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Vitamin D Deficiency: Causes, Symptoms, Diagnosis & Treatment

With inputs from Dr Abhishtita Mudunuri

Updated on: November 2023

With inputs from Dr Abhishtita Mudunuri

Updated on: November 2023

Reviewed by Dr Raja Indana

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Table of contents

Vitamin D deficiency is a common health issue, but it is also one of the most ignored ones too.

Did you know that vitamin D deficiency is associated with cardiovascular diseases, hypertension, diabetes, infections, weak immune system, certain neuropsychiatric disorders, and multiple sclerosis? I bet you didn’t.

Here are some other interesting facts and statistics:

Indians are vitamin D deficient — nearly 76% of our population suffers from vitamin D deficiency. To put that into perspective, every 7 to 8 people (out of every 10 people) you meet daily are vitamin D deficient. In fact, this condition is so prevalent that it has become a public health concern of epidemic proportions.

Further, we like to believe that diet can solve all our problems. But, no, that’s not how it works. Diet alone cannot solve your problem. There’s more to it. That brings us to an important question — even though we know about vitamin D and its deficiency, how much do we actually diagnose it. And do we diagnose it?

Let’s find out. In this guide, we’ll cover:

All about vitamin D & its deficiency
Signs and symptoms
Risk factor
Diagnosis
Treatment
Vitamin D Self Assessment Tracker
The link between vitamin D, diabetes, and Covid-19 and
Some interesting FAQs and more

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Chapter 1: What is vitamin D deficiency?

It is a medical condition where vitamin D (or serum-25 hydroxyvitamin D [25(OH)D]) levels in your blood drop below 30 ng/ml.

A severe vitamin D deficiency increases your risk of osteomalacia (or nutritional rickets). It’s a medical condition that causes your bones to become soft. In infants, it causes the bowing of bones, especially in the weight-bearing bones of the legs. And in adults, osteomalacia increases the risk and cause of bone deformities.

If you are someone with a darker skin complexion and spend most of your time indoors, or if you are older than 65, it’s advisable to get your vitamin D levels checked. Why is this important? We will discuss this in a little while (Check who is at risk for vitamin D deficiency chapter).

Chapter 2: What are the causes of vitamin D deficiency?

Following are some causes of vitamin D deficiency:

Lack of a balanced diet: Not including a balanced diet rich in oily fish, red meat, liver, mushrooms, and other dairy products can lead to vitamin D deficiency.
Not getting enough sunlight: Vitamin D is synthesized when your skin is exposed to UV B rays from the sun. Not getting enough sunlight early in the morning or late evening can cause vitamin D deficiency.
Diseases: Following medical conditions or diseases can cause malabsorption or decreased absorption of vitamin D and cause its deficiency:
Celiac disease
- Crohn’s disease
- Cystic fibrosis
- Weight loss surgeries
- Intestinal surgeries
Your body is unable to convert vitamin D to its active form: Kidney or liver diseases can interfere with vitamin D absorption causing its deficiency.
You are on medications that interfere with your body’s ability to absorb vitamin D: Following drugs or substances can cause vitamin D deficiency.
- Aluminum and magnesium-containing antacids (medication for heartburn and acidity)
- Alcohol
- Tobacco
- ARVs (medications for HIV)
- Barbiturates (medications for seizures, insomnia, etc)
- Corticosteroids (medication for inflammation)
- Hydroxychloroquine (medication to treat rheumatoid arthritis, malaria, and lupus)

vitamin d deficiency india

Chapter 3: What are the symptoms of vitamin D deficiency?

Following are some symptoms of vitamin D deficiency in babies, children, and adults.

In babies and children

Rickets (formation of weak and soft bones)
Bow-legs
Pain in the lower limbs and muscles
Calcium imbalance leading to
- Tetany (involuntary muscle contractions)
- Cardiomyopathy (a condition wherein your heart is unable to pump blood efficiently)
- Seizures

In adults

Symptoms of vitamin D deficiency are not very obvious in adults. Signs and symptoms include

Fatigue
Bone pain
Mood swings
Muscle cramps
Hair Loss
Osteoporosis or brittle bones
Osteomalacia (softening of bones)

Chapter 4: Diagnosis

Diagnosis of vitamin D involves a simple blood test that checks for abnormalities in your vitamin D levels. Vitamin D exists in two main forms. They are

Vitamin D2 (ergocalciferol or pre-vitamin D): It’s a fat-soluble vitamin that comes from plant sources. They are not synthesized in the skin.
Vitamin D3 (cholecalciferol): It’s a fat-soluble vitamin that comes from either animal sources or is synthesized in the skin.

