Vitamin D deficiency

definition

One speaks of a vitamin D deficiency if the physiological need for vitamin D cannot be adequately met. A vitamin D level of 30 µg / l accepted. In Germany in particular, vitamin D levels are well below 20 µg / l. At values ​​between 10-20µg / l one speaks of a manifest vitamin D deficiency. At values ​​<5µg / l of a severe vitamin D deficiency, that of children with a rickets, in adults with a Osteomalacia goes hand in hand.

introduction

Vitamin D is the only one vitaminwhich the Make body yourself can. By rays of the sun, especially through UV-B radiation, the human body is able to produce its own vitamin D. Since vitamin D is unfortunately only found in very few foods, such as in salmon and Offal finds, sunlight is often the only way humans can get their vitamin D from. It is therefore not surprising that, especially in the dark winter months, many people have a vitamin D deficiency. This can lead to devastating disturbances, especially in children.
Also visits to the solarium, in which UV-A radiation is used instead of UV-B radiation, cannot balance the vitamin D requirement.

It is believed that there are around 1 billion people worldwide who suffer from vitamin D deficiency. Only residents around the equatorial line have normal vitamin D levels. This is probably due to the high levels of solar radiation that is there all year round. A severe vitamin D deficiency leads to a Demineralization of the boneswhich makes it frequent too osteoporosis comes.
The consequence of osteoporosis are brittle, unstable bones, which consequently become Broken bones (Fractures) is coming. Especially people in northern countries such as Scandinavia and Canada can only produce insufficient amounts of vitamin D due to the shorter exposure to the sun, and therefore suffer particularly often from osteoporosis and the bone fractures it causes. A study showed that in Oslo and Stockholm there were 3,500 femoral neck fractures for every 100,000 women. In Singapore, however, there were only 300. This is only about a tenth of those affected in Scandinavia.

causes

The most common cause of a vitamin D deficiency is Insufficient intake of vitamin D from food, or one too little formation of vitamin D from sunlight. This occurs especially in the dark autumn and winter months.
Even dark-skinned people who live in Germany are particularly often affected by a vitamin D deficiency, because their dark skin skin (a lot of melatonin) reduces the formation of vitamin D. For this reason, dark-skinned people need 10-50 times more UV-B radiation than fair-skinned people to produce the same amount of vitamin D. Also affected by a vitamin D deficiency are people who are rarely exposed to sunlight (e.g. bedridden patients), or people whose skin is due to covering clothing (e.g. through Burqas) gets very little sunlight.

Other causes of a vitamin D deficiency are Digestive and absorption disorders of the intestine (Maldigestion, Malabsorption) in the context of various diseases such as Celiac disease and Sprue, Crohn's disease or alcoholism.
Not infrequently can Medication Be the cause of a vitamin D deficiency. Typical representatives are here Loop diuretics (which among other things cause an increased excretion of calcium), Glucocorticoids or Calcitonin.

But also Kidney or liver disease With Kidneys- and liver failure can cause a vitamin D deficiency due to insufficient vitamin D production.

Even during the pregnancy an increased need for vitamin D is necessary, which is why deficiency symptoms are common. However, these must be balanced out in order to avoid later developmental damage to the unborn child.

Symptoms

Symptoms of vitamin D deficiency can be numerous. Most often they affect bones, hair, and teeth. But the nervous system is also often affected by its deficiency symptoms.

Every second German has a vitamin D deficiency. Therefore, doctors tend to advise everyone to have their vitamin D levels checked occasionally. Find out more at: Vitamin D rapid test - do I have a vitamin D deficiency?

Symptoms in adults

In adults, the main symptom of a vitamin D deficiency is so-called osteomalacia, a softening of the bones with subsequent skeletal deformation, or osteoporosis (bone loss) in which the bones slowly break down and become brittle.

Read more on this topic at: Osteoporosis symptoms.

Numerous fractures are the result of this disease. Other symptoms of a vitamin D deficiency are general bone pain, psychological abnormalities such as irritability or lack of drive and fatigue, slowed thinking and a generally depressed mood.

Read more on the topic: What role do vitamins play in depression?

