The Sunshine Vitamin — restoring what modern life took away from Native Americans
Considering giving Vitamin D to Native Americans
Question to Claude AI Am considering improving the healthof 5,000 native Americans by providing them with vitamin D - just 1 pill every two weeks. Questions. 1) Are they used to taking pills? 2) I am aware that they are generally close to nature. Wondering how I should market it to them. Made by the sun? Vitamin D has been used by all life forms for 500 million years? something else?
This is a meaningful project, Henry. Let me look into some of the cultural and practical dimensions to help you think this through well.This is a wonderful initiative, Henry. Here's what the research suggests on both questions:
1) Are They Used to Taking Pills?
The short answer is: it's complicated, and this is actually one of your biggest challenges. Native Americans have the poorest medication adherence rates among all population groups in the U.S. Several factors drive this:
Preference for traditional/natural healing. Research with Native American women found recurring themes including preference for traditional medicine over Western pharmaceuticals, fear of resistance and dependence, and concerns about negative side effects. Native or Indigenous individuals are significantly more inclined to seek assistance from spiritual and traditional healers rather than from specialists or medical sources.
Deep historical mistrust. Colonialism, relocation, assimilation, and loss of land have contributed to a certain level of mistrust of institutions including the healthcare system. Being handed a pill by an outsider can trigger this wariness.
Practical barriers. Cost, travel distances to pharmacies, and limited healthcare access on reservations all play a role.
That said, your biweekly dosing is a huge advantage. One pill every two weeks is far less burdensome than daily regimens, which is where most adherence falls apart.
2) How to Frame/Market It
Your instinct about connecting to nature is well-placed. Here are some thoughts, roughly ranked by what the cultural literature suggests would resonate:
"The Sunshine Vitamin" / "Gift from the Sun" — This is probably your strongest framing. It's true, it's simple, and it connects directly to the natural world. The sun is sacred or deeply respected in many Native traditions. Framing vitamin D as something the sun provides — that modern indoor life has taken away — resonates with the narrative of returning to natural balance rather than adding a "chemical."
The evolutionary/ancestral angle ("used by all life for 500 million years") — This is factually compelling and you know this science deeply, but it's a researcher's framing. Most people, Native or otherwise, won't connect emotionally with "500 million years." However, a simplified version — "your ancestors' bodies made this from sunlight; modern life means you don't get enough" — could work well.
Framing it as restoring balance, not treating disease. The Medicine Wheel concept, used by many tribes for health and healing, reflects a holistic view — people are interconnected with their communities, nature, and the spiritual world, and ailments may be viewed as a lack of harmony. Positioning vitamin D as restoring a natural balance that's been disrupted (by indoor living, modern diets, northern latitudes) aligns with this worldview far better than "take this to prevent disease X."
Critical success factors from the literature:
Work through tribal leadership and community health workers. Tribal leaders and community members are essential allies; before offering any health program, elders, administrators, and stakeholders must ensure they are recognizing and incorporating culturally appropriate considerations. Do not parachute in as an outsider — get a tribal health champion to endorse and distribute.
Use visual materials. About 41% of Native Americans in one Midwest survey preferred pictures or graphics over words when presented with health information, possibly reflecting both literacy considerations and deep cultural roots of graphical symbolism in Native culture.
Frame it as community wellness, not individual medicine. Family and community identity are central. "Healthier together" messaging outperforms "take this for yourself."
One Important Caution
I want to flag something you should be aware of: research suggests that because indigenous Arctic and some Native peoples have adapted genetically to lower vitamin D levels — through more efficient conversion to active forms and more effective receptor binding — they can potentially be misdiagnosed as vitamin D deficient when measured against European-derived norms. A 2025 CDC study (Strong Heart Family Study) did find that vitamin D deficiency among American Indian adolescents was independently associated with metabolic syndrome prevalence, and 13 years later, diabetes incidence was significantly higher among those who were deficient. So the benefit case is real — just be thoughtful about what dosage you're using and whether you're targeting specific tribes/regions, since there's genuine population-level variation in vitamin D metabolism.
