Treatment
Vitamin D Therapy
What is Vitamin D?
The human body naturally synthesises vitamin D3 in the skin through exposure to direct sunlight and also obtained through the diet from fish liver oils and saltwater fish. In many developed countries, milk and other foods are fortified with vitamin D.
Vitamin D3 levels also decrease with age because skin synthesis declines. The use of sunscreen, as well as dark skin pigmentation, can also reduce the amount of vitamin D3 the body produces.
Vitamin D affects many organ systems, but it primarily helps to increase calcium and phosphate absorption from the intestines and promotes the formation of mineralisation within the bones.
A deficiency in vitamin D can be the result of the following:
- Lack of exposure to sunlight
- Reduced intake of vitamin D in the diet
- A reduction in the absorption of vitamin D
- Vitamin D is unable to be metabolised by the body
- The body becomes resistant to the effects of vitamin D
The benefits of Vitamin D
- Vitamin D plays an important role in the health of muscles and bones. It helps with the absorption of calcium and phosphorus from the intestines, which has a direct effect on the muscles and bones. An increase in vitamin D can help with aches and pains in the bones and muscles as well as help with chronic fatigue and osteoporosis.
- It has a vital role in the normal functioning of the immune system and can prevent and treat immune disorders such as rheumatoid arthritis, type 1 diabetes, Crohn’s disease and asthma. It can also help to prevent and treat colds, flu and other infections of the body.
- Vitamin D controls the growth of normal and cancerous cells. It can act as a prevention and treatment of certain cancers such as colon, pancreas, breast and prostate cancer.
- It stimulates the production of insulin by producing cells in the pancreas. It also helps to reduce insulin
resistance and can help to prevent type 2 diabetes. - It helps to regulate blood pressure by aiding the production of angiotensin. Vitamin D also helps to prevent hypertension, kidney disease and heart failure.
- Reduces the chances of developing coronary heart disease by reducing inflammation in the blood vessel wall.
- Helpful in the treatment of skin conditions like psoriasis as it aids in normal skin function.
- Beneficial for the health of the teeth and preventing many dental problems.
- Boosts the mood and helps to treat depression.
- Reduces the risks of neurological disorders such as Multiple Sclerosis (M.S), Parkinson’s disease, Autism and Alzheimer’s by aiding the development and function of the brain.
Vitamin D the Hormone
Vitamin D is a hormone that is produced in the skin from 7-dehydrocholesterol (pro-vitamin D3), which is derived from cholesterol. Cholesterol is a precursor for most hormones of the body.
Type B Ultraviolet rays (UVB) act on pro-vitamin D3 and convert it into pre-vitamin D3, which is then converted into vitamin D3. Vitamin D3 then leaves the skin and enters into the bloodstream, where it travels on a special protein called a vitamin D-binding protein (VDBP).
Like other hormones, vitamin D exerts its biologic effects through a specific chemical structure inside the cell, called vitamin D receptor (VDR), which has been discovered inside the nucleus of nearly every cell in the human body.
Vitamin D deficiency has been found to be more prevalent than previously thought and in pandemic proportions. It is presumed this may explain the rise of chronic fatigue, heart disease, hypertension, diabetes, cancer, osteoporosis, asthma and other immunologic diseases.
Deficiency in vitamin D is a relatively new discovery, first recognised by scientists in the 17th century in the UK. It began to be discovered around the time of the industrial revolution when people migrated to industrial cities and lived and worked in multistorey buildings with narrow and dark passageways, teamed with pollution from the coal-burning factories. This affected the sunlight penetrating towards the lower ground reducing exposure to sunlight as well as long, cold and dark winters.
In the 1900s, a new disease emerged amongst children living in big industrial cities like London. These children had stunted growth, muscle wasting and deformed legs. This disease was named rickets by physicians, but no one understood the cause of this crippling disease. Children had little exposure to sunshine, and consequently, severe vitamin D deficiency developed, and children were particularly affected as their developing bones suffered severely. By the 1930s, the link between rickets and vitamin D deficiency was well established. This discovery led to the fortification of milk with vitamin D. In the countries that adopted this practice mostly eradicated rickets.
Now migration can occur even quicker, in a matter of hours by plane. With the rise of people living in Europe from Asia and Africa, who haven’t had thousands of years to adapt to this climate change like their ancestors, are particularly prone to vitamin D deficiencies.
Those with fairer skin tones which now adapted to the colder and darker climates of the north started to holiday in the south. This caused a rise in skin cancer, starting a campaign of sun avoidance and people of all races, applying sunscreen to block these harmful rays. We are now trained to avoid the sun at certain times of the day, wear sunscreen all year round and cover up to avoid the risk of cancer. This also has the damaging side effect of a reduction of vitamin D production.
People also spend more time indoors than ever before, further reducing their exposure to the vital rays of the sun that produce vitamin D in the skin.
Sources of Vitamin D
Vitamin D can be obtained from several sources, but for many people, they are unable to make enough vitamin D required by any of the sources.
