Episode seven

00:00:05 Fiona Spence 

Hi there and welcome to our podcast series focusing on food, well-being and mental health, run by NHS Fife Nutrition and clinical dietetics mental health and learning disability team. My name is Fiona Spence. I'm a registered nutritionist and today I'm joined by 

00:00:21 Fiona Spence 

Vicki Cook, who's a dietitian. In this episode. We're going to be talking about vitamin D but first of all, let's meet Vicky. 

00:00:27 Fiona Spence 

Vicky do you want to tell us a little bit about yourself. 

00:00:30 Vicky Cook 

Oh yes, I know there's an interesting question. And so yeah, I'm a registered dietitian. I've been working for 23 years now, but only the last two in five. Back to Scotland. 

00:00:44 Vicky Cook 

I love food, I love talking about it, and I actually really love simple nutrition messages that everyone can follow for health as we know we get so many mixed messages. 

00:00:54 Vicky Cook 

Such as new fads, what to do about food, and that can be confusing. But when you focus on things and individual nutrients like vitamin D, the message is clear. And today we can discuss it. 

00:01:05 Fiona Spence 

It's exciting. I'm really keen to be talking about this Vicky. 

00:01:08 Vicky Cook 


00:01:10 Fiona Spence 

So I suppose the very first question, Vicky, why do we need to talk about Vitamin D? Why are we talking about it today? 

00:01:16 Vicky Cook 

Well, not only is it 100 years this year that Dame Harriet Chick and her co-workers discovered that rickets could be cured by cod liver oil supplements that was later discovered to be a rich source of vitamin D but as we head back into the winter months, darker mornings and nights. 

00:01:32 Vicky Cook 

Sorry. Yep, sorry to mention it and bring it up so soon. 

00:01:38 Vicky Cook 

We need to increase our vitamin D intake or supplement it. It becomes more necessary due to the fact that the best source of vitamin D is sunlight. 

00:01:47 Vicky Cook 

Not actually food sources. 

00:01:49 Vicky Cook 

So when we link this into mental health, and especially since we're here to talk about feeding our mind after all. 

00:01:55 Vicky Cook 

The concern often with people with mental health diagnosis is that they can often be more socially isolated, staying indoors more, either in the community or in inpatient care settings where access to enough daily natural light is limited. 

00:02:10 Vicky Cook 

And since daily natural sunlight is the best, or should we say the most efficient source of vitamin D? 

00:02:16 Vicky Cook 

It makes mental health patients potentially more at risk of deficiency. 

00:02:20 Fiona Spence 

So what is vitamin D and why do we need it? 

00:02:24 Vicky Cook 

Well, we've briefly touched on rickets, and many people may have heard about it regarding COVID in the pandemic and the link to our immunity. 

00:02:33 Fiona Spence 

Your immunity, as in your immunity that you're struggling with just now. 

00:02:36 Vicky Cook 

That's the one, yeah. 

00:02:38 Fiona Spence 

I sound hoarse, and Vicky is choked with the cold. 

00:02:41 Vicky Cook 

That's the one clearly needs to up our vitamin D. 

00:02:44 Vicky Cook 

But let's actually discuss what it actually does in our bodies. And the breaking news is that vitamin D is not actually a vitamin. 

00:02:52 Vicky Cook 

You make vitamin D under your skin when you're outside in daylight, which is the reason vitamin D is sometimes called the sunshine vitamin.  A vitamin is something that helps our body function. It's a nutrient that we can't actually make in our body. 

00:03:07 Vicky Cook 

But vitamin D is different because even though we call it a vitamin, it's actually a hormone and we can make it within our bodies. 

00:03:15 Fiona Spence 

Love that.  Little mythbuster there. 

00:03:17 Vicky Cook 

Yeah, definitely. So actually Vitamin D works with the minerals calcium and phosphorus for healthy bones, muscles and teeth in our bodies. 

