Vitamin D is a hormone precursor that has a primary function of promoting healthy bone formation by regulating calcium absorption in the gut and maintaining adequate calcium and phosphorus levels in the bloodstream. Vitamin D also plays a number of other critical roles in the body, including modulation of the immune system, cell growth, the inflammatory response, and neuromuscular function. It has been associated with health benefits in the prevention and treatment of many different diseases, including autoimmune disease.
Is it necessary to supplement with vitamin D if you have autoimmune disease?
While it has become increasingly common for conventional and functional medicine practitioners alike to recommend vitamin D supplementation, there is still quite a bit that modern science does not fully understand about vitamin D, including what constitutes an adequate vitamin D level and if it is necessary for everyone to supplement with it. It is certainly clear that vitamin D plays a vital role in health, but the evidence is building to suggest that low vitamin D levels are a consequence or a biomarker of poor health, and not necessarily the root cause of disease. This is an important distinction to make when determining what constitutes an optimal vitamin D level and when it is necessary to begin supplementation. Supplementing with mega doses of vitamin D may not provide a high level of protection against the development or progression of autoimmune disease, and in some cases, it may be harmful. Because of the correlation between low vitamin D levels and autoimmune disease, a simple blood test for 25-hydroxyvitamin D3 is a good place to begin if you are considering vitamin D supplementation.
There is no consensus on the optimal blood levels of vitamin D within the functional medicine community. However, there are several recent studies that suggest the optimal range of vitamin D is likely lower than once was embraced by integrative health practitioners and higher ranges are not necessarily more desirable. In general, a range of 25 – 50 ng/mL may be optimal for most people. There isn’t sufficient evidence that levels above 50ng/mL are beneficial, and in fact, they may increase the risk of decreased bone mineral density, kidney stones, and cardiovascular disease. For people with autoimmune disease that have symptoms under control and their vitamin D level falls within 25 – 50 ng/mL, supplementation is likely not necessary, especially if they are taking other measures to ensure adequate vitamin D. However, if an individual is struggling with autoimmune symptoms and their vitamin D level falls within the lower end of the range, it may be beneficial to begin supplementation.
Besides supplementation, what are ways to ensure an optimal vitamin D level?
The most efficient way to ensure optimal vitamin D levels is through sunlight exposure in which UVB radiation converts cutaneous 7-dehydrocholesterol (a form of cholesterol) to vitamin D3, which is eventually processed to become the biologically active form of 1,25-dihydroxyvitamin D3. There are several factors that impact the production of vitamin D from sun exposure, including skin color, weather conditions, latitude and longitude, time spent in the sun, season, time of day, and the use of sunscreen and clothing. This calculator created by the Norwegian Institute for Air Research can be used as a general guideline for estimating the amount of sun exposure you need in order to produce an optimal level of vitamin D depending on these factors.
During winter in many northern climates, it may be challenging to obtain enough sunlight to produce adequate levels of vitamin D, especially if you are struggling with health concerns and you are not within an optimal range of vitamin D levels. An alternative to natural sunlight exposure is a sunlamp that emits enough UVB radiation to allow the production of vitamin D, while minimizing UVA exposure. In the United States, the Sperti Vitamin D Lamp is the only sunlamp approved by the FDA for the purposes of increasing vitamin D levels. A clinical trial found that this sunlamp was effective in raising serum 25-hydroxyvitamin D3 levels.
