Risking Vitamin D deficiency – the doctor’s advice

Dr Rainer Kumm in South London proactively checks vitamin D status in his patients and says that his data confirms the more widely reported fact that a high proportion of the elderly have dangerously low levels.

Vitamin D is important for bone and general health as it regulates Calcium uptake along with numerous other beneficial effects such as muscle strength, heart function and possibly inflammation plus immunity. Although classed as a vitamin it is effectively a hormone that the body can produce under the influence of sunlight following about 20 minutes exposure per day and from food sources. Hence anyone without sufficient access to sunlight and adequate nutrition rich in Vitamin D such as oily fish or food supplements is ‘at risk’.

However, even when doctors prescribe vitamin D, are the dosing levels sufficient? This was the question that Dr Kumm put to clinical biochemist John Christofides when he recently contacted the laboratory.

The latest BMJ article about Vitamin D states a target level of greater than 60 nmol 25 hydroxyvitamin D (the full scientific name), in order to provide therapeutic benefit. A linear relationship between Vitamin D level and fracture risk as shown in this multi-centre meta-analysis using pooled data from a number of trials worldwide. The report was authored by a large team of authors from both Swiss and US leading universities.

Currently the NICE guideline regarding osteoporosis is being debated with some controversy in the medical press.

Dr Kumm says; "From my own experience I'd say current prescribing is inadequate and haphazard. In my NHS Trust there is no set Audit or systematic ongoing monitoring. Further, there is considerable variation from one consultant to the next regarding whether or not we should test for vitamin D, let alone any information on target levels".

Dr Kumm goes on to say that he feels that this is an extraordinary situation bearing in mind just how fundamentally vitamin D deficiency affects quality of life. 60 nmol is a good set point as below this level other hormones kick in to mobilise Calcium from the bones.

Anyone interested in information on testing vitamin levels – please click here.

For further information:

Vitamin D promotes good health and it's free by Mr John Christofides, Principal Clinical Scientist, West Park Hospital, Epsom, Surrey.

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