Also listed as: Calciferol; Calcitrol; Cholecalciferol; Ergocalciferol

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Vitamin D is a fat-soluble vitamin found in certain foods. It is also formed in the skin as a result of direct exposure to sunlight. The liver and kidneys convert vitamin D from food sources or sunlight to an active form called calcitriol.

Vitamin D helps the body maintain healthy levels of calcium and phosphorus. The body can only absorb calcium, when vitamin D is present. Vitamin D is also needed to build and maintain healthy bones.

People who are deficient in vitamin D are at risk for rickets, a metabolic disease that causes soft, weak bones.  Rickets used to be quite common, but because milk products are now fortified with vitamin D, the disease is now rare.

Uses

Getting the proper amount of vitamin D can help prevent a number of serious health conditions.

Osteoporosis

Adequate amounts of vitamin D throughout one's life (in combination with exercise, proper nutrition, calcium, and magnesium) is necessary for preventing bone loss. Low levels of vitamin D and insufficient sunlight exposure (less than 20 minutes per day) are associated with osteoporosis. Vitamin D is needed to properly absorb calcium. Calcium, together with vitamin D, can help heal bone fractures from osteoporosis and decrease the risk of future bone breaks.

Other Bone Disorders

Vitamin D protects against the rickets and osteomalacia (softening of the bones in adults caused by inability to properly deposit calcium). Seniors in northern climates and people who do not receive direct sunlight for at least 45 minutes per week should make sure they are getting enough vitamin D through fortified milk and dairy products, or taking a vitamin D supplement or a multivitamin containing vitamin D.

Arthritis

Low intakes of vitamin D may be linked to an increased risk of arthritis of the hip in older women and to joint changes seen on x-rays of both men and women. Studies evaluating the use of vitamin D for osteoarthritis have found that it prevents the breakdown of cartilage.

Abnormalities of the Parathyroid Hormones

The parathyroids are four glands located in the neck, which produce parathyroid hormone (PTH). PTH helps the body store and use calcium and phosphorus. Vitamin D is often used to treat disorders of the parathyroid gland.

High Blood Pressure

Scientific studies have suggested a link between low levels of vitamin D and high blood pressure. Low levels of vitamin D may play role in the development of high blood pressure in those with kidney disease or an overactive parathyroid gland (hyperparathyroidism). One study suggested that supplementation with vitamin D and calcium helped to lower blood pressure in older women with low levels of vitamin D and high levels of parathyroid hormone. Your doctor will determine if vitamin D may be helpful for preventing or treating high blood pressure.

Cancer

Laboratory studies indicate that vitamin D may have anti-cancer effects. However, no human studies have directly measured how vitamin D impacts cancer risk.

Study findings on vitamin D and specific cancers such as colorectal cancer have been inconsistent. However, a review of the scientific literature shows strong evidence that vitamin D may reduce the risk of colorectal cancer. It is best to obtain calcium and vitamin D from the diet. Supplements would most likely be needed to reach the suggested amounts for the prevention and treatment of colorectal cancer (800 IU/day of vitamin D and 1800 mg/day of calcium). Some population-based evidence suggests that the same amount of vitamin D may improve survival rates in those with a history of breast cancer. More research is needed.

There is some evidence that a certain form of vitamin D inhibits growth of prostate cancer cells in laboratory tests. Fructose, the sugar found in fruits, stimulates the production of this type of vitamin D. Eating several servings of fruit each day is associated with lower rates of prostate cancer.

Synthetic forms of vitamin D3 show promise in the treatment of various cancers, including breast and skin. However, this research is still in the experimental stages.

Seasonal Affective Disorder (SAD)

SAD is a form of depression that occurs during the winter months because of lack of sunlight. This condition is often treated with photo (light) therapy. A few studies suggest that the mood of those with SAD improves when taking vitamin D supplements. Talk to your doctor about whether this is a safe and appropriate addition to your treatment regimen.

Diabetes

Research shows that supplementing infants and children with doses of 2000 IU per day of vitamin D and higher may protect against the development of type 1 diabetes. A study conducted in northern Finland (where the annual exposure to sunlight is very limited) found that infants given at least 2,000 IU of vitamin D per day (generally from cod liver oil) for the first year of life were significantly less likely to develop type 1 diabetes over a 30-year time course than infants who were fed lower amounts of vitamin D.

