Vitamin D Deficiency
Would you believe that most of the population — up to 90 percent of adults in the U.S. — is believed to have a vitamin D deficiency?
Many physicians are starting to take this vitamin deficiency very seriously.
In fact, this vitamin is one of the most recommended supplements by physicians today to treat and/or prevent vitamin D deficiency symptoms.
Most adults are believed to be at least somewhat deficient in this important vitamin
however, people with dark skin, people who live in northern regions of the world where less year-round sun exposure is experienced, and those who are overweight have an even greater chance of experiencing vitamin D deficiency symptoms.
According to the National Health and Nutrition Examination Survey
the newest statistics demonstrate that more than 90 percent of people with darker skin pigments (including African-Americans, Hispanics, and Asians) living in the United States now suffer from vitamin D insufficiency, while 75 perfect of the white population is deficient.
As the population of overweight and obese adults and children has risen steadily over the past several decades, so has the incidence of vitamin D deficiency symptoms.
Sadly, research shows that vitamin D deficiency correlates with increased risks of developing common cancers, autoimmune diseases, hypertension, and various infectious diseases.
A 2017 study recently revealed that occupation could also play a big role in levels of this vitamin.
Researchers found that shift workers, health care workers, and indoor workers are at a high risk of developing a deficiency due to reduced outdoor time and sunlight exposure.
Luckily, there are ways you can naturally increase your vitamin D levels and decrease your risk of developing health conditions like heart disease, cancer, diabetes, and other vitamin D deficiency symptoms.
Spending time in the sun without sunscreen is your surest way to get enough; eating vitamin D-rich foods also helps improve your blood levels.
Read on to understand just how much time you need in the sun and what foods will help you to avoid vitamin D deficiency symptoms — along with vitamin D benefits.
What Is Vitamin D?
Vitamin D is a fat-soluble vitamin stored in the liver and fatty tissues.
This means increased body fat can absorb this vitamin and keep it from being used.
It’s somewhat different from other vitamins because the body makes most of it independently rather than solely relying on food sources.
What Does It Do in the Body?
Here’s an easy breakdown of how this vitamin is made and what it does in the body:
- The body converts sunshine into chemicals that are then used by the body. In particular, when UV-B sunshine rays land on the skin, a substance in the skin called 7-dehydrocholesterol is converted into vitamin D3.
- 7-dehydrocholesterol, or the cholesterol in our skin — very similar to cholesterol itself — converts “previtamin D” and makes it into usable D3, sometimes called provitamin D.
- Previtamin D first travels through the kidneys and liver in the bloodstream and then is converted into a biologically active and usable substance called calcitriol.
- Vitamin D becomes a hormone within the body, particularly a secosteroid hormone. What we know as vitamin D is a precursor to a steroid hormone.
- Research indicates that it impacts the skeletal structure and blood pressure, immunity, mood, brain function, and the ability to protect ourselves from cancer.
Vitamin D2 vs. Vitamin D3
There are two types of supplemental vitamin D: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol).
The precursor to vitamin D is found in plant and animal products, but animal-derived products of vitamin D3 are thought to be more absorbable and beneficial.
Why? Well, human-made D vitamin is made one of two ways: D2 is created by irradiating yeast and other molds (known as vegetarian vitamin D2) or by irradiating animal oils and cholesterol, creating vitamin D3.
The type our bodies naturally make is called cholecalciferol, vitamin D3.
The body can convert some D2 to be used for body functions but prefers and can use D3 more effectively.
Unfortunately, most vitamin D-fortified foods and dietary supplements mostly contain ergocalciferol, a type of D2, which is neither as absorbable nor convertible by the body into what it needs.
D3 from animal products (specifically from the cholesterol within these products) is closest to what sunlight naturally produces in humans when the skin works to convert UV light.
Vitamin D3 is believed to convert up to 500 times faster than D2 and has been estimated to be four times more effective in humans.
Vitamin D From the Sun
While these serve as food sources, direct exposure to the sun is the best way to absorb this vital vitamin.
When you sit in the sun unexposed, without sunscreen, for roughly 10 minutes, you likely absorb about 10,000 units of natural vitamin D.
However, remember that this amount differs from person to person, depending on skin tone.
