Vitamin D

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    Last Updated: April 4, 2024

    Vitamin D is a fat-soluble vitamin that our skin synthesizes when exposed to the sun. It benefits us in many ways, from bone health to mood.

    Vitamin D is most often used for .

    What is vitamin D?

    Vitamin D is a fat-soluble nutrient. It is one of the 24 micronutrients critical for human survival. The sun is the major natural source, through eliciting vitamin D production in the skin, but vitamin D is also found naturally in oily fish and eggs and is often added to milk and milk alternatives.

    What are vitamin D’s main benefits?

    Supplemental vitamin D is associated with a range of benefits, including improved immune health, bone health, and well-being. Supplementation may also reduce the risk of cancer mortality, diabetes, and multiple sclerosis. Vitamin D is often taken for depression and similar mental health issues, but the evidence is mixed as to whether supplementation improves these outcomes.

    The effects of vitamin D likely depend on a person’s circulating levels of 25-hydroxyvitamin D (25(OH)D; a form of vitamin D that is measured in blood samples to determine vitamin D status), and many of the benefits of supplementation will only be seen when a deficiency is reversed.

    What are vitamin D’s main drawbacks?

    Very high vitamin D levels in the blood exceeding 375 nmol/L or 150 ng/mL are toxic, potentially causing side effects such as loss of appetite, nausea, vomiting, muscle weakness, confusion, dehydration, excessive thirst, and kidney stones.[7] Extremely high blood levels of vitamin D can even be fatal.[8]

    Since vitamin D production in the skin is self-limiting, sun exposure is unlikely to produce vitamin D levels that cause harm (although it may be possible for people with constant, high-level sun exposure, e.g., lifeguards, to synthesize harmfully high levels of Vitamin D).[9] However, vitamin D levels in the blood can readily reach toxic levels with chronic, high-level supplementation.

    Although ultra-high-level supplementation is universally considered to be toxic, there’s some debate on what constitutes the upper limit for safe, “moderate-level” supplementation. Taking around 4,000 IU (100 μg) of vitamin D per day for extended periods (≥6 months) seems to increase the risk of hypercalcemia (high blood calcium) and, among older adults, the likelihood of experiencing a fall.[10]

    A few trials on older adults have found that vitamin D increased the risk of falls,[11][12] and one study observed a decrease in bone mineral density among women taking high doses of vitamin D.[13]

    How does vitamin D work?

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    Vitamin D exerts its effects by binding to and activating the vitamin D receptor (VDR). Upon binding vitamin D, the VDR functions as a transcription factor, regulating the activity of over 1,000 different genes.[14] This “genomic” action of vitamin D tends to be slower-acting, requiring the synthesis of new mRNA and proteins to take effect.

    Vitamin D also works through “non-genomic” mechanisms, causing rapid activation of various signaling pathways within the cell. Although VDRs have been identified on cell membranes, it isn’t currently known whether the more rapid, non-genomic action of vitamin D occurs through membrane-associated vitamin D receptors or a different cellular receptor.[15]

    Although the most commonly associated effects of vitamin D on the body are associated with bone metabolism, the almost ubiquitous presence of VDRs in cells and tissues throughout the body indicates that vitamin D can affect a wide range of physiological processes.[16] The additional effects of vitamin D on the body include, but aren’t limited to, the following:[17]

    • Anticancer effects (promotion of cell death or suppressing proliferation in cancer cells)
    • Brain development[18]
    • Cell differentiation[19][20]
    • Anti-inflammatory effects[21]
    • Antioxidant effects[22]
    • Antibacterial effects (through vitamin D’s effects on immune cells, and its promotion of the expression of genes encoding antimicrobial peptides)[23]
    • Blood vessel protection[24]
    • Nervous system health
    • Calcium regulation

    What are other names for Vitamin D

    Note that Vitamin D is also known as:
    • Cholecalciferol (Vitamin D3)
    • Ergocalciferol (Vitamin D2)
    Vitamin D should not be confused with:
    • 25-Dihydroxyvitamin D (Hormonally active yet not directly supplemented form)
    • Calcitriol

    Dosage information

    IU vs. μg

    Historically, it’s been more common to see vitamin D dosed in international units (IU), rather than micrograms (μg). In 2016, however, the US Food and Drug Administration (FDA) announced that, by 2021, supplement labels had to display vitamin D content in μg.[1] IU is still commonly seen alongside μg, so it’s good to become familiar with both units: 40 IU is equivalent to 1 μg.

    How many grams of vitamin D should I take per day?

    The ideal daily dose of vitamin D should correspond to its recommended daily allowance (RDA), which is currently 400–800 IU (10–20 μg) a day, but this may be too low for many adults. For moderate supplementation, a standard daily dose of 1,000–2,000 IU (25–50 μg) of vitamin D3 is sufficient to meet the needs of most people. Higher daily doses are in the range of 20–80 IU (0.5–2 μg) per kilogram of body weight.

    Vitamin D should be taken daily with meals or a source of fat.[2][3]

    Regarding the daily recommended dose for babies and children, please refer to the question “Should vitamin D supplements be given to infants and children?”.

    What is the ideal daily dose of vitamin D for pregnant women?

    The recommended daily dose of vitamin D for pregnant women varies across different countries. In the US, pregnant women are recommended to take 600 IU (15 μg) of vitamin D daily, unless they have a vitamin D deficiency, which will require higher doses.[4] In the UK, the recommended dosage is slightly lower, 400 IU (10 μg) daily.[5].

    What is the ideal dose of vitamin D for menopausal women?

    The recommended daily dose of vitamin D for women during menopause has not yet been established. However, research has shown that daily doses of 2000–4800 IU (50–120 μg) taken regularly were effective at correcting vitamin D deficiencies and maintaining vitamin D levels.[6]

    What is the maximum dose of vitamin D?

    The Upper Tolerable Intake Level), which is the maximum daily dose of a nutrient that is unlikely to cause side effects, is 4,000 IU (100 μg) per day in the United States and Canada.[4] This is considered a high dose of vitamin D; however, doses above this level are sometimes used for short periods of time (e.g., to reverse a severe vitamin D deficiency quickly), with safety likely determined by the dose and duration of supplementation. High-dose vitamin D supplementation should be done under medical supervision in order to monitor blood levels and watch for signs of vitamin D toxicity (e.g., hypercalcemia).

    What types of vitamin D are there?

    Vitamin D3 supplementation (cholecalciferol) is recommended over D2 supplementation (ergocalciferol), because D3 tends to raise blood levels more effectively.

    Vitamin D is usually available in a wide range of doses and forms (e.g., tablets, capsules, soft gels, drops, powder). Which form to choose and how much to take will depend on the vitamin D content in each supplement and the individual’s specific requirements. For instance, for an adult wanting to take 2000 IU (50 μg) a day of vitamin D, the correct daily dose of a vitamin D drops supplement containing 1000 IU (25 μg) per drop would be 2 drops a day.

    Factors that influence vitamin D levels

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    Examine Database: Vitamin D

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    Frequently asked questions

    What is vitamin D?

    Vitamin D is a fat-soluble nutrient. It is one of the 24 micronutrients critical for human survival. The sun is the major natural source, through eliciting vitamin D production in the skin, but vitamin D is also found naturally in oily fish and eggs and is often added to milk and milk alternatives.

    Is there a difference between Vitamin D2 and Vitamin D3?

    There are two forms of Vitamin D found in food and supplements: Vitamin D2, which is found in mushrooms, and Vitamin D3, which is found in animal foods. Vitamin D2 is not as bioavailable as D3, which means your body cannot use it as readily; however, it can still raise your vitamin D levels.[66] Most D3 supplements are derived from lanolin, a waxy substance secreted by the skin glands of wooly animals. Sheep are sheared, then the lanolin coating is squeezed off the wool. Since the sheep are not killed in the process, this source of D3 will be acceptable to some vegetarians. For vegans, the only acceptable D3 supplements will be the ones explicitly labeled as vegan, which derive their vitamin D3 from lichen extracts.

    What are some dietary sources of vitamin D3?