Why is a vitamin D test done?

A Vitamin D test is done to

Screen for bone disorders
Routine health checkups
Monitor chronic illnesses such as asthma, psoriasis, and other autoimmune diseases

Why do I need a vitamin D test?

Your doctor may prescribe a vitamin D test if you have vitamin D deficiency symptoms. These symptoms include

Weakness in the bones
Soft bones
Malformation of bones, especially in children
Fractures

Or, the test may be performed if you are at a higher risk for vitamin D deficiency. Risk factors include

Osteoporosis
Gastric bypass surgery
Obesity
Little or lack of exposure to sunlight
Having darker skin color
Difficulty absorbing fat in your diet

How to book an online vitamin D test using the MFine app?

You can now book your vitamin D test using the MFine mobile app.

To book a lab test,

Login to the MFine app
Click on the “Lab Tests” icon (You can find this on the top of your screen)
In the search bar, type “Vitamin D”
Add the blood test
Select the lab partner of your choice
Select a date and time slot for your blood test
Provide your name and address
Make the payment, and you are good to go

One of our lab partners will then get in touch with you shortly to collect the blood sample.

MFine provides a digital platform for you to consult a doctor, all from the comfort of your home. You can chat with them or talk to them over a video call. You can also order medicines online using the MFine mobile app.

Download the MFine app now!

What are the risks associated with the vitamin D deficiency test?

There are no known risks associated with a vitamin D test.

When the needle is injected, you may feel a slight sting, but the pain goes away almost immediately.

All our lab technicians are Covid-19 vaccinated and follow proper hygiene such as wearing gloves, sanitizing the injection site, etc.

What is the test procedure to measure vitamin D deficiency?

During the test, the phlebotomist will draw blood from your vein. You may feel a little uncomfortable, but the procedure is over quickly.

After that, your blood sample is sent to an accredited lab of your choice.

Qualified lab technicians will then analyze your blood sample for abnormalities and prepare your report accordingly. Your report will be updated on the MFine app within 72 hours.

How to prepare for the test?

A vitamin D blood test does not require any special preparation, such as an overnight fast. Just make sure you wear a loose or half-sleeved shirt so that the phlebotomist can easily access your upper arm to draw the blood sample.

How to interpret your test results?

25 Hydroxy Vitamin D – Serum	Biological reference	Interpretation
Vitamin D	< 20 ng/ml	Deficiency
	20 – 30 ng/ml	Insufficiency
	30 – 100 ng/ml	Normal
	> 100 ng/ml	Toxicity

Chapter 5: Treatments

Treatment for vitamin D requires a combination of diet, supplements, and exposure to sunlight.

Diet for vitamin D deficiency

Following are some Indian foods rich in vitamin D.

(1) Mushrooms:

It is one of the rich sources of vitamin D. If you have a vitamin D deficiency, you can consume this four times a week.

Mushrooms are also a rich source of fiber, protein, antioxidants, and selenium. It’s also good for people with diabetes, Alzheimer’s, cancer, and heart diseases.

(2) Ricotta cheese:

Ricotta cheese when eaten in moderation can be good for your health. It has a rich source of calcium and provides 25 IU of the vitamin D.

(3) Fish:

Fatty fish such as salmon, mackerel, and tuna are rich sources of vitamin D. Fatty fish is also a good source of omega 3 fatty acids which help lower blood pressure, reduce triglycerides, slow the development of plaques in arteries, and reduce the likelihood of heart attacks and strokes.

(4) Egg:

One egg contains 37 IU of vitamin D. In addition, eggs are also highly nutritious. They are a rich source of proteins, vitamins, and minerals.

(5) Soy milk:

Soy milk is plant-based milk that’s produced by soaking, drying, and grinding soybeans in water. It has a good source of vitamin D, vitamin C, and iron.

(6) Fortified cereals:

Fortified cereals are cereals that have added vitamins and minerals in them, otherwise not present in them naturally. Therefore, when having fortified cereals, ensure that you are getting the right amount of vitamin D.

