There has been a lot of media interest in Vitamin D recently which may have raised a number of questions which I hope to address in this blog. Vitamin D is known as the ‘sunshine vitamin’ as we make it under the skin when outside in daylight. It’s different than other vitamins because it’s actually a hormone (activated vitamin D) that we can make in our bodies. We only receive small amounts of vitamin D through food, so even if you follow a very healthy, well balanced, diet you’re unlikely to be getting enough.
Why is Vitamin D important?
Vitamin D helps to regulate the amount of calcium and phosphate in the body. These minerals are needed to keep bones and teeth strong and healthy. Even if you have a calcium-rich diet, consuming plenty of dairy foods such as milk, cheese, yoghurt and green leafy vegetables, without enough vitamin D you cannot absorb the calcium into your bones and cells where it’s needed.
What happens if we don’t get enough vitamin D
Vitamin D deficiency can lead to bone deformities. If a child experiences prolonged vitamin D deficiency during periods of bone growth it could lead to the development of rickets. Rickets can cause permanent deformities to the bone, weaken muscles and reduced growth.
Adults who don’t receive enough vitamin D are more likely to develop osteomalacia as bones can become softer as they loose the minerals needed to keep them strong. Osteomalacia can result in aching bones and muscles weakness.
Sources of Vitamin D
From April to the end of September, most people should get all the vitamin D they need from sunlight exposure on the skin (on the hands, face, arms or legs). Note: if you are out in the sun, take care to cover up or protect your skin with sunscreen before you turn red or get burnt (visit http://www.nhs.uk/livewell/skin/pages/sunsafe.aspx for more information). However, between October and March we don’t get any vitamin D from sunlight because the sun rays aren’t strong enough.
Most people get little vitamin D from their diet as only a few foods naturally contain the vitamin. There are reasonable amounts of vitamin D found in oily fish such as salmon, herring and mackerel. Depending on the time of year, meat and egg yolk can contain small amounts of vitamin D. Some foods are fortified with small amounts of vitamin D e.g. margarine, some breakfast cereals and some yoghurts.
The Scientific Advisory Committee on Nutrition (SACN) highlight that between September- April these foods alone are insufficient in achieving recommended vitamin D levels. SACN recommends the only way to ensure a healthy vitamin D status is to take a supplement.
Current Vitamin D statistics
According to a report by the National Institute for Health and Care Excellence (NICE), 1 in 6 (12.5%) children and almost a fifth of UK adults are estimated to have low vitamin D status. The report also found that 75% of adults with darker skin tones had low vitamin D levels in the winter months.
Vitamin recommendations for children aged 0-4 years
The Department of Health recommends that:
- Breastfed babies, from birth to one year of age, should be given a daily supplement containing 8.5 to 10mcg of vitamin D
- Formula fed babies should not be given a vitamin D supplement until they are receiving less than 500ml (about a pint) of infant formula a day, as infant formula is fortified with vitamin D
- Children aged 1 to 4 years old should be given a daily supplement containing 10mcg of vitamin D
Vitamin drops containing vitamin D, for children aged 0-4 years, are available at most pharmacies and supermarkets. It’s best for families to speak to their Health Visitor or pharmacist for more information on suitable vitamin drops. Some families will qualify for the Healthy Start scheme whereby they can get free supplements containing the recommended amount of vitamin D. Families should be supported to fill in a Healthy Start form. More information on the scheme can be found at: https://www.healthystart.nhs.uk/
Vitamin recommendations for children over 5 and adults
Between late March/April to the end of September, the majority of people aged five years and above are likely to obtain sufficient vitamin D from sunlight when they are outdoors. However in the autumn and winter months it’s difficult to get enough Vitamin D through food alone, so the Department of Health recommend that everyone, including pregnant and breastfeeding women, considers taking a vitamin D supplement at this time of the year.
However, some groups of people will not get enough vitamin D from sunlight because they have very little or no sunshine exposure. The Department of Health therefore recommends that people should take a daily supplement containing 10mcg of vitamin D throughout the year if they:
- Are not often outdoors, such as office workers or those who are housebound
- Are in an institutions such as care homes
- Usually wear clothes that cover up most of their skin when outdoors
People from minority ethnic groups with dark skin, such as those of African, African-Caribbean or South Asian origin, might not get enough vitamin D from sunlight – so they should also consider taking a daily supplement containing 10mcg of vitamin D throughout the year.
Individuals should be encouraged to talk to their local pharmacist for advice around a suitable vitamin D supplement.
Wellbeing and Nutrition Training
To ensure consistency across the health professional and early years workforces, the Wellbeing and Nutrition Team deliver AfN certified Vitamin D and other micronutrients training. This supports health professionals and early years practitioners to explore the importance of vitamin D, iron and calcium and looks at the current guidance around vitamin recommendations. On completion of the training, support resources and leaflets will be provided which will help practitioners to communicate key messages to families they work with.
The Vitamin D and other micronutrients training explores the following topics:
- Vitamin D, calcium and iron and the role they play within the body
- Dietary sources of vitamin D, iron and calcium
- How vitamin D is produced in the skin and factors that effect vitamin D production
- Factors influencing iron absorption
- The signs of vitamin D, iron and calcium deficiency and groups at risk of deficiency
- The vitamin D, iron and calcium recommendations for at risk groups
- The Healthy Start scheme and other vitamin D drops
More information can be found on the Vitamin D and other micronutrients training page.