Vitamin D Hormonal Deficiency

Paul L. Reller L.Ac. / Last Updated: August 03, 2017


There is no nutritional deficiency that better illustrates the oversimplification of nutrient medicine better than the Vitamin D deficiency. For over 80 years we have operated under misconceptions and deliberate misleading information about a hormonal and metabolic problem of great importance that has been called a simple vitamin deficiency. The nutrient molecule cholecalciferol, designated as Vitamin D3 in 1922, is considered a "conditional nutrient" by experts, and a hormone precursor, not a vitamin. The human metabolism produces and stores almost all of the cholecalciferol it uses, and dietary insufficiency is not the cause of so-called Vitamin D deficiency. On the other hand, when there is an apparent deficiency of D3, a prohormone, supplementation in the diet may help alleviate this deficiency somewhat, but this medical supplementation must use the correct type of Vitamin D supplement and a more complex restorative holistic approach to be most effective. Current recommended dietary values of cholecalciferol, or Vitamin D, are just 200-400 IU per day, though, while the body generates a highly controlled amount of about 20,000 IU per day from conversion of cholesterol in the skin. Supplementation with liquid 5000 IU daily of cholecalciferol is now common in medicine, although correction of the underlying hormone Vitamin D metabolism is needed to fully resolve this common health problem. Understanding this hormonal metabolism is the key. More and more scientific studies around the world are acknowledging that Vitamin D is a secosteroid that has long been misnamed, and that the mechanism of dysfunction in what we still term Vitamin D deficiency involves a multifactorial and broad dysfunction in a hormonal cascade and metabolism that includes the hormone that we still mistakenly call Vitamin D. To correct this problem, associated now with a broad array of chronic diseases, we must look to a more complex and holistic approach to restoration of this hormonal cascade and feedback metabolism. Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) offers the patient the best protocol to individually address this systemic hormonal deficiency, and the importance of this in preventive as well as restorative medicine should not be underestimated. Standard medicine continues to take this proven and important hormonal system lightly, still treating it as an inconsequential nutritional deficiency, and this is harming public health greatly.

Vitamin D insufficiency in blood circulation is now noted for more than a third of the adult population in the United States, with marked deficiency found in about 82 percent of the African-American population, 70 percent of the Hispanic population, and 42 percent of all racial groups taken as a whole, according to the 2006 National Health and Nutrition Examination Survey (PMID: 21310306). It is still unclear whether these subset values are pertinent to the broad population, though, as expected rates of osteopenia in the African-American population are not seen, but it is now certain that hormone Vitamin D status is systematically the same for all racial groups. Research shows that hormone Vitamin D insufficiency is highly correlated with many serious chronic diseases, yet simply taking some Vitamin D cholecalciferol supplement rarely corrects this problem of insufficiency in the long-term by itself. This is because "Vitamin D" is actually a family of molecules that are hormones, and supplementation involves adding a prehormone to the body, which doesn't insure a correction of this complex hormonal metabolism, which is a highly regulated feedback endocrine system. While this article unfortunately points out that what many of us believe, or hope, is just a low level of a nutrient in the diet, it is actually a complex problem with a complex endocrine feedback system and metabolic homeostasis, which is not what we want to hear. Gaining some understanding of the hormone D3 metabolism and underlying causes of deficient production of the hormone will help each individual to correct a very important aspect of our health. Simple taking of any "Vitamin D" pill will not really solve this aspect of disease, although it will help if the patient utilizes a more comprehensive treatment protocol that is individualized to restore this valuable hormonal homeostasis. Obviously, the protocol used in standard medicine for decades, with warnings not to supplement, using the wrong type of supplement, using too low of a dosage of the supplement, decreasing the hormone precursor cholesterol in as many patients as possible to the lowest levels, advising patients to avoid all midday sun exposure to the skin, and still ignoring the full metabolism of the hormone Vitamin D regulation and production, has been a ridiculous and deceitful protocol, and has harmed public health. The extent to which this standard medical attitude has actually contributed to ill health is still being uncovered, but should not be underestimated.

