Vitamin D Deficiency
The Sunshine Vitamin “Shedding Light on Your Health Problems”

Risk    Bones    Cancer    Diabetes    Heart    Respiratory    Restless Leg Syndrome

After I turned 30 I wanted to stop wrinkles from forming. I have done a good job so far. I am almost 50, and my face looks fairly young for my age. In my quest to retain my youth, I would apply sunscreen to my entire body and wear a big hat when I was outside in the sun. I was unaware of the potential damage I was doing inside my body. Several years ago during my yearly doctor’s appointment, I discovered my vitamin D levels were 15 ng/nl , which is considered extremely low. I was shocked because I was leading a very healthy lifestyle and diet, including nuts, large variety of fruits and vegetables, as well as drinking green juice.  I knew that not too many foods contain vitamin D, but I thought for sure I would not have been deficient in anything.

Year 1 (after I had discovered I was vitamin D deficient): I began taking 10,000 iu of vitamin D weekly and for the remainder of the year I continued to take vitamin D supplements.  I knew that egg yolks were one of the very few foods contain vitamin D, but back then I only at egg whites.  We have chickens so I started eating several whole eggs a week.

Year 2: I went back for my yearly physical, and the blood work revealed I was still deficient. Feeling discouraged because I know so much about health and nutrition and I thought I was doing everything right, I was determined to conquer this issue.  I took my vitamin D supplements 3 times a day with calcium and magnesium supplements. I heard this suggestion watching the Dr. Oz show. In addition, I also started eating more fish including salmon, mackerel, tuna and sardines. I began eating sardines for lunch a few times a week, everyone would comment about the smell. I ate sardines more than the other fish because they have the lowest levels of mercury compared to the other fish.

Year 3: I thought my levels would be great, but to my disbelief, they were still low. My doctor advised me to go out in the sun every day. That summer I went in sun without sunscreen for the first 15 minutes, and then I would apply sunscreen. I did not allow my skin to burn because skin cancer is still a concern. As the summer progressed and my skin became tan, I would gradually extend the time and put on coconut oil instead of sunscreen. In the fall and winter when I was outside, I would let the sun shine on my face and on nice days, I would expose my arms to the sun.

Year 4: I was very pleased to discover that my vitamin D level was 50 ng/ml.  The optimal range is 50-70 ng/ml.  Imagine a little sun could do so much for my body.

Not so Or-D-Nary Vitamin

Vitamin D is a nutrient and a hormone that is either produced or stored in the fatty tissues of the body. There are two major types of vitamin D:

• Vitamin D2 (ergocalciferol or pre-vitamin D), found in a limited amount in food such as dairy products, cereals, and fatty fish,

• Vitamin D3 (cholecalciferol) is made by our skin and produced from 7-dehydrocholesterol. This process is triggered by exposure to the sun’s ultraviolet B (UV-B) rays, hence the nickname “the sunshine vitamin.” As little as 10 minutes a day basking in the sun can prevent deficiency (1).

According to a study conducted by the Institute of Medicine in 2010, the recommended daily intake of vitamin D in the U.S. and Canada is 600 IU per day, and that increasing it up to 4,000 IU per day showed no evidence of harm (2).

Vitamin D potentially exerts its effects in nearly all organ systems in the body, hormone production and aids in maintaining healthy teeth and bones. It is also a key factor in the normal function of non-skeletal muscles (such as your heart muscles), brain, prostate, breast, immunity, and in controlling inflammation . Research conducted over the past decade suggests that vitamin D plays a much broader disease-fighting role than once thought, widespread vitamin D deficiencies have become a great concern(3).

What’s D problem?

Most people get sufficient amounts of vitamin D by eating a healthy balanced diet, taking supplemental multivitamins, and getting some summer sun. However, some groups are at risk of not getting enough for their daily needs.