Melanin is a substance that affects how light or dark your skin color is, and the more melanin you have in your body, the darker your skin color will be.
Melanin gets released when we are exposed to the ultraviolet rays of sunshine.
The more sunshine we receive, the more melanin is released into our skin.
It’s believed that up to 90 percent to 95 percent of most vitamin D comes from casual sunlight exposure.
The amount of melanin in your skin affects the amount of vitamin D you can produce, so the fairer your skin, the more quickly you can make it.
The cholesterol in the skin converts melanin into usable vitamin D to be distributed throughout the body.
This is why, for many people, a slight to moderate rise in cholesterol levels can be experienced in the winter months when there is less exposure to sunshine since it’s common to spend much more time indoors.
1. Contributes to Bone Health
Vitamin D plays a role in calcium absorption into the bones. Calcitriol (converted D vitamin) works with the parathyroid hormone to maintain calcium levels.
Additionally, it affects other essential vitamins and minerals that contribute to bone health, including vitamin K and phosphorus.
Vitamin D is partially responsible for maintaining phosphorus levels in the blood. Since it affects calcium’s ability to bind to proteins, it’s believed that it’s also linked to vitamin K.
A deficiency in vitamin D can result in the softening of your bones, called osteomalacia, or a bone abnormality called rickets.
Additionally, a deficiency increases your risk of developing osteoporosis and experiencing fractures or broken bones.
Studies have shown that doses of 800–5,000 international units per day can improve musculoskeletal health by naturally slowing the aging of the skeletal structure and reducing the rate of fractures and falls in older adults over 65.
Older adults with adequate vitamin D levels are more likely to be active, have improved muscle strength, and are less prone to falls and injuries.
When levels are low, the parathyroid becomes overactive. This is known as hyperparathyroidism and results in drops in phosphorus.
Phosphorus, in addition to calcium and other compounds, is needed to mineralize bone density properly.
2. Helps Manage Blood Sugar Levels and Can Prevent Diabetes
Diabetes symptoms result from a lack of insulin or inadequate insulin secretion following increases in insulin resistance.
According to research conducted at the London School of Medicine and Dentistry, calcium is necessary for insulin secretion, and vitamin D promotes calcium absorption and utilization, therefore contributing to insulin secretion regulation.
According to a 2015 study published in Current Diabetes Reviews, vitamin D replacement has beneficial effects on all aspects of type 2 diabetes, including the disease’s incidence, control, and complications.
There is also mounting evidence linking low vitamin D levels to diabetes.
3. Protects Against Cancer
Vitamin D deficiency symptoms have been correlated with increased cancer development risks, especially breast, colon, and prostate cancers.
According to research published in Frontiers in Endocrinology, vitamin D plays a role in factors that influence tumor growth, cell differentiation, and apoptosis.
Researchers have found that increased sunlight exposure and circulating vitamin D levels are associated with reduced occurrence and mortality in many types of cancer.
Research shows that it can affect the risk of breast, colon, and ovarian cancers, possibly due to its role in the cell life cycle or its ability to block excess estrogen.
According to research published in the American Journal of Clinical Nutrition, improving vitamin D and calcium nutritional status substantially reduces cancer risk in postmenopausal women.
Another 2018 study helps solidify these breast cancer findings. Researchers found postmenopausal women with 60 ng/mL or more of 25-hydroxyvitamin D, the main form of vitamin D in the blood, had one-fifth the risk of breast cancer compared to those with under 20 ng/mL.
4. Combats Heart Disease
Many researchers point out that vitamin D deficiency increases cardiovascular disease risks since it regulates blood pressure, cholesterol levels, and inflammation.
Animal studies have shown that the disruption of vitamin D signaling promotes hypertension, atherosclerosis, and cardiac hypertrophy.
According to research from the Vanderbilt University Medical Center, we know that deficient humans are more likely to die from coronary heart disease and other heart-related symptoms.
5. Enhances the Immune System
This vitamin helps with healthy cell replication and may protect against the development of autoimmune conditions in addition to less severe common colds and the flu.
Our immune cells contain receptors for vitamin D, and it’s been shown that this vitamin seems to prevent prolonged or excessive inflammatory responses.