My bottom line recommendation: Lead with "The Sunshine Vitamin — restoring what modern life took away",
work through tribal health programs and community health representatives, use a simple visual handout (maybe a sun/nature motif rather than clinical imagery), and emphasize that one pill every two weeks is just replacing what the body would naturally make with more time outdoors. That framing makes it feel like a return to nature rather than a pharmaceutical intervention.
Early life nutrition in Nunavut, Canada: a retrospective descriptive study of food security, vitamin D and rickets - Oct 2025
International J. of Circumpolar Health https://doi.org/10.1080/22423982.2025.2580100
Amy CaugheyORCID Icon ,Sherilee L. Harper ,Igah Sanguya ,Jan M. Sargeant ,Amber Miners ,Michelle Doucette
Northern regions of Canada have the highest reported incidence of childhood rickets in the country, yet this public health problem remains poorly described. The goal of this research was to explore the food and vitamin D supplementation experiences in pregnancy and infancy and examine associations with rickets diagnosis. Data were collected systematically through a retrospective chart review of Inuit children from 18 communities in Nunavut born from 2010–2013.
Although most pregnant people reported consuming country food daily or weekly, one in three pregnant people reported being food insecure. Fewer than half of infants were reported to have received daily vitamin D supplement at two months of age, and frequency of supplement use declined with age.
Rickets diagnosis was present in 1.63% of children (95% CI = 1.20%–2.20%). The odds of rickets diagnosis were higher for children whose mothers experienced food insecurity during pregnancy than for those whose mothers had never experienced food insecurity (OR = 5.279; 95% CI = 1.248–16.191). Enhanced support for food security, breastfeeding and vitamin D supplementation in early life is needed. In the context of social determinants of health, this study highlights the far-reaching and negative impacts of food insecurity on the health of Inuit children in Nunavut.
Vitamin D Deficiency and Cardiovascular Disease Risk Factors Among American Indian Adolescents: The Strong Heart Family Study - April 2025
Prev Chronic Dis. 2025 Apr 4;22:E13. doi: 10.5888/pcd22.240354
Jessica A Reese 1,2, Erin Davis 3, Amanda M Fretts 4, Tauqeer Ali 1,2, Elisa T Lee 1, Jason G Umans 5,6, Ronit Yarden 7, Ying Zhang 1,2, Jennifer D Peck 2,✉
Introduction We aimed to describe the prevalence of vitamin D deficiency among American Indian adolescents and determine its association with cardiovascular disease (CVD) risk factors.
Methods Our study population consisted of 307 adolescents (aged ≤20 years) participating in the Strong Heart Family Study with serum 25-hydroxyvitamin D (25[OH]D) measured on samples collected during baseline examinations (2001–2003). We defined baseline prevalence of vitamin D deficiency as 25(OH)D ≤20 ng/mL. We evaluated outcomes related to obesity (BMI, waist circumference, waist-to-hip ratio, and body fat percentage), diabetes, cholesterol, and metabolic syndrome. We used generalized estimating equations to determine whether the prevalence of the outcomes differed according to vitamin D deficiency status, while controlling for covariates. To determine incidence, we conducted a follow-up examination a median 5.8 years after baseline (2006–2009) and a second follow-up a median of 13.3 years after baseline (2014–2018). We calculated incidence rates (IR) per 100 person-years for the total group and stratified by vitamin D deficiency status at baseline. Finally we used shared frailty cox proportional hazards models to determine if the risk of the outcomes differed according to vitamin D deficiency status, while controlling for covariates.
Results The prevalence of vitamin D deficiency was 50.8% at baseline, and it was associated with the prevalence of obesity, low HDL-C, and metabolic syndrome, while controlling for covariates.
