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Shedding light on vitamin D

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Trina Patton of Duluth had the scare of her life when her then-infant daughter, Jade, began to have a seizure.

"We didn't know anything was wrong," Patton said. She and her husband, Rod, rushed Jade to the hospital, thinking perhaps the baby had epilepsy.

"Then they said her calcium levels were low and that that was what had caused the seizures," Patton said last week. "It was like, 'huh?' For calcium deficiency?"

Patton credits Dr. Norman Carvalho at Children's Healthcare of Atlanta for quickly diagnosing and treating Jade for rickets, the result of a vitamin D deficiency. She is now a happy, healthy 3-year-old.

As nutrients go, vitamin D has long been on the B-team, but increased cases of rickets like Jade's and new studies across the globe are showing that people, particularly African-Americans, may need far more D than previously believed.

In the Netherlands, researchers are looking at vitamin D deficiency as a cause of colon cancer. In Great Britain, vitamin D is being examined for a link to multiple sclerosis. In France, D has been studied for lowering the rate of fractures among the elderly. In Charleston, S.C., doctors are studying Gullah residents and finding a possible link to high blood pressure, prostate cancer and diabetes.

Many researchers hope the studies will lead to new, higher federal guidelines for vitamin D.

"What the Food and Nutrition Board has set for vitamin D is almost nonsense," said Dr. Reinhold Vieth, director of the bone and mineral laboratory at Mount Sinai Hospital in Toronto and one of the world's leading D researchers. "We've got a stream of publications that prove well beyond a reasonable doubt that grown-ups need more than 800 units a day of vitamin D."

That's four times the current recommended amount of 200 for people under 50. Few people can meet D requirements through diet alone because few foods contain it. The main source of D is ultraviolet B sunlight, and that makes the new D discussion not only widespread but also controversial for fear that people will begin to bask in the sun. Rickets reappears

"This has been a huge firestorm," said Dr. G. Williamson Wray III, an Atlanta dermatologist.

"It's hard to understand why we just can't take it in pill form," Wray said.

Part of the reason is that no one knows for sure just how much vitamin D a person needs. Also, guidelines for D have been unnecessarily low because it can be toxic in extremely high doses, Vieth and others charge.

What is becoming clear, however, is that certain populations, particularly African-Americans, may need even more than 800 units.

"It's a horrible problem among elderly African-Americans," said Dr. Bruce Hollis, professor of biochemistry and molecular biology at the Medical University of South Carolina in Charleston. Hollis has spent years studying Gullah residents near Charleston and has found "startling" rates of lupus, multiple sclerosis, prostate cancer and diabetes that he blames on D deficiency.

African-Americans appear to be at higher risk for deficiency because dark skin prevents absorption of ultraviolet B rays, which in turn trigger vitamin D production in the body. Vitamin D helps the intestines absorb calcium, essential for bone growth and several bodily functions.

But it's not only African-Americans who may not be getting enough sun to produce adequate D. Millions of people who live in sun-deprived environments, including very fair-skinned people in high latitudes, elderly people in nursing homes, and those who work indoors and wear sunblock whenever they are outside, could be affected.

Much of the recent focus on D began with new cases of childhood rickets, a bone-softening disease prevalent in children at the beginning of the 20th century.

In response, milk producers and makers of infant formulas enriched their products with vitamin D. Doctors considered rickets wiped out by midcentury.

It reappeared in the late 1990s.

In North Carolina, doctors identified 30 cases in 2000. All were breast-fed, African-American infants or children.

"We were puzzled," said Dr. H. Neil Kirkman, professor emeritus of pediatrics at the University of North Carolina School of Medicine. "Most of us pediatricians are extremely in favor of breast-feeding, and we were glad to see that breast-feeding become popular in African-Americans."

Breast-feeding rates among African-Americans are far lower than among Caucasians, and many health initiatives have been launched to encourage it.

Before long, the professors at the two schools diagnosed vitamin D deficiency in all 30.

"The thing that surprised us was that we were in North Carolina," said Kirkman, where a low latitude provides for long periods of daylight.

Carvalho of Children's Healthcare said the pieces of Jade's puzzle all fit when she was admitted to the hospital in 2001 because she is African-American and was being breast-fed. Getting 'your fill'

Jade's case was far from isolated in Atlanta.

"We're still seeing several cases each year," Carvalho said. The cases have been in dark-skinned babies.

Doctors stress that the deficiency in African-American breast-fed babies does not mean that women should refrain from nursing. They should supplement their babies with 200 units of vitamin D, which the American Academy of Pediatrics recommends now for all children under 14.

Because a lack of absorption of sunlight is behind most all cases of D deficiency, some doctors think 15 to 20 minutes a day in the sun would help. They are afraid, however, to tell people to go into the sun.

"They don't want to contradict what they've already been saying," Carvalho said. "But at the same time, some things in small amounts are not necessarily that bad. And sunlight is not that bad in small doses."

Establishing a safe amount of sunlight across all races and skin types would be hard, however. For some, even a little sun is very risky, dermatologists said.

"It's a dangerous way to get your fill," said Wray.

But there is no sure way to get one's fill. Vitamin D supplements in amounts high enough to restore healthy levels are not universally available, Vieth said.

"In theory, you should be able to walk down to your drugstore and get 1,000 units," said Vieth. "But whether your pharmacy stocks that is another matter."

For now, the best hope is that the Food and Nutrition Board will recommend a higher level for supplementation, Vieth and others said. That could be a job in itself, the D proponents said.

"Before Christopher Columbus sailed the ocean, people thought you were going to fall off the world if you went too far," Vieth said.

Copyright 2004 The Atlanta Journal-Constitution

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