Vitamin D Deficiency - Health Problems, Symptoms, Treatments

Vitamin D stands for Vitamin Dilemma because Vitamin D deficiencies have been implicated in a wide range of health problems and yet the body itself can produce this essential nutrient when exposed to sunlight. Yet people are told to keep out of the sun and sunscreens block the UV light that stimulates the production of vitamin D.

The natural high levels of melanin in the skin of Black people acts as a natural sunblock. This means that blacks living in the United States and in many European countries, where sun is less intense than in Africa, have less production of the previtamin due to sunlight exposure.

The general advice is that sun-baking and exposure to the sun can cause skin cancer. So people are staying out of the sun and not eating the small number of foods that are good sources of vitamin D and ending up with Vitamin D deficiencies.

Many studies in recent years have linked low levels of vitamin D to a growing number of health risks including heart disease, fragile bones, Rickets in children, high blood pressure, cancer, rheumatoid arthritis and mental development during pregnancy.

There is some evidence that exclusive breast-feeding may inadvertently lead to Vitamin D deficiency because the babies miss out on the Vitamin D supplements added to baby formulas and milk products, unless they are given other supplements.

This article discusses some of the health problems and risks, and looks for solutions to the Vitamin D dilemma.

Are you getting enough Vitamin D?
Are you getting enough Vitamin D? Source: Public Domain

What is Vitamin D

Vitamin D is a fat-soluble vital nutrient that is produced naturally the layers of the skin. Ultraviolet B radiation from sunlight that is absorbed into the tissues of the stimulates previtamin D to be produced through a natural process. This is transformed into the biologically active form of vitamin D in the kidneys.

Doctors around the world are reporting increasing numbers of enquiries, usually by woman over 50, about vitamin D deficiencies and bone health. Tests are showing low levels of Vitamin D in the blood. If vitamin D levels are deficient, the body's absorption of calcium is impaired, and bones become more fragile and prone to fractures. Recent research showed that of the 889 adult patients treated for bone fractures in Missouri, about 75% had blood levels of vitamin D classed as "insufficient" and 40% had levels classed as “deficient” . None of the subjects in this study had any known risk factors for vitamin D deficiency.

A second report, from South Korea, showed that vitamin D levels were significantly lower for about 100 post-menopausal women who had broken their wrists, than for about 100 age-matched controls.

How the body uses sunlight to make its own Vitamin D
How the body uses sunlight to make its own Vitamin D. Source: Public Domain
Best sources of Vitamin D in common foods
Best sources of Vitamin D in common foods. Source: Public Domain

Vitamin D has Many Vital Roles and Functions in the Body

Virtually every tissue in the body has receptors for vitamin D, including intestines, brain, heart, skin, lymphocytes, sex organs, breasts and the placenta. Research studies have shown a link between vitamin D deficiencies of many health problems. These association studies suggest, without establishing a cause and effect relationship, that vitamin D deficiencies cause or contribute to many problems and diseases. These problems include colorectal cancer, bone health, high blood pressure, kidney disease and heart disease. These diseases are more prevalent in black Americans and blacks living in the Northern Hemisphere in the UK and Europe that are known to have higher rates of vitamin D deficiencies. There is also some preliminary evidence that vitamin D deficiency plays a role in Type 2 diabetes, asthma, pre-eclampsia and low birth weight or children, autoimmune diseases like multiple sclerosis and rheumatoid arthritis, and several brain-function disorders like depression, autism and memory loss. 

Vitamin D deficiency during pregnancy has also been linked to impaired speech development in children. See: Vitamin D Deficiency in Mothers Linked to Childhood Speech Problems

It has also been linked to the resurgence of the childhood disease of rickets in US and other western countries. The sudden increase in the incidence of in rickets in Southampton UK astounded local doctors. Studies showed that more than 20% of children tested for bone problems in Southampton showed signs of rickets, which was prevalent in 17th Century England. Rickets can cause various bone deformities, such s bowed legs as well stunted bone growth in children.