Interestingly, the recommended daily amount of vitamin D in Finland was as high as 4,000 to 5,000 IU in the early 1960s. In 1964, it was reduced to 2,000 IU per day, in 1975 to 1,000 IU, and 400 IU in 1992. At the same time, incidence of type 1 diabetes has been on the rise in Finland, particularly throughout the 1980s.

Tuberculosis

Low levels of vitamin D may make a person more likely to get tuberculosis. Preliminary reports suggest that vitamin D may be a worthwhile addition to the usual treatment for this infection.

Atherosclerosis

Low levels of vitamin D may increase the risk of calcium build up in the arteries, a significant component of atherosclerotic plaque. Atherosclerotic plaque build up in blood vessels can lead to a heart attack or stroke. More research is needed to understand the practical implications of this possible relationship between low vitamin D levels and atherosclerosis.

Multiple Sclerosis (MS)

Scientists have observed that MS rates are significantly lower in areas that receive a lot of sunlight and where people eat a lot of fish. Fish is a rich source of vitamin D (see Dietary Sources). The studies have suggested that vitamin D from foods and sunlight may help protect against this condition. However, this does not mean that vitamin D supplements will help prevent or treat MS in people. Further studies are needed.

Other

Vitamin D supplementation may also be helpful for people who:

• Take corticosteroids or anti-seizure drugs, as these are both known to reduce bone mass.
• Follow a strict vegan diet.
• Are overweight or obese. (Obesity appears to alter the body's ability to produce vitamin D in the skin and to absorb it through the intestines. As a result, obesity is associated with vitamin D insufficiency.)
• Have psoriasis. People with psoriasis may have lower  levels of vitamin D . More research is needed.

Dietary Sources

There are two dietary forms of vitamin D:

• Cholecalciferol
• Ergocalciferol

These are naturally found in foods and are added to milk. It is important to note that the milk used to make yogurt and cheese is usually not vitamin D fortified. Foods sources of vitamin D include:

• Cod liver oil (best source)
• Fatty fish such as salmon, mackerel, tuna, sardines, herring
• Vitamin D-fortified milk and cereal
• Eggs

Available Forms

Another form of vitamin D, cholecalciferol, is manufactured by the skin when it is exposed to the ultraviolet (UV) rays of the sun. The color of your skin has an effect on the skin's production of vitamin D. A fair-skinned person can meet his or her vitamin D needs by exposing the face and arms to bright sunlight for as little as 45 minutes a week, while a person with dark skin may need up to three hours of exposure to get the same benefit.

Clouds, smog, clothing, sunscreen, and window glass all decrease the amount of sunlight that actually reaches the skin.

In cooler, northern climates, it is difficult to get enough vitamin D from sunlight during the winter. People who live in such climates may need supplementation

Vitamin D is included in many multivitamins. It can be found alone in over-the-counter preparations in strengths from 50 IU to 1,000 IU as softgel capsules, tablets, and liquid. Higher-dose preparations are also available by prescription. For those who have trouble digesting fat, vitamin D injections are also available by prescription.

How to Take It

Adequate daily intakes for dietary vitamin D are listed below. Use of supplements to obtain these recommended amounts may be appropriate for the elderly and those with limited sun exposure. The elderly, in particular, may be at risk of developing vitamin D deficiency since the body's ability to manufacture vitamin D from sunlight as well as the kidneys' ability to convert vitamin D into usable form, decline with age.

Pediatric

• Infants birth to 12 months: 5 mcg (200 IU)
• Children 1 to 8 years: 5 mcg (200 IU)
• Children 9 to 13 years: 5 mcg (200 IU)
• Adolescents 14 to 18 years: 5 mcg (200 IU)

Adult

• 19 to 50 years: 5 mcg (200 IU)
• 51 to 70 years: 10 mcg (400 IU)
• 70 years and older: 15 mcg (600 IU)
• Pregnant and breastfeeding females: 5 mcg (200 IU)

Precautions

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable healthcare provider.

Taking too much vitamin D (more than 1,000 IU daily) can cause a number of side effects including:

• Excessive thirst
• Metal taste in mouth
• Poor appetite
• Weight loss
• Bone pain
• Tiredness
• Sore eyes
• Itchy skin
• Vomiting
• Diarrhea
• Constipation
• A frequent need to urinate
• Muscle problems

Getting too much sunlight, however, will not provide an excess of vitamin D, nor is one likely to get too much vitamin D from food sources alone. Generally, excess vitamin D is a result of taking supplements in too high a dose.

