Vitamin D and Health: Evolution, Biologic Functions, and Recommended Dietary Intakes for Vitamin D

  • Michael F. HolickEmail author
Original Paper


Vitamin D deficiency is now being recognized as one of the most common medical conditions worldwide. The consequences of vitamin D deficiency include poor bone development and health as well as increased risk of many chronic diseases including type I diabetes; rheumatoid arthritis; Crohn’s disease; multiple sclerosis; heart disease; stroke; infectious diseases; as well as increased risk of dying of many deadly cancers including colon, prostate, and breast. The major source of vitamin D for most humans is exposure to sunlight. However, avoidance of sun exposure has resulted in an epidemic of vitamin D deficiency. Once vitamin D is made in the skin or ingested from the diet, it requires activation steps in the liver and kidney to form 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D. 25(OH)D is the major circulating form of vitamin D used by clinicians to determine a patient’s vitamin D status. A blood level of 25(OH)D <20 ng/ml is considered to be vitamin D deficient whereas a level 21–29 ng/ml is insufficient, and to maximize vitamin D’s effect for health, 25(OH)D should be >30 ng/ml. Vitamin D intoxication will not occur until a blood level of 25(OH)D exceeds 150–200 ng/ml. Both the adequate intake recommendations and safe upper limits for vitamin D are woefully underestimated. For every 100 IU of vitamin D ingested, the blood level of 25(OH)D increases by 1 ng/ml. Thus, children during the first year of life need at a minimum 400 IU of vitamin D/day and 1,000 IU of vitamin D/day may be more beneficial and will not cause toxicity. The same recommendation can be made for children 1 year and older. For adults, a minimum of 1,000 IU of vitamin D/day is necessary and 2,000 IU of vitamin D/day is preferred if there is inadequate sun exposure. The safe upper limit for children can easily be increased to 2,000 IU of vitamin D/day, and for adults, up to 10,000 IU of vitamin D/day has been shown to be safe. The goal of this chapter is to give a broad perspective about vitamin D and to introduce the reader to the vitamin D deficiency pandemic and its insidious consequences on health that will be reviewed in more detail in the ensuing chapters.


Blood Level Kidney Stone Rickets Intestinal Calcium Absorption Calcium Citrate 
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This work was supported in part by NIH grant UL1RRO 25771 and the UV Foundation.


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© Humana Press Inc. 2009

Authors and Affiliations

  1. 1.Vitamin D, Skin and Bone Research Laboratory, Section of Endocrinology, Nutrition, and Diabetes, Department of MedicineBoston University School of Medicine, Boston University Medical CenterBostonUSA

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