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BASIC INFORMATION
DESCRIPTION
Rickets and osteomalacia are two forms for the disorder caused by vitamin D deficiency.
RICKETS
In children, this disease is called rickets, the softening and weakening of bones, usually as a result of either of an extreme and prolonged inadequate intake of vitamin D or from too little exposure to sunlight. Sunlight causes vitamin D to be synthesized in the skin. A deficiency of vitamin D makes it difficult to maintain proper calcium and phosphorus levels in the bone and the lack of vitamin D in turn affects the body's ability to absorb calcium and phosphorus. If a vitamin D or calcium deficiency causes rickets, adding vitamin D or calcium to the diet generally corrects any resulting bone problems for your child. Vitamin D deficiency is the most common cause of nutritional rickets in children, which presents as bowing of the legs. Rickets due to a genetic condition may require additional medications or other treatment. Some skeletal deformities caused by rickets may need corrective surgery.
OSTEOMALACIA
Osteomalacia is not the same as osteoporosis, another bone disorder that can also lead to bone fractures. Osteomalacia results from a defect in the bone-building process, while osteoporosis develops due to a weakening of previously constructed bone.
In adults, vitamin D deficiency disease is referred to as osteomalacia and is usually related to the body's inability to absorb phosphorus and calcium properly. It is most likely to occur in pregnant women and nursing mothers, whose nutritional requirements are higher than normal, or in people with malabsorption problems.
Malabsorption is the failure of the body to properly absorb vitamins, minerals, and other nutrients from food. Even though his or her diet is adequate, and individual with malabsorption develops various nutritional deficiencies. This problem can result form impaired digestion, impaired absorption of nutrients into the bloodstream from the digestive tract (especially the small intestine), or both.
It may also affect individuals who do not get enough exposure to sunshine or those whose diets are so low in fat that adequate bile cannot be manufactured and vitamin D cannot be absorbed. This condition can be caused by chronic renal failure. Osteomalacia is difficult to diagnose and is often misdiagnosed as osteoporosis.
MoonDragon's Health & Wellness: Malabsorption Disorders
Vitamin D is important for calcium balance (homeostasis) and for optimal skeletal health. Vitamin D without subscripts refers to either vitamin D-2 or vitamin D-3. Vitamin D-3, also known as cholecalciferol, is either made in the skin or obtained in the diet from fatty fish. Vitamin D-2, also known as ergocalciferol, is obtained from irradiated fungi, such as yeast. Vitamin D-2 and vitamin D-3 are used to supplement food products or are contained in multi-vitamins. Past studies suggested that vitamin D-3 may be more effective than vitamin D-2 in establishing normal vitamin D stores. However, a study by Holick and colleagues demonstrated that vitamin D-2 and vitamin D-3 appear to be equipotent in raising 25(OH)D concentrations when given in daily doses of 1000 IU.
CAUSES
Vitamin D acts as a hormone to regulate calcium and phosphorus levels in your bones. If you do not get enough vitamin D, your body will not absorb calcium and phosphorus properly. When your body senses the imbalance of calcium and phosphorus in your bloodstream, it reacts by taking calcium and phosphorus from your bones to raise blood levels to where they need to be. This softens or weakens the bone structure, which can result in skeletal deformities, such as bowlegs or improper curvature of the spine. Osteomalacia is the adult version of rickets.
Even as an adult, your bones are undergoing constant remodeling. At any moment, small areas of bone in your body are being broken down by specialized cells called osteoclasts and rebuilt by cells called osteoblasts. Bone construction begins with a base composed of collagen, a fibrous connective tissue. As bone is formed, collagen fibers adhere to each other in a crisscross pattern (matrix). Then minerals, including calcium, are incorporated into the matrix in a process called mineralization. The strength of new bone depends on the amount of minerals incorporated into the matrix: The more minerals built into the matrix, the stronger the bone.
Usually, the cause of osteomalacia is a deficiency in vitamin D. Vitamin D insufficiency can cause osteomalacia because vitamin D facilitates the absorption of calcium and other minerals in your gastrointestinal tract necessary for bone building. Without vitamin D, calcium and other minerals are not absorbed as readily, so they are not available for mineralization in the bone-building process. This results in "soft" bones - called osteomalacia.
Vitamin D deficiency can result from a variety of causes, including:
- Inadequate exposure to sunlight. Your skin produces vitamin D when it is exposed to sunlight. An inadequate exposure to sunlight causes a deficiency in cutaneously synthesized vitamin D. Osteomalacia can develop in people who spend little time in sunlight, wear very strong sunscreen, remain covered while outside, or live in areas where sunlight hours are short or the air is smoggy.
Vitamin D insufficiency is highest among people who are elderly, institutionalized, or hospitalized. Adults in nursing homes or health care institutions are at a particularly high risk. In the United States, 60 percent of nursing home residents and 57 percent of hospitalized patients were found to be vitamin D deficient. However, vitamin D insufficiency is not restricted to the elderly and hospitalized population. Several studies have found a high prevalence of vitamin D deficiency among healthy, young adults. A study from Boston determined that nearly 2/3 of healthy, young adults in Boston were vitamin D insufficient at the end of winter. Similar rates of vitamin D deficiency have been reported in Europe and Canada. A greater prevalence of vitamin D deficiency exists in Middle Eastern countries. A study of 316 young adults aged 30-50 from the Middle East showed that 72.8 percent had 25(OH)D values of less than 15 ng/dL (that is, severely deficient). This was significantly more common in women than in men (83.9 percent VS 48.5 percent). The difference between sexes probably reflects the cultural and religious practices leading to less skin exposure in women than in men.
- Food & nutrition. Your intestines absorb vitamin D that is found naturally in foods you eat, or added to it during processing, or from supplements or multi-vitamins you may take. Eating a lack of vitamin D rich foods can result in rickets or osteomalacia. A diet low in vitamin D is the most common cause of osteomalacia worldwide. However, it is a less common cause in the United States because many foods, such as milk and cereals, are fortified with vitamin D.
