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Sun Exposure Not Enough To Prevent Rickets

Rickets — the bone disease caused by Vitamin D deficiency — is on the rise in England. Even children getting “plenty” of sun exposure are at risk. Doctors are befuddled. Even the children whom doctors considered well-nourished (those from the relatively affluent middle class) are getting the disease. What does this tell you?

The standard, conventional medical wisdom on this subject is simply lacking. We’ve been told that 15 minutes of exposure to the sun, twice per week would be enough for us to produce enough Vitamin D to prevent Rickets. We’ve been told that fortifying our milk and other dairy with synthetic Vitamin D would prevent Rickets. We’ve been told a bunch of malarkey.

Here are a few truths to think about as we challenge conventional medical wisdom on this subject:

1) The traditional diets of robust, healthy peoples from around the globe contain an average of TEN TIMES more fat soluble vitamins (including Vitamin D) than ours do. (source)

2) The inner layers of our skin synthesize Vitamin D when exposed to the sun’s UVB rays, so long as there is enough cholesterol in the system to do so. (source)

3) Showering daily with soap can actually strip the skin of the synthesized Vitamin D before it has a chance to be absorbed into our bloodstream. (source)

4) UVA rays from the sun also destroy Vitamin D. “This helps keep your body in balance; it’s one of the protective mechanisms your body has to avoid overdosing on vitamin D when you’re outside. However, when you’re exposed to sunlight through windows — in your office, your home or your car — you get the UVA but virtually none of the beneficial UVB. UVA is one of the primary culprits behind skin cancer, and it increases photo aging of your skin. ” (source)

5) The vast majority of us have low Vitamin D levels. (source)

Keeping all this in mind, what can you do to ensure you’re getting enough Vitamin D? Particularly in these chilly, cloudy winter months?

Supplementing with vitamin D

The best whole food supplement for increasing vitamin D is, of course, fermented cod liver oil. Why fermented cod liver oil? Well, it really concentrates the vitamin D in the cod liver oil, particularly in proportion to the vitamin A. So you can get the same amount of vitamin D from just 1 ml of fermented cod liver oil as from 2 tablespoons of straight cod liver oil. This makes the fermented cod liver oil much more cost-effective. To find online sources of fermented cod liver oil, check out the listings on my resources page.

Of course, there are also other ways to up your vitamin D:

  • Drink only raw milk from grass-fed cows.
  • Eat healthy eggs from hens raised out on pasture.
  • Spend some quality time out in the sun, exposing as much of your skin as possible for at least 20 minutes per day if you’re fair and up to an hour a day if you’re very dark. Worried about that much sun exposure? Read up on the debate in this post from my archives called Should You Use Sunscreen?

But most of us find that even doing all these things, we still lack sufficient vitamin D in the winter because of the limited and indirect sunshine. Plus we naturally spend a lot more time indoors when it’s cold out! So, why not give yourself a little present of fermented cod liver oil, just to be on the safe side? (I do!)

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I am a passionate advocate for REAL FOOD -- food that's sustainable, organic, local, and traditionally-prepared according to the wisdom of our ancestors. I'm also an author and a nutrition educator. I enjoy playing in the rain, a good bottle of Caol Ila scotch, curling up with a page-turning book, sunbathing on my hammock, and watching my three children explore their world.

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54 Responses to Sun Exposure Not Enough To Prevent Rickets
  1. Liz Snyder via Facebook
    January 25, 2011 | 4:17 pm

    I am pretty sure it’s the daily baths more than anything. DD hated baths as a baby and bathed maybe 2x/month. She has the highest bone density her doc’s office has *ever* seen, and we hadn’t yet incorporated CLO or traditional fats into our diets when she was a babe.

    • KristenM
      January 25, 2011 | 5:48 pm

      I only use soap under my arms and in my groin, and then only when I actually “get dirty” through high-intensity activities. The rest of me is soap-free.

