The Gluten Intolerant are at Risk for Vitamin D Deficiency
Patients with celiac disease and gluten intolerance tend to malabsorb Vitamin D, a fat soluble vitamin. Fat soluble vitamins are absorbed predominantly through the tips of the villi of the intestinal lining, the first place to sustain damage in most gluten sensitive patients. Therefore long before a person may have gluten-related symptoms, vitamin D (and therefore calcium) is having difficulty being absorbed.
The focus with vitamin D deficiency has mostly been on the fact that calcium needs vitamin D in order to be absorbed from our diets putting those with gluten sensitivity at risk for osteoporosis. But despite being one of the most crucial components of healthy bones, vitamin D is also a protector against cancer, diabetes and a valuable component of the immune system. Unfortunately vitamin D has gone largely unnoticed as an important deficiency in the American public, an error I’d like to help correct by educating the community.
- Bone Health: Vitamin D has a multitude of effects, the principal of which is the development and maintenance of bone health. Those who are deficient in vitamin D may be at risk for osteoporosis, osteopenia and osteomalacia -the inability to mineralize bone, causing pain and weakness.
- Diabetes and Cancer: While its effect on bones may be most commonly known, vitamin D also has many other very important functions. It reduces the risk of diabetes and certain forms of cancer including ovary, breast, colon and prostate; it has been shown to improve hypertension; help psoriasis; and it drastically reduces the risk of heart disease. There are even some studies that link Alzheimer's disease, depression and multiple sclerosis to low vitamin D levels.
- Immune Response: In terms of the immune system, vitamin D produces extremely important effects. Namely, studies have shown that people at higher latitudes have a higher rate of multiple sclerosis (MS) - possibly due to deficiency in vitamin D. Several animal studies have shown that animals that can be induced with MS will not get MS if treated with vitamin D beforehand. Another study in Finland found that proper levels of vitamin D actually reduce the occurrence of Type 1 diabetes in children by about 80%.
Research by Dr Michael Holick, author of “The UV Advantage”, has shown that if blood levels of vitamin D are good, it reduces the rate of colon cancer by about 50%.
In children, vitamin D is critically important. Without it, you'll have growth retardation, rickets and other skeletal deformities. In fact, rickets - once considered a disease from a hundred years ago is on the rise. Why? There is not enough vitamin D in breast milk. Could another reason be more undiagnosed gluten sensitivities, hindering a child’s absorption of vitamin D? Food for thought . . . - Sources:
Few foods actually contain any appreciable level of vitamin D naturally. Certain fish, like mackerel and salmon have some, as do oils from fish like cod, shark and tuna. Meats and egg yolks also have some vitamin D in them, but very little. Of course fortified milk has vitamin D, but the amounts in every container are highly variable and insufficient to provide what the average person requires.
People who live at higher latitudes are also at high risk for being deficient. A study in Boston showed that 36% of young adults ages 18 to 29 had insufficient levels of vitamin D. The subjects were local medical school students and hospital residents whose work or studies limited their exposure to sunlight. The bottom line is that people - especially if they live in the north or spend most of their time indoors either need to find ways to get outside or replenish their levels of vitamin D with supplementation.
Other studies show that >30% of the general population is deficient, with >60-90% showing insufficient or suboptimal levels of Vitamin D. People with chronic conditions and inflammation frequently are Vitamin D deficient.
Symptoms associated with Vitamin D deficiency:
hypertension, heart disease
diabetes
arthritis
most cancers
malabsorption (as seen in celiac and gluten intolerance)
migraines
Multiple Sclerosis
asthma, allergies
periodontal and gingival disease
obesity
osteoporosis, osteopenia
musculoskeletal pain, fibromyalgia
psoriasis
chronic wounds
seizure disorders
dementia, depression, and mental illness
Look at the chart below to determine where you fall regarding deficiency.
Interpretation of Blood Levels
10-20 ng/ml = deficient
20-30 ng/ml =insufficiency
30-40 ng/ml = possibly insufficiency
>36 - 40 ng/ml = decreased incidence of heart disease and MS
40-50 ng/ml = probably sufficient levels
>50 ng/ml = sufficient or optimum levels; decreased incidence of cancer
80-100 ng/ml = goal for most cancer patients
>125 ng/ml = potentially toxic
Supplements are an excellent source of vitamin D. It’s estimated that for every 10 ng you wish to raise your level, you need to supplement 1,000 IU/day. When supplementing, use Vitamin D3 – D2 is only 60% absorbed. Also supplement with adequate calcium and magnesium which is important for gluten intolerant patients as those minerals are frequently malabsorbed as well. Supplementation should continue for 5-9 months for maximal benefit. Evaluate levels every 2 – 3 months and get them into the optimal range.
Note: Patients who are potentially Vitamin D sensitive are those with sarcoid lymphoma, TB, renal or liver failure. These patients could get toxic taking Vitamin D and shouldn’t without doctor supervision.
It’s a simple blood test to determine your levels and a very small vitamin tablet to take if necessary. I consider this a small price to pay to handle a deficiency that can create such widespread problems.
Posted 3/31/09 by Dr. Vikki Petersen founder of HealthNow Medical Center in Sunnyvale, California and Author of The Gluten Effect (learn more about Dr. Petersen)
