Vitamin D is important for good health, growth and strong bones, yet 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.

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).
  • Fortified foods (this means they have vitamin D added to them) such as margarine, some cereals, infant formula milk.
  • Egg yolk, liver, and wild mushrooms contain only small quantities of vitamin D.

Vitamin D and sunlight 

Over 90% of vitamin D is derived from ultraviolet B light. For a fair-skinned person, it is estimated that around 20-30 minutes of sunlight on the face and forearms 2-3 times a week is sufficient to make enough vitamin D in the summer months. 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.

People who get very little sunlight on their skin are at risk of vitamin D deficiency (People who stay inside a lot and people who cover up a lot of their body when outside).

Strict 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 the harmful effect of the sun's rays and should never be allowed to burn or be exposed to the strongest midday sun.

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).

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

The body has an increased need for vitamin D:

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:

  • Pregnant or breast-feeding women. Vitamin D deficiency is even more likely to develop in women who have had several babies with short gaps between pregnancies. This is because the body's stores of vitamin D get used up, and there is little time for them to be built up before another pregnancy.
  • Breast-fed babies whose mothers are lacking in vitamin D, or with prolonged breast-feeding, as there is little vitamin D in breast milk. (Note: there are significant advantages to breast-feeding. You should not stop breast-feeding due to concern about vitamin D levels - your baby can simply have vitamin D supplements as drops by mouth.)

The body is unable to make enough vitamin D:

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. 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. 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. 

Not enough vitamin D is being taken in the diet:

Vitamin D deficiency is more likely to occur in people who follow a strict vegetarian or vegan diet, or a non-fish-eating diet.

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. The recommended daily intake of vitamin D in the UK is 400 IU (10 micrograms) per day for an adult, 280 IU (7 micrograms) for children aged between 6 months and 3 years, and 340 IU (8.5 micrograms) per day for infants under 6 months. These recommendations only provide sufficient vitamin D to prevent osteomalacia and rickets and, in the absence of skin synthesis, will not provide an optimal level of vitamin D. Your doctor will discuss the dose, and best treatment schedule, depending on your situation, age, severity of the deficiency, etc.

Reference: April 2017

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Dr Ruth Ward

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