One Third of Canadian Toddlers Are Vitamin D Deficient

I've posted that teens and adults are not getting sufficient vitamin D. But toddlers? Don't toddlers, you know, drink milk?

Apparently not enough, according to the TARGet Kids! (Toronto Area Research Group) study, a cross-sectional population-based dietary survey and clinical examination of Canadian toddlers. Medscape reporter Martha Kerr wrote that the study found 82% of the toddlers had vitamin D insufficiency and 32% were outright deficient.

You'd never guess what the risk factors were. OK, you'd probably guess if you've been awake at any time in the past decade. Snacking while tv watching and not enough milk drinking are the major culprits.

Low milk consumption "was independently associated with low vitamin D levels," Dr. [Jonathon Maguire, MD, a Fellow in the Division of Pediatric Medicine at the Hospital for Sick Children and the University of Toronto in Ontario] told Medscape Pediatrics. There was a 1 nmol/L increase in 25-OH vitamin D level for every ounce of milk consumed (P = .006).

High body mass index (BMI) was associated with vitamin D deficiency, with a 4.7 nmol/L decrease in 25-OH vitamin D level per BMI unit (P = .0009). "This may be associated with a higher fat content of the body," he commented. "Drinking more milk is not associated with a higher BMI, as some people think. In fact, the opposite is true."

TV viewing while snacking was also associated with vitamin D deficiency; the level is 9.6 nmol/L lower if the child watches TV while snacking (P = .022). "This might be related to more time spent indoors, a poorer nutritional intake, low levels of physical exercise ... or a combination of such factors, indicating an unhealthy lifestyle," Dr. Maguire commented.

Doctors are encouraged to screen children for these health risks, especially for drinking less than 12 ounces of a milk a day.

The study doesn't say, but for the sake of vegans I'd recommend a milk alternative that gives the equivalent calcium and vitamin to regular cow's milk.

Most People Need Calcium and Vitamin D Supplements

Here's a phrase that the quack supplement industry hates: "Your body doesn't absorb extra vitamins. All you get from taking vitamin supplements is expensive urine." There are many web pages devoted to "debunking" this as a myth. What none of them bother to mention was that the phrase came about to combat the supplement quacks who were pushing megadoses of vitamins as "cures" for all what ails ya. They were truly ripoffs.

After the megadose crazy faded, the antioxidant fad began. Large doses of Vitamins A and E were supposed to protect from heart disease and cancer. Except that they don't.

You do need some vitamins, of course. Getting the RDA of all the vitamins, minerals, and nutrients is essential. A good diet would provide those, if only more Americans had good diet habits. Since most don't an ordinary multi-vitamin pill couldn't hurt.

Are there any supplements you should take? Yes. As I've posted many times, you probably aren't getting enough calcium and vitamin D. Dr. Marc Siegel backs me up on this in an article from Fox News.

Vitamin D
A lack of vitamin D is associated with heart disease, muscle problems, a loss of mental acuity and fertility problems, Siegel said.

“Everybody should consider taking a vitamin D supplement,” Siegel said. “You need at least 400 international units per day. You should have your doctor check your levels (through a blood test).”

Siegel said proton pump inhibitors (medicines like Nexium or Protonix), which treat acid reflux symptoms, may block the body's absorption of vitamins B₁₂ and D, so anyone on those medicines should have their levels checked regularly. ...

Calcium
You should take 500 to 1,000 milligrams of calcium every day, especially if you are a post-menopausal female, Siegel said. Calcium is essential for keeping bones strong and preventing them from breaking.

Women should continue to get their calcium from outside sources, even if they are taking a supplement, Siegel said.

Strict vegans may be at risk for low levels of vitamin B₁₂ so that's one additional supplement worth taking by them.

You can find additional confirmation of the vitamin myth in Tara Parker-Pope's article, Vitamin Pills: A False Hope? in The New York Times.

Low Vitamin D Levels in Arab-American Women

Everybody needs more Vitamin D. Some groups are particularly at risk. The elderly and those who live in northern climates often don't get sufficiently sun, which helps create vitamin D. Others, like African Americans, don't get enough calcium because their lactose-intolerance lowers the amount of dairy they drink.