      • Lanise
        January 25, 2011 | 9:54 pm

        I’m so glad I’m not the only one. I thought I was weird and never shared that info with anyone. We also only bathe our kids about once a week, unless they wet the bed, than we give them a quick rinse, but without soap. I’m glad we’re doing something right.

      • Heather
        January 26, 2011 | 6:46 am

        We are stinky only soapers too! My son has never had soap on his body and I only wash my pits and groin as needed. We don’t tell *anyone* these things because we already get an earful for our son only bathing once a week rather than every day.

  2. @HilaryFleming
    January 25, 2011 | 4:24 pm

    Great article. Interesting read. Im sharing w my twitterers and fb

  3. Christina
    January 25, 2011 | 4:24 pm

    Kristen, Why do you not mention just straight Vitamin D3 as a supplemental way of boosting one’s Vitamin D levels? I just started my family of 7 on D3 about a month and a half ago because the FCLO is just so pricey and the straight D3 is incredibly cheap (900 servings for about $7 on Vitacost for 2000 i.u.s/serving). Is this a bad way to go? I have a high-quality fish oil I’m giving them for Omega 3’s, in addition to the D3. It’s just cheaper this way. Thoughts?

    • KristenM
      January 25, 2011 | 5:54 pm

      I believe the BEST thing is to maintain health by opting out of as much of the industrialized food system as possible while sticking to whole food supplements. In other words, I don’t really care for supplements that are simply specific, isolated nutrients. I believe our body does MUCH better appropriating nutrients from quality foods than it does from isolated nutrients, and fermented cod liver oil is a FOOD. A quality Vitamin D3 supplement, while surely being much better than simply ignoring the problem altogether, is still an isolated nutrient.

      • Helena
        December 12, 2012 | 9:25 pm

        About one year ago I began taking FCLO and stopped supplementing with D3 as I had been doing for several years. Four months later I had a Vit D retest and my level had dropped from around 60 to around 30. I don’t know how much FCLO I would have to take to replace 4000 IU of D3, certainly not what I could afford. So now I take both.

  4. Gini Shackelford via Facebook
    January 25, 2011 | 4:27 pm

    Your #2 point is a great one. People have become so afraid of cholesterol that their skin and that of their children won’t even work properly now. Try reminding people that cholesterol is a major building block of our cells, and you get a blank stare.

    • KristenM
      January 25, 2011 | 5:54 pm

      So true!

  5. Sue Scott via Facebook
    January 25, 2011 | 4:43 pm

    cholesterol is in breast milk so it has to be good for childrenh

  6. Courtney Paulson Lorenz via Facebook
    January 25, 2011 | 4:49 pm

    At what age are you supposed to start giving little ones FCLO and what is the serving size?

  7. Liz Snyder via Facebook
    January 25, 2011 | 5:04 pm

    Just posted my personal take on baths and vitamin D: http://www.ieatreal.com/231

  8. Jenn
    January 25, 2011 | 5:32 pm

    Shouldn’t one of your recommendations be to not shower every day? And to use soap sparingly, especially on parts of the body that see sun exposure? I’ve started only using soap on my hair and in my pits. Once a week or less, I’ll soap up my whole body with a wash cloth. I pretty much only shower after I’ve done vigorous physical activity or when I’ve gotten actually dirty.

    • KristenM
      January 25, 2011 | 5:55 pm

      Jenn, yes I would certainly recommend that practice. (It’s what I do myself!)

  9. Food Renegade via Facebook
    January 25, 2011 | 5:43 pm

    @ Courtney — The Weston A. Price Foundation recommends that children age 3 months to 12 years get 1/2 teaspoon or 2.5 mL of fermented cod liver oil daily, providing 4650 IU vitamin A and 975 IU vitamin D.

