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As a holistic dentist and functional medicine practitioner, I'm always looking at the big picture of health. If you've been in for a comprehensive evaluation, you've already heard me discuss the importance of nutrition, hydration, supplementation, sleep, breathing, habits, and your environment. In an effort to go deeper on some of these topics for patients who are interested and also for those who haven't come to our clinic yet, I plan to breakdown each of these topics over a series of blogs.
Today, let's discuss an essential nutrient that affects everything from our teeth to our toes: Vitamin D.
Understanding Vitamin D
Vitamin D is a unique nutrient. We refer to it as a vitamin, but it's also a pro-hormone, which means it has the ability to convert into a hormone that has far-reaching impacts on our bodies[1].
Vitamin D plays a vital role in various biological processes, including:
Regulating calcium and phosphate in the body, which are necessary for healthy teeth, bones, and muscles [2]
Supporting immune system function, which is crucial for oral health and overall wellbeing [3]
Modulating cell growth and promoting neuromuscular and cardiovascular health [4]
More specific to oral health, benefits include:
Prevention of tooth decay: Vitamin D's role in calcium regulation can help strengthen teeth and potentially prevent cavities [17] via anti-bacterial and anti-inflammatory effects.
Combat periodontal disease: Adequate Vitamin D levels can enhance immune response and mitigate the effects of periodontal disease [18].
Improve orthodontic treatment outcomes: Early research suggests Vitamin D may accelerate tooth movement during orthodontic treatment [19].
So let's clarify what our aim is. Current lab standards in the US identify a Vit D level of <30ng/mL as a deficiency, and a practitioner would recommend supplementation at that time. The US & Canadian average is 26ng/mL. But levels around 30 ng/mL have only been demonstrated to consistently prevent rickets. Meta data research has demonstrated that patients with serum levels >60mg/nL are protected by 85% from most chronic diseases. More specific to dental health, patients are more likely to present with gum disease and/or have complications healing from tooth extractions or dental implant procedures if their vitamin D levels are at these lower levels.
The Most Common Signs of Vitamin D Deficiency
Vitamin D deficiency is surprisingly common and can manifest through various symptoms, such as:
Fatigue or tiredness [5]
Frequent illnesses or infections [6]
Bone, back or muscle pain [7]
Mood changes, particularly depression [8]
Impaired wound healing, especially in the oral cavity [9]
Why Many Americans Don't Get Enough Vitamin D
Why are so many people deficient in this crucial vitamin? Here are some common reasons:
Lack of sunlight exposure
The body synthesizes Vitamin D when skin is exposed to sunlight [10]. Approximately 80% of vit D3 is built up in the skin (with the other 20% coming from diet or supplementation). However, indoor lifestyles, work schedules, geographic location, and sunscreen use can limit this exposure. More specifically, when using sunscreen with sun protection factor, as little as SPF 8 prevents vitamin D3 production by more than 97%.
Anecdotally, I have observed in my newly opened practice here in PR that many of my patients are super conscious (and safe) with sun exposure and have good habits of wearing sun protective clothing and sunscreen at all times while outside. And when they present with oral health conditions that make me curious if they have suboptimal vit D levels, they test at levels much lower than our target range of 60+ ng/mL. I understand this requires balance, and I promise this is not a post meant to instigate a fight with a FAVORITE neighborhood dermatologist Dr. Julia ;) But instead, I'm only wanting my patients to be educated on the subject and to find the right approach for themselves to ensure we keep you as healthy, as happy, and as beautiful for as long as possible! I actually love that Dr. Julia has spent time educating ME on best practices for skin cancer checks; she's always available for pathology reviews and recommendations to help patients as best as possible.
Poor diet
Few foods naturally contain high levels of Vitamin D. The most abundant sources are fatty fish, beef liver, and egg yolks [11].
Certain health conditions
Some conditions like Crohn's disease, celiac disease, and kidney disease can affect the body's ability to absorb or convert Vitamin D [12].
How to Test for Vitamin D Levels
Vitamin D deficiency is confirmed through a blood test called 25-hydroxy vitamin D test. Your healthcare provider can order this test if a deficiency is suspected [13]. More specific to my patients here in Dorado, you can go to either of the two labs nearby (the one across the street from our office or the one next door to Starbucks). You do not need a prescription. The cost for the test is $40-70 and typically isn't covered by insurance.
Ways to Increase Vitamin D Levels
If you're deficient in Vitamin D, here are ways to boost your levels:
Sun exposure: Aim for 15-30 minutes of midday sunlight exposure on your face and arms, several times per week [14].
Diet: Incorporate foods high in Vitamin D into your diet, like fatty fish, fortified dairy products, and egg yolks [15].
Supplements: If needed, a daily vitamin D supplement may be recommended. Always consult with your healthcare provider before starting any new supplement regimen [16].
For those who are supplementing, they may not be doing so strategically and thus eliminating their potential benefit. It's important for patients to know what their levels are whether they need to be on a therapeutic dosage (5,000-15,000 IU/d) or a maintenance dose (1,000-5,000 IU/d).
