Vitamin D deficiency is often accompanied by symptoms and diseases that are casually dismissed as “old age.”
Vitamin D, which acts more like a hormone than a vitamin, plays several important roles and can affect everything from cognition to cancer. Among its roles, it helps control calcium and phosphate levels in the body.
What sometimes appears to be rapid physical and cognitive deterioration associated with aging, can actually be vitamin D deficiency, which proponents argue could be avoided with supplementation. Vitamin D deficiency has been linked to
osteoporosis, cardiovascular disease, cancer, diabetes, autoimmune diseases, and depression. A majority of the population worldwide is vitamin D deficient.
Vitamin D deficiency has a murky list of symptoms—such as the fatigue, weakness, brain fog, and anxiety that accompany a plethora of diseases. It's also possible that vitamin D deficiency may be lurking with no symptoms at all.
The only way to know for sure if your vitamin D level is low is to test, but the test isn’t always covered by insurance, and Medicare rarely pays for it—assuming a doctor recommends it in the first place. One test costs $30–$100. There’s also no universal lab value or vitamin D level that offers meaningful guidance to those who want to protect themselves against the list of diseases associated with deficiency.
Research has shifted and swayed as to how much vitamin D we need and any risks associated with too much. That situation is confusing to patients and even doctors who may suffer from analysis paralysis. But there are specific findings applicable—especially to seniors—that indicate that supplementing with vitamin D does make a difference.
Understanding Vitamin D Levels
The first step is to test, rather than guess, your vitamin D levels.
Vitamin D is produced in your skin with a lesser amount being absorbed through your food. Then, it's sent to your liver, where it's converted to 25-hydroxycholecalciferol, also known as 25-hydroxyvitamin D, or 25 (OH)D. This is what the test measures.
Exactly how much 25 (OH)D you should have in your blood is up for debate.
GrassrootsHealth, a nonprofit public health research organization made up of 48 scientists,
issued a call to action that
recommends that people of every age need to reach and maintain a 25 (OH) D serum level of between 40–60 nanograms/milliliter (ng/ml) for optimal health. A 2017 report in Nature Reviews Endocrinology
states that despite varying recommendations from medical organizations, all of them agree that anything less than 10 ng/ml should be avoided at all ages. Some experts say 25 ng/ml is normal, while others argue that it's too low.
The aging process is complicated by vitamin D deficiency, in part because it becomes more difficult to synthesize vitamin D from the sunlight as we get older. Intake of vitamin D from foods such as salmon, tuna, milk, eggs, pork, and beef liver is also lower in senior years. We know most older adults are deficient, but what to do about it has become a medical stumbling block.
It’s an issue that’s been complicated to the point of controversy as research creates new
, confusing headlines
every few months. Even a quick glance through undated articles on Today’s Geriatric Medicine’s website
doesn’t settle questions about the benefits of vitamin D, who should take it, and how much they should take.
On top of this, the number of stories
on vitamin D dangers
seems disproportionate to the actual risk
. There's a small group of people
who don’t tolerate vitamin D supplementation, which is why levels should be monitored by lab testing and a physician.
How Much Is Enough?
The Institute of Medicine last set standards in 2019
for a tolerable upper limit dose of vitamin D at 4,000 international units (IU) per day, while the Endocrine Society
at about the same time recommended 10,000 IU per day as the upper limit.
The National Institutes of Health recommendation
is 600 IU daily for people aged 51 to 70 and 800 IU for those older than 70 but not more than 4,000 IU each day. But whether that will allow a patient to reach a serum level of 25 ng/ml, which some consider a health level, is a case-by-case basis. The Epoch Times recently reported
on the trend of higher doses of vitamin D being used for incurable diseases, and research shows that there are benefits to getting the level between 40 and 60 ng/ml.
Dosing is more of an art than a science, as a 2017 study in Dermato-Endocrinology
noted. One goal of the study was to achieve an average serum level of 40 ng/ml among the 3,882 participants. Another goal was to closely study toxicity.
Participants at the beginning of the study were taking an average of 2,100 IU vitamin D daily with an average serum level of 35 ng/ml. The researchers found that it required 6,000 to 7,000 IU (depending on weight) to achieve a vitamin D level of 40 ng/ml. At the end of the study, the average serum level for all participants was 51 ng/ml. Vitamin D intakes of up to 15,000 IU per day were found safe in the study.
Dr. Ellie Campbell
, an integrative primary care specialist, told The Epoch Times that her level was at less than 20 ng/ml when she first checked in 2006, and it took her 1.6 million IUs of vitamin D to reach a level above 50 ng/ml. Since then, she has found that it takes 5,000 IUs daily to keep it at that level.
Many patients aren’t aware of their vitamin D levels, and it frustrates her that labs report levels of 25 ng/ml and 30 ng/ml as “normal.”