  10. Courtney Paulson Lorenz via Facebook
    January 25, 2011 | 5:44 pm

    Great, thanks Kristen! She’s 6wks now, so I’ll have to remember to start when it’s time. :)

  11. Katie @ Wellness Mama
    January 25, 2011 | 5:49 pm

    I’m interested in your opinion on D3 supplementation also. We take D3 by itself and also take Kirll oil and other Omega 3s for their benefits. I think Fermented Cod Liver Oil is great, I’ve also just decided to go this route for the cost.

    • Emily
      December 13, 2012 | 1:51 am

      I know krill oil has a lot of great benefits but they are getting it from the waters around Antarctica and taking the food needed by whales and penguins and birds etc.

  12. Food Renegade via Facebook
    January 25, 2011 | 5:58 pm

    @Liz — Love the post! I’ve also joined your ranks as a dirty, sun-worshipping, unwashed hippie. LOL.

  13. Shannon MacDonald via Facebook
    January 25, 2011 | 6:04 pm

    My guy has allergies and unfortunately egg yolk and FCLO give him hives and milk sends him to hospital by ambulance. Is there any other animal foods that have great vitamin D?

    • Alison
      January 25, 2011 | 9:51 pm

      I was just going to write a comment saying that she should add in things like organ meats, liver especially is a good source of vit. a/d. hope that helps!

      • Emily
        December 13, 2012 | 1:55 am

        My kids love liverwurst (Braunschweiger) on crackers.

    • WordVixen
      January 26, 2011 | 4:25 pm

      I’ve heard that pastured pork fat is the highest dietary source of vitamin D, though I don’t recall where (definitely a Real Food blog, though). Since D is damaged by heat, I’m not sure just how useful this is, but when I start getting the seasonal depression feeling (and I drink plenty of raw milk, eat egg yolks, and take FCLO- but don’t get sunlight due to my work hours) I cook something in lard, and I do feel better.

      *lol* A coworker asked me how many IUs of D I take, and when I told him the foods that I get my D from, you should have seen the look of horror! Especially when I got to the lard part.

  14. Darlene Childers Franco via Facebook
    January 25, 2011 | 6:26 pm

    I LOVE THIS ARTICLE!!! I had to share it with my husband, who thinks everything I do now is *weird* and won’t participate in (ie – water kefir, coconut water, real butter, etc…). Our kids MAYBE get a bath 1-2/week. I just don’t have the energy to do more, and my 1yr old is allergic to every soap but Burt’s Bees, so rarely does he get any lather-action. Funny how I feel Someone is looking out for me (and my tadpoles) despite my ignorance sometimes. Now I can quit feeling so guilty about my kids being a little gritty! :-)

    • Adrienne
      February 9, 2011 | 1:20 pm

      Just an idea for those of you wishing to avoid harsh soaps. Try Dr., Bronner’s unscented castille. We even put it in a foam soap dispenser to you use less. Fill the container w/ 4/5 water and add 1/5 soap. I find it super gentle. They have nice scents too if you’d like to experiment. It’s available at Target and through HerbTrader.com and other retailers.

      I hope you like it as much as we do!

  15. Food Renegade via Facebook
    January 25, 2011 | 7:41 pm

    @Shannon, lard from foraged hogs is a reasonably good source, but liver from pastured cows or hens will be higher.

  16. Cecilia E Long via Facebook
    January 25, 2011 | 8:01 pm

    personally I beleive its the fact that everyone slathers sunscreen on like there is no tomorrow and the fact we ultra pasteurize everything…

  17. Pippi
    January 25, 2011 | 8:28 pm

    Interesting — I’d never heard about the bathing issue. My daughter takes a bath most nights but rarely to we use soap. There’s just no point. Our whole reason for the bath was to help her calm down before bed, though, not to actually clean her :)

    • KristenM
      January 25, 2011 | 8:41 pm

      My kids take daily baths, too, for the fun, calming effect. But we only use soap when they have gotten truly dirty or greasy.

  18. Kristen
    January 25, 2011 | 8:32 pm

    Wow. Just wow. It’s kinda crazy that rickets of all things is on the rise.

