Rx for Readers: Vitamin D

A few months ago, The Jerusalem Post underJudy Siegel-Itzkovich's byline ran an article about the importance ofeveryone testing for vitamin D deficiency by a simple blood test, whichI read with great interest. Maccabi Health Services decided toencourage its family doctors to screen for the vitamin as a result ofher queries. I (61 years old) approached my family doctor and asked forthis test (when I was a young baby I suffered from rickets, a result ofvitamin D deficiency; my mother has osteoporosis). The results cameback that I am in fact suffering from a deficiency of vitamin D, and mydoctor sent me to see an endocrinologist who prescribed me vitamin D3drops - the kind that are given to new babies, but I was told to takeeight drops daily instead of two. Had I not read this article in thePost, I would have carried on as normal, not knowing my bones weresoftening until it was too late.

I would like to know why most of thepopulation are not advised to be screened for vitamin D. Can rickets bepassed on from parent to child? And why was I prescribed these babydrops instead of a regular vitamin D supplement like the on my motheris taking together with Vitamin C?

E.N., Givat Shmuel

Prof. Ted Tulchinsky, an expert on vitamin D supplementationat the Hebrew University-Hadassah Braun School of Public Health andCommunity Medicine, replies:

VitaminD was not on the usual "radar screen" of most doctors, but in recentyears there has been an upsurge of interest, and publications in theprofessional literature showing vitamin D deficiencies in many agegroups in many countries, including sunny countries such as SaudiArabia, Lebanon and Australia. In addition, vitamin D is now betterunderstood as vital for many health issues including bone health aswell as in prevention of cancer and cardiovascular diseases. Latelytherefore doctors are more concerned about this with more testing forvitamin D levels and recommendations for routine vitamin D supplements,which are in Israel given to infants routinely for many years, and theyare now the accepted medical standard for older children and teenagersby the American Academy of Pediatrics, as well as for adults here inIsrael.

Rickets is not inherited but is due to vitamin D deficiency. Itwas assumed by many that Israel is a sunny country and people shouldget production of vitamin D in their skin from sun exposure. However,this varies by season of the year, duration and time of exposure, dresscodes, indoor activity, use of sunscreen, avoidance of sun due toconcern (about skin cancer) and other factors. Haredi, Beduin andEthiopian women are especially vulnerable to vitamin D deficiency.Vitamin D is not abundant in breast milk, thus breastfed infants inparticular need vitamin D supplements. Only one-percent-fat milk inIsrael has been fortified with vitamin D by law for many years, butunfortunately not the regular 3% milk. The major dairies sell specialmilks in cartons with vitamin D and calcium added at much higherprices.

I am not aware of any special advantage of dropsover tablets, but this is reminiscent of cod liver oil used widely inEurope and the Americas by our grandparents and great grandparents andwhich was successful in wiping out rickets during the 1920s to 1940s.Unfortunately the older medical treatments were put aside when grossclinical rickets became less common. The US and Canada adoptedmandatory fortification of all milk in the 1940s, and this is in effectuntil today. As said, we have not yet adopted this standard, althoughthe Health Ministry is currently (and for the past 15 years) working onchanging the milk regulations. I recommend use of fortified milk,preferably 1% fat for adults, as well as the drops prescribed, andregular 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 forReaders, The Jerusalem Post, POB 81, Jerusalem 91000, fax your questionto Judy Siegel- Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and residence.