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What Everyone Should Know About Vitamin D Deficiency – ‘A Disease of Neglect’ and Its Unrecognized Toll

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“Who is at risk of vitamin D deficiency? Everyone is,” says Dr. Michael Holick, PhD, MD, in his fascinating video presentation – “The Vitamin D Pandemic & Its Health Consequences” – free at www.uvadvantage.org/portals/0/pres/.

This presentation offers an entertaining, highly informative review of little-known facts about vitamin D and the role of vitamin D deficiency in a long list of health problems – as well as Dr. Holick’s simple suggestions for avoiding deficiency.

Dr. Holick directs Boston University's General Clinical Research Center. He is also a Professor of Medicine, Physiology and Biophysics, and author of The UV Advantage: The Medical Breakthrough That Shows How to Harness the Power of the Sun for Your Health. This presentation was the keynote address at the 34th European Symposium on Calcified Tissues in Copenhagen, May 2007. Note: bone is a calcified tissue.


People who watch “The Vitamin D Pandemic and Its Health Consequences” typically find it so enlightening that they forward the link to friends, but following are a few key points for reference.

What is vitamin D?
It is calciferol – a fat-soluble vitamin that is best known for supporting absorption of calcium and phosphorous into the bloodstream, but plays a role in many other functions and influences the activity of perhaps 200 genes.

How do we get vitamin D?
From the UV rays of the sun (or artificial source of UV light) and from our diet, in foods or supplements. It is hard to get enough vitamin D from foods. Fish oil contains the most significant amounts, followed by fatty fish, and lower levels are found in foods such as beef liver and egg yolks. Fortified (irradiated) milk is an important source. A quart contains about 400 IU of D. However, our skin is designed to convert the energy in the sun’s rays – first to “pre-D” and then to vitamin D3 – and this is naturally our main source of D.

How is vitamin D deficiency defined?
The level of 25(OH)D (25-hydroxyvitamin D) measured in blood (serum) should be at least 50nmol/L, and Dr. Holick advocates 60 to 75nmol/L. Insufficient/deficient is under 50.

How common is this deficiency?
Amazingly common. Perhaps 50% of all Americans, and even higher proportions of darker skinned and older population groups, fall well below 50nmol/L. Dr. Holick’s reports on studies of deficiency in different age groups at different times of the year are eye-opening.

Why is vitamin D deficiency important?
In children it causes “rickets” – bowed, soft bones, muscle weakness, stunted growth, and high risk of low bone density later in life. This is because vitamin D is needed to support absorption of calcium from the gut to the bloodstream. Mother’s milk contains little vitamin D, so other sources can be important for nursing babies.

In adults, deficiency can lead to “osteomalacia” (a defect in the bone building process, by contrast with osteoporosis, which is breakdown of existing bone structures). Osteoporosis is “silent,” but osteomalacia involves aches and pains in the bones & joints, and muscle aches/weakness that can be generalized or isolated. As Dr. Holick explains it, the defective bone matrix absorbs water and expands, causing pain in the bones’ fibrous outer membrane – the periosteum. (This membrane contains the blood vessels and nerves providing nourishment and sensation in the bones.) He says he diagnoses this condition by pressing to test for pain in certain places such as the breastbone and shin.

Patients with these symptoms are often diagnosed as having fibromyalgia. Dr. Holick says that in his practice, 40% to 60% of patients presenting with these symptoms are vitamin D deficient, and of 150 patients presenting with these symptoms in a Mayo Clinic study, 139 were deficient.

“But that is the tip of the iceberg.” Research is demonstrating that vit D deficiency is also associated with susceptibility to type 1 diabetes, multiple sclerosis, rheumatoid arthritis, infections, tuberculosis, psoriasis, high blood pressure, coronary heart disease, and even common cancers. (Dr. Holick offers an impressive series of slides highlighting the vitamin D deficiency link to incidence of these and other illnesses.)

And to review recent research in the ProHealth.com archive pointing to this link in a long list of health problems, from mood disorders, diabetes, and heart disease to different types of cancer, click here.

Is vitamin D deficiency often missed?
Yes. Often, if the physician finds normal calcium levels in the blood, he/she may look no further, since ability to absorb calcium into the bloodstream depends on vitamin D. However, the sole purpose of the parathyroid glands is to control calcium levels in the blood (calcium builds bones, but also supports conduction of electrical currents among nerve cells in the muscles, heart, and brain). If the parathyroids determine that blood calcium levels are too low to support the brain’s demands, they make more PTH to transfer calcium out of the bones and into the bloodstream. And if the D deficiency continues, hyperparathyroidism (inability to regulate blood calcium) results.

