Vitamin D deficiency: symptoms, foods and when tablets help
Vitamin D deficiency often causes tiredness, bone and muscle aches, back or leg pain and weakness, though many people feel nothing. Very few foods contain it (oily fish, egg yolk, liver, fortified milk), so sunlight and, when a blood test shows deficiency, prescribed tablets are the usual answer.
Vitamin D levels on a lab report
| 25(OH)D level | Usually means |
|---|---|
| Below 12 ng/mL (30 nmol/L) | Deficient: linked to bone disease |
| 12 to 20 ng/mL (30 to 50 nmol/L) | Insufficient for some people |
| 20 to 50 ng/mL (50 to 125 nmol/L) | Adequate for bone and general health |
| Above 50 ng/mL | No added benefit; above 100 can cause harm |
Cut-offs from the US Institute of Medicine. Labs differ, so compare with the range on your own report.
Foods with vitamin D
| Food | Portion | Vitamin D (IU, approx.) |
|---|---|---|
| Salmon or mackerel (imported, tinned) | 100 g | 350 to 600 |
| Tinned tuna | 100 g | 150 to 250 |
| Egg yolk | 1 egg | 20 to 40 |
| Fortified milk or formula | Per label | Check the pack |
| Mushrooms exposed to sunlight | 100 g | 100 to 400 |
| Desi milk, dahi, cheese (not fortified) | Normal serving | Very little |
| Beef liver (kaleji) | 100 g | about 50 |
Even a good diet rarely reaches 600 IU a day in Pakistan, because fortified foods are uncommon and oily fish is not an everyday item. This is the one nutrient where sunlight and a tested, prescribed supplement usually matter more than food.
Sunlight: how to get it safely
- Midday sun (roughly 10 am to 3 pm) is when the skin makes vitamin D.
- Arms and legs uncovered for 10 to 30 minutes, a few times a week, is the usual advice; darker skin needs longer.
- Glass blocks it: sitting behind a window does not count.
- Never burn. If you must stay in the sun longer, cover up or use sunscreen.
Calcium goes with vitamin D
Vitamin D helps the body absorb calcium, so both matter for bones. Adults need about 1,000 mg of calcium a day (1,200 mg for women over 50). A glass of milk, a katori of dahi and a small piece of paneer together cover most of it. Til (sesame) and green leafy sabzi add more. See the seeds guide for til.
See a doctor first if
- You have bone pain, muscle weakness or trouble walking
- Your child has bowed legs, delayed walking or frequent fractures
- You were told to take a high-dose injection or megadose
- You have kidney disease, parathyroid problems or take calcium tablets
- You are pregnant or breastfeeding
Common questions
What are the symptoms of vitamin D deficiency?
Tiredness, aching bones and muscles, low back or leg pain, muscle weakness (trouble climbing stairs or getting up from the floor), frequent illness and low mood. Severe deficiency causes rickets in children and osteomalacia (soft bones) in adults. Many people have no symptoms at all.
Why is vitamin D deficiency so common in Pakistan?
Despite the sunshine, most people get little direct sun on the skin: indoor work, covered clothing, staying out of the midday sun, air pollution and darker skin all reduce how much vitamin D the skin makes. Few Pakistani foods are fortified, so food alone rarely covers it.
How much sunlight do I need?
Most guidance suggests about 10 to 30 minutes of midday sun on the arms, legs or face a few times a week, with darker skin needing longer. Do not burn. Sun exposure alone may not be enough in winter, with pollution, or if you stay covered.
Which foods have vitamin D?
Very few: oily fish (salmon, mackerel, tinned tuna), egg yolks, liver, mushrooms exposed to sunlight, and fortified milk or cereal. An ordinary Pakistani diet gives only a small amount, which is why tests and supplements matter here.
How much vitamin D should I take?
That is a medical decision. General intake guidance is about 600 IU a day for adults up to 70 and 800 IU after that, with an upper limit of 4,000 IU a day for adults. Treatment doses for a proven deficiency are higher and must be prescribed and monitored. Do not take high-dose injections or megadoses on your own.
What is a normal vitamin D level?
Most labs report 25(OH)D in ng/mL: below 12 is deficient, 12 to 20 is insufficient, and 20 to 50 is generally adequate. Very high levels (above 100) can be harmful. Read your own report's range and ask your doctor.
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Sources
- NIH Office of Dietary Supplements. Vitamin D: fact sheet for health professionals
- Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D, 2011
- Demay MB et al. Vitamin D for the Prevention of Disease: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2024
- NHS. Vitamin D