Vitamin D is generally the only nutritional recommendation I will discuss in clinic. Vitamin D is extremely important in musculoskeletal health and can be an easy way to improve your health. Over 20% of British adults and children are deficient in Vitamin D. Therefore, this is a very relevant topic to explore. This blog post will discuss what vitamin D is, sources, benefits and how it impacts musculoskeletal health.
What is Vitamin D?
Vitamin D is a fat soluble vitamin which is incredibly important in musculoskeletal health. We need Vitamin D to aid with calcium absorption in the body. It plays a vital role in bone growth and remodelling of bone and helps keep bone, teeth and muscles healthy.
Sources of Vitamin D
The main source of Vitamin D comes from the sun. Approximately 90% of vitamin D is absorbed through ultraviolet B sunlight. A fair skinned person needs sun exposure of arms and face for 20-30 minutes 3 times per week. This is estimated to generate sufficient amount of Vitamin D in summer. Consequently, for more pigmented skin, this needs to be increased by 2-10 fold (Pearce & Cheetham, 2010). You may be lucky and live in a country which has a lot of sun hours. I, on the other hand, live in London and therefore not blessed with regular good weather! For around 6 months of the year the altitude is such that we get insufficient ultraviolet B light.
Additionally, Vitamin D can be absorbed through your diet. However, only a few food sources contain sufficient amounts. Oily fish, liver, fish oils, egg yolk, mushrooms, supplemented breakfast cereals and infant formula milk are some sources.
Why do We Need Vitamin D?
A lack of Vitamin D can lead to rickets in children and osteomalacia (softening of the bone) in adults. Studies have also found an association between low vitamin D and conditions such as cancer, metabolic syndrome, infectious and metabolic disorders (Pearce & Cheetham, 2010).
Public Health England recommend that we take supplements during the 6 months of autumn. If you belong to one of the risk groups below, it is advised to supplement throughout the year.
High risk groups include those with pigmented skin, elderly, those who are institutionalised, people with renal and kidney disease, obese individuals and people suffering with malabsorption, Furthermore, certain drugs can impact absorption such as anticonvulsants. Atmospheric pollution, latitude and strict sunscreen use can also negatively impact the absorption of Ultraviolet B light (Pearce & Cheetham, 2010). (I am in no way encouraging you not to wear sunscreen with this information).
Vitamin D in Musculoskeletal Health
There is some evidence suggesting Vitamin D supplementation together with calcium can increase bone mineral density and bone callus during fracture healing (Gorter et al. 2014). The above combination of supplements has also been found to reduce falls risk among elderly females (Hassan Murad et al. 2011).
There has been some research suggesting that Vitamin D can be useful in chronic pain conditions. However, a recent Cochrane review from 2015 looked at randomised control trials between placebo and vitamin D. There was no strong evidence to suggest a positive impact of supplementation to reduce pain in this group of people (Straube el al. 2015). You can read more about persistent pain management here and here.
To conclude, I suggest speaking to your GP if you are worried about being deficient. They can carry out tests to identify your specific requirements.This is especially relevant if you belong to a risk group. Public Heath England recommend that you take supplementary Vitamin D to maintain good health in the autumn and winter months.
There are some other excellent resources on this topic if you want further information. The Food Medic has written an in-depth article on food supplementation here. NHS Choices have created this vast resource which you can access here. For more condensed information check out this NHS resource.
If you belong to a low income household in England you can obtain Vitamin D for you and your family free of charge via the HealthyStart Scheme.
Gorter, Erwin A., et al. “The role of vitamin D in human fracture healing: a systematic review of the literature.” Bone 64 (2014): 288-297.
Hassan Murad, M., et al. The Effect of Vitamin D on Falls: A Systematic Review and Meta-Analysis, The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 10, 1( 2011), Pages 2997–3006,
Pearce, Simon HS, and Tim D. Cheetham. “Diagnosis and management of vitamin D deficiency.” Bmj 340 (2010): b5664.
Straube S, Derry S, Straube C, Moore RA. Vitamin D for the treatment of chronic painful conditions in adults. Cochrane Database of Systematic Reviews 2015, Issue 5.