those daily vitamin D goals.

Salmon

Salmon comes in quite a few different varieties — canned sockeye salmon, smoked chinook salmon, canned pink salmon, cooked sockeye salmon, cooked pink salmon and even cooked wild coho salmon — and all of them are chock-full of vitamin D. All of these options will help you hit your goals. After all, a three-ounce serving of canned sockeye salmon contains 17.9 mcg of vitamin D, while a three-ounce portion of cooked sockeye salmon contains 11.1 mcg of vitamin D.

Photo Courtesy: Justin Ong/Getty Images

Smoked Whitefish

Want to change up that salmon intake? Whitefish can help with that. While whitefish are a species of fish, the term also refers to a cluster of types of fish, all of which have a mild, slightly sweet flavor. Some of the most popular "whitefish" include pollock, bass, cod, halibut, grouper and haddock. On average, a standard three-ounce serving of smoked whitefish contains an impressive 10.8 mcg of vitamin D.

Photo Courtesy: Bohemian Nomad Picturemakers/Getty Images

Swordfish

If you're looking for a terrific source of vitamin D, and to break up all that whitefish and salmon, try swordfish. These creatures can grow to be a whopping 1,400 pounds — and nearly 15-feet in length. While you wouldn't want to tangle with one of these in the ocean, encountering it as a nice, grilled steak is a treat. Best of all, a three-ounce portion will provide you with 14.1 mcg of vitamin D.

Photo Courtesy: Shawn Miller/Getty Images

Tilapia

Tilapia is a cluster of fish species that aren't found in nature. That is, tilapia is a farmed fish, which makes it pretty inexpensive. This mild species is the fourth most common type of seafood eaten by Americans, in part because of its versatility. We recommend a nice herb-and-parmesan crust, but, any way you slice it (or season it), a three-ounce portion will provide you with 3.1 mcg of vitamin D.

Photo Courtesy: Mike Kemp/Getty Images

Canned Tuna

Not into canned food? Well, canned fish should probably be your exception. In fact, canned tuna, in addition to being readily available and inexpensive, can make an abundance of tasty meals, from tuna salad and melts to casseroles. Best of all, a three-ounce serving of light tuna canned in oil contains about 5.7 mcg of vitamin D.

Photo Courtesy: LauriPatterson/Getty Images

Mushrooms

The five fish options we've listed above might not have surprised you, but this one might. Many varieties of mushrooms — including portabella, cremini, morels, chanterelles, maitake, and even your basic white button mushrooms — are excellent sources of vitamin D. In fact, half a cup of grilled portabella mushrooms delivers an impressive 7.9 mcg of vitamin D.

Photo Courtesy: Robert Lowdon/Getty Images

Eggs

Eggs — and, in particular, egg yolks — are one of the easiest, cheapest and quickest ways to nab some vitamin D. However, they may not be the food of choice for folks with high cholesterol. If your diet allows, whip up two scrambled eggs and enjoy getting 5% of your recommended daily intake of vitamin D first thing in the morning.

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Milk

Milk is more than just a great source of calcium. In fact, vitamin D is among its significant nutritional benefits. When it comes to a 16-ounce serving of cow's milk, the vitamin D content varies based on the milk's composition. For example, whole milk contains 6.3 mcg of vitamin D, while 2%, 1% and skim milk all contain 5.9 mcg. Even soy and dehydrated (powdered) milk will help you reach your goals by providing 5.8 mcg and 3.4 mcg of vitamin D respectively.

Photo Courtesy: JW LTD/Getty Images

Yogurt

Milk is not the only dairy product capable of delivering some serious vitamin D benefits. Of course, the nutritional value of yogurt changes depending upon the variety. For example, Greek-style yogurt contains more protein and less sugar than other types of yogurt. Nonetheless, you can still expect anywhere from 2 to 3 mcg of vitamin D per eight-ounce serving, regardless of the variety of yogurt.

Photo Courtesy: Westend61/Getty Images

Pork

So far, you've seen lots of fish and dairy options. You might be wondering, Where's the meat? Well, generally speaking, beef and chicken are not great sources of vitamin D. In fact, if you're a meat lover in search of some vitamin D, pork is your best bet. The nutritional value of pork varies depending upon the cut, method of preparation and more, but you're likely to find between 0.2 to 2.2 mcg of vitamin D in a standard three-ounce serving of pork.