- Vitamin D malabsorption problems. People who have undergone resection of the small intestine are at risk for this condition. Diseases associated with vitamin D malabsorption include celiac sprue, short bowel syndrome, and cystic fibrosis. Surgical removal of all or part of the stomach (gastrectomy), or to remove or bypass your small intestine or celiac disease, in which the small intestine does not absorb certain nutrients from the food can result in malabsorption problems and can cause osteomalacia. Celiac sprue is an autoimmune disorder in which the lining of the small intestine is damaged by consuming foods containing gluten, a protein found in wheat, barley and rye. A damaged intestine lining does not absorb nutrients, such as vitamin D, as well as a healthy one does. Additionally, conditions that impair the absorption of any fat soluble vitamin, which includes A, D, E and K, increases the risk of rickets or osteomalacia. Osteomalacia can also be caused by other disorders that interfere with Vitamin D metabolism. These include kidney failure and primary biliary cirrhosis, which occurs when the liver's bile-carrying ducts are damaged. Several kidney disorders, including renal tubular acidosis and Faconi syndrome, cause phosphorus and other substances to be excreted in the urine instead of being absorbed normally into the bloodstream. Tumor-associated osteomalacia occurs when some types of cancers secrete a substance that affects your kidneys' ability to absorb phosphorus causing osteomalacia.
- Hereditary rickets (X-linked hypophosphatemia). Rare genetic forms of rickets occur because of defects in vitamin D metabolism. An inherited form of rickets is caused by the inability of the kidneys to retain phosphorus or a complication of renal tubular acidosis, a condition in which your kidneys are unable to excrete acids into urine. Vitamin D-dependent rickets type I occurs because of a defect in the renal 25-hydroxyvitamin D-1 alpha-hydroxylase that results in decreased 1,25(OH)2D production. Vitamin D-dependent rickets type II occurs when a mutation exists in the VDR.
- Minimal amounts of vitamin D in human breast milk. The American Academy of Pediatrics recommends vitamin D supplementation starting at age 2 months for infants fed exclusively with breast milk.
- Medications. Some medications are associated with vitamin D deficiency. Drugs used to treat seizures, including phenytoin (Dilantin, phenobarbital, phenytek, and rifampin) can induce hepatic p450 enzymes to accelerate the catabolism of vitamin D and cause osteomalacia.
- Race. Darker skin interferes with the cutaneous synthesis of vitamin D. A study from by Holick and coauthors demonstrated that non-Hispanic black subjects require 6 times the amount of UV radiation necessary to produce the similar serum vitamin D concentration seen in non-Hispanic white subjects. The explanation for the increased radiation necessary to increase vitamin D levels is that melanin absorbs ultraviolet radiation. A higher prevalence of vitamin D insufficiency exists among non-Hispanic black persons. Dawson-Hughes and colleagues demonstrated that in Boston, 73 percent of elderly black subjects were vitamin D insufficient, compared with 35 percent of elderly non-Hispanic whites. In a large survey of 1500 healthy black women younger than 50 years, 40 percent were vitamin D deficient (25[OH]D less than 16 ng/mL), as compared with 4 percent of 1400 white women in that study. The decreased efficacy of vitamin D production by darker-pigmented skin explains the higher prevalence of vitamin D insufficiency among darker-skinned adults.
- Age. Vitamin D production in the skin declines with advancing age, making elderly populations more dependent on dietary vitamin D. For the average older person, higher dietary intake of vitamin D may be required to achieve optimal serum levels of 25(OH)D.
SCIENTIFIC VIEW OF VITAMIN D PRODUCTION
The production of vitamin D-3 in the skin involves a series of reactions initiating with 7-dehydrocholesterol. Upon exposure to ultraviolet B (UVB) radiation between the wavelengths of 290-315 nm, 7-dehydrocholesterol is converted to previtamin D-3, which is then converted to vitamin D-3 after a thermally induced isomerization reaction in the skin. From the skin, newly formed vitamin D-3 enters the circulation by binding to vitamin D binding protein (DBP). In order to become active, vitamin D requires 2 sequential hydroxylations to form 1,25-dihydroxyvitamin D (1,25[OH]2D).
Vitamin D is initially hydroxylated in the 25 position by the hepatic microsomal and/or mitochondrial enzyme vitamin D 25-hydroxylase. The second hydroxylation occurs in the kidney by the P450 enzyme 25-hydroxyvitamin D-1 alpha-hydroxylase. Upon entering the cell, the 1,25(OH)2D hormone binds to the vitamin D receptor (VDR). The bound vitamin D receptor then forms a heterodimer with the retinoic acid X receptor (RXR). This heterodimer then goes to the nucleus to bind deoxyribonucleic acid (DNA) and increases transcription of vitamin D-related genes.
The major function of vitamin D is to increase the efficiency of calcium absorption from the small intestine. Heaney and colleagues demonstrated that maximum calcium absorption occurs at levels of 25-hydroxyvitamin D (25[OH]D) greater than 32 ng/mL. Vitamin D also enhances the absorption of phosphorus from the distal small bowel. Adequate calcium and phosphorus absorption from the intestine is important for proper mineralization of the bone. The second major function of vitamin D is for the maturation of osteoclasts to resorb calcium from the bones.
Inadequate circulating 25(OH)D is associated with elevated parathyroid hormone (PTH); this condition is called secondary hyperparathyroidism. The rise in PTH may result in increased mobilization of calcium from the bone, which results in decreased mineralization of the bone.
Of note, prolonged exposure to the sun does not cause vitamin D toxicity. This is because after prolonged UVB radiation exposure, the vitamin D made in the skin is further degraded to the inactive vitamin D metabolites tachysterol and lumisterol.
SYMPTOMS
Vitamin D deficiency begins slowly before physical signs and symptoms of rickets appear. Common early signs and symptoms of vitamin D deficiency include:
- Nervousness.
- Painful muscle spasms.
- Leg cramps.
- Numbness in extremities.
Ultimately more serious signs and symptoms appear with prolonged vitamin D deficiency. When rickets or osteomalacia signs and symptoms develop, they may include:
- Bone (and skeletal) malformations or deformities. This developing is due to softening of the bones, such as bowed legs, knock-knees, scoliosis (curvature of the spine), protruding breast bone, and/or beading at the ends of the ribs.
- Fragile bones. Children with rickets are more prone to bone fractures.
- Tooth decay and dental problems. These include defects in tooth structure, increased chance of cavities, poor enamel and delayed formation of teeth.
- Bone pain. This includes dull, aching pain or tenderness in the spine (especially the lower spine), pelvis, legs and feet. Pain associated with osteomalacia is usually dull and aching and worsens during physical activity. You might notice that gently pressing on a bone, on your shin, for example, produces severe pain.
- Muscle weakness. Decreased muscle tone may make movement uncomfortable. Osteomalacia can cause weakness or stiffness in your arms and legs, decreased muscle tone and discomfort while moving. Some people with osteomalacia walk with a waddling motion.
- Delayed walking in young children may be associated with rickets.
- Irritability.
- Restlessness.
