Vitamin D

October 3, 2020

Overview

Vitamin D is required for the regulation of the minerals calcium and phosphorus found in the body. It also plays an important role in maintaining proper bone structure.

Sun exposure is an easy, reliable way for most people to get vitamin D. Exposure of the hands, face, arms, and legs to sunlight 2-3 times a week for about one-fourth of the time it would take to develop a mild sunburn will cause the skin to produce enough vitamin D. The necessary exposure time varies with age, skin type, season, time of day, etc. Just 6 days of casual sunlight exposure without sunscreen can make up for 49 days of no sunlight exposure. Body fat acts like a kind of storage battery for vitamin D. During periods of sunlight, vitamin D is stored in fat and then released when sunlight is gone.

Vitamin D deficiency is more common than you might expect. People who don't get enough sun, especially people living in Canada and the northern half of the US, are especially at risk. However, even people living in sunny climates might be at risk, possibly because people are staying indoors more, covering up when outside, or using sunscreens to reduce skin cancer risk.

Older people are also at risk for vitamin D deficiency. They are less likely to spend time in the sun, have fewer "receptors" in their skin that convert sunlight to vitamin D, may not get vitamin D in their diet, may have trouble absorbing vitamin D even if they do get it in their diet, and may have more trouble converting dietary vitamin D to a useful form due to kidney problems. In fact, some scientists suggest that the risk for vitamin D deficiency in people over 65 years of age is very high. As many as 40% of older people living in sunny climates such as South Florida might not have optimal amounts of vitamin D in their systems.

Vitamin D supplements may be necessary for older people, people living in northern latitudes, and for dark-skinned people who need extra time in the sun, but don't get it. Talk to your health care provider about whether a supplement is best for you.

Coronavirus disease 2019 (COVID-19): Some experts suggest taking 2000 IU (50 mcg) of vitamin D daily for COVID-19 prevention. While this dose of vitamin D is likely safe, there is no good data to support benefit for COVID-19. If you opt to take vitamin D for COVID-19, be sure to follow healthy lifestyle choices and proven prevention methods as well.

Classification

Is a Form of:

Vitamin

Primary Functions:

Vitamin D deficiency

Also Known As:

Alfacalcidol: 1-alpha-hydroxycholecalciferol, 1-alpha-hydroxycholécalciférol, 1 alpha (OH)D3

How Does It Work?

Vitamin D is required for the regulation of the minerals calcium and phosphorus found in the body. It also plays an important role in maintaining proper bone structure.

Sun exposure is an easy, reliable way for most people to get vitamin D. Exposure of the hands, face, arms, and legs to sunlight two to three times a week for about one-fourth of the time it would take to develop a mild sunburn will cause the skin to produce enough vitamin D. The necessary exposure time varies with age, skin type, season, time of day, etc.

It’s amazing how quickly adequate levels of vitamin D can be restored by sunlight. Just 6 days of casual sunlight exposure without sunscreen can make up for 49 days of no sunlight exposure. Body fat acts like a kind of storage battery for vitamin D. During periods of sunlight, vitamin D is stored in fatty fat and then released when sunlight is gone.

Nevertheless, vitamin D deficiency is more common than you might expect. People who don’t get enough sun, especially people living in Canada and the northern half of the US, are especially at risk. Vitamin D deficiency also occurs even in sunny climates, possibly because people are staying indoors more, covering up when outside, or using sunscreens consistently these days to reduce skin cancer risk.

Older people are also at risk for vitamin D deficiency. They are less likely to spend time in the sun, have fewer “receptors” in their skin that convert sunlight to vitamin D, may not get vitamin D in their diet, may have trouble absorbing vitamin D even if they do get it in their diet, and may have more trouble converting dietary vitamin D to a useful form due to aging kidneys. In fact, the risk for vitamin D deficiency in people over 65 years of age is very high. Surprisingly, as many as 40% of older people even in sunny climates such as South Florida don’t have enough vitamin D in their systems.

Vitamin D supplements may be necessary for older people, people living in northern latitudes, and for dark-skinned people who need extra time in the sun, but don’t get it.