Photo Courtesy: EasyBuy4u/Getty Images

Resource Links:

• The U.S. Department of Health and Human Services and Department of Agriculture's Dietary Guidelines for Americans
• The National Institutes of Health (NIH)

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How Long To Replenish Vitamin D Deficiency

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H Pylori And Vitamin D

H Pylori And Vitamin D

What is an H. Pylori Infection?

Fact Checked Updated: Jan 22, 2021

Helicobacter pylori (H. pylori) is a bacteria that lives in the digestive tract. Experts claim up to two-thirds of the world's population has H. pylori. Many people are not adversely affected by its presence, but some people develop stomach and duodenal inflammation and ulcers. In a very small percentage of the population, infection from H. pylori bacteria leads to stomach cancer.

What Causes H. pylori Infection?

One person can acquire h. pylori bacteria from another, either by a fecal-oral or oral-oral route. It can also be acquired through contaminated water or food. Once the bacteria enters the gastrointestinal (GI) tract, it attaches itself to the lining of the stomach and produces certain toxins like Vac-A that causes inflammation of the stomach lining, which further damages the stomach lining. When acid gets through the lining of a stomach damaged by bacteria, it causes painful ulcers. These ulcers can further complicate with bleeding or perforation. Perforated ulcers are characterized by a hole in the wall of the stomach or small intestinal. Both bleeding and perforated ulcers require surgery. Most people infected with H. pylori do not react this way, however, and experts do not know why others do.

Symptoms of H. pylori Infection

A person infected with h. pylori will only know about the infection if they develop gastritis (inflammation of the stomach) or ulcers. Signs of stomach ulcers include:

• A dull or burning pain in the stomach that gets worse when the stomach is empty
• Nausea
• Loss of appetite
• Indigestion
• Frequent burping
• Bloating
• Vomiting
• Unintentional weight loss

The following symptoms require immediate medical attention. They may indicate complications of the ulcer such as bleeding or perforation.

• Persistent abdominal pain
• Dark or bloody stool
• Difficulty breathing
• Fatigue
• Pale skin
• Vomit that looks like coffee grounds or contains blood
• Dizziness or fainting
• Feeling full after eating a small amount
• Belly pain or swelling
• Constant decreased appetite

Risk Factors for H. pylori

Children are the demographic most likely to contract h. pylori. People who live in crowded areas, or in places that lack clean, running water, are at greater risk of contracting the bacteria, as are those living in developing countries where general living conditions are unsanitary.

4. Diagnosing H. pylori

More than 90% of duodenal ulcer and 70% of stomach ulcer patients are infected with H. pylori. Simple tests can confirm the presence of the bacteria.

• Blood tests. The blood of an infected person will contain antibodies that indicate that he has had the infection recently. Since antibodies can show up for years after eradication of the infection, a blood test is a good way to diagnose past or current H. pylori infection.
• Urea breath test. The patient drinks a liquid or swallows a capsule of urea. He or she then breathes into a bag, and this breath sample is sent to the lab. Higher-than-normal levels of carbon dioxide confirm the presence of H. pylori.
• Stool test. The doctor may wish to have a stool sample sent to the lab to test for foreign proteins.
• Upper gastrointestinal endoscopy. An endoscopy allows the doctor to look at ulcers and test tissue samples for H. pylori. During the exam, a tube with a small camera is inserted into the mouth, through the esophagus, and into the stomach and duodenum. The doctor will evaluate the ulcers and take a tissue sample or biopsy.
• X-ray. The doctor may wish to view the upper GI tract. The patient drinks barium to color the GI tract so that it shows up clearly in the x-ray.

Treating H. pylori

Treatment for H. pylori infection with ulcers usually consists of one to two weeks of medication. The infected individual will take antibiotics -- often two kinds -- to get rid of the bacteria, as well as an acid-blocker medication to heal the stomach lining, keep the ulcers from returning, and reduce pain and inflammation. The newest treatment for H pylori - sequential therapy consists of an antibiotic plus an acid blocker for five days, followed by two other antibiotics plus an acid blocker for the next five days.

