Supplements for improving nutrient absorption and utilization in the body -
Total vitamin D intakes were three times higher with supplement use than with diet alone; the mean intake from foods and beverages alone for individuals age 2 and older was 4.
Some people take very high doses of vitamin D supplements. In —, an estimated 3. adult population took supplements containing mcg 4, IU or more vitamin D [ 41 ]. One might expect a large proportion of the U. population to have vitamin D inadequacy on the basis of vitamin D intakes from foods, beverages, and even dietary supplements.
However, comparing vitamin D intakes to serum 25 OH D levels is problematic. One reason is that sun exposure affects vitamin D status, so serum 25 OH D levels are usually higher than would be predicted on the basis of vitamin D dietary intakes alone [ 1 ].
Another reason is that animal foods contain some 25 OH D. This form of vitamin D is not included in intake surveys and is considerably more potent than vitamins D 2 or D 3 at raising serum 25 OH D levels [ 42 ]. An analysis of NHANES — data on serum 25 OH D levels found that most people in the United States age 1 year and older had sufficient vitamin D intakes according to the FNB thresholds [ 43 ].
Proportions at risk of deficiency were lowest among children age 1—5 years 0. Rates of deficiency varied by race and ethnicity: Again, the pattern was similar for the risk of inadequacy. Vitamin D status in the United States remained stable in the decade between — and — People can develop vitamin D deficiency when usual intakes are lower over time than recommended levels, exposure to sunlight is limited, the kidneys cannot convert 25 OH D to its active form, or absorption of vitamin D from the digestive tract is inadequate.
Diets low in vitamin D are more common in people who have milk allergy or lactose intolerance and those who consume an ovo-vegetarian or vegan diet [ 1 ]. In children, vitamin D deficiency is manifested as rickets, a disease characterized by a failure of bone tissue to become properly mineralized, resulting in soft bones and skeletal deformities [ 44 ].
In addition to bone deformities and pain, severe rickets can cause failure to thrive, developmental delay, hypocalcemic seizures, tetanic spasms, cardiomyopathy, and dental abnormalities [ 45 , 46 ]. Prolonged exclusive breastfeeding without vitamin D supplementation can cause rickets in infants, and, in the United States, rickets is most common among breastfed Black infants and children [ 47 ].
In one Minnesota county, the incidence rate of rickets in children younger than 3 years in the decade beginning in was Rickets occurred mainly in Black children who were breastfed longer, were born with low birthweight, weighed less, and were shorter than other children.
The incidence rate of rickets in the infants and children younger than 7 seen by 2, pediatricians throughout Canada was 2. The fortification of milk a good source of calcium and other staples, such as breakfast cereals and margarine, with vitamin D beginning in the s along with the use of cod liver oil made rickets rare in the United States [ 28 , 50 ].
However, the incidence of rickets is increasing globally, even in the United States and Europe, especially among immigrants from African, Middle-Eastern, and Asian countries [ 51 ].
Possible explanations for this increase include genetic differences in vitamin D metabolism, dietary preferences, and behaviors that lead to less sun exposure [ 45 , 46 ]. In adults and adolescents, vitamin D deficiency can lead to osteomalacia, in which existing bone is incompletely or defectively mineralized during the remodeling process, resulting in weak bones [ 46 ].
Signs and symptoms of osteomalacia are similar to those of rickets and include bone deformities and pain, hypocalcemic seizures, tetanic spasms, and dental abnormalities [ 45 ].
Screening for vitamin D status is becoming a more common part of the routine laboratory bloodwork ordered by primary-care physicians, irrespective of any indications for this practice [ 6 , ].
No studies have examined whether such screening for vitamin D deficiency results in improved health outcomes [ 55 ]. Preventive Services Task Force USPSTF found insufficient evidence to assess the benefits and harms of screening for vitamin D deficiency in asymptomatic adults [ 6 ].
It added that no national professional organization recommends population screening for vitamin D deficiency. Obtaining sufficient vitamin D from natural nonfortified food sources alone is difficult.
