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If you shun the sun, suffer from milk allergies, or adhere to a strict vegan diet, you may be at risk for vitamin D deficiency. Known as the sunshine vitamin, vitamin D is produced by the body in response to skin being exposed to sunlight. It is also occurs naturally in a few foods -- including some fish, fish liver oils, and egg yolks -- and in fortified dairy and grain products.

Vitamin D is essential for strong bones, because it helps the body use calcium from the diet. Traditionally, vitamin D deficiency has been associated with rickets, a disease in which the bone tissue doesn't properly mineralize, leading to soft bones and skeletal deformities. But increasingly, research is revealing the importance of vitamin D in protecting against a host of health problems.

Symptoms and Health Risks of Vitamin D Deficiency

Symptoms of bone pain and muscle weakness can mean you have a vitamin D deficiency. However, for many people, the symptoms are subtle. Yet, even without symptoms, too little vitamin D can pose health risks. Low blood levels of the vitamin have been associated with the following:

• Increased risk of death from cardiovascular disease
• Cognitive impairment in older adults
• Severe asthma in children
• Cancer

Research suggests that vitamin D could play a role in the prevention and treatment of a number of different conditions, including type1 and type 2 diabetes, hypertension, glucose intolerance, and multiple sclerosis.

Causes of Vitamin D Deficiency

Vitamin D deficiency can occur for a number of reasons:

You don't consume the recommended levels of the vitamin over time. This is likely if you follow a strict vegan diet, because most of the natural sources are animal-based, including fish and fish oils, egg yolks, fortified milk, and beef liver. Here are the best vitamin d foods for vegetarians.

Your exposure to sunlight is limited. Because the body makes vitamin D when your skin is exposed to sunlight, you may be at risk of deficiency if you are homebound, live in northern latitudes, wear long robes or head coverings for religious reasons, or have an occupation that prevents sun exposure. Duirng the winter, vitamin D deficiency can be more prevalent because there is less sunlight available.

You have dark skin. The pigment melanin reduces the skin's ability to make vitamin D in response to sunlight exposure. Some studies show that older adults with darker skin are at high risk of vitamin D deficiency.

Your kidneys cannot convert vitamin D to its active form. As people age, their kidneys are less able to convert vitamin D to its active form, thus increasing their risk of vitamin D deficiency.

Your digestive tract cannot adequately absorb vitamin D. Certain medical problems, including Crohn's disease, cystic fibrosis, and celiac disease, can affect your intestine's ability to absorb vitamin D from the food you eat.

You are obese. Vitamin D is extracted from the blood by fat cells, altering its release into the circulation. People with a body mass index of 30 or greater often have low blood levels of vitamin D.

Tests for Vitamin D Deficiency

The most accurate way to measure how much vitamin D is in your body is the 25-hydroxy vitamin D blood test. A level of 20 nanograms/milliliter to 50 ng/mL is considered adequate for healthy people. A level less than 12 ng/mL indicates vitamin D deficiency.

Treatment for Vitamin D Deficiency

Treatment for vitamin D deficiency involves getting more vitamin D -- through diet and supplements. Although there is no consensus on vitamin D levels required for optimal health -- and it likely differs depending on age and health conditions -- a concentration of less than 20 nanograms per milliliter is generally considered inadequate, requiring treatment.

Guidelines from the Institute of Medicine increased the recommended dietary allowance (RDA) of vitamin D to 600 international units (IU) for everyone ages 1-70, and raised it to 800 IU for adults older than age 70 to optimize bone health. The safe upper limit was also raised to 4,000 IU. Doctors may prescribe more than 4,000 IU to correct a vitamin D deficiency.

If you don't spend much time in the sun or always are careful to cover your skin (sunscreen inhibits vitamin D production), you should speak to your doctor about taking a vitamin D supplement, particularly if you have risk factors for vitamin D deficiency.

Vitamin D helps regulate the amount of calcium and phosphate in the body.

These nutrients are needed to keep bones, teeth and muscles healthy.

A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain caused by a condition called osteomalacia in adults.

Government advice is that everyone should consider taking a daily vitamin D supplement during the autumn and winter.

