“We’re seeing a lot of anxiety around COVID-19, and also feelings of being trapped, not being able to connect or engage in pleasurable activities, or not having the typical outlets that help with mood,” says Kristen C. Wynns, PhD, psychologist and founder of Wynns Family Psychology in Cary and Raleigh, North Carolina. “People are struggling, and even the highest functioning person is impacted,” she says. There are many reasons why you might feel down these days — but could a vitamin D deficiency be contributing? “I think a number of people are experiencing depression or low mood due to social isolation and a vitamin D deficiency — I believe it’s a combination of both factors,” says Sue Penckofer, PhD, RN, graduate school associate dean at the Loyola University Chicago, who has coauthored numerous studies on vitamin D and mood. RELATED: Boxed In: ‘COVID-19 and Your Health’
How Social Distancing During the COVID-19 Pandemic May Be Contributing to Low Vitamin D
Most people get the vitamin D they need thanks to the sunlight. “We know that when sun hits the skin, there’s a synthesis that causes your body to produce the vitamin,” says Dr. Penckofer. Also, some foods, like eggs and salmon, contain vitamin D, according to the Cleveland Clinic, but a supplement can help increase your levels further. But with so many of us stuck inside because of social distancing, we likely aren’t getting the typical sun exposure we otherwise would this time of year. And that, potentially, could mean low levels of vitamin D — and a low mood, says Penckofer. In fact, joint guidelines from the American Society for Bone and Mineral Research, the Endocrine Society, the American Association of Clinical Endocrinologists, the European Calcified Tissue Society, the National Osteoporosis Foundation, and the International Osteoporosis Foundation recommend considering vitamin D supplementation during the pandemic. This is because more people are spending time indoors, potentially increasing the risk of deficiency. “For those unable to spend at least 15 to 30 minutes with direct sun exposure each day,” they wrote in their July 9, 2020, statement, “the easiest way to acquire vitamin D is through food supplemented with vitamin D or vitamin D nutritional supplements.” Read on to discover how your potentially low levels of vitamin D might be bringing you down — and what you can do about it. RELATED: Can Taking a Vitamin D Supplement Protect Against COVID-19? Here’s what experts do know: “Both low vitamin D and depression have been connected to inflammation, so it is likely that the underlying reason has to do with inflammation,” says Dr. Chourki. Vitamin D also affects the serotonin pathway, Penckofer says. This hormone does everything from regulate mood to sleep, and appetite to motor skills, just to name handful of functions, according to Stanford University. “Vitamin D is important for helping the enzyme that makes serotonin — when levels are low, you aren’t making as much serotonin,” adds James Greenblatt, MD, chief medical officer at Walden Behavioral Care in Waltham, Massachusetts, and assistant clinical professor of psychiatry at Tufts University School of Medicine in Boston.
Supplementing With Vitamin D May Improve Mood, Studies Suggest
Penckofer coauthored a paper published in September 2017 in the Journal of Diabetes Research that found vitamin D supplementation improved the mood of women with type 2 diabetes, which is a group that is at an elevated risk for depression, the Mayo Clinic notes. They are also among the groups at a higher risk for vitamin D deficiency, noted a past review that Penckofer coauthored. Whether it’s due to depression, body image struggles, or inactivity, “people who have diabetes are more likely to stay indoors, so they aren’t getting the sunlight, the outdoor exercise, and the opportunities to socialize,” which are other factors that can affect mood, says Penckofer. Due to the potential dangers of COVID-19 to their health, people with type 2 diabetes, along with others who have underlying health conditions, may be going out even less than usual — and this could further reduce their vitamin D levels and quality of mental health. Though the women in Penckofer’s 2017 study took 50,000 IU (international units) of vitamin D — which is considered a very high amount — for six months, her more recent research found that even taking a lower dose of vitamin D is effective in raising vitamin D levels and improving mood for women with type 2 diabetes and depression.
