Apart from the needs of those with profound eating/swallowing issues, nutrition was not an important part of my professional life apart from vitamin D. I first came to think about it when I found, working with a community dietitian, that 3 severely disabled patients of mine were Vitamin D deficient – the measurement of serum Vitamin D having just come on stream. Being housebound meant that they lacked adequate vitamin D from sunlight and eating once per week at the local authority day centre didn’t compensate adequately.
It soon became clear to me that many of my patients in the back pain clinic were also vitamin D deficient – with around 40% of my patients having dark skins which reduces the absorption of vitamin D through the skin. Fortunately, this deficiency was seldom enough to cause clinical osteomalacia except on rare occasions.
The onset of a viral pandemic has caused a review of the situation. Working from home with much reduced outdoor activity has stimulated the NHS to recommend routine additional vitamin D supplements during winter months Vitamins and minerals – Vitamin D – NHS
It is important to stress the importance of maximising dietary intake – sources include:-
- oily fish – such as salmon, sardines, herring and mackerel
- red meat
- liver
- egg yolks
- fortified foods – such as some fat spreads and breakfast cereals
It is worth noting that these dietary sources may not be readily obtainable for those on low incomes or with poor dietary habits – I hope you all eat oily fish at least once per week?
It poses the question as to how many of our clients are at risk – particularly those whose health issues keep them relatively indoors. These issues may reflect mental health issues (e.g. agoraphobia [1]) as well as conditions causing immobility. Don’t forget that pregnant and breast-feeding women are at greater risk of vitamin D deficiency.
Conclusions
Our clients may be predisposed to vitamin D deficiency through either lack of dietary intake or inadequate exposure to sunshine. Don’t forget to check whether your clients are taking supplements as recommended by the NHS during the winter months and whether those at risk have discussed this risk with their GP. Supplements (10 micrograms (400 IU) of vitamin D a day) are available over the counter but can also be prescribed.
I am happy to discuss any of the issues raised in these reflections with colleagues who can email me and head the email VRA – professional reflections.
Andrew Frank
Trustee and Past-Chair, VRA
- Leak, A., et al., Agoraphobia, back pain and the rheumatic diseases (letter). Br J Rheum, 1989. 28: p. 554-555.