    Dietary sources of vitamin D include the following foods:[8]

    Most foods are not natural sources of vitamin D, but many in the U.S. are fortified with vitamin D. Some common vitamin-D-fortified foods include the following:

    • milk and other dairy products such as yogurt
    • soy, almond, and oat milk
    • orange juice
    • breakfast cereals

    Most animal-based foods have some vitamin D in the form of the vitamin D metabolite 25-hydroxyvitamin D (25(OH)D), along with small amounts of vitamin D3. The impact of dietary 25(OH)D on vitamin D status is an ongoing area of research, but it is worth noting that if the 25(OH)D content in foods such as beef, chicken, pork, turkey and eggs were taken into account, the amount of vitamin D present in these foods would be 2-18 times higher than the amount of the parent vitamin alone.[68]

    What are vitamin D’s main benefits?

    Supplemental vitamin D is associated with a range of benefits, including improved immune health, bone health, and well-being. Supplementation may also reduce the risk of cancer mortality, diabetes, and multiple sclerosis. Vitamin D is often taken for depression and similar mental health issues, but the evidence is mixed as to whether supplementation improves these outcomes.

    The effects of vitamin D likely depend on a person’s circulating levels of 25-hydroxyvitamin D (25(OH)D; a form of vitamin D that is measured in blood samples to determine vitamin D status), and many of the benefits of supplementation will only be seen when a deficiency is reversed.

    Can vitamin D status affect testosterone levels?

    Potentially. Vitamin D status was associated with androgen levels in men in an observational study,[69] and a randomized controlled trial found that Vitamin D supplementation (around 3000 IU/day or 75 μg/day) increased testosterone levels in healthy overweight men.[70] It is important to note that vitamin D supplementation has not been shown to increase testosterone to supraphysiological levels, nor is there any evidence that supraphysiological vitamin D intake will further enhance testosterone levels beyond moderate-level supplementation. More research is needed to determine the effects of vitamin D supplementation on testosterone levels in different populations.

    Can vitamin D supplementation improve symptoms of multiple sclerosis?

    Multiple sclerosis (MS) is an autoimmune disease that affects the myelin sheath of neurons, which can be thought of as more or less analogous to the insulation on electrical wires. Degradation of the myelin sheath degrades the ability of neurons to propagate signals back and forth between the body and brain, resulting in MS. There are associations between residing in latitudes further away from the equator and increased risk of MS,[81] and more sun exposure during childhood is associated with reduced risk of MS during adulthood.[82]

    Vitamin D has been shown to have a therapeutic effect in mice with experimental autoimmune encephalomyelitis, an animal model for MS. However, human trials to date have not found evidence in support of a role for vitamin D supplementation in the treatment of MS.[83] More research is needed to better understand whether vitamin D supplementation may benefit any particular populations of people with MS.

    It is also important to note that some of the side effects of toxicity from high-dose vitamin D supplementation, such as fatigue, muscle weakness and urinary dysfunction, mimic the course of MS disease progression,[84] underscoring the importance of consulting with a physician before considering aggressive vitamin D supplementation for MS.

    Can vitamin D supplementation help with treatment or prevention of Alzheimer’s disease?

    Numerous studies have been published suggesting that vitamin D may help to ameliorate some factors associated with the etiology of Alzheimer’s disease, prompting some scientists to suggest that it may be helpful for treating or preventing the disease.[85] In support of this idea, Vitamin D treatment has been shown to have neuroprotective effects in in vivo animal studies, and human observational studies have found associations between low vitamin D levels and an increased risk of Alzheimer’s. Additionally, an in vitro study of immune cells cultured from the blood of people with Alzheimer’s found that treatment of these cells with vitamin D can increase their breakdown of amyloid-β protein aggregates, which accumulate in the brains of people with Alzheimer’s disease and may be associated with disease pathogenesis.[86]

    However, clinical randomized controlled trials (RCTs) are the only true test of whether or not any given supplement is useful to treat a disease, and the RCTs to date on vitamin D supplementation and Alzheimer’s have reported mixed results. Although one study found that 800 IU (20 μg) of vitamin D taken daily for 12 months significantly improved cognitive function in people with Alzheimer’s disease,[87] many other trials of vitamin D supplementation in people with Alzheimer’s disease have not found significant effects.[88] Although vitamin D deficiencies may increase Alzheimer’s disease risk, evidence for a therapeut

    Can vitamin D supplementation help with the treatment or prevention of other neurodegenerative diseases?

    Preclinical studies on vitamin D have indicated that it may interact with and interfere with various signaling pathways associated with other neurodegenerative diseases, such as Parkinson’s disease, multiple sclerosis, and vascular dementia. Unfortunately, as with Alzheimer’s disease, the results of clinical trials of vitamin D in people with these neurodegenerative diseases have overall been mixed, although some trials have reported positive effects on disease pathology. More large-scale, multicenter clinical trials are needed to better understand when, or if, vitamin D supplementation might be indicated as part of treatment strategies for neurodegenerative disease.[17]

    Can vitamin D help with erectile dysfunction?

    Research suggests that there may be a link between low vitamin D levels and the risk of developing erectile dysfunction (ED), but there is not yet a known dose for treating it. Further research is needed to determine whether supplementation with vitamin D can be beneficial for people suffering from ED.[91]

    Can vitamin D alleviate depression?

    Many people get depressed during the winter months, when we produce less vitamin D. So, can supplemental vitamin D cure seasonal depression, and maybe other types of depression? No, alas — but it may help.

    Vitamin D is the “sunshine vitamin”,[51] and sunshine is implicated in mood. So it makes sense that researchers have intently explored vitamin D supplementation for depression. But depression is complex, and the mechanisms at work are not well understood. However, careful analysis of the trials testing the effects of vitamin D on depression and mood-related pathways will help provide some insight into whether, or if, vitamin D may be helpful for depression in different contexts or populations.

    Two reviews of observational studies and intervention trials reached the same conclusions: When parsing the observational data, both reviews found a correlation between depression and low levels of vitamin D (≤20 ng/mL). When parsing the trial data, both reviews found benefits from supplementation but also assessed some of the included studies as having low methodological quality and high risk of bias.[92][93]

    Those two reviews were published in 2017 and 2016, shortly after a 2015 meta-analysis of randomized controlled trials (RCTs) reported finding no significant reduction in depression after vitamin D supplementation. Its authors, however, mentioned that “most of the studies focused on individuals with low levels of depression and sufficient serum vitamin D at baseline”.[94] In other words, they didn’t rule out the possibility that in people with higher levels of depression or lower levels of vitamin D, supplementation might be more effective.

    This hypothesis lines up with the conclusions of a 2014 meta-analysis, which found that, if one considered only the studies whose subjects had low levels of vitamin D at baseline (≤20 ng/mL) and were then given enough vitamin D to achieve sufficiency over the course of the trial, then supplemental vitamin D was about as effective as antidepressant medication.[95] However, this meta-analysis did not account for publication bias.

    A 2018 meta-analysis focused on major depression and found a moderate benefit from vitamin D. However, it stresses the low number of qualifying studies (four trials) and, like the 2017 and 2016 reviews, deplores the low methodological quality of some of the studies.[96] Additionally, a 2016 randomized controlled trial of vitamin D supplementation in people with major depressive disorder purportedly saw an antidepressant effect,[97] but this study was retracted in 2021 due to concerns over the validity of the participant data.[98]

    Finally, let’s mention a 2016 RCT that found that pregnant women who took a daily dose of 2,000 IU (50 μg) of vitamin D3 during late pregnancy had lower scores on a postpartum depression screening scale than those who did not supplement.[99] However, this study only addressed postpartum depression in healthy women with a low-to-moderate pre-partum risk of depression; it may not have wider applicability, and further research is needed.

    Vitamin D insufficiency (≤20 ng/mL) has been associated with depression. If your depression is severe, you are more likely to benefit from correcting an insufficiency. If your levels of vitamin D are sufficient, however, then whether your depression is severe or not, supplementation isn’t likely to help. (Due to the poor overall methodological quality of the studies, those conclusions are at best preliminary.)

    In support of this, a number of observational studies have found that people with depression are more likely to have low vitamin D levels.[100] However, randomized controlled trials don’t consistently find beneficial effects of vitamin D supplementation on depression.[101][102] One reason for this could be that benefits only occur if a person has sufficiently severe depression symptoms. In support of this, two meta-analyses of randomized controlled trials found that vitamin D supplementation reduced the severity of depression symptoms in people with depression but had no effect on depression symptoms in people without depression.[103][104]

    Vitamin D receptors can be found pretty much everywhere in the human body, so the ways in which vitamin D might affect your mood are innumerable. One of those mechanisms could be hormonal, since vitamin D helps regulate testosterone levels,[70][69] and since low testosterone can impair the mood of both men[105][106][107][108] and women.[109]

    We should remember, however, that correlation is not causation. As stated above, the observational data suggests a correlation between depression and low levels of vitamin D, but that doesn’t mean that low levels of vitamin D cause the depression. It might be that depressed people go outside less, thus getting less sunlight, thus producing less vitamin D: the depression would then be the cause of the low vitamin D levels, rather than its consequence.

