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A lack of vitamin D, or of common sense?

"My experience of treating vitamin D deficiency has been disappointing"

Are the government's new vitamin D guidelines really necessary, asks Dr Messenger

Suddenly, vitamin D is everywhere. Everywhere, that is, except in our bodies. Newspaper headlines, TV programmes and consumer mags have all been trumpeting the message that, as a sunshine and oily-fish-deprived nation, loads of us are vitamin D deficient.

This topic has been bubbling along for some time, but has now boiled over since Public Health England (PHE) announced that everyone over the age of five should be taking a daily supplement from October to March each year.

I must admit that I have some reservations about this. Outside of the grossest deficiencies causing obvious clinical manifestations – rickets and osteomalacia, in other words – the evidence that a lack of vitamin D is harmful is somewhat fuzzy. Certainly, my experience of treating vitamin D deficiency has been disappointing – it’s become a very common prescription in recent years, and I can only remember one patient who actually felt better for taking it.

And when you look at the prevalence figures, maybe we should consider redefining what we mean by abnormal, and adjusting treatment thresholds, rather than medicalising the nation.

But I have a GP-centric anxiety, too. Come October – as you’ll appreciate, not the quietest month in primary care – I really don’t want a heap of extra consultations to discuss the whys and wherefores of vitamin D, or simply to provide prescriptions for those who are charge-exempt and can get their treatment free.

So pharmacists, could you help us out on this one? Set yourself up as the vitamin D experts. I’m sure you’d do a better job than me. And direct your customers to the brand of your choice with the message that this isn’t something they should expect on the NHS (ie keep away from your GP). After all, PHE’s advice was "consider", remember?

Thanks. Your reward? I’ll buy you lunch. Fancy sitting out in the sun with a rollmop herring?

4 Comments

Gerard Diamond, Primary care pharmacist

I get all the vitamin d prescribing, lab results and prescibing passed to me by GPs and it's interesting and had one elderly lady recently who was skipping about and waxing lyrical and thankful for her loading dose. I bought sone Hux D3 20000 and take them and I do feel that they help my middle age aches and pains well but only slightly less tired than before. So I would give them an overall anecdotal thumbs up on non scientific balance. Suck it and see!

C A, Community pharmacist

I have already had one customer baulk at the price of Vitamin D, and leave with a comment of 'I'm not paying THAT! I'll get it from the doctor for free' ... 

The price you ask? £2.99... for 180 tablets (the PHE recommend 6 months) and this was from a well dressed lady from a well-to-do postcode.

Sorry Dr Messenger I tried :(

Jenny Etches, Community pharmacist

I have many customers, not elderly ones, who've been advised by their GP to take Calceos and Calcichew OTC. Transpires that they need Vit D alone and this is considerably cheaper. 

Mahesh Sodha, Superintendent Pharmacist

Absolutely right. It is cheaper to buy OTC versions even though they might not be licensed. Licensed products are a drain oin NHS resources. However, I would not play down the incidnec of the deficiency in this country. The blood levels results have shocked me. The levels ar not just low but very low and who knows whether the lack of symptoms has any significance? or not? Certainly some patients suddenly have an improvement in back aches.

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