The Epidemic of Vitamin D Deficiency
Only 5% of the hundreds of individuals I have tested in the last few years for vitamin D status actually have adequate vitamin D levels. This is even after a foreign holiday in the sun. This alarming statistic means that 95% of those individuals do not have adequate means to overcome chronic infections, optimise their bone health or potentially keep cancers at bay. I would expect that my clinical experience is typical of the rest of the UK. Why is there such an epidemic of vitamin D deficiency? What can be done to improve this and the health of the nation?
How does vitamin D get made in the body?
Vitamin D is made in your body in the following way:
UVB rays from the sun hit your skin. Your skin uses cholesterol in your skin that acts like a building block. The UVB rays turn this cholesterol into a form of vitamin D called vitamin D3. Your liver and kidneys finish the job by converting it into the active form of vitamin D your body can use. So, sunlight + skin +cholesterol = vitamin D.
What does vitamin D do in your body and why is it so important for health?
Powerful immune effects - Vitamin D acts like a natural antibiotic to help the white blood cells of your immune system clear infections (viral, bacterial, fungal). It activates immune cells that protect the integrity of your gut lining. To do this it needs IR (Infrared) and UV (Ultraviolet) light exposure. Your gut bacteria release large amounts of light. Vitamin D blocks the chemical signalling that increases stress and inflammation (TNF alpha and NK Kappa beta).
Kidney protection - Vitamin D helps protect against high blood pressure by inhibiting the hormone renin in your kidneys. It also protects the kidneys against high amounts of uric acid from fructose metabolism.
Inhibits psoriasis - Psoriasis sufferers should check their vitamin D level as a priority. That’s why light therapy is successful in treating psoriasis. It is ironic that dermatologists tell patients to be afraid of sunlight.
Protects against Cancer - The next time a doctor tells you that sunlight is bad for you, look up this study (Mohr et al. 2005 - Mapping vitamin D deficiency, breast cancer and colorectal cancer) and show it to them. The message of the study: the further away from the equator, where the sun is strongest, the higher the cancer rates!
Protects against Obesity - Levels above 50ng/ml are linked to higher adiponectin levels and lower leptin levels. This means you are less likely to become obese or develop metabolic resistance and type 2 diabetes if your vitamin D level is good.
Protects against heart disease - Good vitamin D status means less hypoxia in the brain and better mitochondrial function in the heart and brain. It helps protect the heart from endotoxins (toxins inside bacteria).
Reduces cellular ageing - Richards (2007) found that higher vitamin D levels are associated with longer telomere lengths. This can help decrease leakiness of mitochondria which drives the actions of the mechanism which dictates telomere length. Telomeres are like caps on the end of chromosomes. shorter telomeres hasten cell death, with all the signs of ageing (wrinkles, weaker muscles, slower healing, high risk of diseases).
Reduces inflammation - It does this by calming down your immune system and helping to stop it overreacting. It promotes the healing and repair of tissues, which can resolve inflammation faster.
Supports Bone Health - This is through increased intestinal absorption of phosphorus and calcium. Some Biological dentists require a vitamin D test before dental work commences.
Helps regulate autoimmune diseases - Please see the work of Dr Hector DeLuca. He says that sunlight and vitamin D are effective against a range of autoimmune diseases like autoimmune encephalitis and MS.
Helps Autophagy - Autophagy is your body’s natural process of cleaning out damaged or unnecessary cells and recycling their parts to make new, healthy cells. The word comes from Greek and means “self-eating.” It is a cellular housekeeping system that helps maintain balance and improve cell function. During fasting, which has become popular, autophagy provides energy by breaking down and reusing cell components. It helps fight infections by destroying harmful invaders like bacteria and viruses.
I hope you are now beginning to see that if you are vitamin D deficient, you are not going to have adequate protection against the many harmful processes in the body.
What triggers vitamin D deficiency?
What factors are likely to promote vitamin D deficiency?
Fat malabsorption - Vitamin D is a fat-soluble molecule. That means it is best absorbed with fats. However, those with a leaky gut, inflammatory bowel diseases, thyroid dysfunction, liver disease, a low fat diet, on steroids, NSAIDS, blood thinners, antacids and synthetic hormones like the Pill, may have a hard time absorbing vitamin D. Do you begin to see why vitamin D deficiency is widespread?
