Mediterranean Diet 101

Vitamin D Deficiency Symptoms

For many people, the symptoms of vitamin D deficiency are subtle and hard to recognize. But, even without obvious symptoms, too little vitamin D can pose health risks.

Updated: June 19, 2021.

Low blood levels of the vitamin D over short or long time, have been associated with the following symptoms:

- Osteoporosis - bones disease where the bone mineral density (BMD) is reduced, bone micro-architecture deteriorated and the amount and variety of proteins in bone tissue are altered. Osteoporosis leads to an increased risk of fractures.

- Osteomalacia - causes weakness of the muscular system and brittle bones often seen in adults with vitamin D deficiency.

- Weight Gain and Fat Loss - Vitamin D 'helps' hormone called leptin to regulate body weight. Insufficient amounts of vitamin D can prevent this 'cooperation' and can lead to undesirable weight gain. Also, sufficient amounts of vitamin D have been found to promote fat loss in calorie-restricted diets.

- Rickets - skeletal deformation mostly seen in children with vitamin D deficiency.

- Multiple Sclerosis - Multiple sclerosis is an inflammatory disease of the central nervous system - brain and spinal cord - characterized by the loss of the myelin sheath that insulates cells. Although the cause of multiple sclerosis is not yet conclusively determined, both environmental and genetic factors and their interactions are claimed to be important, with vitamin D deficiency being linked to higher rates of multiple sclerosis in both children and adults.

- Hair Loss - vitamin D deficiency can interrupt normal hair-follicle cycle (anagen, catagen and telogen phases) and thus lead to hair loss.

- Depression - increasing vitamin D consumption can help in treating depression in both men and women even if vitamin D blood levels are relatively good. Also, some studies show that vitamin D deficiency (when vitamin D levels are low) can lead to depression.

- Fatigue - one of the most common symptoms of a deficiency in vitamin D is a constant feeling of tiredness or fatigue. In many studies dealing with fatigue, almost half of tested people had vitamin D blood levels low to very low.

- Cancer - it has been shown, statistically again, that some types of cancer are more numerous in people with low vitamin D levels. This is still very 'gray' area and much of research has to be done in order to clarify vitamin D role in fighting cancer. Nonetheless, proper vitamin D levels can help in fighting not only various types of cancer, but can lead to overall wellbeing.

- Diabetes - it has been shown by various studies that vitamin D deficiency impair insulin synthesis and secretion in humans and in animal models of diabetes, thus showing vitamin D deficiency's role in the development of type 2 diabetes.

- Psoriasis - vitamin D deficiency can affect people with psoriasis. UVB light treatment and skin creams which include vitamin D have been shown to significantly help such patients.

Vitamin D Deficiency and Osteoporosis

Osteoporosis is bones disease where the bone mineral density (BMD) is reduced, bone micro-architecture is deteriorated and the amount and variety of proteins in bone tissue are altered. As such, osteoporosis leads to an increased risk of bone fractures.

Osteoporosis as disease doesn't come over night, nor can be treated and cured over night. In fact, if diagnosed too late, it can have life long consequences.

Prevention of Osteoporosis

Just as with many other diseases, connection between vitamin D deficiency and osteoporosis is little bit unclear (to say the least) although many studies show 'statistically' that proper vitamin D levels in combination with adequate calcium intake can postpone osteoporosis, sometimes for very long period of time.

Lifestyle is very important factor for prevention of both vitamin D deficiency and osteoporosis. Adequate intake of vitamin D and calcium promote proper mineralization of bones and bone health in general. Also, regular exercises and physical activity can not only prevent bones demineralization, but in fact can lead to increased bone density.

Treating Vitamin D Deficiency and Osteoporosis

Treating osteoporosis is complex task. Although it should be done under supervision of your doctor, sometimes for long period of time, changes in lifestyle can help a lot.

If you are smoker and you consume alcohol, forget tobacco smoking and alcohol - they both can interfere with vitamin D and calcium processes in the body, they harm human immune system etc.

Increase your calcium intake by consuming foods rich in calcium like diary products (low fat and/or cottage cheese, milk if you can tolerate lactose etc) and similar food sources. Also, increase your vitamin D intake by consuming more vitamin D rich foods, by spending more time outside during the day and maybe by taking vitamin D and/or calcium supplements.

