Vitamin D

Vitamin D deficiency
puts more than
your bones at risk

I cannot emphasize strongly enough the importance of Vitamin D in maintaining strong bones. When it is at sufficient levels in the body, it protects against osteoporosis and fractures; but its deficiency is associated not only with bone thinning and fractures, but also increases the risk of a number of other serious diseases, including heart disease, increased susceptibility to infections such as the flu, some cancers, multiple sclerosis, and auto-immune diseases.

While vitamin D deficiency can lead to osteoporosis, this is usually without symptoms until a person experiences a fracture. However there is another bone condition from this deficiency which causes widespread bone and soft tissue pain from inflammation of the lining around bones; this is called osteomalacia.


The only way to know if you are deficient or not is to have a blood test for 25OH Vit. D (you have to get that specific vitamin level, not another form of D). The “basement” level of normal is 32 ng/mL (nanograms per milliliter); but ideally I like to see my patients with a level above 40 ng/mL. Research has verified the value of staying above 40 for bone health.

What if your level is below 40 ng/mL? I generally recommend a daily maintenance dose of 1000 IU (international units) per day of vitamin D3 for anyone older than age 12 years. So if the level is low, I would start at 2000 IU per day, recheck a level 2 months later and then go to a maintenance dose of 1000 units per day. I recommend D3 (cholecalciferol) instead of D2 (ergocalciferol) as a supplement, which is not as potent as D3. However, I do at times prescribe a dose of ergocalciferol at 50,000 units once weekly (for 8 weeks only) for someone severely deficient (available by prescription only). All breast-feeding infants under a year of age should be getting 400 IU per day as a supplement, and older children and teens between 400 and 1000 units per day.

For someone with painful osteomalacia from D deficiency, it may take 6 months of high dose supplementation to relieve the pain, even though the blood levels have come back to normal. So continue the supplements and use other approaches for pain relief in the meantime, such as clinical hypnosis and herbal anti-inflammatory medications

In addition to being effective in preventing osteoporosis and preventing further bone loss in someone who already has lost bone density, vitamin D helps prevent muscle loss and frailty in the elderly. As a result, supplementation with D3 can be part of a comprehensive strategy to prevent falls. As it builds muscle, it also seems to enhance balance and reaction time. Of course the elderly are at increased risk of deficiency not only because they are not outdoors in the sun as much, but also because their skin converts other steroids to vitamin D less efficiently with age.

Besides supplements, where do we obtain it? There are actually very few naturally occurring foods which contain D, wild salmon being the most notable. The most important source in nature for human beings is sunlight. Our skin uses UV-B energy from sunlight to convert another natural steroid in the skin to vitamin D. The process then requires the function of the liver and the kidneys both to be complete, so people with either chronic liver or kidney disease are especially at risk for deficiency. I recommend 15 minutes in a swimsuit or shorts and tank top at mid-day without sunscreen outdoors to get an adequate natural supply without supplements. After 15 minutes, add the sunscreen if you are going to stay out! Dark skinned individuals need more exposure, and you will need a longer time the further away from the equator you live.

In summary, this vitamin is absolutely essential for good health and long life. So get tested, know your blood level, and take a daily supplement if you do not have adequate sun exposure. Your bones will thank you!

To your health,


Robert Pendergrast, M.D. 

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