Does Vitamin D Strengthen Nails

Does Vitamin D Strengthen Nails

Vitamin D Facts: Everything You Need to Know

Medically Reviewed by Dr Samantha Miller, MBChB

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Vitamin D is important for maintaining a healthy body, primarily because it helps you fully maximize your body's absorption and utilization of calcium, an important mineral that we all need. When paired with calcium, vitamin D helps regulate bone remodeling and growth, ensuring healthy, strong bones. Vitamin D can also help protect older adults from osteoporosis, which occurs due to excess bone loss from aging.

Furthermore, this nutrient boosts your immune system and reduces inflammation within your body, potentially warding off future medical conditions in the process. It also plays a vital role in cell growth, neuromuscular functions and protein encoding. Studies have shown that a regular, healthy vitamin D intake can also serve as an antidepressant and make people feel generally happier. But that's not all you'll want to know about vitamin D.

Sources of Vitamin D

Vitamin D is naturally found in certain foods and now appears in many more foods that have been fortified with added nutrients. The best sources of naturally occurring vitamin D are oily fish such as salmon, tuna, cod, sardines and mackerel. Fish liver oils are another good source of vitamin D. Small amounts of the nutrient are present in beef liver, cheese, egg yolks and mushrooms.

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Commonly, vitamin D-fortified foods include whole milk, orange juice, margarine and breakfast cereals. It's important to look at the label and nutrition facts to verify that vitamin D is in a particular food you're considering. Because dairy products are often fortified with vitamin D, lactose intolerant or vegan individuals should keep an eye on their diets to ensure they get enough of the vitamin.

Sun exposure is another method of naturally obtaining vitamin D, as our bodies can create their own vitamin D upon exposure to ultraviolet (UV) rays from the sun. However, it's difficult to gauge exactly how much sun exposure can generate sufficient vitamin D, as overexposure can be harmful, too. UV rays are also known to trigger free radicals, which can lead to skin cancer if left unchecked.

It's been suggested that getting approximately 15 minutes of sun exposure between 10 a.m. and 3 p.m. at least twice a week to your face, arms, legs or back will help your body synthesize enough vitamin D. It's important to note that you can't cover the exposed area of your body with sunscreen if you choose to get vitamin D naturally. The SPF blocks UV rays and can hinder your body's ability to create vitamin D. If you're in the shade or behind a window, the rays will not get through. If the climate where you live is primarily cloudy, it's important to get your recommended amount of vitamin D via other means.

Dietary supplements are also an excellent way of obtaining vitamin D. Supplements come in two forms: vitamin D3 (cholecalciferol), which is identical to the form your body makes when exposed to sunlight, and vitamin D2 (ergocalciferol), which differs slightly from D3 in its chemical side-chain structure. There's some evidence that vitamin D3 increases and maintains overall levels slightly better than vitamin D2.

Side Effects of a Vitamin D Deficiency

Vitamin D deficiency occurs when you don't adequately absorb the nutrient or when your kidneys can't convert the nutrient to its active form. This deficiency can result in medical conditions, two of which are called rickets and osteomalacia.

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Rickets, a disease characterized by a failure of bone tissues to get enough minerals, can result in abnormal, soft bones and skeletal deformities. It's most common in children. Fortunately, it isn't permanent, and kids can consume as few as 1 to 3 teaspoons of cod liver oil a day to reverse the condition.

With the help of fortified foods today, rickets is almost obsolete in the United States. Osteomalacia, characterized by soft and weak bones, is usually present in adults. It's commonly treated with an intense regimen of vitamin D replacement under the care of a physician.

Vitamin D and Other Health Conditions

Vitamin D deficiency has been linked to cardiovascular disease, and people with lower levels of vitamin D appear to be at an increased risk of having a heart attack or stroke. However, the exact relationship isn't clear, and there appears to be no benefit to cardiovascular risk in taking a vitamin D supplement.

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Research is also ongoing to find if there's a link between vitamin D and multiple sclerosis (MS). It appears that vitamin D deficiency is linked to the development of MS, and people with MS and higher levels of vitamin D appear to have reduced disease activity.

Low vitamin D has been linked to an increased risk of contracting respiratory illnesses such as influenza A. It appears that people with low vitamin D levels are at greater risk of severe novel coronavirus (COVID-19) infection. It's not clear yet if routine vitamin D supplementation would reduce this risk.

Because vitamin D is a fat-soluble substance, it can stay in your body for several days. Thus, vitamin D poisoning is possible if you supplement too much vitamin D over a period of a few months. Symptoms of vitamin D overdose include dehydration, vomiting, decreased appetite, irritability, constipation and fatigue. If left unaddressed, vitamin D poisoning can lead to anorexia, over-calcification of the bones and internal organs, kidney stones and hypertension (high blood pressure). It's important to note that vitamin D poisoning usually only occurs with excessive intake of dietary supplements. It's highly unlikely to occur as a result of normal dietary intake and sun exposure.

Daily Dosage Recommendations

The recommended dietary allowances for vitamin D vary depending on your age and other health and life circumstances, such as pregnancy. For infants under 12 months, the recommended intake is 400 international units (IU) or 10 micrograms (mcg). For individuals under 70 years old, the recommended intake is 600IU (15mcg). For individuals over 70 years old, the intake increases to 800IU (20mcg).

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Does Vitamin D Strengthen Nails

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Vitamin D & Arthritis

Vitamin D & Arthritis

10 Healthy Foods That Are Rich in Vitamin D

Photo Courtesy: Michael Godek/Getty Images

Are you getting enough sun? In many parts of the world, that might prove difficult during the winter months — and it can impact more than your sunny disposition.When exposed to sunshine, our bodies produce vitamin D, something our bodies need to maintain healthy bones and teeth; support our immune and cardiovascular systems; and stave off certain diseases, like type 1 diabetes. Some reports suggest that roughly three-quarters of American teens and adults might not be getting enough vitamin D. So, how can you turn that number around?

How Much Vitamin D Do We Need and Where Can We Find It?

