UK's Vitamin D Advice Puts Black People at Risk – and the Government Knows It

The UK government must urgently overhaul its winter vitamin D guidelines, experts say. The calls come as VICE World News reveals that the current recommendations are failing to protect ethnic minority communities and could result in an “unsuccessful national public health policy”, according to research by the government’s own experts.

The guidelines could make health inequalities worse, according to the research. The revelations come as evidence mounts that vitamin D may play a crucial role in helping the body fight off viral infections, including COVID-19.

The current UK vitamin D guidelines are the same for everyone and don’t take ethnic differences into account. The Scientific Advisory Committee on Nutrition (SACN), which advises Public Health England (PHE) and other UK government organisations, says everyone should take a daily 10 microgramme (mcg) supplement of vitamin D between October and March to avoid becoming deficient.

During the pandemic, the government extended that advice to cover periods of lockdown. Vitamin D is largely derived from sunshine hitting the skin between March and September, but people with darker skin synthesise it at a slower rate so their stocks tend to be lower. 

Experts say the additional needs of Britain’s Black, Asian and minority ethnic (BAME) communities are not reflected in the official guidelines, which were laid down in 2016.

Professor Mairead Kiely – who joined SACN in 2019 – wrote in a joint paper published in November 2017 in the Proceedings of the Nutrition Society, urging public health campaigns to ditch their “one-guideline-suits-all approach” or risk making existing health inequalities worse. Despite this, SACN currently still adopts this approach, which Prof. Kiely herself warned would result in an “unsuccessful national public health policy”. 

“Health authorities must now readdress vitamin D requirements among both pregnant women and individuals of ethnic minority in order to overcome the global inequities in vitamin D status and subsequent perinatal outcomes,” she wrote in 2017.

“Outreach strategies must be culturally tailored and population-focused, while avoiding marginalisation.”

Kiely has also made similar arguments more recently. In 2018, she was part of an EU-funded study group known as ODIN, along with fellow University College Cork colleague Professor Kevin Cashman – one of the architects of the UK guidelines – and SACN member Professor Susan Lanham-New of Surrey University.

They found that Somali women living in Finland needed at least 18 mcg of vitamin D daily during the winter months to avoid deficiency, but white women only needed 8 mcg.

The report by Kiely and Cashman warned: “Current vitamin D recommendations have been established based on an assumption that there are no differences between Caucasian and other ethnic/racial groups in terms of vitamin D requirements. 

“The present study adds further evidence that ethnic differences in the dietary requirement for vitamin D do exist.” 

Their findings built on those of Umeå University in Sweden study which concluded in 2017 that a winter intake of 10 mcg would help white children avoid deficiency – but not Black youngsters. 

Even further back, in 2013, US researchers found Black women needed twice as much vitamin D as white women to reach healthy levels.

Yet despite the growing catalogue of evidence, SACN insists on maintaining the status quo.

On average, people in the UK consume around 3 mcg of vitamin D daily through their food. Based on the ODIN findings, taking a 10 mcg supplement in line with SACN guidance would ensure white people get what they need in the winter (8 mcg daily) but leave those with darker skin well short (18 mcg daily).

Official figures from the first wave of the pandemic showed that Black men were three times more likely to die from COVID-19 than white men, while other research found that people of south Asian heritage are most likely to die from the virus in hospital.

BAME people with darker skin have been hit hardest along with other groups in society who tend to have low vitamin D levels, including the elderly and people with obesity. 

Many of the deaths are caused by “cytokine storm” – a frenzied immune response that damages major organs – but vitamin D has been shown to help regulate the body’s reaction as well as protect against respiratory infection in the first place.

There are now calls for the UK government’s vitamin D guidelines to be urgently overhauled. Labour MP Dr Rupa Huq argues that vitamin D deficiency is a problem for all ethnicities, but the government needs to provide public health information that allows people to be more aware of their own individual needs.

She said: “I first became aware of the vitamin D issue when the first Public Health England reports came out showing the BAME people dying of coronavirus at a disproportionate rate as dark skin is a barrier to absorption so that population is deficient.

“But the more I scratched beneath the surface it seems most Brits are lacking in it all year round what with our climate – a fact likely to be worsened when many have been indoors for most of the year. 

“The wave of recent studies showing its mitigation properties means it’s a low-cost, zero-risk no-brainer. The government needs to be much more explicit [about the message].”

Dr Richard Quinton, senior lecturer in endocrinology at Newcastle University, said: “SACN's guidance for everyone to take a daily supplement is admirable in the clarity and simplicity of its message. 

“However, no resources have been deployed to get it through to the public.

“Also, this level of supplementation is almost certainly inadequate for ethnic minorities with darker skins.

“NHS England has instructed that GPs should not routinely prescribe maintenance vitamin D treatment even to patients at high risk of deficiency, or who have previously been proven to be deficient.

“Apart from growing scientific concerns about the role vitamin D deficiency plays in respiratory infections such as TB, influenza and COVID-19, this public health failure results in thousands of children developing rickets each year, which is a national scandal.”

Prof. Kiely told VICE World News that SACN employs a rigorous approach to sifting evidence so that it may take two years for research findings to become policy and no change to dosages was recommended by the most recent review in December.

She also pointed out that SACN recommended that those with darker skin take a daily supplement all year round, not just during the autumn and winter – though the government has since recommended all Britons do so during lockdown. 

When asked why the committee has not changed its advice despite her warning four years ago, she said: “The framework of evidence is key in terms of hierarchy and quality of data. Opinion pieces are not considered.  

“I think the message is loud and clear; everyone in the UK should take 10 mcg/day of vitamin D.

“Taking this dose every single day will bring 97.5 per cent of the population above 25 nmol/L, which is the threshold for protection of bone and now potentially respiratory infection.

“Above this threshold, protection against respiratory infection is not clear.”

She continued: “This dose will bring a sizeable proportion of the population above 50 nmol/L where there are associations with health benefits [but] association is not causation or protection, which is why 50 nmol/L is not the population threshold. 

“This is where we are until there is more and stronger evidence. The UK has acted swiftly in 2020 using all of the available evidence. Further trials and prospective studies will be published in 2021.”

A Public Health England spokesperson said: “Existing advice highlights that people who have dark skin, for example with an African, African-Caribbean or south Asian background, may not get enough vitamin D from sunlight and it is recommended that they consider taking a daily supplement containing 10 microgrammes of vitamin D throughout the year.”