Vitamin Deficiency - Your Stories?

[Ally T]

Some of you will remember I have had issues with hair loss in the past. It has recovered, but I started loosing again a couple of months ago, as in, not handfuls of long curls, but teeny new re-growth hairs between a few mm & 2cm in length, washing down the drain like fuzz. I have also been extremely tired & weary, physically & mentally, snappy with my beautiful girls & achy, which I presumed was due to being on the go constantly.

I saw my Dr & she ordered a MASSIVE batch of blood work, as both of my sisters have underactive thyroid & I am also prone to anaemia due to my Von Willebrands & subsequent monthly blood loss (not to mention the massive random nose bleeds like the one I had yesterday!)

Every thing was perfect. Everything that has a range for the results were smack bang in the middle, low cholesterol, perfect renal results. But in the middle of the lab report in red highlight, was my Vitamin D result. It is basically so low, I'm no longer storing it. This is weird to me given how much I am outside & that I run for around an hour on 3 mornings a week to boot, but it seems as we age we can sometimes loose the ability to process & store certain vitamins? Who knew?!!

When she brought up an initial list of 8 side effects of the loss of Vit D, top of the list were tiredness & physical lethargy, anxiety, hair loss, muscle aches & general pains.

Who knew that such a teeny thing, that I always assumed only lead to rickets in childhood if it lacked, could cause so many things in an adult body??! And that at any time, your body can say nope, fed up or storing & processing that one now....

So i am on a 2 month heavy medical dose, at which point I will move to a milder, daily vitamin pill. She assures me my hormones are all normal, I am not peri-menopausal, which I assumed I must be considering I'm 44 in six months, and that my hair loss has no indicators other than the Vit D. Seems like this has been caught just in time, as it can lead to calcium issues & bone problems if prolonged.

Fingers crossed in a few months I am a new woman!!

Please share your stories of vitamin deficiencies if you have any, for others to read & gain information from.

 

[737liz]

I too have had a d deficiency since my early 20s, which coincided with a whole host of weird allergies that developed. I'm now allergic to fruits and intolerant to nuts.

I'm always outside, consume calcium rich products, and cannot for the life of me store any vitamin D. The docs triple checked my levels because it didn't add up. I too was put on an intensive d drop course for 6 months, which brought me up to low normal levels. My dose was lowered. 18 months later it was back down to pre d drop levels. So, now after over a decade of yoyoing d levels, I take my drops but very irregularly. I get a workup every 3 years or so, and the doc scratches her head and wonders aloud how a girl who spends all day outside can have such low levels, prescribes more drops, sends me on my way.

My nails are still strong, it seems my hair is constantly falling out but I'm not bald yet . What I do notice is I somehow sleep far better when I'm on the mega dose of d. I fall asleep immediately.

I'm glad your doctors caught it, because I think especially for women, it's so important. Please make sure you check your levels again after lowering the d dose as my results showed that I should really stay on a high dose level forever.

My grandmother passed away 2 weeks ago at 101 years old. And it was a fractured hip due to low bone density that caused it. She may have outlived us all of she had stronger bones!

 

[missy]

Alex Im glad they finally found what was causing your symptoms and I am surprised they didn't catch that sooner. Testing for Vitamin D is much more commonplace now because healthcare professionals realize there is a huge problem re Vitamin D deficiency-it isn't a rare occurrence so you are not alone. Just glad they diagnosed you and hopefully you will be feeling much better once your levels come up. Fingers crossed for you!

I want to recommend in case you weren't already told that D3 is more highly available/absorbable and that is the best form to take. In the USA prescriptions Vitamin D is D2 and that isn't the best form to take and it is much better to take the non Rx Vitamin D3 that is easy to get.



From medscape:

Vitamin D: A Rapid Review
Mark A. Moyad, MD, MPH


Dermatology Nursing. 2009;21(1)

Abstract and Introduction
Abstract
Interest in all aspects of vitamin D seems to be surging due to perhaps the increased number of diverse positive studies suggesting it could prevent a variety of chronic diseases. However, before patients and health care professionals are educated on the preventive aspects of this vitamin that acts more like a hormone, a basic rapid review of vitamin D is needed. There are multiple reasons for the high rate of vitamin D deficiency around the world, including an aging population, obesity, protective skin care measures, skin pigmentation, increased awareness, more utilized diagnostic assays, and perhaps even the lack of natural and fortified food and beverage sources. Various benefits and limitations of vitamin D2 and vitamin D3 supplementation are discussed. The proper use of the vitamin D blood test, also known as "25-OH vitamin D," is important, and changing the normal range of this test may allow for a slightly higher cutoff value based on parathyroid hormone reductions and experience from clinical trials of osteoporosis prevention. The vitamin D doses needed to adequately increase blood levels are provided. Finally, increasing the recommended daily allowance of this vitamin to 800 to 1,000 IU per day may be beneficial for most age groups.



Introduction
Sales and interest in vitamin D is surging because there may be a strong relationship between lower rates of a variety of chronic diseases and higher levels of vitamin D (Khazai, Judd, & Tangpricha, 200. Minimally, the impact of vitamin D on calcium absorption and improving bone mineral density are impressive enough to garner attention. Dietary supplementation of vitamin D is not difficult and should be discussed with most patients. However, an objective review is still necessary for the clinician to separate fact from fiction regarding this specific vitamin, which has always acted more like a hormone than a vitamin (Coen, 200.

Why Most People Are Vitamin D Deficient
It has become difficult to identify a population of individuals that has sufficient blood levels of vitamin D. Why are so many people vitamin D deficient? A review of the various factors that can cause vitamin D deficiency are found in (Wolpowitz & Gilchrest, 2006).



Table 1.

demonstrates how easy it is to become deficient in this vitamin. For example, just getting older can reduce vitamin D levels because the mechanisms needed to synthesize its structure from cholesterol become less efficient through time, as is the case with most intrinsic synthesizing methods in the human body. It is obvious that human beings age externally (such as with wrinkles, gray hair). However, it is less obvious that humans also age internally, and inadequate vitamin D synthesis is just one example of this internal aging issue. Low levels of vitamin D are also found in individuals with larger amounts of belly fat or visceral obesity (Aasheim, Hofso, Hjelmesaeth, Birkeland, & Bohmer, 200. Numerous theories abound as to why this is the case, such as hemodilution from greater blood volumes or the finding that adipose tissue is a greater storage site for vitamin D. Higher cholesterol levels may be associated with lower vitamin D blood levels, and conversely, cholesterol-lowering medications, such as statins, may increase vitamin D synthesis (Perez-Castrillon et al., 200.

Table 1.

The lack of reliable dietary sources that contain consistently higher levels of vitamin D has been an issue. It is of interest that the highest concentration of vitamin D is found in some heart-healthy fish, so patients can get "two for the price of one" by consuming fish high in omega-3 and vitamin D, such as salmon. Fortification of some foods and beverages have not solved the vitamin D deficiency problem, and recent studies suggest that the regular intake of vitamin D may increase blood levels greater than weekly or monthly oral intakes of equivalent doses (Chel, Wijnhoven, Smit, Ooms, & Lips, 200. Sunscreen has the ability to block ultraviolet B (UVB) light, and this form of light stimulates vitamin D synthesis in skin tissue. Thus, wearing sunscreen, and sun-protective clothing, or avoiding sunlight all have the ability to result in lower blood levels of vitamin D. However, no clinician should recommend trading one condition for another, and it is a concern that some clinicians advise regular sun exposure several times a week. Why increase a person’s risk for melanoma just to improve vitamin D levels, when supplementation is generally simplistic and cost effective? Melanoma kills, and death rates have not decreased over the last decade; the responsible recommendation lies in proper sun protection and potential vitamin D supplementation. Another thought in some medical circles is that individuals residing in areas with greater sun exposure experience higher blood levels of vitamin D. Theoretically, this makes sense; however, it has not been substantiated through recent research demonstrating low blood levels of vitamin D in individuals residing in Florida and southern Arizona (Jacobs et al., 2008; Levis et al., 2005). Perhaps regular sun avoidance, aging, and obesity are independently or synergistically involved in lowering vitamin D levels in some of these geographic areas.


Dietary Sources of Vitamin D
The only foods that naturally contain vitamin D are seafood, mushrooms, and egg yolks. A partial list of foods and their natural vitamin D content is found in (Chen et al., 2007; National Institutes of Health Office of Dietary Supplements, 200.