People with the following conditions should be cautious when considering taking vitamin D supplements:

• High blood calcium or phosphorus levels
• Heart problems
• Kidney disease

Possible Interactions

If you are currently being treated with any of the following medications, you should not use vitamin D supplements without first talking to your doctor.

Vitamin D levels may be increased by the following medications:

• Estrogen: Hormone replacement therapy with estrogen appears to increase vitamin D levels in the blood; this may have a beneficial effect on calcium and bone metabolism. In addition, use of vitamin D supplements in conjunction with estrogen replacement therapy (ERT) increases bone mass more than ERT alone. However, this benefit may be lost with the addition of progesterone.
• Isoniazid (INH): INH, a medication used to treat tuberculosis, may raise blood levels of vitamin D.
• Thiazide: Diuretics in this class (such as hydrochlorothiazide) increase the activity of vitamin D and can lead to inappropriately high calcium levels in the blood.

Vitamin D levels may be decreased, or its absorption may be reduced, by the following medications:

• Antacids: Taking certain antacids for long periods of time may alter the levels, metabolism, and availability of vitamin D.
• Calcium-channel blockers (such as verapamil): These medications are used to treat high blood pressure and heart conditions may decrease the production of vitamin D by the body.
• Cholestyramine: This cholesterol-lowering medication, known as a bile acid sequestrant, interferes with the absorption of vitamin D (as well as other fat-soluble vitamins).
• Phenobarbital, phenytoin, and other anticonvulsant medications: These medications may accelerate the body's use of vitamin D.
• Mineral oil: Mineral oil also interferes with absorption.

In addition, Vitamin D may enhance the effects of doxorubicin , a medicine used to treat a variety of cancers. More research is needed.

Some doctors  recommend following calcium levels closely if vitamin D is taken with digoxin, a medication used to treat irregular heart rhythms. This is because vitamin D improves absorption of calcium. Calcium, in turn, can increase the likelihood of a toxic reaction from this medication.

Weight Loss Products

Orlistat, a medication used for weight loss, and olestra, a substance added to certain food products, are both intended to bind to fat and prevent the absorption of fat and the associated calories. Because of their effects on fat, orlistat and olestra may also prevent the absorption of fat-soluble vitamins such as vitamin D. Given this concern and possibility, the Food and Drug Administration (FDA) now requires that vitamin D and other fat-soluble vitamins (namely, A, E, and K) be added to food products containing olestra. How well the body absorbs and uses vitamin D from such food products is not clear. In addition, physicians who prescribe orlistat add a multivitamin with fat soluble vitamins to the regimen.

Supporting Research

American Academy of Sciences. Dietary Reference Intakes: Calcium Phosphorus, Magnesium, Vitamin D, and Fluoride . National Academy Press; 1997.

Bikle DD, Halloran BP, Harris ST, Portale AA. Progestin antagonism of estrogen stimulated 1,25-dihydroxyvitamin D levels. J Clin Endocrinol Metab . 1992;75(2):519-523.

Blank RD, Bockman RS. A review of clinical trials of therapies for osteoporosis using fracture as an end point. J Clin Densitom . 1999;2(4):435-452.

Braun J, Sieper J. [Glucocorticoid-induced osteoporosis] Orthopade . 2001;30(7):444-450. German.

Brawley OW, Parnes H. Prostate cancer prevention trials in the USA. Eur J Cancer. 2000;36(10):1312-1315.

Brenner RV, Shabahang M, Schumaker LM, et al. The antiproliferation effect of vitamin D analogs on MCF-7 human breast cancer cells. Cancer Lett . 1995;92:77 – 82.

Chan JM, Giovannucci E, Andresson SO, Yuen J, Adami HO, Wolk A. Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer (Sweden). Cancer Causes Control . 1998;9(6):559-566.

Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet . 1982;1(8263):74-76.

Dawson-Hughes B, Harris SS, Dallal GE. Plasma calcidiol, season, and serum parathyroid hormone concentrations in healthy elderly men and women. Am J Clin Nutr . 1997;65:67 – 71.

Dawson-Hughes B, Harris SS, Krall EA, et al. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age and older. N Engl J Med. 1997;337:670 – 676.

