If you are reluctant to go into the sun, then you really have no other option than to supplement. Especially if you are planning to get pregnant, you simply won't be able to meet your needs via diet (cod liver oil is enough to prevent rickets, but that's about it).

I'd be with your doctor on this one. The fact that (s)he ordered the test is a sign (s)he is up on the literature.

During pregnancy, your body's vitamin D demand will rise dramatically, and its ability to provide the required substrate will determine your risk for gestational hypertension and preterm birth. In a randomized, controlled safety trial, Hollis and Wagner tested 4000 IU/d, 2000 IU/d, and 400 IU/d in pregnant women and found that 4000 IU/d was both safe and associated with the greatest effect on plasma 25(OH)D levels:

1. Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J. Bone Miner. Res. 2011;26(10):2341–2357.
2. Robinson CJ, Alanis MC, Wagner CL, Hollis BW, Johnson DD. Plasma 25-hydroxyvitamin D levels in early-onset severe preeclampsia. Am. J. Obstet. Gynecol. 2010;203(4):366.e1–6.

You can use either the sun or supplements to get your levels in the range between 100 and 150 nmol/L, which is the level associated with lowest risk of complications. You'll want to maintain this level when breastfeeding as well, since you've got to supply baby, too (although if your doc is awake, (s)he'll prescribe a neonatal supplement also).

D3 is the natural form of vitamin D (cholecalciferol), D2 the synthetic (ergocalciferol). There's a fierce debate raging over whether there is a difference, but it's hard to argue against the natural form, especially as there's some evidence that it's more potent.

10 min in the sun between 10 and 2pm 5 days a wk is enough to up your levels - I am good for a few wks then forget to get out there - just reminded me to go take some!

I'm a pregnancy coach & you can read my blog post on the topic, (includes the Vitamin D council's newsletter.)

Gidday from New Zealand, where the ozone layer is even thinner. I've noticed since going more into full-on paleo and eating a lot of beef and lamb fat and butter and coconut oil that I burn a lot less easily. Eg, I sat outside at 1 pm yesterday for about an hour and a half in mild-overcast to sunny conditions (eating a delicious fatty steak I might add). No sunburn today. Four or five years ago I would have got burnt in about 20 minutes. I do have a pretty classic farmer's tan at this point I have to admit.

Local paleo guru Jamie Scott argues that Vitamin D is actually protective against sunburn -- an unfortunate paradox, eh?

http://thatpaleoguy.com/2010/04/21/vitamin-d-protective-against-sunburn/

http://thatpaleoguy.com/2011/01/25/the-good-the-bad-and-the-ugly-of-sunscreens/

http://thatpaleoguy.com/2011/12/10/more-sun-science/

Anyway, as your levels come up and as you increase the saturated fat in your diet, you might want to try judiciously extending your sun exposure.

Hi MayaBee! I'm in Australia too! Highly recommend you read the Vitamin D Solution by Michael F. Holick Ph.D. M.D. In Australia there's an Aussie version of the book, with all of the relevant tables showing how much sun you live based on your skin type and exactly where in Aus you live!

I don't like taking supplements, but do take a very high quality Vitamin D3.

Burning isn't good, but some of the sunscreens have got terrible ingredients - make sure you get a good one!

On sun exposure: It's UVB exposure you are after. And you want to minimise/avoid UVA exposure.
more details and info here: http://www.vitamindcouncil.org/health-conditions/cancer/melanoma/ and http://www.vitamindcouncil.org/about-vitamin-d/how-to-get-your-vitamin-d/uvb-exposure-sunlight-and-indoor-tanning/

On D2 vs D3: Here are some recent studies, No surprises; natural vitamin D3 is better (than synthetic D2):
http://blog.vitamindcouncil.org/2011/11/16/meta-analysis-looks-at-efficacy-of-d2-vs-d3/
http://jcem.endojournals.org/content/96/3/E447.abstract
http://www.ncbi.nlm.nih.gov/pubmed/21735411

On fermented cod liver oil: I would say it is fine to take fermented cod liver oil (fclo), but take it for its Vitamin A, not for its Vitamin D & watch your dose.
What i mean by that is, if you dose your FCLO to get a "good serve" of Vitamin D you will almost certainly (imo) end up with a high (excessive, too high?) dose of Vitamin A.

If you do use FCLO, make sure its all natural, i know most of the non-fermented CLO these days contains synthetic vitamins.

From my readings, all the issues with Vitamin A are associated with supplementation of the synthetic form only. Natural Vitamin A is fine, as long as you don't go overboard, 2,500 IU to 5,000 IU per day from all sources seems to be the normal sort of amount you expect to get from food sources (i do not know what is recommended during pregnancy).

The thing with cod liver oil is that most CLO these days is not 100% natural, the vast majority of CLO products on the market have synthetic Vitamins A and D added during production. This is why they can tell you exactly how much Vits A & D you get per dose. If its all natural CLO, its probably labelled as a 'Food' product & may not even tell you the A & D content, & if it does it will be a variable range & generally lower than that you see in CLO using synthetics. For some more info you can go here http://www.westonaprice.org/cod-liver-oil

Last weekend I decided to sunbathe here. Turns out I forgot how sunburns work - I was expecting I'd know when I'd spent too much time in the sun. I spent less than an hour in the sun but the following day my chest was all red. Interestingly enough, my arms weren't red, not were my legs, probably because they've seen more sun than my chest, which has seen very little.

Transitions from cave-level sunlight to paleo-appropriate sunlight levels need to be gradual. Start with 1 minute in the sun, then 2 minutes a few days later, then 3, and so on. Everyone's skin can tan to some extent; if your diet is paleo and you're really so incapable of spending time in the sun, how do you think your ancestors did it?

I look at my feet and I see just how gradual a process tanning is: my feet have weird tan lines from my previous pair of Vibram Fivefingers which I stopped wearing over a month ago. So it takes longer than a month for skin to adapt.

I would say 75nmol/L (30ng/ml) is too low still, 50ng/ml (124nmol/l) is much better. 30ng/ml maximises calcium absorption, but you need higher blood levels for the anti-cancer effects.

http://www.topicalinfo.org/forum/uploaded/dan/201044232733_VitaminDanddiseases.jpg

http://freetheanimal.com/2012/01/more-clues-toward-determining-optimum-vitamin-d-levels.html

http://www.vitamindwiki.com/tiki-index.php?page_id=62