This blog is co-authored by Fiona MacKay, a retired nurse who worked for Scottish National Blood Transfusion Service for nearly 20 years and is now working as a vaccinator in NHS Lothian, and Helga Rhein, a retired Edinburgh GP, who worked at Muirhouse Medical Group, Access Practice and latterly at Sighthill Health Centre, before volunteering as a vaccinator in 2021.
Our paths crossed when we both worked as vaccinators in one of Edinburgh’s mass vaccination centres. It was a real joy to work at those centres and meet so many folk from different professional backgrounds. We then reflected on how few people know about the need to take an adequate amount of supplementary vitamin D, including our nurse-vaccinator colleagues. So, we got to talk about it. Both of us shared stories, personal and professional, of the problems caused by vitamin D deficiency and the benefits of sufficient daily vitamin D supplementation.
Helga Rhein
As vaccinators, we were helping to prevent Covid-19. It is beyond question that Vitamin D deficiency (VDD) is a significant risk factor for Covid-19, just like age, weight and co-morbidities. Yet too few practitioners and patients are aware of the solid, mounting evidence that high enough levels of Vitamin D also help prevent coronavirus. (1) & (2) This blog is one attempt to share understanding and spur action.
At our latitude in Scotland, we are severely disadvantaged concerning the provision of strong UVB from the sun. The pandemic has also greatly lowered the opportunity to travel to warmer, sunny holiday spots for the past two years. Exposing just your hands and face is not sufficient here in Scotland to reach a healthy Vitamin D blood level but proper outdoor sunbathing is rarely even a possibility here.
Many diseases are influenced by how much vitamin D is available in our bodies. The case for the advantages of having sufficient vitamin D was already made in the blog published by QNIS in June 2020: https://www.qnis.org.uk/blog/covid-vitamin-d/. Caroline, then a treatment room nurse at Sighthill Health Centre, co-wrote the 2020 blog. She pointed out the many benefits patients reported back to her after increasing their vitamin D supplementation over time. The same was true for several nurses.
Human bodies, including all organs and tissues, function best when there is enough vitamin D inside them. Having a vitamin D blood level above 75 nmol/l (although many scientists advocate an even higher level: above 125 nmol/l) could prevent a range of diseases or ameliorate symptoms.
Vitamin D has immunomodulatory functions, regulates genes, and influences the actions of T-cells in the innate and adaptive immune systems. A sufficient level reduces the survival and replication of viruses. Most people who take 2,000-4,000 IU of Vitamin D daily report significantly fewer colds/cases of flu and other infections like UTIs after regularly taking such supplements.
Strengthening the body’s defences, especially during a pandemic, makes sense. That is doubly true for pregnant women, as well as those of childbearing potential. It is no secret that healthy women are much more likely to have safe pregnancies and thriving babies. But it is sometimes forgotten that these health-promoting actions are as beneficial to the health and wellbeing of the woman as they are beneficial to any potential child.
Achieving adequate levels during pregnancy begins with robust vitamin D supplementation before pregnancy.
Preventing illness and harm, while encouraging good health, are central goals for all primary care providers. Preconception (pre-pregnancy) and pregnancy itself are crucial times for preparedness. Avoiding VDD, or nipping it in the bud, is linked to reduced pre-eclampsia, gestational diabetes, pre-term birth, bacterial vaginosis, and depressive symptoms during and after pregnancy. (3-6) Brain development of the foetus, as well as immune system functioning, is positively influenced by sufficient vitamin D levels in pregnancy. (7) (8)
However, achieving adequate levels during pregnancy begins with robust vitamin D supplementation before pregnancy. That is because the beneficial level cannot be reached in either a few days or by taking multivitamins containing a significantly lower amount of vitamin D.
Fiona MacKay
The present official recommendation for pregnant women is to take 400 IU daily. In our experience, and to the best of our knowledge, this is simply not enough to gain the preventative benefits. Indeed, a group of midwives in Belfast (similar latitude to Edinburgh) showed in their study that 400 IU is too low to raise vitamin D to adequate blood levels. (10) An Edinburgh study showed similar results in the Scottish general public: 400 IU is insufficient and will still leave 80% with Vitamin D Deficiency. (11). The Canadian Paediatric Society has, for years, recommended taking 2,000 IU daily during pregnancy. (12).
Compare this with the fact that the multivitamins available free of charge to all pregnant women from the NHS in Scotland include only 10 mcg (400 IU) of Vitamin D. Even the commercial pregnancy multivitamins marketed specifically for pregnancy tend to contain no more than 20 mcg (800 IU). This is not vastly different from having only the first dose of the COVID-19 vaccines we have been administering. Better than nothing, but not good enough to provide the best available protection.
Until such time as Scotland implements adequate food fortification with Vitamin D – as well as Vitamin B9 (folic acid) – practices already seen in Finland, we will have to recommend taking sufficient daily supplements. Supplements are an inexpensive, effective, readily available insurance policy.
Vitamin D deficiency should proactively be assessed and treated before, during and after pregnancy. Everyone in Scotland, no matter their gender, age, or stage of life, will benefit from taking the ‘sunshine vitamin’ and taking the benefits it brings seriously.
References:
(1) https://www.frontiersin.org/articles/10.3389/fpubh.2021.736665/full
(2) https://vitamindforall.org/rollcall.html
(3) https://pubmed.ncbi.nlm.nih.gov/25938886/
(4) https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0180483
(5) https://www.bmj.com/content/346/bmj.f1169
(6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946263/
(7) https://pubmed.ncbi.nlm.nih.gov/25867115/
(8) https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186657
(9) https://pubmed.ncbi.nlm.nih.gov/23045241/
(10) https://pubmed.ncbi.nlm.nih.gov/19331703/
(11) https://pubmed.ncbi.nlm.nih.gov/21697298/
(12)
Explanation of the confusing numbers you might encounter in the literature or when shopping:
Supplement levels
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400 IU = 10 mcg
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2,000 IU = 50 mcg
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4,000 IU = 100 mcg
Blood levels
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75 nmol/l = 30 ng/ml
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25 nmol/l = 10 ng/ml
