The Vitamin D Revolution

In the last decade, enthusiastic scientists have found that vitamin D has an impact on the genes, tissues, and organs of the body. This is an important, even vital, finding.

In our history with vitamin D, we have assumed that its only role was to prevent rickets in children and help them form healthy bones. Essentially, if someone did not have a bone disease such as rickets, osteomalacia, or osteoporosis, vitamin D deficiency was not given any consideration. Once we passed childhood, we did not think about vitamin D deficiency again.

In 2004, it was estimated that the economic burden of vitamin D deficiency due to inadequate access to the sun, supplements, diet, and food fortification costs the U.S. from $40 to $56 billion annually. In 2007, researchers Grant, Garland, and Gorham estimated that it would cost $1 billion each year to provide all adult Americans with 1,000 IU of vitamin D daily. They also estimated that in the United States, the daily provision of 1,000 IU of vitamin D would reduce cancer mortality for females by 9 percent and 7 percent for males. The researchers estimated that this would reduce the country’s annual cost of cancer treatment by $16 to $25 billion.

The researchers also made estimates for Western European countries below 59 degrees latitude: Cancer mortality rates could reduce by 20 percent for females and 14 percent for men.

Worldwide, it is estimated that one billion people have deficient or insufficient levels of vitamin D. References from a number of studies indicate that in North America and northern Europe, between 40 and 100 percent of elderly people are deficient in vitamin D. The Mayo Clinic Proceedings reported on a study from Minnesota that 100 percent of African Americans, East Africans, Hispanics, and American Indians were vitamin D deficient. In addition, more than 50 percent of postmenopausal women who have osteoporosis bad enough that they required prescription medication had insufficient levels of 25D (below 30 ng/ml). One can only guess how much this impacts the amount of money spent on medical treatments. This is one of the reasons why I believe it is my responsibility to help my patients reach optimal vitamin D levels.

Since the late 1980s, we have been told to stay out of the sun to reduce the risk of skin cancer and avoid premature skin aging. Medical groups such as dermatologists advised people to avoid sun exposure and always wear sunscreen when they do spend time outdoors. However, these sweeping warnings about the sun’s dangers were not accompanied by the recommendation to increase vitamin D supplementation. We were avoiding the sun in droves but not replenishing our vitamin D. Not only have we become deficient, but vitamin D experts are beginning to link this deficiency with the rise of the illnesses of modern society.

In evolutionary terms, humans have evolved from living naked near the equator and migrating to the northern hemispheres to where we cover ourselves with clothing year-round. In comparison to our distant ancestors, we are sun starved and therefore vitamin D starved. Our ancestors, bathed in sun for much of the day, probably had naturally occurring levels of vitamin D in their blood between 50 and 90 ng/ml. In my busy medical practice, in five years of testing 25D levels, I have only seen a few people with optimal levels of vitamin D on initial testing.

In my experience, counting on patients to get enough sunshine on a regular basis is not enough to help them elevate their vitamin D levels to optimal rates. This is why I recommend supplementation, and I will talk about specific dosages that I have prescribed for my book.

You are probably wondering about your chances of being vitamin D deficient. The short answer is that it is very likely that you do not have sufficient stores of vitamin D in your system to achieve the optimal health benefits associated with it. In my medical practice, I have estimated that over 75 percent of my new patients are deficient or insufficient in vitamin D.

In addition to low sun exposure due to latitude, weather, season, skin color, and concealing clothing, there are other factors that can increase your risk of vitamin D deficiency.

Part of the greatest risk for vitamin D deficiency is that no one expects to have a vitamin D deficiency! If people made it through childhood without contracting rickets, it is believed that they are in the clear. If you do not have rickets or osteomalacia, how do you know if you are deficient? Vitamin D deficiency has been termed a silent epidemic because the symptoms associated with vitamin D deficiency are more subtle and can be confused with many other medical conditions. Many doctors do not test for it unless bone problems are suspected. I test all of my new patients for it as part of their initial workup.

Interestingly, more studies are linking the symptoms associated with many diseases of civilization with vitamin D deficiency. If you have any of the following common complaints, you may be vitamin D deficient:

• Muscular weakness

• Feeling of heaviness in the legs

• Chronic musculoskeletal pain

• Fatigue or easy tiring

• Frequent infections

• Depression

In my practice, many patients with similar complaints have reported a decrease in their symptoms after following my supplementation protocol. In one such example, I saw a middle-aged physician who experienced persistent neck pain for some years. He had received regular chiropractic adjustments, body work, and acupuncture; and would use occasional ibuprofen for his neck pain.

