By Kylie Blanchard 

Commonly called the “Sunshine” vitamin, Vitamin D plays a key role in the body’s bone-building process through aiding in the absorption of calcium. However, the vitamin is also important in building the body’s immunity and protecting against a variety of diseases. 

“Vitamin D is a fat soluble vitamin that is important to our body as it can break down into a steroid hormone,” says Amanda Allmaras, NP-C at Lifeways Clinic. “Steroid hormones are important for skeletal and non-skeletal health.”

She says there is also evidence that adequate amounts of Vitamin D play a role in preventing chronic illnesses such as kidney disease, lung disorders, diabetes, stomach and intestinal problems, and heart disease. “The Food and Nutrition Board recommends males and females from the ages of 19 to 70 consume at least 600 IU per day,” says Allmaras. “However, dosing varies on patients’ risks, levels and absorption rates.”

The body produces Vitamin D naturally when the sun’s ultraviolet rays penetrate bare skin, but getting enough sunshine can be hampered by a colder climate, more time indoors, or the use of UV-blocking sunscreen. Allmaras notes there are many dietary sources, such as seafood, egg yolks, beef, liver, and Swiss cheese that contain Vitamin D naturally. “Also foods or beverages that state they are fortified with Vitamin D, such as milks, orange juices, yogurts, or cereals,” she notes.

“In addition to dietary support, supplementation or prescription Vitamin D is also available to prevent or treat Vitamin D deficiency,” Allmaras continues. “It is best to take Vitamin D with a fatty meal to promote the most absorption due to the fat soluble properties of the vitamin.”

Factors inhibiting the absorption of Vitamin D include darker skin, which has higher levels of melatonin, the pigment that gives skin its color, and can block the needed sun to produce Vitamin D. Certain health conditions, such as cystic fibrosis and inflammatory bowel disease, impact how the body absorbs nutrients. Obesity can also impact levels of Vitamin D, as the fat soluble vitamin is stored in the body’s fat cells and not absorbed by the body.

“Symptoms of Vitamin D deficiency vary vastly and can be vague at times,” says Allmaras. “Some common symptoms we see clinically include bone pain, myalgia or muscle aches, generalized weakness, as well chronic fatigue, depression, and fibromyalgia-like symptoms. In addition, we see osteoporosis, cancers, infections, and cardiovascular disease linked with Vitamin D deficiency.”

She notes the best way to ensure adequate levels of vitamin D is through blood work. “We prefer to run a Vitamin D, 25-Hydroxy test through serum or blood-work.  Normal adult ranges run between 20-100 depending on the testing facility. Our goal is for patients to be about mid-range at 50-60.”

Allmaras says a 2012 study assessed 634 healthy individuals ages 18 to 50 in each of the year’s seasons, and many of those included in the study were Vitamin D deficient. Results showed 73 percent of those studied were below 30ng/mL of Vitamin D in the spring, 50 percent were below 30ng/mL in the summer, 65 percent were below 30ng/mL in the fall and 69 percent were below 30ng/mL in the winter months. “I would expect these numbers to rise in the elderly or in those living in nursing homes as well,” she notes.

JoAnn Neu, 81, discovered she was Vitamin D deficient after she moved to Bismarck from Tennessee in 2011. “I never had my Vitamin D levels checked in Tennessee, but after I moved up here, my doctor checked my Vitamin D level and she was concerned with how low it was.”

Neu was placed on a high dosage supplement for three months to bring her Vitamin D levels back into an acceptable range. “I was surprised with how low it was as well,” she says, stating she didn’t feel any of the side effects that can indicate a deficiency. “I didn’t even know about Vitamin D deficiency until I was checked.”

If a deficiency is found, Vitamin D levels are rechecked three months after starting any interventions to prevent toxicity or too much Vitamin D being stored by fat cells. Since her Vitamin D level returned to an acceptable range, Neu’s doctor continued to have her take a calcium supplement with Vitamin D, as well as a lower dose Vitamin D supplement.

She says she believes the change in climate after she moved to North Dakota may have contributed to her Vitamin D deficiency. Another factor that also likely contributed was not drinking milk, she notes.

“We definitely had more sunshine down in Tennessee and I think we were out more,” Neu says, adding her husband was recently put on the same course of treatment for Vitamin D deficiency. “I heard at one time everyone who lives in North Dakota should take Vitamin D. I think it does make a difference, with all the cold, cloudy days we have here, that we aren’t getting sunshine or getting outside.”

Allmaras says the National Health and Nutrition Examination also identified  those with no college education, obesity, poor health, hypertension, low high-density lipoprotein cholesterol levels (HDL), and those not consuming milk were significantly deficient. “In addition, individuals most at risk include people with limited sun exposure, mal-absorption or gastrointestinal issues, decreased liver or kidney function, as well as those with inadequate oral intake,” says Allmaras. “It is not clear if more women or men are vitamin D deficient; however, African Americans and Hispanics are at greater risk.”

Vitamin D is especially important for women due to the calcium and phosphate absorption that is needed to prevent bone breakdown and promote bone remodeling appropriately, she notes. “It provides skeletal support as it aids with the absorption of calcium and phosphate in our bones.  It helps to promote bone remodeling and is an important aspect to be monitored in post-menopausal women.”

“Women that are post-menopausal lose the estrogen that helps to protect their bones,” continues Allmaras. “So it is important they have adequate calcium intake as well as Vitamin D so they are absorbed and utilized properly in the body to avoid osteoporosis and decrease their risk of fractures.”