Vitamin D deficiency is a common occurrence. According to statistics, in the USA it is observed in 40-60% of the population, in Russia – similar figures are voiced, in the UK, according to polls – in one fifth of the population. In general, the world is called about 1 billion.
Vitamin D is vital to human health. More than 90% of the nutrient is produced in the skin of the precursor under the action of ultraviolet rays.
Most foods contain an insignificant amount of vitamin. Food rich to them includes:
- Fat fish: sardines, herring, trout, tuna, salmon, mackerel. Cod liver oil.
- Egg yolk, red meat and liver.
In some products, manufacturers additionally add vitamin, for example, milk, some cereals (breakfast cereals).
These recommendations provide an adequate level of nutrient.
Symptoms of vitamin D deficiency in women, men and children
Many people do not have any signs, or they experience common symptoms – fatigue, malaise. Since the manifestations of the deficit are often non-specific or uncertain, the problem is not identified.
Rickets in children and osteomalacia in adults are classic, but extremely rare symptoms of severe vitamin D deficiency, caused by inadequate mineralization of the bone matrix. Nutrient deficiency provokes a low content of calcium and phosphate in the body, which leads to secondary hyperparathyroidism (increased parathyroid hormone (PTH) production).
Scientific research has revealed a link between low vitamin D levels and a number of other disorders:
- malignant tumors of the breast, intestine, prostate, lung;
- metabolic syndrome, obesity;
- type 1 and type 2 diabetes;
- multiple sclerosis, dementia;
- rheumatoid arthritis.
Symptoms of vitamin D deficiency in children
- Rickets – bone deformity caused by a deficiency and affecting children from the age of 6 months. The legs may look curved, softened areas appear on the bones of the skull. Children complain of pain in their bones, legs, muscles, or muscle weakness.
- Poor growth, difficulty walking skills.
- Delays in the growth of teeth.
- High risk of infection: persistent respiratory problems. According to studies, vitamin D helps protect against viral diseases of the respiratory tract, and this is especially true of children. If a child has severe asthma, you can increase vitamin D intake. Due to weakness of the pectoral muscles and the soft chest, breathing is difficult.
- Severe rickets can cause low blood calcium levels. This leads to muscle spasms, seizures and shortness of breath. Children require urgent hospital treatment.
- Weakness of the heart muscle (cardiomyopathy) is extremely rare.
- Nutrient deficiency can provoke irritability in children.
- Hyperhidrosis of the head (excessive sweating) may be an early symptom of calciferol deficiency. Experts recommend nursing mothers to include more foods rich in vitamin D or supplements, so that the child eventually gets enough nutrients.
Symptoms of vitamin D deficiency in infants
Babies with severe deficiency develop muscle spasms, hypocalcemic convulsions (tetanic convulsions), and difficulty in breathing due to a low amount of calcium.
The classic view is a child with bony leg abnormalities, chest, pelvic, skull deformities, poor growth, delayed development of the dentition, pain in the bones. More detailed signs of the disease:
- Softening of areas of the skull, the appearance of the frontal tubercles in the first few months of life, the delayed closure of the fontanelles.
- Sensitive and swollen joints.
- The thickening of the ends of the ribs (rachitic beads) in the area of transition of the cartilage tissue to the bone in 3-6 months old baby.
- Deformed leg bones – X-shaped curvature.
- Slow or waddling gait.
- Developmental disorders: short stature and insufficient weight gain.
- Pain in the bones and joints.
- In severe cases, there may be fractures.
- Slow development of teeth, enamel hypoplasia, caries.
- There may be signs of hypocalcemia, requiring urgent pediatric intervention (seizures, irritability, difficulty breathing with apnea, tetany, stridor), cardiomyopathy, or cardiac arrest, especially in infants.
Symptoms of vitamin D deficiency in adults
1. Pain and muscle weakness (mostly in the arms, either mainly in the legs, or in the arms and legs – called proximal) are the main signs of a nutrient deficiency in adults. They are soft and non-specific with a general lack of well-being.
2. Severe insufficiency – osteomalacia – provokes severe pain and weakness. Difficulties arise when climbing stairs, getting up from the floor, etc. A waddling gait develops.
3. Moderate pressure on the bones can cause soreness, often more pronounced in the ribs or bones of the lower leg. Also noted in the lower back, thighs, pelvic area and legs. Bone pain can be difficult to distinguish from muscle or joint pain. But there are some indicators. Muscle pain is concentrated in a specific area and increases during movement or physical activity, bone pain is wider and deeper. Often there are cracks in the bones, provoking sensitivity and pain.
