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The Health Benefits of Vitamin D
5 min read | Nov 26, 2019
Vitamin D is a fat-soluble vitamin that is needed to be healthy and maintain strong bones. Known as the "sunshine vitamin," vitamin D is formed when skin is exposed to the sun's ultraviolet rays and is also found in dietary supplements and certain foods.
The main function of vitamin D is to help the body absorb calcium and phosphorus in the small intestine. Calcium is needed to support bone mineralization (hardening of bones), cell functions, and proper nerve and muscle function.
People who have a vitamin D deficiency may develop soft, weakened, and brittle bones, a condition known as rickets in children and osteomalacia in adults. Vitamin D is promoted by mainstream clinicians for its role in balancing calcium and phosphorus and for bone health.
There is sufficient evidence to support the use of vitamin D to prevent bone loss or softening of the bones, especially in those who are taking certain medications or managing medical conditions including corticosteroids.
Additionally, there are a number of promising areas of vitamin D research beyond bone disorders. Vitamin D benefits may include the following:
Colds and Flu
The flu virus causes the most illness in the winter months, leading some researchers to hypothesize that influenza may be related to vitamin D levels. Vitamin D levels are lowest during the winter. Also, observational studies have found that people who have low vitamin D levels are more likely to get respiratory infections or report having a recent cold or upper respiratory tract infection.
A study published in the American Journal of Clinical Nutrition examined the use of daily vitamin D supplement (1,200 IU) versus placebo in nearly 340 children during the winter months. After four months, researchers found that the rate of influenza type A was approximately 40% lower than in the placebo group, with no significant difference in influenza type B rates.
According to the Health Professional Follow-Up Study, which checked blood levels of vitamin D in over 18,000 men who were healthy and followed them for 10 years, men who were vitamin D deficient were twice as likely to have a heart attack as men with adequate vitamin D levels.
Supplementation with 1,000 IU of vitamin D, or higher serum vitamin D levels, may have a slightly lower risk of cardiovascular disease and complications.
According to observational studies and preliminary lab studies, higher vitamin D and calcium intake and status may be linked to lower cancer risk (especially colorectal cancer), although it is difficult to separate the effect of the two because of the way vitamin D affects calcium levels. According to a meta-analysis published in the American Journal of Preventative Medicine, those with the highest level of vitamin D had a 50% lower risk of colorectal cancer compared to those taking lower doses.
A four-year study published in 2007 examined the use of calcium (1,400-1,500mg daily), vitamin D3 (1,100IU daily) or a placebo in 1,179 women over 55. The women who took calcium and vitamin D had significantly less risk for all types of cancer combined, as did the women with higher vitamin D levels at the start of the study.
However, not all studies have found vitamin D to slow or prevent the development of cancer. A Women's Health Initiative study published in 2013 did not find a lower cancer risk in those who took vitamin D (vitamin D intake was lower, at 400 IU per day).
The evidence on vitamin D for overweight or obese adults is mixed. According to a study published in Nutrition Journal, 25 mcg daily of vitamin D for 12 weeks in overweight and obese women induced a statistically significant reduction in fat mass compared to those taking a placebo.
Conversely, a 2013 study in Clinical Nutrition examined 4000 IU of vitamin D daily plus resistance training for 12 weeks and failed to find significant changes in fat mass in those taking vitamin D.
In addition to the potential health benefits listed above, some people take vitamin D to treat a wide range of conditions, including:
- Multiple sclerosis
- Dental cavities and gum disease prevention
- Skin conditions including psoriasis, acne, and eczema
- Fatigue, low energy.
- Pain (such as back pain, knee pain, neuropathy)
- Mood disorders including depression, seasonal affective disorder
- Autoimmune disorders such as diabetes, rheumatoid arthritis, Crohn's disease, ulcerative colitis
- Thyroid and kidney disease
There is insufficient evidence to know for sure if vitamin D plays a role in the treatment of these conditions.
Possible Side Effects
Vitamin D is a fat-soluble vitamin. This means that, if consumed in excess, it can build up in the body and cause toxic symptoms, unlike vitamin C and other water-soluble vitamins. Because the buildup is slow, it can take months or years before toxic levels are reached.
Too much vitamin D can result in high levels of calcium in the blood (hypercalcemia), which can lead to calcium deposits in soft tissues such as the lungs or heart, confusion, kidney damage, kidney stones, nausea, vomiting, constipation, weight loss, and poor appetite.
The combination of vitamin D and calcium should not be taken with thiazide diuretics because it could lead to excess calcium levels in the body. People taking calcium-channel blockers should not take vitamin D and calcium, unless under a doctor's supervision, because it may interfere with the effect of the medication.
Anti-seizure medications and rifampin (for tuberculosis) may reduce vitamin D levels.
People with low parathyroid function may be at higher risk of high blood calcium levels while taking vitamin D.
Steroids, laxatives, and cholesterol-lowering drugs may reduce the amount of vitamin D your body can absorb. Ideally, vitamin D should be taken several hours before or after consuming these drugs.
