Vitamin D levels tend to be low in people living in Northern Europe during winter months.
Vitamin D is synthesized in the skin by the action of ultraviolet in sunlight. Although it is also present in the diet – particularly oily fish – synthesis in the skin is the major natural source. As a consequence, many people in Northern Europe tend to have low vitamin D levels in the winter.
Vitamin D levels also tend to be low in people with chronic disorders of the gut, liver, and pancreas.
Vitamin D deficiency has been shown to be common and to correlate with poorer outcomes in patients with inflammatory bowel disease. It is common in patients with undiagnosed coeliac disease, although this usually corrects on a gluten-free diet, and is also common in patients with chronic pancreatitis, and in other conditions, including liver cirrhosis where fat malabsorption occurs (vitamin D is a fat-soluble vitamin).
Vitamin D is important for the immune system, not just for bones.
Vitamin D is best known for its important effects on calcium metabolism and bone formation. However, it also has important effects on the immune system. It helps macrophages (a type of white blood cell that is important in defense against bacteria and viruses) kill pathogens they have engulfed. It also has anti-inflammatory effects and has been shown to suppress the cytokine (inflammatory) response to viruses. This might be beneficial in Covid-19 where severe lung damage can result from an inflammatory “cytokine storm” in response to the virus.
Vitamin D deficiency increases the risk of infection by respiratory viruses.
It has been shown that people with low vitamin D levels are more susceptible to viral respiratory infections and that regular supplementation reduces the risk.
Vitamin D supplementation might help to reduce the risk of severe Covid19 illness – although there is no direct evidence to support this.
No studies of vitamin D supplementation have yet been performed in relation to Covid-19 but its protective effect against respiratory viruses and its ability in the laboratory to reduce inflammatory cytokine responses to viruses suggests that regular vitamin D supplementation might help to reduce risk of severe Covid19 illness.
If you do take vitamin D supplementation the dose is very important.
Vitamin D overdosing is harmful – it can cause dangerous increases in blood calcium and can also potentially have unwanted impacts on the immune system – does is therefore important. Current evidence suggests that for adults a regular daily dose of 25 micrograms (1000 units) is likely to be optimal. There is good evidence that this is safe (daily doses of up to 4000 units are regarded as safe in adults). In healthy adults, there is some evidence that daily dosing of more than 1000 units actually has less beneficial effect although higher doses eg 2,000 units per day may sometimes be used in patients with proven vitamin D deficiency. The National Institute for Health and Care Excellence (NICE) already recommends that all UK adults should take 400 units daily – evidence in relation to respiratory infections currently suggests that a somewhat higher dose of 1000 units per day (for adults) may be optimal.
- most UK adults are vitamin D deficient in the winter months.
- Vitamin D deficiency is particularly common in people with chronic disorders of the intestine, pancreas or liver.
- The regular daily dosing of vitamin D3 1,000 units without calcium (typically one capsule or tablet) is safe and usually sufficient to correct this
- Low levels of vitamin D are associated with increased risk of respiratory viral infection
- Vitamin D supplementation has been shown to reduce the risk of respiratory viral infection
- Laboratory studies show that vitamin D reduces the cytokine response to respiratory viruses – this might be helpful in reducing the risk of serious lung damage in Covid19 infection, although this is unproven.
Get Your Gut Back On Track!
An estimated 110,000 people consume antibiotics daily in Ireland, between December/March. (Source: Health Protection Surveillance Centre).
We asked Nutritional Therapist Rosanna Davison for her Top Tips to get your gut back on track after an illness.
1. Take time out
Don’t push yourself too quickly. Remember your body needs time to rebuild its reserves and regain strength.
Take more rest than usual. If you need to sleep longer, go to bed earlier.
Cut back on non-essential activities; they can wait until you are feeling 100%.
- Embrace fibre-rich foods full of protective nutrients
Fresh vegetables and fruits are rich in dietary fibre, vitamins and antioxidants. Try eating seven to nine portions over the course of each day. Choose different colours so that you nourish your body with a variety of phytonutrients.
Eat a portion of complete protein at each meal, such as poultry, fish, eggs, beans, pulses or tofu.
Consume essential omega-3 fatty acids daily. Avocados, seeds (flax, chia) and oily fish (mackerel, wild and organic salmon), are naturally rich in anti-inflammatory fats.
- Go ‘fermented’
Fermented foods are rich in ‘friendly’ bacteria. Sauerkraut is simple to make at home or buy kefir or kimchi in your local health store.
- Reduce or eliminate sugary foods
Processed foods often contain refined sugars to enhance taste. Excess refined sugar and processed foods may encourage the growth of ‘unfriendly’ bacteria, so aim to buy and eat fresh food.
If you have a sweet tooth, try eating berries (strawberries, blackberries, blueberries, raspberries). They are rich in antioxidants and naturally low in sugar.
If you need a sweetener, try Stevia which is extracted from plant leaves and doesn’t impact blood sugar levels.
Do vegans need to take supplements?
A varied, wholesome vegan diet provides almost all essential nutrients in sufficient quantities. I hear you shouting ‘Noooo! It provides absolutely everything we need!’ and you may be right, but only if you regularly eat certain fortified foods. The sad truth is that modern food production systems and lifestyles make it more difficult for everyone – vegans or not – to get all they need from diet alone. It doesn’t mean a vegan diet is unnatural or unhealthy, in fact the opposite is true. It means that how we grow, produce and consume food has changed and, with an ever-growing population, the demands on the systems that produce our food are so high that certain nutrients become harder to obtain.