Preventing H. pylori

With the majority of the population carrying this bacteria, it may not be possible to avoid an H. pylori infection altogether. However, the following hygiene measures can lower the chance of contracting H. pylori:

• Follow good hygiene techniques after using the bathroom and being outside, and before eating
• Avoid food served by people who do not use good hygiene techniques
• Avoid contaminated water. While traveling in developing countries, drink only bottled water
• Cook meats and other animal products thoroughly before eating

For people who already carry the H. pylori bacteria, the following changes can help prevent stomach ulcers:

• Stop smoking
• Reduce alcohol intake
• Substitute acetaminophen for other pain-relieving drugs (these drugs can also cause gastritis and ulcers)
• Avoid caffeine
• Avoid spicy foods
• Reduce stress levels

Prognosis for H. pylori Infection

People with mild symptoms have an excellent prognosis. Approximately 20 percent of patients with serious symptoms will have a recurrence of the infection, although ulcers usually heal well with little to no scarring. Severe infections left untreated can lead to damage to the stomach and upper GI tract, such as bleeding and perforation, which can be fatal. One more reason to treat this infection: H. pylori infection raises the risk of certain types of stomach cancer. About two percent of people with H. pylori infection develop gastric cancer.

H Pylori And Vitamin D

Source: https://facty.com/ailments/stomach/what-is-an-h-pylori-infection/

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Cremas Con Vitamina D Para Psoriasis

Cremas Con Vitamina D Para Psoriasis

La vitamina D es esencial y necesaria para mantener un estado de salud óptimo en nuestra piel. Así mismo, esta vitamina actúa sobre el envejecimiento cutáneo gracias a que se obtiene en primera instancia por la radiación UV, la cual pasa luego al torrente sanguíneo y se convierte en nutriente. Por este motivo, hemos decidido recomendarte a continuación las mejores 7 cremas con vitamina D para nutrir y rejuvenecer las capas de tu piel.

1. Vita Sciences: crema con vitamina D para la psoriasis

Crema con vitamina D para nutrir la piel seca del cuerpo y rostro, sobre todo para aquellas personas que padecen psoriasis. Cada dosis de este producto libera 2,000 UI de vitamina D3 por dosis medida.

Si sufres de piel seca, picazón u otro tipo de afección similar, esta crema con aceite de vitamina D se encargará de aliviar las molestias y mostrar mejorías en poco tiempo.

2. Pure Valley: crema humectante con vitamina D

Crema con vitamina D que humecta, hidrata y nutre todo tipo de piel. Presentada en botella de 6 oz. Esta fórmula se encarga de prevenir la piel seca y las arrugas.

El extracto de vitamina D que compone la fórmula de esta crema busca aliviar todo tipo de molestias, irritación, quemaduras y marcas sobre las capas de tu piel.

3. AnuMed Intl: crema con vitamina D-3 y magnesio

Fórmula en crema con vitamina D-3, la cual actúa como un nutriente esencial que promueve la absorción de calcio. Así mismo, cuenta con extracto de magnesio que absorbe más rápido las vitaminas en la piel.

Esta crema con magnesio y vitamina D-3 es fácil de aplicar. Al usarla todos los días notarás la mejoría en poco tiempo.

4. NOW Foods: crema facial con vitamina D-3

Crema facial con vitamina D-3 y minerales naturales que actúan para beneficiar las capas de tu piel. Cuenta con 1,000 IU por gramo.

Este tipo de crema facial destaca por su alto componente en vitamina D-3, la cual repara, humecta, hidrata y revitaliza las líneas de la edad que puedas presentar en tu piel.

5. Mariu Badescu: crema antiedad con vitaminas A, D y E

Fórmula en crema antiedad que contiene vitaminas A, D y E, además de ácido hilaurónico. Cada uno de estos ingredientes nutritivos contribuye a revitalizar e hidratar la piel de tu cuerpo.

Esta crema con ingredientes naturales, asegura una intensa hidratación y nutrición para tus poros. Así mismo, protege las capas de tu piel contra la pérdida de firmeza.

6. Sun Dew: crema orgánica con vitamina D

Crema con ingredientes orgánicos y vitamina Dde alta concentración. Se encarga de revitalizar, rejuvenecer y humectar las capas de tu piel.

La vitamina D de esta fórmula cremosa cumple un papel vital en el desarrollo y reparación de las células muertas que puede presentar tu piel, además de actuar sobre el envejecimiento prematuro.

