It was recently reported in the UK that nine out of ten people could be vitamin D deficient, with nearly two thirds of the people surveyed being severely lacking in the essential nutrient, according to new figures. The “extraordinary findings,” as described by health pioneers BetterYou , which were announced ahead of a major national awareness campaign, suggest that a massive proportion of the UK population is at risk of a range of debilitating symptoms brought on by this deficiency. Of those diagnosed as being severely deficient, most (71%) do not take any form of supplement — highlighting a clear link between deficiency and supplementation.
Almost 90% of 168 people interviewed provided either classic symptoms of advanced vitamin D deficiency or listed multiple lifestyle conditions that would predispose them to be deficient
Andrew Thomas, Founder and Managing Director at BetterYou, said: “Our findings further confirm what we have long suspected, that our nation is far more deficient in vitamin D than we would care to admit. Almost 90% of 168 people interviewed provided either classic symptoms of advanced vitamin D deficiency or listed multiple lifestyle conditions that would predispose them to be deficient. These include a combination of having darker skin pigmentation, spending daylight hours indoors and excessive use of UV sun cream. The subject has been discussed in the UK House of Commons, leading to 'at risk' groups being identified and supplementation recommendations made by our Department of Health. The awareness week is the natural next step to raise understanding with the general public.”
Other findings from the survey of 168 UK adults showed that most (77%) spend much of their day indoors. This puts people at risk of deficiency because 90% of the body’s vitamin D must come from sun exposure … with the other 10% being derived from the diet. Almost half of those surveyed also said they regularly suffer with low energy levels (47%) and 40% experienced regular aches and pains in their bones and joints. Both are key symptoms of deficiency. BetterYou, a pioneer of the sublingual delivery of vitamin D, has previously serum tested more than 250 members of the UK general public, none of which displayed a healthy or sustainable level of vitamin D.
Earlier in the year, the Chief Medical Officer for England, Dame Sally Davies, announced her concerns to health professionals regarding a rise in vitamin D related conditions, asking them to consider vitamin D supplementation for at risk groups, including pregnant mothers. Following this, it was announced by UK Labour MP, Kate Green, in September, that cases of rickets have increased more than 400% since 1996.
Sunshine confusion
Ironically, a survey done by the National Osteoporosis Society in May 2012 revealed that more people than before know that sunlight is the best source of vitamin D, and understand that we should leave our skin uncovered for a few minutes each day. However, there are still far too many who mistakenly believe that we should wear sunscreen to obtain vitamin D, unwittingly putting themselves at risk of deficiency and unhealthy bones. The survey, which questioned 600 people in the UK, found that 62% of respondents understood that we need vitamin D to keep our bones healthy, whereas a third correctly believed that the best way to get vitamin D is by going outside in the sun without sunscreen, another third think that you should wear sunscreen. Although they are correct that sunscreen is needed to protect the skin, it is important to allow a few minutes of sunlight to make vitamin D (taking care not to burn if you have sensitive skin).
It is important to allow a few minutes of sunlight to make vitamin D
Dr Helen Macdonald, Chair of the National Osteoporosis Society’s Nutrition and Lifestyle Forum said: “Vitamin D has been long known to improve bone health by helping our bodies to process calcium effectively; it is essential for bone and muscle health as it promotes calcium absorption from our food. Our bones need the added mineral to make them strong and supportive, and vitamin D may play an important role in muscle function. We are encouraged by these survey results, but there is clearly a long way to go to improving awareness of vitamin D.”
The survey has also identified confusion regarding dietary sources: when asked if they took a vitamin D supplement, almost half of respondents said that they did not need to because they ate a healthy balanced diet; but, in reality, only a small amount of our vitamin D comes from food sources. “Although a healthy balanced diet is important for our all-round health, we really do need summer sunlight to maintain our vitamin D levels,” added Dr Macdonald.
Expert opinion
Perhaps as a result of the recent surveys, one of the country’s leading experts in the field of vitamin D deficiency says that more needs to be done to prevent the recent resurgence of childhood rickets. Dr Benjamin Jacobs, consultant paediatrician and Director of Children’s Service at the Royal National Orthopaedic Hospital, UK, is using National Vitamin D Awareness Week to renew calls for parents and pregnant women to consider supplementation, following a rise in serious medical problems affecting children, including rickets, calcium deficiency convulsions and even — albeit rarely — heart failure. Dr Jacobs, who has spent years treating children suffering vitamin D deficiency, described what he sees as an unacceptable lack of vitamin D awareness. Now the consultant says that more needs to be done to make health professionals aware of the issue, as many had been taught that rickets was a disease of the past.
“I’ve noticed a big increase in children suffering from vitamin D deficiency in the last decade. Even today, many doctors, health visitors, midwives and nurses are not sufficiently aware of the problem. Parents need to be made more aware, in a balanced and informed way, of the conditions that deficiency can cause. For some groups, particularly children and pregnant women, supplementation is the best way to go,” he said. And that’s where the manufacturers and producers of supplements come in.
Similarly, osteoporosis is a serious chronic disease that affects hundreds of millions of people worldwide. Vitamin D improves bone mineral density, which lowers the risk of fracture and also improves muscle strength, balance and leg function, which decreases the risk of falling and sustaining a fracture in the first place. As a consequence, vitamin D insufficiency has been linked to a higher risk of osteoporotic fractures. Studies show that adequate vitamin D can reduce the risk of falls and fractures by around 30%. In Germany, research indicated that regular vitamin D supplements can help to achieve healthcare cost savings of between €585–778m in one country alone.
