Exercise, fresh air and sunshine – a simple, old-fashioned prescription for good health, and yet we are often too busy to take advantage of this readily available resource which helps to provide us with strong bones and a healthy cardiovascular system.

One of the vital benefits this therapy provides is a sufficient amount of one of the most essential nutrients our body needs – vitamin D. The sun is not the actual source of the vitamin itself, but a necessary means of triggering body mechanisms to generate and synthesize it.

During the winter months you may find that some clients are suffering from higher levels of pain or perhaps they are more tired than usual. Clients, who are normally active and upbeat, seem less so with no obvious cause. Recent studies have shown that increasing levels of vitamin D through increased sun exposure, eating fortified foods or taking supplements can reduce the aches, pains and fatigue people feel this time of year. Asking your clients a few simple questions about their outdoor activity or vitamin supplementation may help in finding a solution – and increase the effectiveness of your massage.

Why Is Vitamin D Important?

In the body, vitamin D regulates calcium and phosphorus levels in the blood by promoting their absorption in the intestines and ultimately the kidneys. This enables normal mineralization of the skeletal system. Vitamin D also has a positive effect on the immune system in part by promoting phagocytosis, anti-tumor activity and immunomodulatory functions. Vitamin D has shown to be of benefit in treating various inflammatory diseases such as rheumatoid arthritis, osteoporosis, some forms of cancer and autoimmune diseases including type I diabetes.

In children, lack of vitamin D can result in rachitis, more commonly known as rickets. Known to cause skeletal malformations, which commonly manifest in the child having bowed legs or spinal deformities, a deficiency in vitamin D can also be responsible for overall muscle weakness, uncontrollable muscle spasms and costochondral swelling.

Adults over 50 are also at greater risk for vitamin D deficiency. According to government standards, most adults require a minimum of 200 IU (International Units) per day. After age 50 that requirement rises to 400 IU, and after 70 increases to 600 IU. Lack of adequate vitamin D in older adults has been linked to osteoporosis, depression, some cancers (including those of the breast, colon, rectum, ovary, kidney, lung and uterus), multiple sclerosis, type I diabetes and, most recently, heart disease. Recent studies have shown that low levels of vitamin D double the chances of someone having a heart attack or stroke. An inadequate supply of vitamin D has also been shown to be responsible as a cause of generalized muscle pain and weakness.

How Can Your Clients Get Enough Vitamin D?

How much vitamin D, or sunshine exposure, a person needs varies depending on several factors. For example those with light skin need less than those with darker skin. People who live further north require more exposure to sunlight than those who live near the equator. Older adults need more than young people, and heavier people need more than those who are thin. It also depends on the season, how much sun block is used and what time of day one goes out into the sunlight. If you are ill, your body may require more vitamin D to help strengthen the immune system.

The best and easiest way to get vitamin D is to go outside and expose yourself to sunlight for at least 15 minutes per day, preferable early in the day before the sun’s rays are too strong. This also means exposure without sunscreen. A sunscreen with a protection factor of 8 will block more than 90% of the UVB rays needed for the body to produce vitamin D. UVB rays do not penetrate glass, so sitting inside, behind a window will not promote vitamin D production either. Clouds, shade and pollution also reduce the amount of UVB rays that reach your skin.

Few foods contain vitamin D. The best natural food source is fish. A tablespoon of cod-liver oil contains more than 300% of the daily requirement, while cooked salmon or mackerel contain about 90%. Egg yolk, liver and some cheeses contain very small amounts, less than 5% of what is recommended. Some processed foods are now fortified with vitamin D, including many dairy products such as milk, cheese and yogurt. Breakfast cereals and fruit juices may also contain added vitamin D.

On the other hand, some people may choose to take vitamin D supplements. For optimal absorption and efficacy it is best to take Vitamin D together with calcium and magnesium.


There are certain precautions that need to be observed with regard to taking vitamin D supplements. Vitamin D may interact with or affect absorption of certain medications including corticosteroids such as Prednisone, medications for ulcers, blood thinners, cholesterol lowering drugs, anti-seizure medications and certain antibiotics. Liver and kidney disease may impair the assimilation of vitamin D, as can a number of hereditary disorders.

Too much sun exposure has been shown to be responsible for an increase in malignant melanoma, a potential fatal form of skin cancer. So caution needs to be taken in not staying out in the sun long enough to do damage to the skin. Anywhere from 5 to 30 minutes of sun exposure at least twice a week to the face, arms, legs or back is enough to produce sufficient vitamin D synthesis.

Some people exhibit a hypersensitivity to vitamin D in large doses. With quantities higher than 2000 IU, a person with this sensitivity may exhibit symptoms such as nausea, vomiting, constipation, weakness or weight loss. Exposure to the sun will not cause vitamin D toxicity because the body is able to self-regulate the vitamin’s production.

Help Your Clients Stay Healthy This Winter

As a massage therapist you cannot diagnose illness, nor can you prescribe medications, but you can advise clients on ways to optimize their health.

In our Western culture we often stay inside during the winter. Doing so not only keeps us from staying in harmony with the rhythms of nature, yet can also adversely affect our health. Help your clients stay healthy this winter and suggest they take a walk in the morning before heading off to work, or go outside during their lunch break and sit in the sun. The fresh air will do them good, and they can be assured of getting the ever-vital vitamin D.


Cutler, Nicole, L.Ac. “Caution: Hepatitis C and Vitamin D Deficiency.” Hepatitis Central. October 27,2008. 11 Dec 2008 <http://www.hepatitis-central.com>.

“Dietary Supplement Fact Sheet: Vitamin D.” October 21, 2008. National Institutes of Health – Office of Dietary Supplements. 11 Dec 2008 <http://ods.od.nih.gov/factsheets/vitamind.asp>.

“Mayo Clinic – Vitamin D – Builds Bones and More.” July 14, 2008. Mayo Clinic. 11 Dec 2008 <http://www.mayoclinic.org/news2008-mchi/4904.html>.
Roberts-Grey, Gina. “Winter Rx: More Sunshine.” Heart-Healthy Living. Winter 2008: 28-32.