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The many guises of vitamin D deficiency

Posted on: August 25, 2012   by  John Cannell, MD

The many guises of vitamin D deficiency

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Vitamin D deficiency may be on its way to being known in medicine as a grand deceiver, presenting in various guises and imitating different diagnoses. Take a recent case report on rickets mimicking the incurable arthritic disease, ankylosing spondylitis.

Demirbilek H, Aydoğdu D, Ozön A. Vitamin D-deficient rickets mimicking ankylosing spondylitis in an adolescent girl. Turk J Pediatr. 2012 Mar-Apr;54(2):177-9.

Dr. Huseyin Demirbilek and colleagues of the Hacettpe University Faculty of Medicine in Turkey report on a 14-year-old African girl with generalized bone aches referred to their clinic when her symptoms did not improve with treatment. Ankylosing spondylitis was her diagnosis, a disease of the skeleton with variable involvement of other joints. It is a chronic, inflammatory autoimmune disease, which mainly affects joints in the spine and the pelvis, and can cause eventual fusion of the spine.

However, the good doctors noticed she was heavily clothed, had very black skin, and had severe pain on pressure to her sternum. Sure enough, her 25(OH)D was literally 1 nmol/L, her alkaline phosphatase was 2312 (very high), her blood calcium was low with normals between 8.6 and 10.5 (quite different than American normals which often call a calcium of 10 as elevated). Her PTH was 923 (very high). X-rays of her wrists confirmed rickets.

Her disease and her suffering disappeared a month after treatment with a one-time dose of 300,000 IU of vitamin D and 1000 mg/day of calcium. After the one time dose, they very conservatively maintained her on 800 IU/day of vitamin D.

Besides ankylosing spondylitis, vitamin D deficiency may present as frequent infections, chronic pain, heart disease, stroke, multiple autoimmune diseases, fibromyalgia, osteoporosis, gingivitis, diabetes, and in my opinion, sun sensitivity, to name but a few. Vitamin D deficiency is now the grand deceiver.