    Even if depression is a consequence, not a cause, it doesn’t mean that low levels of vitamin D aren’t also a consequence. People who go outside less get less sunlight, but also probably less exercise — and we know that exercise benefits mood,[110] both directly and by promoting better sleep.

    And of course, a consequence can have more than one cause. For instance, a decrease in vitamin D production during the winter months is a possible factor in seasonal affective disorder (SAD),[111] but so is a decrease in illumination,[112] since one meta-analysis[113] and a more recent RCT[114] found that light therapy (using visible light, free of the UVB rays that allow your skin to produce vitamin D) can improve SAD symptoms, often as much as can pharmaceuticals. It should be noted, however, that a few trials with small sample sizes make for rather weak evidence, especially since the meta-analysis didn’t account for publication bias.

    The findings on vitamin D are less consistent. One study found an association between depression and seasonal changes in vitamin D,[115] but another study found no effect of supplemental vitamin D on SAD.[116] And compounding the uncertainty, the researchers of both studies stressed that potential confounders were numerous.

    To summarize:

    • Low levels of vitamin D have been associated with depression, but it doesn’t follow that low levels of vitamin D are the cause of the depression. They’re probably one of the factors at play in seasonal depression, but so is the decrease in illumination.
    • If your vitamin D levels are not low, supplementation isn’t likely to benefit your mood. If they are low, supplementation is more likely to help if you suffer from major depression.
    • If you suspect your vitamin D levels are low, you can have them assessed through a 25-hydroxyvitamin D blood test. Assessing your vitamin D levels twice in a year — in midsummer and midwinter, when there is the most and least sunlight — is an efficient way of estimating what your levels are around the year.
    What are vitamin D’s main drawbacks?

    Very high vitamin D levels in the blood exceeding 375 nmol/L or 150 ng/mL are toxic, potentially causing side effects such as loss of appetite, nausea, vomiting, muscle weakness, confusion, dehydration, excessive thirst, and kidney stones.[7] Extremely high blood levels of vitamin D can even be fatal.[8]

    Since vitamin D production in the skin is self-limiting, sun exposure is unlikely to produce vitamin D levels that cause harm (although it may be possible for people with constant, high-level sun exposure, e.g., lifeguards, to synthesize harmfully high levels of Vitamin D).[9] However, vitamin D levels in the blood can readily reach toxic levels with chronic, high-level supplementation.

    Although ultra-high-level supplementation is universally considered to be toxic, there’s some debate on what constitutes the upper limit for safe, “moderate-level” supplementation. Taking around 4,000 IU (100 μg) of vitamin D per day for extended periods (≥6 months) seems to increase the risk of hypercalcemia (high blood calcium) and, among older adults, the likelihood of experiencing a fall.[10]

    A few trials on older adults have found that vitamin D increased the risk of falls,[11][12] and one study observed a decrease in bone mineral density among women taking high doses of vitamin D.[13]

    Do vitamin D supplements interact with any medications?

    Vitamin D supplements have the potential for interactions with certain medications. Some examples of medications are included below. Since the following is not a comprehensive list, it is important to discuss vitamin D supplementation with your healthcare provider when taking any prescription medications.[71]

    Orlistat (also known as Xenical and Alli). These weight loss drugs may reduce vitamin D absorption from the diet and supplements.[72]

    Statins. Statin drugs reduce cholesterol synthesis in the body. High levels of vitamin D supplementation can potentially reduce the cholesterol-lowering ability of statin drugs by binding to and competing with a common statin-binding enzyme.[73]

    Corticosteroid medications, such as prednisone. Corticosteroids reduce vitamin D metabolism, and vitamin D deficiencies were reported to occur with 2x higher frequency in people taking oral corticosteroids compared to non-users.[74]

    Thiazide diuretics. Diuretics are drugs that promote water loss in the body. Because thiazides decrease calcium loss through urine, and vitamin D increases calcium absorption, taking vitamin D supplements alongside thiazides can potentially lead to dangerously high calcium levels (hypercalcemia).[75][76]

    How does vitamin D work?

    image

    Vitamin D exerts its effects by binding to and activating the vitamin D receptor (VDR). Upon binding vitamin D, the VDR functions as a transcription factor, regulating the activity of over 1,000 different genes.[14] This “genomic” action of vitamin D tends to be slower-acting, requiring the synthesis of new mRNA and proteins to take effect.

    Vitamin D also works through “non-genomic” mechanisms, causing rapid activation of various signaling pathways within the cell. Although VDRs have been identified on cell membranes, it isn’t currently known whether the more rapid, non-genomic action of vitamin D occurs through membrane-associated vitamin D receptors or a different cellular receptor.[15]

    Although the most commonly associated effects of vitamin D on the body are associated with bone metabolism, the almost ubiquitous presence of VDRs in cells and tissues throughout the body indicates that vitamin D can affect a wide range of physiological processes.[16] The additional effects of vitamin D on the body include, but aren’t limited to, the following:[17]

    • Anticancer effects (promotion of cell death or suppressing proliferation in cancer cells)
    • Brain development[18]
    • Cell differentiation[19][20]
    • Anti-inflammatory effects[21]
    • Antioxidant effects[22]
    • Antibacterial effects (through vitamin D’s effects on immune cells, and its promotion of the expression of genes encoding antimicrobial peptides)[23]
    • Blood vessel protection[24]
    • Nervous system health
    • Calcium regulation
    How much fat do I need to absorb vitamin D?

    A moderate amount of fat appears to lead to better vitamin D absorption.

    Fat-soluble vitamins 101:

    • There are four fat-soluble vitamins that humans need: vitamins A, D, E, and K. All the other vitamins are water-soluble.
    • Fat solubility affects two primary things: how well the vitamin is absorbed with fat-containing meals, and how long it’s stored in your body.

    Being fat-soluble is a double-edged sword. On the one hand, you can store those vitamins in your body fat and liver, which means you don’t necessarily need daily intake. A sunny vacation can provide you with enough stored vitamin D to last you weeks or even months.[25]

    On the other hand, you can accidentally overdose on these vitamins more easily. Case studies of vitamin A overdose are actually not that uncommon. Eating the livers of some large fish, seals, or polar bears can easily cause vitamin A poisoning.[26][27][28]

    But most of us don’t eat shark liver or polar bear liver, and vitamin D overdose[29] is less common than vitamin A overdose. In the context of vitamin D intake solely from dietary sources (and not supplements), our problem is less likely to be overdosing on fat-soluble vitamins than it is to be getting enough of them. Let’s take a look at how to get enough vitamin D by taking it with the right amount of fat.

    Some people take a vitamin-D-containing multivitamin in the morning, either with coffee or on an empty stomach. Others take a multivitamin with three eggs and buttered coffee. Whether or not either of these is ideal is an open question.

    It is commonly assumed that vitamin D is better absorbed when taken with a low to moderate amount of fat, as compared to no fat or lots of fat, based on an often-noted study. Specifically, researchers have shown that in people given a single, large dose of vitamin D, taking it with 11 grams of fat leads to higher levels of vitamin D in the bloodstream, compared to taking it with either 35 grams or 0 grams — absorption was 16% higher and 20% higher, respectively.[3] An important caveat to this work is that these apparent differences in absorption were only noted by measuring plasma vitamin D levels 12 hours after taking a single large dose of 50,000 IU (1,250 μg). When plasma vitamin D levels were assessed one month and three months after this large dose, the groups didn’t significantly differ in their levels of circulating vitamin D. One alternative interpretation of this work is therefore that vitamin D may be well-absorbed regardless of the amount of fat it is taken with, or on an empty stomach. Changes in plasma vitamin D levels 12 hours postdose with respect to dietary fat content may simply reflect altered rates of absorption into the bloodstream, rather than increased or decreased absolute absorption, as is commonly inferred from the data. Examining plasma vitamin D levels after a single dose at earlier (<12 hours) and later times (>12 hours) might have shed more light on this. Another possibility, given that participants in the above study had the same blood vitamin D levels regardless of whether they took it with some additional fat, is that the limiting factor for achieving long-term steady state vitamin D levels in the blood is more dependent on absorption of vitamin D into the tissues over time, and less on achieving maximal acute vitamin D levels in the blood after a single dose. The ability of fat to acutely enhance blood vitamin D suggests that fat may enhance intestinal absorption. However, it’s not clear that this ultimately matters in terms of achieving stable, steady-state blood vitamin D levels over a longer period of time. In other words, simply taking vitamin D may be more important than what it is taken with.

