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Murder trial puts spotlight on widespread vitamin deficiency

By Andy Coghlan

Down with this Dickensian disease

JewishWorldReview.com | In
December, 2011, Rohan Wray and Chana Al-Alas walked free from the Old Bailey
court in London after being cleared of killing their 4-month-old son, Jayden,
in 2009. The injuries to his skull, knee, elbow, shoulder, hip, ankle and wrist
-- and hemorrhages in his skull and eyes -- had seemed to suggest the pair was
responsible for their baby's death.

Post-mortems revealed a different story. Jayden
had rickets, a Dickensian disease caused by a shortage of vitamin D, making his
bones abnormally weak and vulnerable to damage.

Further investigations showed that Jayden's
mother was also suffering from a lack of vitamin D. She had been unable to
supply Jayden with enough of the vitamin, either before his birth or afterwards
in her breast milk.

The case has highlighted a resurgence in rich
countries of the potentially fatal diseases that result from a lack of vitamin
D. Irene Scheimberg, the clinical pathologist at the Royal London Hospital who
discovered Jayden's rickets, says there is evidence to suggest vitamin D
deficiency was to blame for the deaths of two other babies she had examined,
and may have contributed to the deaths of the 27 infants she has autopsied in
the last few years, including deaths attributed to asthma, viruses and sudden
infant death syndrome.

In the United Kingdom, cases of childhood
rickets have leapt from 147 in 1997 to 762 in 2010. The story may be similar in
the United States: A study published by the U.S. Centers for Disease Control
and Prevention (CDC), Atlanta, Ga., found that only 5 to 13 percent of
breastfed infants and 20 to 37 per cent of formula-fed babies got enough
vitamin D to meet the recommended daily dose of 400 international units (IUs)
-- or 10 micrograms (Pediatrics). The American Academy of Pediatrics came up
with this figure in 2009 and it was endorsed in 2010 by the U.S. Institute of
Medicine.

There's no national surveillance of rickets in the United States.
"However, hospitalized cases of rickets among infants, indicating severe
vitamin D deficiency, do continue to be reported," says Cria Perrine, lead
author of the CDC study.

So why the deficiencies? The body makes its own
vitamin D in skin, but only if the skin is exposed to sunlight -- something
which tends to be discouraged because it raises the risk of skin cancer.
Rickets flourished during Britain's industrial revolution, when smog blocked
sunlight and children were forced to work all day in factories.

Up to a quarter of the body's vitamin D needs
are provided by our diet. It is abundant in oily fish and eggs, but modern
diets may not include enough of these foods to provide sufficient vitamin D.
Supplements can boost levels of the vitamin, but the few studies available in
the U.S. suggest physicians seldom recommend vitamin D supplements for infants,
says Perrine.

Gillian Killiner, of the British Dietetic
Association, says the importance of vitamin D has been overlooked in the past
decade because of the disproportionate focus on folic acid supplements, which
can help prevent spinal defects in infants if given to pregnant women.

There is even uncertainty over the appropriate
dose of vitamin D to give to pregnant or breastfeeding women. A recent study of
350 women who were between 12 and 16 weeks into pregnancy explored whether
daily doses of 400, 2000 or 4000 IUs of vitamin D should be given. The women
were tracked through to delivery. The results suggest that the highest dose was
required to sustain normal metabolism in the women, and no adverse effects were
found (Journal of Bone and Mineral Research).

London-based coroner Andrew Walker recently
concluded that vitamin D deficiency had claimed another infant by causing
heart-valve failure and impairing immunity to an infection. On Dec. 6, he wrote
to the UK's health minister urging him to ensure that supplemental vitamin D is
offered to all woman who are pregnant or breastfeeding.

In response, the Department of Health has
promised to review the evidence on vitamin D requirements, and repeated a
pledge from 1991 to provide vitamin D to pregnant women.

Boosting awareness is important: disease from
vitamin D deficiency is preventable.

RICKETS IS JUST THE START

Low levels of vitamin D through pregnancy and early childhood might increase
the risk of food allergies, asthma and even multiple sclerosis.

George Ebers, at the University of Oxford, and
colleagues, discovered that MS is more common in those born in the northern
hemisphere in May -- following winter -- than those born in November. The
incidence of MS also increases further from the equator. Both results hint that
lack of exposure to UVB light and subsequent low levels of vitamin D could be
linked to a higher risk of the disease.

Ebers has called on the Scottish government to
fortify essential foods with vitamin D. "Scotland has two new cases of MS
a day and a lifetime cost per case of 1.2 million pounds a year," he says.
"It also has the lowest vitamin D levels in the world."

Lack of vitamin D has also been linked to food
allergies. Carlos Camargo, at Harvard University, says that vitamin D
deficiency in critical periods of development may increase intestine
permeability, meaning the immune system is inappropriately exposed to food
allergens.

Vitamin D interacts with genes at over 2,776
sites on the human genome, including those linked to asthma and diabetes.
"It's got to be an awful lot more important than people give it credit
for," says Ebers.