Hard to swallow

4th August 2009

posted in Class & Poverty, Fat Acceptance, Fat Bias, Health, Nutrition & Fitness, Mind & Body, New Research, Race Issues |

Ever since I found out a few months ago that I was severely deficient in vitamin D, it seems that it’s there’s been a barrage of health articles on the subject. But this Washington Post article (via MSNBC) is the first to link vitamin D with not only diabetes, but also the big bad obesity epidemic.

The lede reports the alarmist find that: “Millions of U.S. children have disturbingly low Vitamin D levels, possibly increasing their risk for bone problems, heart disease, diabetes and other ailments…” Never minding the fact that my doctor told me that most people are deficient in vitamin D, the researchers of two new studies on the subject go on to make value-based judgments on why this is so:

Low Vitamin D levels are especially common among girls, adolescents and people with darker skin, according to the analysis of a nationally representative sample of more than 6,000 children. For example, 59 percent of African American teenage girls were Vitamin D deficient, [Michal L.] Melamed’s study found.

The researchers and others blamed the low levels on a combination of factors, including children spending more time watching television and playing video games instead of going outside, covering up and using sunscreen when they do go outdoors, and drinking more soda and other beverages instead of consuming milk and other foods fortified with Vitamin D.

“This appears to be another result of our unhealthy lifestyles, including a sedentary society that doesn’t go out in the sun much,” Melamed said.

I’m not debating that too little vitamin D is harmful for children — I’m a big proponent of vitamin D after being prescribed it myself and feeling a surge of energy return just days after taking my first supplement. Instead, what I question are the assumptions the researchers come to as to why children today are deficient. Keep in mind that an accurate measure of vitamin D levels appeared only 15 years ago and that it has taken 5-10 years for it to reach widespread use. The tests are so new, in fact, that doctors are still debating the government’s official guidelines for recommended daily intake. Before this, the only indicator of a vitamin D deficiency was rickets, a deformative softening of the bones condition that is usually brought on by a severe case of vitamin D and also calcium deficiencies usually as the result of famine or starvation. Most people who are deficient in vitamin D don’t even know it as the symptoms can be so vague and are often attributable to other conditions/factors. Children today may be no more deficient than their peers of yesteryears; it may be that we are only now able to accurately measure these widespread deficiencies. Let’s dissect these so-called “unhealthy lifestyles” researchers say are now to blame for childhood vitamin D deficiency:

1. Sedentary lives leading to insufficient sunlight exposure: Vitamin D is often called the “sun vitamin” because our bodies produce it upon exposure to the sun, but sunlight is unreliable and several factors influence its ability to induce vitamin D production: angle of the sun, latitude in which one lives, skin pigmentation and use of skin-care products containing SPF. A MedPageToday article on the two studies notes that researchers lacked information on the children’s exposure to sunlight, so no causality can really be established here.

2. Sunscreen use: This is an “unhealthy lifestyle” choice? Really? What’s unhealthier? The leading type of cancer –skin cancer– or a vitamin D deficiency?

3. Increased soda consumption/Decreased milk consumption: The fact that low vitamin D levels are especially common amongst people of color isn’t surprising considering that 95 percent of black people and the great majorities of other people of color are lactose-intolerant –a genetic fact that is never mentioned in either article (or in milk-drinking campaigns and government guidelines). Many people of color lack a digestive enzyme needed to digest the sugars in milk and while this intolerance usually doesn’t manifest itself until adolescence or adulthood, it can still pose problems for children of color. The fact that the still largely milk-white medical community still recommends fortified milk consumption for healthy vitamin D levels demonstrates a classic case of lingering racial discrimination in health care. Research has shown that an inability to digest milk is not a genetic mutation, but rather a genetic norm — the gene for lactase normally switches off as children are weaned and only a small percentage of humans (namely, white folks) in whom the gene is not turned off are able to drink milk into adulthood. This is why some in the medical community have begun to regard us milk-drinking anomalies as “lactose persistent” instead of labeling those who can’t digest milk as “lactose-intolerant.”