So what if you don't get much sun and don't drink much dairy? That's the plight of many Arab-American women. The largest concentration of Arab Americans is in Michigan, a northern state. Researchers there compared women who wore lighter and more revealing western-style clothing to those who wore the traditional skin-concealing garb. Both groups have serious vitamin D deficiencies, but the those wearing traditional dress have only half the vitamin D levels of the other women according to a study released by Henry Ford Hospital researchers.

Medical News Today carried their press release.

Researchers found that all 87 women involved in a small study showed vitamin D levels averaging 8.5 ng/mL (nanograms per milliliter) for those who wore western dress to 4 ng/mL for those who wore the hijab, modest dress with a headscarf. A healthy vitamin D level is 30 ng/mL or higher.

Also, the women consumed little dietary sources of vitamin D. Forty-seven women reported drinking any milk on a weekly basis, but the amount they consume isn't significant enough to boost their vitamin D levels, researchers say. ...

"When people live where the weather is colder and they are more covered with clothing, they depend on their diet for their vitamin D," Dr. Hobbs says. "Unfortunately, most food with the exception of oily fish and vitamin D fortified milk has very little vitamin D. The women in our study drank very little milk, fortified orange juice and had decreased sun exposure because of their dress."

Vitamin D supplements would help. So would getting more sun. Vitamin D deficiency is one of the easiest problems to alleviate. All it needs is more publicity.

Some Vitamin D Tests Flawed

I've been telling you over and over that you probably need more vitamin D than you've been getting. See Everybody Needs More Vitamin D for an example with links to earlier postings.

Scientific studies have "reported that low levels of the vitamin may be linked to medical conditions including certain cancers, diabetes and immune system problems," which has lead many concerned people to get their levels of vitamin D tested, up some 80% over the last year at one laboratory.

A good thing, right? Sure. Unless that laboratory's tests turn out to be faulty, giving levels of vitamin D sometimes too high and sometimes too low.

That's a huge problem recently discovered in numerous tests conducted by national testing giant Qwest Diagnostics, of Madison, N.J.

Mary Brophy Marcus reported on this for USA Today. The problem with the problem is that we have no idea of the scope of the problem.

Testing problems were linked to a small percentage of the company's labs, says Wendy Bost, a spokeswoman for Quest. The company is not making public the locations where the mistakes occurred or saying how many patients may have been affected. However, the pathology publication The Dark Report, who's [sic] current issue drew attention to the Quest case, suggests thousands of patients may have been impacted.

The inaccurate tests typically gave readings that were too high — meaning some patients who need vitamin D supplementation might not have received it — but not in all cases...

While not getting needed supplement can be a long term concern, getting too much when it's not necessary can be dangerous in extremely high doses. Fortunately, the dangerous level is around 10,000 IUs a day, while even the largest doses normally given are 1000 IU or lower.

What to do now?

[Joan Lappe, professor of nursing and medicine at Creighton University in Omaha, Nebraska, who has conducted research in vitamin D] says concerned patients who are taking the vitamin should see their physicians and get double-checked. "If you stop taking it for a couple days or weeks it's OK and probably not going to make that much of a difference for most people," Lappe says. Though she says kids should be evaluated more carefully.

Everybody Needs More Vitamin D

Vitamin D is necessary for many reasons, not least because it helps the body absorb calcium better. I've been telling you You Need More Vitamin D with Your Calcium and that there are Vitamin D Deficiency Problems in Teens and Adults.

Now the American Academy of Pediatrics (AAP) has announced that it is doubling the amount of vitamin D it recommends for infants, children and adolescents.

The previous recommendation, issued in 2003, called for 200 IU per day beginning in the first two months of life.

The change in recommendation comes after reviewing new clinical trials on vitamin D and the historical precedence of safely giving 400 IU per day to the pediatric population. Clinical data show that 400 units of vitamin D a day will not only prevent rickets, but treat it. This bone-softening disease is preventable with adequate vitamin D, but dietary sources of vitamin D are limited, and it is difficult to determine a safe amount of sunlight exposure to synthesize vitamin D in a given individual. Rickets continues to be reported in the United States in infants and adolescents. The greatest risk for rickets is in exclusively breastfed infants who are not supplemented with 400 IU of vitamin D a day.