People at high risk of not getting enough vitamin D, all children aged 1 to 4, and all babies (unless they're having more than 500ml of infant formula a day) should take a daily supplement throughout the year.

Good sources of vitamin D

From about late March/early April to the end of September, most people should be able to make all the vitamin D they need from sunlight.

The body creates vitamin D from direct sunlight on the skin when outdoors.

But between October and early March we do not make enough vitamin D from sunlight. Read more about vitamin D and sunlight.

Vitamin D is also found in a small number of foods.

Sources include:

• oily fish – such as salmon, sardines, herring and mackerel
• red meat
• liver
• egg yolks
• fortified foods – such as some fat spreads and breakfast cereals

Another source of vitamin D is dietary supplements.

In the UK, cows' milk is generally not a good source of vitamin D because it is not fortified, as it is in some other countries.

How much vitamin D do I need?

From about late March/early April to the end of September, the majority of people should be able to make all the vitamin D they need from sunlight on their skin.

Children from the age of 1 year and adults need 10 micrograms of vitamin D a day. This includes pregnant and breastfeeding women, and people at risk of vitamin D deficiency.

Babies up to the age of 1 year need 8.5 to 10 micrograms of vitamin D a day.

A microgram is 1,000 times smaller than a milligram (mg). The word microgram is sometimes written with the Greek symbol μ followed by the letter g (μg).

Sometimes the amount of vitamin D is expressed as International Units (IU). 1 microgram of vitamin D is equal to 40 IU. So 10 micrograms of vitamin D is equal to 400 IU.

Should I take a vitamin D supplement?

Advice for adults and children over 4 years old

During the autumn and winter, you need to get vitamin D from your diet because the sun is not strong enough for the body to make vitamin D.

But since it's difficult for people to get enough vitamin D from food alone, everyone (including pregnant and breastfeeding women) should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter.

Between late March/early April to the end of September, most people can make all the vitamin D they need through sunlight on their skin and from a balanced diet.

You may choose not to take a vitamin D supplement during these months.

People at risk of vitamin D deficiency

Some people will not make enough vitamin D from sunlight because they have very little or no sunshine exposure.

The Department of Health and Social Care recommends that adults and children over 4 take a daily supplement containing 10 micrograms of vitamin D throughout the year if they:

• are not often outdoors – for example, if they're frail or housebound
• are in an institution like a care home
• usually wear clothes that cover up most of their skin when outdoors

If you have dark skin – for example you have an African, African-Caribbean or south Asian background – you may also not make enough vitamin D from sunlight.

You should consider taking a daily supplement containing 10 micrograms of vitamin D throughout the year.

Advice for infants and young children

The Department of Health and Social Care recommends that babies from birth to 1 year of age should have a daily supplement containing 8.5 to 10 micrograms of vitamin D throughout the year if they are:

• breastfed
• formula-fed and are having less than 500ml (about a pint) of infant formula a day, as infant formula is already fortified with vitamin D

Children aged 1 to 4 years old should be given a daily supplement containing 10 micrograms of vitamin D throughout the year.

You can buy vitamin D supplements or vitamin drops containing vitamin D (for under 5s) at most pharmacies and supermarkets.

Women and children who qualify for the Healthy Start scheme can get free supplements containing vitamin D.

See the Healthy Start website for more information.

What happens if I take too much vitamin D?

Taking too many vitamin D supplements over a long period of time can cause too much calcium to build up in the body (hypercalcaemia). This can weaken the bones and damage the kidneys and the heart.

If you choose to take vitamin D supplements, 10 micrograms a day will be enough for most people.

Do not take more than 100 micrograms (4,000 IU) of vitamin D a day as it could be harmful. This applies to adults, including pregnant and breastfeeding women and the elderly, and children aged 11 to 17 years.

Children aged 1 to 10 years should not have more than 50 micrograms (2,000 IU) a day. Infants under 12 months should not have more than 25 micrograms (1,000 IU) a day.

Some people have medical conditions that mean they may not be able to safely take as much. If in doubt, you should consult your doctor.

If your doctor has recommended you take a different amount of vitamin D, you should follow their advice.

You cannot overdose on vitamin D through exposure to sunlight. But always remember to cover up or protect your skin if you're out in the sun for long periods to reduce the risk of skin damage and skin cancer.