Vitamins to help mood

Herbs, Vitamins, and Supplements Used to Enhance Mood

In this Article

Mood problems, including depression and bipolar disorder, are no laughing matter. More than 20 million American adults have a mood disorder and 40 million an anxiety disorder. And these numbers don’t include the average worrywart or person who suffers an occasional bout of the blues.

For depression alone, the annual cost for treatment and lost wages may be as high as $52 billion.

With these statistics, it’s no wonder that many people are searching for mood supplements or other mood-enhancing alternatives to drugs.

The Need for Mood Enhancers

“For so many people, antidepressant medication either stops working or has too many side effects,” says Henry Emmons, MD, a psychiatrist with the Center for Spirituality and Healing at the University of Minnesota. Emmons, author of The Chemistry of Joy: A Three-Step Program for Overcoming Depression through Western Science and Eastern Wisdom, prescribes medications for his patients, but he also highly recommends exercise and good nutrition as physical treatments for depression, combined with a few targeted mood supplements.

Which leads to the question: what vitamins, herbs, supplements, and lifestyle changes are the best mood enhancers?

The experts we talked to didn’t reach complete consensus; more research is clearly needed for the plentiful options available. But here is a brief overview of some of the more common complementary approaches used to treat mood problems.

Of course, if you suffer from severe mood problems see a doctor -- before you reach for mood enhancers or supplements.

Mood Supplements with Potential

One of the most touted herbs used for enhancing mood is St. John’s wort, a yellow-flowered plant containing many chemical compounds that may have medicinal effects.

“Even though the evidence is mixed, it’s better for St. John’s wort than for other herbs,” says Adriane Fugh-Berman, MD, associate professor, Complementary and Alternative Medicine Master’s Program, Department of Physiology and Biophysics at Georgetown University School of Medicine. Fugh-Berman says that trials in the U. S. have been oddly less positive than in Germany, where it is widely prescribed.

SAMe (S-Adenosyl-L-Methionine), derived from an amino acid and also available from protein food sources, is another widely studied mood-enhancing substance that’s commonly used in Europe, Fugh-Berman tells WebMD.

Though the data is less solid, other potential mood enhancers include:

Valerian: an herbal remedy created from dried roots, often taken as a sleep aid and sometimes used for anxiety.
Lavender: aromatherapy, essential oils, and teas use lavender to enhance relaxation and possibly help relieve anxiety and depression.
Omega-3 fatty acids: found in cold-water fish and certain vegetable oils, and available as a supplement, omega-3 fatty acids are sometimes used to help depression and other psychological problems. Emmons recommends a dose of 2,000 to 4,000 milligrams or more when taken for mood problems.
B vitamins: essential for cell metabolism and central nervous system maintenance. Emmons recommends a good B-complex or multivitamin to ensure plenty of B vitamins, which can help stabilize nerve cell membranes.
Vitamin D: although not enough evidence exists to make any claims about the effectiveness of vitamin D as a mood enhancer, at least one study reported benefits from vitamin D in treating seasonal affective disorder, a form of depression that occurs during the winter months.

St. John’s Wort

Around for centuries, St. John’s wort is commonly used today for sleep disorders, anxiety, and mild to moderate depression. However, an analysis of 37 clinical trials found that St. John’s wort may have minimal to no benefit for those with more severe forms of depression.

Although more research is needed, St. John’s wort may also have the potential to reduce symptoms of anxiety, premenstrual syndrome (PMS), or perimenopausal mood changes.

Available as capsules, tablets, liquid extracts, and teas, a typical dose of St. John’s wort ranges from 900 to 1,200 milligrams a day, and it should be taken for at least one to three months, just as with pharmaceutical anti-depressants, to see the best effect.

St. John’s wort does have the potential for serious interactions with a wide variety of prescription drugs, including birth control pills, antidepressants, HIV medications, and blood thinners. It can also interact with other herbs or supplements. Mainly, it may lower the effectiveness of certain medications, Fugh-Berman tells WebMD. St. John’s wort may also lead to an increase in side effects when taken with pharmaceutical antidepressants.