Studies indicate that inflammation is often at the root of many modern, chronic diseases and autoimmune disorders, including:
- multiple sclerosis
- rheumatoid arthritis
- irritable bowel syndrome and other digestive disorders
- high blood pressure
6. Facilitates Hormone Regulation and Helps Improve Mood
Because it acts like a hormone within our bodies and affects brain function, vitamin D deficiency has been linked to an increased risk for mood disorders, including depression, seasonal affective disorder, severe mood problems experienced during PMS, insomnia, and anxiety.
Low levels can also interfere with proper testosterone and estrogen production, leading to imbalances resulting in many unwanted symptoms.
7. Helps with Concentration, Learning, and Memory
Several studies have shown that vitamin D also affects our ability to make decisions, concentrate, and retain information.
Researchers indicate that lower-level people perform poorly on standardized exams, have poor decision-making skills, and have difficulty with tasks requiring focus and attention.
Additionally, some research has shown a correlation between low vitamin D levels and an increased risk of developing schizophrenia and multiple sclerosis.
How Much Do You Need?
Most experts recommend getting about 10 to 15 minutes of direct sunlight daily, without wearing sunscreen, if you are fair- to medium-toned.
If you have dark skin, you will likely need more time in the sun to make enough vitamin D because your skin has more protection against the sun’s effects.
Some experts recommend that darker-toned people spend about 40 minutes to one hour in the sun daily if possible.
If you live farther from the equator (in the U.S., this would be the mid-states or farther north), you need more overall time in the sun (closer to one hour a day).
If it’s winter, you need to double the recommended time to allow enough vitamin D production.
Here is a good rule of thumb to know that the sun is creating vitamin D in your skin:
- You want to look at your shadow and see that it’s shorter than you are. This tells you that the sun is high enough in the sky and strong enough to convert vitamin D in your skin.
- For example, you may experience this from 10 a.m. to 3 p.m. but not as much during other times when the sun is lower and, therefore, less likely to penetrate your skin effectively.
If you are worried about not wearing sunscreen and fear direct sunlight’s effect on your skin, try applying sunscreen to your face and hands but not on your limbs (assuming your limbs are exposed).
This leaves enough unexposed skin to create the vitamin D you need properly.
Vitamin D Deficiency Causes
It’s worth repeating that 50 to 90 percent of most vitamin D comes from casual sunlight exposure.
Your skin makes this vitamin when it comes in contact with the sun’s ultraviolet B (UV-B) rays.
Therefore, one of the biggest reasons that a growing population is experiencing vitamin D deficiency symptoms is our modern, primarily indoor lifestyle.
This contributes to the two most common causes of vitamin D deficiency symptoms:
1. Lack of Sun
Years ago, people spent more time outdoors, walking to do errands and even working outside; today we see a different situation.
Most children spend unprecedented hours inside — watching television, playing video games, and surfing the internet.
Similarly, most adults work indoors, exercise inside gyms, and spend their free time inside their homes, sheltering from the sun.
With all this time indoors, it’s no wonder we don’t get enough of the “sunshine vitamin” and that vitamin D deficiency affects over a billion people worldwide.
Traditionally, the human vitamin D system begins in the skin, not from the foods you eat.
Although food sources of vitamin D can help raise your levels and prevent a deficiency, the sun is your most effective way to sustain proper vitamin D levels.
2. Sunscreens
Not only are we failing to get enough time outdoors in the sun, but when we do, many of us wear sunscreen nearly the entire time.
As the risk for developing skin cancer has also risen in recent years, doctors strongly encourage sunscreen use for children and adults, even during winter and when sun exposure is generally limited.
Alarmingly, some research shows that when you wear sunblock SPF 8, you reduce your body’s ability to make vitamin D by 90 percent.
If you choose a sunblock with a higher SPF of 30 (usually recommended by doctors), your body’s ability is reduced by up to 99 percent.
This results in further deficiencies because even though we spend time outdoors, sunscreen doesn’t allow our bodies to convert vitamin D from the sun.
Research also shows that certain health conditions, such as abdominal obesity, type 2 diabetes, insulin resistance, and hypertension, also increase a person’s risk of vitamin D deficiency.