Adequate levels can also be ensured by consuming foods that are rich in vitamin D, including organ meats, fatty fish, pastured lard, grass-fed butter, and pastured eggs. During the winter months in which sunlight exposure is limited, you should increase your consumption of these foods and consider taking a high quality extra virgin cod liver oil (EVCLO) (such as this product by Rosita Real Foods) and butter oil (such as this product by Corganic). A critical factor to consider in vitamin D supplementation is that vitamin D requires adequate levels of the fat-soluble vitamins A and K2 and several minerals, such as magnesium, zinc, and boron, in order to perform its role in the body. Real food sources of vitamin D usually contain vitamin A present in the correct amounts needed to balance vitamin D. Vitamin K2 can be found in natto, egg yolks, grassfed butter, pastured chicken, and grass-fed beef. Unlike a vitamin D supplement, EVCLO and butter oil will include sources of vitamin D, A, and K2 that are bioavailable and more easily absorbed. Although many people that are dairy intolerant can safely consume butter oil because the milk proteins are removed, it is not advised to take this real food supplement if you are on the elimination phase of the Paleo Autoimmune Protocol.
What else should you know about Vitamin D supplementation?
Consuming a nutrient-dense real food diet that contains the minerals that are co-factors of vitamin D is also a key component to ensuring adequate vitamin D levels. In particular, magnesium plays several critical roles in the production and metabolism of vitamin D. A magnesium deficiency can often be an overlooked cause of low vitamin D levels. Foods rich in magnesium include dark, leafy greens, fish, avocado, bananas, dark chocolate, nuts, and seeds. Because of the importance of magnesium to adequate vitamin D levels, it is wise to supplement with magnesium if your vitamin D levels are low.
If you do determine that it is necessary to supplement with vitamin D, be cautious because not all vitamin D supplements are created equal. It’s important to chose a supplement with cholecalciferol (vitamin D3) versus ergocalciferol (vitamin D2). Although you won’t find any dietary supplement that includes all of the vitamin D co-factors, there are professional line supplements that pair vitamins D3 and K2 and that would be the better option. Keep in mind that it is possible to reach toxicity with vitamin D. While supplementing, you should continue to monitor your vitamin D blood levels and eat a nutrient-dense diet that is rich in the vitamins and minerals that work synergistically with vitamin D.
Thanks for the info. Have you tried the sun lamp? I live in Western Canada so not much sun at all for 6 most of the year. So thinking something like this sunlamp may be a good idea.
Monique
Hello Monique! I have not personally tried the Sperti sunlamp, so I can’t offer direct feedback on it. However, I have had a client that tried it with decent results.
There are different kinds of sunlamps available on the market, but this is the only one that is approved by the FDA in the US for vitamin D production. Other sunlamps can be useful in helping with sleep/wake cycles and seasonal affect disorder/depression, but they do not raise vitamin D3 production.
If you do try the lamp, be sure to check back and let me know your thoughts!
This statement really surprised me: “It is certainly clear that vitamin D plays a vital role in health, but the evidence is building to suggest that low vitamin D levels are a consequence or a biomarker of poor health, and not necessarily the root cause of disease.”
I would guess you’ve read more of the research on this than I have, but I would be quite shocked if Vit-D deficiencies don’t at least in part contribute to the development of disease–in particular allergies, cold, flu, sinus infection, etc.
There is still a lot that isn’t known about vitamin D. The current evidence is pointing in the direction that vitamin D is a biomarker of poor health, and not a causative factor, because of studies that show that vitamin D supplementation and high serum levels of vitamin D do not necessarily reduce the incidence of certain diseases or reduce overall mortality. However, there is still a lot more research that needs to be done! There is no doubt that vitamin D plays an important role in immune system health, but whether or not it is an actual root cause of disease still remains to be determined.
Living in Seattle, statistics show that the general population has a less than stellar amount of vitamin D, so your suggestions make perfect sense. Educating people on the importance of Vitamin D and calcium use in the body can be vital in attempts to prevent future osteoporosis or osteopenia. Even if fractures of vertebra do not occur, studies show that pain related to the back and body can be linked to these processes.
Thank you for your input, and keep up the great work.
I am constantly low in Vitamin D. I was actually refused insurance because of my low Vitamin D.
I’ve never even considered the UV lamp. That could be a good idea. My diet and supplementation alone are definitely not doing the trick.
That calculator is an awesome tool for showing how important outdoor time for many reasons. Those of us up north have our work cut out for us in the winter, so thanks for this article.