Table 2.

Several items from are worth noting. Wild salmon contains as much as 3 times the amount of vitamin D compared to farmed salmon (Chen et al., 2007). Patients inquire regularly about the differences and similarities between farmed and wild fish. Both are equally high in omega-3 fatty acids, which are heart-healthy, and both tend to have a low level of mercury and other contaminants (Mozaffarian & Rimm, 2006). A preliminary difference lies in the inherent vitamin D content of these fish, and generally speaking, both types of fish are healthy to consume.


Table 2.

Vitamin D2 and/or Vitamin D3
There are two types of vitamin D supplements available for over-the-counter purchase (vitamin D2 and vitamin D3). Vitamin D3 is the type that most experts believe should be utilized in clinical practice (Wolpowitz & Gilchrest, 2006). Vitamin D2 is also known as "ergocalciferol," and vitamin D3 is also known as "cholecalciferol." This is important for patients who have purchased a dietary supplement that does not indicate the specific type of vitamin D in the product by number but have listed the scientific name. Most experts now believe that the only form that should be purchased is vitamin D3. Vitamin D2 is also very acceptable, but in the author’s opinion, most individuals should switch to D3. There is a plethora of logical reasons for advocating the use of vitamin D3 over vitamin D2 dietary supplements (Wolpowitz, & Gilchrest, 2006), including:

• UVB light from the sun strikes the skin, and humans synthesize vitamin D3, so it is the most "natural" form. Human beings do not make vitamin D2, and most healthy fish contain vitamin D3.
  
  
• Vitamin D3 is the same price as vitamin D2.
  
  
• Vitamin D3 may be less toxic than D2 because higher concentrations of D2 circulate in the blood when consumed (compared to vitamin D3). It does not bind as well to the receptors in the human tissues compared to vitamin D3.
  
  
• Vitamin D3 is the more potent form of vitamin D, which is a potential benefit. For example, obesity tends to lower blood levels of vitamin D, so a more potent form is needed.
  
  
• Vitamin D3 is more stable on the shelf compared to D2, and is more likely to remain active for a longer period of time and when exposed to different conditions (temperature, humidity, and storage). This is perhaps why the amount of vitamin D2 in certain fortified food products have been significantly lower than that advertised on the label in numerous instances.
  
  
• Vitamin D3 has been the most utilized form of vitamin D in clinical trials, and there have only been a few clinical trials of vitamin D2 to prevent bone fractures in adults.
  
  
• Vitamin D3 is more effective at raising and maintaining the vitamin D blood test (again, D2 binds less tightly to the vitamin D receptors in the body; therefore, D2 does not circulate as long in the body, which means it has a shorter half-life).
  

Vitamin D2 is a fungus/yeast-derived product, and it was first produced in the early 1920s by exposing foods to ultraviolet light (Wolpowitz & Gilchrest, 2006). This process was patented and licensed to pharmaceutical companies. Currently, many major prescription forms of vitamin D are actually vitamin D2 and not vitamin D3. Vitamin D2 is synthetically made from radiating a compound (ergosterol) from the mold ergot. Vitamin D3 is made commercially and synthetically in a similar way that it is produced intrinsically in human and animal skin when exposed to UVB light. Wool sources of 7-dehydrocholesterol are used (from cholesterol), and irradiatied to form active vitamin D3. Vegetarians or especially vegans may be opposed to the use of vitamin D3 supplementation because it is derived from an animal source, and these individuals should be guided to the vitamin D2 form. Multivitamins have either vitamin D2 or D3, but many companies are now utilizing mostly vitamin D3. Cod liver oil has vitamin D3 in it.


Rickets, a defect in bone growth in infancy and childhood, was first identified in 1650 (Welch, Bergstrom, & Tsang, 2000). It was not until 1922 that medical research demonstrated that something in cod liver oil prevented and cured rickets. Additionally, vitamin D2 added to milk in the United States and Europe in the 1930s essentially eliminated rickets (disease of weak bones in children) or osteomalacia (same disease of weak bones but in adults). Currently, fortification with vitamin D2 or D3 has continued to keep rickets scarce in North America. The minimum amount of vitamin D needed to prevent rickets is 100 IU (2.5 mcg) per day in infants with little to no sun exposure.


The Vitamin D Blood Test (25-OH Vitamin D): Who, How, When, and Where
Clinically speaking, things began to change in the 1970s when the blood test for vitamin D (known as the "25-OH vitamin D" test) became more accurate and widely utilized (Wolpowitz & Gilchrest, 2006; Zerwekh, 200. This test reflected the total amount of vitamin D in the body that was coming from all sources (diet, dietary supplements, and the sun), which makes this test extremely important in the field of nutrition. Low concentrations of 25-OH vitamin D causes secondary hyperparathyroidism (high levels of parathyroid hormone or PTH). This means a person loses more calcium from his/her bones when PTH is abnormally high (PTH>65 pg/ml) and has an even greater risk for bone loss. Vitamin D3 seemed more effective than D2 at raising this important blood test. Furthermore, preliminary work showed that enzymes in the liver and the final vitamin D receptors (VDR) in important tissues bind vitamin D3 more effectively. As humans age, these metabolic differences make a very large difference in terms of effectiveness. Almost all successful anti-fracture clinical trials have used vitamin D3 at a dosage of at least 800 IU/day (20 mcg per day).


Ideally, the vitamin D blood test should be offered from the fall season through winter when vitamin D blood levels are at their lowest. Spring and summer months can give patients and clinicians a false sense of vitamin D security. Patients should have a 25-OH vitamin D test yearly from September through March, around the same time they get their fasting lipid level. Fasting is not necessary to obtain a vitamin D level; however, getting blood tests at the same time makes sense, reducing the burden of time on the patient. Some health insurances cover vitamin D testing and some do not, and prices vary from $10 to $50, so local laboratory costs should be checked before telling the patient that a vitamin D test is needed.


An example of the greater need for utilizing the vitamin D blood test are men on androgen or hormone deprivation treatment for prostate cancer or those on this or a similar medication for other medical conditions (such as women being treated for breast cancer). It is now common knowledge that these life-saving medications that reduce estrogen and testosterone can also increase the risk of bone loss. In the author’s opinion, less than 1% of men and women are offered a vitamin D test when given this injection, and this is disappointing. Some of these men and women will be prescribed a bisphosphonate or another drug without hesitation if needed. However, some of these men and women were not given the chance to maintain their bone mineral density through lifestyle changes (such as weight lifting) and supplement intake of calcium and vitamin D before being offered the prescription medication. In other words, health care professionals should offer a cholesterol-lowering drug if diet and exercise do not work (for example, cardiovascular prevention), but patients should be educated about lifestyle changes as well. Therefore, when diet, exercise, and blood tests do not work to maintain bone mineral density, the bisphosphonates and other osteoporosis prevention medications are a wonderful option, and are more effective with diet and exercise.


Personal Belief Regarding Vitamin D Testing
I am often asked when vitamin D blood testing should begin and who really qualifies for vitamin D blood testing. My answer is simple. Who does not qualify for vitamin D testing annually or once every few years? To my knowledge, no group in the world consistently carries a higher than normal vitamin D blood level. This is true for African Americans, Asians, Caucasians, Hispanics, babies, pregnant women, adolescents, older adults, and middle-aged individuals. This has confirmed my belief that few people do not qualify for regular testing.


The "Ideal" Vitamin D Blood Level
Over the past few decades, the "normal" blood level of vitamin D (25-OH vitamin D) was based on the amount needed to keep PTH from becoming abnormally high. Again, PTH at high levels can cause calcium loss from the bone, so this would make sense that vitamin D could maintain or improve bone health at these levels. However, PTH can change due to renal function, exercise level, the time of day, or even diet. There has been no consensus on the optimal level of vitamin D intake to reduce PTH, and this is why many laboratories report the normal range of vitamin D to be so wide (20 to 40 ng/ml, or in some cases, 50 to 100 nmol). However, this is tantamount to saying a normal total cholesterol level is between 100 to 500.


