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Q & A on New Government Advice for Vitamin D
Why is vitamin D important?
Vitamin D regulates calcium and phosphate levels, which are essential to bone, teeth and muscle health.
Low vitamin D levels are associated with a higher risk of poor musculoskeletal health such as rickets, osteomalacia, falls, and muscle strength. In extreme cases of deficiency, children can develop rickets, a condition where the bones become soft and misshapen as they grow. In adults, deficiency can lead to osteomalacia, a condition that causes severe muscle and bone pain.
Do we get enough vitamin D?
According to national dietary surveys in the UK, across the population approximately 1 in 5 people have low vitamin D levels (defined as serum or blood levels below 25 nmol/L). Residents in care homes have been reported to have a higher prevalence of low vitamin D levels.
We need to have about 10 micrograms of vitamin D each day to maintain healthy blood levels of vitamin D. However the vitamin is only found in a limited number of foods and for most people, the main source of vitamin D is made from the action of sunlight on their skin. So there is a concern that we may not be able to achieve adequate vitamin D levels through diet alone, particularly when sunlight, is scarce as in the autumn and winter months.
Why has new guidance on vitamin D been issued?
The Scientific Advisory Committee on Nutrition, SACN, the committee of independent experts that advises Government on matters relating to diet, nutrition and health, reviewed the scientific literature to ascertain whether the existing vitamin D recommendations were still appropriate. Their report Vitamin D and Health has now been published, in which SACN recommends that we have enough vitamin D to maintain a healthy blood vitamin D level (at least 25 nmol/L) all year round to protect our muscle and skeletal health. Previously it was thought that the majority of the population could get enough vitamin D from sunlight in summer to maintain body stores in winter, but this may not be so.
What is the new guidance, and how does it apply to care homes?
The new advice from Public Health England, based on the recommendations of SACN report, is that adults and children over the age of one should consider taking a daily supplement during autumn and winter.
Between October to March, people aged 5 years and above should consider taking a supplement of 10 micrograms. This is because although we need to rely on dietary sources in winter, but vitamin D is found only in a small number of foods such as oily fish, eggs, liver, red meat and foods fortified with vitamin D like some breakfast cereals, fat spreads and powdered milk. Therefore it might be difficult to get enough from foods that naturally contain vitamin D and/or fortified foods alone. In the summer months though, sufficient vitamin D can be obtained from sunlight when people spend time outdoors, alongside with the intake of foods that naturally contain or are fortified with vitamin D.
People from minority ethnic groups with dark skin such as those of African, African-Caribbean and South Asian origin might not get enough vitamin D from sunlight in summer so they should consider taking a daily supplement containing 10 micrograms vitamin D throughout the year.
For care homes
SACN's review concluded that groups at risk of low vitamin D include people whose skin has little or no exposure to the sun, like those in care homes, frail or housebound people, or people who habitually wear clothes that cover most of their skin while they are outside. The government’s new advice recommends that these groups consider taking Vitamin D tablets all year round. The advice relevant to care homes has in fact not itself changed, as care home residents are known to be more at risk of having low vitamin D levels, and the previous recommendations likewise were for this group to take vitamin D supplements.
So what are the main messages we should take from the new advice?
Vitamin D is important for good bone and muscle health. The best source of Vitamin D is sunlight and residents should be offered the opportunity to spend time outside. However, it is important not to let skin burn in the sun as this can cause skin damage and increase the risk of skin cancer. It is also good practice to make sure food sources of Vitamin D are on the menu, such as oily fish (e.g. mackerel, salmon, trout, sardines), eggs, and fortified breakfast cereals. Why not try canned salmon for example in a fishcake recipe, or in a fish pie? In addition, the advice for care home residents remains to take a daily supplement of 10 micrograms of vitamin D all year round.
Read the full guidance here: SACN Vitamin D and Health Report