- Failure to grow normally. Impaired or delayed growth in height or limbs may be a result of rickets.
- Profuse sweating.
- Chronic muscle aches and pains.
CLINICAL MANIFESTATIONS OF OSTEOMALACIA (RICKETS)
PREVENTION
Although most adolescents and adults receive much of their necessary vitamin D from exposure to sunlight, infants and young children need to avoid direct sun entirely or be especially careful by always wearing sunscreen.
VITAMIN D SUPPLEMENTS
In light of these factors, and because human milk contains only a small amount of vitamin D, the American Academy of Pediatrics (AAP) recommends that all breast-fed infants receive 400 international units (IU) of oral vitamin D daily beginning during the first two months of life and continuing until the daily consumption of vitamin D-fortified formula or milk is two to three glasses, or 500 milliliters (mL). AAP also recommends that all children and adolescents should receive 400 IU a day of vitamin D.
Vitamin D supplements for infants generally come in droplet form. Use only supplements that contain up to 400 IU of vitamin D per mL or tablet. Avoid supplements containing a higher concentration of vitamin D (some forms come in levels of up to 8,000 IU/mL), because they are unsafe for children.
For adults, the Institute of Medicine (IOM) recommends that adults up to age 50 consume 200 IU daily. For people between ages 50 and 70, the IOM recommends 400 IU every day, and people over age 70 are advised to consume 600 IU daily.
PREVENTING OSTEOMALACIA
Osteomalacia caused by inadequate sun exposure or a diet low in vitamin D often can be prevented. Here are a few suggestions to help reduce your risk of developing osteomalacia:
- Spend a few minutes in the sun. Direct sun exposure to your arms and legs for five to 10 minutes daily is sufficient for proper vitamin D production. If you live in a cold climate and do not get much sun exposure during the winter, you can build up vitamin D stores in your skin during the warmer months.
- Using sunscreen regularly helps prevent skin cancer and premature skin aging, but there is some concern that the frequent application of strong sunscreen increases your risk of developing osteomalacia. Using sunscreen will not increase your risk if you follow the American Academy of Dermatology's guidelines for sunscreen use. If you are going to be in the sun for more than 20 minutes, the Academy recommends that you generously apply sunscreen with a sun protection factor (SPF) of at least 15 to all exposed skin surfaces and reapply every two hours or after swimming or heavy sweating.
- Eat foods high in vitamin D. These include foods that are naturally rich in vitamin D, including oily fish (salmon, mackerel, sardines) and egg yolks. If you're a vegetarian, look for foods that are fortified with vitamin D, such as cereal, bread, milk and yogurt.
- Take supplements, if needed. If you do not get enough vitamins and minerals in your diet or if you have a medical condition affecting the ability of your digestive system to absorb nutrients properly, ask your health care provider about taking vitamin D and calcium supplements.
- Weight-bearing exercise, such as walking, helps strengthen bones, but if you have slight fractures in your bones due to osteomalacia, avoid strenuous exercise until your bones heal.
GETTING ENOUGH CALCIUM
Calcium and phosphorus consumption are also important for bone formation in childhood. Breast milk is a good source of calcium, as are most commercially available formulas.
Recommended daily intake of calcium is as follows (serving sizes vary with age):
- 1 to 3 years of age. 500 milligrams (mg) (two servings of dairy products a day).
- 4 to 8 years of age. 800 mg (two to three servings of dairy products a day).
- 9 to 18 years of age. 1,300 mg (four servings of dairy products a day).
- 19 to 50 years of age. 1,000 mg a day (three servings of dairy products a day).
- Older than 50. 1,200 mg a day (nearly four servings of dairy products daily).
Milk and dairy products are common sources of calcium. Other sources of calcium include leafy green vegetables (for example, spinach), fortified orange juices, fortified breakfast cereals and calcium supplements.
VITAMIN D DEFICIENCY RISKS & SUPPLEMENT TREATMENT
RICKETS RISK FACTORS
Children 3 to 36 months old are most at risk of rickets because they are growing rapidly, and vitamin D, calcium and phosphorus play a major role in the growth process.
Other risk factors for rickets include:
- Lack of vitamin D. Breast-fed infants who do not receive supplemental vitamin D are at increased risk of developing rickets because although vitamin D does cross from mother to baby in the breast milk, it is not enough to prevent a deficiency. While exposure to sunlight could produce the necessary amounts of vitamin D, sunburn and skin cancer are real dangers. Sunscreens, which are used to protect against these dangers, can decrease vitamin D production by blocking the sun's ultraviolet rays.
- Lack of calcium and phosphorus. Children who do not get enough calcium and phosphorus in their diets are at increased risk of rickets.
VITAMIN D INSUFFICIENCY STUDIES
The treatment of vitamin D insufficiency can decrease the risk of hip and non-vertebral fractures. A meta-analysis found that vitamin D supplementation reduces the risk of hip fractures by 18 percent when vitamin D and calcium are taken together. Most of the trials that demonstrated the anti-fracture efficacy of vitamin D used approximately 800 IU of vitamin D-3. The minimum 25(OH)D level at which anti-fracture efficacy was observed was 30 ng/ml (74 nmol/L), suggesting a threshold for optimal levels of 25(OH)D for fracture protection.
Vitamin D insufficiency contributes to osteoporosis by decreasing intestinal calcium absorption. Treatment of vitamin D deficiency has been shown to improve bone mineral density. An analysis of the Third National Health and Nutrition Examination Survey (NHANES III) demonstrated a positive correlation between circulating 25(OH)D levels and bone mineral density.
Vitamin D supplementation has been associated with a reduction in falls involving the older population. A meta-analysis demonstrated that vitamin D supplementation resulted in a reduction in falls of about 22 percent in ambulatory and institutionalized elderly subjects, as compared with controls.
Epidemiologic data suggest that vitamin D deficiency places adults at risk for developing cancer; these apparently include breast, colon, and prostate cancer. Several studies using cultured cancer cells in mice models have also supported the notion that vitamin D prevents the growth of cancers. Larger, randomized clinical trials are underway in humans to establish the role of vitamin D in the prevention of cancers.
Vitamin D insufficiency may increase the risk for type I and type II diabetes mellitus. In NHANES III, lower vitamin D status was associated with higher fasting glucose and 2-hour glucose after an oral glucose tolerance test. Furthermore, vitamin D supplementation in adults has been associated with improved insulin sensitivity in several small, case-control studies.
A meta-analysis evaluated the effect of vitamin D supplementation (using a mean supplementation dosage of about 500 IU daily) on all-cause mortality in 18 randomized controlled trials and found a 7 percent relative risk reduction for death.