Apart from fortified milk, foods naturally rich in vitamin D are scarce –seafood tops the list, along with some cheeses, yogurts, cereals and juices. Since food is not a reliable source of vitamin D, doctors usually recommend taking supplements, which are available over-the-counter in low doses and by prescription for high doses like mine. The supplements aren’t overly-expensive, but can be pricey for families on a budget when you consider that it first requires a doctor’s visit to determine if a deficiency exists and what dosages are needed, along with seasonal follow-up appointments to determine future dosages. Since people of color tend to be disproportionately poorer than white people, it stands to reason that this may not be a lifestyle “choice” as it is a socio-economic fact of life.

Even more interesting are the medical findings of the studies, which are listed in more detail on the MedPageToday article:

Children with low levels of 25-hydroxyvitamin D were more likely to be overweight and/or obese (P for trend <0.001 for both), but even after the researchers adjusted for age, gender, race/ethnicity, body mass index, socioeconomic status, and physical activity, they found that low vitamin D was often accompanied by high systolic blood pressure, high blood sugar, and metabolic syndrome.

These conditions, which are all risk factors for cardiovascular disease, were present regardless of whether the children were overweight or not, the researchers said.

Missing in both articles is the mention that a chief symptom of metabolic syndrome is weight gain. This may be because many in the medical community believe weight gain not to be a symptom of metabolic syndrome, but rather a cause of it. WebMD’s page on metabolic syndrome states matter-of-factly: “Metabolic syndrome is caused by an unhealthy lifestyle that includes eating too many calories, being inactive, and gaining weight, particularly around your waist.” Since the studies are the first of their kind, more observation is needed, but it stands to reason that if so many children are deficient in vitamin D, then just as many, if not more, adults are also deficient. And if a vitamin D deficiency has been linked to metabolic syndrome and high blood sugar independent of weight, then perhaps not all people with the condition are just lazy, Twinkie-munching couch potatoes with a spare tire or two.

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This entry was posted on Tuesday, August 4th, 2009 at 9:55 am and is filed under Class & Poverty, Fat Acceptance, Fat Bias, Health, Nutrition & Fitness, Mind & Body, New Research, Race Issues. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

1 On August 4th, 2009, Lori said:

This is really interesting. I literally just got a call half an hour ago from my doctor’s office telling me that the results of my prenatal blood work (all 8 vials of it) were back, and everything was fine except my vitamin D, which was very low. I drink a lot of milk and generally spend at least an hour a day outside, so I was really surprised to hear that! But, I realized that I also have pretty dark skin and I don’t usually have much skin exposed in the sun, so that could be part of it.

Ugh, though. I was so glad that my blood sugar and blood pressure were fine, figuring that that meant they couldn’t blame my being fat for any health problems, and now it turns out my vitamin D deficiency could be blamed on it.

posted on August 4th, 2009 at 10:36 am

2 On August 4th, 2009, Shoshie said:

Also ignored is that many people who live in northern climates may not get getting enough vitamin D simply from their location. Even though that’s common enough knowledge up here in Seattle, where it’s DARK in the winter and people frequently buy sunlamps (that is, if you can afford them). My university actually has a place in the health center you can go and soak up the sunlamps during the winter.

And also, I call them out on singling African Americans without any separate explanation. I always learned that the reason people developed lighter skin was specifically because of the northward spread of the human population, because it’s easier to make vitamin D with lighter skin. That’s why rickets was primarily found in African American populations, not through any fault of those bodies or those people, but because they were dragged here (here being North America) without sufficient time to adjust on the evolutionary timescale.

