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Vitamin D Deficiency and Insufficiency Guidance

Getting enough, but not too much, vitamin D is required to keep your body working well. Vitamin D helps with strong bones and might help prevent some cancers. Signs of vitamin D deficiency can include muscle pain, discomfort, tiredness and anxiety. To get sufficient vitamin D, look for certain foods, supplements, and thoroughly considered sunlight.

tuna, egg, diary, peas and Vitamin D

What is vitamin D deficiency and Insufficiency?

Vitamin D deficiency means that you do not have sufficient vitamin D in your body. Vitamin D is distinct because your skin actually produces it by using sunshine. Fair-skinned people and those who are more youthful transform sunshine into vitamin D far better than those who are darker-skinned and over age 50.

The term “insufficiency” means a mild decrease and “deficiency” means a greater decrease in vitamin D levels.

Why is vitamin D so important?

Vitamin D is among many vitamins our bodies need to stay healthy. This vitamin has numerous functions, including:

– Keeping bones strong: Having healthy bones protects you from different conditions, including rickets. Rickets is a condition that causes children to have bones that are weak and soft. It is caused by a lack of vitamin D in the body. You require vitamin D so that calcium and phosphorus can be used to construct bones. In adults, having soft bones is a condition called osteomalacia.

– Absorbing calcium: Vitamin D, together with calcium, helps build bones and keep bones strong and healthy. Weak bones can lead to osteoporosis, the loss of bone density, which can cause fractures. Vitamin D, when either taken orally or from sunlight exposure is then converted to an active kind of the vitamin. It is that active type that promotes ideal absorption of calcium from your diet plan.

– Working with parathyroid glands: The parathyroid glands work minute to minute to balance the calcium in the blood by interacting with the kidneys, gut and skeleton. When there is sufficient calcium in the diet plan and sufficient active Vitamin D, dietary calcium is absorbed and put to good use throughout the body. If calcium consumption is insufficient, or vitamin D is low, the parathyroid glands will ‘obtain’ calcium from the skeleton in order to keep the blood calcium in the typical range.

What are the health results of vitamin D deficiency?

Getting enough vitamin D may likewise contribute in helping to keep you healthy by protecting against the list below conditions and possibly helping to treat them. These conditions can consist of:

– Heart illness and high blood pressure.

– Diabetes.

– Infections and immune system conditions.

– Falls in older people.

– Some types of cancer, such as colon, prostate and breast cancers.

– Multiple sclerosis.

What are the sources of vitamin D?

You can get vitamin D in a range of ways. These can consist of:

– Being exposed to the sun. About 15-20 minutes 3 days per week is typically adequate.

– Through the foods you consume.

– Through nutritional supplements.

What does sunlight have to do with getting sufficient vitamin D?

There are health benefits of sunlight. Vitamin D is produced when your skin is exposed to sunshine, or rather, the ultraviolet B (UV-B) radiation that the sun emits. The quantity of vitamin D that your skin makes depends upon such elements as:

– The season: This factor depends a bit on where you live. In areas such as Cleveland, OH, the UV-B light does not reach the earth for six months out of the year due to the ozone layer and the zenith of the sun.

– The time of day: The sun’s rays are most effective in between 10 a.m. and 3 p.m.

– The quantity of cloud cover and air contamination.

– Where you live: Cities near the equator have higher ultraviolet (UV) light levels. It is the UV-B light in sunlight that causes your skin to make vitamin D.

– The melanin content of your skin: Melanin is a brown-black pigment in the eyes, hair and skin. Melanin causes skin to tan. The darker your skin, the more sun direct exposure is required in order to get enough vitamin D from the sun.

What does your diet plan have to do with getting adequate vitamin D?

Vitamin D does not take place naturally in lots of foods. That’s why specific foods have added vitamin D. In fact, more recent food nutrition labels show the amount of vitamin D consisted of in a particular food product.

It might be difficult, especially for vegans or people who are lactose-intolerant, to get enough vitamin D from their diet plans, which is why some individuals might select to take supplements. It is constantly important to consume a range of healthy foods from all food groups. The vitamin content of different foods is displayed in the following tables.