COMPLICATIONS
RICKETS
While easily treated once it is diagnosed, rickets has a severe list of complications if left untreated. Untreated vitamin D deficiency rickets may lead to:
- Delays in your child's motor skills development.
- Failure to grow and develop normally.
- Skeletal deformities.
- Chronic growth problems that can result in short stature.
- Seizures.
- Dental defects.
OSTEOMALACIA
The most common complications of osteomalacia are chronic pain, muscle weakness and bone fractures. These complications can hamper your ability to move about easily. Less commonly, vitamin D deficiency can lead to low blood-calcium levels (hypocalcemia) because vitamin D facilitates intestinal absorption of calcium. This can be dangerous because proper blood levels of calcium are essential for heart function. Severe cases can lead to an irregular heart rhythm and eventual heart failure.
DIAGNOSIS & TREATMENT
PREPARING TO SEE A HEALTH CARE PROVIDER
You are likely to start by first seeing your family health care provider or your child's pediatrician. It is a good idea to be well prepared for your appointment. Here is some information to help you get ready for your child's appointment, and what to expect from your child's health care provider.
Write down any symptoms your child is experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Make a list of all medications, as well as any vitamins or supplements, that your child is taking.
Write down questions any questions you have for your child's health care provider.
For rickets, some basic questions to ask your health care provider include:
- What is the most likely cause of my child's symptoms?
- Are there any other possible causes for my child's symptoms?
- What kinds of tests does my child need?
- How is the type of rickets my child has treated?
- How can I prevent this from happening again?
- Are there any brochures or other printed material that I can take home with me?
- What Web sites do you recommend visiting?
In addition to the questions that you have prepared to ask your health care provider, do not hesitate to ask questions during your appointment at any time that you do not understand something.
WHAT TO EXPECT FROM YOUR HEALTH CARE PROVIDER
Your child's health care provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your child's practitioner may ask:
- When did your child first begin experiencing symptoms?
- How much milk does your child consume daily?
- What about other dairy products?
- How much time does your child spend outdoors?
- Does he or she regularly wear sunscreen?
KEEP A FOOD JOURNAL
Before your appointment, it is a good idea to track your child's diet so that you can better assess whether he or she is getting enough vitamin D, and other nutrients. If your child's nutrition needs improvement, you and you child may be referred to a nutritionist for consultation and meal planning.
DIAGNOSIS
PHYSICAL EXAMINATION
Your health care provider will check if the pain or tenderness is coming directly from the bones, instead of the joints and muscles surrounding them.
In children with a severe vitamin D deficiency, the examination may reveal bowing in the legs.
In adults with a severe vitamin D deficiency, the examination can reveal periosteal bone pain. This is best detected using firm pressure on the sternal bone or tibia.
LAB TESTS
Blood tests are used to measure calcium and phosphorus levels to see if they are normal. In cases of osteomalacia caused by vitamin D deficiency or by phosphorus loss, abnormal levels of vitamin D and the minerals calcium and phosphorus are often detected.
Serum 25(OH)D: The circulating half-life of 25(OH)D is 2 weeks. This is the best test to determine vitamin D status. A 25(OH)D level of less than 32 ng/mL is considered vitamin D insufficient. A 25(OH)D level of less than 15 or 20 ng/mL have been used to define vitamin D deficiency. Intestinal calcium absorption is optimized at levels above 32 ng/mL. Parathyroid hormone levels start to rise at 25(OH)D levels below 31 ng/mL,41 which is another marker of vitamin D insufficiency.
Parathyroid hormone (PTH): Although not always required for the diagnosis of vitamin D insufficiency, a serum PTH may be used to help establish the diagnosis of vitamin D insufficiency. Often, patients with vitamin D insufficiency have a corresponding elevated PTH, indicating secondary hyperparathyroidism. An inverse relationship exists between PTH and 25(OH)D levels. Usually, PTH levels decrease after the correction of a vitamin D insufficiency.
X-RAYS
Your health care provider may take images of affected bones to look for softening or weakness. Slight cracks in the bones that are visible on X-rays, referred to as Looser transformation zones, are a characteristic feature of people with osteomalacia.
BONE SCAN
This procedure detects areas of increased and decreased bone metabolism in your body. During this test, a radioactive dye is injected into a vein and a camera takes pictures of how much radioactive dye collects in your bones. If you have osteomalacia, the radioactive dye may appear to be unevenly distributed in some areas of your bones.
BONE BIOPSY
During a bone biopsy, your health care provider inserts a slender needle through your skin and into your bone to withdraw a small sample for viewing under a microscope. Although a bone biopsy is very accurate in detecting osteomalacia, it is not often needed to make the diagnosis.
MEDICAL HISTORY
Kidney problems, celiac disease or diagnosis of a sibling with rickets may help lead your health care provider to a diagnosis of rickets.
CONVENTIONAL MEDICAL TREATMENT
The aim of treatment for rickets is to solve the underlying disorder. If deficiencies in vitamin D, calcium or phosphorus are at fault, replacing vitamin D and those minerals generally eliminates the signs and symptoms of rickets, such as bone tenderness and muscle weakness. Improvement generally occurs within three months.
Vitamin D deficiency can be corrected using various methods, although no standard treatment regimen exists. The following are expert recommendations for the prevention and treatment of vitamin D deficiency.
PREVENTION OF VITAMIN D DEFICIENCY IN CHILDREN
Breastfeeding (up to age 1 year): 400 IU vitamin D-3 per day plus sensible sun exposure.
Inadequate sun exposure or dark skin (ages 1-18 years): 400-1000 IU vitamin D-3 per day plus sensible sun exposure.
PREVENTION OF VITAMIN D DEFICIENCY IN ADULTS
Inadequate sun exposure or if aging (age greater than 50 years), pregnant, or lactating: 800-1000 IU vitamin D-3 per day plus sensible sun exposure, or 50,000 IU vitamin D-3 per month plus sensible sun exposure.
Malabsorption syndromes: 50,000 IU of vitamin D-2 every week.
Drugs that increase the metabolism of activated vitamin D: 50,000 IU vitamin D-2 every 1, 2, or 4 weeks.
TREATMENT OF VITAMIN D DEFICIENCY IN CHILDREN
Breastfeeding without vitamin D supplementation (up to age 1 year): Vitamin D-2 or vitamin D-3, 1000-2000 IU per day with calcium supplementation.
Inadequate sun exposure or dark skin (ages 1-18 years): 50,000 IU vitamin D2 every week for 8 weeks.