7. Vitaminerals: crema reparadora para la piel

Fórmula cremosa reparadora para la piel con vitamina E, D, A y pantenol. Esta crema cuenta con ingredientes ricos en vitaminas y 100% orgánicos, los cuales buscan hidratar, rejuvenecer y mejorar el aspecto de tu piel.

Las múltiples vitaminas que componen esta crema reparadora, son vitales para actuar contra el envejecimiento prematuro que podría afectar las capas de tu piel. Fácil de usar y comprobada científicamente.

También te puede interesar: ¿Cómo puedo rejuvenecer mi piel y eliminar las líneas de expresión?

Cremas Con Vitamina D Para Psoriasis

Source: https://laopinion.com/guia-de-compras/7-cremas-con-vitamina-d-para-nutrir-y-rejuvenecer-tu-piel/

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Can We Get Vitamin D From Sunlight Through Glass

Can We Get Vitamin D From Sunlight Through Glass

Photo Courtesy: Michael Godek/Getty Images

Are you getting enough sun? In many parts of the world, that might prove difficult during the winter months — and it can impact more than your sunny disposition.When exposed to sunshine, our bodies produce vitamin D, something our bodies need to maintain healthy bones and teeth; support our immune and cardiovascular systems; and stave off certain diseases, like type 1 diabetes. Some reports suggest that roughly three-quarters of American teens and adults might not be getting enough vitamin D. So, how can you turn that number around?

The National Institutes of Health (NIH) makes recommendations for what one's daily intake of vitamin D should be based on age, gender and other factors. The recommendations, in micrograms (mcg), can be summarized as follows:

Photo Courtesy: Sean Gladwell/Getty Images

• Infants (up to 12 months): 10 mcg daily
• Children (1 to 13 years): 15 mcg daily
• Teens (14 to 18 years): 15 mcg daily
• Adults (19 to 50 years): 15 mcg daily
• Older adults (51 to 70 years): 15 mcg daily
• Seniors (70+ years): 20 mcg daily

So, how can you supplement your vitamin D intake if all that basking in the sun isn't cutting it? Thanks to the Dietary Guidelines for Americans, we've rounded up 10 healthy foods that can help you reach those daily vitamin D goals.

Salmon

Salmon comes in quite a few different varieties — canned sockeye salmon, smoked chinook salmon, canned pink salmon, cooked sockeye salmon, cooked pink salmon and even cooked wild coho salmon — and all of them are chock-full of vitamin D. All of these options will help you hit your goals. After all, a three-ounce serving of canned sockeye salmon contains 17.9 mcg of vitamin D, while a three-ounce portion of cooked sockeye salmon contains 11.1 mcg of vitamin D.

Photo Courtesy: Justin Ong/Getty Images

Smoked Whitefish

Want to change up that salmon intake? Whitefish can help with that. While whitefish are a species of fish, the term also refers to a cluster of types of fish, all of which have a mild, slightly sweet flavor. Some of the most popular "whitefish" include pollock, bass, cod, halibut, grouper and haddock. On average, a standard three-ounce serving of smoked whitefish contains an impressive 10.8 mcg of vitamin D.

Photo Courtesy: Bohemian Nomad Picturemakers/Getty Images

Swordfish

If you're looking for a terrific source of vitamin D, and to break up all that whitefish and salmon, try swordfish. These creatures can grow to be a whopping 1,400 pounds — and nearly 15-feet in length. While you wouldn't want to tangle with one of these in the ocean, encountering it as a nice, grilled steak is a treat. Best of all, a three-ounce portion will provide you with 14.1 mcg of vitamin D.

Photo Courtesy: Shawn Miller/Getty Images

Tilapia

Tilapia is a cluster of fish species that aren't found in nature. That is, tilapia is a farmed fish, which makes it pretty inexpensive. This mild species is the fourth most common type of seafood eaten by Americans, in part because of its versatility. We recommend a nice herb-and-parmesan crust, but, any way you slice it (or season it), a three-ounce portion will provide you with 3.1 mcg of vitamin D.

Photo Courtesy: Mike Kemp/Getty Images

Canned Tuna

Not into canned food? Well, canned fish should probably be your exception. In fact, canned tuna, in addition to being readily available and inexpensive, can make an abundance of tasty meals, from tuna salad and melts to casseroles. Best of all, a three-ounce serving of light tuna canned in oil contains about 5.7 mcg of vitamin D.

