Getting enough? Vitamin D for you and me.

Funny how an idea can be swimming around in your mind then, POW! All of a sudden, it's headline news. Apparently, ignorance of the importance of Vitamin D can kill. Wow! I'd been planning to write about it, but I didn't know that! And, just in case you wonder, I'm not being flippant - because for poor little Jayden, although his case is unusual, that's the shocking truth. If his parents had known, about the 'Sunshine Vitamin' as it's sometimes called; if the doctors treating the poor little baby had recognised the signs of its absence, this little baby would still be alive today. What a tragic and completely preventable outcome!

Yet, it could happen to anyone of us! Apparently, according to the BBC (assuming they  got their facts right) 74% of parents and more than half of Healthcare professionals in the UK are also ignorant of the facts! That I find completely shocking (especially as the Daily Mail seems to churn out articles about Vitamin D with a fair amount of regularity)! The parents - perhaps not so shocking (as when I think about it - I didn't know, until the dietitian warned me to give Baby Vitamin D drops) but surely you would expect the Healthcare professionals to know and be doing something about it! Wouldn't you?

In fact, it seems that due to dietary measures (like taking Cod liver Oil) that were taken when Rickets was a common occurrence, the disease appeared to have died out and was relegated to the pages of history. It was considered by many as a Victorian disease. Doctors in practice now, may never have come across a case and so therefore may not actually recognise it, when they see it. 

Unfortunately, it appears that during the 1950's concern developed over whether people might be having too much Vitamin D and, in the UK, dietary supplements were stopped. This seems to have contributed to a modern rise in the number of cases. Add to this, concerns about over exposure to UV rays, which have led many to avoid contact with the sun - a natural source of Vitamin D.

Why is it so important?

The fact is, whatever age we are, we all need Vitamin D. Among other things, it helps to regulate the amount of calcium (remember that, from my previous post) and phosphate in the body which, in turn, means healthy bones and teeth. 

It also helps your body's immune system - one of the reasons why there may be a connection between children with food allergies and Vitamin D deficiency. It is also thought that Vitamin D may play significant role to play in preventing cancer, cardiovascular disease, and multiple sclerosis, although further research is needed to prove these links.

What is recognised, is that lack of Vitamin D, causes problems with bones. In older people it can lead to Osteomalacia. Sadly, in Jayden's case, it led to a severe case of rickets. 

Who needs it?

Recently Public Health England updated their advice on Vitamin D (Updated July 2016). They now recommend that all adults take a daily Vitamin D supplement, especially during Autumn and Winter, when it is not possible to get our daily Vitamin D allowance from the sun. However, there are some groups more at risk, than others, from Vitamin D deficiency. These include:

• pregnant women
• breastfeeding women
• babies and young children (under five years old)
• older people (over 65)
• people whose skin is not exposed to the sun e.g. because it is covered up by clothing or because they are housebound
• darker skinned people

So how much of the 'Sunshine Vitamin' does one need?

Well this, like calcium, depends on where you live! 

In the UK, The Department of Health recommends the following:

• pregnant & breastfeeding women - 10 µg (microgrammes) or 400 iu/international units (daily
• babies & young children (6 months to 5 years)* - 7.0-8.5 µg daily (in the form of drops)
• older people, the housebound, dark skinned etc. - 10 µg daily

*However, formula fed babies do not require drops, unless they are fed less than 500ml formula a day - as formula is especially fortified with the correct amount of Vitamin D. Breastfed babies (there's little Vitamin D in breast milk) may need, however, to be given Vitamin D drops from the age of one month, unless the mother has been taking supplements during pregnancy!

In the US, the FNB recommends slightly higher doses of Vitamin D:

• 0-12 months 10 µg daily
• 1-70 years    15 µg daily
• 70+ years      20 µg daily

These amounts are based on the supposition that those concerned are getting minimal sun exposure.

Where can I get it?

Sadly not in chocolate! I know!! Believe me, I have looked! However a study is currently being conducted into how three squares of dark chocolate a day could help prevent skin damage from the sun - which is important if your'e planning on getting your Vitamin D RDA from sunlight!

Sunlight

Vitamin D is not called the 'Sunshine Vitamin' without reason! Interestingly enough, it seems that you cannot overdose on Vitamin D absorbed in this way, however, you can get skin burned and that, of course, can be harmful. 

Some research has indicated that between 5 -30 minutes of sun between 10am and 3 pm (without sunscreen) at least twice a week provided a sufficient amount of sun exposure. That was with face, arms, legs or back exposed. 

