Vitamin D

April 6, 2013 at 5:57 pm | Posted in rheumatoid arthritis (RA) | 3 Comments

Thank you to Eileen from Italy for commenting on my last (winging) post, and suggesting that I might be vitamin D deficient, as this could well be a major factor in season affective disorder (SAD). I don’t actually think I suffer from SAD – I was just having a low mood day, and these are rare; however, I started to look into vitamin D and came up with some interesting stuff I thought I’d share.

What is vitamin D for?

Vitamin D is used by the body to absorb phosphorous and calcium from food, and we use calcium and phosphorous to make healthy bone. In children a lack of vitamin D can lead to rickets and in adults it can cause osteomalacia, a softening of the bones leading to pain and tenderness in bone and muscles. It has also been suggested, as Eileen mentioned, that it could be a contributing factor to SAD.

Where does vitamin D come from?

We create vitamin D using direct sunlight on our skin – hmm, there’s been a bit of a lack of that round here lately!

Vitamin D doesn’t just come from sunshine though. You can also find it in oily fish (which includes mackerel, salmon, trout, sardines, herring and anchovies and tuna but not tinned tuna apparently, as the canning process alters its content of oil.) Hmm … I really like salmon and sardines but hardly ever eat them. I eat a fair bit of tinned tuna, but that doesn’t help!

So where else could I get it from? Eggs – nope, very rarely eat eggs. (Perhaps that’s something to do with being a Penguin?) Spreads that have been fortified – erm, nope, hardly ever use spread on anything. Some fortified breakfast cerials – YES! So I checked out my cerials – a 30g portion gives you 25% of the recommended daily allowance (RDA). Hmm, well I’m trying to lose weight, so I try to have a bit less than 30g so I’m not even getting that 25%.

Anyway, according to this NHS article it’s hard to get it from food alone, and there definitely has been a lack of sun over the last year!

Who’s at risk

Apparently, according to the NHS and Department of Health a number of people are at risk of vitamin D deficiency in the UK and according to this report in The Telegraph vitamin D deficiency is becoming a very significant problem in children.

Adults at risk, and who should probably take supplements, are: “pregnant and breastfeeding women, especially teenagers and young women; people aged 65 years and over; 

  • people who have low or no exposure to the sun, for example those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods;
  • people who have darker skin, for example people of African, African-Caribbean and South Asian origin, because their bodies are not able to make as much vitamin D.” Well I don’t fall into any of those categories in theory, but I’ve been virtually house or office-bound for the last few months due to various flares combined with appalling weather! Also there are a number of studies, including this one suggesting that obesity leads to vitamin D deficiency. Well, I’m not obese but I’m certainly overweight and the study I’ve just linked to shows that deficiency increases in proportion to BMI increase. So … it’s not looking to good for me right now!

 

What to do?

It is possible to get a blood test to see what the vitamin D levels are doing, but frankly I really doubt that my cash-strapped GPs would be interested in doing one! I could pay for one – or I could just think ‘Hey, this makes sense’ and take a supplement. I’ve opted for the latter.

A word of warning about supplements

Hubby and I popped down to the chemist yesterday and had a look at the vast range of supplements available. I was really shocked to discover that even the lowest doses of vitamin D supplement were way, way higher than the RDA. This is probably because, as sensibly suggested by hubby, they’re meant as a boost for people who have really low vitamin D, but since I don’t know where I am level-wise I thought taking the lowest does of vitamin D only supplement, which was 250% of the RDA, still seemed dodgy. So I’ve settled for multivitamins. Even they contain 10o% of RDA of various things including D, but I thought OK, if I’m getting a bit more than 100% it probably doesn’t matter – but 250, 500, 1000% – just seemed a bit crazy.

The danger of a vitamin D ‘overdose’

Vitamin D is not an example of ‘you can’t have too much of a good thing!’ If you have much too much then you can absorb too much calcium, and that can lead to it being deposited in places you really don’t want it – like the kidneys. Excess of vitamin D can also cause calcium to be removed from the bones (don’t ask me why!), which again is not something one wants!