Photo Courtesy: LauriPatterson/Getty Images

Mushrooms

The five fish options we've listed above might not have surprised you, but this one might. Many varieties of mushrooms — including portabella, cremini, morels, chanterelles, maitake, and even your basic white button mushrooms — are excellent sources of vitamin D. In fact, half a cup of grilled portabella mushrooms delivers an impressive 7.9 mcg of vitamin D.

Photo Courtesy: Robert Lowdon/Getty Images

Eggs

Eggs — and, in particular, egg yolks — are one of the easiest, cheapest and quickest ways to nab some vitamin D. However, they may not be the food of choice for folks with high cholesterol. If your diet allows, whip up two scrambled eggs and enjoy getting 5% of your recommended daily intake of vitamin D first thing in the morning.

Photo Courtesy: valentinrussanov/Getty Images

Milk

Milk is more than just a great source of calcium. In fact, vitamin D is among its significant nutritional benefits. When it comes to a 16-ounce serving of cow's milk, the vitamin D content varies based on the milk's composition. For example, whole milk contains 6.3 mcg of vitamin D, while 2%, 1% and skim milk all contain 5.9 mcg. Even soy and dehydrated (powdered) milk will help you reach your goals by providing 5.8 mcg and 3.4 mcg of vitamin D respectively.

Photo Courtesy: JW LTD/Getty Images

Yogurt

Milk is not the only dairy product capable of delivering some serious vitamin D benefits. Of course, the nutritional value of yogurt changes depending upon the variety. For example, Greek-style yogurt contains more protein and less sugar than other types of yogurt. Nonetheless, you can still expect anywhere from 2 to 3 mcg of vitamin D per eight-ounce serving, regardless of the variety of yogurt.

Photo Courtesy: Westend61/Getty Images

Pork

So far, you've seen lots of fish and dairy options. You might be wondering, Where's the meat? Well, generally speaking, beef and chicken are not great sources of vitamin D. In fact, if you're a meat lover in search of some vitamin D, pork is your best bet. The nutritional value of pork varies depending upon the cut, method of preparation and more, but you're likely to find between 0.2 to 2.2 mcg of vitamin D in a standard three-ounce serving of pork.

Photo Courtesy: EasyBuy4u/Getty Images

Resource Links:

• The U.S. Department of Health and Human Services and Department of Agriculture's Dietary Guidelines for Americans
• The National Institutes of Health (NIH)

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Can We Get Vitamin D From Sunlight Through Glass

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Can Low Vitamin D Cause Joint Pain

Can Low Vitamin D Cause Joint Pain

BMJ. 2008 Jun 14; 336(7657): 1371–1374.

Lesson of the Week

Unrecognised severe vitamin D deficiency

John L Sievenpiper

¹Endocrine Unit, Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP

Mark Verrill

¹Endocrine Unit, Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP

Richard Quinton

¹Endocrine Unit, Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP

Simon H S Pearce

¹Endocrine Unit, Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP

This article has been cited by other articles in PMC.

Vitamin D deficiency remains common and may mimic other musculoskeletal disorders or mental health problems

Since Glisson gave the first authoritative description of rickets in 1650 and McCollum and coworkers described its cause as vitamin D deficiency in 1922,¹ clinical descriptions of hypovitaminosis D have become more variable, making the condition less recognisable.² At the same time, the condition remains highly prevalent world wide, yet is preventable.³ We present two cases of longstanding undiagnosed severe vitamin D deficiency with important clinical consequences.

Case reports

Case 1

A 53 year old woman of Pakistani origin underwent mastectomy for invasive ductal carcinoma of the right breast with adjuvant radiotherapy and tamoxifen treatment. Over the next two years she presented at her follow-up appointments with migratory musculoskeletal pains, including pain in the right arm, loin, right posterior chest with bony tenderness and whole body discomfort. A chest x ray showed an irregularity of the upper cortex of the right posterolateral seventh rib. An isotope bone scan showed multiple areas of increased radionuclide uptake in the ribs and left sacroiliac joint. We made a working diagnosis of metastatic bone disease and started the aromatase inhibitor anastrazole and the oral bisphosphonate sodium clodronate.