Concerning Finding of British Study on the Rising Incidence of Rickets in Children

The condition, nutritional rickets, usually results from a dietary deficiency of vitamin D. This impairs the body's ability to absorb calcium from the diet, resulting in poor bone development. If rickets occurs in infancy or early childhood, the weak bones can become severely deformed, occasionally resulting in the need for major surgery.

Most individuals produce their own vitamin D when their skin is exposed to sunlight. Other sources of vitamin D include foods to which the vitamin is added in processing, such as milk, and most vitamin preparations. At the beginning of the 20th century, nutritional rickets was a common disease, particularly among infants in urban areas of the United States. With the advent of routine vitamin D supplements, however, the problem virtually disappeared by mid-century.

Prof Clarke, based at Southampton General Hospital, said vitamin D supplements should be more widely adopted to halt the rise in cases. A lack of vitamin D can be caused by poor diets and insufficient exposure to sunlight, which helps the body synthesise the vitamin. "A lot of the children we have seen have got low vitamin D and require treatment," he said.

In my 22 years at Southampton General Hospital, this is a completely new occurrence in the south that has evolved over the last 12 to 24 months and we are seeing cases across the board, from areas of deprivation up to the middle classes. Prof Nicholas Clarke Prof Clarke said vitamin D supplements should be more widely adopted to halt the rise in cases. "There is a real need to get national attention focused on the dangers this presents."

'He added that the "modern lifestyle, which involves a lack of exposure to sunlight, but also covering up in sunshine" had contributed to the problem. "The return of rickets in northern parts of the UK came as a surprise, despite the colder climate and lower levels of sunshine in the north, but what has developed in Southampton is quite astonishing," said Prof Clarke.

"We are facing the daunting prospect of an area like Southampton, where it is high income, middle class and leafy in its surroundings, seeing increasing numbers of children with rickets, which would have been inconceivable only a year or so ago."

Several articles published in the Journal of Pediatrics highlight an emerging incidence of rickets in the US, perhaps linked to an increase in breast-feeding in infants who miss out on the supplemental vitamins added to formulas, milk and other diary products.

A study in North Carolina, of 30 children diagnosed with rickets, were all African-American and breast-fed children who received no supplemental vitamin D (which is present in milk formulas). The researchers suggested that the lack of vitamin D in the diet and their dark skin, may have predisposed these infants to rickets. The rise in the incidence of rickets in the general population as well has lead to the researchers calling for all infants to get Vitamin D supplements.

Another dilemma for the Vitamin D problem is that very few natural foods and ingredients contain good levels of vitamin D. Such foods are not common in most foods as the best sources are fatty cold-water fish like salmon, and salt water species such as sardines, bluefish, anchovies, tuna and mackerel, as well as cod liver oil.

Some foods are fortified with the vitamin D, especially infant formula, milk and, more recently, some brands of yogurt, cheese, orange juice and breakfast cereal.

But there is no screening of vulnerable groups to ensure enough vitamin D is being provided in diets, especially as many weight conscious people have moved away from dairy products and fatty foods.

Another risk factor is skin color and the fact that many people or all colors spend less time in the sun, and when they do they wear sunscreens.

Dark skin evolved in equatorial Africa, where the sun is intense year round and just a brief daily exposure to UVB (the sun's burning rays) is sufficient to achieve adequate blood levels of vitamin D. But melanin in the skin acts as a natural sunblock, and among blacks living in the United States, where sun is less intense, less of the previtamin is produced.

Research studies based on thousands of adult participants in the National Health and Nutrition Examination Survey conducted from 2001 to 2006, revealed much higher rates of vitamin D deficiency among non-Hispanic blacks than non-Hispanic whites. Furthermore, in separate studies, lower levels of vitamin D among blacks across the

country were associated with a greater incidence of colorectal cancer, high blood pressure, protein in urine (a precursor of kidney disease) and cardiovascular deaths.

For an interesting article on the evolution of skin color in humans see Did Skin Color Evolve as an Adaptation to Sunlight Intensity?

