Why does the government ignore evidence for the benefits of Vitamin D ?
Posted at HealthInSightUK Nov 26, 2013
Rufus Greenbaum discovered the appalling truth when he investigated a little known committee that decides which supplements should be available on the NHS.
Some years ago I became interested in how the government and the Department of Health deal with preventing illness. My own health had improved after I had lost a lot of weight and I felt so much better that I began researching what else could keep me feeling so well. One bit of advice that kept cropping up was to keep Vitamin D levels topped up.
It seemed such a simple way to improve health in all sorts of ways that I contacted various experts to find out why the government was ignoring the evidence. After all, vitamin D is very cheap and making it widely available on the NHS would surely have all sorts of cost-saving health benefits.
Among those I spoke to was a doctor who had just written a book about Vitamin D and sunshine, plus a well-known academic and a campaigning journalist. They all explained that the two bodies that were key to getting any supplement or health initiative approved for the NHS were NICE (National Institute of Clinical Excellence) and one I'd never heard of: SACN (Scientific Advisory Committee on Nutrition www.sacn.gov.uk ).
Even though Vitamin D had been a hot area of research for over a decade, the SACN hadn't assessed the evidence for over five years - their last significant paper on it had been in 2007. Then their conclusion had been much the same as it had been for decades - all we need is a minuscule amount in the blood stream ( 25 nmol/L ) to avoid rickets and other bone problems.
On that basis we are all doing pretty OK since the UK average is between 25 and 50 nmol/L. However that is way below the amount now recommended by the 40 eminent experts from around the world whose work I had been following. Their advice was that every adult should have between 100 and150 nmol/L in their bloodstream to prevent some major long-term illnesses.
In their Call-To-Action program - which can be found at www.grassrootshealth.net - they say: "There are newly appreciated associations between low levels of vitamin D and a range of fairly common disorders including: tuberculosis, psoriasis, multiple sclerosis, inflammatory bowel disease, type-1 diabetes, high blood pressure, increased heart failure, myopathy, breast and other cancers.
It's probably worth clarifying how vitamin D is measured at this point. It gets a bit tricky because it can be measured in two different ways: - nanomols per litre (nmol/L) - used in the UK - and nanograms per millilitre (ng/mL) used in the USA. To convert one to the other 25 nmol/L = 10ng/mL. There are also two ways of measuring the amount contained in food or supplements - micrograms (μg or even mcg=millicentigrams) and in international units - IU. Traditional UK advice has been that an adult needed 200IU or 5 micrograms a day.
The amount which people need to get in their food or from a supplement to raise the amount in their blood by a certain amount varies enormously. But a rough guide is the basic intake of 200 IU (5 μg) per day can raise the vitamin D in your blood by 2 ng/mL (5 nmol/L) in about 3 months. So to push your blood level up from 25 nmol/L to 125 nmol/L you would need at least 100 μg or 4,000 IU a day for 3 months.
My experience made it clear that the reason doctors weren't being told, or at least encouraged, to check patient's levels and supplement if they were too low was that the SACN was only advising about the minimum required to avoid problems and not the optimum need to provide better health. Also, the SACN did not seem to accept some of the latest research, especially Observational studies. What happened next confirmed this.
I did a bit more sleuthing and discovered that the body that SACN reported to was the now defunct Food Standards Agency (FSA). So in December 2009 I went to the next meeting of the Food Standards Agency and asked whether they were aware of the Call-To-Action group and all the evidence for widespread deficiency they had been collecting and the benefits of supplementing to correct it. The answer I received was alarmingly inadequate.
The FSA - the body set up to monitor our food and eating habits - told me two things: that everyone could receive sufficient Vitamin D from their food and secondly that anyway people could get what they needed from the sun. Neither is true in the UK.
You would have to eat at least four oily fish a week (which almost no one in the UK does) to be getting even close to the amount Call-to-Action were recommending and in the UK it is impossible to make any vitamin D from the sun for about six months of the year. I was so incensed by this level of ignorance and the harm it was doing to people that I went home and wrote a 9-page letter to the Chairman of the SACN and hand- delivered it the next day. I also wrote covering letters to all 5 of the Health Ministers and a few other significant people like the Chief Medical Officer.