Consult a doctor or pharmacist about interactions before using St. John’s wort. Although uncommon, side effects of St. John’s wort may include:

Gastrointestinal upset
Skin reactions, especially when exposed to sun
Fatigue
Anxiety
Sexual dysfunction
Dizziness
Headache
Dry mouth

SAMe(S-Adenosyl-L-Methionine)

SAMe has been studied a lot for depression. Although current trials are not conclusive, an analysis of 28 studies showed that SAMe produced statistically significant improvement in the symptoms of depression when compared to a placebo. Some studies have shown that improvements were comparable to conventional antidepressants, such as the class of medications called tricyclic antidepressants.

Emmons suggests SAMe for those with a type of depression that produces low energy. He prescribes 400 to 800 milligrams daily, depending upon need or tolerance. The dose most often used for depression in clinical studies is 800 to 1,600 milligrams daily for up to 6 weeks.

Although SAMe usually causes few problems, you should use caution if you have diabetes, low blood sugar, or an anxiety or other type of psychiatric disorder. Gastrointestinal problems, headaches, fatigue, and skin rashes are the most common side effects.

Mood Enhancers That May Be Unsafe

Kava kava. A ceremonial beverage used commonly in the Pacific Islands, kava kava earned its claim to fame as an herb that’s very helpful for anxiety. Unfortunately, kava kava has largely fallen out of favor because concentrated forms for sale in the U.S. have been associated with a rare risk of significant liver problems.

According to the FDA, you should consult a doctor before using kava if you have liver disease or are taking drugs that affect the liver. Likewise, you should see your doctor if you experience any signs of liver illness after taking a kava supplement.

5-HTP. This is a precursor to a neurotransmitter called serotonin. Although some health care providers recommend it for mood problems, others are more cautious. “It is not clear whether 5-HTP is immune from the same problems L-tryptophan had,” Fugh-Berman tells WebMD, referring to an amino acid that was taken off the market in 1989 due to a dangerous contaminant. This concern has been largely disputed, and 5-HTP is generally considered safe, and effective for depression when taken at 150-300 milligrams daily.

As you evaluate other mood supplements, keep in mind that the FDA does not strictly regulate herbs and supplements; it treats them like foods rather than drugs. The makers of supplements don’t have to show their products are safe or effective before selling them on the market.

This makes it harder for you to assess their strength, purity, and safety. Fugh-Berman advises doing your own research on effectiveness and adverse effects, using reliable, unbiased sources, and by consulting groups that independently evaluate dietary supplements.

Lifestyle Changes for Enhancing Your Mood

“If you look at the research on exercise for depression, it’s equal to or better than medication for depression -- probably the best outright alternative treatment for depression,” says Emmons, who often recommends mild, rhythmic activities such as walking, biking, or jogging. “It may not be enough for a lot of people, but it’s a good place to start.”

Reporting in a February 2008 issue of Cerebral Cortex, German researchers described PET scans and recently available chemicals they used to prove that running does, in fact, release mood-enhancing endorphins. The more released, the greater the effect.

How much exercise is enough to enhance mood? Three hours of moderate activity per week may do the trick, according to a study published in the January 2005 American Journal of Preventive Medicine.

Emmons also strongly recommends a variety of stress management techniques, such as learning meditation to self-regulate thoughts, called mindfulness.

“People with recurring depression tend to get triggered very quickly -- almost like a track is laid down, a slippery slope,” he says. “It pays to put some real effort into learning to recognize this immediately and to learn ways to steady yourself.”

Even certain computer games can help create more positive thought patterns. Based on scientifically tested tools published in the journal of the American Psychological Association, MindHabits is one example. It helps players reduce stress and boost esteem by training the mind to refocus the way it perceives the world.

SOURCES:

