Vitamin D: FAQ
September 24

Sunshine

There is an old Italian saying “Where the sun does not go the doctor does.”

For about the last 25 years, doctors (dermatologists in particular) have demonized sun exposure and repeatedly told us it is bad for you and causes cancer. But is that true? In the last few years, numerous studies have shown that modest exposure to sunlight may actually be good for you, helping the body produce the vitamin D it needs to keep bones healthy and protect against cancer, including skin cancer. Though repeated sunburns–in children and very fair-skinned people–have been linked to melanoma, there is no credible scientific evidence that moderate sun exposure causes it. Since it’s almost impossible to get adequate amounts of vitamin D from food alone (including fortified milk and fatty wild fish), sun is your best source. I’m not suggesting you go bake in the sun with your suntan oil or go to tanning salons. But getting some sun without getting sunburned makes healthy sense.

We evolved in the sun; we were made to get some sun, not to live our lives indoors and slather on sunscreen every time we go outside. If the sun is shining where you are today, get out and enjoy it, talk about a free natural treatment! All you need is a little common sense when heading outdoors, do it gradually and always avoid sunburn.

Special Note: Remember to take antioxidants when you sit in the sun, as these can help prevent skin cells from sun damage.

What is vitamin D?

Although it’s called a vitamin, vitamin D is really a hormone and not actually a vitamin. Vitamins cannot be produced by your body, we get them from dietary sources, whereas vitamin D is made in your body. It’s your body’s only source of calcitrol (activated vitamin D), the most potent steroid hormone in the body.

What does vitamin D do?

Like all steroid hormones, vitamin D is involved in making hundreds of enzymes and proteins, which are crucial for preserving health and preventing disease. It has the ability to interact and affect more than 2,000 genes in the body. It enhances muscle strength and builds bone. It has anti-inflammatory effects and bolsters the immune system. It helps the action of insulin and has anti-cancer activity. This is why vitamin D deficiency has been linked with so many of the diseases of modern society. Because of its vast array of benefits, maintaining optimal levels of D is essential for your health

Where do I get vitamin D from?

Only about 10% of your vitamin D comes from diet, so it is nearly impossible to get adequate amounts of vitamin D from your diet.

The only 2 reliable sources of vitamin D are the sun and supplements.

Sunlight exposure is the only reliable way to generate vitamin D in your own body. Vitamin D is produced by your skin in response to exposure to ultraviolet radiation from the sun. In fact, this is such an efficient system that most of us make 20,000 units of vitamin D after only 20 minutes of summer sun without suntan lotion. That’s 100 times more than the government recommends per day! There must be a good reason why we make so much in so little time.

But these rays cannot penetrate glass to generate vitamin D in your skin, so you don’t generate vitamin D when sitting behind a glass window, whether in your car or at home.

Also sunscreens, even weak ones, almost completely block your body’s ability to generate vitamin D.

The other reliable source is supplements. Most important is that you take vitamin D3, (cholecalciferol) the active form of vitamin D. Do not take vitamin D2 as it is not as biologically active nor as effective, and nor as safe as vitamin D3. And taking the right amount is crucial, most doctors tend to under dose. The current recommendations from the Food and Nutrition Board of the U.S. Institute of Medicine: from 200 to 600 IU/day depending on one’s age, are way too low. These values were originally chosen because they were found to prevent osteomalacia (bone softening) and rickets

How much sunshine do you need?

All living things need sun, the key is balance. Too much sun exposure can cause melanoma and skin aging, while too little creates an inadequate production of vitamin D. The amount needed depends on the season, time of day, where you live, skin pigmentation and other factors. As a general rule, if you are not vitamin D deficient, about 20 minutes a day in the spring, summer and fall on your face and arms or legs without sunscreen is adequate. It doesn’t matter which part of the body you expose to the sun. Many people want to protect their face, so just don’t put sunscreen on the other exposed parts for those 20 minutes.

If you live north of 37 degrees latitude (approximately a line drawn horizontally connecting Norfolk, Virginia to San Francisco, California) sunlight is not sufficient to create Vitamin D in your skin in the winter months, even if you are sitting in the sun in a bathing suit on a warm January day! The further you live from the equator, the longer exposure you need to the sun in order to generate vitamin D

Can I take cod liver oil to get my vitamin D?

