The darker season is almost here. In autumn and winter the skin produces less vitamin D from sunlight, so it is worth checking whether you are getting enough and whether a blood test is necessary in your case.
Asking for a blood test to measure vitamin D levels has become something of a trend in recent years. Most healthy people, however, do not need a blood test before starting a vitamin D supplement. A preventive dose taken from autumn to spring is usually enough to keep the level safely within the normal range.
A preventive dose is enough for a healthy person
At Estonia’s latitude, a healthy adult usually needs only 1000–2000 IU (25–50 µg) of vitamin D per day as a supplement from September to April (the months with an “r” in their name). No blood test is needed beforehand. From May to August a healthy person usually gets enough from the sun.
The right dose is not the same for everyone. It depends on your age, your state of health and how much vitamin D you get from food and sunlight. When choosing a supplement, follow the recommendation on the package or the advice of a healthcare professional.
More is not always better
The European Food Safety Authority (EFSA) considers up to 4000 IU (100 µg) per day safe for a healthy adult. Higher doses should not be taken on your own for long periods: too much vitamin D can raise the blood calcium level, and in some conditions (for example sarcoidosis, an overactive parathyroid gland or severe kidney disease) even a smaller dose may be too much. Therapeutic doses are prescribed and monitored by a doctor.
How to improve the absorption of vitamin D
Vitamin D is fat-soluble, so its absorption depends on how and when you take it.
- Take it with a meal that contains fat. A breakfast or lunch with healthy fats (nuts, seeds, avocado, eggs, butter, oily fish, olive oil) improves absorption.
- Prefer oil-based capsules or drops. Gel capsules or oil drops (coconut, hemp or olive oil based) help the active ingredient absorb better.
- Take it in the first half of the day. Taken in the evening, vitamin D may disturb the production of melatonin, the sleep hormone, in some people.
- Keep an eye on magnesium and vitamin K2. Magnesium is needed to activate vitamin D in the body. Vitamin K2 helps direct absorbed calcium to the bones and teeth.
When should you discuss a test with a doctor?
It is worth discussing the need for a blood test with a doctor mainly if:
- your vitamin D level has been low before;
- you have a chronic illness or take long-term medication;
- you take higher doses than usual.
Below are the situations in which a test is medically justified.
When is a blood test medically justified?
If you have health problems, ask your doctor whether a blood test is needed. A test is indicated when there is a specific disease, an absorption disorder or a risk factor.
1. Disorders of bone and mineral metabolism
- Osteoporosis and osteopenia. When bone density is reduced, the exact vitamin D level is needed to set the correct treatment dose.
- Frequent fractures. Especially after minor injuries or in older people.
- Unexplained joint, muscle or bone pain. Severe vitamin D deficiency can cause softening of the bones (osteomalacia) or chronic muscle weakness.
2. Absorption disorders and digestive diseases
- Coeliac disease and inflammatory bowel diseases (Crohn’s disease, ulcerative colitis).
- The state after bariatric (weight-loss) surgery.
- Chronic liver diseases or pancreatic insufficiency.
3. Long-term use of certain medicines
- Glucocorticosteroids, for example long-term prednisolone treatment.
- Anti-epileptic medicines.
- Certain antifungal and weight-loss medicines.
4. Kidney and liver failure
Vitamin D is converted into its active hormone form only in the liver and kidneys. In severe kidney or liver failure, monitoring of the level is needed and often also the use of the active form of vitamin D according to a doctor’s prescription.
5. Severe overweight
Visceral and subcutaneous fat tissue binds vitamin D, so less of it reaches the bloodstream. With a body mass index above 30 a higher dose may be needed, and it is worth checking the level to set it.
6. Checking the effectiveness and safety of treatment
- If a test has previously shown a severe deficiency and a doctor has prescribed a treatment dose, a repeat test is done after 3–6 months to confirm that the level has recovered.
- If high doses are taken for a long time, to rule out overdose and hypercalcaemia, i.e. a too-high blood calcium level.
Summary
If you have none of the health problems or symptoms listed above, it is enough to take a preventive dose of 1000–2000 IU (25–50 µg) per day from autumn to spring with a meal containing fat. No blood test is needed for this.
If something on the list above applies to you, your vitamin D level has been low before or you take higher doses, discuss the need for a test with a doctor or pharmacist. At Valvekliinik you can have a blood test without a referral if needed and go through the results with a doctor.
Frequently asked questions
Most healthy people do not need it. A preventive dose of 1000–2000 IU (25–50 µg) per day from September to April keeps the level in the safe range without a test. A test is needed in the case of a specific disease, an absorption disorder or a risk factor, and also if the level has been low before or you take higher doses.
A healthy person does not need one. You can start the usual preventive dose in September without a prior test. If you have a chronic illness, take long-term medication or suspect a vitamin D deficiency, ask a doctor or pharmacist about the right dose and whether a test is needed.
A healthy adult: 1000–2000 IU (25–50 µg) per day from autumn to spring. EFSA considers up to 4000 IU (100 µg) per day safe for a healthy adult. This does not apply to everyone: in sarcoidosis, an overactive parathyroid gland or severe kidney disease even a smaller dose may be too much. Treatment doses are prescribed by a doctor and taken under medical supervision.
In the first half of the day, with a breakfast or lunch that contains fat. Taken in the evening, it may disturb melatonin production in some people.
From May to August a healthy person usually gets the necessary amount from the sun. Supplements are usually started again in September.
This article is general health information and does not replace a doctor’s assessment. If you have an illness, take long-term medication or use higher doses, consult a doctor or pharmacist.
References
- Demay MB et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2024;109(8):1907–1947. https://doi.org/10.1210/clinem/dgae290
- Holick MF et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2011;96(7):1911–1930. academic.oup.com
- EFSA NDA Panel. Dietary reference values for vitamin D. EFSA Journal 2016;14(10):4547. www.efsa.europa.eu
- Volke V. New guideline on the use of vitamin D for disease prevention (in Estonian). Eesti Arst, 2024. eestiarst.ee
- Tartu University Hospital United Laboratories. Laboratory handbook: Vitamin D (25-OH), S,P-Vit D (25-OH) (in Estonian). www.kliinikum.ee
- SYNLAB Estonia. Laboratory diagnostics of vitamin D (in Estonian). synlab.ee
- Dawson-Hughes B et al. Dietary Fat Increases Vitamin D-3 Absorption. J Acad Nutr Diet 2015;115(2):225–230. pubmed.ncbi.nlm.nih.gov
