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Vitamin D Deficiency and Lupus

 
Contents:

Introduction

Over the past several years, the scientific and medical communities have begun to make a connection between Vitamin D (25-hydroxyvitamin D or [25(OH)D]) levels and the body’s immune response. We are writing this blog, not to promote the use of vitamin D as a lupus treatment, but rather to help inform you as to some of the important research and information that is currently available on vitamin D deficiency and its role in lupus. Some studies have shown that as many as 67% (and even a higher percentage in other studies) of individuals with Systemic Lupus Erythematosus (SLE) are vitamin D deficient which makes this research all the more relevant to gaining more understanding about the connection between vitamin D levels and lupus disease activity.

As you probably already know, Systemic lupus erythematosus  is a very long name for the very complicated disease that is more commonly known as lupus.  Lupus is a widespread and chronic (lifelong) autoimmune disease that, for unknown reasons, causes the immune system to attack the body’s own tissue and organs, including the joints, kidneys, heart, lungs, brain, blood, or skin.  SLE can affect nearly every organ system in the body. At times, individuals with lupus may have periods with few to no symptoms, and at other times the individual may have high disease activity which often includes unpredictable and debilitating bouts with symptoms of the disease. These periods of increased disease activity are called flares.

What is vitamin D and how does it affect the body?

What is vitamin D?

  1. It is the only vitamin that the body can produce on its own. Your body needs to get all other vitamins from the foods you eat or by taking supplements.
  2. Once your body gets vitamin D, it turns it into a hormone (called either activated vitamin D or calcitriol). It is the ONLY vitamin that does this.

Here are some of the systems and processes that vitamin D effects:

  • It is essential for strong bones because it helps the body absorb the calcium from the food you eat (digestive system). Without vitamin D, all of the calcium that you ingest would just pass through you digestive tract unabsorbed.
  • It also encourages your bone cells to strengthen your bones by adding more calcium to them. 
  • Muscle function
  • Cellular growth and changes
  • Circulatory/Cardiovascular system
  • Respiratory system
  • Brain development
  • Anti-cancer effects
  • The immune system’s T-cells and dendritic cells. Dendritic cells play an important role in protective immunity.
  • Vitamin D is also thought to have antibacterial and anti-inflammatory properties

What do the studies about vitamin D deficiency and lupus show?

Many studies have now shown that there is a link between vitamin D and lupus. Here are some fast facts based on these studies:

  • Individuals with lupus are more likely to have low levels of vitamin D.
  • Individuals with lupus who have higher levels of vitamin D tend to have fewer lupus symptoms.
  • The risk factors for heart disease in individuals with lupus increases if vitamin D levels are low.
  • The risk for high blood pressure and elevated lipids is higher in individuals with SLE and with a vitamin D deficiency.
  • Some studies have shown that giving vitamin D supplements to individuals with lupus can reduce the chances and occurrences of flares.
  • Adding vitamin D in vitro (test tube experiments performed with cells or biological molecules) has been shown to reverse abnormalities in the immune system characteristic of SLE.

There is some conflicting information as to the efficacy of vitamin D supplements in individuals with lupus, but for the most part the results looks promising.

Dr. Edie Vickers of the An Hao Natural Healthcare Clinic believes that vitamin D supplements can provide benefits to individuals with lupus. Dr. Vickers briefly discusses her thoughts about vitamin D in this KFL video:

https://www.youtube.com/watch?v=FSqGTTLsgkk [EMBED VIDEO HERE].

The results from several recent studies is a bit less clear.  A recent Lupus in the News [LINK TO ARTICLE] article discussed a 2017 study conducted by researchers from Universities of Medical Sciences in Tabriz and Urmia, Iran that showed promise for supplementing diets with vitamin D. Through their meta-analysis, the researchers concluded that vitamin D supplements may decrease disease activity in individuals with lupus, but they also indicated that more studies need to be done to determine the overall effectiveness of vitamin D supplements. By contrast, however, a study conducted by researchers at the Department of Rheumatology at Al Zahra Hospital in Iran and published in 2017 concluded there were no significant improvements in SLE symptoms for the individuals who were given vitamin D supplements. So, though promising, clearly, more research is needed.

