The Determination Of The Vitamin D Level
Determination Of The Vitamin D Level

Although vitamin D deficiency is widespread, patients’ blood counts are rarely collected. In many cases, the test is not even initiated if there are symptoms suggestive of a deficit. Vitamin D deficiency as the cause of many diseases is currently unknown to the majority of doctors.

The latest research findings have so far only been taken into account by a few doctors in their practice. The usual publicity among doctors carried out by pharmaceutical companies is omitted because vitamin D hardly makes any profit.

Given the serious consequences of a vitamin D deficiency, the patient is well advised to take action himself if a deficiency is suspected. The suspicion will often be confirmed with a laboratory examination. The determination of the vitamin D blood level (25-hydroxy-cholecalciferol) is relatively complex. The lab charges about $30- $50 for this. It is usually unnecessary to determine the concentration of active vitamin D (1,25-hydroxy-cholecalciferol).

25-Hydroxy-Cholecalciferol (25-OH-D3), also known as calcidiol, is the inactive storage form of vitamin D. In this article, this 25-vitamin D level is continuously mentioned, because only it provides information about how well the vitamin D stores are filled.

The 25-vitamin D level is stable during the day. Sunbathing and supplements can raise it in the following hours. Without UVB irradiation of the skin and vitamin D supply, the 25-vitamin D level drops by 10 to 30 percent per month (average about 20%).

1,25-Hydroxy-Cholecalciferol (1,25- (OH) 2-D3), also called calcitriol, is the active form of vitamin D because this compound activates the vitamin D receptors in the cell nuclei. The active form is measured in pg/ml (picogram: 10−12g), the storage form in ng/ml (nanogram: 10−9 g).

This means that the blood level of active vitamin D is only one thousandth of that of inactive. The conversion of the stored 25-10 active 1,25-vitamin-d varies greatly extent and is continuously adjusted as required. This level increases with muscle activity. The 1,25-vitamin D concentration in the blood is therefore subject to considerable fluctuations. It is usually not necessary to determine the level of the active vitamin D. The decisive factor is how well the vitamin D stores are filled.

Alternatively, if there is clearly no supply, the level can also be estimated.

The Determination Of The Vitamin D Level As The Basis For Further Treatment

If a vitamin D deficiency is suspected, a laboratory test is useful as it clarifies the severity of the deficiency. A laboratory test can also be calculated to determine the correct individual dose for vitamin D therapy. Optimal vitamin D levels are essential for regaining and maintaining good health. Patients suffering from acute vitamin D deficiency syndrome experience at least an improvement in about 80% of the cases, and often even a complete cure.

The vitamin D test is also recommended to treat or prevent chronic degenerative diseases, as these are often promoted by a vitamin D deficiency. This has been proven for rickets and osteomalacia (softening and deformation of the bones), osteoporosis, cancer, a decline in mental performance, tuberculosis, susceptibility to infections, immunodeficiency, and autoimmune diseases.

If pale skin indicates a vitamin D deficiency, then tanned skin is by no means proof that the vitamin D level is satisfactory or optimal. This is due to tanning being stimulated by UVA radiation (immediate pigmentation in contrast to slow and lasting tanning by UVB radiation). A certain amount of tan can be achieved with just a single sunbath; while even with UVB-intensive sunbathing of the whole body, the vitamin D level is raised by a maximum of around 2 ng/ml.

And often, only the skin on the face, hands, and forearms is tanned, but the rest of the body is pale because there is no full-body tanning. The vitamin D gain is correspondingly low. Pale skin indicates a deficiency, even if the face is tanned.

When the sun is low, and the atmosphere is cloudy, a considerable tan can be caused by UVA radiation after a few sunbathing, although hardly any vitamin D effective UVB radiation reaches the earth’s surface. In this case, too, the tanned skin only simulates a good vitamin D supply.

When using sunscreens, the formation of vitamin D is blocked because it intercepts the UVB radiation. The reddening reaction is postponed, and a too-long stay in the sun is made possible. Nevertheless, a considerable part of the UVA radiation passes through the light protection chemicals, which stimulates skin pigmentation. Anyone who uses sunscreen every time they sunbathe can be tanned and still suffer from a vitamin D deficiency.