Common Symptoms of Vitamin D Deficiency
There is a great body of evidence that shows that people with vitamin D deficiency are at an increased risk of developing health complications and conditions like cardiovascular disease, metabolic syndrome, various types of cancer, immune disorders, and adverse pregnancy outcomes.
According to several scientific studies and reviews, vitamin D deficiency symptoms can be linked to the following health problems:
- osteoporosis
- heart disease
- high blood pressure
- cancer
- autoimmune diseases
- depression
- insomnia
- arthritis
- diabetes
- asthma
- multiple sclerosis
- chronic pain
- psoriasis
- fibromyalgia
- autism
Researchers suggest that anyone with these health conditions or the following symptoms should be tested for vitamin D deficiency:
- weakness
- chronic fatigue
- depression
- trouble sleeping
- anxiety
- weak or broken bones
- weakened immune system
- inflammation and swelling
The only way to know if you are deficient is to have your doctor perform a 25-hydroxy vitamin D test. This will tell you if and how severely you are lacking.
When your doctor performs a blood test and gives you the results for your vitamin D levels, keep these numbers in mind:
- 50+ equals a good level
- 30–50 means you want to supplement with vitamin D, work on spending more time in the sun, and add vitamin D foods into your diet
- less than 30 means you are very deficient and want to take immediate action to bring those levels up
Talk with your doctor about supplementing with higher doses of vitamin D if you are severely deficient or have a shallow level, according to the tests.
When your doctor performs a vitamin D test, specify that you would like to have the 25-hydroxyvitamin D test done, sometimes called the 25(OH) D test.
Some other types of vitamin D tests can show normal or even elevated levels, which are actually inaccurate and can hide a serious deficiency, so the 25(OH) D test seems to be the most accurate when determining your true vitamin D levels.
Natural Ways to Boost Vitamin D
Foods and Sources
While some foods provide vitamin D, exposure to sunlight is still the best way to get the amount you need to prevent vitamin D deficiency symptoms.
However, research suggests that eating foods that are rich in vitamin D also helps you acquire more, so try adding these good-quality, natural sources into your diet regularly:
- Sunlight: Aim for 15-20 minutes of midday sun exposure on bare skin a few times a week. Factors like skin tone, sunscreen use, and time of day impact how much vitamin D your skin produces. Those with darker skin tones might need longer exposure times.
Always practice safe sun habits and consult a doctor if you have concerns If you have darker skin or live farther north (in the Northern Hemisphere, like Boston), you need about an hour of sun in the summer to get about 1,000 IUs of vitamin D.
- Halibut
- Carp Fish
- Mackerel
- Eel
- Maitake Mushrooms (exposed to UV light)
- Salmon
- Whitefish
- Portobella Mushrooms (exposed to UV light)
- Swordfish
- Rainbow Trout
- Cod Liver Oil
- Sardines
- Tuna
- Eggs
- Raw Milk
Food Chart
| Food | Vitamin D Content (IU) | Serving Size |
|---|---|---|
| Salmon (3 oz) | 450 – 600 | 3 oz |
| Mackerel (3 oz) | 350 – 450 | 3 oz |
| Cod liver oil (1 tbsp) | 1360 | 1 tbsp |
| Fortified Milk (1 cup) | 115 – 125 | 1 cup |
| Egg Yolk (1 large) | 40 | 1 large |
| Mushrooms (UV-exposed) | Varies* | 1 cup |
Vitamin D in Mushrooms
Mushrooms are exciting and rare food when it comes to vitamin D.
They are one of the only plant sources of vitamin D and actually act similarly to how human skin absorbs more vitamin D when exposed to the sun.
In some mushrooms available in certain health food stores, the vitamin D content is boosted by exposing these mushrooms to ultraviolet light.
Mushroom nutrition contains plant sterols that can convert UV light to vitamin D. Exposing mushrooms to as little as five minutes of UV light is believed to produce a substantial amount of vitamin D.
While mushrooms are typically grown indoors, many growers are beginning to grow them outdoors to take advantage of this — or they place the growing mushrooms under sunlamps.
Rare and sometimes difficult-to-find maitake mushrooms, for example, contain a huge amount of vitamin D. Portobello mushrooms and other mushroom varieties also make good sources, but they are not nearly as high.
