People At Risk Of Vitamin D Deficiency
Some people will not make enough vitamin D from sunlight because they have very little or no sunshine exposure.
The Department of Health and Social Care recommends that adults and children over 4 take a daily supplement containing 10 micrograms of vitamin D throughout the year if they:
- are not often outdoors for example, if they’re frail or housebound
- are in an institution like a care home
- usually wear clothes that cover up most of their skin when outdoors
If you have dark skin for example you have an African, African-Caribbean or south Asian background you may also not make enough vitamin D from sunlight.
You should consider taking a daily supplement containing 10 micrograms of vitamin D throughout the year.
Other Ways To Get Vitamin D
If youre not ready to hop on the supplement train, youre able to get in vitamin D through food and sunshine . There arent many foods that naturally contain vitamin D, but the National Institute of Health stating fatty fish and fish oils are among the best sources. The top 3 food sources include:
- Cod liver oil, 1 tablespoon: 1360 IU
- Rainbow trout, 3 ounces: 645 IU
- Sockeye salmon, 3 ounces: 570 IU
Your skin also absorbs UV rays from the sun and coverts it into vitamin D. The amount you get is all dependent on time of day, cloud coverage, skin melanin, and sunscreen. Some researchers claim getting outdoors between 10 a.m. and 4 p.m. for about 5 to 30 minutes twice per week will lead to sufficient vitamin D synthesis.
What Causes Low Vitamin D
Anything that interferes with the bodys ability to make vitamin D through the skin, including liver or kidney disease, can cause deficiency. Malabsorption syndromes or a diet low in foods containing vitamin D can also lower vitamin D levels.
The following factors may interfere with our body’s ability to make vitamin D:
- Chronic illness or disability that prevents regular sun exposure
- Living at latitudes above 37 degrees north or below 37 degrees south of the equator over winter, although this is controversial, and studies have shown only Caucasians show a correlation with low vitamin D levels and latitude.
- Skin color: Individuals with a darker skin produce less vitamin D with the same amount of sunlight exposure than individuals with lighter skin color.
- Age: Older people are less efficient at making D3 and less likely to go outside in the sun.
- Religion or culture: People whose beliefs require them to cover most of their skin and/or face usually do not receive adequate sunlight for their skin to make vitamin d.
- Avoidance of the sun and use of sunscreen: Fears of skin cancer and skin aging mean people spend less time in the sun than in the past, although only 10 minutes of direct summer sun is necessary to make an adequate daily dose of vitamin D.
In addition, a poor intake of vitamin D through the diet may also contribute however, studies have shown less than 10% of the vitamin D in our body is obtained through diet, so it is not considered a major contributing factor.
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Why Is Vitamin D So Important
Vitamin D is one of many vitamins our bodies need to stay healthy. This vitamin has many functions, including:
- Keeping bones strong: Having healthy bones protects you from various conditions, including rickets. Rickets is a disorder that causes children to have bones that are weak and soft. It is caused by a lack of vitamin D in the body. You need vitamin D so that calcium and phosphorus can be used to build bones. In adults, having soft bones is a condition called osteomalacia.
- Absorbing calcium: Vitamin D, along with calcium, helps build bones and keep bones strong and healthy. Weak bones can lead to osteoporosis, the loss of bone density, which can lead to fractures. Vitamin D, once either taken orally or from sunshine exposure is then converted to an active form of the vitamin. It is that active form that promotes optimal absorption of calcium from your diet.
- Working with parathyroid glands: The parathyroid glands work minute to minute to balance the calcium in the blood by communicating with the kidneys, gut and skeleton. When there is sufficient calcium in the diet and sufficient active Vitamin D, dietary calcium is absorbed and put to good use throughout the body. If calcium intake is insufficient, or vitamin D is low, the parathyroid glands will borrow calcium from the skeleton in order to keep the blood calcium in the normal range.
