We carry an article focusing on the management of Vitamin D in Ireland. Authors Dr Mary Flynn, Oonagh Lyons, Megan Thompson, Rossella De Luca and Martyna Sanecka give readers an overview as to how much Vitamin D we really need.

Dr Mary Flynn is a Registered Dietitian (DI 011691) who has worked for many years in public health, clinical nutrition and academia in Ireland, Canada and the Middle East. She currently serves as a member on CORU Council and the Dietitian’s Registration Board. In 2014 she was awarded the inaugural medal for excellence in Public Health Nutrition by the Nutrition Society in the UK. She was appointed as a member of the first Healthy Ireland Council by the Minister for Health in Ireland and has been a Visiting Professor at the Ulster University, Northern Ireland since 2012.

In this follow-on article, we speak to Dr Flynn to learn more about the role pharmacists and their teams can play in ensuring Irish people get enough, but not too much, Vitamin D.

Dr Flynn, we asked you to contribute an educational article about vitamins, minerals, and supplements in Pharmacy News – why did you choose to focus on Vitamin D?

Because it was a great opportunity to update pharmacy staff on the new recommendations where now almost everyone is recommended to take a vitamin D supplement. The only exceptions to these new Department of Health recommendations are infants (aged up to 1 year) who consume more than 300mls of formula a day – and that’s due to the high amounts of vitamin D added to infant formula.

Why were you keen to highlight these recommendations to Pharmacy Staff?

Pharmacy staff are highly regarded in their local communities as experts on medication use and over-the-counter healthcare treatments. The local pharmacy is very often the first-place people go to when feeling unwell and seeking advice that can be trusted.

Supplements are presented in tablet, powder, liquid and droplet form and look like medicines –but they aren’t! Supplements are regulated as food products. As food items, supplements can be sold in any food retail outlet but people often prefer to buy supplements in pharmacies where they can access advice and guidance from pharmacy staff.

Why do pharmacies have such an important role in guiding consumers on supplements?

When it comes to Vitamin D supplements, the recommendations on how much people need every day are quite complex. The amount needed varies according to age, skin type and, for women, if pregnant. So, I was very keen to update pharmacy staff on all of this because of the valuable role they play in guiding people towards the right Vitamin D supplements and on the daily dose that will provide enough but not too much!

Another source of confusion is that many Vitamin D supplements marketed in Ireland are labelled using IU (International Units), which is the North American unit of measurement and is very different from the µg (micrograms) units used in the EU. Department of Health advice is always given using µg.

Note: The Department of Health are finalising a range of resources, which will be available from Hallowe’en and will cover all of these issues (daily µg amounts of vitamin D needed by various groups, etc.).

Why did you want to write about Vitamin D around this time of year?

Right now, we have just entered Vitamin D wintertime in Ireland. Between Hallowe’en and St Patrick’s Day the geographic location of Ireland (52° – 55° North) means we get no Vitamin D from sunlight. Without this most important source of Vitamin D, it’s almost impossible to get enough as food sources (even fortified food) are limited. Therefore, almost everyone needs a Vitamin D supplement at this time of year. Also, wintertime brings lots of viruses. While the pandemic might be over, COVID-19 has not gone away and people are anxious to protect themselves. Labelling on supplement products can bear claims, such as helping to ‘build immunity’ or providing ‘essential nutrients for health’ etc. Such claims can be compelling –especially for those worried about their own health, or that of a loved one. Pharmacy staff can cut through the bewildering amount of information on these overthe-counter products and advise people about the most appropriate Vitamin D supplement (given their age, skin type etc.) recommended by the Department of Health for people living in Ireland.

Can people get too much Vitamin D?

Yes, and the only way people can take excessive levels is through supplements – either by exceeding recommended daily doses, or through use of very high dose Vitamin D supplements. Levels of Vitamin D naturally present in food, or added in the case of fortified foods, are low. Upper Levels have been set internationally to signal the highest cut off levels beyond which excessive supplemental intake can have toxic effects. These Upper Levels are up to 10 times more than people need and vary according to body size e.g., being much lower for small children compared with adults. Because Ireland is part of the EU, there are a wide variety of Vitamin D supplements on the market – some providing much higher doses than is recommended by the Department of Health. So, pharmacy staff have a key role in guiding people on safe and recommended intakes of supplemental Vitamin D. People who need very high daily amounts of Vitamin D are prescribed medicinal vitamin D products and have follow-up monitoring by their physician.

What advice could you give to pharmacists to spot people at risk from Vitamin D deficiency?

People of dark-skinned ethnicity, pregnant women and older adults have higher needs and are advised to take a Vitamin D supplement all year round. Adolescents are another group with high needs due to the period of rapid bone growth and development they are going through.

How does Vitamin D fit in with various other supplements available?

Unlike other supplements, Vitamin D supplements are needed by almost everyone living in Ireland. Along with folic acid for women of child-bearing age, supplements of Vitamin D are the only products recommended by the Department of Health. The need for both of these supplements (vitamin D and folic acid) is based on strong scientific evidence that takes account of the dietary intakes of people of all ages living in Ireland. The need for other supplements varies according to people’s dietary habits or health e.g., dietary habits where certain food groups are avoided, or during recovery from illness where dietary intakes were limited etc.

Finally, what advice on Vitamin D supplements would you give Pharmacy Stores in Ireland?

I would recommend that pharmacy stores:

1. Stock Vitamin D supplements that provide the daily doses recommended by the Department of Health.

2. Stock Vitamin D supplement products that label daily doses in µg (micrograms) units used in the EU and in Department of Health recommendations.

3. Look out for the Department of Health resources on Vitamin D and make this information available to customers near Vitamin D supplements on sale.

4. Avoid stocking supplements that provide excessively high daily doses