Why are we asking if you have been tested for vitamin D deficiency in this month’s MEA website poll? | 1 June 2016

Vitamin D conceptVitamin D deficiency can occur in ME/CFS and people in the moderate or severe category are at increased risk – especially if they are housebound and do not get out in the sunshine and/or are on some form of restrictive diet.

So checking for vitamin D deficiency should, where appropriate, form part of the clinical assessment for ME/CFS.

Taking a vitamin D supplement, after taking advice from your doctor or pharmacist, is also sensible if you are at increased risk.

Treating any significant degree of vitamin D deficiency – which should be under medical supervision – is also important.

All aspects of vitamin D, and vitamin D deficiency, are covered in the MEA information leaflet on vitamin D:

www.meassociation.org.uk/shop/management-leaflets/vitamin-d/


SUMMARY OF KEY POINTS RELATING TO THE VITAMIN D (25-HYDROXYVITAMIN D) BLOOD TEST


Looking for reference ranges?

The National Osteoporosis society (NOS) guidelines (UK, 2013) and the Institute of Medicine (US) classify vitamin D results as follows:

* 25-hydroxyvitamin D of less than 30 nmol/L is deficient
* 25-hydroxyvitamin D of 30-50 nmol/L may be inadequate in some people
* 25-hydroxyvitamin D of greater than 50 nmol/L is sufficient for al most the whole population.

Low blood levels of 25-hydroxyvitamin D may mean that you are not getting enough exposure to sunlight or enough vitamin D in your food to meet your body’s demand or that there is a problem with its absorption from the intestines. Occasionally, drugs used to treat seizures, particularly phenytoin (epanutin), can interfere with the liver’s production of 25-hydroxyvitamin D.

High levels of 25- hydroxyvitamin D usually reflect excess supplementation from vitamin pills or other nutritional supplements.

More info on the vitamin D blood test: http://labtestsonline.org.uk/understanding/analytes/vitamin-d/tab/glance/


SUMMARY OF RESEARCH INTO VITAMIN D AND ME/CFS FROM THE MEA PURPLE BOOK


Consider vitamin D deficiency in adults with restrictive diets and/or lack of access to sunlight.

A retrospective study of serum 25-OH (hydroxy) vitamin D le vels in 221 ME/CFS patients found moderate to severe suboptimal levels, with a mean level of 44.4nmol/l (Berkovitz et al 2009).

Vitamin D deficiency often goes unrecognised and can cause bone or muscle pain and muscle weakness. It can co-exist with ME/CFS.

Levels < 25nmol/ml may be associated with symptoms. NB: Low serum calcium and phosphate and an elevated alkaline phosphatase are consistent with osteomalacia.


RECENT HEALTH ITEM ON VITAMIN D DEFICIENCY IN THE DAILY MAIL


www.dailymail.co.uk/femail/article-3404027/Is-surprise-reason-t ired-vitamin-D-energy-lower-blood-pressure.html


ABSTRACT OF THE PAPER FROM BERKOVITZ S ET AL (International Journal for Vitamin and Nutrition Research, 2009,79, 250 – 254)


Serum 25-hydroxy vitamin D levels in chronic fatigue syndrome: a retrospective survey.

INTRODUCTION
Patients with chronic fatigue syndrome (CFS) may be at risk of osteoporosis due to their relative lack of physical activity and excessive time spent indoors, leading to reduced vitamin D synthesis. We hypothesized that serum 25-OH vitamin D levels are lower in CFS patients than in the general British population.

SUBJECTS AND METHODS
We performed a retrospective survey of serum 25-OH vitamin D levels in 221 CFS patients. We compared this to a group of patients attending the hospital for other chronic conditions and to a large British longitudinal survey of 45-year old women, using a variety of appropriate statistical approaches.

RESULTS
25-OH vitamin D levels are moderately to severely suboptimal in CFS patients, with a mean of 44.4 nmol/L (optimal levels >75 nmol/L). These levels are lower and the difference is statis tically significant (p<0.0004) than those of the general British population from a recent national survey, but similar to those in patients with other chronic conditions. CONCLUSIONS This data supports the recommendation made in recent NICE guidelines that all patients with moderate to severe CFS should be encouraged to obtain adequate sun exposure and eat foods high in vitamin D. Oral or intramuscular vitamin D supplementation should be considered for those whose levels remain suboptimal. Dr Charles Shepherd
Hon Medical Adviser, ME Association