Adequate vitamin D throughout childhood may reduce the risk of osteoporosis. In adults, new evidence suggests that vitamin D plays a role in the immune system and may help prevent infections, autoimmune diseases, cancer and diabetes.

Adults may be higher recommendations as well, according to an article by Carol M. Bareuther on the Triton.

On the heels of the AAP’s announcement, the National Academy of Sciences’ Institute of Medicine (IOM) is set to review its recommendations for adults. Currently, adults up to age 50 should consume 200 IUs per day, adults aged between 51 and 70 should have an intake of 400 IUs, and adults aged 71 and over should consume 600 IUs.

I've noticed that major brands like Caltrate and the store brands that copy its lead have labels proclaiming "advanced levels of vitamin D" on its bottles of Calcium 600+D calcium supplement. That means 600 mg of calcium and 400 IU of vitamin D in each pill.

Be careful not to overdo the D. There are warnings associated with amounts of 2000 IU per day and over.

Vitamin D Deficiency Problems in Teens and Adults

The best way to get Vitamin D is to get sun on your bare flesh for at least 15 minutes a day.

But people have been told for years to cover up, to slather themselves with sunblock, or just not spend time in the sun.

Is this leading to a problem? Could be, wrote Mary Brophy Marcus, in an article and a sidebar in USA Today.

Older adults have long been known to be short on Vitamin D, probably because they tend to spend less time outdoors than younger people. Whatever it is about our modern lifestyles, however, younger adults, teens, adolescents, even infants are showing the effects.

Pediatricians had thought the problem had been solved among children with the vitamin D fortification of milk, cereal and other foods. But an ever-lengthening roster of studies is revealing vitamin D deficiency is more common than previously believed in youngsters, including breast-fed babies and teens.

"Vitamin D deficiency is much more of a health problem than anyone realized," says Catherine Gordon, director of the bone health program at Children's Hospital Boston. In the June issue of the Archives of Pediatrics and Adolescent Medicine, Gordon and her colleagues found that 40% of infants and toddlers tested below average for vitamin D. In a previous study, Gordon and fellow researchers discovered that 42% of adolescents were vitamin D deficient.

Breastfeeding is no help here because there is no vitamin D in human milk. [The rise in breastfeeding is therefore coinciding with a rise in rickets.] None in cow's milk either, but all milk in the U.S. is fortified with some vitamin D. But people are drinking less milk and of course you, my readers, are especially likely not to get many dairy products in your diets.

Vitamin D supplements are therefore a good idea for those who may no be getting enough from their diets or from the sun.

Current recommendations by the Institute of Medicine suggest 200 IUs of vitamin D a day for children and 400 IUs for adults, but [Lisa] Callahan, [co-director of the Women's Sports Medicine Center at the Hospital for Special Surgery in New York], who serves on an institute committee that aims to update those guidelines, says she suggests higher levels to many of her patients, at least 800 to 1,000 IUs a day.

Some sun is necessary to get the ultraviolet B (uvB) rays that activate it. But this is harder for those prone to skin cancer and darker-skinned peoples (who are also statistically more likely to be lactose intolerant) to achieve safely.

You can get a blood test to see if you have sufficient levels of vitamin D in your system. The deficiency mark is 20 ng/mL [nanograms per milliliter] or lower. A normal reading is 30 ng/mL or higher.

Low Vitamin D Levels Put Healthy Children at Risk

Humans can make vitamin D just by exposing their skin to sunlight. The first humans, living in sunny Africa, had no problems with this. Their skins became as dark as possible to prevent the overabundance of sun from doing them harm. But what happened when humans started living in the cold north, and needed to cover their skin much of the year?

One thing they did was evolve lighter colored skins that allowed the UV rays of the sun to more easily penetrate. But there was more going on that led to the spread of this mutation. A post on ScienceBlogs.com talks about the science:

Frank W. Sweet published an essay in 2002* which offered that the feasibility of a farming lifestyle at very high latitudes in Europe due to peculiar climatological conditions served to drive Europeans to develop light skins over the last 10,000 years. In short, Sweet argues that the diets of pre-farming peoples were richer in meats and fish which provided sufficient Vitamin D so that skin color was likely light brown as opposed to pink. But with the spread of agriculture Vitamin D disappeared from the diets of northern European peoples and so only by reducing their melanin levels could they produce sufficient amounts of this nutrient to keep at bay the deleterious consequences of deficiencies.