Vitamin D content of various foods (source: MyFoodData.com)

 Fish (Salmon)

Vitamin D
per 6oz Fillet
Vitamin D
per 100g
Vitamin D
per 200 Calories
28.4μg
(142% DV)
16.7μg
(84% DV)
21.4μg
(107% DV)

Cremini (Chestnut) Mushrooms (Exposed to UV Light)

Vitamin D
per Cup
Vitamin D
per 100g
Vitamin D
per 200 Calories
27.8μg
(139% DV)
31.9μg
(160% DV)
290μg
(1450% DV)

Fortified Milk

Vitamin D
per 16oz Glass
Vitamin D
per 100g
Vitamin D
per 200 Calories
6.3μg
(32% DV)
1.3μg
(7% DV)
4.3μg
(21% DV)

Fortified Milk Substitutes (Soy Milk)

Vitamin D
per 16oz Glass
Vitamin D
per 100g
Vitamin D
per 200 Calories
5.8μg
(29% DV)
1.2μg
(6% DV)
7.3μg
(36% DV)

Fortified Tofu

Vitamin D
per Cup
Vitamin D
per 100g
Vitamin D
per 200 Calories
5.7μg
(28% DV)
2.5μg
(13% DV)
5.4μg
(27% DV)

Fortified Yogurt

Vitamin D
per Cup
Vitamin D
per 100g
Vitamin D
per 200 Calories
3.2μg
(16% DV)
1.3μg
(7% DV)
2.5μg
(13% DV)

Fortified Breakfast Cereal

Vitamin D
per 3/4 Cup
Vitamin D
per 100g
Vitamin D
per 200 Calories
2.5μg
(12% DV)
8.3μg
(42% DV)
5.2μg
(26% DV)

Fortified Orange Juice

Vitamin D
per Cup
Vitamin D
per 100g
Vitamin D
per 200 Calories
2.5μg
(12% DV)
1μg
(5% DV)
4.3μg
(21% DV)

Pork Chops

Vitamin D
in 1 Pork Chop
Vitamin D
per 100g
Vitamin D
per 200 Calories
2.1μg
(10% DV)
1μg
(5% DV)
0.8μg
(4% DV)

Eggs

Vitamin D
in 1 Large Egg
Vitamin D
per 100g
Vitamin D
per 200 Calories
1.1μg
(6% DV)
2.2μg
(11% DV)
2.8μg
(14% DV)

Foods High in Vitamin D2

FoodServingVitamin D
#1 Portobellos (Exposed To Sun/UV)per cup diced79% DV
(15.9μg)
#2 Fortified Soy Milkper 16oz glass29% DV
(5.8μg)
#3 Morel Mushroomsper cup17% DV
(3.4μg)
#4 Fortified Almond Milkper cup12% DV
(2.4μg)
#5 Fortified Rice Milkper cup12% DV
(2.4μg)
#6 Shiitake Mushroomsper cup5% DV
(1μg)
#7 Oyster Mushroomsper cup3% DV
(0.6μg)
#8 White Button Mushroomsper cup2% DV
(0.3μg

Foods High in Vitamin D3

FoodServingVitamin D
#1 Salmonper 6oz fillet142% DV
(28.4μg)
#2 Rainbow Troutper 5oz fillet67% DV
(13.5μg)
#3 Herringper 5oz fillet39% DV
(7.7μg)
#4 Canned Sardinesper cup drained36% DV
(7.2μg)
#5 Whole Milkper 16oz glass32% DV
(6.3μg)
#6 Tilapiaper 6oz fillet31% DV
(6.3μg)
#7 Low-Fat and Skim Milkper 16oz glass29% DV
(5.9μg)
#8 Fortified Orange Juiceper cup12% DV
(2.5μg)
#9 Roasted Pork Ribsper rack12% DV
(2.5μg)
#10 Canned Tunaper 3oz9% DV
(1.7μg)

How much vitamin D do you need?