Basically, I call bullshit on this article. Why don’t you all in DC come up to the other Washington some winter and THEN tell me that the solution to getting enough vitamin D is just play outside more and eat better. Grr.

posted on August 4th, 2009 at 10:47 am

3 On August 4th, 2009, Weightless One said:

I was diagnosed with Vitamin D deficiency several years ago. I’m lactose intolerant and a very fair-skinned caucasian. Since I was fat, I was told that I spent too much time in front of the TV and not enough time outside. When I asked how long you needed to spend outside sans sunscreen (I burn just looking outside during a sunny day), I was told 15 minutes a day. Hell, I spend more than 15 minutes a day outside without sunscreen just walking to and from work! Obviously there is something else going on here. Also, Vitamin D (correct me if I’m wrong here) is a fat-soluble vitamin. Could all of those years of being harangued and forced onto a nonfat diet have anything to do with being deficient? I wonder…

posted on August 4th, 2009 at 11:01 am

4 On August 4th, 2009, spoonfork38 said:

My kids are probably covered—they pretty much eat every fortified thing on the food list (I’m working on getting them to like seafood) and they play outside every day it’s sunny, of course with plenty of sunscreen, but some UV must be coming in, since they’re browning—but I don’t regularly eat anything on the list, and I work in a basement pretty much all day, five days a week.

So I guess I’d beter look into this!

posted on August 4th, 2009 at 11:02 am

5 On August 4th, 2009, Vixen said:

Sensing a trend here, hopefully due to an accurate lab test and wider awareness not just the magic-pill-du-jour. I just got my labs back and lo and behold, everything was peachy keen — blood sugar, cholesterol, allsorts — EXCEPT my Vit D levels.

I had mentioned to my (new) ARNP that a recent doc had recommended checking for anemia if my energy level didn’t come up. My energy level never comes up, except for brief flashes here and there. She suggested testing my ridiculously Caucasian obese Seattle-dwelling PMLE-rocking blood for Vitamin D, too. Yup.

Got me to wondering if my usual surge of energy and goodwill on vacations — where I go out of my way to make my skin behave so I can be outside — hasn’t been partly down to getting enough sun exposure for a change.

I just started supplements and I figure anything that seems to change in the first week is probably the placebo effect, so we’ll see. But I’m hopeful.

posted on August 4th, 2009 at 11:44 am

6 On August 4th, 2009, Weightless One said:

Oh, and also, they changed the guidelines for Vitamin D levels a few years ago just like they moved the bar on overweight/obese with the BMI in the 1990s.

posted on August 4th, 2009 at 11:48 am

7 On August 4th, 2009, The Bald Soprano said:

Arrgh. I just went two rounds with my doctor about getting my vitamin D and B12 tested –mostly because of your earlier post– (I won, but the public insurance won’t pay for the tests, so I’m shelling out the EUR 60 for them tomorrow), and she said that hardly anyone is D-deficient, as long as you go out in the sun (which I don’t do that much, at least without sunscreen) –and milk here in Germany ISN’T fortified with D, even! (I do drink a lot of milk, like all of my family members, but well, since there isn’t any D in it here…) –and I was at the doctor to see why my fatigue has gotten worse again in spite of supposedly normal thyroid levels (with medication) now. Oh, and I’m allergic to seafood.

(at least she’s eagerly double-checking the slightly low haemoglobin levels that my ex-endocrinologist never even bothered to mention to me over the past two years…)

posted on August 4th, 2009 at 12:02 pm

8 On August 4th, 2009, Rachel said:

Ugh, though. I was so glad that my blood sugar and blood pressure were fine, figuring that that meant they couldn’t blame my being fat for any health problems, and now it turns out my vitamin D deficiency could be blamed on it.

Actually, what this study shows is one’s weight may not be to blame for, but be caused by a vitamin D deficiency. About 60 percent of obese children studied were deficient, but considering that the studies also linked vitamin D deficiencies to metabolic syndrome and high blood sugar, their obesity could thus be a symptom, at least in part, of these two conditions, which are symptoms themselves of a vitamin D deficiency. If that makes sense.

@Weightless One: I don’t know about vitamin D being fat-soluble, but will look into it. And they’re also considering revising vitamin D levels in the next government guidelines that come out next year. In this case however, since what we know about vitamin D and its effect on health is still in its infancy, I can understand why the recommended intake levels are still being altered. Unlike BMI, that is, which was lowered arbitrarily, without any real scientific justification, and recommended by a board with extensive ties to the commercial diet industry.

posted on August 4th, 2009 at 12:27 pm

9 On August 4th, 2009, Lucy said:

Because I can totally see the leap from sitting inside watching TV to wearing sunscreen WHEN YOU DO GO OUTSIDE. Only a lazy, non-conscientious lard-ass would wear sunscreen and cover up, right?

