1. What are at least a few things an athlete should know about Vitamin D?

1. Spending x amount of time in the sun (this depends on the latitude and skin
pigmentation of the athlete).
2. There are vitamin D sun lamps for the home (e.g. Spurty)
3. Do not supplement with synthetic vitamin D.
4. If you supplement with lichen-derived vitamin D, you should also take vitamin A
as preformed retinol (e.g. fish oil) with your vitamin D supplement.
5. Supplement with magnesium bisglycinate in order to build up and maintain
vitamin D levels.

One cup of raw, chopped mushrooms contains 733 IU of vitamin D - 122% of the RDA
(ODS, 2022). Boiling or cooking mushrooms does not change the vitamin D content,
however, sautéing in fats may cause vitamin D to leach out and reduce the vitamin D
content in the mushrooms, but if the fat is used in the sauce, then it will be consumed
(Cardwell et al., 2018). Cod liver oil has the highest vitamin D content of any food (1
Tbsp = 1,360 IU) and it's also available as gel caps for those who can't handle the
liquid. Cod liver oil contains nature’s ratio of vitamin A to vitamin D. Adequate sunlight
exposure is the easiest way to increase the body's vitamin D stores (Alfredsson et al.,
2020).

2. Digging deeper into possible causes, what are contributors to a Vitamin D

insufficiency or deficiency in adults?

Vitamin D deficiency is caused by a combination of inadequate intake (or absorption) of

magnesium and inadequate intake of sunshine. Just like working adults, many athletes
do not get enough sunlight due to their demanding schedules. Individuals living at
higher latitudes, especially those with darker skin, are at an increased risk for vitamin D
deficiency and should take cod liver oil to maintain healthy vitamin D levels (Oberg et
al., 2014).

Taking high doses of synthetic Vitamin D depletes the body’s magnesium (Reddy &
Edwards, 2019) and potassium (Ferris et al., 1962) store, and inhibits the uptake and
metabolism of vitamin A (Kriegel et al., 2020). Magnesium is required in the process of
binding Vitamin D to its transport protein and in the process of converting stored vitamin
D into active vitamin D (Al Alawi et al., 2018; Uwitonze & Razzaque, 2018).
Supplementation of vitamin D can deplete the body’s magnesium stores, which then
creates a state of vitamin D deficiency. Increasing magnesium levels in the body may
even raise vitamin D levels to normal without increasing intake of cod liver oil or
sunbathing (Deng et al., 2013).

References

Al Alawi, A. M., Majoni, S. W., & Falhammar, H. (2018). Magnesium and Human Health:
Perspectives and Research Directions. International journal of endocrinology, 2018,
9041694. https://doi.org/10.1155/2018/9041694
Alfredsson, L., Armstrong, B. K., Butterfield, D. A., Chowdhury, R., de Gruijl, F. R.,
Feelisch, M., Garland, C. F., Hart, P. H., Hoel, D. G., Jacobsen, R., Lindqvist, P. G.,
Llewellyn, D. J., Tiemeier, H., Weller, R. B., & Young, A. R. (2020). Insufficient sun
exposure has become a real public health problem. International Journal of
Environmental Research and Public Health, 17(14), 5014.
https://doi.org/10.3390/ijerph17145014

Cardwell, G., Bornman, J. F., James, A. P., & Black, L. J. (2018). A review of
mushrooms as a potential source of dietary vitamin D. Nutrients, 10(10), 1498.
https://doi.org/10.3390/nu10101498

Deng, X., Song, Y., Manson, J. E., Signorello, L. B., Zhang, S. M., Shrubsole, M. J.,
Ness, R. M., Seidner, D. L., & Dai, Q. (2013). Magnesium, vitamin D status and
mortality: results from US National Health and Nutrition Examination Survey (NHANES)
2001 to 2006 and NHANES III. BMC Medicine, 11, 187. https://doi.org/10.1186/1741-
7015-11-187

Ferris, T. F., Levitin, H., Phillips, E. T., & Epstein, F. H. (1962). Renal potassium-
wasting induced by vitamin D. The Journal of Clinical Investigation, 41(6), 1222–1229.
https://doi.org/10.1172/JCI104583