Fox J. Verapamil induces PTH resistance but increases duodenal calcium absorption in rats. Am J Physiol . 1988;255(5):E702-707.

Gallagher JC, Fowler SE, Detter JR, Sherman SS. Combination treatment with estrogen and calcitriol in the prevention of age-related bone loss. J Clin Endocrin Metabol . 2001;86(8):3618-3628.

Garland CF, Garland FC, Gorham ED. Calcium and vitamin D: their potential roles in colon and breast cancer prevention. Ann NY Acad Sci . 1999;889:107-119.

Gillespie WJ, Avenell A, Henry DA, O'Connell DL, Robertson J. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

Giovannucci E. The epidemiology of vitamin D and cancer incidence and mortality: a review. Cancer Causes Control 2005 Mar;16(2):83-95.

Giovannucci E, Rimm EB, Wolk A, et al. Calcium and fructose intake in relation to risk of prostate cancer. Cancer Res . 1998;58(3):442-447.

Gloth FM, Alam W, Hollis B. Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder. J Nutr, Health Aging . 1999l3(1):5-7.

Godsall JW, Baron R, Insogna KL. Vitamin D metabolism and bone histomorphometry in a patient with antacid-induced osteomalacia. Am J Med. 1984;77(4):747-750.

Grant WB, Garland CF. A critical review of studies on vitamin D in relation to colorectal cancer. Nutr Cancer 2004;48(2):115-123.

Harrell CC, Kline SS. Vitamin K — supplemented snacks containing olestra: implication for patients taking warfarin [letter]. JAMA . 1999;282(12):1133-1134.

Harris SS. Vitamin D in type 1 diabetes prevetion. J Nutr 2005 Feb;135(2):323-325.

Hathcock JN. Metabolic mechanisms of drug-nutrient interactions. Fed Proc . 1985;44(1):124-129.

Hayes CE, Cantorna MT, DeLuca HF. Vitamin D and multiple sclerosis. [Review] Proc Soc Exp Biol Med. 1997;216(1):21-27.

Heikkinen AM, Tuppurainen MT, Niskanen L, et al. Long-term vitamin D3 supplementation may have adverse effects on serum lipids during menopause hormone replacement therapy. J Endocrino . 1997;137:495 – 502.

Henning HV. Aluminum toxicity [in German]. Klin Wochenschr . 1989;67(24):1221-1228.

Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr 2004 Mar;79(3):362-371.

Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet . 2001;358(9292):1500-1503.

Jänne PA, Mayer RJ. Chemoprevention of colorectal cancer. N Engl J Med . 2000;342(26):1960-1968.

Kampman E, Slattery ML, Caan B, Potter JD. Calcium, vitamin D, sunshine exposure, dairy products and colon cancer risk (United States). Cancer Causes Control . 2000:11:459-466.

Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol . 1987;2(1):10-32.

Lane NE, Gore R, Cummings SR, et al. Serum vitamin D levels and incident changes of radiographic hip osteoarthritis. A longtitudinal study. Arthritis Rheum . 1999;42(5):854-860.

Langman M, Boyle P, et al. Chemoprevention of colorectal cancer. Gut . 1998;43:578 – 585.

Lansdowne AT, Provost SC. Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl).1998;135(4):319-323

LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J. Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA . 1999;281:1505-1511.

Li YC, Qiao G, Uskokovic M, Xiang W, Zheng W, Kong J. Vitamin D: a negative endocrine regulator of the rennin-angiotensin system and blood pressure. J Steroid Biochem Mol Biol 2004 May;89-90(1-5):387-392.

Lochner JD, Schneider DJ. The relationship between tuberculosis, vitamin D, potassium and AIDS. A message for South Africa? [Afrikaans]. S Afr Med J . 1994;84(2):79-82.

Lokeshwar BL, Schwartz GG, Selzer MG, et al. Inhibition of prostate cancer metastasis in vivo: a comparison of ,23-dihydroxyvitamin D (calcitriol) and EB1089. Cancer Epidemiol Biomarkers Rev . 1999;8(3):241-248.

Martinez ME, Giovannucci EL Colditz GA, et al. Calcium, vitamin D, and the occurrence of colorectal cancer among women. JNCI. 1996;88:1375 – 1382.

Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther . 1982;4(6):423-440.

McAlindon TE, Felson DT, Zhang Y, et al. Relation of dietary intake of serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham study. Ann Intern Med . 1996;125:353-359.