00:03:26 Vicky Cook 

So it actually helps everything function from that point of view. Vitamin D is also important in protecting muscle strength, so it prevents things like osteomalacia. 

00:03:37 Vicky Cook 

Which can then help things like prevent falls and as previously mentioned, rickets. 

00:03:43 Vicky Cook 

So when we look at the fact that many of our dementia patients will predominantly be staying inside, so they're not getting the exposure to natural sunlight and are increased risk of falls, the importance of supplementing vitamin D could be key in falls prevention as well as preventing osteomalacia as well. 

00:04:01 Fiona Spence 

Now, maybe people will be familiar with osteoporosis, but Osteomalacia, can you just tell us? 

00:04:05 Vicky Cook 

Basically osteomalacia is the adult form of rickets. 

00:04:09 Vicky Cook 

So I suppose it's slightly less well known and it's slightly milder potentially, but really it's about the softening of the bones because the bones aren't getting metabolised properly through lack of the minerals getting into the bones, so things like the calcium and phosphorus and natural stuff. 

00:04:28 Fiona Spence 

And the important stuff?  

00:04:29 Fiona Spence 


00:04:31 Vicky Cook 

Yeah, that's it. That's it. 

00:04:33 Vicky Cook 

So it's actually the sun's ultraviolet rays that allow the vitamin D to be made in the body. 

00:04:41 Vicky Cook 

So you don't have to sunbathe to make vitamin D. In the UK ultraviolet light is only strong enough to make vitamin D on exposed skin. 

00:04:50 Vicky Cook 

So things like, you know, like your hands, your face on your arms or your legs as they're exposed during April to September. Not all year round, however, strong sunn also burns skin, so we need to balance. 

00:05:01 Vicky Cook 

I know it's usually not too much of an issue in Scotland, but you know, we do sometimes get those hot sunny days. 

00:05:08 Vicky Cook 

Uhm, so we need to make sure that we balance making vitamin D and we’re safe in terms of our sun and our skin care as well. 

00:05:15 Vicky Cook 

We need to cover up and protect their skin with sunscreen and before you turn red or get burnt, obviously, but there's more information on that on the NHS Choices website. 

00:05:26 Fiona Spence 

And you only really need like a small patch of skin to be visible for the sun to be able to do its job. 

00:05:32 Vicky Cook 

Yeah, that's right. That's right. So I guess that's why it's during the autumn and winter months and that's why we're talking about it now, thinking ahead. 

00:05:42 Vicky Cook 

And we get vitamin D from our body stores and from our food sources. It was previously thought that these stores that we'd built up during the summer months would be enough to keep us going, but it's now known that these are insufficient to keep up the vitamin D levels that we require. 

00:05:59 Vicky Cook 

So the only way to ensure healthy vitamin D status at this time of year through the autumn and winter months is to take a supplement. 

00:06:07 Vicky Cook 

And this is because even if you have a calcium rich diet, so eating things like low fat dairy foods, green leafy veg or things like oily fish, egg yolks which are considered the richest source of vitamin D. 

00:06:19 Vicky Cook 

Without enough Vitamin D, you can't absorb the calcium into your bones and cells where it's needed. So the vitamin D may have other important roles in your body. 

00:06:27 Vicky Cook 

But the bone sort of side of things is probably the one that we are most that where most of the evidence sits at the minute. 

00:06:35 Fiona Spence 

I think it's really interesting because I think there's been so much 

00:06:38 Fiona Spence 

Press about vitamin D, particularly throughout the pandemic, and that was making people really aware of the importance of this vitamin, but I'm not so sure how aware people are of why it's so important, so I think it's really good for you 

00:06:53 Fiona Spence 

To come here today and actually explain the importance of it, it's about our bones. It plays a massive role in supporting the uptake of calcium, doesn't it? 

00:07:02 Vicky Cook 

That's it, yeah, absolutely. Which makes it relevant to everybody. That's at the end of the day, it's not just people who are vulnerable, it actually makes it relevant to everybody. 