    So is it true that a good diet will lead to less body odor then? Reading the comments on the lack of bathing… I mean, when I don’t at least take a two minute daily shower I feel grimy and within a day or two there is some definite body odor. You wouldn’t necessarily be able to smell me from a few feet away, but….

    • KristenM
      January 25, 2011 | 8:48 pm

      I think diet definitely affects body odor. That said, the real kicker is how much you sweat and how much that stinks. That seems to be determined not just by diet, but also by frequency of bathing with soap. It’s like the No Poo people who don’t use shampoo. They say that with time, your hair adapts to making less oil since it’s not always being stripped out by harsh shampoos. So, in turn, you need less shampoo (or maybe even none). So it goes with soap. If you just give your skin a chance to have healthy naturally-produced oils, bacteria and yeast colonize your warm, moist areas (pits & groin, mostly), they’ll produce a mildly pleasant odor when you sweat vs. the stinky odor that comes from an imbalance created by using soap. Interesting isn’t it?

    • Ariane
      February 10, 2011 | 10:07 am

      What helped immensely for me is to switch deodorants, I used to use “regular” aluminium spray on deodorant, and even with it on I sweated profusely and stank even after a few hours. Since then I’ve switched to a “natural” potassium alum roll on, and only use shampoos and soaps with natural and organic (no synthetic) ingredients.
      I now only take two showers a week and my pits now only start to -slightly- smell after about 3 days, even with my daily yoga practice.

      Body odor is partially diet (I can smell it when people eat a very spicy diet for example, and I’ve also been told by a vegan he could tell by my smell I eat meat, and when people eat alot of processed crap I personally usually also tend to think their body odor is pretty crap)
      but it is in my opinion also very dependant on what kind of lotions, soaps and deodorants you use, it makes a HUGE difference imo.

  19. Shannon MacDonald via Facebook
    January 25, 2011 | 8:42 pm

    Thanks! I do actually have some lard that we rendered awhile ago and it’s in our freezer. Time to take it out. And I’ll try to get my paws on some chicken livers to make pate. I bet my little carnivore would love it.

  20. Erin L.
    January 25, 2011 | 9:12 pm

    My hubby and I had our Vit D levels checked (the correct way, according to Dr. Mercola) before we started taking FCLO. A year later when we had our levels checked, they had only increased by a couple of points. We are taking the recommended amounts diligently. Any thoughts on why this would be? Is FCLO just not very effective with certain people?

    • Alison
      January 25, 2011 | 9:54 pm

      are you taking the recommended dose on the bottle i.e. 2 ml? if so that’s not enough…..the healthy home economist just posted a great video about how much cod liver oil you should really be taking….i recommend you check it out. I am a nursing mom and i just upped my dose to 2 teaspoons a day and my 11 mo. old takes almost a full tsp. good luck!

      • Erin L.
        January 27, 2011 | 1:23 pm

        Thank you, Allison. I watched the video you recommended. Turns out we were only taking half a teaspoon. We’re doubling our dose, so we’ll see what the tests show next year. I appreciate you taking the time to respond to my question!

  21. Bryan Lambeth via Facebook
    January 25, 2011 | 9:54 pm

    Very interesting. My daughter and then wife recently had the flu, so I upped my usual daily dose of 1 tsp of FCLO to 1 1/2 tsp this last week as a precaution and so far so good. It’s been about a year now without any respiratory infections for me. They won’t take FCLO or extra vitamin D and this is the second respiratory infection for my daughter since the school year started and the first for my wife since she had a bad bout of pneumonia last February.

  22. Jessica
    January 26, 2011 | 3:16 am

    Does anyone know if eggs laid in the winter time have just as high levels of vitamin D as those produced during the summer?

  23. Ed Bruske
    January 26, 2011 | 3:58 am

    This certainly runs counter to a huge report recently issued by the Institute of Medicine, a branch of the National Academy of Sciences, which found that while Americans and Canadians appear to have too little vitamin D in their diet, they have plenty circulating in their blood, indicating they get plenty from the sun. The IOM concluded that additional vitamin D supplements are not necessary.

