Vitamin D is important for good health, growth and strong bones. A lack of vitamin D is common because many of us stay indoors - in offices, classrooms and spend very little time outdoors these days. Many others live in countries without much sunlight Vitamin D is mostly made in the skin by exposure to sunlight. Most foods contain very little vitamin D naturally, though some are enriched with added vitamin D. A mild lack of vitamin D may not cause symptoms but can cause tiredness and general aches and pains.
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What is vitamin D?
Vitamin D is a vitamin that is needed for good health. Unlike other vitamins, we do not need to get vitamin D from food. A main source of vitamin D is made by our own bodies. It is made in the skin by the action of sunlight. This is a good thing because most foods contain no or very little vitamin D naturally. Foods that contain vitamin D include:
· Oily fish, such as sardines, pilchards, herring, trout, tuna, salmon and mackerel. The best dietary source of vitamin D is oily fish and cod liver oil
· Fortified foods - this means they have vitamin D added to them, such as margarine, some cereals, infant formula milk.There is little or no vitamin D in UK milk and dairy products. Only infant formula milk and margarine have statutory vitamin D supplementation in the UK.
· Egg yolk, liver, and wild mushrooms contain only small quantities of vitamin D.
What is the relationship between Vitamin D and sunlight
Ultraviolet B (UVB) rays in sunlight convert cholesterol in the skin into vitamin D. For a fair-skinned person, it is estimated that around 20-30 minutes of sunlight on the face and forearms around the middle of the day 2-3 times a week is sufficient to make enough vitamin D in the summer months in the UK. However, for people with darker skin for as black African, Asians and the elderly, the amount of time needed exposed to sunlight to make enough vitamin D can be much more than this. The sunlight has to fall directly on to bare skin; sun falling in through a window is not enough.
For six months of the year (October to April), much of western Europe (including 90% of the UK) lies too far north to have enough UVB rays in sunlight necessary to make vitamin D in the skin. So, many people especially dark skinned people often lack vitamin D and are at risk of not getting enough vitamin D unless they get it in their diet.
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Note: If you have lighter skin too much exposure to the sun's rays can be damaging. Sunburn should be avoided at all costs because it can increase your risk of skin cancer.
This girl needs about four hours of direct sunlight a day
This lady needs about six hours of direct sunlight a day
Why do we need vitamin D?
A main action of vitamin D is to help calcium and phosphorus in our diet to be absorbed from the gut. Calcium and phosphorus are needed to keep bones healthy and strong. So, vitamin D is really important for strong and healthy bones. In addition, vitamin D seems to be important for muscles and general health. There is also some evidence that vitamin D may also help to prevent other diseases such as cancer, diabetes, high blood pressure and heart disease.
Who gets vitamin D deficiency?
Vitamin D deficiency means that there is not enough vitamin D in your body. Broadly speaking, this can occur in three situations:
Where the body has an increased need
Those who with an increased need for vitamin D are growing children, pregnant women, and breast-feeding women (especially women who have had several babies with short gaps between pregnancies) need extra vitamin D because it is required for growth. So, vitamin D deficiency is more likely to develop in the following groups of people:
Where the body is unable to make enough vitamin D
1. People who get very little sunlight on their skin are at risk of vitamin D deficiency. This is more of a problem in the more northerly parts of the world (including the UK and northern America) where there is less sun. These people include those who stay inside a lot, for example, those in hospital for a long time, or housebound people.
2. People who cover up a lot of their body when outside, for example, wearing veils such as the niqab or burqa.
3. Sunscreen use can potentially lead to vitamin D deficiency, particularly if high sun protection factor (SPF) creams (factor 15 or above) are used. Nevertheless, children especially should always be protected from prolonged exposure to the sun's rays especially at noon and should never be allowed to burn.
4. Elderly people have thinner skin than younger people and so are unable to produce as much vitamin D. This leaves older people more at risk of vitamin D deficiency.
5. People who have darker skin, for example, people of African, African-Caribbean and South Asian origin, because their bodies are not able to make as much vitamin D with a little amount sunlight.
6. Some medical conditions can affect the way the body handles vitamin D. People with Crohn's disease, coeliac disease, and some types of liver and kidney disease, are all at risk of vitamin D deficiency.
