Vitamin D plays an essential role in keeping our bones, teeth and muscles healthy. Naturally,
we obtain our daily requirements from diet and sun exposure. However, deficiency may
occur amongst individuals with darker skin and those experiencing inadequate sun exposure.
So, if you want to learn more about Vit D, the symptoms of deficiency and how we replace
it, keep watching.
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My name is Dr Hart-Pinto. In this series, we will review all areas of nutrition, helping
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What is Vitamin D and why is it so important?
Vitamin D is essential for the regulation of two minerals: calcium and phosphate. Therefore,
Vitamin D plays an imperative role in maintaining healthy bones, teeth and muscles. Vitamin
D additionally plays a regulatory role in the body's immune system. However, the mechanism
of how Vitamin D influences the immune system is not well understood. Researchers have demonstrated
the development of autoimmune inflammatory diseases is associated with low levels of
Vitamin D.
Vitamin D is present in our bodies in 2 forms: • Ergocalciferol (Vitamin D2)
and • Chole-calciferol (Vitamin D3) - Most potent
formation, produced by your skin cells when exposed to sunlight, but also consumed in
the diet through animal-based foods
The best dietary sources of vitamin D are: • oily fish including salmon, sardines,
herring and mackerel OR Cod-liver oil • red meat
• liver • egg yolks
• fortified foods – e.g., margarine and breakfast cereals
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Causes of Deficiency
Vitamin D deficiency is common, estimated to affect between 40% and 80% of the UK population
and regularly affects more than 40% in other counties.
The most common cause of Vitamin D deficiency is lack of adequate sun exposure. Our skin
naturally produces up to 90% of our required Vitamin D when exposed to sunlight. However,
environmental factors may impede vitamin D production via this method.
UVB sunlight during the winter months is limited for those living in the northern hemisphere.
Some countries have more variable weather conditions, further restricting the availability
of direct sunlight. Darker skin types contain higher concentrations
of the skin pigment melanin. Melanin plays a role in sun damage protection. However,
the increased pigmentation also makes the skin less efficient in vitamin D production.
Clothes that cover most of the body and face are also problematic. Consequentially, sunlight
is unable to reach our vitamin D producing skin, limiting production.
Finally, as we age, our bodies ability to produce Vitamin D reduces. Furthermore, this
is compounded by an increasing desire to wear more clothes, spend more time indoors, and
develop medical conditions, such as liver and kidney disease. All of which influence
our vitamin D.
Certain medications can also affect our Vitamin D levels by:
• Limiting gastrointestinal absorption o Orlistat -
• By promoting the breakdown of vitamin D in the body
o Antacids o Colestyramine – used for gallstone prevention
o Corticosteroids o Rifampicin – a type of antibiotic
o thiazide diuretics o Digoxin & calcium-channel blockers
o Antiepileptic medications o highly active antiretroviral treatment (HAART)
What are the symptoms of Vitamin D deficiency? Children with Vitamin D deficiency develop
a condition called rickets. Here the deficiency results in inadequate calcification of bones.
Meaning bones are softer with a tendency to bend, creating the classical bow-legged appearance.
Additionally, children may experience bone pain and muscle weakness.
Adults also experience symptoms of bone pain and muscle weakness. However, a mature skeleton
means rickets does not develop. Instead, bones become weakened, in a condition called osteomalacia,
increasing the risk of fractures.
How will my doctor diagnose Vitamin D deficiency? Diagnosis of Vitamin D deficiency is via a
blood test. Your risk of developing the symptoms of Vitamin D deficiency depend on circulating
levels. • Sufficient levels are greater than 50nmol/l.
• Inadequate levels are patients at 25–50 nmol/L
• Deficiency is amongst patients with less than 25 nmol/l
Treatment Where your doctor identifies you have less
than sufficient levels of vitamin D, they will recommend replacement. Oral supplementation
with Vitamin D3 is the treatment of choice for most people. In cases requiring rapid
correction, such as those displaying symptoms due to severe deficiency, a loading regime
of 300,000 units is necessary. This large dose should be divided over several weeks,
for example, 50,000 units once a week for six weeks.
For those with less severe deficiency, there is no requirement for this loading regime.
Therefore, you will likely be prescribed supplementation in line with a maintenance regime. Maintenance
regimes require supplementation with between 800 – 2000 units daily.
Routine monitoring of vitamin D levels is not always needed. Some doctors, however,
may consider rechecking your vitamin D levels at 3-6 months. Additionally, your doctor needs
to review calcium levels one month after commencing treatment.
Should the circumstance arise where your primary care physician or GP struggles to regain control
of vitamin D deficiency, a specialist referral is required.
Vitamin D deficiency prevention Given the prevalence of Vitamin D deficiency
in the northern hemisphere, current UK guidance advises all adults should consider taking
Vitamin D supplementation of 400 Units. Particularly during Autumn and Winter months.
It is advisable for older individuals, 65 plus, and anyone at increased risk for vitamin
D deficiency to consider supplementation of 400 units daily throughout the year. Fortunately,
Vitamin D is available over the counter at these concentrations and is, therefore, readily
available for everyone. Lifestyle changes are an essential means to
maintain a healthy level of vitamin D and prevent deficiency. Most people should produce
a healthy amount of vitamin D when exposed to sunlight, particularly during sunnier months.
Longer durations of sun exposure is necessary among those with darker skin. Excessive sun
exposure, however, can be dangerous and is associated with the development of skin cancers.
So please take care. Dietary changes, aiming to incorporate the
foods we have discussed earlier, can further naturally fortify your vitamin D, so why not
give that a try.
Is it possible to take too much Vitamin D? Yes, taking too much vitamin D can be dangerous.
Excess vitamin D can result in a build-up of calcium in the body, known as hypercalcaemia.
Bone and joint pain, muscle spasms, irregular heartbeats, nausea, vomiting and confusion
are all symptoms of hypercalcaemia. High levels of calcium also increase your risk of developing
renal stones, ouch! Therefore, you should avoid supplementation with anything more than
4000 units per day unless prescribed by your doctor.
What about prognosis? Once identified, Vitamin D deficiencies are
easily treatable with oral supplementation. Therefore, it is imperative to follow your
doctor's advice on oral supplementation and lifestyle factors.
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Of course, this video does not provide individual medical advice and is intended for informational
purposes only. Do not consider this as a substitute for professional
medical advice, diagnosis or treatment. Please do not ignore professional medical
advice in seeking treatment because of something you have heard here.
If you believe you may have a medical emergency, immediately call your doctor or ambulance
service.