Worldwide, an estimated one billion people have inadequate levels of vitamin D in their blood, and deficiencies can be found in all ethnicities and age groups. These people include:

• Pregnant and breastfeeding women
• Children under the age of five
• Elderly – 65 and over
• Obese
• People who are not exposed to sunlight (such as during winter, those who are housebound or confined indoors for long periods)
• People with darker skin such as those of African, African-Caribbean and South Asian in origin (1,3,4)

Vitamin D and Matters of the Heart

Out of 57 million deaths in 2008, WHO identified cardiovascular diseases (CVD) as being responsible for 17 million, or 48% of deaths due to noncommunicable diseases worldwide (12).

Most epidemiological studies link vitamin D deficiency to increased CVD, but casualty and the underlying mechanisms associating these two are not established. In a study by Weng, et. al. (2013) on mice with diet-induced vitamin D deficiency, it was found that they had about 2-8-fold chance for developing atherosclerosis and hypertension as compared to mice with sufficient vitamin D diet (6). The Health Professional Follow-up Study conducted in a span of 10 years in nearly 50,000 men, also had similar results. Their findings suggest that men with deficient vitamin D levels were twice as likely to have a heart attack as compared to those with adequate vitamin D (7). Related studies show that low vitamin D levels were associated with higher risk for heart failure, stroke, and eventually, death (8,9,10,11)

With these findings, it is suggested that vitamin D supplementation can be used as a potential therapeutic option for reducing blood pressure and atherosclerosis.

Vitamin D versus Diabetes

Type 1 diabetes (T1DM) is an autoimmune disease occurring in the pancreas. It accounts for about 90% of diabetes in children and adolescents, with the highest incidence in Finland and Sardina.

Recent studies have shown vitamin D’s potential capabilities in controlling the progression and possible complications of T1DM. The effects of vitamin D may be attributed to its capability to control inflammation and immune responses affecting the pancreatic islets, hence, preventing or minimizing the development of T1DM (15).

A 30-year study following more than 10,000 Finnish children who regularly received vitamin D, found that nearly 90 percent had a lower risk of developing type 1 diabetes than those who did not (13). This study is also supported by other case-control trials in Europe that suggest protective effects of vitamin D in T1DM (16).

D’ Bone and Muscle Builder

With the increasing number of people with vitamin D deficiency, physicians see the resurgence of rickets. This disease is characterized by muscle soreness, weakness, and bone pain. Vitamin D deficiency decreases the absorption of dietary calcium to only 10-15%, and 50-60% for dietary phosphorous. Due to the prevention of efficient absorption, there is poor mineralization of the bones. Weak bones and muscles can cause increased incidents of fall, which can lead to disability and death, especially in older people. Skeletal deformities result in the complications observed in rickets, as well as the development of osteoporosis and fractures in later life (17).

A summary of evidences from combined studies on fracture prevention suggested that intakes of vitamin D of about 800 IU per day can reduce hip and non-spine fractures by 20%, while lower intakes do not provide any benefit (18). Related studies emphasized on the importance of dosage of vitamin D supplements in the prevention of bone complications. It was found that 700 to 1000 IU per day lowered the risk of falling by 19%, but taking 200 to 600 IU per day did not offer effective protection (19)

Restless Leg Syndrome

A recent study suggests a possible connection between restless leg syndrome and vitamin D deficiency.  Restless leg syndrome affects 10% of adults and 2% of children.  Restless leg syndrome is either an involuntary movement of the legs or an overwhelming urge to move the legs.  It normally occurs in the evening when sleeping or resting.  It can interfere with getting a good night sleep and become overwhelming for many people.  50% of all cases runs in families and has a genetic component.  But, new research suggests a possible connection between vitamin D deficiency and restless leg syndrome. (35) If you are experiencing any of these symptoms you might want to have your vitamin D levels checked.

Vitamin D: The Seasonal Stimulus

The increased incidence of respiratory infections especially observed during the winter season led the British physician, R. Edgar Hope-Simpson to propose that epidemic influenza is closely associated with ‘seasonal stimulus’ involving solar radiation.

