Vitamin D 4.5 ng/ml means : causes, sources, risks, treatment

In this article we discuss what a Vitamin D value of 4.5 ng/ml means, what are its causes and how to calculate your Vitamin D deficiency risk score, and how to improve your Vitamin D as well as a treatment plan and possible risks.

What does a Vitamin D level of 4.5 mean?

A vitamin d level of 4.5 is considered to be deficient.

What is my Vitamin D level in SI units, for value of 4.5 in standard units?

In order to convert the value of Vitamin D from ng/ml into the SI Units, we must use a formula of conversion : Vitamin D in SI units (nmol/L) = Vitamin D in ng/ml*2.496¹ Based on the given formula, the value of Vitamin D in SI units for a value in ng/ml of 4.5 is 11.2 nmol/L

Is a Vitamin D value of 4.5 considered low or high?

Based on your Vitamin D value of 4.5. you are classified as having a severe Vitamin D deficiency.

Vitamin D Levels

Category	Level (ng/mL)	Description
Severe Deficiency	< 10	Severely low vitamin D levels **You are here**
Moderate Deficiency	10 - 20	Moderate Vitamin D Deficiency
Insufficiency	20 - 30	Mild to Insufficient
Healthy	30 - 80	Normal Vitamin D Levels
Toxicity	> 80	Potentially harmful vitamin D levels

What are the sources of Vitamin D?

Food	How it helps with Vitamin D
Pork chops	Pork chops contain Vitamin D, particularly if they include the bone.
Sardines	Sardines are a good source of Vitamin D, especially when consumed with the bones.
Shrimp	Shrimp contain some Vitamin D, especially when consumed in larger quantities.
Canned tuna	Canned tuna, especially if it's canned with bones, can be a source of Vitamin D.
Fortified orange juice	Certain brands of orange juice are fortified with Vitamin D to increase its nutritional value.
Canned mackerel	Canned mackerel, like fresh mackerel, is a good source of Vitamin D.
Fatty fish (salmon, mackerel, tuna)	Fatty fish are excellent sources of Vitamin D, particularly wild-caught species.
Salmon skin	Salmon skin contains some Vitamin D, but it's recommended to consume the flesh for better nutrient balance.
Cheese	Certain types of cheese, like Swiss and cheddar, contain small amounts of Vitamin D.
Mushrooms	Some mushrooms exposed to UV light can produce Vitamin D2.

What are the causes of Vitamin D deficiency?

Cause	Description
Kidney disorders	Kidney diseases can reduce the activation of Vitamin D in the body, affecting its functions.
Certain types of cancer	Some cancers and their treatments can impact Vitamin D levels and metabolism.
Liver diseases	Liver disorders can affect the conversion of Vitamin D into its active form.
Certain hormonal disorders	Hormonal imbalances can influence Vitamin D metabolism and its effects on the body.
Certain autoimmune diseases	Autoimmune disorders may interfere with Vitamin D metabolism and utilization.
Use of sunscreen	Sunscreen blocks UV rays that are needed for Vitamin D production when exposed to sunlight.
Cystic fibrosis	Individuals with cystic fibrosis are at a higher risk of Vitamin D deficiency due to malabsorption.
Limited outdoor activities	A sedentary lifestyle with minimal outdoor time can result in reduced sunlight exposure.
Strict vegan or vegetarian diet	Limited intake of animal products, which are sources of Vitamin D, can contribute to deficiency.
Dark skin	Higher melanin levels in dark skin reduce the skin's ability to produce Vitamin D from sunlight.

What symptoms will I experience with a Vitamin D of 4.5 ng/ml?

The symptoms of Vitamin D deficiency in children and adults are manifested by rickets and osteomalacia respectively. These conditions may show a variety of symptoms ranging from mild muscle pain, and bone pain to developmental abnormalities and fractures. For a Vitamin D level of 4.5 the symptoms are enlisted in the table below:

Vitamin D level 4.5 Symptoms in Children

Symptom	Description
Fractures	Due to weakened bones, children with rickets are more prone to fractures even with minor injuries.
Delayed Walking	Some children with rickets may experience delays in achieving developmental milestones, like walking.
Bone Pain	Children with rickets often complain of bone pain, which can be especially pronounced in the legs, pelvis, and spine.
Curvature of the Spine	Rickets can contribute to spinal deformities, such as scoliosis or kyphosis (excessive forward curvature of the upper spine).
Bone Deformities	Rickets can lead to bone deformities, such as bowed legs or knock-knees, due to weakened bones unable to support the body's weight properly.
Dental Problems	Rickets can affect the development of teeth, leading to dental issues such as delayed eruption and enamel defects.
Difficulty Breathing	In severe cases, rickets can cause deformities of the ribcage, leading to difficulty in breathing and increased susceptibility to respiratory infections.
Delayed Healing	Fractures and other injuries may take longer to heal in children with rickets.
Delayed Puberty	In severe cases, rickets can delay the onset of puberty due to its impact on bone and overall development.
Muscle Cramps	Vitamin D deficiency associated with rickets can lead to muscle cramps and spasms.

