Also indexed as: 1,25-dihydroxyvitamin D, Calciferol,
Calcipotriol, Cholecalciferol, Ergocalciferol, Irradiated Ergocalciferol
The fat-soluble vitamin D’s most important role is maintaining blood levels of calcium, which it accomplishes by increasing
absorption of calcium from food and reducing urinary calcium loss. Both effects keep calcium
in the body and therefore spare the calcium that is stored in bones. When necessary, vitamin D
transfers calcium from the bone into the bloodstream, which does not benefit bones. Although
the overall effect of vitamin D on the bones is complicated, some vitamin D is necessary for
healthy bones and teeth.
Where is it found?
Cod liver oil is an excellent dietary
source of vitamin D, as are vitamin D-fortified foods. Traces of vitamin D are found in egg
yolks and butter. However, the majority of vitamin D in the body is created during a chemical
reaction that starts with sunlight exposure to the skin. Cholecalciferol (vitamin D3) is the
animal form of this vitamin.
Vitamin D has been used in
connection with the following conditions (refer to the individual
health concern for complete information):
Who is likely to be deficient?
In adults, vitamin D deficiency may result in a softening of the bones known as osteomalacia. This condition is treated with vitamin
D, sometimes in combination with calcium
supplements. Osteomalacia should be diagnosed, and its treatment monitored, by a doctor. In
people of any age, vitamin D deficiency causes abnormal bone formation. It occurs more
commonly following winter, owing to restricted sunlight exposure during that season. Living in
an area with a lot of atmospheric pollution, which can block the sun's ultraviolet rays, also
appears to increase the risk of vitamin D deficiency.1 2
Vitamin D deficiency is more common in strict
vegetarians (who avoid vitamin D-fortified dairy foods), dark-skinned people,3
alcoholics, and people with liver or kidney disease. People with liver and kidney disease can
make vitamin D but cannot activate it.
Vitamin D deficiency is more common in people suffering from intestinal malabsorption, which may have occurred following
previous intestinal surgeries, or from celiac
disease.4 People with insufficient pancreatic function (e.g., those with
pancreatitis or cystic fibrosis) tend to be
deficient in vitamin D. Vitamin D deficiency is also common in individuals with
hyperthyroidism (Graves' disease), particularly women.5
In children, vitamin D deficiency is called
rickets and causes a bowing of bones not seen in adults with vitamin D deficiency. Vitamin
D deficiency is common among people with hyperparathyroidism, a condition in which the
parathyroid gland is overactive. In a study of 124 people with mild hyperparathyroidism,
vitamin D levels were below normal in 7% of them and suboptimal in 53% of them.6
Vitamin D deficiency is also common in men with advanced prostate cancer. In one study, 44% of 16 men with
advanced prostate cancer had decreased blood levels of vitamin D.7
One in seven adults has been reported to be deficient in vitamin D.8 In one
study, 42% of hospitalized patients under age 65 were reported to be vitamin D
deficient.9 In this same study, 37% of the people were found to be deficient in
vitamin D, despite the fact they were eating the currently recommended amount of this
nutrient. Vitamin D deficiency is particularly common among the elderly. Age-related decline
in vitamin D status may be due to reduced absorption, transport, or liver metabolism of
vitamin D.10
How much is usually taken?
People who get plenty of sun exposure do not require supplemental vitamin D, since sunlight
increases vitamin D synthesis when it strikes bare skin. Although the recommended dietary
allowance for vitamin D is 200 IU per day for adults, there is some evidence that elderly
people need 800 to 1,000 IU per day for maximum effects on preserving bone density and
preventing fractures.11 12 13 14 Sun-deprived
people should take no less than 600 IU per day and ideally around 1,000 IU per
day.15 16
Are there any side effects or interactions?
People with hyperparathyroidism should not take vitamin D without consulting a physician.
People with sarcoidosis should not supplement with vitamin D, unless a doctor has determined
that their calcium levels are not elevated.
Too much vitamin D taken for long periods of time may lead to headaches, weight loss, and kidney stones. Rarely, excessive vitamin D may even
lead to deafness, blindness, increased thirst, increased urination, diarrhea, irritability, children’s failure to
gain weight, or death.
Most people take 400 IU per day, a safe amount for adults. Some researchers believe that
amounts up to 10,000 IU per day are safe for the average healthy adult, although adverse
effects may occur even at lower levels among people with hypersensitivity to vitamin D (e.g.
hyperparathyroidism).17 In fact, of all published cases of vitamin D toxicity for
which a vitamin D amount is known, only one occurred at a level of intake under 40,000 IU per
day.18 Nevertheless, people wishing to take more than 1,000 IU per day for long
periods of time should consult a physician. People should remember the total daily intake of
vitamin D includes vitamin D from fortified milk and other fortified foods, cod liver oil, supplements that contain vitamin D, and
sunlight. People who receive adequate sunlight exposure do not need as much vitamin D in their
diet as do people who receive minimal sunlight exposure.
