Wednesday, December 19, 2012

Vitamin D and Osteoporosis in Celiac Disease

Osteoporosis can be a deadly disease.  Osteoporosis related fractures (hip, spine, wrist) may be preventable but currently account for 1.5 million fractures per year in the US in patients over the age of 65.  Many patients admitted to the hospital with a hip fracture may die or suffer medical complications in the year following their fracture, and many have a life-long deterioration in function.

So what does this have to do with Celiac Disease?

When I was diagnosed with celiac disease I had my vitamin D level checked.   It was low.   After going GF, allowing my GI tract to heal, and supplementing my diet with calcium and vitamin D I was able to bring my levels back into the normal range.

Some Signs/Symptoms of Vitamin D Deficieny

Muscle weakness or soreness
Joint Pain

Our body stores calcium in our bones and if we do not have sufficient stores of vitamin D we can not absorb the calcium from our GI tract.  When the small intestines are damaged due to celiac disease you can not absorb nutrients normally.  One of the nutrients that is not absorbed is vitamin D.  Vitamin D is absorb from food, supplements and the sun but must pass through the liver and kidney to become biologically active.

Foods that contain Vitamin D

Some fish (salmon, tuna, mackerel)
Egg yolks
fortified foods (cereals, milk and even some juice is fortified with vitamin D)

Kemppainen et al in Bone in 1999 stated that vitamin D deficiency occurs in 64% of men and 71% of women.  They also found the prevalence of osteoporosis to be 26%.

We absorb vitamin D from our diet, supplements and the sun.  Although the sun does play a role in vitamin D production (but I won't bore you with the physiology) sunscreen blocks about 95% or more of the rays needed to convert vitamin D.  I did a study looking at one years worth of patients undergoing total hip or total knee replacement in San Diego (lots of sun, right?) and almost 50% of patients were deficient in vitamin D.

Daily Recommendations

Current recommendations state that if you are less than 50 years old that you take 1,000 mg of calcium per day and increase it to 1,200 mg if you are a woman over 50 or a man over 70.  You should also take 600 to 800 IU of vitamin D per day.

The NIH has a good resource here.

I tell patients to assume your bones are a bank.  Instead of storing money, your bones store calcium.  Unfortunately, you can only make deposits for a period of time.  As we age we start to pull calcium out of the bones - we start making withdrawals on our investment.  So your goal as a child and young adult is to make sure you consume calcium, vitamin D, don't smoke, exercise and avoid excessive alcohol to maximize your investment and develop healthy, strong bones.

I take a daily vitamin (Centrum) every morning and at night I take an Os-Cal (400 IU vitamin D and 500 mg calcium).  This has brought me into the normal range.

Consult your doctor.  More is not always better.  You can overdose on vitamin D and there are side effects.   Before taking a high volume of supplements you should check with your physician and follow their advice.

Eat well,

The Un-Gluten Guy

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