The National Institutes of Health (NIH) makes recommendations for what one's daily intake of vitamin D should be based on age, gender and other factors. The recommendations, in micrograms (mcg), can be summarized as follows:

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• Infants (up to 12 months): 10 mcg daily
• Children (1 to 13 years): 15 mcg daily
• Teens (14 to 18 years): 15 mcg daily
• Adults (19 to 50 years): 15 mcg daily
• Older adults (51 to 70 years): 15 mcg daily
• Seniors (70+ years): 20 mcg daily

So, how can you supplement your vitamin D intake if all that basking in the sun isn't cutting it? Thanks to the Dietary Guidelines for Americans, we've rounded up 10 healthy foods that can help you reach those daily vitamin D goals.

Salmon

Salmon comes in quite a few different varieties — canned sockeye salmon, smoked chinook salmon, canned pink salmon, cooked sockeye salmon, cooked pink salmon and even cooked wild coho salmon — and all of them are chock-full of vitamin D. All of these options will help you hit your goals. After all, a three-ounce serving of canned sockeye salmon contains 17.9 mcg of vitamin D, while a three-ounce portion of cooked sockeye salmon contains 11.1 mcg of vitamin D.

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Smoked Whitefish

Want to change up that salmon intake? Whitefish can help with that. While whitefish are a species of fish, the term also refers to a cluster of types of fish, all of which have a mild, slightly sweet flavor. Some of the most popular "whitefish" include pollock, bass, cod, halibut, grouper and haddock. On average, a standard three-ounce serving of smoked whitefish contains an impressive 10.8 mcg of vitamin D.

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Swordfish

If you're looking for a terrific source of vitamin D, and to break up all that whitefish and salmon, try swordfish. These creatures can grow to be a whopping 1,400 pounds — and nearly 15-feet in length. While you wouldn't want to tangle with one of these in the ocean, encountering it as a nice, grilled steak is a treat. Best of all, a three-ounce portion will provide you with 14.1 mcg of vitamin D.

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Tilapia

Tilapia is a cluster of fish species that aren't found in nature. That is, tilapia is a farmed fish, which makes it pretty inexpensive. This mild species is the fourth most common type of seafood eaten by Americans, in part because of its versatility. We recommend a nice herb-and-parmesan crust, but, any way you slice it (or season it), a three-ounce portion will provide you with 3.1 mcg of vitamin D.

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Canned Tuna

Not into canned food? Well, canned fish should probably be your exception. In fact, canned tuna, in addition to being readily available and inexpensive, can make an abundance of tasty meals, from tuna salad and melts to casseroles. Best of all, a three-ounce serving of light tuna canned in oil contains about 5.7 mcg of vitamin D.

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Mushrooms

The five fish options we've listed above might not have surprised you, but this one might. Many varieties of mushrooms — including portabella, cremini, morels, chanterelles, maitake, and even your basic white button mushrooms — are excellent sources of vitamin D. In fact, half a cup of grilled portabella mushrooms delivers an impressive 7.9 mcg of vitamin D.

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Eggs

Eggs — and, in particular, egg yolks — are one of the easiest, cheapest and quickest ways to nab some vitamin D. However, they may not be the food of choice for folks with high cholesterol. If your diet allows, whip up two scrambled eggs and enjoy getting 5% of your recommended daily intake of vitamin D first thing in the morning.

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Milk

Milk is more than just a great source of calcium. In fact, vitamin D is among its significant nutritional benefits. When it comes to a 16-ounce serving of cow's milk, the vitamin D content varies based on the milk's composition. For example, whole milk contains 6.3 mcg of vitamin D, while 2%, 1% and skim milk all contain 5.9 mcg. Even soy and dehydrated (powdered) milk will help you reach your goals by providing 5.8 mcg and 3.4 mcg of vitamin D respectively.

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Yogurt

Milk is not the only dairy product capable of delivering some serious vitamin D benefits. Of course, the nutritional value of yogurt changes depending upon the variety. For example, Greek-style yogurt contains more protein and less sugar than other types of yogurt. Nonetheless, you can still expect anywhere from 2 to 3 mcg of vitamin D per eight-ounce serving, regardless of the variety of yogurt.

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Pork

So far, you've seen lots of fish and dairy options. You might be wondering, Where's the meat? Well, generally speaking, beef and chicken are not great sources of vitamin D. In fact, if you're a meat lover in search of some vitamin D, pork is your best bet. The nutritional value of pork varies depending upon the cut, method of preparation and more, but you're likely to find between 0.2 to 2.2 mcg of vitamin D in a standard three-ounce serving of pork.

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Resource Links:

• The U.S. Department of Health and Human Services and Department of Agriculture's Dietary Guidelines for Americans
• The National Institutes of Health (NIH)

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Vitamin D Deficiency And Pregnancy

Vitamin D Deficiency And Pregnancy

Many nutrients are vital to the health of the human body, and vitamin D is no exception. It helps the body absorb calcium, which is essential for ensuring bones grow and stay strong. However, vitamin D deficiency has been linked to a host of other diseases. This list includes depression, heart disease and even some forms of cancer. If you don't get enough sun, like many swing shift workers, or lack an adequate amount of the nutrient in your diet, you may have a deficiency. Here are ten important signs that you are deficient in this essential nutrient.

Inexplicable Aches and Pains

Lethargy and unexplainable generalized pains are symptoms of some worrisome diseases like fibromyalgia and arthritis. But these symptoms might be telling you that you have a vitamin D deficiency. Without enough vitamin D to absorb adequate amounts of calcium, the bones can lose strength resulting in a deep ache or pain. This may be even more noticeable in the winter when sun exposure decreases for everyone. There are more incidents of broken bones in the winter time. Those with higher levels of vitamin D show increased muscle function in their extremities compared to those with less vitamin D in their blood.