Uses

A rare, inherited bone disorder marked by low levels of phosphate in the blood (familial hypophosphatemia). Taking vitamin D in forms known as calcitriol or dihydrotachysterol by mouth along with phosphate supplements is effective for treating bone disorders in people with low levels of phosphate in the blood.
A rare disorder that can lead to bone and kidney damage (Fanconi syndrome). Taking vitamin D2 by mouth is effective for treating low levels of phosphate in the blood due to a disease called Fanconi syndrome.
Underactive parathyroid (hypoparathyroidism). Low levels of parathyroid hormone can cause calcium levels to become too low. Taking vitamin D in forms known as dihydrotachysterol, calcitriol, or ergocalciferol by mouth is effective for increasing calcium blood levels in people with low parathyroid hormone levels.
Softening of the bones (osteomalacia). Taking vitamin D3 is effective for treating softening of the bones. Also, taking vitamin D in a form known as calcifediol is effective for treating softening of the bones due to liver disease. In addition, taking vitamin D2 is effective for treating softening of the bones caused by medications or poor absorption syndromes.
A bone disorder that occurs in people with kidney disease (renal osteodystrophy). Taking vitamin D in a form known as calcitriol by mouth manages low calcium levels and prevents bone loss in people with kidney failure.
Rickets. Vitamin D is effective for preventing and treating rickets. A specific form of vitamin D, calcitriol, should be used in people with kidney failure.
Vitamin D deficiency. Vitamin D is effective for preventing and treating vitamin D deficiency. Vitamin D also improves symptoms that result from vitamin D deficiency. Taking vitamin D2 by mouth or administering it as a shot into the muscle seems to help treat a muscle disease associated with vitamin D deficiency.
Bone loss in people taking drugs called corticosteroids. Taking vitamin D by mouth prevents bone loss in people taking drugs called corticosteroids. Also, taking vitamin D alone or with calcium seems to improve bone density in people with existing bone loss caused by using corticosteroids.
Weak and brittle bones (osteoporosis). Taking vitamin D3 along with calcium seems to help prevent bone loss and bone breaks.
Psoriasis. Applying vitamin D in the form of calcitriol, calcipotriene, maxacalcitol, or paricalcitol can help treat plaque-type psoriasis. Applying vitamin D along with corticosteroids seems to work better than applying vitamin D or corticosteroids alone. But taking vitamin D by mouth does not seem to improve psoriasis.
Cavities. Analysis of clinical research suggests that taking vitamin D2 or vitamin D3 reduces the risk of cavities by 36% to 49% in infants, children and adolescents.
Heart failure. Some early research suggests that people with low vitamin D levels have an increased risk of developing heart failure compared to those with higher vitamin D levels. Some research shows that taking vitamin D supplements can help reduce the risk of developing heart failure in some women. Also, most research suggests that taking vitamin D supplements may decrease the risk of death in people with heart failure.
Bone loss in people with overactive parathyroid (hyperparathyroidism-related bone loss). Taking vitamin D3 by mouth seems to reduce parathyroid hormone levels and bone loss in women with a condition called hyperparathyroidism.
Infection of the airways. Most research shows that taking vitamin D helps prevent respiratory infections in children and adults. A respiratory infection can be the flu, a cold, or an asthma attack triggered by a cold or other infection. Some research shows that taking vitamin D during pregnancy reduces the risk of these infections in the child after birth. But conflicting results exist.
Preventing tooth loss (tooth retention). Taking calcium and vitamin D3 by mouth appears to prevent tooth loss in elderly people.

Recommended Dosing

The following doses have been studied in scientific research:

ADULTS

BY MOUTH:

