BBC News

By Andrew Hosken

26 January 2012

Dr Irene Scheimberg and Dr Marta Cohen believe they have discovered vitamin D deficiency in a significant number of children who have died of Sudden Infant Death Syndrome. The doctors say that vitamin D deficiency and associated diseases such as the bone disease rickets could potentially explain deaths and injuries that are often thought to be suspicious.

They fear that children with such deficiencies may have been taken away from their parents and placed in foster care for no good reason. The findings in children from London and Yorkshire followed the discovery by Dr Scheimberg in 2009 of congenital rickets in a four-month-old baby whose parents had been accused of shaking him to death.

In Yorkshire, Dr Cohen found moderate to severe levels of vitamin D deficiency in 45 children, mostly infants aged less than 12 months, who died of natural causes. Of the 24 sudden infant deaths Dr Cohen investigated from this group, 18 – or 75% – were deficient in vitamin D. Dr Scheimberg said severe vitamin D deficiency could make the bones of small babies very brittle and capable of fracture with little or no real force. “Obviously if you have bones that fracture easily then they will fracture easily they will fracture with any normal movement like trying to put a baby grow on a baby you will twist their arm. In a normal child you won’t produce anything. But in a child whose bones are weakened and [who have] an abnormal cartilage growth area, then it’s easier for them to get these very tiny fractures or even big fractures.”

Dr Scheimberg, based at the Royal London Hospital in Whitechapel has said “I think there should be a commission that studies all these cases [which would] take into consideration the age of the children, the gender, the race and the way in which the way these families live – particularly when the children are still alive and living in foster care when they could be back with their families.”

Recently Chana Al-Alas,19, and Rohan Wray, 22, were acquitted of murdering their son Jayden after the jury learned that his fractures, supposedly telltale signs of abuse, could have been caused by his severe rickets. Dr Scheimberg also discovered rickets in Jayden’s mother. Dr Scheimberg discovered vitamin D deficiency in a further 30 cases in London. Vitamin D deficiency was found to be a cause of death in three cases. Cardiomyopathy, a disease of the heart muscle, was discovered in two small babies. A third died of hypocalcemic fits, a condition of low serum calcium levels in the blood caused by vitamin D deficiency.

Vitamin D deficiency was a co-existing finding in the sudden and unexpected deaths of eight children, so-called Sudden Infant Death or Sids; in five children with bronchial asthma and another five with combined bacteria-polyviral or polyviral infections. Two of the babies, including baby Jayden, also had fractures.

Vitamin D is actually a hormone, and endocrinologists are experts in how the body is regulated by the hormone excreting glands – or endocrine organs. Stephen Nussey is professor of endocrinology at St George’s Hospital at Tooting in south London. He believes that, despite repeated government recommendations on vitamin D supplementation, vitamin D deficiency is still not being taken sufficiently seriously by the authorities.

Earlier this week, the chief medical officer for England, Dame Sally Davies, wrote to doctors, nurses and other health professionals advising them to consider vitamin D supplementation for certain at risk groups, including pregnant mothers.

“We know a significant proportion of people in the UK probably have inadequate levels of vitamin D in their blood. People at risk of vitamin D deficiency, including pregnant women and children under five, are already advised to take daily supplements. Our experts are clear – low levels of vitamin D can increase the risk of poor bone health,
including rickets in young children,” she explained. “Many health professionals such as midwives, GPs and nurses give advice on supplements and it is crucial they continue to offer this advice as part of routine consultations and ensure disadvantaged families have access to free vitamin supplements through our Healthy Start scheme.

Gerry Gajadharsingh writes:

Blood tests to check serum Vitamin D 25OH, was one of the most requested private blood test in 2011, not sure about the NHS, this time of the year in particular reveals that many people, perhaps the majority of the UK population may have insufficient levels. We get Vitamin D from dietary sources but we also need sunlight to convert it, in Northern Hemishere countries from October to March the UV radation from the sun is not at the adequate wavelength to do the job properly. No wonder so many people feel “low” at this time of the year, never mind the recession, check your Vitamin D levels and make sure you have adequate amounts in your diet or use short term replacement, especially for vunerable groups.

Sugar should be “controlled substance”, say experts.

The Independent 2 February 2012.

According to a team of leading public health expert’s, sugar is so harmful it should be controlled in the same way as tobacco and alcohol and they believe that sugar is more than just empty calories that make people fat. They argue that high calorie sweetened food is indirectly responsible for 35 million annual deaths worldwide due to conditions such as heart disease, diabetes and cancer. Worldwide consumption of sugar has tripled in the last 50 years fuelling a global obesity epidemic. The main culprit is aid to be fructose, a sugar molecule commonly added to processed food in sweetening agents such as high fructose corn syrup. There is increasing evidence that excess fructose has harmful effects on the body. The levels consumed in the west are said to alter metabolism raise your blood pressure, disrupt hormone signalling and cause significant damage to the liver. These hazards are similar to that of drinking too much alcohol.

Speaking about their article in the journal Nature, Professor Lustig said,” as long as the public thinks that sugar is just empty calories; we have no chance in solving this. There are good calories and bad calories, just as there are good fats and bad fats….But sugar is toxic beyond its calories.” The experts propose adding taxes to processed foods that contain any form of added sugar. These would include carbonated drinks, sugar sweetened beverages such as juice and chocolate milk, sugared cereals.