Ideally, how much vitamin D should one get in the diet?
1,000 IU daily, as a general rule for adults. IU stands for International Units and is a measure of a vitamin or drug’s activity/effect. One IU of vitamin D is 0.025 micrograms. (For individuals with marked deficiencies, medical doctors may prescribe much higher intake temporarily as needed to achieve healthy levels. And, based on recent science, U.S. vitamin D researchers have recommended an increase in the RDI to 2000 IU, now under study by the Institute of Medicine.)

How much sun exposure is recommended?
During non-winter months, Dr. Holick advocates at least 10 minutes on 10% of the body surface (e.g., arms or legs) “followed by good sun protection,” two to three times a week. This balances the need for vitamin D with need to minimize skin cancer risk.

Can you make any vitamin D in winter?
Little or none, if you live above the 35th latitude north or south of the equator. That's only slightly north of such 'southern' cities as Atlanta, Georgia, which is at 33 north. In a study, subjects exposed to sunlight in Boston (42.19 north) were able to make “zero vitamin D” from November through February. To check the latitude where you live, click here.

How much does sun block reduce the body’s ability to make D from sunshine?
SPF 15 reduces it by 99%.

Do darker skinned people need more sun than lighter skinned to produce vitamin D?
Yes. In studies, darker skinned subjects “couldn’t budge” their serum D levels until they had 5 to 10 times as much sun exposure as caucasians. [Tables in Dr. Holick’s book – The UV Advantage – help people in different parts of the world with five skin types to determine how much unprotected sun exposure to get.

What amount of sun exposure creates "toxic" levels of vitamin D?
This can’t happen, as the body automatically switches off vitamin D conversion when supply reaches a certain level.

Does ability to make vitamin D decline with age?
It takes longer to make sufficient D as we age. One of Dr. Holick’s studies, published in the Lancet, found for example that a 70-year-old would make 75% less than a 20-year-old with the same sunlight exposure time. So the older person would likely benefit from increasing sun exposure from 15 minutes to 30 minutes.

Are obese people more likely to be deficient?
A study of normal weight vs. obese subjects with the same amount of UV exposure found vitamin D levels averaged 55% lower in the obese group.

Does taking supplemental calcium and vitamin D work to counter osteoporosis and osteomalacia?
Yes it does.

Note: This information has not been evaluated by the FDA. It is generic and is not meant to prevent, diagnose, treat or cure any illness, condition, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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15 thoughts on “What Everyone Should Know About Vitamin D Deficiency – ‘A Disease of Neglect’ and Its Unrecognized Toll”

  1. moineau says:

    so what does this do to the entire theory of the marshall protocol which claims that vit d is not a vitamin and rather a steroid?

    1. Clarella says:

      The Vitamin D Council says it’s a steroid hormone on their website, so it isn’t something new that the Marshall Protocol invented! http://www.vitamindcouncil.org/vitaminDPhysiology.shtml

    2. moineau says:

      ok, no problem. but are we not getting enough or do we need to eliminate and take antibiotics? i find this all confusing. it seems contradictory.

    3. Clarella says:

      People with autoimmune disease often have a low vitamin D level as part of their disease, unless they’ve been taking supplements. But what’s measured is 25-D, the hormone precursor. If they were to get their 1,25-D measured, it would probably be high, showing inflammation. But 1,25-D is a tricky and expensive test, so it isn’t routinely done.

      When the 25-D measures low, the doctor prescribes a D supplement. For a while this makes the patient feel better, because it’s a steroid and suppresses the immune system just like prednisone, stopping it from killing the pathogens causing the disease, and thus stopping the pathogens from releasing their toxins into the bloodstream as they die. But meanwhile the pathogens are partying, so eventually the patient deteriorates.

      So the Marshall Protocol cuts out vitamin D as much as possible. It works – I’ve been on it and I’m better now, leading a normal life and feeling great.

      There’s a blog-style website that gives more info in a very readable way, at http://www.Bacteriality.com.

    4. moineau says:

      i’ve been to the site and am considering marshall, been sick for almost 11 years now and tired of sitting/lying on the couch. how long did it take you to begin to feel well again? did you do the whole thing, the light, the antibiotics, the drug, forgot the name, they recommend (the vasodialator). i consulted with goldstein and took isoxsuprine, an old vasodialator, which cured my energy problems for a year, then it quit working and so did dr. goldstein. i’m very interested in marshall but also a bit scared as my heart has a lot of arrhythmia. any personal insight would be appreciated.

