Rickets used to be a fairly common childhood disease due
to vitamin-D deficiency and lack of sunlight exposure. It led to bone
deformity, including bowed legs that are seen in some older people today.
Fortifying milk and other foods with vitamin D, along
with increased public health awareness, greatly reduced the incidence of
rickets but vitamin-D deficiency remains a problem – especially in the
Lack of vitamin D affects bone metabolism leading to
osteoporosis, muscle weakness and increased risk of fracture. Conversely, proper amounts of vitamin D may
decrease the risk of cancer, cardiovascular disease and infection.
Vitamin-D deficiency is very common in older
For several years now, I have been checking vitamin D
levels in my patients. More than half have some degree of insufficiency and
many are severely deficient. I am amazed
by how often patients who appear relatively healthy and seem to eat a balanced
diet are affected.
One problem is that older people often don’t eat the
same foods as when they were younger. Fortified milk, margarine, cereal, and
eggs, which are great sources of vitamin D for young people, are often missing
from my older patients’ diets.
The best natural dietary sources of vitamin D come from
fresh salmon (preferably wild caught) but canned fish, including salmon, tuna,
mackerel and sardines, are also rich in vitamin D.
Dried shitake mushrooms are another great source but are
usually not diet staples.
Exposure to sunlight increases skin synthesis of vitamin
A sensible amount of sun exposure to the arms and legs
would be five to 30 minutes at least three days per week. That’s enough to get
the benefit while avoiding skin damage from too much exposure.
Because many of my patients’ diets are deficient in
vitamin D, I recommend a vitamin D supplement often in combination with
calcium. For most people, 800 to 1000 units per day from supplements and
dietary sources will suffice. For those with severe deficiency, I order a
prescription dose of vitamin D for several months along with a supplement to be
If you think you may be vitamin-D deficient – many
people are – check with your doctor about getting a blood test or start taking
a supplement and spend a little more time outdoors in the sun. But don’t forget the sunscreen!
Dr. James Davis is
a board-certified geriatrician with the highly ranked UCLA Geriatrics Program
in Santa Monica and Westwood. For more information, visit www.uclahealth.org or
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