It is really hard to keep up with the current health recommendations, especially regarding vitamins and supplements. One of the vitamins I definitely include on a daily basis is vitamin D. While we rarely see true vitamin D deficiency, many people have low levels of vitamin D that leave them feeling poorly. Being low in vitamin D can leave you drained, depressed, achy, and generally not feeling well. It may even increase your risk for certain kinds of illness like heart disease or cancer. Since it is inexpensive and easy to get it’s one you won’t want to miss.

Vitamin D is one of a few fat-soluble vitamins that is necessary for humans. Very few foods contain vitamin D with the exception of some fatty fish and liver. It is also found as a supplement in some dairy products such as milk. For most humans, the primary source of vitamin D is from conversion in the skin from sunlight. However, the vitamin D made in the skin is not biologically active and the liver and kidney are required to convert the inactive form of vitamin D. Because vitamin D is a fat soluble, it means it is stored in fat. Unlike water soluble vitamins (vitamin C, vitamin B etc), you can get too much vitamin D. It is important to check with your physician before taking this or any supplement.

How much vitamin D do we need? There are different recommendations depending on who is making them; however, it is generally accepted that a level of at least 32 ng/ml of 25-OH vitamin D is optimal. 25-OH vitamin D is the metabolite that is converted in the liver and measured in the blood. It is currently estimated that almost 70% of Americans are deficient in vitamin D.  You can learn about your vitamin D level by getting a simple blood test done, and your doctor can order it for you. Unfortunately, insurance doesn’t always pay for it, but many people choose to pay out of pocket. If you are a member of a Direct PrimaryCare practice, you can likely get it done for just a few dollars at your doctor’s office.  It is about $11.00 at my office.

Since vitamin D is not found in many foods, it is hard for Americans to get enough. In times past, people ate a more primordial diet including organ meats and spent lots of time in the sun. Now, we eat more processed food and spend our days indoors. Many of us wear sunscreen and avoid the sun and this then limits the amount of vitamin D we can get from the sun.  In addition, we know that obesity limits the absorption of vitamin D because the vitamin D is stored in fat and thus unavailable for absorption. People with darker skin have a harder time absorbing vitamin D and so they are more at risk for deficiency too. Just like everything else, aging affects the levels of vitamin D because it is harder to absorb this as we get older. Lastly, a good deal of Americans lives far enough north that the rays of the sun in the winter are not adequate to provide the amount of needed vitamin D. Even though it is a bit difficult to get adequate vitamin D, it is well worth the effort.

The vitamin D that comes from the sun is much more active and is easier to store than dietary vitamin D. During the summer humans can absorb 10000-20000 IU vitamin D in about 20-30 minutes in the midday sun, but it can be hard to decide which is more important — getting sun for vitamin D or avoiding skin cancer.  We know that we can store some of the vitamin D from the sun and so 10-15 minutes of sun exposure on the arms and legs daily should be adequate along with a supplement and some dietary vitamin D. If you plan to be out longer than that it would be best to wear sunscreen but get out and soak up the sun when you can!

Illnesses like scurvy and osteomalacia are caused from low vitamin D. Osteoporosis is also related to a low vitamin D level, especially in older women. These illnesses are not terribly common in the modern world because we do have access to lab work and supplements. So, what is the big deal with vitamin D? It seems there are tons of relevant associations with vitamin D and wellness. They are not all proven with randomized controlled trials, but the associations are strong. Let’s have a look and check out some of the benefits of having an adequate level of vitamin D: less aches and pains, less inflammation, less arthritis pain, lower risk of cardiovascular disease, better blood sugar control in diabetics, less viral infections (including COVID???), lower risk of cancer, and possibly less autoimmune disease. This sounds almost too good to be true!

It seems that most of the benefits of vitamin D are related to less inflammation. We know that people with adequate levels of the vitamin have lower rates of heart disease, stroke, and high blood pressure. In addition, rates of diabetes are lower in those with normal vitamin D levels too.  It seems that having a normal level of vitamin D is somewhat protective for getting viral infections.  It is hypothesized that this occurs because vitamin D boosts proteins that help fight off infection.  For this reason, those with asthma benefit from having normal levels of vitamin D.  The real place I see benefits in my clinic are with general well-being. After getting levels of vitamin D in the recommended ranges, many people feel generally better, less tired, more energetic and have fewer daily aches and pains.

As with anything else, you can definitely get too much of a good thing. Remember that all these possible benefits of vitamin D come to those who have NORMAL levels. It is not desirable to have a higher than recommended level. However, most people I check do not have normal levels, and this is why I have chosen to supplement my vitamin D. I am careful not to take more than needed and I follow my vitamin D level to be sure I’m not getting too much. If this is one small thing I have in my feel-good arsenal, I’ll take it!  It’s time to break out the shorts and head outside!

Camryn Lee


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