Understanding Vitamin D
Vitamin D is uniquely synthesised in the skin when exposed to ultraviolet B (UVB) radiation from sunlight, making it the primary natural source for most people. Dietary sources are limited; fatty fish such as salmon and mackerel contain meaningful amounts, while fortified dairy products and cereals provide additional intake in some regions.
Once consumed or synthesised, vitamin D is biologically inactive and must undergo two hydroxylation steps—first in the liver to form 25-hydroxyvitamin D (25(OH)D), then in the kidneys to produce calcitriol, the active hormonal form. This circulating hormone regulates calcium and phosphate homeostasis, supports bone remodelling, modulates immune responses, and influences the expression of over 200 genes throughout the body.
Vitamin D Status and Deficiency
Serum 25(OH)D concentration is the standard biomarker for assessing vitamin D status. Clinical thresholds are:
- Deficiency: Below 20 ng/mL (50 nmol/L)
- Insufficiency: 20–29 ng/mL (50–72.5 nmol/L)
- Sufficient: 30 ng/mL (75 nmol/L) and above
Population surveys indicate that 20–100% of older adults and women in North America and Europe fall below sufficient levels, with children and younger adults at comparable risk worldwide. Inadequate sun exposure, darker skin pigmentation, dietary restriction, and malabsorption are the main contributors to deficiency.
Body Mass Index and Vitamin D Requirements
Body mass index (BMI) is calculated from height and weight to stratify vitamin D dosing recommendations, as adipose tissue sequesters vitamin D and reduces bioavailability in individuals with obesity.
BMI = weight (kg) ÷ [height (m)]²
weight— Body weight in kilogramsheight— Height in metres
Factors Influencing Vitamin D Needs
Your vitamin D requirement varies based on multiple factors:
- Age: Infants and children have different targets than adults and older adults.
- Pregnancy and lactation: Requirements increase to support fetal development and milk production.
- Weight status: Obesity increases the dose needed to achieve equivalent serum levels.
- Skin pigmentation: Melanin reduces UVB penetration; individuals with darker skin require 3–6 times longer sun exposure to synthesise equivalent vitamin D.
- Current serum level: Those with confirmed deficiency require higher supplemental doses to reach sufficiency.
Practical Considerations for Vitamin D Optimisation
Vitamin D management requires attention to individual circumstances and measurement timing.
- Sun exposure timing matters — Midday sun (11 AM–3 PM) provides the strongest UVB intensity. Cloudy days, window glass, and high latitudes significantly reduce synthesis rates. A fair-skinned person may achieve adequate synthesis in 10–30 minutes of noon exposure, whereas someone with darker skin may need 3–10 times longer under identical conditions.
- Seasonal and geographic variation — Winter months and high-latitude living reduce UVB availability year-round. At latitudes above 35°N or 35°S, winter sun provides insufficient UVB for cutaneous synthesis, making dietary intake or supplementation essential during these periods.
- Retest timing after supplementation — Serum 25(OH)D rises slowly with supplementation; allow 8–12 weeks at a stable dose before retesting. Rapid dose adjustments based on single measurements can lead to over-supplementation, which increases urinary calcium loss and hypercalcaemia risk.
- Fat-soluble absorption — Vitamin D is fat-soluble and requires dietary fat for optimal absorption. Taking supplements with a meal containing fat enhances bioavailability. Malabsorption disorders, bariatric surgery, and certain medications (e.g., orlistat) impair vitamin D absorption and may necessitate higher doses.