CULTURE,
GENETICS, MODERN MEDICINE AND NON COMPLIANT HEALTH CARE PROVIDERS
Why is
this Social Anthropologist writing an article about the scientific aspects of
recently popularized Vitamin D? Epidemiologists, those troubadours of tragedy,
while polishing their tools, find that there is Vitamin D deficiency present
ubiquitously. Supplement manufacturers and their paid peon professors jump into
the game recommending more and more supplementation with Vitamin D in pill
forms. They ignore nature and Science, as it happens in many of the human
chronic conditions that are nebulous.
Then
Science comes to the rescue, scientists not paid for by drug companies lay out
the dissection of Vitamin D “deficiency”.
While
doing my morning reading of medical materials, on this 21st day of
November 2013, the just published New England Journal had an interesting
article (aren’t all medical articles interesting? Depending upon the keen mind
of the reader?)
Vitamin
D Binding Protein and Vitamin D status of Black Americans and White Americans
NEJM
2013, 369:1991-2000/November 21, 2013
Working
with American Indians I had wondered why ALL of them had low Vitamin D levels
and that in many of them, supplementation with oral Vitamin D pills did not
bring up their blood levels of Vitamin D?
I was
thinking along two lines.
(Malay Moslem women attending a Human Rights Conference! It is obligatory for them to wear cover up)
American
Indians were all lean and now all are overweight or obese. Could there be some
identifiable chemical that has caused their obesity also responsible for their
low Vitamin D levels? Or what changes in hormonal metabolism occurs when a
person becomes overweight or obese and how does it affect the Vitamin D levels
in the blood?
Could
there be some chemical produced by the bacteria in the gut that would have been
necessary for proper assimilation of Vitamin D in its metabolic pathway, which
is now disturbed by the relentless onslaught of artificial food and its
chemical constituents? As a medical student I had a great interest in inflammatory
bowel disease and bone disease including Arthritis. A study from Malaysia has
shown that the presence of Inflammatory Bowel Disease has an effect on
metabolic bone health but not the low levels of Vitamin D.
If you
have worked as Medical Doctor in any country with large Black populations, such
as Jamaica in my case, it would quickly come to your attention that
Osteoporosis was very uncommon among the Blacks. And at the same time, in
keeping up with their fellow blacks in the USA, Jamaican blacks are “deficient”
in vitamin D despite the fact that they live in Sunny Jamaica!
It is
thought that evolutionarily the necessity for Vitamin D eventually made the
human skin lighter as humans went north to inhabit colder climes. It is estimated that Blacks need about 20
times the exposure of Whites to accumulate the necessary Vitamin D.
Migration
to the new world occurred around 500 years ago (a forced one at that) and the
body had to make some changes as it moved away from its equatorial habitat.
And
this article I was reading this morning, may give us a clue how that was
accomplished.
Our
skins can manufacture the precursor of this hormone given the proper exposure to the sun. Bedouin and Arab women who cover themselves top to bottom are notoriously low
in Vitamin D levels despite living in the desert. Even among Asians, there were
racial differences. In Malaysia, in a study of post menopausal women, 70 per
cent of the Malay were Vitamin D deficient where as only 10 per cent Chinese
were. It is well known that Malaysian Chinese are fitter, leaner and eat better
than their Malay counterparts and in the study the Vitamin D deficiency was
related to Malay Race, Increased Body Mass Index and Increased Fat Mass. The
fact that the Malay women were covering themselves up (a very recent
phenomenon) perhaps does not help.
(Malaysian Chinese are leaner and live longer than other races in Malaysia)
Culture
has something to do with your health, in the context of traditional life it may
have helped you but in the context of a modern life, which may include
migration, it may play havoc with your genes. East Indians who migrate to
colder climes and still ate their chapattis were found to have osteomalacia in
Scotland. Asians living in Southern USA have lower Vitamin D levels.
With
200 million people living in countries not of their own has a great cultural
impact and the unknown effect is on the ancestral metabolism we carry with
ourselves. How to adjust our genes that may be used to Curry and Dal to the
vagaries of McDonalds? (an East Indian metabolism or any Asian metabolism could never adapt to McDonalds). Migrants get fat, they get more Metabolic problems than
the locals (Cambodians in Australia, Guatemalans and Mexicans in the USA,
Pakistanis in UK) and this would easily tie in with the article that I was
reading this morning, Genes and maladaptation within a rapid time frame.
(the Bedu women who live in the desert are fiercely independent despite the fact they are completely covered, here a saudi Bedu is driving a truck, which is probited to the Arab women)
Vitamin
D is manufactured in the skin and converted first in the liver to 25 dihydroxy
Vitamin D and then for a second time to 1,25 di hydroxyvitamin D in the Kidney.
This is the active form of the hormone, Calcitrol.
If we
all have originated in Africa, as it is commonly believed, there was no need
for food to contain Vitamin D and this is the case. There are very few natural
nutritional sources of Vitamin D: fatty fish, fish liver oil, egg yolk.
Lately
vitamin D deficiency has been touted as the cause of multiple diseases and
immune deficiencies and cancer, but when is a “deficiency” on a lab test a true
“deficiency” in the body?
This
paper puts the first light on this matter.
25 OH
Vitamin D the precursor of Calcitrol, the hormone is the major circulating form
of Vitamin D; it circulates bound to a specific carrier protein, Vitamin D
Binding Protein (DBP). DBP also transports Vitamin D (made in the skin by
sunshine or obtain through diet: two sources in the diet, Plants give us D2 and
animals give us D3 which is the more active form
In this
important study published in NEJM (one reason for Doctors who read to subscribe
to NEJM), Blacks had lower DBP than whites but the bioavailable 25 OH vitamin D
were similar despite them being “deficient”.
Blacks,
Asians, Mexicans, American Indians all have low values of 25 OH vitamin D, does
this mean that they are all Vitamin D deficient and they should all take
hundreds of pills? The lower levels of DBP among Blacks and Asians perhaps are
an evolutionary tactic of the Great Spirit!
To
complicate matters further, studies from Thailand shows that genetic variations
in DBP would affect the response of Vitamin D supplementations on the 25 OH
vitamin D levels!
So once
again, culture, genetics interact.
So for
the Doctors, it is no longer sufficient just to order Vitamin D levels and
treat the results on your Electronic Health Records
: They
have to know the race of the patient, mixture of the races, as Mexicans have a
high rate of Native Indian blood
: They
have to know the metabolic bone health status of their patients, such as Bone
Density
: Currently
we cannot easily measure DBP levels or DBP genetic variations
Keep in
mind that Vitamin D deficiency may not be a “deficiency” at all for the
majority of the populations of this world
And
when repeated blood levels of Vitamin D refuse to budge, the doctors must not
begin to accuse the patient of not taking the medications or increase the
medications they are already on.
Instead
the Health Care Provider has to become COMPLIANT with the knowledge of his
patients social and cultural status