4. Depression, mood swings. Vitamin D helps to produce neurotransmitter – serotonin, which affects the feeling of happiness. Researchers attribute low levels of nutrients to episodes of depression. In areas where there are few sunny days a year, experts recommend lamps for light therapy. They help maintain vitamin D levels during the dark winter months.
5. Infertility. According to research, nutrient deficiency may play a role in the development of polycystic ovary syndrome (PCOS), the leading cause of female infertility. One of the common symptoms of the disease – black acanthosis – a condition in which the skin darkens and thickens.
6. Chronic infections. The effect of vitamin D extends to more than 2000 genes in the human body, so it is not surprising that the work of the immune system is also related to the level of the nutrient. With a sufficient amount of vitamin the immune system is stable and able to fight infections and diseases, with a lack of it becomes vulnerable.
More detailed description of the signs of the disease:
- Symptoms of the underlying disease (for example, chronic kidney disease, malabsorption) that caused nutrient deficiency may prevail.
- Early symptoms include constant fatigue, pain in the bones and joints.
- Late manifestations include muscle weakness (especially proximal), paresthesia (disorder of sensitivity).
- Severely affected patients may experience difficulty in walking: a stumble gait or a change in gait with proximal muscle weakness and marked adductor spasm (pain and tension in the muscles, restriction of movement).
- Other signs include spinal curvature, symptoms of hypocalcemia (low calcium in the blood).
- The patient may have multiple fractures, which are often bilateral and symmetrical. Typical areas: femoral neck, scapula, ribs, vertebrae.
- Possible skeletal deformity of the spine (scoliosis, kyphosis) and the skull.
- The deformation of the teeth, hyporeflexia (reduction of reflexes, mainly spinal).
Possible long-term effects of vitamin D deficiency:
- Increased morbidity and mortality from cancer in men, especially for malignant tumors of the digestive system.
- The development of atherosclerosis and increased morbidity and death from cardiovascular diseases.
- Increased susceptibility to severe infections and mortality in critical patients.
Causes of vitamin D deficiency
Nutrient deficiency continues to spread among children and adults.
- Dark skin. In South Asia, vitamin D deficiency occurs in 94% of healthy adults. The body of people with dark skin can not synthesize the necessary amount of nutrient.
- Children’s age and age over sixty five years.
- Strict use of sunscreen.
- Permanent stay in the house or in the hospital.
- The presence of this violation in the family history.
The lack of nutrient can be associated with the following three reasons.
one. Increased body’s need for vitamin D
Nutrient deficiency is likely to develop in the following groups of people:
- Pregnant and lactating women. Deficiency also occurs in women who give birth to children at short intervals.
- Breast-fed babies when there is not enough nutrient in the mother’s body. Either babies who use only breast milk, especially after six months, because this product is low in vitamin D.
2 The body is not able to synthesize the required amount of nutrient
- The body of the elderly is not able to produce the right amount of nutrient.
- People who receive little ultraviolet radiation are at risk of vitamin D deficiency. This is a problem in the northern regions.
- Some pathologies affect the ability of the human body to produce nutrients (gastrointestinal malabsorption): short bowel syndrome, cystic fibrosis, chronic pancreatic disease, biliary tract disease (eg, primary biliary cirrhosis, biliary fistulas, biliary atresia), Crohn’s disease, celiac disease , cirrhosis. Also operations (resection of the stomach and intestines) affect the absorption.
- Rarely, people without any risk factors and diseases develop this disorder. It is not clear why this is happening, perhaps due to a metabolic problem, how the nutrient is synthesized or absorbed. So, healthy people with fair skin, getting enough sunlight, may be deficient in vitamin.
- Deficiency develops when taking certain medications, among them: carbamazepine, phenytoin, primidone, rifampicin, highly active antiretroviral therapy, colestyramine and cadmium.
- A serious lack of calcium in the diet can cause rickets, despite adequate levels of vitamin D.
3 Vitamin D deficiency in the diet
It is more common in people following a strict vegetarian or vegan diet, or who do not use fish.
How to determine the lack of vitamin D?
Assumptions that indicate a deficiency are based on a medical history, symptoms, lifestyle. Diagnosis can be made with a simple blood test.