You could ask the workers at your health food store or the farmers at your local market if their mushrooms were grown indoors or outdoors to know if the mushrooms you are purchasing contain higher amounts of vitamin D.
Vitamin D in Pasteurized Milk and Raw Milk
Interestingly, and despite what many people think, regular, pasteurized milk does not naturally contain much vitamin D at all. Synthetic vitamin D is added to pasteurized cow’s milk, soy milk, and rice milk.
According to the USDA, almost all of the U.S. milk supply is fortified with 400 IU of vitamin D per quart, but foods made from milk, like cheese and ice cream, are usually not fortified.
Synthetic vitamin D added to foods is believed to be much less effective than naturally occurring vitamin D and can potentially block natural vitamin D’s effects.
On the other hand, Raw milk is believed to contain a small amount of vitamin D naturally, which is found in its fat and not destroyed during pasteurization.
Some sources show that raw milk has about 38 IUs of vitamin D per quart (four cups).
However, it’s hard to know for sure how much is in raw milk because it differs greatly depending on the specific milk being tested and correlates with the health of the animal that it came from.
On top of this, the USDA does not list the official vitamin D content of raw milk, and many sources claim different amounts to be present within raw milk.
Keep this in mind if you consume raw milk to increase your vitamin D levels.
Raw milk is thought to be a better source of vitamin D than pasteurized milk because unpasteurized raw milk is usually superior in almost every vitamin and mineral overall.
Raw milk normally comes from cows that are free to graze outside and eat their natural diet of grass instead of being force-fed grains and living indoors.
Because the animal is healthier, so is its milk.
A lot of the nutrients that are in regular milk are also destroyed during the high-heat pasteurization process.
Therefore it seems logical that higher quality raw milk would have more vitamin D, to begin with, and retain more of it since it does not go through this nutrient-destroying, high-heat pasteurization process.
Supplements and Dosage
You may wonder how much vitamin D I should take.
Because vitamin D deficiency symptoms are a growing concern worldwide, especially in Western developed nations, authorities recently increased the recommended daily intake of vitamin D to double the previous amount for newborns, children, and adolescents.
According to the USDA, the RDA for vitamin D is 600 IU per day for adults.
However, getting more like 5,000 IU per day may be more effective, especially since there is little risk in over-supplementing with vitamin D and many benefits to gain from having adequate levels.
Keep in mind that this is a general recommendation, and there is no way to know the exact amount that’s best for you without a blood test.
You may need a higher or lower amount and should speak to your doctor. This way, you can purchase a good-quality, food-based vitamin in the proper dose you need right away.
Some studies have shown that in patients with documented vitamin D deficiency, a very high, cumulative dose of at least 600,000 IU administered over several weeks appears to be necessary to replenish stores within the body.
This shows that having a blood test to detect your exact vitamin D levels can be beneficial in telling you exactly how to replenish your body levels properly.
Ideally, you want to supplement with a high-quality, whole-food-based multivitamin or vitamin D supplement until your blood level of vitamin D is between 50–60 nanograms per milliliter.
Typical vitamin D supplement dosages range from 400-800 IU per day, but it’s essential to consult your doctor for the right amount for you.
Recommendation for Children:
- Below 5: 35 units per pound/day
- Ages 5–10: 2,500 units/day
Recommendation for Adults (including pregnant women):
- 5,000 units/day
However, to be clear, below is the USDA’s official recommendation of vitamin D:
Children:
- 1–3 years: 600 IU (15 mcg/day)
- 4–8 years: 600 IU (15 mcg/day)
Older Children and Adults:
- 9–70 years: 600 IU (15 mcg/day)
- Adults over 70 years: 800 IU (20 mcg/day)
- Pregnant and breastfeeding: 600 IU (15 mcg/day)
Certain supplements do provide the preferred type of vitamin D3. To get the best vitamin D3 supplement, look for a fermented, food-based source of D3 (preferably fermented with a healthy bacteria such as L. bulgaricus) paired with fermented botanicals and supplementary probiotics for maximum absorption and effectiveness.
How Much Is Too Much? Risks and Side Effects
Luckily your skin can regulate vitamin D conversion according to heat and other factors. It can store previtamin D for future use and destroy amounts above and beyond what is safe.