What is the best blood level of vitamin D? Several prominent experts reviewed a large number of past studies to arrive at an answer to this question (Bischoff-Ferrari, Giovannucci, Willett, Dietrich, & Dawson-Hughes, 2006). Their findings were satisfactory in this author’s opinion. A variety of health changes not specific to bone health were evaluated, and the researchers sought to determine what level of vitamin D could maintain muscle strength, prevent falls, improve dental health, and prevent cancer (especially colorectal cancer). Weaker evidence for vitamin D includes preventing multiple sclerosis, other cancers, arthritis, hypertension, and tuberculosis, as well as solving insulin problems (diabetes mellitus). These researchers also reviewed a variety of other areas apart from keeping PTH normal and looked at studies that included a variety of ethnic groups. These experts found a consistent answer, which is that most clinical studies in a variety of health areas point toward a blood level of vitamin D that is between 90 to 100 nmol/L, or 35 to 40 ng/ml, for preventive health.


Why not surpass the number of 35 to 40 ng/ml as some experts have suggested? Unfortunately, higher does not mean better. Medical research is replete with examples of where a little higher helped, but more was not necessarily better. Supraphysiologic levels beyond what is now recommended in this manuscript is not yet supported in medical literature. It is interesting that some studies (for example, in the area of prostate cancer) have not yet found considerable benefits to achieving such higher vitamin D levels (Mucci & Spiegelman, 200. In fact, it has been suggested that long-term significant increases in vitamin D could be detrimental. Thus, some experts suggest that there is no harm of carrying high vitamin D levels (70 ng/ml or more for example), but this recommendation is based on acute and not chronic observations. Not long ago, this same philosophy was applied to selenium or vitamin E, and ample evidence now exists to suggest that toxicity can occur when these nutrients are given chronically in mega-doses to achieve higher-thannormal blood levels of these nutrients.


Dosage of Vitamin D Needed To Achieve 35 to 40 ng/ml (90-100 nmol/L)
Historically, 400 IU (10 ug) of vitamin D was recommended for better health because it closely approximated the amount of vitamin D in a teaspoonful of cod liver oil. However, 800 to 1,000 IU is the dose that may have a better chance of giving a patient a normal vitamin D level. In some countries, vitamin D is listed in micrograms, and the relationship is as follows:

• 2.5 mcg (micrograms) = 100 IU.
  
  
• 5 mcg = 200 IU.
  
  
• 10 mcg = 400 IU.
  
  
• 15 mcg = 600 IU.
  
  
• 20 mcg = 800 IU.
  

It is much easier to access the patient’s need after a vitamin D blood test. Few individuals would allow their clinician to simply guess an individual’s cholesterol level before placing him/her on some type of medication. Clinicians have access to an accurate lipid test that provides guidance. The same is true for vitamin D levels. Clinicians should not suggest high intakes of vitamin D (5,000 IU for example) before recommending the 25-OH vitamin D test.


Health care professionals need to keep in mind that in general, 100 IU (2.5 mcg) of vitamin D per day can raise the vitamin D blood test only 1 ng/ml or just 2.5 nmol/L after 2 to 3 months. How much vitamin D is needed per day to obtain a normal vitamin D blood level? The following examples include:

• 100 IU (2.5 mcg) per day increases vitamin D blood levels 1 ng/ml (2.5 nmol/L).
  
  
• 200 IU (5 mcg) per day increases vitamin D blood levels 2 ng/ml (5 nmol/L).
  
  
• 400 IU (10 mcg) per day increases vitamin D blood levels 4 ng/ml (10 nmol/L).
  
  
• 500 IU (12.5 mcg) per day increases vitamin D blood levels 5 ng/ml (12.5 nmol/L).
  
  
• 800 IU (20 mcg) per day increases vitamin D blood levels 8 ng/ml (20 nmol/L).
  
  
• 1000 IU (25 mcg) per day increases vitamin D blood levels 10 ng/ml (25 nmol/L).
  
  
• 2000 IU (50 mcg) per day increases vitamin D blood levels 20 ng/ml (50 nmol/L).
  

If the vitamin D blood test was 30 ng/ml (75 nmol/L) and a 40 ng/ml (100 nmol/L) level was desired, 1,000 IU (25 mcg) of vitamin D per day over several months should be taken to achieve a normal blood level or 40 ng/ml (100 nmol/L). Upon reaching the goal, most individuals need to supplement with 800 to 1,000 IU per day to maintain this level. Only working closely with a clinician over time can provide the most accurate answer. However, issues of insurance and health care access suggest that 800 to 1,000 IU is ample for many individuals who are not able to have their blood tested.


Calcium and Vitamin D Recommended Daily Allowances
Calcium and vitamin D work synergistically to provide optimal potential clinical benefits, and this is now well known from clinical research (Khazai et al., 200. Regardless of the adult age, the average intake of calcium is about 600 mg to 800 mg per day at best. These recommended dosages from various government organizations and from the author’s personal experience are found in (Prentice, 2002).


Table 3.

By 10 years of age (double figures) nutritional intake should include approximately 1,000 mg of calcium a day total (from diet and supplements) and close to 1,000 IU of vitamin D (from diet and supplements after blood testing) for the rest of one’s life, regardless of gender.


The daily requirement of vitamin D in is disputed by this author. The minimum requirement should be from 400 to 800 IU in all ages, and especially, from age of a few years old to over 70 years, it should be at least 800 IU. However, as stated previously, the exact determination of minimum vitamin D intake should come from a blood test given in the fall or winter. Also, patients should be told that vitamin D is a fat-soluble vitamin that takes months to deplete; it also does not have to be in a calcium supplement as some companies advertise. It is difficult today, however, to find a calcium supplement without vitamin D in it.


Table 3.

Side Effects and Toxicity
Some studies have given healthy individuals 100,000 IU tablets or more once every 4 to 6 months without acute toxicity (Wolpowitz & Gilchrest, 2006). A 21-year-old man or women exposed to summer UVB light generates 10,000 IU (the equivalent of 250 mcg, 25 multivitamin pills of vitamin D, or 100 glasses of milk) of vitamin D in 15 to 20 minutes. However, longer exposure does not produce more vitamin D. Humans were basically built to produce and carry higher levels of vitamin D when exposed to the sun. Previous research suggests that the first sign of real side effects or toxicity of vitamin D occurs at a blood level of greater than 88 ng/ml (220 nmol/L) where abnormally high blood levels of calcium result from too much absorption of calcium from food and that can lead to problems (Bischoff-Ferrari et al., 2006; Wolpowitz & Gilchrest, 2006). Regardless, as mentioned earlier, apart from the acute toxicity of hypercalcemia or hypercalciuria, the long-term implications of blood levels of 70 to 90 ng/ml are not known, and in this author’s opinion, should not be entertained without more long-term safety data.


Conclusion
It is difficult to remember if I ever received a lecture on vitamin D during my university or medical training years. Perhaps I did, but I was not listening. Today, after reviewing the medical literature, vitamin D has my attention as well as the attention of most specialties. There seems to be a multitude of lessons that can be learned from the vitamin D deficiency rates around the world. For example, it seems that the more access to health care, the better the diet, and the lower the rate of obesity, the higher the potential blood level of vitamin D. However, part of the vitamin D deficiency issue also lies in health care professional advice being followed and the aggressive promotion of sun avoidance for better skin health.


Clinicians need to remember their message’s implications whenever disease-specific education is applied to any patient. The next time advice is given to use sunscreen and other sun-protective measures, there should also be ample time given to the various proven methods of raising vitamin D levels, including fish consumption and vitamin D supplementation, not just to improve bone health, but to improve overall health and well being.

 

[Ally T]

Thanks for your stories @missy & @737lizakg . I shall make sure I get a follow up test, but also keep in mind that my fatigue & hair loss in the future can be a warning. I'm looking forward to falling asleep quickly, I must say. I haven't been able to drop off in quicker than an hour or two for years!

It IS weird that some people just don't like to process some things at times. I know my MIL, who is 72 & over the last two years completed the 6 Majors, marathoning all around the world, has trouble storing iron since she upped her regime. The more she runs, the more treatment she needs. Her times start to drop off, at which point she'll get checked & they'll find out she's not storing properly again. She has a check in Feb as it happens, as she is running both Boston & Beijing late spring.

I have to say, I was expecting a results appointment that just said "everything is fine, you're just weird/old/knackered/balding, so off you pop!" I was extremely happy that there was actually SOMETHING flagged, and not only because of my lovely precious curls, but because it also answered lots of other minor health symptoms that I always brush aside.

Generally, my Dr can be a bit aloof & sometimes you have to stand your ground, but this time she's been fab.

 

[Ally T]

@737lizakg sorry to hear about your grandmother. But what a fabulous age!

