Why we need vitamin D — and sun exposure isn't the only way to get it

Vitamin D is a real multi-tasker. It “helps your body absorb calcium, which is essential for strong bones and teeth and helps prevent rickets in children and osteoporosis in adults,” a registered dietitian tells. “Vitamin D also plays a role in supporting a healthy immune system and glucose metabolism and reducing inflammation.”

But 35% of Americans aren’t getting enough of it.

There are several reasons why — the main factors being lack of sun exposure (the body produces vitamin D when exposed to the sun’s ultraviolet light), location, age and skin color, explains a registered dietitian. “The darker the skin tone, the harder it is to synthesize vitamin D from the sun,” she explains. According to the National Library of Medicine, the most at-risk populations for vitamin D deficiency are the elderly, obese people, nursing home residents and hospitalized patients.

But before you run out to pick up a bottle of supplements or start walking around without any sunscreen, here’s what experts want you to know about vitamin D.

Bone health isn’t its only superpower

Strong bones and osteoporosis prevention might be vitamin D’s claims to fame, but they’re not its only specialty. According to the National Institutes of Health, the nutrient helps your immune system fight off viruses and bacteria, which is especially timely for cold and flu season. Vitamin D also assists in regulating blood sugar and helps your brain manage mood. For example, some studies have found links between low blood levels of vitamin D and an increased risk of depression.

The sun isn’t the only way to get more vitamin D

Before stocking up on capsules from the vitamin aisle, evaluate your diet for vitamin D gaps. That’s right: The sun isn’t the only way to get this important nutrient. “Fatty fish like salmon, tuna and sardines are packed with vitamin D and egg yolks, beef liver and cheese contain smaller amounts,” says Rush. Many foods are also fortified or enriched with vitamin D, he adds, including milk, plant-based milk alternatives, cereal, orange juice and yogurt. “Checking the nutrition facts label is the easiest way to see if a food contains vitamin D,” he says.

More isn’t better when it comes to vitamin D

There is such a thing as vitamin D toxicity that can pose serious health risks. “Overdoing it on vitamin D, usually from high-dose supplements, can lead to elevated calcium levels in the blood known as hypercalcemia,” explains Rush. “This can trigger a range of symptoms, including nausea, vomiting, muscle weakness, confusion and even kidney stones. In severe cases, vitamin D toxicity can cause kidney failure, heart problems and in rare instances, death.”

The recommended daily allowance of vitamin D is 600 international units (IU) for people ages 1 to 70 and 800 IU for adults over 70. “However, your doctor may recommend a higher dose if you have a deficiency,” Rush says.

The supplement shouldn’t be taken alone

“Vitamin D is a fat-soluble vitamin, meaning it's absorbed best when consumed with fat,” says Rush. “Having a snack with some healthy fats, like avocado, nuts or seeds, can help your body absorb the vitamin D supplement more effectively.”

It’s also a good idea to make sure you’re getting enough vitamin K — another nutrient found in leafy greens — or if your doctor recommends it, taking a supplement with both vitamins (such as D3 and K2). That’s because vitamin K and D work together, with vitamin K helping to distribute the calcium produced by vitamin D.

It’s not an excuse to get more sun exposure

Low vitamin D doesn’t give you a free pass to a day of sun tanning. “Some research suggests that five to 30 minutes of midday sun exposure several times per week could be enough for most people to produce sufficient vitamin D,” says Rush. The proper amount of time varies depending on your skin tone, the amount of skin exposed to the sun, the time of day, the season and where you live, he adds.

Whether you spend five or 30 minutes getting your vitamin D fix, it shouldn’t be without sunscreen. According to The Skin Cancer Foundation, “Clinical studies have never found that everyday sunscreen use leads to vitamin D insufficiency. In fact, the prevailing studies show that people who use sunscreen daily can maintain their vitamin D levels.” That’s because no sunscreen offers 100% protection from the sun’s UV rays so even with sunscreen, some of those rays will still reach your skin. “It’s important to protect your skin from sun damage to reduce the risk of skin cancer,” Rush says.

 

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How to Tell if You Have a Vitamin D Deficiency (and What to Do About It)

Vitamin D is one of the most common deficiencies in the UK, with the NHS suggesting that one in five of us have low levels of the nutrient. Because we get it from the sun, the past lockdown measures have meant that we’ve been spending even less time in natural sunlight than usual.

Even more concerning is that conditions associated with a lack of vitamin D are reportedly on the up. And this includes diseases that were once eradicated from the UK, such as rickets. 

However, it’s not all bad news. A 2020 Medichecks study found that nearly two-thirds of Brits tested during lockdown had good levels of the vitamin, a 10% improvement on the previous year.

How can we ensure that we keep getting enough of the sunshine vitamin?

It is important to note that there is a difference between being low in vitamin D and having a deficiency, says Toral Shah MSc, nutritional scientist and functional medicine practitioner. “Vitamin D deficiency is incredibly dangerous, with fatigue, bone pain and fractures, muscle weakness and cramps and mood changes. Whereas having insufficient levels means not having enough to be optimally healthy.