I was diagnosed as D-deficient last year, and given these capsules to take, which I admit I’ve been slacking on. Then again, in the same visit, I was also told that I’m sensitive to dairy products and should limit my intake. Um. And if all you need is fifteen minutes outside, I certainly do more than that on a regular basis. So what the hell?

posted on August 4th, 2009 at 12:40 pm

10 On August 4th, 2009, Bree said:

I have a B12 deficiency and anemia, which I inherited from my mom. My last bloodwork results did not indicate a vitamin D deficiency, but I am biracial and semi lactose-intolerant (I can’t drink whole milk or eat cheese on its own or it causes me extreme bloating and stomach discomfort). But I’m fine with dairy products mixed in with other foods or in other textures.

Not surprising that researchers would try and link the lack of vitamin D to fat without looking into other factors first. That’s the style of fat reporting these days.

posted on August 4th, 2009 at 12:52 pm

11 On August 4th, 2009, Toni said:

I was given a battery of tests a few months ago and I was told I was Vitamin D deficient as well.. and I’m on the prescription D dose as well.. I couldn’t BELIEVE the change in energy from before to after. I don’t like milk as a rule, so I have been also supplementing my diet with more fish and yogurt.

posted on August 4th, 2009 at 1:14 pm

12 On August 4th, 2009, living400lbs said:

Another Seattle-area person here with a vitamin D deficiency. I posted a bunch of links here. Apparently fat people absorb less D from pills and manufacture less from the same sun exposure as thin people.

That said, the further north you live, the less vitamin D you can manufacture. There’s a reason cod liver oil was a traditional supplement among Northern Europeans.

posted on August 4th, 2009 at 1:28 pm

13 On August 4th, 2009, Weightless One said:

@Rachel – I agree. The BMI change and Vitamin D change were for different reasons, but they both shifted more folks into another category overnight. More people became labeled as overweight/obese and more people were labeled Vitamin D deficient when nothing changed about the people in question. That’s all I was trying to say in my round about way.

posted on August 4th, 2009 at 1:49 pm

14 On August 4th, 2009, Amy said:

Vitamins A, D, E and K are fat soluble, and this is one of the reasons why it is important to have a moderate amount of fat in one’s diet. Its also important because it means that these vitamins are stored in the fat reserves in one’s body, and are not simply excreted (urinated) out like vitamins B and C. Vitamin A can be dangerous if taken in too high quantities, as it persists in the body.

posted on August 4th, 2009 at 1:52 pm

15 On August 4th, 2009, pyewacketsid said:

I just got diagnosed as D-deficient too, and am feeling better with the supplements (and some other changes). I’m fair-skinned and live in FL. Two things:

1)My doc was showing me recent research that shows that, even if you spend 15 minutes out in the sun with no sunscreen and generate thousands of lovely d-3 units, IT TAKES 2-3 DAYS TO ABSORB FULLY from the skin’s surface. Which means if you take a shower, you’re washing most of it away. Explains a lot.

2) WRT sunscreen, I keep in mind that basal and squamous cell carcinomas (caused by sun exposure) are among the most successfully treatable cancers out there. A basal can go years without treatment, and squamous is more aggressive, but you still have months to tend to it before it gets really dangerous. Melanoma is the fucker that will pop up quickly, metastasize, and kill you while you’re still trying to make an appointment (I have a friend dying of it right now), and it manifests in areas that DON’T get sun exposure.

Now, Vitamin D deficiency is associated with the nasty, frequently untreatable cancers like colon, pancreatic, and prostate. So when it comes to the good ol’ SPF, our family uses enough to prevent burning, but we don’t try to stay lily-white.

posted on August 4th, 2009 at 2:55 pm

16 On August 4th, 2009, Rachel_in_WY said:

On a related note, I get pretty bad allergy-induced excema when my D and B12 levels get low. No topical treatments even touch it, but three weeks of taking D, a B-complex, and flaxseed oil clear it up completely. Also, when my D levels are low I feel like I’m low thyroid regardless of what the blood tests say.