Industry in action
The International Osteoporosis Foundation (IOF), working with DSM, recently launched an interactive global map of vitamin D status, which presents a snapshot of vitamin D levels worldwide. The map and accompanying publication confirm that vitamin D insufficiency is a major public health issue in both the developing and industrialised world, with more than one third of all the populations studied showing insufficient levels of vitamin D. DSM strongly supports IOF’s call for healthcare decision makers to take immediate action to address vitamin D insufficiency as a priority public policy issue, and emphasise the role of supplementation as a key tool for addressing this problem.
Key findings include the following:
- Overall, insufficient vitamin D levels were detected in more than one third of the study population
- Vitamin D insufficiency affects both the developing and industrialised world
- The main source of vitamin D is sunlight, but even in sunny countries, vitamin D levels are generally low and below recommended levels
- Rates of vitamin D insufficiency are higher among women than men
- It is estimated that 50–70% of the European adult population have insufficient levels of vitamin D
- In US adults, vitamin D insufficiency estimates range from 20% (non-Hispanic whites) to 70% (non-Hispanic blacks)
- Older people are especially at risk for vitamin D insufficiency, including older women who are a risk group for osteoporosis, and those living indoors in institutionalised care
Dr Manfred Eggersdorfer, Senior Vice President Nutrition Science and Advocacy, DSM, commented: “The maps are a major advance in the fight against vitamin D deficiency. We know that vitamin D deficiency is linked to serious diseases such as rickets in children and osteoporosis in the elderly, but our understanding of the scale and extent of the problem was far too limited. We now have a much better understanding of the picture of vitamin D insufficiency, and confirmation of its importance as a global public health issue.”
Beyond bones
A snippet of good news is that as scientific research reveals further potential benefits of the “sunshine vitamin”, Global Health Trax (GHT) is reporting brisk sales of its plant-based vitamin D3 — the only 100% plant-based vitamin D3 product on the North American market. Recent scientific studies suggest that increased intakes of vitamin D may reduce the risk of both Alzheimer’s disease and fractures among the elderly, whereas sufficient levels of vitamin D may support lung functionality in smokers.
A new study from Harvard University and Brigham and Women’s Hospital reported that maintaining sufficient levels of vitamin D in the blood may help to support lung function in smokers
In addition to a New England Journal of Medicine paper, which published the results of a meta-analysis that supported the concept of high doses of vitamin D supplements for the reduction of fractures among the elderly, French researchers writing in The Journal of Gerontology: Medical Science linked higher intakes of vitamin D with a lower risk of developing Alzheimer’s disease, the most common form of dementia, and a new study from Harvard University and Brigham and Women’s Hospital (Boston, MA, USA), involving 626 men, reported that maintaining sufficient levels of vitamin D in the blood may help to support lung function in smokers.
GHT, an industry leader in nutritional supplements, introduced plant-based vitamin D3 last year, thanks to an agreement with ESB Developments, of Nottingham, UK. “Scientific evidence is regularly emerging in support of the health benefits of vitamin D for both body and mind,” said Jim Rex, President and CEO of GHT. “And although our product is suitable for both vegetarian and vegan diets, we’re encouraged to see that the mainstream North American market has also responded favourably — as demonstrated by both the diversity of our direct-to-consumer sales and the increased interest in private-label opportunities.”
In the pharmacy
Further good news, on the other side of the Atlantic, the Scottish Medicines Consortium (SMC) has recommended the use of Internis Pharma’s Fultium-D3 800 IU capsules for the prevention and treatment of vitamin D deficiency or for patients at risk of vitamin D insufficiency. This provides an immediate opportunity for patients in Scotland to benefit from the first licensed vitamin D3 capsules in the UK and also the first vitamin D3 monotherapy to be SMC approved.
Scientific evidence is regularly emerging in support of the health benefits of vitamin D for both body and mind
Until this recent landmark decision, treatment could only be given through the use of either a combination calcium therapy, which often gave an unnecessary and unpalatable chalky calcium taste, expensive unlicensed imports and ‘specials’ and nutritional supplements available over-the-counter with a highly variable vitamin D3 content. Fultium-D3 contains the same daily amount of vitamin D3 as the leading twice-daily calcium/vitamin D3 products but without the often-unnecessary calcium. Studies have shown that in some patients, calcium supplements may be detrimental owing to intolerance or the risk of adverse effects for some patients.
Alan Walker, Joint CEO of Internis Pharma, said: “We are delighted with the SMC’s decision, based on our submission reinforcing the well-established safety and efficacy profile of colecalciferol. This move is in line with our wider aim at Internis to provide healthcare professionals in both primary and secondary care greater access to licensed treatments for patients who are suffering from vitamin D deficiency.”
He continued: “We are confident that this positive decision by the Scottish Medicines Consortium will be welcome news to the prescribers within the medical profession. The therapeutic use and safety profile of colecalciferol for vitamin D deficiency and as an adjunctive treatment in osteoporosis is well established, but this is the first oral vitamin D3 monotherapy to be licensed in the UK.”
Conclusion
Referring to the IOF deficiency map, Dr Eggersdorfer added: “It has created a very clear picture as to where the vitamin D insufficiency knowledge gaps exist and where further research is required. There is far too little data available, for example, in relation to adolescents and young people, and across the developing world in general. These maps are an important starting point, but it is essential that research continues to better understand the scale of vitamin D insufficiency.”
DSM joins IOF in calling on healthcare policy makers to raise awareness of vitamin D insufficiency and to take action to ensure intake of recommended vitamin D levels, including through safe and effective measures such as food fortification, access to proper supplements and better consumer education.