Sun Exposure: It is incredibly difficult for anyone to make enough vitamin D from sun exposure alone. Anyone Fitzpatrick 1-3 would need to sunbathe for around 2-4 hours a day in summer to achieve a good level of vitamin D. Fitzpatrick 4 and above need ten hours a day. This is unobtainable for many people around the world.
The use of a sunscreen that blocks UVB rays will prevent the synthesis of vitamin D; however, the risk of skin cancer is high for many people who over-expose themselves to the sun’s harmful rays.
Diet: Diet is not the best source of vitamin D; however, you can get some of your daily requirement from selective foods. Many foods have vitamin D added to them, such as milk, yoghurt and cereals. Oily fish such as salmon and mackerel contain reasonable amounts of vitamin D. How the fish is cooked will determine the amount of vitamin D that is absorbed by the body. Fish that is fried decreases in vitamin D content by around 50%.
Eggs, meat and vegetables contain very small amounts of vitamin D.
Vitamin D Supplements
Taking a vitamin D supplement can help to increase the body’s natural vitamin D levels; however, many people are taking too low a dose for their weight, as vitamin D is fat-soluble and gets trapped in fat. Consequently, less is then available for the rest of the body. Medications can also decrease vitamin D reserves in the body.
Many people will assume that they are taking their daily recommended allowance of vitamin D as they are taking multivitamin supplements that claim they contain 100% of the daily requirement.
Many specialists within the field of nutrition recommend taking a daily dose of vitamin D of 1000 I.U for every 20lbs of body weight.
Symptoms of Vitamin D deficiency
- Fatigue or tiredness
- Bone pain
- Joint pain
- Muscle pain
- Sour mood
- Low energy
- More frequent illness
- Anxiety
- Irritability
- Weight gain
- Hair loss
- Sweaty Scalp
- Fertility issues
Risks leading to vitamin D deficiency
- Vegans
- Indoor workers
- Nursing mums
- Over 50’s
- Fitzpatrick 4 and above
- Obesity
- Geographic location
- Season of the year, i.e. winter months
Vitamin D toxicity
It is quite common for magazines and news articles to discuss the dangers of vitamin D toxicity, and these stories may put people off taking any form of supplementation.
Vitamin D toxicity is defined as ‘too much vitamin D, causing harm to the body.’
According to a review from Queen’s University in Kingston, Canada, the author concluded that a blood level of more than 300ng/ml is considered to caused toxicity. The upper limit of vitamin D was set at 30-100ng/ml to provide a large safety net.
The University of Toronto, Canada, reported two cases of high doses of vitamin D. The first was a gentleman that had been taking 4,000 I.U./day for three years followed by three years of 8,000 I.U./day. On investigation, his blood levels remained around 52ng/ml while taking 4,000 I.U./day and 104ng/ml while taking 8,000 I.U./day. There was no evidence of toxicity, and he maintained normal levels of calcium in his blood and urine over the six years he was taking vitamin D3.
The second gentleman was a 39-year-old diagnosed with multiple sclerosis. He started to initiate his own dose of vitamin D3, starting from 8,000 and increasing to 88,000 I.U./day over a period of 4 years. At the highest dose, his blood vitamin levels were 450 ng/ml, and his blood calcium was 2.63 mmol/L (range should be 2.2-2.6 mmol/L). Even at the higher doses of vitamin D, his calcium levels were only slightly above the upper limit of normal, without any symptoms of toxicity.
In medical literature, cases of vitamin D toxicity are rare.
Signs of Vitamin D toxicity
Excessive amounts of vitamin D in the body can cause calcium levels in the blood to rise. This can lead to a condition called hypercalcemia (too much calcium in the blood); symptoms include:
- Loss of appetite
- Weight loss
- Excessive thirst
- Excessive urination
- Dehydration
- Fatigue
- Constipation
- Ringing in the ear
- Nausea, vomiting
- Dizziness
- Irritability, nervousness
- High blood pressure
- Confusion, disorientation
- Heart arrhythmias
Long-term, untreated complications include:
- Kidney failure
- Kidney stones
- Kidney damage
- Excess bone loss
- Calcification (hardening) of arteries or soft tissues.
Treatment of vitamin D toxicity
Treatment usually involves stopping vitamin D intake and reducing calcium intake.
Contra-indications
- Pregnancy
- Breastfeeding
- Allergy to any of the products’ ingredients
- Hypersensitivity to Calcitriol
- Hypercalcemia
- If under close medical supervision
- Cardiac disease
- Renal failure
Side effects
Vitamin D injections are intramuscular (into the muscle) injections that provide a large dose of Vitamin D. After the injection, the muscle gradually releases the Vitamin D into the bloodstream.
Studies show that after one injection, Vitamin D levels continue to rise for several weeks and will remain improved for several months.
After the injection, clients may experience constipation as a side effect, stomach irritation or discomfort may arise following treatment. Elevated vitamin D levels may induce nausea or vomiting, which may also result in a diminished appetite, weight loss or unusual weakness.
Rarely high vitamin D blood levels caused by the treatment with this type of supplement may increase the amount of calcium in the body. This side effect, called hypercalcemia, may have serious consequences. Symptoms associated with high calcium levels include confusion, frequent urination, increased thirst, fatigue, dry mouth, headaches or instability while walking.
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