Wednesday, 30 July 2014

Surge in vitamin D deficiency rates

Wouldn't it be a tragedy if we show in 100 years that repleting the population of vD prevented a large proportion of MS? #MSBlog #MSResearch

"For those of you living in the US you may find the following non-MS-related publication of interest. It shows a surge in vitamin D deficiency diagnoses and mirrors that what is happening in the UK. We are in the process of auditing our own MS neurology practice to see how large the increase is in our outpatient setting. Why is this occurring?

Sun-blockers: It is well known that over the last 15-20 years dermatologists and the cosmetic industry have massively increased our consumption of sun blockers. Dermatologists tell us to avoid sunburn to prevent skin cancer and the cosmetic industry to prevent sun damage that is a major cause of skin aging. Sun blockers reduce the skin's production of vD and are clearly contributing to the rising incidence of vD deficiency? Men be warned the cosmetic industry are targeting you; there is an ever increasing consumption of cosmetics with sun-blockers by men, in particular the younger generation. Almost all of the new male cosmetics now include sun blockers badged as anti-aging agents.

Outdoor activities: Other behavioural changes has been the shift from outdoor activities to indoor activities. Children and teenagers now spend much less time in the sun. Why? This is the era of facebook and gaming. Young girls spend large amounts of time on social networks and boys playing computer games. There are several studies from the past that have demonstrated that outdoor activities in childhood protect against MS; reversing this trend is very worrying.

Fish consumption: It is well known that fish consumption worldwide is going down. This is based on economic factors, as we deplete fish stocks prices have risen and consumption has dropped. We are also increasingly eating farmed fish which has about a third of the vD levels of wild fish; wild fish have higher vD levels because of their diet is higher in phytoplankton which provides the vD.

Pollution and weather: Atmospheric pollution and cloud cover is another issue; this is a particular problem in certain areas of the world. In heavily polluted areas of the world air pollution exacerbates vD deficiency as it acts a ultraviolet B light filter.

Cultural changes: I have mentioned before that covering up for cultural reasons is a problem for woman. Whether or not covering up is for religious or other cultural reasons it contributes to very low vD levels in some parts of the world.

Low vD recommended daily allowance (RDA): The current RDA of vD of 400IU per day is based on rickets prevention studies in the early half of the 20th century. When these studies were done the role of vD in immune and other functions were not known. There is an international lobby that is trying to get the RDA of vD increased; however, without more data it looks as if public health doctors are reluctant to adopt the advice. We now promote physiological vD supplementation in all children and relatives of MSers as per the Vitamin D Council's recommendations. Despite this we have found that adherence to our advice is poor. Therefore we have started Digesting Science. This is a course to teach children of MSers about MS and the link between low vD and MS. The idea is to get children to be adherent to their vD supplementation regimen via education. "


Huang et al. Surge in U.S. Outpatient Vitamin D Deficiency Diagnoses. National Ambulatory Medical Care Survey Analysis. South Med J. 2014 Apr; 107 (4) :214-7.

OBJECTIVES: In light of the growing medical interest in the potential consequences of vitamin D deficiency, it is important that clinicians are informed about the varying factors that may complicate the assessment of vitamin D status and the diagnosis of deficiency. To better understand the frequency of vitamin D deficiency diagnoses in the ambulatory setting over time, the objective of this investigation was to examine unspecific, general, and bone-related vitamin D deficiency diagnoses between 2007 and 2010 and to determine whether the rate ofdiagnoses differed by patient age and sex.

METHODS: We used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to assess the rate of vitamin D deficiency diagnoses provided between 2007 and 2010 during outpatient visits with non-federally employed physicians in offices and hospitals. Two hundred ninety-two unweighted patient visit records were included. Trends in vitamin D deficiency diagnosis over time, diagnosis of bone disease associated with a vitamin D deficiency diagnosis, and patient age and sex were reported.

RESULTS: The number of diagnoses for vitamin D deficiency rapidly increased from 2007 to 2010. More than 97% of diagnoses were for unspecific vitamin D deficiency; 9.6% of vitamin D deficiency visits also resulted in a diagnosis of osteoporosis or bone fracture.

CONCLUSIONS: Although the rate of diagnoses for vitamin D deficiency increased between 2007 and 2010, many diagnoses rendered were for nonspecific disease; therefore, vitamin D deficiency screening may have been ordered for preventive care purposes rather than as a diagnostic aid.