    The same researchers did a later study that showed 32% higher plasma vitamin D levels when people took a large dose with a meal containing 30 grams of fat, compared to a fat-free meal. But again, they used a single large dose of 50,000 IU of vitamin D.[30] Although they tested blood vitamin D levels at additional acute time-points (10, 12, and 14 hours), testing at additional timepoints beyond 14 hours (ideally, 24-48 hours, while the vitamin D meal was still present in the intestines) would have been necessary to see whether or not the plasma levels of the people who ate the fat-free meal ever reached those of those who ate the fatty meal, as one would expect if the effect of a fatty meal is to expedite the intestinal uptake of vitamin D. Unfortunately, the study authors failed to perform any longer-term followup.

    More research is therefore needed to better understand interactions between meal fat content and vitamin D absorption. Taking the evidence all together, it is safe to say that vitamin D is absorbed well enough no matter which type of meal (or no meal) it is taken with. Since vitamin D is stored in body fat, the apparent effects of meal fat content relative to changes in acute absorption may ultimately be less important than regular consumption to support optimal steady-state levels.

    Does sunscreen decrease vitamin D?

    Your body can produce vitamin D when the skin is exposed to ultraviolet B (UVB) rays.[31] Yet it is these rays that sunscreens are designed to primarily block.[32] So will using sunscreen tank your vitamin D levels?

    Sunscreen and vitamin D production

    Sunscreen can decrease vitamin D production under both controlled laboratory testing and real-world conditions.[33][34] This decrease is most notable if sunscreen is used consistently and properly (i.e., when using a broad-spectrum sunscreen, the right sun protection factor (SPF), amount, and reapplication schedule).[35][36][37]

    Yet, the amount to which sunscreen decreases vitamin D production appears to be small — a counterintuitive finding.[38] How could this be? Two factors have been proposed as possible explanations:[38]

    1. People may not be appropriately using sunscreen during periods of sun exposure (i.e., incorrect type, amount, SPF, or application frequency). If not used correctly, UVB rays could easily reach areas of your skin where sunscreen is absent or where coverage is not sufficient enough.

    2. While sunscreen does a good job of blocking most UVB rays, it doesn’t entirely block them. A high amount of exposure to UVB rays is not required to kickstart vitamin D production in the skin. So, it’s possible that low amounts of UVB radiation could get past the sunscreen to initiate vitamin D creation.

    One important caveat — studies to date have generally been conducted on people with less skin pigmentation (i.e., those with Fitzpatrick skin types 1–3). A different result may be seen in those with Fitzpatrick skin types 4–6.

    How much sun do I need for vitamin D production?

    Generally speaking, 5 to 30 minutes of unprotected sun exposure to the hands, face, and arms at least three times a week between 11 a.m. and 3 p.m. is considered enough to keep blood vitamin D levels out of the deficient range (<30 nmol/L or <12 ng/mL).[39][40] image

    When determining how much sunlight you might need, there are two basic factors to consider:

    • The UV index (a measure of UV radiation intensity, from 0 to 11+)
    • Your Fitzpatrick skin type (a measure of how your skin responds to UV rays, from 1 to 6)

    When the UV index forecast in your area is 3 or higher, people with Fitzpatrick skin types 1 or 2 should keep unprotected sun exposure to less than 10 minutes; skin types 3 or 4, less than 15 minutes; and skin types 5 or 6, less than 30 minutes.[41][42]

    Fitzpatrick skin type scale

    image

    Keep in mind that longer periods of unprotected sun exposure don’t necessarily lead to higher vitamin D production, as the UVB rays will eventually cause the vitamin D in your skin to degrade to an inactive state.[43] This is a safety mechanism that helps protect your body against vitamin D toxicity.

    Don’t stop using sunscreen just to get your vitamin D levels up — a balance can be struck here. In addition to an appropriate dose of sun exposure, you can increase vitamin D through diet and supplementation. Diet and supplementation strategies will be particularly important for those who live in areas of low sun exposure or at latitudes where the sun’s rays may not be as potent for vitamin D production (greater than 37 degrees north and south of the equator).

    To summarize: Depending on the UV index and your skin type, 5–30 minutes of unprotected sun exposure to the hands, face, and arms at least three times a week between 11 a.m. and 3 p.m. should be enough to keep your vitamin D levels out of the deficient range. However, for people who live in northerly locations, have darker Fitzpatrick skin types, and/or lack sun exposure, supplementation may be required to maintain adequate vitamin D levels, as dietary sources of vitamin D tend to be inadequate.[48]

    Who needs to supplement vitamin D?

    Supplementation is required to prevent a vitamin D deficiency for most people, since dietary sources of vitamin D tend to be inadequate,[48] and the amount of vitamin D produced in the skin through sun exposure can vary with geographical location[49] and individual skin pigmentation.[50]

    Vitamin D insufficiency, defined as blood levels less than or equal to 20 ng/mL, may affect as much as 50% of the population worldwide,[51][52] including 41.6% of Americans. Unsurprisingly, low levels are especially common in Americans with darker skin; Vitamin D insufficiency affects 82.1% of the African American/Black population, and 69.2% of the Hispanic population.[53]

    image

    More surprisingly, it appears that even people who live in countries with sunlight year round often don’t produce enough vitamin D.[54] This is probably due, at least in part, to most people now working indoors, leaving little skin exposed when venturing outside, and sometimes also using sunscreen.

    However, the only way to know for sure if your vitamin D levels are sufficient is to undergo a 25-hydroxyvitamin D blood test. Assessing your vitamin D levels twice in a year — in midsummer and midwinter, when there is the most and least sunlight — is an efficient way of estimating what your levels are around the year.

    In Canada and the United States, the Recommended Daily Allowance (RDA) for vitamin D falls between 400 and 800 IU (10–20 μg) (International Units).[40] These amounts, which some researchers criticize as inadequate,[55][56] can be obtained naturally from only a few food sources, notably fatty fish (such as salmon, tuna, and sardines). However, in Canada and the United States, milk is often fortified with vitamin D.

    image
    Since few foods are rich in vitamin D, supplementation is a valid option. Should your blood test show that your vitamin D levels are low, start supplementing with 2,000 IU (50 μg) a day (a number that, based on the available evidence, should provide the best balance of efficacy and safety), then get tested again after a couple of months.

    To summarize: It is estimated that as much as half the world, including more than 40% of Americans, have low levels of vitamin D (≤20 ng/mL). People with darker skin and people who seldom go unprotected under the sun are especially at risk. The only sure way to test for vitamin D deficiency is a 25-hydroxyvitamin D blood test; if levels are low, supplement.

    What are some of the factors that can increase the risk of having a vitamin D deficiency?

    Adequate vitamin D levels are defined as having blood levels of vitamin D (25(OH)D) in the range of 50-125 nmol/L (12-20 ng/mL).[57] The only way to determine vitamin D status is through a blood test.

    Where you live may influence your risk of Vitamin D deficiency. Vitamin D synthesis rates tend to vary with geographical location, which influences the amount of UVB exposure from the sun. People further away from the equator have lower rates of vitamin D synthesis,[58] and weather patterns associated with more cloud cover and darkness also can also reduce how much vitamin D is made through sun exposure.[59]

    Breastfeeding[60] - see “Should vitamin D supplements be given to infants and children?” below.

