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Good point. From my reading, Saudi HCW are advising some women there, however observant people of any faith that requires complete coverage are at risk for a whole host of illnesses. Perhaps religious traditions could be interpreted to include some private "sun time."
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y.
Wayse V, Yousafzai A, Mogale K, Filteau S.
Centre for International Child Health, Institute of Child Health, University College London, London, UK.
OBJECTIVES: To determine whether subclinical vitamin D deficiency in Indian children under 5 y of age is a risk factor for severe acute lower respiratory infection (ALRI). DESIGN: A hospital-based case-control study. SETTING: Sanjeevani Paediatrics Hospital, a private hospital in Indapur, India. PARTICIPANTS: A total of 150 children including 80 cases and 70 controls, aged 2-60 months, were enrolled. Case definition of severe ALRI as given by the World Health Organization was used for cases. Controls were healthy children attending outpatients' service for immunization. MAIN OUTCOME MEASURE: Association of serum 25-hydroxyvitamin D3 (25OHD3) with severe ALRI, controlling for demographic and other potential risk factors. RESULTS: Serum 25OHD3 increased with age. Factors significantly associated with decreased risk of severe ALRI in univariate analysis were: exclusive breastfeeding in the first 4 months (cases 35/78 (45%), controls 41/64 (64%); P=0.02); introduction of other dietary liquids than milk only after 6 months (cases 46/70 (66%), controls 31/66 (47%); P=0.03); use of liquid petroleum cooking fuel (cases 32/80 (40%), controls 40/70 (57%); P=0.04); infant not covered in swaddling cloths when exposed to sunlight before crawling (cases 11/52 (21%), controls 25/54 (46%); P=0.006); and serum 25OHD3>22.5 nmol/l (cases 16/80 (20%), controls 48/70 (69%); P<0.001). In multivariate analysis, factors associated with significantly lower odds ratio for having severe ALRI were: serum 25OHD3>22.5 nmol/l (OR: 0.09; 95% CI 0.03-0.24; P<0.001) and exclusive breastfeeding in the first 4 months of life (OR 0.42; 95% CI 0.18-0.99; P=0.046) with age and height/age as significant covariates. CONCLUSION: Subclinical vitamin D deficiency and nonexclusive breastfeeding in the first 4 months of life were significant risk factors for severe ALRI in Indian children.
Subclinical vitamin D deficiency and nonexclusive breastfeeding in the first 4 months of life were significant risk factors for severe ALRI in Indian children.
"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Dr., that would of course be the preferred course of action. However, I suspect (strongly) that changing the habits adhered to for a thousand years will be very difficult to do. We might get some to fill their tanks if there were some place private to allow sun exposure, a roof perhaps.
While taking geography courses at university, one of the binding precepts of the discipline was the landscape doesn't lie. One of the cities we looked at was Islamabad. As a brand new city built from the ground up, we had an opportunity to see what current social mores were and, how they dictated through city and building design what customs were dictated as necessary to protect. What we saw was a strict adherence of limiting the ability of women to expose themselves to the view of others. Women's quarters predominantly occupied second floors, semi-opaque screens covered the windows and, access out of a neighborhood courtyard was prohibited without the accompaniment of a male relative. While there is some latitude in poorer neighborhoods to draw water from wells, how much exposure is still extremely limited. What a study like this could accomplish is a change in behaviour in the future. The restriction of women's movement is not to necessarily control women but, rather to protect them from other men. There is no doubt they love the females in the family. Perhaps after the pandemic, when it is obvious that covering the women from head to toe is detrimental to their health, we will see some changes. We can hope.
Please do not ask me for medical advice, I am not a medical doctor.
Avatar is a painting by Alan Pollack, titled, "Plague". I'm sure it was an accident that the plague girl happened to look almost like my twin.
Thank you,
Shannon Bennett
Dr., that would of course be the preferred course of action. However, I suspect (strongly) that changing the habits adhered to for a thousand years will be very difficult to do. We might get some to fill their tanks if there were some place private to allow sun exposure, a roof perhaps.
