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  5. Bone health and new guidance on Vitamin D

Bone health and new guidance on Vitamin D

New recommendations have been published about the amount of vitamin D we need to keep healthy bones.

What is vitamin D and where is it found?

Vitamin D helps the body absorb calcium, needed to help keep bones and teeth healthy.

It is made by the skin when exposed to sunlight. The amount of vitamin D people make will depend on a number of factors, such as how strong the sunlight is. In the UK, people will usually have sufficient vitamin D from sunlight in the months between March and September but will have difficulty getting enough vitamin D in the winter months.  

Food sources of vitamin D are essential when time in the sun is limited.  Foods that contain vitamin D include:

  • oily fish such as salmon, sardines, pilchards, trout, herring, kippers and eel
  • egg yolk, meat, offal and milk contain small amounts but this varies during the seasons
  • margarines and some yoghurts have added or are ‘fortified’ with vitamin D
  • infant formula milk
  • cod liver oil (don’t take this if you are pregnant).

What are the new recommendations?

Public Health England and the Scottish Government have updated their advice on vitamin D intakes, based on the new recommendations from the Scientific Advisory Committee on Nutrition:

  • everyone in the general population aged four years and older, is recommended to have an intake of 10 micrograms of vitamin D per day. In the winter months they may struggle to get enough vitamin D and should consider taking a daily supplement containing 10 micrograms of vitamin D, from October to February
  • all infants from birth to one year old should have an intake of between 8.5 to 10 micrograms per day. This should be as a daily supplement, unless the infant is having more than 500ml of infant formula a day, as formula is already fortified with vitamin D
  • children aged one to four years should have a supplement of 10 micrograms per day, all year round
  • pregnant and breastfeeding women should consider taking a supplement of 10 micrograms vitamin D per day
  • those in groups at risk of vitamin D deficiency such as those who are housebound, older people, those with darker skin tones and those who cover their skin completely when outside, should consider taking a supplement of 10 micrograms of vitamin D per day, all year round.

Prior to this guidance it was thought that most people would get enough vitamin D from spending time in the sun. Specific recommendations on the required amount of vitamin D were only given to at risk groups and not to the general population.

Are the recommendations different for people with coeliac disease?

There are no specific recommendations on vitamin D intakes for people with coeliac disease. Current advice would therefore be the same as for the general population.

When you are first diagnosed with coeliac disease, the lining of your gut is damaged due to eating gluten. This can mean that you don’t absorb nutrients from food as well, and can lead to nutritional deficiencies. Treatment with the gluten-free diet will heal your gut and improve the absorption of nutrients from food. Some people might need specific vitamin supplements and it is best for you to speak with your GP or dietitian for individual advice. Your GP can prescribe a supplement and monitor any nutritional deficiencies.

So am I getting enough vitamin D? How many people have low vitamin D levels and what are current intakes?

The National Diet and Nutrition Survey published in 2014, looked at UK diets from 2008 to 2012, and found that average intakes of vitamin D from the diet are low:

Age (years)Average daily intake of vitamin D (microgramsAverage intake as a percentage of the daily 10 microgram recommendation (%)
1.5 - 3 1.9  19
4 - 10 2.0 20
11 - 18 2.1 21
19 - 64 3.3 33

Public Health England advises ‘low levels of vitamin D in the blood is not the same as having a deficiency, where you would be unwell, but rather means that you are at greater risk of developing a deficiency. If a person is deficient of vitamin D they will be clinically unwell and will need to be treated by a doctor.’

What happens if I don’t get enough vitamin D?

Some babies and children can develop rickets if they do not get enough vitamin D. Rickets is a condition that affects bone development in children. It causes the bones to become soft and weak, which can lead to bone deformities. It can cause bone pain, poor growth and deformities of the skeleton, such as bowed legs, curvature of the spine, and thickening of the ankles, wrists and knees. Although cases of rickets have increased recently they are still small in number.

Adults can develop osteomalacia if they do not get enough vitamin D. This can result in soft bones, bone pain and muscle weakness.

Speak with your GP, if you or your child are experiencing symptoms of rickets or osteomalacia.

Supplements

Vitamin D supplements and multivitamins are now widely available to buy from pharmacies, supermarkets and health food shops. Some women who are pregnant or breastfeeding and children aged six months to four years may qualify for Healthy Start vitamins which contain vitamin D.

If you are taking a calcium supplement, some calcium supplements are combined with vitamin D.

Can you take too much vitamin D?

There is no problem with taking a vitamin D supplement at the recommended amounts, alongside spending time in the sun, as your body will only make what you need. However, it is important not to have more than one supplement containing vitamin D. Taking too many vitamin D supplements over a long period of time can cause more calcium to be absorbed by the body than can be excreted. This leads to high levels of calcium in the blood.

If you are unsure if you should be taking supplements, speak to your doctor, Dietitian or pharmacist who will provide further advice.

Further information

Further information on calcium and vitamin D, along with information on bone health and osteoporosis is available on our website.

Further information on how to get enough vitamin D from sunlight, without risking sun damage is available on the NHS website.

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