Please help me make sense of a vitamin D deficiency

[Calathan]

I've been having a wide variety of symptoms over the past year, including upper abdominal pain, acid reflux, chest pain, joint pain, neck pain, muscle pain, and having my eyes be very sensitive to light.  In December last year, I was diagnosed with a vitamin D deficiency from one of the many tests I got to try to determine the cause of these symptoms.  At the time, my level of vitamin D was 18.2 ng/mL with a reference range of 32 - 100 ng/mL.  I was prescribed 50,000 IU of vitamin D once a week for 8 weeks, which I took.  I also started taking a multivitamin containing vitamin D once a day, when previously I was taking it once or twice a week.  The multivitamin contains 100% of the recommended vitamin D for an adult based on the U.S. recommendations (not sure what amount that is).  I also regularly drink orange juice supplemented with vitamin D, and was doing so both before and since I was diagnosed with the deficiency.  I don't spend a lot of time outdoors, but I probably walk outside for 20-30 minutes a day about 4 or 5 days a week.

Since I was never retested to see if my vitamin D levels had become normal, I asked my gastroenterologist to retest me last week.  It turns out that my vitamin D levels are still low (or have returned to being low), this time being something like 25 or 26, again with a reference range of at least 32 for a normal level (I forget the exact number he said my level was, but it was in the mid 20s . . . I assume the units are ng/mL like before).  The gastroenterologist thought that I did not have a problem with absorbing vitamin D, and just need to take a higher dose each day.  However, that just doesn't make sense to me.  If I'm already getting 100% of the recommended amount from a multivitamin, plus having fortified orange juice, plus whatever I get from fortified dairy foods and from sunlight, how would I have too little if I was absorbing it properly?

I have been taking cimetidine for a month (400 mg twice daily), and I told the doctor that last week when I had the blood test (he told me to keep taking the cimetidine).  I've heard that taking cimetidine can reduce vitamin D levels, but I don't know if the doctor perhaps forgot I was taking it, or if he didn't think that was the cause of my deficiency.  I was taking the cimetidine for acid reflux after getting side effects from omeprazole.  I also think that I may have become lactose intolerant over the past year, and I hear that lactose intolerance can cause vitamin D deficiency.  However, most of my dietary vitamin D comes from non-dairy sources, and I still have a lot of dairy anyway but just take lactaid pills, so I don't know if being lactose intolerant could be contributing to my vitamin D deficiency.

So really I was wondering if my vitamin D deficiency is probably being caused by not absorbing it well, or if I am somehow not getting enough.  Does it make sense to take an even higher daily dose of vitamin D, or would that not actually be treating the real cause of the problem?  Also, would the vitamin D deficiency be a possible cause of all the symptoms I have had (it is the only thing I've been diagnosed with), or would it more likely be another symptom of whatever is the root cause, or perhaps totally unrelated?  Should I perhaps stop taking cimetidine and try to deal with acid reflux in some other way, or is that unnecessary to achieve normal vitamin D levels?

[Calathan]

Thanks for the reply.

In answer to your questions:

1.  My various symptoms started at several different points from August 2008 through sometime in 2009.  I was not under any stress before the first symptoms started, and did not make any changes in my life or diet.  However, the initial symptoms themselves and my frustration with my doctor at the time gave me stress, and I also started several different medications, so any of those could have led to the later symptoms.  The whole story is really long, but to summarize, I've since changed doctors and have less stress from my doctors.  I still have some stress form my symptoms, but no stress at all from non-medical aspects of my life.

2. Each of my individual symptoms often goes away and comes back.  The ones that have been most constant or frequent are a sore neck, eyes that are very sensitive to light, frequent mildly blurred vision in my right eye (though occasionally it sees perfectly), some amount of abdominal pain or discomfort (though it might be signficant for a couple weeks, then very mild for a couple weeks, then signficant again), pain in one spot in my chest (above and to the right of my left nipple) that seems to often be associated with gas in my stomach and belching, white gunk in my throat, and a feeling of being off-balance when standing, as if my neck or spine isn't supporing me.  Recently I've also felt soreness in my legs, particularly the knees, when I stand for more than a few minutes.  I also sometimes get soreness running down my arm from the elbow (or occasionally the whole arm) into the last two fingers of my hand (it has happened with each arm).  This sometimes makes my fingers feel a little sore, weak, or tingly, but not severely for any of those.

There were other symptoms I have had that have at least partially improved.  For a couple months I had pain in or near my shoulders every day, but the exact spot would change frequently (e.g. it could be the top of the left shoulder in the morning, the armpit of the right arm in the evening, then the back of one shoulder the next day).  That however went away, though my shoulders will still often make popping sounds when I move them a lot.  I had a lot of soreness in my fingers, which started with initial bouts of being very sick.  I had significant stomach pain, then the next day had the pain in my fingers and felt too tired and weak to do anything but lie in bed or on the couch all day.  The symptoms went away in 24 hours, but recurred 2 days later.  They then went away again, but after a couple weeks I got a more constant soreness in my fingers without the tiredness and weakness.  I still have some soreness in my fingers, but not as bad.  For a month I was very tired every day, but that went away, so that I am not more tired than normal now (though I do seem to get more physical pain if I miss sleep now than I did previously . . . i.e. sore muscles and the like instead of just feeling metally tired).  For a while I had migrane like headaches, that were significantly worse than any normal headaches I get, but those have gone away.  Those might have been due to TMJ problems due to chewing gum (thought I had chewed gum for years, I had started chewing a harder gum when they started, and they went away after a couple months when I stopped chewing gum).  For a few weeks I was having bad acid reflux, but it went away after I started taking acid reducing medicine.  For a while I had costocondritis type pain along my ribs, which was releaved by ibuprofen (much more so than any of my other symptoms are).  I still very occasionally get pain like that, but not every day like it was for a while.

3. I'm kind of skeptical about taking more vitamin D, and am not sure if it is a good idea.  I think I should have normal vitamin D levels with the amount I get right now, and think that taking more of it would not be addressing whatever is actually causing the levels to be low.  However, I'm not sure if taking more vitamin D would be a good idea anyway or not.

Anyway, thanks for any advice you can give me.

[boron]

Calathan,
Vitamin D can be lowered from several reasons. According to one study you should get enough of vit D if your arms, hands and face are exposed to the sun as little as twice a week for 10-15 minutes without getting any vit D with the food.

Having low vit D after several months of supplements speaks (to me) there is something what interferes with vit D metabolism...something what constantly pushes your vit D levels down.

At this point I feel strongly reluctant to recommend you any additional test, since it may, before you notice it, cost you a fortune...

I'm searching this issue for someone...low vit D despite geting supps..and most of other results normal..having vague pains, tiredness,

So, if you want...
1. When exactly your symptoms started (date..month?) What happened before that? Started some medication, stress, changed diet, big event...?
2. What symptoms you currently have (exact symptoms (nausea, constipation, numbness, tender points, non-refreshed sleep, fatigue, fever, changed temperature, appetite..) where, when, triggers/relievers - import.)

3. What do you think you should do? Anything on your mind..not necessary strictly medical related, but..what should you do..something bothering you..something to leave, to start?