If your routine blood tests have shown you to be vitamin D deficient then this information is for you.

Vitamin D is important in helping the body absorb calcium, making strong bones and teeth and supporting muscle and nerve function. Low vitamin D levels increase the risk of osteoporosis and may affect the normal function of the immune system. Calcium is vital for strong teeth and bones because it gives them strength and rigidity.

Our bones contain protein, calcium salts and other minerals. Each bone is made up of a thick outer shell with a strong inner mesh that looks like honeycomb. Thinning of the bone (osteopenia) occurs when the structure of the bone becomes thin causing the bones to be fragile.

Osteoporosis literally means ‘porous bones’ and osteoporosis is a common problem in women after the menopause. This is because falling oestrogen levels are linked with a loss of bone density. However, osteoporosis may also occur in men, young women (particularly if they have experienced an early menopause) and children.

Two types of cells are constantly at work in our bones, building new bone and breaking down old bone. In our twenties, the construction cells (called osteoblasts) work hard, building strength into our skeleton while from our forties, the demolition cells (osteoclasts) become more active and our bones gradually reduce in density. This natural ageing process may be accelerated after a bone marrow transplant especially if patients have needed prolonged steroid treatment.

Whatever your age or sex, it is vital to make sure that you have a balanced diet. A healthy diet will provide you with all the vitamins, minerals and calories you need to keep your bones healthy. Vitamin D is made in our body using direct sunlight but it is also found in some foods naturally or may have been added.

How much vitamin D do I need?
Recommended daily intakes of vitamin D are shown below

Birth to 12 months 200 international units (IU)or 5 micrograms)
1- 50 years 200IU
51-70 400IU
71 + 600 IU

An adult over 51 needs 400 international units (IU) or 10micrograms. If you are indoors most of the time then this will mainly be supplemented by diet alone.

How can I increase my vitamin D levels?

You can increase your vitamin D levels in a number of ways:

  • Exposure to sunlight

Vitamin D is predominantly formed by the action of direct sunlight on the skin. It is the UVB rays that seem to be most helpful. Sunlight to your face, arms, back OR legs for 20 minutes, 4 times a week will enable your body to produce more vitamin D. This can be staggered throughout the day in 5-10 minute intervals, although sun exposure in the period between 11am and 3pm is likely to be most effective as the UVB rays are stronger during this time of the day. Cloud cover can reduce UVB rays by 50%.

It is very important that you do not get sunburnt. However, ten minutes in direct sunlight even in very fair skinned people should not induce sunburn. If you are worried about getting burnt it may be advisable to protect delicate skin such as your face, by wearing a hat, and instead bare your arms and legs.

It is impossible to generate too much vitamin D in your body from sunlight exposure as the body regulates production and only generates what it needs.  However, your illness may mean that you may be indoors more than usual. In addition, low levels of sunlight in the UK may also make it difficult to maintain or increase vitamin D levels by relying on this route.

  • Vitamin D sources in your diet

Particular food choices can help supplement the vitamin D made from sunlight.  Oily fish/ eggs/margarine and breakfast cereal are the best ways to do this. Below is a list of foods containing vitamin D.

Salmon 100g 360 IU
1 Egg 20 IU
Fortified breakfast cereal 2 cups 80 IU
Mackerel  100g 345 IU
Sardines canned in oil 250 IU
Tinned tuna in oil  100g 235 IU
Margarine 1 table spoon 60 IU

If you are researching vitamin D you will find that it is found in abundance in cod liver oil. However, so are high amounts of vitamin A and omega 3. Whilst these are very good for you, taking large amounts of cod liver oil may lead to harmful levels of vitamin A. Therefore please do not use cod liver oil as a source of vitamin D.

  • Calcium sources in your diet

Dairy products e.g. milk (including semi-skimmed), cheese, ice-cream and yoghurt are good sources of calcium.

  • Calcium and vitamin D supplements

We advise that you also consider taking oral vitamin D / calcium supplements and we will discuss this with you. We will monitor your vitamin D levels by measuring the level in your blood.

If you have very low levels of vitamin D when you are admitted for your transplant or during any other admission then we will consider giving you an injection of vitamin D. If this is the case then we will also need to take a weekly blood sample to check your calcium levels.

Even with adequate sunlight and a diet rich in vitamin D you may find that your levels remain low and this may be due to medication, diarrhoea or other bowel problems.

Chronic vitamin D deficiency may require months of supplementation and regular sunlight exposure to rebuild stores and achieve adequate vitamin D levels.

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