McMurray DN, Bartow RA, Mintzer CL, Hernandez-Frontera E. Micronutrient status and immune function in tuberculosis. Ann NY Acad Sci . 1990;587:59-69.

National Institutes of Health, Office of Dietary Supplements. Facts About Dietary Supplements: Vitamin D. August 2001. Available at http://www.cc.nih.gov/ccc/supplements/intro.html.   Accessed November 1, 2005.

Nutrients and Nutritional Agents. In: Kastrup EK, Hines Burnham T, Short RM, et al, eds. Drug Facts and Comparisons . St. Louis, Mo: Facts and Comparisons; 2000.

Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C. Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab . 2001;86(4):1633-1637.

Potter JD. Nutrition and colorectal cancer. Cancer Causes Control. 1996;7:127-146.

Ravid A, Rocker D, Machlenkin A, et al. 1,25-Dihydroxyvitamin D3 enhances the susceptibility of breast cancer cells to doxorubicin-induced oxidative damage. Cancer Res . 1999;59:862-867.

Reichrath J. Will analogs of 1,25-dihydroxyvitamin D(3) (calcitriol) open a new era in cancer therapy? [Review] Onkologie . 2001;24(2):128-133.

Rook GA, Steele J, Fraher L, et al. Vitamin D3, gamma interferon, and control of proliferation of Mycobacterium tuberculosis by human monocytes. Immunology . 1986;57(1):159-163.

Schumann K. Interactions between drugs and vitamins at advanced age. Int J Vitam Nutr Res . 1999;69(3):173-178.

Schlagheck TG, Riccardi KA, Zorich NL, Torri SA, Dugan LD, Peters JC. Olestra dose response on fat-soluble and water-soluble nutrients in humans. J Nutr . 1997;127(8 Suppl):1646S-1665S.

Self TH, Chrisman CR, Baciewicz AM, Bronze MS. Isoniazid drug and food interactions. Am J Med Sci . 1999;317(5):304-311.

Semba RD, Garrett E, Johnson BA, Guralnik JM, Fried LP. Vitamin D deficiency among older women with and without disability. Amer J Clin Nutr . 2000;72:1529-1534.

Sowers MF, Lachance L. Vitamins and arthritis: The roles of vitamins A, C, D, and E. Rheum Dis Clin North Am . 1999;25(2):315-331.

Staberg B, OxholmA, Klemp P, Christiansen C. Abnormal vitamin D metabolism in patients with psoriasis. Acta Derm Venereol . 1987;67(1):65-68.

Thomas MK., Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998;338:777 – 783.

Thornquist MD, Kristal AR, Patterson RE, et al. Olestra consumption does not predict serum concentrations of carotenoids and fat-soluble vitamins in free-living humans: early results from the sentinel site of the olestra post-marketing surveillance study. J Nutr . 2000;130(7):1711-1718.

Valmadrid C, Voorhees C, Litt B, Schneyer CR. Practice patterns of neurologists regarding bone and mineral effects of antiepileptic drug therapy. Arch Neurol . 2001;58(9):1369-1374.

Watson KE, Abrolat ML, Malone LL, et al. Active serum vitamin D levels are inversely correlated with coronary calcification. Circulation . 1997;96(6):1755-1760.

Wilkinson RJ, Llewelyn M, Toossi Z, et al. Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case-control study. Lancet . 2000;355(9204):618-621.

Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr . 2000;72(3):690-693.

• Review Date: 11/1/2005
• Reviewed By: Amy Paturel, MPH, MS Nutrition. Previously reviewed by: Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor Integrative Medicine, Boston, MA; Gary Kracoff, RPh (Pediatric Dosing section February 2001), Johnson Drugs, Natick, Ma; Steven Ottariono, RPh (Pediatric Dosing section February 2001), Veteran's Administrative Hospital, Londonderry, NH; Margie Ullmann-Weil, MS, RD, specializing in combination of complementary and traditional nutritional therapy, Boston, MA. All interaction sections have also been reviewed by a team of experts including Joseph Lamb, MD (July 2000), The Integrative Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh (August 2000), Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant Professor, University of Mayland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000), President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

Statements made on this site has not been evaluated by the Food and Drug Administration.Energyade is not intended to diagnose, treat or cure or prevent a disease. Information on this site provided for eductional purposes only. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition or disease. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information purposes only -- they do not constitute endorsements of those other sites.