    Medical conditions that limit the absorption of dietary fats.[61] As a fat-soluble vitamin, the absorption of vitamin D is dependent on the ability of the gut to absorb fats from the diet.[62]

    Dark skin pigmentation. Darker skin color reduces absorption of UVB, limiting production of vitamin D by the skin during sunlight exposure.[57]

    Obesity. People with obesity (defined as a BMI of 30 or more) tend to have lower vitamin D levels compared to people without obesity, which is thought to be caused by an increased sequestration of vitamin D in subcutaneous fat stores.[57]

    Gastric bypass surgery. During gastric bypass surgery, parts of the gastrointestinal tract that absorb vitamin D are bypassed, limiting absorption and potentially causing a deficiency.[63][64]

    Aging. The ability to make vitamin D in the skin during sun exposure decreases with age, by an amount of 13% per decade, according to one study comparing vitamin D synthesis after a single incidence of sun exposure in younger and older adults.[65]

    Should vitamin D supplements be given to infants and children?

    The American Academy of Pediatrics (AAP) recommends that exclusively breastfed infants receive 400 IU (10 μg) a day of vitamin D for the first year of life and that toddlers and older children receive 600 IU (15 μg) a day. This is to prevent the consequences of vitamin D deficiency (particularly rickets), since human milk and most foods are inadequate sources of vitamin D, and the majority of infants and children do not get enough sun exposure to produce all the vitamin D that they need.[60]

    There are two important exceptions to this vitamin D supplementation recommendation. First, formula-fed infants that consume at least 32 oz of formula per day usually do not require supplementation, since most formulas are fortified with vitamin D. Second, if a lactating parent is supplementing with 6400 IU (160 μg) a day of vitamin D, studies find that enough vitamin D passes into the breastmilk to negate the need for direct infant supplementation.[89]

    Vitamin D toxicity in children is rare, but not impossible. The estimated tolerable upper limits set by the AAP are 1000 IU (25 μg) a day for children 0–1 years old, 2500 IU (62.5 μg) a day for children 1–3 years old, 3000 IU (75 μg) a day for children 4–8 years old, and 4000 IU (100 μg) a day for children nine years and older. Toxicity usually occurs with accidental ingestion of large doses of supplemental vitamin D, as found in a case series of 7 children who consumed between 266,000 and 800,000 IU (6650–20000 μg) a day due to erroneously manufactured supplements.[90]

    Vitamin D supplementation in infants and children should be discussed with a clinician, especially if there are concerns about vitamin D serum levels. A clinician can order blood work to better guide any supplement decisions.