Since 2010, suddenly, the substance called Vitamin D has been hailed as the next "miracle cure", medical doctors are routinely testing for deficiency in circulation, and the number of prescriptions of Vitamin D3 have been astronomical (at what an inflated price from the pharmacist). While this would lead many patients to believe that they just need to get some Vitamin D and most of their health problems will improve, the actual story is a bit more complicated. First, Vitamin D supplement is not a vitamin, but a prohormone, and second, the D3 measured in circulation is the prehormone 25-dihydroxy-cholecalciferol, called calcidiol, and not the cholecalciferol or ergocalciferol that we take as a supplement, and third, the actual effective hormone is 1,25-dihydroxycholecalciferol, or calcitriol, which is not routinely tested to determine Vitamin D3 deficiency. Added to this is the research findings regarding problems with so-called Vitamin D receptors, which are actually hormone receptors found in the nucleus of almost all human cells. In essence, the health benefits from Vitamin D3 supplementation come from achieving hormonal balance, and not directly from the Vitamin D3 supplement itself. Supplementation with a 5000 IU daily D3 cholecalciferol supplement can be very beneficial, but unless the underlying causes of this hormone deficiency are addressed, the long-term benefits may not materialize. Standard medicine still downplays this systemic hormonal metabolism and refers to it as the free and total Vitamin D levels, instead of simply describing it in useful terms that elucidate the need to restore the whole system.

To illustrate that 'Vitamin D' is actually a hormone, or prehormone/prohormone, and that hormonal imbalance is tied to Vitamin D deficiency, we could look at a long-term study done by the U.S. military, published in 2012. Researchers went back and studied frozen blood samples of military personnel taken between 2002 and 2008, and analyzed the association between low levels of Vitamin D hormone and diabetes, a disorder of the pancreatic hormones insulin and glucagon. The researchers chose 1000 subjects that later developed Type 1 Diabetes, and matched them with 1000 non-diabetic subjects with similar age and characteristics when the blood was drawn, but who did not develop diabetes. These researchers found a strong association between low levels of Vitamin D hormone and later development of Type 1 Diabetes, with a risk for developing the disease when experiencing low levels at more than threefold for those whose Vitamin D hormone levels were below 17 nanograms. One of the study authors, Dr. Cedric F. Garland, of the University of California at San Diego, stated that while not proving causation, Type 1 Diabetes has all of the hallmarks of a disease related to a biochemical deficiency. Another study published in 2009 (Borker VV et al; Pediatric Diabetes Nov. 2009) showed that children newly diagnosed with Type 1 Diabetes had a lowered level of Vitamin D hormone than healthy controls (20 nanograms on average compared to 26 for healthy controls). Clearly, restoration of the hormone Vitamin D metabolism could be an invaluable part of the holistic protocol to prevent or treat diabetes, yet it is still not taken seriously.

Since Vitamin D hormone is a regulator of a number of important mechanisms in the body, but not directly responsible for pancreatic function and insulin production, this implies that the causative relationship is hormonal imbalance. A 2013 large population-based cohort study, conducted by the German Cancer Research Center (see study links in Additional Information) found that concentrations of 25-hydroxyvitamin D (25(OH)D) were inversely associated with with all-cause and cause-specific mortality, especially cardiovascular diseases, cancer, and respiratory diseases. A comprehensive study by the U.S. National Institutes of Health, entitled The National Institute of Environmental Health Sciences Uterine Fibroid Study, randomly reviewed the D3 cholecalciferol blood levels of 836 women, ages 35 to 49, from a community screening project conducted from 1996 to 1999, and assessed their history of uterine fibroid onset since that time. The findings showed that only 50 percent of the white women, and only 10 percent of the black women, with a history of uterine fibroids, had physiologically sufficient levels of hormone Vitamin D in circulating blood, and that those with a sufficient hormone Vitamin D level had a 32 percent lower risk of acquiring uterine fibroids, which affects at least 10-20 percent of women in the United States. The hormone Vitamin D deficiency in the African American population is due to the dark skin pigment and greater need for midday sun exposure to stimulate production of the hormone precursor in the pigmented cells of the skin, and African American women are more prone to develop uterine fibroids. A number of small studies have also found that plasma hormone Vitamin D deficiency is found in a high percentage of women with polycystic ovarian syndrome (PCOS), and in 2013 a large pilot study is being conducted at Yale University to assess this association. The challenge of finding out why these Vitamin D hormonal deficiencies occur, and how to holistically correct them, may be one of the most important subjects in preventive medicine and longevity. Unfortunately, there is no simple and direct causative relation between Vitamin D deficiency and these diseases, because the Vitamin D deficiency is, in a sense, more of a marker of disease, indicating a broader hormonal imbalance, rather than a direct causative factor. The individual patient needs to gain a better understanding of this important hormonal system and take measures to insure better function. Holistic preventive medical care in Complementary Medicine can be very helpful in this regard.