Sweat of the Brow

Especially concerning in infants and young children is an excessively sweaty head, particularly the forehead. This can be a clear indicator of a vitamin D deficiency or a host of other problems. It has been common practice for decades that doctors ask new mothers if they notice any unusual sweating in their infants head, face or neck. This sweating can be indicative of serious problems.

There are some-not-so-worrisome causes of a sweaty head, such as fever or being wrapped up for naps. Sweating during feeding is also normal. If you are concerned about your baby's sweating, contact your pediatrician.

Weakened Immune System

Those with less than sufficient levels of vitamin D are significantly more vulnerable to upper respiratory infections. This includes sinus infections and colds, and lower respiratory infections, like bronchitis and pneumonia. Those with adequate vitamin D levels experienced fewer complications during hospital stays and after surgeries.

Vitamin D levels at or above recommended levels are associated with more efficient immune function and decreased respiratory inflammation. With decreased inflammation comes decreased incidence of infection and decreased occurrences of asthma.

Chronic Kidney Disease

Like obesity, chronic kidney problems can be the cause of vitamin D deficiency as opposed to being the result of deficiency. Certain kidney diseases can inhibit the production of vitamin D by the body as well as the breakdown of dietary vitamin D into its useful form. This process is vital to general health because even if adequate amounts of vitamin D are taken in, without the ability to create the active form, the body cannot use the vitamin. This active form of the vitamin helps to feed calcium and other vital minerals to the bones.

While there might be vitamin D and calcium available to the body, without proper kidney function, the body cannot use it. As the body starves for vital calcium, it sets off a parathyroid reaction. This is a process that begins dissolving bones for calcium.

If you are in the early stages of kidney disease, keep a particular eye on vitamin D levels, especially if dialysis is an option.

Your Skin is Naturally Darker

Whether you are just of a darker complexion or you are an outdoorsy type with a tan, the increased melanin in your system will decrease the amount of vitamin D you produce as a result of direct sunlight. Though it increases your protection from sunburn and hot weather exposure, melanin can make it very difficult to produce the daily recommended vitamin D levels, especially as you age and your need for vitamin D increases.

The recommended daily level of vitamin D is 600 IU for all ages, but for those over 70 that number increases to 800 IU, and in African Americans, it can take 10 percent longer to produce the same amount of vitamin D as a fair-skinned person. Sunscreen has the same effect as melanin slowing the process of vitamin D synthesis. This doesn't mean you can skip sunscreen, but just be aware you may need more exposure to reach the desired amount.

Your Mood is Low

Vitamin D deficiency is directly related to depression. That is because vitamin D plays a huge role in mood regulation. Many of the brain's major receptors are vitamin D, especially those in the brain linked to mental health. This one fact links mental health to vitamin D deficiency.

It is not fully understood why or how the vitamin affects mood but the evidence is mounting. In 2006, a study showed that older adults with less than adequate levels of vitamin D were at an increased risk for depression. There is evidence that adding vitamin D by either dietary or supplemental means can help those who struggle with depression and seasonal affective disorder, which is a more depressed mood during the colder winter months.

Less Than Optimal Muscular Performance

Noticeable muscle weakness, such as trouble climbing stairs or decreased performance in the gym, can be a sign of a vitamin D deficiency. Without enough vitamin D in the diet, muscles don't get the fuel that they need to function at optimal levels.

In young adults and elderly, there have been numerous cases of extended vitamin D deficiency causing extreme muscle weakness, sometimes to a disabling extent. In these cases, the addition of vitamin D into the patient's diet improved the condition after a short time. This is especially evident in the elderly as their demand for vitamin D increases. If you are experiencing noticeable muscle weakness, adding a suitable supplement might be a good avenue to explore.

Higher Bodyweight

Another inverse relationship, excess weight can make it easier to develop a vitamin D deficiency. As weight increases, the body requires more vitamin D to keep it functioning regularly. This makes it harder for you to hit an appropriate balance.

As vitamin D is a fat-soluble nutrient, deficiency precedes obesity as well. As the body notices a lack of fat-soluble nutrients, it is spurred to store more fat. Supplementation and adequate time outside can help combat vitamin D deficiency and all the negative side effects including risk for obesity.

Digestion Difficulties

Vitamin D plays a vital role in so many different bodily functions, from bones to mental well-being, but it is fat soluble. If you have a digestive issue such as Crohn's disease, irritable bowel syndrome or gallbladder problems, you are less able to absorb this vitamin along with other vital nutrients and may have to take extra steps to ensure that you have the nutrition you need.

Age 50+

As you age, three different things happen in regards to vitamin D. You require more to have the optimal function, you naturally produce less vitamin D when you are outside and exposed to sunlight. And your kidneys have to work harder for longer to turn vitamin D into its most useful form. With this in mind, if you are 50 or older and you are noticing some of the other symptoms on the list, you may want to ask your doctor about vitamin D deficiency and what you can do about it.

Vitamin D Deficiency And Pregnancy

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Consequences Of Vitamin D Deficiency

Consequences Of Vitamin D Deficiency

• What Is It?
  • What is vitamin D?
• Vitamin D Requirements
  • What are the vitamin D requirements?
• Symptoms and Signs
  • What are vitamin D deficiency symptoms and signs? What are health risks of vitamin D deficiency?
  • What are vitamin D deficiency symptoms and signs? What are health risks of vitamin D deficiency? (Continued)
  • What are vitamin D deficiency symptoms and signs? What are health risks of vitamin D deficiency? (Continued)
• Causes
  • What causes a vitamin D deficiency?
  • What causes a vitamin D deficiency? (Continued)
• Who Is at Risk
  • Who is at risk for vitamin D deficiency?
• Testing
  • How do health care professionals diagnose a vitamin D deficiency?
• Treatment
  • What is the treatment for a vitamin D deficiency?
• How to Prevent
  • Is it possible to prevent vitamin D deficiency?
• Vitamin D Daily Limits Chart
  • What are symptoms and signs of an excessive vitamin D intake (Daily Limits Chart)?
• Center
  • Vitamin D Deficiency Symptoms and Treatment Center
• Comments
  • Patient Comments: Vitamin D Deficiency - Symptoms
  • Patient Comments: Vitamin D Deficiency - Causes
  • Patient Comments: Vitamin D Deficiency - Tests
  • Patient Comments: Vitamin D Deficiency - Treatment
• More
  • Vitamin D FAQs

Vitamins are considered essential nutrients because either your body cannot make them or they are made in inadequate amounts to prevent negative health consequences or diseases. Source: Bigstock

What is vitamin D?

