It’s time to add some sun (vitamin D) to milk and bread

Free vitamin D supplements will be sent to more than two million clinically vulnerable people in England this winter. More than 80% of patients hospitalized with COVID-19 are deficient in vitamin D compared to the general population. In a small study, a high dose of vitamin D appeared to reduce the severity of COVID-19. While some scientists disagree on whether vitamin D should be used more widely, there is consensus that we should all be taking vitamin D supplements.

But the UK should go further and fortify staple foods such as flour and milk with vitamin D, which is common practice in Canada, Sweden, Finland and Australia. After all, research shows that one third of people don’t take the pills given to them. And many of the vulnerable people the pills are sent to take several other medications and suffer from conditions that increase memory loss and therefore can be confused. Many people who need them the most will not take the free pills.

A century ago, more than 80% of children in industrialized Europe and the northern hemisphere had bone damage caused by rickets. Growing up in Canada in the 1910s, my grandfather had rickets and lived his life with bow legs. Rickets is caused by a deficiency of vitamin D. Vitamin D is the “sunshine vitamin” because the body creates it when the skin is exposed to the sun. During Canada’s long, cold winters, little skin is exposed to the sun.

In the 1930s, a number of countries, including Canada, made fortification of essential foods with vitamin D mandatory. Overnight, vitamin D deficiency (and rickets) almost disappeared. Unfortunately, this trend could be reversed slightly with some evidence that rickets rates are on the rise.

In the UK, people need vitamin D even more than in Canada. Most of the inhabited regions of Canada are found in the south of the United Kingdom. In the UK the days are shorter in winter and there is even less time to expose the skin to the sun. Most people go to school or work before sunrise and leave their school or office after sunset. Their skin is never exposed to the sun. These conditions are ripe for vitamin D deficiency.

Vitamin D deficiency appears to be common, affecting around a billion people worldwide, a quarter of adults and a tenth of children in the UK. Severe vitamin D deficiency (less than 12 nanograms / milliliters in the blood) is rare as diets have improved since my grandfather’s time. Oily fish, red meat, eggs, certain mushrooms and fortified breakfast cereals contain vitamin D. to help with breathing.

Taking vitamin D reduces the risk of fractures, improves muscle function, and may even reduce the risk of death from some cancers. A large study of 7,000 patients found that women who take vitamin D during pregnancy have a lower risk of preeclampsia, gestational diabetes, low birth weight, and possibly postpartum hemorrhage. partum. A study of nearly 100,000 people found that taking vitamin D supplements slightly reduced premature death. With all these benefits, why oppose fortification of essential foods with vitamin D?

Libertarians might say that people should choose whether or not to take vitamin D. Force-feeding with vitamin D could violate their freedom and raise taxes. Plus, too much vitamin D can cause damage. It increases the risk of a number of things, including excessive urine, feeling thirsty, dizziness, headache, bone pain, kidney stones, and even liver failure. It can also interact with some prescription drugs, such as statins. Some studies also suggest that fortified milk tastes different.

Finding the right balance

There are easy ways to benefit from the fortification while avoiding its pitfalls. Some of the objections are not based on evidence. For example, fortifying staple foods with vitamin D hardly costs anything. And an economic analysis by the journal Nature found that the economic benefits (saving money due to fewer people suffering from vitamin D deficiency) outweighed the costs.

To avoid forcing vitamin D on the population, the solution is for the government to recommend and subsidize fortification. Companies that have added vitamin D to their milk and bread could advertise it following guidelines from Public Health England.

To avoid an overdose, food should not be over-fortified. The World Health Organization has guidelines for safe dosages of vitamin D fortification. In Canada and the United States, milk is fortified at a rate of approximately 1 mcg / 100 ml. Drinking a cup of milk provides around 3 mcg of vitamin D, just under a third of what is currently recommended in the UK. One would have to drink 100 cups of fortified milk to be damaged by vitamin D. Giving people a choice also addresses the objection that fortified foods taste different.

Finally, anyone taking drugs that may interact with vitamin D should tell their doctor if they take a lot of fortified foods. Although, again, this is not a problem in countries that require fortification of foods.

Fortifying essential foods with reasonable amounts of vitamin D is an inexpensive intervention with a small but important health benefit. This could be achieved before the next flu season – or another COVID-19 wave.