I learnt 2 things from this exercise:
- That ministers don't want to know about widespread vitamin D deficiency because they all referred me back to the SACN, saying they were "waiting for advice from our experts, the SACN". This committee was as good as government expertise on vitamin D could be.
- That the naive idea that I and others had that SACN and related government bodies were interested in discovering how nutrition and supplements could improve people's health was simply wrong.
This became all too clear when I went to the next SACN meeting following the delivery of my letter.
The committee did discuss it and the chairman and the minutes of the meeting gave me the response:
"What you are asking for is "Risk Management" but this committee only does "Risk Assessment"”.
In other words the SACN - the official source of information about food and supplements – is not allowed to advise about how any food could make you healthier and better able to fight off disease. Its only concern is to work out the minimum amount that people need to prevent the general population having a problem. As far at vitamin D is concerned that's the amount needed to stop rickets - a connection that was first made in the 1920's.
So it is no wonder most UK NHS doctors are not very interested in checking your vitamin D status. Their advice about this remarkable hormone comes from a committee whose awareness of its potential has moved on little in nearly a hundred years.
The result is that if your NHS vitamin D blood test shows you have 26 nmol/L or more, there is no need for you or your doctor to do anything. This level is set at the equivalent of 50 in USA, plus there are valid bone-related reasons for it to be more than 75 and the international experts are calling for 100-150.
This is like a car always running on an empty tank of fuel or a photocopier always running with little toner on reserve. How much better if we keep the reserve topped up so that our body can use as much as it needs when it needs it. When we are Adonis or Aphrodite of 20 most of us have chemicals in our bodies that are at their peak. By the time we reach 40 many of these chemicals have reduced and this is when some of the longer-term illnesses of older age start to begin to develop. I am following the hypothesis that it might help to replenish these chemical to levels like I had when I was younger. This involves a combination of choosing specific foods for optimum nutrition and adding some supplements
But even this minimalist Risk Management strategy for Vitamin D is failing in the UK. Every year between 2008 and 2011 there were over 700 recorded cases of Rickets in the UK. This is a scandal, as the Department of Health knows how to avoid it – but they have forgotten what their predecessor once knew. In the past, food was fortified with Vitamin D and the government gave Cod Liver Oil to children in the 1940s and 1950s, but both of these actions were stopped.
Even more alarming, it seems very likely that this dangerous and utterly inadequate approach is what doctors are taught – I spoke to a GP who told me that “I know nothing about nutrition”. This is like their “evidence-based” approach to all other nutritional supplements, which they often describe as expensive urine. I am reminded of the quite from Wendell Berry: “People are fed by the food industry, which pays no attention to health, and are treated by the health industry, which pays no attention to food.”
I was so shocked by this that I decided to do what I could to improve doctors’ lamentable education about vitamin D. So during 2010 and 2011 I arranged four scientific conferences about Vitamin D in the Wellcome Trust and BMA House. Many researchers and medical professionals attended, plus press, together with Dietitians, Nutritionists, members of the public and food manufacturers. There were nearly 1,000 people in total, the events were professionally recorded and some of the videos have been watched on YouTube by more than 15,000 people.
You can see more at:
www.vitamindassociation.org/events Videos of my scientific conferences
www.vitaminduk.com My occasional blog
www.grassrootshealth.net Download the Call-To-Action
www.vitamindcouncil.org Subscribe to their newsletter
www.vitamindwiki.com The most information about Vitamin D anywhere
I can't tell how much effect this has had but the SACN is now preparing a new report on Vitamin D. It will take three years and is due to be published in September 2014. The committee may also soon become more pro-active as a result of becoming part of the new body Public Health England which has a remit to focus on optimum public health and to explore ways to achieve it.