Although Cod liver oil contains a fair amount of vitamin D, it also contains high amounts of vitamin A. Vitamin A antagonizes the action of vitamin D and can be toxic at high levels.

What are other food sources of vitamin D?

  • Fatty wild fish like mackerel, salmon, halibut, tuna, sardines and herring
  • Fortified milk, orange juice and cereal
  • Dried Shitake mushrooms
  • Egg yolks

To get adequate amounts of vitamin D from food, you would have to eat at least 5 servings of salmon a day or drink 20 cups of fortified milk.

My doctor prescribed Drisdol, 50,000 IU per week. What is it?

Drisdol is a prescription of 50,000 IU tablets of vitamin D2 or ergocalciferol. Ergocalciferol is not vitamin D but it is similar. D2 is not normally found in humans and most studies show it does not raise 25(OH)D levels as well as (cholecalciferol or vit D3) does. If you are vitamin D deficient, the best thing to do, is to take vitamin D3

What about the use of tanning beds to get my vitamin D?

I tend not to recommend them because we don’t really know if they are safe. Because the light sources vary with different tanning beds, it makes them unpredictable and possibly unsafe. In addition, most commercial tanning beds emit an unknown amount of EMF and because one is so close to the actual bed, it may be an unnecessary high dose. Theoretically both these problems could be overcome, but in reality they usually are not.

Why is there an epidemic of vitamin D deficiency?

It is estimated that anywhere from 30 to 100% of Americans, depending upon their age and community living environments, are deficient in Vitamin D. More than half of all American children are vitamin deficient. Supposedly almost 3/4s of pregnant women are vitamin D deficient, predisposing their unborn children to all sorts of problems. Worldwide, it is estimated that the epidemic of vitamin D deficiency affects one billion people. In my practice over 80% of patients whose vitamin D levels I check are deficient.

No one is exactly sure why this is happening apart from the fact that we spend too much time indoors and when we go out into the sun, we lather sunscreen on ourselves. I think it must be more than that. But whatever the reason, the reality is we have a major epidemic on our hands.

How much vitamin D do I need?

How much vitamin D you need varies with age, body weight, percent of body fat, latitude, skin coloration, season of the year, use of sun block, individual variation in sun exposure, and – probably – how ill you are.

As a general rule, old people need more than young people, big people need more that little people, fat people need more than skinny people, northern people need more than southern people, dark-skinned people need more than fair skinned people, winter people need more than summer people, sun block lovers need more than sun block haters, sun-phobes need more than sun worshipers, and ill people may need more than well people.

What I and many of my colleagues around the country are finding is that even people spending what we thought was adequate amount of time in the sun, are still showing up with low blood vitamin D levels. I am not sure why at this stage but there is an easy and cheap solution…vitamin D supplementation.

Here are some guidelines:

  • If your blood level is above 45ng/ml and for maintenance, I recommend 2,000-4,000 IU daily depending on age, weight, season, how much time is spent outdoors, where one lives, skin color and obviously blood levels. In other words if you are older, larger, living in the northern latitudes during the winter, are not getting sun and have dark skin, I recommend the higher maintenance dose.
  • If your blood level is 35-45 ng/ml, I recommend you correct it with 5,000 of vitamin D3 a day for 3 months under a doctor’s supervision and then recheck your blood levels.
  • If your blood level is less than 35 ng/ml, I recommend you correct it with 10,000 of vitamin D3 a day under a doctor’s supervision and then recheck your blood levels after 3 months. It takes a good 6 months usually to optimize your vitamin D levels if you’re deficient. Once this occurs, you can lower the dose to the maintenance dose of 2,000 – 4,000 IU a day.

What are the symptoms of vit D deficiency?

There is no clear pattern of symptoms. In fact many people remain asymptomatic despite low levels. But here are the more common symptoms

  • Fatigue
  • General muscle pain and weakness
  • Muscle cramps
  • Joint pain
  • Chronic pain
  • Weight gain
  • High blood pressure
  • Restless sleep
  • Poor concentration
  • Headaches
  • Bladder problems
  • Constipation or diarrhea

What diseases are associated with Vit D deficiency?