He concluded that, with the decreased exposure to sunlight, some people develop vitamin D deficiency. This eventually leads to a profound effect on immunity, hence contracting illnesses such as the common cold. A study conducted by Cannell and his colleagues (2006) concluded that vitamin D, or lack of it, may be Hope-Simpson’s ‘seasonal stimulus’ (20).

A Little Sun Won’t Hurt: Studies on Cancer Prevention

Several decades ago, researchers became intrigued by the relationship between increased cases of colon cancer deaths and geographic location. Pooled data showed that people living near the equator had lower rates of death from colon cancer as compared to those living in higher altitudes. Many hypothesized that the differences in latitude and race may reflect differences in exposure to solar radiation, which in turn affects the incidence of colon cancer.

The increasing trend for vitamin D deficiency, combined with the associated risks of certain types of cancer in these patients, is now receiving considerable attention.

Studies have suggested that vitamin D deficiency may contribute to the numerous premature deaths from colon (21), breast (22,23), ovarian (24), and prostate (25) cancer annually (26). Such findings were attributed to vitamin D’s potential as a protective agent against tumor growth. A collection of studies indicated that vitamin D inhibits the development of malignancies by preventing the proliferation of, and stimulating programmed cell death in tumor cells (27, 28, 29, 30).

The National Academy of Sciences recommends the following daily intakes of vitamin D by age group: 1-50 years of age, 200 IU; 51-70 years of age, 400 IU; and older than 71 years, 600 IU (31). Research conducted by Platz et al (2009) and Grau et al (2009) concluded that sufficient vitamin D intake to achieve 30-35 ng/mL (about 500 IU per day) was associated with reduced risk for colonic adenomas.

If sunlight is used as a source of vitamin D, it should be noted that exposure should be monitored such that you do not burn your skin. In relation to the development of cancers, it cannot be denied that damaging excess exposure to ultraviolet radiation has considerable evidence for its role in skin cancer. Exposure time longer than 20 minutes was found not appreciably increase the formation of vitamin D, and could increase the risk of skin cancer.(34)

With the given findings from a collection of reliable researches conducted in the past few decades, it was proposed that vitamin D supplementation could be used to address vitamin D deficiency. Powerful evidence indicates that adequate levels of vitamin D result in lower rates of incidence of cancer, disability, fractures, other co-morbidities, and premature death. However, despite these promising studies, the use of vitamin D has not been adopted as a mode of therapy for these conditions.

With these findings and the continuous research and studies, it is imperative that you ask your physician to order blood work to determine your vitamin D level.