Feeling tons better today – I doubt that relates to two-days-worth of multivitamins (because I don’t think they’ll have kicked in yet), but I suspect it could have a lot to do with two days of sunshine, some warmth in the air, a couple of walks (the first proper walks of the year) and some gardening!

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3 Comments »

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  1. I get my Vit D levels tested whenever I have a blood test. I have had low Vit D for a long time now, and even with supplementation of pure D (can’t remember the levels, but the recommended dose), it’s still not up to what UK Dr’s recommend. My levels were worrying low apparently when I was initially tested, though now they are up to just being ‘borderline’.

    There are some researchers who are beginning to wonder whether low Vit D is linked to a variety of auto-immune diseases – of which Palindromic Rheumatism is one, and so is RA – so it may be worth getting tested for that reason next time you get your bloods done anyway. Recommended levels of D do also differ around the world and there are those who think that the UK recommended level is actually too low.

    I’ve also read lots about how basically people in the UK – whatever their background – do get low in D during the winter, and it’s becoming a bigger problem with people being worried about skin cancer and covering up more. Saying all that, I don’t think it’s as much help for SAD as my lamp has been, which is definitely recommended for the winter months.

  2. I think all of us in the northern hemisphere need to supplement from October to April. I had mine tested and I was a star once. A year later my levels were too low due to taking less. It’s hard to get the happy medium

  3. To add to what Ruth said – low vit D has been linked to autoimmune disease for years, just they don’t know if it is cause or effect. A study in Finland showed that babies supplemented with vit D from birth were far less likely to go on to develop type 1 diabetes by teenage than babies given no supplements.

    If you’d asked I could have handed you a load of reliable references!!! The NHS stuff spouts the very out of date recommendations. About 2 years ago a friend asked me to do some library research for her: I have polymyalgia rheumatica, she has giant cell arteritis, linked autoimmune disorders. One of the tests which should be done in the differential diagnosis is vit D – because a low level can cause the same symptoms as PMR. She had developed the symptoms (muscle and joint pain etc) and her GP said PMR but she wasn’t convinced and (on the basis of my work) asked for vit D to be done. Her blood level was in the 20s I think – the local trust recommended level is something like 80-140 (new guidelines)! She was given 50,000 IU per week for a couple of months and that got it up to where it should be – the symptoms went within 2 weeks, she was able to walk again (it had been that bad). They returned a few months later – the vit D was back down again. After a couple of goes it was decided that she needs a top up every 6 months or so on a permanent basis. Formerly it required prescription by a consultant, now the GP may do it in the NE.

    Another friend in S Wales had a blood level of 16 but her doctors have refused to treat despite that being way below their guideline “treat below 30″ until very recently. After 2 weeks of high dose she is able to walk for 15 mins twice a day – before she struggled to do 5 min once. She also has low calcium which they have refused to treat – but they wanted her to start taking alendronic acid because of osteoporosis. The data sheet for AA says very clearly that both calcium and vit D depletion MUST be corrected first or it simply is pointless giving it. That is routinely ignored.

    The test for vit D costs £25 at an NHS lab in the B’ham area who do testing for other hospitals and for the public. The vit D is not that expensive either. Personally, I buy H&B’s, Boots also do a good high dose one, and I take 5000 IU a day. 4000 IU is accepted by the FDA as a perfectly safe supplemental level and some authorities reckon we need about 7000 IU a day on an ongoing basis to function well. The theory is that we get about 20000 IU from sun exposure in a period of about 20 mins and can stock up in the summer for the winter. The practice is that it must be between 11am and 3pm and between May and September. The rest of the year the sun is striking the skin at too slanting an angle to trigger the process in the skin. Factor 8 sunscreen reduces the amount made by over 90%, you make the most at age 20, by age 70 you are making less than a quarter of that. If you live north of Turin you aren’t getting enough even under optimum conditions – I live just north of Turin, nearly 90% of residents in our region are vit D depleted and as a result at risk of bone problems. This is a rural region with loads of farmworkers, working outside all year. They are depleted too.

    So there are a few facts – not derived from noddy sites but from the medical literature in the USA and Europe. If all of us with autoimmune arthritises were replete with vit D – would we feel better? I know several who do!


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