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A few months ago, The Jerusalem Post under Judy Siegel-Itzkovich's byline ran an article about the importance of everyone testing for vitamin D deficiency by a simple blood test, which I read with great interest. Maccabi Health Services decided to encourage its family doctors to screen for the vitamin as a result of her queries. I (61 years old) approached my family doctor and asked for this test (when I was a young baby I suffered from rickets, a result of vitamin D deficiency; my mother has osteoporosis). The results came back that I am in fact suffering from a deficiency of vitamin D, and my doctor sent me to see an endocrinologist who prescribed me vitamin D3 drops - the kind that are given to new babies, but I was told to take eight drops daily instead of two. Had I not read this article in the Post, I would have carried on as normal, not knowing my bones were softening until it was too late.
I would like to know why most of the population are not advised to be screened for vitamin D. Can rickets be passed on from parent to child? And why was I prescribed these baby drops instead of a regular vitamin D supplement like the on my mother is taking together with Vitamin C?
E.N., Givat Shmuel
Prof. Ted Tulchinsky, an expert on vitamin D supplementation at the Hebrew University-Hadassah Braun School of Public Health and Community Medicine, replies:
Vitamin D was not on the usual "radar screen" of most doctors, but in recent years there has been an upsurge of interest, and publications in the professional literature showing vitamin D deficiencies in many age groups in many countries, including sunny countries such as Saudi Arabia, Lebanon and Australia. In addition, vitamin D is now better understood as vital for many health issues including bone health as well as in prevention of cancer and cardiovascular diseases. Lately therefore doctors are more concerned about this with more testing for vitamin D levels and recommendations for routine vitamin D supplements, which are in Israel given to infants routinely for many years, and they are now the accepted medical standard for older children and teenagers by the American Academy of Pediatrics, as well as for adults here in Israel.
Rickets is not inherited but is due to vitamin D deficiency. It was assumed by many that Israel is a sunny country and people should get production of vitamin D in their skin from sun exposure. However, this varies by season of the year, duration and time of exposure, dress codes, indoor activity, use of sunscreen, avoidance of sun due to concern (about skin cancer) and other factors. Haredi, Beduin and Ethiopian women are especially vulnerable to vitamin D deficiency. Vitamin D is not abundant in breast milk, thus breastfed infants in particular need vitamin D supplements. Only one-percent-fat milk in Israel has been fortified with vitamin D by law for many years, but unfortunately not the regular 3% milk. The major dairies sell special milks in cartons with vitamin D and calcium added at much higher prices.
I am not aware of any special advantage of drops over tablets, but this is reminiscent of cod liver oil used widely in Europe and the Americas by our grandparents and great grandparents and which was successful in wiping out rickets during the 1920s to 1940s. Unfortunately the older medical treatments were put aside when gross clinical rickets became less common. The US and Canada adopted mandatory fortification of all milk in the 1940s, and this is in effect until today. As said, we have not yet adopted this standard, although the Health Ministry is currently (and for the past 15 years) working on changing the milk regulations. I recommend use of fortified milk, preferably 1% fat for adults, as well as the drops prescribed, and regular sun exposure for 20 minutes at least five times per week.
Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel- Itzkovich at (02) 538-9527, or e-mail it to firstname.lastname@example.org, giving your initials, age and residence.