VITAMIN D
are typically negligible. Other factors, which limit this exposure include age, skin pigmentation, regular use of sunscreen and covering up of the skin for religious reasons.
Once vitamin D hits our skin, it is then transported to the liver after absorption where (in the form of calcidiol) it is stored for future use. Calcidiol (25-hydroxy D) is sent all over the body where different tissues (including the kidneys) convert it to activated vitamin D23 (calcitriol), which is needed for a healthy immune system.
WHAT CAN INCREASED VITAMIN D LEVELS DO FOR THE BODY? Immunity enhancement: Vitamin D has become incredibly popular due to its impactful ability to ward off colds and fl u. A meta-analysis published in the British Medical Journal (BMJ) concluded that vitamin D was not only safe, but could also help to protect against respiratory tract infections – which covers everything from colds and fl u to pneumonia.
Reduction in fall risk and bone fractures: Vitamin D can also assist with preventing falls. As we age, accidental falls are less embarrassing and more threatening and, as such, are much more likely to lead to bone fractures and a hospital visit. Vitamin D, however, supports muscle function, consequently reducing the risk of falls in individuals, particularly the elderly. A meta-analysis from the BMJ shows that subjects experience a reduction in falling and fracture risk by 29 per cent with vitamin D supplements. It should be noted, however, that these results were achieved by doses of at least 700iu-11000 international units (iu); lower doses were considered ineffective.
Reduction in cardiovascular risk: Vitamin D has been linked to the reduction of cardiovascular events by reducing the prevalence of co-morbid diseases, such as diabetes and blood pressure, reducing infl ammation of the cardiovascular system and reducing the risk of arterial calcifi cation (hardening of the arteries).
Reduction in sleep and pain problems: A recent review study, which was published in the Journal of Endocrinology – ‘The interfaces between vitamin D, sleep and pain’ – demonstrated that low vitamin D levels were associated with both elevated pain and irregular sleep patterns. The study authors concluded that vitamin D supplementation
12 - SCOTTISH PHARMACIST
had an important role to play in the therapeutic improvement of sleep, and in the prevention and treatment of chronic pain conditions.
WHAT IS THE RECOMMENDED DOSE OF VITAMIN D? This can be a diffi cult one to answer since the dosage is very much dependent on an individual’s existing vitamin D level and personal requirements. The government recommendation is that all individuals should consider taking at least 400iu in autumn and winter months per day.
Unfortunately, vitamin D can be diffi cult for some patients to absorb. Being fat soluble, it is best absorbed in oil containing formulas such as capsules, since these provide the dietary fats that assist in digestive absorption.
Elizabeth Roddick, pharmacist and owner of New Life Pharmacy, who has been running a vitamin D clinic for the people of Netherlee, South Glasgow for the past three years, believes that the Scottish government’s announcement is a great move forward in recognising the role of vitamin D defi ciency in many chronic conditions and illnesses.
‘What strikes me particularly about this announcement,’ Elizabeth told SP, ‘is that the government is recognising that everyone can benefi t from a vitamin D supplement. While this is nothing new to me, I have been aware for some years of the fact that other healthcare professionals were not taking notice of the advice that was being proffered by researchers.
‘I’m glad to say, however, that recently I have been aware of an increasing number of GPs, who are prescribing vitamin D supplement - to the elderly in particular.
‘I suppose it goes without saying that the elderly are more likely to experience a vitamin D defi ciency than other age groups, simply because of the amount of time that they spent indoors. Those in residential homes are particularly affected and I fi rmly believe that all residents of nursing homes should be automatically given supplements.
‘Research has also shown that vitamin D has a marked impact on the immune system with regard to recurrent respiratory tract infections; with some studies reporting a drop of up to 50 per cent in the number of infections a patient experiences.
‘To be honest there are few people who wouldn’t benefi t from a vitamin D supplement. The government has now said that the under fi ves should be taking 400iu or 10mcg daily, but the problem is that the Healthy Start vitamins don’t contain enough to meet the guidelines as they only contain 300iu, and so even this age group needs to take an extra supplement to meet the required levels.’
Despite the fact that she is seeing an increasing number of people coming into the pharmacy actively seeking vitamin D supplements, Elizabeth is concerned at the amount of negative articles that regularly appear in the media.
‘It’s vitally important that we get the right advice out to everyone in this regard,’ she continues. ‘As pharmacists, we need to push the government guidelines and, if necessary, carry out the testing in our pharmacies. Unfortunately, NICE have said that vitamin D level testing should not be done on the NHS because it is so costly, and GPs are told not to test unless a medical problem indicates a lack of the vitamin (at which point 800iu is generally prescribed). I am, however, seeing active GPs prescribing it more and more regularly – particularly for the elderly.
‘The fact that vitamin D is a secosteroid hormone means that it has powerful auto-immunity properties
GOVERNMENT RECOMMENDATIONS
Following recommendations from the Scientifi c Advisory Committee on Nutrition (SACN), Scottish Government advice on vitamin D for all age groups has been updated as follows:
FROM BIRTH:
The government suggests a vitamin D supplement from birth if a baby is formula fed.
FROM SIX MONTHS TO ONE YEAR:
Infants from six months to one year of age, whether exclusively or partially breastfed, should be given a daily supplement containing 8.5-10 micrograms vitamin D.
Babies fed infant formula should not be given a vitamin D supplement unless they are receiving less than 500 mls (about a pint) of formula a day because formula is fortifi ed with vitamin D and no other supplementation is required.
AGES ONE-FOUR YEARS:
Children aged one-four years of age should be given a daily supplement containing 10 micrograms of vitamin D. AGES FIVE YEARS AND ABOVE:
Everyone aged fi ve years and above, including pregnant and breastfeeding women and population groups at risk of defi ciency, should consume 10 micrograms of vitamin D/day.
and it’s for that reason it is so benefi cial to a wide range of patients.
‘The symptoms that I tend to look out for in the pharmacy are patients, who seem to experience constant respiratory tract infections, but who are otherwise healthy. Children, who may not be getting enough sleep, have also benefi tted. Any patients to whom I’ve recommended a vitamin D supplement have returned to the pharmacy to tell me that they feel stronger and are experiencing fewer infections.
'I honestly believe that vitamin D supplementation is required for most people, but, because there are a wide range of doses available and often confl icting advice, it can be confusing. Patients need pharmacists to be able to provide advice and information as well as products, and to guide patients through doses.’ •
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