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Your exposure to sunlight is limited. Because the body makes vitamin D when your skin is exposed to sunlight, you may be at risk of deficiency if you are homebound, live in northern latitudes, wear long robes or head coverings for religious reasons, or have an occupation that prevents sun exposure. You have dark skin.
The low vitamin D levels [meaning serum 25(OH)D] found in many people with chronic diseases are a result of the disease, rather than the cause. Marshall explains this by saying that the disease process causes 1,25-D to rise to an unnaturally high level.