For vitamin D deficiency: 50,000 IU per week for 6-12 weeks has been used. However, some patients require higher doses for longer periods of time to maintain optimal blood levels of vitamin D.
For preventing osteoporosis: 400-1000 IU/day of vitamin D in a form known as cholecalciferol has been used in older adults. Usually it is taken along with 500-1200 mg of calcium per day. Some experts recommended higher doses of 1000-2000 IU daily, and 0.43-1.0 mcg/day of calcitriol have been used for up to 36 months.
For preventing bone loss due to use of corticosteroids: 0.25-1.0 mcg/day of vitamin D in forms known as calcitriol or alfacalcidol have been used for 6-36 months. In many cases, these forms of vitamin D are used along with calcium. Also, 50-32,000 mcg/day of vitamin D in the form of calcifediol has been used for 12 months. Finally, 1750-50,000 IU of vitamin D has been taken in daily or weekly doses for 6-12 months.
For heart failure: 800 IU/day of vitamin D in a form known as cholecalciferol has been taken alone or along with 1000 mg/day of calcium for 3 years. 400 IU/day of vitamin D in a form known as cholecalciferol has been taken with 1000 mg/day of calcium in postmenopausal women.
For bone loss caused by having too much parathyroid hormone (hyperparathyroidism): 800 IU/day of vitamin D in a form known as cholecalciferol has been used for 3 months.
Multiple sclerosis (MS): 400 IU/day of vitamin D has been used to prevent MS.
For preventing respiratory tract infections: 300-4000 IU of vitamin D in a form known as cholecalciferol has been used for 7 weeks to 13 months.
For preventing tooth loss in the elderly: 700 IU/day of vitamin D in a form known as cholecalciferol has been taken in combination with calcium 500 mg/day for 3 years.

APPLIED TO THE SKIN:

For a specific type of psoriasis called plaque psoriasis: A form of vitamin D known as calcipotriol has been applied to the skin alone or along with corticosteroids for up to 52 weeks. Typically calcipotriol is gen at a dose of 50 mcg/gram. Specific products used in clinical studies include Daivobet and Dovobet. These products contain 50 mcg/gram of calcipotriol and 0.5 mg/gram of betamethasone dipropionate.

AS A SHOT:

For vitamin D deficiency: 600,000 IU of vitamin D (Arachitol, Solvay Pharma) given as a single shot into the muscle has been used.

CHILDREN

BY MOUTH:

For preventing respiratory tract infections: 1200 IU/day of vitamin D in a form known as cholecalciferol has been given to school-aged children during the winter to prevent the flu. Also, 500 IU/day of cholecalciferol has been used to prevent worsening of asthma symptoms caused by respiratory tract infections.

Most vitamin supplements contain only 400 IU (10 mcg) vitamin D.

The Institute of Medicine publishes recommended daily allowance (RDA), which is an estimate of the amount of vitamin D that meets the needs of most people in the population. The current RDA was set in 2010. The RDA varies based on age as follows: 1-70 years of age, 600 IU daily; 71 years and older, 800 IU daily; pregnant and lactating women, 600 IU daily. For infants ages 0-12 months, an adequate intake (AI) level of 400 IU is recommended.

Some organizations are recommending higher amounts. In 2008, the American Academy of Pediatrics increased the recommended minimum daily intake of vitamin D to 400 IU daily for all infants and children, including adolescents. Parents should not use vitamin D liquids dosed as 400 IU/drop. Giving one dropperful or mL by mistake can deliver 10,000 IU/day. The US Food and Drug Administration (FDA) will force companies to provide no more than 400 IU per dropperful in the future.

The National Osteoporosis Foundation recommends vitamin D 400 IU to 800 IU daily for adults under age 50, and 800 IU to 1000 IU daily for older adults.

The North American Menopause Society recommends 800 IU to 1000 IU daily for all.

Guidelines from the Osteoporosis Society of Canada recommend 400-1000 IU of a specific form of vitamin D called cholecalciferol for people up to age 50, and 800-2000 IU per day for people over 50.

The Canadian Cancer Society recommends 1000 IU/day during the fall and winter for adults in Canada. For those with a higher risk of having low vitamin D levels, this dose should be taken year round. This includes people who have dark skin, usually wear clothing that covers most of their skin, and people who are older or who don't go outside often.

Many experts now recommend using vitamin D supplements containing cholecalciferol in order to meet these intake levels. This seems to be more potent than another form of vitamin D called ergocalciferol.

Vitamin D Supplements Frequently Asked Questions

Which is the best vitamin D supplement?

The recommended form of vitamin D is vitamin D3 or cholecalciferol. This is the natural form of vitamin D that your body makes from sunlight. Supplements are made from the fat of lambs' wool. However, a clinical study reported in 2008 suggested that vitamin D2 works as well as vitamin D3.

Do vitamin D supplements work?

Studies have found that D3 is more effective, and the conclusions of a 2012 meta-analysis argue that D3 is the preferred choice for supplementation. The government body also recommends that those at risk of lower vitamin D levels, including people with darker skin, take a supplement year-round.

What is the proper way to take vitamin D?