@missy great article - thanks for posting.

 

[MarionC]

Alex, i recently wrote on PS about having a complete turnaround after a minor diet change. Years of suffering, then ...voila! All is well.
I anticipate great changes for you!
Glad you are on the road to recovery.

 

[lyra]

My rheumatologist put me on prescription level Vitamin D. It is common in his practice. I don't know if those of us with auto immune diseases are more prone to be Vitamin D deficient, but that could be an issue I suppose. I was anemic at one point, requiring the shots every 2 weeks. That was awful. Then from there I went magnesium deficient. Then Vitamin D. Each previous deficiency eventually righted itself. It's not diet for me. My hair has thinned due to medications I'm on, and it sucks.

 

[ksinger]

A friend convinced me to, and now I take my vit D with some magnesium and K-2. Rather than try to explain, here is a site that gives a readable "why". I don't think it can hurt and it might stave off some other problems.

https://www.precisionnutrition.com/stop-vitamin-d

I think vitamin D testing should be as common as a CBC. So many people are deficient. Of course they also need to agree on what, exactly, the optimum range is. It's all over the place from what I can tell. In any case, vitamin D deficiency is one of the puzzle pieces - an easily modifiable one - in the multiple sclerosis puzzle. There is no single cause because that's way too easy. But fill the cauldron with the proper genetics and several other yes answers to various risk factors, and you're likely to get MS. Taking one of the known or strongly-suspected and easy-to-fix puzzle pieces off the board, can only be a good thing, right?

 

[t-c]

You don't really want to store Vit D (in fat cells) as that renders it inaccessible. Ideally you want to get Vit D in your daily diet.

I was massively deficient in Vit D (<1% of normal levels per a blood test) after I moved to a northern city with very short daylight in the winter. It manifested itself as Seasonal Affective Disorder. I took prescription supplements initially, but eventually just went with over-the-counter vitamin supplements and incorporating more Vit D in my diet (salmon, eggs, green veg, etc...).

 

[ksinger]

You don't really want to store Vit D (in fat cells) as that renders it inaccessible. Ideally you want to get Vit D in your daily diet.

I was massively deficient in Vit D (<1% of normal levels per a blood test) after I moved to a northern city with very short daylight in the winter. It manifested itself as Seasonal Affective Disorder. I took prescription supplements initially, but eventually just went with over-the-counter vitamin supplements and incorporating more Vit D in my diet (salmon, eggs, green veg, etc...).

Since they pretty much can't tell why you're deficient - absorption problem or genetics or whatever, and typically can't tell how long you've been in that status because they do not test for D as a matter of course, but only when something is wrong, the leisurely attempt to eat lots of vitamin D - which may or may not work - to get your D back up, is not usually an option. In my case, it is suspected that MS patients with higher levels of vitamin D, do better with less progression. Most neuros will strongly suggest that you supplement until your levels are up. Now, per my linked article above, I'm not sure they are prescribing the right type of D, or considering any balance issues with magnesium and calcium. But supplementing (and it took a bunch, it's true) got me up to acceptable levels. I'm pretty sure diet would not have cut it. Now, sitting in the sun might have worked, but I'm a redhead who burns in about 15 minutes, so that wasn't really my thing. I guess I spent too much time trying to not end up looking like a leather handbag, that I ended up with something worse.

 

[lyra]

I know it can be complex. I can't sit in the sun because one of my medications makes me extremely sun sensitive. My diet is fine really. So I take the prescriptions. I also now have to take folic acid because methotrexate depletes folic acid in the body. It must be working. For the first time in decades, my nails are growing, lol. Still flimsy as ever and it's actually annoying to have to deal with filing them.

 

[LightBright]

I wanted to mention that Vitamin D deficiency is common and in certain populations in the US— northern latitudes and darker skin play a role in our ability to manufacture enough D from sun exposure. It is common in children, babies, etc.

I believe this simple test should be given as part of a regular workup especially to those hoping to conceive, and to newborn babies and children. Some autism researchers believe that Vitamin D deficiency plays a role in autism. Higher D levels equate to fewer problems during pregnancy including diabetes and pre-e.

It’s very simple and cheap to get enough D. You take a D3 supplement to the point at which your body’s 25(OH)D level is over 50 and below about 80ng/ml. People who have malfunctioning gallbladders may have to take more D3 per day than normal.

I’ve monitored my D levels and kept my levels within those guidelines for about 15 years, after I discovered I was deficient, and had no problems with overdosing. When I had cancer treatment, my oncologist reiterated these guidelines. I take 5,000 IU per day to maintain my levels. One tiny D3 pill per day.

I don’t know why regular physicians don’t commonly test for D deficiency, but they don’t. You should ask.

 

[TooPatient]

DH was out of work on a disability leave for 6 months due to what turned out to be a B12 deficiency.

He had gotten to where he could barely walk, couldn't sit in a chair, couldn't stand without help, could barely feed himself, and more. I was taking him for deep tissue massage, traction, and steroid injections just to maintain that level of function. The specialists were looking at things like MS, Parkinson's, severe spinal damage, and other things that would "make MS look good" according to one of the guys ordering MRIs.

The best thing to ever happen was all of them to be unavailable over Christmas. I came on PS one night exhausted and not sure how to keep going as he was facing more than a week of no treatment (that as was barely kept him going). One of the ladies here was talking about her B12 treatment and her symptoms. It all clicked as something we hadn't looked at yet. I ran to the store and bought OTC sublingual tabs to try (couldn't hurt and didn't interact with the pain meds and stuff they had him on). What a difference! He was doing so much better so quickly. Went in to see the Dr a week later and he could actually walk in unassisted! Everyone was shocked.

5 MRIs
Several sets of x-rays
Half a dozen sets of blood work

All that for a simple vitamin deficiency that no one bothered to check because "we don't have that in the US" so why bother to look.

 

[t-c]

DH was out of work on a disability leave for 6 months due to what turned out to be a B12 deficiency.

He had gotten to where he could barely walk, couldn't sit in a chair, couldn't stand without help, could barely feed himself, and more. I was taking him for deep tissue massage, traction, and steroid injections just to maintain that level of function. The specialists were looking at things like MS, Parkinson's, severe spinal damage, and other things that would "make MS look good" according to one of the guys ordering MRIs.

The best thing to ever happen was all of them to be unavailable over Christmas. I came on PS one night exhausted and not sure how to keep going as he was facing more than a week of no treatment (that as was barely kept him going). One of the ladies here was talking about her B12 treatment and her symptoms. It all clicked as something we hadn't looked at yet. I ran to the store and bought OTC sublingual tabs to try (couldn't hurt and didn't interact with the pain meds and stuff they had him on). What a difference! He was doing so much better so quickly. Went in to see the Dr a week later and he could actually walk in unassisted! Everyone was shocked.

5 MRIs
Several sets of x-rays
Half a dozen sets of blood work

All that for a simple vitamin deficiency that no one bothered to check because "we don't have that in the US" so why bother to look.

B12 deficiency is associated with macrocytic anemia which would be seen in standard CBC lab tests. If macrocytic anemia is observed, the next work-up is usually for B12 deficiency, among others. But perhaps your husband didn't present this way?

 

[Ally T]

@TooPatient oh my goodness! What a complete nightmare that must have been! I'm so glad things are resolved for your DH & life is somewhat returning to normal. Hugs to you!

 

[TooPatient]

B12 deficiency is associated with macrocytic anemia which would be seen in standard CBC lab tests. If macrocytic anemia is observed, the next work-up is usually for B12 deficiency, among others. But perhaps your husband didn't present this way?

I'm not sure why they didn't check. I know the general practitioner was thinking either spinal injury/wear or neurological disorder. The spinal specialist ruled out spinal injury or wear and figured neurological or autoimmune. The neurologist ruled out MS but was looking at other obscure stuff since the other specialists couldn't find anything. We discovered the B12 thing before his appointment with the rheumatologist.

I forget now what all blood work they did, but everything was right down the middle of normal. He had something like 6 or 8 blood draws where each one took a whole handful of tubes of blood. The results sheets were entire pages of different tests so a huge number of things checked. Each Dr got prior tests so didn't duplicate. It was insane!

 

[t-c]

I'm not sure why they didn't check. I know the general practitioner was thinking either spinal injury/wear or neurological disorder. The spinal specialist ruled out spinal injury or wear and figured neurological or autoimmune. The neurologist ruled out MS but was looking at other obscure stuff since the other specialists couldn't find anything. We discovered the B12 thing before his appointment with the rheumatologist.