How And When To Take Vitamin D Supplements
So whats the best way to take vitamin D supplements?
Even if a supplement says you can take it on an empty belly, vitamin D seems to do best with a meal. This is especially true when paired with a meal higher in fat. One study showed adults taking vitamin D with a fat-heavy meal had a 32 percent boost in vitamin D blood levels after 12 hours compared to those taking the supp with a fat-free meal.
Should you take vitamin D morning, noon, or night? Honestly, its up to you and your preferences. There seems to be no ideal time, although some research claims it may be best to take in the morning rather than at night. Thats because increased vitamin D levels may suppress melatonin the hormone responsible for regulating our snooze cycle according to a 2018 article.
If youre an expecting mama, vitamin D is usually recommended to be part of your daily supplement routine. You should confirm with your doctor how much is safe for you, specifically.
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The Latest Research On Vitamin D Supplements
Vitamin D supplements have long been touted as important to bone health. The problem is that several studies have found that they dont live up to the hype. Vitamin D supplementation doesnt prevent fractures or falls, or have any effect on bone mineral density that is clinically meaningful, according to large review of over 81 clinical trials published in October 2018 in The Lancet Diabetes and Endocrinology. 30265-1″ rel=”nofollow”> 4)
Nor was vitamin D supplementation found to reduce the risk of cancer, heart attack, stroke, or cardiovascular death in a randomized, controlled clinical trial involving over 25,000 participants that was published in January 2019 in The New England Journal of Medicine. Yet researchers found that those who developed cancer had a 25 percent lower death rate when they were taking vitamin D. The findings also included a possible reduction in cancer risk for African Americans, which researchers wrote warrants further study.
Meanwhile, though observational studies have suggested a link between low vitamin D levels and the risk of developing type 2 diabetes, a randomized, controlled clinical trial published in June 2019 in The New England Journal of Medicine did not support that conclusion. Vitamin D3 supplementation at a dose of 4,000 IU per day did not result in a significantly lower risk of diabetes compared with a placebo.
Still, before you dispose of your supplements, speak with your doctor.
What Happens If I Take Too Much Vitamin D
Taking too many vitamin D supplements over a long period of time can cause too much calcium to build up in the body . This can weaken the bones and damage the kidneys and the heart.
If you choose to take vitamin D supplements, 10 micrograms a day will be enough for most people.
Do not take more than 100 micrograms of vitamin D a day as it could be harmful. This applies to adults, including pregnant and breastfeeding women and the elderly, and children aged 11 to 17 years.
Children aged 1 to 10 years should not have more than 50 micrograms a day. Infants under 12 months should not have more than 25 micrograms a day.
Some people have medical conditions that mean they may not be able to safely take as much. If in doubt, you should consult your doctor.
If your doctor has recommended you take a different amount of vitamin D, you should follow their advice.
You cannot overdose on vitamin D through exposure to sunlight. But always remember to cover up or protect your skin if you’re out in the sun for long periods to reduce the risk of skin damage and skin cancer.
Page last reviewed: 03 August 2020 Next review due: 03 August 2023
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What Are Prenatal Vitamins For During Pregnancy
They help promote the development of the babys teeth and bones. It also might be beneficial to look for a prenatal vitamin that contains vitamin C, vitamin A, vitamin E, B vitamins, zinc and iodine. In addition, your health care provider might suggest higher doses of certain nutrients depending on the circumstances.
Best Liquid For Babies: Nordic Naturals Baby’s Vitamin D3
Third-party purity tested and non-GMO verified, Nordic Naturals’ liquid vitamin D3 formula for babies offers 400 IU of D3 per serving. Made with organic extra-virgin olive oil, it’s free from gluten, milk derivatives, and anything artificialand comes with a measured dropper so it can be easily added to formula or breast milk. This pick also just so happens to be the official baby’s vitamin D3 supplement pick of the American Pregnancy Association.