VDR dysfunction - Vitamin D only does what it does by activating something called the Vitamin D Receptor (VDR). You need both to be working properly to get the benefits of vitamin D. Imagine your body is a bustling city and the Vitamin D Receptor (VDR) is a special lock on the door of a control tower. Vitamin D is like a key that unlocks that door. When the key (vitamin D) fits into the lock (the VDR), it opens the door and allows the control tower to send out important instructions to the city. The control tower (VDR) is found in many parts of the body - like your immune cells, bones, and gut. Once the door is open, it helps turn on genes and processes that are vital for keeping the city running smoothly. Most people just measure vitamin D. However, if the blood level of Vitamin D is fine but the Vitamin D Receptor (VDR) isn’t working properly, it is like having a key (vitamin D) but the lock (VDR) is jammed or broken. This spells problems for bone health, immune function and all the rest. A number of things, including EBV, mould and flu infections, heavy metal toxicity and deficiencies can impair VDR function. Interference with the VDR will give the same result as a low blood level of vitamin D.
Trouble with Vitamin D-Binding Proteins (DBPs) - Vitamin D is transported in the blood by a special carrier called DBP (Vitamin D-Binding protein). This helps deliver vitamin D to where it needs to go. There are two types of DBPs: High-affinity DBP holds on to vitamin D very tightly. Low-affinity DBP holds vitamin D more loosely. If there is an imbalance between high and low-affinity DBP, it affects how vitamin D moves and is used by your body.
Too much high-affinity DBP – Vitamin D gets “stuck” on the DBP and isn’t easily available to your cells. This can make it seem like you have low vitamin D levels (because your body can’t use it properly) even if you have technically enough in storage.
Too much low-affinity DBP - Vitamin D is released too easily, but it might be lost too quickly instead of being stored or used efficiently. This could lead to overall lower vitamin D reservesLow Cholesterol - Cholesterol is the raw material for vitamin D production. When sunlight hits your skin, it triggers a chemical reaction. This reaction converts cholesterol into vitamin D. Low HDL can be a sign of poor sun exposure. Adequate vitamin D levels can also help balance cholesterol as vitamin D influences how your liver processes fats. Doctors frequently say that a high HDL is heart-protective.
Certain Medications - can interfere with vitamin D metabolism. These include: anticonvulsants, glucocorticoids, weight-loss medications that block fat absorption.
Certain infections - interfere with VDR function. These include: Epstein Barr Virus, Aspergillus and flu.
Autoimmune diseases - like lupus or MS, may alter how your body responds to vitamin D.
Thyroid or adrenal problems - can alter how vitamin D interacts with other system in your body.
Liver/kidney diseases - can disrupt vitamin D function.
Obesity - In people with excess body fat, vitamin D can get “trapped” and isn’t available for use.
Nutrient deficiencies - like magnesium, calcium, phosphorus can cause vitamin D resistance.
Aging - our skin produces less vitamin D from sunlight as we age and kidneys become less efficient at activating it.
Detecting vitamin D deficiency
How do you find out if you are vitamin D deficient?
Don’t guess, test!
Vitamin D3(25OH) - this is the storage form of vitamin D and the test I run most. This test can be measured in two values (ng or nmol), depending on what the lab uses. These are the Functional Medicine vitamin D ranges we are looking for are:
65-85ng/ml or 160-210 nmol/L Please note that the NHS considers 25-50 nmol/L as “adequate.” The focus is on avoiding severe deficiency like rickets or osteomalacia. With the Functional medicine ranges, the focus is on the “optimal” range for overall health, not just preventing deficiency. For someone fighting a chronic infection, the standard Functional Medicine advice is for the vitamin D level to be in the upper third of the range.
Calcitriol (D-1,25) - This is the active form vitamin D. Blood tests usually measure 25OH vitamin D to assess vitamin D levels, not D-1,25, because the active form can appear normal even if your body’s stores are low. Think of 25OHD as the money in your savings account and D-1,25 as the cash you take out to spend. You need to have enough in savings (25OHD) to make sure there’s always cash available (D-1,25) when you need it.
Parathyroid Hormone (PTH) - This works closely with vitamin D to keep bones strong and muscles and nerves working properly. When calcium levels in your blood are low, PTH signals your bones to release calcium and tells your kidneys to activate more vitamin D so your body absorbs more calcium from food. If your body is resistant to vitamin D, it can’t absorb enough calcium from your food, even if you have enough vitamin D in your blood. When calcium levels stay low due to vitamin D resistance, your body thinks it needs more calcium. So the parathyroid glands try to fix the problem by pulling calcium from your bones and increasing vitamin D activation (even though resistance makes this less effective). Therefore, if PTH levels are high, it may be a sign that your body isn’t responding well to vitamin D or that you’re not getting enough calcium.
Here’s what the test results can tell us:
Vitamin D in top third of range + PTH in lower third of range = Vitamin system working normally.
Normal vitamin D + elevated PTH = VDR dysregulation (vitamin D resistance).
Low 25 OHD + high Calcitriol D-1, 25 = Preponderance of high affinity DBPs.