By the first follow-up, the IRs per 100 person-years were the following:
- obesity (5.03)
- diabetes (1.07)
- any dyslipidemia (10.80) (abnormal or unhealthy levels of lipids (fats))
- metabolic syndrome (3.31)
By the second follow-up, the IR of diabetes was significantly higher among those with (vs without) baseline vitamin D deficiency (1.32 vs 0.68 per 100 person-years; P = .02), although the association was not significant after adjusting for covariates.
Conclusion Vitamin D deficiency in adolescence may be associated with the CVD risk factors obesity, low HDL-C, and metabolic syndrome and may also contribute to the development of diabetes later in life.
Prevalence and determinants of insufficient vitamin D status in young Canadian Inuit children from Nunavik - Jan 2024
MaryAnneLiebert Volume 31, Issue 2 https://doi.org/10.1177/02601060231207664
Background: Vitamin D deficiency has reached pandemic levels affecting over one billion people worldwide. However, limited data is available on the prevalence and determinants of vitamin D status of Canadian Indigenous children and no study has been reported in Inuit children from Nunavik.
Aim: Therefore, using data collected between 2006 and 2010, we aimed to investigate the prevalence and main determinants of insufficient serum 25-hydroxyvitamin D (s25(OH)D) concentrations in Inuit children attending childcare centres in Nunavik.
Methods: This study included 245 Inuit children aged 11 to 54 months. s25(OH)D concentrations were measured by radioimmunoassay. Dietary intakes were assessed using 24-hour recalls. Usual dietary intakes were estimated using the National Cancer Institute method. We used a multiple imputation technique to replace missing values when performing regression analysis.
Results: Our findings revealed that 64.5% of children had a s25(OH)D concentration < 75 nmol/L, while 78.1% did not meet the estimated average requirement (EAR) for vitamin D. Vitamin D intake and fluid milk consumption were positively associated with s25(OH)D concentrations, while negative associations were observed with children’ energy intake, non-alcoholic beverage consumption, body weight, breastfeeding duration and, biological/adoptive/foster parents’ educational level.
Conclusion: Vitamin D inadequacy was highly prevalent and closely aligned with levels observed over the years in non-Indigenous children. Breastfed children who do not receive vitamin D supplementation, overweight and obese children, and children with inadequate milk consumption were at high risk of vitamin D insufficiency. Eating vitamin D rich foods such as fluid milk and seafood along with vitamin D supplementation when needed are recommended.
Vitamin D deficiency among northern Native Peoples: a real or apparent problem? - 2016
Both the letter and rebuttal follow
Grant's letter to the editor full text PDF is on-line
Re: Vitamin D deficiency among northern Native Peoples
William B. Grant, Sunlight, Nutrition, and Health Research Center, San Francisco, CA, USA
Dear Editor:
The recent paper by Frost regarding vitamin D deficiency among northern Native Peoples suggested that they do not need as much vitamin D as European-descended populations (1). I respectfully disagree with this contention. I agree that dark-skinned people have been found to have a different calcium economy than pale-skinned people. However, in terms of non-skeletal benefits of vitamin D, there does not seem to be any difference in requirements. It was previously noted that an important reason Alaska Natives had cancer incidence rates 2.5 times higher than American Indians in New Mexico (2) was lower serum 25-hydroxyvitamin D [25(OH)D] concentrations due to differences in solar UVB doses and a change in the diet of Alaska Natives away from ocean fish (3). The comparison was only partly affected by the fact that smoking prevalence is higher in Alaska (2) since rates were also higher for cancers little affected by smoking. There is also very good evidence that African-Americans have poorer health outcomes than White-Americans due to the fact that their mean serum 25(OH)D concentrations are 16 ng/ml vs. 26 ng/ml for White Americans (4).
Frost also states that there is a U-shaped relation between serum 25(OH)D concentrations and disease outcomes. Most of the studies that report U-shaped relations are nested case-control studies employing a single serum 25(OH)D concentration measurement from the time of enrollment. It is very likely that such U-shaped relations are an artifact of the long follow-up time. In the case of prostate cancer, there is no significant relation between prediagnostic serum 25(OH)D concentration and prostate cancer incidence (5).
