Frequently Asked Questions On Vitamin D Deficiency And How To Deal With It

There are diseases that are emerging in the 21st century and Vitamin D deficiency is one of them. There are a lot of misconceptions regarding Vitamin D deficiency and its diagnosis and management, this blog aims to clear all those.

Any disease can be better understood by asking questions and getting satisfying answers for the same. The following FAQs will help you understand Vitamin D deficiency and its treatment.

Q1. What is Vitamin D and why does our body need it?

Vitamin D is a fat-soluble vitamin. Vitamin D promotes calcium absorption in the gut and maintains adequate serum, calcium and phosphate concentrations to enable normal mineralisation of bones. It is also needed for bone growth and bone remodelling. Without sufficient vitamin D, bones can become thin, brittle or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from osteoporosis.

Adding an over-the-counter vitamin D supplement can make improvements in just three to four months time. Vitamin D with a strength of 1000-2000 international units daily is the recommended dose for most adults.

Dr. M.G. Kartheeka, MBBS, MD

Q2. What are the symptoms of Vitamin D deficiency?

Vitamin D deficiency doesn’t always cause symptoms. When it does, some of the symptoms may include:

•  Difficulty in thinking clearly
•  Bone pain
•  Frequent bone fractures
•  Muscle weakness
•  Soft bones that may result in deformities
•  Unexplained fatigue

Vitamin D deficiency is known to be associated with an increased prevalence of preeclampsia (high blood pressure in pregnancy) which is a common cause of increased mortality rates in pregnancy. In children, it is also associated with small infant size and the development of common childhood diseases, such as asthma and type 1 DM.

Dr. Ashish Bajaj – M.B.B.S, M.D.

Q3. Who is prone to Vitamin D deficiency?

Breastfed infants

Vitamin D requirements cannot ordinarily be met by human milk alone. Exclusively and partially breastfed infants should be supplemented with 400 International Units (IU) of vitamin D per day.

Older adults

Older adults are at an increased risk of developing vitamin D deficiency in part because, as they age, their skin cannot synthesise vitamin D as efficiently, they are likely to spend more time indoors and they may have inadequate intakes of the vitamin.

People with limited sun exposure

Homebound individuals, women who wear long robes and head coverings for religious reasons and people with occupations that limit sun exposure are unlikely to obtain adequate vitamin D from sunlight. Because the extent and frequency of the use of sunscreen are unknown, the significance of the role that sunscreen may play in reducing vitamin D synthesis is unclear.

In healthy, asymptomatic antenatal women, 1000-2000 IU can be supplemented daily in the second and third trimesters, without fear of vitamin D toxicity.

Dr. Ashish Bajaj – M.B.B.S, M.D.

People with dark skin

Greater amounts of the pigment melanin in the epidermal layer result in darker skin and reduce the skin’s ability to produce vitamin D from sunlight.

People with inflammatory bowel disease and other conditions causing fat malabsorption

Because vitamin D is a fat-soluble vitamin, its absorption depends on the gut’s ability to absorb dietary fat. Individuals who have a reduced ability to absorb dietary fat might require vitamin D supplementation. People who are obese or who have undergone gastric bypass surgery.

A body mass index ≥ 30 is associated with lower serum 25(OH) D levels compared to non-obese individuals.

Q4. What are the sources of Vitamin D?

Foods that provide vitamin D include:

> Fatty fish, like tuna, mackerel and salmon

> Foods fortified with vitamin D, like some dairy products, orange juice, soy milk and cereals, cheese and egg yolks.

Q5. What is an active form of Vitamin D?

Vitamin D, as either D3 or D2, does not have significant biological activity. Rather, it must be metabolised within the body to the hormonally-active form known as 1, 25-dihydroxycholecalciferol. This transformation occurs in two steps:

Within the liver: Cholecalciferol is hydroxylated to 25-hydroxycholecalciferol by the enzyme 25-hydroxylase.

Within the kidney: 25-hydroxycholecalciferol serves as a substrate for 1-alpha-hydroxylase, yielding 1, 25-dihydroxycholecalciferol, the biologically active form.

Q6. What tests are done to diagnose vitamin D deficiency?

The most accurate way to measure how much vitamin D is in your body is the 25-hydroxy vitamin D blood test. A level of 20 nanograms (ng)/millilitre (mL) to 50 ng/mL is considered adequate for healthy people. A level of less than 12 ng/mL indicates vitamin D deficiency.

Q7. Do you have to fast for a vitamin D blood test?

Fasting is not necessary to obtain a vitamin D level; however, getting blood tests at the same time makes sense, reducing the burden of time on the patient.

Q8. What is the treatment for Vitamin D deficiency?

Treatment depends on the levels of vitamin D. For people with vitamin D deficiency, doctors may advise oral ergocalciferol (vitamin D2) at 60,000 IU per week for eight weeks. After vitamin D levels normalise, experts usually recommend maintenance doses of cholecalciferol (vitamin D3) at 800 to 1,000 IU per day from dietary and supplemental sources. Your doctor may also prescribe nano vitamin D supplements or injectable vitamin D for better absorption when needed.

Q9. What is Vitamin D toxicity?

Vitamin D toxicity should not be diagnosed solely on the basis of an elevated 25(OH)D level; instead, it should be recognised as a clinical syndrome of both hypervitaminosis D and hypercalcemia, in which hyperphosphatemia and hypercalciuria also commonly (although not always) occur. Patients with vitamin D toxicity could be present with clinical symptoms and signs of hypercalcemia (e.g. nausea, dehydration and constipation) and hypercalciuria (e.g., polyuria and kidney stones).

Q10. What are Rickets, Osteomalacia and Osteoporosis?

Rickets is a condition that affects bone development in children. It causes the bones to become soft and weak, which can lead to bone deformities.

Rickets in adults is known as osteomalacia or soft bones.

Osteoporosis is a bone disease. The name comes from the Latin for ‘porous bones’.The inside of a healthy bone has small spaces, like a honeycomb. Osteoporosis increases the size of these spaces such that the bone loses its strength and density. At the same time, the outside of the bone grows weaker and thinner.

Written By: Dr Vaibhav. B. Kasodekar

Dr Vaibhav. B. Kasodekar is a Consulting Orthopaedic Surgeon at Jaslok Hospital & Research Centre. He has secured degrees of M.S. (Ortho), DNB (Ortho), FCPS and D.Ortho and has a fellowship in joint replacement and arthroscopy surgery from North America and Singapore. He has been practising orthopaedics for the past several years and is one of the most sought doctors by renowned hospitals and medical institutions in the country.

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Ref

1. https://apps.who.int/nutrition/events/2015_vit_d_workshop_pregnantwomen_21to24Apr15/en/index.html
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427646/
3. https://www.ncbi.nlm.nih.gov/books/NBK532266/#:~:text=Patients%20with%20a%20prolonged%20and,D%20deficiency%20leading%20to%20osteoporosis.
4. https://pubmed.ncbi.nlm.nih.gov/26204630/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912737/

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