Doctor Q&A: Am I taking too much vitamin D? Doctor Renée answers your burning health questions

Hey, Doc, I am very chesty every morning and always feel the need to bring up phlegm. What might this be? It's odd. I don't have any other signs of an infection. Any clarification would be welcomed

Not so odd for me as this is something I see in GP all of the time. It’s a really common issue and often is accompanied by a cough, worse in the morning, or constant clearing of the throat first thing.

There are a few conditions which can cause this and I will start from most common to least.

Postnasal drip

The mucus from the nasal passages drips down the back of the throat. This can be triggered by allergies or infection, and as you lose voluntary muscle control when you sleep, this allows a build-up of mucus that you have to clear when you wake.

Gastroesophageal Reflux Disease (GORD)

When stomach acid flows back into the oesophagus and rises high enough at night (due to lying down) it irritates the throat and causes the production of excess mucus

Asthma People with asthma can experience more symptoms during the evening hours, leading to increased inflammation and airway mucus production which then builds up overnight.

Smoking and Environmental Irritants Smoking and environmental irritants can make morning phlegm worse. Smoking produces thicker mucus and increases its production in your airways and as smoking kills the small hairs that line your airways and move constantly to clear pollutants this allows mucus to build. Outdoor elements like dry air quality and pollutants can also contribute to morning phlegm.

Now in terms of what you can do, there are several simple remedies at home which may help.

Hydration - Ensuring adequate hydration during the day can help thin mucus and so prevent nighttime build-up.

Elevate your head - adjust your head during your sleeping position by elevating the bed head or by sleeping on several pillows can help prevent both postnasal drip and acid reflux.

Take allergy prevention measures - try a simple antihistamine at bedtime and put your mattress, duvet and pillows inside anti-allergy bedding.

As a GP, when trying to treat this I often suggest a steroid nasal spray to calm down the mucus membranes which when irritated ooze! This often works well and you can either buy a hay fever steroid nasal spray over the counter or ask your GP to trial mometasone which has the lowest systemic absorption. Do google how to use a steroid nasal spray because if you don’t do it correctly, it won’t work. Combine this with hydration and hopefully you will cough no more!

Hey doctor, do you think the recommended daily doses for vitamin D from the Department of Health and Social Care are sufficient? I take probably five times the recommended amount of vitamin D and I haven't encountered any problems. Thank you

It is very difficult to say that the UK RDA is anything but safe. Being sufficient is a very individual thing and it varies so much from person to person.

Vitamin D is not naturally found in many foods, but you can get it from fatty fish such as herrings, salmon, mackerel and sardines (with the bones). Additionally, your body makes vitamin D when exposed to direct sunlight. However, in the Northern Hemisphere, we don’t get enough sunlight to make adequate amounts, and the darker your skin, the poorer your ability to make it. Our diets don’t, as a rule, offer enough, and if you are obese, your levels will be lower (66 per cent of UK adults are overweight or obese).

Vitamin D is implicated in many disease processes and can keep the following at bay:

Infections - people with low vitamin D seem less able to fight off common and more serious infections.

Cancer - more studies are needed to determine whether vitamin D supplementation reduces the risk of certain cancers.

Cognitive health - low levels of vitamin D in the blood have been associated with cognitive decline.

Psoriasis/eczema - oral vitamin D or a cream that contains calcipotriene to the skin can treat plaque-type psoriasis/eczema in some people.

Inherited bone disorders - vitamin D supplements can be used to help treat inherited disorders resulting from an inability to absorb or process vitamin D.

Multiple sclerosis - long-term vitamin D supplementation has been shown to reduce the risk of multiple sclerosis.

Osteoporosis - adequate vitamin D and calcium in diets can slow bone mineral loss, help prevent osteoporosis and thus reduce bone fractures.

In the UK, 400IU is the recommended doses of vitamin D daily for everyone over the age of one. This is, however, lower than many equivalent countries, so the questions to be answered are: what is the maximum dose and what harm can be done if you overdose?

Children nine and over, adults and pregnant/breastfeeding women who take more than 4,000 IU a day of vitamin D might experience:

• Nausea and vomiting
• Weakness
• Confusion
• Poor appetite/weight loss
• Constipation
• Heart arrhythmia
• Kidney stones and kidney damage

In summary, the UK recommended dose may be adequate for some but not for others and the only way to know is to do a blood test. The problem is that routine vitamin D testing in the NHS is now not supported and many GPs can’t do it.

My advice to maximise absorption and increase the readiness of your body to absorb your supplementation is to take your vitamin D as a combination with K2 and have it as a spray for sublingual (under the tongue) administration. I do it this way, and I use BetterYou sublingual spray.

Hey Dr Renee, this one is one is for my daughter. She's 13 and is starting to get really bad acne. It's purple in colour. It gives her a lot of pain and she feels very self-conscious. We have tried antibiotics but it doesn't seem to be clearing up. What would you recommend? Your help is much appreciated. Thank you

Oh my goodness, this is a question close to my heart. As a GP I see acne often and I am so sad to say that GPs often don’t take it seriously enough because they underestimate the stigma and lifetime effect of scarring. So, my approach is always swift and I have very clear lines as to what to do and that line is drawn by whether the acne is scarring or not.

Let’s assume your daughter’s acne, even if purple, is not leaving a permanent scar when each lesion heals. If this is the case then things can be quite straightforward in terms of treatment and there is a ladder to follow. So, I always start with a combination of benzoyl peroxide and an antibiotic, brand name Duac, which is applied once at night and can work brilliantly on its own. If this is working but not completely or not working well at all, then I add a topical retinoid. This, too, is applied at night (pregnancy must be avoided). Thereafter, if the spots are still coming, it’s time to think about a daily anti-biotic, usually tetracycline, and I like lymecycline because it only needs to be taken once a day. We usually recommend trying an antibiotic for three months to see it is going to work and after that trying another. Hopefully that sorts things out, but if it doesn’t…

This is where my second line is. If your daughter’s lesions are scarring, there is no time to waste. I know only too well from my years owning a skin clinic that treating scars once they have arrived is much harder than stopping them in the first place and the latter should always be the aim of a good GP. So, if you have scars you need an urgent referral to dermatology for consideration of Roaccutane. Roaccutane is an oral form of retinoid and it works. You may read scary things about Roaccutane online and I want to put some balance to that. When Roaccutane was first used the dose used was much higher than now and there appeared to be an association with low mood and rarely suicide. Firstly, it is important to remember that acne can cause low mood, especially in young people just finding their way in the social world and it is difficult to untangle the two. Secondly, the dose is now much lower and these reports have lessened. The thing I would say is that acne when hard to treat is stigmatising and depressing and causes incredible distress in teenagers, so if all of the above fails or scarring is present, I would go for Roaccutane and you know I am a doctor that avoids medication unless absolutely necessary and this is one of those times.

While waiting for an appointment with a dermatologist, continue with the creams/antibiotics as prescribed.

Additionally, there are some home remedies that make claims for acne and these include aloe vera, apple cider vinegar, tea tree oil, zinc and even turmeric. It’s difficult to find any convincing evidence but there is an article here that discusses them.

You do also need to consider product ingredients as some are more prone to cause acne than others. These are called comedogenic products and in my YouTube vlog here I include a link to a product checker.

Good luck.