8/14/2019 GoodHealth - Should We Be Tested For Vitamin D Deficiency Oct2013.pdf

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The cost of testingfor vitamin D levelshas risen to S150million a yearcompared to 51million back in 2000.Australia is said tobe in the grip of avitamin D deficiencyepidemic, with sixoutofl0ofusreportedly scoringbelow the normalblood levels of5O nmol/L, which weall need for healthybone maintenance.Yet some expertsare proposingrestrictions ontesting for all butthose with riskfactors. This raisesthe question: Dowe really needthese tests?

More of us are being diagnosed with low levels of the

Yesthat are still being debated anddiscussed - such as increased risk ofcancers, muscle weakness and otherautoimmune disorders.

I think we need to be cognisantthat we're talking about a populationhealth level of risk. lt's similar to workwe've done in other micronutrientareas, such as iodine and folic aciddeficiency, where we said,'Rather .lthan thinking that this is a problem for ithe individual, we need a strategy that ftargets the population as a wholel fBut we also need to get some Iclearer guidelines as to when to test, twho to test and how often to repeat Ithe tests after supplementation. For Imost people, three tests per annum Ewould probably be adequate - and twe could save the government Iaround 520 to S30 million a year. tMy general advice is to get a test Idone at a time when you're most at Irisk - at the end of winter or early tspring - then another in the summer, fwhen your levels should be at their Ihlghest. And if you are deficient, get Ianother test two or three months Iafter you've started taking vitamin D ItTJi'::Hff;:HJ''''' /

Should we he\,TTAMdINDunshine vitamin.Two experts I

STtrVEN BOYACtrSClinical professor at SydneyMedical SchoolWe need to test for vltamin D levels.Theres no doubt that, like anymicronutrient, low vitamin D levelsare not good for health. What we'refinding in our recent Universiry ofSydney study ofclose to 30,000people is that 58 per cent werevitamin D deficient by the end ofwinter to early spring.

Our studies show females agedbetween 20 and 39 are more at riskthan other groups in terms of havinglow vitamin D - probably becausethey're much more sun aware andthey wear lots of sunblock and usecosmetics with built-in sunscreen -and this gives them some potentialconsequences of long-term risk ofdeveloping osteoporosis.

We normally accept anything upto 50 to 75 nmo/L as being adequate,and these young women -particularly those with darker skin- are running at levels of less than25.|f you extrapolate that and say,'Well, they'll have these levels for 20to 30 years, what are the potentiallong-term consequence on theirbone metabolism?'Then there arealso allthe other physiologicalconsequences of low vitamin D

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8/14/2019 GoodHealth - Should We Be Tested For Vitamin D Deficiency Oct2013.pdf

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tested*

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FI ToUil?; "rtthey'll get rickets, and if they're anadult, they'll get osteoporosis. Butdoctors became very interested lntesting their patients on the basis thatthey might have low vitamin D levels.And in many cases it turned out theydid. So the doctor would end upprescribing vitamin D supplements,and then do a follow-up check to seethat the levels went back up to normal

But we shouldn't be medicalisingan avoidable deficiency. The reasonso many people have a vitamin Ddeficiency is because they're avoidingthe sun. 5o instead of looking for lowvitamin D levels and recommendingsupplements, doctors should belooking at thelr patients' habitsand asking them how often theygo out in the sun.

People should have at least l0minutes of sunlight exposure withoutsunblock to the face, arms, handsand neck sometime in the middleof the day in winter. ln summer,get the same amount of exposurebefore lOam or after 2pm. You'll getadequaLe vitamin D conversion inyour skin with that small amount ofsunlight. And the risk in relation tocancer is not a significant issue. o

Dr, CM,Nff?\.

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tell Bonnie Vaughan why they think we should - or shouldn't - be testedNo MICHAEL HARRISONVice-president of the Royal College ofPatholog ists of Austra lasiaThere is a real role for looking forvitamin D deficiency in those who maybe at high risk, such as people whocover up for cultural reasons; who avoidsun exposure because they've had amelanoma; whose work might keepthem out of the sun; who have bonemetabolism problems; who have darkerskin; or older people in nursing homes.But for the majority who are otherwisewell, testing vitamin D levels is a wasteof scarce healthcare resources.

We don't go out looking forunsuspecteo scurvv by measuringblood vitamin C levels; nor do wetest for vitamin E or A levels. We justassume that if you're eating a normal,balanced diet, then you naturallyhave enough of ali those vitamins. lt'sthe same for vitamin D. lf you lead anormal, healthy life and you have somemoderate sunlight exposure, you'llbe guaranteed to have an adequatevitamin D level of 50 or above.

There's been a lot of informationcoming out about the associationbetween vitamin D deficiency andchronic disease. The only one that'sbeen categorically proven is bonedisease: lf a growing child oradoiescent is viLamin D defrcienr,

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