Spending more time outside and practicing some kind of sport will be very beneficial to you - you will increase your natural vitamin D production due to increased sun exposure, you will promote increase in bone density ('stressed' bones tend to have higher density - natural body response to the stress. That is why astronauts during and after spending some time in zero gravity conditions have problems with bone demineralization.).

If you are taking any medicaments that can interfere with vitamin D and calcium intake, your doctor will probably increase your daily vitamin D and calcium supplement doses. Also, in the cases of severe vitamin D deficiency, oral supplements might not be enough (if you are afraid of needles, good luck...).

Often, patients with problems with osteoporosis have joint and other problems - increasing omega-3 (group of essential fatty acids) intake can be very beneficial. Great thing is that omega-3 is found in larger quantities in fatty fish (also rich in vitamin D - feel free to check Vitamin D Rich Foods article).

Treating osteoporosis is complex process and is unique to each individual.

Osteoporosis or Osteomalacia

Many people consider osteoporosis and osteomalacia to be the same - they are very similar, but they are NOT the same. Their symptoms can be avoided or at least significantly minimized and diseases postponed by proper vitamin D and calcium intake and by changing life style. Of course, other issues play important role in both osteoporosis and osteomalacia, but that is way beyond the scope of this article ...

Vitamin D Deficiency and Osteomalacia

Although osteomalacia is very similar to osteoporosis, they are two different medical conditions.

Vitamin D deficiency can be one of the causes of both diseases, but things are little bit more complex regarding differences between osteoporosis and osteomalacia.

Osteoporosis vs. Osteomalacia

Symptoms: Their symptoms are similar, but not identical - main symptoms of osteoporosis are bone mass reduced with normal mineralization while main symptoms of osteomalacia are bone mass variable with decreased mineralization.

Onset Age: Age at onset - osteoporosis generally affects elderly people in general and postmenopausal women while osteomalacia affects persons of any age.

Etiology: Osteoporosis: idiopathic, endocrine abnormalities, inactivity, disuse, alcoholism, calcium deficiency etc. Osteomalacia: vitamin D deficiency, abnormality of vit D pathways, hypophosphatasia syndromes, long-term anticonvulsant therapy, renal tubular acidosis.

Pain Symptoms: Osteoporosis pain symptoms - referable to a site. Osteomalacia pain symptoms - generalized bone pain.

Signs: Signs of osteoporosis: tenderness at fracture site. Signs of osteomalacia: tenderness at fracture site and generalized tenderness.

Radiographic features: Radiographic features of osteoporosis: mainly axial skeleton fracture. Radiographic features of osteomalacia: often symmetric pseudofractures or completed fracture in appendicular skeleton.

Lab tests: Lab tests for osteoporosis: serum calcium and serum phosphate (normal), alkaline phosphatase (normal even within 5 days of new fracture), urinary calcium (high or normal), bone biopsy (tetracycline labels normal). Lab tests for osteomalacia: serum calcium (low or normal - high in hypophosphatasia), serum phosphate (low or normal), alkaline phosphate (elevated unless hypophosphatasia), urinary calcium (normal or low - high in hypophosphatasia), bone biopsy (tetracycline labels abnormal).

As one can see, osteoporosis and osteomalacia are very similar even for trained personnel. Treating osteomalacia and osteoporosis is very complex process and should be done individually, according to each patient needs.

Prevention of Osteomalacia

Prevention of osteomalacia and osteoporosis is similar, although many more studies must be taken in order to accurately determine what and when must be done for prevention.

Generally, prevention of osteomalacia starts even before pregnancy itself and lasts during pregnancy and continues during entire life. Vitamin D deficiency influence osteomalacia through vitamin D and calcium interaction, so increasing their intake can be beneficial in preventing osteomalacia. There are numerous studies suggesting such conclusions, but scientists are not yet 100% sure about many 'little' things.

