How do I get vitamin D?

Some of your daily intake of vitamin D should come from your diet. The nutrient occurs naturally in foods including salmon, mackerel, canned tuna, egg yolks, cheese, mushrooms and beef liver, and in fortified foods such as milk, yogurt, orange juice and breakfast cereal. Sunlight triggers vitamin D production in the body, which is why it’s known as the sunshine vitamin.

Because vitamin D can come from food, sun and supplements, the best measure of one’s vitamin D status involves blood tests through a primary care doctor.
 
This content originally appeared online at Baptist Health South Florida.
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Lucette Talamas, RD
Nutrition & Dietetics
People can get Vitamin D in 4 different ways:
  1. Food. Very few foods naturally contain Vitamin D. Some of the best sources include fatty fish such as salmon, tuna, and mackerel and fish liver oils. Small amounts are found in cheese and egg yolks. Interestingly, some mushrooms contain vitamin D but the amount varies. 
  2. Fortified foods. These are foods that usually don’t have vitamin D but it was added during processing. Examples of vitamin D fortified foods include milk, milk alternatives like soy or almond milks, some yogurts, and ready-to-eat breakfast cereals. Fortification with vitamin D is a voluntary process so amounts vary in different products. Make sure to check the Nutrition Facts label to see if Vitamin D is listed.
  3. Sunlight exposure. We can produce Vitamin D when our skin absorbs ultraviolet (UV) rays from the sun, which causes a cascade of reactions at a cellular level that result in the production of active Vitamin D. There are many factors that may affect the synthesis of Vitamin D including the season of the year, time of day, length of day, cloud cover, smog, skin melanin content, and sunscreen use. One must use precaution whenever exposing the skin to the sun due to the concerns of skin cancer.
  4. Dietary supplements. Vitamin D is found in supplements in two different forms: Vitamin D2 (ergocalciferol) and Vitamin D3 (cholecalciferol). Be sure to talk to your healthcare provider prior to taking a supplement to make sure it is appropriate when considering your overall health plan and to prevent any possible interactions with certain medications.   
Penn Medicine
Administration
Vitamin D is frequently referred to as the “sunshine vitamin.” That’s because a common source of vitamin D is sun exposure. While sun exposure is great for vitamin D, frequent sun exposure is not recommended because too much sun exposure is associated with an increase in skin cancer risk.

Natural sources of vitamin D include cod liver oil and fatty fishes such as tuna, herring, catfish, sardines and salmon.

Wild salmon may have as much as 4 times more vitamin D than farm raised salmon. Because these foods are not eaten on a daily basis, more common sources of vitamin D are in fortified foods such as dairy through milk and yogurt consumption. Oil spreads and cereals may also be fortified. It is best to check the nutrition facts section of the food label.

Supplements also are available in the form of ergocalciferol (made by plants) or cholecalciferol (made in the skin).
 
There are many ways to get your vitamin D. In this WisePatient video, internist Carlos Rios, MD, of The Mount Sinai Medical Center, describes the best sources of vitamin D, from sunlight to dietary supplements.
Vitamin D is very important for your bones, your immune system and for preventing cancer. Your skin makes vitamin D from the sun, but there is really no safe amount of unprotected sun exposure, due to risk of skin cancer. Medical organizations including the American Academy of Pediatrics and the American Academy of Dermatology recommend that you obtain vitamin D from a healthy diet that includes food naturally rich in vitamin D, foods fortified with vitamin D, milk and other beverages fortified with Vitamin D and dietary supplements. I recommend that all of my patients protect themselves from the sun, eat a healthy diet and take a daily vitamin with a vitamin D.
Audrey K. Chun, MD
Geriatric Medicine
Foods that are good natural sources of vitamin D include salmon, herring, mackerel and sardines.

A number of foods and beverages are being supplemented with vitamin D; know how much vitamin D you're getting from your diet if you take supplements or are considering supplementation.
Vitamin D is unique. Made in the body, it holds dual roles -- promoting the absorption and regulation of calcium and phosphorus in your blood and depositing these minerals in bones and teeth, making them stronger and healthier.

