Vitamin D Facts

Shining a light on this critical nutrient

The Ongoing Problem of Low Vitamin D Levels 

41%

OF U.S. ADULTS HAVE VITAMIN D INSUFFICIENCY 1

60%

OF U.S. NURSING HOME RESIDENTS HAVE VITAMIN D DEFICIENCY 10

50%

OF PEOPLE GLOBALLY HAVE VITAMIN D INSUFFICIENCY 11

The Importance of Vitamin D

What percentage of Americans are vitamin D deficient or insufficient?

The prevalence of vitamin D deficiency was found to be 28.9% and vitamin D insufficiency 41% in a subset of 26,010 US adults surveyed as part of the ongoing National Health and Nutrition Examination Survey (NHANES) 2001-2010. 1 Vitamin D deficiency is a major health concern because it has been linked to depression, fatigue, muscle aches, increased risk of respiratory infections, autoimmune disorders, osteoporosis, osteomalacia, osteoarthritis, increased risk of infection and some cancers. Vitamin D insufficiency has been associated with reduced calcium absorption, decreased bone density, potential mild decrease of the blood calcium level, accelerated bone resorption, an increased risk of falls, and potentially fractures. Vitamin D deficiency and insufficiency can seriously affect a person’s quality of life. 2,3,4

How is vitamin D different than other vitamins?

Unlike other vitamins, vitamin D is a prohormone. Dietary vitamin D first goes to the liver then the kidney converts it to its active form and distributes the active form throughout the body, which by definition makes vitamin D a “hormone-like” vitamin. Meaning it is synthesized and released from an endocrine organ, the kidneys. Vitamin D receptors are located throughout the body which helps explain why vitamin D is important for so many aspects of health. 8

Who is more at risk of vitamin D deficiency or insufficiency?

In the U.S., seniors, South Asians, Hispanics and non-Hispanic Blacks are groups that have a higher prevalence of low vitamin D levels. Other situations that may lead to vitamin D deficiency or insufficiency include limited sun exposure, fat malabsorption conditions (such as celiac disease), and obesity. 5,6,7

What is the importance of vitamin D in the body?

Vitamin D was first known for its role in bone health and plays a key role in the metabolism, or cellular processes, of calcium and phosphorus, which are needed for bone integrity. Vitamin D has many other important functions too. It plays a key role in the immune system, oral health, as well as muscle health and strength. Vitamin D is also involved in regulating gene transcription and promoting protein synthesis. All of these critical functions make vitamin D important for multiple aspects of human health. 9

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  1. Liu X, Baylin A, Levy PD. Vitamin D deficiency and insufficiency among US adults: prevalence, predictors and clinical implications. British Journal of Nutrition. 2018;119(8):928-936.
  2. Holick MF. The vitamin D deficiency pandemic: a forgotten hormone important for health. Public health reviews. 2010;32(1):267-283.
  3. Amrein K, Scherkl M, Hoffmann M, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. European journal of clinical nutrition. 2020;74(11):1498-1513.
  4. MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest. 1985;76(4):1536-1538.)
  5. Kweder H, Eidi H. Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status. Avicenna J Med. 2018;8(4):139-146. doi:10.4103/ajm.AJM_20_18). 3. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#h5
  6. Emmanuel M. K. Awumey, Devashis A. Mitra, Bruce W. Hollis, Rajiv Kumar, Norman H. Bell, Vitamin D Metabolism Is Altered in Asian Indians in the Southern United States: A Clinical Research Center Study, The Journal of Clinical Endocrinology & Metabolism. 1998; 83(1): 169–173, https://doi.org/10.1210/jcem.83.1.4514
  7. Castro JP, Penckofer S. The role of vitamin D in the health of Hispanic adults with diabetes. Hisp Health Care Int. 2014;12(2):90-8. doi: 10.1891/1540-4153.12.2.90. PMID: 24871915.
  8. Sassi F, Tamone C, D’Amelio P. Vitamin D: nutrient, hormone, and immunomodulator. Nutrients. 2018;10(11):1656.
  9. Hewlings SJ, Medeiros DM. Nutrition: Real People, Real Choices. Pearson Prentice Hall; 2009.
  10. Elliott ME, Binkley NC, Carnes M, Zimmerman DR, Petersen K, Knapp K, Behlke JM, Ahmann N, Kieser MA. Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D. Pharmacotherapy. 2003; Jun;23(6):702-10.
  11. Nair R, Maseeh A. Vitamin D: The “sunshine” vitamin. J Pharmacol Pharmacother. 2012; Apr;3(2):118-26.
  12. Bilezikian JP, Bikle D, Hewison M, et al.Mechanisms in Endocrinology: Vitamin D and COVID-19. European Journal of Endocrinology. 2020;183(5):R133-r147.
  13. van Etten E, Mathieu C. Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. The Journal of steroid biochemistry and molecular biology. 2005;97(1-2):93-101.
  14. Ginde AA, Mansbach JM, Camargo CA, Jr. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Archives of internal medicine. 2009;169(4):384-390.
  15. A Kempker, J., & S Martin, G. Vitamin D and sepsis: from associations to causal connections. Inflammation & Allergy-Drug Targets (Formerly Current Drug Targets-Inflammation & Allergy) (Discontinued). 2013; 12(4): 246-252.
  16. Zdrenghea, M. T., Makrinioti, H., Bagacean, C., Bush, A., Johnston, S. L., and Stanciu, L. A. Vitamin D modulation of innate immune responses to respiratory viral infections, Rev Med Virol. 2017; 27:e1909. doi: 10.1002/rmv.1909.
  17. Vetter V, Denizer G, Friedland LR, Krishnan J, Shapiro M. Understanding modern-day vaccines: what you need to know. Annals of medicine. 2018;50(2):110-120.
  18. Cannell JJ, Vieth R, Umhau JC, et al. Epidemic influenza and vitamin D. Epidemiology and infection. 2006;134(6):1129-1140.
  19. Martineau A R, Jolliffe D A, Hooper R L, Greenberg L, Aloia J F, Bergman P et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data BMJ. 2017; (356):i6583 doi:10.1136/bmj.i6583.
  20. Zabetakis I, Lordan R, Norton C, Tsoupras A. COVID-19: The Inflammation Link and the Role of Nutrition in Potential Mitigation. Nutrients. 2020 May 19;12(5):1466. doi: 10.3390/nu12051466. PMID: 32438620; PMCID: PMC7284818.
  21. Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. The Journal of clinical endocrinology and metabolism. 2011;96(1):53-58.
  22. Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003;77(1):204-210.
  23. Rosen CJ, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, et al. IOM committee members respond to Endocrine Society vitamin D guidelines. J Clin Endocrinol Metab. 2012;97:1146-52.
  24. MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011;96:1911-30.
  25. Amrein K, Scherkl M, Hoffmann M, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. European journal of clinical nutrition. 2020;74(11):1498-1513.