Until then, you can take control of your own health, by reading the advice in my blog at: www.vitaminduk.com Look for “How much do I need ?” and decide how to measure your own blood level and supplement it. There is even a very simple self-test described at: www.vitamindwiki.com Press your sternum bone and your shin bones as hard as you can and see if they hurt. If they do, Mayo Clinic says that there is a 93% chance that you are severely deficient.
Testing for vitamin D deficiency and taking simple steps to improve it would be a good first step and I'm hopeful – but not confident - that the next SACN report will contain more positive advice for the politicians, medical professionals and the public.
But as long as the attitude to nutrition and supplements in general continues to reflect the same level of ignorance I found at the SACN, then the huge potential for actively and effectively using diet and life-style change to prevent and treat our epidemic of chronic disease is going to be lost.
(Private) Meeting was held by SACN on 1st October 2013
01 Chair's welcome, apologies, changes to declarations of any conflicts of interest
02 Minutes of the previous meeting
03 Matters arising from the previous meeting
04 Report back from the Committee on Toxicity
05 Conclusions regarding 25(OH)D thresholds to use as a basis for setting DRVs for vitamin D:
Consistency of approach regarding evidence on supplementation with vitamin D alone and with calcium
Review of conclusions from 8th meeting on serum 25(OH)D concentrations associated with selected health outcomes
Agreement of 25(OH)D thresholds (by life-stage) to be used as basis for setting DRVs (including pregnancy/lactation/breast-fed & non breast-fed infants)
06 Effect of sunlight on endogenous synthesis of vitamin D
07 Seasonal variation in 25(OH)D status: what are the implications for setting DRVs
Response from Professor David Fraser
How to optimise vitamin D supplementation to prevent cancer, based on cellular adaptation and hydroxylase enzymology
Greater seasonal cycling of 25(OH)D is associated with increased parathyroid hormone and resoption
08 Further discussion on approaches for setting an appropriate DRV value(s) for vitamin D:
Estimation of dietary requirement for vitamin D in healthy adults
Estimation of dietary requirement for vitamin D in free-living adults under 64 years of age
Estimation of dietary requirement for vitamin D in healthy adolescent white girls
Systematic review and meta-regression analysis of vitamin D intake-serum 25(OH)D relationship to inform European recommendations
Dose response to vitamin D supplementation in postmenopausal women
Estimations of dietary requirements for vitamin D: impact of season
See also VitaminDWiki
- Vitamin D and Bone Health – UK National Osteoporosis Society – April 2013
- Presentation: pre and post natal vitamin D, with audience comments – Manchester UK Sept 2013
- 30 to 50 ng of vitamin D is optimal – Central Europe consensus Sept 2013
- To be reimbursed for supplements in the UK the benefits must now be approved by EU – Aug 2013
- National Osteoporosis Society of UK declares that 12 ng of vitamin D is enough – June 2013
- Vitamin D conference in England - April 23-25 2014
- Dark Skinned adults need more than 45 minutes of UK summer sun daily – June 2013
- Draft of UK policy on Vitamin D, keeping 10 ng definition - March 2013
- A look at inner workings of committee looking at vitamin D for UK - Dec 2012 SACN
- Low vitamin D associated with poor regions in the UK, median was 10 ng – Nov 2012
- Vitamin D Recommendations around the world - IU and ng
- Video presentation including proof of vitamin D - Nov 2012 by Greenbaum -who wrote the above letter
- NHS (UK) mistakenly says more than 1000 IU of vitamin D can be harmful – Dec 2013
- Let 1000 die from vitamin D deficiency rather than incur 1 lawsuit
- Reminder: Doctors have at least 10 reasons to be reluctant to increase vitamin D: which has the following quote
It is difficult to get a man to understand something when his salary is dependent upon his not understanding it Upton Sinclair - Only 1 in 3 in Scotland is vitamin D deficient ( less than 10 ng) - Nov 2013
- Quick self test of vitamin D deficiency not quantitative, but FREE
- Overview Deficiency of vitamin D has the following chart for Europe
Short url = http://is.gd/UKvitd2013