As I have fair skin I try to avoid the sun. Do I = need vitamin D? - Health

A Cheshire = reader=20 with reddish hair and fair skin tends to = avoid=20 the sun in the summer but is worried = that she=92s=20 not getting enough vitamin D. Should she = be=20 taking supplements?

NI_MPU('middle');
The answer is = yes. In=20 the unsophisticated 1940s vitamin D was = always=20 known at school by those doing human = biology as=20 the =93sunshine vitamin=94. Then medical = opinion=20 believed that the more sun anyone had = the=20 better. The glass in schoolroom windows = was made=20 so that ultra-violet rays penetrated it = easily.=20 At boarding school, young children lined = up at=20 bathtime to go under sun lamps. The = children, as=20 pale from the British weather as slices = of=20 Mother=92s Pride white bread, could then = be=20 toasted to a healthy looking brown to = please=20 their absentee parents.

Patients and doctors alike now know = better:=20 melanomas and other forms of skin damage = are=20 directly related to exposure to the sun = and at=20 no time of life is it more important = than in=20 childhood to prevent burning. Nor is = there any=20 type of skin at greater risk than the=20 milky-white complexion, possibly = freckled, with=20 pale blue eyes and fair or red hair, the = type of=20 skin that our reader has.=20

My generation were prescribed sun; = the=20 present generation are told about the = importance=20 of avoiding the sun. They are encouraged = to use=20 screening lotions, to wear tightly woven = long-sleeve shirts to keep the sun off = the chest=20 and arms, and a hat to protect the face. = This is=20 all excellent advice, but as with so = many good=20 prescriptions, there is a downside and = the=20 inevitable risk-benefit analysis is = needed. Too=20 little sun can cause vitamin D = deficiency.=20

The number of people in this = sun-deprived=20 generation who are suffering vitamin D=20 deficiency is increasing. Vitamin D is = vital for=20 the absorption of calcium so they are = also=20 liable to suffer more osteoporosis. = There is=20 even a well-founded suggestion that SAD, = the=20 form of depression that the = lightdeprived=20 develop in winter time, is more = prevalent in=20 those with low levels of vitamin D.=20

It is not only children who may = suffer=20 calcium and vitamin D deficiency; a = study of=20 Scottish adults suffering fractures = showed that=20 97 per cent had vitamin D deficiency, = and=20 research among adults in the Medway = found that=20 there was vitamin D inadequacy of 88.7 = per cent=20 of those visiting their doctor.=20

Elderly people living in institutions = don=92t=20 develop prison pallor only from lack of=20 sunlight; they also suffer vitamin D = deficiency,=20 almost universally unless steps are = taken to=20 counteract it. The deficiency of=20 sunlight-generated vitamin D is made = worse by=20 the nature of older people=92s skin, = which becomes=20 progressively less able to utilise = vitamin D=20 just as the kidney is also less = efficient at=20 converting the vitamin D synthesised by = the=20 sunlight to its active form.=20

There are two types of vitamin D: = vitamin D3=20 is derived from cholesterol of animal = origin as=20 well as from the sun, and vitamin D2, = derived=20 from plants. Whatever its source, = vitamin D is=20 converted to its active form in the = liver and=20 kidney and is stored until it is needed. =

Vitamin D in the diet =97 fish oil, = eggs,=20 butter, liver and meat =97 is inadequate = by itself=20 to counteract a lack of vitamin D made = by the=20 sun. Margarine is fortified with vitamin = D and=20 so are some cereals but even so vitamin = D joins=20 folic acid as an essential vitamin that = in the=20 modern world needs supplementing at = some, or at=20 all, times of life.Vitamins are measured = in=20 international units, or micrograms; I = take 5mcg=20 daily, the recommended adult amount.=20

Calcium as well as vitamin D is = needed to=20 maintain healthy bones and I am a firm = believer=20 that far too few people are taking = bisphos-=20 phonates, another of the modern wonder = drugs.=20 Bisphosphonates are needed, as well as = vitamin D=20 and calcium, to prevent osteoporosis and = to=20 reduce the annual mortality from = fractured=20 bones. Preventing osteoporosis and = thereby=20 reducing the shrinkage of old age also = reduces=20 the amount of backache.=20

Bisphosphonates in rather heavier = doses also=20 have an important part to play in the = treatment=20 of cancer of the breast. Its influence = on the=20 bones (if the cancer has spread there) = extends=20 the lives of women with this trouble. = Recent=20 research has shown, as has long been = suspected,=20 that adding vitamin D to chemotherapy = for=20 advanced cancer of the prostate also = enables men=20 to live longer. There is every = likelihood that=20 heavy doses of bisphosphonates would = also=20 inhibit the effect of any prostate = tumour spread=20 to the bones.=20

At a recent London meeting, Dr = Richard Keen=20 discussed the use of a bisphosphonate = tablet=20 that is already combined with vitamin = D3.=20 Marketed as Fosavance, it is to all = intents=20 Fosamax Mark 2 and has the advantage = that those=20 taking it will receive both an adequate = intake=20 of vitamin D as well as the = bisphosphonate. This=20 will therefore keep osteoporosis at bay = and=20 reduce the likelihood of fractures.=20

Dr Keen, who works at the metabolic = unit at=20 the Royal National Orthopaedic Hospital = and at=20 University College London, said that = Fosavance=20 is useful in treating and preventing=20 osteoporosis. He is interested in the = origins of=20 osteoporosis in women: 50 per cent of = bone=20 strength in women is laid down in the = two years=20 either side of the time they start their = periods, just the age when a fear of = weight gain=20 makes them subject to a fascination with = dietary=20 fads, many of which dissuade them from = taking=20 calcium-rich dairy produce. Contrary to = a=20 popular myth Fosavance and Fosamax can = be taken=20 by the same patients as those taking = calcium=20 supplements and dairy produce. Food, = mineral=20 waters, some other medication and = calcium should=20 be taken only at least 30 minutes after=20 Fosavance tablets otherwise their = absorption is=20 reduced.=20

One of our correspondents has = e-mailed to ask why taking the = life-saving=20 Lipitor, one of the statins, means that = he is=20 not allowed to have grapefruit in the = morning.=20 It has been one of the minor pleasures = of his=20 life for years.=20 =

As I have fair skin I try to avoid = the sun.=20 Do I need vitamin D?