Adriane Fugh-Berman, MD, associate professor, Complementary and Alternative Medicine Master’s Program, department of physiology and biophysics, Georgetown University School of Medicine.
Henry Emmons, MD, psychiatrist, Center for Spirituality and Healing, University of Minnesota.
The National Institute of Mental Health Web site: “The Numbers Count: Mental Disorders in America.”
Agency for Healthcare Research and Quality Web site: “S-Adenosyl-L-Methionine for Treatment of Depression, Osteoarthritis, and Liver Disease.”
National Center for Complementary and Alternative Medicine Web site: “Get the Facts: St. John’s Wort and Depression,” “Herbs at a Glance: Lavender.”
MedlinePlus Web site: “Lavender (Lavandula angustifolia Miller),” “St. John's wort (Hypericum perforatum L.),” “Kava (Piper methysticum G. Forst).”
Kasper, S. et al. BMC Medicine, 2006; vol 4: pp 14.
Geller, S. et al. Menopause, May-June 2007; vol 14: pp 541–549.
NIH Office of Dietary Supplements Web site: “FDA Issues Consumer Advisory for Dietary Supplements Containing Kava.”
Boecker, H. et al. Cerebral Cortex, 2008; vol 18: pp 2523-2531.
Dunn, A.L. et al. American Journal of Preventive Medicine, 2005; vol 28, Issue 1, pp 1-8.
Dandeneau, S. et al. Journal of Personality and Social Psychology, October 2007; vol 93: pp 651-666.
Papakostas, G. The Journal of Clinical Psychiatry, 2009; vol 70, Suppl 5: pp 18-22.
Turner, E. Pharmacology & Therapeutics, 2006; vol 109: pp 325-338.

Vitamins and Your Mental Health

Taking vitamin supplements has long been recognized as a great way to improve your physical health. After all, even if you eat a healthy diet full of nutrient-dense foods, there are still some vitamins and minerals you might not be getting, or some you need just a little more of to be at your healthiest. For example, many individuals take fish oil supplements if they do not consume salmon and other oily fish regularly. Fish oil is high in omega-3 fatty acids, which is known to promote heart health, reduce inflammation, and improve healthy brain function. If you know you aren’t eating fish at least twice a week, fish oil could be a useful supplement.

Check out our Wellness Wednesday series.

While it’s common knowledge that vitamins promote physical health, fewer people know that the vitamins and minerals entering our bodies affect our mental health, too. When it comes to health and nutrition, it is truly impossible to separate our minds from our bodies. The two are inextricably linked — when one is neglected, the other may suffer. Taking vitamins that support a healthy body can also support mental health and brain function.

When our bodies experience certain vitamin deficiencies, it can cause our organs to grow weak and work less effectively. When our organs aren’t functioning properly, we are more likely to develop various conditions and ailments which can drastically affect our well-being, both physical and mental. The brain is an organ too, and it requires certain nutrients to function. There are several important vitamins and minerals that support the body’s biochemical reactions and promote the healthy function of brain cells and neurotransmitter pathways.

What are neurotransmitters?

Neurotransmitters are the chemical messengers of the brain.

A vitamin deficiency of any of these important nutrients could negatively impact both physical and mental health. Micronutrients have a powerful effect on the body and have many health benefits. For lots of people experiencing depression or other mental health disorders, there are several natural supplements for mental health which could be helpful when combined with the right medication and psychotherapy.

The Best Vitamins for Mental Health

Depression is a mood disorder affecting over 17 million people in the U. S. today, and that number only reflects the reported cases. There are far more people experiencing depression who don’t seek treatment. Depression is typically treated with medications and psychotherapy. However, some lifestyle changes can help treat and prevent depression as well, including the regular consumption of certain vitamins, minerals, and herbs. Some common vitamins known for improving mental health and supporting brain function are:

B Vitamins

B vitamins are some of the best vitamins for mental health. B vitamins are known for their mood-altering properties. They can help fight fatigue, improve your memory, and allow you to function all-around with more clarity. Deficiencies in B vitamins, including Thiamine (B1), Riboflavin (B2), and B12, can lead to depression, anxiety, fearfulness, and irritability.

B12 and folate (B9) are important vitamins for maintaining a healthy nervous system. Vitamin B12 and folate are needed for producing norepinephrine, serotonin, and dopamine. Norepinephrine and serotonin are neurotransmitters in the brain which influence mental behavioral patterns and moods. Dopamine is another type of neurotransmitter that contributes to feelings of pleasure, motivation, achievement, and stimulates your natural reward center. Low levels of either of these chemicals can lead to depressive symptoms.

Eating a diet of vitamin B-rich foods, as well as taking daily supplements could improve mental health, may help improve mood, and reduce depression and anxiety in many individuals. Foods like fish, lean pork or beef, poultry, eggs, whole-grains, nuts, and milk are high in B vitamins.

Vitamin C

Vitamin C might just be the most “mainstream” or well-known of all vitamins. Many people are aware of vitamin C and its immune-boosting properties. Even those of us least familiar with the different vitamins and their uses are likely to take a vitamin C tablet or drink a glass or two of orange juice when we feel cold or flu symptoms coming on.

