UK doctors warn of ‘resurgence’ in rickets

The cold winter months (many of us will be experiencing these right now�) bring with them a risk of vitamin D deficiency ” something which I have written about before (see article from 29th November 2006 pasted below). Low levels of vitamin D may predispose to a variety of conditions including seasonal affective disorder (winter depression), cancer and an increased risk of infection. However, before the sustained interest in vitamin D that we have seen over the last few years, vitamin d was really only famous for one thing: its role in the building of healthy bones.

Vitamin D assists the absorption of calcium from the gut, and also assists its retention in the body through an effect on the kidneys. Low levels of vitamin D can therefore lead to calcium deficiency in the body, which can obviously have a negative impact on bone formation. In adults, vitamin D deficiency in the condition osteoporosis. However, in children, vitamin D deficiency can lead to the condition rickets, which is characterised by weakened bones that are prone to deformity and fracture.

Here in the UK, there is a view that while rickets was thought to have been eradicated through improved nutrition, the condition is now experiencing a bit of a resurgence. Doctors in the UK are now warning that some women do not have sufficiently high levels of vitamin D during pregnancy to promote healthy bone formation in their unborn child. As a result that child is a risk of developing rickets.

One reason for the upsurge in rates of rickets concerns the migration of individuals of Asia, Afro-Caribbean and Middle Eastern decent to the UK. The action of sunlight on the skin makes vitamin D, but the darker someone’s skin, the more sunlight is required to make a given amount of vitamin D. Also, some individuals may wear clothes that do not allow much skin exposure to the sun, which further ups their risk of vitamin D deficiency.

There is yet another risk factor for vitamin D deficiency that is related to latitude. I read today at latitudes of 52 degrees north (above Birmingham in the UK), there is no sunlight of the appropriate wavelength necessary for making vitamin D in the skin during the winter months. If this is true, then individuals living above this latitude are clearly as special risk of vitamin D deficiency during the winter.

In the UK, the Government has recently announced its ‘Healthy Start’ programme, which is designed to offer support to the most vulnerable individuals. Among other things, this scheme provides free nutritional supplements to those deemed to be in need.

Bearing in mind the growing evidence base for the benefits of vitamin D on health and wellbeing, there is good reason to imagine that the issue of low vitamin D levels in certain populations and in children may have very broad implications. This most recent story regarding rickets once again should remind us that vitamin D deficiency is a real phenomenon, and one that can generally be averted using relatively simple and cheap strategies.


How vitamin D deficiency in winter poses hazards for our health (and what to do about it) – 29 November 2006

The contracted days and climatic changes that come at this time of year can us not only cold, but short on sunlight too. Getting adequate exposure to the sun’s rays is important for maintaining mood, and it’s action on the skin is also the main way the body meets its needs for vitamin D ” a nutrient which research has shown to have a range of benefits for the body and brain. Studies show that the winter months can leave us low in vitamin D. So, what are the consequences of vitamin D deficiency, and what can we do to ensure we remain topped up with this important nutrient throughout the winter?

Vitamin D is perhaps best known for its role in the manufacture of healthy bone. However, evidence that has been amassing over the last few years has found that vitamin D has the ability to reduce the risk of the development and spread of cancerous tumours. No surprise then that studies show that increased sunlight exposure is associated with a decreased risk of several forms of cancer, including those of the breast, prostate and colon.

What is perhaps even less well known is that vitamin D seems to have an influence on the wellbeing of not just the body, but the brain also. Published research shows that this nutrient actually has the potential to combat seasonal affective disorder (SAD) “sometimes referred to as the ‘winter blues’ or ‘winter depression’. In one study, just five days of treatment with vitamin D (at a dose of 400 or 800 IU per day) was found to improve winter mood [1]. Further evidence for the potential for vitamin D to alleviate SAD came from research in which individuals were treated with either 600 or 4000 IU of vitamin D each day for at least six months. Both dosages of vitamin D led to improvements in the participants’ mood and general well-being, with those on the higher dose of vitamin D benefiting the most [2]. This link between vitamin D and mood helps to explain, at least in part, the biochemical basis for SAD.

Bearing in mind its importance for mental and physical health and wellbeing, it makes sense to ensure that our bodies get enough vitamin D throughout the winter months. Seeing as most of our needs for this nutrient generally come from the action of sunlight on our skin, then it helps for us to get out more. This is an issue in the winter, of course, as we are less likely to venture out when the weather is inclement. Wrapping up to protect ourselves from the elements and the shortened days obviously compound the problem. So, whenever possible, it helps to get out more, particularly on bright days. Taking a walk for half and hour or more at lunchtime, for instance, can do much to stimulate vitamin D production in the body.