    Update History

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    4. Endometriosis-associated pelvic pain - Fariba Almassinokiani, Sepideh Khodaverdi, Masoud Solaymani-Dodaran, Peyman Akbari, Abdolreza PazoukiEffects of Vitamin D on Endometriosis-Related Pain: A Double-Blind Clinical TrialMed Sci Monit.(2016 Dec 17)
    5. Low-density lipoprotein (LDL) - Abolfazl Mehdizadehkashi, Samaneh Rokhgireh, Kobra Tahermanesh, Neda Eslahi, Sara Minaeian, Mansooreh SamimiThe effect of vitamin D supplementation on clinical symptoms and metabolic profiles in patients with endometriosisGynecol Endocrinol.(2021 Jan 29)
    6. Upper Respiratory Tract Infection Risk - Ginde AA, Blatchford P, Breese K, Zarrabi L, Linnebur SA, Wallace JI, Schwartz RSHigh-Dose Monthly Vitamin D for Prevention of Acute Respiratory Infection in Older Long-Term Care Residents: A Randomized Clinical TrialJ Am Geriatr Soc.(2017 Mar)
    7. Upper Respiratory Tract Infection Risk - Aloia J, Islam S, Mikhail MVitamin D and Acute Respiratory Infections—The PODA TrialOpen Forum Infect. Dis..()
    8. Upper Respiratory Tract Infection Risk - Grant CC, Kaur S, Waymouth E, Mitchell EA, Scragg R, Ekeroma A, Stewart A, Crane J, Trenholme A, Camargo CA JrReduced primary care respiratory infection visits following pregnancy and infancy vitamin D supplementation: a randomised controlled trialActa Paediatr.(2015 Apr)
    9. Upper Respiratory Tract Infection Risk - Martineau AR, Jolliffe DA, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz G, Esposito S, Ganmaa D, Ginde AA, Goodall EC, Grant CC, Janssens W, Jensen ME, Kerley CP, Laaksi I, Manaseki-Holland S, Mauger D, Murdoch DR, Neale R, Rees JR, Simpson S, Stelmach I, Trilok Kumar G, Urashima M, Camargo CA, Griffiths CJ, Hooper RLVitamin D supplementation to prevent acute respiratory infections: individual participant data meta-analysisHealth Technol Assess.(2019 Jan)
    10. Multiple Sclerosis Symptoms - Ghasem Mosayebi, Ali Ghazavi, Keyvan Ghasami, Yahya Jand, Parviz KokhaeiTherapeutic effect of vitamin D3 in multiple sclerosis patientsImmunol Invest.(2011)
    11. Multiple Sclerosis Symptoms - Margitta T Kampman, Linn H Steffensen, Svein I Mellgren, Lone JørgensenEffect of vitamin D3 supplementation on relapses, disease progression, and measures of function in persons with multiple sclerosis: exploratory outcomes from a double-blind randomised controlled trialMult Scler.(2012 Aug)
    12. Multiple Sclerosis Symptoms - Pierrot-Deseilligny C, Rivaud-Péchoux S, Clerson P, de Paz R, Souberbielle JCRelationship between 25-OH-D serum level and relapse rate in multiple sclerosis patients before and after vitamin D supplementationTher Adv Neurol Disord.(2012 Jul)
    13. Multiple Sclerosis Symptoms - J Killestein, E L J Hoogervorst, M Reif, N F Kalkers, A C Van Loenen, P G M Staats, R W Gorter, B M J Uitdehaag, C H PolmanSafety, tolerability, and efficacy of orally administered cannabinoids in MSNeurology.(2002 May 14)
    14. Multiple Sclerosis Symptoms - P Fox, P G Bain, S Glickman, C Carroll, J ZajicekThe effect of cannabis on tremor in patients with multiple sclerosisNeurology.(2004 Apr 13)
    15. Multiple Sclerosis Symptoms - Raymond Hupperts, Joost Smolders, Reinhold Vieth, Trygve Holmøy, Kurt Marhardt, Myriam Schluep, Joep Killestein, Frederik Barkhof, Manolo Beelke, Luigi M E Grimaldi, SOLAR Study GroupRandomized trial of daily high-dose vitamin D 3 in patients with RRMS receiving subcutaneous interferon β-1aNeurology.(2019 Nov 12)
    16. Multiple Sclerosis Symptoms - William Camu, Philippe Lehert, Charles Pierrot-Deseilligny, Patrick Hautecoeur, Anne Besserve, Anne-Sophie Jean Deleglise, Marianne Payet, Eric Thouvenot, Jean Claude SouberbielleCholecalciferol in relapsing-remitting MS: A randomized clinical trial (CHOLINE)Neurol Neuroimmunol Neuroinflamm.(2019 Aug 6)
    17. Multiple Sclerosis Symptoms - Jody Corey-Bloom, Tanya Wolfson, Anthony Gamst, Shelia Jin, Thomas D Marcotte, Heather Bentley, Ben GouauxSmoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trialCMAJ.(2012 Jul 10)
    18. Multiple Sclerosis Symptoms - Vahid Shaygannejad, Mohsen Janghorbani, Fereshteh Ashtari, Hamed DehghanEffects of adjunct low-dose vitamin d on relapsing-remitting multiple sclerosis progression: preliminary findings of a randomized placebo-controlled trialMult Scler Int.(2012)
    19. Upper Respiratory Tract Infection Symptoms - Dubnov-Raz G, Rinat B, Hemilä H, Choleva L, Cohen AH, Constantini NWVitamin D supplementation and upper respiratory tract infections in adolescent swimmers: a randomized controlled trialPediatr Exerc Sci.(2015 Feb)
    20. Upper Respiratory Tract Infection Symptoms - Murdoch DR, Slow S, Chambers ST, Jennings LC, Stewart AW, Priest PC, Florkowski CM, Livesey JH, Camargo CA, Scragg REffect of vitamin D3 supplementation on upper respiratory tract infections in healthy adults: the VIDARIS randomized controlled trialJAMA.(2012 Oct 3)
    21. Upper Respiratory Tract Infection Symptoms - Li-Ng M, Aloia JF, Pollack S, Cunha BA, Mikhail M, Yeh J, Berbari NA randomized controlled trial of vitamin D3 supplementation for the prevention of symptomatic upper respiratory tract infectionsEpidemiol Infect.(2009 Oct)
    22. Upper Respiratory Tract Infection Risk - Aglipay M, Birken CS, Parkin PC, Loeb MB, Thorpe K, Chen Y, Laupacis A, Mamdani M, Macarthur C, Hoch JS, Mazzulli T, Maguire JL, TARGet Kids! CollaborationEffect of High-Dose vs Standard-Dose Wintertime Vitamin D Supplementation on Viral Upper Respiratory Tract Infections in Young Healthy ChildrenJAMA.(2017 Jul 18)
    23. Upper Respiratory Tract Infection Risk - Avenell A, Cook JA, Maclennan GS, Macpherson GCVitamin D supplementation to prevent infections: a sub-study of a randomised placebo-controlled trial in older people (RECORD trial, ISRCTN 51647438)Age Ageing.(2007 Sep)
    24. Upper Respiratory Tract Infection Risk - Rees JR, Hendricks K, Barry EL, Peacock JL, Mott LA, Sandler RS, Bresalier RS, Goodman M, Bostick RM, Baron JAVitamin D3 supplementation and upper respiratory tract infections in a randomized, controlled trialClin Infect Dis.(2013 Nov)
    25. Upper Respiratory Tract Infection Risk - Bergman P, Norlin AC, Hansen S, Rekha RS, Agerberth B, Björkhem-Bergman L, Ekström L, Lindh JD, Andersson JVitamin D3 supplementation in patients with frequent respiratory tract infections: a randomised and double-blind intervention studyBMJ Open.(2012 Dec 13)
    26. Upper Respiratory Tract Infection Risk - Loeb M, Dang AD, Thiem VD, Thanabalan V, Wang B, Nguyen NB, Tran HTM, Luong TM, Singh P, Smieja M, Maguire J, Pullenayegum EEffect of Vitamin D supplementation to reduce respiratory infections in children and adolescents in Vietnam: A randomized controlled trialInfluenza Other Respir Viruses.(2019 Mar)
    27. Upper Respiratory Tract Infection Risk - Simpson S, Mei I, Stewart N, Blizzard L, Tettey P, Taylor BWeekly cholecalciferol supplementation results in significant reductions in infection risk among the vitamin D deficient: results from the CIPRIS pilot RCTBMC Nutr.()
    28. Upper Respiratory Tract Infection Risk - Hauger H, Ritz C, Mortensen C, Mølgaard C, Metzdorff SB, Frøkiær H, Damsgaard CTWinter cholecalciferol supplementation at 55°N has little effect on markers of innate immune defense in healthy children aged 4-8 years: a secondary analysis from a randomized controlled trialEur J Nutr.(2019 Jun)
    29. Low-density lipoprotein (LDL) - Zittermann A, Frisch S, Berthold HK, Götting C, Kuhn J, Kleesiek K, Stehle P, Koertke H, Koerfer RVitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markersAm J Clin Nutr.(2009 May)
    30. Interleukin 5 - Barker T, Martins TB, Hill HR, Kjeldsberg CR, Henriksen VT, Dixon BM, Schneider ED, Dern A, Weaver LKDifferent doses of supplemental vitamin D maintain interleukin-5 without altering skeletal muscle strength: a randomized, double-blind, placebo-controlled study in vitamin D sufficient adultsNutr Metab (Lond).(2012 Mar 9)
    31. Tuberculosis Symptoms - Ganmaa D, Giovannucci E, Bloom BR, Fawzi W, Burr W, Batbaatar D, Sumberzul N, Holick MF, Willett WCVitamin D, tuberculin skin test conversion, and latent tuberculosis in Mongolian school-age children: a randomized, double-blind, placebo-controlled feasibility trialAm J Clin Nutr.(2012 Aug)
    32. Upper Respiratory Tract Infection Symptoms - Goodall EC, Granados AC, Luinstra K, Pullenayegum E, Coleman BL, Loeb M, Smieja MVitamin D3 and gargling for the prevention of upper respiratory tract infections: a randomized controlled trialBMC Infect Dis.(2014 May 19)
    33. Upper Respiratory Tract Infection Symptoms - Shimizu Y, Ito Y, Yui K, Egawa K, Orimo HIntake of 25-Hydroxyvitamin D3 Reduces Duration and Severity of Upper Respiratory Tract Infection: A Randomized, Double-Blind, Placebo-Controlled, Parallel Group Comparison StudyJ Nutr Health Aging.(2018)
