Vitamin D Deficiency: 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, 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 about Vitamin D deficiency and about its treatment.

1. 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 mineralization of bones. It is also needed for bone growth and bone remodeling. 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.

2. 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

3. 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, skin cannot synthesize 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.

• 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 with the non-obese individuals.

4. 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
•  Beef liver
•  Cheese
•  Egg yolks

5. 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 metabolized 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.

6. 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.

7. 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.

8. What Is The Treatment Of Vitamin D Deficiency?

For people with vitamin D deficiency, treatment may include oral ergocalciferol (vitamin D2) at 60,000 IU per week for eight weeks. After vitamin D levels normalize, experts recommend maintenance doses of cholecalciferol (vitamin D3) at 800 to 1,000 IU per day from dietary and supplemental sources.

9. 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 recognized 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).

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

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