Vitamin D Newsletter
German and British children, vitamin D and long Ago
With the 400 IU/day recommendation of the American Pediatric Association in mind, I ran across this amazing paper while surfing Medline for Vitamin D. According to this paper, all infants in the German Democratic Republic (East Germany) received dangerously high doses of Vitamin D every three months in their doctor's office. The policy was in place for 35 years. The first 600,000 IU dose was given at three months and then every three months until the child was 18 months of age. This works out to an average of 6,000 IU per day (actually, for several technical reasons it is not equivalent) for 18 months. The authors collected blood before the dose and then 2 weeks after the quarterly dose to obtain 25(OH)D, 1,25(OH)2D, and calcium levels on a total of 43 infants.
Before the first dose, at 3 months of age, the average infant was extremely deficient (median 25(OH)D of 7 ng/mL). Two weeks after the first dose the average 25(OH)D level was 120 ng/mL, the second dose, 170 ng/mL, the third dose, 180 ng/mL, the fourth dose, 144 ng/mL, the fifth dose, 110 ng/mL and after the sixth and final dose, 3.6 million total units, at age 18 months, the children had mean levels of 100 ng/mL. That is, by the 15 and 18 month doses, the children were beginning to effectively handle these massive doses.
The highest level recorded in any of the 43 infants was 408 ng/mL at age 9 months, two weeks after the third 600,000 IU dose. 34% of the infants had at least one episode of hypercalcemia but only 3 had an elevated serum 1,25(OH)2D. The authors reported that "all the infants appeared healthy," even the infant with a level of 408 ng/mL, that is, no clinical toxicity was noted in any of these infants.
They also reported that "repeated inquires in GDR have failed to identify clinical Vitamin D toxicity as a result of the prophylactic program." The pediatricians and health officials in the GDR just did not look hard enough for toxicity as such doses will certainly cause clinical toxicity, right? Or maybe such doses only cause asymptomatic hypercalcemia and not clinical toxicity. It would be interesting to look at the infant mortality in East Germany during those years, compared to similar Eastern European countries, as well as current cohorts of German adults who underwent such treatment as an infant.
Two years after Great Britain halved its Vitamin D dose for infants, due to the "Great Vitamin D Panic," the incidence of infantile hypercalcemia was unchanged.
Fifty years ago, Great Britain laid the foundation for every subsequent U.S. Food and Nutrition Board (FNB) Vitamin D recommendation when England had a fit of hysteria, the "Great Vitamin D Panic." Professor Bruce Hollis wrote about this scare in some detail in a 2004 paper, and how the British panic affected the American FNB. He also details the role the Williams syndrome played in the "Great Vitamin D Panic." Williams syndrome is a genetic malformation that causes, among other things, infantile hypersensitivity to Vitamin D, elevated 1,25 levels even without supplemental Vitamin D, and often hypercalcemia in response to supplemental Vitamin D. (In fact, it was by studying the Williams Syndrome that I became more convinced of the relationship of Vitamin D to autism. Kids with the Williams syndrome, the only human disease with greatly elevated serum 1,25 levels around birth, grow up to have an adult personality that is the phenotypic opposite of autism, thus they are an experiment of nature.)
Anyway, in the midst of the panic, Great Britain reduced infant supplementation by one-half in 1957, expecting to see a reduction in infantile hypercalcemia (7.2 cases per month in the country). It did not. Two years later, in 1959, the incidence of infantile hypercalcemia in Great Britain was essentially unchanged (6.8 cases per month.) However, by 1961, the reported incidence was apparently halved to 3 cases per month. The British Paediatric Association concluded "it remains speculative whether the decrease in hypercalcemia by 1961 is a consequence of reduced Vitamin D intake" because it was "not chronologically related to the reduction of Vitamin D intakes introduced in 1957."
It seems likely that what happened was this. The "Great Vitamin D Panic" began in the early 1950s and British pediatricians began drawing lots of blood calcium levels on their infant patients, fearful they were toxic. They kept drawing frequent blood calcium levels and thus detecting high baseline blood calcium levels until 1960 when the "Great Vitamin D Scare" ebbed and they drew fewer and fewer infantile blood calcium levels. Thus fewer high baseline levels were detected and, by 1961, fewer British infants diagnosed with high blood calcium. It was simply due to fewer blood tests ordered for calcium; it had nothing to do with Vitamin D.
Page last edited: 28 July 2010