Vitamin D Deficiency: Back to the Future?

Auburn, May 2, 2003 --- Vitamin D deficiency. Scientists once thought they had this problem 
licked. Now it appears they still have some work to do.

Vitamin D is the easiest or the most elusive vitamin to obtain, depending on who you are.

Adults typically can make this vitamin merely through adequate sunlight exposure on the skin – 
as little as 10 to 20 minutes a day.

Adequate amounts of vitamin D also can be obtained from milk and dairy products, which have 
been fortified since scientists uncovered a link between vitamin D and the debilitating disease 
known as rickets. Rickets, a disease that abounds in Charles Dickens novels set in the dark, 
soot-ridden streets of 19th century Industrial London, is reflected in skeletal abnormalities – the 
result of inadequate amounts of vitamin D received during childhood.

Even today, long after health experts declared victory and trained their sights on seemingly more 
pressing nutritional concerns, vitamin D deficiencies are still a risk among the very old -- elderly 
people who can’t obtain adequate amounts of the vitamin from sunlight or dairy products – and 
the very young – breast-feeding infants.

Osteoporosis, a crippling bone disease, is often the price of vitamin D deficiency among older 
people. Until recently, health experts assumed that the risk of osteoporosis was best addressed 
by consuming adequate amounts of calcium.  

As it turned out, a key ingredient was missing – vitamin D.  

“The problem associated with vitamin D deficiency stems from stressing calcium as the only 
safeguard against bone disease,” says Dr. Robert Keith, an Alabama Cooperative Extension 
System nutritionist and Auburn University professor of nutrition and foods. 

“They were right – you need your calcium. But as they soon learned, this strategy didn’t work as 
well as they had hoped because older people still weren’t getting adequate amounts of vitamin D, 
which also provides a crucial safeguard against brittle bones.”

“So now, the rule of thumb is to consume amounts of calcium and vitamin D.”

For older people, the current recommendation for vitamin D is 600 IUs daily.

 Breast-feeding infants are also prone to vitamin D deficiency, but for different reasons.

“We tend to think of breast milk as the perfect baby food;” Keith says, adding, “it really is the gold 
standard.”

“Nevertheless, breast milk, unlike baby formula, does fall short of vitamin D.” 

“It’s almost like Mother Nature is saying, ‘I don’t need to put too much vitamin D into this milk 
because the baby’s going to be out in the sun,’” Keith observes.  “And three or four thousand 
years ago, that certainly was the case.  Women were out in the garden carrying their infants or 
strapping them to their backs – a virtual guarantee that they would produce sufficient amounts of 
vitamin D from the exposure to sunlight.”

Today, though, for a variety of reasons – often because mothers are afraid to expose their infants 
to potentially harmful ultraviolet rays – fewer infants are exposed to adequate sunlight.  And this 
presents a special problem for those who breast-feed.

Experts recommend that breast-fed infants receive between 100 and 200 IUs of vitamin D each 
day.

Likewise, for some elderly people, obtaining the right amounts of vitamin D often isn’t easy. In 
many cases, lactose intolerance prevents them from obtaining adequate amounts of vitamin D 
from milk and dairy products. Even sunlight exposure is no guarantee, since elderly people don’t 
make the vitamin in their skin as readily as younger people.

For these people, daily calcium supplements fortified with adequate amounts of vitamin D are the 
only alternative, though Keith says these should be taken only after consultation with a physician.

For breast-feeding infants, he says, the problem is less challenging, since even short but 
consistent exposure to sunlight can provide adequate amounts of the vitamin. 

“We’re talking about 10 or 20 minutes a day, during which half the baby’s body is exposed – not 
long enough to cause significant tanning or sunburn but long enough to ensure they get enough 
exposure to make adequate amounts of vitamin D.”

Mothers also should consult with their baby’s pediatrician to explore other vitamin D supplement 
options in addition to breast-feeding, Keith says.

(Dr. Robert Keith, Alabama Cooperative Extension System Nutritionist and Auburn University 
Professor of Nutrition and Foods, 334-844-5686.)