The human body needs various vitamins and minerals in adequate quantities to function properly. The body needs vitamins for growth and development. Vitamin D3 is one of the most important nutrients for the body. Vitamin D3 also known as cholecalciferol is the only vitamin which is produced by the human body itself on exposure to ultraviolet rays of the sun. This is the reason why it is also called the sunshine vitamin. The vitamin plays a vital and very important role in the overall health of the human body. Vitamin D3 is a vitamin and is also a hormone.
Cholecalciferol is a type of vitamin D which is manufactured by the skin and is also found in various food items and is also taken as a dietary supplement. This vitamin is useful in treating and managing deficiency of vitamin D to prevent diseases like rickets etc. It can also be used for other conditions like familial hypophosphatemia and hypothyroidism that lead to low calcium in the blood and Fanconi syndrome. The supplements are taken orally. If the supplements are taken in excess doses, it can result in constipation, confusion, vomiting and weakness. Kidney stones might also develop. The intake might be unsafe in people suffering with severe kidney problems.
Cholecalciferol was initially described in 1936. It is specified in the World Health Organization’s list of essential medications as one of the most effective and safe medicines which are needed in a human body’s health system. It is available as an over the counter drug and as a generic medicine. This vitamin is produced in the human body after exposure to UV rays of the sun. This is converted in the liver to calcifediol which is further converted to calcitriol in the kidneys.
The vitamin plays an important role in the human body. It aids the body in absorbing calcium which is important for healthy bones and teeth. It helps in increasing the uptake of calcium in the intestines. It helps in preventing bone mass and averts other disorders related to the bones like arthritis. It is converted into a hormone by the human body wherein it controls the levels of calcium, phosphorous, neuromuscular function and bone metabolism. It is found in foods like fish which included salmon, tuna, sardines and cod liver oil. It can also be found in small quantities in cereals, egg, bread, cheese, fortified milk etc.
There are two forms of vitamin D: Vitamin D2 and Vitamin D3. Vitamin D2 is commonly present in foods and Vitamin D3 is made by the body on exposure to the sun. Though contested, it is commonly believed that a better form of vitamin D supplement to take is vitamin D3 as it is thought to be easier for the body to absorb. Another reason is that the human body commonly does not allow the circulation of a large amount of vitamin D3 in the bloodstream whereas the opposite happens for vitamin D2. Therefore it is considered safer to take vitamin D3 supplements.
The safe upper limit for the intake of vitamin D3 is 10000 international units (IU’s). Because the presence of vitamin is rare in food items many people fail to get adequate amounts of vitamin D3 in their diet. People who are not exposed to enough sunlight are also at the risk of vitamin D3 deficiency. The recommended doses of vitamin D3 according to age are:
Age below 50 years – Recommended dosage 200 IUs
Age between 50 – 71 years – Recommended dosage 400 IUs
Age above 71 years – Recommended dosage 600 IUs
Deficiency of vitamin D3 can occur in anyone, but some people are more at risk than others. This might be the reason because they require more vitamin D3 than others. The people might include Women who are pregnant and are breastfeeding, young women and teenagers in particular, infants and children less than 5 years of age, Elderly people above 65 years of age, Dark complexioned people particularly of South Asian, African, African Caribbean origin and people who are housebound or who wear fully covered clothing due to cultural reasons.
People with little exposure to sunlight are more likely at risk for vitamin D3 deficiency. Some of the major reasons include:
- Age: Aged people are more at risk to suffer from vitamin D3 deficiency because of several factors like less thickness of the skin which leads to less absorption of vitamin D from sunrays, less amount of intake of vitamin D3 in the diet and less exposure to sunlight. As age increases, the body is not able to produce adequate amounts of vitamin D3. Elderly people also require higher amounts of this vitamin because of age-related problems of decline in function of the kidneys.
- Obesity: People who are overweight according to their body mass index measurements are at a higher risk of developing vitamin D3 deficiency. The relationship between these has not been fully understood but it can be attributed to other factors like diet and sunlight exposure.
- Darker skin colour: Light-skinned people have higher vitamin D levels because of reduced pigmentation, whereas in dark-skinned people there is a higher level of melanin which functions like a sunblock and thus might need higher levels of vitamin D.
- Malabsorption: There are certain conditions which produce create problems of malabsorption like celiac disease, short bowel syndrome, exocrine pancreatic insufficiency from cystic fibrosis and inflammatory bowel disease. Thus, people suffering from these conditions are at a higher risk of vitamin D3 deficiency.
- Sun Exposure: Wearing clothes that cover large parts of the skin are related to the lower vitamin D levels in some people. Various lifestyle factors like indoor work, less and less time spent doing outdoor activities also contribute to the deficiency. This has also been linked to urbanisation because of air pollution that blocks the UV rays of the sun and an increase in indoor jobs.
- Critical Illnesses: The levels of vitamin D decline in the body during intensive care stays. People who take Vitamin D supplements prior to admission in intensive care units are less likely to die. Vitamin D3 supplements are often given to reduce the mortality rate without any serious side effects.