Vitamin D Deficiency and Weight Gain

weightlossAlthough vitamin D is best known for it's very important role in bone health, numerous recent studies have found that vitamin D also helps in regulation of many vital processes in the body, such as immunity, energy production and regulation of cell growth. Obviously, vitamin D deficiency is associated with weight gain and obesity, but it is not clear if inadequate vitamin D causes obesity and weight gains or the other way around.

It has also been discovered that fat cells have receptors that bind to vitamin D and that the vitamin D can change the fat cell's metabolism and growth. This provides a viable link between vitamin D deficiency and weight gain.

Again, relation between vitamin D, vitamin D deficiency, weight gain and weight loss is pure - statistical. For example:

- people with adequate vitamin D levels starting low calorie diet wanting to lose weight (body fat) have better success rate than people with low vitamin D levels starting low calorie diet.

- people with normal vitamin D levels who successfully lost weight (fat) while dieting, on average, lost more fat at faster rate when compared with people with low(er) levels of vitamin D who also successfully lost weight (fat).

- people with higher body fat percentage (bf%) usually have lower vitamin D blood levels than people with lower body fat percentage.

Being 'sunshine vitamin', stimulation of natural production of vitamin D by spending more time outside, doing some sort of physical activity (just walking around or running, cycling etc) can also promote fat loss due to higher energy expenditure. This is indirect connection between vitamin D and fat loss, but when you want to lose fat, every little thing counts :o)

Vitamin D Deficiency and Rickets

ricketsRickets is a medical condition of bones softening in children due to impaired metabolism or deficiency of vitamin D, phosphorus, magnesium and/or calcium, potentially leading to deformity and fractures.

In many developing countries, rickets is among the most frequent childhood diseases with predominant cause being a vitamin D deficiency. Lack of adequate calcium, phosphorus and magnesium intake in the diet may also lead to rickets (cases of severe diarrhea and vomiting may be the cause of these deficiencies).

Although rickets can occur in adults, the majority of cases occur in children suffering from severe malnutrition during the early stages of childhood.

Note: Increasing concern over excessive exposure to sunlight causing cancer, led people to avoid exposure to sunlight by keeping out of the sun, covering up and using sunblock creams to cause the incidence of rickets to increase significantly due to inadequate sun exposure and lowered natural vitamin D production.

Signs and symptoms of rickets include (but are generally not limited to): bone pain or tenderness, dental problems, muscle weakness, increased tendency for fractures, skeletal deformity, bowed legs, knock-knees, growth disturbance etc.

The primary cause of rickets is a vitamin D deficiency - vitamin D is required for proper calcium absorption from the gut and for proper mineralization of the bones. Of course, if minerals needed for proper bone health (primary calcium, but also phosphorous, magnesium etc) are insufficient, rickets is possible to occur.

Rickets may be diagnosed by: blood tests (serum calcium may show low levels of calcium, serum phosphorus may be low and serum alkaline phosphatase may be high, vitamin D levels), arterial blood gases may reveal metabolic acidosis and X-rays of affected bones may show loss of calcium from bones or changes in the shape or structure of the bones. Bone biopsy is rarely performed but will confirm rickets.

Prevention and Treatment of Rickets

Prevention starts even during mom's pregnancy and lasts during early childhood. Best prevention is adequate sun exposure of pregnant mom and later of small baby (for adults 15-20 minutes, 3 times per week at UV sun rays of around 3, for babies and small children - check with their doctor), adequate intake of vitamin D and calcium trough proper diet and supplementing vitamin D, calcium and other minerals using supplements.

Vitamin D Deficiency and Multiple Sclerosis

Link between vitamin D deficiency and multiple sclerosis is little bit unclear. There are many scientific studies going on and they give valuable information about this issue.

Multiple sclerosis is also known as "encephalomyelitis disseminata" or "disseminated sclerosis". It is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination. It affects the ability of nerve cells in the brain and spinal cord to communicate with each other effectively. Multiple sclerosis has a broad spectrum of signs and symptoms, with onset usually occurring in young adults and it is more common in women.

It is believed that multiple sclerosis occurs as result of genetic, environment, infectious as well as other issues. Also, it is believed that it is immune-mediated health problem due to complex interaction between individual genetics and yet undefined environment and/or infectious issues. Again, many data from researches are just statistical indicator about relationship between genetics and other factors that can lead to multiple sclerosis.