Symptoms and Diagnosis for Vitamin D Deficiency

The symptoms for vitamin D deficiency can be very subtle but can include fatigue, general aches and pains or frequent infections. Some people may have no noticeable symptoms at all. If you have pain in your bones or weakness that causes mobility issues (this can be a symptom of severe vitamin D deficiency), please seek medical attention immediately.

How is a vitamin D deficiency diagnosed?

According to the Vitamin D council,  a blood test is the only accurate way to test for a vitamin D deficiency. There are several ways that you can have your vitamin D tested:

  1. Asking for the test at a doctor’s office: Ask your doctor to specifically give you the 25(OH)D blood test. FYI, there is another test called the 1,25(OH)2D test but the 25(OH)D is the only way to test whether or not you are getting enough vitamin D. You may want to check with your insurance to see if you are covered for this test prior to going in.
  2. At-home blood test: It is actually possible to order an in-home vitamin D test kit from the Vitamin D Council through their website (https://www.vitamindcouncil.org) for around $60.. In-home tests are easy to use and involve you pricking your finger to get a small blood sample. You then send your test to a laboratory for results. We cannot confirm the accuracy of this particular test, but The Vitamin D Council has very good information on a variety of issues regarding vitamin D health.
  3. Ordering a test from a website and have your bloodwork done at a lab: There are a few websites recommended by the Vitamin D council where you can bypass your physician and go straight to a testing lab: com, healthcheckusa.com, and privatemedlabs.com. All of these companies sell the 25(OH)D test. The price of these is a bit higher than the order-at-home blood test.

What is considered a good level for vitamin D?

According to Dr. Thomas, author of The Lupus Encyclopedia, a good level for vitamin D is 30ng/ml if on steroids, although he states that a Johns Hopkins study suggests around 40ng/ml. Here is a chart with information taken from The Vitamin D Council showing the recommended levels of vitamin D from other various organizations:*To reach and maintain the Vitamin D Council’s recommended levels of 50 ng/ml, a daily dosage of 5,000 IU/day of vitamin D supplement would be needed. To reach and stay above the 30ng/ml level recommended by the Endocrine Society, a supplement of around 2,000 IU/day would be advised. To read more on this and other guidelines for reaching certain levels of vitamin D, please visit this link.

IMPORTANT NOTE: Nobody with lupus should attempt to take high doses of vitamin D to control their disease activity, and as always, please speak with your treating physician before starting or stopping any medication or supplement. There is no study as to the long term effects of high dosages of vitamin D. Currently the recommended daily allowance is 600IU a day until age 70, please consult with your physician before taking more than the recommended daily allowance.

Are certain people more likely to develop a vitamin D deficiency?

The answer is yes. Here are a several groups of people who are more likely to develop this deficiency:

  • People with darker skin tones: Melanin protects the skin from UV rays. People with darker skin have more melanin and therefore absorb fewer UV rays. This means that people with more melanin make vitamin D much more slowly than those with lighter skin after sun exposure.
  • People who spend a lot of time indoors during the day: Naturally, these people will have the least amount of UV exposure.
  • The elderly: With thinner skin, the ability to produce vitamin D is reduced.
  • Infants who are breastfed and not given a vitamin D supplement: If the mother takes a supplement, this can help.
  • People who cover their skin all of the time or wear sunscreen to block out UV rays: This often includes many individuals with lupus who suffer from photosensitivity and need to avoid UV rays. Wearing sunscreen is still recommended but can limit your body’s ability to produce vitamin D.
  • People who live in the Northern US, Canada or other locations in the upper Northern hemisphere: This has to do with the reduced number of hours of sunlight as you get further from the equator.
  • During times of year where there is less sunlight (winter, for example): Interestingly, individuals with lupus often suffer higher incidence of flares during these months as well.
  • Women who are pregnant
  • People who are very overweight or obese

Where can you get more vitamin D?