Lori,

Take lots of D now, because it’s fat-soluble (as Weightless One correctly noted) and so if you plan to breastfeed, the D you absorb now will influence the D levels in your milk then, unlike water-soluble vitamins that go straight into your milk. It makes me wonder if newborns are more vulnerable to rashes and excema because of a D deficiency…

posted on August 4th, 2009 at 3:01 pm

17 On August 4th, 2009, Rachel said:

Vitamin A can be dangerous if taken in too high quantities, as it persists in the body.

Unlike vitamin A, which Amy noted can be dangerous in high quantities, you can’t take too much vitamin D. In fact, my doctor says the more the better, given vitamin D’s anti-oxidant properties in warding off several cancers.

posted on August 4th, 2009 at 3:04 pm

18 On August 4th, 2009, Jackie said:

In regards to lactose intolerance. Lactaid sells these chewables and pills that have the lactase enzyme in them.

posted on August 4th, 2009 at 4:11 pm

19 On August 4th, 2009, Piffle said:

I understand that you can take too much vitamin D, it can throw off your calcium levels:

http://ods.od.nih.gov/factsheets/vitamind.asp

If you take too much you can raise your blood calcium to the point of causing confusion and heart rhythm abnormalities. The upper limit recommended for long term safety is 2,000 units; though my understanding is that you can take much more than this short term to get your levels up to normal. I’m not a medical professional though, so take this with a grain of salt.

That said, I take the 2,000 units and while I don’t feel more energetic, my joints hurt less. I tried going off them in the summer because I don’t wear sunscreen, I garden for about an hour a day; and I’m fair skinned. The joint pain came right back, so somehow my body isn’t making enough from the sun even with way more than the recommended exposure.

There’ve been differences in blood pressure and cardiovascular problems between POC and whites for a long time; I wonder if this vitamin D difference could explain some of it?

posted on August 4th, 2009 at 4:32 pm

20 On August 4th, 2009, rachel with a little r said:

On my local news here was a story about how so many of “our” kids (I don’t know…they must’ve been talking about theirs and someone else’s, cause it ain’t theirs and mine!) are deficient in Vitamin D. The answer? “Kids need to drink more milk!” No mention was made that you can photosynthesize your own. Which, yeah…I guess most everyone in our society knows that already, but perhaps there are a few who don’t? in any case, I thought it was really strange they made a plug for milk but not sunshine. But then, hehe, sunshine is free, and milk is relatively expensive, not to mention, completely unnecessary for a healthy diet (*gasp!*)

posted on August 4th, 2009 at 9:53 pm

21 On August 5th, 2009, lilacsigil said:

I live in Australia (skin cancer capital of the world), I’m extremely fair-skinned, I go outside every day and garden, I drink plenty of milk and don’t like soda…and yet I’m still Vitamin D deficient, and so are many other Australians. It could be related to my thyroid condition, though. Isn’t it nice of the article to blame unhealthy behaviours like wearing sunscreen and being lazy!

posted on August 5th, 2009 at 5:18 am

22 On August 6th, 2009, Marlie said:

I was surprised by the statistic that 95% of black people are lactose intolerant, and so I clicked on the link.

The website specifies that 95% of African blacks and 75% of North American blacks are lactose intolerant. Because your source separates the two, I don’t think it’s correct to combine them in your post.

posted on August 6th, 2009 at 3:31 pm

23 On August 6th, 2009, Rachel said:

You’re right, Marlie. For some reason, I read it as African-American. Still, 75 percent is quite a hefty percentage, especially when combined with the large numbers of other minorities and an estimated 15 percent of white folks who are lactose-intolerant.

posted on August 6th, 2009 at 3:44 pm

24 On August 10th, 2009, The Bald Soprano said:

I just had to come back and post, because I just this morning got my latest blood test results, and voila, I am also very D-deficient (the reference range was 30-70 ng/ml, and mine was 5). I have a prescription for a supplement in my hot little hands, and I’m looking forward to maybe not having to sleep every six hours for a change.

posted on August 10th, 2009 at 7:06 am