00:07:12 Fiona Spence 

And we do, you know, like you say, you know, we do get our sunny days and things, but we do live in a country where we have not got the privilege of having such a great amount of sun exposure. 

00:07:23 Fiona Spence 

No sunbathing anyway. 

00:07:23 Vicky Cook 

No not all year round either, that's for sure. 

00:07:27 Fiona Spence 

So tell us then, how much do we actually need? 

00:07:29 Vicky Cook 

Well, it's actually quite interesting to know that until 2016 there were actually no UK dietary vitamin D recommendations for the general population. 

00:07:39 Vicky Cook 

Just for those considered to be at risk of deficiency, which we will come on to in a minute. But now everyone, including children, should consider taking a daily supplement containing 10 micrograms of Vitamin D or 400 international units. 

00:07:55 Vicky Cook 

Uhm, so particularly during the winter months, which are considered to be October to March? 

00:08:02 Vicky Cook 

So, but it's also worth noting that although this advice has been in place since 2016, the latest data for the UK shows that serum concentrations 

00:08:11 Vicky Cook 

So that's your blood concentrations of vitamin D, especially in adolescent boys and girls, or those who are housebound individuals, or those with dark skin in particular. 

00:08:22 Vicky Cook 

Are still lower than what they would deem acceptable to have vitamin D levels in your body. 

00:08:28 Fiona Spence 

It's quite scary though, isn't it? Because you don't. Nobody gets tested for this, so nobody will ever know what their vitamin D levels are. 

00:08:36 Vicky Cook 

So it's specifically recommended that groups that are at higher risk of vitamin D deficiency take a daily supplement in all year round because of that. Uhm, so because it's not tested routinely. 

00:08:48 Vicky Cook 

So we've been talking about these at risk groups, so these include all pregnant and breastfeeding women, infants and children under the age of five years. 

00:08:59 Vicky Cook 

People who have low or no exposure to the sun, for example, those who cover their skin for cultural reasons, or are housebound or confined indoors for long periods, or live in an institution. People over 65. And that's because their skin is not as good at making vitamin D. 

00:09:17 Vicky Cook 

And people from minority ethnic groups with dark skin, such as those from Africa and. 

00:09:21 Vicky Cook 

Afro Caribbean and South Asian origin, who require more sun exposure to make as much vitamin D in their skin, so the current guidelines on sun exposure should be followed, which is 10 to 15 minutes of unprotected Scottish Sun exposure. 

00:09:42 Vicky Cook 

Is actually safe for all. 

00:09:44 Fiona Spence 

See, I'm quite a big believer in this, do you know when you've got the kids going out to play and it is a hot day? 

00:09:49 Fiona Spence 

And some people may disagree, but actually putting your kids out into play in the sun before you sunscreen them. 

00:09:56 Fiona Spence 

Do you know, just give them that bit of time. They're not going to burn. They're not going to be out there for that long before you get them sunscreen ’ed up, but just allowing their skin at that prime time of day because isn't, it's there's a specific time of day, isn't? 

00:10:08 Vicky Cook 

It is yeah 

00:10:10 Vicky Cook 

It's that best time, it's that mid-day sort of time. 

00:10:11 Fiona Spence 

Exposed to it's like between 11:00 in the morning until 2:00 in the afternoon or something. That sort of middle of the day when the sun is at its highest or something, isn't it? 

00:10:14 Vicky Cook 

Yeah, absolutely. 

00:10:22 Vicky Cook 

There is something to be said about that and that's what they're saying 10 to 15 minutes you're going to get enough. 

00:10:27 Vicky Cook 

But actually your skin isn't then at risk. So once the sunscreen is correctly applied and if it is correctly applied, Vitamin D synthesis is blocked. So 

00:10:40 Fiona Spence 

Yeah, so particularly for the kids 'cause if you're using factor 50. 

00:10:42 Vicky Cook 

Yeah, absolutely. 