He came to me approximately five years ago when I was first measuring vitamin D levels. His vitamin D blood level was at 11 ng/ml! This was significantly deficient, and I immediately started him on a corrective dose of vitamin D to bring his level up quickly.

After taking vitamin D for approximately six weeks, the patient told me that his chronic neck pain had decreased by approximately 90 percent. He needed to see the chiropractor much less often and did not require frequent acupuncture treatments. He was delighted.

I explained to him that because of his dramatic response to vitamin D, it was a sign that he had had osteomalacia of his neck bones. Osteomalacia is adult rickets! With severe vitamin D deficiency, there is a defect in the bone-hardening process, characterized by a deep, gnawing pain in the muscles and bones.

After several months, we repeated the blood test to assess his vitamin D level, and indeed, his levels were now over 40 ng/ml.

The patient that I have just described to you was me. Because of my Sikh dress (which covers most of my body) and my fair skin and subsequent sun avoidance, my vitamin D level started out extremely low. In correcting it, my neck pain was basically eliminated. I had cured myself of osteomalacia!

The statistics regarding vitamin D deficiency are startling. However, it is not my intention to strike fear into your heart but to present you with some facts. Vitamin D deficiency is reaching epidemic proportions, and it is affecting the current and long-term health of our children. But despite the alarming statistics, vitamin D deficiency is very simple to correct.

Children are spending an increasing amount of time indoors, and when they are outside, they are covered with sunscreen and protective clothing. This has increased the prevalence of vitamin D deficiency. Several research studies have gathered information about children’s levels of vitamin D and reported the incidence of rickets in African-American children. A study in Minnesota found that 100 percent of the children who were African American, East African, Hispanic, and American Indian were deficient in Vitamin D.

In studies conducted in Maine and Massachusetts, 52 percent of African-American and Hispanic adolescents and 48 percent of white preadolescent girls were deficient in vitamin D. Another study conducted in the winter throughout the United States revealed that 42 percent of females aged 15 to 49 were deficient. The studies all showed these groups to have vitamin D blood levels of less than 20 ng/ml, which exposes them to a risk of osteomalacia. However, one Boston study showed that 24 percent of the girls tested during their annual physical had levels below 15 ng/ml, and 14 percent had levels below 8 ng/ml! European children are found to be at high risk for vitamin D deficiency because few foods are fortified with the vitamin. Even in sunny parts of the world such as India, Turkey, and Lebanon, between 30 and 50 percent of the children studied had deficient vitamin D levels (less than 20 ng/ml).

Infants who are breast-fed exclusively are at risk for vitamin D deficiency. Human breast milk contains very little naturally occurring vitamin D, typically only about 20 IU of vitamin D per one liter. A breast-fed baby will get virtually no vitamin D unless their mothers have vitamin D levels of at least 30 ng/ml. So if the mother is deficient and is not taking vitamin D supplements, then the breast-fed child will also be deficient. Although taking oral vitamin D is safe for infants, many who are breast-fed are not given any supplementation. As a result these children have blood levels of less than 20 ng/ml, which increases their risk for getting rickets. This explains why researchers are reporting a rise in the number of incidents of rickets in infants who are exclusively breast-fed.

This leads us into a look at pregnant and nursing mothers.

In a study of women giving birth—despite taking their prenatal vitamins with 400 IU of vitamin D—73 percent of the women were severely vitamin D deficient, and 80 percent of the babies had severe vitamin D deficiency at birth. Many of the mothers were taking a multivitamin with 400 IU of vitamin D and were also drinking vitamin D–fortified milk every day. Some of the women in these studies had severely deficient levels of 10 and 15 ng/ml.

Vitamin D penetrates a woman’s milk very poorly, and a mother who takes 400 IU/day is still not able to raise the vitamin D level of her breast-feeding baby. However, mothers who take 4,000 IU/day can raise the blood levels of their babies to greater than 30 ng/ml.

A New York study showed that 69 percent of paired infants and mothers were vitamin D deficient. A Canadian study found that only 11 percent of women in their second trimester had adequate levels of vitamin D in their blood. Women who are breast-feeding may also be diminishing their own levels of vitamin D as they pass on their own stores of it to their babies.