5 Responses to The many guises of vitamin D deficiency

  1. eewright

    Vitamin D defiency is indeed the grand deceiver! I’m living proof!!! I developed very severe Laryngopharngeal Reflux (LPR) also known as “burning throat” and “silent acid reflux” in July 2009. It was a long and torturous 6 months to get diagnoised. I was told over and over that I had allergies inspite of the severist neck, head, cheek, throat, ear pain. I downed Flonase and allergy medications by the buckets to no avail and the pain was excrucitating. I couldn’t sleep and never missed any day sof work despite the excrucitating pain. Many of my Drs treated me with distain for troubling them so much. I was in so much pain and so ashamed that I had something no one could figure it out. I trusted my Drs to diagnois me correctly. What a mistake! I finally asked for an allergist. He diagnosed me in 3 mintues flat! I had “silent acid reflux”. What followed was 2 1/2 years of steady decline. All the ENTs and GI’s gave me tons of antibiotics and Proton Inhibitors (PPIs) which did absoultely nothing for me. I got worse and worse. I developed severe pnuemonia (30% of patients on PPIs develope infections due to PPIs devating effects on the gastro system). A fundoplicaiton surgery followed in May 2010. And my throat pain got worse! I was bedridden for 5 months and couldn’t take the pain anymore of LPR. It was unbearable. I checked myself into an ER @ $250 for the visit. What a waste all my time, visits and money and my health went to hell steadily. The ER Dr. gave me a psych Dr and they sent me to counseling just to ask me what did I think the stress was that was causing my problem. All I could keep saying was that I wasn’t stressed, that I had unbearable throat/head head and that I couldn’t take it anymore. I told them my medical documented I had it. I had retired and moved and had by this time had to start with new Drs. What a nightmare! These new Drs thought it was stress and put me on pills to reduce my stress while I burned to death! The new GI was angry I was bothering her as she took my new intake information. By now I was losing hope and resigned to accepting whatever they told me. The GI pounded the keys and interrupted me constantly to tell me “…I’ve never heard of such a thing!…” when I told her my symtoms. I was devasted. I thought I was in the twilight zone and I felt I was losely my ability to tolerate the pain, now after almost 1 1/2 years in constant unbearable pain. When she checked my neck area I winced. She said “does that hurt”. I said yes, “I feel like I have 4 big balls in my throat”…she didnt say anything. The GI made a call and said, “would you check one for me? I just want to be sure before I send her back to her primary dr.” Later I put two and two together, it was an ENT she had called. The GI Dr didn’t say good bye to me or offer me any comforting words. She was angry with me and didn’t really believe me. Several weeks later the new ENT scoped my throat finally and he said I was burned to a crisp and said he had to run tests and scans. They did all types of test and lab work. He said I had a separate issue of a 3 centemeter thyroid nodule that had to come out. He said he also he had to do a biopsy on my severely burned throat. I told him I wasn’t sure I could tolerate the surgery or the biopsy because the throat pain was so severe and I couldn’t tolerate any medication, as it caused the burned to become even more severe. I also demanded a new GI that had a bed side manner. The newer GI couldn’t do anyhing for me but she did say “we believe you now”. They all told me there was no such thing as LPR. Even though my record showed that I was diagnosed with it. When I showed the new GI the UC LPR web page she couldn’t believe what she was seeing. She said, “Where did you get this?” I answered “from the UC web site which is printed at the top”. She asked if she could have the print out. The GI stated, “I interned there but never heard of this before.” They tried Carafate on me to no avail. In Jan 2011 I began to slowly take over my treatment with the GI. She allowed me to. I found that probiotics gave me a 30% improvement. She wrote me a medical probiotic prescription. And I at least was able to get out of bed and although I was still suffering horrible I improved a small bit. I asked for a referral to a UC system as they couldn’t do anything for me to explain the mystery of LPR. In May 2011 I developed some other issues like incontinence, joint pain, I couldn’t lift my arms to cloth myself or wash or comb my hair, weakiness in my legs, my wrist and ankles were swollen and bone pain. But my head/throat pain trumped everything else. I never bothered to tell my Drs these problems as they treated me with such distain when I went in for my appointments. Around July 2011 the head regional GI saw me and stearnly told me I had to learn to live with the pain of LPR for the rest of my life. He kept shrugging his sholders with my inquiries. He wanted out of the room. He basically told me I did not have LPR but they didn’t know what I had. They denied paying to send me to a UC system. He said I had a neurological problem that would take 10 years for science to figure out. I came home that day so depressed in Aug 2011. I felt my life was over. I was not sure I could take the pain for the rest of my life. My family life was falling apart. My family thought is was mental health issues and things were dissentigrating at home. But I knew that I had something no Dr around me recognized. I knew I was not crazy. I knew I was sane. I had by now learned the mechanics of what was wrong with me by researching. My small muscle spinchters (UES/LES) in the escophogus were not working. They had gone “limp”. No Dr ever explained to me anything. I had to figure it out alone by researching the atatomical problem I had. The day I was told I had to live with pain for the rest of my life, I came home and sat at my computer and deceided that I had to find something to help myself. I entered into the computer “what strengthens muscles?” and up popped a few articles on Vitamin D. The more I read the more I thought it could work. I researched the type of Vitamin D to take. I took a Vitamin D test immediately. I had a score of 25. I stopped and thought about this score for awhile. Why wasn’t it lower? I had avoided the sun for 40 years, since I was a young women. And it hit me. We had just built a swimming pool and I had been out more than I usually did with the grandchildren when they came over to swim. But most of the time I had been bedridden. I began taking Vitamin D at 6,000 IU in Aug 2011. I’ve had a slow and steady improvement for the last 12 months. My life is normal now. I’m so lucky I was tenacious and never gave up on myself and that I read and read and researched constantly to connect the dots. By the way my LPR is almost gone. Just faint whispers once in a great while! All the aches and pains are gone, the incontinence is gone and I’m one lucky person to have pulled myself out of the nightmare of declining health. Thank goodness for the internet as I was able to find the answers to my horrible throat/neck pain. Thank you for the work you do on the Vitamin D Council and pushing the medical and pharmecuetical communities to offer tests and presciption advice to patients suffering. Vitamin D and the sunshine are simple and inexpensive health promoting things that can reduce health issues better than any medication can.

  2. John Cannell, MD

    What a nightmare. I am so glad we could be of help. It sounds as if you would be wise to keep your 25(OH)D level in the high normal range, given your past history.

  3. Anh Phan

    I totally agree with eewrigth “Vitamin D and the sunshine are simple and inexpensive health promoting things that can reduce health issues better than any medication can” My long term IBS, frequent flu with horrible throat/neck pain went away within 3 months with vitamin D supplement high dose ( I start from 1000IU gradually increase to 10000IU/day). It cost me less than 20 buck for the cost of vitamin D. The experience with vitamin D leads me to study intensively on nutrient science and integrative, holistic medicine. I hope and wish people aware more about any safe and cheap treatment before going to any invasive drugs and operation.

  4. John

    “Sun sensitivity” should be recognized as a preliminary vitamin D deficiency type of test. It’s probably linked to your body attempting to produce much more vitamin D than if you were in the “normal” range.

  5. Rita and Misty

    John, I wonder if it would be possible to develop such a study. I’m beginning to think that without an optimal 25(OH)D level, your body cannot properly utilize sunshine for the many sun-dependent pathways (e.g. melatonin and serotonin production) in addition to cutaneous vitamin D production. And, this is what makes intermittent sun exposure potentially harmful, I think.

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