What fewer people know is that vitamin C also plays an important role in mental health. While the link between vitamin C and mood might be surprising, many people who are deficient in vitamin C experience depression and chronic fatigue. Conversely, even people with normal vitamin C levels in their system found that taking additional vitamin C improved their mood and cognitive function. Some research has also shown that vitamin C can help lower anxiety symptoms.

Taking vitamin C supplements and eating plenty of fruits and vegetables high in vitamin C, like citrus fruits and red peppers, can have an impact on mood, energy levels, and anxiety. However, if you are taking oral vitamin C supplements, make sure to stay within the 2,000 milligrams recommended daily amount.

Vitamin D

Vitamin D is another great natural supplement for mental health. Vitamin D contributes to healthy brain function, among other health benefits. Studies have shown that when tested, many people experiencing depression are also experiencing lower-than-normal vitamin D levels. On the other hand, people with low levels of vitamin D in their system are more likely to experience bouts of depression, anxiety, and other mental conditions than other people with normal levels of vitamin D.

Sunlight is the primary source of vitamin D for most people. People living in warm, sunny places are less likely to have vitamin D deficiencies. Conversely, people living in more northern climates, where the sun is scarce for months at a time, are more likely to be vitamin D deficient due to low sun exposure. Vitamin D deficiency is common amongst people who are suffering from seasonal affective disorder (SAD). If you experience more depressive symptoms during low sunlight months, vitamin D supplements could be especially beneficial.

Zinc

Micronutrient and mineral deficiencies are a huge problem worldwide and can lead to numerous health conditions, including depression. Zinc is a mineral found throughout the human body, as well as in other animals. Meat, poultry, legumes, dairy, and whole grains all have relatively high levels of zinc.

Zinc is an essential trace element related to many biological and biochemical functions, including the immune system and metabolism, as well as brain growth and development. Research has shown that low zinc levels can lead to reduced brain function and other behavioral disturbances. Taking zinc supplements can be effective in reducing depressive symptoms, especially in women. Some studies have shown that when combined with the proper medication, zinc has positive effects in treating ADHD. Zinc is especially effective in treating mental health conditions and depression when combined with magnesium.

Magnesium

Magnesium is another important mineral found in the human body which is critical in regulating and calming the nervous system. Increased magnesium intake can reduce depression, premenstrual syndrome in women, and hypertension in children with ADHD.

Several studies have shown that low magnesium levels are linked to depression. While more research is needed before we can understand exactly how and why magnesium affects mental health, one possible reason is that magnesium regulates gut microbes, which are linked to the hippocampus. Taking magnesium supplements can help regulate unhealthy gut microbes which contribute to depressive symptoms.

Omega-3 Fatty Acids

Omega-3 fatty acids are found in most fish and some marine algae. However, they are most prevalent in oily fish like salmon, herring, and sardines. Scientists started researching the effects of omega-3 fatty acids on mood disorders when they discovered that depression is less common in nations that traditionally eat a diet rich in fish. Fatty acids can easily travel through cell membranes where they can interact with molecules responsible for regulating mood. They also improve cell membrane fluidity and influence neurotransmitter function, all of which contribute to an improved mental state.

Saffron

Saffron is a brightly colored, fragrant spice commonly used in Middle Eastern and Indian cuisine. It is made from the dried petals of a flower called the Saffron Crocus. Saffron has been shown to boost levels of the mood-enhancing neurotransmitter, serotonin. Supplementing with saffron can significantly reduce symptoms of depression by increasing serotonin levels. However, more research is needed to understand the full scope of saffron’s ability to treat mental health conditions.

Holistic Mental Health Care at Sage Neuroscience Center

At Sage Neuroscience Center, we understand that mental health is different for everyone. Each individual is unique and deserves custom treatment. Having knowledge and access to a variety of treatment options is crucial, and so is educating yourself about the various lifestyle changes that might positively affect your mental health. To learn more about how vitamins and other natural supplements help improve mental health, contact the team here at Sage Neuroscience Center.