Avoiding Vitamin D Deficiency - The Multiple Dilemmas

Because of the growing concern about a possible epidemic of health problems cause by vitamin D deficiency many doctors and researchers have called for widespread screening of serum levels of Vitamin D and government action to remedy the problem. This screenings should be particularly applied to groups with greater risk for a deficiency such as: dark skinned people, older people, obese children and adults, and pregnant or nursing women.

Charts of Recommended Daily Allowances and Foods which are a good source of Vitamin D are shown below:

Recommended Daily Allowances of Vitamin D and Foods which are a good source of Vitamin D
Recommended Daily Allowances of Vitamin D and Foods which are a good source of Vitamin D. Source: Public Domain

Chart of Foods Rich in Vitamin D (Listed by amount - see serving size)

Food
Serving
Internat. Units per serve
Food
Serving
Internat. Units per serve
Fish oil, cod liver
100 g
10000
Fast foods, egg, scrambled
100 g
68
Mushrooms, shiitake, dried
100 g
1660
OSCAR MAYER, Salami (hard)
100 g
62
Fish, herring, Atlantic, raw
100 g
1628
Margarine, fortified
1 tablespoon
60
Cod liver oil
1 tablespoon
1360
Fish, flatfish (flounder and sole species), raw
100 g
60
Tuna, bluefin, cooked
100 g
920
Tuna, canned, light or white
100 g
59
Salmon, sockeye, canned
100 g
780
Bologna, pork
100 g
56
Fish, salmon, sockeye, canned, drained solids with bone
100 g
763
Butter, salted
100 g
56
Fish, herring, Atlantic, pickled
100 g
680
Milk, lowfat, fluid, 1% milkfat, with added vitamin A
100 g
52
Fish, salmon, pink, canned, solids with bone and liquid
100 g
624
Cream, fluid, heavy whipping
100 g
52
Fish, halibut, Greenland, raw
100 g
600
Pork sausage, fresh, raw
100 g
52
Salmon, pink, canned
100 g
580
Fortified margarine
2 teaspoons
51
Swordfish, cooked
3 oz
566
Oscar Mayer, Liver Cheese, pork fat wrapped
100 g
49
Tuna, skipjack, cooked
100 g
508
Soy milk, fluid, calcm fortified
100 g
49
Fish, catfish, channel, wild, raw
100 g
500
Pickle and pimiento loaf, pork
100 g
48
Sardines, Pacific, canned
100 g
480
Braunschweiger (a liver sausage), pork
100 g
48
Fish, sardine, Pacific, canned in tomato sauce, drained solids with bone
100 g
480
Picnic loaf, pork, beef
100 g
48
Fish, salmon, pink, canned, drained solids with bone
100 g
466
Salami, cooked, beef
100 g
48
Salmon (sockeye), cooked
3 oz
447
Sardines, canned in oil, drained, 2 sardines
2 sardines
46
Milk, dry, nonfat, instant, with added vitamin A
100 g
440
Ham and cheese loaf or roll
100 g
44
Fish, mackerel, Atlantic, raw
100 g
360
Sausage, Polish, pork and beef, smoked
100 g
44
Cereals, QUAKER, Instant Oatmeal
100 g
342
Sausage, smoked link sausage, pork and beef
100 g
44
Fish oil, sardine
100 g
332
Cheese, swiss
100 g
44
Milk, dry, nonfat, regular, without added vitamin A
100 g
332
Thuringer, cervelat, summer sausage, beef, pork
100 g
44
Salmon, Atlantic, cooked
100 g
328
Fish, cod, Atlantic, raw
100 g
44
Mollusks, oyster, eastern, wild, raw
100 g
320
Ice creams, vanilla, rich
100 g
44
Infant formula, ROSS, SIMILAC, low iron, powder, not reconstituted
100 g
316
Milk, reduced fat, fluid, 2% milkfat, with added vitamin A
100 g
43
Milk, dry, whole
100 g
312
Liver, beef, cooked
3 oz
42
Infant formula, MEAD JOHNSON, ENFAMIL, low iron, powder, not reconstituted
100 g
310
Egg, 1 large (vitamin D is found in yolk)
1 large
41
Mushrooms, shiitake, cooked, with salt
100 g
303
Shake, fast food, vanilla
100 g
41
Infant formula, WYETH-AYERST, store brand soy, with iron, powder, not reconstituted
100 g
303
Milk, nonfat, fluid, with added vitamin A (fat free or skim)
100 g
41
Cereals ready-to-eat, MALT-O-MEAL, Corn Flakes
100 g
296
Ready-to-eat cereal, fortified with 10% of the DV for vitamin D
1 cup
40
Infant formula, MEAD JOHNSON, LOFENALAC, with iron, powder, not reconstituted
100 g
290
Fast foods, english muffin, with egg, cheese, and canadian bacon
100 g
32
Trout, cooked
100 g
280
Egg, whole, cooked, omelette
100 g
29
Fish, sardine, Atlantic, canned in oil, drained solids with bone
100 g
272