Vitamin D deficiency has been shown to play a role in almost every major disease. This includes:

  • Osteoporosis and Osteopenia
  • 17 varieties of Cancer (including breast, prostate and colon)
  • Heart disease
  • High blood pressure
  • Obesity
  • Metabolic Syndrome and Diabetes
  • Autoimmune diseases
  • Multiple sclerosis
  • Rheumatoid arthritis
  • Osteoarthritis
  • Bursitis
  • Gout
  • Infertility and PMS
  • Parkinson’s Disease
  • Depression and Seasonal Affective Disorder
  • Alzheimer’s Disease
  • Chronic fatigue syndrome
  • Fibromyalgia
  • Chronic Pain
  • Periodontal disease
  • Psoriasis

What about vitamin D toxicity?

It is impossible to generate too much vitamin D in your body from sunlight exposure: your body will self-regulate and only generate what it needs. Although very rare, it is possible to overdose and become toxic with supplementation as vitamin D is a fat soluble vitamin and therefore stored in the body for longer periods of time. Therefore if you are taking 5,000 IU or more daily, you should have your blood levels monitored approximately every 3 months.

What blood test should I have to check my vitamin D levels?

The only blood test that can diagnose vitamin D deficiency is a 25-hydroxy-vitamin D (25 OH vitamin D). Unfortunately, some doctors are still ordering the wrong test, 1,25-dihydroxy-vitamin D. In fact a common cause of high 1,25-dihydroxy-vitamin D is a low 25(OH)D or vitamin D deficiency. So when doctors see the 1,25-dihydroxy-vitamin D is normal or high and tell their patients that they are OK, they are often vitamin D deficient.
Your doctor should do this test for you. Unfortunately even some of the labs, in particular Qwest, have had problems with correct results, usually giving erroneously high results.

If you don’t want to go through your doctor, the ZRT lab does a blood spot test that you can order without going through a doctor.

What is the ideal blood level of 25 hydroxy vitamin D?

The current ranges for “normal” are 20 to 55 ng/ml. These are much too low!!! They may be fine if you want to prevent rickets or osteomalacia, but not for optimal health. The ideal range for optimal health is 50-80 ng/ml.

How often should I have a 25 hydroxy vitamin D blood test?

At least once a year especially at the beginning of winter. If you are supplementing, I suggest you monitor your vitamin D levels approximately every 3months until you are in the optimal range. If you are taking high doses (10,000 IU a day) your doctor must also check your calcium, phosphorous, and parathyroid hormone levels every 3 months.

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  • Katie

    I was concerned about my doctor prescribing 100,000 units of vitamin D per week. He informed me that I was “100% deficient”. I am to take this amount for 8 weeks and then 50,000 for another 8 weeks. Are there any side effects in taking this amount for such a long time?
    I already have taken 6 weeks worth and feel great. No more fatigue or achy bones or muscles. I do notice bouts of “hot flashes” and night sweats, which I find to be a bit strange since my doctor also informed me that I was not in peri-menopause ( I am forty-eight) Prior to taking these supplements I use to get super cold, to the point that I would have to take a hot bath to warm up. On these days/nights my husband was never cold. No I definitely feel warmer. Just wondering if this could be from the supplements?

  • Katie

    I was concerned about my doctor prescribing 100,000 units of vitamin D per week. He informed me that I was “100% deficient”. I am to take this amount for 8 weeks and then 50,000 for another 8 weeks. Are there any side effects in taking this amount for such a long time?
    I already have taken 6 weeks worth and feel great. No more fatigue or achy bones or muscles. I do notice bouts of “hot flashes” and night sweats, which I find to be a bit strange since my doctor also informed me that I was not in peri-menopause ( I am forty-eight) Prior to taking these supplements I use to get super cold, to the point that I would have to take a hot bath to warm up. On these days/nights my husband was never cold. No I definitely feel warmer. Just wondering if this could be from the supplements?

  • http://www.drfranklipman.com/should-i-drink-milk-to-prevent-osteoporosis/ Dr Frank Lipman – Should I Drink Milk To Prevent Osteoporosis?

    [...] healthy bones, exercise frequently and supplement with at least 2,000 IU’s of vitamin D as well. Get your vitamin D levels [...]