Dosage and Preparation
In the United States, the Institute of Medicine's recommendations for vitamin D intake, which were originally released in 1997 and updated in 2018, are as follows:
- Birth to 1 year - 400 IU/day (10 mcg)
- Between 1 and 70 years - 600 IU/day (15 mcg)
- Over 70 years - 800 IU/day (20 mcg)
- Pregnant and nursing women - 600 IU/day (15 mcg)
Some professional organizations, including The Endocrine Society, recommend a higher daily intake of 1500-2000 IU/day (25-50 mcg) for all adults. There is growing consensus that reference intakes need to be reassessed, based on increasing evidence that vitamin D deficiency is widespread and also due to research on the complex role of vitamin D in the prevention of many diseases.
Because there are many sources of vitamin D, the best way to measure one's vitamin D level is to get one's level checked with a blood test for a form known as 25-hydroxyvitamin D. In general, vitamin D levels below 30 nmol/L (12 ng/mL) are too low for bone health and overall health. A vitamin D level of 50 nmol/L or above is sufficient for most, although vitamin D levels above 125 nmol/L (50 ng/mL) are probably too high.
The safe upper limit of vitamin D is 1,000-1,500 IU/day for infants, 2,500-3,000 IU for children 1-8 years, and 4,000 IU/day for children 9 and older, adults, pregnant and breastfeeding women.
What to Look For
The main source of vitamin D comes from exposure to the sun. The American Academy of Dermatology advises that we obtain vitamin D from foods and supplements rather than UV exposure, because of the risk of skin cancer.
Vitamin D in Foods
Vitamin D rich foods include certain types of fatty fish, such as herring, mackerel, salmon, tuna, and sardines. Egg yolks, cheese, and beef liver provide smaller amounts of vitamin D. Mushrooms provide some vitamin D, with mushrooms that have been exposed to ultraviolet light being higher in vitamin D.
Although there are few foods that naturally contain vitamin D, many common foods are often fortified with vitamin D such as milk, breakfast cereals, soy milk, rice milk (and other plant-based milks), yogurt, orange, and margarine.
Vitamin D Supplements
Vitamin D supplements are also available as capsules, gummies, liquid, or chewable tablets. Cod liver oil is also still used. Vitamin D in supplements or in enriched foods may be vitamin D2 and D3. Vitamin D3 (cholecalciferol) is the preferred form due to better utilization in the body. In addition to single supplements, multivitamins and calcium supplements provide vitamin D, but the amount varies widely so it's important to read labels.
People who follow a vegetarian or vegan diet should check the source of vitamin D in fortified foods and supplements; while vitamin D3 is widely considered the better-utilized form, vitamin D3 is often sourced from animals (primarily sheep's wool) while vitamin D2 comes from plant sources. Vitamin D gummies may also contain gelatin.
Also keep in mind that the safety of supplements in pregnant women, nursing mothers, children, and those with medical conditions or who are taking medications has not been established. You can get tips on using supplements, but if you're considering the use of vitamin D supplements, talk with your primary care provider first. Self-treating a condition and avoiding or delaying standard care may have serious consequences.
Is there more than one kind of vitamin D?
There are two major types of vitamin D in humans. Vitamin D3 (cholecalciferol) is the type produced in the body in response to exposure to the sun's ultraviolet B rays. Vitamin D2 (ergocalciferol) is synthesized in plants. Both types must be converted in the liver and kidneys to the active form, 1,25 dihydroxyvitamin D, to be utilized in the body.
What are some risk factors for vitamin D deficiency?
There are certain groups of people who are at higher risk for vitamin D deficiency. They include:
- People with limited sun exposure. The amount of vitamin D formed from exposure to the sun is affected by season and latitude. In general, in northern cities such as Boston or New York, there aren't enough UVB rays to form vitamin D during the fall and winter months. People who are homebound, women who wear robes and head coverings for religious reasons, and people whose jobs or work hours limit their exposure to sunlight are likely not obtaining significant amounts of vitamin D from sunlight.
- People who use sunscreen. The use of sunscreen prevents the formation of vitamin D, too. Even sunscreen with an SPF of 8, an amount found in many daily moisturizers, can greatly reduce vitamin D production.
- People with greater skin pigment. People with darker skin have more melanin, the pigment that gives skin its color. Melanin absorbs UV rays, which reduces the skin's ability to produce vitamin D. The more pigment in a person's skin, the more important it is that he or she consumes enough vitamin D. One study found that an estimated 65% of African-Americans were deficient in vitamin D, compared with 29% of Hispanics and 14% of Whites.
- Older people. Older people are at greater risk of vitamin D deficiency, as the ability to produce vitamin D dwindles with age. In fact, vitamin D levels in elderly subjects have been found to be approximately 30% of the levels found in young adults. It is estimated that 20% to 100% of older adults living in the United States, Canada, and Europe, suffer from vitamin D deficiency.
- People who can't properly absorb fat (fat malabsorption). Vitamin D requires some dietary fat in order to be absorbed in the small intestine. People with conditions that cause fat malabsorption, such as cystic fibrosis, celiac disease, Crohn's disease, Whipple disease, and chronic liver disease, are more prone to vitamin D deficiency. People with kidney disease may not be able to convert vitamin D to its active form.
- People who are obese. If you are overweight or obese, you may be at higher risk for vitamin D deficiency. Check your BMI with a healthcare provider to determine your risk.
- Infants who are exclusively breastfed. Vitamin D requirements for infants can't be met by human breast milk alone. Consult your pediatrician before using vitamin D supplements in infants.
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