A Chinese proverb states that;
Hardly a glowing endorsement for UK health policy makers who continue to dwell in bureaucratic inertia when it comes to preventive healthcare for the nation, instead content to focus on, the often not too favourable, disease treatment outcomes. With a litany of examples to select from, on the occasion of the first national awareness week I'm going to focus on the endemic that is vitamin D deficiency in the UK, and the lack of guidance for resolution.
In the UK vitamin D deficiency is believed to cost the UK taxpayer a staggering £29 billion annually - over a quarter of the NHS budget. Compare this to smoking which costs £6 billion annually. Hard to believe until we realise that the government has sat playing the policy fiddle while our health has burned. Osteoporosis, cancer, heart disease, diabetes, inflammatory diseases and depression are all rampant in the UK, and all found on the impressive list of which evidence links vitamin D to their aetiology. A recent report in the European Journal of Clinical Nutrition found vitamin D sufficiency extends life and slashes death from chronic disease by as much as 20% prompting the authors to conclude that correcting vitamin D deficiency is:
With our dietary sources of vitamin D extremely limited, only providing 5-10% of our needs, to stay sufficient we must rely on sunshine exposure. But in order to synthesise vitamin D from the sun we need wavelengths in the range of 290-320nm, which we only get from sunshine in Britain (and other countries of similar latitude - 51 degrees) from April to October. This means that from now till the end of March we effectively experience a 'vitamin D winter', where even on sunny days during the winter months it won't be the correct UVB wavelength for making vitamin D. From summer to the end of winter, vitamin D levels will typically drop by 6-12 ng/ml - sufficient to catapult someone into a state of severe deficiency . And, what we find is that over half the population fail to reach the very minimal levels for health (20ng/ml) and a jaw-dropping nine in 10 fail to reach the upper desirable levels (32ng/ml) .
But, government guidelines remain archaic, resolute in ignoring two decades of groundbreaking medicinal research and progression. Recommendations remain in place that the general population do not need to be supplementing and those vulnerable groups should only take the tiniest of doses (400IU) tantamount to putting a plaster on a broken leg.
It's all very disconcerting, and it seems we need look no further afield to explain why cases of osteoporosis, heart disease and diabetes show a much higher prevalence in the winter. That if you are diagnosed with colon, breast and prostate cancer, among others, in the winter your three year survival chances are much lower than a summer diagnosis. There is an alarming prevalence of winter pregnancies producing infants with deficiencies so bad they present to emergency rooms with seizures and heart failure.
Even within Britain we see significant intra-national variation. With a shorter summer and cloudier weather the Scottish get some of the lowest sun exposure in Europe, and are twice as likely to be vitamin D deficient than their south of England counterparts. Could this explain the north-south difference in rates of heart disease, cancer and autoimmune disease - a phenomenon not explained by other lifestyle factors such as smoking, diet or alcohol consumption? And, with strong evidence to implicate vitamin D in its aetiology, should we be surprised that Scotland has the highest rate of multiple sclerosis in the world?
It all leaves just one option, the whole UK population should be supplementing with vitamin D. And, to know how much to take we turn to a neat dosing study conducted in Ireland. The authors calculated that, in order to be confident that most adults (97.5%) maintain levels above the minimal needed levels 20ng/ml (and many at the higher 30ng/ml range) during winter a dose of 1,120IU (1,100-1,200IU range) per day is required . You may find it difficult to find such doses but a 1,000 IU supplement does the job perfectly. Just take one capsule per day, then on one day of each week take two capsules (eight per week in total) and you will be getting an average ideal dose of 1,140IU. It's a small change that stops the current trend of paying a later, exorbitant price.
Find out more on correcting vitamin D deficiency, and other widespread nutritional deficiencies in the UK in The Health Delusion
1. Grant, W.B., An estimate of the global reduction in mortality rates through doubling vitamin D levels. Eur J Clin Nutr, 2011. 65(9): p. 1016-26.
2. Rapuri, P.B., et al., Seasonal changes in calciotropic hormones, bone markers, and bone mineral density in elderly women. J Clin Endocrinol Metab, 2002. 87(5): p. 2024-32.
3. Hypponen, E. and C. Power, Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am J Clin Nutr, 2007. 85(3): p. 860-8.
4. Cashman, K.D., et al., Estimation of the dietary requirement for vitamin D in healthy adults. Am J Clin Nutr, 2008. 88(6): p. 1535-42.
Follow Aidan Goggins on Twitter: www.twitter.com/modern_medicine