Over the next six months her pains worsened, and areas of tenderness in the arms, legs, ribs, and left sacroiliac joint were poorly controlled by cocodamol. A repeat bone scan showed no change (fig 1)​ . A poor prognosis was given and combination chemotherapy (adriamycin, taxotene) was planned, but first she took a six week summer trip to Pakistan to visit family. On her return to the United Kingdom, her symptoms had completely resolved. A whole body computed tomography scan showed a pelvic stress fracture but no evidence of visceral metastasis. Chemotherapy was delayed.

Fig 1 Tc 99m HDP bone scanbefore rescue therapy with vitamin D (left) showed increased uptake of radionuclide tracer in ribs and left sacroiliac joint. After rescue therapy (right), scan showed no appreciable uptake at any sites

Her symptoms relapsed during winter and spring. When pain in the left lateral ribs and right hip worsened, she was switched to a second line aromatase inhibitor, exemestane. She was also given an intravenous infusion of the aminobisphosphonate pamidronate 90 mg, after which she acutely developed distal paraesthesiae and muscle spasms. A positive Chvostek's sign was noted along with serum corrected calcium of 1.25 mmol/l (normal range 2.12-2.60 mmol/l).

She was treated with intravenous calcium gluconate followed by oral calcium carbonate and was referred to the endocrinology service. At follow-up, her serum corrected calcium was 2.17 mmol/l and she had a raised plasma parathyroid hormone concentration of 474 ng/l (normal range 10-60 ng/l) and a serum 25-hydroxyvitamin D concentration of 19 nmol/l (local laboratory reference range 25-75 nmol/l). She had risk factors for severe hypovitaminosis D (skin pigmentation, use of traditional full-body coverings, residence at high latitude (55°N), and multiparity) and reported an aversion to consumption of dairy products. Severe vitamin D deficiency was diagnosed. Because of previous irregular follow-up and variable concordance with medication, she was treated with intramuscular cholecalciferol 300 000 U monthly and oral calcium carbonate 1 g daily.

Four years later her symptoms had entirely resolved, biochemistry was normal, and repeat isotope bone scans (fig 1) also remained normal.

Case 2

A 35 year old woman of Pakistani origin presented to her general practitioner with unexplained migratory muscle and bone pains in the middle trimester of her third pregnancy. The pain continued for six months and after the birth of her childa diagnosis of postpartum depression with somatisation was made and treatment with fluoxetine started. Her pains persisted over the next two years and were variously recorded as plantar fasciitis, muscle pain, backache, and generalised joint pain.

On assessment in the endocrine clinic, she reported increasing pains in her ribs and hip on the right, both heels, and lower abdomen. Physical examination revealed an antalgic gait with right sided hip pain, proximal myopathy, and tenderness over her right lower ribs. Several risk factors for vitamin D deficiency were identified: skin pigmentation, use of a head scarf, multiparity, and residence at 55° North latitude. She did not eat cheese, and rarely ate milk or fish, and had a history of iron deficiency anaemia.

Subsequent investigations confirmed severe vitamin D deficiency, with a corrected serum calcium of 1.89 mmol/l (normal range 2.12-2.60 mmol/l), plasma parathyroid hormone of 864 ng/l (normal range 10-60 ng/l) and 25-hydroxyvitamin D of 7 nmol/l (local laboratory reference range 25-75 nmol/l). An x ray of her pelvis showed a pseudofracture (Looser's zone) on the right lesser trochanter (fig 2)​ . She was given oral ergocalciferol 10 000 U daily. Her daughter, 30 months old, was described as having leg deformity, and treatment with ergocalciferol drops was started after assessment.

Fig 2 Pseudofracture (white arrow) of the medial aspect of the right femur proximal to the lesser trochanter

Discussion

These cases highlight that osteomalacia secondary to severe vitamin D deficiency may remain unrecognised for many years, at one extreme staying below the clinical threshold as a migratory non-specific pain syndrome and at the other extreme mimicking metastatic bone disease and leading to a spurious indication for chemotherapy.

