Update: If you are Japan-Earthquake-Nuclear-reactor or Lybian-war "fatigued", please read ahead.
Update 2: I did want to address the Vitamin D2 (Ergocalciferol) versus D3 (Cholecalciferol) debate. I recommend either (or bot, at different phases of treatment) depending on my patient. Yes, Vitamin D3 is better for you and should be more effective. However, to my knowledge, there exists no PRESCRIPTION Vitamin D3 option. I can only prescribe (and have Insurance pay for) Ergocalciferol 50,000 IU (daily for a few days and then weekly for several weeks). Why is this important? It is not that I feel compelled to always write a prescription, it is that many PATIENTS WILL SIMPLY NOT BUY INTO the notion that their path to feeling better is NOT necessarily found at the pharmacy. Yes, I practice a bit of psychology too. :>)
I practice traditional Western primary care medicine in the Northeastern United States. My job is to see and treat a large cohort of "Dis-eases" in a contemporary American primary care practice. Being in full-time practice for five years has allowed me to meet tens of thousands of individuals who suffer many ills including: depression, chronic pain, substance abuse and addiction. In our society, it is the family physician who is on the front lines of the war against these illnesses. These patients are often complex cases that take time and energies not easily found in specialists' schedules. Too often, these individuals hurt the bottom line in the fee-for-visit scheme of medical business and as such are shunned by many of my colleagues. For reasons not fully obvious to me, I attract these patients. Given this vast opportunity to help others, I have tried to educate myself in the importance of having "the raw materials of life" available to us in our bodies in order to live a life without dis-ease.
In this context is how I learned of the importance of Vitamin D deficiency/insufficiency in the etiology of hard to define medical illness. Please follow me on this voyage in my description of my understanding of what I have learned.
Vitamin D is a group of fat-soluble secosteroids, the two major physiologically relevant forms of which are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D3 is produced in the skin of vertebrates after exposure to ultraviolet B light from the sun or artificial sources, and occurs naturally in a small range of foods. In some countries, staple foods such as milk, flour and margarine are artificially fortified with vitamin D, and it is also available as a supplement in pill form.
Vitamin D insufficiency can result in thin, brittle, or misshapen bones, while sufficiency prevents rickets in children and osteomalacia in adults, and, together with calcium, helps to protect older adults from osteoporosis. Vitamin D also modulates neuromuscular function, reduces inflammation, and influences the action of many genes. Vitamin D is a steroid vitamin, a group of fat-soluble prohormones, which encourages the absorption and metabolism of calcium and phosphorous.
What causes vitamin D Deficiency? Vitamin D is on of the most common types of vitamin deficiency. This condition appears as a result of not ingesting enough preformed vitamin D (found in eggs, fish, fortified milk and cod liver oil), lack of sun exposure (the sun helps us produce this vitamin), and malabsorption (due to conditions that keep vitamin D from converting into active metabolites). Certain conditions keep us from getting enough sun exposure, people who live near the north pole, people with dark skin, old and young people who don’t go out too much, and people who cover their skin frequently (like for example in some Muslim countries) can suffer of vitamin D deficiency caused by inadequate sun exposure. Sun exposure is the deciding factor in our levels of vitamin D, since we don’t get too much of it from food.
Imagine a new patient coming to me to establish. She is a 50-something white female who recently had her thyroid removed because of a suspicious nodule. She had Gastric Bypass years earlier and has suffered from anxiety, depression, OCD-symptoms, chronic fatigue, iron deficiency anemia. She simply has not felt well for many years and was at her wits end. Her medication list proves to me her desperation. She is currently taking Xanax 1 mg three times daily, Oxycodone IR 5 mg 4x/day, Fentanyl patch 25 mcg and Zoloft 300 mg daily.
I listen to her concerns. She feels awful. She was just released from the hospital becasue of a "complication" from her Thyroid surgery. She can not eat due to the pain in her throat. She has not slept for three days. She is in back pain constantly. She can not take it anymore. I do a thorough physical examination and do not find anything of consequence. At this point I pause. I am tempted to tell my new patient that she should relax and find some time to heal from her surgery and that everything may be in her head and that she will be fine. However, I decide to "work her up". I run a battery of tests including a Complete Blood count, an Iron level, a Thyroid function level, a Complete metabolic panel and yes, a Vitamin D level.
What I find would not surprise me. She is severely anemic. She is severely Vitamin D deficient. And yes, she is completely hypothyroid. No one had told her after her Gastric Bypass surgery that she would need to take extra Vitamins and supplements the rest of her life because with half her stomach gone and with all the anti-acid drugs she was taking that much of her food would simply not be absorbed by normal digestion. She would need to crush many of her pills and avoid capsule medications simply because they would pass right through her.
I wish I could tell you that her case was a rarity in my practice, but it is not. I am seeing more and more Gastric Bypass individuals who are ill. Surgeons and subsequent medical doctors have left these patients without the Nutritional know-how to lead a healthy and productive life. These patients go from doctor to doctor with one complaint or another and are given the "bandaid treatment of the day"- whether it be Xanax for anxiety, Oxycodone for the pain, or Zoloft for the severe depression they are suffering.
Please do not let yourself or your loved one be my next GBGB - "gastric bypass gone bad".