There is widespread and increasing evidence that vitamin D is of major importance to the health of all our body systems yet in the UK it is believed that over a third of individuals have a significant and health affecting vitamin D deficiency.
At our clinics see a large number of clients who present with widespread aches and pains and possible other health issues too. When advised to obtain a Vitamin D test many report a significant deficiency in Vitamin D. With regulated supplements, physio treatment and exercises they find that not only the pain resolves but they feel a whole lot better overall with more energy and enjoyment of life. So why Vitamin D deficiency does affects so many aspects of our health?
How we get Vitamin D
Vitamin D helps to regulate the amount of calcium and phosphate in the body which is necessary to keep bones, teeth and muscles healthy.
The vitamin is made by our body under the skin in reaction to sunlight and according to current UK guidelines most of us should be able to get all the vitamin D we need from sunlight during the spring and summer months.
Unlike other vitamins it is not possible to obtain enough vitamin D through diet alone. Good sources include oily fish such as salmon and sardines, red meat, liver, egg yolks, and fortified foods such as fat spreads and some breakfast cereals but you would need to eat 10 egg yolks a day for sufficient vitamin D so sunlight is the main requirement
Vitamin D deficiency is being linked to an increasing number of health issues-the most well-known being rickets. Rickets was common a century ago during the industrial revolution, when diets were poor and many cities were surrounded by thick smog which limited sunlight. Yet rickets had largely disappeared by the Forties, thanks to improved nutrition and Vitamin D being added to margarine and breakfast cereals.
But today the disease is back with a vengeance.
Officially, one in 1,000 children has rickets, with up to 70 per cent of those under 16 being deficient in Vitamin D, according to research.
Why is vitamin D deficiency on the increase?
The obvious problem is the lack of sunshine we have in the UK-and even when it is sunny many people work and travel indoors.
Added to this has been the advice regarding skin cancer and the increasing use of sunblock meaning our skin is exposed to very little sunlight whatever the weather.
As it is absorbed by fat cells the increasing prevalence of obesity may also be a factor in reducing the available vitamin D in the body
Benefits of Vitamin D
As well as its importance in bone health and development there is increasing evidence regarding other benefits of vitamin D. Various scientific studies have found significant evidence that maintaining good levels of vitamin D is linked to:
Prevention of asthma flare ups
A recent review of studies concluded that Vitamin D supplements could halve risk of serious asthma attacks. A review of previous data found that vitamin D supplements could have a protective effect against serious asthma attacks when taken alongside normal asthma treatment.
A Healthy immune system
Most people also think that vitamin D is really a vitamin, but in reality, the active form of vitamin D is one of the most potent hormones in your body, and regulates more genes and bodily functions than any other hormone yet discovered. Vitamin D is produced as a pro-hormone in your skin after sunlight exposure, and is then converted to the potent hormone form.
The immune system defends the body from foreign, invading organisms, promoting protective immunity while maintaining tolerance to self. The implications of vitamin D deficiency on the immune system have become clearer in recent years and in the context of vitamin D deficiency, there appears to be an increased susceptibility to infection and auto immune diseases.
Type 2 Diabetes
Vitamin D is believed to help improve the body’s sensitivity to insulin – the hormone responsible for regulating blood sugar levels – and thus reduce the risk of insulin resistance, which is often a precursor to type 2 diabetes.
Cardiovascular conditions
Recently vitamin D deficiency has been identified as a potential risk factor cardiovascular disease (CVD)
Vitamin D deficiency has been associated with CVD risk factors such as hypertension and diabetes
It could be suggested that vitamin D deficiency contributes to the development of CVD through its association with risk factors, such as diabetes and hypertension. However, direct effects of vitamin D on the cardiovascular system may also be involved. Vitamin D receptors are expressed in a variety of tissues, including those in the heart and vitamin D has been shown to affect inflammation and cell health.
Reduction in falls in over 60s:
A large analysis of data from ten studies in older adults also showed that vitamin D supplements reduced falls by 14% compared with inactive placebo.
This was thought to be due to better protein synthesis in fast twitch muscle fibres which help to maintain balance and co-ordination and rapidly respond to instability to help prevent a fall.
Joint and muscle pain
Those with low levels of vitamin D often report general lethargy and joint and muscle pain which improves rapidly and markedly with increasing levels of Vitamin D intake and blood levels.
Alzheimer’s
There is yet more evidence linking vitamin D deficiency to Alzheimer’s disease
In a large 2014 study investigated the possible link between vitamin D deficiency and the risk of developing Alzheimer’s disease and other forms of dementia. Though scientists expected to find an association between the two, they were surprised to find that not getting enough vitamin D could double the risk of developing these conditions.
How to increase Vitamin D levels.
With Vitamin d proving to be increasingly important in such major health issues such as dementia and heart disease it appears we should all be both aware of our own vitamin D status and if we need to improve it.