Other strategies included controlling access with measures such as age limits for the purchase of sugary drinks, and tightening controls on vending machines and snack bars in schools and workplaces.

However scientists stressed that to achieve a social shift away from high sugar consumption, the public had to be better informed about the science behind sugar.

Gerry Gajadharsingh writes:

Remember sugar does not just mean the white or the brown stuff. All carbohydrates, fruit, vegetables and starches (rice, potato, bread, pasta etc) are broken down in the body into the simple carbohydrate glucose. Therefore we suggest low gylcaemic load carbohydrates to reduce the sugar load in your body and decrease the insulin response (the hormone whose job it is to move glucose out of the blood stream where it can be destructive in high amounts and into the cells). The principals of Metabolic Balance are a great way of doing this.

Wednesday 1st February 2012 The Daily Telegraph

Heartburn Drugs Raise Women’s Risk of Hip Fracture by Third Over the counter indigestion drugs taken by millions of people to treat heartburn, acid reflux, or peptic ulcers may increase the risk of a hip fracture by a third. Research has shown that post menopausal women who take proton pump inhibitors such as Omeprazole and Lansoprazole are 35% more likely to suffer a broken hip. The risk rose according to how long the women had been taking the drugs; with those who had been taking them for six to eight years were found to be 50% more likely to suffer the fracture. US researchers have evidence of a significant association between PPI’s and hip fractures and that careful consideration should be given to prescribing the drugs for long time use as they are thought to interfere with the body’s absorption of calcium, weakening bones. The study published in the British Medical Journal of 80,000 nurses found that for every 2,000 post-menopausal women taking the drugs for a year, there would be more than four fractures, compared to three in the 2,000 not taking them. The risk of hip fracture among women who were regularly using PPI’s for at least two years was 35% higher. This held true even when factors such as exercise and calcium intake were considered. The risk returned to a normal level two years after the women stopped taking the PPI’s. Hamed Khalili the lead author at Massachusetts General Hospital wrote: “Our data suggests the importance of carefully evaluating the need for long term continuous use of PPI’s particularly in individuals with a history of smoking”. Last year there were almost 40 million prescriptions dispensed in England for PPI’s.

Gerry Gajadharsingh writes: We have suspected that for some time PPI’s may be causing some adverse problems and either affecting micronutrient absorption or utilisation, this study is, I am sure, the start of more research into this area. Whilst PPI’s are great drugs short term for conditions such as GORD (gastro-oesophygeal reflux disease, gastric ulcers etc), surely it makes sense that clinicians help patients understand the lifestyle factors that contribute to these conditions, therefore reducing the need for PPI’s in the first place.

The Times, Thursday,
29 September, 2011

On average, American employers pays $10,944 towards annual private medical insurance premiums with workers chipping in $4,129 according to the Kaiser family foundation 2011 employer health benefits survey. Since 2001 premiums have risen 113% compared with 34% for workers’ wages and 27% for inflation.

A separate survey published this week by the journal archives of internal medicine may have found another reason: insured Americans are getting too much healthcare. 42% of doctors in the nationwide survey said that the patients in their practices were over treated and 28% said they ordered more tests and were making more referral to specialists and they would ideally like to. Three quarters of doctors said that the fear of malpractice lawsuits prompted them to practice more aggressive medicine they could not be sued for failing to order a test that was suggested. 40% said they ordered tests and consultations because they did not spend sufficient time with their patients. Interestingly 40% of doctors also said they suspected other primary physicians ordered extra tests to boost their own income.

Gerry Gajadharsingh
comments:

Although I work primarily in the UK, I have worked in the US and teach internationally and I’m not surprised by these figures. Cultural differences in both patient expectations and the impact of fear in the medical profession from lawsuits, particularly in the US, leads to quite different practices of medicine. In my experience, it is probably correct, that an average US patients will expect a spectrum of blood tests and imaging before I am even allowed to touch them (even though in my opinion some of those investigations may not be clinically warranted), compared to an average UK patient who often doesn’t see the need for additional investigation (even though I think they actually are definitely clinically warranted). As a clinician I would like to think that I request additional investigations such as blood testing and imaging, only when clinically relevant.

As for private medical insurance companies, they simply have no idea what I actually do nor do they seem to want to. I was referred a very interesting complex patient recently from another medically recognised specialist, because neither they, nor their GP knew what was wrong with them and so asked my opinion. I see all new patients from minimum of 60 minutes and on the invoice its written “Diagnostics 60 minutes”. When the patient presented this invoice to her private medical insurance company they would not accept it, saying that osteopath don’t diagnose, they just treat!

Never mind the fact that my regulator, the General Osteopathic Council, stipulates a requirement for an osteopath to make a diagnosis of that particular patients problem, present a treatment plan to the patient to gain consent and then to follow that treatment plan. The vast majority of my patients have been misdiagnosed, or have never fully understood what is wrong with them before. Making an accurate diagnosis is time consuming and often needs a clinician to think laterally, I must admit patients sometimes do not help themsleves, they say “well I tried this and I tried that” and only seem to take their problem serviously when they are not getting better, c’est la vie!

I’m grateful that over 70% of my patients choose to pay my fees out of their own income and do not rely on the vagaries of private medical insurance to determine what I can and cannot do for them!