(7) Milk:

Milk is an excellent source of vitamin D. Apart from vitamin D, they’re also rich in proteins, fats, and carbohydrates.

(8) Butter:

Dietitians recommend butter for strong bones. Butter contains vitamin D and calcium required for strong bones. Apart from these, butter also contains vitamin E which plays a role in your skin health.

(9) Other food items:

Some other foods rich in vitamin D are

Avocado
Broccoli
Kiwi
Peanuts
Walnuts.

Sunlight

An excellent way to increase vitamin D levels in your body is by stepping out in the sun. Your skin synthesizes vitamin D when it’s exposed to UV B rays. In fact, doctors say it’s the best way to naturally improve your vitamin D levels.

When is the intensity of UV B at its peak?

At noon, the intensity of UV B rays from the sun is at its highest, meaning you need to spend very less time in the sun to synthesize vitamin D. But you could also injure yourself from heat and sunburns. Therefore doctors recommend getting 20 to 30 minutes of sunlight every day between 10 am to 1 pm for maximal absorption. But sometimes it may be difficult to get sunlight every day due to work or other family commitments. If that’s the case, we recommend taking short D – Breaks between 10 am to 1 pm, i.e., a short 15-minute break in between your busy schedule or office hours, just like you’d take a tea break. This will help improve your vitamin D levels in the longer run.

Vitamin D supplements

Another way to meet your daily requirement for vitamin D is by taking vitamin D supplements. You can take this in the form of

Multivitamin tablets
Vitamin D tablets or capsules
Injections
Cod liver oil capsules

What to look for in vitamin D supplements?

When taking supplements look at the labels for the following:

Vitamin D2
Vitamin D3
Expiry date

Who should take vitamin D supplements?

Doctors recommend vitamin D supplements for the following group of people:

People who don’t get enough sun
Senior citizens above 65 years
Obese people
Dark-skinned people
Nursing infants drinking breast milk
People diagnosed with osteoporosis

How much vitamin D do you need?

A person’s daily dose of vitamin D depends on their age and underlying health conditions. Here are some guidelines to consider.

Age	Daily requirement of vitamin D
0 – 12 months	400 IU
1 – 18 years	600 IU
19 – 70 years	600 IU
Above 70 years	800 IU

Caution: Do not self-medicate. Doing so may cause vitamin D toxicity which can be injurious to your health. Always consult your doctor before taking any vitamin D supplement.

Consult a doctor now!

Chapter 6: Who is at risk for vitamin D deficiency?

Following people are at a higher risk for vitamin D deficiency than others:

Elderly: The efficiency of your skin to synthesize vitamin D decreases with age. People over 65 years of age are at a higher risk for vitamin D deficiency. Further, with age, they are also prone to other diseases that can hamper vitamin D absorption in the body.
People who spend most of their time indoors: People missing the first rays of the sun are at risk for vitamin D deficiency. If you cannot wake up early in the morning for reasons such as health, or work, you could instead step out in the sun in the early evenings between 4 pm and 5 pm to receive your daily dose of healthy sunshine.
People with dark skin: People with darker skin complexion tend to have more melanin in their skin than light-skinned people. Melanin is a skin pigment that shields people from harmful UV rays of the sun. But in the process of doing so may also interfere with the synthesis of vitamin D from the skin. If you have darker skin, consider getting your daily dose of vitamin D through diet or supplements.
People with medical conditions: Sometimes, despite taking all precautions, people can still suffer from vitamin D deficiency due to certain medical conditions that either prevent vitamin D from being absorbed efficiently into the system or due to vitamin D not being converted to its active form.
Obese people: People who are obese are less able to convert vitamin D to its active hormonal form, leading to its deficiency.

Chapter 7: Why do I need vitamin D?

Vitamin D, also called the sunshine vitamin, is a fat-soluble vitamin required for our:

Growth and development:

Vitamin D helps absorb calcium and phosphate from the small intestines. These minerals play an important role in

Building strong bones and teeth
Regulating heartbeat
Regulating the secretion of certain hormones such as parathyroid hormones
Regulation of nerve functioning
Muscle contraction and relaxation
Building cell membranes
Building DNA etc

Metabolism and weight loss:

A study has shown that women who met their daily requirement for vitamin D experienced more weight loss over one year, losing an average of 3.2 kg more than other women who were vitamin D deficient. Several theories have attempted to explain this weight loss and some studies suggest that:

Vitamin D potentially reduces the formation of new fat cells in the body, and
They also suppress the storage of fat cells, or
It could be that by regulating serotonin levels, vitamin D helps you feel fuller after meals, which could trigger weight loss. Serotonin is a neurotransmitter that affects everything from sleep to your emotions and behavior.