While taking geography courses at university, one of the binding precepts of the discipline was the landscape doesn't lie. One of the cities we looked at was Islamabad. As a brand new city built from the ground up, we had an opportunity to see what current social mores were and, how they dictated through city and building design what customs were dictated as necessary to protect. What we saw was a strict adherence of limiting the ability of women to expose themselves to the view of others. Women's quarters predominantly occupied second floors, semi-opaque screens covered the windows and, access out of a neighborhood courtyard was prohibited without the accompaniment of a male relative. While there is some latitude in poorer neighborhoods to draw water from wells, how much exposure is still extremely limited. What a study like this could accomplish is a change in behaviour in the future. The restriction of women's movement is not to necessarily control women but, rather to protect them from other men. There is no doubt they love the females in the family. Perhaps after the pandemic, when it is obvious that covering the women from head to toe is detrimental to their health, we will see some changes. We can hope.
I agree with Shannon on many points. Any attempt to change the cultural and religious habits of this or any group from the outside will be DOA. Rather than tamper with a dress code and social practices that have an unintended severe health consequence, IMO it would be better to simply provide those observant woman an effect alternative that does not require them to change these highly valued practices.
In this regard, adding 5000iu of vitamin D2 to their daily diet would provide them and their future children with significant health benefits without the need for them to change any cultural or religious practice. Trying to change the strongly held beliefs of any people from the outside always meets with significant resistance no matter what the intention of those from the outside are.
Today I have been doing a literature review on the effect of vitamin D supplementation serum levels of 25 OH vit D3. I have learned many interesting things.
Below is an article that explored vitamin D levels in women living within the UAE, a Middle Eastern nation where most women practice culturally determined dress codes. This study evaluates the effect of vitamin D2 supplementation in these women of childbearing age.
In the study, they found that vitamin D deficiency was highly prevalent and use of even an average oral dose of 2000iu was not enough to raise the 25 OH vit D levels to desired levels. The authors conclude that higher orals doses of vitamin D are needed to achieve the stated goals.
This conclusion is consistent with many other abstracts referenced on this FT thread and my studies. In essence, to reach a 25 OH vit D level of between 50ng and 70ng/ml requires a daily intake of at least 5,000iu. For many achieving this goal requires a daily intake of 10,000iu. These doses are much higher than recommended by the keepers of the US RDA or even the more liberal National Acadomy of Sciences recommendation of 2000iu daily. The important point is that daily doses between 5000iu and 10000iu appear to be safe for most people as long as the daily intake of calcium does not exceed 1250mg from all sources (diet and supplements).
Grattan Woodson, MD
Efficacy of daily and monthly high-dose calciferol in vitamin
D? deficient nulliparous and lactating women13
Hussein F Saadi, Adekunle Dawodu, Bachar O Afandi, Reem Zayed, Sheela Benedict, and Nicolaas Nagelkerke
ABSTRACT
Background: We previously found a high prevalence of vitamin D deficiency and low medication regimen compliance in Arab and East Indian women residing in the United Arab Emirates (UAE). The
appropriate dosing regimen for improving vitamin D status in this population is not known.
Objective: We aimed to determine the efficacy of daily and monthly supplementation with vitamin D2, the only high-dose calciferol available in the UAE, in lactating and nulliparous women.
Design: Healthy lactating (n 90) and nulliparous (n 88) women were randomly assigned to consume 2000 IU vitamin D2/d or 60 000 IU vitamin D2/mo for 3 mo. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured by radioimmunoassay at baseline and every month.
Results: Most women had vitamin D deficiency [ie, 25(OH)D 50 nmol/L] at study entry. Mean SD 25(OH)D concentrations at 3 mo were significantly higher than baseline in both lactating (39.8 12.4 and 25.2 10.7 nmol/L, respectively) and nulliparous (40.4 23.4 and 19.3 12.2 nmol/L, respectively) women (P 0.001 for both). In total, vitamin D supplementation was effective in achieving serum 25(OH)D concentrations of 50 nmol/L in 21 (30%) of 71 women at endpoint.
Conclusions: Oral vitamin D2 supplementation with 2000 IU/d or 60 000 IU/mo for 3 mo was safe, and it increased serum 25(OH)D concentrations significantly; however, only a small proportion of the women studied achieved concentrations of 50 nmol/L. This sug- gests that, when sunlight exposure is limited, doses of vitamin D2 higher than those currently studied may be needed. Monthly dosing appears to be a safe and effective alternative to daily dosing. Am J Clin Nutr 2007;85:1565?71.