In healthy people, the amount of vitamin D needed per day varies by age. The chart below shows the often-cited recommendations of the Institute of Medicine, now the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine. It is important to know that these are general recommendations. If your doctor is checking your blood levels, he or she might recommend higher or lower doses based on your individual needs.

If you have osteoporosis, your doctor might suggest a blood test of your vitamin D levels. The amount of vitamin D supplement can be customized for each person, based on the results. For many older patients, a vitamin D supplement containing anywhere between 800 to 2000 IUs daily, which can be obtained without a prescription, can be both safe and beneficial. It is important to speak with your doctor about your individual needs.

People by ageRecommended dietary allowance (IU/day)Upper level intake (IU/day)
6 months* Infants 0-4001,000
Infants 6-12 months*4001,500
Children 1-3 years old6002,500
Children 4-8 years old6003,000
People 9-70 years old6004,000
People over 70 years old8004,000
Females 14-50 years old, pregnant/lactating6004,000

*refers to adequate intake vs recommended dietary allowance of the other age groups (source: my.clevelandclinic.org)

Recognise deficiency from insufficiency

NICE acknowledges that there is no clear consensus on when to diagnose vitamin D deficiency or insufficiency, and thresholds may vary between laboratories; however, the National Osteoporosis Society (NOS), NICE and the Institute of Medicine have agreed reasonable thresholds for defining vitamin D status (see Table 1 – source).

Table 1: Vitamin D thresholds1,5,6
Serum 25OHD levels (nmol/l)Vitamin D status
<30Deficient
30–50Insufficient (may be inadequate in some people)
>50Sufficient

The Scientific Advisory Committee on Nutrition, which informed the PHE report on vitamin D supplementation, advises that the risk of skeletal ill-health increases with a vitamin D level less than 25 nmol/l, but this variance is unlikely to make a huge difference to the management of vitamin D deficiency in the real world.

What causes vitamin D deficiency?

Vitamin D deficiency can be caused by particular medical conditions, such as:

Cystic fibrosis, Crohn’s illness, and celiac illness: These diseases do not permit the intestines to absorb enough vitamin D through supplements.

Weight reduction surgical treatments. Weight-loss surgeries that minimize the size of the stomach and/or bypasses part of the small intestines make it extremely hard to take in enough quantities of specific nutrients, vitamins, and minerals. These individuals need to be carefully kept an eye on by their physicians and need to continue to take vitamin D and other supplements throughout their lives.

Weight problems: A body mass index greater than 30 is connected with lower vitamin D levels. Fat cells keep vitamin D isolated so that it is not launched. Vitamin D deficiency is most likely in obese people. Weight problems often makes it required to take larger doses of vitamin D supplements in order to reach and preserve regular D levels.

Kidney and liver illness: These illness lower the quantity of an enzyme required to alter vitamin D to a kind that is used in the body. The Absence of this enzyme results in an insufficient level of active vitamin D in the body.

What other factors can lead to vitamin D deficiency?

Age: The skin’s capability to make vitamin D lessens with age.

Mobility: People who are homebound or are seldom outdoors (for instance, people in nursing homes and other facilities) are not able to utilize sun exposure as a source of vitamin D.

Skin color: Dark-colored skin is less able to make vitamin D than fair-colored skin.

Human breast milk: A woman’s breast milk only includes a percentage of vitamin D. Often infant formulas likewise only include a small amount of D also. Therefore, infants are at danger of not getting enough vitamin D. This is specifically real for infants who are only fed breast milk.

Can medications cause a vitamin D deficiency?

Yes. Vitamin D levels can be decreased by certain medications. These consist of:

  • Laxatives
  • Steroids (such as prednisone)
  • Cholesterol-lowering drugs (such as cholestyramine and colestipol)
  • Seizure-control drugs (such as phenobarbital and phenytoin)
  • A tuberculosis drug (rifampin)
  • A weight-loss drug (orlistat)

Always inform your medical professional about the drugs you take and any vitamin D supplements or other supplements or herbs/alternative health products that you take.

What are the signs and symptoms of vitamin D deficiency?