TREATMENT OF VITAMIN D DEFICIENCY IN ADULTS
When osteomalacia arises from a dietary or sunlight deficiency, replenishing low levels of vitamin D in your body usually cures the condition. Several types of vitamin D supplements are available, so your health care provider will probably recommend a supplement depending on the dose you need and whether you have any other health problems. Generally, people with osteomalacia take vitamin D supplements by mouth for a period of several weeks to several months. Less commonly, vitamin D is given as an injection or through a vein in your arm.
If your blood levels of calcium or phosphorus are low, you may take supplements of those minerals as well. In addition, treating any condition affecting vitamin D metabolism, such as kidney failure or primary biliary cirrhosis, often helps improve the signs and symptoms of osteomalacia.
After beginning osteomalacia treatment, you may undergo periodic blood tests to make sure that blood levels of vitamin D and certain minerals are within normal limits and have X-rays to determine whether your bones are improving. You'll likely notice that your symptoms lessen within a few weeks. However, your health care provider may suggest that you continue taking vitamin D indefinitely to prevent osteomalacia from recurring.
Inadequate sun exposure, or if aging (age greater than 50 years), pregnant, or lactating: 50,000 IU vitamin D-2 per week for 8 weeks (Repeat for another 8 weeks if 25(OH)D remains less than 30 ng/mL.
Malabsorption syndromes: UVB irradiation (tanning bed or portable UVB device). 50,000 IU of vitamin D-2 every day or every other day.
Drugs that increase the metabolism of activated vitamin D: 50,000 IU vitamin D-2 every 2 weeks for 8-10 weeks or every week if 25(OH)D is less than 30 ng/dL.
DIET & VITAMIN D
Your health care provider may prescribe a vitamin D supplement or ask you to increase your intake of vitamin D-fortified foods, including fortified breakfast cereal, orange juice, fish and processed milk.
Getting a sufficient intake of calcium is crucial to maintaining healthy bones. Your health care provider can suggest an appropriate level of calcium intake depending on your age and whether you have absorption problems. The combination of increased vitamin D intake with calcium may be enough to eliminate the effects of rickets entirely.
Individuals who do not have exposure to sunlight are at risk for vitamin D deficiency if they do not ingest adequate amounts of foods that contain vitamin D. However, most dietary sources of vitamin D do not contain sufficient amounts of vitamin D to satisfy daily requirements. Foods thought to contain high amounts of vitamin D-3 are oily fish, such as salmon, mackerel, and blue fish, as well as fortified milk and other dairy products. A single serving (3.5 oz.) of wild-caught salmon has 988 +/- 524 IU vitamin D-3, an amount that remains unchanged after baking but that decreases by 50 percent if the salmon is fried in vegetable oil. In comparison, farm-raised salmon has only 25 percent the content of vitamin D-3 found in the flesh of wild salmon, whereas blue fish and mackerel have even lower vitamin D-3 levels, at 280 +/- 68 and 24 IU, respectively. Fortified milk may contain less than the stated amount of vitamin D-3 on the product (in some cases less than 80 percent of the amount). Vegetables are not a good source for vitamin D.
The following foods contain the indicated amounts of vitamin D, as reported by the US Department of Agriculture's (USDA's) Nutrient Data Laboratory:
MEDICATIONS
Drug Category: Fat-soluble vitamins.
The goals of drug therapy are to correct the vitamin D deficiency, reduce morbidity, and prevent complications.
Vitamin D promotes absorption of calcium and phosphorus in the small intestine. It also promotes renal tubule resorption of phosphate.
Drug Name Description Adult Dose Pediatric Dose Contraindications Interactions Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus1.25-5 mg/d (50,000-200,000 U) PO.Precautions
TREATING COMPLICATIONS
For some cases of bowlegs or spinal deformities, your health care provider may suggest special bracing to position your child's body appropriately as the bones grow. More severe skeletal deformities may require surgery.
FOLLOW-UP & FURTHER OUTPATIENT CARE
After correction of their vitamin D status with oral vitamin D, patients should have a repeat test of their 25(OH)D level to confirm that they are in the normal range. If a patient remains persistently low despite several attempts at correction with oral vitamin D, a trial of UVB light therapy (ie, by tanning lamps) may be considered to improve vitamin D status.
CONSIDERATIONS
Food allergy testing may be beneficial.
There are a number of combination supplement products available that contain many of the nutrients recommended in the table below (Nutritional Supplements). Read product descriptions to determine which product is best for you and your needs.
HERBAL & HOLISTIC RECOMMENDATIONS
HERBS
Dandelion Root, Horsetail, Nettle, and Oatstraw are all good sources of calcium and magnesium.
Herbal Remedies: Dandelion Information
Herbal Remedies: Dandelion Supplements & Products
Herbal Remedies: Dandelion Tea, Organic, NOW Foods, 30 Tea Bags
Herbal Remedies: Dandelion Root, Vegetarian Supplement, Nature's Way, 540 mg, 180 VCaps
Herbal Remedies: Dandelion Root Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Dandelion Root Powder (Taraxacum Officinal), 4 oz. Bulk
Herbal Remedies: Horsetail Information
Herbal Remedies: Horsetail Supplements & Products
Herbal Remedies: Horsetail Tincture, 2 fl. oz.
Herbal Remedies: Horsetail Herb Grass, Nature's Way, 440 mg, 100 Caps
Herbal Remedies: Nettle Information
Herbal Remedies: Nettle Leaf Supplements & Products
Herbal Remedies: Nettle Herb, Nature's Way, 435 mg, 100 Caps
Herbal Remedies: Nettle Leaf Powder (Urtica Dioica), 4 oz. Bulk
Herbal Remedies: Nettle Tincture, 2 fl. oz.
Herbal Remedies: Nettles Extract Tincture, Herbal Remedies USA, 2 fl. oz.
Herbal Remedies: Oat Straw Information
Herbal Remedies: Oatstraw Supplements & Products
Herbal Remedies: Oatstraw Tincture, 2 fl. oz.
Herbal Remedies: Bones, Hair, Teeth, & Fingernails Formula Tincture, 2 fl. oz.
RECOMMENDATIONS
Change your diet. Eat more raw fruits and vegetables, raw nuts and seeds, yogurt and cottage cheese. A diet high in calcium is essential.
Do not consume sugar, junk foods, or carbonated beverages.
Have a hair analysis done to check for mineral deficiencies.
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the dosages recommended here are for adults. For a child between the ages of 12 and 17 years, reduce the dose to 3/4 the recommended amount. For a child between the ages of 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.