Immunity:

Before antibiotics came into use, vitamin D was largely used to treat tuberculosis (unknowingly). Treatment included exposing patients to sunlight, which was thought to kill the tuberculosis bacteria directly. Even today, cod liver oil, a rich source of vitamin D, is widely used to prevent vitamin D deficiency and hence prevent respiratory infections.

Bone health:

Vitamin D is absolutely necessary for our bone health. Without vitamin D, our bodies wouldn’t be able to effectively absorb calcium (a mineral essential for the development of bones and muscles) from our small intestines. Children who lack vitamin D, develop rickets, weak bones, bowed legs, and other skeletal disorders. Adults who lack vitamin D develop osteoporosis.

Mental health:

Did you know that people seeking treatment for depression are very often asked to have their vitamin D levels checked? Vitamin D deficiency levels have been associated with depression, PMS in women and cognitive impairments in older adults. So the next time you feel depressed, consider stepping out early in the morning to get some sun. You will feel better.

Chapter 8: How often should one check vitamin D levels?

Getting checked for serum-25 hydroxyvitamin D levels is not recommended for everyone unless otherwise specified by your doctor. But if you are on treatment for any condition where you are prescribed vitamin D supplements, then your doctor may ask you to recheck your vitamin D levels after three months.

Also, please note, do not self-medicate yourself. Overconsumption of vitamin D supplements can cause vitamin D toxicity. For people who think they require supplements, it’s better you speak with a doctor first.

Want to consult a doctor online or book a lab test? Try the MFine app. At MFine, you can chat, call, or video call with one of our doctors available online at affordable rates.

Download the MFine app now!

Chapter 9: What is vitamin D toxicity?

Vitamin D toxicity (or hypervitaminosis D) is a serious medical condition that occurs due to excess vitamin D in your body. i.e., when your vitamin D levels exceed 100 ng/ml.

It occurs due to excessive consumption of vitamin D supplements and not by diet or sun exposure.

While sun exposure regulates your production of vitamin D, your diet doesn’t contain large amounts of vitamin D.

How does vitamin D toxicity affect your health?

It causes excessive production of calcium (hypercalcemia). Excessive calcium in your body can cause

Nausea
Vomiting
Weakness
Frequent urination
Irregular heartbeat
Formation of calcium stones in your kidneys and
Bone pain

Chapter 10: What is the link between low vitamin D levels and diabetes?

Vitamin D plays an important role in the secretion and regulation of insulin
Vitamin D also plays an important role in the protection of beta cells (pancreatic cells that secrete insulin) from cytokines (a form of immune cells)

We all know that type 1 diabetes is an autoimmune disease. It’s a condition where the cytokines (a form of immune cells) mistake beta cells (cells in the pancreas that secrete insulin) to be as foreign and destroy them. When beta cells are destroyed, there’s insufficient insulin secretion, causing a rise in your blood sugar levels.

But when there’s enough vitamin D in our system, the likelihood of type 1 diabetes decreases. Vitamin D protects beta cells by reducing the inflammation caused by cytokines, thereby regulating insulin secretion and lowering the likelihood of type 1 diabetes.

Chapter 11: Vitamin D and Covid-19

According to a study by David O. Meltzer et al., 2020 on vitamin D status and Covid-19, it was found that:

About 80% of people with Covid-19 were vitamin D deficient
People with Covid-19 and vitamin D deficiency also had a high number of inflammatory markers such as ferritin and D-dimer
Covid-19 patients with vitamin D deficiency had a higher prevalence of hypertension and cardiovascular disease and were more likely to stay admitted to hospitals due to Covid-19
Patients with vitamin D deficiency were more likely to have severe Covid-19 symptoms
In another study, it was found that Covid-19 patients who had normal vitamin D levels were at a 51.1% lower risk of dying from Covid-19

Read a complete guide on Covid-19.

Chapter 12: When to see a doctor?

