Vitamin D: GP Tips

GP Tips: Vitamin D supplementation

Who needs what? When do they need it? Where do they get it?

We had lots of questions on the course, and have since, relating to Vitamin D. It’s fair to say that GPs have not really embraced (so far!) the official advice for supplementation to all children, pregnant and breast feeding women and all the over 65s. One of my colleagues with pre-school children recently discussed this in her GP study group, and none of the GPs who were pregnant or have children had embraced this advice for themselves and their own children.  Partly this is due to genuine scepticism about the need and or potential risks and benefits (the rationale is laid out here http://www.dh.gov.uk/health/2012/02/advice-vitamin-d/), but partly I think also because there has been so much confusion about who needs what, when they need it and where you get it. So, we just love to keep things really simple….

 ► What does the NHS actually recommend? And what preparations are available?

 http://www.nhs.uk/Conditions/vitamins-minerals/Pages/Vitamin-D.aspx

 ‘Taking 25 mcg or less a day of Vitamin D is unlikely to cause harm’

Group	Recommended daily dose of supplementation	Example products
Pregnant and breast-feeding women	10 mcg ≡ 400 IU Daily	Healthy Start or Pregnacare vitamin tablets
Children aged 6 months to 5 years Breast-fed infants, from 1 month of age IF mother has not taken supplements in pregnancy Babies fed infant formula (which is fortified) do NOT need supplementation until receiving <500ml formula daily	7 – 8.5 mcg ≡ 300 IU	Healthy Start vitamin drops (contain 7.5 mcg per 5 drops) or Abidec drops (contain 10mcg per 0.6mls)
Adults Everyone aged over 65 Other adults who may be at risk e.g. darker skin, poor sun exposure, housebound etc	10 mcg ≡ 400 IU Daily	Standard combinations of calcium and vitamin D containing 10mcg ≡ 400 iu daily (see below) Vitamin D alone supplements available OTC e.g. from Boots, Holland and Barrett etc (10mcg/400 IU and 25 mcg/1,000 IU preparations available)

Note that the calcium component of preparations often leads to poor tolerability (they really do taste of chalk!). Furthermore there have been recent concerns possibly linking calcium supplements with raised MI risk. Vitamin D alone can easily be obtained OTC, for example

·         Boots offer a 12.5 mcg (500IU) and 25 mcg (1,000 IU) supplement

·         Holland and Barrett offer a 10 mcg (400 IU) and 25 mcg (1,000IU) supplement.

·         Sub-lingual sprays supplying 1,000IU daily are also available

And advise patients have a calcium-replete diet

http://www.nos.org.uk/~/document.doc?id=981

 For a full list of all available preparations, see

http://www.nelm.nhs.uk/en/NeLM-Area/Other-Lib-Updates/Drug-Discontinuation-And-Shortage/Vitamin-D---Available--products-for-DOH-recommendations/

►What about treating Vitamin D deficiency?

 This of course is a different issue, and requires treatment with high dose colecalciferol, as discussed by Zoe on the course (see Spring 2012 book for the guideline, p.245).  For example, adults with proven deficiency should have 20,000 IU units 3 per week (60,000IU weekly) for 8-12 weeks followed by 1-2,000 IU daily for 12 weeks.

 When I was a kid, our mothers gave us a tea spoon of cod liver oil (can still taste it – yuk!) and bundled us outside at 9am with instructions to ‘not come home until tea time’. We’d hang around the rec, smoke John Players No. 6 (aged 10…) and try to avoid being attacked by rival gangs. Being beaten up was a constant threat. We were about as relaxed as wilderbeest strolling across the Serengeti. But at least we’d make lots of vitamin D…

Simon

With thanks to Drs Zoe Ballantyne and Cathy Scott