(1) Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357:266-81.
(2) Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, D.C.: National Academies Press, 2010.
(3) Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004; 158:531-7.
(4) Lips P. Worldwide status of vitamin D nutrition. J Steroid Biochem Mol Biol. 2010; 121:297-300.
(5) Longo, DL, Kasper, DL, Jameson, JL, Fauci, AS, Hauser, SL, Loscalzo, J. (2012). Principles of Internal Medicine (18th ed). McGraw-Hill Companies, Inc.
(6) Weng S, Sprague J, Oh J, Riek A, Chin K, Garcia M, Bernal-Mizrachi C: Vitamin D Deficiency Induces High Blood Pressure and Accelerates Atherosclerosis in Mice. 2013; 8(1): e54625. [PMID: PMC3551761]
(7) Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008; 168:1174-80.
(8) Pilz S, Marz W, Wellnitz B, et al. Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. J Clin Endocrinol Metab. 2008; 93:3927-35.
(9) Pilz S, Dobnig H, Fischer JE, et al. Low vitamin D levels predict stroke in patients referred to coronary angiography. Stroke. 2008; 39:2611-3.
(10) Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease.Circulation. 2008; 117:503-11.
(11) Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008; 168:1340-9.).
(12) World Health Organization. (n.d.). Programmes: Global Health Observatory. Retrieved June 25, 2014, from World Health Organization:
(13) Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001; 358:1500-3.
(14) Definition, epidemiology and classification of diabetes in children and adolescents.Craig ME, Hattersley A, Donaghue KC Pediatr Diabetes. 2009 Sep; 10 Suppl 12():3-12.
(15) Chakhtoura M, Azar S. The Role of Vitamin D Deficiency in the Incidence, Progression, and Complications of Type 1 Diabetes Mellitus. Int J Endocrinol. 2013; 2013: 148673 [PMID: PMC3610375]
(16) Zipitis CS, Akobeng AK. Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis. Arch Dis Child. 2008; 93:512-7.
(17) Holick MF. Resurrection of vitamin D deficiency and rickets.J Clin Invest 2006; 116(8):2062-2072 [PMC: 1523417]
(18) Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Arch Intern Med. 2006; 166:424-30.
(19) Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. 2009; 339:b3692.
(20) Cannell JJ, Vieth R, Umhau JC, Holick, MF, Grant WB, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Epidemiol Infect.2006; 134(6): 1129-1140 [PMC:2870528
(21) Garland C, Garland F. Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol. 1980;9: 227–231. [PubMed]
(22) Gorham E, Garland C, Garland F. Acid haze air pollution and breast and colon cancer in 20 Canadian cities.Can J Public Health. 1989;80:96–100. [PubMed]
(23) Garland F, Garland C, Gorham E, Young J Jr. Geographic variation in breast cancer mortality in the United States: a hypothesis involving exposure to solar radiation. Prev Med. 1990;19: 614–622. [PubMed]
(24) Lefkowitz ES, Garland CF. Sunlight, vitamin D, and ovarian cancer mortality rates in US women. Int J Epidemiol. 1994;23(6):1133–1136. [PubMed]
(25) Schwartz GG, Hulka BS. Is vitamin D deficiency a risk factor for prostate cancer? (Hypothesis). Anticancer Res. 1990;10(5A):1307–1311. [PubMed]
(26) Grant WB. An estimate of premature cancer mortality in the US because of inadequate doses of solar ultraviolet-B radiation. Cancer. 2002;94(6): 1867–1875. [PubMed]
(27) Colonic epithelial cell proliferation decreases with increasing levels of serum 25-hydroxy vitamin D.Holt PR, Arber N, Halmos B, Forde K, Kissileff H, McGlynn KA, Moss SF, Kurihara N, Fan K, Yang K, Lipkin M Cancer Epidemiol Biomarkers Prev. 2002 Jan; 11(1):113-9.
(28) Vitamin D3 analogs and their 24-oxo metabolites equally inhibit clonal proliferation of a variety of cancer cells but have differing molecular effects. Campbell MJ, Reddy GS, Koeffler HPJ Cell Biochem. 1997 Sep 1; 66(3):413-25.
(29) The effect of dietary vitamin D3 on the intracellular calcium gradient in mammalian colonic crypts. Brenner BM, Russell N, Albrecht S, Davies RJ Cancer Lett. 1998 May 15; 127(1-2):43-53.
(30) Calcium and calpain as key mediators of apoptosis-like death induced by vitamin D compounds in breast cancer cells. Mathiasen IS, Sergeev IN, Bastholm L, Elling F, Norman AW, Jäättelä M J Biol Chem. 2002 Aug 23; 277(34):30738-45.
(31) National Academy of Sciences, Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press; 1997.
(32) Platz EA, Hankinson SE, Hollis BW, et al. Plasma 1,25-dihydroxy- and 25-hydroxyvitamin D and adenomatous polyps of the distal colorectum. Cancer Epidemiol Biomarkers Prev. 2000;9(10): 1059–1065.[PubMed]
(33) Grau MV, Baron JA, Sandler RS, et al. Vitamin D, calcium supplementation, and colorectal adenomas: results of a randomized trial. J Natl Cancer Inst. 2003;95(23):1765–1771. [PubMed]
(34) Chen T. Photobiology of vitamin D. In: Holick M, ed. Vitamin D: Molecular Biology, Physiology, and Clinical Applications. Totowa, NJ: Humana; 1999: 17–37.
(35) Oran, M. et al. Possible association between vitamin D deficiency and restless legs syndrome. Neuropsychiatric Disease and Treatment, 2014.

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