Recent years have seen a sharp increase in the incidence of tuberculosis, but now another 'Victorian' disease is on the rise. Rickets, caused by vitamin D deficiency, is staging a comeback, prompting the Government to recommend that pregnant or breastfeeding women boost their vitamin D intake in the darker winter months.
What is rickets?
Rickets is a bone disease that can lead to bone deformities, stunted growth and general ill-health. Symptoms in children include:
- tender swollen joints
- bone pain and tenderness
- muscle weakness and pain
- breathing difficulties
- bow legs or knock knees
- delayed walking or waddling gait
- delayed closure of the fontanelle (soft spot on a baby's head)
- delayed eruption of the teeth or weak tooth enamel.
What causes it?
The disease is caused by a long-term deficiency of vitamin D, which helps keep our hearts healthy and muscles working properly but is also vital to the normal development of nerves, teeth and bones. Vitamin D is essential because it helps calcium to be absorbed from the intestine and into the bone. Without it, bones weaken and become soft.
The deficiency also causes seizures, has been linked to an increased risk of heart disease and may also worsen the symptoms of Crohn's disease and similar conditions.
People with only a mild deficiency may have no symptoms and be unaware of the problem or may experience only slight tiredness or aches. The most common symptoms are muscle weakness and pain and bone pain.
Who is at risk of Vitamin D deficiency?
Most people have enough Vitamin D stored in their body to last for two to three years, but more and more healthcare professionals are reporting cases of deficiency.
You are at risk if you suffer from fat malabsorption or have a poor diet and no regular exposure to sunlight - 90 per cent of our Vitamin D is made by the action of sunlight on the skin.
In winter we maintain adequate levels of the vitamin through dietary intake and the reserves stored in our bodies. When at latitudes of 52 degrees north (above Birmingham), there is no ultraviolet light of the appropriate wavelength for the body to make vitamin D in the skin.
Vitamin D deficiency is common among the white population, but most at risk are children, pregnant women and breastfeeding mothers within the Asian, Afro-Caribbean and Middle Eastern communities. Some research has suggested that as many as 1 in 100 children in ethnic minority groups may have rickets.
This increased suspectibility is due to these populations' dark skin, which absorbs less sunlight. Clothing worn for cultural reasons may also limit a person's exposure to the sun.
Dr Colin Michie, a paediatrician at Ealing Hospital, says, "We are seeing significant numbers of children with vitamin D deficiency. If a pregnant or breastfeeding woman is lacking in vitamin D, the baby will also have low vitamin D and calcium levels, which can lead babies to develop seizures in the first months of life.'
How do you prevent Vitamin D deficiency?
Everyone should ensure they have:
- enough vitamin D in their diet (the main sources are oily fish, eggs, fortified cereals and breads, milk and cheese)
- adequate exposure to sunlight. According to the Department of Health, you can get enough vitamin D by exposing your arms, head and shoulders to the sun for 15 minutes per day during the summer, when the sun is not at its most harmful.
The Scientific Advisory Committee on Nutrition recently stated that children in high-risk groups should take vitamin D supplements. Now the Government is recommending that when sunshine hours are limited, pregnant and breastfeeding women and children under four take a daily supplement of 10 micrograms.
Families eligible for the Healthy Start scheme can obtain free Healthy Start Vitamins for Women and Healthy Start Children's Vitamin Drops through their GP or health visitor. Some Primary Care Trusts also sell Healthy Start vitamins to non-beneficiaries for a small cost. Other supplements can be bought at supermarkets and pharmacies.
More Information
- The Scientific Advisory Committee on Nutrition (SACN) report 'Update on Vitamin D' is available at www.sacn.gov.uk/reports.