There are only three ways to get vitamin D:

  1. By exposing the bare skin to the sun
  2. By taking supplements
  3. Dietary intake from foods

Vitamin D has long been known as the “sunshine vitamin” because it is produced by the body in response to ultraviolet light exposure from the sun. Therefore, exposure to sunlight is one way to get more vitamin D, with 20-25 minutes per day being a helpful amount to affect your vitamin D levels positively. If you have photosensitivity or live in a climate with less available sunshine, this may not be an option for you.  Ultraviolet lamps and bulbs are also available for indoor use. Vitamin D supplements are commonly prescribed to raise vitamin D levels. With supplements dosage can be controlled to meet the individual’s needs. Please speak with your doctor about finding the right dosage of vitamin D supplements for you.  And do not begin taking any supplements without first speaking to your physician. If you are taking too much vitamin D you may get hypercalcemia and begin experience feeling sick, loss of appetite, being thirsty, frequent urination, pain in the abdomen, muscle pain or weakness, fatigue and/or confusion. Special care should be taken when taking vitamin D supplements for those who have the following conditions:

  • Kidney disease
  • Kidney stones
  • Liver disease
  • High blood calcium levels
  • Hyperparathyroidism
  • Hodgkin’s or non-Hodgkin’s lymphoma
  • Granulomatous disease
  • Hormonal disease
  • If you are taking certain medications: This can include high blood pressure medications, medications for irregular heartbeat, and other drugs that may interfere with vitamin D and may require more than the usual dosage of vitamin D.
  • Let your doctor know all medications and supplements that you are currently taking.

Vitamin D can also be found in certain foods as well. Some foods that contain high amounts of vitamin D are fatty fish (such as mackerel, trout, salmon, tuna and eel) and fish oils, egg yolks, cheese, fortified– meaning vitamin D has been added- cow’s milk (contains 100 IU’s in one 8 ounce glass), fortified cereals, fortified orange juice, and beef liver. 

In Conclusion

While the research is certainly interesting and even promising, there is no conclusive research that shows that low vitamin D levels cause lupus nor can the physiological and clinical significance be confirmed. It is also difficult for researchers to determine whether low levels of vitamin D cause lupus or whether the lupus causes the low levels of vitamin D. Overall, more research and experimentation is needed to determine a more clear answer about the helpfulness of vitamin D to help manage and treat lupus. What we do know is that, given its relative safety in combination with the beneficial effects on the immune system, there is optimism that correcting a vitamin D deficiency in individuals with SLE may lead to better outcomes.  We will keep reading and watching for any developing studies and information on this topic and, as always, keep you informed.

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References

Am I deficient in vitamin D? (2018). Retrieved from: http://www.vitamindcouncil.org/
Bishak, Y. Ghavamzadeh, S., Hassanalilou, T., Khalili, L., Payahoo, L., Shokri, A. (2017).
Role of vitamin D deficiency in systemic lupus erythematosus incidence and aggravation. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5743852/pdf/13317_2017_Article_101.pdf
Karimifar, M., Karimzadeh, H., Shirzadi, M. (2017). The effect of Vitamin D supplementation in disease activity of systemic lupus erythematosus patients with vitamin D deficiency: a randomized clinical trial. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5361443/?report=printable
Laino, C. (2011). Vitamin D shows early promise against lupus. Retrieved from: http://www.webmd.com/lupus/news/
Ludwig, J. (n.d.). Everything you need to know about vitamin D: functions, sources, possible benefits, and more. Retrieved from: https://www.everydayhealth.com/vitamin-d/
Quittner, E. (n.d.). 12 ways to get your daily vitamin D. Retrieved from: http://www.health.com/
Thomas, D. E. (2014). The lupus encyclopedia: A comprehensive guide for patients and families. Baltimore, MD.: Johns Hopkins University Press.’
Walsh, N. (2014). Low vitamin D linked with worse lupus. Retrieved from: http://www.medpagetoday.com/

 

Article co-authored by Kerrie Sundbom and Liz Heintz.

All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus. To use one of these images, please contact us at info@kflupus.org for written permission; image credit and link-back must be given to Kaleidoscope Fighting Lupus.

All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.

 

Article by : Elizabeth Heintz

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.