Vitamin D3, is this our most deficient nutrient?

Recent articles indicate that the prevalence of vitamin D deficiency is much higher than previously recognised (more than 90% in patients with chronic pain, according to a recent study published by the Mayo Clinic), and that vitamin D supplementation is much safer than previously recognised.  The recent studies by Al Faraj (2003), Vieth, Chan, and MacFarlane (2001), and Heaney et al (2003) all used daily doses of 4,000 IU per day or more with no evidence of adverse effects. click here or image below.

Recent articles have also suggested that vitamin D may have a role in the prevention and treatment of many chronic diseases.  We are clearly on the verge of a paradigm shift with regard to our understanding and clinical use of vitamin D

Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clinic Proceedings. 2003

Introduction
Whilst we are all familiar with the importance of vitamin D in calcium absorption and bone metabolism, many doctors and patients are not aware of the recent research on vitamin D and the widening range of therapeutic applications available for cholecalciferol, which can be classified as both a vitamin and a steroid hormone(1). Additionally, whilst it was commonly assumed that the upper limit of toxicity was approximately 1,000 IU per day, we now know that the physiologic requirement of vitamin D may be as high as 4,000 IU per day, which is approximately half of the 10,000 IU that can be produced endogenously with full-body sun exposure(2). Click here for more information on Vit D assosciated health problems.

Vitamin D deficiency and musculoskeletal pain
Vitamin D deficiency causes dull, achy musculoskeletal pain that this incompletely responsive to both pharmacologic and manual treatments. The pain may be widespread or confined to a particular area, most commonly the low back and lumbar spine. The mechanism by which this pain is produced has been clearly elucidated:

1) vitamin D deficiency causes a reduction in calcium absorption,

2) production of parathyroid (PTH) hormone is increased to maintain blood calcium levels,

3) PTH results in increased urinary excretion of phosphorus, which leads to hypophosphatemia,

4) insufficient calcium phosphate results in deposition of unmineralized collagen matrix on the endosteal (inside) and periosteal (outside) of bones,

5) when the collagen matrix hydrates and swells, it causes pressure on the sensory-innervated periosteum resulting in pain.(3) Indeed, several clinical investigations have recently shown that vitamin D deficiency is particularly common among people with musculoskeletal pain.(4, 5)

Non-musculoskeletal manifestations of hypovitaminosis D
Both the peripheral and central nervous systems have multiple sites of action for vitamin D, and it appears likely that vitamin D modulates serotonin and melatonin synthesis and metabolism. Alterations in vitamin D levels appear to explain, at least in part, the adverse psychological effects of sunlight deprivation, such as which occurs in winter(6). Preliminary evidence suggests that vitamin D deficiency may also be particularly common among patients with inflammatory and autoimmune disorders, and that vitamin D may modulate inflammatory responses (7, 8, 9).

Bio-D-Mulsion and the importance of micro-emulsification
The Biotics Research vitamin D is micro-emulsified to enhance absorption. Independent clinical experience suggests that their micro-emulsion form of vitamin D provides significant improvements in serum levels of 25-OH-vitamin D following supplementation (10). Each drop of Bio-D-Mulsion supplies a full 400 IU of vitamin D3, micro-emulsified for greater absorption and utilisation - particularly important for those with malabsorption conditions. With an increased knowledge of the importance of maintaining adequate Vitamin D levels, many clinicians recommend supplementation and annual screening for 25-OH-Vitamin D levels, especially for patients at risk for deficiency and those who may benefit from supplementation.

References
1. Norman AW. Vitamin D. In: Brown ML (Editor). Present Knowledge in Nutrition. Sixth Edition. Washington: International Life Sciences Institute Nutrition Foundation; 1990. P.108-116
2. Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999 May;69(5):842-56 Available on-line at http://www.ajcn.org/cgi/reprint/69/5/842.pdf on March 29, 2004
3. Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. 2003 Dec;78(12):1457-9
4. Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine. 2003 Jan 15;28(2):177-9
5. Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003 Dec;78(12):1463-70
6. Lansdowne AT, Provost SC. Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl). 1998 Feb;135(4):319-23
7. Yamashita H, Noguchi S, Takatsu K, Koike E, Murakami T, Watanabe S, Uchino S, Yamashita H, Kawamoto H. High prevalence of vitamin D deficiency in Japanese female patients with Graves' disease. Endocr J. 2001 Feb;48(1):63-9
8. Huisman AM, White KP, Algra A, Harth M, Vieth R, Jacobs JW, Bijlsma JW, Bell DA. Vitamin D levels in women with systemic lupus erythematosus and fibromyalgia. J Rheumatol. 2001 Nov;28(11):2535-9
9. Van den Berghe G, Van Roosbroeck D, Vanhove P, Wouters PJ, De Pourcq L, Bouillon R. Bone turnover in prolonged critical illness: effect of vitamin D. J Clin Endocrinol Metab. 2003 Oct;88(10):4623-32
10. "I Have Tested Nearly 2,000 Patients. [W]hen we switched our patients to a vitamin D that was in a form that made it easier to absorb - their vitamin D levels normalized very rapidly. … Biotics Lab called Bio-D-Mulsion… it is micro-emulsified for even greater absorption and utilization.” Mercola J. Bio-D-Mulsion (Emulsified Vitamin D): The Vital Supplement that I Strongly Recommend to Nearly All of My Patients is Now Available! http://www.mercola.com/forms/vitamind.htm on March 25, 2004

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 Independent research

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