[snip]
INTRODUCTION
Several studies have shown that women from the Middle East and women from the Indian subcontinent generally have low serum concentrations of 25-hydroxyvitamin D [25(OH)D], mostly as a result of low vitamin D intake and inadequate sunlight exposure (1? 8). Infantile vitamin D deficiency rickets also is common in many Middle Eastern and Asian countries (9, 10). Exclusively breastfed infants who lack adequate sunshine expo- sure and whose mothers have low vitamin D stores are frequently vitamin D deficient and thus at high risk of nutritional rickets (11, 12). Measures to prevent vitamin D deficiency include greater exposure of skin to sunlight, greater fortification of food items with vitamin D, and vitamin D supplementation.
Many Middle Eastern and East Indian women residing in the United Arab Emirates (UAE) maintain a very conservative style of dress that covers most of the body when they are outside, which limits sunlight exposure. In addition, vitamin D fortification of food is not mandatory in the UAE and many other Middle Eastern countries, and the current dietary intake of vitamin D is relatively low (8).
Vitamin D supplementation currently remains the most appropriate mode for improving the vitamin D status of this high- risk population.
There is mounting evidence that, in the absence of adequate exposure to sunlight, 1000 IU dietary or supplemental vitamin D/d is required in adults to prevent vitamin D deficiency (13?17). However, a critical factor affecting the outcome of such treatment is adherence to medication. Our clinical experience indicates a low compliance with vitamin D supplement use in women in the UAE. In a survey of prenatal multivitamin supplement use in the UAE, only 40% of Middle Eastern women who delivered at term in a maternity hospital reported using their prescribed prenatal vitamins in the last trimester of pregnancy (18). Intermittent high-dose regimens could overcome low compliance. A dose of 50 000 IU vitamin D2/d has been suggested as effective in maintaining acceptable vitamin D status (19). Because the biological half-life of 25(OH)D is effectively 1?2 mo (15), dosing less than once every 2 mo may generate large fluctuations in 25(OH)D concentrations that may not be desirable or effective (20). Our objective was to determine the effectiveness and safety of 2 vitamin D supplementation regimens (a daily dose of 2000 IU or a monthly dose of 60 000 IU oral vitamin D2) in improving the vitamin D status of a convenience sample of lactating and nulliparous women residing in the UAE.
We chose to study this relatively high dose of vitamin D because our previous studies showed a high prevalence of severe vitamin D deficiency in this population (8, 11). Furthermore, daily dietary intake of 2000 IU of vitamin D3 or of a combination of vitamin D2 and vitamin D3 was previously reported to be safe and effective in improving vitamin D status in lactating women (21, 22). In the present study, we used vitamin D2, rather than the more potent vitamin D3, because the former is the only high-dose calciferol available in the UAE. We are not aware of any studies of this dose in non- lactating women of childbearing age. For ethical reasons, we did not want to use vitamin D doses 2000 IU/d so as not to exceed the current upper tolerable safe intake level for healthy adults recommended by the Institute of Medicine?s Food and Nutrition Board (23), especially when baseline serum 25(OH)D concentration results would not be available until the supplementation dose had been administered. Our hypothesis was that the monthly regimen of vitamin D supplementation would be as effective as the daily regimen in improving vitamin D status and that it would therefore be a reasonable alternative strategy, especially for patients from whom poor compliance is anticipated. vitamin D2 each.
For ethical reasons, we did not want to use vitamin D doses 2000 IU/d so as not to exceed the current upper tolerable safe intake level for healthy adults recommended by the Institute of Medicine’s Food and Nutrition Board(23), Information sent to that institute might help to change the established upper limits.
I think it would take at least 3 generations of women acquiring sufficient Vitamin D to produce a generation free of the negative effects, since each woman at birth is already impacted by her mother's deficiency. If you start administering Vit D the day a female child is born it will take multiple generations ("passages" if you will) to undo the negative impacts. I hope that the immune system might respond faster, i.e., within 4 to 6 weeks.
Now, the VDR abnormalities - are the irreversible? That sounds like an interesting and beneficial area to research.
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
While we may know about the benefits of a traditional diet, what do you think are the odds of getting Inuit to give up the easy modern diet? We can't treat indigineous people like an endangered species to be preserved.
I believe nutritional education should be increased, explaining to people how their traditional diets filled a niche in their body's requirements and how they can ensure they find an appropriate substitute from among the modern foods they like to eat. It could also be explained that different ethnic groups have different configurations of their VDR. Their traditional diet may have compensated for this variation, but they need to find a modern way of dealing with that situation.
If I was trying to convince some groups to compensate for their tradition requiring women to cover their bodies, I think I'd talk to their religous leaders and explain how Vitamin D deficiency might be impacting the health and fitness of their men. Have their own academic institutions do the research and the religous leaders could announce the results along with how they will deal with the problem. Don't most religions say people should stay healthy?