00:10:44 Fiona Spence 

Should be nothing getting through. 

00:10:46 Vicky Cook 

But we also have to say, obviously staying in the sun for prolonged periods without protection of sunscreen increases your risk of skin cancer. So obviously we're wanting to avoid that, absolutely. 

00:10:54 Fiona Spence 

And you don't want to get burnt. Absolutely. It's horrendously painful for starters, but yeah, really not good for you at all. 

00:11:00 Vicky Cook 

Yeah, but there is, I suppose a point to note, however, since we're talking about the vulnerable groups and the requirement for having vitamin D supplement. 

00:11:11 Vicky Cook 

Action taken too much vitamin D over a long period of time can cause excess calcium to build up in the body. 

00:11:18 Vicky Cook 

And this can actually weaken bones and damage the kidneys and the heart, so that although there's recommendations for 10 micrograms or 400 international units as the daily amount, especially in winter months or all year round for those who are vulnerable, there is actually recommendations on top of that for the excess amounts that you shouldn't exceed. 

00:11:39 Fiona Spence 

And what did they reckon the excess amounts or excessive amounts of Vitamin D would be to cause things like that? 

00:11:45 Vicky Cook 

Well, they they've stipulated that adults and children over the age of 11. 

00:11:50 Vicky Cook 

Should avoid daily high doses of vitamin D containing more than 100 micrograms, which is 4000 international units, which is obviously 10 times . 

00:11:59 Fiona Spence 

Yeah. So if you were taking a supplement which is typically 10 micrograms, you'd have to take ten of them a day for it to be quite excessive. 

00:12:06 Vicky Cook 

Yeah, absolutely. I suppose there's this, like. 

00:12:08 Fiona Spence 

But then you be able to buy supplements that are more than 10 micrograms. People may not be aware that it comes in that you can buy it in different, different concentrations. 

00:12:15 Vicky Cook 

Definitely. Absolutely. That's it. That's it. 

00:12:19 Vicky Cook 

But I suppose then there is people who take multiple multivitamins, so I guess it's just being aware of the vitamin D content if you're taking more than one multivitamin to make sure that you're not exceeding. 

00:12:31 Fiona Spence 

But at the same time that isn't enough because we had a conversation about this other day, didn't we, we were talking about, you know, the multi vitamins that you can get for kids and actually it doesn't meet the recommendation these multi vitamins with them and they state on the labels you know contains Vitamin D, really healthy for your immune system and your bones and things. 

00:12:50 Fiona Spence 

But it doesn't actually have 10 micrograms in it. I think they're about 2 1/2. 

00:12:56 Vicky Cook 

Yeah, so and then if you took four of them to meet your vitamin D, then you'd be overdosing on certain other ones. 

00:12:59 Fiona Spence 

Yeah, 'cause. You've all got your other vitamins that are in there that you don't need to be taking anymore of 

00:13:04 Vicky Cook 

That's right. That's right. And so for children age 1 to 10 who potentially fall into that bracket of the ones that have the lower doses, they should avoid supplements with more than 50 micrograms. 

00:13:15 Vicky Cook 

So that's 2000 international units in infants under 12 months should have no more than 25 micrograms a day. 1000 international units. 

00:13:24 Vicky Cook 

So it's quite large doses that are recommended that you don't exceed. 

00:13:29 Vicky Cook 

It's not like it's just above the recommendation for everybody, so that's quite good. 

00:13:35 Fiona Spence 

Yeah, I can't imagine in this country we've got a huge problem with people taking too much vitamin D if anything, it's probably people not taking enough. 

00:13:43 Vicky Cook 

Yeah, I think that's right. But I think some people have certain medical conditions which mean they might not be able to safely take as much. UM, but that's where the recommendation is at a safe level for everybody. 

00:13:55 Vicky Cook 

And so you should seek advice from your clinician. If you have any doubts if that is you or if your clinician has advised you to take a different amount of vitamin D for whatever reason, you obviously always follow their advice rather than the standard 10 micrograms, 400 international units that's given to everybody. 

