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Hypothesis: Less severe muscle damage if vitamin D level had been normalized – July 2013

Does low serum 25 OH vitamin D interact with very strenuous physical activity, facilitating development of rhabdomyolysis?

Med Hypotheses. 2013 Jul 26. pii: S0306-9877(13)00321-6. doi: 10.1016/j.mehy.2013.06.029. [
Conrad BN, Glueck CJ.
Jewish Hospital Cholesterol Center, 3200 Burnett Avenue, Cincinnati, OH 45229, United States. Electronic address: dydxbc at gmail.com.

BACKGROUND: Vitamin D plays an important and increasingly understood role in muscle health and performance. Vitamin D exhibits a nuclear receptor for transcription interaction and a transmembrane receptor, giving it genomic and non-genomic interactions. Vitamin D receptors have been described that affect muscle function. Vitamin D has also been correlated with muscle performance. Beyond its role in normal muscle function, vitamin D deficiency can interact with statins to produce myalgia-myositis, which can be reversed by normalizing serum vitamin D [7,13].
Exertional rhabdomyolysis may occur in diverse settings including

  • marathons,
  • ice skating,
  • bicycling and
  • swimming.

Our hypothesis is that subjects with pre-existing low serum 25OHD are selected out for exertional rhabdomyolysis during strenuous activities.

METHODS: We review exercise induced severe rhabdomyolysis in association with heat stroke with subsequent disseminated intravascular coagulation in a thin, athletic, dark skinned, conditioned young man, occurring in the setting of a 5K race, subsequently found to have severe 25 OH vitamin D deficiency (6ng/ml, laboratory lower normal limit >30ng/ml).

CONCLUSION: We suggest that when very low vitamin D is documented, it be normalized before major prolonged exertion. We hypothesize that normalization of vitamin D before heavy exertion could perhaps prevent the severe muscle damage events and sequelae as was the case for this patient.

Copyright © 2013. Published by Elsevier Ltd. PMID: 23896214


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