2. If you could go back to when you were a student and give yourself one piece of advice, what would it be?

I still think of myself as a student. We never stop learning. We are in this life for such a short amount of time, so my advice is to be the best you can be and don’t worry about what anybody else is doing. Stay in your lane and don’t worry about the person who is about to overtake you, or who is behind you. I spent so many years on the running track, so I always think of things as a runner. If you take something and don’t pass it, it does not matter. I am the queen of retakes. It just means you know it so much better the second time. Be confident in yourself and if you don’t know, just ask. You want to make a difference in what you do. My final point would be that when opportunities come your way, take them.

 3. What led to your interest in nutrition, and specifically your research interest in bone health and vitamin D?

Last year I won the British Nutrition Foundation Award which is awarded to one scientist, and because of this I really reflected back as to how I came to love nutrition. There were three things that I did when I was younger that influenced this. Firstly, I started off in Epsom and trained with some of the best equestrian people, where I learnt so much especially about the nutrition of horses. Secondly, I was a Wimbledon ball girl and our coach taught us how nutrition was key in athletic training. I thereafter moved away from horse riding and focussed on athletics and was selected for the World Student Cross Country Championship. Because of this, I watched a renowned trainer at Crystal Palace train his athletes and saw his emphasis on nutrition. These three experiences instilled nutrition into my mind. 

Having done a Masters in Human Nutrition, and realising that a lot of people did not think that nutritional science was a science in itself, I felt I could make more of a small contribution to life as a nutritionist than a sport and exercise scientist. 

I then worked with a rheumatology and bone biologist, and I was very interested in stress fractures and that’s where my interest in bone health stemmed from. We did a very good piece of research on a big cohort of Aberdeen women, and we found a link between a high fruit and vegetables intake and better bone health, which received a lot of exposure. I was able to ride off that and write grants and do research in acid-base homeostasis, but eventually it became very hard to get funding. I switched to vitamin D as I saw grants were available, and I contacted the best lab in the world for measuring vitamin D to ask if they would be on board for a grant. From there it snowballed, and that is where I am still today doing research in the field. 

4. You have been involved in many research projects throughout your career. Are there any projects that you feel were the most instrumental within the development of your career?

I did my PhD off a very small budget and found fascinating results around acid-base homeostasis and bone health. In 1997, we published the paper in the American Journal of Clinical Nutrition with a very boring title called ‘Nutritional influences on bone mineral density in post-menopausal women’ which wasn’t able to capture people’s attention. Later, in 1999 the Framingham Group published in the same journal a similar study but in an older cohort, and because it had a more captivating title it got more interest. I learnt from this and in the American Journal of Clinical Nutrition 2000 millennium issue we put ‘fruit and vegetable’ in the title which made all the difference. Although it was not a very strong study as it was cross-sectional, it caught people’s attention and from this experience I learnt a lot. On the vitamin D front, I managed to get a funding on the D-FINES project (Vitamin D, Food Intake, Nutrition and Exposure to Sunlight in Southern England). We also got funding for the D2-D3 study which challenged the idea that they are the same. These three studies were very instrumental in the development of my career.  

5. It is well documented that the UK population has low levels of vitamin D, especially during winter months. What are the implications of a low vitamin D status and what simple strategies can individuals apply in their daily lives to combat this?

Having looked at the literature and data working with SACN, there is an awful amount of controversy for what is the cut-off for vitamin D deficiency. But certainly, we know that a very significant percentage of the population are below 25nmol/L which we do not want. The jury is still out with the ramification of low vitamin D affecting the risk of infection and upper respiratory tract infections, but it certainly has an effect on rickets and osteomalacia risk. Many adults have mild osteomalacia and do not realise it. Without a doubt, we need to shift the population to be above 25nmol/L to decrease these risks. Simple strategies for improving vitamin D status include safe sunlight exposure, dietary intake of fortified foods, and dietary intake of vitamin D-rich foods. Vitamin D supplements should be taken by pregnant women and population groups at increased risk of vitamin D deficiency such as those with dark skin, people confined indoors and those who habitually cover their skin while outside. 

6. Studies have shown that ethnic minorities, specifically western dwelling South Asian populations, have a lower vitamin D status. Are there particular reasons for this and do you have thoughts on specific strategies for improving vitamin D status within these population groups?    

We have done a lot of our own analyses as this is becoming more and more relevant, especially in the South Asian population who are very deficient. I think it is a culmination of many different things; for one it is the lifestyle of not going out and getting as much sun exposure as white European populations, being covered up by clothing which inhibits vitamin D production, and having darker skin, but we have also found that these populations tend to eat less vitamin D. Vitamin D supplementation should be taken across the board in these populations. 

7. You recently published a report in BMJ Nutrition, Prevention & Health about the role of Vitamin D and COVID-19. What are some of the key messages from this paper?

I did this report in the first couple of weeks during lockdown, as I saw so much on the internet about vitamin D and it being ‘the magic bullet’ to prevent you from getting COVID-19. This is bad science. I got twenty other authors to join me, and the aim of the report was to show where the evidence is now with vitamin D. We showed ways on improving vitamin D status for example safe sunlight exposure, dietary intake of fortified foods, and dietary intake of vitamin D-rich foods. If you are self-isolating and not getting out, then you should be on a supplement looking at the government’s recommendation of 400IU (10µg) of vitamin D. As it stands, we do not want anyone in the UK population to be vitamin D deficient, but it is not a COVID-19 risk strategy because the evidence is not there. 

8. It is clear that there is a need for more studies carried out in the field of vitamin D in relation to the SARS-CoV-2 virus. What types of studies, in your opinion, would be needed to strengthen the evidence base within this topic?

A randomised control trial, supplementing with vitamin D,  to see if we can find differences between the incidence of COVID-19, however this can be ethically difficult and therefore challenging. I think we should take blood samples to routinely record the vitamin D status of every patient with COVID-19 and we could at least look at markers of immune function or upper respiratory tract infection and do a case control study.