hat do muscle aches and bone pain as well as increased muscle weakness and an increased risk of falls, heart failure, and several forms of cancer all have in common?
 
If you answered vitamin D deficiency, you would be right on target naming this unsuspected epidemic.
 
Vitamin D deficiency was first recognized as causing rickets, a disease seen in growing children in which poor mineralization of bone resulted in several clinical pictures—the most common being bowing of the legs. Rickets appeared treatable with as little as 100 IU (international units) of vitamin D, so the recommended 400 IU per day seemed ample. Recent research is proving that assumption incorrect, and it is becoming obvious that we are facing a global epidemic of vitamin D deficiency.
 
Vitamin D is made in the skin when sunshine or ultraviolet light converts the building blocks of vitamin D into the active vitamin D3.
 
How Much Sunshine Do I Need?
The amount of sunshine an individual needs depends on where they live. In northern and southern climates (at a latitude above 40 degrees) during the winter, the sun’s rays are not strong enough to provide sufficient ultraviolet to produce vitamin D. For persons living below these latitudes, about 10 minutes of direct sun exposure of arms, legs, and face three to four times a week should remove the risk of vitamin D deficiency.
 
The fear and risk of skin cancer has caused many to avoid sunlight and to use sunscreen agents. As with most things, balance is required to avoid the skin cancer risks on the one hand, and the vitamin D deficiency risks on the other.
 
The amount of pigment in your skin is another factor, because it slows the formatting of vitamin D. If you don’t get enough sunshine—and even in warm, southern climates many are so homebound and office-bound that they don’t—you may need supplemental vitamin D. In Europe it has been shown that current routine fortification and supplements may not compensate for the low sun-induced manufacturing of vitamin D2 in the skin.
 
In general, the vitamin D intake in Europe is low, being no more than about two to three micrograms per day.
 
Vitamin D Deficiency Increases Risk for What Diseases?
Several researchers have shown a wide variety of problems associated with vitamin D deficiency. These disorders include osteoporosis, osteomalacia, increased risks of deadly cancers, cardiovascular disease, multiple sclerosis, rheumatoid arthritis, and type 1 diabetes mellitus. Muscle weakness with resulting falls and fractures, hypertension, and infectious disease have all been implicated with vitamin D deficiency.
 
How Does Vitamin D Deficiency Affect Bones?
Vitamin D is needed for calcium absorption. A lack of calcium has several effects. When the amount of calcium being absorbed is low, parathyroid hormone levels rise, and this hormone draws calcium from bones to defend blood levels. Studies have shown that when vitamin D levels are lower, the parathyroid levels are higher. This means the bones may have less calcification from two mechanisms, less calcium available, and more calcium being dragged out of the bones. Osteoporosis results in deformity, such as the humped back of the elderly. Osteomalacia results in soft bones that become painful. In fact, much that is labeled fibromyalgia, depression, or chronic pain syndrome may in fact be symptoms of osteomalacia, resulting from vitamin D deficiency.
 
How Safe Is It to Take Vitamin D Supplements?
In a major review of the literature covering 167 studies, A. Cranney, T. Horsley, S. O’Donnell, and others could find little evidence of any vitamin D toxicity at dosages currently being recommended.
 
Massive doses of vitamin D may be troublesome, but 1,000 IU per day would be very helpful to most people.
 
Why Is Vitamin D Sometimes Referred to as a Hormone?
Vitamin D acts on nearly all tissues by stimulating the formation of enzymes that enhance cellular functions. It is not only calcium metabolism but cell division that is influenced. In addition, vitamin D is carried in the bloodstream, so its actions are like those of a hormone, which is a substance secreted at one place, then carried by the blood to act in another place.
 
Can Vitamin D Supplementation Cure Osteoporosis?
Studies have shown vitamin D plus calcium supplementation results in a small increase in bone mineral density in older adults. In general, however, reversal of osteoporosis is not a very satisfactory process. Prevention is the key; that is why vitamin D needs to be taken in adequate amounts throughout life. Osteomalacia, the painful softening of bone, is reversed by vitamin D treatment and many feel much better after a few weeks of treatment.
 
Osteoporosis is where the whole bone—the protein scaffolding and the calcium on it—is lost. Osteomalacia is where the protein infrastructure is there, but it is decalcified. These osteomalacic bones are more pliable, weaker than normal, and not quite as brittle as the osteoporotic bones.
 
How Does Vitamin D Reduce Fracture
Rates if It Does Not Cure Osteoporosis?
A most significant way is that it reduces the number of falls in the elderly. This is because muscle power is improved or muscle weakness, as a result of vitamin D deficiency, is reversed.
 
It has been estimated that an achievement of a minimum blood level of 32 ng/ml would provide a 50 to 60 percent fracture reduction in the population overall. When one considers that 20 percent of people sustaining a hip fracture do not survive 12 months after the break, this is astounding.
 
In a three-year French study reported by P. Meunier, a reduction of 23 percent in the number of fractures was seen in a population of 3,270 elderly women in nursing homes given 800 IU of vitamin D, plus 1,200 milligrams of calcium, daily. Researchers also document a fall in their parathyroid hormone levels.
 
As Meunier states, “It is never too late to prevent hip injuries with calcium and vitamin D supplements.” 
 
__________
Allan R. Handysides, M.B., CH.B., FRCP, FRCSF, FACOG, is director of the General Conference Health Ministries Department.





 
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