In part 2 of his post, the pseudonymous Razib makes the lactose connection clear.

Adult lactose digestion, blonde hair, very light skin and blue eyes are all extant at very high frequencies around the Baltic sea. The last three characters are diagnostic for northern European populations.1 We know that lactose tolerance is a recent adaptation, within the last 10,000 years. We know that one of the major skin color genes in humans, SLC24A5, has swept to near fixation in Europeans relatively recently, on the order of 10,000 years. We also know that OCA2 has been subject to a recent bout of selection. Agriculture arose in the Middle East about 10,000 years ago and finally "conquered" southern Scandinavia as late as 5,000 years ago. I am beginning to suspect that the cultural revolution prompted by the transition from hunting & gathering to farming was followed by a genetic revolution due to co-evolutionary dynamics. In exchange for scalable caloric resources in the form of grains human populations were faced with a narrowed diet so that their nutrient streams became depauperate. Where it was feasible these agricultural populations naturally turned to animal husbandry to supplement their diet and round out their nutritional balance. Like grain farming dairying is a relatively scalable enterprise, especially if the cattle are fed upon unpalatable leavings or fallow land which would otherwise be underutilized. In the specific context of Vitamin D, though pre-fortified cow milk is a poor source of this nutrient in comparison with fish, it would have provided a non-trivial supplement (also, there is some reason to assume that modern cattle might produce somewhat deficient milk in terms of Vitamin D load because of factors of diet and sun exposure).

It therefore shouldn't come as a shock to anyone that those living in colder climates of the United States are also at risk for Vitamin D deficiency.

A press release on Eurekalert.com highlighted the findings of a new study just published in the American Journal of Clinical Nutrition, Vol. 86, No. 1, 150-158, July 2007. "Risk factors for low serum 25-hydroxyvitamin D concentrations in otherwise healthy children and adolescents," by Francis L Weng, Justine Shults, Mary B Leonard, Virginia A Stallings and Babette S Zemel.

Many otherwise healthy children and adolescents have low vitamin D levels, which may put them at risk for bone diseases such as rickets. African American children, children above age nine and with low dietary vitamin D intake were the most likely to have low levels of vitamin D in their blood, according to researchers from The Children’s Hospital of Philadelphia.

A study in the current issue of the American Journal of Clinical Nutrition measured blood levels of vitamin D in 382 healthy children between six years and 21 years of age living in the northeastern U.S. Researchers assessed dietary and supplemental vitamin D intake, as well as body mass, and found that more than half of the children had low blood levels of vitamin D. Of the subjects, 55 percent of the children had inadequate vitamin D blood levels and 68 percent overall had low blood levels of the vitamin in the wintertime.

...

Vitamin D is crucial for musculoskeletal health. The primary dietary source of the vitamin is fortified milk, but the best way to increase vitamin D levels is from exposure to sunshine. Severe deficits in vitamin D may lead to muscle weakness, defective bone mineralization and rickets. In addition to musculoskeletal effects, vitamin D is important for immune function, and low blood levels of the vitamin may contribute to diseases such as hypertension, cancer, multiple sclerosis and type 1 diabetes. Decreased blood levels of vitamin D have also been linked to obesity.

Milk needs to be fortified with Vitamin D because it does not have any naturally. But milk is a good source of calcium, and the new agricultural diet of the northern Europeans lacked sufficient calcium. That's one of the reasons that the lactose tolerance mutation and the white skin mutation appear to have evolved in close harmony. Milk still has an important role to play for those who want it.

An article on the study by Joi Preciphs of Bloomberg News makes the point forcefully:

Vitamin D-deficient diets are also associated with milk allergy; intolerance to lactose, a sugar found in dairy products; and strict vegetarianism.

You can get Vitamin D from other sources than milk, and calcium pills with Vitamin D are widely available. But milk-free diets all too easily can lead to this problem for those who are not aware.

Dairy-free is a choice, and can be a perfectly healthy one. But you have to understand all of its ramifications and make the adjustments needed to stay healthy when you remove a good source of many bioavailable nutrients. Eat smart.

*Essays on the Color Line and the One-Drop Rule.