Vitamin D: Immune Health, Levels, and Intake 

The most recognized roles for vitamin D in supporting a healthy immune system include reinforcing the barrier provided by epithelial cells (like skin cells), enhancing the cell’s ability to produce vitamin D at the site of infection, increasing other key defenses of innate immunity and decreasing inflammatory markers. At the site of infection vitamin D has antibacterial and antiviral benefits.12-14 Vitamin D influences some of the genes involved in the innate and adaptive immune systems and in inflammation and therefore affects susceptibility to and severity of bacterial and viral infections. 15,16

The immune system has two parts that overlap, adaptive and innate. Innate immunity is the human body’s first defense against infection. It includes physical barriers including the skin, mucus and lining of the lungs and intestines, as well as cells with receptors that quickly recognize pathogens. The adaptive immune system fights against pathogens or antigens very specifically, but it takes longer to develop. It is activated by exposure to pathogens. 17,18

Observational studies report consistent independent associations between low serum concentrations (amount in the blood) of 25-hydroxyvitamin D (the major circulating vitamin D metabolite) and susceptibility to acute respiratory tract infection. In an analysis of 25 studies, vitamin D supplementation reduced the risk of acute respiratory tract infection among over 11,000 subjects who were supplemented. Daily or weekly supplementation benefited the subjects more than just a large single dose. Those that were most deficient benefited the most. 19

While scientists have not yet determined an exact answer to this question, mechanisms have been proposed. It is known that inflammation and what is called a cytokine storm, which is when an infection triggers your immune system to flood your bloodstream with inflammatory proteins called cytokines, play a critical role in COVID-19 patient outcomes. This dramatic inflammatory reaction can kill tissue and damage organs. Adequate vitamin D levels as well as a healthy balanced diet, particularly the Mediterranean Diet, have been identified as beneficial to offset this inflammatory response. Additionally, vitamin D may exhibit antiviral effects by interfering with viral replication and through its ability to stimulate the immune system and reduce inflammation. 20

The Institute of Medicine recommends a dietary intake of Vitamin D of 600 IU (15 mcg)/day for all ages over 1 year (and for pregnant and lactating women), with increases to 800 IU (20 mcg)/day for individuals over 71 years. 21

Food sources of vitamin D include fatty fish (salmon, mackerel, sardines, cod liver oil) and some types of mushrooms (Shiitake), especially if sundried, contain cholecalciferol (vitamin D3). Because vitamin D not easily obtained from food, many countries, including the US and Canada, encourage the fortification of commonly consumed foods, such as milk, orange juice, other dairy products and cereals with vitamin D. Many people have inadequate sun exposure to meet vitamin D requirements and few people are able to obtain enough vitamin D from food sources alone, therefore supplementation is important. How much to supplement is less clear and will vary based on vitamin D status. Deficient and insufficient individuals will need a different supplemental strategy than those who are not. There is no agreed upon dose globally, recommendations often range from 400-2000 IU (10-50 mcg)/day and your doctor may recommend more. However, a common dose of 1000 IU (25 mcg) of vitamin D3, has been identified to be safe and beneficial for health. 22

While there is no global consensus on optimal serum vitamin D levels, the Institute of Medicine recommends keeping levels consistently above 50 nmol/L (20 ng/mL)23, and the Endocrine Society Clinical Practice Guidelines recommend maintaining blood levels of 25(OH)D consistently above 75 nmol/L (30 ng/ml). 24 Some research indicates that a daily vitamin D dose of 800 IU (20 mcg) can achieve a target 25(OH)D level of at least 50 nmol/L (or 20 ng/mL) in most healthy individuals, and 2000 IU (50 mcg) is sufficient to achieve a level of at least 75 nmol/L (or 30 ng/mL).25

To convert IU to mcg or mg, the Council for Responsible Nutrition offers a conversion calculator at www.belabelwise.org/conversion-calculator.