See Osteoporosis & Calcium and Osteoporosis for more information about nutrition and treatments.
RICKETS, OSTEOMALACIA & VITAMIN D DEFICIENCY SUPPLEMENTS
Information, products and supplements for rickets and osteomalacia, two disorders caused by vitamin D deficiency.
Boron Chelate, Nature's Way, 3 mg, 100 Caps
Boron Chelate helps to prevent the loss of calcium, phosphorus and magnesium through the urine.Boron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm, 16 fl. oz.
WaterOz Ionic Boron is a pure liquid Boron supplement. WaterOz Ionic Boron is pure liquid Boron. Boron is essential to bone metabolism and calcification of bones, and helps prevent osteoporosis, arthritis, and tooth decay. Boron is necessary for cartilage formation and repair; it affects calcium, magnesium, and phosphorus levels. Memory and brain function can be improved with boron.Calcium Complex Bone Formula, Nature's Way, 100 Caps
Nature's Way Calcium Complex Bone Formula provides the key minerals and trace elements necessary for the dynamic process that maintains bone mass.CellFood Silica Liquid Drops, 4 fl. oz.
Cellfood Silica contains all of these elements which support bones, arteries, connective tissue, healthy hair, skin, and nails.Coral Calcium Complex Liquid, 100% Pure Okinawan, Dynamic Health, 32 fl. oz.
This coral calcium liquid provides valuable marine nutrients.Dandelion Root, Vegetarian, Nature's Way, 540 mg, 180 VCaps
Nature's Way Dandelion Root capsules are a convenient way to enjoy the diuretic, antiviral and digestive properties of dandelion herb. This supplement is acceptable for vegetarians.Dry Vitamin A & D, Nature's Way, 15,000 IU/ 400 IU, 100 Caps
Vitamin A & D are both involved in the cycles of mineral and hormone balance which help to maintain normal bone formation and density. In addition, Vitamin A is an important nutrient in maintaining cell membrane integrity, and normal vision and reproduction.Horsetail Herb Grass, Nature's Way, 440 mg, 100 Caps
Horsetail herb contains approximately 22 milligrams of Silica per capsule or 4.94% and Nature's Way Horsetail Grass is certified organically processed by Oregon tilth.Iron Gluconate, Nature's Way, 18 mg, 100 Caps
Nature's Way Iron gluconate is an advanced chelate form which provides superior absorption and it contains no artificial ingredients or preservatives.Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.
Just An Ounce, Calcium and Magnesium Liquid can help with the development of strong bones and teeth, also prevents muscle cramping, risk of colon cancer, maintain regular heart beat, protects against osteoporosis and helps relax the central nervous system.Oat Straw Tincture, 2 fl. oz.
Oat Straw is most often used as a topical remedy for irritated and inflamed dry skin.Once Daily Multi-Vitamin With Iron, All Natural, Lactose-Free, Nature's Way, 100 Tabs
Nature's Way Daily Multi Vitamin with Iron provides many of the essential nutrients that modern diets may lack. They are useful for protection, growth and maintenance of body systems as they age.Silymarin Milk Thistle Extract, NOW Foods, With Artichoke & Dandelion Extract, 300 mg, 50 VCaps
Silymarin Milk Thistle Extract has been extensively researched in Europe since the 1960's. Milk Thistle has been shown to nutritionally support healthy liver function.Zinc Chelate, 100% Natural, Zinc Supplement, Nature's Way, 30 mg, 100 Caps
Nature's Way chelated zinc supplement is 100% natural chelated with an advanced amino acid complex for superior absorption.Herbal Remedies: Rickets / Osteomalacia Information
Herbal Remedies: Rickets / Osteomalacia Supplements, Information & Products
OSTEOPOROSIS SUPPLEMENTAL PRODUCTS
Information, products and supplements for osteoporosis, a progressive disease in which the bones gradually weaken, resulting in poor posture and brittle bones that are prone to fracture (breaks).
Arth-X Platinum - Natural Arthritis Supplement for Bone and Joint Pain and Stiffness, 90 tabs, Trace Minerals
Arth-X Platinum is the most complete and effective dietary supplement and may be a good Natural Arthritis Treatment for you to support and aid in the relief of bone and joint pain and stiffness.Barlean's Fishery's Oil, Fresh Catch Cod Liver Oil, 8 fl. oz.
Barlean's Fishery brings you Fresh Catch Cod Liver Oil, a pure and pristine source of molecularly distilled cod liver oil ideal for those who seek a naturally occurring, well-balanced ratio of EPA, DHA and vitamins A & D.Barlean's Fish Oil Capsule, Omega-3 EPA / DHA, 250 Softgels
Barlean's Fish Oil Capsule's signature formula is ideal for people who are seeking the absolute highest quality fish oil at the best value.Barlean's Organic Oil Fresh Catch Fish Oil EPA - DHA Concentrate, 60 Softgels
Fresh Catch Barlean's Organic Oil Super High Potency EPA - DHA is a pure and pristine source of fish oil providing highly concentrated EPA Omega-3 to support cardiovascular, joint, immune and colon health for your vibrant health and energy.Barlean's Organic Oil, Premium Potency DHA Omega-3, 90 Softgels
Barlean's Organic Oil provides Fresh Catch® Super Potency DHA, a pure and pristine source of molecularly distilled, fish oil providing highly concentrated DHA omega-3 to support memory, cognition and emotional well-being for your vibrant health and energy.Barlean's Organic Oil, Super High Potency Omega-3 EPA, 60 Softgels
Fresh Catch Barlean's Organic Oil Super High Potency EPA is a pure and pristine source of fish oil providing highly concentrated EPA Omega-3 to support cardiovascular, joint, immune and colon health for your vibrant health and energy.Boron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm, 16 fl. oz.
WaterOz Ionic Boron is a pure liquid Boron supplement. WaterOz Ionic Boron is pure liquid Boron. Boron is essential to bone metabolism and calcification of bones, and helps prevent osteoporosis, arthritis, and tooth decay. Boron is necessary for cartilage formation and repair; it affects calcium, magnesium, and phosphorus levels. Memory and brain function can be improved with boronCalcium Complex Bone Formula Nature's Way, 100 Caps
Calcium, Magnesium, and other minerals help maintain normal structure and development of bones. Studies have shown that calcium supplementation may help to maintain normal bone density among women as they age.Calcium Gluconate Powder, NOW Foods, 100% Pure, 7 oz.
Calcium - naturally occurring in some foods - is a mineral that is necessary for bone maintenance and formation and many other normal functions of the body and calcium can also aid in the removal of other minerals from the body.Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.