    34. Upper Respiratory Tract Infection Symptoms - Jung HC, Seo MW, Lee S, Kim SW, Song JKVitamin D₃ Supplementation Reduces the Symptoms of Upper Respiratory Tract Infection during Winter Training in Vitamin D-Insufficient Taekwondo Athletes: A Randomized Controlled TrialInt J Environ Res Public Health.(2018 Sep 14)
    35. Upper Respiratory Tract Infection Symptoms - Martineau AR, Hanifa Y, Witt KD, Barnes NC, Hooper RL, Patel M, Stevens N, Enayat Z, Balayah Z, Syed A, Knight A, Jolliffe DA, Greiller CL, McLaughlin D, Venton TR, Rowe M, Timms PM, Clark D, Sadique Z, Eldridge SM, Griffiths CJDouble-blind randomised controlled trial of vitamin D3 supplementation for the prevention of acute respiratory infection in older adults and their carers (ViDiFlu)Thorax.(2015 Oct)
    36. Upper Respiratory Tract Infection Symptoms - Laaksi I, Ruohola JP, Mattila V, Auvinen A, Ylikomi T, Pihlajamäki HVitamin D supplementation for the prevention of acute respiratory tract infection: a randomized, double-blinded trial among young Finnish menJ Infect Dis.(2010 Sep 1)
    37. Upper Respiratory Tract Infection Risk - Camargo CA Jr, Ganmaa D, Frazier AL, Kirchberg FF, Stuart JJ, Kleinman K, Sumberzul N, Rich-Edwards JWRandomized trial of vitamin D supplementation and risk of acute respiratory infection in MongoliaPediatrics.(2012 Sep)
    38. Upper Respiratory Tract Infection Risk - Camargo CA, Sluyter J, Stewart AW, Khaw KT, Lawes CMM, Toop L, Waayer D, Scragg REffect of monthly high-dose vitamin D supplementation on acute respiratory infections in older adults: A randomized controlled trialClin Infect Dis.(2019 Aug 17)
    39. Upper Respiratory Tract Infection Symptoms - Manaseki-Holland S, Qader G, Isaq Masher M, Bruce J, Zulf Mughal M, Chandramohan D, Walraven GEffects of vitamin D supplementation to children diagnosed with pneumonia in Kabul: a randomised controlled trialTrop Med Int Health.(2010 Oct)
    40. Pneumonia Symptoms - Choudhary N, Gupta PVitamin D supplementation for severe pneumonia--a randomized controlled trialIndian Pediatr.(2012 Jun)
    41. Risk Of Cardiovascular Disease - Wang L, Manson JE, Song Y, Sesso HDSystematic review: Vitamin D and calcium supplementation in prevention of cardiovascular eventsAnn Intern Med.(2010 Mar 2)
    42. Pain - McAlindon T, LaValley M, Schneider E, Nuite M, Lee JY, Price LL, Lo G, Dawson-Hughes BEffect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trialJAMA.(2013 Jan 9)
    43. Glycemic Control - Carrillo AE, Flynn MG, Pinkston C, Markofski MM, Jiang Y, Donkin SS, Teegarden DImpact of vitamin D supplementation during a resistance training intervention on body composition, muscle function, and glucose tolerance in overweight and obese adultsClin Nutr.(2012 Aug 31)
    44. Glycemic Control - Harris SS, Pittas AG, Palermo NJA randomized, placebo-controlled trial of vitamin D supplementation to improve glycaemia in overweight and obese African AmericansDiabetes Obes Metab.(2012 Sep)
    45. Muscle Mass - Salehpour A, Hosseinpanah F, Shidfar F, Vafa M, Razaghi M, Dehghani S, Hoshiarrad A, Gohari MA 12-week double-blind randomized clinical trial of vitamin D3 supplementation on body fat mass in healthy overweight and obese womenNutr J.(2012 Sep 22)
    46. Pulse Wave Velocity - Rajakumar K, Moore CG, Khalid AT, Vallejo AN, Virji MA, Holick MF, Greenspan SL, Arslanian S, Reis SEEffect of vitamin D3 supplementation on vascular and metabolic health of vitamin D-deficient overweight and obese children: a randomized clinical trial.Am J Clin Nutr.(2020-Apr-01)
    47. Fibromyalgia Symptoms - Florian Wepner, Raphael Scheuer, Birgit Schuetz-Wieser, Peter Machacek, Elisabeth Pieler-Bruha, Heide S Cross, Julia Hahne, Martin FriedrichEffects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trialPain.(2014 Feb)
    48. Fibromyalgia Symptoms - J F de Carvalho, F A G da Rocha Araújo, L M A da Mota, R B Aires, R P de AraujoVitamin D Supplementation Seems to Improve Fibromyalgia Symptoms: Preliminary ResultsIsr Med Assoc J.(2018 Jun)
    49. Fibromyalgia Symptoms - Atalay Dogru, Ayse Balkarli, Veli Cobankara, Sevket Ercan Tunc, Mehmet SahinEffects of Vitamin D Therapy on Quality of Life in Patients with FibromyalgiaEurasian J Med.(2017 Jun)
    50. Fever - Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida HRandomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildrenAm J Clin Nutr.(2010 May)
    51. Upper Respiratory Tract Infection Symptoms - Zhou J, Du J, Huang L, Wang Y, Shi Y, Lin HPreventive Effects of Vitamin D on Seasonal Influenza A in Infants: A Multicenter, Randomized, Open, Controlled Clinical TrialPediatr Infect Dis J.(2018 Aug)
    52. Influenza Risk - Jorde R, Witham M, Janssens W, Rolighed L, Borchhardt K, de Boer IH, Grimnes G, Hutchinson MSVitamin D supplementation did not prevent influenza-like illness as diagnosed retrospectively by questionnaires in subjects participating in randomized clinical trialsScand J Infect Dis.(2012 Feb)
    53. Influenza Risk - Urashima M, Mezawa H, Noya M, Camargo CA JrEffects of vitamin D supplements on influenza A illness during the 2009 H1N1 pandemic: a randomized controlled trialFood Funct.(2014 Sep)
    54. Testosterone - Pilz S, Frisch S, Koertke H, Kuhn J, Dreier J, Obermayer-Pietsch B, Wehr E, Zittermann AEffect of vitamin D supplementation on testosterone levels in menHorm Metab Res.(2011 Mar)
    55. Risk Of Cardiovascular Disease - Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, Kinkeldei J, Boehm BO, Weihrauch G, Maerz WIndependent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortalityArch Intern Med.(2008 Jun 23)
    56. Risk Of Cardiovascular Disease - Parker J, Hashmi O, Dutton D, Mavrodaris A, Stranges S, Kandala NB, Clarke A, Franco OHLevels of vitamin D and cardiometabolic disorders: systematic review and meta-analysisMaturitas.(2010 Mar)
    57. COVID-19 Severity - Igor H Murai, Alan L Fernandes, Lucas P Sales, Ana J Pinto, Karla F Goessler, Camila S C Duran, Carla B R Silva, André S Franco, Marina B Macedo, Henrique H H Dalmolin, Janaina Baggio, Guilherme G M Balbi, Bruna Z Reis, Leila Antonangelo, Valeria F Caparbo, Bruno Gualano, Rosa M R PereiraEffect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19: A Randomized Clinical TrialJAMA.(2021 Mar 16)
    58. COVID-19 Severity - Shaun Sabico, Mushira A Enani, Eman Sheshah, Naji J Aljohani, Dara A Aldisi, Naif H Alotaibi, Naemah Alshingetti, Suliman Y Alomar, Abdullah M Alnaami, Osama E Amer, Syed D Hussain, Nasser M Al-DaghriEffects of a 2-Week 5000 IU versus 1000 IU Vitamin D3 Supplementation on Recovery of Symptoms in Patients with Mild to Moderate Covid-19: A Randomized Clinical TrialNutrients.(2021 Jun 24)
    59. COVID-19 Severity - Marta Entrenas Castillo, Luis Manuel Entrenas Costa, José Manuel Vaquero Barrios, Juan Francisco Alcalá Díaz, José López Miranda, Roger Bouillon, José Manuel Quesada Gomez"Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study"J Steroid Biochem Mol Biol.(2020 Oct)
    60. Breast Cancer Risk - Garland CF, Gorham ED, Mohr SB, Grant WB, Giovannucci EL, Lipkin M, Newmark H, Holick MF, Garland FCVitamin D and prevention of breast cancer: pooled analysisJ Steroid Biochem Mol Biol.(2007 Mar)
    61. Breast Cancer Risk - Crew KD, Gammon MD, Steck SE, Hershman DL, Cremers S, Dworakowski E, Shane E, Terry MB, Desai M, Teitelbaum SL, Neugut AI, Santella RMAssociation between plasma 25-hydroxyvitamin D and breast cancer riskCancer Prev Res (Phila).(2009 Jun)
    62. Aromatase-Inhibitor Related Joint Pain - Qamar J Khan, Pavan S Reddy, Bruce F Kimler, Priyanka Sharma, Susan E Baxa, Anne P O'Dea, Jennifer R Klemp, Carol J FabianEffect of vitamin D supplementation on serum 25-hydroxy vitamin D levels, joint pain, and fatigue in women starting adjuvant letrozole treatment for breast cancerBreast Cancer Res Treat.(2010 Jan)
    63. Low-density lipoprotein (LDL) - Seibert E, Lehmann U, Riedel A, Ulrich C, Hirche F, Brandsch C, Dierkes J, Girndt M, Stangl GIVitamin D3 supplementation does not modify cardiovascular risk profile of adults with inadequate vitamin D statusEur J Nutr.(2015 Nov 30)
    64. Inflammation - Gepner AD, Ramamurthy R, Krueger DC, Korcarz CE, Binkley N, Stein JHA prospective randomized controlled trial of the effects of vitamin D supplementation on cardiovascular disease riskPLoS One.(2012)
    65. Blood Pressure - Scragg R, Sowers M, Bell CSerum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination SurveyAm J Hypertens.(2007 Jul)
    66. Sleep Duration - Majid MS, Ahmad HS, Bizhan H, Hosein HZM, Mohammad AThe effect of vitamin D supplement on the score and quality of sleep in 20-50 year-old people with sleep disorders compared with control groupNutr Neurosci.(2018 Sep)
