3 step plan for treating vitamin D deficiency

Posted on Sun, 12 Feb 12

Vitamin D deficiency is an important health issue that affects the vast majority of people. So how do you know if you are deficient and what can you do about it?

The reason vitamin D deficiency is so common is because you need sunshine to make it and modern living means few people are getting enough. You can get vitamin D from food but unless, like a grizzly bear, you only eat wild salmon all day (a rich source of vitamin D) you will never get enough from your diet.

It is in your interest to know if you are deficient because low levels of vitamin D appear to be as important as smoking, not exercising and living on junk food when it comes to your risk of a whole host of serious illnesses (1).

Step 1: Do you have vitamin D deficiency?

The problem with vitamin D deficiency is that you are unlikely to know you have it. Symptoms may include fatigue and muscle pain but often there are no signs at all. The best way to find out is to take a test.  

Depending on which country you live in you can get a simple home test kit for a very small fee:

• United Kingdom & Europe
• North America & Canada

Home kits are very accurate do-it-yourself finger prick tests, so there is no painful blood draw or visit to a pathology lab or doctor required. A test is not only essential to work out if you are deficient but also great for monitoring your supplemented levels over time.

Once you have your results check them against the current guidelines below (2,3):

Step 2: What do you do if you are deficient?

If you are deficient a 5000 IU daily dose of vitamin D3 for three months will get you back to an optimal range in most cases.

Another well studied treatment for deficiency is 50,000 IU of vitamin D once a week for 8 weeks. For most people this will approximately double blood levels (4).

Once you have finished your vitamin D "top up" take another test and see what your levels are, if you were very low to begin with and you are still not in the sufficient range (>75-150 nmol/liter) you may need to repeat another treatment.

Step 3: How much vitamin D should you take each day?

The most current guidelines for supplemental vitamin D needed to prevent and treat deficiency are as follows (2):

*Minimum daily requirement.  **Amount of oral vitamin D that may be needed to raise the blood level of 25(OH)D consistently above 30 ng/mL. *** Maintenance tolerable upper limits (UL) of vitamin D not to be exceeded without medical supervision. **** Levels of daily supplemental vitamin D that may be needed to correct vitamin D deficiency.

Obese children and adults may need at least 2 to 3 times more vitamin D for their age group to satisfy their body's vitamin D requirement.

Sunlight and diet

There are several factors that reduce your ability to produce vitamin D from sunlight including living in far northern and southern latitudes, dark skin, increasing age, indoor and city living, air pollution and sun protection such as sunscreen. So even in countries with very high amounts of sunlight and close proximity to the equator vitamin D deficiency prevalence is still very high.

Few foods are sources of vitamin D and food sources alone are inadequate for your daily vitamin D requirements. Even the richest sources of vitamin D such as salmon, mackerel, sardines, herring, trout, and fresh tuna only provide 500–1000 IU vitamin D per 100 g. Farmed salmon, which most people eat nowadays, provides a measly 100–250 IU per 100g serving. To put this in perspective, an adult would need to eat 2-4 servings of wild salmon every day to maintain daily vitamin D requirements (5).

Vitamin D supplements

Supplements are generally considered the easiest and safest way to ensure you get enough vitamin D.

Safety

Historically there have been concerns about vitamin D toxicity however it is now well established that toxicity is extremely rare and associated with very high and inadvertent supplemental doses. Doses of 10,000 IU daily have been used for up to 5 months with no adverse effects and studies suggest that only when more than 10,000 IU of vitamin D is ingested daily for several months to several years will vitamin D intoxication occur (4). So there is little reason for concern, and plenty of reasons to benefit.

References:

1. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008 Apr;87(4):1080S-6S.

2. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin d deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30.

3. Holick MF. Vitamin D deficiency. N Engl J Med. 2007 Jul 19;357(3):266-81.

4. Holick MF. Vitamin D: a D-Lightful health perspective. Nutr Rev. 2008 Oct;66(10 Suppl 2):S182-94

5. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008 Apr;87(4):1080S-6S.