The "sunshine" vitamin is a hot topic. You may have recently found out that you are deficient or know someone who is. It's shocking for most people when they have never had a problem before and believe nothing has changed to make it a problem now. The truth is that a lot has changed, and vitamin D deficiency and insufficiency are now a global public health problem affecting an estimated 1 billion people worldwide.

Vitamins are considered essential nutrients because either your body cannot make them or they are made in inadequate amounts to prevent negative health consequences or diseases. So it's essential that you provide vitamins for your body by food and/or supplements. Vitamin D was discovered to be essential when it was found to be needed for the treatment of rickets. Vitamin D is one of the four fat-soluble vitamins (A, D, E, and K). There are two forms of vitamin D: D2 and D3. Vitamin D2, also known as ergocalciferol, comes from fortified foods, plant foods, and over-the-counter supplements. Vitamin D3, also known as cholecalciferol, comes from fortified foods, animal foods (fatty fish, cod liver oil, eggs, and liver), supplements, and can be made internally when your skin is exposed ultraviolet (UV) radiation from the sun. Structurally, these two are not the same. Many believe that vitamin D should be classified as a hormone, with some calling it the forgotten neurosteroid. The health consequences of being deficient go far beyond rickets and what occurs with any other vitamin. And unlike other vitamins, it can be made by your body when exposed to the sun and the active form in your body, called calcitriol, has similarities to other hormones (estrogen, cortisol, and testosterone).

The real dangers of excessive exposure to the sun and skin cancer have been greatly publicized and resulted in people covering up and using sunscreen when in the sun. We have also had a shift in spending less time outdoors because of increased work hours and more sedentary lives. As a result, vitamin D levels began dropping without most health care professionals realizing it. Researchers have been focusing on the consequences of vitamin D deficiency and have found an alarming number of health issues outside of its role with rickets. These include skeletal diseases like osteoporosis, certain cancers, cardiovascular disease, autoimmune diseases, infections, inflammatory bowel diseases, psychological disorders, cognitive disorders, obesity, and or mortality. Correcting vitamin D deficiency is not as simple as taking a pill or getting more sun. This article will teach you all that you need to know about the benefits of achieving and maintaining optimal vitamin D levels and how you can do it.

Symptoms of Vitamin D Deficiency

Does vitamin D deficiency cause symptoms?

Yes, deficiency of vitamin D can cause bone pain and muscle weakness. However, mild vitamin D deficiency is not necessarily associated with any symptoms. Vitamin D has been referred to as the "sunlight vitamin" because it is made in our skin when we are exposed to sunlight.

The RDA is the average daily intake sufficient to meet the nutrient requirements of nearly all (97.5%) healthy individuals. Source: Bigstock

What are the vitamin D requirements?

Only 20% of our vitamin D is meant to come from our diet with the remaining 80% provided by our skin from UV-B exposure to the sun. There are currently two sets of guidelines for vitamin D intake. Typically, vitamin guidelines are established by the Institute of Medicine (IOM) in the form of Recommended Dietary Allowances (RDA) or adequate intakes (AI). The RDA is the average daily intake sufficient to meet the nutrient requirements of nearly all (97.5%) healthy individuals. These guidelines were set on a population model to prevent vitamin D deficiency based on bone health (osteomalacia, rickets, bone mineral density, and calcium absorption) for the general population. The Endocrine Society put together a task force to review the research and came up with a set of guidelines based on a medical model for those at risk for a deficiency. The two recommendations are as follows:

	Infants	1 to 18 years old	19 to 70 years old	71+ years old
IOM	400 IU/day	600 IU/day	600 IU/day	800 IU/day
Endocrine Society	400-1,000 IU/day	600-1,000 IU/day	1,500-2,000 IU/day	1,500-2,000 IU/day

These amounts are based on what is needed to maintain the blood levels that each guideline committee has established as ideal. The higher the blood level that you need to maintain, the more vitamin D you will need to maintain that level. If your blood level is deficient, these are not the guidelines for you to follow. You will first need to get your levels up by taking vitamin D above these amounts and then you will follow these levels once you have reached your adequate level. Your health care provider can provide recommendations for a safe way to do this.

Many other health benefits of vitamin D and risks associated with deficiency have been reported include autoimmune disease. Source: Wikipedia – Bruce Blaus

What are vitamin D deficiency symptoms and signs? What are health risks of vitamin D deficiency?

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By the turn of the 20th century, 90% of the children living in New York, Boston, and Leyden in the Netherlands were afflicted with rickets, a bone deforming disease. The first observation of this disease was in the mid-1600s by Whistler and Glissen, who reported that children living in industrialized cities in Great Britain had short stature and deformities of the skeleton, especially of the lower legs. It wasn't until 1889 that the discovery that "sunbathing" was important for preventing rickets came about.

