Most of the medical and social ills predominant in Victorian times, such as child labour, high infant mortality, open sewage systems and terrible nutritional diets for the working classes are thankfully, things of the past. Amongst the medical ailments brought about by these poor living conditions was a disease know as rickets. Rickets was primarily due to poor nutrition, specifically a lack of vitamin D, a vitamin found abundantly in dairy and fish products. This disease affected mostly children and resulted in improper bone formation, leading to bending of the bones or non-calcification of the bones, leaving either bowed bones or ‘cartilaginous ‘ bones in babies, a syndrome known affectionately as Floppy Baby Syndrome.
Well those days are long past, right? Apparently not. In the last few years there has been a disturbing rise in the number of reported cases of rickets.
Biology of vitamin D
Vitamin D by itself is not ‘active’ in the body. In order for vitamin D to be used properly by the body for the calcification of bones, it needs to be hydrolyzed into usable metabolites. The hydrolysis of vitamin D is achieved by UV irradiation of the skin (i.e. exposure to sunlight). Very little sunlight is needed to achieve this hydrolysis (fortunately for the sun-starved residents of the UK). 20 minutes in the summer sun will cause the conversion of vitamin D to its active form in an excess of 50 times the daily recommended intake of vitamin D (400IU).
Symptoms of rickets
Although rickets may occur in adults, this is extremely rare and most reported cases are in babies or infants. Symptoms of rickets include:
- Bone pain or tenderness
- Dental problems
- Muscle weakness
- Increased tendency for bone fractures
- Skeletal deformity such as bowed legs, knock-knees and spinal deformities
If left unchecked, these symptoms will severely diminish the child’s health, cause pain and even premature death.
Prevention and treatment of rickets
Fortunately prevention and treatment of rickets is simple — the diet must contain sufficient vitamin D. For the vast majority of the UK population, no supplements are required as long as the person eats dairy products and / or fish as part of their regular diet. Again, for the majority of the population, normal exposure to a limited amount of sunlight will be sufficient to activate the vitamin D into its active form, allowing for proper calcification of the bones. For individuals who lack a diet that includes dairy or fish products (e.g. vegans or lactose intolerant individuals), dietary supplements of vitamin D are readily available in a pill form.
People who are diagnosed with rickets can be successfully treated with dietary supplements and UV-sunlight. This will reverse the symptoms and the proper bone calcification process will resume. In a short time the person will be cured of rickets and restored to healthy life.
So why is rickets becoming a problem in the 21st century?
It would seem illogical that Rickets is once again becoming a disease in the western world but facts are facts, and it is. The populations that are most affected are the ethnic minorities, particularly Asian and Afro-Caribbean children. The primary reason why these sub-populations are affected is because they have darker skins than the normal lily-white indigenous populations. Peoples with darker skins require more sunlight than those with fair skins to convert vitamin D into its active form. So it is possible that dark-skinned people may develop rickets even if they are getting the same exposure to sunlight as fair-skinned people.
Another factor that comes into play is that social and religious beliefs require, in some cases, the individual to cover all skin. Covering up completely can be a problem in a country lacking much sunshine.
A further complication may be an over-reaction by parents to the fear of skin cancer, so that infants are smothered with sunblock to prevent those harmful, carcinogenic UV rays from reaching the skin. Unfortunately such diligence will also prevent those nasty UV rays from hydrolyzing the vitamin D, putting the individual at greater risk of developing rickets.
A more dangerous but extremely rare cause of rickets is an ‘autosomal-linked’ genetic mutation of the gene(s) responsible for the hydrolysis of vitamin D. Such cases need to be treated medically with synthetic metabolites. However it should be stressed that such mutations are extremely rare (one in 10 million) and do not account for the increase in rickets seen today.
The increase in the number of cases of rickets does not need to be alarming. As with most conditions, an elementary education of the population into the causes and prevention of rickets would be enough to stop the occurrence of this disease. Extra care needs to be taken to make sure that people with dark skins are well informed and health authorities need to be encouraged not to overdo fearmongering about exposure to healthy levels of sunlight.
Andrew Creasey has a PhD in Molecular Genetics from the University of Newcastle. For over 25 years, he has worked in business, specialising in the biotechnology industry, taking in a variety of positions in many diverse geographic locations. He presently resides in Houston, Texas.
For more information on Vitamin D as well as up to date recommendations see Charlotte’s blog New Vitamin D Recommendations