    • KristenM
      January 26, 2011 | 10:38 am

      I remember reading about that, too. I think what it boils down to is this: there is no real, agreed upon standard for what blood serum levels of Vitamin D (in its various forms) should be. There isn’t even a standard blood test! There are several different ways of measuring blood serum levels, and they’ve been shown to produce WIDELY different results using the same patient’s blood.

  24. Charlotte Polizzo via Facebook
    January 26, 2011 | 8:56 am

    @Bryan, same here with me. I’ve been taking FCLO and incorporating my own rendered lard and schmaltz when and where possible -so far I’m the only one in my family to bypass all the respiratory infections going around like wildfire (both at office and home). True testament to eating and staying healthy!

  25. Cara
    January 26, 2011 | 9:26 am

    Great post! Scary to hear this news about ricktes increasing in England but there is literally no sun here in winter (experiencing this firsthand myself). Even a cold New England winter generally has beautifully sunny days. It’s just not so here… the sun has been out for 10 minutes max the course of this week (I’m in East Anglia). I will try to get FCLO, thank you for sharing!

    Cara

  26. Laura
    January 28, 2011 | 11:13 pm

    I recently read on Green Pastures’ website that most of the vit. D in their FCLO is vitamin D2- I thought this was the kind we were not supposed to take. Does anyone know anything about this?

  27. Elizabeth
    January 30, 2011 | 11:30 am

    My late grandmother (born in 1913) was a really “sickly” baby. Her family was pretty well-to-do, and she had all the best doctors in our hometown at the time. No one could figure out what was wrong with her, so as the story goes, her mother took her by train to Atlanta to see a doctor there. He diagnosed her with Rickets, and they were all completely mystified by it! It was pretty unheard of for someone like my grandmother to have Rickets.

    My grandmother ended up being VERY short… well under 5 feet, though I don’t know her exact height other than by the time I was 12 years old I could see the top of her head, despite the fact that she ALWAYS wore high heels. She lived quite a long life (93 years old), but had Alzheimer’s the last 15-20 years of her life, sadly.

    Her mother, my great-grandmother, died early in life of breast cancer. I don’t know for sure, but I wonder if my grandmother was formula-fed rather than breastfed. Given what formula was like back then it wouldn’t surprise me if that contributed to her low Vit D levels. She was also pretty fair complexioned, so I’m sure that they kept her bundled up pretty good.

    So Rickets has always been on my personal radar… I make sure that my kids get plenty of sun (without sunscreen as much as possible), they were both breastfed (not sure if it would help with this issue but I always think of it as a protective factor for many things), we drink grass-fed raw milk, etc. I would like to start them on CLO but it’s hard for me to figure out how to get it in them!

    • Lena Hong
      December 13, 2012 | 3:11 am

      I mix my kids’ CLO with the elderberry syrup. My daughter takes it without problems. My son, who is more picky, needs some convincing. Usually I have to promise him a square of dark chocolate afterwords.

  28. Jun
    February 9, 2011 | 1:53 pm

    Laura, from what I understand vit D2 is plant based and vit D3 is animal.

  29. M
    February 9, 2011 | 9:56 pm

    Actually, according to Dr. Holick who is a famous Vitamin D researcher and advocate you CANNOT WASH OFF Vitamin D from skin because it’s made in the living skin cells.