*Editor’s Note: This post was originally published Published on: Feb 4, 2014 and has been updated Mar 11, 2021

Bryan Krumm, CNP

Psychiatric Nurse Practitioner

Bryan Krumm is a Mental Health Nurse Practitioner whose goal is to provide evidence-based treatment, according to the best standards of practice, utilizing the most current research to maximize therapeutic outcomes and incorporating the patient as an active part of their care. Bryan is particularly interested in PTSD and medical cannabis. Outside of work, Bryan is into music, politics, and philosophy.

Read Bryan Krumm’s Full Bio | Browse All Articles Written by Bryan Krumm

5 vitamins for a good mood: what seasonal products are best to look for them in? it's getting sharper. And the mood is getting worse.

September 20, 2022

Source:: iStockphoto

The debate about whether it is better to get vitamins from the most varied and nutritious diet or take supplements has been going on between doctors, scientists and ordinary people who care about their health for years. There is no single and absolutely correct answer here and cannot be. Each person is individual: everything affects the intake and absorption of vitamins - from lifestyle to stress and the region of residence.

But no one will deny that with the onset of the rainy season, piercing icy winds and cold, mood deteriorates, performance decreases, we get sick with ARVI more often, chronic "sores" become aggravated. Many believe that due to a lack of vitamins, immunity decreases and they go to the pharmacy for jars of vitamin complexes. Can vitamins improve mood, and which ones we really need in the off-season - we discussed with the allergist-immunologist, pathophysiologist Elena Paretskaya.

If the mood is at zero

Our diet and the intake of various substances with food significantly affects the overall well-being, performance and mood. If you have a headache in the morning, you barely woke up and feel weak and weak, although you have not yet had time to get out of bed, you are unlikely to be cheerful and joyful during the day.

A runny nose, sore throat, body aches and other signs of a cold won't bring positive things to life. Constant chilliness, skin problems, if it dries and itches, deterioration in appearance - pallor, dull hair, brittle nails - also do not add optimism and strength.

Everything in the body is interconnected, so the lack of vitamins or microelements, if this is what it is, will affect both health and mood. There is a group of substances that affect the functioning of the nervous system and mood almost directly, and there are those that work indirectly - by being included in metabolic processes.

Read also

Find yourself a diagnosis

Unfortunately, the diagnosis of hypovitaminosis can only be made by exclusion. The thing is that its manifestations are very similar to many other diseases, conditions and reactions of the body. Therefore, only a bad mood, drowsiness or appearance problems is not a reason to immediately drink vitamins from a pharmacy. It is important to go to the doctor, undergo at least a basic examination in order to exclude the onset of a cold, exacerbation of various chronic "sores" and discuss your diet, daily routine with a specialist.

If you are generally healthy and the doctor has confirmed this, you can (and should) replenish your vitamin reserves through a rational combination of nutrition and supplements, which contain exactly those vitamins that are most often lacking in autumn.

In general, in winter and autumn, our compatriots of different ages are most often deficient in the following five vitamins.

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Retinol: for beauty and youth

Retinol is the scientific name for the well-known vitamin A. Its main task is to maintain skin regeneration and hydration, the normal state of the mucous membranes in the mouth and not only, protect vision from negative influences and maintain its sharpness.

In addition, it is a powerful antioxidant, a substance that fights free radicals that damage cells and accelerate aging. In plant foods, it is usually found in the form of a pro-vitamin - carotene, and is absorbed most actively along with fats . In animal food, it is also sufficient, so it is quite possible to cover the needs for retinol at the expense of food. In the autumn months, pay attention to:

Salads with carrots, pumpkin and vegetable oil (so the vitamin is better absorbed).
Beef liver in different versions - stewed, in the form of pate, stew with vegetables.
Red and yellow bell pepper.
Cod liver, fish roe.
Sea buckthorn.

Read also

Vitamin D: for a sunny mood on cloudy days

In autumn, people are severely lacking in vitamin D. In the scientific language, it is called cholecalciferol, and we habitually call it the “sunshine” vitamin. You can get it by being in the open sun for at least 10-15 minutes every day, but in many regions this is now impossible. Therefore, it is worth adding 9 to the diet0045 fish oil, oily fish or vitamin D drops, capsules, tablets .

The minimum dose for adults is 600-800 IU, but many suffer from a deficiency of the substance, the doctor will help them choose the dose after the results of the analysis of the level of vitamin D in the blood plasma.

