Could you be low or deficient?
The answer to that is very likely yes! especially if you live in the UK. Unfortunately, we have a few obstacles to achieving optimal levels of this critical nutrient that is so important for a healthy immune system and healthy bones, but its behaviour has far reaching action, even affecting our mental health.
Although not needed in large amounts, an absence or deficiency of vitamin D exposes us to a number of health concerns. Some common symptoms of deficiency can be fatigue, listlessness, poor sleep, aching bones and muscles, headaches, poor immune health, low mood/anxiety and depression.
I often test and find vitamin D deficiency in my clients who present with autoimmune conditions and diabetes, asthma, depression, recurrent infections, fibromyalgia/chronic fatigue syndrome. The most common complaint I hear is fatigue, the kind where you wake up feeling exhausted and find it hard to get through the day without taking a rest or nap.
How is vitamin D made?
When our skin cells called melanocytes are exposed to UVB light they covert 7-dehydrocholesterol (D2) to vitamin D3 which is then transported in the blood to your liver and kidneys where it is transformed to vitamin D in its active form. This is quite a complicated process as Vitamin D firstly needs to pick up extra oxygen and hydrogen molecules in the liver to become 25-hydroxyvitamin D but it still needs to be activated at the next step in the kidneys to become 1,25 dihydroxyvitamin D.
What does Vitamin D actually do?
Vitamin D is best known for supporting healthy bone tissue through its action in the gut where it increases absorption of calcium which helps us to have healthy bones. However, vitamin D receptors can be found in many other body organs and tissues where it has a beneficial action on the heart, blood vessels, endocrine system and in muscles.
Who is most prone to deficiency?
Those with malabsorptive conditions i.e. irritable bowel diseases Crohns, colitis, coeliac disease result in poor digestion of nutrients and without enough circulating vitamin D the intestines will not absorb calcium efficiently which can lead to osteoporosis. We also now have a much better understanding of how important vitamin D levels are for maintaining a healthy immune system also mood. Low levels of deficiency of vitamin D are highly correlated with anxiety and depression
Vitamin D deficiency is known to promote an inflammatory environment which leads to dysbiosis of the gut microbiota, even in clinically healthy individuals therefore deficiency is common in those with IBS/IBD and Coeliac disease.
Vitamin D deficiency is common in infants, children those with autoimmune conditions, IBD, people over the age of 65 and people with darker skin. However, I would go so far as to say it is so common in the UK, we all need to pay attention and check our levels every year. Teenagers are a particularly prone group as they are often indoors, studying, on social media, gaming and sadly rates of teenagers suffering with low mood and anxiety is worse than ever since the pandemic with lockdown having been so hard on this generation.
How do we become deficient?
The problems are firstly geographical; living in the Northern hemisphere where we just don’t receive enough UVB light from the sun which is how vitamin D is made.
If you are fair skinned then you are much more likely to be applying suncream and covering up with hats and clothing preventing your ability to make vitamin D, on the other hand, if you have darker skin you are in need of higher amounts of vitamin D. Interestingly, Researchers in Canada discovered new emerging evidence that sunlight increases our vitamin D levels and can change the human gut microbiome, particularly in people who are vitamin D-deficient.
Layer on top of this, the fact that our British weather even in summertime can force us indoors and with so many of us working inside for most of the day, we simply do not get the UVB exposure needed to create optimal levels especially through winter.
Case study of severe vitamin D deficiency
Let me tell you about a recent case of vitamin D deficiency that sadly went undetected for years until she came to see me last year with chronic fatigue, debilitating muscle aches, depression and joint pain and a history of recurrent infections. I quickly suspected a vitamin D deficiency amongst others missing critical nutrients which we tested for using a simple home-test kit which just requires a finger prick bloodspot (you can ask me about how I can help you get one of these).
As suspected, she had severe deficiency with levels of just 26 nmol/L (an optimal level is between 100-120nmol/L). Surprisingly this test was done during our last summer when she had managed to get regular sun exposure and if you remember it was blisteringly hot. After working together and implementing some healthy changes to her diet and supplementing at a high dose to get her vitamin D levels back to where they should be, after just 12 weeks she has found a new lease of life.
This is what she goes onto say….
“I have a new lease of life. I’m currently in training for a 24 hour gym triathlon, We’re trying to raise money for a charity that takes Special Needs children and young adults to Toronto next year. I’m currently running around 4-5k every other day, and I couldn’t even run for a bus 3 months ago!”
Can I get Vitamin D from food?
Dietary sources of vitamin D are limited and unlikely to be enough alone. You could expect to meet about 20% of your needs if you eat a good range of vitamin D rich foods every day with the other 80% synthesized by the skin when exposed to UVB light, which is why we should be supplementing over winter months.
The best dietary sources of Vitamin D are: oily fish, shellfish, white fish, eggs, mushrooms cow’s milk and fortified milks, yoghurts and cereals.
Oily fish provides the highest amount of vitamin D but even then it is unlikely to be enough unless you intend to eat an Eskimo’s diet for the foreseeable future. You would need to eat about 1 fillet of salmon, 2 fillets of halibut, 2 cans of tuna, ½ pint of milk, one egg every day to get just 400IU of vitamin D in one day which is not enough for most of us. This leads me onto the need for supplementing…
How much should you supplement and when?
The NHS recommended supplement dose is 400IU however this falls short for most of us and experts in their field have been arguing over the correct dose of vitamin D for years. This year, under pressure from Covid-19 studies which overwhelmingly demonstrated the efficacy of vitamin D supplements in reducing risk of infection and reducing length and severity of cases. A recent statistics relating to all evidence of vitamin D deficiency in Covid-19 cases where it was found that the worst affected directly correlated with lowest levels of vitamin D, as reported by Cutolo M., et al., 2020 “Overall, 41% of respiratory disease mortality was statistically attributable to vitamin D insufficiency or deficiency.” Cutolo goes onto say “Although the degree of protection generally increases as 25(OH)D serum concentration increases, the optimal range is considered to be in the range of 100–150 nmol/L. In order achieve those levels, approximately half the population should take at least 2000–5000 IU/day of vitamin D.65
In my humble opinion, it is simply not worth guessing when it comes to vitamin D! For a relatively small cost you could find out exactly what your needs are and get the recommended supplemental dose.
Vitamin D should be supplemented alongside some other key nutrients such as magnesium, vitamin K2 and calcium which work in synergy. Vitamin D helps to pull calcium from your diet from the gut and transports it to bone tissue, but it needs a little guidance to reach its destination from the help of vitamin K2 and magnesium. Furthermore, depending on your age and stage of life you may also need to supplement with additional calcium. For example, women over the age of 45 lose an average 1% of their bone density each year and may not be getting enough from dietary means alone to compensate and keep bones strong and resilient. This is especially true for women with a low BMI, history of Osteoporosis or bone fragility, vegans or those who have a dairy/lactose intolerance which is one of the richest source of dietary calcium.
How can I get tested?
You can arrange a blood spot test kit through me. I highly recommend testing if you have any of the symptoms I have mentioned or if you would just like to be sure you have enough vitamin D. I believe that testing is so much better than just guessing and taking a random dose and hoping for the best. Vitamin D deficiency is hugely under-diagnosed and is so easy to correct with life-changing results.
Sometimes I think we get so used to feeling sick and tired that we believe that to be our “normal”, but I can tell you that I have seen hundreds of vitamin D test results at all times throughout the year and all too commonly see them below optimal and very often they are severely deficient. Don’t leave it to chance. Test don’t guess is my motto.
If you would like to arrange a test, get in touch to find out more.