Misdiagnosed Vitamin D Deficiency

Interviewer:  Because of what you said where a lot of doctors aren't seeing this as a need to get tested for, vitamin D deficiency is probably still misdiagnosed as another of other things, is that correct?

Dr. James Dowd:  Yes it probably is overlooked in a number of different diseases. Chronic pain.  Something that's rising significantly in the United States right now.  There was a study that was done looking at chronic pain and they found that patients who had low vitamin D levels below normal were using twice as much pain medications as the patients in the pain clinic who had normal vitamin D levels.  And so there's a correlation there with how much pain you experience among patients with chronic pain.  Another example of a disorder that is sometimes misdiagnosed and is vitamin D deficient is fibromyalgia which is one of these chronic pain disorders.  Now I would say that the challenging thing is, because vitamin D is so prevalent it can sometimes be difficult to tease out cause from effect.  OK.  And someone who is miserably ill is going to get even less sun exposure, going to be eating the wrong foods, is going to be less physically active.  And so you don't want...I'm not saying everybody with fibromyalgia has vitamin D deficiency but probably 70% because 70% of the population is deficient.  And within those groups, and I have examples in the book of that and I'm sure other practitioners have had similar experiences is that there are occasional patients with fibromyalgia where that is primary driver of their pain and fatigue and misery and when you correct that they get dramatically better.  And you certainly don't want to miss those patients where vitamin D, a simple inexpensive solution is the primary driver of their symptom complex.

Interviewer:  Could a person be deficient and not really know it?  Is there harm in that?

Dr. James Dowd:  IN fact, most patients who have vitamin D deficiency don't know it.  And they either don't know it because they don't know what symptoms are associated with deficiency or they don't know it because they just feel fine.  And they've never measured and this is human nature that if I feel fine there's nothing wrong.  But we know that if you feel fine you could still have a cholesterol of 400.  A blood pressure of 200 over 120.  And a whole host of other things going on and you won't know until something really bad happens, OK?  So symptoms unfortunately are often a fairly late sign in any disease process of deficiency or imbalance.  And so just because you don't have any symptoms doesn't mean that you're not at risk.  Take the risk quiz online.  Or get tested and find out.  Because it's a simple test.  It's relatively inexpensive and there's some immediate things you can do to change your risk.

Interviewer:  So like any other disease like you mentioned, cholesterol, high blood pressure.  Good to get it checked to stay on top of it because once you get too far down the road it takes a lot longer to get where you want to be, a more optimal health?

Dr. James Dowd:  Right.  Well the longer you're deficient in something the more likely pathology, biological abnormalities have occurred as a consequence.  As an example, recently the institute of medicine came out with recommendations on vitamin D.  And I wrote a blog that talked about how they sort of missed the mark.  Which most of the people in the vitamin D field feel they've missed the mark.  They've moved in the right direction they're just moving at a snail's pace.  So they increased the recommended D amounts and they decreased the recommended calcium intakes.  But they just need to do that a lot more.  There was a paper I found that actually came out about a year and a half ago which really sort of definitively tells us what the cut point is for normal vitamin D levels.  And it was a study, an autopsy study, sort of gruesome.  Autopsy study done in Germany.  Because they were going to use bone biopsies as the test and it's hard to get people to volunteer for bone biopsies.  So they said, well what we want to do is take people who died from trauma but not from chronic illness and we're going to biopsy their bone and we're going to look for changes which is really a balance of mineralized versus unmineralized bone.  And there's a certain ratio that's normal and when you get outside that ratio it suggests 6there's a mineralization defect meaning calcium's not getting put into the bone normally and the most common cause of that is vitamin D deficiency.  So they thought, this would be a great way to find out over a group of people at the tissue level, not just the blood test level but actually tissue level where's this threshold for vitamin D deficiency.  And since they had blood from these former people they could measure the D level, do the bone biopsy and correlate the two.  And what they found was that as long as your vitamin D level was greater than 30 you had a normal ratio of unmineralized to mineralized bone.  And when you fell below 30 that's when you started seeing...it wasn't universal meaning everybody who had a level below 30 had abnormal mineralization of their bone...but all of the cases of abnormal mineralization fell below that threshold.  That's pretty definitive to me that there is a threshold there and that we need to have a level above 30.  Well the institute of medicine said, oh no anything above 20 or 25 is fine.  

Interviewer:  Even with that study out?

Dr. James Dowd: Even with that study out.  And after the recommendations came out I called up several of the other researchers of vitamin D.  Reinhold Vees [sp] I sent him an email I said, so what gives Reinhold?  Did they not read this data?  He says, oh they read it and it's in their report they just completely misinterpreted the study. So the institute of medicine unfortunately, there's these researchers who have been doing research on vitamin D for 30, 40 years and the institute of medicine considers them tainted, biased.  And so instead they got a whole bunch of researchers who don't do research on vitamin D to analyze the data and decide what the recommended amounts should be.  That would be like hiring non astrophysicists to work on our space program. And non rocket scientists.  Well, they're biased.  So instead of hiring rocket scientists and physicists to run NASA we're going to hire home builders and you know, plumbers.  What?  Why aren't you hiring the people who have been doing the research for the last 40 years?  It makes no sense to me.  But this is the logic that they use.  And I really can't explain the logic but it does explain their recommendations being off the mark as far as what the people who've been doing research for 30 and 40 years are saying about vitamin D.

Interviewer:  So really this should be part of our protocol when we check our blood pressure and check our cholesterol.  That should be right up there?

Dr. James Dowd:  Yeah, I honestly think for the amount that it costs which is I want to say a vitamin D test costs 50, 70, 80 bucks.  That's cheaper than a lipid profile.  Cholesterol profile's 200 bucks sometimes.  And you don't have to measure it all the time. So you measure it peak and trough.  End of summer, end of winter.  Find out what their highs and lows are.  Or replace them and then measure it peak and trough to see that they're where you want them to be at peak and trough.  And as long as they don't lose a tremendous amount of weight and their lifestyle doesn't change dramatically you may not need to measure it ever again. They just need to stay on the amount of supplement that keeps them in the middle.  So it's not something, unlike the cholesterol where you're constantly monitoring it, because there's a very simple way to replace this and normalize it unlike cholesterol when you're on meds and they sometimes work and they sometimes don't work and they have all kinds of side effects and toxicity.  This is very simple. You make the diagnosis.  You calculate the dose.  We actually have tables in the book that tell you how to very precisely calculate vitamin D replacement.  And then you remeasure two or three months later and see if you're on target.  And then you might check a peak r a trough to see that they're on target at the extremes of the year and then you're done.  And so maybe you measure it two, three, four, five, six times tops and you make never have to measure it again.  So how is this an expensive proposition?  It seems to me to be very, very simple.