Severe lack of vitamin D causes rickets, which appears in children as inaccurate development patterns, weakness in muscles, pain in bones and defects in joints. This is extremely uncommon. Nevertheless, children who are deficient in vitamin D can also have muscle weakness or sore and painful muscles.

Lack of vitamin D is not quite as apparent in grownups. Signs and symptoms might include:

  • Fatigue
  • Bone pain
  • Muscle weakness, muscle aches, or muscle cramps
  • Mood changes, like depression or anxiety

Diagnosis And Tests of Vitamin D Deficiency

How is a vitamin D deficiency detected?

Your doctor can order a blood test to measure your levels of vitamin D. There are 2 types of tests that might be ordered, but the most common is the 25-hydroxyvitamin D, called 25( OH) D for short. For the blood test, a service technician will use a needle to take blood from a vein. You do not require to fast or otherwise get ready for this type of test.

What do vitamin D test results mean?

There are some differing viewpoints about what levels of vitamin D work the best for each individual. Laboratories might use different numbers for reference. Please discuss your outcomes with your doctor.

How typically do you require to get your vitamin D levels inspected?

Doctors do not generally order routine checks of vitamin D levels, but they might require to inspect your levels if you have specific medical conditions or risk factors for vitamin D deficiency. In some cases vitamin D levels can be inspected as a cause of signs such as lasting body aches, a history of falls or bone fractures without substantial injury.

Management And Treatment of Vitamin D Deficiency

How is the deficiency treated?

The goals of treatment and prevention are the same– to reach, and after that keep, an appropriate level of vitamin D in the body. While you might think about eating more foods which contain vitamin D and getting a little bit of sunlight, you will likely be told to take vitamin D supplements.

Vitamin D can be found in two kinds: D2 and D3. Vitamin D2, also called ergocalciferol, originates from plants. Vitamin D3, is called cholecalciferol, comes from animals. You need a prescription to get Vitamin D2. Vitamin D3, however, is available over the counter. It is more easily taken in than Vitamin D2 and lasts longer in the body dose-for-dose. Work with your doctor to find out if you need to take a vitamin supplement and how much to take if it is required.

Can you ever have too much Vitamin D?

Yes. You can get excessive vitamin D if you overdo the supplements. Surprisingly, you can not get excessive vitamin D from the sun. Vitamin D toxicity is, luckily, rather unusual but can lead to hypercalcemia and together the signs can include:

  • Nausea
  • Increased thirst and urination
  • Poor appetite
  • Constipation
  • Weakness
  • Confusion
  • Ataxia (a neurological condition that might cause slurring of words and stumbling)

Do not take higher-than-recommended dosages of vitamin D without first discussing it with your doctor. However, your doctor might suggest higher dosages of vitamin D if he or she is examining your blood levels and changing your dose appropriately. Also, be cautious about getting large dosages of vitamin A together with the D in some fish oils. Vitamin A can likewise reach toxic levels and can trigger severe issues.

Prevention

How can I help avoid deficiency?

The goals of treating and preventing the lack of vitamin D of treatment and prevention are the same– to reach and keep a sufficient level of vitamin D in the body. Your doctor will let you understand if you require to take or keep taking vitamin D supplements. If so, they will also let you know how much you need to take. You may likewise want to consider:

Eating more foods which contain vitamin D: See the vitamin D food sources table included in this post. Keep in mind that foods alone normally do not meet the day-to-day suggested levels of vitamin D.

Getting some direct exposure to sunlight, but not too much: Exactly just how much sun direct exposure is needed isn’t clear. 10 to 15 minutes of sun exposure two to three times a week to the face, arms, legs or back might be all that is needed to soak up an ideal amount of vitamin D. You might require more sun direct exposure (especially in early spring and late fall) if:

  • You are older
  • You have a darker skin colour
  • You reside in northern climates

Using sunblock, and standing behind a window, avoids Vitamin D from being produced in the skin. Nevertheless, you ought to bear in mind that too much sunshine increases the risk of skin cancer and ages the skin. That is why taking a properly dosed D supplement is often recommended beside the routine sun exposure.


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