Vitamin D increases both calcium and
phosphorus absorption and has also been reported to increase absorption of aluminum. Increased
blood levels of calcium (which may be a marker for vitamin D status) have been linked to heart disease.19 Some,20
but not all,21 research suggests that vitamin D may slightly raise blood levels of
cholesterol in humans.
Are there any drug
interactions?
Certain medicines may interact with vitamin D. Refer to drug interactions for a list of those medicines.
References
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1. Agarwal KS, Mughal MZ, Upadhyay P, et al. The impact of atmospheric
pollution on vitamin D status of infants and toddlers in Delhi, India. Arch Dis Child
2002;87:111–3.
2. Manicourt DH, Devogelaer JP. Urban tropospheric ozone increases the
prevalence of vitamin D deficiency among Belgian postmenopausal women with outdoor activities
during summer. J Clin Endocrinol Metab 2008;93:3893–9.
3. Kyriakidou-Himonas M, Aloia JF, Yeh JK. Vitamin D supplementation in
postmenopausal black women. J Clin Endocrinol Metab 1999;84:3988–90.
4. Basha B, Rao S, Han ZH, Parfitt, AM. Osteomalacia due to vitamin D
depletion: neglected consequence of intestinal malabsorption. Am J Med
2000;108:296–300.
5. Yamashita H, Noguchi S, Takatsu K, et al. High prevalence of vitamin D
deficiency in Japanese female patients with Graves' disease. Endocr J
2001;48(6):63–9.
6. Silverberg SL, Shane E, Dempster DW, Bilezikian JP. The effects of
vitamin D insufficiency in patients with primary hyperparathyroidism. Am J Med 1999;
107:561–7.
7. Van Veldhuizen PJ, Taylor SA, Williamson S, Drees BM. Treatment of
vitamin D deficiency in patients with metastatic prostate cancer may improve bone pain and
muscle strength. J Urol 2000;163:187–90.
8. Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D
insufficiency in an adult normal population. Osteoporos Int 1997;7:439–43.
9. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in
medical inpatients. N Engl J Med 1998;338:777–83.
10. Harris SS, Dawson-Hughes B, Perrone GA. Plasma 25-hydroxyvitamin D
responses of younger and older men to three weeks of supplementation with 1800 IU/day of
vitamin D. J Am Coll Nutr 1999;18:470–4.
11. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium
and vitamin D supplementation on bone density in men and women 65 years of age or older. N
Engl J Med 1997;337:670–6.
12. Dawson-Hughes B. Calcium and vitamin D nutritional needs of elderly
women. J Nutr 1996;126(4 Suppl):1165–7S.
13. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to
prevent hip fractures in the elderly women. N Engl J Med 1992;327:1637–42.
14. Dawson-Hughes B, Harris SS, Krall EA, et al. Rates of bone loss in
postmenopausal women randomly assigned to one of two dosages of vitamin D. Am J Clin
Nutr 1995;61:1140–5.
15. Glerup H, Mikkelsen K, Poulsen L, et al. Commonly recommended daily
intake of vitamin D is not sufficient if sunlight exposure is limited. J Intern Med
2000;247:260–8.
16. Bischoff-Ferrari HA, Giovannucci E, Willett WC, et al. Estimation of
optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J
Clin Nutr 2006;84:18–28.
17. Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D
concentrations, and safety. Am J Clin Nutr 1999;69:842–56.
18. Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D
concentrations, and safety. Am J Clin Nutr 1999;69:842–56.
19. Lind L, Skarfors E, Berglund L, et al. Serum calcium: a new,
independent prospective risk factor for myocardial infarction in middle-aged men followed for
18 years. J Clin Epidemiol 1997;50:967–73.
20. Heikkinen AM, Tuppurainen MT, Komulainen M, et al. Long-term vitamin
D3 supplementation may have adverse effects on serum lipids during postmenopausal hormone
replacement therapy. Eur J Endocrinol 1997;137:495–502.
21. Scragg R, Khaw KT, Murphy S. Effect of winter oral vitamin D3
supplementation on cardiovascular risk factors in elderly adults. Eur J Clin Nutr
1995;49:640–6.
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The information presented in Aisle7 is for informational purposes only.
It is based on scientific studies (human, animal, or in vitro), clinical experience,
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