    5. Clarella says:

      The MP takes into account the fact that a lot of chronic disease folk have undiagnosed cardiac problems, so it goes very slowly and cautiously – and therefore takes a long time. I started over four years ago, and got great results straight away, and slower (but steady) progress since. But some people don’t feel better for quite a long time – everyone’s different.

      You have to have a sort of four-legged stool – avoiding vit D in the diet, avoiding sunlight, taking Olmesartan (Benicar), and taking low-dose, pulsed antibiotics. The light factor doesn’t affect everyone the same, so some have to be more strict about it than others.

      I was long ago cured of the symptoms of my diagnosed disease, but I keep going with the MP because so many more things are resolving – things I’d put up with for years, not realising I could ever be free of them, such as allergies.

      If you want to find out more, there’s an introductory site at http://www.CureMyTh1.org (Th1 being the official label for immune diseases), where you can ask questions and get help finding your way round the rather complex MP site (www.MarshallProtocol.com).

    6. moineau says:

      wow, that was such a great response and answered many of my questions. ty for keeping up on the vit d thing on immunesupport, it’s important that “users” perceptions and experience be added to all this information overload and seemingly contradictory research.

      i have a lot of pollen and food allergies myself, can barely digest carb, complex or no, anymore. the worst symptoms, though, are 24/7 pain for which i take oxycontin (as little as i can get by with) and gabapentin, and enormous fatigue/weakness/vertigo. i’ve also become a diabetic w/ very high cholesterol (the former from my mom and the latter from my dad).

      i’m going to get more serious about marshall, talk to my doc at kaiser who is open to trying various things with me, and get the needed test.

      you’re just lovely. thanks for giving so generously of your time. xoxoxox ~laura

    7. Clarella says:

      Diabetes responds to the MP! It’s another Th1 disease 🙂

    8. moineau says:

      diabetes a th1? that is great! my partner of 15 years is, of course, looking at all this carefully. he asked me to ask you what it was exactly that the mp fixed for you: cfs? allergies? not sure what your primary th1 was. thanks, clarella (o great clarifier) :>) ~laura

    9. Clarella says:

      Mine was sarcoidosis, with severe uveitis and hypercalcaemia. But all the chronic diseases seem to have so many symptoms in common that I wasn’t surprised when I first read Marshall’s theories on how they’re all related. I mean, CFS isn’t just fatigue, is it? It’s all sorts of aches and pains and brain fog as well. With sarc I had all that too.

      The relief from allergies was a huge surprise bonus – after a lifetime of hay fever misery for three months every year, I now sail through each spring with only very minor snuffles on very bad days.

      But to be fair, I still have my lifelong eczema. Sometimes I think “you can’t win ’em all”, and sometimes I see its ups and downs so closely linked to the different antibiotic cycles, that I think maybe I’ll get rid of it too some day. Watch this space…!

    10. Carricol says:

      Those who are advocating the use and supplementation of Vitamin D need to look again at what they are saying and doing. They are doing one no favors when they make this recommendation. Vitamin D is a seco-steroid and not a vitamin even though it is erroneously called as such. Vitamin D suppresses the immune system like any other steroid and does not strengthen it. When one notes improvement in the symptoms of a condition by supplementing with Vitamin D that improvement is illussory. The symptoms of the chronic condidion were almost certainly the immune system trying to fight the pathogens causing the condition (immunopathology). When Vitamin D levels are increased the immune system shuts down and quits fighting the pathogens. One feels better because there is no more immunopathology. Actually, now the pathogens now have free rein to grow and multiply without resistence from the immune system. This makes the person feel better in the short run and creates the illusion that Vitamin D has helped. In reality, it sets one up for a day of reckoning down the road when the pathogen polulation continues to increase and something finally breaks. See attached link for further information. http://www.marshallprotocol.com/forum2/10821.html

    11. moineau says:

      yes, and cfs also seems like a variety of th1 diseases rather than simply one, as many of my friends have very different illnesses. for me, it’s almost a constant hot flash, weakness, dizziness, swollen glands, odd electrical sensations (probably cardio related), elevated white blood cell count every time; and fibromyalgia with all 18 tender points in deep play. it’s miserable and i’m ready for a new approach.

      goldstein was a maverick; the year of reprieve provided by goldstein showed me that at least remission was possible, and now a cure? i’m ready to feel well again.

      that is such great news about the diabetes and may be the tipping pt for my gp who wants me to do something (ie, take more meds) about the diabetes and cholesterol. i’m ready, and you have been a guiding light for me. thanks again. xoxox

    12. stoneyhill says:

      This is like saying that if one has a headache or muscle pain it is because of an aspirin deficiency.

  2. soffy says:


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