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Vitamin D and Your Health Deficiency

Vitamin D Deficiency Syndrome
=============================

Abstract
--------

We propose Vitamin D Deficiency Syndrome (VDDS) exists when 25(OH)D
levels of less than 50 ng/mL are found in patients with two or more of
the following conditions: osteoporosis, heart disease, hypertension,
autoimmune diseases, certain cancers, depression, chronic fatigue, or
chronic pain. VDDS is more common among dark skinned races, the aged,
and those who avoid the sun.

In-Home ZRT Vitamin D Blood Test Kit Vitamin D Test Kit Don't be
vitamin D deficient—Vitamin D Test Kits available! Serum 25(OH)D
levels are obtained when the disorder is suspected. Serum 1,25(OH)2D3
levels have no place in diagnosing the syndrome and will mislead the
physician. Sunlight, artificial light, oral or parental vitamin D, or
a combination, aimed at restoring circulating levels of 25(OH)D
between 50–80 ng/mL is the treatment of choice. Controlled sunlight is
the safest form of vitamin D repletion. Vitamin D3 cholecalciferol is
the preferred form of oral vitamin D.

Vitamin D is safe when used in physiological doses (those used by
Nature). Physiological doses are doses of at least 5,000 IU per day,
from all sources (sun, diet, and supplements). Should hypercalcemia
occur with such doses, it is due to vitamin D hypersensitivity
syndrome, not vitamin D toxicity. Vitamin D hypersensitivity syndromes
include conditions such as primary hyperparathyroidism, occult cancers
(especially lymphoma), or granulomatous disease (especially
sarcoidosis). In such cases, treatment of vitamin D deficiency should
be done under the care of a knowledgeable physician. A serum 25(OH)D,
serum 1,25(OH)2D3, PTH, and SMA will lead the clinician in the right
direction.

What a "Syndrome" Is
--------------------

Webster's Dictionary defines a syndrome as a "group of symptoms or
signs typical of a disease, disturbance, condition, or lesion...a set
of concurrent things" while a disorder is a "derangement of function:
an abnormal physical or mental condition." Webster's Third New
International Dictionary, Unabridged. Copyright 1993 by
Merriam-Webster, Incorporated.

Stedman's Medical Dictionary defines syndrome as "the aggregate of
symptoms and signs associated with any morbid process, and
constituting together the picture of the disease."

A PubMed search reveals 622,857 papers with the word syndrome in the
title. If the search is limited to core clinical journals containing
the word syndrome in the title, published within the last year, some
of returns include: pathological demand avoidance syndrome, Newson E,
Le Marechal K, David C. Pathological demand avoidance syndrome: a
necessary distinction within the pervasive developmental disorders.
Arch Dis Child. 2003 Jul;88(7):595–600. irritable bowel syndrome,
Harris ML, Aziz Q. Brain-gut interaction in irritable bowel syndrome.
Hosp Med. 2003 May;64(5):264–9. insulin resistance syndrome or the
metabolic syndrome, Miller JL. Insulin resistance syndrome.
Description, pathogenesis, and management. Postgrad Med. 2003 May;Spec
No:27–34. Ginsberg HN. Treatment for patients with the metabolic
syndrome. Am J Cardiol. 2003 Apr 3;91(7A):29E–39E. fatal malignant
hyperthermia-like syndrome, Hollander AS, Olney RC, Blackett PR,
Marshall BA. Fatal malignant hyperthermia-like syndrome with
rhabdomyolysis complicating the presentation of diabetes mellitus in
adolescent males. Pediatrics. 2003 Jun;111(6 Pt 1):1447–52.
premenstrual syndrome, Girman A, Lee R, Kligler B. An integrative
medicine approach to premenstrual syndrome. Am J Obstet Gynecol. 2003
May;188(5 Suppl):S56–65. organic dust toxic syndrome, Seifert SA, Von
Essen S, Jacobitz K, Crouch R, Lintner CP. Organic dust toxic
syndrome: a review. J Toxicol Clin Toxicol. 2003;41(2):185–93.
Marshall's syndrome, Berlucchi M, Meini A, Plebani A, Bonvini MG,
Lombardi D, Nicolai P. Update on treatment of Marshall's syndrome
(PFAPA syndrome): report of five cases with review of the literature.
Ann Otol Rhinol Laryngol. 2003 Apr;112(4):365–9. long QT syndrome,
Viskin S, Justo D, Halkin A, Zeltser D. Long QT syndrome caused by
noncardiac drugs. Prog Cardiovasc Dis. 2003 Mar–Apr;45(5):415–27.
acute respiratory distress syndrome, Derdak S. High-frequency
oscillatory ventilation for acute respiratory distress syndrome in
adult patients. Crit Care Med. 2003 Apr;31(4 Suppl):S317–23. Lynch
Syndrome, Chung DC, Rustgi AK. The hereditary nonpolyposis colorectal
cancer syndrome: genetics and clinical implications. Ann Intern Med.
2003 Apr 1;138(7):560–70. non-S-T segment elevation acute coronary
syndrome, McKay RG. "Ischemia-guided" versus "early invasive"
strategies in the management of acute coronary syndrome/non-ST-segment
elevation myocardial infarction: the interventionalist's perspective.
J Am Coll Cardiol. 2003 Feb 19;41(4 Suppl S):96S–102S. sudden infant
death syndrome, Beckwith JB. Defining the sudden infant death
syndrome. Arch Pediatr Adolesc Med. 2003 Mar;157(3):286–90. precordial
catch syndrome, Gumbiner CH. Precordial catch syndrome. South Med J.
2003 Jan;96(1):38–41. Churg-Strauss syndrome, Noth I, Strek ME, Leff
AR. Churg-Strauss syndrome. Lancet. 2003 Feb 15;361(9357):587–94.
Goodpasture's syndrome, Shah MK, Hugghins SY. Characteristics and
outcomes of patients with Goodpasture's syndrome. South Med J. 2002
Dec;95(12):1411–8. Hashimoto encephalopathy syndrome, Chong JY,
Rowland LP, Utiger RD. Hashimoto encephalopathy: syndrome or myth?
Arch Neurol. 2003 Feb;60(2):164–71. and chronic fatigue syndrome Afari
N, Buchwald D. Chronic fatigue syndrome: a review. Am J Psychiatry.
2003 Feb;160(2):221–36..