For many people, consuming vitamin D-fortified foods and exposing themselves to some sunlight are essential for maintaining a healthy vitamin D status.
However, some groups might need dietary supplements to meet their vitamin D requirements. The following groups are among those most likely to have inadequate vitamin D status. Consumption of human milk alone does not ordinarily enable infants to meet vitamin D requirements, because it provides less than 0.
Although UVB exposure can produce vitamin D in infants, the American Academy of Pediatrics AAP advises parents to keep infants younger than 6 months out of direct sunlight, dress them in protective clothing and hats, and apply sunscreen on small areas of exposed skin when sun exposure is unavoidable [ 59 ].
An analysis of NHANES — data found that only Older adults are at increased risk of developing vitamin D insufficiency, partly because the skin's ability to synthesize vitamin D declines with age [ 1 , 61 ]. In addition, older adults are likely to spend more time than younger people indoors, and they might have inadequate dietary intakes of the vitamin [ 1 ].
Homebound individuals; people who wear long robes, dresses, or head coverings for religious reasons; and people with occupations that limit sun exposure are among the groups that are unlikely to obtain adequate amounts of vitamin D from sunlight [ 62 ].
The use of sunscreen also limits vitamin D synthesis from sunlight. However, because the extent and frequency of sunscreen use are unknown, the role that sunscreen may play in reducing vitamin D synthesis is unclear [ 1 ].
Black Americans, for example, typically have lower serum 25 OH D levels than White Americans. However, whether these lower levels in persons with dark skin have significant health consequences is not clear [ 14 ].
Those of African American ancestry, for example, have lower rates of bone fracture and osteoporosis than do Whites see the section below on bone health and osteoporosis. In addition to having an increased risk of vitamin D deficiency, people with these conditions might not eat certain foods, such as dairy products many of which are fortified with vitamin D , or eat only small amounts of these foods.
Individuals who have difficulty absorbing dietary fat might therefore require vitamin D supplementation [ 63 ]. Individuals with a body mass index BMI of 30 or more have lower serum 25 OH D levels than individuals without obesity.
However, greater amounts of subcutaneous fat sequester more of the vitamin [ 1 ]. People with obesity might need greater intakes of vitamin D to achieve 25 OH D levels similar to those of people with normal weight [ 1 , 64 , 65 ]. Individuals with obesity who have undergone gastric bypass surgery can also become vitamin D deficient.
In this procedure, part of the upper small intestine, where vitamin D is absorbed, is bypassed, and vitamin D that is mobilized into the bloodstream from fat stores might not raise 25 OH D to adequate levels over time [ 66 , 67 ].
Various expert groups—including the American Association of Metabolic and Bariatric Surgery, The Obesity Society, and the British Obesity and Metabolic Surgery Society—have developed guidelines on vitamin D screening, monitoring, and replacement before and after bariatric surgery [ 66 , 68 ].
The FNB committee that established DRIs for vitamin D found that the evidence was inadequate or too contradictory to conclude that the vitamin had any effect on a long list of potential health outcomes e.
Similarly, in a review of data from nearly studies published between and , the Agency for Healthcare Research and Quality concluded that no relationship could be firmly established between vitamin D and health outcomes other than bone health [ 69 ].
However, because research has been conducted on vitamin D and numerous health outcomes, this section focuses on seven diseases, conditions, and interventions in which vitamin D might be involved: bone health and osteoporosis, cancer, cardiovascular disease CVD , depression, multiple sclerosis MS , type 2 diabetes, and weight loss.
Most of the studies described in this section measured serum 25 OH D levels using various methods that were not standardized by comparing them to the best methods.
Use of unstandardized 25 OH D measures can raise questions about the accuracy of the results and about the validity of conclusions drawn from studies that use such measures and, especially, from meta-analyses that pool data from many studies that use different unstandardized measures [ 5 , 9 , 70 ].
More information about assay standardization is available from the Vitamin D Standardization Program webpage. Bone is constantly being remodeled. However, as people age—and particularly in women during menopause—bone breakdown rates overtake rates of bone building.