Cheese, parmesan, hard
100 g
28
Fish, mackerel, jack, canned, drained solids
100 g
252
Ice creams, vanilla, light
100 g
26
Infant formula, MEAD JOHNSON, ENFAMIL, NUTRAMIGEN, with iron, powder, not reconstituted
100 g
250
Egg yolk
1 yolk
25
Cereals ready-to-eat, MALT-O-MEAL, High Fiber Bran Flakes
100 g
248
Spinach souffle
100 g
25
Fish, tuna, light, canned in oil, drained solids
100 g
236
Salami, cooked, turkey
100 g
24
Fish, caviar, black and red, granular
100 g
232
Fast foods, fish sandwich, with tartar sauce and cheese
100 g
20
Cereals ready-to-eat, MALT-O-MEAL, Chocolate Flavored Crisp Rice Cereal
100 g
230
Sandwiches and burgers, hamburger, large, single meat patty, plain
100 g
16
Salmon, chum, canned
100 g
224
Candies, fudge, vanilla, prepared-from-recipe
100 g
16
Fish, salmon, chum, drained solids with bone
100 g
224
Fast foods, hamburger, regular, double patty, plain
100 g
16
Herring, cooked
100 g
216
Candies, fudge, chocolate, prepared-from-recipe
100 g
16
Cereals ready-to-eat, KELLOGG, KELLOGG'S ALL-BRAN WITH EXTRA FIBER
100 g
210
Soy milk, fluid
100 g
16
Cereals ready-to-eat, KELLOGG'S, FRUIT HARVEST Strawberry/Blueberry
100 g
205
Bread, egg
100 g
16
Cereals ready-to-eat, KELLOGG'S, FROSTED FLAKES 1/3 Less Sugar
100 g
202
Candies, fudge, vanilla with nuts
100 g
14
Cereals ready-to-eat, GENERAL MILLS, GENERAL MILLS Berry Burst CHEERIOS, all flavors
100 g
200
Candies, fudge, chocolate, with nuts, prepared-from-recipe
100 g
14
Egg, whole, dried
100 g
188
Sausage, Berliner, pork, beef
100 g
13
Cereals ready-to-eat, KELLOGG'S, CORN FLAKES With Real Bananas
100 g
175
Potatoes, mashed, dehydrated, prepared from flakes without milk, whole milk and butter added
100 g
12
Tuna fish, canned in water, drained, 3 ounces
3 oz
154
Sandwiches and burgers, cheeseburger, large, single meat patty, plain
100 g
12
Cereals ready-to-eat, KELLOGG, KELLOGG'S Corn Flakes
100 g
152
Sausage, summer, pork and beef, sticks, with cheddar cheese
100 g
12
Crustaceans, shrimp, mixed species, raw
100 g
152
Sausage, pork and beef, with cheddar cheese, smoked
100 g
12
Cereals ready-to-eat, wheat, puffed, presweetened, single brand
100 g
148
Fast foods, hamburger, regular, single patty, plain
100 g
12
Tuna, yellowfin (albacore, ahi), cooked
100 g
140
Sandwiches and burgers, cheeseburger, regular, single meat patty, plain
100 g
12
Orange juice fortified with vitamin D (amount varies)
1 cup
137
Fast foods, sundae, strawberry
100 g
12
Cereals ready-to-eat, GENERAL MILLS, Multi-Grain Cheerios
100 g
126
Fast foods, sundae, hot fudge
100 g
12
Cereals ready-to-eat, oats, corn puffed mixture, presweetened, single brand
100 g
125
Milk, goat, fluid
100 g
12
Cereals ready-to-eat, KELLOGG, KELLOGG'S FROOT LOOPS
100 g
125
Cheese, cheddar
100 g
12
Milk, nonfat, reduced fat, and whole, vitamin D-fortified
1 cup
120
Cheese, camembert
100 g
12
Fish, herring, Atlantic, kippered
100 g
120
Fast foods, sundae, caramel
100 g
8
Mackerel, cooked
100 g
108
Potatoes, mashed, home-prepared, whole milk and butter added
100 g
8
Fortified orange juice
1 cup
106
Fast foods, ice milk, vanilla, soft-serve, with cone
100 g
8
Sardines, Atlantic, canned
100 g
93
Shake, fast food, strawberry
100 g
8
Mushrooms, canned, drained solids
100 g
90
TACO BELL, BURRITO SUPREME with beef
100 g
7
Fortified rice or soy beverage
1 cup
88
Fish, fish portions and sticks, frozen, preheated
100 g
7
Cereals ready-to-eat, KELLOGG'S, SMART START Soy Protein
100 g
85
Cheese, Swiss, 1 ounce
1 oz
6
Fish, cod, Atlantic, canned, solids and liquid
100 g
84
Potatoes, mashed, home-prepared, whole milk added
100 g
6
Cereals ready-to-eat, KELLOGG, KELLOGG'S JUST RIGHT Fruit & Nut
100 g
83
Potatoes, mashed, home-prepared, whole milk and margarine added
100 g
6
Yogurt, fortified with 20% of the DV for vitamin D
6 oz
80
Mollusks, clam, mixed species, raw
100 g
4
Milk, canned, evaporated, nonfat
100 g
80
Milk, human, mature, fluid
100 g
4
Infant formula, MEAD JOHNSON, ENFAMIL, low iron, liquid concentrate, not reconstituted
100 g
78
Snacks, corn-based, extruded, puffs or twists, cheese-flavor
100 g
2