Vitamin D level 4.5 Symptoms in Adults

Symptom	Description
Difficulty Climbing Stairs	Muscle weakness and bone pain can make climbing stairs difficult for those with osteomalacia.
Fractures	Brittle and weak bones due to osteomalacia increase the risk of fractures even with minor injuries.
Fatigue	Generalized fatigue and weakness are common symptoms of osteomalacia.
Tingling or Numbness	Nerve-related symptoms such as tingling or numbness can occur as a result of osteomalacia.
Bone Deformities	Osteomalacia can lead to bone deformities, such as bowed legs or a curvature of the spine.
Joint Pain	Osteomalacia-related muscle and bone weakness can result in joint pain and discomfort.
Short Stature	In childhood cases, untreated osteomalacia can result in short stature and growth delays.
Weight Loss	Some individuals with osteomalacia may experience weight loss due to the overall impact on health.
Muscle Cramps	Deficiencies in bone mineralization and electrolytes can lead to muscle cramps and spasms.
Difficulty Walking	Muscle and bone weakness can make walking and moving difficult for individuals with osteomalacia.

What additional risks do I face with a Vitamin D level of 4.5?

Level	Risk
Your value is Less Than 25	Increased risk of fallsBischoff-Ferrari
Your value is Less Than 10	40% more risk of mortality compared to those with vitamin d above 40Ginde AA
Your value is Less Than 8	More risk of cardiovascular mortality than those with a median vitamin d of 28Dobnig H
Your value is Less Than 15	Two fold higher risk of having high blood pressure as those with Vitamin D above 26Reis JP
Your value is Less Than 21	Increased risk of diabetes, hypertension, obesity and high triglyceride levelsMartins D

What is my Vitamin D deficiency score and how to calculate it?

Since your value of Vitamin D 4.5 is below the normal limit of 30, you must evaluate the following 4 factors that may be contributing to your deficiency. Based on a study done by Garg et al the following Vitamin D Insufficiency and Deficiency Score can predict and determine your causes of deficiency.

As per the study 4 major factors are invovled in Vitamin D deficiency.

Factors and Descriptions

Factor	Description
Physical Activity	Engaging in regular physical activity can contribute to improved metabolism and Vitamin D levels.
Obesity	Obesity, indicated by a body mass index (BMI) of 25 kg/m² or higher, can lead to Vitamin D deficiencies
Diet	Dietary intake of at least 100 Grams (gms) of milk/dairy products OR at least 100 gms fish or 1 egg with yolk for four or more days in the last seven days was considered Adequate
Daily Sun Exposure	Daily exposure to sunlight is important for the body's synthesis of Vitamin D. Spending at least 1.75 hours in the sun each day can help maintain Vitamin D levels, which is essential for bone health and immune function.

• Insufficiency Score for Vitamin D : 4.5

• You get less than 1.75 hours of sunlight per day
• AND
• Insufficient Dietary Intake
• AND
• Obesity
• AND
• Insufficient Exercise
• Score : Your Vitamin D Insufficiency Score ranges between 14 - 18.

What is the treatment plan for a Vitamin D level of 4.5?

Vitamin D supplmentation is the only way to correct for deficiencies. The tables below list the dosages of Vitamin D supplements recommeded for different age groups, depending on the level of the Vitamin D. Since your value of Vitamin D is 4.5 the relevant supplement dosages are indicated below.^{Pawel Pludowski}

Recommended Daily Dosing for Vitamin D in cases where the Vitamin D Level is < 10 ng/dl

Age Group	Vitamin D Intake Per Day	Duration
Infants < 1 month	1000 IU/d	3 months
Infants 1–12 months	2000 IU/d	3 months
Children 1–11 yrs.	4486 IU/d**(Represents a value in the range of 3000 - 6000, must be adjusted as per patient.)	3 months
Children 11–18 yrs.	6000 IU/d	3 months
Adults	6000 IU/d	3 months

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