Kriegel, F. L., Reichardt, P., Krause, B. C., Singh, A. V., Tentschert, J., Laux, P., Jungnickel, H.,
& Luch, A. (2020). The Vitamin A and D Exposure of Cells Affects the Intracellular Uptake of
Aluminum Nanomaterials and its Agglomeration Behavior: A Chemo-Analytic Investigation.
International journal of molecular sciences, 21(4), 1278. https://doi.org/10.3390/ijms21041278

Oberg, J., Jorde, R., Almås, B., Emaus, N., & Grimnes, G. (2014). Vitamin D deficiency
and lifestyle risk factors in a Norwegian adolescent population. Scandinavian journal of
public health, 42(7), 593–602. https://doi.org/10.1177/1403494814541593

Office of Dietary Supplements (ODS). (Aug 12, 2022). Vitamin D: Fact sheet for health
professionals. National Institutes of Health (NIH).
https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

Reddy, P. & Edwards, L. R. (2019). Magnesium Supplementation in Vitamin D

Deficiency. American journal of therapeutics, 26(1), e124–e132.
https://doi.org/10.1097/MJT.0000000000000538

Uwitonze, A. M., & Razzaque, M. S. (2018). Role of magnesium in vitamin D activation

and function. The Journal of the American Osteopathic Association, 118(3), 181–189.
https://doi.org/10.7556/jaoa.2018.037

When prescribing Vitamin D, the main debates are whether synthetic supplements of
isolated Vitamin D are healthful or harmful, what the ideal serum level is, and whether it
is wise to avoid the sun in fear of skin cancer when our bodies naturally produce
Vitamin D when exposed to sunlight.
Synthetic vitamin D is not the same as the vitamin D found in foods. Supplementing with
Vitamin D only can cause atherosclerosis of the heart, arteries and other soft tissues
(Fraser, 2021), including the kidneys (Zager, 1999). Vitamin D depletes magnesium
stores (Reddy & Edwards, 2019), which is counter productive because magnesium is
required for the synthesis of Vitamin D to occur in the liver and kidneys (Al Alawi et al.,
2018), therefore it is vital to include Magnesium in a Vitamin D supplementation
regimen. In fact, Magnesium supplementation alone may raise Vitamin D levels (Deng
et al., 2013). We should aim to get most of our Vitamin D from the sun, and acceptable
secondary sources include whole foods and whole-food supplements.

In nature, Vitamin D occurs only in trace amounts, except for in certain foods (Fraser,
2021; MIC, 2022). Significant amounts of Vitamin D are found in the liver of beef and
some fish (e.g. cod, tuna, salmon), as well as in egg yolks (Harvard, 2022; MIC, 2022).
Vitamin D never occurs naturally without Vitamin A and they are actually cofactors
(Schrader et al., 1993). In beef liver, Vitamin K is also present. I would only recommend
whole-food based Vitamin D supplements, such as beef liver or cod liver oil as these
are balanced the way nature intended, with Vitamin A.

Some doctors and nutritionists believe that optimal serum Vitamin D levels is upwards
of 60 or even 80 ng/mL. However, some studies have shown that levels over 25 ng/mL
are not helpful and can even be harmful (i.e. U shaped curve in relation to Vitamin D
serum levels). One such study was a cross-sectional survey of over 10,000 individuals
completed between 2001-2004 (Amer & Qayyum, 2013).

As far as exposure to UV rays, we need to look to nature again. People with high
pigmentation need more sunlight to produce Vitamin D and people with low
pigmentation need less sunlight to produce adequate levels of Vitamin D. The Western
world lives in fear of the sun causing skin cancer while at the same time slathering on
toxic known and unknown carcinogens and endocrine disruptors to protect ourselves
from this perceived danger.

References

Al Alawi, A. M., Majoni, S. W., & Falhammar, H. (2018). Magnesium and Human Health:
Perspectives and Research Directions. International journal of endocrinology, 2018,
9041694. https://doi.org/10.1155/2018/9041694

Amer, M., & Qayyum, R. (2013). Relationship between 25-hydroxyvitamin D and all-
cause and cardiovascular disease mortality. The American journal of medicine, 126(6),
509–514. https://doi.org/10.1016/j.amjmed.2012.11.021

Fraser D. R. (2021). Vitamin D toxicity related to its physiological and unphysiological

supply. Trends in endocrinology and metabolism: TEM, 32(11), 929–940.
https://doi.org/10.1016/j.tem.2021.08.006
Harvard T. H. Chan School of Public Health. (2022). The Nutrition Source: Vitamin D.
Accessed on 31 Mar, 2022 from https://www.hsph.harvard.edu/nutritionsource/vitamin-
d/

