Vitamin D, Part 1: The “English Disease” and me
No, it’s not syphilis, nor anything to do with public schools and some of the stereotypical things learned there, as (Swedish) Nigel pointed out.
“Engelska sjukan” (The English disease) = Rickets.
Barnasjukan = children’s disease
Classic rickets, a deficiency disease of children characterized by improper development or hardening of bones, is due to lack of sufficient vitamin D in the diet, or to insufficient ultraviolet radiation from direct sunlight, a lack that prevents conversion of the element 7-dehydrocholesterol in the skin to vitamin D. The type of skeletal deformities depends largely on the child’s age when the vitamin-D deficiency occurs. A child who has not yet learned to walk develops vertebral curvatures; a walking child develops leg curvatures.
The British physician Francis Glisson did a very detailed description of the disease. That is way the disease also is called the English disease in some countries.
OK, so I seem to have the adult version, but it struck me as darkly funny. And Nigel continues to be baffled because, yeah, even southern Sweden is a good bit north of here, and he’d never heard of anybody with the “English Disease” there.
Finally, I’m trying to put together some posts on vitamin D deficiency–and I say “posts” because I can tell right now that this will need split up.
I hadn’t thought much about vitamin D, especially before I moved to Greater London from Virginia. After I’d been here a year or two, I read that being low on it can contribute to seasonal depression (which has been a much bigger problem for me at this latitude), so I did start taking 100% RDA cod liver oil capsules in the fall and winter–but didn’t think much more about it. I mean, I was taking the recommended amount; if anything, I worried a bit about getting too much in alongside food sources and the daily multivitamin. I also started spending more time in the sun when there was some, with only a little SPF 8 to keep from burning at the beginning of the season–so, how could there be a problem?
I didn’t even connect that to my health getting progressively worse over the seven years next month I’ve been living in the UK, to the point that I’ve rarely been getting out of the house lately. Why should I, based on the standard advice?
Then, a couple of months ago IIRC, I ran across an update post at Free the Animal, A Most Successful Self-Experiment: Over 18 Months Soap and Shampoo Free (which is more meta/philosophical). In the comments, some interesting discussion of vitamin D came up, and I looked at some of his earlier posts concerning it, including The Institute of Medicine Vitamin D FAIL.
I am so glad I did.
This was the first indication I’d seen (or paid attention to) that the RDA might be much lower than people actually need. I was pretty skeptical at first–especially after all the “oh noes, you’ll poison yourself!”–but this stuff checked out. I will save some of the more general risks of not getting enough D for another post, but, yeah, I’d been thinking pretty much totally in terms of osteoporosis, rickets, and Dickens’ London. A sufficient level to prevent rickets is not necessarily sufficient to keep you healthy otherwise, as research keeps finding.
Convinced that I probably was not getting enough D after all–especially with continuing digestive problems related to the celiac–I ordered some 2400iu supplements and started taking them. (I have since doubled and then quadrupled, temporarily.)
A couple of weeks later, I noticed that not only did my really troublesome brain fog seem to be improving, so were the muscle spasms, cramps, and twitches. With the brain fog, I hadn’t felt like looking much more deeply into what being low on D will do to you, but I vaguely remembered seeing something about a connection to fibromyalgia symptoms and other kinds of chronic pain.
Indeed. Just Google “vitamin d pain”. I got angrier and angrier (and sadder, and more exasperated and frustrated, and…) the more I read. This is not some kind of obscure new knowledge. Reading basic lists of symptoms of D deficiency, I got even angrier, etc.–because I’ve had (and repeatedly seen doctors about) most of them. I thought I was going to blow one or more gaskets as I kept seeing very mainstream overviews, such as one from Patient UK, starting off with sentences like “Vitamin D deficiency is a very common problem – more than half of the UK population has insufficient levels of vitamin D.” In the last post, I quoted scarier recent figures, based on more recent research on optimal blood levels: “It is disturbing …. that nearly 90% of the current [White British] study population was affected by hypovitaminosis D during the winter and spring, and 60% had sub-optimal concentrations year-round.” And I find it even more disturbing that doctors seem unaware of this; again, that 90% study was published in 2007. Even with my history of celiac, nobody has apparently even considered that vitamin D status might be a problem.
Good article on Medscape: Vitamin D Deficiency and Related Disorders.
As I’ve written about some before, I have been dealing with a lot of chronic pain and fatigue for years and years. Taking care of some other celiac- and diabetes-related vitamin and mineral deficiencies helped with it some for a while, but it has kept getting worse. I’ve just given up on trying to get any kind of treatment for it, after enough brushoffs and insults, so rely on a combination of mindfulness, massage, stretching, meditation, rather a lot of thankfully-non-prescription-here weak codeine preparations (think 1/4 a Tylenol 3–you would have to try very, very hard to develop a physical dependency), and so on.
I’ve also been getting more and more obvious bone pain, which has been scaring me, since my mom died of bone cancer which got dismissed as fibromyalgia for years. I have been feeling so awful in general this winter that it’s been scaring me, and I’ve been getting suicidal thoughts again from the pain levels.
Finding out that the sternum pain in particular is a classic sign of osteomalacia from D deficiency eased my mind remarkably–much as I don’t like the idea of having that either! From Vitamin D supplementation in the treatment of musculoskeletal pain (pretty comprehensive!):
Patients with vitamin D deficiency may have pain that affects any part of their bodies, however, the lower back and lumbar spine are most commonly affected. The best physical examination for assessing vitamin D deficiency is for the doctor to apply pressure with the thumb on the bony surfaces of the sternum, anterior tibia, radius, and ulna. Patients with osteomalacia will report tenderness and pain that is disproportionately severe in relation to the minimal pressure that is applied.
Erm, yeah. I was cringing just at the idea of pressure on my sternum. My sacrum is like that too, and both have been for years now. And when you’ve got tight, spasming muscles pulling on sore bones, that can be something.
On osteomalacia, from Neurology and General Medicine by Michael J. Aminoff (citations omitted, and emphasis added):
The classic clinical features include musculoskeletal pain, skeletal deformity, muscle weakness, and symptomatic hypocalcemia. The early symptoms are vague, and without a high index of suspicion the diagnosis is easily missed. Bone pain is invariably present and is especially prominent in the spine, ribs, pelvis, and lower extremities. The pain is worse with muscle strain, weight bearing or pressure, but persists with rest…These patients are most often misdiagnosed as having fibromyalgia, chronic fatigue syndrome, or myositis and treated inappropriately with nonsteroidal anti-inflammatory drugs (NSAIDs)…
The limb-girdle muscles are the most affected…Weakness is accompanied by myalgias and muscle atrophy.
And they rarely believe you when you say NSAIDs just don’t help the pain at all, besides tearing your stomach up–oh yes, it’s not inflammatory in the first place. 😡 See also Hypocalcemia in Emergency Medicine and Hypomagnesemia in Emergency Medicine for overviews. This is some serious stuff, besides the quality of life complications.
Then there’s the brain fog, increased TLE symptoms (low calcium and magnesium levels from D deficiency will lower your seizure threshold; they’re electrolytes, after all), out-of-control asthma (immune problems and more muscle spasms), immune-related skin problems I mentioned in the last post, totally out-of-control blood sugar (Vitamin D and Diabetes: Let the Sunshine In), and so on. Most of the health problems I have been running into for years are associated with D deficiency.
As for just how common (and commonly overlooked) a problem this seems to be, and some of the health problems it will cause/contribute to, that will have to wait for a less personally-focused second post.