“Normal is determined by a scattergraph by the last 100 or so specimens,” Campbell said. “They’re not reporting optimal.”
In other words, don't have a good scientific basis for making any specific claims about what ideal 25 (OH) D levels are. What we do know is that diseases arise when levels get too low and that people with higher levels do better.
There are at least four reasons elderly populations should consider vitamin D supplementation.
1. Vitamin D Lowers the Risk of Dementia
A new study
examining the vitamin D supplementation habits of 12,388 participants from the National Alzheimer's Coordinating Center data linked supplementation to significantly lower rates of dementia. Results were published this month in Alzheimer’s & Dementia: Diagnosis, Assessment and Disease Monitoring
Among the nearly 3,000 participants who developed dementia over the decade-long study, 75 percent had no vitamin D and the other 25 percent had only baseline exposure. Overall, the study found vitamin D was associated with a 40 percent lower risk of dementia.
There are currently about 50 million people living with dementia worldwide, a number that’s expected to triple by 2050, according to the study.
Professor Zahinoor Ismail of the University of Calgary and the University of Exeter, who led the research, said in a statement
"We know that vitamin D has some effects in the brain that could have implications for reducing dementia, however, so far, research has yielded conflicting results. Our findings give key insights into groups who might be specifically targeted for vitamin D supplementation. Overall, we found evidence to suggest that earlier supplementation might be particularly beneficial, before the onset of cognitive decline."
2. Vitamin D Reduces Recurrent Vertigo
A study published in 2020 in Neurology found that those who supplemented with vitamin D (and calcium) to get to a minimum level of 20 ng/mL of 25 (OH) D reduced their chances of recurrent episodes of benign paroxysmal positional vertigo
, the most common type that happens when a change in head position causes a spinning sensation.
Conducted in Korea, the study compared a group of 445 people taking vitamin D to 512 people in an observation group that didn’t receive supplements or have their levels monitored. There was a 24 percent reduction in the annual recurrence rate for those who took vitamin D, according to a statement
about the study.
Traditional treatment involves a physical movement performed by a doctor that shifts the particles in the ear that are causing the vertigo, which can contribute to falls, fractures, and head trauma.
“Our results are exciting because so far, going to the doctor to have them perform head movements has been the main way we treat benign paroxysmal positional vertigo,” said Dr. Ji-Soo Kim of Seoul National University College of Medicine in South Korea. “Our study suggests an inexpensive, low-risk treatment like vitamin D and calcium tablets may be effective at preventing this common, and commonly recurring, disorder.”
3. Vitamin D Helps Prevent Cancer
When it comes to advanced cancer, vitamin D supplementation can extend life, according to a 2020 study
published in the Journal of the American Medical Association. In a clinical trial of 25,871 patients, vitamin D reduced the risk of metastatic or fatal cancers in those with a normal body mass index.
The Vitamin D Council
highly recommends women with breast cancer take 5,000 to 15,000 IU per day of vitamin D and check levels to ensure that they stay above 70 ng/ml. For prevention, the level recommended is 60 ng/ml. Several studies show a benefit associated with reducing breast cancer.
“There’s no drug on the market that can lower your breast cancer risk to that level,” she said. “Everyone should know about this.”
4. Vitamin D Reduces Falls and Fractures
Older studies show as much as a 72 percent reduction in falls
among those with higher vitamin D levels in nursing homes. On the other hand, a recent and highly publicized study
in The New England Journal of Medicine concluded that there was no correlation between vitamin D and fractures in older adults.
Critics of that study, which had dosing inconsistencies, as well as a few other 2022 studies, say there’s a distinct benefit for taking vitamin D. One of those studies in the Journal of Bone and Mineral Metabolism
reviewed 28 studies of 61,744 cases and 9,767 hip fractures and concluded that low serum vitamin D levels in the elderly are associated with an increase in the risk of hip fracture.
“What a difference we could make to the nursing home population because they fall less often,” Campbell said. “It’s one of the cheapest, easiest interventions. If we push those levels to where the science tells us it should be, our patients are recipients of the benefits.”
The New England Journal of Medicine study received plenty of publicity, but it’s drawn some criticism, too. Participants in the trial were given an initial high dose of vitamin D and then received a smaller daily dose of 2,000 IUs, while the placebo group was permitted to take up to 800 IUs per day. Grassroots Health was critical
of this type of research for creating skepticism and preventing optimal dosing.
Additional research has found
that not only does low vitamin D translate to more falls, but it's also associated with muscle weakness and pain, as well as gait disorders. Data demonstrated that those with a level of 20 ng/ml of 25 (OH)D and higher had better use of their lower extremities.
The Vitamin D Council
keeps an updated list of conditions that may benefit from using this hormone, along with links to studies. Grassroots Health
also has information about vitamin D, testing, levels, and transformation stories.