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Vitamin D is critical to impulse control. Impulse control is one of the major stumbling blocks that seperates man from the great apes.
This topic was on a recent PBS program - "ape genius". Not only do they have poor impulse control, but while they do cooperate, it's for immediate needs. They cannot control their behavior as part of a means of reaching a goal.
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
The larger benefit to supplementing vitamin D in some D deficient cultures may be impusle control.
Regional traditional diets and cultures are critical. If regional diets and culture did not contribute vitamin D to some degree man would not, could not live there.
Tom
To research any link between vitamin D and impulse control, it would be interesting to test violent criminals - of all ethnic groups.
If we assume traditional diets supplied sufficient Vitamin D, and we futher assume that Vitamin D can improve the immune system, then wouldn't it follow that these communities should have fared better than they did in the 1918 pandemic? While there were other factors that may have contributed to that situation, their high CFR might indicate their traditional diets created only marginal Vitamin D levels.
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Another unique group to follow for Vitamin D and influenza statistics is:
Nudists!
If there's a positive correaltion, I think we'd have a little difficulty putting it on our NPI list.
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Actually, there has been a study of people who's bodies have extensive sunshine exposure - surfers.
surfers in Hawaii who are in the sun and water continuously don't have vitamin D levels comparable to lifeguards that don't go in the water. The surfers typically have levels in the 70s while the lifeguards and others who are in the sun as much without going into the water will have vitamin D levels around 100.
the above article makes the assertion that sun-derived Vitamin D is formed on the skin and can be washed off, thereby not pepetrating the skin - giving the surfer lower levels than the lifeguard.
Another of his assertions is that sunshine can lower Vitamin D levels, because while UVB raises levels, UVA destroys it. Windows filter out the UVB, but allow some UVA - so sun through windows is lowering Vitamin D levels.
I haven't researched the above aritlce by Dr. Mercola - has anyone else seen literature about these ideas?
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Low vitamin D status despite abundant sun exposure.
Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, Hollis BW, Drezner MK.
University of Wisconsin Osteoporosis Research Program, Madison, WI 53705, USA. nbinkley@wisc.edu
CONTEXT: Lack of sun exposure is widely accepted as the primary cause of epidemic low vitamin D status worldwide. However, some individuals with seemingly adequate UV exposure have been reported to have low serum 25-hydroxyvitamin D [25(OH)D] concentration, results that might have been confounded by imprecision of the assays used. OBJECTIVE: The aim was to document the 25(OH)D status of healthy individuals with habitually high sun exposure.
SETTING: This study was conducted in a convenience sample of adults in Honolulu, Hawaii (latitude 21 degrees ).
PARTICIPANTS: The study population consisted of 93 adults (30 women and 63 men) with a mean (sem) age and body mass index of 24.0 yr (0.7) and 23.6 kg/m(2) (0.4), respectively. Their self-reported sun exposure was 28.9 (1.5) h/wk, yielding a calculated sun exposure index of 11.1 (0.7).
MAIN OUTCOME MEASURES: Serum 25(OH)D concentration was measured using a precise HPLC assay. Low vitamin D status was defined as a circulating 25(OH)D concentration less than 30 ng/ml.
RESULTS: Mean serum 25(OH)D concentration was 31.6 ng/ml. Using a cutpoint of 30 ng/ml, 51% of this population had low vitamin D status. The highest 25(OH)D concentration was 62 ng/ml.
CONCLUSIONS: These data suggest that variable responsiveness to UVB radiation is evident among individuals, causing some to have low vitamin D status despite abundant sun exposure. In addition, because the maximal 25(OH)D concentration produced by natural UV exposure appears to be approximately 60 ng/ml, it seems prudent to use this value as an upper limit when prescribing vitamin D supplementation.
These data suggest that variable responsiveness to UVB radiation is evident among individuals, causing some to have low vitamin D status despite abundant sun exposure. In addition, because the maximal 25(OH)D concentration produced by natural UV exposure appears to be approximately 60 ng/ml, it seem …
But, as reported previously, the lifeguard had a level of 100!
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
While we may know about the benefits of a traditional diet, what do you think are the odds of getting Inuit to give up the easy modern diet? We can't treat indigineous people like an endangered species to be preserved.