I get a lot of questions about supplements and understand why people are confused. Over the years, I’ve worked on many vegan research projects and as science and population studies reveal ever more data, the guidelines and recommendations change and evolve. Hence, what we were told 10 years ago may no longer be up-to-date and that’s why different opinions arise, depending on where and when we got our information. It’s my job to keep up-to-date, so hopefully I can bring some clarity to the supplement discussion!
So what’s needed? The trio of nutrients to keep a close eye on are vitamin B12, vitamin D and iodine. You may not need to supplement with all these, all year long, but it depends on several factors. Read on…
Vitamin B12 naturally comes from bacteria in the soil and both people and animals would traditionally have got it from eating unwashed plants. However, we not only wash vegetables before we eat them (and for good reasons), but food production is now so sanitised that most vegetables are washed in chlorine, or other sterilising solutions, so there’s not a trace of B12 left.
People are not generally aware that most farmed animals are given B12 supplements and this is how the vitamin eventually ends up in their flesh. So, the argument that meat is a natural source of B12 doesn’t really stack up as meat-eaters essentially consume B12 supplements recycled by the animals that were given them!
It is absolutely necessary that we have a reliable source of vitamin B12 for our bodies. We need it to make red blood cells, for a healthy heart and circulation, and it’s essential for the nervous system. It takes years to develop a B12 deficiency, so on one hand, you don’t need to worry about not having taken B12 for a while. On the other hand, you do need to pay attention, as when symptoms develop, it’s usually serious.
To ensure adequate intake, you should have at least 5µg (micrograms) daily from supplements or fortified foods. The B12 used in both foods and supplements is produced commercially by growing bacterial cultures in large vats – and it’s always suitable for vegans.
There are two forms of B12 in supplements – cyanocobalamin (cheap) and methylcobalamin (expensive). Cyanocobalamin is the stable ‘inactive,’ form of B12 and is used in supplements and to fortify foods and drinks. Once ingested, it’s activated by your body so it can be used. Methylcobalamin is the ‘active’ form of vitamin B12 as it does not require any metabolic reactions to be activated. It costs more and is not so stable.
So which one to choose? Unless you’re a heavy smoker, have kidney failure or any other serious condition affecting your metabolism, cyanocobalamin – the cheap form of B12 – is perfectly fine. Intakes up to 2,000µg a day are safe and you can take either a lower dose daily or a higher dose a couple of times a week.
We need vitamin D for healthy bones, teeth and muscles and it also performs other essential functions in our metabolism. It is produced in the skin when exposed to sunlight and this is the main source of vitamin D for most people. However, if you always use sun-block, cover most of your skin or live in a country, like the UK, where we don’t get enough sunlight over the winter, you need a supplement, whether you’re vegan or not.
The UK Government now recommends that we all take a supplement from October to April and, if you protect your skin ferociously over the sunnier spring and summer months, you should take a supplement all year long. Otherwise, just 20 minutes of sunlight on the face and arms is all that is required by the body to manufacture sufficient vitamin D.
Fortified breakfast cereals, bread, plant milks and vegan margarines can be useful sources if exposure to sunlight is not practicable, but may not be enough. When it comes to supplements, there are two types and your body can use both, but it’s advisable to check the source – vitamin D2 is always vegan, but vitamin D3 can be of animal origin. Many vegan foods are fortified with vitamin D2 and labelled so, but if not specified, especially on cereal products, vitamin D tends to be of animal origin. If you choose to supplement your diet, there’s a range of quality and affordable vegan supplements with vitamin D2. There are also those made from algae or mushrooms that contain D3 and these are recommended if you need a higher dose. When deciding on your dosage, 10µg per day is enough and you shouldn’t go above 25µg.
Iodine has been a hot topic lately, especially with plenty of tabloid ‘experts’ warning that vegans are missing out. This mineral is necessary for thyroid function and helps to regulate how energy is produced and used in the body.
The amount of iodine in plants depends upon the iodine content of the soil in/on which they are grown. The closer to the sea, the more iodine and therefore vegans can get enough from plant foods, but there’s no guarantee. Seaweed, which of course grows in seawater, is always a good source and includes nori, laver, dulse and the kelp family (kombu, arame, wakame). But be warned – kelp absorbs far more than other seaweeds and you can get too much iodine from it. So, while seaweed consumption is encouraged, kelp should be used only sparingly.
It’s best to use a kelp supplement so you know exactly how much iodine you’re taking – it’s cheap, reliable and you don’t have to worry about taking too much. The recommended daily intake is 140µg and intakes up to 500µg are considered safe. In many countries, iodised salt is commonly used to ensure iodine intake, but it’s not the norm in the UK.
The dairy industry has been boasting about the iodine content of cow’s milk. What they don’t tell you is that it’s not a natural component of milk, but comes from iodinated cattle feed, supplements, iodophor medication, iodine-containing sterilisers of milking equipment, teat dips and udder washes. Cow’s milk is neither a natural nor the best source of iodine, so we can happily leave all that dairy out of our diet.
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