The Evidence On Extra Vitamin D
We know that people with low vitamin D levels are at risk for health problems, but the question is, if you treat the low vitamin D, can you prevent those issues? says Erin Michos, M.D., an associate professor of medicine and epidemiology at the Johns Hopkins University School of Medicine. And there havent been any trials showing this is the case.
A review of 21 clinical trials involving 83,291 people with an average age of 66, published just last week in JAMA Cardiology, found that taking vitamin D supplements for at least one year didn’t significantly reduce the risk of cardiac events such as heart attack and stroke, or death from any cause.
A key limitation: Few of the trials focused specifically on the effects of supplements on cardiovascular disease, but instead on issues such as bone density.
For this and other reasons, the researchers say that more studies on older adults, with a focus on heart-related conditions such as heart failure, would be “of interest.” Still, they write, “The findings suggest that vitamin D may not confer cardiovascular protection and may not be indicated for this purpose.”
There’s other recent research, too. An early 2019 study of more than 25,000 people 50 or older, published in the New England Journal of Medicine, found that taking 2,000 IU of vitamin D daily for five years failed to decrease the incidence of cancer or cardiovascular disease.
Calcium And Vitamin D: A Partnership
Calcium and vitamin D is the dynamic duo that works together to strengthen and protect your bones. For years, healthcare providers have recommended that postmenopausal women take calcium and vitamin D supplements to prevent osteoporosis, a bone-thinning disease that is a major cause of devastating fractures in old age.
Research linking calcium supplements to heart attack and stroke caused many to take vitamin D supplements alone for prevention.
Calcium supplements can increase calcification in the arteries and predispose people, especially women, to heart disease, he says. Thats why we always prefer dietary calcium. However, some people get adequate dietary calcium but are low in vitamin D.
Risks And Side Effects
Vitamin D and calcium are incredibly important. Symptoms of low calcium and vitamin D can range from bone loss to muscle pain to cramps and weakness. If you think that you may have deficiency, your doctor can test your blood levels to help determine the best course of treatment for you.
Keep in mind that there are several calcium and vitamin D side effects that you should be aware of if you do decide to start supplementation. A few of the most common symptoms include nausea, vomiting, constipation and fatigue. In some studies, calcium supplements have also been linked to a higher risk of kidney stones, prostate cancer and even heart disease, although research has turned up conflicting findings. More studies are needed to understand whether other factors may be involved as well.
Consuming high amounts of either micronutrient can also have harmful side effects on health. Therefore, its important to use supplements only as directed and be sure to talk to a trusted health care professional before starting supplementation, especially if you have any underlying health issues or are taking other medications.
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How Much Is Too Much
Many people don’t realise that you can have too much of a good thing. In very high doses, many minerals and vitamins can harm your body. Current guidelines say adults shouldn’t take more than the equivalent of 100 micrograms a day. But vitamin D is a ‘fat-soluble’ vitamin, so your body can store it for months and you don’t need it every day. That means you could equally safely take a supplement of 20 micrograms a day or 500 micrograms once a month. Don’t worry – your doctor or pharmacist aren’t trying to poison you! You can divide the monthly dose by 30 to give you the daily equivalent, which is what counts.
Of course, speaking of too much of a good thing, too much sunshine can be disastrous for your health. Any redness or even tanning of your skin is a sign that your skin has been damaged. In spring and summer, you can get your vitamin D from 15 to 20 minutes a day with arms and face uncovered in full sun. But don’t get burnt – this raises the risk of all kinds of skin cancer, but particularly of deadly melanoma.
Groups At Risk Of Vitamin
Obtaining sufficient vitamin D from natural food sources alone is difficult. Consumption of vitamin D-fortified foods and exposure to some sunlight are essential for maintaining a healthy vitamin D status. Dietary supplements might be required to meet the daily need for vitamin D in some group of people.
Breastfed infants
Vitamin D requirements cannot ordinarily be met by human milk alone, which provides < 25 IU/L to 78 IU/L. Vitamin D content of human milk is related to the mother’s vitamin D status therefore mothers who supplement with high doses of vitamin D may have high levels of vitamin D in their milk. American Association of Paediatricians recommends that exclusively and partially breastfed infants must be supplemented with 400 IU of vitamin D per day, the recommended daily allowance for this nutrient during infancy.
Older adults
Older adults are at high risk of developing vitamin D insufficiency because of aging. Their skin cannot synthesize vitamin D as efficiently, they are likely to spend more time indoors, and they may have inadequate intakes of the vitamin.
People with limited sun exposure
People with dark skin
People with fat malabsorption
People who are obese or who have undergone gastric bypass surgery
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Reduce The Risk For Type 2 Diabetes
Observational studies in cell models suggest that vitamin D may help increase insulin sensitivity, boost beta cell function, and lessen inflammation all potential benefits for reducing the risk of and helping manage type 2 diabetes, notes an article published in March 2014 in Endocrinology and Metabolism Clinics of North America.
