United Kingdom

Adding vitamin D to flour would prevent 10million cases of deficiency

Fortifying food with vitamin D would spare 10million people from risk of health problems caused by deficiency in the nutrient, researchers have calculated.

Experts at Birmingham University said mandatory fortification of vitamin D in wheat flour would significantly reduce the burden on the NHS.

The researchers, writing in the European Journal of Clinical Nutrition, calculated the policy would cut vitamin D deficiency rates by a quarter.

Over the next 90 years this would cut the number of people suffering from vitamin D deficiency by 10million - slashing cases of rickets, muscle weakness and even heart failure.

Adding vitamin D to wheat flour would prevent 10 million new cases of vitamin D deficiency in England and Wales over the next 90 years, say researchers at the University of Birmingham

Since 2016 Public Health England has advised people to take a 10micrograms vitamin D supplement in the winter months.

But experts say it is unrealistic to expect people to follow the advice.

Instead, they call for vitamin D to be added to common foods - a policy already used in the USA, Canada, Sweden, Finland and Australia.

As well as saving lives this policy - which would cost just 12p per person per year - would remove a huge burden on the NHS.

It would save the public purse £65million by reducing demand for healthcare and treatment for vitamin D deficiency and its complications.

Vitamin D is known to strengthen the bones and muscles - and emerging evidence suggests it also protects against respiratory infections, boosts cognition and may even cut the chance of dying from cancer.


Levels of vitamin D in the body can be determined via a blood test. The chemical measured in the blood is called 25-hydroxy-vitamin D, and the results are reported in units of nanomoles per litre (nmol/l).

The Department of Health defines low vitamin D as having a level of 25 nmol/l. This figure was set about 20 years ago, at a level above which no risk of rickets could be identified.

However, it is not, and never has been, a diagnostic clinical threshold: dipping below this score does not indicate illness or disease.

Doctors do not know how low levels have to be, or for how long, to cause health problems.

Public Health England recommends we take a daily 10 microgram (written on bottles as µg or mcg) vitamin D supplement in winter. 

This dose was calculated to make sure the vast majority of us achieve a 25 nmol/l blood level. The current number who fall below this level is about one in five.

One in five British adults and one in six children is deficient in the vitamin, thanks to our modern diets, indoor lifestyle and grey weather.

During the spring and summer, the skin makes vitamin D when it is exposed to the sun.

But in the autumn and winter Britain's gloomy weather, and our indoor lifestyles, means most people have to rely on their diet to get enough of the vital vitamin.

They can do that by eating liver, eggs, red meat and plenty of oily fish - but with these foods not as fashionable as they used to be, millions of people are deficient in the vitamin.

Researcher Dr Magda Aguiar said food fortification in Finland has reduced vitamin D deficiency from 13 per cent to 0.6 per cent.

'While both supplements and fortified foods are important sources of vitamin D for the UK population, evidence suggests current UK supplementation polices are not working,' she said.

'Addressing vitamin D deficiency in the UK requires a multi-disciplinary approach and preventing conditions that are the consequence of deficiency would save the NHS money to the extent that it would more than compensate for the money needed to implement flour fortification at a national level.

'We now hope that UK policy makers will consider a new national policy to fortify foods such as wheat flour with vitamin D to address this serious health issue. This will lead to significant benefits for the population, particularly the most vulnerable groups.' 

Fellow researcher Professor Emma Frew said: 'We have provided compelling evidence that a new strategy is not only safe but would also improve vitamin D intake, which in turn would enhance the health of millions in England and Wales.

'Most previous research into strategies to improve population vitamin D intake have focused only on supplementation programmes, which are generally expensive and not sustainable in the long term.

'Our study showed that, even though supplements are still a viable option for those at a higher risk, food fortification strategies should be prioritized as a response to the rising prevalence of vitamin D deficiency, as it is a safe and cost-saving option.' 

The Government has long been reluctant to fortify food, but in June - in a move which suggested a change in approach - announced plans to put folic acid in flour, after a decade of pressure from scientists and campaigners.

A Department of Health source said there was no plan to fortify flour with vitamin D.


Poor lifestyles are causing a surge of diseases linked to the Victorian era in the UK, experts warned in March 2017.

A fall in living standards and growing financial inequality are thought to be behind a rise in cases of rickets, gout, syphilis and scarlet fever.


Rickets was made famous by Tiny Tim in Charles Dickens' A Christmas Carol

Rickets, made famous by Tiny Tim in Charles Dickens' A Christmas Carol, has increased by 39 per cent between 2009 and 2010.

The disease, which can be caused by a vitamin D deficiency, leaves sufferers with brittle bones and skeletal deformities.

Despite being common in 19th century Britain, it was all but wiped out due to ongoing improvements in nutrition.

It is thought that a fear of contracting skin cancer could be making parents overly cautious about sun exposure, putting youngsters at risk of the condition.

As well as sun exposure, vitamin D can obtained by eating foods such as oily fish, egg yolks and liver.

In January 2017, a think-tank warned rising inflation means poor families are unable to afford nutritious foods to prevent the onslaught of the disease.


Cases of gout increased by 41 per cent between 2009 and 10, from 6,908 to 9,708, The Sun reports.

The form of arthritis, caused by a build-up of uric acid, a waste product of the body, famously afflicted Henry VIII and was rife in the Victorian era.

An 'obesity epidemic' and ageing population is behind the rise in gout in recent times, according to the UK Gout Society.


The rising numbers of people having unprotected sex has been blamed for an increase in syphilis.

Once a death sentence, the vast majority of those infected today are curable via penicillin injections.

Figures for the sexually transmitted infection have nearly doubled in the past eight years, from 2,646 to 5,217, according to Public Health England.

Scarlet fever, which causes a rash, jumped by 198 per cent in a year (stock)

Scarlet fever 

Cases of scarlet fever also jumped by 198 per cent between 2009 and 2010, data shows.

The highly contagious disease causes a sore throat, fever and rash, which can occasionally lead to pneumonia if not treated promptly.

Although fatal in the Victorian era, the disease is restricted to no more than unpleasant symptoms if treated early.

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