Vitamin D is naturally present in very few foods. However, it is added to many and is also available as a dietary supplement. The most common natural and fortified sources of vitamin D include:
  • Sunshine: Your body converts sunlight into vitamin D after it hits unprotected skin. However, be careful to avoid extended exposure to sunlight without sunscreen.
  • Some fish, especially canned salmon or sardines
  • Milk
  • Fortified cereals such as cornflakes
  • Eggs
  • Margarine
Janis Jibrin, MS, RD
Nutrition & Dietetics
You get vitamin D from three main sources: the sun (when its rays hit your skin, your body makes vitamin D), supplements, and foods such as milk that are enriched with vitamin D. If you eat fatty fish such as salmon, mackerel, tuna, and sardines, you're also getting about 100 to 300 IU per 3½-ounce serving. (Fresh wild salmon contains more: 300 -- 1,000 IU.) In winter months, when people get little sunlight and the sun is too weak to have much vitamin D -- creating power, about half of Americans are deficient.
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Ways to increase your vitamin D intake:
  • 15 minutes of sun exposure a day
  • Take 1,000 IUs of Vitamin D daily
  • Eat foods rich in vitamin D, such as milk, cheese, yogurt, salmon, mackerel and tuna.
This content originally appeared on doctoroz.com
Dr. Robin Miller, MD
Internal Medicine
Most people in the US should probably be using vitamin D. Since vitamin D comes from skin absorption after sun exposure and since most of us use sunscreen that blocks this process, most of us are deficient in vitamin D. To make matters worse, as we get older our absorption of vitamin D becomes impaired. In addition, most people are not avid milk drinkers and that is another source of vitamin D.

Therefore, it is very important for all of us to know what our vitamin D levels are. This can be done with a simple blood test. Once your doctor knows your level, he or she will be able to tell you how much to take.  

I was very busy testing my patients' levels and decided to check mine. I actually had the lowest level of all. Once I started supplementing with vitamin D I felt so much better. I had energy and noticed that even my balance was better. Adequate vitamin D levels are important for health and wellness.
Neal Spruce
Neal Spruce on behalf of dotFIT
Fitness
The safest and most practical way to increase the body’s level of vitamin D is by taking a daily multivitamin mineral formula (MVM) that contains between 600-1200 IU of vitamin D. The new recommended intake is 600 IU daily for adults up to age 70, which is 3 times more than the previous recommendation. For people older than 70, the new goal is 800 IU/day. Considering research shows that most people never met the old low recommendations, to reach these new goals with food alone is probably not going to happen for most. Food sources of vitamin D are scarce or not popular, and sunlight (under the right conditions skin can produce some vitamin D when exposed to sunlight) is no longer recommended as a source because it increases the risk of skin cancer and is too variable. Below is a list of foods with relatively high vitamin D content. Other than milk and possibly eggs, as the foods listed are not common to the daily American diet. Add the facts that many adults no longer get nearly as much milk as when they were younger and you would need a lot of eggs to make a dent in your daily requirements, a MVM makes the most sense since it also contains other nutrients your diet may be short on.

Quick facts on Vitamin D: although the Institute of Medicine’s (IOM) raised the recommendation of vitamin D as noted above, most top vitamin D researchers still think they are too low. Many recent studies have linked high blood levels of vitamin D to a reduced risk of many chronic diseases including heart disease, hypertension, cancers, diabetes and others. Therefore, most vitamin D experts recommend blood levels of 25-hydroxyvitamin D to be no less than 30 ng/ml (nanograms per milliliter), which may require a daily intake of at least 1000 IU/day of vitamin D.
 