Light-skinned people can see the lack of sun immediately. This is not possible for dark-skinned people because of the basic pigmentation of their skin. In addition, people with dark skin (skin types 4 to 6) need more UVB radiation to produce the same amount of vitamin D as light-skinned people. Dark-skinned people require a UVB radiation dose ten times higher than light-skinned people.

Visual diagnosis can also be misleading in light-skinned people if the skin’s tanning subsides faster than the vitamin D level falls. So not everyone who looks pale in winter has to have a deficiency. Because of all these uncertainties in the visual diagnosis, the doctor should develop a vitamin D awareness and understand the patient’s lifestyle in conversation with the patient. How often has he sunbathed in the past? What time of day? The whole body? With or without sunscreen? Where did they spend their last vacation? Do they go to the solarium regularly, and do they use UVB lamps? Do they take vitamin D supplements? If so, in what dose? Can the sun be tolerated without complications? The often negative answers confirm that a vitamin D test is advisable.

In older people, the ability to produce vitamin D is often reduced, so that their vitamin D level rises less after sunbathing than in younger people.

Suspicions for a deficiency can occur in people who: consume tobacco, are overweight or obese, live in closed rooms, city dwellers (the atmospheric cloudiness due to the air pollutants reduces the UVB radiation intensity), work in a factory or office, frequent night shifts (then the sunny days are also overslept), spend no to little time outdoors during lunchtime (the unclothed area of skin exposed to the sun is decisive), use sunscreen when sunbathing, or use of medication that disrupts the vitamin D metabolism (antiepileptic drugs such as phenytoin or carbamazepine).

Normal Calcium Levels ​​Are Not An Objection To Determining The Vitamin D Level

Many believe that it is enough to check the calcium level. Since this is usually normal, assume that an adequate calcium supply is guaranteed. But this view is wrong. The organism is forced to attack the bone’s calcium reserves in order to ensure the function of nerves and muscles, including the heart muscle. A calcium level that is too low would result in a breakdown with convulsions.

The calcium level in the blood therefore does not allow any conclusions to be drawn about the calcium balance. Calcium levels may be normal, although calcium is lost through the kidneys and calcium absorption through the gut is poor.

The organism can suffer from an extreme calcium deficiency and be in calcium-saving mode, although the blood levels ​​are normal. Despite normal calcium levels, the symptoms and illnesses of an acute vitamin D deficiency set in, and over time, chronic deficiency diseases develop.

A statement about calcium absorption and utilization is only possible if the vitamin D level is taken into account. This level alone provides information about whether vitamin D therapy is appropriate.

Calcium levels ​​of 2.1 or 2.2 mmol/l in the lower normal range, however, suggest a strong vitamin D deficiency.

The ALP Level As An Instrument For Review And Follow-Up

Bone resorption is suspected if the alkaline phosphatase (ALP) levels ​​are well above 100 U/l (units or units per liter) with normal liver levels. High levels ​​of over 120 U/l may be an indication of advanced osteoporosis.

After 1 to 2 years of vitamin D therapy, the ALP levels ​​usually drop to around 50 to 70 U/l.

Since the inexpensive ALP level is often determined, it is worth looking for higher levels ​​in the medical record. They are an indication of a history of vitamin D deficiency. Increased ALP levels ​​give reason to check the vitamin D level.

The regular determination of the ALP levels is also suitable for monitoring the progress of osteoporosis patients. However, even when extremely deficient in vitamin D, people with low body weight often have normal ALP levels. With them, checking the vitamin D level cannot be avoided.

ALP norm levels should be viewed with caution. For adults, the limit level was set at 100 U/l, and for older adults, it can even be 140 U/l. However, in this area, bone loss is already taking place, which is usually promoted by a vitamin D deficiency. In children, ALP levels of up to 500 or even up to 700 U/l are classified as “still normal for their age,” although treatment with vitamin D can halve such high levels quickly.

Only ALP levels that are reached after a long time with adequate vitamin D levels should be considered harmless and normal. For adults, these levels are usually in the range of 50 to 80 U/l.

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