Vitamin D deficiency after a catastrophic injury
It’s Autumn which means everyone in the UK aged 4 years and above, should be taking a supplement containing vitamin D until at least the end of March.
This includes people after a catastrophic injury, as well as case managers, solicitors, allied health professionals and the general public.
People who usually need to extend this recommendation and take a supplement containing vitamin D year-round include:
- people who spend much of their time indoors;
- people who are very vigilant about wearing sunscreen;
- people who cover up most of their skin when they go outside; and/or
- people with dark skin pigmentation.
Many of our clients after a catastrophic injury would fall into the category of needing year-round supplementation due to being inside a lot and/or being very vigilant about sun safety when outdoors. Speak to their GP about this, as they will need to keep an eye on the person’s serum calcium levels.
Why is vitamin D important?
Vitamin D helps keep our muscles working properly, reduces the risk of falls and helps to develop and maintain strong bones. Vitamin D also helps to regulate the levels of calcium and phosphorus in the body. Inadequate levels of vitamin D are known to increase the risk of: bone fractures, muscle weakness, pain in joints and muscles (due to osteomalacia), cancer, autoimmune diseases, hypertension, depression and infectious diseases including upper respiratory tract infections.1, 2 There is also research suggesting that vitamin D deficiency causes cognitive decline in the elderly.3 Sixty-five percent of people with post-traumatic brain injury chronic fatigue are deficient in vitamin D.4 Forty-five percent of people on anti-epileptic drugs have also been found to have vitamin D deficiency.5
How much is recommended?
The amount of vitamin D recommended by the Scientific Committee on Nutrition is 10 micrograms (400 IU) per day. In the UK, you can get this from your skin (without sunscreen) being exposed to sunlight for short periods of time each day between April and October. However, contrary to popular belief, enjoying the sunshine through the window of your car or home will not produce vitamin D because the glass blocks the UVB rays needed to produce it.6 Clothing and sunscreen with an SPF of 15 or higher, block the production of vitamin D as well. It is extremely difficult to get sufficient levels of vitamin D from food alone – the best sources are oily fish, egg yolks and fortified foods like breakfast cereal — but you would need to eat quite a lot of it every day in order to get enough. That means a supplement is the best option for most people.
Vitamin D can be taken as a stand-alone supplement but if you or your client are already taking a calcium supplement or multivitamin and mineral supplement, just make sure the brand you are taking contains sufficient levels of vitamin D. Vitamin D is also added to oral nutrition supplements (eg. Ensure) so check with a GP or dietitian to see whether your client needs any extra. Vitamin D supplements are available as capsules, liquid/drops or an oral spray. I don’t generally recommend cod liver oil because it can contain unsafe levels of vitamin A.
There are two types of vitamin D:
Vitamin D3 (colecalciferol) – is produced from sheep’s wool. It does the best job of raising Vitamin D levels in the blood but is not suitable for vegans.7
Vitamin D2 (ergocalciferol) – is produced from fungi and is suitable for vegans. It may not be as effective at increasing the vitamin D levels in your blood as Vitamin D3.7
Is a blood test required?
If it is likely a person has been deficient in vitamin D for some time, I will often ask the GP to check their blood levels. This would include most people after a catastrophic injury because they usually spend months in hospital or rehabilitation (away from sunlight) during their recovery. Certain medications, such as anti-seizure medication and glucocorticoids actively destroy vitamin D so these people will need to have a blood test as well.7 The purpose of a blood test is to see if the person is deficient, because if so, the GP will need to prescribe an extremely high dose of vitamin D (short term) to bring the person’s levels up into the normal range quickly. Members of the general public (eg. Case managers, solicitors and allied health professional), can just start taking a vitamin D supplement without a blood test.
If you have any questions about vitamin D or would like me to assess a client, please get in touch at firstname.lastname@example.org. To get more articles like this one emailed straight to your inbox, please sign up for my monthly newsletter below.