I forget now what all blood work they did, but everything was right down the middle of normal. He had something like 6 or 8 blood draws where each one took a whole handful of tubes of blood. The results sheets were entire pages of different tests so a huge number of things checked. Each Dr got prior tests so didn't duplicate. It was insane!

I’m glad you figured it out and your DH has recovered, but if you’re curious and have a copy of blood test results on hand, check the CBC (complete blood count) results, specifically if MCV (mean corpuscular volume) is elevated.

I understand trying to get a diagnosis: it took well over a year to get mine and I stumped the docs enough that they wrote a paper on it (yet I wasn’t even offered co-author ).

 

[YadaYadaYada]

I went to a neurologist a couple of years ago. Was having a hard time with my memory, would get lost easily, would be at a light and suddenly panic I was on the wrong side of the road even though I wasn't.

Balance problems, I would trip and fall easily and actually fell on pavement carrying my one year old, thankfully he landed on the grassy strip next to the sidewalk but it was a five foot fall. That prompted me to get to a doctor.

They did a full blood workup and determined by B12 was low, not so common in someone who eats meat and eggs so more than likely an absorption problem. Technically I should get shots but I am needle phobic so I get drops that go on my tongue.

Here is the kicker though, I have a problem remembering to take it and of course low B12 causes problems with memory and cognition so it's kind of an endless circle.

 

[yennyfire]

My rheumatologist put me on prescription level Vitamin D. It is common in his practice. I don't know if those of us with auto immune diseases are more prone to be Vitamin D deficient, but that could be an issue I suppose. I was anemic at one point, requiring the shots every 2 weeks. That was awful. Then from there I went magnesium deficient. Then Vitamin D. Each previous deficiency eventually righted itself. It's not diet for me. My hair has thinned due to medications I'm on, and it sucks.

That's interesting. I supposedly have lupus (I say supposedly because I had one flare up about 4 years ago that lasted 3 weeks--the blood tests revealed that it was lupus, but it resolved itself (thank goodness!) and I've not had a problem since) and I also have a Vit D deficiency and take a supplement. I've been EXHAUSTED lately, which I attributed to running around like a madwoman each and every day, but then I realized I haven't taken my vitamin D for a few weeks. I wonder if that has something to do with it?? I'm taking my pill as we speak and will try to continue to remember. Hopefully, this will help the exhaustion. By the way, I also religiously wear sunscreen year round (have already had skin cancer removed from my arm-ugh) and my dr. said that the sunscreen prevents the absorption of vit D from sunlight, so perhaps someone of you who are outside a lot, yet still have a deficiency are also wearing sunscreen???

@Alex T I hope that the heavy dose of D resolves your hair loss issue and other symptoms....fingers crossed it's just that simple!!

 

[Phoenix]

I went to a neurologist a couple of years ago. Was having a hard time with my memory, would get lost easily, would be at a light and suddenly panic I was on the wrong side of the road even though I wasn't.

Balance problems, I would trip and fall easily and actually fell on pavement carrying my one year old, thankfully he landed on the grassy strip next to the sidewalk but it was a five foot fall. That prompted me to get to a doctor.

They did a full blood workup and determined by B12 was low, not so common in someone who eats meat and eggs so more than likely an absorption problem. Technically I should get shots but I am needle phobic so I get drops that go on my tongue.

Here is the kicker though, I have a problem remembering to take it and of course low B12 causes problems with memory and cognition so it's kind of an endless circle.

Stephanie, could the balance problem be due to an ear issue? For the last few weeks, I've been having anear inflammation/ blockage following a previous flu/ viral infection. I fainted once a few weeks ago -first time ever - and have been suffering from dizziness since then, which is lessening in severity though. I also did a hearing test which showed I was suffering from very slight hearing loss.

 

[Phoenix]

@Alex T , sorry to hear about your hair loss. I know you and I have posted about it on my beauty & health thread.

I too am Vit D- deficient, which is unusual since I live in the tropics where it's sunny almost all year round and I go out jogging/ walking a lot (like half an hour to an hour three times a week). I only wear sunscreen on my face and not on my body, since the latter never burns. I suppose it is bc of my auto-immune disease Hashimotos.

I am now taking Vit D supplement as well as eating more Vit-D enriched foods.

On the hair loss issue, there are so many causes. I hope you can get to the root of the problem (no pun intended). Fingers crossed that it is your Vit-D deficiency, as that's easily fixed. I definitely feel your pain!! I just updated my thread on my hair loss incidentally.

 

[YadaYadaYada]

Stephanie, could the balance problem be due to an ear issue? For the last few weeks, I've been having anear inflammation/ blockage following a previous flu/ viral infection. I fainted once a few weeks ago -first time ever - and have been suffering from dizziness since then, which is lessening in severity though. I also did a hearing test which showed I was suffering from very slight hearing loss.

Hey Phoenix,

Sorry you are having to go through that, I hope the hearing loss isn't permanent.

In my case it was all related, since I've been supplementing I haven't had the balance problems. It's just a matter of remembering to take it regularly!

 

[Phoenix]

Hey Phoenix,

Sorry you are having to go through that, I hope the hearing loss isn't permanent.

In my case it was all related, since I've been supplementing I haven't had the balance problems. It's just a matter of remembering to take it regularly!

Stephanie, thanks. My hearing should be back to normal once the ear inflammation is gone. I'll go and have another hearing test though just to make sure.

Relieved to hear it's just a supplement issue for you.

 

[Ally T]

@yennyfire It definitely could be your Vit D levels dropping off. One of my things has been utter exhaustion, so I was expecting low iron, the obvious culprit. I had no idea lack of D can make you so tired?! I am on day 4 of the medication now & I have to say, I slept well last night & feel so much more alert this morning than usual. I also am constantly running around from dawn to dusk!

@Phoenix I too run at least 3 to 4 times per week, for a minimum if 45 minutes. I don't wear sunscreen daily unless it's hot summer (the UK can be somewhat overcast) & so I am mystified as to why I have stopped processing the D I'm getting. I eat super healthy 90% of the time & have always eaten lots of leafy greens & beans, pulses etc. My Dr said there really was no cause for concern - it can be very common & particularly here in the U.K. & in women around my age. I started shampooing with the Nioxin system 4 around 2 weeks ago, as I have had successful recovery with this in the past, and last night when I washed my hair, the shedding was much smaller than it has been over the last few months. Significantly less. It really cheered me up! I think with Nioxin it is a long term commitment, and in the past I have stopped using it after a year when my hair has thickened up. So this time, despite preferring a gentle, organic hair system, I will continue with Nioxin. I am also dropping the harsh hair colour routine (I'm very dark with a lot of grey now) for the gentle Olia products, which tend in me to wear off the grey roots after about 3 weeks, but it's mostly oil based, gentle & less harsh. In 2013 when I had HUGE loss & very visible scalp, I switched to this for a year. It's a pita to have to address my roots every 3 weeks, but if that's what I have to do to help out, then I will do it. Shall pop over to read your updated thread now...

 

[missy]

Alex as mentioned above it is important to take Vitamin D (D3 preferably) with a few other supplements. Especially Vitamin K2.

Another critical point to remember is you shouldn't take any vitamin D supplement without taking vitamin K2. Vitamin K2 deficiency is connected to vitamin D toxicity symptoms, which includes excessive calcification that can contribute to the hardening of your arteries.

One of the functions of vitamin K2 is to direct calcium to areas in your body where it is needed, such as your bones and teeth. It also functions to keep calcium away from areas where it shouldn’t be, including your soft tissues and arteries.

Here's some info that you might find helpful.

https://articles.mercola.com/sites/articles/archive/2012/12/16/vitamin-k2.aspx

https://www.vitamindcouncil.org/about-vitamin-d/vitamin-d-and-other-vitamins-and-minerals/

The way that vitamins and minerals work in your body is interconnected. How well vitamin D works depends on the amount of other vitamins and minerals that are present in your body. The other vitamins and minerals needed to help vitamin D work well are called cofactors.

To get the most benefit from vitamin D, you must have other cofactors in your body. Vitamin D has a number of cofactors; the ones listed below are the most important.

• Magnesium
• Vitamin K
• Zinc
• Boron
• Vitamin A

Doctors and scientists are still working to understand fully how different vitamins and minerals work together in your body, and how that affects your health.

