In these past few weeks, we have seen wide-spread media attention toward Vitamin D or the “Sunshine Vitamin”. This attention is in light of various studies linking Vitamin D deficiency to COVID-19. The National Institute for Health and Care Excellence (NICE) published an evidence summary on the 29th June 2020 stating there is no supporting evidence for taking Vitamin D to specifically prevent or treat COVID-19. However, unrelated to COVID, Public Health England recommends that UK residents take 10 micrograms (400 IU) of Vitamin D per day between October and March. Undoubtedly Vitamin D is associated with the maintenance of health, however, the extent to which it effects the immune systems fight against respiratory infections is currently unknown. This article aims to demystify the claims associated with Vitamin D and provide an insight on how the changing trends in healthcare are influencing our populations perspective on Food Supplements.
Vitamin D and UK Deficiency
Vitamins are organic compounds required in small quantities for proper metabolism and to maintain health. There are two different types of Vitamin D:
- Vitamin D2 (ergocalciferol)- synthesised by plants
- Vitamin D3 (cholecalciferol) – synthesised by the skin when exposed to sunlight, or sourced through our diet (i.e. fish, meat and eggs)
Vitamin D is needed to absorb calcium and phosphate, contributing to healthy muscles, bones and teeth. In the epidermis of the skin, UVB from sunlight converts 7-dehydrocholserol (7-DHC) into pre-D3. Pre-D3 is then converted into D3 through another thermosensitive process.
It is not known how long we need to be in the sun to produce enough Vitamin D and there are other factors that affect the skins ability to absorb UVB. These include:
- The level of pigmentation (melanin) in the skin
- The position of the sun in the sky (zenith angle) – during winter months in the UK the sunlight doesn’t contain enough UVB radiation for our skin to make Vitamin D.
Ideally, we would source our Vitamin D from food, adjusting our diet to account for this. However, sourcing the full daily dose of Vitamin D through food is hard to achieve. This, combined with the lack of a balanced diet for the majority of people in the UK, has resulted in 1 in 5 people with low Vitamin D levels.
Vitamin D and COVID-19
There have been some controversial reports linking Vitamin D deficiency to COVID-19. One paper in the Journal of Clinical Endocrinology & Metabolism stated 82% of hospitalised COVID patients in Spain were Vitamin D deficient. To understand the significance of this data, it was compared to a population-based control (i.e. to people without COVID-19). Only 47% of individuals in this control study were Vitamin D deficient. Comparing those to figures, you could understand why there has been some excitement around lack of Vitamin D and COVID-19. But the Scientists among us will also understand, this doesn’t demonstrate a cause-and-effect relationship. For example, the elderly are more vulnerable to severe COVID, but independent from this they are also at higher risk of Vitamin D deficiency. This suggests an independent correlation between Vitamin D and COVID-19, rather than cause and effect.
No doubt this relationship will continue to be investigated for years to come, however until then, PHE and NICE have issued disclaimers cautioning the link of Vitamin D deficiency to COVID-19. Therefore, the guidance release by PHE is based on the belief people will have spent more time indoors than usual this year, so should supplement to maintain health.
The Social Perspective on Vitamin D
In recent years we have witnessed a shift in the Healthcare industry, from prescription medicines to Over-The-Counter (OTC) and General Sale List (GSL) products. This is in response to the change in consumer focus. Where previously consumers relied on healthcare professionals’ advice, now we see a growing number of patients seeking their own answers via the internet. Our population is not only becoming more health conscious but demanding more transparency and control over their individual health. Therefore, we see pharmaceutical companies choosing to develop and invest in products that can be bought straight off the shelf. As with any national/global crisis, they tend to push market further into the direction it was already moving. Already this industry shift has been exemplified by COVID-19, with hand sanitiser (an OTC) sales increasing by more than 300% in one week. I expect this trend will continue to be accelerated post-COVID and this will translate into the long-term uptake of Food Supplements.
In attempt to investigate the current social perspective on Food Supplements, I ran a social media poll asking a group 21-25-year olds whether they currently took Vitamin D supplements. 56 people responded, with 44% taking Vitamin D and 56% choosing not to supplement. For a relatively small data sample, in an age group that isn’t known to be health conscious, I was surprised to see almost half chose to take Vitamin D supplements. However, what this data doesn’t describe is if supplementation has increased in comparison to older generations. During World War 2 children took daily Cod Liver Oil (Vitamin D supplement) along with concentrated orange juice (Vitamin C). However, today this practice seems to have fallen out of favour. I would hypothesis, that when fortified foods were introduced and rationing was made redundant (1950s), people turned away from supplementation believing they could attain all their necessary nutrients from food.
But now, because of the shift in scientific opinion with the backdrop of a global pandemic, health-conscious consumers are increasing their uptake of Food Supplements and Vitamin D. In fact, it’s almost certain there will be an increase in people taking Vitamin D supplements in the UK, as from January 2021, the UK government will be providing free Vitamin D supplements to the most vulnerable in our population. This might have the knock-on effect of encouraging the rest of the population to supplement.
As it stands, I believe the social perspective on Food Supplements remains dynamic. Whereas in the past the social perspective might have been tightly tied to the government’s scientific opinion, now, because of the wide availability of information via the internet, consumers are educating themselves and in doing so becoming more empowered, directing the market to suit their needs. As for whether Vitamin D significantly impacts ability of the immune system, and its effectivity in fighting off COVID-19, more scientific evidence is needed. Hopefully, the ever-increasing demands of the consumer will continue to drive positive change to our healthcare system and the medicines available to us.