Multiple Sclerosis and Vitamin D

Statistically, multiple sclerosis is more common in people who live farther from the equator, although many exceptions exist. Decreased skin sunlight exposure has been linked with a higher risk of multiple sclerosis. Decreased vitamin D intake and natural production has been the main biological mechanism used to explain the higher risk among those less exposed to the sun.

Also, some scientific studies have shown that rare genetic variation, which causes reduced levels of vitamin D in children, appears to be directly linked to multiple sclerosis.

Again, these are 'just' statistical data, but are showing relationship between multiple sclerosis and vitamin D deficiency.

Increasing vitamin D levels by increasing natural vitamin D production from skin exposure to sun rays and by increasing vitamin D intake (from vitamin D rich foods and/or supplements) can be beneficial in (among other things) strengthening immune system and thus fighting vitamin D deficiency symptoms, multiple sclerosis included ...

Vitamin D Deficiency and Hair Loss

bald head 1Plenty of vitamins contribute to strong and healthy-looking hair - not only vitamin D. Many studies are underway with the goal of understanding the role of vitamin D deficiency in hair loss and benefits of higher levels of vitamin D in promoting hair growth.

People who have been taking supplements with vitamin D have experienced a gradual decrease in the hair loss. Vitamin D helps in the development and growth of healthy hair and maturity of hair follicles. Certain fatty acids (for example, fatty acids found in fish oils) together with fat-soluble vitamins (mainly vitamins A, D, E) help in eliminating dandruff, scalp psoriasis and also hair loss by regulating the flow of oils that nourish the collagen and promote strength and health of hair. Also, such environment, rich in essential fatty acids and fat-soluble vitamins helps in absorption of calcium (also magnesium, zinc and other minerals) which is also important for normal hair growth and health of skin.

Note that vitamin D deficiency can lead to hair loss, but also too much vitamin D can also cause hair loss. Mega doses of vitamin D can be toxic (for example 50.000 IU of vitamin D several times per week - such doses must be prescribed by your doctor!) and can cause imbalances with other minerals such as calcium and phosphorous. Hair that falls out in patches is mostly associated with some kind of an autoimmune condition (for example, alopecia areata), stress etc. If vitamin D deficiency is the only cause of hair loss, hair may respond very well once the levels of vitamin D are in the normal range (and other macro and micro nutrients are present in sufficient amounts).

Treatment of vitamin D deficiency is relatively easy - spend more time on the sun, eat more vitamin D rich foods and if needed, take some vitamin D supplement with lower or medium amount of vitamin D (400 - 1000 IU per pill) as prevention of vitamin D deficiency.

Good thing is that vitamin D rich foods are also often rich in essential fatty acids (for example, CLA, omega-3 and other fatty acids), other fat-soluble vitamins (mainly A, E), protein and minerals (calcium, phosphorous, magnesium, zinc etc).

Vitamin D Deficiency and Depression

There are many types and symptoms of depression and anxiety, but recent researches show that there is a strong relationship between vitamin D deficiency and depression. Unfortunately, exactly how vitamin D and depression are linked is still unclear. Some scientists claim that data from studies show that it is not possible to determine if vitamin D deficiency results in depression or depression may increase risk for low vitamin D levels.

Vitamin D generally promotes overall wellbeing and health, two very important issues in feeling good, not depressed. But, there is lots more than that ...

Seasonal affective disorder is a situational mood disorder caused by decreasing daylight in the winter months. High doses of vitamin D during these months have proven to be a very effective remedy for seasonal affective disorder, leading most people to believe that normal neurotransmitter function depends in part on adequate vitamin D synthesis and vitamin D blood levels in general. However, every tissue in the body has vitamin D receptors, including the heart, muscles, brain etc, which means that vitamin D is needed at every level for the body to function properly.

sunVitamin D levels are inversely related to those of another mood-regulating hormone - melatonin. Melatonin helps modulate circadian rhythms, with darkness triggering melatonin secretion by the pineal gland within human brain, bringing people down gently at night for sleep. Insomnia, mood swings and food cravings are influenced by melatonin. Sunlight shuts melatonin production off, while triggering release of vitamin D — that's why doctors recommend getting outdoors as a remedy for jet lag.