Syndromes range from a group of behaviors (pathological demand
avoidance syndrome), a group of signs and symptoms (irritable bowel
syndrome and premenstrual syndrome), a group of clinical and lab
findings (variably called the insulin resistance syndrome, metabolic
syndrome, or syndrome X), a single clinical finding with various
etiologies (organic dust toxic syndrome), a collection of clinical
findings presumably of various etiologies treated with a single
surgical procedure, tonsillectomy (Marshall's syndrome), a specific
and abnormal EKG with multiple etiologies (long QT syndrome), a
specific germline mutation usually resulting in colon cancer (Lynch
syndrome), life-threatening cardiac dysfunction without a specific
finding, QT elevation, whose etiology is multifactorial (non-ST
segment elevation acute coronary syndrome), a diagnosis of exclusion
with various etiologies including parental murder (sudden infant death
syndrome), a single but common symptom (precordial catch syndrome), a
rare vasculitis with diverse diagnostic and pathological criteria
(Churg-Strauss syndrome), a collection of acute multisystem
dysfunction presumed secondary to an unknown hypersensitivity
(Goodpasture's syndrome), a syndrome of encephalopathy associated with
a high antibody concentration some call mythical (Hashimoto
encephalopathy syndrome), to a syndrome diagnosed entirely on symptoms
(chronic fatigue syndrome). Therefore the word syndrome has various
medical uses—uses that fit the lay dictionary definition.

For example, the ICD-9 contains a descriptive syndrome, misery and
unhappiness disorder (313.1). ICD-9. World Health Organization
International Classification of Diseases, 1998. Another example is
false memory syndrome, a syndrome first coined in the legal arena, but
now widely used in the psychiatric literature. Analysis of any of the
multiple and varied syndromes listed above makes it clear to the
reader that strict criteria do not exist for naming a new syndrome.
All that is important is that the syndrome describes a useful clinical
concept, grounded in medical science, which helps doctors alleviate
suffering.

Vitamin D Deficiency Associated Symptoms
----------------------------------------

We propose that Vitamin D Deficiency Syndrome is a group of symptoms
or signs typical of a disease, disturbance, condition, or lesion, a
set of concurrent things and a derangement of function. VDDS is the
aggregate of symptoms and signs associated with the morbid process of
vitamin D deficiency, and constitute together the picture of the
disease.

Osteoporosis, heart disease, hypertension, autoimmune diseases,
certain cancers, depression, chronic fatigue, and chronic pain
comprises potential manifestations of the syndrome. That is not to say
these illnesses are caused by vitamin D deficiency, nor that repletion
of the vitamin D system will cure these illnesses. At this point, all
that can be said is that these illnesses are associated with vitamin D
deficiency.

D Deficiency-Illness Link
-------------------------

In a series of upcoming posts to this website, we will use the
following five criteria to link each illness in VDDS with vitamin D
deficiency:

1. Epidemiological evidence the incidence of each illness subsumed
  by VDDS has increased as UVB exposure has lessened.

2. Evidence that each illness subsumed by VDDS is associated with
  low 25(OH)D levels.

3. Evidence that the illnesses comprising VDDS show significant
  co-morbidity.

4. Theoretical models that explain how vitamin D deficiency plays a
  causative role in each illness of VDDS.

5. Clinical evidence that treatment with physiological doses of
  vitamin D improve each illness in VDDS.

Using these five requirements, we propose that Vitamin D Deficiency
Syndrome, or VDDS, exists when 25(OH)D levels are less than 50 ng/mL
in patients with two or more of the following conditions:
osteoporosis, heart disease, hypertension, autoimmune diseases,
certain cancers, depression, chronic fatigue, or chronic pain. VDDS is
a group of diseases that are associated with chronic vitamin D
insufficiency, and which cause a significant derangement of function.
VDDS is more common among blacks, the aged, and those who either avoid
the sun or are deprived of it.

Multifactorial Illness
----------------------

It is important to clearly state once again, we are not saying these
illnesses are all caused from vitamin D deficiency; they are all
multifactorial illnesses. We are not saying that vitamin D will cure
all these illnesses; it will not, although it may help. We are only
saying that evidence exists for a dictionary definition of a syndrome
that associates vitamin D deficiency with these illnesses. Scientific
evidence currently exists that some of these illnesses may be caused
by vitamin D deficiency. Furthermore evidence exists that some of
these illnesses may be helped by vitamin D repletion. The current
evidence varies with each illness. For example, strong evidence exists
that vitamin D reduces osteoporotic fractures, but only two small
studies exist to show vitamin D helps depression.

However, those practicing medicine are not practicing science.
Scientists practice science by conducting controlled experiments.
Physicians practice medicine by making clinical decisions. Clinical
decisions are always made using a benefit versus risk analysis, with
current scientific knowledge as the cornerstone of the decision making
process. Practicing physicians use this formula in every clinical
decision they make, with every patient and do so many times a day.
They need to make the same decision concerning VDDS and vitamin D
repletion.

John Jacob Cannell MD Executive Director 2003.12.27 updated 2010.01.08

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