Some exposure to the sun can be helpful, but be careful!

In an interview I heard on the radio, the other year, a more conservative amount was suggested. 10 minutes (without sun screen) of exposing arms and legs to the sun, when the temperature was over 25 degrees Celsius, was considered sufficient. As I remember it, I believe the advice was to avoid the midday sun, but to get late afternoon sun, where possible. Of course, living in the UK, that can prove tricky!

Last summer, with that in mind, I got Baby out and about as often as possible and held back slapping sun screen on Baby, until she had been out in the sun for at least 10 minutes. The dietitian seemed happy with that (as I had also been concentrating on getting Vitamin D into her diet) but as baby had proved to have a reaction to her Vitamin D drops, was still keen for me to start giving Baby Junior Soya milk (with added Vitamin D) so that Baby's intake could be more easily calculated and assessed.

However, because of the risks of skin cancer, most Health Professionals advising on Vitamin D prefer that people look to diet or supplements for their RDA instead of relying on sunlight.

Diet

There are (limited) ways of ensuring that you get your Vitamin D RDA through your diet. Should you be thinking of trying to do so, the following (extracted from the US Office of Dietary Supplements NIH) could prove useful:

Table 3: Selected Food Sources of Vitamin D [11]

Food	IUs per serving*	Percent DV**
Cod liver oil, 1 tablespoon	1,360	340
Swordfish, cooked, 3 ounces	566	142
Salmon (sockeye), cooked, 3 ounces	447	112
Tuna fish, canned in water, drained, 3 ounces	154	39
Orange juice fortified with vitamin D, 1 cup (check product labels, as amount of added vitamin D varies)	137	34
Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 1 cup	115-124	29-31
Yogurt, fortified with 20% of the DV for vitamin D, 6 ounces (more heavily fortified yogurts provide more of the DV)	80	20
Margarine, fortified, 1 tablespoon	60	15
Sardines, canned in oil, drained, 2 sardines	46	12
Liver, beef, cooked, 3 ounces	42	11
Egg, 1 large (vitamin D is found in yolk)	41	10
Ready-to-eat cereal, fortified with 10% of the DV for vitamin D, 0.75-1 cup (more heavily fortified cereals might provide more of the DV)	40	10
Cheese, Swiss, 1 ounce	6	2

* IUs = International Units. 40 IU is the equivalent of 1 µg (microgramme)
** DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration to help consumers compare the nutrient contents among products within the context of a total daily diet. The DV for vitamin D is currently set at 400 IU for adults and children age 4 and older.

Please note: milk in the US is fortified with Vitamin D. This is not so, in the UK. However, if you're dairy free and are using a milk substitute, then it probably is fortified with Vitamin D (as well as Calcium). Just check the carton, to make sure!

Dietary Supplements

In the UK, Vitamin D supplements can be obtained fairly easily - they can be bought over the counter at pharmacies and supermarkets. Additionally, women and children who are under 'Healthy Start' can get free Vitamin D supplements. Pregnant women, however, should avoid Vitamin supplements that also contain Vitamin A.

Is there a 'right' kind of Vitamin D supplement?
It's difficult to get a definitive answer on this one, although people often seem to prefer D3 over D2. A recent study would seem to indicate D3 is perhaps better, but personally, I think it indicates that D2 is also fine.

How much is too much?

Believe it or not, it is possible to have too much Vitamin D! As with anything, it's all about moderation. Taking too much Vitamin D over a long period can cause the body to absorb too much calcium, which can lead to kidney problems. It's a particular problem for people with hyperparathyroidism, who are more sensitive to Vitamin D and also for pregnant women too as too much can cause some foetal abnormalities. 

However, there should be no need to panic about such things if you are taking normal Vitamin D supplements. For example, my daily calcium supplement, which also contains my daily dose of Vitamin D,   provides - 10mcg (100% of my RDA - UK). The NHS Choices website, maintains that doses of 25mcg or less is 'unlikely to cause harm'. 

In fact, the levels considered suitable by the NHS (UK) are way below the Upper Intake Levels as set out by the National Academies Press (US): 

• 0-6 months   25 µg/1 000 IU
• 6-12 months 38 µg/1 500 IU
• 1-3 years      63 µg/2 500 IU
• 4-8 years      75 µg/3 000 IU
• 9-71+ years  100µg/4 000 IU                  (IU = International Unit)

So that's all right then, for us! 

Now let's pass the message on...