But vitamin D supplementation was not found to lower the risk of developing type 2 diabetes in a randomized, controlled clinical trial involving more than 3,600 participants that was published in June 2019 in the New England Journal of Medicine, despite prior observational studies suggesting that it could. A dose of 4,000 IU of vitamin D per day did not result in a significantly lower risk of diabetes compared with a placebo.
Good Sources Of Vitamin D
From about late March/early April to the end of September, most people should be able to make all the vitamin D they need from sunlight.
The body creates vitamin D from direct sunlight on the skin when outdoors.
But between October and early March we do not make enough vitamin D from sunlight. Read more about vitamin D and sunlight.
Vitamin D is also found in a small number of foods.
- fortified foods such as some fat spreads and breakfast cereals
Another source of vitamin D is dietary supplements.
In the UK, cows’ milk is generally not a good source of vitamin D because it is not fortified, as it is in some other countries.
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Advice For Infants And Young Children
The Department of Health and Social Care recommends that babies from birth to 1 year of age should have a daily supplement containing 8.5 to 10 micrograms of vitamin D throughout the year if they are:
- breastfed
- formula-fed and are having less than 500ml of infant formula a day, as infant formula is already fortified with vitamin D
Children aged 1 to 4 years old should be given a daily supplement containing 10 micrograms of vitamin D throughout the year.
You can buy vitamin D supplements or vitamin drops containing vitamin D at most pharmacies and supermarkets.
Women and children who qualify for the Healthy Start scheme can get free supplements containing vitamin D.
See the Healthy Start website for more information.
Where Else Is Vitamin D Naturally Available
Although the sun is the only natural way for our bodies to synthesize vitamin D, we can still provide it through food or supplements.
Unfortunately, very few foods have naturally occurring vitamin D, and the majority that do are not vegan-friendly, like fatty fish, egg yolks, and beef. Some other foods, like milk or cereal, are fortified with vitamin D, meaning that its added into the product during production.
Depending on your dietary needs, these may not be great options. One of the only naturally occurring, vegan-friendly foods that can be a good source of vitamin D are mushrooms. Otherwise, supplementing may be necessary if you find that you do not have adequate levels of vitamin D in your body.
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Vitamin D Deficiency: Consequences
VDD results in abnormalities in calcium, phosphorus, and bone metabolism. VDD causes a decrease in the absorption of dietary calcium and phosphorus, resulting in an increase in PTH levels. The PTH-mediated increase in osteoclastic activity creates local foci of bone weakness and causes a generalized decrease in bone mineral density , resulting in osteopenia and osteoporosis. An inadequate calciumphosphorus product causes a mineralization defect in the skeleton. In young children who have little mineral in their skeleton, this defect results in a variety of skeletal deformities classically known as rickets. VDD also causes muscle weakness affected children have difficulty in standing and walking, whereas the elderly have increasing sway and more frequent falls, thereby increasing their risk of fracture.
Who Is At Risk Of Vitamin D Deficiency
Some people are at higher risk of vitamin D deficiency:
- Breastfed infants, because human milk is a poor source of vitamin D. If you are breastfeeding, give your infant a supplement of 400 IU of vitamin D every day.
- Older adults, because your skin doesn’t make vitamin D when exposed to sunlight as efficiently as when you were young, and your kidneys are less able to convert vitamin D to its active form.
- People with dark skin, which has less ability to produce vitamin D from the sun.
- People with disorders such as Crohn’s disease or celiac disease who don’t handle fat properly, because vitamin D needs fat to be absorbed.
- People who have obesity, because their body fat binds to some vitamin D and prevents it from getting into the blood.
- People with chronic kidney or liver disease.
- People with hyperparathyroidism
- People with sarcoidosis, tuberculosis, histoplasmosis, or other granulomatous disease
- People with some lymphomas, a type of cancer.
- People who take medicines that affect vitamin D metabolism, such as cholestyramine , anti-seizure drugs, glucocorticoids, antifungal drugs, and HIV/AIDS medicines.
Talk with your health care provider if you are at risk for vitamin D deficiency. There is a blood test which can measure how much vitamin D is in your body.
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Reasons Why Your Body Needs Vitamin D
Medically reviewed by Rosanna Sutherby, PharmD on August 11, 2020. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
Why do we need vitamin D? The âsunshine vitaminâ is well-known as a nutrient that helps build strong muscles and healthy bones by increasing the bodyâs ability to absorb calcium and phosphorus. But in recent years, itâs been shown to play a role in other aspects of health, as wellâand here weâll highlight some of those findings to help explain why the body needs vitamin D, so read on.
What Causes Vitamin D Deficiency
You can become deficient in vitamin D for different reasons:
- You don’t get enough vitamin D in your diet
- You don’t absorb enough vitamin D from food
- You don’t get enough exposure to sunlight.
- Your liver or kidneys cannot convert vitamin D to its active form in the body.