Since then, many other health benefits of vitamin D and risks associated with deficiency have been reported. These include the following:

Autoimmune disease

• Type 1 diabetes (T1DM): Research has shown that children with type 1 diabetes have a higher chance of having a vitamin D deficiency compared with the general population. In Finland, the recommendation for daily vitamin D supplementation was gradually reduced from 4,000-5,000 IU/day in 1964 to 400 IU/day in 1992. During this period, T1DM increased by 350% in those 1-4 years of age, 100% in those 5-9 years of age, and 50% in those 10-14 years of age. In 2006, authorities required that all dietary milk be fortified with vitamin D2, and the incidence of T1DM plateaued and began to decrease.
• Multiple sclerosis (MS): Current evidence supports that vitamin D deficiency increases the risk of developing MS and alters the disease activity in people with MS. Numerous studies have linked the occurrence of MS with birth month. There is also a higher prevalence of MS in geographic areas farther from the equator, where people are exposed to less sunlight. The lack of sunlight exposure appears to be a significant predictor, and research is ongoing in this area. A large review of studies shows that with adequate vitamin D levels in people with MS there are fewer relapses, lower risk of development of new lesions in the brain, less disability and disease severity, and better nonverbal long-term memory performance. Studies now need to be done to confirm if this is directly due to vitamin D levels.
• Lupus: People with lupus are often photosensitive, causing rashes and possible disease flares when exposed to sunlight. The resulting lack of exposure to sunlight puts them at high risk for vitamin D deficiency. Evidence has shown that a deficiency can affect disease activity and damage along with contributing to morbidity and mortality in people with systemic lupus erythematosus (SLE).
• Rheumatoid arthritis (RA): A review of research found that people with the highest vitamin D levels had a 24.2% lower risk of developing RA compared to those with the lowest levels. They also found that there was a higher rate of vitamin D deficiency among people with RA than with the general population, and the activity of RA got worse as the level decreased.
• Autoimmune thyroid disease (AITD) (Graves' disease and Hashimoto thyroiditis): In a review of 20 studies, they found that AITD patients have lower levels and were more likely to have vitamin D deficiency compared with controls. In a review of 26 studies of Graves' disease, they concluded that low vitamin D status may increase the risk of Graves' disease.

Many other health benefits of vitamin D and risks associated with deficiency have been reported include cancer. Source: iStock

What are vitamin D deficiency symptoms and signs? What are health risks of vitamin D deficiency? (Continued)

Cancer

• The link between the sun and cancer is typically not seen as a positive one because of the connection with skin cancer. UV-B radiation from the sun is said to be the most important environmental risk factor for nonmelanoma skin cancer. Because the sun is the primary source of vitamin D, researchers are looking to see what role it plays in skin cancer. Some believe that enough sun exposure to keep your vitamin D levels up, while protecting your skin from damage, is beneficial to skin cancer survival. There has also been research to show the protective effect that vitamin D has with the development of other cancers, including colon, breast, and prostate cancer.
• In 1941, U.S. pathologist Frank Apperly published geographic data that demonstrated for the first time an inverse correlation between levels of UV-B radiation in North America and mortality rates from cancers. This study suggested that more exposure to UV-B radiation led to fewer deaths from cancers. Since this was published, other studies have suggested that there may be an association between an increased risk of dying of various malignancies (for example, colon, breast, ovarian, melanoma, and prostate cancer) and living far from the equator.
• The anti-inflammatory properties of vitamin D may also be able to assist with lowering pain levels in cancer patients when deficiencies are corrected.

Cognitive disorders

It's been shown that vitamin D plays a crucial role in brain development, brain function regulation, and a healthy nervous system. Vitamin D deficiency has been found to be common in patients with Parkinson's disease, Alzheimer's disease, schizophrenia, depression, anxiety disorders, dementia, and older adults with cognitive decline. A meta-analysis reported a 2.4-times greater risk of cognitive impairment in people with low vitamin D levels versus those with adequate levels. It's been suggested that maintaining adequate levels of vitamin D levels throughout life may help to prevent age-related neurological disorders.

A summit with the leading experts, including physicians and scientists, from across the world convened in 2013 to review the research in this area and to come up with clear guidelines for the medical and scientific communities. There was a unanimous agreement that low vitamin D levels and/or the insufficient utilization of vitamin D can be considered a risk factor for cognitive decline and dementia in general and supplementation was needed to correct these levels. A review of vitamin D levels in 170 women, 65-77 years of age, over 10 years found that adequate vitamin D levels may be protective against declines in cognitive flexibility and psychomotor speed components of executive function.

The association between lack of sunlight and depressive disorders was first noted 2,000 years ago. There are numerous studies showing low levels of vitamin D are associated with major depression and the symptoms of depression. In a study of over 6,000 people over the age of 50, those with lower vitamin D levels reported more depressive symptoms (for example, felt sad, felt lonely, couldn't get going). Those with the lowest vitamin D levels reported the greatest degree of depressive symptoms. Only small-scale studies have shown success in improving these symptoms by correcting the deficiency. Much more research is needed in this area to find out how best to treat it.

Cardiovascular disease (heart disease)

• Vitamin D deficiency is associated with an increases in hypertension (high blood pressure), hyperlipidemia, peripheral vascular disease, coronary artery disease, myocardial infarction, heart failure, and stroke. The anti-inflammatory effects of vitamin D may be the reason for this, and studies are ongoing to examine this relationship.
• A review of six studies that included over 6,400 people found that patients with peripheral arterial disease (PAD) had lower levels of vitamin D and that vitamin D insufficiency may contribute to the development of more advanced PAD. Further research needs to be done to confirm the cause and effect.

SLIDESHOW

Vitamin D Deficiency: How Much Vitamin D Is Enough? See Slideshow

Many other health benefits of vitamin D and risks associated with deficiency have been reported include infections, inflammation reduction, IBD, obesity, skeletal disease, and type 2 diabetes risk reduction. Source: iStock

What are vitamin D deficiency symptoms and signs? What are health risks of vitamin D deficiency? (Continued)

Infections

• It's possible that maintaining adequate vitamin D levels could lessen the length and severity of upper respiratory infections and possibly even prevent them from occurring in some people. A review of 12 studies, including 2,279 children, found that children with lower respiratory infections (LRTI) had significantly lower vitamin D levels compared with controls. There was also a relationship between the how low the level went and the incidence and severity of LRTI. The role of vitamin D in reducing the risk of hospital-acquired infections, such as pneumonia, bacteremia, urinary tract infections, and surgical site infections is also being investigated.

Inflammation reduction

• Many of the health benefits associated with vitamin D may come from its role in decreasing inflammation. Research has shown a decrease in levels of C-reactive protein, a marker of inflammation, with increased levels of vitamin D.