While this aspect of hormonal balance, rather than a simple dietary deficiency seen in other vitamin deficiency diseases, complicates the subject of oral supplementation therapy, the most important fact that the patient needs to know is that over 80 percent of cholecalciferol utilized in this hormonal metabolism comes from body fat stores regardless of oral intake. Comparisons of Vitamin D hormone deficiency to Vitamin C deficiency and rickets, or other simple vitamin deficiencies, for example, does not hold water. Since almost all of our D3 precursors come from storage in our fat cells, healthy fat cells, now acknowledged as an important endocrine organ, are also important, and both Vitamin D deficiency and insulin resistance may be attributed in a large sense to chronic inflammation and unhealthy lipids. Taking Vitamin D supplemental cholecalciferol allows a potential for increased calcitriol production, but does not guarantee that we are solving the deficiency. Like all hormones, our bodies need the precursor, or prohormone, and then there is a complex system of feedback regulation to insure that our bodies have a proper amount of the hormone available, but not too much, as an excess amount creates toxicity. Vitamin D toxicity is rarely caused by excess supplementation, though, but rather by a more serious dysfunction in the Vitamin D3 hormonal metabolism, and even in cases of severe disease, prolonged therapy with extremely high dosage of Vitamin D, closely monitored, rarely results in toxicity. There is virtually no need for patients to worry about Vitamin D toxicity with a normal 5000 IU supplementation. Larger dose supplementation is rarely needed, as the body has a strict daily rate limiting mechanism that makes supplementation with levels such as 50,000 IU ineffective. Numerous long-term studies have also consistently found that such large dose supplementation results in a higher circulating level with blood tests that is reversed again to deficiency as soon as this large dose supplementation stops. Current focus on Vitamin D toxicity and use of high dose supplements is proven to be a mistaken treatment protocol for almost all patients, yet persists even as standard treatment by many Complementary Medicine physicians. Sensible treatment protocol for hormone Vitamin D deficiency involves a moderate 5000 IU liquid supplement of cholecalciferol, combined with a more holistic and individualized approach to systemic hormonal balance and restoration. D3 has become known to be a very important hormone in the body, utilized by a wide variety of cells to stimulate many important cellular processes, but for many individuals with health problems and hormonal imbalances, simply increasing the supply of the prohormone, or precursor, may not be enough to correct the hormone deficiency. This is where a more comprehensive holistic therapeutic approach becomes important. Working on the whole health picture insures both correction of Vitamin D hormonal deficiencies, and creates a healthier life.

The hormonal deficiency, or imbalance, called Vitamin D deficiency, is now linked in scientific studies to a variety of diseases, including Type 1 Diabetes, Osteoporosis, Psoriasis, Rheumatoid Arthritis, Depression, Inflammatory Bowel Disease, Multiple Sclerosis, Cardiovascular disease, Chronic Fatigue syndrome, Hypertension, Leiomyomas (uterine fibroids), Polycystic Ovarian Syndrome, early stages of Alzheimer's disease and other neurodegenerative dementias, and various other hormonal and immune imbalances. Understanding what so-called Vitamin D deficiency, which is actually a hormonal imbalance, really entails, enables the patient and physician to correct this problem efficiently. Utilizing a holistic approach with Complementary and Integrative Medicine (CIM/TCM) helps each individual correct the various health problems underlying their hormone Vitamin D deficiency.

As the subject of Vitamin D or hormone D3 deficiency has become more prominent in relation to a variety of common diseases, the research has blossomed, revealing more important, but confusing, aspects of this hormonal homeostasis. In 2008, a study at the Queensland University of Technology, and National Center for Environmental Toxicology at the University of Queensland in Australia, found that there was a nonlinear relationship between exposure to sunlight, or UNV radiation, and cholecalciferol synthesis. The research found that the production of cholecalciferol in the skin with exposure to sunlight is directly restricted by the concentration of its precursor, 7-dehyrocholesterol, or 7-DHC (see the link to the study in Additional Information). Deficiency of the ultimate Vitamin D hormone may thus be related to a number of problems, the first of which is restriction or alteration of the cholesterol metabolite in the skin. Since a considerable percentage of the population now takes a cholesterol inhibiting drug, or statin, this may be of great significance. Of course, there are always a number of factors that could be causing a deficiency of 7-DHC in the stored epidermis. The overuse of statin drugs is now clearly proven to be a contributor to many disease states, though, and many healthier protocols are more effective to regulate lipid cholesterols. The negative effects of hormone Vitamin D deficiency, clearly linked to insulin resistance and cardiovascular disease, are perhaps greater than the benefits from taking statin drugs for a majority of the patients prescribed them.

