Indoor living and increased awareness of the dangers of sun exposure: These two factors have contributed to what experts are calling a pandemic of vitamin D deficiency.

Vitamin D is crucial for our bone and muscle health. Low amounts of vitamin D have been associated with rickets in children (a condition causing weak, brittle bones) and osteoporosis and fractures in adults. Vitamin D deficiency has also been linked to depression, certain types of cancer and certain autoimmune diseases.

The Sunlight-Vitamin D Connection

One of the repercussions of our modern lifestyle is a lack of exposure to sunlight, the ingredient necessary to “kick start” our vitamin D absorption process. Our skin contains a “precursor” to vitamin D. The ultraviolet B (UVB) rays of the sun activate this precursor, starting the process for it to become the active form of the vitamin that our bodies can use.

In ancient times, people were primarily hunters and gatherers, spending most of their day outside. Absorbing sufficient amounts of sunlight to activate the vitamin D precursor was not a problem. Today, however, we spend the majority of our time indoors, away from natural sunlight.

Furthermore, as we became more aware of the dangers of sun exposure, the medical community started urging people to avoid the sun as much as possible. Precautions, such as wearing sunscreen every day and avoiding sun exposure during peak sunlight hours, have reduced incidences of skin cancer.

However, they have created a new (though much more treatable) problem—we are not getting the sunlight exposure we need to activate our vitamin D.

Getting More Vitamin D: Sunlight Not Required

The problem only worsens in winter, with less sunlight and even more time spent indoors. So how do we ensure that we are getting the vitamin D we need to keep our bones and muscles healthy?

As a dermatologist, I do not recommend returning to the days of unlimited sun exposure! We need to do all we can to keep our bodies healthy.

One easy way to get more vitamin D is through our diets. Fish, such as salmon and mackerel, are natural sources of vitamin D. And in the United States, much of our dairy is fortified with vitamin D. By simply eating more fish, milk, yogurt and cheeses, we can get our daily recommended allowance of vitamin D. If you cannot eat (or don’t like) dairy and fish, talk to your doctor about a vitamin D supplement. Experts recommend a daily dose of at least 800 international units (IU).

For people who are seriously deficient, dietary changes may not be enough. You may need a prescription-strength tablet. Then, when your body reaches a healthy level, you can get your vitamin D needs from a regular multivitamin or from your diet.

Tanning Beds: NOT the Answer!

Tanning beds may seem like a perfect winter solution to vitamin D absorption. However, the light rays they use are primarily UVA, not the UVB rays the skin needs to convert the precursor vitamin D to an active form of vitamin D. In addition, the strong, direct UVA rays increase your risk of skin cancer and photoaging (premature aging of the skin due to UV exposure). Stay away from tanning beds—they don’t help, and they can even harm.

Vitamin D Deficiency: Who Is at Risk?

Nearly all of us are at some risk for vitamin D deficiency due to our indoor lifestyle. However, there are some populations that are at higher risk, including:

  • Postmenopausal women: Postmenopausal women often have weaker bones because of hormonal changes. Vitamin D deficiency can make them even more at risk for developing fractures.
  • African-Americans: The higher levels of melanin (pigment) in their skin make it harder to efficiently absorb the UVB rays.
  • Those living in cold climates: People who live farther from the equator have a harder time absorbing sufficient UVB rays, because there is a decreased amount of UVB photons at higher latitudes.
  • Those with a history of skin cancer: This population is most likely to wear sunscreen all the time and avoid sun exposure.
  • Those with malabsorption issues: If you have Crohn’s disease, celiac disease, cystic fibrosis or liver problems, your body may have a harder time absorbing vitamin D.
  • Those with liver or kidney disease: Enzymes in the liver and kidneys convert the inactive form of vitamin D in the skin to its biologically active form.
  • Those taking certain medications: Medications, such as anti-seizure medications, gluococorticoids, HIV medications, certain antibiotics and herbal supplements (St. John’s wort) can interfere with your body’s ability to absorb the vitamin D.
  • Obese patients: Vitamin D is a fat soluble vitamin. In people who are obese, much of the vitamin D remains in the fat tissue and does not travel through the blood.
  • Elderly patients: Aging causes a decreased concentration of the precursor form of vitamin D in the skin.

Symptoms of Vitamin D Deficiency

Be on the lookout for symptoms of vitamin D deficiency. Muscle weakness or unexplained, frequent falls or fractures are the most common symptoms. Other symptoms can include:

  • Bowlegs (in children)
  • Bone pain
  • Hair loss
  • Depression

Vitamin D Deficiency: Easy to Diagnose

If you or a family member experiences any of these symptoms or if you are in one of the high-risk groups, see your doctor. We can diagnose vitamin D deficiency through a simple blood test and safely get you back on track through dietary changes or a supplement.


Patricia Lucey, MD, is board-certified in dermatology. She completed a fellowship in cutaneous oncology/melanoma, focusing on detecting and managing melanoma and other skin cancers. Dr. Lucey is especially interested in early detection of melanoma and providing thorough skin cancer screenings. She educates patients and families about the importance of regular screening and the dangers of sun exposure. Read Dr. Lucey’s profile.