Apart from sunlight, the other major source of vitamin D is our diet. ‘Oily’ fish such as salmon, mackerel and sardine are rich in vitamin D, and including at least 2 or 3 portions of these in the diet each week will help. Another option for those looking for a convenient food course of vitamin D is cod liver oil ” which contains up to about 500 international units (IUs) of vitamin D per teaspoon. Please check the labels as the vitamin D level in cod liver oil is highly variable from brand to brand.

Cod liver oil, like other fish oils, is also rich in so-called omega-3 fats. These come in two main forms: docosohexaenoic acid (DHA) and eicosapentaenoic acid (EPA). A high consumption of these fats has been linked with a reduced risk of ‘cardiovascular’ conditions such as heart attack and stroke. Omega-3 fats have a natural anti-inflammatory effect in the body, and there is some thought that this biochemical benefit may be part of the explanation for why cod liver oil can provide relief from conditions like osteoarthritis and rheumatoid arthritis. And like vitamin D, these fats also have benefits for the brain. DHA appears to be important for the structural integrity of the brain, while EPA seems to have a more important role in the day-to-day running of the brain. Omega-3 fats show promise in the prevention and/or treatment of many mental ailments including depression and dementia [3].

To get useful levels of vitamin D and omega-3 fats from cod liver oil one needs to take in the region of 1 ” 2 teaspoons (5 – 10 mls) a day throughout the winter. It is generally uneconomical to do that with capsules containing, say, half or one ml of cod liver oil. For this reason, the most cost effective approach is to take cod liver oil off the spoon. One obvious barrier to this is taste. Fortunately, cod liver oils that have been naturally flavoured (often with lemon or orange) are now available and represent a practical option for those who simply don’t like the taste of cod liver oil and may even have positive aversion to it as a result of being force-fed it in childhood. Because of its rich stash of vitamin D and other nutrients, cod liver oil is one supplement well worth considering for individuals keen to preserve their physical and mental wellbeing throughout the winter months.

Note:
Cod liver oil also contains vitamin A ” which has been linked with an increased risk of birth defects. Pregnant women or women who may become pregnant are advised not to consume more than 10,000 IU of vitamin A per day in supplement form. This equates to about 2 teaspoons of cod liver oil per day.

References:

1. Lansdowne AT, et al Vitamin D3 enhances mood in healthy subjects during winter.
Psychopharmacology (Berl). 1998;135(4):319-23.

2. Vieth R, et al. Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutrition Journal 2004;3:8 [http://www.nutritionj.com/content/3/1/8]

3. Schaefer EJ , et al. Plasma Phosphatidylcholine Docosahexaenoic Acid Content and Risk of Dementia and Alzheimer Disease: The Framingham Heart Study
Archives of Neuroogy. 2006;63:1545-1550

4 Responses to UK doctors warn of ‘resurgence’ in rickets

  1. Chris Highcock 28 December 2007 at 8:43 pm #

    Dr Biffa

    Do you think there is any relation between this worry over Vitamin D deficiency and the prevalence of low fat diets. If Vit D is fat soluble and we are not getting enough fat, is that likely to contribute to low levels of vit D?

    Chris

  2. Tiggy 29 December 2007 at 12:43 am #

    So has anyone tested to see if people living north of Birmingham have low levels of Vitamin D in the winter? Is this why they eat more chip butties up there? :-) Surely differences would have been perceived by now?

    I’m thinking of buying a light box, but what I want to know is, is it any different to the light from my Philips UV facial lamp? I know the light boxes cut out the UV rays, but I’m quite willing to put up with those and at a reasonable distance, and on a low setting, it would be okay for my eyes. I don’t think I get enough UV rays either as my skin type is Middle Eastern.

  3. Cindy Moore 30 December 2007 at 12:36 am #

    I was shocked when I saw this article in the news. Are they at least specifying D3? Here in the US the prescription form that is sometimes ordered is D2!

  4. R.Weaver 30 December 2007 at 8:53 pm #

    A response to Dr.Briffa’s article of 21st Nov.2007, reference was made to Dr.William Davis, author of The Heart Scan Blog, who points out, among other things, that supplements of Vit.D. are only effective if they are gel-based capsules of D3,cholecalciferol.

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