Ashlee Williams, MD (Host): Feeling tired, moody, or noticing weird bone pain? It might not be stress or aging. It could be low vitamin D, and most people don't even know they're deficient. Let's break down the signs why it matters and how to fix it before it affects your long-term health. Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams. And today, I'm talking with Dr. Kristy Golden, a board-certified podiatric surgeon here at Kaiser Permanente, about why vitamin D matters, how to see the signs of deficiency and what you can do to maintain healthy levels. Dr. Golden, thank you so much for being here.

Kristy Golden, DPM: Thank you. Thank you for having me.

Host: Dr. Golden, why is vitamin D so important for our health?

Kristy Golden, DPM: Great question. This is something I'm constantly talking about, particularly post-pandemic. So, vitamin D has a major role in bone health, okay? Without sufficient vitamin D, bones can become thin or brittle, or even misshapen if it happens during childhood; increasing risk of things like bone pain, what we call periostitis, which is non-traumatic bone pain; stress fractures, increased risk of traumatic fractures. So like when you fall, you're more likely to break a bone if your vitamin D is low, and an increased length of time it takes for fractures to heal.

Vitamin D has other roles in the body, including reduction of inflammation as well as, modulation of cell processes like for cell growth and muscle formation, immune function, even glucose metabolism. I'm sure many of us remember in the pandemic, vitamin D deficiency was big news, right? People that were vitamin D deficient were doing poorly against the virus, right? And that really increased our awareness of the other functions of vitamin D.

Host: Well, vitamin D plays such an important role. How much vitamin D should we be taking in each day?

Kristy Golden, DPM: I generally recommend 2000 units of vitamin D3 per day, in addition to a one-a-day vitamin, particularly if you're at risk for vitamin D deficiency. Now, if you've had a history of low vitamin D in your past, then I would recommend having your levels checked by your primary care doctor annually, and then increasing the strength of the supplementation as needed.

In Podiatry, what I do for symptomatic vitamin D deficiency is actually treat with a prescription weekly supplement. That's about 50,000 units of vitamin D3 per week for about 12 weeks, and then recheck the levels. So, it kind of depends on your symptoms of vitamin D deficiency, if any, as well as your history and your risk factors for vitamin D deficiency. But as a general rule, for everybody listening, I would say 2000 units a day.

Host: Got it. So, there's the over-the-counter vitamin D, there's the prescription strength. Can you talk about other ways that people can get vitamin D?

Kristy Golden, DPM: Sure. Vitamin D is found naturally in a few foods, such as like the flesh of a fatty fish, fish liver oil, beef, egg yolks, cheese. In American diets, fortified foods like milk and breakfast cereals provide most of the vitamin D in the diet. However, it's hard to get enough vitamin D from your diet, even if you're eating all of those foods on a daily basis.

Most people in the world can meet at least some of their vitamin D through their exposure to sunlight. Type B UV radiation does get absorbed through the skin and helps with the conversion of vitamin D synthesis. However, older patients and folks with darker skin tones are less able to produce vitamin D from sunlight, which makes them at a higher risk for deficiency, actually. It's not often enough vitamin D exposure from both the dietary sources of vitamin D as well as the sunlight.

Host: Dr. Golden, thank you so much for touching on some reasons why some groups of people may be low in vitamin D deficiency. I know when I first had my little baby, the pediatrician said that we needed to supplement with vitamin D for my infant. Can you talk a little bit about who is most at risk for low levels of vitamin D and deficiency? And are there any groups in which getting enough vitamin D is particularly important?

Kristy Golden, DPM: Sure. So, I would actually say, everybody, it's very important to get your vitamin D. You know, as a bone and joint doctor, we see people coming in the office all the time with symptoms that seem vague, that they have not had attributed to vitamin D deficiency. So, that would be my short answer to your questions. Like, it's important for everybody.

But going back to what you said about babies and children, yes, vitamin D is crucial for healthy bone development. A deficiency can lead to rickets, although that's not very common. It is a condition that causes a weakening and a softening of the bones. It's rare because we have fortified foods, but it's important to note. Breastfed infants, they should receive vitamin D supplementation in drop form by the guidance of their pediatrician.