- Inadequate Intake from food sources: The highest source of this vitamin are fish products. Very few vegetarian options are available. Bread, fortified milk and cereals contain vitamin D3 in very small amounts. Hence, vegetarians are more prone to vitamin D3 deficiency.
- Use of Sunscreens: People use sunscreens due to the fear of skin tans and skin cancer. Sunscreens containing high SPF inhibit the body from absorbing adequate amounts of vitamin D. Thus these people are more prone to vitamin D3 deficiency.
The signs of vitamin D3 deficiency are not easily recognizable. The symptoms can be from mild to severe. The symptoms are classified below:
- Pain: Many times the deficiency is not noticed until it becomes severe. Pain in the bones and muscles, difficulty in standing up, fractures, hip pain are some of the signs to look for. People suffering from breast cancer who take a drug known as an aromatase inhibitor also experience muscle and joint pain and bone loss. Taking vitamin D3 supplements can help in relieving the symptoms.
- Oral Health: Strong teeth and healthy gums are dependent on vitamin D3. This deficiency can result in various dental problems. Vitamin D3 also plays an important role in the healing of wounds.
- Heart Disease: Many symptoms of heart ailments like blood vessel inflammation, heart attack and increase in LDL, the bad form of cholesterol can point towards the deficiency of vitamin D3. A level of vitamin D3 which is above 30 ng/ml can reduce the risk of heart attack by half.
- Skin: Dry skin is one of the most common signs of vitamin D3 deficiency which is caused by the lack of antioxidants. Vitamin D3 also prevents premature ageing, makes the skin supple etc. Many times vitamin D3 creams are used to treat psoriasis and other skin conditions.
- Thyroid gland: Vitamin D3 plays an important role in the functioning of the thyroid gland. The treatments for the proper functioning of the gland-like using herbs, progesterone or raising levels of T3 need the correct amount of vitamin D3 to be present.
- Neurological Symptoms: Vitamin D3 helps in relaxing the skeletal and involuntary muscles. Symptoms of vitamin D3 deficiency include cramping and constriction of the blood vessels. This leads to an increase in blood pressure which leads to the increase in the possibility of migraines and headaches. This can also result in insomnia, depression, hopelessness and schizophrenia in extreme cases.
- Rickets: Vitamin D3 helps in maintaining bone health by facilitating calcium absorption. Rickets is the most prominent sign of deficiency of vitamin D3. It is caused when the body is unable to bind and absorb calcium and phosphate. This is often caused due to low levels of vitamin D3 in the body.
Cognitive Difficulties: It has been noted that people with vitamin D3 deficiency have poor mental functions. This is the reason why elderly people need more vitamin D3 through supplements.
Serum concentration of 25(OH)D is generally used in the calculation of the vitamin D levels. Most of the vitamin D is converted to 25(OH)D thus it helps in giving an accurate result. If the levels are above 200 ng/ml, it is thought to be toxic. But there is very little data to document these cases. Thus, it is considered safe to treat people at risk for vitamin D deficiency without any test because vitamin D toxicity rarely happens. Though, this might happen due to excessive intake of vitamin D supplements.
Vitamin D3 deficiency might cause long-term problems if left untreated for a long duration of time. There are various ways to treat this condition, which include:
- Sun Exposure: Exposing one to adequate sunlight is the most effective way to beat vitamin D3 deficiency. There is no need to sweat it out in the heat. Spending only 10 to 15 minutes in the day in direct sunlight with arms, legs, back or face exposed is considered enough to take care of the vitamin D3 needed by the body. People with dark complexion need more time to absorb the sunlight than light-skinned people. Excess vitamin D3 is stored in the fat cells and liver which is used during winter months.
- Foods: There are very less natural sources of vitamin D3. Some of these are cheese, eggs, beef liver and fatty fish which have small amounts of vitamin D3. Cod liver oil is considered a good source of vitamin D3. Apart from these, fortified milk and orange juice also contain some level of vitamin D3. Increasing consumption of these foods can also help treat vitamin D3 deficiency.
- Supplements: Various prescription supplements are available which can help in fighting this condition. These supplements should be taken after consultation with a doctor as they might cause side effects and in some cases can lead to some allergic reactions. While taking vitamin D3 supplements, other supplements should be stopped except prescribed by a physician. Antacid use should be avoided. The antacids contain certain minerals which can cause side effects if taken with the supplements. Recommended dose per day of vitamin D3 supplements for various groups is as follows:
Infants and children aged 6 months to 5 years – 7-8.5 micrograms
Pregnant and breastfeeding women – 10 ug
People above 65 years of age – 10 micrograms
People with little or no sun exposure – 10 micrograms
In general, there are rarely any side effects from taking vitamin D3. Some side effects, if they occur might include swelling of the face, tongue and throat, trouble breathing, allergic reactions like rash and itching, severe dizziness, changes in heart rhythm etc.
Some very rare side effects include dry mouth, fatigue, vomiting and headache.
Vitamin D3 might have interactions with certain drugs like Zemplar, Hectorol, Alli or Xenical, Donovex, Mineral oil, Magnesium Hydroxide, Digoxin etc. Alcohol consumption should also be limited as it can decrease the absorption of vitamin D3 in the body.
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