You should consider seeing a doctor if

You experience unexplained pain in your bones, joints, and muscles
You fall sick often
You feel lethargic or weak
You feel depressed
You are diabetic
You have Irritable Bowel Syndrome
You have Crohn’s disease

Many times, it’s difficult to tell if you have vitamin D deficiency. And most people with vitamin D deficiency don’t even show any symptoms until it’s too late. Therefore, a good rule of thumb is to get a full-body check done at least once a year.

Chapter 13: Conclusion

Vitamin D is a fat-soluble vitamin present in our bodies in two different forms — D2 and D3. We get vitamin D2 from plant sources and D3 from sunlight and animal sources.

(Vitamin D2 is not synthesized in our skin).

Vitamin D is also a hormone important for our daily functioning. They are essential for the growth and development of our bones & muscles, our mental health, and our immunity.

If you are someone who keeps falling sick very often or is depressed or has unexplained pain in your bones and muscles, chances are that you may have vitamin D deficiency.

At MFine we provide affordable doctor consultations. Do explore our website or app. You can even order medicines online and book an online lab test. We provide at-home sample collection for most lab tests.

Chapter 14: Frequently Asked Questions

Could a vitamin D deficiency be the reason behind your belly fat?

No vitamin D deficiency does not cause weight gain, but obese people are more prone to vitamin D deficiency. Interestingly, a study recently showed that women with normal or sufficient vitamin D levels lost 3.2 kgs more weight than women with vitamin D deficiency over one year.

How long does it take to recover from a severe vitamin D deficiency? How soon can I start seeing the positive effect of vitamin D medication and sun exposure?

On average this can take anything between three to four months. In case it takes longer, you need to speak to your doctor to diagnose the underlying reason causing it.

Can I donate blood if I have vitamin D Deficiency?

You can donate blood irrespective of your vitamin D status provided you have no illness or communicable disease. But a doctor’s advice may be needed in such cases.

Is vitamin D deficiency common for infants?

Vitamin D deficiency is prevalent in infants worldwide as infants are less exposed to sunlight than adults.

Can vitamin D deficiency cause dark circles under the eyes?

Vitamin D deficiency along with vitamin B12, E, and K deficiencies can cause dark circles. To prevent dark circles, get good sleep, eat a balanced diet, expose yourself to the sun, and try to incorporate workouts at least 4 times a week.

Can a vitamin D deficiency cause depression?

People with depression tend to be low on vitamin D.

Vitamin D regulates your dopamine levels, a neurotransmitter (dopamine is also called the “happy hormone”). In short, yes, vitamin D deficiency can cause depression.

How long does it take to notice the effects of vitamin D deficiency?

It can take anything between 3 – 4 months or more.

However, note that most adults do not show symptoms of vitamin D deficiency until it’s too late. The only sure way to know if you have a deficiency is by getting a blood test done.

Is Your Child at Risk for vitamin D Deficiency?

Children all over the world are at risk for vitamin D deficiency. Malnutrition is the most common cause of it. If your child has soft bones or bow legs, you need to see a doctor immediately.

Can too much vitamin D be harmful?

Too much vitamin D can cause avitaminosis (or vitamin D toxicity). Symptoms include

Nausea
Vomiting
Fatigue
Irregular heartbeats
Formation of calcium stones in your kidneys

How does one become deficient in vitamin D, even if they get daily sun exposure and eat a balanced diet?

It could then be due to an underlying medical condition that’s preventing you from absorbing vitamin D. Check with your doctor if you have any of these medical conditions:

Celiac disease
Crohn’s disease
Cystic fibrosis
Obesity or
If you’ve had weight-loss surgeries

Why does vitamin D deficiency keep happening to me?

It could be due to the following reasons:

You aren’t getting enough vitamin D from your diet
You can’t absorb enough vitamin D from your diet due to a medical condition
You aren’t getting enough sunlight

It would be best if you spoke with your doctor about this.

What diseases can cause low vitamin D?

Celiac disease
Crohn’s disease
Cystic fibrosis
Obesity
Cancer

Are COVID-19 deaths linked to vitamin D deficiency?

There is a strong correlation between Covid-19 and vitamin D deficiency. People with vitamin D deficiency are more likely to have severe symptoms of Covid-19. (Check the Vitamin D and Covid-19 chapter above).

References

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