Take vitamin D by mouth as directed. Vitamin D is best absorbed when taken after a meal but may be taken with or without food. Alfacalcidol is usually taken with food.

What are the symptoms of low vitamin D?

Symptoms of vitamin D deficiency can include muscle weakness, pain, fatigue and depression. To get enough D, look to certain foods, supplements, and carefully planned sunlight.
...
Signs and symptoms might include:

Bone pain.
Muscle weakness, muscle aches, or muscle cramps.
Mood changes, like depression.

How long does it take to correct a vitamin D deficiency?

The treatment dose of vitamin D depends on your age, how low your blood vitamin D level is, and what is causing the level to be low. Most often your doctor will lower the vitamin D dose after six to eight weeks of treatment. You will then stay on this lower “maintenance” dose for as long as you need.

When should I take vitamin D morning or night?

Getting into a habit of taking your Vitamin D with a healthy breakfast is a good start. However, there's little evidence whether taking Vitamin D3 at night or in the morning is more effective. If you're not a morning person or you skip breakfast, taking your supplement in the evening with a meal is good.

Is 2000 IU of vitamin D safe?

Mayo Clinic recommends that adults get at least the RDA of 600 IU. However, 1,000 to 2,000 IU per day of vitamin D from a supplement is generally safe, should help people achieve an adequate blood level of vitamin D, and may have additional health benefits.

Does vitamin D affect bowel movements?

In some cases of vitamin D overdose, toilet habits can be affected, says Dr Andrew Thornber, chief medical officer at Now Patient. These changes can include diarrhoea, constipation and frequent urination. Too much vitamin D can also affect blood and calcium levels.

Does Vitamin D Help immune system?

Vitamin D can modulate the innate and adaptive immune responses. Deficiency in vitamin D is associated with increased autoimmunity as well as an increased susceptibility to infection. The classical actions of vitamin D are to promote calcium homeostasis and to promote bone health.

How long should I take vitamin D?

For vitamin D deficiency: 50,000 IU per week for 6-12 weeks has been used. However, some patients require higher doses for longer periods of time to maintain optimal blood levels of vitamin D. For preventing osteoporosis: 400-1000 IU/day of vitamin D in a form known as cholecalciferol has been used in older adults.

When should I take vitamin D supplements?

Take vitamin D by mouth as directed. Vitamin D is best absorbed when taken after a meal but may be taken with or without food. Alfacalcidol is usually taken with food.

Can too much vitamin D cause joint pain?

Brittle bones and bone pain

When there is too much calcium circulating freely in the bloodstream, the body may not have enough hormones to bind the mineral to the bones effectively. Vitamin D toxicity can cause hypercalcemia and subsequent problems with the bones. Some symptoms include: severe back or joint pain.

What diseases are caused by low vitamin D?

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.

What are the side effects of vitamin D?

Most people do not commonly experience side effects with vitamin D, unless too much is taken. Some side effects of taking too much vitamin D include weakness, fatigue, sleepiness, headache, loss of appetite, dry mouth, metallic taste, nausea, vomiting, and others.

Why is my vitamin D low even with supplements?

What causes a vitamin D deficiency? 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.

Can you check vitamin D levels at home?

The EverlyWell Vitamin D Test is an easy way to check your vitamin D level.

What is the best medicine for vitamin D deficiency?

In persons with vitamin D deficiency, treatment may include oral ergocalciferol (vitamin D₂) at 50,000 IU per week for eight weeks. After vitamin D levels normalize, experts recommend maintenance dosages of cholecalciferol (vitamin D₃) at 800 to 1,000 IU per day from dietary and supplemental sources.

Does vitamin D affect sleep?

Research links vitamin D levels to sleep quality. In fact, several studies associate low levels of vitamin D in your blood to a higher risk of sleep disturbances, poorer sleep quality and reduced sleep duration. Summary Vitamin D deficiency may negatively impact sleep quality.

What is the difference between vitamin d3 and vitamin D?

Vitamin D2 is ergocalciferol and comes from plant-based sources. Vitamin D3 is cholecalciferol and comes from animal-based sources. Both supplements are processed in the body by the liver to 25-hydroxyvitamin D, though vitamin D3 is thought to provide higher levels of 25D.

What is the recommended amount of vitamin D?

Clinical Studies

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