Vitamin D Deficiency

Vitamin D is known as the sunshine vitamin, because the body produces it as a response to sun exposure. But would it surprise you to know that even living in our sunshine paradise of Cayman, we appear to have a higher than average amount of vitamin D deficiency? You can be deficient from a variety of causes.  Working indoors, the use of sun protection (A sunscreen with sun protection factor (SPF) 30 can reduce the body’s ability to synthesize the vitamin by 95 percent), a dark skin and genetic predisposition can all make your vitamin D levels drop.

In fact, it’s the amount and powerful nature of our sunshine that means we tend to shun the sun, work indoors and use high factor (30+) sun protection, all of which serve to leave some of us deficient. Deficiencies can also arise in people suffering from milk allergies, or those adhering to a strict vegan diet. There are other underlying causes too.

Importance of Vitamin D

Vitamin D is essential for the maintenance of strong bones, through its role in helping the body use calcium from our diet. Historically, vitamin D deficiency was associated with rickets, a disease in which the bone tissue doesn’t properly mineralize, leading to soft bones and skeletal deformities. However, research is also revealing the importance of vitamin D in protecting against a host of health problems, including cardiovascular disease, by far the world’s greatest health-related cause of death.

Putting diseases aside for a moment, vitamin D is also important in the normal functioning of the body too. It plays an important role in regulating more than 200 genes throughout the body, keeps abnormal cells from multiplying in breast and colon tissues, helps regulate blood pressure in the kidney, and helps in the regulation blood sugar levels too.

Ironically, if you engage in vigorous sport, you may want to develop a closer interest in vitamin D. Firstly, atheletes are more likely to be deficient but also vitamin D is important in skeletal muscle repair and remodeling. Combine that with ageing too and there is a growing body of evidence of the beneficial effects of vitamin D.
Research also suggests that vitamin D could play a role in the prevention and treatment of a number of different conditions, including type 1 and type 2 diabetes, hypertension, glucose intolerance, and multiple sclerosis.

Clearly a deficiency is going to have some consequences, including the following potential ones, of varying severity:

  • Increased risk of death from cardiovascular disease
  • Fatigue, exercise intolerance & skeletal injuries
  • Cognitive impairment in older adults
  • Severe asthma in children
  • Some forms of cancer
  • Immune system related issues

Symptoms of Vitamin D Deficiency

Given its role in healthy bone structure, bone pain and muscle weakness can mean you have a vitamin D deficiency. For many people though, the symptoms are more subtle.

  • Becoming sick or picking up infections more often
  • Fatigue and tiredness
  • Back pain
  • Other bone pain and loss
  • Depression
  • Slower wound healing
  • Hair loss
  • Muscle pain

If you suffer from any of these, it can be worth having vitamin D levels tested to see if you are deficient.

Causes of Vitamin D Deficiency

Vitamin D deficiency can occur for a number of reasons, with the main ones being listed below.

Insufficient Consumption of Vitamin D Containing Foods

This is more likely if you follow a strict vegan diet, because many of the natural sources of vitamin D are animal-based, including fish and fish oils, egg yolks, milk, and things like beef liver.

Insufficient Exposure to Sunlight

The body makes vitamin D when your skin is exposed to sunlight and so you may be at risk of deficiency if you work mostly indoors, cover up consistently when out and use high factor suncreams to protect against sun damage. Given our consciousness about the risks of too much sun, in Cayman we can be sufficiently good at avoiding it that we run a greater risk of vitamin D deficiency.

Darker Skin

The pigment melanin reduces the skin’s ability to make vitamin D in response to sunlight exposure. This produces a higher incidence of deficiency in naturally dark populations (well, this includes us here in Cayman, of course), as well as increasing the risk in people who darken e.g. over time through ageing.

Kidneys Function

As people age, their kidneys are less able to convert vitamin D to its active form, thus increasing their risk of vitamin D deficiency.

Excess Alcohol Consumption

Drinking too much alcohol can contribute to vitamin D deficiency. In Cayman, across the population, we tend towards higher than average alcohol consumption and this may help explain why we also appear to have a higher than average amount of vitamin D deficiency, despite our sunny climate.

Poor Absorbtion of Vitamin D in the Digestive Tract

Certain medical problems, including Crohn’s disease, cystic fibrosis, and celiac disease, can affect your intestine’s ability to absorb vitamin D adequately from the food you eat.


Vitamin D is extracted from the blood by fat cells, altering its release into the circulation. Consequently, the more fat cells we might have, the higher our risk of vitamin D deficiency. 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 a specific blood test called the 25-hydroxy vitamin D blood test. Levels of 25 ng/mL to 80 ng/mL are considered optimal for healthy people and, although there remains some debate, a level of less than 30 ng/mL indicates vitamin D insufficiency and less than 20 ng/mL indicates vitamin D deficiency.

If you have symptons of or certain risk factors for vitamin D deficiency, health insurance should cover all or part of the cost of this test, depending on your policy and coverage.

This is a test we can organise here at Integra, and if you want us to ascertain your insurance cover beforehand, simply complete the enquiry form. In any event, if you book a consultation to discuss symtoms, we will always discuss the merits, costs and coverage of any laboratory test we advise, prior to proceding with it.


Dr Francisco Martinez

Dr Francisco Martinez


Dr Martinez is a family health specialist with a Master in Assessment Medicine and extensive experience in family health and urgent care, as well as geriatrics & palliative care, from Spain and UK, before moving to Cayman in 2012.

Book an Appointment

Important Instructions

Please simply work through the steps onscreen. If you believe you have symtoms of vitamin D defiency, please select ‘New Problem’ and if you simply want to get your levels checked without the presence of symptoms, please select ‘Adult Wellness’. Please note that even if you have previously seen Dr Martinez, if this is your first visit to Integra, you need to tick ‘no’ with respect to Existing Patient. If you are using a smartphone, it helps to turn your screen sideways (landscape). Thank you.


General Vitamin D Deficiency Enquiry Form

Please use this form to make more general enquiries about Vitamin D Deficiency. The form will be passed to Dr Martinez and all information will be held confidentially

Your Gender

Treatment for Vitamin D Deficiency

Supplementation of vitamin D is an obvious possibility but before leaping to that as a ‘simple solution’ it is important to recognise that vitamin D deficiency has a wide variety of underlying causes and it may be vital to address some of those too, rather than simply replacing what’s deficient.

Equally, the symptoms associated with vitamin D deficiency can also be caused by a number of other conditions, both benign and more severe. It is important to ascertain the cause before simply getting rid of the symptoms.

So, although it may sound like common sense (because it is), ultimately the right solution depends on the underlying nature of the problem and that’s something your doctor will want to discuss with you in the event you do find yourself vitamin D deficient.