Are you suffering from the most common vitamin deficiency?

Worldwide, vitamin D deficiency is the most common vitamin deficiency. Inadequate exposure to sunlight is the most frequent cause. Unbelievably, vitamin D deficiency is very commonplace even in sunshine-drenched countries. Vitamin D deficiency can also result from poor dietary intake. It is challenging to meet one’s vitamin D needs without adequate sunshine exposure.

Vitamin D is one of four fat-soluble vitamins. The others are A, E, and K.

The two forms of vitamin D:

Vitamin D2 – This form is made by plants
Vitamin D3 – This is made in the skin when exposed to sunlight. D3 is more active than D2. Other sources include fortified foods, fatty fish, fish liver oils, liver, and egg yolks.

D2 and D3 are metabolised by the liver and kidneys, respectively, to produce active vitamin D (calcitriol). Vitamin D is stored in the liver and fatty tissue.

Active vitamin D facilitates the absorption of calcium and phosphorous from the intestine. These minerals are then incorporated into bones, facilitating their growth, integrity, and repair.

Vitamin D deficiency most commonly occurs in individuals who:

Do not spend enough time in the sun.
Have a darker complexion.
Are older.
Cover most of their skin, e.g. for religious reasons, or who wear sunscreen when outdoors.
Are under 6 months.

Other causes:

Reduced fat absorption. May occur with age.
Some liver and kidney disorders.
Certain medications – e.g. corticosteroids, verapamil, asthma meds, chemotherapeutic agents, oestrogen replacement therapy, laxatives, statins, antacids, some diabetes medications, diuretics, PPIs (e.g. omeprazole, Alocid, Nexium, pantoprazole), Xenical.

Diagnosis

One is considered vitamin D deficient if 25-hydroxy-vitamin D blood levels are less than 20 nanograms/mL and insufficient if the level is 20-29 nanograms/ mL.

Vitamin D deficiency in infants and the elderly

Infants who are primarily breastfed are predisposed to vitamin D deficiency because breast milk is a poor source of vitamin D. Such infants should be given a vitamin D supplement for their first year.

The elderly are more prone to vitamin D deficiency because:

Vitamin D requirements increase with age.
Their skin is not efficient at making vitamin D.
Many spend most of their day indoors.
If bedridden/ hospitalized for extended periods.
May be taking medications that reduce vitamin D absorption.

Symptoms and signs of vitamin D deficiency

Initially, most persons with vitamin D deficiency are asymptomatic. Within months to a few years, those who are vitamin D deficient may experience:

Frequent and more severe respiratory tract illnesses such as upper respiratory tract infections, bronchitis, pneumonia, and respiratory tract complications from COVID-19.
Extreme tiredness, a long-established and overlooked cause of chronic tiredness.
Poor sleep, especially in children has been linked to vitamin D deficiency.
Musculoskeletal pain especially in the lower back. Those with degenerative arthritis, muscle pains, and generalized pains are more likely to have vitamin D deficiency than those without such.
Depression especially in older adults, may be a result of vitamin D deficiency. Having adequate vitamin D blood levels in pregnancy is associated with a lower chance of post- partum depression.
Anxiety can be a by-product of low levels of vitamin D.
Poor wound healing can result from vitamin D deficiency. Adequate vitamin D levels promote the growth of new tissue, reduce inflammation and wound infections, and ultimately promote wound healing. The foot ulcers of diabetics with low vitamin D levels take longer to heal.
Bone demineralization and ultimately osteoporosis can result from chronic vitamin D deficiency. This increases the chances of bone fractures, even after minor trauma. After bone demineralization, supplementation with vitamin D, even in high doses, does not reverse the process.
Hair loss is often reported, especially in women.
Pins and needles sensation in feet/ hands, and muscle twitches/ spasms can result from low calcium blood levels because of vitamin D deficiency.
Bowed legs (rickets) in children can arise from severe vitamin D deficiency.

Who should take vitamin D supplements?

Those with deficient and insufficient blood levels.
Infants up to 12 months of age.
Postmenopausal women.
If you are on any of the medicines listed above
Elderly persons – especially those housebound/ hospitalized
Women antenatally or when breastfeeding
Those with chronic kidney or liver disease
The obese
Persons with parathyroid tumours

Recommended sources of vitamin D

Compared to a very fair person, darkly pigmented and older persons may require up to 6 times the sun exposure to make the same amount of vitamin D. 5-30 minutes of sun exposure between 10 am and 3 pm, 2 to 3 times a week, is adequate to meet vitamin D3 needs. The arms, legs, face, or back should be exposed.
Vitamin D3 supplement is more efficient than D2 for raising active vitamin D levels.

Check with your doctor to see if you need an oral supplement and what dose is recommended.

Author: Dr. C. Malcolm Grant – Family Physician – Family Care Clinic, Arnos Vale – Former Tutor, Faculty of Medical Sciences, UWI, Cave Hill, Barbados. For appointments: clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)

Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper, or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.