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Vitamin D is a fat-soluble vitamin that can be synthesized from sun exposure or obtained from the diet. There are two types of vitamin D: D2 (ergocalciferol) and D3 (cholecalciferol). Vitamin D2 is synthesized by plants and not produced by the human body. On the other hand, vitamin D3 is produced by the human body from sun exposure, when conditions permit, and can be consumed from limited food sources such as fortified milk, egg yolks, meat and fatty fish.
Vitamin D3 is essential for bone and immune health and many of us simply don’t get enough of it.* Vitamin D3 can be obtained from sunlight; however, many people don’t get enough exposure to direct light as they would need to meet their vitamin D needs. The capacity of our skin to synthesize vitamin D3 can also be negatively influenced by factors such as the aging process, skin pigmentation, and sunscreen use. Research shows that nearly 80% of the general population has vitamin D insufficiency (low normal levels), with up to 15% of the population experiencing overt deficiency.
Vitamin D is found in our diet, but we also produce it through exposure to sunlight. Research suggests that daily sun exposure without sunblock, particularly between the hours of 10 a.m. and 4 p.m, may support vitamin D synthesis.
A number of regional factors impact the ability for people to get necessary levels of vitamin D through sun exposure alone, including cloud cover patterns, smog, and the angle with which the sun hits the earth. In cities north of 37 degrees latitude (imagine a line drawn between San Francisco and Richmond, VA), it’s hard for people to produce enough vitamin D from sun exposure, especially between the months of November and March. The ability for skin to absorb light also impacts how well people can produce vitamin D, as does the use of sunscreen and the number of hours per day spent inside. It should be noted that UVB rays necessary to produce vitamin D do not penetrate glass, so sitting near a window indoors won’t help you produce sufficient vitamin D.
Because vitamin D is an essential nutrient, it is recommended that individuals with limited sun exposure increase dietary intake of vitamin D either through foods high in vitamin D or through dietary supplementation.
Vitamin D - Fact Sheet for Health Professionals
National Institute of Health - Office of Dietary Supplements, National Institute of Health - Office of Dietary Supplements, 2021
More than 53 million adults in the United States have or are at risk of developing low bone mass and structural deterioration of bone tissue which may increase the risk for bone fracture. Vitamin D is essential for bone health due to its role in promoting calcium absorption and maintaining adequate levels of calcium in the body. Vitamin D also supports normal development and growth of muscle fibers. Inadequate vitamin D levels can adversely affect muscle strength and may lead to muscle weakness and discomfort.
Healthy skeletal development, from infancy and childhood through adulthood and old age, requires adequate intakes of calcium and vitamin D. A meta-analysis of nine randomized controlled trials evaluated 33,265 patients older than 65 years who took vitamin D supplements or placebo. Participant follow up after 12 to 84 months exhibited a significant reduction in non vertebral fractures with cholecalciferol supplementation, while ergocalciferol supplementation did not exhibit similar changes.
In recognition of vitamin D’s role in supporting healthy bones across a wide range of age groups, the European Food Safety Authority (EFSA) has authorized health claims for vitamin D and its role in the normal growth and development of bone in children; its contribution to normal absorption/utilization of calcium and phosphorus; and its contributions to the maintenance of normal bones. The United States Food and Drug Administration (FDA) has set the Daily Value (DV) for vitamin D at 20 mcg (800 IU) for adults and children aged 4 years and older to maintain bone health and normal calcium metabolism in healthy people.
Vitamin D Fact Sheet for Health Professionals
US Department of Health and Human Services, National Institue of Health - Office of Dietary Supplements, 2021
Pharmacologic Therapy for Vitamin D Deficiency
Dana Neutze, Anne Mounsey and Laurie Davidson, Am Fam Physician, 2013
Healthy Bones Guide
National Osteoporosis Foundation, National Osteoporosis Foundation, 2021
Dietary Reference Intakes for Calcium and Vitamin D
Institute of medicine, The National Academies Press, 2011
Scientific Opinion on the substantiation of a health claim related to vitamin D and contribution to normal bone and tooth development pursuant to Article 14 of EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2009 Scientific Opinion on the substantiation of health claims related to vitamin D and maintenance of bone and teeth (ID 150, 151, 158), absorption and utilisation of calcium and phosphorus and maintenance of normal blood calcium concentrations (ID 152, 157), cell division (ID 153), and thyroid function (ID 156) pursuant to Article 13(1) of Regulation (EC) No 1924/2006 on request from the European Commission, EFSA Regulation (EC) No 1924/2006
EFSA 2014: European Food Safety Authority (EFSA), EFSA Journal, 2014
Using a randomized, placebo-controlled, double-blind design, researchers studied the effects of vitamin D supplementation in pregnant women and found that there was an effect on regulatory immunity. IL-10+ CD4+ T cells produce regulatory cytokines which help mediate inflammatory responses. Supplementation of 2,000 IU vitamin D produced a significant increase in the concentration of IL-10+ CD4+ cells in the peripheral blood. Women that took 2,000 IU daily saw an increase of 27% from baseline to their third visit.
Vitamin D3 has been shown to act at the first stage of the body’s immune response. This response has been shown to be very similar to that of IL-10, an anti-inflammatory cytokine which modulates anti-inflammatory responses in the immune system.
Authoritative bodies outside the United States have recognized the relationship vitamin D plays with the immune system. The European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies (NDA) concluded that a cause and effect relationship has been established between the dietary intake of vitamin D and contribution to the normal function of the immune system and healthy inflammatory response. Additionally, Health Canada corroborates that vitamin D helps to maintain and support immune function.
Daily cholecalciferol supplementation during pregnancy alters markers of regulatory immunity, inflammation, and clinical outcomes in a randomized, controlled trial
Zerofsky MS, Jacoby BN, Pedersen TL, Stephensen CB, JN, 2016
Vitamin D3 affects differentiation, maturation, and function of human monocyte-derived dendritic cells
Piemonti L, Monti P, Sironi M, Fraticelli P et al, J Immunol, 2000
Scientific Opinion on the substantiation of health claims related to vitamin D and normal function of the immune system and inflammatory response (ID 154, 159), maintenance of normal muscle function (ID 155) and maintenance of normal cardiovascular function (ID 159) pursuant to Article 13(1) of Regulation (EC) No 1924/2006
EFSA 2010: European Food Safety Authority (EFSA), EFSA Journal, 2010
Multi-Vitamin/Mineral Supplements Monograph
Health Canada, 2018, 2018