Page 77 - Retail Pharmacy November/Decemeber 2020

76 HEALTH VITAMIN D FROM PAGE 75 determining why a vitamin D deficiency is an issue in Australia and globally. She pursues this interest through researching vitamin D levels in women globally in conjunction with researchers from the Illawarra Health and Medical Research Institute, to shed some light on the issue. The research includes bone density scans, blood tests and muscle strength tests, as well as lifestyle, skin type, diet, sun exposure and latitude, with the intent being to gather information that assists in learning what recommendations can be given to people to ensure sufficient vitamin D levels. This Wollongong-based project is similar to a study centred on the African- Caribbean population of the UK that Ms Vearing completed, where she concluded that darker skinned people take longer to absorb the same amount of vitamin D compared with lighter skinned people in the UK, a country of relatively little sunshine throughout the year. This makes darker skinned people more at risk of a vitamin D deficiency and consequent poor bone health because darker skin has more melanin, a compound that can inhibit vitamin D production. Mr Webster says age is also generally seen as impacting vitamin D levels, because, as one gets older, vitamin D production in skin can become less efficient. The difference between D2 and D3 Mr Webster says vitamin D comes in the form of vitamin D2 (also called ergocalciferol and found in plants) and vitamin D3 (also called cholecalciferol and found in animals). A study published in the Journal of Clinical Endocrinology & Metabolism showed that vitamin D3 was 87 per cent more successful in raising vitamin D levels in the blood of 33 healthy adults, compared with D2. Vitamin D3 was also stored more effectively in the body’s fat cells. Another small study published in the European Journal of Clinical Nutrition found that while vitamin D2 and D3 were both effective in boosting vitamin D levels, people who took vitamin D3 kept up higher blood levels of vitamin D 77 days after stopping the supplements. “These vitamins are created when the ultraviolet rays of the sun act upon a form of cholesterol,” Mr Webster said. “In certain plants, the ultraviolet rays convert a molecule called ergosterol into vitamin D2. In humans, vitamin D begins as a substance in the skin called 7-dehydrocholesterol. The ultraviolet B (UVB) rays from the sun convert 7-dehydrocholesterol into vitamin D3. “It travels through the bloodstream to the liver, where it is turned into 25-hydroxycholecalciferol (25(OH)D or calcidiol) – a prohormone for the vitamin D hormone. It then travels through the bloodstream to the kidneys, where it’s converted into the active form 1,25-dihydroxycholecalciferol (1,25(OH)2 D3 or calcitriol). “1,25(OH)2 D3 is the active vitamin D hormone. “There is agreement that D3 is two or three times as potent in raising the level of 25-hydroxycholecalciferol compared with vitamin D2, so D3 is the one we want.” Mr Webster says that sometimes a deficiency in vitamin D3 can be difficult to measure because of inflammation in the body. “Levels of useful vitamin D3 can be impacted by acute or chronic inflammatory processes,” he said. “Excessive sun exposure that creates sunburn can lead to lower levels of vitamin D because it’s an inflammatory process.” He says a vitamin D deficiency clinically results in rickets in children, and muscle weakness, muscle fractures and intensified bone loss in adults. “By this stage, the horse has well and truly bolted,” Mr Webster said. “Mood disorders, poor immunity, hormonal ups and downs, inflammation, infections, fatigue, headaches and poor sleep could well indicate that a person’s blood levels have dropped well below the 20ng/ml or 30ng/ml that are considered sufficient,” Mr Webster said. He highlights that if a person is suffering from insomnia at night, they would do well to take vitamin D supplements to help them sleep. He says that to maintain healthy vitamin D levels, the recommended dose is 200IU per day for infants, and 400 to 600IU up to 1000IU per day for older men and women. Pregnant women are recommended 2000IU per day, the same as for breastfeeding women. “I recommend people use between 2000IU and 4000IU a day, which would get them roughly 100,000IU in a month,” Mr Webster said. “Vitamin D toxicity is pretty hard to get. You’d have to take mega doses.” The exception could be people with or at risk of kidney disease, as too much vitamin D can affect the kidneys, causing stones and other problems. “I’m treating a client in a clinic and finding I need to use much more – from 5000IU a day to 10,000IU to 20,000IU a week,” Mr Webster said. “This entails swallowing quite a few capsules in a clinical environment and not a retail setting.” He says consumers aren’t spoilt for choice because, as vitamin D only comes in one strength, there aren’t many vitamin D products on the market. Picture of health: 37 jigsaw pieces Mr Webster emphasises that in addition to being cognisant of the significant role vitamin D plays in optimal health, the correct approach is to see the “picture of health as comprising 37 jigsaw pieces”. “Many people picture it with three pieces and then put another three pieces in but still can’t see the picture,” he said. “There’s often a real struggle in terms of what to isolate, with science wanting to give power to an isolated entity. But in truth, health has to be looked at holistically.” He says pharmacists should, when it’s appropriate, advise their patient or customers to test their vitamin D levels. “This recommendation is especially relevant now as vitamin D is useful for uplifting mood when people are contending with lockdown, job losses, job uncertainty, fragility and anxiety,” he said. “The vitamin also balances out the fact that so many people are spending a lot more time indoors and not getting daylight exposure. At the end of the day, it’s not just about vitamin D being made on the skin but also about light through the retina and helping with circadian rhythms.” Statistics on D deficiency The Australian Bureau of Statistics estimates that 23 per cent of Australian adults are vitamin D deficient (<50nmol/ lt), 17 per cent are mildly deficient (30-49 nmol/lt), six per cent are moderately deficient (13-29 nmol/lt) and one per cent are severely deficient (<13nmol/lt). The Australian Health Survey showed that in 2011-12 vitamin D deficiency ranged from 31 per cent in those aged 18 to 34 years to 15 per cent in those aged 65–74. RETAIL PHARMACY • NOV/DEC 2020