Lack of sunshine is blamed for chronic illnesses, reports Lindsay McIntosh
A new warning about vitamin D deficiency has reignited the debate about its link to the appalling health record in Scotland.
Sir Harry Burns, Scotland's Chief Medical Officer, and his opposite numbers in Northern Ireland, Wales and England, have written to health professionals to reiterate advice about the ‘sunshine vitamin' for groups such as pensioners and pregnant women.
However, experts have told The Times that the guidance does not go far enough and that the time has come for a national vitamin D programme for the general population in Scotland to help combat conditions such as multiple sclerosis (MS), myalgic encephalopathy (ME) and osteoporosis.
A detailed article commissioned by The Times and carried online today, by Professor George Ebers, from the Nuffield Department of Clinical Neurology at the University for Oxford, highlights the connection between high incidence of MS and the absence of sunshine, particularly in the West of Scotland. He urges the Scottish government to take action, arguing that the cost of treating MS is far greater than that of prescribing vitamin D.
“I calculate that the cost of treating MS over the past six years has cost Scotland some £6 billion,” he writes. “Supplementing the entire population with dirt-cheap vitamin D is trivial by comparison, roughly one week's worth of accumulating MS cases.”
As The Times has reported, a shortage of vitamin D has been established as a factor in the country's higher rates of MS, diabetes, high blood pressure, arthritis, several types of cancer, cardiovascular diseases and other ailments. Together they give Scotland one of the worst health records in Western Europe.
It is more than three years since Oliver Gillie, a scientist and writer, unveiled his research, Scotland's Health Deficit: An Explanation and a Plan, showing extensive parallels between Scotland's dull weather and indices of disease. High rainfalls and lack of sunshine in Glasgow and the West of Scotland reflects levels of chronic illness there that cannot be explained by deprivation or smoking. Lack of sunshine in Orkney and Shetland corresponds to the highest prevalence of MS in the world.
By contrast, the South Coast of England, where such diseases are less common, receives 400 more hours of sunshine a year than Scotland. Even Durham, close to the same latitude as Glasgow, receives 50 per cent more sun.
However, yesterday's letter, sent to GPs, practice nurses, health visitors and community pharmacists, merely sets out a reminder of existing recommendations, which include that pregnant and breast-feeding women should take a daily supplement containing 10 micrograms of vitamin D and that children aged six month to five years should take drops. There is also advice to those aged 65 years and over, and those who are not exposed to much sun, to take a daily supplement containing ten micrograms. The letter also concedes that “up to a quarter of people in the UK have low levels of vitamin D in their blood, which means they are at risk of the clinical consequences of vitamin D deficiency”.
Supplements ‘slow progress of MS' | by Lindsay McIntosh
It is barely 2pm but already it is half-dark and sleet is tipping down in the shopping centre car park near Glasgow. At one end, there is a health clinic glowing with light. Inside, Dr Tom Gilhooly and his colleagues are dispensing vitamin D to patients struggling with condition such as MS and Chronic Fatigue Syndrome (CFS), which are linked to a lack of the supplement.
“Most people are deficient in Scotland,” he says. “And today is a good example of why. We don't get a lot of penetrative sunlight.”
In climes more tropical than Rutherglen, the Lanarkshire town where Dr Gilhooly's clinic is located, the skin can produce 20,000 international units (IUD) in 20 minutes.
In the UK, official recommendations suggest a daily allowance of about 400 IUD. Dr Gilhooly describes it as a “gross underestimate”, which should be closer to 5,000 IUD in Scotland.
Dr Gilhooly, a GP, set up the Essential Health clinic because he wanted to treated patients without traditional drugs. He began by looking at vitamin D, as well as omega-3. “Vitamin D is hugely deficient in the population. If you correct that, then you can reassess and say, ‘Do you still need treatment or have your symptoms gone away?'”
Maggie Gilchrist's CFS, also known as ME, was making her job as a nursery school head teacher almost untenable when she turned up at Dr Gilhooly's surgery three years ago. She had “tried everything, including faith healing,” to find relief.
Dr Gilhooly put her on the immune system-boosting drug Low Dose Naltrexone and sent her to have her vitamin D level tested. At about 30, it was not low enough for the NHS routinely to prescribe a supplement, but Dr Gilhooly told her to take enough to raise it to about 100.
“I am a completely different person,” said says. “My staff couldn't believe the difference.”
She tells everyone she knows to take vitamin D because “in this part of the world our light is so much lower than even down in the South of England”.
Dr Gilhooly, too, believes there is a “very strong argument” for it being taken by everyone.
Another patient John Hinshelwood, has a family history of disease that can be linked to low vitamin D. Then, the year he turned 50, he had primary progressive multiple sclerosis diagnosed.
Patients with primary progressive MS, unlike those with the more common form, do not have good and bad days but get gradually worse. However, for Mr Hinshelwood, from East Renfrewshire, the decline has been slow. He is still able to walk short distances on his own, seven years on. He puts his relatively good health down to the action he has taken. “There seems to be a link between low vitamin D and MS,” he said.
Now he and his wife, Anne, 56, both take supplements. While he believes his decline has been halted, his wife is more pragmatic. “What I think is, would it have been a lot faster if he hadn't been doing these things,” she says. Mr Hinshelwood believes vitamin D should be prescribed more widely “like fluoride in water'.
Problems cannot be ignored | Commentary by Professor George Ebers
It takes courage and vision to roll out a national health programme. But if it helps to save lives, that is what any self-respecting government needs to consider. As my report argues today, research closely links the severely low levels of vitamin D in the Scottish population to its high incidences of multiple sclerosis. Knowledgeable doctors are prescribing vitamin D to patients suffering a whole range of diseases.
Hitherto, blame has been placed on poor diet, lack of exercise, excessive drinking and smoking. Of course, all of these contribute to Scotland's appalling health record. But that is not the whole story, as the research now demonstrates. The lack of sunshine, an increasingly indoors lifestyle and constant warnings about over-exposure to the sun have all contributed to levels of vitamin D that are alarmingly low.
Other countries have taken action to tackle a health problem. The US virtually eliminated neural tube defects (spin bifida and other diseases) by prescribing vitamins. Scotland could do the same. But it will take courage and vision.
The Scottish government has failed to respond to recommendations from experts to supplement the population in favour of feeble recommendations of supplements to dark-skinned people and already pregnant women. (In)action seems to ignore lessons already learnt, implying this is now all about compliance rather than disagreement in principle.
For neural tube defects it proved, in the end, crucial that folate sufficiency was in place at the time of conception and waiting until newly pregnant women came to doctors' surgeries was too late. Giving vitamin D supplements to all Scots now seems the most prudent course of action.
Professor Eber's article appears in full on the online edition of The Times.