Most of people can sense the positive influence of sunlight in their own lives by the immediate lift they get from taking a walk outdoors on a beautiful sunny day. Now there may be many factors at work that brighten their mood in such cases, but sun exposure is almost certainly a critical piece.

Again, there are many numerous studies about vitamin D deficiency and depression, giving (again) statistical data about it - whatever data they provide, when you 'feel blue', go outside and enjoy little bit of sunshine, it will help you feel better, relief some stress and even promote natural production of vitamin D in your body ...

Vitamin D Deficiency and Fatigue

fish stewMany patients that often feel tired and have muscle cramps, after testing vitamin D blood levels find out that they are vitamin D deficient.

With multiple roles of vitamin D in human body, it's no wonder that there is strong link between vitamin D deficiency and fatigue.

When someone is vitamin D deficient, there are numerous of symptoms these people may experience with chronic fatigue being one of them.

In order to know for sure whether chronic fatigue is caused by a vitamin D deficiency, individuals will need to visit their physician or doctor. He or she can perform a blood vitamin D level test in order to measure the amount of vitamin D present. If an individual is found deficient, the doctor can determine the best method for increasing needed vitamin D intake with the patient. It's important to always visit a doctor before starting taking supplements or vitamins, as the doctor needs to determine the root cause of the chronic fatigue. Also, these supplements have various vitamin D amounts per pill and often doctor might prescribe you a multivitamin supplement (containing vitamin D among other micronutrients) rather than vitamin D only supplement.

Fighting vitamin D deficiency and fatigue often means changing life habits and changing daily nutrition - one needs to consume more protein, vitamins, minerals and healthy fats to promote muscle regeneration and repair after physical activities. Complex carbs should be used as source of energy and for replenishing glycogen reserves in muscles, liver and other organs not only after exercise, but also in everyday life.

Fish and similar foods should be consumed regularly - if not on daily basis, then 2-3 times per week, but consider fish species that are really rich in vitamin D and combine that with regular outside physical activities like walking, running, cycling etc.

Vitamin D Deficiency and Cancer

Connection between levels of vitamin D and various types of cancers are still unclear. There are numerous studies about this issue and their results are, like results in most of such studies, statistical.

Anyway, first connection between vitamin D deficiency and some types of cancers was made in the late 1970's, when it was found that the incidence of colon cancer was nearly three times higher in New York than in New Mexico and it was hypothesized that lack of sun exposure (resulting in a lack of vitamin D) played a significant role.

Some facts about vitamin D and cancer:

- many studies have found naturally produced vitamin D to be associated with reduced risk of breast, colon and rectal cancer

- a randomized controlled trial with 1100 IU/day vitamin D3 plus 1450 mg/day calcium found a 77% reduction in all-cancer incidence. (this study was published in 2007 and was criticized on several grounds including lack of data, use of statistical techniques etc. Nonetheless, it clearly showed direction for future studies.)

- geographical studies have found reduced risk in mortality rates for 15-20 types of cancer in regions of higher solar UVB doses

- mechanisms have been proposed to explain how vitamin D acts to reduce the risk of cancer from starting, growing, and spreading.

- some studies showed that those diagnosed with breast, colon and prostate cancer in summer in Norway had higher survival rates than those diagnosed in winter.

- those with higher vitamin D blood levels at time of cancer diagnosis had nearly twice the survival rate of those with the lowest levels.

- people with darker skin and those that 'always' use some kind of skin protection (clothes, high factor protection sun block creams) have an increased risk of cancer in part due to lower vitamin D blood levels because of lower vitamin D skin production.

- higher UVB exposure and the nutrition rich in vitamin D early in life has been found associated with reduced risk of breast and prostate cancer.

- some studies found lowered risk of breast, colon and rectal cancer as vitamin D blood levels rise to over 40 ng/mL (100 nmol/L).

