(Updated on 12/22/2019)
ICD-10-CM Diagnosis Code
Vitamin D deficiency is a common diagnosis. In essence, this vitamin added to calcium and phosphate, is vital to your bone health and a functioning immune system.
Furthermore, in a large study, the rate of multiple sclerosis was twofold higher in individuals with low blood vitamin D levels (20 ng/ml).
Vitamin D deficiency Symptoms
The majority of people who have mild to moderate deficiency will not show any symptoms. However, individuals who have prolonged severe deficiency might suffer from bone pain or tenderness, muscle weakness, difficulty walking, and bone fractures.
Low blood vitamin D level
The amount of vitamin D deposits go down with advanced age. Also, in cold winter days, vitamin D production in the skin reduces, and in some individuals stops entirely.
Did you know that African-Americans have higher bone density and lower fracture risk compared to other races?
The common causes of vitamin D deficiency are related to low intake, absorption, and production. Patients who don’t consume enough vitamin D rich foods (listed below) or have difficulty in producing this vitamin because of kidney issues, and/or lack exposure to sunlight will have low blood level of this vitamin.
1) Vitamin D2 (ergocalciferol): Is synthesized in plants and fungi following the exposure to ultraviolet light.
2) Vitamin D3 (cholecalciferol): Ultraviolet-B radiation from the sun prompts the production of vitamin D3 from 7-dehydrocholesterol (7-DHC) in the skin.
Several studies suggest that vitamin D3 is absorbed better and is more efficient in elevating the total blood vitamin D level.
Vitamin D2 supplementation is a good option for vegetarians especially vegans who don’t eat animal products.
To receive a sufficient amount of vitamin D, ultraviolet B (UV-B) sunlight should cover roughly 20% of the body. But exposure to so much sunlight can be harmful to skin health through speeding up the aging process and consequently, causing skin cancer.
Wearing white cotton transmits more UV-B to the body than black wool and allows for blood vitamin D concentrations to increase.
Additionally, sunscreen could reduce the absorption of UV-B and consequently cause lower blood levels of this vitamin.
For instance, sunscreen with a sun protection factor (SPF) of 8 can decrease vitamin D3 absorption by 95%, and SPF 15 can decrease it by 98%.
Foods high in vitamin D
|Food||content in IU|
|Dried shitake mushrooms (non-radiated)||1660/100g|
|Atlantic herring (raw)||1628/100g|
|Canned pink salmon with bones in oil||624/100g|
|Fortified orange juice/soy milk/rice milk||400/L|
|Canned tuna/sardines/salmon/mackerel in oil||224–332/100g|
|Yogurt (normal, low fat, or nonfat)||89/100g|
Adapted from United States Department of Agriculture
Vitamin D levels
Ideal blood vitamin D level is a matter of debate. But based on research data—a blood 25(OH) vitamin D level between 30-40 ng/ml is an acceptable level. This blood level is important for maintaining the general health of an individual including his or her bone health.
Treating pregnant women with vitamin D is safe.
The Institute of Medicine recommends a daily dosage of 600 IU of vitamin D for every pregnant women and nursing.
Did you know that the breast milk of a healthy mother doesn’t provide the suggested daily amount of Vitamin D?
Vitamin D deficiency in children
Severe blood vitamin D deficiency can cause rickets and/or low blood calcium level in children. Moreover, low blood calcium levels on its own can cause seizures.
Rickets is a disease that mostly seen in malnourished children especially if they live in areas with limited exposure to sun. A low blood level (<20 ng/ml) of this vitamin has been associated with muscle weakness in children.
Daily recommended amount for children and adults
|Infant and children 0-1year||400 IU/ daily|
|Children 1 year and older||600 IU/ daily|
|Adults 18-50 year||600 IU/ daily|
|Adults 50-70 year||600-800 IU/daily|
|Pregnant women||At least 600 IU/daily|
My opinion and analysis:
This vitamin appears to play an important role in our health. Above all, the numbers of people who aren’t diagnosed with this condition are larger than we might expect.
Unanswered questions about the effects of this vitamin on our mood and different functions of our body remain. But what we know is that the blood level of this vitamin should be above 20 ng/ml, and optimally between 30-40 ng/ml.
Low blood vitamin D level could harm our body but taking too much of it can also be damaging. Elevated blood levels could cause kidney stones and calcifications of the arteries.
Certainly, the primary source of supplementation should be through your food intake and well-balanced nutrition. But often, you have no choice than taking vitamin D supplementation (see above recommendations).
Lastly, I don’t recommend relying on sunlight for gaining adequate vitamin D, considering potential harm of prolonged exposure to the sunlight including skin cancer and rapid aging of the skin.
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