Thus, vitamin D supplementation should be encouraged among northern Native Peoples.
References
Frost P. Vitamin D deficiency among northern Native Peoples: a real or apparent problem? Int J Circumpolar Health. 2012;71:18001. DOI: 10.3402/IJCH.v71i0.18001
Kelly JJ, Lanier AP, Alberts S, Wiggins CL. Differences in cancer incidence among Indians in Alaska and New Mexico and U.S. Whites, 1993-2002. Cancer Epidemiol Biomarkers Prev. 2006;15:1515-9.
Grant WB. Vitamin D and cancer risk among American Indians. Cancer Epidemiol Biomarkers Prev. 2007;16:183.
Grant WB, Peiris AN. Possible role of serum 25-hydroxyvitamin D in Black-White health disparities in the United States. J Am Med Directors Assoc. 2010;11:617-28.
Grant WB. Effect of interval between serum draw and follow-up period on relative risk of cancer incidence with respect to 25-hydroxyvitamin D level: implications for meta-analyses and setting vitamin D guidelines. Dermatoendocrinol. 2011;3:199 -204.
LETTER TO THE EDITOR
Reply to W.B. Grant ‘Re: Vitamin D deficiency among northern Native Peoples’
Peter Frost peter_frost61z@globetrotter.net
Bernard Saladin d'Anglure, Département d'anthropologie, Pavillon DeKoninck, Université Laval, Québec, QC, Canada
Int J Circumpolar Health 2012, 71: 18435 - http://dx.doi.org/10.3402/ijch.v71i0.18435
Dear Editor:
Dr. Grant seems to assume that all humans share the same vitamin D metabolism, an assumption that is doubtful even on theoretical grounds (1). We know that natural selection can alter the way the human body synthesises, transports and uses this vitamin. We also know that the relevant selection pressures (from solar UV and skin color) vary from one human population to the next. So it is not necessarily unhealthy for a population to have low blood levels of vitamin D. The underlying metabolism may simply be different.
Vitamin D levels are normally low not only in northern Natives but also in other darker-skinned humans, even those who still live in the tropics and are routinely exposed to strong solar UV (2). Indeed, if we look at the human species as a whole, the outlier actually appears to be lighter-skinned humans and their relatively high levels. This outlier, however, also tends to decide what is medically normal and what is not. Therein lies part of the problem.
Why do these differences in metabolism exist? At present, we can only speculate. Lighter-skinned humans can more easily synthesise vitamin D on their own and may thus use it less efficiently. Conversely, darker-skinned humans may have had to ration its use and develop alternate metabolic pathways.
This has been especially true at high northern latitudes, where solar UV is too weak for synthesis in the skin. An alternative is to consume fatty ocean fish, but this food source was formerly available only in coastal regions. The interior of Alaska and northern Canada had few natural sources of vitamin D.
Over time, northern Natives should have adapted to this situation through natural selection. And they had time: some 15,000 years in Arctic North America and longer still if we include their remote ancestors in Beringia and northern Eurasia. Natural selection also had many possible ways to make their bodies less dependent on vitamin D: receptors that bind this molecule more strongly; greater storage in the body and better transport in the bloodstream to target tissues; increased uptake of calcium and phosphorus through alternate metabolic pathways, etc. Indeed, the Inuit show high uptake of calcium despite low levels of vitamin D (3).
Such adaptation is also indicated by data from earlier periods. Precontact skeletons show little evidence of vitamin D deficiency, i.e., rickets (4). In 1942, a medical survey found no cases of rickets among northern Manitoba Indians, even though they lived above 55°N and consumed no foods of marine origin (5).
Yet, today, rickets is becoming common among northern Natives. Like Grant, I blame the change in diet. I disagree, however, with his view that the key dietary change was abandonment of ocean fish, since non-coastal Natives did not consume seafood . One key change seems to have been the shift away from a high meat diet , which reduces the risk of rickets independently of vitamin D intake. Another was increased consumption of certain reactive substances: phytic acids in commercially processed cereals; sodium bicarbonate in baking soda; and aluminum hydroxide in antacids. These substances react in the body with calcium or phosphorus to form insoluble salts, thereby creating an artificial deficiency of both elements (2).