Deficiency is usually a much bigger concern than consuming too much vitamin D.
Vitamin D toxicity is believed to be very rare. It usually consists of a buildup of calcium in the blood, called hypercalcemia.
Regarding the proper vitamin D dosage, you should be much more concerned about getting enough than taking too much.
That said, a recent 2019 study found that supplementing with higher doses of vitamin D did not improve bone health but actually lowered bone mineral density among healthy adults.
In this three-year study involving over 300 participants, doses of 400 IU, 4,000 IU, and 10,000 IU were taken per day.
Results show that compared to the 400 IU group, higher doses of vitamin D resulted in statistically significant lower radial bone mineral density but did not change bone strength.
Further research is needed to determine whether or not higher doses of vitamin D daily impact bone health negatively.
Also, keep in mind that because vitamin D is a fat-soluble vitamin, it ideally needs to be consumed with fat to have optimal absorption.
If you are going to eat a food source of vitamin D, it’s best to combine it with some more essential fat source, too, like ghee, coconut oil, nuts, seeds, or fish.
Vitamin A and vitamin D have an important relationship. Some studies have recently suggested that vitamin D deficiency can worsen when a person takes a high supplemental intake of vitamin A.
These studies reveal that when blood levels of vitamin D fall below 50 on a vitamin D blood test (which means the person is nearing deficiency), higher supplemental vitamin A intake can worsen the problem.
The good news is that when vitamin A and D levels are both sufficient, research has shown that they work together to help your body metabolize the vitamins and use them to their best ability.
Supplementing with very high doses of vitamin A is not recommended, so if you have a known vitamin D deficiency or experience vitamin D deficiency symptoms, it can lead to certain problems.
Who’s at Risk for Vitamin D Deficiency
Key Risk Factors
- Limited Sun Exposure:
- People who live in northern latitudes (less sunlight).
- Homebound individuals.
- Those who primarily work indoors or at night.
- People who cover most of their skin for religious or cultural reasons.
- Skin Pigmentation:
- Individuals with darker skin tones have more melanin, which reduces the skin’s ability to produce vitamin D from sunlight.
- Age:
- Older adults have less efficient vitamin D production in their skin.
- Infants who are solely breastfed may not receive sufficient vitamin D.
- Medical Conditions:
- Kidney or liver diseases can impair the body’s ability to convert vitamin D into its active form.
- Digestive disorders like Crohn’s disease, celiac disease, and ulcerative colitis can interfere with vitamin D absorption.
- Obesity, as body fat can bind to vitamin D and limit its availability.
- Medications: Certain medications, such as steroids, can affect vitamin D metabolism.
- Dietary Restrictions:
- Vegans and strict vegetarians may have difficulty getting enough vitamin D from food sources alone.
- Those with lactose intolerance or milk allergies might avoid natural vitamin D sources like dairy.
Important Notes
- Everyone can be at risk for vitamin D deficiency, but these factors increase the likelihood.
- Emphasize talking to a doctor for personalized risk assessment and testing.
Final Thoughts
- Up to 90 percent of adults in the U.S. may suffer from vitamin D deficiency symptoms, leading to major health issues, such as cardiovascular disease, diabetes, autoimmune disease, and cancer.
- Two major causes of vitamin D deficiency symptoms are a lack of sun exposure and sunscreen use.
- When you sit in the sun unexposed, without sunscreen, for roughly 10 minutes, you likely absorb about 10,000 units of natural vitamin D. This is the most effective way to increase your levels to prevent vitamin D deficiency symptoms.
- There are also food sources, including fish, mushrooms exposed to UV rays, eggs, and raw milk. Eating these foods can help increase your levels, but sun exposure is the best way to avoid vitamin D deficiency symptoms.
- The most common vitamin D deficiency symptoms include weakness, chronic fatigue, depression, anxiety, trouble sleeping, weak bones, and a weak immune system.
- Vitamin D deficiency symptoms can include other health conditions, such as diabetes, heart disease, and more.
- Meanwhile, vitamin D benefits include supporting bone health, managing blood sugar, protecting against cancer and heart disease, boosting immunity, regulating hormones, improving mood, and helping with concentration, learning, and memory.