The Food and Nutrition Board in the United States sets Recommended Dietary Allowances (RDA) for the amount of some vitamins and minerals. These tell you the amount you need to take every day to stay healthy and are different for each vitamin and mineral. If you’re eating a healthy, balanced diet you should be getting most of the vitamins and minerals you need (with the exception of vitamin D!).

Magnesium

You can find magnesium in leafy greens, nuts and seeds.

Your body needs magnesium to help it work properly and efficiently. Every organ in your body needs magnesium to work properly and it’s a key part of the process that turns the food you eat into the energy your body needs. Magnesium is important for functions such as controlling your blood pressure and blood sugar levels and keeping your heart beating regularly.

Magnesium helps your body to use vitamins and other minerals, such as calcium, phosphorus, sodium, potassium, and vitamin D.

You can get good amounts of magnesium from foods such as leafy green vegetables like spinach, nuts and seeds, and whole grains (wheat germ or bran).You can also get magnesium by taking magnesium supplements. However, many people in the United States probably don’t get enough magnesium from the foods they eat. African Americans and other ethnic groups are more likely to be lacking in magnesium than white Americans.

What we say
The Vitamin D Council believes that the daily amounts of magnesium recommended by the Food and Nutrition Board aren’t enough to keep your body healthy; and that both men and women may need more than is recommended. Some research studies show that your body needs between 500 and 700 mg a day.

Magnesium may help vitamin D by helping your body activate vitamin D into a form your body can use, though it’s not known how much is ideal or if not getting enough magnesium harms your ability to fully make activated vitamin D. Also, magnesium is important in helping vitamin D to maintain calcium in the body and is essential for bone health.

If you want to take magnesium, and you’re taking medications or have health problems, check with your physician first. See the Office of Dietary Supplements for more information on magnesium.

Vitamin K
Your body needs vitamin K for two important reasons; to help wounds heal properly, by making sure your blood clots, and to keep your bones strong and healthy. There is also some research which shows that vitamin K may help to protect against developing conditions like heart disease, prostate cancer and Alzheimer’s disease.

Vitamin K is important in making sure that the calcium you get from foods or supplements is used in your bones. Vitamin D and vitamin K work together to strengthen your bones and to help them develop properly.

There are two main types of vitamin K.

1. Vitamin K1, which comes from leafy green vegetables like kale, chard and spinach.
2. Vitamin K2, which comes from meats (organ meats in particular, such as liver), eggs, insects and hard cheeses. This type of vitamin K2 is called MK-4. There is also a different kind of vitamin K2, called MK-7, which comes from natto.

Vitamin K can also be taken as a supplement, either as K1 or K2, and the K2 can be either MK-4 or MK-7.

Which type?
Research is still trying to sort it all out, but research is showing that you likely need both vitamin K1 and K2.

The National Academy of Sciences has set Adequate Intake (AI) levels for vitamin K, which is the amount that adults and children need every day.

National Academy of Sciences has set Adequate Intake (AI) levels for vitamin K:
Children under 1 year 2-2.5 mcg
Children 1-3 years 30 mcg
Children 4-13 years 55-60 mcg
Adolescents 14-18 years 75 mcg
Adult men 120 mcg
Adult women 90 mcg
Women who are pregnant or breastfeeding 75-90 mcg

For more information regarding the vitamin K, read our page, “The synergistic relationship between vitamin D and vitamin K.”
Caution!
If you’re taking blood thinning medicines, such as Warfarin or Coumadin, don’t take vitamin K supplements. This is because it may affect how well your blood clots.

Zinc

Zinc is important to the body for a variety of reasons.

Zinc is a mineral and it’s found mainly in your muscles and bones. It is important for:

• fighting infection and healing wounds.
• helping your body to make new cells and substances called enzymes.
• helping your body to use the carbohydrate, fat and protein in food.
• growth and development – so it’s vital to get enough during pregnancy, childhood and adolescence.
• your sense of taste and smell.

You can get zinc from a number of foods. Oysters contain more zinc that any other food, but it’s also found in red meat, poultry, beans, seafood such as crab and lobster and nuts. Some breakfast cereals have zinc added to them.

Much of the zinc we get from foods comes from meat, and the zinc that is found in vegetables and grains is harder for your body to use. This means that if you’re a vegetarian, you may need more zinc every day than people that eat meat. If you’re over the age of 60, you’re also more likely to be lacking in zinc.

Zinc isn’t stored in your body, so you need to eat foods that contain it every day, or take supplements. Supplements are available in a number of different forms, such as tablets and capsules or as part of many multivitamins. Some cold lozenges that contain zinc are also labeled as supplements.

Zinc may help vitamin D to work inside the cells of your body. It’s also important in making sure that the calcium you get from foods or supplements is used in your bones. Vitamin D and zinc work together to strengthen your bones and to help them develop properly.

Caution!
If you’re taking amiloride, prednisone, cyclosporine or any other medicine that suppresses your immune system (immunosuppressant) you shouldn’t take zinc supplements without talking to your physician first.

Boron
Boron is a trace mineral, which means it’s only present in small amounts in your body, and your body only needs small amounts of it to stay healthy. It’s essential for good health and helps your body to use other minerals such as calcium and magnesium properly. It helps to keep your bones healthy, affects how well your brain works and affects the hormone levels in your body, for example your level of testosterone.

You get boron from the foods you eat and from some drinks. Fruit, leafy vegetables and nuts contain good amounts of boron, as does wine, cider and beer. Peanut butter, avocado and raisins are other good sources of boron. You can also take boron as a supplement.

There is no recommended dietary allowance for boron to tell you how much you need each day. However there is a Tolerable Upper Intake Level (UL). UL is the maximum dose you can take, when you wouldn’t be likely to have any harmful effects. The National Academy of Sciences UL for boron is:

The National Academy of Sciences UL for boron is:
Children 1-3 years 3mg
Children 4-8 years 6mg
Children 9-13 years 11mg
Adolescents 14-18 years 17mg
Adults 20mg
Boron works with vitamin D to help your bones use the minerals they need, such as calcium. This ensures you have strong and healthy bones.

Caution!
Don’t take boron supplements if you have kidney disease or your kidneys are not working well. This is because your kidneys need to work hard to get rid of boron from your body.

Vitamin A
Your body needs vitamin A for good eyesight, to help you fight infection and to keep your skin and mucous membranes healthy. Mucous membranes are the linings inside parts of your body such as your nose, your intestines and your lungs. Vitamin A is also important in the development of cells and is therefore vital for a baby developing inside the womb.

There are two main types of vitamin A:

1. Beta-carotene, which you can get from brightly colored fruits and vegetables, such as carrots, apricots, mango and leafy greens.
2. Retinol, which you can get from organ meats (such as liver) and dairy products such as butter, cheese and milk.

You can also take vitamin A as a supplement, both in the forms beta-carotene and retinol. However, it’s possible to take too much retinol, and as your body can’t get rid of it easily, this can be harmful. Your body can get rid of excess beta-carotene, however.

Don’t take more than the recommended daily allowance of vitamin A in the form of retinol. Vitamin A can also interact with a number of medicines, so if you’re thinking about taking a supplement and you’re taking medicines or have health problems speak to your physician for advice. If you don’t get enough vitamin D, you could be more at risk of the harmful effects of too much vitamin A.

Vitamin A and vitamin D work together to help your “genetic code” work properly. If you don’t have enough vitamin A, vitamin D may not be able to perform this function properly. On the other hand, research also shows that if you have too much vitamin A, vitamin D does not work as well. At this time, however, researchers don’t know how much vitamin D you need compared to how much vitamin A you need.

Our take
We think that humans most likely get enough vitamin A through diet and do not need to supplement with retinol.

