Seven signs you’re deficient in vitamin D

Vitamin D is the one food supplement the NHS recommends for adults. Photo / 123RF
With over half of us not getting enough of the “sunshine vitamin”, we look at the tell-tale signs of deficiency and how to boost your levels.
Vitamin D, the so-called “sunshine vitamin” as it’s produced in the skin during sun exposure, is one of the most important nutrients for our health, yet many of us are not getting enough of it.
Blame our lengthy winters and indoorsy lifestyles, but 57% of us have lower than “optimal” levels.
It is the one food supplement the UK’s National Health Service (NHS) recommends for adults, saying we should all consider taking it during the autumn and winter months. (All children aged 4 and under are advised to supplement, too).
But what are the signs that you might not be getting enough?
Vitamin D deficiency is linked to chronic fatigue, says Nichola Ludlam-Raine, a specialist dietitian and the author of How Not To Eat Ultra-Processed. She points to a study of female nurses in 2015, where a connection was found between low levels (89% of the participants were deficient in this vitamin) and self-reported fatigue. And a 2019 study of 480 older adults also linked low levels with fatigue symptoms.
“Supplementation can improve energy levels by supporting immune function and reducing inflammation,” says Ludllam-Raine.
However, it’s a controversial subject. Ashley Grossman is an emeritus professor of endocrinology at Oxford University, and says it’s important to remember a common symptom such as tiredness can have lots of causes – so he would only link the two if the level of vitamin D measured in a blood test is below the level of 50nmol/L.
You can ask for a blood test from your GP to measure your levels of vitamin D, but the NHS typically only offers these if you are showing signs of a serious deficiency, such as chronic widespread pain or suspected bone disease.
Vitamin D research has shown certain levels in the blood may help reduce the risks of respiratory infections, including the flu and Covid. A 2019 review found vitamin D supplementation helped reduce the risk of respiratory tract infections.
Grossman describes the recent recommendations regarding the amount of the vitamin we should take as complete and wide-ranging.
“Empirical evidence implies that vitamin D supplements might generally help reduce the risk of respiratory infection in normal children,” says Grossman. “But again it’s controversial – the recommendations are between 400IU and 2000IU [international units], but 800-1000IU is the most popular amount sold.”
For anyone suffering frequent infections or illness without any known cause, it’s best to speak to your GP about the appropriate supplements for your overall health. This is crucial if you’re pregnant or over 75.
“There is no harm in taking reasonable supplements, and I generally recommend 1000-2000 IU units a day if the level is less than 50nmol/L in most patients,” says Grossman. “Multi-vitamin supplements are fine, but most of the other vitamins and minerals are unnecessary, and you should check if the amount of vitamin D included is sufficient.”
Recommended daily intake of vitamin D
Vitamin D plays a crucial role in calcium absorption and bone metabolism, and a deficiency in it has been linked to an increased risk of developing bone diseases such as osteoporosis.
However, often osteoporosis isn’t diagnosed until a bone is broken, perhaps after a sudden fall. “Suffering pain in your bones is not a symptom of osteoporosis,” says Grossman. “But in someone with bone pain (and no other cause), I would advise a supplement if their level is less than 50nmol/L. Severe vitamin D deficiency causes ‘osteomalacia’, not osteoporosis, which is chronic bone pain and often muscle weakness.”
“In children with known bone disease, there could be strong indications for treatment.”
It’s not always easy to pinpoint the causes of muscle pain, but a vitamin D deficiency may be a potential cause. As vitamin D is a nutrient that supports muscle function, a deficiency of it can contribute to muscle weakness and soreness, says Ludlam-Raine.
The vitamin D receptor is present in nerve cells called nociceptors which sense pain. This vitamin may also be involved in your body’s pain signalling pathways, which may play a role in chronic pain. A 2014 study found 71% of people with chronic pain had a deficiency in the vitamin.
“Vitamin D plays a role in controlling inflammation, helping fight infections, along with skin repair, so if you’re lacking in it then it makes sense that the healing process can be impaired,” says Ludlam-Raine. A 2014 study in 221 people found those with severe vitamin D deficiency were more likely to have higher levels of inflammatory markers that can negatively affect healing.
Adequate levels may speed up wound recovery according to Ludlam-Raine, and in a group of 60 people with diabetes-related foot ulcers, those who took vitamin D supplements over the course of 12 weeks experienced significant wound healing improvements compared with the placebo group.
“Some people are more at risk of having very low levels, especially the elderly, the institutionalised, those physically confined to their home, and people with darker skin who are living in darker climates, as we are in UK,” Grossman notes.
There seems to be a connection between vitamin D deficiency and hair loss, particularly in conditions like alopecia areata, says Ludlam-Raine. “Alopecia areata is an immune disease characterised by severe hair loss. In one study, 48 people who suffered with the condition found that applying a synthetic form of vitamin D topically (over 12 weeks) reported a significant increase in hair regrowth.”
In another separate review, higher vitamin D levels were connected to less hair loss.
The most likely reason for the scales creeping up is you’re consuming more calories than your body actually needs rather than lacking any vitamin. However, Grossman says “there is some evidence that in patients with ‘pre-diabetes’, empiric treatment [supplementation] may slightly slow down the progression to diabetes”.
Ludlam-Raine notes: “Many people living with obesity do have low levels of vitamin D. The relationship between vitamin D and weight gain isn’t fully understood, and the supplementation’s effects on weight loss require more research.”
As well as through sunlight (ideally in the earlier part of the day) or supplementation, we can boost our levels through our diet. Ludlam-Raine recommends the following tips to up our intake:
UV-exposed mushrooms: Mushrooms placed in sunlight for a couple of hours before cooking naturally have boosted vitamin D content.
Fortified plant-based milks: Many almond, soya, oat, and other plant-based milks are fortified with vitamin D (it will be listed on the label, but the organic plant milks do not usually have added vitamins).
Fortified dairy milks: Some dairy brands, such as McQueens Dairies’ vitamin D-enriched semi-skimmed milk, offer extra vitamin D too.
Fortified cereals: Many breakfast cereals (even Coco Pops) also contain added vitamin D.
Egg yolks: A rich source, especially if the hens are free-range and exposed to sunlight.
Oily fish: Salmon, mackerel and sardines are one of the best sources, and tinned versions are non-perishable. Red meat and liver particularly are high in vitamin D.