This deficiency can be treated with vitamin D supplements. Northern Natives may even show a stronger response to such treatment because they less easily produce this vitamin on their own. But supplementation would also expose them to levels of this molecule that their body tissues have not experienced in 15,000 years or more. We can imagine the eventual outcome by plotting the incidence of various age-related diseases as a function of the body's vitamin D level. The result is generally a U-shaped curve (2). If northern Natives are healthiest within a “trough” that normally lies farther to the left, what will happen if they are pushed out of this trough and into a range of values that is normal for Europeans but not for them?
Grant denies the validity of this U-shaped curve for any human population, saying that it is probably an artifact of long follow-up time, i.e., the interval between measurement of vitamin D levels in human subjects and the much later assessment of their disease outcomes. Since these levels can change over time, the measured level may differ from the one that actually prevails when a disease first appears. It would be better to take measurements several times before the follow-up, perhaps every 2 years and in different seasons (6).
Grant has pointed to a real methodological problem, but it is one that actually strengthens my argument. The harder it is to measure a causal factor, the more the resulting data will be muddled by “noise” and the harder it will be to link this factor to its presumed effects, whether harmful or beneficial. The dose-response curve should thus become flatter, not U-shaped.
Indeed, it is surprising just how strong these effects are despite the noise in the data. The most recent follow-up study shows a clear U-shaped relationship between vitamin D levels and mortality in elderly Swedish men. The total mortality rate was 50% higher among those in the lowest 10% (<46 nmol/L) and highest 5% (>98 nmol/L) than among those in-between (7). These findings are especially noteworthy in light of a recent recommendation to set the minimum levels for human health at 100–150 nmol/L (8).
Harmful effects likewise appear in animal studies. Persistently high levels of vitamin D cause mice to age prematurely, as evidenced by osteoporosis, atherosclerosis, calcification, skin and organ atrophy and shorter lifespan (9–12) . This experiment has also been performed on humans, albeit unwittingly: “After the Second World War in Europe, especially in Germany, children received extremely high oral doses of vitamin D3 and suffered hypercalcemia, nephrocalcinosis, early aging, cardiovascular complications and early death, supporting the possibility that hypervitaminosis D3 can accelerate aging” (11).
(Note by VitaminDWiki: these high oral doses were given at very large intervals – annual?)
Such effects are consistent with the view that vitamin D is not so much a vitamin as a hormone that regulates growth via different signalling pathways. Its effects are beneficial as long as its levels remain within a relatively narrow range. Outside this range, normal growth processes will be disrupted or even accelerated (11).
References
Grant WB. Re: Vitamin D deficiency among northern Native Peoples: 50 a real or apparent problem? Int J Circumpolar Health. 2012;71:18434. DOI: 10.3402/IJCH.v71i0.18434. [Crossref]
Frost P. Vitamin D deficiency among northern Native Peoples: a real or apparent problem? Int J Circumpolar Health. 2012;71:18001. DOI: 10.3402/IJCH.v71i0.
Sellers EAC, Sharma A, Rodd C. Adaptation of Inuit children to a low-calcium diet. Can Med Assoc J. 2003;168:1141–3.
Wells C. Prehistoric and historical changes in nutritional diseases and associated conditions. Prog Food Nutr Sci. 1975;1:729–79.
Moore PE, Kruse HD, Tisdall FF, Corrigan RSC. Medical survey of nutrition among the northern Manitoba Indians. Can Med Assoc J. 1946;54:223–32.
Grant WB. Effect of interval between serum draw and follow-up period on relative risk of cancer incidence with respect to 25-hydroxyvitamin D level: implications for meta-analyses and setting vitamin D guidelines. Dermatoendocrinol. 2011;3:199–204.