Over time, bone density can decline, and osteoporosis can eventually develop [ 71 ]. More than 53 million adults in the United States have or are at risk of developing osteoporosis, which is characterized by low bone mass and structural deterioration of bone tissue that increases bone fragility and the risk of bone fractures [ 72 ].
About 2. Osteoporosis is most often associated with inadequate calcium intakes, but insufficient vitamin D intakes contribute to osteoporosis by reducing calcium absorption [ 1 ].
Bone health also depends on support from the surrounding muscles to assist with balance and postural sway and thereby reduce the risk of falling.
Vitamin D is also needed for the normal development and growth of muscle fibers. In addition, inadequate vitamin D levels can adversely affect muscle strength and lead to muscle weakness and pain myopathy [ 1 ].
Most trials of the effects of vitamin D supplements on bone health also included calcium supplements, so isolating the effects of each nutrient is difficult.
In addition, studies provided different amounts of nutrients and used different dosing schedules. Among postmenopausal women and older men, many clinical trials have shown that supplements of both vitamin D and calcium result in small increases in bone mineral density throughout the skeleton [ 1 , 74 ].
They also help reduce fracture rates in institutionalized older people. However, the evidence on the impact of vitamin D and calcium supplements on fractures in community-dwelling individuals is inconsistent.
It concluded that the current evidence was insufficient to evaluate the benefits and harms of supplementation to prevent fractures. In addition, the USPSTF recommended against supplementation with 10 mcg IU or less of vitamin D and 1, mg or less of calcium to prevent fractures in this population, but it could not determine the balance of benefits and harms from higher doses.
The USPSTF also reviewed the seven published studies on the effects of vitamin D supplementation two of them also included calcium supplementation on the risk of falls in community-dwelling adults age 65 years or older who did not have osteoporosis or vitamin D deficiency.
It concluded with moderate certainty that vitamin D supplementation does not reduce the numbers of falls or injuries, such as fractures, resulting from falls [ 77 , 78 ]. Another recent systematic review also found that vitamin D and calcium supplements had no beneficial effects on fractures, falls, or bone mineral density [ 79 , 80 ].
The mean age of all participants was Most participants were vitamin D sufficient; at baseline, only 2. Vitamin D supplementation did not lower the risk of total fractures, hip fractures, or nonvertebral fractures as compared with placebo.
No substantial between-group differences in fracture incidence were found by race, ethnic group, BMI, age, baseline 25 OH D levels, or whether participants took supplemental calcium, were at high fracture risk, or had a history of fragility fractures.
Bone mineral density, bone mass, and fracture risk are correlated with serum 25 OH D levels in White Americans and Mexican Americans, but not in Black Americans [ 14 , 83 ].
Factors such as adiposity, skin pigmentation, vitamin D binding protein polymorphisms, and genetics contribute to differences in 25 OH D levels between Black and White Americans. One clinical trial randomized Black women age 60 years and older mean age The results showed no association between 25 OH D levels or vitamin D dose and the risk of falling in the participants who completed the study.
In fact, Black Americans might have a greater risk than White Americans of falls and fractures with daily vitamin D intakes of 50 mcg 2, IU or more [ 14 ]. Studies examining the effects of supplemental vitamin D on muscle strength and on rate of decline in muscle function have had inconsistent results [ 55 ].
One recent clinical trial, for example, randomized 78 frail and near-frail adults age 65 years and older to receive 20 mcg IU vitamin D 3 , 10 mcg 25 OH D, or placebo daily for 6 months.
The groups showed no significant differences in measures of muscle strength or performance [ 85 ]. All adults should consume recommended amounts of vitamin D and calcium from foods and supplements if needed.
Older women and men should consult their health care providers about their needs for both nutrients as part of an overall plan to maintain bone health and to prevent or treat osteoporosis.
Laboratory and animal studies suggest that vitamin D might inhibit carcinogenesis and slow tumor progression by, for example, promoting cell differentiation and inhibiting metastasis. Vitamin D might also have anti-inflammatory, immunomodulatory, proapoptotic, and antiangiogenic effects [ 1 , 87 ].