WaterOz Ionic Calcium is a pure liquid Calcium supplement. Calcium is one of the most essential of the major biochemical elements needed in human nutrition. It is needed in every organ of the body, including the brain. Calcium is called the "knitter" because it promotes healing or knitting everywhere in the body. It is valuable for tone, power, strength, longevity, vitality, and endurance, healing of wounds, counter-acting acids, and helping regulate metabolism.Cervical Traction System, 5 lb. Weight
An effective, affordable and convenient way to help restore proper cervical curve.Cervical Traction System, 3 lb. Weight
An effective, affordable and convenient way to help restore proper cervical curve.Coral Calcium (Okinawa) Plus w/ Magnesium & Vitamin D, 100% Natural, NOW Foods, 500 mg, 100 VCaps
Okinawa Coral Calcium Plus with Magnesium, Vitamin D and 70 other trace minerals provides essential minerals, restores body alkalinity, supports the immune system, and is bio available for better absorption.EstroSoy Plus Black Cohosh, Nature's Way, 355 mg, 60 Caps
EstroSoy Plus relieves hot flashes and night sweats, supports breast health, and promotes healthy bones by helping the body retain calcium. Soy, which contains natural phytoestrogens called isoflavones, has been clinically proven to ease hormonal transition. Women with a soy-rich diet report lower incidence of hot flashes and other menopause symptoms.Female Estrogen with Progesterone Tincture, 100% Organic, 2 fl. oz.
Female Estrogen With Progesterone formula is used mainly to promote hormonal balance. It does not contain hormones, however.Foam Roll, 13 5/8" x 3 3/4"
Use this roll for a wide variety of comfort and support applications.Fresh Catch Fish Oil, Barlean's Oil - EPA - DHA - World's Freshest Fish Oil, 8 Fl Oz.
Fresh Catch Fish Oil is a pristine source of ultra-purified fish oil capsule providing naturally occurring levels of EPA and DHA for your vibrant health and energy.Healthy Adult from Barlean's Organic Oils, Omega-3 Concentrate, 60 Softgels
Fresh Catch® Healthy Adult formula is one of Barlean's Organic Oils, a pure and pristine source of molecularly distilled fish oil formulated with the ideal dose and ratio of highly concentrated EPA and DHA omega-3 for the vibrant health and energy of healthy adults.Healthy Mom, High Potent Omega-3's for Nutrition During Pregnancy and Lactation, 90 Softgels
Fresh Catch® Healthy Mom is a pure and pristine source of molecularly distilled, pharmaceutical grade fish oil formulated with the ideal dose and ratio of DHA and EPA to address the health and nutrition priorities of pregnant and lactating women.Irwin Naturals, EstroPause, Menopause Support, 80 Gelcaps
Irwin Naturals EstroPause has been carefully formulated to support hot flash control, memory & mood, estrogen production, bone density, eye, heart, colon and vaginal moisture.Just An Ounce Calcium and Magnesium Liquid, Almond Flavor, 16 fl. oz.
Just An Ounce, Calcium and Magnesium Liquid can help with the development of strong bones and teeth, also prevents muscle cramping, risk of colon cancer, maintain regular heart beat, protects against osteoporosis and helps relax the central nervous system.Menopause Support Formula, Estro Genesis, Includes 2 Free CD's, 60 Tabs
Estro Genesis is the first complete menopause support formula that also supports total women's health.MSM Supplement (Methylsulfonylmethane), 1,000 mg, 120 Caps, Pure Lignisul with Free 4 oz. Lotion
Buy MSM Supplement caps and get a 4 oz. Lotion free. MSM supplement plays a beneficial role in connective tissue and joint flexibility, immune health, arthritis, osteoporosis, rheumatoid arthritis, inflammation, pain, hair, skin, nails, athletic injuries, acne, wrinkles and allergies.Nature's Way Barley Bran, STD 60% Beta Glucan Nature's Way, 60 VCaps
Nature's Way's Barley Bran, has one of the highest Barley Beta Glucan contents commercially available which makes it the supplement of choice for anyone looking to pump up their cardiovascular health.Nature's Way Silica Supplement Gel, 17 fl. oz., 500 ml.
Original Silica Supplement gel is a colloidal preparation of natural silica, a good source of elemental silicon, in which microscopic particles of silica are so finely dispersed in water that a gel is formed.OsteoBoron Bone and Joint Health, with 200 mg Green Food Concentrates each NOW Foods, 90 VCaps
Boron is an important trace mineral for bone and joint health throughout life, as well as for the development and maintenance of healthy bone density. NOW OsteoBoron is a superior form of Boron that has been the subject of clinical studies demonstrating its efficacy in the support of healthy joints.Overhead Traction System
This water-filled weight bag provides variable tension to alleviate pressure on the spinal column.Pelvic Block, Adult, 1 Pair
A common positioning tool for a variety of treatment techniques. Features Scoot-Gard to prevent slipping.Prenatal Vitamin with Folic Acid, 100% Natural & Complete, Nature's Way, 180 Caps
Nature's Way Prenatal Vitamin with Folic Acid is a complete vitamin formulated to support the health of the mother and child.Solid Bone for Bone and Muscle Strength, TCM Formula, Luma Zhuanggu, 500 mg each Capsule, 60 Caps
This time-honored formula is used in Chinese medicine for its bone and muscle strengthening to maintain healthy, strong bones and muscles.Soy Isoflavones with Digestive Enzymes, NON-GMO, SoyLife, 500 mg, 100 Caps
We guarantee at least 12.5mg of soy isoflavones per capsule.Herbal Remedies: Osteoporosis Information
Herbal Remedies: Osteoporosis Supplements, Information & Products
MALNUTRITION & MALABSORPTION DISORDER SUPPLEMENTS
Information, supplements and products for malnutrition and malabsorption, a condition that results in failure of the body to properly absorb vitamins, minerals, and other nutrients from food.
Alive! Whole Food Energizer, Multi-Vitamin & Mineral With Naturally Occurring Iron (No Iron Added), Nature's Way, 90 Tablets
No other supplement contains more life-giving nutrients than Nature's Way Alive Multi-Vitamin. Alive Multi-Vitamin is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands.Alive! Whole Food Energizer, Multi-Vitamin & Mineral With 18 mg Iron Added, Nature's Way, 90 Tablets
No other supplement contains more life-giving nutrients than Nature's Way Alive Multi-Vitamin. Alive Multi-Vitamin is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands.Crazy Makers: How The Food Industry Is Destroying Our Brains & Harming Our Children By Carol Simontacchi, C.C.N., M.S.
