From the Guidelines
To address low vitamin D levels, I recommend taking a vitamin D3 supplement of 1,000-2,000 IU daily for maintenance. This is based on the most recent evidence from the U.S. Preventive Services Task Force recommendation statement published in the Annals of Internal Medicine in 2015 1. According to this study, inadequate dietary vitamin D intake, decreased vitamin D absorption, and limited UVB exposure can all decrease vitamin D levels.
Importance of Vitamin D
Vitamin D is crucial for:
- Calcium absorption
- Bone health
- Immune function
- Mood regulation Low vitamin D can cause:
- Fatigue
- Bone pain
- Muscle weakness
- Increased susceptibility to infections
Recommendations
To improve vitamin D levels, consider the following:
- Take supplements with a meal containing some fat to improve absorption
- Spend 15-30 minutes in sunlight several times weekly with arms and legs exposed (without sunscreen initially)
- Incorporate vitamin D-rich foods like:
- Fatty fish (salmon, mackerel)
- Egg yolks
- Fortified dairy products
- Mushrooms into your diet
Monitoring Vitamin D Levels
It is essential to have your levels checked periodically, as both deficiency and excess can cause health problems. Severe and prolonged vitamin D deficiency can cause bone mineralization diseases, such as rickets in children and osteomalacia in adults 1.
Special Considerations
Most people don't get enough vitamin D from sunlight and diet alone, especially those:
- Living in northern latitudes
- With darker skin
- Who spend limited time outdoors In such cases, supplementation may be necessary to maintain adequate vitamin D levels.
From the Research
Definition and Diagnosis of Low VitD
- Low VitD is defined as a serum 25-hydroxyvitamin D level of less than 20 ng per mL (50 nmol per L), while insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng per mL (50 to 75 nmol per L) 2
- Common manifestations of vitamin D deficiency include symmetric low back pain, proximal muscle weakness, muscle aches, and throbbing bone pain elicited with pressure over the sternum or tibia 2
Treatment and Prevention of Low VitD
- The goal of treatment is to normalize vitamin D levels to relieve symptoms and decrease the risk of fractures, falls, and other adverse health outcomes 2
- Treatment may include oral ergocalciferol (vitamin D2) at 50,000 IU per week for eight weeks, followed by maintenance dosages of cholecalciferol (vitamin D3) at 800 to 1,000 IU per day from dietary and supplemental sources 2
- Vitamin D supplementation of at least 700 to 800 IU per day reduces fracture and fall rates in adults 2
- A daily vitamin D supplementation with 2000 IU (50 µg) of vitamin D3 may be considered a simple, effective, and safe dosage to prevent and treat vitamin D deficiency in the adult general population 3
Optimal Supplementation Doses
- Supplementing with 1,000 IU/day raises vitamin D levels to the recommended range, but levels drop below this range after a 30-day break 4
- A dose of 2,000 IU/day maintains vitamin D levels within the recommended range, even after the break 4
- Increasing the dose to 4,000 IU/day produces a rapid rise, though levels drop more significantly after stopping supplementation 4
- Effective vitamin D supplementation in healthy young adults can be achieved with a daily dose of 2,000 IU during winter 4
Relationship with Other Nutrients
- Calcium and vitamin D are essential for maintaining bone health 5, 6
- Vitamin K2 and magnesium may also contribute to the maintenance of skeletal health, although data regarding their efficacy are inconclusive 5
- Calcium supplementation alone is not recommended for fracture prevention in the general postmenopausal population, but may be beneficial for patients at risk of fracture with insufficient dietary intake and absorption 5