Inflammatory bowel disease (IBD)

• When there is an inability to properly absorb nutrients in the GI tract, there is a higher risk for nutritional deficiencies. Vitamin D's role goes beyond this in that the level of deficiency may impact the severity of IBD, and maintaining adequate levels may keep you in remission longer. There has even been evidence showing larger numbers of cases of IBD in northern latitudes suggesting it has a role in prevention, as well.

Obesity

• A study including over 500 adults found that vitamin D deficiency was linked to greater fat mass, but only in those with elevated parathyroid hormone (PTH), suggesting the cause may lie in controlling that level.

Skeletal disease

• Vitamin D enhances the absorption of dietary calcium by 30%-40% and phosphorus by 80%. Without it, only 10%-15% of calcium and 60% of phosphorus is absorbed. Vitamin D promotes calcium absorption in the gut and maintains blood calcium levels to enable normal mineralization of bone and prevent abnormally low blood calcium levels that can then lead to tetany.
• Vitamin D insufficiency leads to secondary hyperparathyroidism that causes increased bone loss, osteopenia, osteomalacia, osteoporosis, and increased fracture risk. Furthermore, moderate elevations of parathyroid hormones (PTH) may promote insulin resistance, weight gain, hypertension (high blood pressure), and left ventricular hypertrophy.
• Fall prevention is a public health goal for the elderly. Each year, one in three people 65 years and older experiences at least one fall, with 5.6% resulting in a fracture, and vitamin D can play a role in preventing this. There are vitamin D receptors in human muscle that have a direct effect on muscle strength. A severe vitamin D deficiency can cause myopathy, which can cause muscle weakness and pain. Vitamin D supplementation can reverse this and improve balance. Supplementing 700-1,000 IU/day of vitamin D3 has been shown to possibly reduce falls by 19%-26%. Vitamin D3 at a dosage of greater than 800 IU/day given with calcium has been shown to reduce the risk of fractures by 10%-15%.
• Another advantage to correcting a vitamin D deficiency has been seen in decreasing knee and hip pain. A longitudinal population-based cohort study of 769 randomly selected older adults aged 50-80 years found that moderate vitamin D deficiency predicts the incidence or worsening of knee pain over five years and possibly hip pain over 2.4 years.

Type 2 diabetes risk reduction

• Research has shown that those with blood vitamin D levels over 25 ng/mL had a 43% reduced risk of developing type 2 diabetes compared with those with levels under 14 ng/mL. Adequate vitamin D levels have been associated with improved blood sugar levels and decreased insulin resistance in some studies.

Adequate vitamin D levels have also been linked with improvements in kidney function, erectile dysfunction, sleep apnea, diabetic retinopathy, and decreased manic episodes in bipolar patients. There is ongoing research to determine links with vitamin D deficiency and the increase in the prevalence of asthma and allergies, autism, preterm birth, gestational diabetes, and preeclampsia.

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A woman looks at the sun through a window. Source: iStock

What causes a vitamin D deficiency?

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A deficiency in vitamin D can result from inadequate exposure to sunlight, inefficient production in the skin, not enough vitamin D in your diet, and health conditions that can affect it including, gastrointestinal disorders, renal diseases, and liver diseases.

Darker skin

Melanin is what gives skin its color. Light-skinned people have less melanin than those with darker skin. Melanin is able to absorb UV-B radiation from the sun and reduce the skin's capacity to produce vitamin D3 by 95%-99%. Dark-skinned individuals have natural sun protection and require at least three to five times longer exposures to make the same amount of vitamin D as a person with a white skin tone. African-Americans have a population mean serum 25(OH)D level of 16 ng/mL, whereas white Americans have a level of 26 ng/mL.

Weight

Being overweight or obese may put you at risk for a vitamin D deficiency. A recent review of 23 studies showed that obese subjects had 35% higher rates of vitamin D deficiency compared with normal-weight subjects and 24% higher rates compared with overweight subjects. While diet and decreased sun exposure may have some impact on this, there appears to be an increased need that cannot be met without a supplement. One study tested the blood levels of vitamin D after sun exposure in both obese and non-obese subjects. Both saw an initial rise in vitamin D levels after similar exposures, but 24 hours later, there was 57% less vitamin D in the blood of the obese subjects. Both groups had a similar capacity of the skin to produce the vitamin. The difference was seen in the release of vitamin D from the skin into the circulation.

QUESTION

Next to red peppers, you can get the most vitamin C from ________________. See Answer

Limited exposure to the sun can cause a vitamin D deficiency. Source: Wikipedia – Bruce Blaus

What causes a vitamin D deficiency? (Continued)

Limited exposure to the sun

You may look out your window and see the sun shining and think that you are safe from this deficiency, but that is not always the case. Even in sunny climates, there is an increased prevalence of vitamin D deficiency. We have all heard about the dangers of skin cancer and the need for sunscreen to protect us from this disease. This knowledge and the preventive actions we take have significantly decreased our vitamin D levels. Sunscreen protects so well against UV-B rays that an SPF of 30 decreases vitamin D synthesis in the skin by more than 95%. On top of this, we tend to spend more time indoors. One study found that it took Caucasians exposure of more than 30% of their body every day in the summer to make the optimal amounts of vitamin D. Most adults work indoors and wear more clothing during the workweek, which leaves only about 10%-15% of their body exposed to UV for short periods, so they cannot meet their vitamin D needs through the sun alone. Even if you do have some exposure to the sun, the total amount of vitamin D you can produce is affected by the season, time of day, ozone amount, latitude, and the number of clouds in the sky.

The important thing about using the sun for vitamin D production is to know that less is more. You are better off with short regular exposures to the sun rather than prolonged exposure for many reasons. The process is not as simple as the sun hitting your skin and vitamin D appearing in your blood. What actually happens is that vitamin D3 is first transformed by a process known as hydroxylation in the liver to 25-hydroxyvitamin D3, often written as (25(OH)D3), and then again in the kidney to its active form, 1,25-dihydroxyvitamin D3, written as (1,25(OH)2D3). The level that is checked in your blood is 25-hydroxyvitamin D, often written as 25(OH)D, which includes vitamin D2 and D3. By staying in the sun, you limit this process and can actually get less vitamin D. You also have a lower risk of burning and damaging your skin with short exposures.