Disclaimer

Information on this website should not be considered medical advice for COVID-19 or any other illness.  If you are concerned that you may have COVID-19 or other serious illness, you should contact your healthcare practitioner immediately.  Always talk to your healthcare practitioner about any dietary supplements you are taking or plan to take.  Click here to learn more about the content on this website.

Adaptive Immunity

Vatsal Thakkar

How does vitamin D
benefit the immune system?
What is innate and
adaptive immunity?
What is the impact of vitamin D
on respiratory infections?
What role does vitamin D
play in COVID-19?
What intake of vitamin D
is recommended?
What blood levels of vitamin D
should you maintain?

The most recognized roles for vitamin D in supporting a healthy immune system include reinforcing the barrier provided by epithelial cells (like skin cells), enhancing the cell’s ability to produce vitamin D at the site of infection, increasing other key defenses of innate immunity and decreasing inflammatory markers. At the site of infection vitamin D has antibacterial and antiviral benefits.12-14 Vitamin D influences some of the genes involved in the innate and adaptive immune systems and in inflammation and therefore affects susceptibility to and severity of bacterial and viral infections.

The immune system has two parts that overlap, adaptive and innate. Innate immunity is the human body’s first defense against infection. It includes physical barriers including the skin, mucus and lining of the lungs and intestines, as well as cells with receptors that quickly recognize pathogens. The adaptive immune system fights against pathogens or antigens very specifically, but it takes longer to develop. It is activated by exposure to pathogens. 17,18

Observational studies report consistent independent associations between low serum concentrations (amount in the blood) of 25-hydroxyvitamin D (the major circulating vitamin D metabolite) and susceptibility to acute respiratory tract infection. In an analysis of 25 studies, vitamin D supplementation reduced the risk of acute respiratory tract infection among over 11,000 subjects who were supplemented. Daily or weekly supplementation benefited the subjects more than just a large single dose. Those that were most deficient benefited the most. 19

While scientists have not yet determined an exact answer to this question, mechanisms have been proposed. It is known that inflammation and what is called a cytokine storm, which is when an infection triggers your immune system to flood your bloodstream with inflammatory proteins called cytokines, play a critical role in COVID-19 patient outcomes. This dramatic inflammatory reaction can kill tissue and damage organs. Adequate vitamin D levels as well as a healthy balanced diet, particularly the Mediterranean Diet, have been identified as beneficial to offset this inflammatory response. Additionally, vitamin D may exhibit antiviral effects by interfering with viral replication and through its ability to stimulate the immune system and reduce inflammation. 20

The Institute of Medicine recommends a dietary intake of Vitamin D of 600 IU (15 mcg)/day for all ages over 1 year (and for pregnant and lactating women), with increases to 800 IU (20 mcg)/day for individuals over 71 years. 21

Food sources of vitamin D include fatty fish (salmon, mackerel, sardines, cod liver oil) and some types of mushrooms (Shiitake), especially if sundried, contain cholecalciferol (vitamin D3). Because vitamin D not easily obtained from food, many countries, including the US and Canada, encourage the fortification of commonly consumed foods, such as milk, orange juice, other dairy products and cereals with vitamin D. Many people have inadequate sun exposure to meet vitamin D requirements and few people are able to obtain enough vitamin D from food sources alone, therefore supplementation is important. How much to supplement is less clear and will vary based on vitamin D status. Deficient and insufficient individuals will need a different supplemental strategy than those who are not. There is no agreed upon dose globally, recommendations often range from 400-2000 IU (10-50 mcg)/day and your doctor may recommend more. However, a common dose of 1000 IU (25 mcg) of vitamin D3, has been identified to be safe and beneficial for health. 22

While there is no global consensus on optimal serum vitamin D levels, the Institute of Medicine recommends keeping levels consistently above 50 nmol/L (20 ng/mL)23, and the Endocrine Society Clinical Practice Guidelines recommend maintaining blood levels of 25(OH)D consistently above 75 nmol/L (30 ng/ml). 24 Some research indicates that a daily vitamin D dose of 800 IU (20 mcg) can achieve a target 25(OH)D level of at least 50 nmol/L (or 20 ng/mL) in most healthy individuals, and 2000 IU (50 mcg) is sufficient to achieve a level of at least 75 nmol/L (or 30 ng/mL).25

To convert IU to mcg or mg, the Council for Responsible Nutrition offers a conversion calculator at www.belabelwise.org/conversion-calculator.