Low 25 OHD + low Calcitriol D-1, 25 = Possible preponderance of low affinity DBPs.
There can be lots of combinations of the above.
It can be a good idea to check blood calcium and Red Cell Magnesium levels too.
What can you do?
Get out into the sunshine - even in winter! Get up at sunrise and enjoy the first red light of the morning. Do check your omega-3/omega-6 range. This is important. If your omega-6 is too high compared to omega-3, your skin may overreact to sun exposure, leading to redness or damage. Similarly, if you eat too much sugar, you are more likely to burn. So, please be sensible.
Try to avoid sunblock, skin makeup and sunglasses. Wear a cap to avoid glare and bathe in the shade where you will still get beneficial light.
Control the light in your environment - quality blue light blocking glasses after sundown plus a red blue light blocking lamp. Again, individual judgement on this is essential.
Supplement with vitamin D as appropriate. Be guided by your test results. Monitor levels in until stably in a good range. In some studies, VDR dysregulation was addressed successfully by supplementing vitamin D at a higher daily dose.
Add a vitamin K2 supplement. As vitamin D helps your body absorb calcium from your diet, vitamin K activates proteins that keep calcium from being deposited in soft tissues like arteries, reducing the risk of calcification.
Address other case factors as needed which would affect vitamin d levels i.e. chronic pathogen burden, immune imbalances, oxidative stress.
What about vitamin D toxicity?
During the Industrial Revolution, the severe vitamin D deficiency disease rickets was widespread in the UK.
By the early 1900s, researchers began linking sunlight and diet to rickets prevention.In the 1920s, scientists identified vitamin D as essential for calcium absorption and bone health. It was discovered that exposure to ultraviolet (UV) light allowed the skin to produce vitamin D, and foods like cod liver oil were rich sources of this nutrient.
Various scientists and researchers played a role in the discovery of vitamin D. Dr Edward Mellanby first identified the effects of vitamin D. German chemist Adolf Windaus (1876-1959) clarified the chemical structure of vitamin D and its formation from precursor raw materials like cholesterol when exposed to ultraviolet (UV) light. American biochemist Elmer McCollum (1879-1967) identified a substance (later called vitamin D) in cod liver oil that could prevent rickets, distinct from vitamin A (the retinol component of cod liver oil).
In the 1920s and 1930s, the UK government introduced fortification of foods with vitamin D. This was aimed at preventing rickets and combatting other health issues. Rickets is a bone disease that occurs in children due to a deficiency of vitamin D, calcium or phosphate. It leads to weakened, soft and deformed bones and was historically a major public health issue, particularly in industrialised regions with limited sunlight. It gives a typical bow-legged appearance. My grandfather and his father both suffered from rickets.
During World War 11, the UK government mandated vitamin D fortification in margarine as part of broader wartime nutritional policies. This was supplemented by free or subsidized cod liver oil for children and pregnant women.
In the 1950s, an outbreak of hypercalcemia was identified in the UK with nearly 200 infants. Despite there being no evidence that vitamin D was the problem, fortification was stopped. The symptoms that the children suffered from were elfen faces, developmental delays, and cardiovascular stenosis. Although it has since been found that these children had Williams syndrome, a rare genetic disorder associated with hypercalcemia, fortification with vitamin D has never been reintroduced and there remains a certain wariness about vitamin D supplementation.
Professor Michael Hollick, a world authority on vitamin D, states that vitamin D toxicity is one of the rarest conditions in the world. Studies show 10,00 to 20,000 iu a day to be safe. It is important to remember that people’s requirements are different and that they can react differently to supplementation. If in doubt, look up the symptoms of vitamin D toxicity. Better still, test your level!
If you would like help with any of the above, please get in touch with the Good Health Clinic on goodhealthclinic@outlook.com to request a free 30 minute Enquiry Call or book an appointment. Please note that an Enquiry call is not a consultation but an exploratory call to see if this is a clinical approach you wish to pursue.
To your very good health,
Suzanne Jeffery (Nutritional Medicine Consultant)
M.A.(Oxon), BSc.(NMed), PGCE, MNNA, CNHC
The Good Health Clinic at The Business Centre, 2, Cattedown Road, Plymouth PL4 0EG
Tel no: 07836 552936/ Answer phone: 01752 774755
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All advice given out by Suzanne Jeffery and the Good Health Clinic is for general guidance and informational purposes only. All advice relating to other health professionals’ advice is for general guidance and information purposes only. Readers are encouraged to confirm the information provided with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by other practitioners and physicians. Suzanne Jeffery and the Good Health Clinic will not be liable for any direct, indirect, consequential, special, exemplary or other damages arising therefrom.