Vitamin Supplements

Vitamin D is the joker in the pack. It masquerades as a vitamin but follows none of the rules. To begin with we don’t need it in the diet because we can make it ourselves, and secondly it doesn’t work as a coenzyme in the way that most of the other vitamins do. Vitamin D is formed from a group of chemicals which are known as sterols and react to sunlight and radiation to form the active vitamin. All animals including man possess these sterols and they are found close to the surface of the skin. When sunlight reaches the body it changes the structure of these sterols, and they are absorbed into the bloodstream as cholecalciferol and pass to the liver. Further changes occur here and the new products are transported to the kidney. A final change takes place producing the active form of the vitamin 1.25-dihydroxycholecalciferol, and this travels in the bloodstream to the intestinal walls. Once it reaches this site its main function is to assist in the absorption of calcium from the diet, across the gut walls and into the bloodstream. The calcium is then transported to the bones and teeth and can be used where it is needed. This type of function, with so many changes and different sites of action, resembles the behaviour of a hormone rather than a vitamin, and purists would argue that vitamin D has no place among the true vitamins. It would seem unlikely that it will ever be removed from the list, and it does conform to the vitamin pattern in some respects. A lack of vitamin D can cause the deficiency disease, rickets, and it is possible to supply the vitamin by diet alone.

Rickets

This disease has been known for many hundreds of years and is caused by a lack of calcium in the bone, producing deformities and poor growth. The origin of the name is uncertain, but it his been suggested that it comes from the Greek word rachis meaning spine, or from an Anglo-Saxon word ricket meaning twisted. A third possibility is that it stems from an early English word, rucket which means bucket. This last idea is thought to reflect the bucket-like appearance of the ribs in advanced cases of rickets.

The importance of vitamin D in preventing rickets is closely related to the availability of calcium both in the diet and in the body. Bone growth depends on the deposition of salts and minerals within the matrix, or structure, of the bone, and calcium is one of the most widely used minerals. Bone is not a dead tissue, but is constantly forming and reforming its structure like other areas within the body. Calcium is both deposited and removed from the bone all the time. When it is deposited we say it is absorbed and when it is removed we say it is resorbed. Calcium is also needed in the blood for nerve and muscle functions and, if blood levels fall too low, then calcium is resorbed from the bone to make good this loss. This is controlled by a hormone called parathormone and it comes from the parathyroid glands in the neck. Parathormone works with vitamin D to keep the balance of calcium exactly right between the bone and the blood. When supplies are low then the vitamin can help to extract more calcium from the intestines into the bloodstream and any excess can be deposited back in the bones. There is a vast supply of calcium in the bones of a grown man, but children have a smaller supply and rickets develops when the bones have been robbed of the calcium they need for growth. The remaining structure of the depleted bones is too weak to support the weight of the body. Typical symptoms are bow legs and a twisted spine. This disease became very widespread with the advance of the industrial revolution. Crowded, smokey towns meant there was little or no sunlight reaching children living there. Many living in those areas were very poor and living on deficient diets, so the children were born without adequate stores in their bodies. Vitamin D is stored in the liver like vitamin A but only in small amounts, greater reserves are found in the fat tissues.

The connection between rickets, cod liver oil and sunshine was discovered in the 1920s when a great pioneer in nutrition, Dame Harriet Chick, was working with orphan children in Vienna. She used cod liver oil to cure their rickets, but she also realised that sunshine could produce the same effect. The chemical similarities between the active vitamin in the oil and the vitamin produced by sunlight on the skin was discovered in the next few years, and by the 1930s vitamin D was incorporated into milk and infant foods in an attempt to eradicate this widespread disease. Rickets became unheard of after the war and in the ‘fifties and early ’sixties, but within the last few years cases have been reported among immigrant children. It is thought that the pigment in black skin acts as a filter in tropical climates to prevent an over production of vitamin in skin which is constantly exposed to sunlight, but in colder climates, with little or no sunlight, this pigment is a distinct disadvantage, blocking out the small amount of radiation which is needed for vitamin D production. Many of these children feel the cold in this country and wear more clothes. Some of them follow a strict vegetarian diet which restricts the few dietary sources available to them i.e. fish and liver. If the disease is spotted in good time at clinics and hospitals then a small supplement of the vitamin can prevent permanent malformation of the bones. The changing state of bone, particularly in childhood, means that early deformation can be corrected if vitamin D is provided and the diet altered in time.

Osteomalacia

Older people do not suffer from rickets in the same way that children do, but a lack of calcium and vitamin D in the diet can produce a similar weakness of the bone and this is described as osteomalacia. Groups of adults who are most ‘at risk’ to this condition include those who are ill and cannot get out into the sunshine. It can also affect people who work at night and never see daylight, or others who, by custom or religion, always cover their entire bodies with veils and robes when they go out, thus preventing the sunlight reaching any part of the skin. This loss of natural vitamin D is often accompanied by a low intake of calcium and more of the mineral is leached out of the bone to compensate for the low levels in the blood.

The normal flux of calcium between bone and blood alters slightly after the age of forty with rather more calcium leaving the bone than returning to it. This is absolutely normal and causes no problems among healthy individuals, but in osteomalacia this process is accelerated causing weakening of the bone. A state is reached where it fractures easily and takes a long time to mend. Additional vitamin D in the diet can help to reduce this condition, but it should be used as a long term programme rather than a short term help. The condition is often seen among old people who may be housebound and living on a very poor diet.

Lack of vitamin D should be guarded against in all age groups. Tiny babies have a supplement at a very early age, usually in the form of a preparation from the clinic. This is administered in drops together with vitamin A and instructions for the correct dose should be followed very carefully. Too much vitamin D is toxic and can cause symptoms of sickness, dizziness and diarrhoea.

Vitamin D is not well supplied by the diet. It is found in fish liver oils, and there is a small amount in cream, butter, liver and kidneys. It is not found in fruit and vegetables or cereals. Certain moulds and fungi contain a substance which is similar to the sterols in our skin and these can be turned to active vitamin D, ergocalciferol, by the action of sunlight or radiation and this property can be used for commercial preparation of the vitamin.

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