Vitamin C: for colds and blues

Ascorbic acid is considered to be the most “anti-cold” vitamin. It helps to strengthen the immune system, supports the liver, has antioxidant properties, protecting the cells of the whole body from external aggression. In the fall, you can get a serving of vitamin C from:

During the period of a cold, you can additionally take supplements with ascorbic acid, up to 1000 mg per day.

Read also

Vitamin E: for romance

Vitamin E is considered a substance that maintains beauty, youth and stimulates the reproduction process. It helps to normalize hormonal metabolism, improve mood, increase libido. You can find it in various vegetable oils, nuts, seeds .

B vitamins: mood stimulants

B vitamins are involved in the functioning of the nervous system, pyridoxine or vitamin B6 is especially important. It protects against stress, improves mood, improves sleep and performance. There is a lot of it in pistachios, walnuts and garlic . But often we do not get enough of it from food. Therefore, supplements with vitamin B6 can supplement the diet. And it is especially good if pyridoxine is combined with magnesium - then its effect will be enhanced.

Text author:Alena Paretskaya

Hormone of happiness or good mood vitamin - Adonis Medical Center in Kyiv

Everyone would like to have such a magic pill to eat and instantly become happy, brave and healthy. But this happens only in children's books and even in songs.

But there are good mood vitamins. Remember the words of Monatik: "Do not be bored, get - VITAMIN D"!

The fact is that one of the features of vitamin D is that it provides us with a good mood and relieves depression.

What else is the value of vitamin D ?

Today, there are many studies showing that this vitamin plays a more significant role than we imagined. Due to the diverse effects on the body, it was even called prohormone D.

Everyone knows that vitamin D is formed in the skin under the influence of sunlight and that its lack can provoke children's rickets. But this is not all the properties of this vitamin. In addition, the fat-dissolving nutrient prohormone D, by acting on the mechanism of calcium-phosphorus metabolism, strengthens bone tissue and improves immunity. With its help, not only calcium, magnesium, phosphates are absorbed, it is also involved in the process of growth, restoration of all body cells and numerous other processes: it is actively involved in the formation of insulin, regulates blood clotting, and even has an antitumor effect.

There are only two natural ways to produce vitamin D in the blood

1. Produced by exposure to ultraviolet rays. Moreover, the amount of prohormone produced depends on many factors: the time of day and the angle of incidence of sunlight, the use of sunscreen, and even air pollution.

2. Ingested with food. The largest amount of vitamin D is found in seafood. Since childhood, many have been familiar with fish oil obtained from fatty fish or cod liver. But there is a lot of controversy around him today, so it is not advisable to appoint him to yourself. In the list of vitamin-containing products, the leaders are: mackerel, salmon, tuna, egg yolk, herring, red caviar, beef liver, shiitake mushrooms, milk, ricotta cheese and others.

It is very important that we get our portion of the vitamin, especially in autumn and winter, directly from food. For a healthy person, this should be enough, unless, of course, the fish or bird lived in places not deprived of sunlight. In the same case, if the fish was grown in a fish farm, there will be little prohormone D.

Why is vitamin D deficiency dangerous?

There is a clear link between vitamin D deficiency and the development of numerous diseases.

100% of people with a lack of this prohormone experience depression and depressed mood, lethargy, fatigue, and 70% of them have problems with hair, skin, nails.

In addition, a lack of prohormone D can provoke the development of diabetes, increases the risk of oncological processes, heart, infectious, viral, reproductive diseases. Asthma, heart attack, stroke, infertility, pathology of the gums, teeth, memory loss, mental performance are a short list of possible ailments. The lack of solar vitamin especially affects the cold season.

The production of vitamin D is affected not only by nutrition, the presence of sunny days and the season, but also by age, even skin color, which is determined by melanin pigment. In a swarthy person, a large number of melanin cells interferes with the production of this vitamin. Therefore, in hot countries where the sun shines all year round, dark-skinned children can get rickets. In pale-faced prohormone D is produced faster and easier. Quite often, its deficiency is found in athletes, people with diseases of the musculoskeletal system, or those who live in northern latitudes.

What are the symptoms of prohormone D deficiency?

chronic fatigue;

- rapid eye fatigue;

- deterioration of vision;

- frequent infections;

- muscle weakness;

- development of osteoporosis;

- damage to tooth enamel, nails, hair

Vitamin D deficiency is not diagnosed by eye. Before buying pills, consult your doctor.

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