This week marked a very important event in what is a very important year for vitamins - the 100th anniversary of their discovery. The International Osteoporosis Foundation (IOF), with the assistance of DSM, has just launched a major mapping exercise designed to better understand the global vitamin D situation. The conclusion is clear: it's time to bring the "sunshine vitamin" out of the shadows.
Before we explore the findings and their significance it's important to remind ourselves of the role that vitamin D plays in human health. Vitamin D is essential for building and maintaining healthy bones and muscle strength, and we all need it in early childhood to prevent rickets, and throughout adulthood for healthy bones, and especially into old age to avoid osteoporosis.
So what do the maps tell us? Well, for a start, they provide the most complete picture yet of the global vitamin D deficiency situation. Unfortunately, this picture confirms many of our worst fears about vitamin D.
More than a third of people worldwide, in both the developing and industrialized world, are lacking in vitamin D, with, for example, an estimated 50 -70 % of the European adult population having insufficient vitamin D levels. And Asia, with a few exceptions - Taiwan, Thailand and Vietnam - showed a widespread insufficient vitamin D status across different countries. Despite sunlight being the main source of vitamin D, even in sunny countries and regions such as India and the Middle East, Vitamin D levels are generally low and below recommended levels. It also confirms the elderly as a population group that is particularly vulnerable to deficiency.
This raises some fundamental questions. Firstly, we are faced with numerous global health problems, so how "major" is vitamin D? And, secondly, what should be done about it?
The latest estimate is that 9 million osteoporotic fractures occur worldwide every year, and in the European Union (EU) someone has a fracture as a result of osteoporosis every 30 seconds. With an ageing population, the yearly incidence of hip fracture alone in the EU is expected to more than double over the next decade.
So if we are agreed that the human costs of vitamin D deficiency are unacceptable and we must act now to address it, what form should this action take?
There are two main sources of Vitamin D; people's diet; and, the most important source, sunlight. The solution would therefore appear to be fairly straightforward: ensure that people get enough vitamin D through exposure to sunlight and their diet. The reality is somewhat different.
Although it is possible to meet vitamin D needs through diet, the reality is that even if you eat all the right foods this is still difficult to achieve. This is compounded by the fact that for cultural, economic and practical reasons not everybody can have access to, or would want to eat, enough of the right vitamin rich foods. I am a big fan of eggs - but I would not, for example, want to eat 40 a day to reach my recommended daily intake! And many people cannot access or afford the fatty fish that are the best source of vitamin D.
Again, you would have thought that getting enough vitamin D through sun exposure would be pretty straightforward; however, as the Maps confirm, it is anything but. There are many reasons for this, including: geographical location (poor UVB at higher latitudes), lack of sun during winter months, wearing concealing clothing and modern lifestyles with limited outdoor activity. And, of course, we also need to be very careful about sun exposure. So whilst the increasing use of sun screen protects our skin, it also limits our capacity to produce vitamin D.
Various socio-economic and demographic developments are also working against our ability to generate vitamin D. You can see this in countries such as India, where the shift from an agrarian to a more modern and diversified economy means that people are spending less time working outside and more of their time in offices and factories. Our ageing populations are creating additional challenges in relation to vitamin D. This is partly because the capacity of elderly people to generate vitamin D through sunlight deteriorates with age, but also because more and more are house-bound or living in institutional settings. Too many are quite literally living in the shadows.
Diet and sunlight exposure are therefore key to combating vitamin D deficiency, and awareness of their importance has to be raised, but an effective strategy has to take account of their limitations and find additional ways to close the vitamin D gaps. This is where food fortification and supplements become so important.
The research shows that in the US, where certain foods such as milk, yoghurt, juices and cereals are routinely fortified with vitamin D, the overall vitamin D status is significantly higher compared to other regions. There are other factors involved, of course, but I don't think this is a coincidence.
And vitamin D supplements have been found to reduce the risk of falls and hip fractures by 30%, safely and inexpensively. The IOF recommends vitamin D supplementation for everyone over the age of 60 - around 75% of hip fractures occur in people 65 years and older - as well as for those who are known to be deficient or at high risk of osteoporosis.
The maps also tell us that significant gaps exist in our knowledge and understanding of vitamin D status between and within different countries and regions. The data is, for example, limited for Africa, Central and South America. And, in terms of population groups, the most striking data gaps are found in children and adolescents. Just as my company DSM supported the mapping work of the IOF, we will work with all relevant stakeholders to ensure that these gaps are filled.
When I step back and think about the mapping exercise and what it all means, I am torn between two emotions: frustration on the one hand, and optimism on the other. Frustration that even 100 years on from the first discovery of vitamins, people around the world are still frequently not getting enough of the vitamins that they need and suffer unnecessarily because of this.
Yet I am also optimistic that if action is taken to take the "sunshine vitamin" out of the shadows through greater awareness, an increase in the recommended intake, fortifying more foods, enabling proper access to supplements, and educating consumers about their choices, then this is a battle that we can win.
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