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Low Vitamin D Increases Risk for Injuries

A study of 214 prospective National Football League players found that 73 percent of those who were deficient in vitamin D had a severe lower leg injury when they played in college, compared to only 40 percent of those who were not deficient in vitamin D (Arthroscopy, Dec. 21, 2017). Eighty-six percent of those who missed college games because of lower leg injuries were vitamin D deficient.

If you suffer muscle or tendon injuries , particularly during the winter or early spring, ask your doctor to order a blood test for hydroxy vitamin D. If it is below 30 ng/ml, you probably need more exposure to sunlight or you may need to take vitamin D pills.

My Personal Experience
During my competitive running career, I spent more time injured than training because of wintertime muscle injuries in Boston and Washington, D.C. Many years later, I found the cause: my wintertime vitamin D3 blood level was below 20 ng/ml (normal for the general population is >20 ng/ml and for athletes is >30). Since I moved to Florida nine years ago, I have not had even one wear-and-tear sports injury. I now know that people who are genetically susceptible to vitamin D deficiency are the ones most likely to suffer muscle weakness, injuries and poor athletic performance. I believe that sunlight offers benefits that cannot be obtained from vitamin D pills.

No Need to Take More than 1000 IU of Vitamin D
There is no proven benefit from taking doses of vitamin D >1000 IU/day or having very high blood levels (>30ng/ml). Raising blood levels of hydroxy vitamin D from 20 to 30 ng/ml with high doses of vitamin D pills increases calcium absorption by only one percent and does not increase bone mineral density or physical function, compared with placebo (Curr Opin Endocrinol Diabetes Obes, Dec 2016;23(6):440-444). High doses of vitamin D can cause nausea, constipation, kidney stones, frequent urination, muscle weakness, irregular heartbeats and possibly arteriosclerosis. See my report on Vitamin D Research

The Institute of Medicine recommends that adults need only 600–800 IU of vitamin D per day and that blood levels of hydroxy vitamin D do not need to be higher than 20 ng per milliliter (Curr Opin Endocrinol Diabetes Obes, Dec 2016;23(6):440-444). Higher blood levels of hydroxy vitamin D (greater than 20 ng/ml) do not make bones stronger than lower blood levels as they do not reduce levels of parathyroid hormone or bone resorption (Curr Rheumatol Rep, June 2011;13(3):257-64).

Confusion about Vitamin D Deficiency
It is difficult for doctors to identify patients with vitamin D deficiency because most commercial laboratories do not offer a test for the active form of vitamin 1,25 dihydroxy vitamin D. Instead, laboratories measure an inactive form called hydroxy vitamin D. The massive doses of vitamin D recommended by some doctors do not raise the active form of vitamin D because your own body tries to protect you from poisoning by breaking down the active form. You cannot develop vitamin D poisoning from too much sunlight because sunlight breaks down vitamin D just as it helps your body to make it, so as you keep exposing your skin to sunlight, blood levels reach a certain level and do not rise higher. Massive doses of vitamin D pills such as 150,000 IU every three months fail to raise blood levels of the active 1,25 hydroxy vitamin D (J Adolesc Health, Jul 2015;57(1):19-23).

Many studies show that people with dark skin have lower levels of the inactive form of vitamin D. It's a different story when doctors measure blood levels of the active form of vitamin D. People with dark skin are able to use a much higher proportion of the active form of vitamin D (N Engl J Med, Nov 21, 2013;369(21):1991-2000).

You probably do not need to take vitamin D pills if your blood level of hydroxy vitamin D is above 30 ng/ml unless you have a condition that your doctor feels puts you at increased risk for the signs and symptoms of a deficiency. You can take up to 1000 IU/day of vitamin D pills if your blood levels are below 30 ng/ml. Most researchers and clinicians now feel that, with few exceptions, high doses of vitamin D are not beneficial and are potentially harmful. People who could possibly benefit from treating low blood levels of hydroxy vitamin D (<20 ng/ml) include those who:
• are inactive and do not go outdoors
• suffer from generalized muscle and joint pain
• are athletes with recurrent injuries and decreased performance
• have weak bones (osteoporosis)
• are diabetic, particularly if LDL cholesterol is over 100
• have an auto-immune disease
• are critically ill or debilitated
• suffer from muscle pain from taking statin drugs

My Recommendations
If you suffer from muscle pain, injuries or weakness:
• Get your hydroxy vitamin D level checked. That is the only available dependable test. If it is below 30 ng/ml (75 nmol/L), you may be deficient. You can try taking vitamin D3 at a dose of up to 2000 IU/day for a month.
• If that does not bring your hydroxy vitamin D level to normal, you can check with your doctor about taking higher doses. However, taking more than 2000 IU/day is highly controversial.
• Some people will have their hydroxy vitamin D levels above a normal 30 ng/ml and still suffer from muscle weakness, fatigue, pain and injuries. These people may benefit from exposure to sunlight. Sunlight offers benefits that may go beyond just those of raising vitamin D levels.
• Since skin cancer is caused by cumulative exposure to sunlight over a lifetime, you should restrict exposure to sunlight on your most-often sun-exposed areas: head, face, top of ears, arms and hands. Try exposing your legs and bathing suit areas. Be careful to avoid sunburn. Start with low exposures of a few minutes and work up gradually. You cannot tell that you have suffered a sunburn until the next day when your skin will burn, itch and perhaps blister. 

December 31st, 2017
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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