Visit the Office of Dietary Supplements for more information on vitamin A

Caution!
Too much vitamin A can be harmful to a developing baby, so if you’re pregnant don’t take vitamin A supplements. Don’t eat large amounts of liver or foods made from liver such as pate either, as these contain large amounts of vitamin A.

and
http://www.nutritionaloutlook.com/j...s-new-science-vitamin-d-k2-magnesium-and-zinc

Loss of bone density impacts 54 million Americans, putting them directly in the path of danger of developing osteoporosis. Osteoporosis significantly increases risk of fracture, with studies suggesting that one in two women and one in four men over the age of 50 will experience a broken bone as a result. Estimates suggest that by 2025, osteoporosis will be the source of three million fractures and over $25 billion in healthcare costs each year.1




Combating osteoporosis is a lifelong endeavor requiring prudent lifestyle choices. This includes exercise and also diet, with evidence indicating that nutrition plays a major role in promoting skeletal health.2 Consuming the necessary vitamins and minerals from food as well as from dietary supplements should be an important pillar of any bone-health program. Take calcium. Calcium is well-known for its benefits to bone mineral density, as it is the most abundant mineral in the human body.3

Calcium’s effects, however, depend heavily on the actions of several other vitamins and minerals, including vitamin D, magnesium, vitamin K2, and zinc. We call these cofactors,
and they are believed not only to be critical to bone health but also to be most effective when present together in adequate amounts.



Vitamin D

Vitamin D is a crucial cofactor for bone health, as it regulates calcium balance and directly affects the osteoblast cells responsible for bone building and bone remodeling. Several studies link vitamin D deficiency with a higher risk of falls and fractures.4

Today, vitamin D deficiency is increasingly recognized as a worldwide epidemic, illustrated by the fact that more than 60% of postmenopausal women have inadequate serum levels of 25(OH)D, a common marker used to assess vitamin D status. The Institute of Medicine (IOM) defines vitamin D deficiency as serum levels of 25(OH)D less than 50 nmol/l (or 30 ng/ml). Vitamin D deficiency is a significant public health concern, and even populations of countries with abundant sun exposure often don’t meet target levels.5

But some newer clinical studies assessing vitamin D supplementation are yielding conflicting results. Ahead, we take a look at several.

Photo © iStockphoto.com/Jaykayl



For a Cochrane Database review, Alison Avenell and colleagues looked at interventional studies using vitamin D, or vitamin D in combination with calcium, and assessed the benefits of these nutrients for preventing hip fractures.6 Their review included 53 studies consisting of 91,971 participants categorized as postmenopausal women or older men.

Based on the research reviewed, the authors concluded that there is a lack of high-quality evidence that vitamin D intervention alone will prevent hip fractures in this population; however, they said, there is high-quality evidence that vitamin D in combination with calcium results in a small reduction in hip fracture risk. Also, they noted strong evidence linking the combination of vitamin D and calcium supplementation with a statistically significant reduction in the risk of new non-vertebral fractures.

The studies reviewed used a broad range of vitamin D doses, which may have impacted results. The authors emphasized that, while vitamin D is important for bone health, it was clear that the combination of vitamin D and calcium supplements was more effective than vitamin D alone for preventing fractures.

Kirsti Uusi-Rasi and colleagues in Finland aimed to determine the effect of exercise training, vitamin D, and the combination of both on reducing the risk of falls in older women.7 This two-year randomized trial included 409 white European women between the ages of 70 and 80 with a history of at least one fall during the previous year and no vitamin D use. The women were randomized into four groups: placebo, vitamin D (800 IU/day) without exercise, placebo plus exercise, and vitamin D (800 IU/day) plus exercise. The exercise routine comprised strength and balance training. The primary outcome was the number of monthly reported falls. The study also assessed bone density and measures of physical functioning, including muscle strength, balance, and mobility.

According to the researchers, vitamin D was not found to enhance the effect of exercise on physical functioning; however, vitamin D maintained femoral neck bone density measurements and increased trabecular density in the tibia.

Erin LeBlanc and Roger Chou are two of the contributing authors responsible for conducting a review on vitamin D for the U.S. Preventive Services Task Force.8 This task force determined that intervention with vitamin D was associated with an overall 11% decreased risk for falls. In an invited commentary accompanying the Uusi-Rasi study,9 LeBlanc and Chou state that adding the data from this well-conducted trial to the data they reviewed earlier does not change their conclusion supporting the potential benefits of vitamin D. They caution generalizing the results from this new study because the current study doesn’t represent the diversity seen in the U.S. population, they say. They also suggest that the dose of vitamin D (800 IU/day) may have been too low to enact change, considering that experts generally recommend daily doses between 1000 IU–2000 IU, especially in individuals at increased risk of falls. LeBlanc and Chou conclude that because of the low cost and low safety risk of vitamin D–based intervention, vitamin D should be kept in the armamentarium for prevention of falls.

In a Korean study, Hyeonmok Kim and colleagues from the Asan Medical Center at the University Of Ulsan College Of Medicine in Seoul conducted a study on 1,209 men and women aged 50 years and older to determine the association of vitamin D and femoral neck strength.10 The researchers analyzed bone mineral density measurements along with measures of femoral neck strength (including compression strength, bending strength, and impact strength) and found that both were significantly higher with increasing levels of vitamin D, and that these benefits were especially pronounced in women.

Additional clinical research provides important insights into the effects of vitamin D beyond direct effects on bone tissue. In a study evaluating the effects of vitamin D on bone mineral density and fracture risk, Jane Cauley, from the University of Pittsburgh, and colleagues enrolled 2,067 women with an average age of 48.5 years and who were entering menopause.11 In the study, women from multiple ethnic groups were followed for an average period of 9.5 years, with researchers measuring serum levels of vitamin D as 25(OH)D at the third annual clinical visit. Bone mineral density and fractures were determined at each annual visit. The average 25(OH)D level was 21.8 ng/ml, and 43% of the women had serum levels lower than 20 ng/ml.

Women with 25(OH)D levels greater than 20 ng/ml had a 45% reduced risk of non-traumatic fracture over the 9.5-year follow-up period compared to those with 25(OH)D levels less than 20 ng/ml.

However, researchers did not find an association between serum vitamin D levels and traumatic fracture in this cohort, leading the researchers to speculate that the protective effects of vitamin D on fractures may be mediated by mechanisms other than increased bone mineral density. The ancillary benefits of vitamin D, including improvements in muscle strength as well as physical performance, may be more important than vitamin D’s effects on bone mineral density, they said.

Many researchers continue to speculate that a potential reason for the inconsistent results among vitamin D bone-health trials is that the administered dose may be too low.

Max Brincat and colleagues made this argument in a recent paper, pointing out that in many population groups, standard supplemental amounts fail to adequately raise vitamin D levels into the target range.5 While the Institute of Medicine defines vitamin D deficiency as serum 25(OH)D levels less than 50 nmol/l (20 ng/ml), the authors suggest that the appropriate target level in elderly individuals may be higher (75 nmol/l, or 30 ng/ml), and that doses higher than 800 IU–1000 IU per day would be required to achieve these targets. One bit of good news: David Dudenkov and colleagues from the Mayo Clinic found no increased risk of toxicity with serum 25(OH)D levels over 50 ng/ml, affirming the safety of higher doses.12

Based on the research, vitamin D clearly supports healthy bone mineral density and benefits muscle strength and physical performance in aging individuals; however, vitamin D works best in combination with adequate calcium. Several other nutrients also contribute to calcium and vitamin D’s actions.



Magnesium

Magnesium makes up nearly 1% of bone mineral content. Magnesium is directly required for the transport of calcium ions across cell membranes. Inadequate magnesium intake has been shown to result in low blood levels of calcium as well as resistance to some of the actions of vitamin D.

“Magnesium is necessary to convert vitamin D into its active form so that it can ‘turn on’ calcium absorption,” says Todd Johnson, director of marketing at Albion Minerals (Clearfield, UT), a leading manufacturer of mineral chelates.

Decreased magnesium content causes bone to become more brittle. “Research has shown that magnesium deficiency is a frequently occurring disorder that can lead to loss of bone mass, abnormal bone growth, and skeletal weakness,” Johnson says.

Unfortunately, it’s become clear that people aren’t getting enough magnesium through diet alone. Worse still, magnesium deficiency is more common in the elderly,13 potentially placing the population at higher risk of osteoporosis and other bone-health defects.


Experiments conducted in mice bone marrow cells have found that magnesium deficiency results in increased formation of bone-resorbing osteoclast cells.14 But recent studies showed that in female rats with sufficient calcium intake, magnesium supplementation led to increased bone mineral density and bone size by improving bone tissue metabolism.15

Sara Castiglioni and colleagues from the University of Milan in Italy identified several mechanisms whereby deficient magnesium levels adversely impact bone.16 First, magnesium deficiency leads to an altered structure of apatite crystals in bone, decreasing stiffness as well as bone’s load-bearing capacity. Magnesium deficiency also decreases the activation of vitamin D. By contrast, correcting magnesium deficiency through supplementation has been shown to normalize vitamin D metabolism. Magnesium deficiency also leads to low-grade inflammation, which is detrimental to bone health. Magnesium may additionally act as an important buffering agent, thereby protecting against osteoporosis onset.