7. Sometimes, some people without any other risk factors or diseases become deficient in vitamin D. It is not clear why this occurs. It may be due to a subtle metabolic problem in the way vitamin D is made or absorbed. So, even some otherwise healthy, fair-skinned people who get enough sun exposure can become deficient in vitamin D.
8. Vitamin D deficiency can also occur in people taking certain medicines. Examples include: carbamazepine, phenytoin, primidone, barbiturates and some anti-HIV medicines.
Where the body doe snot have enough dietary vitamin D
Vitamin D deficiency is more likely to occur in people who follow a strict vegetarian or vegan diet, or a non-fish-eating diet.
How common is vitamin D deficiency?
It is very common. A recent survey in the UK showed that more than half of adults in the UK did not have enough vitamin D. In the winter and spring about 1 in 6 people have a severe deficiency. It is estimated that about 9 in 10 adults in the UK of African and South Asian origin may be vitamin D-deficient.
Am I vitamin D deficient?
It may be suspected from your medical history, symptoms, or lifestyle. A simple blood test for vitamin D level can make the diagnosis. Blood tests for calcium and phosphate levels and liver function may also show changes linked to a low level of vitamin D. Sometimes, a wrist X-ray is done for a child. This can assess how severe the problem is by looking for changes in the wrist bones.
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What are the symptoms of vitamin D deficiency?
Many people have no symptoms, or only vague ones such as tiredness or general aches. Because symptoms of vitamin D deficiency are often very nonspecific or vague, the problem is often missed. The diagnosis is more easily reached in severe deficiencies with some of the classical symptoms and bone deformities.
Symptoms of Vitamin D deficiency in babies and children
- Babies with severe vitamin D deficiency can get muscle spasms (cramps), seizures and breathing difficulties. These need urgent hospital treatment. Children with severe deficiency may have soft skull or leg bones. Their legs may look curved (bow-legged). They may also complain of bone pains, often in the legs, and muscle pains or muscle weakness. This condition is known as rickets.
- Poor growth. Height is usually affected more than weight. Affected children might be reluctant to start walking.
- Tooth delay. Children with vitamin D deficiency may be late teething as the development of the milk teeth has been affected.
- Irritability in children can be due to vitamin D deficiency.
- Children with vitamin D deficiency are more prone to infections. Respiratory (breathing) symptoms can occur in severe cases. Breathing can be affected because of weak chest muscles and a soft ribcage.
General tiredness, vague aches and pains and a general sense of not being well are the common symptoms. In more severe deficiency there may be more severe pain and also weakness. Muscle weakness may cause difficulty in climbing stairs or getting up from the floor or a low chair, or can lead to the person walking with a waddling pattern.
Bones can feel painful to moderate pressure (often more noticeable in the ribs or shin bones). Bone pain often also occurs in the lower back, hips, pelvis, thighs and feet. Here are some more sympyoms:
1.) The flu - In a study published in the Cambridge Journals, it was discovered that vitamin D deficiency predisposes children to respiratory diseases. An intervention study conducted showed that vitamin D reduces the incidence of respiratory infections in children.
2.) Muscle weakness - According to Michael F. Holick, a leading vitamin D expert, muscle weakness is usually caused by vitamin D deficiency because for skeletal muscles to function properly, their vitamin D receptors must be sustained by vitamin D.
3.) Psoriasis - In a study published by the UK PubMed central, it was discovered that synthetic vitamin D analogues were found useful in the treatment of psoriasis.
4.) Chronic kidney disease - According to Holick, patients with advanced chronic kidney diseases (especially those requiring dialysis) are unable to make the active form of vitamin D. These individuals need to take 1,25-dihydroxyvitamin D3 or one of its calcemic analogues to support calcium metabolism, decrease the risk of renal bone disease and regulate parathyroid hormone levels.
5.) Diabetes - A study conducted in Finland was featured in Lancet.com in which 10,366 children were given 2000 international units (IU)/day of vitamin D3 per day during their first day of life. The children were monitored for 31 years and in all of them, the risk of type 1 diabetes was reduced by 80 percent.
6.) Asthma - Vitamin D may reduce the severity of asthma attacks. Research conducted in Japan revealed that asthma attacks in school children were significantly lowered in those subjects taking a daily vitamin D supplement of 1200 IU a day.