Exposure to sun
The message from doctors has long been regarding the dangers of spending too much time in the sun-namely skin cancer. Cover up. Use a high sun protection factor lotion. Avoid exposure between 10am and 2pm.
However, this is being reconsidered in the evidence of widespread vitamin D deficiency.
The new message from Cancer Research UK, as of this year, is ‘Never be red at the end of the day’ – and that ten to 15 minutes of midday sun exposure, without wearing suntan cream, is actually beneficial.
However, there will always be limitations to sunlight for most inhabitants in the UK so supplements are the recommended answer. However there appears to be very little agreement by the world’s health advisors as to the optimum supplementary dose.
Vitamin D daily intake. Recommended daily allowance (RDA)
Public Health England (PHE) Advice
The new advice from PHE is that adults and children over the age of one should consider taking a daily supplement containing 10mcg of vitamin D, particularly during autumn and winter.
People who have a higher risk of vitamin D deficiency are being advised to take a supplement all year round including those who:
- Spend most of their time indoors
- Those who cover their skin when they outside.
- People with dark skin, from African, African-Caribbean and South Asian backgrounds do not synthesise sunlight so effectively
- Older people: With increasing age, your ability to synthesise your own vitamin D reduces. In one study, people aged 62 to 80 years synthesised four times less vitamin D than those aged 20 to 30 years’.
- Are obese: since fat cells hold on to the nutrient and alter its release into the bloodstream.
- Digestive disease that cause a reduction in the body’s ability to absorb fat: e.g. Crohn’s disease, ulcerative colitis and celiac disease
However, this is thought by other experts to be the MINIMUM dose and if you are already deficient in vitamin D it will simply maintain you at your current level. If you are already deficient you will not deteriorate but it will not bring your levels to optimal.
One nutritional expert states ‘If you’re only interested in protecting the future health of your bones, then the Government recommended daily dose of 10mcg is probably fine. But, if you want to maintain optimum blood levels that boost your immunity and protect against other health issues, a higher dose is needed. In any case, to suggest that the same 10mcg dose will suit everyone, from a tiny infant to a strapping body-builder and a frail, elderly lady is illogical.
Other Recommendations for Vitamin D supplementary doses
1) If you are under the age of 50, many experts suggest that, in the absence of sun exposure, an intake of 25mcg (1000iu) vitamin Dall year round is more appropriate than 10mcg for optimum adult immune health. If you are over the age of 50, a higher intake of at least 50mcg vitamin D3 may be needed.
2) Osteoporosis Canada advises healthy adults aged 19-50 consume 400-1,000 IU daily, and those over 50, or younger adults at high risk, get 800-2,000 IU daily. The organization advises year-round vitamin D supplementation for all Canadian adults.
3) The Recommended Dietary Allowance (RDA) for vitamin D is ten times lower than what we actually need, say two teams of researchers who have challenged the US’s National Academy of Sciences (NAS) and the Institute of Medicine (IOM), both responsible for the RDA.
“The error has broad implications for public health regarding disease prevention and achieving the stated goal of ensuring that the whole population has enough vitamin D to maintain bone health,” says Dr. Cederic Garland, an adjunct professor at University of California, San Diego.
4) A Canadian research team reviewed each of the 10 studies the IOM used to arrive at their RDA and their calculations revealed that 600 IU of vitamin D per day puts only half of the amount that they had assumed in the blood.
Is it possible to take too much vitamin D?
The main consequence of vitamin D toxicity is a build-up of calcium in your blood (hypercalcemia), which can cause poor appetite, nausea and vomiting. Weakness, frequent urination and kidney problems also may occur.
NB Health Canada’s safe upper limit is 4,000 IU per day
Conclusion
There is increasing evidence that there is likely to be a lack of vitamin D in many people living in the modern world in a country with limited sunshine.
The effects of that deficiency are proving to be far more serious and wide-ranging that was previously thought yet vitamin D testing is not routine in the UK and appears to not be considered by many health professionals as a possible issue in a patient’s health. Yet whenever a random sample of individuals is tested in studies the majority show a significant and sometimes alarming low level of Vitamin D.
With the current controversy regarding the best and safest dose of supplementation the best advice is to have your Vitamin D levels checked and adjust any supplements accordingly. For those with very low levels a 6 -8 weeks high dose of vitamin D maybe prescribed by your GP and levels re checked after wards and ongoing maintenance dose calculated
At Physio-Answers we have advised many patients to be checked when they present to us with joint and muscle pain and many report they were significantly deficient. Subsequent improvement and management of their vitamin D has been an important part of their recovery. So if you are suffering aches and pains, night pain or morning stiffness than come for a check-up with we and we can advise you as to the best and most holistic approach to your problems. Call 020 3538 3808 to make an appointment or discuss any worries toy may have with one of our experienced physiotherapists.