The National Cancer Council in Australia recently published a position paper on ways to minimize the risk of skin cancer while maintaining adequate vitamin D levels via exposure to the sun. Currently, one-third of the population there is deficient. Extended and deliberate sun exposure without any form of protection when the UV index is 3 or above is not recommended for anyone. When the UV index is below 3, sun protection is not recommended, and it is recommended that people be outdoors in the middle of the day with some skin uncovered on most days of the week.

Who is at risk for vitamin D deficiency?

Being that the sun is the primary source of vitamin D, your exposure, or lack of it, will impact your risk for a deficiency.

The Endocrine Society recommends screening and treatment for individuals at risk, including older adults with a history of falls or nontraumatic fractures; obese children and adults (BMI > 30 kg/m2); African-American and Hispanic children and adults; pregnant and lactating women; and people with musculoskeletal diseases, chronic kidney disease, hepatic failure, malabsorption syndromes, and some lymphomas. Ongoing monitoring is recommended for the elderly, people with disabilities, and hospitalized people as they have been shown to have a significantly higher risk.

Research has begun to focus on who is deficient or insufficient in their vitamin D levels. Finding a deficiency does not mean that vitamin D is the cause of any ongoing symptoms. It simply means that there is a possible relationship, and more studies need to be done to clarify the relationship between vitamin D insufficiency or deficiency and disease processes.

Malabsorption

People with one of the fat malabsorption syndromes (for example, Crohn's disease or celiac disease) and people who have had bariatric surgery are often unable to absorb enough of the fat-soluble vitamin D.

Age

Elderly: It has been shown that as we age our body has a decreased ability to synthesize vitamin D from exposure to the sun. There can be as much as 25% reduced production over the age of 70. While this can have an impact, it doesn't cause as much of a deficiency as the other risk factors.

Children: A study done in Ethiopia found that schoolchildren between the ages of 11-18 years were more likely to be overweight or obese when they were deficient in vitamin D. Another study of 301 students aged 11-19 years found that 12% of the students were deficient, and 53% had insufficiency. It also found that as body weight increased (measured by BMI) the level of vitamin D decreased.

Medications and medical conditions

A wide variety of medications, including antifungal medications, anticonvulsants, glucocorticoids, and medications to treat AIDS/HIV, can enhance the breakdown of vitamin D and lead to low levels.

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There are two blood tests for vitamin D. One is for a compound called 1,25(OH)2D and the 25-hydroxyvitamin D, written as 25(OH)D test. See the detailed test result chart. Source: Thinkstock Images

How do health care professionals diagnose a vitamin D deficiency?

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All it takes is a simple blood test to find out if you are deficient in vitamin D, but you need to have the correct test done and at the correct time of year. There are two blood tests for vitamin D. One is for a compound called 1,25(OH)2D. This is one that is not a good measure for your current vitamin D level. It has a short half-life and can be impacted by your parathyroid hormone (PTH), calcium, and phosphorus levels, so it's not a true measure of your vitamin D status. The preferred test is the 25-hydroxyvitamin D, written as 25(OH)D. This is the most accurate measure of your current vitamin D status as it reflects what you get from your diet, supplements, and the sun. It is also the one that the majority of the research studies measure. As with the guidelines for how much to consume, there are also two sets of guidelines for what your blood level should be. One is written by the Institute of Medicine (IOM) and the other by the task force for the Endocrine Society. These levels are for serum (blood) 25(OH)D:

	IOM Guidelines	Endocrine Society Guidelines
Deficient	Below 12 ng/mL	Below 20 ng/mL
Insufficient	12 to 20 ng/mL	21-29 ng/mL
Sufficient	Over 20 ng/mL	30-60 ng/mL
Ideal		40-60 ng/mL
Considered safe		<100 ng/mL

The largest meta-analysis ever conducted on all of the published studies between 1966 and 2013 regarding 25(OH)D levels and all-cause mortality found that the lowest mortality (death) risk is seen when the levels are >40 ng/mL. According to this, the IOM guidelines are too low and there is a plea calling on the public health authorities to change the recommendations for both the ideal blood level and the requirements needed to achieve this level.

Your 25(OH)D level will change by season if you vary how much time you spend in the sun each season. Keep this in mind when scheduling your test.

A man shops for vitamin D supplements. Source: Veer

What is the treatment for a vitamin D deficiency?

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The amount of vitamin D that is needed to correct a deficiency will depend on the severity of the deficiency and your individual medical conditions. The time of year will also impact your needs. For example, if you are on the low end of adequate blood levels and heading into the winter months you would need a bit more than if you were heading into the summer months if you spend time out in the sun. The goal for everyone is to get your stores to a safe level and prevent them from dropping with a maintenance plan.

Vitamin D3 is the best choice for supplements. Vitamin D2 supplements do not raise your levels the same amount as D3 and, in some cases, they have been shown to decrease levels over long-term use. Natural sources of vitamin D2 are scarce, and the majority of research has been done using D3 supplements.

What you take is as important as how you take it. Vitamin D supplements should be taken with a meal that contains fat. Studies have shown that when taken on an empty stomach versus with a meal containing fat, there was an average of 32% more vitamin D absorption in the fat-containing meal. This ranged from 11%-52%. Even an 11% reduction is significant and can impact your vitamin level. A recent study instructed people to take their supplement with their largest meal (typically the one with the most fat), and in three months, their blood levels went up an average of 56.7%.

Some supplements can be taken on a daily, weekly, or monthly basis. It's a matter of preference and, most importantly, which one you will be more likely to take. When you are deficient, it is recommended to have your blood tested after two to three months of taking the supplement to be sure that your levels are going up. Work with your doctors to find the optimal plan for you.

