Best ways to obtain Vitamin D
SUN - When one is exposed to the midday sun, the average person can produce
anywhere from 10,000 IU to 50,000 IU of vitamin D in the course of a
relatively short amount of time. As I stated above, it would take
significantly longer for persons with darker complexions to produce those
levels. If the skin overproduces vitamin D, the body will degrade the excess
on the spot. Therefore, one can never have high or toxic blood levels caused
by sun exposure alone. And remember, ALL of our ancestors got most of their
vitamin D from the sun. By the way, sun exposure increases the production of
endorphins which make us feel better and strengthen our immune systems.
So how do you accomplish "prudent sun exposure"? (Caution: This doesn't
apply to you if you are taking doxycycline! Avoid sun exposure until off the
medicine. Also if your skin is "Type I" or you have been told by your doctor
"no sun", then skip this next section. In either case, be sure to get a
vitamin D 25-OH blood test to see if you need to use diet and/or
supplementation to obtain your vitamin D.)
What I tell my patients to do is to plan on 10-30 minutes of sun exposure
(preferably in a bathing suit for larger skin exposure) 3-4 times a week
during summer months. The key thing to remember is that you should plan to
stop the exposure when you begin to notice a slight "pinkening" of the skin.
At the time you notice the pink, you can then apply sunscreen if you wish to
continue in the sun, or simply come out of the sun.
DIET - Although not the ideal way to get all of your vitamin D, certainly the
right foods could be helpful. In fact, in the Scandinavian countries,
apparently most people get their summer vitamin D from the sun and their
winter vitamin D from wild caught oily fish. Therefore, fish such as salmon
and mackerel would be very good sources of vitamin D and other excellent
nutrients such as omega 3 oils.
Another potential source is cod liver oil. A teaspoon of cod liver oil
contains about 400 IU of vitamin D, and it is believed that this fact resulted
in the government's establishment of 400 IU as the recommended amount of daily
intake of vitamin D. However, we now believe that 400 IU is woefully too low
a recommendation for vitamin D. One caution concerning the extensive use of
cod liver oil is the fact that it contains significant amounts of vitamin A.
High doses of vitamin A may have an adverse effect on the bones of some
people. Therefore, I recommend using some cod liver oil, but not making it a
major source of vitamin D for most people.
Perhaps the poorest dietary source is milk and for several reasons. First of
all, the amount of vitamin D in milk is inconsistent and is often not natural
vitamin D3, rather most often synthetic, non-human vitamin D2 is used.
Secondly, there is not enough in the average glass of milk to do the job, yet
people are lulled into a sense of complacency thinking that that is all they
need. Third of all, the majority of the world is lactose intolerant and
therefore avoids milk. So if you plan to get some of your vitamin D from
milk, don't count on too much from that source. Like cod liver oil, get some
vitamin D from milk if you can, but most dietary vitamin D should come from
Vitamin D Supplementation
The preferred form of vitamin D is human vitamin D, which is also known as
vitamin D3 (cholecalciferol). This is the form of vitamin D formed in the
skin when exposed to UVB radiation. A synthetic form is also available called
vitamin D2 (ergocalciferol). I don't recommend vitamin D2 unless there is no
choice except D2 because D2 is only 25-30% as effective as vitamin D3.
Before embarking on a vitamin D supplementation program, the first rule is
that you need to know your vitamin D 25-OH level. As I have stated before,
most experts do not recommend the 1,25-OH as a marker for vitamin D status.
Dr. John Cannell, Executive Director of the Vitamin D Council, states:
"Calcitriol [Vitamin D 1,25-OH] levels should never be used to determine if
you are deficient in vitamin D."
If your level is mildly low - 30 to 40 ng/ml - consider supplementation with
vitamin D3 at an amount of 1,000 to 2,000 IU per day.
When levels are moderately low - 20 to 30 ng/ml - consider using vitamin D3
2,000 to 3,000 IU per day.
If levels are very low - 15 to 20 ng/ml - consider using 3,000 to 4,000 IU per
day of vitamin D3.
Extremely low levels are less than 15 ng/ml, and this situation I suggest
supplementation with prescription 50,000 IU of vitamin D3 weekly for 4-8
weeks, followed by 4-5,000 IU of vitamin D3 daily. By the way, most
prescriptions of 50,000 IU of vitamin D are in the form of vitamin D2. You
may need to seek out and use a compounding pharmacy in order to get
prescription 50,000 IU vitamin D3. It is available but you may have to look
In extremely low levels, I routinely follow blood levels every 2-3 months
until levels are stable. All others, I check levels 2-4 times per year.
Adjustment in dosages should be made based on blood levels.