Scotland is beginning to move on its vitamin D deficiency problem. Several months ago, Oliver Gillie pulled no punches in what he had to say: Scots die younger because of vitamin D deficiency.
Scotland’s response to its countrywide problem of vitamin D deficiency reminds me of theater, a tragedy. Dr. Mark Findlay and colleagues of the Dumfries and Galloway Royal Infirmary surveyed Scottish doctors to ask what they were doing, asking what they did after they tested their patients’ vitamin D blood levels and found they were low.
The authors got data on 33 general practices and 1162 patients, with 70% of patients having levels below 20 ng/ml and a fourth of patients with levels below 10 ng/ml. The calcium levels floored me. Twenty-one percent of patients had calcium levels below the lower limit of normal and low blood calcium usually indicates the severest form of vitamin D deficiency, occasionally leading to seizures, muscle spasms and even death.
Now for the divergence. The primary care doctors treated only 68% of these patients, meaning deficiency was ignored 32 % of the time. When they did treat, they often used non-human vitamin D (ergocalciferol) in low doses, but more worrisome is that doctors in Scotland treated 20% of the severely deficient patients in Scotland with vitamin D analogues, medications that doctors should reserve mainly for advanced kidney disease and never use for simple vitamin D deficiency.
People have to trust their doctor and studies show they do. However, the authors concluded, “Those who were treated frequently received inadequate doses or inappropriate forms of therapy.”
Outside of changing national health food fortification policies and various agency positions on vitamin D, doctors’ offices are where much of the work needs to be done. There is a huge gap in doctors’ understanding of doses needed to raise blood levels and the kind of vitamin D they should be suggesting or prescribing. We often hear of cases where a patient falls below 20 ng/ml and the doctor will suggest taking a 600 IU/day supplement in attempt to adequately raise blood levels. It won’t; that’s why we educate. We’ll keep working at it; we’ll get there.