Initial diagnostic studies:
1. Biochemical analysis of blood: kidney function, electrolytes (including serum calcium and phosphate levels), liver function (LFTs), amount of PTH.
- More than 80% of adults with osteomalacia have a high serum alkaline phosphatase concentration.
- Hypocalcemia, hypomagnesemia, and hypophosphatemia may be present, depending on the severity, duration of the disease, and calcium intake in the patient’s diet.
- An increase in plasma PTH (secondary hyperparathyroidism) is characteristic, but not always, found in patients with osteomalacia.
2. A test for anemia, the presence of which suggests possible malabsorption.
3. A microscopic examination of urine sediment helps to determine if a patient has chronic kidney disease.
4. Analysis of 25-hydroxyvitamin D (25-OHD) most reliably determines the amount of nutrient.
- In symptomatic osteomalacia or rickets, the concentration (25-OHD) in serum is less than 25 ng / ml.
- Norm 25-OHD – between 50 and 70 ng / mol, but more optimal level – 75 ng / mol and above.
An assessment is performed to identify the underlying cause of vitamin deficiency if, for example, celiac disease or cystic fibrosis, which causes malabsorption, is suspected.
Further investigations for rachitis / osteomalacia
1. Children for the diagnosis of rickets appoint an x-ray of a long bone.
2. For adults, if the diagnosis is obvious, the following tests are possible:
- An x-ray of the bones — the femoral neck, pelvis, ribs, and shoulder blades — reveals pathological areas.
- The DEXA study diagnoses low bone density.
- MRI helps to study the state of soft tissue when the ligament is broken
- CT is used to assess pathological fractures.
- Bone scans show areas of inflammation in the ribs and near the joints.
3. Ilium biopsy shows reduced mineralization, but is now rarely required.
Treatment of vitamin D deficiency in women, men and children
The main therapy – taking supplements – ergocalciferol or calciferol. It can be tablets, capsules, liquid medication, injections. Given the situation, age, severity of the condition, the doctor recommends a dose, a treatment schedule. Learn about the effect of nutrient on the prevention and treatment of various diseases in the article – The benefits of vitamin D for men, women and children.
The effect of a single injection of vitamin D lasts about six months. This is a very effective and convenient form of therapy. Suitable for people who do not like to take oral medications or simply forget to do it.
Tablets or liquid preparations with a high content of vitamin D
The dose of medication can be taken every day, every week or every month – depending on the specific situation and doctor’s prescription. For high doses, follow the instructions exactly. The advantage of high doses – the rapid elimination of the deficit, which is very important for children.
Conventional tablets, powders or liquid preparations.
They are taken daily for about a year so that the vitamin deficiency is compensated. This option is suitable for prevention or with a slight deficit.
Supportive therapy after eliminating a lack of vitamin D
Although the body’s reserves are replenished, further treatment is required to prevent a shortage in the future. This is due to the fact that perhaps any risk factor still continues to have an effect. The prescribed dose may be less than the amount needed to treat the deficiency.
If any risks when taking dietary supplements?
It is worth paying attention to the following situations:
- If other medications are taken: digoxin (in atrial fibrillation) or thiazide diuretics (bendroflumethiazide – used to treat high blood pressure) – high doses of vitamin D should be avoided. Taking digoxin needs careful monitoring.
- When the following diseases occur: kidney stones, certain types of kidney disease, liver disease or hormonal disorders. You may need to consult a specialist.
- Vitamin D should not be taken with elevated levels of calcium in the body or certain types of cancer.
- The dose will need to be increased if certain medications are taken that affect the nutrient. These include: carbamazepine, phenytoin, primidone, barbiturates, and some medications for treating HIV infection.
Multivitamins are not suitable for long-term therapy with high doses, since vitamin A in their composition is harmful in large quantities.
General treatment recommendations:
- Contact your nutritionist or find information yourself.
- Under the influence of ultraviolet rays specified period of time.
- Take a dietary supplement with vitamin D.
- Treat the underlying disease.
- Follow prescribed therapy. It may require orthopedic intervention.
- Treat pain.
Treatment of vitamin D deficiency in children
For children with rickets, calciferol, ergocalciferol or coralciferol is preferred in tablets.
- Infants before six months are prescribed 3,000 IU daily, increasing to 6,000 IU after. The daily rate for children 12-18 years old is 10,000 IU.
- Maintenance dose – 400 IU every day – suitable for a child of any age.