In the last 15 years, studies have shown a significant benefit for over half of the patients in numerous studies treating a wide variety of disorders with Vitamin D3 cholecalciferol. Poor calcium regulation in osteoporosis and osteomalacia, insulin resistance and metabolic syndromes, chronic high blood pressure, autoimmune disorders such as multiple sclerosis, chronic kidney disease, health problems in hemodialysis, and breast and prostate cancers, have all been treated successfully with Vitamin D3 cholecalciferol high dose. A study published in the March 13, 2013 edition of the journal of the American Heart Association, Hypertension, and conducted at Brigham and Women's Hospital, Massachusetts General Hospital, and the Dana Farber Cancer Institute, showed that Vitamin D3 cholecalciferol prohormone had a dose-dependent effect on high blood pressure, especially in the female population, with 4000 IU per day reducing high systolic blood pressure on average 4 points for black Americans in studies, a significant reduction. The link to thyroid and parathyroid function suggests that patients with these problems could also benefit. These many studies have also revealed, though, that the active hormone levels, and the circulating prehormone levels, have not increased significantly in a high percentage of patients receiving the high dosage supplementation with the prohormone. For these patients, a more comprehensive treatment protocol may be necessary to achieve the desired results in the long run. Utilizing a more comprehensive restorative protocol, with short courses of acupuncture, herbal and nutrient medicine, and bioidentical hormone topical creams in addition to a quality 5000 IU liquid cholecalciferol supplement could provide dramatic results. Such a protocol could also restore this hormonal metabolism and end the need for the supplement. Most studies have shown that simply taking this supplement will always improve the hormone Vitamin D levels in circulation, but when stopping the supplement, they quickly fall. This means that the causes and factors involved in the deficiency need to be addressed.

Standard high dose Vitamin D3 supplementation utilizes 5000 IU (international units) of cholecalciferol, but if the precursors are present in sufficient amounts in our body (stored metabolites of cholesterol in the epidermis), the skin cells can manufacture 50,000 IU with less than 10 minutes of midday sun exposure to ultraviolet light (UVB radiation). It is thought that a rate limiting effect limits production to 20,000 IU, though, unless there is increased demand. The fact that many healthy, active individuals, who get midday sun exposure regularly, and eat well, are still deficient in circulating D3, tells us that there is more to the problem than a simple lack of sunshine or an unhealthy diet. Vitamin D3 prehormone calcidiol (produced from the D3 prehormone cholecalciferol) is also stored in body fat, and various mechanisms insure that we store and utilize it in a balanced manner. This allows us to have a constant supply of D3 hormone when the sun is not shining. Insulin resistance and Metabolic Syndrome often leads to obesity, which is tied to a systemic problem of fat cell metabolism and low-grade inflammatory dysfunction in the fatty tissues, which is now recognized as an endocrine system. Many studies link hormone Vitamin D deficiency to insulin resistance and diabetes, showing that there is a 'vicious cycle' of dysfunction.

Increasing midday sun exposure to the skin and taking a cholecalciferol supplement does indeed correct the so-called Vitamin D deficiency in many patients, with persistence, but in even more patients this does not have a significant effect, because the real problem is an underlying metabolic and hormonal imbalance. Since calcidiol may also store in the body fat, and measurement of circulating calcidiol is thus not completely precise in predicting the availability of this prehormone, we have been wary of utilizing high dose supplementation in the past. Supplementation toxicity has been observed in patients that received 50,000 IU daily for 3-4 months, but most of these cases involve prescription of D2 ergocalciferol, or other Vitamin D metabolites that have less affinity for D3 receptors, and store less easily in our fat cells. Use of Vitamin D prehormone supplementation at this dosage is still used, but always with monitoring in a specialist's clinic. Symptoms of toxicity include high blood pressure, loss of appetite, and nausea, followed by excess urination, and further prolonged treatment may damage the kidneys. There has been no note of toxicity with standard 1000 to 5000 IU supplementation for a few months, but the high dosage in not recommended for children.

The deficiency of the hormone called Vitamin D3 can be easily monitored now with blood-spot laboratory analysis of active Vitamin D3 metabolites, and clinically, physicians and patients are finding that a great majority of patients are highly deficient in this hormone, and that even high dosage of the supplement doesn't have enough effect. This is because there are natural limitations in conversion of the prehormone to the prohormone, and a variety of health issues and hormonal balancing must be optimized. Understanding these health issues and addressing them holistically is the answer to effective restoration of the D3 hormone. The problem with misnaming is confusing to the patient in this task, because we mistakenly call the prohormones cholecalciferol and ergocalciferol vitamins, namely D3 and D2, and we also call the main version of the hormone in circulation Vitamin D3, instead of calcitriol. Researchers have also now identified a second important hormone that our bodies create from the prehormones in our kidney and adrenal glands, and this hormone, now also called Vitamin D3, is important in the regulation of cartilage formation. Increased need for this second version of the hormone could also effect the amount of the calcitriol produced. Calling these chemicals by their real names would emphasize their ties to healthy cholesterol and calcium regulation. Simplistic supplementation with some version of what is called Vitamin D may not have sufficient effect in many patients and discourage use. While it is not suggested that the patients should abandon Vitamin D3 cholecalciferol supplementation, they should be aware that there may be a need to correct the underlying problems leading to this important hormone deficiency to make the supplementation effective, as well as individualizing needs and dosages, and to utilize more monitoring.