I believe nutritional education should be increased, explaining to people how their traditional diets filled a niche in their body's requirements and how they can ensure they find an appropriate substitute from among the modern foods they like to eat. It could also be explained that different ethnic groups have different configurations of their VDR. Their traditional diet may have compensated for this variation, but they need to find a modern way of dealing with that situation.
If I was trying to convince some groups to compensate for their tradition requiring women to cover their bodies, I think I'd talk to their religous leaders and explain how Vitamin D deficiency might be impacting the health and fitness of their men. Have their own academic institutions do the research and the religous leaders could announce the results along with how they will deal with the problem. Don't most religions say people should stay healthy?
.
Yes Denise, this is the strategy to use in cultures dominated by men and what my posts have been trying to infer but not state explicitly for a variety of reasons.
Since you have made this explicate, it frees me to extend your remarks.
What we know now or can extrapolate from the scientific literature is that vitamin D deficiency is a problem that affects all humankind and has become more severe due to both the effects of technological change and culture.
Men and women in both the developed and underdeveloped worlds have a high prevalence of vitamin D deficiency. The incidence of this condition increases with latitude since with rising latitudes the ability to obtain vitamin D from the sun diminishes.
Modern people be they occupants of the developed or under developed worlds and irrespective of what latitude they live in are all at risk for being vitamin D deficient by virtue of current customs and lifestyles.
What is clear from the literature is that a healthy level of 25 OH vit D is between 50ng and 70ng/ml, serum levels almost no one has today irrespective of where they live or whether or not they take vitamin supplements.
The data in the peer reviewed medical literature clearly shows that those with inadequate levels of 25 OH vit D are at increased risk for wide and diverse serious acute and chronic diseases. A partial list includes infections, cancer, and autoimmune disorders like rheumatoid arthritis, multiple sclerosis and systemic lupus.
Further more, as pointed out by you and others on this thread, trying to change human cultural practices, even if the recommended change would result in great benefit to those who adopt the change is a doomed strategy.
First, no one has the right to tell someone else how to live their life. This is the basis of human rights and hopefully in the future we humans will come to accept this principal, which is essential for our peaceful coexistence.
That said, there is no reason that universal vitamin D supplementation for all people everywhere should not be persuaded by the public health authorities both within every nation as well as by the WHO and health oriented NGOs that operate internationally.
While there is no controversy over the human need for vitamin D what remains controversial is how much vitamin D humans need. The US RDA of 400iu daily appears to be ridiculously low. The data suggest that people need at least 5,000iu to reach healthy levels of 25 OH vit D and 10,000iu daily to reach optimal levels of this hormone in the blood.
The only way practical way to achieve these levels on a consistent basis by those living today the way we do across the globe requires supplementation for the vast majority.
Supplementing the diet with 5,000 or 10,000iu of vitamin D is a very low cost way to address this problem. This suggestion is not likely to interfere with our customs or religious practices. The widespread adoption of this recommendation will be of great benefit to all humanity irrespective of whether they are rich or poor or live in the northern or southern hemispheres.
With respect to influenza, how might adoption of this practice be of benefit? There are two ways I can think of. Those with optimal levels of vitamin D who become infected with the novel strain can be expected, based upon the experimental and observational data published in the medical literature, to have less morbidity and mortality than similar people who are vitamin D deficient. Secondly, the patient who is vitamin D replete who contracts the pandemic flu and recovers only to become the victim of post-influenza bacterial pneumonia has a much better chance of surviving the second infection than someone who is vitamin D deficient.
Of course, the above is simply my opinion. It is based upon my study of this issue and experience with vitamin D over the last 26 years as a practicing physician and bone and metabolic disease researcher. What is important to understand however that the views I have expressed above are far from the consensus position and therefore must be understood as such.
Try looking at relationships between VDR abnomalities and diseases with suceptiblity for ethinic groups. Different abnormalities affect different groups, but there is an association in all the diseases I listed in a earlier post. e.g., the article below is talking about TB, but it goes to the association between VDR abnormalities.
IMO, those with the adverse VDR polymorphism are out of luck when it comes to vitamin D2 or D3 supplementation. The prevalence of the adverse double polymorphism is fortunately low at about 3% yet they represent about 8% of patients seen with osteoporosis. Their overrepresentation among this group of people is no surprise given the fact that one of the consequences of this common genetic condition is poor absorption of dietary calcium.
While this polymorphism is not trivial, since there is nothing we can do about it now suggest that a better strategy is to help those without this adverse genetic change that are vitamin D deficient correct their nutritional deficiency. This approach has the potential to help the greatest number of people at the lowest cost.
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