    67. Fibromyalgia Symptoms - David S Arvold, Marilyn J Odean, Maude P Dornfeld, Ronald R Regal, Judith G Arvold, Gene C Karwoski, David J Mast, Paul B Sanford, Robert J SjobergCorrelation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trialEndocr Pract.(2009 Apr)
    68. Parathyroid Hormone - David D Chandy, Jahnavi Kare, Shakal N Singh, Anjoo Agarwal, Vinita Das, Urmila Singh, V Ramesh, Vijayalakshmi BhatiaEffect of vitamin D supplementation, directly or via breast milk for term infants, on serum 25 hydroxyvitamin D and related biochemistry, and propensity to infection: a randomised placebo-controlled trialBr J Nutr.(2016 Jul)
    69. Type 1 Diabetes Incidence - Mohr SB, Garland CF, Gorham ED, Garland FCThe association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwideDiabetologia.(2008 Aug)
    70. Glycemic Control - A M Borissova, T Tankova, G Kirilov, L Dakovska, R KovachevaThe effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2 diabetic patientsInt J Clin Pract.(2003 May)
    71. Insulin - Mitri J, Dawson-Hughes B, Hu FB, Pittas AGEffects of vitamin D and calcium supplementation on pancreatic β cell function, insulin sensitivity, and glycemia in adults at high risk of diabetes: the Calcium and Vitamin D for Diabetes Mellitus (CaDDM) randomized controlled trialAm J Clin Nutr.(2011 Aug)
    72. Calcium Absorption - Abrams SA, Hawthorne KM, Chen ZSupplementation with 1000 IU vitamin D/d leads to parathyroid hormone suppression, but not increased fractional calcium absorption, in 4-8-y-old children: a double-blind randomized controlled trialAm J Clin Nutr.(2013 Jan)
    73. Fracture Risk - Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, Thoma A, Kiel DP, Henschkowski JPrevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trialsArch Intern Med.(2009 Mar 23)
    74. Bone turnover markers - Wu M, Bhimavarapu A, Alvarez JA, Hunt WR, Tangpricha VChanges in bone turnover after high-dose vitamin D supplementation during acute pulmonary exacerbation in cystic fibrosis.Bone.(2023-Sep)
    75. Total Antioxidant Capacity (TAC) - Heidari H, Amani R, Feizi A, Askari G, Kohan S, Tavasoli PVitamin D Supplementation for Premenstrual Syndrome-Related inflammation and antioxidant markers in students with vitamin D deficient: a randomized clinical trialSci Rep.(2019 Oct 17)
    76. Depression Symptoms - Dadkhah H, Ebrahimi E, Fathizadeh NEvaluating the effects of vitamin D and vitamin E supplement on premenstrual syndrome: A randomized, double-blind, controlled trialIran J Nurs Midwifery Res.(2016 Mar-Apr)
    77. Anxiety Symptoms - Abdollahi R, Abiri B, Sarbakhsh P, Kashanian M, Vafa MThe Effect of Vitamin D Supplement Consumption on Premenstrual Syndrome in Vitamin D-Deficient Young Girls: A Randomized, Double-Blind, Placebo-Controlled Clinical TrialComplement Med Res.(2019)
    78. Anxiety Symptoms - Tartagni M, Cicinelli MV, Tartagni MV, Alrasheed H, Matteo M, Baldini D, De Salvia M, Loverro G, Montagnani MVitamin D Supplementation for Premenstrual Syndrome-Related Mood Disorders in Adolescents with Severe Hypovitaminosis DJ Pediatr Adolesc Gynecol.(2016 Aug)
    79. Cramps - Bahrami A, Avan A, Sadeghnia HR, Esmaeili H, Tayefi M, Ghasemi F, Nejati Salehkhani F, Arabpour-Dahoue M, Rastgar-Moghadam A, Ferns GA, Bahrami-Taghanaki H, Ghayour-Mobarhan MHigh dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescentsGynecol Endocrinol.(2018 Aug)
    80. Glycemic Control - Shaban Nazarian, John V St Peter, Raymond C Boston, Sidney A Jones, Cary N MariashVitamin D3 supplementation improves insulin sensitivity in subjects with impaired fasting glucoseTransl Res.(2011 Nov)
    81. Insulin Resistance - Wallace HJ, Holmes L, Ennis CN, Cardwell CR, Woodside JV, Young IS, Bell PM, Hunter SJ, McKinley MCEffect of vitamin D3 supplementation on insulin resistance and β-cell function in prediabetes: a double-blind, randomized, placebo-controlled trial.Am J Clin Nutr.(2019-Nov-01)
    82. Colorectal Cancer Risk - Gorham ED, Garland CF, Garland FC, Grant WB, Mohr SB, Lipkin M, Newmark HL, Giovannucci E, Wei M, Holick MFOptimal vitamin D status for colorectal cancer prevention: a quantitative meta analysisAm J Prev Med.(2007 Mar)
    83. Aromatase-Inhibitor Related Joint Pain - Prieto-Alhambra D, Javaid MK, Servitja S, Arden NK, Martinez-García M, Diez-Perez A, Albanell J, Tusquets I, Nogues XVitamin D threshold to prevent aromatase inhibitor-induced arthralgia: a prospective cohort studyBreast Cancer Res Treat.(2011 Feb)
    84. Insulin - Sepehrmanesh Z, Kolahdooz F, Abedi F, Mazroii N, Assarian A, Asemi Z, Esmaillzadeh AVitamin D Supplementation Affects the Beck Depression Inventory, Insulin Resistance, and Biomarkers of Oxidative Stress in Patients with Major Depressive Disorder: A Randomized, Controlled Clinical TrialJ Nutr.(2016 Feb)
    85. All-Cause Mortality - Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud CVitamin D supplementation for prevention of mortality in adultsCochrane Database Syst Rev.(2011 Jul 6)
    86. Fall Risk - Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski JFall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trialsBMJ.(2009 Oct 1)
    87. Fall Risk - Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DPA higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose studyJ Am Geriatr Soc.(2007 Feb)
    88. Fall Risk - Michos ED, Kalyani RR, Blackford AL, Sternberg AL, Mitchell CM, Juraschek SP, Schrack JA, Wanigatunga AA, Roth DL, Christenson RH, Miller ER, Appel LJThe Relationship of Falls With Achieved 25-Hydroxyvitamin D Levels From Vitamin D Supplementation: The STURDY Trial.J Endocr Soc.(2022-Jun-01)
    89. Functionality in Elderly or Injured - Guralnik JM, Sternberg AL, Mitchell CM, Blackford AL, Schrack J, Wanigatunga AA, Michos E, Juraschek SP, Szanton S, Kalyani R, Cai Y, Appel LJ,Effects of Vitamin D on Physical Function: Results From the STURDY Trial.J Gerontol A Biol Sci Med Sci.(2022-Aug-12)
    90. HbA1c - Kositsawat J, Freeman VL, Gerber BS, Geraci SAssociation of A1C levels with vitamin D status in U.S. adults: data from the National Health and Nutrition Examination SurveyDiabetes Care.(2010 Jun)
    91. Tuberculosis risk - Middelkoop K, Stewart J, Walker N, Delport C, Jolliffe DA, Coussens AK, Nuttall J, Tang JCY, Fraser WD, Griffiths CJ, Kumar GT, Filteau S, Hooper RL, Wilkinson RJ, Bekker LG, Martineau ARVitamin D supplementation to prevent tuberculosis infection in South African schoolchildren: multicenter phase 3 double-blind randomized placebo-controlled trial (ViDiKids).Int J Infect Dis.(2023-Sep)
    92. Upper Respiratory Tract Infection Symptoms - Somnath SH, Biswal N, Chandrasekaran V, Jagadisan B, Bobby ZTherapeutic effect of vitamin D in acute lower respiratory infection: A randomized controlled trialClin Nutr ESPEN.(2017 Aug)
    93. Power Output - Owens DJ, Sharples AP, Polydorou I, Alwan N, Donovan T, Tang J, Fraser WD, Cooper RG, Morton JP, Stewart C, Close GLA systems-based investigation into vitamin D and skeletal muscle repair, regeneration, and hypertrophyAm J Physiol Endocrinol Metab.(2015 Dec 15)
    94. Pancreatic Cancer Risk - Skinner HG, Michaud DS, Giovannucci E, Willett WC, Colditz GA, Fuchs CSVitamin D intake and the risk for pancreatic cancer in two cohort studiesCancer Epidemiol Biomarkers Prev.(2006 Sep)
    95. Alzheimer's Disease Symptoms - Jingya Jia, Jing Hu, Xiaoxu Huo, Rujuan Miao, Yanping Zhang, Fei MaEffects of vitamin D supplementation on cognitive function and blood Aβ-related biomarkers in older adults with Alzheimer's disease: a randomised, double-blind, placebo-controlled trialJ Neurol Neurosurg Psychiatry.(2019 Dec)
    96. Blood Pressure - Witham MD, Nadir MA, Struthers ADEffect of vitamin D on blood pressure: a systematic review and meta-analysisJ Hypertens.(2009 Oct)
    97. Otitis Media Risk - Marchisio P, Consonni D, Baggi E, Zampiero A, Bianchini S, Terranova L, Tirelli S, Esposito S, Principi NVitamin D supplementation reduces the risk of acute otitis media in otitis-prone childrenPediatr Infect Dis J.(2013 Oct)
    98. Cathelicidin - Sanders EC, Burkes RM, Mock JR, Brown TT, Wise RA, Hansel NN, Liu MC, Drummond MBBronchoalveolar Lavage and Plasma Cathelicidin Response to 25-Hydroxy Vitamin D Supplementation: A Pilot Study.Chronic Obstr Pulm Dis.(2021-Jul-28)
    99. Wound Healing - Halschou-Jensen PM, Sauer J, Bouchelouche P, Fabrin J, Brorson S, Ohrt-Nissen SImproved Healing of Diabetic Foot Ulcers After High-dose Vitamin D: A Randomized Double-blinded Clinical Trial.Int J Low Extrem Wounds.(2023-Sep)
    100. Acne Symptoms - Ruikchuchit T, Juntongjin PRole of vitamin D supplement adjunct to topical benzoyl peroxide in acne: a randomized double-blinded controlled study.Int J Womens Dermatol.(2024 Oct)