The D is not just for Diabetes!
More studies are being done on the implications of Vitamin D deficiency in persons with diabetes.
As much as pharmacology and medical science are unlocking the impacts of different chemicals on our bodies, the basic vitamins on the side of our Flintstones bottles still hold a great deal of mystery. There are commonly known and understood cause and effect relationships between some vitamins and physiology. For example:
- Vitamin C has long been associated with the immune system
- Vitamin E with healthy skin and hair
- Vitamin D has always been associated with healthy bone development and maintenance.
However further research has now linked Vitamin D to every disease state from Asthma to depression, respiratory infections and, yes, diabetes.
In a recent small study on painful peripheral neuropathy (A common and often debilitating complication of diabetes that causes burning, shooting, stabbing or stinging pain in the hands or feet) it was found that of all patients with neuropathy, those who also had pain and diabetes (type 2 in this study) also had the lowest levels of Vitamin D in their blood (lower than those with diabetes but without neuropathy, those with neuropathy but not diabetes and those with diabetes, neuropathy, but not pain).
At this point this is only an associative finding, in that it is not understood whether the Vitamin D deficiency is a causal factor in painful peripheral neuropathy, cooccurring, or unrelated. While vitamin D deficiencies have been linked to the development of diabetes, both types 1 and 2, Vitamin D supplementation has not been shown to reduce the onset or progression of diabetes.
Likewise, Vitamin D has been explored as an adjunctive treatment in fibromyalgia, another disease that causes nerve pain and hypersensitivity similar to that experienced in peripheral neuropathy. However Studies have not shown vitamin D supplementation to have an impact on improvement of quality of life for chronic pain issues. One hypothesis is that vitamin D deficiency lowers the pain threshold. So someone with reduced vitamin D levels may feel greater pain at a lower level of stimulus.
Is Vitamin D Deficiency Increasing?
Vitamin D deficiency in increasing in our modern world as people spend less time outdoors with direct sunlight, and use stronger UV protectants.
Exposure to sunlight activates vitamin D into a usable form that is stored in fatty acids for use in times of less available sunlight. Vitamin D is also less available in the diets of modern Americans as the popularity of vegan/plant based diets or those who do not intake dairy as dairy products are fortified with additional vitamin D. persons who have undergone gastric surgeries may also have reduced vitamin absorption, including vitamin D. In people with diabetes there may also be an aspect of malabsorption of Vitamin D.
Persons with diabetes are more likely to also have auto immune related digestive issues such a celiac, which reduce vitamin D absorption. Studies have also shown that digestive changes in enzyme production in people with diabetes can inhibit absorption of calcium and Vitamin B.
The effects of Vitamin B on nerve function is nearly identical to believed effects of vitamin D, so there may be a correlation in both the cause of these deficiencies and their impacts on nerve function, pain and cognition. This also demonstrates that there is no single aspect of pain disorders or nerve damage that can be addressed via a single causal factor.
How to get more vitamin D in your diet:
Maintaining vitamin D levels is relatively straight forward, get enough in your diet, and get enough sunshine for your body to be able to use it!
Good sources of dietary vitamin D include:
- Fish (Swordfish, salmon, sardines, tuna)
- Fortified dairy products
- Eggs
- Liver
The most biologically available vitamin sources are those from food, but vitamin D is also a readily available and inexpensive supplement.
You should discuss your personal vitamin D needs and how to best meet them with your prescriber. A cautionary message however is that due to the popularity of vitamin D supplementation for so many things, insurance companies have dramatically cut their willingness to pay for vitamin D level testing. Chances are, unless you have a documented bone density or bone development related disease, your insurance will not cover the cost of vitamin D testing. It is also not terribly useful testing to begin with, as therapeutic levels to manage different diseases or symptoms have not been established. So this testing is essentially just checking to see if levels have risen or fallen, but not to establish whether a goal level has been achieved or maintained.
You should work with your prescriber to assess vitamin D needs and appropriate supplementation as excessive levels of vitamin D can produce toxicity including calcium imbalances in the blood, anorexia, kidney stones and arrhythmias.
As researches continue to explore and unravel the complicated interweaving of vitamins, genetics, hormones, immune responses and environmental factors that are both the cause of, and caused by diabetes, we often see that the weave is more complex than we ever dreamed. This often leads to more questions than answers, but it also leads to innovative and creative therapy and prevention options. The one common thread that continues to arise is that diabetes is a far more complex disease in both cause, and complications, than any one silver bullet will ever be able to fix. Only by being aware of our bodies’ complex needs and processes can we maintain optimal wellness and reduce complication risks.
The team at Integrated diabetes uses a team approach to patient care as a response to this dynamic and complex interweaving of physiology. We need a forward thinking interdisciplinary approach to treatment and management from the worlds of nutrition, pharmacology, physiology, exercise and mental health that goes far beyond just “Checking in with the numbers”.
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