Vitamin D: The must have supplement!

What is it?

Let me start by telling you a bit about vitamin D… the boring bit. Vitamin D is a fat-soluble vitamin which is made by our skin when sunlight directly touches it. As the vitamin is synthesised (made) by the body, it strictly isn’t a true vitamin and is actually considered to be a hormone. It is responsible for increasing gut absorption of calcium, magnesium and phosphates, contributing towards bone health and remodelling. Other positive effects include influencing cell differentiation (the process in which cells become specialised to perform specific functions), neuromuscular and immune functions AND reducing inflammation. All pretty important stuff really!

It was discovered during the effort to identify the dietary deficiency in children with rickets. This is where vitamin D supplements are commonly used to treatment or prevent rickets. The main source of the vitamin is through sun exposure, but it is also present in some food. Good sources of vitamin D are in the flesh of fatty fish, which is trout, salmon, tuna and mackerel. Otherwise, there are few other foods where it can be naturally found in significant quantities. There are very small amounts in beef liver, egg yolk, cheese and mushrooms that are exposed to UV light, but best not to rely on these.

Now on to the fascinating stuff… or maybe I’m just a bit of a geek!

How to make Vitamin D?

Vitamin D is made through the skin by being exposed to direct sunlight. Sitting in the sun for 30 minutes generates 20,000iu of vitamin D!!! Wowee! That’s a lot, especially compared to the NHS recommendation of supplementing 400iu a day. That’s a drop in the ocean compared to natural synthesis, but more on that later.

There are a few key features that I need to make you aware of to ensure good production of the stuff. Firstly, SPF blocks the synthesis of vitamin D! This is so important to know if you are someone who constantly has suncream on when in the sun. You won’t be making any vitamin D, so please do not assume you are just because you are physically in the sun. You need to have at least 25% of your skin exposed to make adequate amounts, so think arms and legs out. Even better if you are lucky enough to be in a swimsuit by the beach and have your torso in the sun. The largest skin surface on our body. Vitamin D can only be produced by UVB rays, which comes from the sun and does NOT come from sun beds.

In the UK, the sun is only strong enough to help us make vitamin D between the hours of 11am-4pm, during April to September. A good way of telling if you are making vitamin D is if your shadow is shorter than you. Check it out next time you are outside and the sun is shining. What you will notice is that this isn’t possible during the UK winter months and even worse the further north you go.

A staggering 87% of the UK population are deficient by the end of winter! You wouldn’t believe that even by the end of summer, 60% are still deficient! You need to be in it to make it, so it’s no good working inside all day and thinking just because it’s “summer time” you are making a sufficient amount. So, the best solution is to try and get 20-30 minutes sun exposure daily in the summer WITHOUT sun cream on. Then if you are going to be in direct sunlight for the rest of the day, cover up or use sunscreen. In the winter, take a supplement!

Blood Results

This is my favourite conversation to have with patients and it’s the difference between what the NHS deem as acceptable and what optimal is. Something I have learnt is quite different with many standard blood tests. The NHS state that 50 or above is acceptable, but you need your levels to be around 150 to be functioning on an optimal level.

Common symptoms of low vitamin D?

Now most people won’t necessarily know if they are deficient, but some of these symptoms may resonate with you. Being very low in vitamin D can produce symptoms of Chronic Fatigue Syndrome and Fibromyalgia, so I would say if you’ve ever been diagnosed with this it’s really important to keep your levels up. Other symptoms can include general muscle/joint pain and stiffness, chronic neck or back pain, migraine/headaches, depression or anxiety and persistent fatigue. There is another symptom that I thought was worth discussing on its own – growing pains. I’ve heard many parents mention that their children complain of this. I can not stress enough… it is not normal to have growing pains! PLEASE get their levels of vitamin D checked if you or your children are suffering with this sensation. This is likely to be the cause.

Risk Factors

There are a few groups of the population that are more at risk of being or becoming deficient in vitamin D. The elderly due to their skin becoming frail and unable to produce good quality vitamin D. People that are overweight, because the vitamin is fat soluble so the more fat cells someone is carrying, the more vitamin D is absorbed in that region. The last group are people of colour. This is because the pigmentation in their darker skin reduces production of vitamin D in the skin. Interestingly enough, these are the 3 subgroups of people that were more at risk of developing serious symptoms from the virus COVID-19 and vitamin D became a treatment protocol used in ICU due to it’s links.

Supplementation

To conclude this blog with the key take home message, is that every person living in Britain MUST take a vitamin D supplement in the winter months. It’s a no brainer! Even during the summer months too, if you don’t get outside in the sunshine much.

The NHS NICE guidelines recommend that you take 400iu a day in the form of a pill that you swallow, but as discussed earlier, this won’t even touch the sides on what you could make if you spent 30 minutes sat in the real thing. The other point to note is that we do not absorb vitamin D as well in the gut as we do the mouth, so it’s best to take a type that is “sublingual” rather than a tablet you swallow. That can be a spray, drop or chewable tablet – the choice is yours.

Before we go onto the optimal recommended doses from a functional medicine perspective, I would like to reassure you that it is very hard to overdose on vitamin D. It is a supplement that your body will just excrete what you don’t need. You’ve never heard of someone overdosing on vitamin D from sitting out in the sun too much! Obviously damaged skin, but nothing about the vitamin D it produces.

Daily recommended dose is based on age, size and weight. Please see below:

• Toddlers 1000iu
• 4-8 year olds 2000iu
• 8-12 year olds 3000iu
• Teenagers 3000-5000iu
• Adults 4000-5000iu
• Adults (3 stone overweight) 7000-8000iu
• Adults (5+ stone overweight) 10,000iu

Contraindications

If you are reading this article feeling inspired to improve your health by taking a vitamin D supplement and haven’t been advised to through a healthcare practitioner, please note these contraindications. Please note that if you have Sarcoidosis, you MUST NOT take vitamin D. If you are taking the blood thinner Warfarin, you MUST NOT take vitamin K. Please do consult a pharmacist if you have any questions or concerns regarding current prescriptions that you may be taking.

I haven’t spoke about vitamin K, but it is an important side kick to vitamin D and should be taken as a combined supplement for best absorption and use within the body. The mechanism of how these vitamins work in combination and are best utilised can get very confusing. Other essential elements that are required for the best results with vitamin D are magnesium, B6 and calcium. Not that people are deficient in calcium if they consume dairy, but the others are common deficiencies… that’s a subject for another blog.

If you require some high quality vitamin D supplements, our clinic is always fully stocked! A tasty chewable tablet which comes in a 4000iu dose, making it easy for your one a day! Any questions, ask your practitioner or front desk the next time you are in. We’d be happy to help!