At MrsK's request - ask about your vit D level and why!

Hi all!

In the \"Pain on reduction\" thread MrsK has posted a comment about how she has it on good authority that everyone over 60 should get the vit D level in their blood tested and then said I'd tell you why!! :oops: :lol: I'll do my best and I hope you won't find it too long-winded!

I'm sure many of you have heard at some point that you get all the vitamin D you need from your diet and from sun exposure - I've been told that by my doctor. This is one of the myths I will try to explain here together with why it is important to this group in particular.

It is well known in the scientific and medical communities that low levels of vitamin D are found in patients with auto-immune disease, especially multiple sclerosis and arthritises but it isn't known whether this is cause or effect - i.e. is the disease caused by the deficiency of the vitamin or is the lack due to the autoimmune disease or even has it nothing to do with it at all. Whichever it is, this must have had an effect on the assessment of what is called the \"normal range\" acceptable for the amount of vit D in our blood. To get a figure for this normal range, blood samples are taken from many people, the level is measured in all of them and then they look at the range of measurements made and take a set of figures which excludes the very high and very low levels and call this the \"normal range\". Common sense would suggest that if there are a lot of people who have low levels then whilst the range you get after doing this is representative of what is found in the general population, it does not mean that this is the best level for the body to function. The opposite is also true of course - if everybody is very unhealthy and has a high cholesterol level then the \"normal range\" might be on the high side of what is good for you.

In Victorian times it was realised that the poor living conditions and diets led to the development of rickets - children did not get enough calcium in their diet nor did they get enough exposure to the sun. This combination led to poor bone structure and rickets. Diets were improved, including supplements, and children were encouraged to go out in the sun. Remember the cod liver oil? Before the 1950s, especially during the war, food had added calcium and vit D (in milk, flour and margarine) to make sure there was enough even in restricted diets. At some point there was a scandal when a baby milk company made a mistake and added too much and babies were made ill so the practice was stopped in Europe although it still continues in the USA.

Vitamin D can also be made in our skin by the action of sunlight on cholesterol. You will all remember that we spent a lot of time outside when we were younger and no-one ever told us to put sun-screen on, whatever time of day it was. We ate eggs for breakfast and tea, ate cakes made with flour, margarine, eggs and milk. We had plenty of calcium, cholesterol and sunlight.

In recent years we have been told we shouldn't eat cholesterol-containing foods, we shouldn't go out in the sun in the middle of the day and if we do go out we should use high-factor sun-screens or cover up. The effect of this has been that we no longer make much vitamin D in our skin - using a factor 8 sunscreen reduces the amount of vit D made by about 95%! In addition, the sun has to strike the skin at an angle closer to vertical than it ever really manages in the UK - if you live north of Turin in Italy the amount is less than optimum! Between April and September you get some if you go out with bare arms and face at midday - there is no chance from November to February.

And getting vit D from your diet? You must eat more than 8oz of oily fish at least 3 times a week to get anything like what you need. Other than that there is almost none in our diet in the UK as nothing is fortified - even then you would need 40 tablespoons of margarine or 40 eggs a day to get enough! Oily fish is realistically the only source - salmon, and preferably wild salmon, sardines or mackerel. Fresh tuna has some but much less and tinned has almost none.

And now I'm going to introduce a touchy subject - age! If you are 20 you will make a reasonable amount of vit D - providing you are out in the sun and your cholesterol is OK. But studies on young healthy residents in Boston USA showed that even they had quite low levels of vit D in their blood - low even by the old accepted levels for the normal range. As you get older, your manufacturing company in the skin gets tired and less efficient and by the time you are 70 your body is making a quarter of what it did at 20. Add to that the fact that most older people just don't go out and sunbathe in skimpy summer clothes and you can see that at our ages (PMR is usually found in the over 50s) we're just not producing sackloads of vit D.

You will still get the story from pharmacists and doctors that it is dangerous to take too much vit D as it is a fat soluble vitamin - I suspect they think that that means it is present in all fat, which I've just shown isn't true - and is stored in the fat in our bodies and isn't released if you have too much (on the other hand, if you take too much vitamin C you just pee it out!). Nevertheless, there have been many studies in recent years which suggest that the currently accepted normal levels are far too low and that it is not dangerous to ingest much larger amounts of vit D than we are doing at present. It has been shown that if you boost the vit D levels of the elderly in care homes you can improve their balance and reduce the number of falls they have - and also the number of fractures as a result. A whole range of studies have led to the conclusion that the current normal range of 20 to 45 (I won't bother you with the units) is too low and that at least 50 to 75 would be much better for us.

However - this normal range was established years ago and, as I have shown, there have been massive changes in llifestyle since then which must have had a massive impact on the amount of vit D we have in our bodies. The truth is that for a large part of the population, their vit D level is below even the bottom end of this scale which is accepted by many authorities to be far too low. It is accepted even in the UK that 20 is low and 10 is far too low.

Anyone who is put onto calcium supplements and alendronic acid should always have their blood calcium checked beforehand and this is usually done. This is because if you have a too high or a too low calcium it can make you very ill. If it is high you don't need supplemets - if it is low and you are to take alendronic acid that takes more calcium out of your blood and it might get too low. That must be sorted out first. Nowadays your doctor will usually check your vit D level too - but not always. Some people - like MrsK - have never been given calcium/vit D supplements (AdCal or Calcichew) others find they disagree with them and stop taking them. Or they are taking so many tablets they miss some out. If they have a good diet with dairy products it probably doesn't matter for the calcium - but what about the vit D?

The current recommendations for the over 50s are for a supplement of 400 IU in the UK but some experts believe that we really need to take in about 2500 to 3000 IU of vit D a day. The 2 AdCal tablets you take have a total of 800IU, plus there will be a bit from your diet (depending on how much salmon you can afford!) and in the summer a bit from the sun - difficult to see how you are getting enough, isn't it? Even after months of taking the supplements and living in northern Italy - not far north of Turin and I use almost no sunscreen and go out in the full sun every day in the summer - my blood level just scraped in at 20.

There is a problem in the UK in that high dose supplements are not approved for GP use - although your consultant can approve them. The problem is getting them to agree you need them. Another problem is that the NICE guidelines state that \"it is assumed that post-menopausal women have an adequate calcium intake AND THAT THEY ARE VIT D REPLETE\". i.e. there is no need to measure their blood levels. I was nowhere near vitamin D replete at diagnosis and MrSK has also just had her vit D measured after demanding it because of muscle pain that she was sure was not PMR - and it was very low. OK - we are just two but how many more of us are in the same situation?

Although we can't get high dose vit D from our doctors - we can get it from Boots. We don't need more calcium but there is a good chance we need more vit D - given the figures I quoted earlier. There are reputable studies to show that lack of vit D is also associated with at least 12 cancers besides the autoimmune spectrum of diseases and there are a lot of mainstream doctors who are coming round to the idea that we need more vit D to live healthily - if I hadn't found evidence of that I wouldn't be writing this. I don't jump on every bandwagon claiming this or that is the cure-all - but in this case both the Mayo Clinic and the Cleveland Clinic have published work in the field besides a lot of others.

I leave it to you to consider and if anyone has any questions about anything I've missed out or that isn't clear - ask me please. It was a lot but I think it is an important aspect of our PMR journey.

cheers all,

EileenH

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