12 comments:

  1. I am now 39, I was diagnosed with MS last year. When I was a child I was always out playing in the garden and would sit on the school field for play and lunch times. I also lived in New Zealand for two years with my family when I was 11 years old and got severly sunburnt on a mountain skiing trip once. My face had blisters, no one mentioned suncreen to me. I also used to walk to school. Returned to UK two years later again used to walk to school and sit out on school field at lunchtimes. Got sunburnt sunbathing a few times. I don't think vit D stores it self in the body and a constant supply is needed. I would walk to work when I was an adult, although I would often wear a hat when weather cooler/cold. I don't think drivers get any vit D through a car windscreen.

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  2. My GP is young and very much on the button, but she was reluctant to refer me for a vitD blood test, asking me why ever I thought I might be deficient. When the results came through, she was so surprised she rang me at home! When later I asked to be put permanently on high-dose, she was good enough to say that she would prescribe whatever my neuro recommended, so that's been fine and I'm on 5,000iu daily. My point is - she's surely typical of many GPs. What's being done to educate them?

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  3. Erm, what about rising levels of obesity, Prof G? Surely that has an effect on developing MS risks, too?

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  4. I asked one of the GP's at my surgery about vit D. He said if you were to blood test the whole of the UK population for Vit D levels many would come back low level.

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  5. I guess though the thing is to eliminate the risk factors. Low Vit D is seen as a risk.

    If I could turn back time to before I had my first MS relapse I would do the following: My first relapse was triggered by stress I think. The second relapse was triggered by infection which was not treated with antibiotics. I was run down and stressed also at the time. I didn't know it was MS until during this second relapse. If I knew then what I know now I would have tried the best I could to avoid stress in my life and be aware of infections.

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  6. Low Vit D levels are a tragedy even without the possible MS link. Within the last year more than a few people I know have had all sorts of problems because of low Vit D.

    One girl in her early 20s had bad back pain and problems moving.
    One lady in her 70s suddenly found herself unable to get up and move around one day.
    One teenager is waiting for an operation to correct her legs. She can't run at all, can't walk long distances

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  7. I always knew that a raised temperature made my symptoms worse. I didn't have saunas, kept away from steam rooms and stopped exercising that would make my temperature rise. I tried to keep out of the sun. I've always eaten a healthy diet, I know this because my MS nurse sent me to a dietician, as I now have Osteoporosis in my vertebrae. Surprisingly, when I had the blood test I had high vitamin D levels. Am I some sort of freak? I've been told you can't get enough Vit D from food alone.
    I now sit in the sun 10 mins twice a day when at the beginning and end of the day.

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    1. It is unlikely that anyone with osteoporosis would have high vitamin d levels. There are a number of possible things to check. Do you have the data from the lab, if so check firstly they did a 25(OH)D test and not a 1,25(OH)D test. If they did a 25(OH)D test find the value and the units and check it against the recommendations of the Vitamin D Council, there are 2 units (ng/mL and nmol/L) used for 25(OH)D you need to know the one for your test. If they did a 1,25(OH)D test, they did the wrong test. High 1,25(OH)D in the blood commonly occurs with low 25(OH)D, called secondary hyper-parathyroidism. If you cannot get the data get them to do it again and this time give you the data. The term high is meaningless. Sun at the beginning and end of the day will not make vitamin d as this requires UVB and this is absorbed by the atmosphere as it passes through. For vitamin d it needs either to be midday or buy a UVB lamp sold for the keeping of reptiles indoors.

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    2. Thank you. Next time I go to my Orthopaedic consultant at probably the most famous Orthopaedic hospital in the country, I'll ask him what he meant.

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    3. Wouldn't you risk melanoma being in the sun at midday without sunblock?

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    4. Melanoma is associated with burning not sun exposure. If you are out for only 10 minutes it will not matter assuming that this will not burn you. Or take supplements. If you live away from the equator then the sun only works for part of the year anyway. The UVA in the morning and evening sun does harm without benefit, at least at midday you get some benefit. Remember also that the toxic range for vitamin d is much higher than the normal range, and toxicity is identified by high blood calcium levels not your 25(OH)D level. I am amazed that a good hospital did not give you actual values. Last time it was checked I had a 25(OH)D of 128ng/nL and all the endocrine consultant at the teaching hospital said was "you might consider lowering that a bit",which I have, but not much. My calcium levels normal normal. So a fear of out of 'normal' range vitamin d is not universal.

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