Linus Pauling Institute. (2022). Micronutrient Information Center (MIC). Accessed 31

Mar 2022 from https://lpi.oregonstate.edu/mic/vitamins/vitamin-D

Reddy, P. & Edwards, L. R. (2019). Magnesium Supplementation in Vitamin D

Deficiency. American journal of therapeutics, 26(1), e124–e132.
https://doi.org/10.1097/MJT.0000000000000538

Schrader, M., Bendik, I., Becker-Andr, M., & Carlberg, C. (1993). Interaction between
Retinoic Acid and Vitamin D Signaling Pathway. The Journal of Biological Chemistry.
268(24), 17830-17836. Retrieved from https://www.jbc.org/article/S0021-
9258(17)46779-2/pdf

Zager R. A. (1999). Calcitriol directly sensitizes renal tubular cells to ATP-depletion- and
iron-mediated attack. The American journal of pathology, 154(6), 1899–1909.
https://doi.org/10.1016/S0002-9440(10)65448-X

Magnesium deficiency (frank or subclinical) is a significant and ever growing problem in

the United States (DiNicolantonio et al., 2018) for various reasons including modern
agriculture and food processing practices (Davis et al., 2004; Guo et al., 2016;
Rosenoff, 2012) and increased magnesium wasting due to the historically high levels of
mental and physical stress that we endure (Cuciureanu & Vinnk, 2011; Pickering et al.,
2020).

Even individuals with mild liver disease can experience impaired vitamin D synthesis
(Iruzubieta et al., 2014). With an estimated 25% of Americans living with liver steatosis
(Non-alcoholic Fatty Liver Disease), it stands to reason that an increasing number of American
residents will experience impaired vitamin D synthesis.

Phoenix, Arizona is located at 33.4484° North Latitude, where vitamin D synthesis from
the sun is unlikely for at least half of the year (Wacker & Holick, 2013).

References

Arshad, T., Golabi, P., Henry, L., & Younossi, Z. M. (2020). Epidemiology of non-alcoholic
fatty liver disease in North America. Current Pharmaceutical Design, 26(10), 993–997.
https://doi.org/10.2174/1381612826666200303114934

Cuciureanu, M. D. & Vink, R. (2011). Magnesium and stress. Magnesium in the Central
Nervous System [Internet]. In R. Vink & M. Nechifor (Eds.). University of Adelaide Press.
https://www.ncbi.nlm.nih.gov/books/NBK507250/
Davis, D. R., Epp, M. D., & Riordan, H. D. (2004). Changes in USDA food composition
data for 43 garden crops, 1950 to 1999. Journal of the American College of Nutrition,
23(6), 669–682. https://doi.org/10.1080/07315724.2004.10719409

DiNicolantonio, J. J., O'Keefe, J. H., & Wilson, W. (2018). Subclinical magnesium

deficiency: a principal driver of cardiovascular disease and a public health crisis. Open
Heart, 5(1), e000668. https://doi.org/10.1136/openhrt-2017-000668
Guo, W., Nazim, H., Liang, Z., & Yang, D. (2016). Magnesium deficiency in plants: An urgent
problem. The Crop Journal, 4(2), 83-91. https://doi.org/10.1016/j.cj.2015.11.003.

Iruzubieta, P., Terán, Á., Crespo, J., & Fábrega, E. (2014). Vitamin D deficiency in
chronic liver disease. World Journal of Hepatology, 6(12), 901–915.
https://doi.org/10.4254/wjh.v6.i12.901

Pickering, G., Mazur, A., Trousselard, M., Bienkowski, P., Yaltsewa, N., Amessou, M.,
Noah, L., & Pouteau, E. (2020). Magnesium status and stress: The vicious circle
concept revisited. Nutrients, 12(12), 3672. https://doi.org/10.3390/nu12123672
Rosanoff, A. (2012). Changing crop magnesium concentrations: impact on human
health. Plant and Soil, 368, 139-153. https://doi.org/10.1007/s11104-012-1471-5

Wacker, M., & Holick, M. F. (2013). Sunlight and Vitamin D: A global perspective for
health. Dermato-Endocrinology, 5(1), 51–108. https://doi.org/10.4161/derm.24494