Muscle weaknesses, muscle cramps and tetany are also described. Tetany describes an over-excitability of nerve cells, which is caused by a calcium deficiency. It manifests itself in the form of tingling sensations, paresthesia, wild grimacing and sudden, involuntary muscle tension. In severe cases, cardiac arrhythmias can even occur. Studies have also described an increased susceptibility to bacterial and viral infections (e.g. colds / flu), as well as overdevelopment of the gums (also Gingival hyperplasia called). Important warning signs of a vitamin D deficiency include brittle nails with white spots in the nail bed, as well as hair loss.

In order to be able to clearly diagnose the vitamin D deficiency, however, the vitamin D level must be determined. Doctors advise all people to take the vitamin D rapid test regularly. Find out more at: Vitamin D rapid test - who should absolutely do it?

Symptoms in Children

The leading symptom of a vitamin D deficiency in children is the world-famous rickets, a bone mineralization disorder in which fragile, inferior bones are formed which begin to bend as the children grow. The comparable clinical picture in adults is called osteomalacia.

Typical symptoms of rickets include general symptoms such as fatigue, restlessness, headaches and increased irritability, especially Skeletal changes that can occur as early as the 3rd month of life. These include a curvature of the spine, the classic knock knees or bow legs (Genoa valga or vara), indentation of the lateral skull bone with light finger pressure (craniotabes), flabby abdominal muscles that generate the classic image of a "frog belly", as well as muscle weakness, seizures and a tendency to tetany (involuntary strong muscle tension).

Other typical symptoms of a vitamin D deficiency are a reduced immune defense, which leads to increased infections, delayed tooth eruption with tooth enamel defects and tooth decay, since healthy teeth, like bones, are dependent on vitamin D.

• diagnosis

The diagnosis of rickets in children is usually made on the basis of a good medical history and clinical examination, which is then followed by an X-ray and a blood sample. The x-ray shows changes typical of rickets, such as the "rickets rosary", which stands for cartilage bulges at the rib borders. A blood test shows an increase in parathyroid hormone, a decrease in 25-hydroxyl-calcitriol (active form of vitamin D) and an increase in alkaline phosphatase, which is significant for disorders of bone metabolism or for liver and bile duct diseases.

Find out more at: Vitamin D rapid test - who should absolutely do it?

• therapy

Therapy for rickets in children would be high doses of vitamin D3 in the form of tablets for several weeks. Calcium should also be given at the same time as a prophylaxis against a sudden calcium deficiency. The skeletal changes usually recede after a few weeks after vitamin D administration. Subsequently, however, care should be taken to ensure a sufficient supply of sunlight or another dose of vitamin D3. Rickets has become rare in Germany today, but in spite of everything there are always children who suffer from a severe vitamin D deficiency. This often affects dark-skinned children of immigrants who have not received adequate vitamin D prophylaxis in their home country and who are unable to produce enough vitamin D in Germany due to their dark skin color.

Read more on this topic at: Rickets.

Pathophysiology - what happens when there is a vitamin D deficiency

Vitamin D is a precursor Cholecalciferol formed which either via the food recorded or through the sunlight is formed. This Cholecalciferol then goes through several reactions in liver and kidney until it becomes active vitamin D (or also Calcitriol called). In this form, vitamin D causes an increase in calcium in the body blood, as well as a mineralization, i.e. the structure, of the bones.
However, if there is a lack of vitamin D, calcium can only be absorbed in small amounts from food (due to the reaction). This in turn leads to a calcium deficiency in the blood, which has to be compensated for using various counter-regulatory mechanisms. For this, the human body pours that in large quantities Parathyroid hormone which has the task of "providing calcium". For this, the parathyroid hormone uses its ability from calcium bone mobilize out. In other words, the bone is broken down to maintain all of the calcium in the blood. Doctors call this phenomenon the so-called secondary hyperparathyroidism. The consequence of this overregulation of the parathyroid hormone, however, is an increasing breakdown of the bone (demineralization), which leads to thin, brittle bones and consequently bone fractures. To prevent such an effect, it is important to have enough vitamin D in the body.