The task force for the Endocrine Society makes the following recommendations:

• For children 1-18 years of age who are vitamin D deficient, we suggest treatment with 2,000 IU/d of vitamin D3 for at least six weeks or with 50,000 IU once a week for at least six weeks to achieve a blood level of 25(OH)D above 30 ng/mL, followed by maintenance therapy of 600-1,000 IU/day.
• We suggest that all adults who are vitamin D deficient be treated with 50,000 IU of vitamin D3 once a week for eight weeks or its equivalent of 6,000 IU of vitamin D3 daily to achieve a blood level of 25(OH)D above 30 ng/mL, followed by maintenance therapy of 1,500-2,000 IU/day.
• In obese patients, patients with malabsorption syndromes, and patients on medications affecting vitamin D metabolism, we suggest a higher dose (two to three times higher; at least 6,000-10,000 IU/day) of vitamin D to treat vitamin D deficiency to maintain a 25(OH)D level above 30 ng/mL, followed by maintenance therapy of 3,000-6,000IU/day. One study found that for every 33 lbs. of body weight the serum 25(OH)D level was 4 ng/mL lower at the end of one year of monitoring. This could lead to a significant change in the amount required to supplement based on your body weight and starting serum level.
• African-Americans: The population means serum 25(OH)D level is lower in African-Americans than whites, but supplementation is as effective in this population.

From

Foods that contain vitamin D: Raw salmon filet, a glass of milk, fresh shiitake mushrooms, and canned tuna. Source: Wikipedia – Bruce Blaus

Is it possible to prevent vitamin D deficiency?

A few foods naturally contain vitamin D, and other foods are fortified with it. With only 20% of our vitamin D intake expected from food, exposure to the sun and taking supplements remain the primary sources. Follow your health care provider's recommendations for supplementing on a regular basis, get some sun exposure, consume foods that contain vitamin D, have regular blood work to monitor your level, and make adjustments to your intake based on your medical needs and seasonal changes.

• 1 tsp cod liver oil has 400 to 1,000 IU/vitamin D
• 3.5 oz salmon, fresh (wild) has 600 to 1,000 IU/vitamin D
• 3.5 oz salmon, fresh (farmed) has 100 to 250 IU/vitamin D
• 3.5 oz salmon, canned has 300 to 600 IU/vitamin D
• 3.5 oz sardines, canned has about 300 IU/vitamin D
• 3.5 oz mackerel, canned has about 250 IU/vitamin D
• 3.5 oz tuna, canned has 236 IU/vitamin D
• 3.5 oz shiitake mushrooms (fresh) has about 100 IU/vitamin D
• 3.5 oz shiitake mushrooms (sun-dried) has about 1,600 IU/vitamin D
• 1 egg yolk has about 20 IU/vitamin D
• 8 oz fortified milk or yogurt has 100 IU/vitamin D
• 8 oz fortified orange juice has about 100 IU/vitamin D
• 3 oz fortified cheese has about 100 IU/vitamin D

A chart displays the daily supplement intake tolerable upper limits for vitamin D. Source: Getty Images/iStockphoto
Getty Images/Hemera
Bigstock

What are symptoms and signs of an excessive vitamin D intake (Daily Limits Chart)?

There have never been warnings about getting too much vitamin D from the sun so many do not realize that there is such a thing as too much vitamin D. There are negative health consequences from too much vitamin D, but this can only happen with excessive doses of supplements. A Tolerable Upper Limit (UL) has been set to avoid any issues, but there is some controversy about how much is too much. A blood level above 150 ng/mL appears to be the point at which problems occur, but some suggest that levels above 120 ng/mL should be the cap. Potential problems are hypercalcemia (elevated calcium in the blood, causing weakness, confusion, constipation, loss of appetite, and painful calcium deposits), hypercalciuria (excess calcium in the urine), and hyperphosphatemia (elevated phosphate levels in the blood). Over the long term, the elevated blood levels of calcium can lead to vascular and tissue calcification, with subsequent damage to the heart, blood vessels, and kidneys. Research has shown that very high doses of vitamin D can actually increase the risk of falls and fractures. A study of 2,256 community-dwelling women, aged 70 years or older, found that over five years those given very high doses of vitamin D experienced 15% more falls and 26% more fractures than those in the placebo group.

The current UL set for vitamin D supplements is as follows:

	Infants	1 to 3 years	4 to 8 years	9 to 18 years	19+ years
IOM	1,000-1,500 IU/day	2,500 IU/day	3,000 IU/day	4,000 IU/day	4,000 IU/day
Endocrine Society	2,000 IU/day	4,000 IU/day	4,000 IU/day	4,000 IU/day	10,000 IU/day

The arguments against these upper limit levels stem from the fact that you can get 10,000-25,000 IU from exposure to the sun in one day. The IOM states that excessive sun exposure does not result in vitamin D toxicity because the sustained heat on the skin is thought to photodegrade vitamin D3 as it is being formed. Studies have shown that long-term supplementation over 10,000 IU/day can cause kidney and tissue damage, but this would only occur over a long period of time. One study reports that you would need to consume 50,000 IU/day over several months to reach toxicity blood levels. A recent study found that high-dose vitamin D supplementation (20,000-40,000 IU/week) caused a slight but significant increase in hemoglobin A1C and C-reactive protein, and a decrease in serum HDL ("good" cholesterol). The best way to avoid any issues is to take appropriate levels to correct a deficiency or insufficiency and have your blood checked after a few months and then decrease to maintenance levels once you have reached the correct level.

There is no disputing the fact that vitamin D plays many crucial roles in our well-being, and many of us have either deficient or inefficient blood levels. An affordable, convenient way to test vitamin D levels, similar to finger-sticks used for blood sugar testing, can play a vital role in correcting low blood levels. Changes to our lifestyle, diet, and regular supplementation are the keys to curbing the vitamin D deficiency pandemic.

Medically Reviewed on 2/18/2021

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Consequences Of Vitamin D Deficiency

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