- You take medicines that interfere with your body’s ability to convert or absorb vitamin D
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Is Vitamin D Deficiency An Epidemic No Its Not
Thomas Carpenter, MD, Yale Medicine pediatric endocrinologist and director of the Yale School of Medicines Center for X-Linked Hypophosphatemia
Based on the United States Dietary Association and National Health and Nutrition Surveys , the bulk of the population is not vitamin D-deficient. The population we tend to see vitamin D deficiency inand its typically in wintertimeare breastfed infants. Breast milk doesn’t have much vitamin D in it. That’s what spurred a recommendation from the American Academy of Pediatrics that every breastfed infant be given vitamin D . But if infants aren’t given multivitamin drops, they need to be given 200 IU a day of vitamin D for the first two months of life and 400 units a day afterwards until theyre drinking formula or milk, which are each fortified with vitamin D.
How Thinking About Vitamin D Has Changed
For the first 20 years I was a doctor, I hardly ever checked anyone’s vitamin D levels. We knew people with very low levels were at higher risk of ‘thinning’ of the bones . So we did used to prescribe calcium and vitamin D supplements for people at high risk of breaking a bone.
Occasionally we’d check someone’s blood levels of vitamin D and discover they were very low – so we’d give them a single injection of very high-dose vitamin D. But that was about it.
In the last decade, there has been a complete revolution among doctors in our attitudes to vitamin D. Once we started measuring it, I certainly discovered at least half my patients were short of vitamin D and one in six patients were severely deficient. So we started recommending supplements routinely for anyone at risk of osteoporosis as well as other conditions .
But on 5th October 2018 a new study on vitamin D and osteoporosis was published which is likely to change our thinking again.
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In Your Digestive System
Vitamin D also gets to work in your intestines. Here, it helps your body absorb the calcium from your healthy diet and from any calcium supplements.
Make sure you get enough Vitamin D in a format which your body can use. Support your diet and lifestyle with a quality daily Vitamin D3 supplement which can be absorbed and digested by your body.
Which Type Of Vitamin D Is Best For You
If you would like a little more of the sunshine vitamin in your life, but do not know which type of vitamin D is best for you, dont worry – were on the case!
Our nutritionists have created a handy guide outlining which type and form of vitamin D will help you thrive.
Whether you are looking for vitamin D for adults, vegans, children and babies or for when you are pregnant, there is a suitable type for everyone.
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The Final Verdict On Vitamin D
No bones about it, the endocrinologists we interviewed agree with our dermatologist.
“Just being outdoors, you get a fair amount of sun exposure and some sun-related generation of vitamin D, says Dr. Insogna. Because skin cancer, particularly melanoma, can be such a devastating disease, it’s best to use sunblock when outdoors in strong sunlight for any prolonged length of time. Because this may limit the amount of vitamin D you get from sun exposure, make sure your diet includes sources of vitamin D from foods or supplements, he says.
Both your skin and your bones will thank you.
Uv Levels In Victoria
As shown in the table below, from mid-August to April, average UV levels in Victoria are three and above for much of the day. This level of UV increases the risk of overexposure and skin damage, and sun protection is recommended. Using good sun protection should not put people at risk of vitamin D deficiency.From May to mid-August, average UV levels in Victoria are low . During this time, sun protection is not recommended, unless you work outdoors, are near highly reflective surfaces , or are outside for extended periods.
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What Is The Difference Between Vitamin D2 And D3
Vitamin D2 and D3 are the two most important forms for your health.
There are 2 main forms of vitamin D:
- Vitamin D2 made by plants, with wild mushrooms and those grown under a UV light being the best source
- Vitamin D3 made by our skin when we are exposed to enough sunlight. Animal products like fish, meat, eggs and dairy as well as a vegan-friendly fungus called lichen also naturally contain this type of vitamin D
Fortified foods can contain either form.
Do I Get Enough Vitamin D In The Winter
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Q.Can I get enough vitamin D from sunlight, even if I live in a place with little sunlight during the winter?
A. Most people can make enough vitamin D from sun exposure during the summer, but for many, synthesis can be inadequate in the winter. A 2016 study led by researchers at the Centers for Disease Control and Prevention estimated that 14 to 18 percent of Americans have inadequate vitamin D, although what constitutes a healthy blood level is subject to debate.
Synthesis of vitamin D, which is critical for bone health, requires exposure to ultraviolet-B rays from the sun. In the summer, when the sun is directly overhead, vitamin D synthesis can be very efficient. For someone with light skin in a temperate climate at midday, 10 minutes a day of exposure to 10 percent of your bodys surface area, such as your arms and face, will give you what you need, said Dr. Bess Dawson-Hughes, director of the Bone Metabolism Lab at the USDA Nutrition Center at Tufts University. Closer to the Equator, even less time is required.
Thats a rough estimate, though, and many factors can interfere with vitamin D synthesis. People with darker skin need two to three times the sun exposure to make the same amount of vitamin D, and synthesis also declines with age, Dr. Dawson-Hughes said. Environmental factors like clouds, ozone and air pollution can likewise decrease vitamin D production, she said.
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