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Deficiency of sunlight and vitamin D

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39581.411424.80 (Published 12 June 2008) Cite this as: BMJ 2008;336:1318

Rapid Response:

Vitamin D deficiency

I am surprised that some of our colleagues still question the adequacy of the clinical evidence for the benefits of vitamin D. The reference range of 25 hydroxy vitamin D 75-150 nmol/l in Europe (32-100 ng/ml in the USA) is wide enough to prevent that. In my experience of treating more than 2000 patients with vitamin D deficiency in the cloudy upstate New York, you need to give almost 300,000-500,000 IU of vitamin D2 to raise 25, hydroxy vitamin D by 10 ng/ml. Intoxication with vitamin D ( a serum level of 375 nmol/l or 150 ng/ml)is nearly impossible when patients are given reasonable doses under medical supervision. This unfounded fear of vitamin D intoxication has been cited in European countries like Germany as a reason not to fortify milk with vitamin D. Vitamin D benefits mirror the widespread presence of vitamin D receptors in the body. Most people think that vitamin D impacts only the bones. If this was the case, why would you find vitamin D receptors in lymphocytes, brain, heart, blood vessels, prostate, colon, breasts, thyroid, ovaries, testicles, lungs ...? Many observational studies have clearly shown the anti-cancer effects of vitamin D, its favorable effects in preventing auto-immune disorders such as multiple sclerosis and type 1 diabetes. Vitamin D is crucial for muscle strength, hence the fatigue as a prominent symptom of vitamin D deficiency. Proximal myopathy is a cardinal feature of osteomalacia, which can lead to falls and fractures.

If you want to see more patients with vitamin D deficiency, look in your own practice: those patients with fatigue, aches and pains, and proximal muscle weakness are very likely to be vitamin D deficient. Those patients who present with atypical chest pains, in whom cardiac causes have been ruled out, most likely have rib pains rather than the fashionable term "costochondritis" (press on the xiphoid process gently to see the exquisite tenderness. Those patients with tender bones (they don't like to be touched) are very likely to have vitamin D deficiency. Vitamin D is a public health problem. It is the duty of governments to revise the reference ranges of vitamin D to make it in line with the numbers mentioned by Dr. Holick. These governments should also update the required daily dose of vitamin D (1000-2000 IU of vitamin D3 a day).

Dermatologists should soften their stance on sun exposure. 5-10 minutes of daily sun exposure is considered a judicious dose of sun rays for vitamin D production.

1. Holick MF. Vitamin D deficiency. N Engl J Med

2007;357:266-8

2. Holick MF.

Resurrection of vitamin D deficiency and rickets

J. Clin. Invest; 2006: 116(8): 2062-2072

Competing interests: None declared

Competing interests: No competing interests

29 June 2008
Shirwan A. Mirza, MD, FACP, FACE
Private Practice
New York, USA