AARP Hearing Center
What Does Low Vitamin D Mean?
Advice on why a deficit in the ‘sunshine vitamin’ is important, and how to increase your level
James Yates
I’ve been told I have low vitamin D. Does it matter?
When I tell patients their vitamin D level is low, they often shrug and ask, “Does it really matter?” It’s a fair question; after all, a vitamin D deficiency usually doesn’t yield any obvious symptoms. But as we get older, it can affect some of the things we value most: strong bones, good balance, healthy muscles and the ability to remain independent.
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Many people worry about cancer or heart disease, but a serious fall that results in a hip fracture or other broken bone is one of the events I fear most for my older patients.
I’ve seen it happen too many times. Someone is living independently and enjoying life. Then a fall leads to a broken hip. The surgery may go well, but recovery can be long and difficult. Some patients never fully regain the mobility they once enjoyed.
Vitamin D plays a key role in preventing that scenario. It allows your body to absorb calcium from the foods you eat. When you don’t have enough of it, your body may pull calcium from your bones to keep your level normal. Over time, this can weaken the bones and increase your risk of osteoporosis and fractures.
Yet a low vitamin D level is also very common: Nearly 20 percent of middle-aged and older adults are vitamin D–deficient. One challenge is that the deficiency can develop slowly, over many years. That’s why blood testing is often the only way to know where you stand. A bone density test can also help determine whether your bones are being affected. When we identify a low vitamin D level early, we have an opportunity to protect bone health before a fracture occurs.
We also know that vitamin D helps support muscle function, which may improve balance and stability. Those two factors become increasingly important as we age.
I also pay close attention to vitamin D levels in patients with chronic kidney disease. Many people don’t realize they have kidney disease, as there may be no symptoms in its early stages. Yet the kidneys play an important role in activating vitamin D, and when kidney function declines, your vitamin D level often falls.
Other conditions that increase the risk of D deficiency include liver disease, obesity, Crohn’s disease, ulcerative colitis, celiac disease and previous bariatric surgery. Some medications can also interfere with D levels, including certain weight-loss, cholesterol-lowering, anti-seizure and antibiotic drugs.
What’s more, vitamin D’s role extends beyond bones to the immune system and lung health.
So how can you improve your vitamin D level? Food is a great starting point. Fatty fish such as salmon, tuna, trout and mackerel are excellent sources, as is cod liver oil. Egg yolks, certain mushrooms and fortified beverages and foods such as milk, plant-based milk (including soy, almond and oat), yogurt, orange juice, margarine and breakfast cereal can also help. Most milk sold in the U.S. is fortified with vitamin D.
Sunlight also contributes, as our skin produces vitamin D when exposed to ultraviolet light, though this ability diminishes with age. Moreover, many older adults don’t spend enough time outdoors or use sun protection, or they live in northern climates where there are fewer D-producing rays, especially in winter. For those reasons, sunlight alone is oftentimes not enough to maintain a healthy level.
Supplements are the most practical solution. The National Institutes of Health recommends 800 international units (IU) daily for adults who are 71 and older. However, the appropriate dose depends on your blood level, medical history, age, diet and medicines you take. That’s why I encourage you to discuss supplementation with your health care provider.
A word of caution: More isn’t always better. Excessive supplementation can result in vitamin D toxicity, causing a dangerously high calcium level that leads to nausea, weakness, kidney stones, heart-rhythm problems and even kidney damage. My advice is simple: Know your number. If your vitamin D level is low, don’t dismiss it. Work with your health care provider to bring it to a range that is right for you.
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