Wednesday, 22 February 2012

Vitamin D Dilemma!

The level of Vitamin D in our population has recently been the focus of some concern - The Chief Medical Officer for England has spoken out about this (here). Having recently been told that my own Vitamin D levels are very low, I am really interested in the approaches suggested to increase all of our vitamin D levels.

Vitamin D is "the sun vitamin", absorbed through the skin from sunlight. Modern lifestyles are mostly to blame for these deficiencies, as we now spend more and more time indoors. The Department of Health notes the following groups of people are at risk of Vitamin D deficiency:
  • all pregnant and breastfeeding women, especially teenagers and young women
  • infants and young children under 5 years of age
  • older people aged 65 years and over
  • people who have low or no exposure to the sun, for example those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods
  • 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

The fourth point is particularly interesting. As a result of my primary health conditions, my physical activities were dramatically reduced - I spent more and more time indoors, and although tried to walk at weekends for fresh air, I am significantly deficient in Vitamin D.

When patients become ill and especially with limited energy or mobility, they are very likely to reduce the time they spend outdoors. It is a balance between being completely OTT, providing unnecessary treatment, and preventing secondary condition in patients already suffering with considerable ill health. Maybe patients with vitamin D levels on the low side should be advised to have supplements during a period of relapse?

Although not life threatening, Vitamin D deficiency can cause significant disability, and for patients with already disabling primary conditions, the diagnosis of additional secondary conditions can be very stress full. I am aware of the criteria for screening programs (Wilson & Junger, WHO, 1968), and current screening criteria (UK National Screening Committee) but I feel this could be of great value to patients with long term conditions that limit mobility and energy levels.

. . . It would be interesting to find out about the effect of Vitamin D deficiency in this sub-group (patients with long-term conditions affecting their mobility), since bone has a 'use it or loose it' aspect. . . with minimal weightbearing and use of lower limb bones, would the effects of Vitamin D deficiency be more pronounced in this group?

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