Prison doctor on lack of vitamin D in solitary confinement – July 2013

Clipped from Prisoner Hunger Strike Solidarity

Context

Prison hunger strike by 12,000 inmates in California in July 2013
Author has recently been a doctor of prisoners in California
PBSP =Pelican Bay State Prison
SHU =security housing unit = solitary confinement (with little access to sunshine)
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The first purely medical issue that I want to reveal has to do with the lack of appropriate health care specifically for patients in long term solitary confinement. During most of my time at PBSP, as a primary care provider, I reviewed the mental health notes in the medical records for my patients per visit. That is just the practice of good medicine, but this was important because many of my patients were on atypical antipsychotics, anti-depressesants, and mood altering medications that had medical side-effects. Some of these drugs were newly introduced to patient populations and needed to be actively and intelligently followed as various patient populations were being exposed to them. I do not ever remember seeing a note or a diagnosis of seasonal affective disorder (SAD) in long term solitary confinement patients or in patients in other parts of the prison. I have gone back and had recent numerous discussions with current and former mental health practitioners and staff with whom I worked at PBSP, to try to understand why this diagnosis, that occurs in people who are deprived of natural photons, is not discussed or diagnosed in this vulnerable population. I do not have a clear answer. PBSP currently has very competent mental health practitioners. They should be given a chance to explain this apparent historical mystery.

There is evidence that vitamin d deficiency alone affects cognition, depression, anxiety and a multiplicity of medical problems. The relationship between sad and vitamin d deficiency is still being worked out, but we do know that both conditions respond to increased exposure to natural light. In the case of vitamin d deficiency, it has been demonstrated that light exposure alone is not adequate to reverse the deficiency. Diet can help, but in the setting of the PBSP SHU there are reasons why diet supplementation alone may not work.

In one of the specific medical habeas corpus cases out of the PBSP SHU in which I participated, the judge found that my former patient was not being given food that was fresh enough and nutrient rich enough to keep him healthy. So, the food that the patients are getting in the solitary confinement environment may not be nutritionally adequate to treat vitamin D deficiency.

Evidence demonstrates, particularly that African-American males in the northern hemisphere are at greater risk for vitamin d deficiency. They have low measurable levels of vitamin d compared to non-whites. I am African-American and started taking vitamin d supplements in January of this year in the form of vitamin D3 at a dose 4,000 iu per day. In May, my provider checked my blood level of vitamin d and surprisingly, i am deficient as of that measurement after intentional supplementation. This is a worrisome anecdote for PBSP SHU patients.

Vitamin D is added to milk, but let us remember that African- Americans have a very high rate of lactase deficiency and cannot digest milk without dietary aids. (I also have lactase deficiency.)
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See also VitaminDWiki

• Prisoners have very low vitamin D and get TB, influenza, and depression
  includes another item "Suicide rate 9X higher for females in prison that outside" suicide
• Moscow prison to install tanning beds - Nov 2010
• Prisoners in psychiatric wards have very low levels of vitamin D – Oct 2012
• Suicide 2X more likely with low vitamin D (in military) – Jan 2013
• 99 percent of psychiatric population had less than 30 ng of vitamin D – June 2013
• Overview Dark Skin and Vitamin D
• All items in Skin Color and vitamin D 468 items
• Low vitamin D and depression - Study and meta-analysis, April 2013
• Mental health problems cut in half when have adequate level of vitamin D – Jan 2013
• Depression book talks about vitamin D - Nov 2012
• Search VitaminDWiki for PRISON 97 items as of March 2014

See also web

• New York Promised Help for Mentally Ill Inmates – But Still Sticks Many in Solitary ProPublica Aug 2013
• The Best Reporting on Mental Illness in Prisons ProPublica Aug 2013
  The Department of Justice estimated in 2006 that over half of all U.S. inmates suffer from a mental health problem.

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