Fred Pescatore, MD
General Practice
The best way is to take vitamin D3 supplements -- have your blood level taken first and monitored when you are on the supplement though as you can take too much. The next best way is to sit in the sun for twenty minutes without sunscreen -- however, this is not advisable for a variety of reasons. Then you can eat more foods that contain vitamin D, such as eggs, skins of potatoes, salmon and other fatty fish.
Dariush Mozaffarian, MD
Internal Medicine
When possible, get your vitamin D from your diet and modest sun exposure, making sure to avoid burning. About five to 30 minutes of sun exposure between 10 a.m. and 3 p.m. at least twice a week to the face, arms, legs, or back without sunscreen will enable you to make enough of the vitamin. When sun-generated vitamin D is not feasible, and if you don't get much vitamin D in your diet, then consider a daily supplement to meet the recommended dietary intake of 600 to 800 IU per day. If you take a multivitamin that contains some vitamin D, but less than 600 to 800 IU, your diet and some sun exposure will likely make up the difference. You could also take a separate vitamin D supplement to be sure you're getting the recommended amount. Some scientists believe there is enough evidence to advise taking 1,000 IU per day or more of supplementary vitamin D, which is well below the safe upper limit of 4,000 IU. However, the potential benefits of higher doses remain controversial. Large studies now underway should help determine if these higher doses offer benefits beyond bone health.
Dr. Vonda Wright, MD
Orthopedic Surgery
Vitamin D is present in oily fish, eggs, and dairy products in variable amounts. It is not found in plant foods. However, vegans can obtain vitamin D from vegetable margarines, some soy milks, and certain other foods that are fortified with the vitamin. Vitamin D is also synthesized by the skin when it is exposed to sunlight. Synthesis of vitamin D in this way is usually adequate to supply all the body's requirements. Most vegans will obtain sufficient vitamin D providing they spend time outdoors on bright days. Fortified foods further ensure adequate amounts. Vegans who may be confined indoors may need to take vitamin D supplements.
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The best source of D is that which is derived from the sun, as this form stays in the body longer with greater lasting benefits. Plus, a little goes a long way. Ten minutes of unprotected sun (sunscreen blocks the useful UV rays) three times a week is enough. After 10 minutes, apply the sunscreen. People who live in the Northern half of the US get little to no vitamin D activation from sunshine during the winter months through early spring. So along with your multivitamin, increase your consumption of D containing foods listed from highest to lowest in vitamin D content.
Johns Hopkins Medicine
Administration
On average, 90 percent of a person’s vitamin D intake comes from UV light from the sun. Only 10 percent is from dietary sources.
 
Sunlight is an extremely effective source of vitamin D, but there are drawbacks, as well. Many people live in areas of the world that are too far from effective sun sources. Some people can’t or don’t want to go out in the sun because of the potential damaging effects to the skin -- sunscreen is great for protecting the skin, but prevents vitamin D production. Or they avoid sun exposure because of skin conditions or even cultural or religious beliefs -- some women have to stay covered in public. Darker-skinned individuals require more exposure than their fairer-skinned neighbors.
 
As far as diet, there are very few food sources that contain sufficient amounts of vitamin D that the average person would have in their daily diet. Fatty fishes or their by-products (think cod liver oil) and fortified cereals and dairy are examples of good sources, but they often don’t provide nearly enough to retain a sufficient blood level of vitamin D.
 
Most physicians would recommend a supplement. Depending on your current level which can be determined by a simple blood test, your physician may suggest an over-the-counter vitamin D3 supplement to boost it up. However, if you are deficient, or severely deficient, you may require a prescription strength version of vitamin D2 which would provide a much larger amount.
Michael T. Murray, ND
Naturopathic Medicine
Vitamin D is often added to milk and other foods. Some natural sources of vitamin D are cod-liver oil; coldwater fish, such as mackerel, salmon, and herring; butter; and egg yolks. Vegetables are low in vitamin D, but the best plant sources of vitamin D are dark green leafy vegetables. Vitamin D has the greatest potential to cause toxicity in comparison to other fat-soluble vitamins. Supplementation greater than 400 IU per day, the RDA for children, appears to be unwarranted.
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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.