The Sunshine Vitamin - A Cautionary Tale

Have you been hearing a lot about vitamin D recently?

Chances are you have heard or read something about vitamin D in relation to Covid-19 in the past months. So what is all the fuss about and why is it so important we have enough of it?

Vitamin D is a steroid hormone which is produced from cholesterol, when your skin is exposed to the sun. This is why it is often called the "Sunshine Vitamin". It is however very difficult to get enough vitamin D from sun exposure alone and so we need to top it up through our diet or supplements.

Contrary to what you might think....

Deficiency in vitamin D is not just something British people suffer from in the winter time. Our two children were born and brought up in Dubai in the UAE, a place where the sun shines brightly pretty much every day of the year. By the time they were eight and ten we were surprised to discover that they (and I) were very deficient in vitamin D. We only found out because our daughter broke her arm, falling over lightly on the grass at school, and then a year later, her heel, by tripping on a tennis ball. In a strong and healthy ten-year-old, it is pretty difficult to sustain these types of injuries in such circumstances. The orthopaedic surgeon was bemused when treating her heel fracture and said it would normally only be possible to fracture the heel bone if you have been dropped from a height or been in a car crash. He tested her vitamin D levels and they were found to be extremely low, (24 nmol/L (Nanomoles per Litre), when healthy optimal levels are said to be 50-70 nmol/L, (although opinions on this do seem to differ). It seemed, despite all those trips to the beach and the al fresco living, we were definitely not getting enough vitamin D from the sun.

We were all put on an initial high dose until our levels rose sufficiently and this was later reduced to a daily maintenance dose. My eyes were opened to something I had been totally unaware of and thought would never be possible in such a sunny climate. We do try to eat as much oily fish as possible each week, but it is very hard to eat enough of that to make an impact, especially if you are deficient in the first place.

It is important to be tested and not just supplement blindly, because although it is very rare, vitamin D toxicity can occur, presenting symptoms such as confusion, drowsiness, depression, constipation, and high blood pressure. The NHS does not routinely test patients for Vitamin D, even if requested, so it generally has to be done privately. It is a simple blood test and could be well worth the investment. Interestingly, the leading German children's orthopaedic surgeon we consulted in Dubai told us that, within reason, there is not much danger in taking an appropriate maintenance dose of vitamin D, because any excess is stored in the body's fat cells, until it is needed. I have found this view is very different to the one held by doctors and pharmacists in the UK, where there seems to be a lot more caution exercised.

So how did we all end up so deficient?

It was quite possibly due to my routine over-use of sun-block, our habit of nearly always wearing long-sleeved sun tops, hats and generally shying away from the full glare of the desert sun. I find it hard to remember occasions when we have had sunburn and resorted to the aloe Vera gel in the fridge. There is no doubt that the risks of skin cancer are very real and incredibly dangerous, but the challenges of vitamin D deficiency are also said to be far-reaching and equally life-threatening. We were advised by the aforementioned orthopaedic surgeon, to continue using a reasonably high-protection sun cream, but to spend the first twenty minutes of our time in the sun unprotected. This apparently enables your body to do it's magic, but does not allow you to burn. (Please note that this advice applies to Dubai in the UAE, but would not necessarily be safe in other countries, depending on the ozone layer).

Apart from compromised bone health, what are the other symptoms people experience?

Vitamin D deficiency is known as "a silent epidemic" as "symptoms are subtle and may take years or decades to surface" according to Chris Gunnars' article in Healthline, of 6th March 2019,

(https://www.healthline.com/nutrition/vitamin-d-101). The first thing that springs to most people's mind is rickets but this has been eradicated from most Western countries through the fortification of various foods with vitamin D. It is also known to be the be linked to osteoporosis, reduced mineral density and increased risk of falls and fractures in older people. Other studies show that those with low vitamin D levels have a much "greater risk of heart disease, diabetes (types 1 and 2), cancer, dementia and autoimmune diseases like multiple sclerosis". It is also linked to a reduced life-expectancy. However, it is important to note that none of this research is conclusive and the symptoms are only associated with a lack of vitamin D. More studies are apparently required.

What about Vitamin D helping to boost our immune system and protect us from Covid-19?

This is something that has been circulating a lot in the past months and may be why you have become more aware of vitamin D. If you look on the NHS website (www.nhs.uk) and at the article "News analysis: Health claims about vitamin D examined," there is nothing about vitamin D being effective in fighting off infections, flu or Covid-19. Professor Tim Spector, Head of Department of Twin Research and Genetic Epidemiology, at King's College, London, Co-founder of Zoe; (joinzoe.com) and author of both "the Diet Myth" and "Spoon Fed", says (in this article https://covid.joinzoe.com/post/vitamin-supplements-covid) that “The evidence in the scientific literature to support vitamin supplements is pretty dreadful.“ "I would say there's absolutely no data to support most of them, with only two or three possible exceptions.” He goes on to say; "There was also one report about vitamin D with a summary of a few bad studies to show it could help the immune system,” “But these are mostly observational studies and rigorous vitamin D supplementation trials for various conditions have proven that it’s not helpful.” It mentions in the article that in fact several studies have shown that " vitamin D supplementation does not reduce rates of colds and flu. It also did not lower the risk of catching swine flu (H1N1) during the 2009-10 epidemic. In fact, looking at it the other way around, low vitamin D may just be a marker of being less healthy."

What is the best way to support my immune system to fight COVID-19?‍

According to Tim Spector, "The answer is simple, although much less alluring than the pricey supplement concoctions advertised online". "Get a balanced diet, with plenty of diversity of plants, fruits, and vegetables,”. “That will give you all the vitamins and minerals you need.” "And as a bonus, a healthy diet with lots of different plants will also help keep your gut microbes happy."

“That's the most certain way you can maximize your immune system,” according to Tim. “A healthy microbiome is likely to support your immune system and in turn - whilst no guarantee - will increase your chances of staying healthy too.”

This view on vitamins is in stark contrast to Patrick Holford's standpoint, covered at length and in great detail in "The Optimum Nutrition Bible". This highly regarded book is said to be "The Book You Have To Read If Your Care About Your Health" It is listed on Amazon as being "completely revised and updated to include the latest cutting edge research". Patrick Holford is the founder of the Institute for Optimum Nutrition, (ION) one of the UKs leading Nutrition schools with highly successful graduates including Amelia Freer. Patrick Holford retired as Director from ION in 1997 to focus on writing, teaching and researching. He now has his own supplements brand called "Patrick Holford Optimum Nutrition Supplements" and a website called "Holford Direct".

It seems that this is still a much debated area that calls for caution and our own research. The vitamins and supplements industry is huge, lucrative and has undoubtedly boosted its sales over the past year through a fearful public keen to do anything to avoid getting Covid-19 and boost their immune systems. Like many things in nutrition, it is not clear cut and we all need to take a personal and tailored approach according to our own needs. Consulting your GP and being aware of the pitfalls of supplements is key before heading down to your local health store or making a bumper order on Amazon, especially where vitamin D is concerned.