7.) Periodontal disease - Those suffering from chronic tooth decay or gum disease that causes swelling and bleeding gums should consider raising their vitamin D levels to produce defensins and cathelicidin, compounds that contain microbial properties and lower the number of bacteria in the mouth.
8.) Cardiovascular disease - Congestive heart failure is associated with vitamin D deficiency. Research conducted at Harvard University among nurses found that women with low vitamin D levels (17 ng/m [42 nmol/L]) had a 67 percent increased risk of developing hypertension.
9.) Schizophrenia and Depression - These disorders have been linked to vitamin D deficiency. In a study, it was discovered that maintaining sufficient vitamin D among pregnant women and during childhood was necessary to satisfy the vitamin D receptor in the brain integral for brain development and mental function maintenance in later life.
10.) Cancer - Researchers at Georgetown University Medical Center in Washington DC discovered a connection between high vitamin D intake and reduced risk of breast cancer. These findings, presented at the American Association for Cancer Research, revealed that increased doses of the sunshine vitamin were linked to a 75 percent reduction in overall cancer growth and 50 percent reduction in tumor cases among those already having the disease. Of interest was the capacity of vitamin How is vitamin D deficiency diagnosed
What is the treatment for vitamin D deficiency?
The treatment is to take vitamin D supplements. This is a form of vitamin D called ergocalciferol or calciferol. Vitamin D can be given as an injection or as a medicine (liquid or tablets). Your doctor will discuss the dose, and best treatment schedule, depending on your situation, age, severity of the deficiency and so on. Here is what your doctor may prescribe for you:
Injection
A single small injection of vitamin D will last for about six months. This is a very effective and convenient treatment. It is useful for people who do not like taking medicines by mouth, or who are likely to forget to take their tablets.
High-dose tablets or liquids
There are different strengths available and a dose may be taken either daily, weekly or monthly. This will depend on your situation and on which particular treatment guideline your doctor is using. Always check with your doctor that you understand the instructions - with high doses of vitamin D it is important to take the medicine correctly. The advantage of the higher-dose treatment is that the deficiency improves quickly - important in growing children.
Standard-dose tablets, powders or liquids
These are taken every day for about 12 months so that the body can catch up on the missing vitamin D. This is a rather slow method of replacing vitamin D, but is suitable if the deficiency is mild, or for prevention. A disadvantage is that all these preparations contain either calcium or other vitamins, giving them a strong taste which some people dislike.
Maintenance therapy after deficiency has been treated
After vitamin D deficiency has been treated, the body's stores of vitamin D have been replenished. After this, maintenance treatment is often needed long-term, to prevent further deficiency in the future. This is because it is unlikely that any risk factor for vitamin D deficiency in the first place will have completely resolved. The dose needed for maintenance may be lower than that needed to treat the deficiency.
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Preventing vitamin D deficiency
Groups of people who are prone to develop vitamin D deficiency are advised to take vitamin D supplements routinely. In February 2012 the Chief Medical Officers for the United Kingdom issued the following recommendations:
- All pregnant and breast-feeding women should take a daily supplement containing 10 micrograms of vitamin D.
- All infants (babies) and young children aged 6 months to 5 years should take a daily supplement containing vitamin D in the form of vitamin drops. However, those infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products are fortified with vitamin D. Breast-fed infants may need to receive drops containing vitamin D from one month of age if their mother has not taken vitamin D supplements throughout pregnancy.
- People aged 65 years and over and people who are not exposed to much sun should also take a daily supplement containing 10 micrograms of vitamin D.
In addition a doctor may advise routine vitamin D supplements for people with certain gut, kidney or liver diseases, and people prescribed certain medicines, and to certain people with darker skin.
You can buy vitamin D supplements at pharmacies. They are also available on prescription to certain groups of people. Also, women and children from families in UK who are eligible for the Government’s Healthy Start scheme can also get free vitamin supplements which include vitamin D.
How to prevent Vitamin D deficiency
To avoid the many chronic diseases associated with vitamin D deficiency simply take a walk under the sun every day!
NOTE: Care is needed with vitamin D supplements in certain situations so ask your doctor before you start taking any medication for vitamin deficiency.
Multivitamins are not suitable for long-term high-dose treatment because the vitamin A they also contain can be harmful in large amounts.
Information from patient.co.uk and medicinenet.com
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