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What are the signs of low vitamin D?

A vitamin D deficiency can be serious, so it is crucial to fix low levels of vitamin D before they turn into a deficiency. However, doing so can be tricky. “You tend to only get clear cut signs when you are severely lacking in vitamin D,” explains Toral. “But there might be general signs that your body isn’t working optimally because of low vitamin levels.” These signs include:

• Low immune system, such as finding you pick up colds and infections very easily, especially during the winter months
• Not recovering well from exercise
• Struggling to sleep
• Feeling tired

If you aren’t exposed to a lot of sunlight, you’re probably right to assume you’ll be low in vitamin D. “In the UK and in northern latitudes, especially during winter, we’re almost all insufficient,” says Toral. We also need to be especially careful now we are all spending longer time inside: “especially at the beginning of lockdown, when we could only leave the house for an hour a day, we wouldn’t have been getting enough sun on us.”

Toral also points out the importance of wearing suncream when we’re outside, but points out that this does block the absorption of sunlight and limit the amount of vitamin D we can make.

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Who is most at risk of low vitamin D levels?

Well, right now, most of us. But there are some groups of people who should be even more cautious of vitamin D levels, including: 

• Vegans and vegetarians. “Some of the main sources of vitamin D include oily fish, eggs and fortified dairy products, so if you don’t eat these then you could be at risk,” says Toral.
• People with dark skin. “Melanin makes it harder for you to make vitamin D,” explains Toral. “But also because levels are set according to the needs of white people, there’s not enough studies to show how much people of colour need.”
• Elderly people. “When you’re in your 70s you make about a quarter of the amount of vitamin D that people in their 20s make,” says Toral.  

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How can you improve levels of vitamin D?

Of course, we can improve the amount of time we spend outside in the sun and eating those high vitamin D foods. However, time outside is also not an option for everyone, such as those who are currently shielding from coronavirus, and the NHS advises that dietary sources aren’t enough to provide you with all of the vitamin D you need. 

If you’re worried about your vitamin D levels, then you should talk to your GP to get a blood test. 

 

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Malnutrition: What you need to know

Malnutrition refers to when a person's diet does not provide enough nutrients or the right balance of nutrients for optimal health.

Causes of malnutrition include inappropriate dietary choices, a low income, difficulty obtaining food, and various physical and mental health conditions.

Undernutrition is one type of malnutrition. It occurs when the body does not get enough food. It can lead to delayed growth, low weight, or wasting.

If a person does not get the right balance of nutrients, they can also have malnutrition. It is possible to have obesity with malnutrition.

When a person has too little food, a limited diet, or a condition that stops their body from obtaining the right balance of nutrients, it can have a severe impact on their health. In some cases, this can become life threatening.

This article looks at malnutrition in detail, including the causes, symptoms, and treatments associated with it.

What is malnutrition?
Malnutrition occurs when a person gets too much or too little of certain nutrients.

Undernutrition occurs when they lack nutrients because they eat too little food overall.

A person with undernutrition may lack vitamins, minerals, and other essential substances that their body needs to function.

Malnutrition can lead to:

    short- and long-term health problems
    slow recovery from wounds and illnesses
    a higher risk of infection
    difficulty focusing at work or school

Some deficiencies can trigger specific health problems. For example:
A lack of vitamin A

Around the world, many children develop vision problems due to a lack of vitamin A.

A lack of vitamin C

A lack of vitamin C can result in scurvy. Scurvy is rare in the United States, but it can develop if a person does not have a varied diet with plenty of fresh fruits and vegetables.

Older adults, young children, those who consume a lot of alcohol, and some people with certain mental health conditions may be particularly at risk.

An overall deficiency

Lacking all nutrients can lead to kwashiorkor, which is a "severe form of malnutrition." One symptom of this condition is a distended abdomen.

Marasmus is another potential result of severe nutritional deficiency. A person with marasmus will have very little muscle or fat on their body.
Symptoms

Some signs and symptoms of malnutrition include:

    a lack of appetite or interest in food or drink
    tiredness and irritability
    an inability to concentrate
    always feeling cold
    depression
    loss of fat, muscle mass, and body tissue
    a higher risk of getting sick and taking longer to heal
    longer healing time for wounds
    a higher risk of complications after surgery

Eventually, a person may also experience difficulty breathing and heart failure.

In children, there may be:

    a lack of growth and low body weight
    tiredness and a lack of energy
    irritability and anxiety
    slow behavioral and intellectual development, possibly resulting in learning difficulties

Treatment is possible. In some cases, however, malnutrition can have long-term effects.

Anorexia nervosa is a mental health condition that can lead to severe malnutrition. Learn more about it here.

Causes

Malnutrition can occur for various reasons. The sections below outline these potential causes in more detail.