More Studies on Vitamin D and Mood Are Needed
Still, not every study shows vitamin D is a mood cure-all. One of Choukri’s studies, published in August 2018 in the Journal of Nutritional Science, found that supplementation in healthy women did not provide any benefits to psychological well-being — but taking a break did. “Most of our participants were staff or students at a university, and there was an improvement in well-being for both the vitamin D and placebo groups during the university holiday period!” explains Chourkri. RELATED: 10 Healthy Foods to Boost Your Mood On the flip side, research suggests that not getting enough sleep, having a poor-quality diet, and inactivity can contribute to low mood independently, regardless of vitamin D status. Here’s a closer look at the relationship among vitamin D status, these habits, and mood and health. RELATED: 8 Smart Tips for Successfully Managing Stress
Vitamin D and Sleep
There’s a scientific link between getting adequate vitamin D and sleeping well, which plays a role in mood on its own. “Vitamin D is important in the process of making serotonin, and you need serotonin to make melatonin,” says Dr. Greenblatt. Melatonin is a hormone that promotes sleep, according to the Mayo Clinic. A meta-analysis published in October 2018 in the journal Nutrients concluded that vitamin D deficiency is linked with a higher risk of sleep disorders. It’s all connected: Lack of sleep alone, regardless of vitamin D status, may contribute to depressive symptoms, along with anxiety, notes the National Sleep Foundation. According to the Mayo Clinic, symptoms of depression may include tiredness and a lack of energy, sleep disturbances like insomnia, and a loss of interest in pleasurable activities. RELATED: The Relationship Between Insomnia, Anxiety, and Depression: It’s Complicated
Vitamin D and Exercise
Low mood from vitamin D may make someone less likely to be active, says Penckofer. And inactivity can trigger a vicious cycle that further contributes to low mood. A study published in April 2019 in the International Journal of Environmental Research and Public Health found that sedentary behavior and low physical activity were linked to anxiety and depression. And a review published in June 2015 in Cognitive Behavior Therapy found that exercise can even help reduce anxiety symptoms and bad mood, the authors noted. Another study, published in September 2018 in The Lancet Psychiatry, found that all types of exercise — from walking to cycling — were associated with improved mental health. According to the Mayo Clinic, exercise boosts endorphins, gets your mind off stressful situations, gives you confidence, and can provide social interaction. Improving vitamin D status may improve mood, helping you to get out the door and move more. Vitamin D may also independently offer benefits for physical health. A study published in July 2018 in the Journal of Orthopaedic Science found that for elderly people, exercise and taking a vitamin D supplement each on their own helped improve muscle mass and physical function. Therefore, getting the vitamin D you need not only boosts mood and may help compel you to move more, but it also may help you get more out of your workout. RELATED: Why Exercise Boosts Mood and Energy
Vitamin D and Food Choices
Research suggests a vitamin D deficiency is more prevalent in people with obesity. One small study, published in July 2018 in the International Journal of Preventative Medicine, found that obese people who supplemented with a high dose of vitamin D for six weeks decreased their weight, body mass index (BMI), waist circumference, and hip circumference significantly. Obesity is a complex disease: Both genetics and daily lifestyle habits affect risk, past research suggests. Yet having low mood, potentially due to vitamin D deficiency, may make you more likely to reach for potato chips or that bag of cookies rather than healthier choices, like carrot sticks or an apple. You can blame cortisol, the stress hormone, which can cause you to overeat when you’re feeling emotional distress, according to Harvard Medical School. What you eat similarly impacts mood, just like your sleep and exercise habits. For example, previous research suggests that chamomile may provide a soothing effect by producing more of the feel-good chemicals dopamine and serotonin. Carbohydrates can also boost the production of serotonin, according to the Massachusetts Institute of Technology (MIT), though make sure you’re choosing healthy, whole grain options, rather than refined carbs like cookies and crackers. Meanwhile, poor food and drink choices can contribute to low mood. Take sugar: A study published in July 2017 in Scientific Reports found that eating too much refined sugar could up your risk of depression. So, too, may caffeine and alcohol bring down your mood, according to the Mayo Clinic and past research, respectively. RELATED: The Ultimate Diet Plan for a Happier, Less-Stressed You
Beyond Mood, Getting Adequate Vitamin D Is Key for Long-Term Health
Skimping on D may seem like no biggie in the grand scheme of things, especially in the time of COVID-19, but prioritizing getting enough of the sunshine vitamin is critical for your long-term health. “We do see deficient vitamin D levels are related to many different diseases — type 2 diabetes, Alzheimer’s disease and dementia, and [some] types of cancers,” says Mary Byrn, PhD, RN, associate professor in the Marcella Niehoff School of Nursing at Loyola University Chicago. “Therefore, treating deficient vitamin D levels is not harmful, and I would recommend that everyone work with a healthcare provider to reach sufficient vitamin D levels.” The Cleveland Clinic also notes that a vitamin D deficiency can cause other physical health issues, like osteoporosis and osteomalacia, and can even impact your nervous system and immune system, which is the last thing anyone needs during a pandemic like the current one. RELATED: Can Supplements Protect Me Against the New Coronavirus?