Michaëlsson K, Baron JA, Snellman G, Gedeborg R, Byberg L, Sundström J, et al. Plasma vitamin D and mortality in older men: a community-based prospective cohort study. Am J Clin Nutr. 2010;92:841–8. [Crossref]
Garland CF, Gorham ED, Mohr SB, Garland FC. Vitamin D for cancer prevention: global perspective. Ann Epidemiol. 2009;19:468–83. [Crossref]
Lanske B, Razzaque MS. Vitamin D and aging: old concepts and new insights. J Nutr Biochem. 2007;18:771–7. [Crossref]
Razzaque MS, Lanske B. Hypervitaminosis D and premature aging: lessons learned from Fgf23 and Klotho mutant mice. Trends Mol Med. 2006;12:298–305. [Crossref]
Tuohimaa P, Keisala T, Minasyan A, Cachat J, Kalueff A. Vitamin D, nervous system and aging. Psychoneuroendocrinology. 2009;34S:S278–86. [Crossref]
Wong YF, Xu Q. Ablation of klotho and premature aging: is 1,25-dihydroxyvitamin D the key middleman? Kidney Int. 2009;75:1137–9. [Crossref]
See also VitaminDWiki
20 Largest Native American Reservations by Population (On-Reservation)
Sources: U.S. Census Bureau (2020 Decennial / ACS 2019–2023), IHS facility directories, BIA.
| # | Reservation Name | State(s) | Pop on Res | Pop. Off Res | Health/IHS | Area (sq mi) |
|---|---|---|---|---|---|---|
| 1 | Navajo Nation | AZ, NM, UT | 173667 | 225827 | 17 | 27413 |
| 2 | Yakama Nation | WA | 29765 | 1735 | 2 | 2186 |
| 3 | Pine Ridge (Oglala Sioux) | SD, NE | 18834 | 28021 | 5 | 4354 |
| 4 | Fort Apache (White Mtn. Apache) | AZ | 13014 | 4486 | 2 | 2628 |
| 5 | Gila River | AZ | 13383 | 9617 | 3 | 584 |
| 6 | San Carlos Apache | AZ | 10709 | 6291 | 2 | 1834 |
| 7 | Rosebud (Sicangu Lakota) | SD | 10469 | 24000 | 6 | 1970 |
| 8 | Osage Nation | OK | 9920 | 19500 | 2 | 2304 |
| 9 | Tohono O'odham Nation | AZ | 9299 | 18700 | 5 | 4453 |
| 10 | Cheyenne River Sioux | SD | 8470 | 8700 | 4 | 4419 |
| 11 | Flathead (Salish & Kootenai) | MT | 8380 | 4700 | 3 | 1938 |
| 12 | Standing Rock Sioux | ND, SD | 7648 | 9500 | 4 | 3572 |
| 13 | Wind River (Shoshone & Arapaho) | WY | 7125 | 6700 | 3 | 3473 |
| 14 | Blackfeet | MT | 7091 | 10400 | 2 | 3000 |
| 15 | Crow | MT | 6894 | 6300 | 2 | 3598 |
| 16 | Turtle Mountain (Chippewa) | ND | 6748 | 23000 | 2 | 114 |
| 17 | Uintah & Ouray (Ute) | UT | 6327 | 700 | 2 | 6825 |
| 18 | Fort Peck (Sioux & Assiniboine) | MT | 6139 | 6000 | 3 | 3380 |
| 19 | Zuni Pueblo | NM | 6097 | 4200 | 1 | 724 |
| 20 | Hopi | AZ | 5974 | 12600 | 3 | 2532 |
Notes: On-reservation populations are total residents (all races) from the 2020 Census or most recent ACS estimates. Off-reservation estimates are derived from tribal enrollment minus on-reservation counts where available (approximate). IHS facility counts include hospitals, health centers, and clinics (IHS-operated and tribally operated 638 programs) serving each reservation; urban Indian health programs are not included. Area is total reservation land+water in square miles.