Page 51 - Retail Pharmacy Assistants - November 2020

V itamin D is drawing focused attention as a nutrient that could potentially be used in the fight against Covid-19. The current deficit in people’s vitamin D levels doesn’t bode well in this fight, with at least one in four people demarcated as having a vitamin D deficiency in Australia, with many healthcare professionals convinced that the problem is even more widespread. The Australian Bureau of Statistics estimates that just under one in four Australian adults are vitamin D deficient, 17 per cent are mildly deficient, six per cent are moderately deficient and one per cent is severely deficient. The Australian Health Survey showed that in 2011-12, vitamin D deficiency ranged from 31 per cent in those aged 18-34 years to 15 per cent in those aged 65–74. It doesn’t stop there, with vitamin D deficiencies considered a public health issue at a global level. Mark Webster, an integrated health practitioner and owner of Stay Well Pharmacy in Christchurch, New Zealand, comments to Retail Pharmacy Assistants that vitamin D deficiencies are widespread globally, adding that many people are unaware of this and oblivious to its significance. The “main issue”, Mr Webster emphasises, is that the importance of vitamin D isn’t well understood by the public, or pharmacists and their assistants, with many believing that sunlight will produce adequate levels of vitamin D in the body and that the role of vitamin D is usually associated with maintaining normal blood levels of calcium and phosphorus. “The truth of the matter, though, is that it plays a much bigger role than that: it’s involved in many areas, sequences, compartments and processes that are connected to cancer, osteoporosis, hypoparathyroidism, ageing, anaemia, congestive heart failure, embolism, heart attacks, hypertension preeclampsia, colitis, Crohn’s disease, irritable bowel syndrome, deafness, diabetic nephropathy, urinary incontinence, age-related macular degeneration, conjunctivitis, hair loss, short-sightedness, diabetes, Grave’s disease, obesity, backache, Alzheimer’s disease, gingivitis, tooth decay, asthma, respiratory tract infections and female infertility, to name a few. “It can be synthesised by the body when exposed to adequate amounts of sunlight, but what constitutes an adequate amount and what of people with different skin types, not to mention the modus operandi of ‘slip, slop, slap’ for sun protection?” Mr Webster highlights the important role in the body’s immune function that the vitamin plays. “Vitamin D is good to help combat infection and for immunity as a whole,” he said. “So, when faced with the need to increase immunity, vitamin D is an essential part of the picture. “Interesting research is emerging on the role of vitamin D in relation to Covid-19. This isn’t something new, as research has been around for other viral infections for some time, too.” Many previous studies have noted the link between low vitamin D levels and higher rates of respiratory diseases, such as asthma, tuberculosis and viral infections that attack the lungs. Picture of health a holistic one Mr Webster says that while being aware of the significant role vitamin D plays in health and wellbeing is important, the best approach is to see the “picture of health as comprising 37 jigsaw pieces”. “Many people picture it with three pieces, then put another three pieces in, but still can’t see the picture,” he said. “There’s often a real struggle in terms of what to isolate, with science wanting to give power to an isolated entity. But in truth, health has to be looked at holistically.” He says a vitamin D deficiency clinically results in rickets in children and muscle weakness, muscle fractures and intensified bone loss in adults. “By this stage, the horse has well and truly bolted,” Mr Webster said. “Mood disorders, poor immunity, hormonal ups and downs, inflammation, infections, fatigue, headaches and poor sleep could well indicate that a person’s blood levels have dropped well below the 20ng/ml or 30ng/ml that are considered sufficient,” Mr Webster said. He encourages pharmacists and their assistants, when appropriate, to advise VITAMIN DEFICIENCIES 49 their patients or customers to test their vitamin D levels. “This recommendation is especially relevant now as vitamin D is useful for uplifting mood when people are contending with lockdown, job losses, job uncertainty, fragility and anxiety,” Mr Webster said. “The vitamin also balances out the fact that so many people are spending a lot more time indoors and not getting daylight exposure – at the end of the day it’s not just about vitamin D being made on the skin but also about light through the retina and helping with circadian rhythms. “And pharmacy assistants can suggest vitamin D supplements for people who are suffering from insomnia at night.” He says that to maintain healthy vitamin D levels, the recommended dose is 200IU per day for infants, and 400 to 600IU up to 1000IU per day for older men and women. Pregnant women are recommended 2000IU per day, the same as for breastfeeding women. “I recommend people use between 2000IU and 4000IU a day, which would get them roughly 100,000IU in a month,” Mr Webster said. “Vitamin D toxicity is pretty hard to get. You’d have to take mega doses.” The exception could be people with or at risk of kidney disease, as too much vitamin D can affect the kidneys, causing stones and other problems. “I’m treating a client in a clinic and finding I need to use much more – from 5000IU a day to 10,000IU to 20,000IU a week,” Mr Webster said. “This entails swallowing quite a few capsules in a clinical environment and not a retail setting.” He says consumers aren’t spoilt for choice because, as vitamin D only comes in one strength, there aren’t many vitamin D products on the market. Vitamin D and Covid-19 Dr Ian Brighthope from Brighton in Melbourne comments that a government- backed program to address vitamin D deficiency, which is widespread among the elderly, would have an immediate effect on their ability to withstand the coronavirus. A number of governments, including the Scottish and Norwegian administrations, have recommended citizens take vitamin D supplements. Dr Brighthope says he is one of many TO PAGE 50 “Vitamin D is clinically effective, with enough scientific evidence to support its use immediately, and it’s safe, cheap and available now.” RETAIL PHARMACY ASSISTANTS • NOV 2020