Care New England Health Systems
Butler Hospital: (401) 455-6200
CNE Wellness Center: (401) 732-3066
Kent Hospital: (401) 737-7000
VNA of Care New England: (401) 737-6050
Women & Infants Hospital: (401) 274-1100

Vitamin D

IMAGE Vitamin D is a fat-soluble vitamin. Fat-soluble vitamins are stored in the body's liver and fatty tissues. Vitamin D acts as both a vitamin and a hormone.
Vitamin D is found in some foods, but the main sources are vitamin D-fortified milk and sunlight. The ultraviolet rays of the sun react with cholesterol present on the skin and create previtamin D3. This compound goes through a series of reactions in the kidneys and the liver, and the final product is vitamin D.

Functions

Vitamin D's functions:
  • Plays a crucial role in the growth and maintenance of strong, healthy bones
  • Maintains normal blood levels of calcium and phosphorus
In children with low vitamin D levels, the supplement can improve bone mineral density. While the evidence does not give a clear answer, it has also been suggested that vitamin D supplementation may reduce the risk of osteoporosis and seasonal flu in children, and high blood pressure and some forms of cancer.
Vitamin D has also been found to improve pain symptoms in patients with low vitamin D levels.

Recommended Intake

Here are the guidelines for vitamin D intake:
Age Group Recommended Dietary Allowance or Adequate Intake (IU/Day)
0-12 months 400
1-70 years 600
71+ years 800
Pregnant or nursing women 600
IU: international units
The American Academy of Pediatrics recommends supplementation for all children who do not receive at least 400 IU of vitamin D daily. Breastfed babies may require a supplement within the first few days of life. Bottle-fed babies who do not consume enough vitamin-D fortified formula may also need the supplement, as well as any child who does not get plenty of vitamin D in their diet.
As seen above, requirements for pregnant women are the same as for healthy adults, though some believe that pregnant mothers should take more vitamin D than recommended. Furthermore, some experts believe that people at highest risk for vitamin D deficiency, such as older adults or those with limited sun exposure during the winter months, should take 1,000 IU or more daily. However, since the risk of vitamin D toxicity increases with higher doses, such recommendations ought to be discussed individually with a physician.

Vitamin D Deficiency

Symptoms of overt vitamin D deficiency are rare today, but can include the following:
  • Rickets —in children, a disease in which the bones become soft and weak
  • Osteomalacia —in adults, a disease in which the bones become soft and weak
  • Muscle weakness
More mild vitamin D deficiency is thought to be relatively common, especially in higher latitudes, and may lead to increased risk of osteoporosis.

Vitamin D Toxicity

Since vitamin D is stored in the body and not excreted in the urine like most water-soluble vitamins, it is possible for it to accumulate and reach toxic levels. Here are safe upper level intakes for vitamin D:
Age Group Upper Level Intake (IU/Day)
0-6 months 1,000
7-12 months 1,500
1-3 years 2,500
4-8 years 3,000
9 years and older 4,000
Pregnant or nursing women 4,000
Symptoms of toxicity:
  • Nausea
  • Vomiting
  • Poor appetite
  • Constipation
  • Weakness
  • Weight loss
  • High blood pressure
  • Raised levels of calcium in the blood, which can cause:
    • Confusion
    • Heart rhythm abnormalities
    • Deposits of calcium in soft tissues, like the kidney, heart, and lungs
It is unlikely for sunlight and diet to cause vitamin D toxicity.
If you have problems with any symptoms related to vitamin D toxicity, take less vitamin D supplements.

Major Food Sources

Fortified foods provide the most vitamin D. Examples of foods that may be fortified with vitamin D are:
  • Milk
  • Cereal
  • Orange juice
  • Yogurt
  • Margarine
  • Soy beverages
There are not many foods that are natural sources of vitamin D. Of those foods that have vitamin D naturally are (most to least):
  • Fatty fish, such as salmon, tuna, and mackerel
  • Beef liver
  • Cheese
  • Egg yolks
  • Mushrooms
A relatively small amount of sun exposure can provide adequate vitamin D. In a study of naval personnel in submarines, six days of sun exposure proved capable of supplying enough vitamin D for 49 sunless days. However, the actual synthesis of vitamin D through sunlight is affected by season, latitude, time of day, cloud cover, smog, use of sunblock, and skin pigmentation.

Health Implications

Populations at Risk for Vitamin D Deficiency

The following populations may be at risk for vitamin D deficiency and may require a supplement:
  • Breastfeed babies—Human milk does not have enough vitamin D. Breastfed babies should receive a 400 IU vitamin supplement each day to make up for this.
  • Older adults—Studies suggest that adults over age 65 have less ability to synthesize vitamin D through sunlight exposure than adults aged 20-30. They are also likely to spend less time out in the sun. Elderly women with vitamin D deficiency may benefit from taking D3 supplements. Talk to your doctor, though, before taking these.
  • Locales with limited sun exposure—People who live above latitudes of approximately 40°N and below latitudes of approximately 40°S are at risk for deficiency during most of the winter months.
  • People with dark skin—Those with darker skin are less able to make vitamin D from the sun.
  • People who are obese —Body fat can bind to some vitamin D preventing it from getting into the blood where it can be used by the body.
  • People with a reduced ability to absorb dietary fat—Because vitamin D is a fat-soluble vitamin, fat is required for its absorption from foods. Some conditions that can cause fat malabsorption include Crohn's disease , cystic fibrosis , celiac disease , pancreatic enzyme deficiency, and liver disease.

Tips For Increasing Your Vitamin D Intake

Here are tips to help increase your intake of vitamin D:
  • If you take a vitamin supplement, make sure it contains vitamin D.
  • Drink vitamin D-fortified milk.
  • Get sun exposure, but be careful to watch for sunburn. Sunlight is a major cause of skin cancer .

RESOURCES

Academy of Nutrition and Dietetics http://www.eatright.org

Office of Dietary Supplements http://ods.od.nih.gov

CANADIAN RESOURCES

Dietitians of Canada http://www.dietitians.ca

Health Canada http://www.hc-sc.gc.ca

References

Bischoff-Ferrari HA, Willett WC, Wong JB, et al. Fracture prevention with vitamin D supplementation. JAMA. 2005;293(18):2257-64.

Calcium and vitamin D for treatment and prevention of osteoporosis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated June 25, 2013. Accessed October 1, 2013.

Duplessis CA, Harris EB, Watenpaugh DE, et al. Vitamin D supplementation in underway submariners. Aviat Space Environ Med. 2005;76:569-75.

Vitamin D. Office of Dietary Supplements. National Institutes of Health website. Available at: http://ods.od.nih.gov/factsheets/vitamind.asp . Updated June 24, 2013. Accessed October 1, 2013.

Vitamin D intake and supplementation. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated June 25, 2013. Accessed October 1, 2013.

Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122:1142-1152.

4/5/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010;91(5):1255-1260.

2/11/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Winzenberg T, Powell S, Shaw KA, Jones G. Effects of vitamin D supplementation on bone density in healthy children: systematic review and meta-analysis. BMJ. 2011;342.

7/28/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Bjelakovic G, Gluud LL, Nikolova D, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev. 20116;(7):CD007470.

3/6/2013 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Schreuder F, Bernsen RM, van der Wouden JC. Vitamin D supplementation for nonspecific musculoskeletal pain in non-Western immigrants: a randomized controlled trial. Ann Fam Med. 2012 Nov-Dec;10(6):547-55.

Revision Information