    He also says: “Vitamin D2 is as effective as D3 when given daily. We have completed a 6 year study showing 1,000 IU of vitamin D2 was as effective as 1,000 IU of vitamin D3 in raising blood levels of 25(OH)D. Thus, vitamin D2 is as equally effective as vitamin D3 and either form can be used. ” But, I think I’ll stick with D3 anyways:)
    If you want more info read his book The Vitamin D solution. It’s eyeopening.
    http://tinyurl.com/Vitamin-D-solution

  30. Elizabeth
    February 10, 2011 | 12:23 am

    I’m a nurse practitioner and I recently worked for the VA prior to having twins. Although the federal goverment and researchers give differing stories on Vit D-the why, how and how much, etc., The VA felt strongly enough about the importance of an adequate Vitamin D level, that we were testing pretty much EVERYONE for 25-(OH) D. I would order a megadose once a wekk for 4 weeks (20,000 IU) of D3 (Cholecalciferol) and then 1000 daily and recheck levels in 8 weeks. GEnerally everyone’s levels were up using the supplements within that time frame. If a patient was taking D2 (ergocalciferol) already, I would try increasing their dose first. Generally we saw better results with D3. Although “artificial” the supplements worked. I agree that we should try to get what we need form food but sometimes adding supplements is the faster and easier way to go. It can also be easier to get a little kid to take a vitamin D drop than a fishy tasting concoction. I have one twin who will take anything from a syringe. The other one gags even on the strawberry flavored CLO. No way she’s taking the fermented stuff!
    Please don’t feel guilty if you can’t afford the FCLO. Do what you can, eat the best your budget allows for and take a supplement. If one brand doesn’t work, try another. Fillers can affect absorption much more than the fact that the D3 is not from a food source. And more expensive doesn’t always mean better either. Read labels and try to use liquigels or liquids as they are better absorbed since there is less to bind with and hence less for your body to breakdown before it can absorb the D3.
    One more thing- my husband was just diagnosed with skin cancer on his temple. A friend of his died of a skin cancer that literally ate away part of his face. And I lost a nurse friend of mine at age 33 to melanoma-we have daughters the same age. This is the result of years of sun exposure (and in the case of my friend-frying in baby oil as a teenager. She was a fair brunette) Please don’t go crazy in the sun and get sunburned or stay out for hours at a time. Limit it to your 15-20 minutes a day without sunscreen and then cover up, get back inside, go in the shade and wear a zinc based sunscreen so you don’t have to deal with biopsies and “prognoses” later on in life. He’s not fair, hasn’t had blistering sunburns, has brown hair and eyes and tans really easily. It’s just years of chronic sun exposure.
    Good luck.

    • KristenM
      February 10, 2011 | 10:24 am

      Elizabeth — You may be interested in reading this article, which cites research indicating that melanoma really is NOT linked to sun exposure at all. Start by reading it, then go back to the source article to read more in depth.

  31. Jen
    December 12, 2012 | 9:10 pm

    I love this stuff. I work at Whole.Foods in the Whole Body Department none the less and my husband is a.rep for Standard Process. As a Weston A. Price chapter leader, I am constantly educating people of all these poimts. Regardless, I still get…”But Dr. Oz says…..”. That is what we are up against if you will.

  32. Rachel
    December 13, 2012 | 8:26 am

    I don’t have a good source of raw milk close by, but I do get some grass-fed, low temp pasteurized milk from Whole Foods from a farm in western PA. What are your thoughts on low-temp pasteurized? I know it’s not as good as raw, but does it still retain some of the health benefits?

  33. Bethany
    February 1, 2013 | 4:02 pm

    At what age is it safe to have a baby in the sun for longer periods of time. I am due in April and just thinking about the summer. My 4 year old son and I consume lots of healthy fats and don’t use sunscreen unless we are going to be at the beach all day or something. Everyone keeps telling me I need to be careful about the baby in the sun. I was going to get a water wrap so we can still go to the pool, but what are the guidelines for babies in the sun?

  34. Karl
    February 2, 2013 | 7:44 am

    what about going in sauna?

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Who Am I?

My name is Kristen Michaelis. I'm a nutrition educator, author, and mother of three. I adore hats, happy skirts, horizons full of storm clouds, the full-bodied feel of wind as I ride motorcylces, reading in my hammock, and a hearty shot of Caol Ila scotch. I'm also a rebel with a cause.