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A lack of vitamin D is very common. Vitamin D is mostly made in the skin by exposure to sunlight. Most foods contain very little vitamin D naturally, though some are fortified (enriched) with added vitamin D. A mild lack of vitamin D may not cause symptoms but can cause tiredness and general aches and pains. A more severe lack can cause serious problems such as rickets (in children) and osteomalacia (in adults), described below. Treatment is with vitamin D supplements. Some people are more at risk of vitamin D deficiency, and so are recommended to take vitamin D supplements routinely. These include all pregnant and breast-feeding women, all babies and young children aged 6 months to 5 years, people aged 65 and over, and people who are not exposed to much sun. A doctor may also recommend routine supplements for certain people with darker skin, and for people with certain gut, liver or kidney diseases.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:The best dietary source of vitamin D is oily fish and cod liver oil. 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.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 and the elderly, the amount of time needed exposed to sunlight to make enough vitamin D can be much more than this.
Note: it is not the same as sunbathing; the skin simply needs to be exposed to sunlight. But, the sunlight has to fall directly on to bare skin (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 in the UK are at risk of not getting enough vitamin D unless they get it in their diet. Note: too much exposure to the sun's rays can be damaging. Sunburn should be avoided at all costs (mainly because it can increase your risk of skin cancer).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 and heart disease.
Vitamin D deficiency means that there is not enough vitamin D in your body. Broadly speaking, this can occur in three situations:Growing children, pregnant women, and breast-feeding women 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:This can occur for various reasons:Vitamin D deficiency is more likely to occur in people who follow a strict vegetarian or vegan diet, or a non-fish-eating diet.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 South Asian origin may be vitamin D-deficient. Most affected people either don't have any symptoms, or have tiredness or vague aches and pains, and are unaware of the problem.Many people have no symptoms, or may complain of 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 (typical) symptoms and bone deformities.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.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, etc. Briefly, one of the following may be advised.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.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.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.Once 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.Various groups of people (detailed earlier) are prone to develop vitamin D deficiency. Therefore, certain people are advised to take vitamin D supplements routinely. In February 2012 the Chief Medical Officers for the United Kingdom issued the following recommendations:In addition a doctor may advise routine vitamin D supplements for people with certain gut, kidney or liver diseases, 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. Women and children from families who are eligible for the Government’s Healthy Start scheme (see below) can also get free vitamin supplements which include vitamin D.If you are unsure as to whether you should be taking a regular supplement of vitamin D, or what the appropriate dose is, then your doctor, pharmacist, health visitor or midwife can advise.
Care is needed with vitamin D supplements in certain situations:Multivitamins are not suitable for long-term high-dose treatment because the vitamin A they also contain can be harmful in large amounts.It is very unusual to get side-effects from vitamin D if taken in the prescribed dose. However, very high doses can raise calcium levels in the blood. This would cause symptoms such as thirst, passing a lot of urine, nausea or vomiting, dizziness and headaches. If you have these symptoms, you should see your GP promptly, so that your calcium level can be checked with a blood test. Some guidelines advise that people taking high vitamin D doses should have their calcium levels checked during the first few weeks. In practice, this is not usually done unless you develop symptoms of a high blood calcium level.The outlook is usually excellent. Both the vitamin levels and the symptoms generally respond well to treatment. However, it can take time (months) for bones to recover and symptoms such as pain to get better or improve.