In the last 15 years, all of these D3 chemicals, cholecalciferol, calcidiol, calcitriol, and its analogue hormones, have been found to be important to a wide variety of cellular processes. We have known of the importance of these chemicals since 1922, but have been wary of toxicity from higher dosage, and the Vitamin D supplements in the past usually consisted of other metabolites than cholecalciferol (beware of the supplement products that only say Vitamin D). This use of other Vitamin D metabolites itself may have created a problem with the hormone balance in the body. Also, the advice to always wear sunblock on the skin, and even the habit of wearing standard sunglasses has decreased the ability of the body to create Vitamin D cholecalciferol. There are a variety of reasons, not just one, that create widespread Vitamin D hormone deficiency in the population. Besides taking cholecalciferol supplement and getting up to 10 minutes of direct midday sun exposure to the skin (midday exposure is important, as the precursors mainly respond to a limited band of ultraviolet), there may be other ways to help restore this important hormonal metabolism by holistically improving your health, adopting specific dietary habits, and avoiding environmental chemicals. Ignoring the big picture is not a ticket for success.

Utilizing a professional, such as a Naturopath, or Licensed Acupuncturist and Herbalist with knowledge of Nutrient Medicine, insures that you avoid the pitfalls of poor utilization and problems with nutrient supplements as a medicine. With Vitamin D, which is not a vitamin but a prohormone, a more comprehensive treatment protocol may be needed for you to utilize Vitamin D3 and restore the whole system.

The problems with Vitamin D supplementation in the past will shock the patient population. A study (cited below) in 1992, in Japan, found that the common forms of Vitamin D supplement, ergocalciferol and 7-dehydrocholesterol (7DHC), did not transport to the skin as the precursor to cholecalciferol, but mostly were excreted in feces, with the remaining Vitamin D supplement metabolizing into simple cholesterol or brassicholesterol. Despite this fact, Vitamin D supplements and multivitamins almost exclusively used ergocalciferol and 7HDC until recently, and some Vitamin D products still use these chemicals instead of cholecalciferol. More recent research has found that oral supplements exert a limited effect on total production of the Vitamin D3 prehormone, with most of the hormonal metabolism coming from stored Vitamin D in fatty tissues, which are best utilized when hormonal balance and metabolic and inflammatory mechanisms are healthy and optimal. For decades, standard medicine advised patients to avoid higher dosage of Vitamin D in supplementation, suggesting that they should stick to supplement doses of about 100 to 500 IU, and that workable dosages of 5000 IU of cholecalciferol were dangerous. Now that the research is overwhelming concerning widespread hormone Vitamin D deficiency, and the many health problems associated with this deficiency, as well as the safety profile of this dosage of cholecalciferol D3, this advice is reversed. Still, standard medicine is again lagging behind the research, pretending that a supplement course alone will fix the problem. A more holistic approach to correcting this hormonal imbalance is needed.

When something doesn't work, the rational course of action is to find out why. Instead, the medical community is touting increased prescription of Vitamin D3 cholecalciferol without exploring the problems of why the public at large is deficient in this hormone, and why, for a large percentage of patients, simple supplementation does not have enough effect. Again, for many patients, a combination of increased midday sun exposure for 10 minutes (a walk outside at lunch with arms and face exposed to direct sunlight; sunlight refracted through glass is insufficient; skin covered with sun block is insufficient), and supplementation with Vitamin D3 cholecalciferol of high quality, does have a dramatic effect over time, but for many more, this is insufficient to correct the hormonal imbalance. For these patients, understanding of the problem will lead to the steps necessary to restore your health. This may take a more holistic approach to treatment and therapeutic routines. The first step is to read and research, so that you will understand the individualized approach necessary to bring back optimum health. When the problems with your health are complex, and a variety of health problems are interrelated, the patient needs to take a proactive approach and be the most active member of the treating team. This article will help you to understand your condition and take the steps necessary to correct them.