00:14:11 Fiona Spence 

Maybe a helpful way of doing it is actually to buy multi vitamin that doesn't have vitamin D in it and have a separate supplement and if somebody typically takes a multi vitamin and they're not getting in the right equivalent of that, Vitamin D, in there you could just you can buy vitamin D on its own. 

00:14:25 Vicky Cook 

You can, yeah, it's yeah, it is available to buy actually, on its own. And if you were the, I suppose that's also a separate note that vitamin D3 is twice as effective as vitamin D2. 

00:14:39 Fiona Spence 

And that has it on the back of the label what you're buying as well doesn’t it? 

00:14:41 Fiona Spence 

It'll say D2 or D3. 

00:14:42 Vicky Cook 

Yeah, it does. Yeah. 

00:14:45 Fiona Spence 

So D3 is the one to go for if you're buying a vitamin D supplement. 

00:14:49 Vicky Cook 

Yeah, and that's because it's more effective at raising your serum, like we said before, your blood levels of their active vitamin D concentrations. 

00:14:57 Vicky Cook 

So if you were buying it separate or even if you were looking at your multivitamin. 

00:15:01 Vicky Cook 

Packet to look for ones that have D3 rather than D2. 

00:15:05 Vicky Cook 

A separate note to that the vitamin D fortificant which is most commonly used as lanolin from sheep's wool and. 

00:15:14 Vicky Cook 

Which makes the format potentially unpopular with vegetarians or obviously be unacceptable to vegans. So, uhm, D2 is if you got that, it's from fungi, so it's acceptable for anybody, but like it's stated, it's not as effective. 

00:15:33 Fiona Spence 

And it wouldn't matter if you increased your dose? 

00:15:37 Fiona Spence 

If you increased how much D2 you had, it's not going to make any difference. It's still just, not as effective as D3. 

00:15:43 Vicky Cook 

From the evidence at the minute, it doesn't look like it. 

00:15:47 Vicky Cook 

But they are actually looking at more sources, probably because of exactly that to make it. 

00:15:55 Fiona Spence 

I was just curious.  Make it more accessible for everyone. 

00:15:56 Vicky Cook 

Make it more so accessible to everybody. So yeah, so that they're going to be able to make it available across the board. 

00:16:06 Fiona Spence 

So it's been really interesting, Vicki, thank you.  I think if we’re bringing it to a close, it would be really helpful for you to run through our groups at risk of low vitamin D. 

00:16:15 Vicky Cook 

Yeah, no problem. 

00:16:17 Vicky Cook 

So it's babies and young children. 

00:16:19 Fiona Spence 

And this is from birth. 

00:16:20 Vicky Cook 

Yeah, this is from birth. I guess the only ones that you're not as concerned about taking a supplement. 

00:16:26 Vicky Cook 

Would be those who are formula fed, and if they're having more than 500 mls of formula, the vitamin D would actually be in that. 

00:16:33 Fiona Spence 

It's already fortified in formula. 

00:16:34 Vicky Cook 

It's already fortified, so for those who are taking less, or who are doing a combined breastfeeding formula feed or predominantly breastfeeds, they would need a supplement of Vitamin D from birth. 

00:16:45 Fiona Spence 

And health visitors will keep mothers and infants right with how to supplement a baby 

00:16:51 Vicky Cook 

Yeah, absolutely. And they're provided nationally and so the health visitor would provide them for you also. 

00:16:57 Vicky Cook 

Perfect. OK, so any children and adolescents who spend a little time playing outside that covers all of the  

00:17:04 Vicky Cook 

Pregnant and breastfeeding women. Anybody over the age of 65 because their skin is just not as good at making vitamin D anymore. 

00:17:14 Vicky Cook 

People with darker skin tones. So that's people of Asian, African, Afro Caribbean, Middle Eastern descent, living in the UK or. 