Also postmenopausal women. So as estrogen levels decline, the risk of osteoporosis actually goes up. And so, vitamin D is essential because it helps the body absorb calcium and then just reducing that risk of brittle bones and fractures. So, I always am counseling my women around postmenopausal age to be sure that they're taking their vitamin D supplements. Older adults in general, women and men, I mean, aging reduces the skin's ability to produce vitamin D from sunlight. So, just a factor of aging does increase your risk of vitamin D deficiency. And people with darker skin tones, we touched on this a little bit, but higher levels of melanin reduces the skin's ability to synthesize vitamin D from the sun. So, it's important for those individuals to be sure that they're supplementing. And those with limited sun exposure, which I always say is all of us. I mean, unless you're a farmer working outside in a tank top all day, you're not getting enough sun exposure to keep your vitamin D up, particularly in our DC suburban Maryland region.

And incidentally, glass really decreases the ability of sun to penetrate your skin. So if you're working near a window, you might think you're getting vitamin D from that sunlight, but it's actually not the case. So, anyone who's working inside, or working outside with full-coverage clothing really need to supplementing with vitamin D because they're at risk.

And finally, I would add, there's some chronic conditions that can impede absorption of vitamins like Crohn's disease or Celiac's disease. So, folks with those conditions should be extra cognizant of vitamin D supplementation as well.

Host: I'll have patients come in for their routine physicals or health assessments, and we'll do testing and they'll show that they're deficient in vitamin D from time to time. But some people actually come in having some symptoms. Can you talk a little bit about what symptoms come along with vitamin D deficiency?

Kristy Golden, DPM: Sure. I mean, there's a lot of anecdotal symptoms attributed to vitamin D deficiency. A lot of them are difficult to prove because there are things like depression that are multifactorial and difficult to kind of pin on one problem, but it has been noted that mood changes and depression are associated with vitamin D deficiency.

From a bone and joint standpoint, the symptoms of vitamin D deficiency is the achiness. You know, that "I'm not injured, but I feel like I am. Every time I walk, I feel like my bones are creaking. My bones feel like they're breaking underneath me." I mean, that's something I hear everyday patients tell me.

Of course, people who are overweight or are not wearing supportive shoes, right, will have a higher risk of feeling those symptoms. But almost always, if you're feeling that way, vitamin D deficiency is a part of the reason.

Host: And from a primary care standpoint, I've had people come in, if people are having hair loss, it's something that we test for, is vitamin D deficiency and also just general fatigue, which could be attributed to so many things. But that's also one of the things that we check in the primary care clinic. So, speaking of checking for vitamin D, what is the best way to test for it?

Kristy Golden, DPM: It's a simple blood test. I order it routinely for any bone and joint surgery or for anyone exhibiting symptoms like I've discussed or really anyone with foot pain that I can't explain with a trauma. I will check their vitamin D. So, vitamin D gets reported in a laboratory range that's quite wide. The normal range of vitamin D is like from 30 to 100. So, you'll get a number. And depending on what your number is will determine what the treatment or what the goals are for your vitamin D supplementation.

So if I'm checking vitamin D levels and they are below 30, my treatment is 50,000 units of vitamin D taken in a prescription tablet once per week for 12 weeks. And then, I repeat the lab work after those 12 weeks is over to be sure that we've gotten it to normal. Sometimes it takes even longer depending on how low the vitamin D was to begin with. I always recommend taking vitamin D supplementation with a fatty meal because it's a fat-soluble vitamin. So often, if you're taking it on an empty stomach, you're just not absorbing it all anyway.

Now if the vitamin D returns and it's within normal range, but on the lower end of normal, I just counsel the patient on the importance of continued supplementation, minimum of 2000 units a day for life really to maintain normal values.

Host: I love the tip about the taking it with fatty foods. That's really great. Thanks so much for this valuable information, Dr. Golden. Here are the key takeaways.

One, vitamin D is essential for bone health, immune function and overall well-being. Two, many people have low levels, especially those with limited sun exposure, darker skin, or certain health conditions. Three, symptoms of low levels can include fatigue, bone pain, muscle weakness, and mood changes. Four, you can get vitamin D from sunlight, food sources like fish and fortified dairy and supplements if needed. And five, a simple blood test can help determine if you're deficient and it's important to avoid excessive intake.

For more advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you found this episode helpful, don't forget to subscribe and share it with others. Thank you. And from all of us at Kaiser Permanente, be well.