Volume 199 - Issue 6
Vitamin D and health in adults in Australia and New Zealand
Author: Bettina Douglas
Med J Aust 2013; 199 (6): 394. || doi: 10.5694/mja12.11635
Published online: 16 September 2013
Published online: 16 September 2013
Vitamin D3 in oral supplements is derived from animal sources, so it is important to address this when recommending vitamin D supplementation to a person who adheres to a vegetarian diet.
To the Editor: Vitamin D currently receives considerable attention in the literature.1,2 A recent MJA Open supplement on nutrition and the vegetarian diet identified vitamin D as one of the few nutrients that may not be adequately supplied by a mainly plant-based lacto-ovo-vegetarian diet.3 Although the main source of vitamin D is from skin exposure to sunlight, this suggests particular challenges in treating people with vitamin D deficiency who adhere to a vegan or vegetarian diet. Oral vitamin D supplementation is recommended to treat moderate to severe deficiency and for people in high-risk groups.1
Prescribers may not be aware that cholecalciferol in supplements is derived from animal sources, through ultraviolet irradiation of 7-dehydrocholesterol from lanolin obtained from sheep.4 Committed vegetarians are likely aware of this, and supporting information is readily available on the internet. An informal survey of oral cholecalciferol products on pharmacy and health store shelves found that some claimed to be gluten-free or halal but none stated they were vegetarian or vegan. Anecdotally, this is a barrier to the uptake of vitamin D supplementation by vegetarians.
It is important to address this when recommending vitamin D supplementation to a vegetarian. Optimising safe sun exposure and exploring dietary sources of vitamin D in line with an individual’s beliefs and values will facilitate development of an acceptable treatment plan and improve the likelihood of adherence.5
With the recognition of the importance of healthy levels of vitamin D and the reported growth in people choosing to follow a more plant-based diet,6 the wider availability of vegetarian-friendly oral vitamin D supplements in Australia should be a priority.
Competing interests
No relevant disclosures.
References
- Nowson CA, McGrath JJ, Ebeling PR, et al; Working Group of Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia and Osteoporosis Australia. Vitamin D and health in adults in Australia and New Zealand: a position statement. Med J Aust 2012; 196: 686-687. 0_CHDGHGID
- Rosen CJ, Adams JS, Bikle DD, et al. The nonskeletal effects of vitamin D: an Endocrine Society scientific statement. Endocr Rev 2012; 33: 456-492. 0_i1142872
- Reid MA, Marsh KA, Zeuschner CL, et al. Meeting the nutrient reference values on a vegetarian diet. MJA Open 2012; 1 Suppl 2: 33-40. 0_i1142874
- Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281. 0_i1142877
- National Prescribing Service. Competencies required to prescribe medicines: putting quality use of medicines into practice. Sydney: NPS, 2012. http://www.nps.org.au/health-professionals/professional-development/prescribing-competencies-framework (accessed Aug 2013).
- Stanton RA. A plant-based diet — good for us and for the planet [editorial]. MJA Open 2012; 1 Suppl 2: 5-6. 0_CBBGHCJG