Generally, it takes a few weeks of taking daily vitamin D supplements for vitamin D levels in the body to rise. Each 1,000 IU of vitamin D3 taken daily is expected to raise blood levels of 25(OH)D by 10 ng/ml after a few weeks. So I typically encourage a patient to test first; then we determine what daily dosage (if any) is needed; and then pending their baseline data, we may decide to retest after 3-4 months to determine if the patient can decrease to a maintenance dosage at that time.
Other things to consider...
Is vit D the long-awaited panacea? No. Of course not. It can definitely have a huge impact on overall health and wellness, but it must be a part of a balanced lifestyle that includes good nutrition, sufficient hydration, high-quality sleep, proper breathing, and genuine purpose. We will continue to post more about all of these ideas to support our patients in their pursuit to be the healthiest and happiest versions of themselves, and more specifically, we will have additional posts related to vitamin K2, zinc, vitamin A, among other vitamins and minerals that work synergistically with vit D and can also enhance your biological pathways for optimal function.
In the meantime, remember that your healthcare provider or functional medicine practitioner can help determine the best approach for you. This blog does NOT take the place of personalized health counseling. It is important to collaborate with a provider who understands your history and goals and has the expertise to guide you on that pathway.
Stay tuned for more health-focused insights!
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[1]: [Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266-281.](https://www.nejm.org/doi/full/10.1056/nejmra070553)
[2]: [Peterlik, M., & Cross, H. S. (2009). Vitamin D and calcium deficits predispose for multiple chronic diseases. European Journal of Clinical Investigation, 39(5), 397-412.](https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2362.2009.02122.x)
[3]: [Aranow, C. (2011). Vitamin D and the immune system. Journal of Investigative Medicine, 59(6), 881.](https://jim.bmj.com/content/59/6/881.short)
[4]: [Holick, M. F. (2004). Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. The American Journal of Clinical Nutrition, 80(6), 1678S-1688S.](https://academic.oup.com/ajcn/article/80/6/1678S/4690510)
[5]: [McCarty, D. E., et al. (2012). Resolution of fatigue in patients with vitamin D deficiency. Endocrine Practice, 18(4), 567-572.](https://www.ncbi.nlm.nih.gov/pubmed/22440996)
[6]: [Aranow, C. (2011). Vitamin D and the immune system. Journal of Investigative Medicine, 59(6), 881.](https://jim.bmj.com/content/59/6/881.short)
[7]: [Plotnikoff, G. A., & Quigley, J. M. (2003). Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clinic Proceedings, 78(12), 1463-1470.](https://www.ncbi.nlm.nih.gov/pubmed/14661675)
[8]: [Anglin, R. E., et al. (2013). Vitamin D deficiency and depression in adults: systematic review and meta-analysis. The British Journal of Psychiatry, 202(2), 100-107.](https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/vitamin-d-deficiency-and-depression-in-adults-systematic-review-and-metaanalysis/853D0F13E22AC91841C27473D9A01BE6)
[9]: [Qutob, A. F., et al. (2019). The role of Vitamin D in the immune system as a pro-survival molecule. Clinical Therapeutics, 41(5), 889-906.](https://www.clinicaltherapeutics.com/article/S0149-2918(19)30130-9/fulltext)
[10]: [Holick, M. F. (2004). Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. The American Journal of Clinical Nutrition, 80(6), 1678S-1688S.](https://academic.oup.com/ajcn/article/80/6/1678S/4690510)
[11]: [U.S. Department of Agriculture, Agricultural Research Service. 2011. USDA National Nutrient Database for Standard Reference, Release 24.](https://ndb.nal.usda.gov/)
[12]: [Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266-281.](https://www.nejm.org/doi/full/10.1056/nejmra070553)
[13]: [Holick, M. F., & Chen, T. C. (2008). Vitamin D deficiency: a worldwide problem with health consequences. The American Journal of Clinical Nutrition, 87(4), 1080S-1086S.](https://academic.oup.com/ajcn/article/87/4/1080S/4633477)
[14]: [Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266-281.](https://www.nejm.org/doi/full/10.1056/nejmra070553)
[15]: [U.S. Department of Agriculture, Agricultural Research Service. 2011. USDA National Nutrient Database for Standard Reference, Release 24.](https://ndb.nal.usda.gov/)
[16]: [Dawson-Hughes, B., et al. (2017). The National Osteoporosis Foundation, Endocrine Society, and North American Menopause Society (2017) position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis International, 28(4), 1001-1025.](https://link.springer.com/article/10.1007/s00198-016-3893-4)
[17]: [Hujoel, P. P. (2013). Vitamin D and dental caries in controlled clinical trials: systematic review and meta-analysis. Nutrition Reviews, 71(2), 88-97.](https://academic.oup.com/nutritionreviews/article/71/2/88/1823750)
[18]: [Laky, M., et al. (2012). Impact of vitamin D levels on periodontal surgery outcomes. Journal of Periodontology, 83(6), 1477-1482.](https://aap.onlinelibrary.wiley.com/doi/abs/10.1902/jop.2012.110566)
[19]: [Perillo, L., et al. (2020). Influence of vitamin D on orthodontic movement: a systematic review. Journal of Biological Regulators and Homeostatic Agents, 34(2), 43-49.](https://www.ncbi.nlm.nih.gov/pubmed/32214065)
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