  • http://pulse.yahoo.com/_Q4CQQDR4U2OZXWCUGYBF276ZUA Carl Haizen

    To become truthful, I even could not envision how tough it is to find decent piece of information on the above topic. It took me a few hours prior to I arrived across your website about Vitamin d3

  • Samantha

    Hi Dr. Lipman. I love this post. Could you tell me: when choosing a Vitamin D3 supplement, are most supplements created equal? If I buy D3 supplements from Rite Aid, how do they compare to supplements from a more sheeshy vitamin place?

  • http://www.drfranklipman.com/sunny-side-up/ Sunny Side Up: Get Your Healthy Glow

    [...] actual benefits to sun exposure in limited doses. Recent studies have shown that optimizing your Vitamin D levels may actually help prevent as many as 16 different types of cancers. And the best way to [...]

  • Gkolossvary

    I received my Vitamin d-3 today.  the package sat by my front door and the gel caps are all glued together by the heat.  Can I still take these gel caps or are they useless?  Gundi

  • Mlgb2003

    I am taking the equivilent of 50,000 IU a day of D3 spray and feel great.  My doctor was so surprised after he ordered a blood test and he said that I was the first patient he has had that had a normal D level.  Yeah!

  • roey

    My husband and I are doing your cleanse.  We are on the 8th day.  He just had a reoccurance of gout.  we were hoping the cleanse would lower his uric acid and clear kidneys. 2 years ago he did a 7 day green juice fast which kept gout at bay without meds for over 1 year.  He is resisting going on meds…we are wondering if the cleanse has brought it on and should he continue and finish it for 6 more days??

    Gout Trouble

  • Harmed_by_vit_D

    The information listed here on Vit. D 1 25 is incorrect. I have Sarcoidosis (Bernie Mac, Bill Russell had/have it as well). I was told that my Vit. D 25 OH is low and that I needed to go on supplemental vitamin D. This had disastrous results for me. I have since learned this has happened to many other Sarcoidosis patients. The doctor had only checked my vitamin D 25 OH and not Vit. D 1 25. Giving vitamin D to a Sarcoidosis patient often causes hypercalcemia and hypercalcuria causing problems with kidneys (sometimes failure), bones, heart etc. Hypercalcemia has caused many hopsitalizations and sometimes even stroke. Malignancy and other disease states have high vit. D 1 25 as well. Supplementation is very harmful here as well. Vitamin E used to be the rage….people said it prevented cancer. Now they are finding supplemental forms of E actuallly increase prostate cancer risk. I wish someone would have warned me instead of taking on the opinion that is expressed here in this ill-informed view of vitamin D 1 25.

    The paragraph on vitamin D toxicity fails to mention that the real issue with vitamin D is calcium toxicity.  The very thing that could help these patients avoid harmful calcium levels (testing vitamin D 1 25) is exactly the opposite of what this article is recommending. I’m quite saddened that such a negligent article will be read by many and that the people who have conditions where vitamin D supplements are contraindicated… they will continue to be harmed by information such as this whereas the Doctor here will continue to sell his vitamin D supplement on his website and profit from the information here. I don’t think the error is intentional….it’s just that he is not the one who will pay for the error.The very thing that could help these patients avoid harmful calcium levels (testing vitamin D 1 25) is exactly the opposite of what this article is recommending. I’m quite saddened that such a negligent article will be read by many and that the people who have conditions where vitamin D supplements are contraindicated… they will continue to be harmed by information such as this whereas the Doctor here will continue to sell his vitamin D supplement on his website and profit from the information here. I don’t think the error is intentional….it’s just that he is not the one who will pay for the error.

  • Harmed_by_vit_D

    The information listed here on Vit. D 1 25 is incorrect. I have Sarcoidosis (Bernie Mac, Bill Russell had/have it as well). I was told that my Vit. D 25 OH is low and that I needed to go on supplemental vitamin D. This had disastrous results for me. I have since learned this has happened to many other Sarcoidosis patients. The doctor had only checked my vitamin D 25 OH and not Vit. D 1 25. Giving vitamin D to a Sarcoidosis patient often causes hypercalcemia and hypercalcuria causing problems with kidneys (sometimes failure), bones, heart etc. Hypercalcemia has caused many hopsitalizations and sometimes even stroke. Malignancy and other disease states have high vit. D 1 25 as well. Supplementation is very harmful here as well. Vitamin E used to be the rage….people said it prevented cancer. Now they are finding supplemental forms of E actuallly increase prostate cancer risk. I wish someone would have warned me instead of taking on the opinion that is expressed here in this ill-informed view of vitamin D 1 25.

