eileen

September 9, 2008

Light shines on vitamin D deficiency epidemic

By MARY BROPHY MARCUS
USA TODAY

Giving your children all they need to grow big and strong might not be as simple as a gummy vitamin and three square meals. They still might be susceptible to an epidemic that's starting to gain the notice of pediatricians and bone doctors across the country: vitamin D deficiency.

Mike Stone joined a growing legion of children diagnosed with the condition when an X-ray of his 14-year-old bones revealed a skeleton so thin it appeared clear on film.

"My doctor thought the machine was broken and that they should take an X-ray on another one," says Stone, 22, a recent graduate of Tufts University in Boston.

The machine wasn't broken. Stone was seriously vitamin D deficient, and though he had felt a "snap" in his back — the impetus for the doctor's visit — he had no fractures. But his bones had become perilously thin, 50 percent less dense than they should have been. His doctor immediately put him on vitamin D supplements to correct the problem.

For years, doctors have been aware that older people tend to be low in vitamin D and need extra supplements to help keep bones strong, says Lisa Callahan, co-director of the Women's Sports Medicine Center at the Hospital for Special Surgery in New York.

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 breastfed 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 percent of infants and toddlers tested below average for vitamin D. In a previous study, Gordon and fellow researchers discovered that 42 percent of adolescents were vitamin D deficient. "Vitamin D deficiency was twice as common in teens as we assumed it would be."

There also is the issue of some children not being able to ingest foods or liquids rich in vitamin D, further complicating the problem.

"We will be hearing much more about vitamin D and its role in health and disease," says Beverley Manganelli, a registered dietician at Huterdon Medical Center's Nutrition and Diabetes Management Center. "If you or your child has the challenge of a milk allergy, lactose intolerance or if you are a vegan, it may be even more difficult to maintain adequate vitamin D status. Vitamin D status may also be compromised if you have had gastric bypass surgery.

"A registered dietitian can evaluate you or your child's current intake and make recommendations that will help achieve and maintain a balanced diet and adequate vitamin D status."

Positive effects

A review of vitamin D medical literature published last July in The New England Journal of Medicine by Michael Holick, professor of medicine, physiology and biophysics at Boston University Medical School and director of the Bone Health Care Clinic there, indicated that numerous studies are showing vitamin D does much more than boost bone health in children and adults.

In children, it can inhibit future hip fractures, and it might help reduce the risk of type 1 diabetes.

Sunlight, diet — particularly oily fish and enriched milk — and supplements are good sources of vitamin D, Holick says.

However, according to Hunterdon Regional Cancer Center oncology dietician Nicole Baker-Schaldone, choosing just any supplement is not a good idea since there is a rhyme and reason behind each one.

"If someone chooses to use a supplement to increase vitamin D intake, it's important to look at the type," Baker-Schaldone says. "Vitamin D3 (cholecalciferol) is up to three times more readily absorbable than Vitamin D2 (ergocalciferol). Vitamin D3 is the form from animal products and sunlight. (But) before taking any supplements its important to talk to a health-care provider and a dietitian can help you select a vitamin that's best for you."

Knowing the differences

Vitamin D is different from other vitamins because though the body stores it, it needs ultraviolet B rays from the sun to activate it, says James Dowd, professor of medicine at Michigan State University and author of "The Vitamin D Cure."

Fifteen minutes a day will do the trick, he says. When vitamin D is dispatched to the liver and kidneys, it is changed into forms that body tissues can use. It helps the body absorb and regulate calcium and promotes mineralization of teeth and bones.

Current recommendations by the Institute of Medicine suggest 200 IUs of vitamin D a day for children and 400 IUs for adults, but Callahan — 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.

Overdoing on vitamin D is unlikely if you are obtaining it only from diet, Gordon says. But parents should consult their pediatrician before raiding pharmacy shelves for supplements because of different dosages and types. She also says the doctor might want to run a blood test because vitamin D deficiency is hard to detect.

"There aren't any obvious early symptoms. It may be silent until it manifests in more serious ways, like rickets — weak bones and teeth — in children," Gordon says.

How does it happen?

Parents surprised by their children's vitamin D deficiency diagnosis might ask why it occurs in a culture in which good nutrition seems a no-brainer. Experts say there might be a genetic link, but other factors also are at play.

"Breast milk is not D-rich, so rickets is seen more often in infants now that breastfeeding is popular again. It's also not abundant in many foods," says Tanya Edwards, head of the integrative medicine department at the Cleveland Clinic. Also, she says kids don't play outside as much as they used to.

But the food and milk issues still trumps everything else.

"The food supply in America is deficient in certain essential nurtients," says John Bucek, director of the Somerset Family Medicine Residency program at Somerset Medical Center in Somerville, "and as a result more and more things must be bought and taken as supplements" such as vitamins, minerals and essentially fatty acids.

"Food allergy (also) is more prominent, and many more people avoid cow's milk," adds Bucek, noting that cow's milk is very high in vitamin D.

Getting help

Stone, who with brother Doug has produced an educational video about vitamin D for schools, says religiously taking supplements and ramping up his diet with lots of fish, milk and yogurt over the years has helped him grow normally and avoid bone and other problems as an adult. But he also is careful not to overdose on calcium in the process, which can lead to kidney stones.

"I feel great," says Stone, who is 5-foot-9 and weighs in at a slim but healthy 155 pounds. "I play tennis, squash, and I'm training for my first Boston Marathon next year."

Staff writer Jeff Weber contributed to this story.

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"under exposure to UV rays is as dangerous as overexposure....this is D life" eileen