All milk and milk products in the country will be fortified with vitamin D, in a decision long awaited by public health experts, The Jerusalem Post has learned. Deficiency of the vitamin can result in osteoporosis (flimsy bones leading to fractures) and raise the risk for a wide variety of health problems, including dementia, heart and kidney diseases, chronic back pain, tooth loss, inflammatory bowel disease and chronic liver disease. Optimal levels of vitamin D may also prevent the production of cancer cells and protect against specific autoimmune disorders such as multiple sclerosis (MS). Senior Health Ministry officials have said for years that they were having trouble overcoming opposition from dairy companies - which sell milk fortified with vitamin D (and calcium) in cartons significantly more expensive than ordinary milk. But the ministry and the Israel Standards Institution finally joined forces to require the companies to go along. The price of dairy products will not be raised to accommodate the fortification, as vitamin D is very cheap. Dr. Itamar Grotto, the ministry's deputy director-general in charge of public health services, told the Post that he wasn't sure when the new regulations would go into effect, as companies have to adjust their products and packaging. Maccabi Health Services recently began to encourage its general practitioners and family physicians to send all patients for vitamin D testing, after finding that 36 percent of blood samples tested in its labs were deficient in the essential vitamin (having less than 20 milligrams per milliliter, while 32 mgs. is regarded as desirable). Maccabi director-general Dr. Ehud Kokia decided to take action after receiving a request from the Post to take the initiative. Vitamin D testing is not performed during routine blood work unless it is specifically requested, and since awareness of the deficiency problem is low, few doctors and patients asked for it. It has long been thought that those living in sunny Israel would have little problem with vitamin D deficiency because exposure to the sun's ultraviolet rays produces the vitamin in the skin. But Kokia told the Post that as lifestyles change and people spend more time indoors, while also covering themselves up more to reduce the risk of skin cancer and wrinkles, fortification was needed. In most Western countries, even sunny ones, vitamin D enrichment of dairy products is routine. Diabetics and the overweight are more likely to be deficient in vitamin D than others, but religious people who cover themselves up for reasons of modesty are also at high risk. Prof. Ted Tulchinsky, a former ministry official and currently a food fortification and mother-and-child health expert at the Hebrew University-Hadassah Braun School of Public Health, has been pushing the ministry to fortify milk products, saying that the US made it mandatory in 1941. The reason he gave for the ministry not working hard on fortification for many years is "lethargy, apathy and conservatism. The vitamin manufacturers don't make big money from it. The ministry didn't get around to it." About a decade ago, said Tulchinsky, the ministry examined cows for vitamin D and found none. He explained that decades ago, cows grazed in pastures and were exposed to the sun. But today (except for dairies selling organic milk), they are raised indoors or in shade, so they don't produce the vitamin in their milk. The American Pediatric Association recently informed all its members that everyone from birth through 18 years should get 400 International Units (IUs) of Vitamin D per day. But the Health Ministry recommends only giving newborns 400 IUs until the age of one year. Meanwhile, demands by public health experts to fortify all flour and baked goods with folic acid to minimize the risk of neural tube defects in newborns have not yet been reflected in Health Ministry policy. "We are working on it now, but it requires legislation, unlike the vitamin D fortification," Grotto said.