    The paragraph on vitamin D toxicity fails to mention that the real issue with vitamin D is calcium toxicity.  The very thing that could help these patients avoid harmful calcium levels (testing vitamin D 1 25) is exactly the opposite of what this article is recommending. I’m quite saddened that such a negligent article will be read by many and that the people who have conditions where vitamin D supplements are contraindicated… they will continue to be harmed by information such as this whereas the Doctor here will continue to sell his vitamin D supplement on his website and profit from the information here. I don’t think the error is intentional….it’s just that he is not the one who will pay for the error.The very thing that could help these patients avoid harmful calcium levels (testing vitamin D 1 25) is exactly the opposite of what this article is recommending. I’m quite saddened that such a negligent article will be read by many and that the people who have conditions where vitamin D supplements are contraindicated… they will continue to be harmed by information such as this whereas the Doctor here will continue to sell his vitamin D supplement on his website and profit from the information here. I don’t think the error is intentional….it’s just that he is not the one who will pay for the error.

  • Harmed_by_vit_D

    The information listed here on Vit. D 1 25 is incorrect. I have Sarcoidosis (Bernie Mac, Bill Russell had/have it as well). I was told that my Vit. D 25 OH is low and that I needed to go on supplemental vitamin D. This had disastrous results for me. I have since learned this has happened to many other Sarcoidosis patients. The doctor had only checked my vitamin D 25 OH and not Vit. D 1 25. Giving vitamin D to a Sarcoidosis patient often causes hypercalcemia and hypercalcuria causing problems with kidneys (sometimes failure), bones, heart etc. Hypercalcemia has caused many hopsitalizations and sometimes even stroke. Malignancy and other disease states have high vit. D 1 25 as well. Supplementation is very harmful here as well. Vitamin E used to be the rage….people said it prevented cancer. Now they are finding supplemental forms of E actuallly increase prostate cancer risk. I wish someone would have warned me instead of taking on the opinion that is expressed here in this ill-informed view of vitamin D 1 25.

    The paragraph on vitamin D toxicity fails to mention that the real issue with vitamin D is calcium toxicity.  The very thing that could help these patients avoid harmful calcium levels (testing vitamin D 1 25) is exactly the opposite of what this article is recommending. I’m quite saddened that such a negligent article will be read by many and that the people who have conditions where vitamin D supplements are contraindicated… they will continue to be harmed by information such as this whereas the Doctor here will continue to sell his vitamin D supplement on his website and profit from the information here. I don’t think the error is intentional….it’s just that he is not the one who will pay for the error.The very thing that could help these patients avoid harmful calcium levels (testing vitamin D 1 25) is exactly the opposite of what this article is recommending. I’m quite saddened that such a negligent article will be read by many and that the people who have conditions where vitamin D supplements are contraindicated… they will continue to be harmed by information such as this whereas the Doctor here will continue to sell his vitamin D supplement on his website and profit from the information here. I don’t think the error is intentional….it’s just that he is not the one who will pay for the error.

  • avery

    Here is a link (from the new enland journal of medicine) regarding hypervitaminosis D that occurred in 8 healthy people. Depending on the amount of incorrectly fortified milk they drank, it equates to 30,000IU per day to 50,000IU per day of vitamin D.
    http://www.nejm.org/doi/full/10.1056/NEJM199204303261801
    Dr. Frank Lipman cited in one of his posts on vitamin D to “do no harm”….I think everyone out there going full speed, no limit on vitamin d supplementation needs to heed these words.

    Some types of cancers, granulomatous disorders (like TB, Chron’s, sarcoidosis etc.), primary hyperparathyroidism can result in hypercalcuria or hypercalcemia with intake of vitamin d supplementation – which in turn can result in hospitalization (and rarely death) and kidney damage. In some of these diseases there is low vitamin d 25 but high levels of the active vitamin d 1,25. 24 hr. urine calcium and blood ionized calcium needs to be checked in some of these diseases. England is a step ahead of us in having warning labels on their vitamin d supplements.