Examining the relationship of diet to changing levels of chemicals in the brain, this book offers nutritional primers, solutions and recipes to stop the damage.Digestion Enzymes, Liquid Gel, Nature's Secret, 60 Softgels
Nature's Secret has once again set a new standard for intestinal health with the world's first digestive enzyme in a liquid gel cap. Liquid-Gel Digestion Enzymes helps soothe the stomach and fuel the digestive system.Digestion Essentials Ultimate Digestion Formula, Peter Gillham's Natural Vitality, 120 Tablets
Digestion Essentials is a superior formulation of digestive enzymes along with digestive acids. Digestion is a vital process necessary for the breakdown and absorption of nutrients needed for basic health.Enzymes, All Complete, 250 mg, 90 Caps
All Complete Enzymes, dietary supplement, is an important combination of critical enzymes that help support normal digestive function, cholesterol levels, fat metabolism and more, all in one convenient tablet.Haritaki Detoxification & Rejuvenation, Banyan Botanicals, 90 Tabs
As a natural laxative and purgative, Haritaki removes undigested food and accumulated toxins from the gastrointestinal tract. It strengthens and nourishes the tissues and supports proper function of the colon, lungs, liver and spleen.Lactobacillus Acidophilus Supplement, Non-Dairy, 100 Caps
Lactobacillus Acidophilus Supplement taken as a dietary supplement may help to detoxify and to rebuild a balanced intestinal flora.Lecithin Fine Vegetarian Granules, NOW Foods, 97% Phosphatides, Pure & Fresh, 1 lb.
Contains Choline & Inositol which are essential for the breakdown of fats and cholesterol. It helps prevent arterial congestion, helps distribute bodyweight, increases immunity to virus infections, cleans the liver and purifies the kidneys.Multi-Vitamin & Multi-Mineral, Baby & Children's Liquid, ChildLife, 8 fl. oz.
Children's liquid Multi-Vitamin & Multi-Mineral formula provides the optimal dosage of all the essential vitamins and minerals with trace elements for infants and children of all ages and it tastes great!Primadophilus Bifidobacterium For Children, Powder, Freeze Dried & Refrigerated, Nature's Way, 5 oz.
Primadophilus powder for children is designed to deliver helpful bacteria to the gut. These microorganism strains are essential to maintaining healthy intestinal flora. Other medications taken to combat illness or infection can reduce the number of beneficial bacteria as an unwanted side effect.Primadophilus For Kids, Cherry, Nature's Way, 30 Chewable Tabs
Under normal conditions, trillions of bacteria exist in the intestines. As part of the body's defenses they help maintain good health by preventing harmful microorganisms from infiltrating the body. Medications taken to combat illness or infection can reduce the number of beneficial bacteria as an unwanted side effect.Primadophilus For Kids, Orange, Nature's Way, 30 Chewable Tabs
Designed specifically with children age 2-12 in mind, Primadophilus for Kids chewable tablets contain a special blend of Bifidobacterium longum, Lactobacillus acidophilus and Lactobacillus rhamnosus.Primadophilus Lactobacillus, Nature's Way, 290 mg, 180 VCaps
Original True Potency is designed to deliver helpful bacteria to the gut. These Lactobacillus microorganism strains are essential to maintaining healthy intestinal flora.Primadophilus Reuteri, Nature's Way, 90 VCaps
Primadophilus stimulates gastrointestinal epithelial cell development and improves intestinal cell structure leading to more efficient nutrient uptake, enhanced physical growth and overall better health.Spirulina (Blue Green Algae) Tincture, 2 fl. oz.
Spirulina is rich in chlorophyll, beta carotene, vitamins (including Vitamin B-12), minerals, amino acids, DNA, RNA, and enzymes.Super Digestive Enzymes, 90 Caps
Super Digestive Enzymes contain a complete and balanced digestive enzyme formula.Trikatu Appetite & Digestive Stimulant, Banyan Botanicals, 90 Tabs
Trikatu literally means "three pungents," as it contains the herbs ginger, black pepper and pippali. The powerful heating quality of this combination is traditionally used to enkindle the digestive fire and to effectively burn kapha, fat and toxins. Trikatu supports healthy metabolism, allowing nutrients to be properly digested and assimilated, thus aiding in weight management.Triphala Balancing Formula For Detoxification & Rejuvenation, Banyan Botanicals, 90 Tabs
Triphala is recommended and used more than any other Ayurvedic herbal formulation. Popular for its unique ability to gently cleanse and detoxify the system while simultaneously replenishing and nourishing it, this traditional formula supports the proper functions of the digestive, circulatory, respiratory and genitourinary systems.Triphala Guggulu Metabolic Function, Banyan Botanicals, 90 Tabs
Triphala Guggulu effectively decongests the channels of the body and scrapes away toxins held within the tissues. It is particularly useful for weight management as it enkindles the digestive fire, promotes healthy metabolism and releases excess kapha from the system. Used preventively, Triphala Guggulu minimizes the accumulation of toxins in the GI tract, blood and joints by supporting proper digestion and elimination.Vitamin B-50 Complex With B-2 Coenzyme, 100% Natural, 330 mg, 100 Caps
B Vitamins, as found in a Vitamin B Complex, are precursors of coenzymes involved in the conversion of cellular energy, manufacture of hormones and proteins, and repair and maintenance of nerve structures.Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Herbal Remedies: Malnutrition / Malabsorption Information
Herbal Remedies: Malnutrition / Malabsorption Supplements & Products
NOTIFY YOUR HEALTH CARE PROVIDER IF...
Your child exhibits signs or symptoms of rickets, such as bone pain, muscle weakness or obvious skeletal problems, make an appointment with your child's health care provider.
It is important to seek medical advice anytime you experience chronic bone pain or muscle weakness, which may indicate osteomalacia or another bone disorder. Vitamin D deficiency can lead to low blood-calcium levels, which can be serious. Call your health care provider if you have any of the following signs and symptoms:
- Seizures.
- Numbness around your mouth or in your arms and legs.
- Spasms in your hands or feet.
- Irregular heartbeat (tachycardia).
You have any symptoms or an increase of symptoms or other signs of vitamin D deficiency, malnutrition or have health conditions that cause malabsorption problems, or if you have symptoms of bone disorders such as osteoporosis.
You have any unexpected or unusual symptoms. Some people may have sensitivity, allergies, or other health conditions which would prevent them from using certain medications, herbs or other treatments.
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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