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Vitamin D Deficiency

Vitamin D Deficiency - patient information

You have been found to be somewhat lacking in the essential Vitamin D. Initial treatment if necessary is described below.

What does Vitamin D do?

Vitamin D has a number of important functions. For example it helps regulate the amount of calcium and phosphate in the body, and calcium and phosphate are needed to help keep bones and teeth healthy.

Moderate to Severe Deficiency ( level < 25 nmol/l )

You will have been given a prescription as treatment of your deficiency with high dose vitamin D tablets called

Dekristol® (cholecalciferol) capsules 20,000 international units per capsule. Take 3 tablets once per week for 12 weeks. This will replace your deficiency.

Further blood test: If you are severely deficient then

towards the end of this 12 week period please book to have a follow up blood test as it is important that we check your calcium levels. Vitamin D levels will not be checked as it can take up to 6 months for levels to rise following supplementation and therefore the laboratory will allow a repeat after a minimum of 6 months.

You should then continue to take Cholecalciferol Tabs (the specific form of Vitamin D required)

as a supplement . Take 2 x1000 international units per day for another 9 months as a dietary supplement. You can buy this over the counter in most pharmacists and health food stores and we will not provide it on prescription as it is defined as a ‘supplement’.

We recommend Lamberts Vitamin D3 tablets 1000units but there are many others.

Mild Insufficiency

- treat for 12 weeks ( level 25 - 50 nmol/l )

This normally improves with oral supplementation of 2,000units of Cholecalciferol

taken every day for 12 weeks . You can buy this over the counter in most pharmacists and health food stores and we do not provide it on prescription. This is because there is no robust evidence supporting its use and the NHS therefore considers it to be a ‘supplement’.

We recommend Lamberts Vit D3 tablets 1000 units but there are many others nowadays.

There is no need for any follow up blood test and we will not normally offer this

Supplementation therapy ( or when level > 50 nmol/l)

If you were severely deficient we do advise that after the first year’s treatment

you continue to take 1000 units daily in the longer term as a dietary supplement. Possibly even lifelong.

Most people with milder deficiency do not need ongoing supplementation after 12 weeks replacement. However if you wish to continue you can continue to take 1000 units daily in the long term but you must purchase this without a prescription.

Supplementation therapy with vitamin D must be bought at the pharmacy –

we do not provide it on prescription as this is not recommended by NHS Surrey..

See the next page regarding natural sources of Vitamin D.

The main message here is SUNLIGHT

Natural Sources of Vitamin D

SUNLIGHT ON SKIN

We get most of our vitamin D from sunlight on our skin.

This is because the vitamin forms under the skin in reaction to sunlight. During summer two or three exposures (of at least the face and arms without sunscreen and not behind glass) of 20 to 30 minutes each week, between 10am and 3pm, should provide adequate amounts of vitamin D. Older people and those of non‐white ethnicity will have higher requirements. Due to the latitude in the UK, from October to April sun exposure is not adequate for sufficient synthesis of vitamin D.

Dietary Sources

Vitamin D is found in a small number of foods.

Good food sources are oily fish and eggs . Other food sources include fortified foods such as margarine, breakfast cereals and powdered milk. Liver and liver products are also good sources of vitamin D, but they are also a rich source of vitamin A which can be toxic if too much is eaten. Consequently you shouldn’t eat liver on average more than once per week. Liver should be avoided entirely in pregnancy.

How much do I need?

Vitamin D is a fat-soluble vitamin. This means you don't need it every day because any of the vitamins your body doesn't need immediately is stored for future use. Most people should be able to get all the vitamin D they need from their diet and by getting a little sun.

Unfortunately though many people are mildly deficient of Vitamin D

The present recommended daily intake for recommended groups** is 25 micrograms

(0.025 mg) of vitamin D each day, which is the same as 1000 international units.

**Recommended Groups:

The over 65s, or those at risk – eg the housebound, pregnant and breastfeeding women and those who always dress ‘extensively covered’.

However if you have had any degree of deficiency in the past we recommend 1000 international unit as a long term dietary supplement.

However you will have to buy this as we can only prescribe Vitamin D for replacement of deficiency not on-going supplementation.

Food

International Units(IU) per serving

Pure Cod liver oil

, 1 Tablespoon (Note: most refined cod liver oils today have the vitamin D removed! Check your label to be certain.)

1,360

Salmon

, cooked, 3½ ounces

360

Mackerel

, cooked, 3½ ounces

345

Tuna fish

, canned in oil, 3 ounces

200

Sardines, canned in oil

, drained, 1¾ ounces

250

Milk, nonfat, reduced fat, and whole, vitamin D fortified, 1 cup

98

Margarine, fortified, 1 Tablespoon

60

Pudding, prepared from mix and made with vitamin D fortified milk, ½ cup

50

Ready-to-eat cereals fortified with 10% of the DV for vitamin D, ¾ cup to 1 cup servings (servings vary according to the brand)

40

Egg, 1 whole (vitamin D is found in egg yolk)

20

Liver, beef, cooked, 3½ ounces

15

Cheese, Swiss, 1 ounce

12



 
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