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Vitamin K2 + D3 With Organic Virgin Coconut Oil
- Contains 5000 IU of Vegan Vitamin D3 & 100 mcg of Vitamin K2 as MK-7
- Made with Vitashine D3 – a patent, plant based form of Vitamin D3 from Lichen and MenaQ7 – a patent form of MK7 from Chickpea
- 100% Plant based – Vegan Certified & Non-GMO Verified. Soy, Gluten, Gelatin & Carrageenan free
- Formulated with Organic Coconut Oil – Note: Capsules may appear ‘cloudy’ due to the Coconut Oil
How Is A Vitamin D Deficiency Diagnosed
Your doctor can order a blood test to measure your levels of vitamin D. There are two types of tests that might be ordered, but the most common is the 25-hydroxyvitamin D, known as 25D for short. For the blood test, a technician will use a needle to take blood from a vein. You do not need to fast or otherwise prepare for this type of test.
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What Is A Low Vitamin D Level
There is a bit of controversy regarding what is considered a low vitamin D level between different expert organizations. A vitamin D level measures levels of 25D in the blood .
Most experts recommend:
- Levels of 20-50 nanograms/milliliter of 25D: Sufficient
- Levels of 12-19 ng/ml: Borderline
- Levels of less than 12 ng/ml: Deficient
However, not everybody agrees, and some organizations suggest different cut-off values.
The Institute of Medicine states:
- Levels above 20 ng/ml: Sufficient
- Levels below 20 ng/ml: Deficient
Note that several members of the IOM committee publicly stated that over screening for vitamin D deficiency was a problem which typically resulted in unnecessary treatment. They were not in agreement with a cut-off level of 20 ng/ml for deficiency and recommended a lower level of 12.5 ng/ml.
The Endocrine Society states:
- Levels above 30 ng/ml: Sufficient however, some assays are inaccurate and levels of 40-60 ng/ml better guarantee sufficiency
- Levels of 21-29 ng/ml: Insufficient
- Levels below 20 ng/ml: Deficient
Talk to your doctor about what he/she considers to be a low vitamin D level.
What Is The Difference Between Vitamin D2 And D3
Vitamin D2 and D3 are two important forms of vitamin D. D2 comes from plants and D3 comes from mainly animal sources or it is made by our bodies when our skin is exposed to sunlight. D3 is better absorbed and more potent than D2. Fortified milk or juice is more likely to contain D2 because it is cheaper to produce.
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What Does Vitamin D Do
Most people know that vitamin D is good for calcium absorption and bone health, but vitamin D is also important for many other vital bodily processes.
A lack of vitamin D has been associated with:
- An impairment in memory and thinking skills in older adults
- Bone, back, or muscle pain
- Severe asthma in children
- Skin wounds that take a long time to heal.
Research also suggests low vitamin D may be a factor in several other conditions such as diabetes, high blood pressure, and multiple sclerosis.
How Much Vitamin D Should I Take
There is some controversy about whether people should take vitamin D as an oral supplement or just improve their level of sun exposure, while still staying sun safe.
An estimated 90% of vitamin D in our bodies is made when our skin is exposed to sunlight, which means our diet only contributes a small amount. However, there are certain groups of people, such as babies, young children, people with mental or physical disabilities, people with malabsorption syndromes, the elderly, and people who cover their skin for religious or cultural reasons that are at high risk of becoming vitamin D deficient.
The recommended daily intake of vitamin D is:
- Aged birth to 1 year: 400 IU
- Aged 1-70 years: 600 IU
- Aged > 70 years: 800 IU
The safe upper limit of vitamin D is 4,000 IU/day for adults. But even though dosages above this amount are not recommended, doctors may still prescribe them for people who are vitamin D deficient. The upper limit for children is 1000IU for infants up to 6 months 2,500IU for toddlers up to 3 years 3,000IU for children aged 4-8 years, and 4,000IU for those aged 9 years and older. Blood levels should be monitored when someone is taking high doses of vitamin D.
