Effects of Vitamin D on Muscle and Bone Health in Athletes

Introduction

Vitamin D is one of four fat soluble vitamins and exists in two forms: D2 and D3. Vitamin D2 is

synthesized when the skin absorbs UVB rays and is then converted to vitamin D31. The human body

generally does not synthesize a sufficient amount of vitamin D from the sun. However, there are some

foods naturally rich in vitamin D such as salmon, liver, sardines and mushrooms2. Even with these two

ways of obtaining vitamin D, it is generally not enough, supplementation or the addition of vitamin D

fortified foods is often needed. It is recommended that we consume 600 IU (international units) per day,

though some health care providers have suggested amounts of approximately 1,000 IU would be more

sufficient1. Vitamin D has a half-life of approximately three weeks but frequent replenishment is still

needed3. Vitamin D has long been known for its beneficial effects on bone, muscle health and more

recently, its effects on preventing chronic diseases. It is needed to help absorb calcium and phosphorus

which are both very important to the building of bones. It is estimated that approximately 1 billion people

in the world have an insufficient intake of vitamin D. This includes the elderly, those with dark skin, or

living in areas with less sunlight2. Vitamin D deficiency is also often seen in athletes, particularly those

who have dark skin and spend most of their time training indoor such as dancers and gymnasts4. The

purpose of this paper is to evaluate how consuming an adequate to increased amount of vitamin D can

affect the muscle, bone health and performance of various athletes.

Methods

To find content for this paper the University of North Floridas library database was first used as

a means of collecting background data. From there, Dr. Andrea Arikawas course packet for the

Advanced Nutrition Science II class was consulted to gather information on vitamin Ds synthesis and

function in the body. Next, the search term original research vitamin D in athletes was used on the

UNF database to find original studies. The types of studies that were used in this paper include cross

sectional clinical, controlled prospective and randomized double-blinded placebo-controlled. Websites

that were not accessible from the UNF database were excluded from this paper. The databases PubMed

and Science Direct were also used with the search term vitamin D in athletes. Only articles

designated as original research were reviewed from these two databases. There was a much higher

prevalence of studies relating vitamin D to muscle strength and power as opposed to bone health, possibly

due to the expensive nature of testing bone health.

Main Findings

In a cross-sectional clinical study conducted by Hamilton et al, 342 professional footballers (soccer

players) from the Star football league in Qatar fasted for 12 hours before a non-mandatory medical and

musculoskeletal examination. Blood samples were drawn to determine the levels of 25(OH)D, also

known as calcifediol, or vitamin D. The most commonly accepted definitions 25(OH))D are adequate:

>30ng/ml, insufficient: 20-30ng/ml, deficient: <20ng/ml and severely deficient: <10ng/ml. The levels of

blood 25(OH)D were analyzed using chemiluminescent immunoassay (CLIA) technology. A DXA
scanner was used to asses bone mass, soft tissue fat free mass, and fat mass. An isokinetic dynamometer

was used to determine the isokinetic peak torque of the athletes at various ranges of motion. Of the 342

athletes who participated in the study, 84% had 25(OH)D levels lower than 30ng/ml, but greater than

10ng/ml, indicating insufficiency and deficiency. 12% of the athletes had levels of 25(OH)D less than

10ng/ml, indicating a severe deficiency. The lean body mass and total body mass of the players who had

insufficient 25(OH)D, were greater than those with severe deficiency. The athletes who were severely

deficient in 25(OH)D had a slightly lower absolute hamstring and quadriceps isokinetic peak torque than

the insufficient and sufficient groups. However, the other isokinetic tests did not show a major significant

difference. The overall results of the study concluded that 25(OH)D deficiency is highly prevalent in the

Qatar Star league footballers, and a severe deficiency in 25(OH)D is linked to a lower lean body mass and

lower body mass. However, the 25(OH)D concentration in the blood did not have a consistent effect on

the isokinetic peak torque in the athletes. One of the possible reasons for the vitamin D deficiency in the

athletes could be linked to the tendency of practice to be held at night due to the excessive heat outdoors

during the day. This could cause a lack of vitamin D synthesis in the skin4.

Another study by Wyon et al was performed to determine the effects of oral supplementation of

vitamin D3 in elite ballet dancers on certain physical fitness and injury factors. It was a controlled

prospective study that included 24 elite ballet dancers, 17 in the intervention group and 7 in the control

group. Similar to the Qatar footballer study, an isometric muscular strength test was used along with a

vertical jump height test. The same dancers were monitored the previous year and all showed to have
insufficient or deficient 25(OH)D during the winter months and only 15% of the dancers had sufficient

levels during the summer months. This particular part of the study, however, was conducted from

January through May. To measure muscular strength, the dancers sat in an isometric strength chair that

tested their quadriceps contraction strength of the dominant leg. To test the muscular power the dancers,

they performed a vertical jump test using a jump meter. Injuries were also reported during the length of

the study. During the study the intervention group received vitamin D supplementation of 2000 IU daily

over a period of 4 months. The intervention group showed a 19% increase in quadriceps strength after 4

months of supplementation and a 7.2% increase in muscular power (vertical jump) while the control

group showed no change in muscle strength and a 2% decrease in muscle power. The intervention group

reported no injuries while the control group had five participants who reported 1 injury, one participant

who reported 2 injuries and only one participant who had no injuries5. The results from the study, in

contrast with the Hamilton et al study showed that 25(OH)D levels did have an effect on the athletes

performance, however, the Hamilton study did not include supplementation and only the serum 25(OH)D

levels measured at the beginning of the study were used as the means of comparison.