Measuring blood levels of 25-hydroxyvitamin D to determine vitamin D blood levels avoids some of the limitations of assessing dietary intake. However, vitamin D levels in the blood vary by race, with the season, nutritional habits and possibly with the activity of genes whose products are involved in vitamin D transport and metabolism. These variations complicate the interpretation of studies that measure the concentration of vitamin D in serum at a single point in time. To fully understand the effect of vitamin D on cancer and other health outcomes, new randomized trials and studies need to be carried out. Also, the appropriate dose of vitamin D to use in such trials is still not clear.

Vitamin D Deficiency and Diabetes

diabetesIt has been shown by various studies that the occurrence of diabetes in a population generally increases in relation to distance from the equator.

The link between diabetes and vitamin D deficiency is still being studied but it seems that there are special areas within the insulin-producing pancreas that are targeted and influenced by vitamin D. It is theorized that low vitamin D levels leads to inadequate stimulation of these areas of the pancreas, decreased insulin production, delayed release of insulin and high sugar levels.

Vitamin D and Type 1 Diabetes

Scientists suggested a link between vitamin D deficiency during infancy and later development of type 1 diabetes. Vitamin D deficiency in breastfed babies results primarily from maternal deficiency during pregnancy and subsequent breastfeeding. Vitamin D deficiency in mothers and children results primarily from lack of sun exposure (or use of high-SPF sunscreens) and eating vitamin D deficient foods. It has been shown that vitamin D helps regulate the immune system and that when levels are low, it creates an environment where the immune system can attack the insulin-producing pancreatic cells resulting in their destruction and the onset of type 1 diabetes.

Vitamin D and Type 2 Diabetes

The link between vitamin D deficiency and type 2 diabetes seems less clear. It has been shown that vitamin D deficiency impair insulin synthesis and secretion in humans, suggesting a role in the development of type 2 diabetes. It is suggested that low vitamin D levels may create an environment that allows for elevated blood sugar levels due to the effect of vitamin D on insulin producing cells. This effect is supported by evidence of hyperglycemia in patients with low vitamin D levels. Based on this information, scientists have hypothesized that vitamin D deficiency may contribute to the development of type 2 diabetes. To further support the point that vitamin D influence blood sugar levels, numerous studies have also shown that high glucose can be improved simply through replacement of vitamin D.

Vitamin D Deficiency and Psoriasis

Psoriasis is type of an autoimmune disease that affects mostly the skin. It occurs when the immune system mistakes the skin cells as a pathogen and then sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis as disease is not contagious, but it has been linked to an increased risk of stroke.

Psoriasis affects skin, joints (psoriatic arthritis) and nails (psoriatic nail dystrophy). Cause of psoriasis is not well understood, but it is believed that several components are included like genetics, skin injury, environmental factors, stress, weakened immune system, alcohol, smoking etc.

There are many available treatments for psoriasis patients, but because of its nature, psoriasis is still a challenge to treat.  Treating high blood lipid levels may lead to improvement of patient condition.

One of the treatment of psoriasis is phototherapy in the form of sunlight, which has been used for a long time effectively. This phototherapy among other things, promotes natural vitamin D production - this increases vitamin D levels and helps regulate autoimmune system (among other things).

Also, treating patients with fish oils rich in omega-3 essential fatty acids, vitamin A, vitamin D and vitamin E has also showed beneficial results.

Unfortunately, there are no exact data regarding vitamin D deficiency and psoriasis - obviously, high(er) vitamin D intake can promote overall wellbeing and strengthen the immune system and thus can help in treating psoriasis.

Nonetheless, there are insufficient scientific studies to conclude direct relation between vitamin D deficiency and psoriasis.

If you do have psoriasis-related problems, then changing a life style can be good for you in the long run (after all, psoriasis as medical condition is usually life time problem):

- spend more time on the sun, with problematic areas of skin exposed to the sun rays

- eat healthy meals with higher amounts of fat-soluble vitamins (mostly vitamins A, D and E) and omega-3 EFAs

- monitor your health with your doctor regularly - if you notice drop in vitamin D levels, be sure to rectify that.

Importance of the vitamin D in human body is obviously huge. There are still many uncertainties about vitamin D role in many processes, but, hopefully future scientific studies are going to prove or disprove certain 'facts' about vitamin D.

In the mean time, enjoy some sunshine from time to time and enjoy your seafood ...

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