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Information on the latest vitamin D news and research.

Find out more information on deficiency, supplementation, sun exposure, and how vitamin D relates to your health.

Weeping for Scotland

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 Health Deficit: an explanation and a plan

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.

Findlay M, Anderson J, Roberts S, Almond A, Isles C. Treatment of vitamin D deficiency: divergence between clinical practice and expert advice. Postgrad Med J. 2012 Feb 23. [Epub ahead of print]

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.

  About: John Cannell, MD

Dr. John Cannell is founder of the Vitamin D Council. He has written many peer-reviewed papers on vitamin D and speaks frequently across the United States on the subject. Dr. Cannell holds an M.D. and has served the medical field as a general practitioner, emergency physician, and psychiatrist.

3 Responses to Weeping for Scotland

  1. Blog post on the same article was titled
    Scottish doctors ignoring vitamin D? http://www.vitamindwiki.com/tiki-view_blog_post.php?postId=65
    282 people had vitamin D test results less than 10 nanograms
    Only 61% were getting any vitamin D replacement therapy after 3-15 months
    Mean dose was an inadequate 800 IU of vitamin D
    Maximum dose with 2000 IU
    Only 1.4 % got a loading dose of vitamin D

  2. helga.rhein@blueyonder.co.uk says:

    Dear John,
    I am a general practitioner (GP) in Scotland. And i am prescribing daily preventative vitamin D and high doses most certainly to those who are deficient.
    But, in defense of my fellow GPs, we here in Scotland have a bit of an uphill struggle:
    1. UK guideline STILL say 25 nmol/l (=10 ng/ml) is sufficient.
    2. There are no UK licensed preparations which we could easily prescribe, unless low dosed together with calcium. And many of them are D2. Our prescribing advisers strongly advise us NOT to prescribe the UK-unlicensed preparations and tell us if we do we, the individual GP, would be personally liable in cases of mishaps. So, most GPs are put prescribing this. I am an exception, since they recognized me as a ‘specialist’.
    3. Testing for 25(OH)D is restricted – because GPs did understand the significance and country-wide requests for testing have hugely increased. This is a funding issue.

    So, it is a bit like a conspiracy. And I’m sure big pharma loves it. Lots of diseases in Scotland, as Oliver says. But we are ‘working’ at it.
    And, just in case of doubt, I am still a strong defender of the NHS, which I hope we can keep in Scotland, unfortunately England just moves towards breaking it up.
    best wishes – Helga

  3. Brant Cebulla says:

    Helga, thanks for your insight. How does this approach in the UK compare to other European countries? In what kind of doses do “unlicensed preparations” come in?