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Rickets: a deficiency in vitamin D or calcium?

Posted on: October 10, 2011   by  John Cannell, MD

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It is just so agonizingly slow. But finally, one expert, based on a study of middle-class women, discovered what obstetricians who have been checking vitamin D levels all along have known for years: all pregnant women should have a vitamin D blood test. As this story shows, pregnant women are very likely to be vitamin D deficient.

Jenny Hope. 20th August 2011. Pregnant women hit by return of rickets because they’re not getting enough sun.

While this story fails to discuss it, and I am unaware of any scientific papers on the subject, there may have been a big difference in calcium intake between Victorian times and modern times. Most people don’t think of rickets as a disease of calcium deficiency, but that’s what it is. Without enough vitamin D, not enough calcium gets absorbed and infants’ bones become weak.

In Nigeria, rickets is usually a case of calcium deficiency.

However, one can get rickets with normal vitamin D levels, as equatorial African researchers have repeatedly documented, if calcium intake is low enough.

Pettifor JM, Fischer PR, Thacher TD, Arnaud J, Meissner CA. Dietary calcium deficiency & rickets. Indian J Med Res. 2008 Nov;128(5):673-4; author reply 674-6.

In fact, a good question is: what works better to cure rickets, vitamin D or calcium? In Nigeria, the answer is calcium, not vitamin D. Thank a South African scientist named John Pettifor for this important discovery.

Thacher TD, et al A comparison of calcium, vitamin D, or both for nutritional rickets in Nigerian children. N Engl J Med. 1999 Aug 19;341(8):563-8.

So what was calcium intake in Victorian England? It is not entirely an academic question. I suspect calcium intake is much higher now than in Victorian times. One could predict that vitamin D deficiency, in the face of adequate calcium intake, would present differently in modern times, perhaps as asthma, autism, or autoimmune disorders (the three modern childhood epidemics) and not as often as rickets (the Victorian epidemic). In fact, with adequate dietary calcium, the first clinical presentation of modern childhood vitamin D deficiency may have nothing to do with bones.

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