by Dr Rachel Hughes
Vitamin D is essential for our health, general well-being, and especially for our bones. It is mostly made in the skin through exposure to sunlight. You can also get Vitamin D through your diet
A lack of vitamin D is very common, 1 in 5 adults and children in Wales will have a low vitamin D level.
Sources of Vitamin D
There are two main sources of vitamin D – from the sunlight, and from your diet.
Sunlight
Ultraviolet B (UVB) sunlight is the best way to boost vitamin D. Exposure of 10 to 15 minutes to the Welsh summer sun, without sunscreen, several times a week is probably a safe balance between adequate vitamin D levels and any risk of skin cancer. Sunbeds are not recommended as a way to top up vitamin D.
IMPORTANT – everybody should be aware that the longer they stay in the sun, especially for prolonged unprotected periods, the greater the risk of skin cancer. So the advice is to stay covered up and use sunscreen (with a high UVB factor) for the majority of the time spent outside. Skin should always be covered up or protected before it starts to turn red or burn.
Diet
Good sources of vitamin D include:
- Oily fish including trout, salmon, mackerel, herring, sardines, anchovies, pilchards, and fresh tuna. – Amount will depend on preparation
- Cod liver oil (not advised in pregnancy due to vitamin A content) and other fish oils
- Egg yolks, liver and red meat
- Supplemented breakfast cereals
- Margarine
Who is at Risk?
- All pregnant and breastfeeding women, especially teenagers and young women, are particularly at risk of vitamin D deficiency.
- Young children under 5 years of age.
- Older people aged 65 years and over.
- People who are not exposed to much 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, because it takes their skin more time to produce as much vitamin D as it does for someone with lighter skin.
Symptoms
A lack of vitamin D can cause the following symptoms:
Babies
Severe deficiency can lead to muscle spasms, fits and breathing difficulties as a result of consequent low calcium levels
Children
Poor growth, tooth delay, irritability, more prone to infections. Severe deficiency can lead to rickets which can present with bone pain, muscle pain or muscle weakness.
Adults
General tiredness, muscle aches and pains. More severe deficiency (osteomalacia) can lead to more severe muscle pain and weakness.
All pregnant and breastfeeding women should take a daily supplement containing 10 micrograms of vitamin D, to ensure the mother’s requirements for vitamin D are met and to build adequate fetal stores for early infancy.
Who needs supplements?
We recommend that the following individuals take vitamin D supplements:
| Who? | How Much? |
| All Pregnant and breastfeeding women | 10 micrograms per day |
| People aged 65 years and over and people who are not exposed to much sun such as housebound individuals and those who cover their skin for cultural reasons, should also take a daily supplement | 10 micrograms per day |
| All babies and young children aged 6 months to 5 years.
Babies who are fed infant formula should not need a vitamin D supplement until they are having less than 500ml (about a pint) of infant formula a day. These products are fortified with vitamins and minerals and there is a risk of having too much vitamin D if a baby is drinking more than 500ml of formula milk per day as well as vitamin D supplement.
Breastfed infants should be given a vitamin D supplement from one month of age if the mother did not take a vitamin D supplement throughout her pregnancy. | 7 to 8.5 micrograms per day |
| If you have been advised to do so by your doctor or nurse following a blood test. | See below |
Sometimes a doctor or nurse might request a Vitamin D blood test depending on your symptoms.
Those with a very low level of Vitamin D on a blood test will be called into the surgery to discuss starting intensive treatment.
If your doctor or nurse informs you that your vitamin D is slightly low or borderline, there is no need for intensive treatment. Taking a supplement of high strength vitamin D containing 2000 or 2500 units daily (equivalent to 50 – 62.5 micrograms daily) long term is recommended. These can be purchased over the counter from a pharmacy or supermarket.
Are free Vitamin D supplements available?
Pregnant and breastfeeding women and families with young children are eligible for Healthy Start and can get free vitamin supplements containing vitamin D. In Wales, Health Boards have a statutory responsibility to make Healthy Start vitamins available locally to women and children on the scheme. For more information, visit: www.healthystart.nhs.uk
Single vitamin D supplements or vitamin drops containing vitamin D (for under 5’s) are available to buy at most pharmacies and supermarkets for those who are not eligible
for Healthy Start. Healthy Start supplements cannot be prescribed.
REMEMBER – pregnant women should avoid taking multivitamins containing vitamin A (retinol) due to the risk of causing birth defects – check the box.