Observational studies and clinical trials provide mixed evidence on whether vitamin D intakes or serum levels affect cancer incidence, progression, or mortality risk. Some observational studies show associations between low serum levels of 25 OH D and increased risks of cancer incidence and death.
In a meta-analysis of 16 prospective cohort studies in a total of , participants who had 8, diagnoses of cancer, 5, participants died from cancer [ 88 ]. Importantly, not all observational studies found higher vitamin D status to be beneficial, and the studies varied considerably in study populations, baseline comorbidities, and measurement of vitamin D levels.
Clinical trial evidence provides some support for the observational findings. The study reports included 3—10 years of follow-up data. The study included 25, men age 50 years and older and women age 55 years and older who had no history of cancer, and most had adequate serum 25 OH D levels at baseline.
Rates of breast, prostate, and colorectal cancer did not differ significantly between the vitamin D and placebo groups. However, normal-weight participants had greater reductions in cancer incidence and mortality rates than those with overweight or obesity.
A few studies have examined the effect of vitamin D supplementation on specific cancers. Below are brief descriptions of studies of vitamin D and its association with, or effect on, breast, colorectal, lung, pancreatic, and prostate cancers. Some observational studies support an inverse association between 25 OH D levels and breast cancer risk and mortality, but others do not [ ].
The Women's Health Initiative clinical trial randomized 36, postmenopausal women to receive IU vitamin D 3 plus 1, mg calcium daily or a placebo for a mean of 7 years [ 98 ]. You need both soluble and insoluble fibers to help your system digest food at the right rate — not too slow, not too fast.
Supplemental fiber products help with digestion, as do products that have added ingredients such as inulin, which encourages the growth of beneficial bacteria—probiotics.
In other words, prebiotics fiber lead to greater amounts of probiotics the bacteria that helps break down your high protein diet. These are only some of the most important ways you can assist digestion.
Also consider adding ginger to calm your stomach, glutamine to promote more efficient and pleasant digestion, and zinc carnosine, a compound that helps your body quickly repair your intestinal mucosa, which is damaged by every meal you eat. There is a method behind the muscle, as biologist and researcher Keith Barr, Ph.
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Read article. In cases where gallstones or inflammation become severe, the gallbladder may need to be removed. This procedure can alter the dynamics of bile release and also affect nutrient absorption. Bitter foods and herbal bitters are known for their ability to stimulate the production of bile.
Bile, stimulated by bitter foods, emulsifies fats, breaking them down into smaller particles for better absorption. When fat is better absorbed via bile, the body can then properly absorb fat-soluble vitamins.
Including bitter foods in your diet or taking an herbal bitter supplement before meals may support better digestion and nutrient absorption.
Your gut bacteria has a bidirectional relationship with vitamins and minerals. For example, certain nutrients can affect the diversity and composition of your gut microbiome. On the other hand, gut bacteria can influence nutrient absorption and even produce essential vitamins like vitamin K and biotin.
Dysbiosis is when there is an imbalance of gut bacteria. This can cause many other problems downstream, but it can also negatively affect nutrient absorption. Eating an anti-inflammatory diet rich in fruits, vegetables, nuts, seeds, and whole grains while limiting added sugar can support the growth of healthy gut bacteria.
We also recommend one of our most commonly used probiotics, MegaSporeBiotic. Read more about our favorite soil-based probiotic. Synergistic Nutrient Absorption Certain nutrients enhance each other's absorption and effectiveness. For example, vitamin C enhances the absorption of iron.
If you want to increase iron or ferritin levels , pairing an iron-rich food with a source of vitamin C like citrus or tomatoes will optimize iron absorption and transport.
Furthermore, Vitamin D3 and vitamin K2 are crucial for bone health, as they work together to regulate calcium metabolism and direct calcium into the bones instead of the arteries. This is why we include vitamin K2 in our vitamin D drops.
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