Similar cases are likely to become more prevalent. In the UK, nearly 90% of adults aged 45 have suboptimal concentrations of vitamin D (<75 nmol/l) in winter and spring, of whom 16% have severe vitamin D deficiency (<25 nmol/l).⁴ Acknowledged as an emerging problem in the South Asian community more than three decades ago,^{5 6 7} vitamin D deficiency affects nearly all non-white residents of the UK to some degree, and 50% have severe deficiency in winter and spring.⁸ Women are especially at risk for moderate to severe (<25-40 nmol/l) vitamin D deficiency.⁴ The risk is fourfold for those who are multiparous and fivefold for those who are veiled.⁹ Poor exposure to sunlight, higher latitude, winter season, inadequate diet, older age, obesity, and housebound status are also important risk factors.^{3 4 9 10 11 12 13}

The high prevalence of hypovitaminosis D mandates early clinical recognition. Widespread pain, which may also be a presenting feature of affective disorders, can be a prominent manifestation in South Asians.^{14 15} Pain is 3.5 times as prevalent in South Asians with severe hypovitaminosis D (<25 nmol/l) than those without in the UK.¹⁵ But the lack of specificity complicates interpretation. Symptoms of hypovitaminosis D, including diffuse or migratory pain affecting several sites (especially the shoulder, pelvis, ribcage, and lower back) have also been misdiagnosed as physical illnesses, including fibromyalgia, polymyalgia rheumatica, and ankylosing spondylitis.² Associated polyarthralgias and synovitis of the hands and feet have been confused with rheumatoid arthritis and polymyositis, and myopathy with proximal weakness has been confused with amyotrophic lateral sclerosis, and pseudofractures have been misinterpreted as metastatic bone disease.² Although persistent, non-specific musculoskeletal pains and weakness may represent a unifying set of features,^{2 3 16} this overlap with other rheumatological conditions, as well as depression, necessitates a high index of suspicion in the diagnosis of hypovitaminosis D.

Experts have called for adequate vitamin D status to be dealt with at the public health level.^{17 18} Higher 25-hydroxyvitamin D thresholds have been proposed as the health sequelae of mild hypovitaminosis D deficiency have expanded beyond rickets and osteomalacia to include low bone mineral density, impaired function of the legs, fractures, admissions to nursing homes, colorectal and prostate cancer, non-Hodgkin's lymphoma, periodontal disease, type 1 diabetes, and multiple sclerosis.³ Evidence is emerging of the epidemiological link of vitamin D deficiency to breast cancer, and also that dietary supplementation could reduce cancer risk.^{19 20}. A meta-analysis of randomised controlled trials has also shown a modest reduction in all cause mortality in groups treated with vitamin D.²¹

An optimal serum concentration was recently defined as ≥75 nmol/l on the basis of several of these outcomes.²² This higher threshold necessarily implies a revision of the current recommended intakes for vitamin D. An increase in daily vitamin D intake from 200-600 IU ²³ to ≥1000 IU for all adults has been proposed, to achieve serum concentrations ≥75 nmol/l. This includes input from the primary source of vitamin D, cutaneous photosynthesis from ultraviolet B sunlight, which supplies 90% of total circulating levels in most people.²⁴ Achieving these vitamin D targets in the UK presents a considerable challenge—obstacles include high latitude, persistent cloud cover, office based Western lifestyles, and inadequate dietary sources of vitamin D, including a lack of food fortification⁴ and suitable over the counter preparations.⁴

Guidance on screening, recommended intakes, and exposure to sunlight has not adapted to changing demographics and epidemiology. In particular, UK recommendations for exposure to sunlight may not have struck the necessary balance between preventing skin cancer and avoiding vitamin D deficiency.²⁵ Warnings to limit direct exposure to sunlight, seek shade, cover skin, and apply sunscreens with a protection factor of 15 or more (factor 15 blocks vitamin D photosynthesis by 99%) do not have uniform health effects across different skin colours, dress habits, or age groups.^{3 18 22 24} In the absence of effective prevention strategies for severe hypovitaminosis D, clinicians must remain vigilant to its heterogeneous and potentially sinister clinical presentation.

Notes

We thank Richard Peace of the regional medical physics department, Royal Victoria Infirmary, for help with the bone scan images.

Contributors: JLS performed the literature search, retrieved the papers, and wrote the manuscript. EAM collated the clinical data for case 1 and revised significant intellectual content. MV was in charge of the oncological management in case 1 and revised significant intellectual content. RQ was in charge of the endocrinological management in case 1 and revised significant intellectual content. SHP was in charge of the management in case 2, revised significant intellectual content, had the idea for the manuscript, and is the guarantor.

Funding: None.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Patient consent obtained.

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Can Low Vitamin D Cause Joint Pain

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2427091/

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