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Synthesis pathway for Vitamin D from sunlight exposure to processing in the Liver
Synthesis pathway for Vitamin D from sunlight exposure to processing in the Liver. Source: Public Domain
Effects of Rickets in Children with a Deficiency of Vitamin D
Effects of Rickets in Children with a Deficiency of Vitamin D. Source: Public Domain
Symptoms of Health Problems related to a deficiency of Vitamin D in Adults
Symptoms of Health Problems related to a deficiency of Vitamin D in Adults. Source: Public Domain
History of the Disease of Rickets in Children
History of the Disease of Rickets in Children. Source: Public Domain
Signs and Symptoms of Rickets in Children
Signs and Symptoms of Rickets in Children. Source: Public Domain
People at risk of Vitamin D Deficiency
People at risk of Vitamin D Deficiency. Source: Public Domain
Signs that you may need more Vitamin D via increase sun exposure or in your diet
Signs that you may need more Vitamin D via increase sun exposure or in your diet. Source: Public Domain
Vitamin D metabolism summary and role played in the body
Vitamin D metabolism summary and role played in the body. Source: Public Domain
Incidence of Vitamin D Deficiency
Incidence of Vitamin D Deficiency. Source: Public Domain
Symptoms of Vitamin D Deficiency
Symptoms of Vitamin D Deficiency. Source: Public Domain
Diseases related to Vitamin D Deficiency
Diseases related to Vitamin D Deficiency. Source: Public Domain
Goals of treatment for Vitamin D Deficiency
Goals of treatment for Vitamin D Deficiency. Source: Public Domain