A low intake of food

Some people develop malnutrition because there is not enough food available or because they have difficulty eating or absorbing nutrients.

This can happen as a result of:

    cancer
    liver disease
    conditions that cause nausea or make it difficult to eat or swallow
    taking medications that make eating difficult — due to nausea, for example

Mouth problems such as badly fitting dentures may also contribute to malnutrition.
Mental health conditions

Undernutrition or malnutrition can affect people with:

    depression
    dementia
    schizophrenia
    anorexia nervosa

Social and mobility problems

Factors that can affect a person's eating habits and potentially lead to malnutrition include:

    being unable to leave the house or reach a store to buy food
    finding it physically difficult to prepare meals
    living alone, which can affect a person's motivation to cook and eat
    having limited cooking skills
    not having enough money to spend on food

Digestive disorders and stomach conditions

If the body does not absorb nutrients efficiently, even a healthful diet may not prevent malnutrition.

Examples of digestive and stomach conditions that may cause this include:

    Crohn's disease
    ulcerative colitis
    celiac disease
    persistent diarrhea, vomiting, or both

Alcohol use disorder

Consuming a lot of alcohol can lead to gastritis or long-term damage to the pancreas. These issues can make it hard to digest food, absorb vitamins, and produce hormones that regulate metabolism.

Alcohol also contains calories, so a person may not feel hungry after drinking it. They may therefore not eat enough healthful food to supply the body with essential nutrients.

Risk factors

In some parts of the world, widespread and long-term malnutrition can result from a lack of food.

In the wealthier nations, however, those most at risk of malnutrition include:

    older adults, especially when they are in the hospital or long-term institutional care
    people who are socially isolated — for example, due to mobility issues, health problems, or other factors
    people with a low income
    people recovering from or living with a serious illness or condition
    those who have difficulty absorbing nutrients
    people with chronic eating disorders such as bulimia or anorexia nervosa

Some people may need to take supplements if they follow a specific diet. Which supplements are good for a person following vegan diet? Find out here.

Diagnosis

If a person shows or notices any signs of malnutrition, the first step will be to find out why.

If a doctor suspects Crohn's disease, celiac disease, or another condition, they may carry out laboratory tests to confirm a diagnosis. Treating these conditions can improve a person's nutritional status.

They may also carry out the following:

    blood tests for general screening and monitoring
    tests for specific nutrients, such as iron or vitamins
    prealbumin tests, as malnutrition commonly affects levels of this protein
    albumin tests, which may indicate liver or kidney disease

A tool to identify risk

Some tools can help identify people who have or are at risk of malnutrition.

One way to assess adults is by using the Malnutrition Universal Screening Tool (MUST). Research has shown this to be a reliable tool.

Experts designed this tool to identify adults, especially older adults, with malnourishment or a high risk of malnutrition. It is a five-step plan that can help healthcare providers diagnose and treat these conditions.

The five steps are as follows:

Step 1: Measure a person's height and weight, calculate their body mass index (BMI), and provide a score.

Step 2: Note the percentage of unplanned weight loss and provide a score. For example, an unplanned loss of 5–10% would give a score of 1, while a 10% loss would score 2.

Step 3: Identify any mental or physical health conditions and provide a score. For example, if a person has been acutely ill and taken no food for over 5 days, the score will be 3.

Step 4: Add the scores from steps 1, 2, and 3 to obtain an overall risk score.

Step 5: Use local guidelines to develop a care plan based on the score.

The score will be one of the following:

    low risk: 0
    medium risk: 1
    high risk: 2 or more

Doctors only use MUST to identify overall malnutrition or the risk of malnutrition in adults. The test will not identify specific nutritional imbalances or deficiencies.

Nutritional-deficiency anemia can result if a person's diet cannot provide the nutrients they need. Learn more about it here.

Treatment
If a doctor diagnoses malnutrition, they will make a treatment plan for the person. The person may also need to meet with a nutritionist and other healthcare providers.

Treatment will depend on the severity of the malnutrition and the presence of any other underlying conditions or complications.

It may include:

    ongoing screening and monitoring
    making a dietary plan, which might include taking supplements
    treating specific symptoms, such as nausea
    treating any infections that may be present
    checking for any mouth or swallowing problems
    suggesting alternative eating utensils

In severe cases, a person may need to:

    spend time in the hospital
    gradually start taking in nutrients over a number of days
    receive nutrients such as potassium and calcium intravenously

The person's healthcare team will continue to monitor them to ensure that they are getting the nutrition they need.

Prevention

To prevent malnutrition, people need to consume a range of nutrients from a variety of food types.

Older adults, young children, people with severe or chronic illness, and others may need additional care to ensure that they obtain the nutrients they need.

Anyone who starts to show signs of malnutrition or undernutrition should see a doctor for a diagnosis and treatment.

In the U.S., effective treatment is usually available, although the outlook and time needed for recovery will depend on the cause of the malnutrition.

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