As reported by the BBC, Labour MP Kate Green has this week proclaimed that the government is not doing enough to tackle a "shocking rise" in the cases of rickets, which has risen from 184 cases in 1996 to 762 in 2011. She called for raised public awareness amongst those most affected and to make sure guidance about diet and sunshine exposure is "clear, consistent and well targeted". Here, here.
Of course, no one in their right mind, me included, would challenge the well intentioned sentiment behind these statements. The re-emergence of rickets, a disease that we should only really be reading about in history books about Victorian England, not breaking news in 21st Century Britain, can be easily prevented simply by providing enough vitamin D, making this escalation in cases totally unacceptable in an era of sophisticated modern healthcare.
But I've got two bones to pick (forgive the dodgy pun) with this. I wholeheartedly agree with calls for raised public awareness amongst those affected by vitamin D deficiency. But why the myopic focus on rickets, which is merely the most brutally visible tip of the iceberg of vitamin D deficiency in the UK? Vitamin D deficiency is not a marginal issue affecting a few hundred children each year, rather, the bone health of great swathes of the UK population is in jeopardy due to insufficient vitamin D. During the winter and spring, over half the UK population has vitamin D levels below that needed for healthy bones [1]. This is potentially compromising the bone health, and future risk of osteoporosis and fractures, of millions of Brits.
But even with this revelation, we're still barely beyond the tip of the iceberg of vitamin D deficiency, a field that has proven a hotbed of research over the last decade. And what is that research showing? A lack of vitamin D - all too typical amongst Brits - could plausibly be increasing the risk of just about every modern-day health problem you care to mention, such as common cancers, diabetes, cardiovascular disease, multiple sclerosis, rheumatoid and osteo-arthritis, depression, dementia, infectious diseases, and pregnancy complications such as pre-eclampsia and caesarian delivery. Why only focus on rickets, the most blatant manifestation of the vitamin D deficiency epidemic in the UK?
MP Kate Green is reported as arguing that recommendations to promote our vitamin D intake should be "clear, consistent and well targeted". But that only works if we have government guidelines that are effective and reflect the current evidence, which they don't. Current recommendations for vitamin D intake in the UK are shambolic and stuck in the dark ages. Despite soaring rates of vitamin D insufficiency, the UK is the only country in Europe with no recommended vitamin D intake for 'healthy' adults. Even among vulnerable groups such as older people and pregnant and breastfeeding women, official recommendations for vitamin D supplements are deplorably low and doing precious little to alleviate the problem of vitamin D insufficiency. We can take some heart in the fact that the Scientific Advisory Committee on Nutrition is currently reviewing dietary recommendations for vitamin D, but are not expected to report until 2014. In the meantime, official advice on vitamin D remains risible.
Yes, we need to stamp out rickets, and that is a priority. But don't be fooled that vitamin D deficiency affects a tiny minority of the British population. There's every chance that you, and your family, will run health risks from a lack of vitamin D this winter, and relying on prehistoric government guidelines won't protect you. Offering a solution to the public health crisis of vitamin D deficiency was one of the biggest motivations behind my recent book The Health Delusion, and I truly hope this issue receives the genuine attention it deserves - and sooner rather than later.
[1] Hyppönen E, Power C (2007) Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am J Clin Nutr 85(3):860-8.