Bone painFatigueMuscle aches, cramps, or weakness
Children with a vitamin D deficiency may develop rickets, which can cause bone pain and joint deformities, the Cleveland Clinic notes. There are certain groups known to be at a higher risk for vitamin D deficiency, which may necessitate supplementation. According to Medline Plus, risk factors for vitamin D deficiency include:
Lack of sunshineTaking certain medicationsHaving darker skinHaving an underlying health conditionBeing overweight
But simply having low mood may be enough cause to pick up a box of vitamin D pills next time you’re out. “We are all dealing with a lot of stress right now, and for some people more vulnerable to mood disorders,” Greenblatt says, “it might be helpful for a physician to look at your vitamin D levels.”
Testing for Low Vitamin D
To know whether you need to supplement, consult your doctor on your vitamin D status. You can complete an initial appointment via telemedicine or in person if you prefer. Your provider can then request a lab test, but this part must be done in person. According to an analysis from Blue Cross Blue Shield, you’ll pay an average of $50 for this test, which is typically covered by health insurance. If your vitamin D levels are low, your doctor may recommend a higher dose. Penckofer says that after the test, expect for it to take six to eight weeks to reach your ideal level of vitamin D. She adds that doctors usually test again after three months, to see how your levels have changed. “Research and doctors would agree that 30 ng/ml [nanograms per milliliter] is where you need to be,” says Penckofer. That 30 refers to the amount of vitamin D in your bloodstream, according to the National Institutes of Health (NIH). RELATED: Research Suggests Vitamin D and Calcium Supplements Can Reduce Fracture Risk
Tips for Choosing a Vitamin D Supplement to Potentially Boost Mood
Recommendations vary, but Greenblatt says you can safely take 1,000 to 2,000 IU of vitamin D per day. Guidelines from the NIH also suggest that to raise vitamin levels, at least 1,500 to 2,000 IU per day of supplemental vitamin D may be required in adults. Selecting a safe and effective vitamin D supplement is complicated. “Most vitamins are not approved by the [U.S. Food and Drug Administration (FDA)], so it’s hard to give guidance,” says Penckofer. Vitamin D supplements are not under the same scrutiny as traditional medications, as far as FDA regulation goes. Still, she says if your doctor has you taking a high dose, he or she will likely tell you what brand they use or recommend in their practice, adds Penckofer. Pro tip: You’ll want to ask your doctor for brand suggestions, too, even if you are taking a lower dose. “A physician also may have a preferred vendor,” she says, based on feedback from patients or research they’ve done on their own. RELATED: What Are the Best Sources of Vitamin D? Along with supplementation, you’ll also likely get a recommendation from your doctor to seek out sunshine. “Short exposure to the sun would help,” says Greenblatt. According to the NIH, about 10 to 15 minutes per day of direct sunlight (without sunscreen and not through a window or screen) on the arms, face, or the backs of your hands, may be sufficient. Adds Dr. Wynns, “My number one recommendation is to get outside and exercise in nature, because of the research on exercise, sunlight, nature, and mood — it’s the trifecta. Even more so, during this time, I’m emphasizing that if you’ve been cooped up, it’s important to get outside for a quick walk, or sit out on your deck in your yard.” An article published in June 2017 in Frontiers in Psychology cited a wealth of research that suggests exercising outdoors may improve mental well-being. If you’re going to exercise outdoors during the COVID-19 pandemic, though, be sure to follow social distancing recommendations and wear a cloth mask if you can, as the Centers for Disease Control and Prevention recommends. Some good news now that summer is underway: “We build up our stores of vitamin D during the summer months,” says Choukri. That means, hopefully, you can get lots of sunshine this season, to get your vitamin D levels back on track. RELATED: Your COVID-19 Summer Safety Guide
