Vitamin D Deficiency in Aging updated June, 2023

Sun protection is essential, effective summer strategies include - sun block use and re-apply every 2 – 3 hours at the beach or pool, wear long protective clothing and sun glasses outdoors, work out in the air conditioned gym, or jog/bike in the evening when it is cooling down.

On the other hand, many people may not realize they are not getting enough sun all day/all summer long and lack of sun exposure is a common cause for vitamin D deficiency. When the sun's UV-B rays hit the skin, a reaction takes place that enables skin cells to manufacture vitamin D. Vitamin D is essential for strong bones, because it helps the body use calcium from the diet.

Vitamin D deficiency begins silently and it is asymptomatic. Therefore, it is often unnoticeable in the early stage. Aging population is at a higher risk for vitamin D deficiency due to several risk factors. These include diminished diet or malabsorption; insufficient sunlight exposure, thinning skin thickness, certain medications interfere with body’s ability to convert vitamin D, impaired intestinal absorption and impaired hydroxylation in the liver and kidneys.

Actually, many people may have vitamin D deficiency without knowing it, until discovered it was linked with other health conditions. Research evidence suggests that vitamin D deficiency could be linked to several chronic diseases, including cardiovascular disease, cancer, and dementia/ cognitive impairment in elder adults. 

Common Causes for Vitamin D Deficiency

Insufficient sun exposure in daily life or use too much sun protection (sunscreen inhibits vitamin D production), or have milk allergies, or with a strict vegan diet, are common cause for vitamin D deficiency. Other risk factors are dark skin, obesity, absorption and digestion disorders, or lack of vitamin D intake. 

The main cause of aging-associated vitamin D deficiency is low vitamin D production in aging. As we age, there is a reduction in the skin's concentration of 7-dehydrocholesterol [8]. Specifically, for each decade past the age of 40, there is approximately a 10 to 15% decrease in the level of 7-dehydrocholesterol. 

Diagnosis

Measurement of serum 25-hydroxyvitamin D (25[OH]D) is the best test to determine vitamin D status. levels of 25(OH)D are interpreted as follows:

• 21-29 ng/mL (52.5-72.5 nmol/L): Vitamin D insufficiency
• < 20 ng/mL (< 50 nmol/L): Vitamin D deficiency

Symptoms of bone pain and muscle weakness can mean vitamin D deficiency. However, for many people, the symptoms are subtle.

Treatment for Vitamin D Deficiency

Treatment for vitamin D deficiency involves getting more vitamin D -- through diet and supplements. Although there is no consensus on vitamin D levels required for optimal health -- and it likely differs depending on age and health conditions -- a concentration of less than 20 nanograms per milliliter is generally considered inadequate, requiring treatment.

Guidelines from the Institute of Medicine increased the recommended dietary allowance (RDA) of vitamin D to 600 international units (IU) for everyone ages 1-70, and raised it to 800 IU for adults older than age 70 to optimize bone health. The safe upper limit was also raised to 4,000 IU. Doctors may prescribe more than 4,000 IU to correct a vitamin D deficiency.

NaturalFood Sources of Vitamin D

Vitamin D is found in relatively few foods. The richest natural sources of vitamin D are fish liver oils, salt-water fish such as sardines, herring, salmon and mackerel are also rich in vitamin D. Eggs, meat, milk and butter also contain vitamin D, but in small amounts. Plants are poor sources, with fruit and nuts containing no vitamin D at all. The amount of vitamin D in human milk is not enough for the infant needs.

Most dietary sources of vitamin D do not contain sufficient amounts of the vitamin to satisfy daily requirements. The following foods contain the indicated amounts of vitamin D, including fortified foods, as reported by the US Department of Agriculture's (USDA's) Nutrient Data Laboratory:

• Fortified milk (8 oz) - 100 IU
• Fortified orange juice (8 oz) - 100 IU
• Fortified cereal (1 serving) - 40-80 IU
• Pickled herring (100 g) - 680 IU
• Canned salmon with bones (100 g) - 624 IU
• Mackerel (100 g) - 360 IU
• Canned sardines (100 g) - 272 IU
• Codfish (100 g) - 44 IU
• Swiss cheese (100 g) - 44 IU
• Raw shiitake mushrooms (100 g) - 76 IU
• Most multivitamins (1 tab) - 400 IU 

Prevention

The best treatment is prevention.

Enjoy sunshine and outdoor activities. Human body can obtain a sufficient amount of vitamin D by being out in the sun for up to 30 minutes. In addition, research finds vitamin D3 bolsters the immune system (better than vitamin D2). 

Eat a healthy balanced diet. Also, certain foods, such as milk, cheese, and breakfast cereals, are fortified with vitamin D. Take vitamin D supplements under medical guidance. Vitamin D is better absorbed with meals. Vitamin D is a fat-soluble vitamin, meaning that it does not dissolve in water and is absorbed best in your bloodstream when paired with high fat foods. For this reason, it's recommended to take vitamin D supplements with a meal to enhance absorption.

Annual wellness physical is important for prevention and detect any health condition changes which require medical attention. Keep in mind to check Vitamin D levels in routine blood test and discuss with your doctor for deficiency correction treatment if necessary. 

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