Following the release of the Chief Medical Officer’s annual report last month attention has been focussed on one area in particular. Professor Dame Sally Davies has suggested that to improve the nutrition status of children, primarily regarding the increase in rickets, all under-fives should be given free vitamin supplements. She is asking NICE to look into the cost effectiveness of this method, with the idea that prevention is cheaper than cure. However, do we really want all of our children taking synthetic compounds every day? Is this really the solution to a problem caused only by poor lifestyle and diet?
There have been mixed results from research into the
benefits and safety of the use of vitamins. The concern is directed towards
extra large doses, particularly when they are stored by the body. It is also
generally accepted that synthetic vitamins are not metabolised as effectively
as in the natural state and the absence of the context of the food they are
contained in impedes their absorption. Water-soluble vitamins, for example
vitamin C, are not stored in the body and so any amount over that needed per
day will only be excreted –essentially, money down the drain. I have never
personally been convinced of the need for vitamins taken as a day-by-day
routine unless there is a medical need, for example when I was iron deficient
in pregnancy. I was also uncomfortable when given multivitamin drops for my
daughter when we were discharged from hospital as we had fully established
breastfeeding which should naturally provide all the nutrients she required.
It is clear to see why the public might be unsettled by this
‘give them all a tablet’ solution, when the evidence for and against supplements
is questionable and it may seem that only some children may need them in the
first place. However, we must accept that we are society as a whole and we most
definitely have a problem. The annual report informs us that up to 40% of
children have vitamin D levels below the optimal level and 12% are deficient.
The result of this can be rickets, hypocalcaemic convulsions and motor delay.
Medical professionals have seen an increase in rickets by almost 400% in the
last 9 years. I suggest that the majority of parents do not wish to cause their
children harm so there needs to be improvement rather than blame and general
criticism of parents by the media, public and government themselves (the report
even claims that we should be “profoundly ashamed”). This is problem that may
affect some groups more than others but it is a nationwide issue and it is too
easy to blame immigration, moronic parents, and claim ‘it wasn’t like that in
my day’ etc. Far too little government
funding is used for education and health promotion relating to diet and lifestyle.
We need positivity and not shame to battle our sedentary culture.
The best way to achieve required levels of vitamin D is
through safe exposure to sunshine for around 10-15minutes a day. This is easily
achievable and far superior to the synthetic version found in supplements. It
may be true that winter sun can be quite inadequate for achieving optimal
levels of vitamin D but they can be topped up through eating oily fish and
eggs. As the UK sun has not changed a huge factor coming into play in
deficiency in children is the over-anxiety towards sunburn and skin cancer,
resulting in children being constantly slathered in sunscreen. The obvious
decrease in outdoor activity and imposition of technology into recreational
time also holds responsibility. Are we
going to ignore this and allow it to worsen while hoping a quick fix supplement
will work?
Free vitamins through the ‘Healthy Start’ scheme have been
offered for children of low-income families with little success. Reports of
poor uptake, supply and availability problems have led to an inadequate impact
on deficiency-related illness. This could be evidence that in fact this method
is not conducive to success. Giving children non-satisfying nutrients in this
way involves commitment to a boring routine. Will offering them to all children
really prove cost effective at all in that case? The theory is that in offering
vitamins universally the stigma attached to hand-outs and being on benefits is
therefore removed. There is also evidence of success in this approach on a
smaller scale, by trial in Birmingham.
Perhaps more focus should be targeted on pregnant women
taking supplements. The Department of Health recommends that all pregnant and
breastfeeding women take vitamin D, however from personal experience there is
little to ensure women know this or check that this is happening. A child’s
vitamin D stores are established at this early stage from the mother’s own
levels and so intervention at this early stage could have a measurable impact.
It makes me wonder if a universal approach is necessary when
the evidence points towards greater prevalence of rickets in specific groups
ie. those with darker skin or those with cultural reasons for covering up. Is there anything wrong in checking on the
nutrition status of children as a case by case matter? Should our healthcare system not be able to
detect deficiencies before they reach the disease state and intervene
accordingly?
It is clear that something needs to be done to target the
alarming rise in rickets in children and I suspect this is an indication of the
poor nutrition status of children on the whole. The worry of how taxes are
spent seems to concern people especially with expensive sounding schemes that
may not bring success. However, what better to spend on than the health of
future generations that will live with the consequences of a society and
lifestyle that we have collectively created. Perhaps anxiety towards artificial
nutrients has led to focus on this point, but should we really worry about
children taking vitamins when they are already added to formula milk and
fortified cereals, staples of our children’s diets. I remain unconvinced that I
should be giving them to my daughter but maybe when offered universally it will
be a matter of choice for parents. But would this defeat the point entirely?
The debate continues...
#vitamins #children #vitaminD #vitd #rickets #vitaminsforchildren #deficiency #healthystart #annualreport #chiefmedicalofficer #underfives
by Rachel Brophy
Update: On further investigation and speaking to a health visitor about this I have decided that vitamin D supplementation is a good idea for myself and my daughter as I do not feel we are getting enough sunshine. Better to be safe than sorry although there is no denying, shop bought vitamins are expensive!
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