By Dr. Wesley Davis
DNP, ENP-C, FNP-C, AGACNP-BC, CEN 

Dear NP

 

January 28, 2021



Dear NP,

I was recently diagnosed with vitamin D deficiency. What risks are associated with this diagnosis? What is the best way to increase my vitamin D level?

Dear Reader,

Vitamin D deficiency can cause a host of unpleasant symptoms. These can include fatigue, depression, slow wound healing and many more symptoms. Most people are diagnosed with a vitamin D deficiency after experiencing one or more of these symptoms, so the fact that you’ve been diagnosed means you’re already on the right track to feeling better.

And the good news is that this isn’t a challenging problem to solve in most cases.

Vitamin D sometimes slips through the cracks of people’s nutritional intake. This is because most of our vitamin D doesn’t even come from food. According to the CDC, our most important vitamin D source is sunlight, not food.

This is because Vitamin D is one of the few vitamins that our body can produce all on its own. Vitamin D is actually two different vitamins, D2 and D3. Similar to how plants photosynthesize their food, we photosynthesize our vitamin D.

Sun exposure triggers the cells in our skin to produce vitamin D3. Meanwhile, we get vitamin D2 mainly from plant-based foods. While these vitamins are technically distinct, they’re generally lumped together when making a vitamin D deficiency diagnosis since most people with a deficiency lack both forms.


Under normal sunlight exposure conditions, you shouldn’t need to think too much about vitamin D in your diet. However, “normal” for our evolutionary ancestors may mean something entirely different to the amount of sunlight we get in a modern lifestyle. Many people work indoors all day.


Other factors that can affect how much vitamin D we synthesize include skin pigmentations (darker complexions produce less vitamin D), latitude (influencing length of day) and skin cancer (or a genetic predisposition to it).

If you have a vitamin D deficiency, there are three main ways to increase your Vitamin D levels:

Get more sun: This advice needs to be taken with a grain of salt. Skin cancer is far more dangerous than a vitamin D deficiency, so if you are at an elevated risk of skin cancer due to genetic history or prior sun damage, you may want to consider another source of vitamin D. For everybody else, this is the easiest and the cheapest way to get the vitamin D you need.


Contrary to what you may have heard, it does not take a ton of sunlight. About 10-30 minutes of intense, midday sun a few times a week should give you all you need. It may take longer in certain latitudes or if you are of a darker complexion, but if you are giving yourself a sunburn trying to get your vitamin D, you are trying too hard!

Diet: As we’ve said before, dietary vitamin D should not be of huge concern if you are getting enough sun, but many vitamin D-rich foods are healthy anyway, so it certainly cannot hurt. To get your D2 make sure to eat lots of fruits and vegetables, especially leafy greens.

For D3, fish and eggs are a great source. In general, D3 is more common in animal-based foods, while D2 is more common in plant-based foods. Many foods like milk and cereal are also artificially fortified with vitamin D (a common practice by manufacturers to help prevent rickets in children).

Supplements: Any daily multivitamin will have a healthy dose of vitamin D. You can also get vitamin D-specific supplements. In the US, vitamin D3 is available over-the-counter, but D2 is only available as a prescription. This is because D2 generally only needs to be supplemented in people with specific illnesses like rickets or hypoparathyroidism. D3 is better for the average person supplementing to correct a deficiency.

Regardless of what strategy you use to boost your vitamin D intake, talk to a health care provider. It is possible to get too much vitamin D, leading to some nasty side effects. Moreover, your health care provider can evaluate whether you need a prescription for vitamin D2 or whether D3 supplements will do the trick (or none at all).

Dr. Wesley Davis is an Emergency Nurse Practitioner at Crook County Medical Services District and Coordinator of the Family and Emergency Nurse Practitioner program at the University of South Alabama. He encourages readers to send their questions to [email protected]

 
 

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