Vitamin D has long been known to help the body absorb calcium which is needed for bone

health. The two micronutrients work together in tandem not only to induce muscle movement but also to

form strong bone mass6. In a randomized double-blinded placebo-controlled study by Silk et al, the

effects of vitamin D supplementation in conjunction with calcium supplementation were tested in male

jockeys. Jockeys are often forced to maintain an extremely low body weight. In order to do this, they
often succumb to unhealthy methods of maintaining a low weight such as caloric restriction and

extremely high amounts of physical activity even during critical growing years. This often leads to a low

bone and muscle mass. The study consisted of 29 male jockeys from the ages of 16-32 years of age. The

athletes completed a anthropometric measurements and filled out a dietary questionnaire to evaluate

current vitamin D, calcium and caloric intake. Then bone mineral density, bone geometry and bone

strength were assessed in the jockeys non dominant tibia. Blood samples were also drawn from the

jockeys to test for calcium and vitamin D, the results showed an insufficient intake of both. After

gathering baseline information, the intervention group was supplemented with 800mg of calcium along

with 400 IU of vitamin D while the control group was supplemented with a placebo. The study tested for

blood markers of bone change such as P1NP, CTX and vitamin D concentration. At the conclusion of the

6-month study it was observed that the intervention group had a cortical bone content 6.6% greater,

cortical area 5.9% larger, cortical density 1.3% greater and a total bone area of 4.4% higher while the

placebo group had no significant changes in bone. The intervention group also had a greater serum

vitamin D increase at the conclusion of the study when compared to the placebo group. However there

were no significant changes in serum calcium in either group. The evidence from this study demonstrated

that vitamin D supplementation in conjunction with calcium supplementation can be a viable strategy to

improve the bone health of weight restricted athletes7. Often times we associate athletes to having above

average health but in this particular case the athletes had below than average health due to their extremely

low caloric intake, weight and bone health. The results from this study are promising because even
though the sample size was small, the supplementation of vitamin D along with calcium showed

improved bone health even in the compromised athletes.

A study by Koundourakis et al was designed to study the association between vitamin D levels in

blood serum and muscle strength, speed and aerobic capacity in professional soccer players in Greece.

The study had a second purpose of evaluating the vitamin D serum levels during the off season period.

The study consisted of 67 male soccer players with an average age of 25.6 and height of 1.81m. Blood

samples were drawn at the beginning of the study to test for serum vitamin D levels along with an

anthropometric evaluation. To test muscle strength the athletes performed squat jumps (SJ), and

countermovement jumps (CMJ). For speed the athletes participated in a 10m spring, 20m sprint, and the

athletes were also tested to determine VO2max. The results of the study showed a positive correlation

between vitamin D levels and SJ, CMJ and VO2max in the athletes. At both the beginning and the end of

the study there was a negative correlation between vitamin D and the sprint times of both the 10m and

20m sprint. The study also followed the athletes in the off season. The amount of serum vitamin D

actually increased during this period, though conversely the SJ, CMJ and VO2max decreased even with

the increase of vitamin D. However the changes in SJ, CMJ and VO2max could also be attributed to the

increase in weight and body fat. Though this study did not include vitamin D supplementation it was

clearly demonstrated that there was a positive linear correlation between the amount of vitamin D in the

athletes blood serum and their athletic performance. What proves this study to be interesting though is

even though the vitamin D levels increased during the off season, the performance of the athletes still
declined with weight and fat gain. This indicates that vitamin D is beneficial to athletes during exercise

but when going through periods of low exercise, the effects of vitamin D on muscle are not seen as much.

In other words, vitamin D plays a supportive role in athletic performance but is not the sole determinant

of it. However, it should still not be overlooked that the athletes in this study who had a higher vitamin D

serum level also displayed better athletic performance8.

Conclusion

There are many implications for this information in regards to sports dietetics. When working

with athletes who are required to keep a low body mass such as figure skaters, ballet dancers and as

discussed above, jockeys this information will be very valuable when creating meal plans for them. It

should be noted that a diet high in calcium and vitamin D is needed in order to maintain healthy, strong

bones, muscle strength and speed. This is particularly helpful when the athletes are training for many

hours each day but need to consume a lower calorie diet. This information will also be useful when

working with athletes such as football players and soccer players who do not need to restrict their calories

but do need to maintain as healthy body mass in order to sustain the high amount of running they do.

Perhaps the most useful implication of this knowledge though is in athletes who do not train outside such

as dancers, gymnasts and basketball players. These athletes generally do not spend enough time in the

sun so it is difficult for them to synthesize their own vitamin D. Supplementation in these athletes should

be highly recommended.
 Based on the evidence from this study, it is clear that there is a positive correlation between

vitamin D intake and athlete performance. However, more studies are needed in order to have more clear

evidence of the mechanism of action and the amount of vitamin D that provides the most optimal results.

Three of the four studies review in this paper concluded that there was an improvement in performance

with higher vitamin D intake but it should be noted that the sample sizes were rather small and only

represented athletes with a high skill level and did not represent all skill levels. It is well known that

calcium and vitamin D often work in tandem so if there is an increase in vitamin D, an increase in

calcium should also occur. Nonetheless, there seems to be evidence that it can improve muscle strength,

power, speed and bone mass, all of which is very important for athletic performance.
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