Guidelines do not currently differentiate between supplementation with different forms of vitamin D .
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How Much You Need
The vitamin D recommendation, established by the Food and Nutrition Board of the Institute of Medicine, is 600 IU a day after age 70, it rises to 800 IU daily. Nutrition facts labels are based on daily values for healthy adults who eat 2,000 calories a day, and the daily value, which is only 400 IU a day, is less than what the IOM recommends. So if the label says your supplement has 100 percent of the daily value of vitamin D, it has 400 IU.
Optimal Vitamin D Status
At the present time, 25D levels in the range of 30 to 60 ng/mL are considered optimal, but higher levels up to 100 ng/mL are often seen in individuals with outdoor occupations receiving intense sun exposure without ill effects. Correlative studies of 25D with muscle strength or risk of breast or colon cancer have prompted several investigators to suggest that the optimal 25OHD target for multiple health outcomes is 40 to 50 ng/mL., Garland et al suggest that increasing 25D to a range of 40 to 60 ng/mL from the current US average could reduce risk of breast cancer by 25% and colon cancer by 27%. Intakes of at least 4,000 IU daily from all sources would be needed to maintain 25D levels of 40 to 60 ng/mL. Practically speaking, supplements of 2,000 IU daily plus some sun exposure would probably be required to maintain a 25D level of 40 to 60 ng/mL year round.
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Thorne Research Vitamin D
On the surface, Thorne Research Vitamin D-1000 looks pretty standard. Its a vegetarian cellulose-based vitamin D supplement that delivers 1000 IU per day.
However, its got one interesting and unusual ingredient: the amino acid leucine.
The choice of this particular amino acid might seem a bit puzzling at first, but Thorne Research might be ahead of the curve: a 2015 study on elderly patients found that adding leucine to the vitamin D supplementation regimen of people at risk for sarcopeniathe loss of muscle mass associated with agingfound that leucine helped prevent this muscle loss .
Its not clear how or why this works, but it might be a good idea to go for Thorne Researchs vitamin D offering if you are getting older and want to think about your muscle mass retention.
Best Gummy For Kids: Nature Made Kids First Vitamin D Gummies
These strawberry-, peach-, and mango-flavored gummies provide kids from ages four to 18 with 1,000 IU of vitamin D3 to support healthy bone and tooth development.* Made with natural fruit flavors and colors derived from natural sources, they’re free of high-fructose corn syrup, gluten, artificial flavors, and artificial sweeteners. This is a nutrition ritual that kids look forward to!
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Recognition And Management Of Vitamin D Deficiency
PAULA BORDELON, DO MARIA V. GHETU, MD and ROBERT LANGAN, MD, St. Luke’s Family Medicine Residency Program, Bethlehem, Pennsylvania
Am Fam Physician. 2009 Oct 15 80:841-846.
Vitamin D deficiency affects persons of all ages. Common manifestations of vitamin D deficiency are symmetric low back pain, proximal muscle weakness, muscle aches, and throbbing bone pain elicited with pressure over the sternum or tibia. A 25-hydroxyvitamin D level should be obtained in patients with suspected vitamin D deficiency. Deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng per mL , and insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng per mL . The goal of treatment is to normalize vitamin D levels to relieve symptoms and decrease the risk of fractures, falls, and other adverse health outcomes. To prevent vitamin D deficiency, the American Academy of Pediatrics recommends that infants and children receive at least 400 IU per day from diet and supplements. Evidence shows that vitamin D supplementation of at least 700 to 800 IU per day reduces fracture and fall rates in adults. In persons with vitamin D deficiency, treatment may include oral ergocalciferol at 50,000 IU per week for eight weeks. After vitamin D levels normalize, experts recommend maintenance dosages of cholecalciferol at 800 to 1,000 IU per day from dietary and supplemental sources.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
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