But that’s not all. Metabolic acidosis is common in aging adults consuming a western diet and has been shown to influence calcium loss from bone, inhibit the activity of osteoblasts, stimulate osteoclast activity, and negatively affect bone mineralization. By also buffering excess acidity, it is likely that magnesium further protects against the development of osteoporosis.

In an analysis of women participating in the Women’s Health Initiative Observational Study, Tonya Orchard and colleagues estimated total magnesium intake and compared this to overall bone mineral density.17 They found that postmenopausal women consuming greater than 422.5 mg of magnesium daily had higher hip and whole-body bone mineral density than women who consumed less than 206.5 mg of magnesium daily on average. (Interestingly, however, the incidence of hip and total fractures did not differ across different intakes of magnesium in this cohort. In fact, the risk of lower arm and wrist fractures increased with higher magnesium intakes. The authors posit that this may be because the women who had the highest magnesium intakes were more physically active and thus likelier to experience falls.)

Another recent study confirmed the benefits of magnesium to physical performance in postmenopausal women. Nicola Veronese and colleagues from the University of Padova in Padova, Italy, enrolled 139 healthy women with an average age of 71.5 years in a randomized controlled trial in which participants were allocated to a control group or were supplemented with 300 mg of magnesium daily for 12 weeks.18 Exercise and fitness ability were assessed at baseline and again after 12 weeks.

The group supplementing with magnesium showed significant improvements in physical performance compared to the control group, suggesting that magnesium supplementation is an important factor in delaying the onset of deterioration of physical performance associated with age.



Vitamin K2

Vitamin K—and more specifically vitamin K2, the menaquinone form of vitamin K—continues to shine as a vitamin that supports multiple aspects of bone health. Vitamin K2 plays a direct role in transporting calcium from circulation into bone tissue by activating (carboxylation) two key calcium transport proteins in the bloodstream: matrix Gla protein, which transports calcium from circulation into bone, and osteocalcin, which reduces calcification of arteries and plays a significant role in bone development.19,20

Furthermore, vitamin K2 has been shown to work hand in hand with vitamin D in multiple ways. Vitamin D enhances the absorption of calcium from the intestinal tract into circulation, while vitamin K2 aids calcium’s transport into bone tissue. Additionally, vitamin D promotes the production of osteocalcin from the bone-building osteoblast cells, while K2 serves to activate osteocalcin to perform its calcium-transport function.19

Research continues to validate vitamin K2’s benefits to bone health and heart health. Two common supplemental forms of vitamin K2 are menaquinone-4 (MK-4) and menaquinone-7 (MK-7), with the number designations referring to the length of the molecular side chains.

Z.-B. Huang’s group from Zhejiang, China, conducted a meta-analysis assessing the role of vitamin K2 in the prevention and treatment of osteoporosis in postmenopausal women.21 In reviewing 19 randomized controlled trials consisting of 6,759 participants, the authors found that in postmenopausal women with osteoporosis, vitamin K2 supplementation achieved significant improvement in vertebral bone mineral density and reduction in the overall risk of fractures. Vitamin K2 also led to a decrease in under-carboxylated (inactive) osteocalcin, thus favoring bone mineralization.

Earlier, Martinus Knapen and colleagues from the Netherlands conducted a three-year, placebo-controlled study in healthy postmenopausal women to assess the effects of vitamin K2 MK-7 on bone health.22 Participants supplemented with 180 mcg/day of MK-7 or a placebo.

MK-7 supplementation led to increased bone strength and a decrease in the rate of decline of bone mineral content and bone density that normally occurs as a result of the aging process. The researchers also found less loss of vertebral height in the mid-back compared to placebo treatment, suggesting that MK-7 is a nutritional factor impacting both bone density and strength in postmenopausal women.



Zinc

Zinc is essential to human health. It plays a critical role as a structural component of proteins, acts as an enzymatic cofactor, and functions as a transcriptional regulator for a large array of cellular and biochemical processes.

Studies in cultured osteoblasts have shown potent stimulation of bone formation following exposure to zinc, leading to enhanced deposits of calcium. Additional studies found that by inhibiting nuclear factor-kappa B, a potent mediator of inflammation and bone resorption, zinc was able to suppress the differentiation of osteoclasts, inhibiting bone resorption.23

Sadly, zinc deficiency is also widespread in the global population—a fact that animal research has shown may impact the normal physiological action of vitamin D on calcium metabolism24 and interfere with the anabolic activity of vitamin D on bone tissue.25

Photo © iStockphoto.com/danleap



Payal Bhardwaj and colleagues from Punjab University in Chandigarh, India, conducted a study in a rat model of postmenopausal osteopenia to investigate the impact of zinc supplementation on prevention of bone loss.26 They found significant changes to the cortical bone structure in rats in which estrogen deficiency was induced, including poor microarchitecture and resorbed areas of bone tissue. Zinc supplementation was able to arrest these changes, while improving overall bone microarchitecture, enhancing antioxidant defenses in bone tissue, and improving regulation of several markers of bone metabolism.

Additionally, a meta-analysis by Jianmao Zheng and colleagues from Sun Yat-sen University in Guangzhou, China, looked at published human studies relating serum levels of several minerals to the incidence of osteoporosis and concluded that low serum levels of zinc seem to be an important risk factor for this disease condition.25



Strong Evidence

Maintaining optimal bone health requires a lifelong habit involving sound dietary and lifestyle choices.

Adequate calcium intake through diet and supplementation is essential. However, it is just as essential to consume sufficient and balanced amounts of critical cofactors for healthy bones—either via food or supplement—including vitamin D, magnesium, vitamin K2, and zinc.

Together, these important nutrients work to ensure that the metabolic processes supporting bone remodeling work efficiently for a lifetime.

 

[Phoenix]

@Alex T, which Nioxin shampoo are you using? and what's the difference between shampoo and cleanser? Are you also using their scalp treatment too? I looked online and there are many available, not sure which is/ are the best, lol.

 

[Ally T]

@Alex T, which Nioxin shampoo are you using? and what's the difference between shampoo and cleanser? Are you also using their scalp treatment too? I looked online and there are many available, not sure which is/ are the best, lol.

I am using System 4, which is for noticeably thinning, chemically treated hair. The Cleanser is a shampoo, then there is a conditioner which has to be left on the scalp for a couple of minutes, and then a scalp treatment, which in system 4 is a mouse. I tend to squirt a little of that into my fingertips, rub my hands together until it goes back to a liquid, then slide my fingers into my scalp & massage it all over. In system 4, the scalp treatment has a sunscreen in it (argghhh!) to protect the scalp from burning. Obviously there's not much chance of that happening in the U.K. at the moment, and I could do without it because of the Vit D, but I shall switch onto a different system once I have (fingers crossed) seen recovery to density. I have used System 2 in the past when hair loss had recovered, and the scalp treatment for that one is a liquid that you pump into the roots & massage. It really might be worth you giving it a try? Please only buy from a reputable supplier though, as there are a lot of fakes out there I believe

 

[Phoenix]

@Alex T, thank you for that. I will certainly try. I'd like to replace the volume that I've lost. I'm going to buy it from a department store.

 

[PierreBear]

Hope you are feeling better Alex T! Thanks for starting this thread and keeping us all educated.

I was surprised to find I was vitamin D deficient even though I'm in the sun often due to workouts/training. Sunblock blocks harmful UV rays but also blocks the nutrients that our bodies need. I take a daily vitamin supplement and my D levels are within range though always in the very low side. I'm not sure if I've seen dramatic effects of being low in vitamin D so I won't know until a blood result shows me, which is only on an annual basis right now.

 

[Ally T]

@PierreBear I think it maybe quite a common deficiency?! Particularly in northern countries such as mine, which whilst can be very beautiful & sunny, can also have long periods of miserable, grey skies in Autumn & Winter. It's alarming to think that our lifestyles & skin protection can be making us ill. And Vit D is so incredibly complicated, in that it helps calcium absorption & also affects hormone levels. I have been staggered by the amount of medical information out there about it, and I hope this thread can be of help to others with any vitamin deficiency.

I hope your blood tests show an improvement for you & I'm glad you haven't felt too run down as a result of low levels. You must keep us posted on any changes.