Health Are you getting enough vitamin D? Its known as the sunshine vitamin and is essential for healthy bones and muscles. Heres how to get enough of this nutrient when sunshines in short supply WORDS: GEORGINA WINTERSGILL V itamin D is best known as a bone-health hero, helping the body absorb calcium and phosphate to keep bones and muscles strong. If you dont have enough, your bones can soften. In children, this can lead to rickets, and in adults it can lead to osteomalacia and a higher risk of falls. Bone health is clearly important for everyone, but is it particularly important for people with arthritis? Dr Christine Haseler, a GP with a special interest in arthritis, says: The risk with arthritis is that you may not be mobile, so youre less likely to be spending long periods of time outdoors and topping up your vitamin D levels in the sun. Vitamin D is essential for bone health. With osteoarthritis, especially as you get older, you may be more likely to be frail and prone to falling. If your bone health isnt good and you fall and fracture your hip, thats very serious. If youve had inflammatory arthritis throughout your life and if it has been persistent you may have had times without weight-bearing exercise. You may also have been on steroids, and both can lead to thinner bones and osteoporosis. Preventing thinning of the bones means you have some protection if you get into difficulty. Vitamin D is essential to help prevent thinning of the bones, especially where they have a higher risk from a longterm condition such as a type of inflammatory arthritis. As well as its role in bone health, vitamin D may have anti-inflammatory effects. Dr Sarah Schenker, a dietitian and author of the British Dietetic Associations food factsheet on arthritis, says: Vitamin D seems to have a role in reducing inflammation and keeping the immune system healthy, making it an important nutrient for different types of arthritis. People with rheumatoid arthritis (RA) may be more likely than others to be deficient in vitamin D. In 2018, an Indian study found that 84 per cent of participants with RA had a vitamin D deficiency, compared with 34 per cent of participants without RA. Researchers concluded that vitamin D deficiency may be one of the causes of the development or worsening of RA. Hello sunshine So how do we get vitamin D? The main source is sunlight our bodies create vitamin D when bare skin is exposed to ultraviolet B rays. During spring and summer, most peoples bodies can make all the vitamin D they need from a balanced diet and being out in the sun for short periods every day, without sunscreen and with some skin uncovered. The ideal amount of time to spend outside isnt known, as it varies between people and depends on how much sunshine is available, but be careful not to burn. Dr Haseler recommends combining sun exposure with exercise. For bone health, the best activity is walking, with as many aids as you require, she says. Its weight bearing, it gets your joints moving, it exposes you to sun, and it can be done at various levels of disability. Local councils often run walking for health groups, which are adapted for any level. Gardening is good, too. It keeps you active, it gets you outside, and it has the added benefit that youre more likely to go outside if you have an inviting environment. The right level Around 27 per cent of adults have inadequate vitamin D levels, according to 2018 research by digital healthcare company Forth. People over the age of 65 are known to be at higher risk, as older skin is less efficient at making vitamin D. Certain other groups are at higher risk, too. These include people who have little or no exposure to the sun, either because they spend much of their time indoors or because they cover their skin when they go out. This can sometimes be for cultural or religious reasons. People with dark skin from African, Afro-Caribbean and south Asian backgrounds are also at higher risk, as darker skin doesnt absorb sunlight as well as lighter skin. During autumn and winter (from October to early March), the Department of Health recommends that everyone over the age of five consider a daily supplement containing 10mcg of vitamin D. Those at higher risk should consider a supplement throughout the year. A wide variety of supplements containing vitamin D are available from chemists and supermarkets. Look for vitamin D3, which is the same form of the vitamin that the body makes from sunlight, and is generally absorbed better than vitamin D2. Fish oil, such as cod liver oil, can be an appropriate alternative source of vitamin D and may have other benefits for arthritis, too. A 2018 study at the University of Surrey found that a daily dose led to pain reduction in people with osteoarthritis. Dr Schenker says: The omega 3 fatty acids in fish oil are thought to help reduce inflammatory substances in the body. However, fish oil can sometimes be high in vitamin A, so make sure youre not taking in too much vitamin A, or vitamin D, from other supplements. If youre not at higher risk and choose not to take a supplement during spring and summer, ensure you maintain adequate vitamin D levels through sunshine and vitamin D-rich foods. Dr Haseler recommends doing this even if you take a supplement throughout the year. The word supplement means its in addition to a healthy lifestyle, she says. And, of course, there are lots of other benefits from sunshine and a varied diet. GO FISH Vitamin D is found naturally in certain foods, including oily fish (such as salmon, sardines, pilchards, trout, herring, kippers, mackerel and tuna), red meat, beef liver, egg yolks and mushrooms. Other foods are fortified with vitamin D, including fat spreads, some breakfast cereals, and some non-dairy milk alternatives. You can also buy mushrooms with enhanced vitamin D, as the growers have exposed them to ultraviolet light. Unfortunately, its difficult to get enough vitamin D from food and, during autumn and winter, there simply isnt enough sunlight. Even during spring and summer, there may not be enough sunlight for example, if its very cloudy or the atmosphere is polluted.