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Vitamin D Deficiency
Written By : Bruce Kaler, MD 
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Vitamin D deficiency is the latest of many abnormalities that are being implicated in numerous common maladies from heart disease and strokes to depression and diabetes. There are so many references and speculation about the prevalence of deficiency that the only thing that is clear, is that nothing is clear.

We have learned a great deal more in recent years about Vitamin D and its different forms. We are learning that it may play a more important role than the traditional musculoskeletal health for which it has been known. Vitamin D has long been important for calcium metabolism. An association of low vitamin D levels with a number of other conditions has recently been recognized. However, the association does not mean it is the cause of the problem. There are often many other factors and their intricate interplay that play a role in a disease process while some of these factors may only be coincidental companions. Even though reputable experts are advocating checking vitamin D levels and begin treating low levels they admit that what is really needed are long term randomized, controlled studies of large groups of people to really see if vitamin D supplementation actually reduces heart disease, death or any of the other conditions with which it is being implicated.

This is really a case of guilt by association without adequate proof. There are numerous examples in both life and the practice of medicine where we collectively have jumped on the band wagon with certain recommendations that seemed intuitive, logical and full of promise only to be proven later as ineffective or even worse dangerous. Vitamin and nutrient supplementation is one of the more vague areas of science in terms of adequate proof to justify use of a product. Vitamin C use for treatment or prevention of colds has been shown to be pretty much useless. Many supposed deficiencies rectified by supplementation, not through consumption of a balanced diet, have been unsuccessful for reasons we don't completely understand. Use of estrogen supplementation for postmenopausal women as a protective cardiovascular effect was accepted premise for many years. When actually studied carefully, which had never been done, lacked any protective effect and had adverse effects in many cases.

The current wisdom is that previous levels for recommended daily allowance are too low. Although there are no clear guidelines for what is enough to restore and maintain healthy levels of vitamin D, regimens have been suggested by a number of experts. It is definitely difficult to consume vitamin D from the diet adequately as sources such as oily fish (e.g. sockeye salmon) would have to be consumed in quantity. Daily exposure to sunlight converts vitamin D through the skin. However this is diminished in darkly pigmented skin, use of sunscreen, elderly, or a lot of us who spend less time outdoors. Certain foods are fortified with vitamin D, like milk, but the amounts are insufficient to meet these new goals experts are discussing. Toxicity is a low risk but possible if the new increased recommendations were exceeded. Symptoms might include itching, weakness, thirst, loss of appetite, or excessive urination.

Checking levels of vitamin D is easy enough as well as supplementation. But one has to wonder about the larger picture: is it really effective. Is it cost effective to implement all these efforts for something that may or may not be useful?

I, for one, don't know!

 
 
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