Consequences of vitamin D deficiency

There are now many studies that prove that a vitamin D deficiency can lead to various diseases.
The typical consequences of a vitamin D deficiency today include Cardiovascular diseases, various cancers and immune defects, which in turn can be associated with various autoimmune diseases such as multiple sclerosis or type 1 diabetes.
Of course, a vitamin D deficiency alone is not the cause of these diseases, but a deficiency in vitamin D can contribute to the development of these diseases. Studies have shown that vitamin D has an anti-inflammatory and vascular protective effect, which prevents cardiovascular diseases and can also protect against cancers such as colon, prostate and breast cancer.

Both the overdose and the lack of vitamin D can lead to diarrhea. Intervention by the doctor may be necessary under certain circumstances. Read more about diarrhea from vitamin D at: Vitamin D diarrhea-is it dangerous?

Hair loss due to vitamin D deficiency

Reasons for Hair loss are there many. examples for this are Thyroid disease, Drug side effects, stress or mental stress. Often, however, there is also a vitamin D deficiency behind it. To understand how a vitamin D deficiency increases the growth of the hair one needs to understand the hair growth cycle.

The three phases of this cycle are: Anagen-, the Catagen- and the Telogen phase.
In the Catagen phase (or transition phase) stops hair growth in which Telogen phase the hair dies and falls out. Studies have shown that vitamin D deficiency can mess up the stages. The result is that the individual phases can now be variably lengthened or shortened and the telegon phase (death of the hair), for example, starts earlier. The result is: hair loss.

Diagnosis

In order to clarify a vitamin D deficiency, a blood test is carried out by the doctor. This should definitely be done if there are already manifest signs of a vitamin D deficiency or if there is a suspicion of a vitamin D deficiency. This is necessary, for example, for those affected who have a reduced bone density, have an increased loss of calcium and vitamin D during dialysis, who take drugs such as barbiturates or loop diuretics or who are only reduced due to underlying diseases (celiac disease, sprue, Crohn's disease) Can absorb calcium and vitamin D through the intestines.

Typical findings for a vitamin D deficiency would be: a decrease in 25-hydroxyl calcitriol (the active form of vitamin D), an increase in parathyroid hormone (antagonist to vitamin D) and an increase in alkaline phosphatase, which in this case Disturbances of the bone metabolism illustrated. The assessment of a vitamin D deficiency is particularly effective in the winter months from January to April.

The vitamin D test can also be carried out independently at home. Find out more about this topic at: Vitamin D rapid test - who should absolutely do it?

therapy

If a vitamin D deficiency is ultimately found, vitamin D must be substituted, i.e. are supplied to the body from the outside (e.g. in the form of tablets). According to the new guidelines, 20,000 IU vitamin D3 (e.g. Dekristol® capsules) should be taken once a week for 8 weeks.

If afterwards the vitamin D levels are still below the normal limit, the therapy should be continued for a further 8 weeks. If there is still no improvement afterwards, vitamin D3 should be taken permanently every 2-3 weeks. Another possibility would be to ensure sufficient sunlight exposure and to take vitamin D in addition in low doses.

Also read: High-dose vitamin D - when useful, when dangerous?

prophylaxis

The German Society for Pediatric and Adolescent Medicine (DGKJ) gives children a daily dose of one vitamin D tablet (10-12.5µg = 10-12.5µg =.) In the first twelve months of life, regardless of exposure to sunlight and vitamin D intake in breast milk 400-500 IU) recommended as prophylaxis from the end of the first week of life until the end of the first year of life. This prophylaxis can also be continued in the winter months in the second year of life. No further prophylaxis is necessary after the age of two.

Adults with insufficient exposure to sunlight are generally recommended (and especially in winter) a vitamin D dose of 800 to 1000 IU every 2-3 weeks.
A vitamin D dose of 1000-2000 IU every 2 weeks is recommended for pregnant and breastfeeding women.

However, it must be noted here that science is still finding it difficult to agree on the exact amounts or doses that are necessary in order to be beneficial to health.For example, some researchers in the field of vitamin D advocate a daily dose of up to 5000 IU in winter.

For an individual, correct dosage, however, you should always consult a doctor before taking vitamin D independently.

Another prophylactic measure is to have your vitamin D level checked regularly. Find out more at: Vitamin D rapid test - who should absolutely do it?