Vitamin D Deficiency – Common Medical Problem
Many of my patients, who come into the office for their physical exams, mostly their major complaints are feeling dizzy, weakness, tiredness and no energy along with body aches and bone pain. Usually, I run all routine blood tests along with vitamin D, and most of the time I find low vitamin D and the rest of the blood tests usually normal. – Dr. Sarla Kumari
Specialist Physician Diabetologist at Canadian Specialist Hospital Dubai
Some times, the patient himself asks to have their vitamin D levels checked. They may have a family member with osteoporosis, or perhaps they have had bone thinning themselves. Some, they want to know that they’re doing everything they can to keep their bones strong. Vitamin D is critical for healthy bones.
My very first response to patients is to tell them they are deficient in sunshine vitamin. Which sun shine vitamin? Its vitamin D! Why sunshine? Usually, we get this vitamin from sun exposure. We do have this vitamin in foods but in very small quantities.
Vitamin D is not only a vitamin. It’s an important hormone for many health issue. The primary function of vitamin D, it’s an important factor for bone health , if we are deficient we will get weak bones and risk of fractures.
What could be other symptoms of low vitamin D:
- Weakness, tiredness, dizzy
- No energy
- Bone and Back Pain
- Impaired Wound Healing
- Bone Loss
- Hair loss
- Muscle Pain
There are common risk factors for vitamin D deficiency:
- Having dark skin.
- Being elderly
- Being overweight or obese
- Not eating much fish or dairy
- Living far from the equator where there is little sun year-round
- Always using sunscreen when going out
- Staying indoors
- Very hot weather – so people spend most of time indoor in air conditioned environment
Normal daily vitamin D requirement ranges from 400-800 I.U For normal adults, we need around 1000, I.U in post menopausal and elderly patients.
So, what is the current cutoff value at which people are considered “low,” and thus at risk for developing bone thinning and having fractures? (We are talking about the blood level of 25-hydroxy-vitamin D, which is usually measured in nanograms per milliliter.). This is where there is a lot of argument.
In 2010, the venerable Institute of Medicine (IOM) issued a report based on lengthy examination of data by a group of experts. To sum up, they estimated that a vitamin D level of 20 ng/mL or higher was adequate for good bone health, and subsequently a level below 20 was considered a vitamin D deficiency.
In my practice, and in most, it is not uncommon to see a vitamin D level less than 20. When that happens, I tell the patient that they are deficient and recommend fairly aggressive replenishment, usually I give first shot of injection of vitamin D that is about 300,000 I.U followed by oral replacement for 3 months.
Along with that I usually advised them, they should have sun exposure at least 15-20 minutes; not wearing any with dark color clothes; they need light colored clothing and to expose their arms, legs and face; sun exposure directly outside not from glass window because sun rays cannot penetrate the glass window; should be in the morning, 10-15 MINUTES sun exposure provide at least 10 thousand vitamin D I.U, as well as , increase food containing vitamin D like fish, vitamin D fortified cereals, dairy ongoing supplementation.
Follow up: for vitamin D, repeat levels in 3 month time, to see further how much replacement needed; if normal, usually we give them maintenance doses; check vitamin D levels at least once in year.
Second advice to my patients is they should not take large doses without checking as high levels of vitamin D can be toxic.