A relatively fast biochemical response is usually noted in children, in whose body the level of alkaline phosphatase normalizes over three months.
It is likely that other members of the child’s family also suffer from a lack of nutrients. They are recommended maintenance dose of calciferol.
Treatment of vitamin D deficiency in adults
Calciferol therapy in a volume of 10,000 IU per day and 60,000 IU weekly will lead to the restoration of nutrient reserves in eight to twelve weeks.
The maintenance treatment dose will be 1,000-2,000 IU per day or 10,000 IU per week.
For severe malabsorption or for problems with taking oral agents, an intramuscular dose of 300,000 IU of calciferol every four weeks for three months can be considered, after which the same amount – once or twice a year.
- Drugs that combine calcium and vitamin D, should be avoided in the long term, since the calcium component is usually not needed.
- Alfacalcidol or calcitrol is not effective in correcting vitamin deficiency and may cause hypercalcemia.
- Vitamin D intake is contraindicated in patients with hypercalcemia or metastatic calcification. Relative contraindications include primary hyperparathyroidism, kidney stones and severe hypercalciuria.
- Care must be taken when prescribing vitamin D to patients who are also taking certain medications, including thiazide diuretics (which interfere with calcium excretion) and digoxin.
The elimination of pathological lesions in bones associated with insufficient mineralization can take several months. Alkaline phosphatase and PTH levels will begin to decline during the first three months of treatment, but a year may pass to reach the desired range.
In some adults, the risk factors for vitamin D are persistent, they will need a lifelong dietary supplement.
- Serum calcium concentration should be checked regularly for a number of weeks after starting therapy. Then, after 3-4 months of treatment, the content of vitamin D, PTH and calcium is determined in order to evaluate the effectiveness and performance of therapy. The level of vitamin D and calcium should be monitored every six months – a year.
- For kidney diseases, 1,25-dihydroxycholecalciferol is monitored until the amount of alkaline phosphatase is restored to normal. Then the treatment is reduced to maintenance therapy. Alfacalcidol can be used with vitamin D deficiency due to kidney disease.
- Hypocalcemic tetany requires urgent treatment with intravenous calcium gluconate (initially 10 mmol of a 10% solution).
Further prevention is needed to prevent a possible relapse. It includes the removal of any underlying cause, lifestyle recommendations (diet, sun) and often long-term supplementation:
- Infants up to one year: 200 IU per day.
- Children over the year: 280-400 IU daily.
- Adults: 400 IU per day. To a greater extent, this recommendation is for certain groups: those who do not receive sunlight; old people; taking anticonvulsant drugs; in diseases of the kidneys or liver.
The prognosis is due to the main cause of the deficiency, but the result of treatment is usually good.
Therapy of simple deficiency with the use of supplements and / or ultraviolet rays plus the correction of predisposing factors lead to a significant improvement.
Rickets and osteomalacia quickly respond to vitamin D. These complications of severe deficiency in the absence or delay of treatment lead to permanent bone deformities. Increased mobility with muscle strength is the first clinical response to therapy, but there may be a temporary increase in bone pain.
Some groups of people may require long-term maintenance treatment.
Until resistance to therapy has been identified, bone healing often begins several weeks after the start of treatment and full recovery is achieved within six months.
Prevention of vitamin D deficiency
It is estimated that 20-30 minutes of exposure to ultraviolet rays on the face and forearm area at noon in a person with fair skin create the equivalent of about 2000 IU of vitamin D. For people with pigmented skin and the elderly, the amount of sunlight should be increased 2-10 times to achieve this level of nutrient. Too much exposure to ultraviolet rays can be harmful, so tanning should be avoided.
Certain groups are at risk of deficiency, for this reason they are recommended to take dietary supplements:
- Pregnant and lactating women (600 IU, according to RDA).
- Infants and children aged six months to five years.
- Elderly people from sixty five years.
- Deficient exposure to ultraviolet radiation.
The doctor may recommend the usual supplements with vitamin D for people:
- with diseases of the intestine, kidney and liver;
- taking some medication;
- with dark skin.
Colecalciferol or ergocalciferol can be used to prevent a primary deficiency — 400 IU daily — to healthy adults. At high risk of failure, 800 IU per day is recommended.
Early detection and treatment of potential causes, such as intestinal malabsorption, chronic kidney disease, are also preventive measures.
Complementary information on vitamin D deficiency informative video