Graded Reading - Intermediate
In Britain today, many people are increasingly being diagnosed with vitamin D deficiency. But what are the signs of deficiency, how can we treat this and why is it important? To help us understand this recent phenomenon, first of all let us take a look at the role of Vitamin D in the body.
What is Vitamin D?
What we call 'Vitamin D' is actually a group of fat-soluble compounds which can be produced in your skin when it is exposed to the ultraviolet rays in sunlight. For this reason it is often known as the 'sunshine vitamin'. It has two main roles in the body
• Bone maintenance: Vitamin D aids the absorption of calcium and phosphorus from the diet and helps control their levels within the body. These minerals are very important for bone growth and maintenance.
• Immune system regulation: Vitamin D also regulates and strengthens the functioning of the immune system.
Your body can produce all the vitamin D it needs as long as you regularly expose large parts of your skin to sunlight. However, in Britain and other countries located quite far from the equator, there is not always sufficient sunlight in the months October to March to allow the body to manufacture enough vitamin D to meet its needs. Consequently, people generally need to rely on their diets to get enough of the vitamin. Unfortunately, not many foods naturally contain vitamin D. The best dietary sources are oily fish and fish oil, plus some mushrooms which have been exposed to ultraviolet light. In addition, cereals, dairy products and margarine often come fortified with added vitamin D. However, it must be remembered that in the UK cows' milk is not a good source of vitamin D because it isn't fortified as it is in some other countries.
What are the signs and symptoms of deficiency?
Vitamin D deficiency is very common and it is estimated that one billion people worldwide have low levels of the vitamin in their blood. However, many do not realise that they are deficient because the following symptoms are quite subtle and the patient may only show some of them.
Frequent illness or infection. Vitamin D plays an important role in immune function. Therefore, one of the most common symptoms of deficiency is increased risk of illness or infection.
Fatigue and Tiredness. Excessive fatigue and tiredness may be a sign of vitamin D deficiency.
Bone and back pain. Low bloods levels of vitamin D may be a cause or contributing factor to bone pain and lower back pain.
Depression. Depression is associated with low vitamin D levels and some studies have found that taking supplements can improve mood.
Slow healing of wounds. Inadequate vitamin D levels may lead to poor wound healing following an operation, injury or infection.
Bone loss. In older people, low bone mineral density may be a sign of vitamin D deficiency.
Hair loss. For ladies, long-term hair loss can indicate a lack of vitamin D.
Muscle pain. There seems to be a link between low vitamin D and on-going (chronic) pain in various muscle groups. A deficiency affects the normal interaction between the vitamin and the nerve cells where we experience pain.
So, why are we seeing such an increase in vitamin D deficiency?
In the UK, it is thought that as many as 1 in 5 people are currently vitamin D deficient. Even worse, the number of children admitted to hospital with the bone disease rickets almost doubled between 1997 and 2011. This serious disease, which is caused by a lack of sunshine, used to occur frequently in the time of Charles Dickens when child labour and poor working conditions were common. In more modern times we thought the disease was a thing of the past, but the recent increase has led many to look at changing social trends.
Firstly, it has been suggested that both children and adults are no longer spending sufficient time outside to allow enough vitamin D to be made. A recent survey estimated that three-quarters of primary school age children are now spending less than an hour each day playing outdoors. Summer is particularly important for this in Britain, where sufficient UVB (ultraviolet B) only penetrates the atmosphere between the months of April and September to make vitamin D. Both children and adults are increasingly spending leisure time indoors even in summer because of the attraction of electronic devices, on-demand television and gaming.
Secondly, fear of sun damage and skin cancer has progressively changed attitudes to sun protection, meaning that we tend to cover all exposed skin with either clothing or sun screen. Even daily face moisturisers and make-up products now routinely include sun screen of at least 15 SPF.
In addition, the current popularity of weight loss and fitness programmes has tended to discourage people from consuming dairy produce, especially full-fat versions, leading to a smaller intake of fat-soluble vitamins like vitamin D. Furthermore, a high percentage of exercise is now carried out indoors at the gym, instead of outdoors.
How to treat the deficiency
Unfortunately, most people are unaware that they have a vitamin D deficiency until they have a blood test. However, once the deficiency is discovered, it is simple to treat. You can either increase your sun exposure, eat more foods rich in vitamin D or take a vitamin D supplement. Low dose supplements can be purchased from the pharmacy and, in more severe cases, a higher dose can be obtained from the doctor. However, most dermatologists recommend that in summer we try to increase our exposure to the sun by spending approximately 15 minutes per day outside. This is sufficient for adults with pale skin; people with darker skin will need a little longer. It is important to expose both your face and arms so that you build stores of vitamin D that will take you through the darker winter months. Experts say that it is preferable to have sun exposure little and often, rather than staying in its rays for a single long period, risking sunburn.
However, whichever method (or combination of methods) is chosen, there are big benefits for your health and the feeling of increased well-being definitely makes the changes worthwhile.
NHS: Vitamin D. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ [03/01/19]
The 'Times: How to increase your vitamin D levels. Available from: https://www.thetimes.co.uk/article/how-to-increase-your-vitamin-d-levels-dxqpq9dss [03/01/19]
The Times: Rise in rickets, the 'English disease'. Available from: https://www.thetimes.co.uk/article/ rise-in-rickets-the-english-disease-b0r7p960v [03/01/19]
Healthline: 8 Signs and Symptoms of Vitamin D Deficiency. Available from: https://www.healthline.com/nutrition/vitamin-d-deficiency-symptom [03/01/19]
Vitamin D: comprehension questions
1. Explain briefly why the body needs Vitamin D.
2. Why do many people in Britain need to ensure that their diet contains sufficient vitamin D from October to March?
3. The text highlights a number of typical symptoms of vitamin D deficiency, so why is it difficult to diagnose without a blood test?
4. In the article, what are the three main trends named as possible causes of the recent increases in vitamin D deficiency?
5. What guidelines are given for exposing the skin to sunlight in order to maximise vitamin D production?