    Dr. Frank Lipman: I beg you, on behalf of those of us out there that can be harmed by vitamin d supplementation, can you start putting a caution section on your posts regarding vitamin d? Can you look into your stance on vitamin d 1,25? John S. Adams (UCLA endocrinologist) has written quite a bit on this topic. Please, please re-evaluate. You said yourself, do no harm. Thanks for reading this.

  • avery

    I must correct my post….many of the patients that had hypervitaminosis d had not been previously healthy but had previous health issues like diabetes, previous cancers, heart issues etc. Some patients presented with symptoms only around the time of consumption of the excessively fortified milk….my bad.

  • Allie

    My brother told me he has been taking vitamin D pills so he can get more in his system. He said it made him feel amazing like a new healthy person. I forget how many IU he was taking, but I got pills that are 5,000 IU and (I’m fifteen) I was wondering is that too many?

  • Ginger

    my dr put me on 50,000 iu of vit d2 a week. Is that safe and are there any side effects from taking that much?

  • Yosra

    how to know my body level ?

  • Anonymous

    To measure vitamin D levels you need to do a simple blood test.

  • Jen

    Try Metabolic Maintenance. They don’t have magnesium stearate in them or anything else that could be considered harmful, ie additives…

  • Kj

    I just heard on The People’s Pharmacy this morning that Vit D supplements induce kidney stone formation and the caution to take only low dosages. (Would this relate to Vit D sort of making calcium available but it’s not being incorporated into the bones, etc?) Other comments on this and other cautions being publicized about avoiding too much Vit D?

    Thank you!

  • Kj

    Some black physicians I’ve heard caution black patients not to take Vit D or take low doses; I understand them to say that it causes fat deposits in black (due to high melanin). By the same token, I’ve read some black physicians advise black patients living in northern climates that they, in fact, need more Vit D than other lighter skinned populations. This sounds discrepant. What is the true nature of Vit D and dark-skinned persons?
    Thanks!

  • MS Kaushal

    Very informative & useful.

  • Michelle

    I am allergic to lanolin. Are Dr.Lipman’s D3 vitamins made from lanolin extract?

  • Anonymous

    Yes, in fact the D3 is extracted from sheep’s wool so depending upon your level of sensitivity, you may want to avoid it.

  • Anonymous

    Yes, in fact the D3 is extracted from sheep’s wool so depending upon your level of sensitivity, you may want to avoid it.

  • Peter Freese

    Hi, I own a tanning salon and I tan twice a week to keep my base tan and my vitamin D level up. I am disappointed to read that you feel sunshine is good but tanning beds are not. Sorry, tanning beds are just like the sun and do everything the sun does for you including produce vitamin D. Stop dancing around the issue please and tell people when you live in an area where the sun is not strong enough to produce vitamin D to get their bare ass into a tanning bed for 5 minutes. They will not burn in 5 minutes but their body will certainly produce some much needed vitamin D 3. I am sick of the ” Sun Scare People” They are the ones killing people by telling them to stay out of the sun.
    Peter Freese

  • http://diabetesdigest.com/ NATURE MADE VITAMINS

    Different fruits and veggies provide different vitamins that help our body with specific things. Our body uses nature made vitamins such as vitamin A which nourish our cells, and allows for proper maturation. Vitamin A is found in foods such as carrots and leafy greens and is responsible for keeping your eyesight in good health.

  • Ag

    Yes! The hot flashes thing is happening to me too and didn’t start until I started the ergocalciferol 50000 units a week.

  • Nilesh

    If I apply Sun Screen on my Skin & take 1/2 hr sun bath to get Vitamin-D ? OR the Sun Screen Gen will not allow ?

  • Anonymous

    Right, the sunscreen will block absorption.

  • Jan

    Has anyone had a foot deformity caused by a Vitamin D deficiency?

  • tonya

    We “evolved” in the sun??? LOL.I’m sorry but its hard to take advice serious from those who continue to perpetuate evolution as fact, when you know its a theory that has never been proven.

  • DinnyR

    Um, yes it has. There are fossils and things. Believe what you want to believe, I think the Easter Bunny brought us, myself, but please don’t confuse belief with fact. The two can, albeit uneasily, coexist. To see how, seek out the movie “Inherit the Wind.” The part of your quoted statement that *I* have trouble with is the assertion that the sun is our friend, when malignant melanoma is on the upswing.