Recommendations are now coming out for pregnant women to get their vitamin D level tested every three or four months during pregnancy, and that is what I do in my own practice.

Because vitamin D is a fat-soluble vitamin, it is absorbed by, and stored in, fat cells. In people who are obese, there are more fat cells to collect the vitamin D that has been ingested or made from sun exposure. As a result, there is less vitamin D available to the kidneys and intestines and therefore less calcium available to maintain strong bones.

In a study published in the summer of 2008, blood levels of postmenopausal women living in the U.K. at 57 degrees north latitude were found to be on average 23 ng/ml in the fall, even though they are supposed to be at their highest at this time. In the spring, their levels were an average of 19 ng/ml. Researchers associated these low levels with bone loss and obesity and observed that the women in the study with the highest body mass index (BMI) had the lowest levels of vitamin D.

Michael Holick, M.D., Ph.D., has made a connection between people who are obese and vitamin D deficiency–related osteomalacia. He indicated that individuals who are obese and deficient in vitamin D might experience muscle weakness and pain. They may tend to exercise less because of the pain and weakness, which in turn can increase obesity. While more research is necessary in this area, Dr. Holick indicated that treating obese people for vitamin D deficiency could relieve the pain of osteomalacia and make way for them to increase their physical activity.

More than half of Americans over 65 are vitamin D deficient, putting them at greater risk for bone fractures. Elderly people, especially those who are shut-ins, are at high risk for vitamin D deficiency because they are not getting adequate exposure to the sun. As many as 30 percent of those who are over 60 years of age, even if they are living at lower latitudes (closer to the equator), have been shown to have insufficient levels of vitamin D in the winter (lower than 30 ng/ml). Up to 26 percent of elderly people living in higher latitudes have blood vitamin D levels of less than 30 ng/ml in the summer. Even if elderly people do get some sun exposure, their ability to metabolize vitamin D becomes less efficient as they age, as they have less vitamin D precursor in the skin. Compared to young people, elderly adults need up to four times more exposure to UVB rays to make adequate vitamin D. Older individuals may also tend to be even more sun scared and more likely to avoid exposure, therefore, decreasing their usable vitamin D levels.

Low levels of vitamin D in elderly people can cause osteoporosis and make existing osteoporosis worsen. As the U.S. population ages, researchers expect the number of osteoporosis-related fractures to increase from more than 2 million in 2005 to more than 3 million in 2025. The associated medical costs were estimated to have been $17 billion in 2005 and are projected to be more than $25 billion in 2025.

According to researchers, levels of vitamin D that are lower than 30 ng/ml have appeared to increase the risk of fractures in elderly people. Of great concern to my patients who have elderly parents is the fear of their parents falling and sustaining injury or fracture. As people age, they may lose muscle mass and strength, and this weakening can lead to an increased risk of falling. Researchers have estimated that by age 65, one in three people falls each year, and one in two falls each year by the age of 80. About 20 to 30 percent of those who fall sustain an injury, and at least 50 percent of those injuries are fractures.

Muscle performance in elderly people may also be affected by low levels of vitamin D. Researchers have discovered vitamin D receptors in the muscles, and insufficient levels of vitamin D (lower than 30 ng/ml) are associated with impaired performance in the lower extremities.

In my book, I will discuss the heartening findings that researchers have made regarding vitamin D supplementation and its positive effects on falls, fractures, bone loss, and muscle performance in the elderly.

As I have mentioned, vitamin D is fat soluble. People who have illnesses that prevent them from absorbing fat properly could be at risk for vitamin D deficiency. Individuals with diseases such as Crohn’s disease and cystic fibrosis may be unable to absorb fat-soluble vitamin D properly. Those who have undergone gastric-bypass surgery may have a diminished ability to absorb fat and, therefore, vitamin D. If you have had liver or kidney failure, that could impair the ability of these organs to process vitamin D.

With these incidence reports of vitamin D deficiency, it becomes clear that most people are at risk. As I have explained, even with the best intentions of raising your levels of vitamin D, you could still be deficient. Despite drinking milk, eating salmon, and taking a multivitamin, 32 percent of healthy people studied in Boston were found to have deficient levels of vitamin D. After 25 years of experience as an integrative-medicine doctor, I diagnosed myself with adult rickets! Believe me, anyone can be vitamin D deficient.