00:17:21 Vicky Cook 

Other northern climates. 

00:17:24 Vicky Cook 

Uhm, if you always cover most of your skin when you're outside. 

00:17:28 Vicky Cook 

The further north you live, that's another one. Unless sufficiently strong sunlight is there to make the Vitamin D So that's us.  

00:17:38 Fiona Spence 

So that's us, huh? The Scotland population, basically the whole of Scotland 

00:17:41 Fiona Spence 

Living in darkness, yeah all year round. That’s us. 

00:17:47 Vicky Cook 

That's it. And anyone who spends very little time outside during the summer, so those who are housebound, those who are shop or office workers or night shift workers also fall into that and if you live in an area where the air is actually quite polluted. 

00:18:06 Vicky Cook 

So smoggy places where the UV light doesn't get through. 

00:18:10 Fiona Spence 

That would make sense, but you wouldn’t automatically think of that. 

00:18:13 Vicky Cook 

No. So they are, they are the at risk, but like as you say, most of us in Scotland. 

00:18:19 Fiona Spence 

Maybe quite helpful as well, I know that there's such a huge proportion of people that now care for elderly parents. 

00:18:26 Fiona Spence 

And who are more housebound and things like that. So maybe even consider a 

00:18:30 Fiona Spence 

To know if you're a carer, consider a supplement for an older relative. Maybe. Wouldn't spring to mind as something that you would ordinarily do for them, but actually something like that may be quite helpful. 

00:18:42 Vicky Cook 

Definitely. And for yourself if you're the one inside caring for them all the time. We're quite good at looking after other people but sometimes it's the carers themselves. 

00:18:50 Vicky Cook 

That need to consider the amount of time that they're actually spending in time looking after other people. 

00:18:58 Fiona Spence 

Thank you. This has been so interesting to talk to you. So there's a couple of things that I've, you know, really rang home with me. 

00:19:04 Fiona Spence 

And number one, you know risk factors such as softening in the bones and the role that vitamin D plays in terms of our bone health really important. And second one, it's importance with our immune system, particularly ours at the moment. 

00:19:20 Vicky Cook 

Let's kick this. 

00:19:22 Fiona Spence 

And the third one, you know, the vulnerable groups and it, it did actually feel like, you know, you were referring to all of the Scottish population there. 

00:19:28 Fiona Spence 

You know, people need to take note that this is an important vitamin or hormone. There we go. There's my final one. 

00:19:34 Fiona Spence 

That amazing little fact that you put in there that it's not actually a Vitamin it's a hormone. 

00:19:38 Fiona Spence 

Exactly and so the importance of our hormone Vitamin D and. 

00:19:43 Vicky Cook 

Who knew? 

00:19:44 Fiona Spence 

Who knew? Yeah. 

00:19:46 Fiona Spence 

So yeah, then you know it does play such an important role, but probably greatly overlooked. 

00:19:52 Fiona Spence 

So it's been really helpful you coming here today and going over all this with us. It's been a joy. 

00:20:00 Vicky Cook 

Always is. It's I think it's just one of those, doesn't it, that it's quite a simple thing to find, to supplement and I think especially as we are testament to. 

00:20:09 Vicky Cook 

As we move into the winter bug months, and the lessening of the sunlight that we really need to be thinking about one of the simple ways that we can maybe protect our health a little bit more. 

00:20:20 Fiona Spence 

Yeah, but like you said, you know, you can get vitamin D anywhere on the shelves, supermarkets anywhere and it's this just double check on the back that its D3 and if you're 

00:20:29 Fiona Spence 

Vegan D2 options more relevant to you. 

00:20:32 Vicky Cook 

Yeah, that's it. 

00:20:34 Fiona Spence 

Thank you so much for joining us today, Vicky and we look forward to welcoming you back to another podcast soon. 

00:20:38 Vicky Cook 

Fantastic. See you soon, bye.