[p2p-research] Vitamin D and health (skin color issues)

[Paul D. Fernhout]

Ryan Lanham wrote:
> On Fri, Oct 9, 2009 at 11:35 AM, Paul D. Fernhout wrote:
>> Glad we've found something we can agree on in this area. :-)
>> 
>> You've probably seen this site that I stumbled across yesterday? 
>> http://www.vitamindcouncil.org/ 
>> http://www.vitamindcouncil.org/newsletter/vitamin-d-and-h1n1-swine-flu.shtml
>> http://www.vitamindcouncil.org/newsletter/h1n1-flu-and-vitamin-d.shtml
>> 
>> 
> No one yet has a theory as to why Vit D works on flu. Of course it most 
> likely is something to do with calcium channels in cells, but we don't 
> know how or why yet. It is widely understood it has major influence on 
> heart disease, breast cancer, bowel cancer, bone density, and several 
> other cancers. It has emerged as sort of the "real" vitamin C...which was
>  hyped for a decade based on Linus Pauling's early understanding of 
> anti-oxidants and their implications. C is good too, but has nowhere near
>  the health benefits of Vitamin D3 which if regularly supplemented would 
> probably cut national health costs by 20% (and that number is widely 
> circulated and discussed--some say as high as 25%). D3 is not an 
> anti-oxidant, but rather is really best described as a hormone.
> 
> Indeed I would go so far as to say that if an adult did no other thing to
>  aid their health, the science suggests that taking 4000-8000 IU of 
> gelcap (not solid) Vitamin D3 ...not D2, is about the best thing you can 
> do for yourself and it will cost less than 1/4 of a US dollar a day.
> 
> The blogs I read on this include Animal Pharma, hyperlipid and few others
>  if you have any interest. Anyone interested in diabetes, Omega 3s, low 
> carb, high saturated fat diets (especially plant based)...I'm the guy. 
> Email me on the side. I am very current with what multiple sides are 
> saying on these topics and there are some wonderful wonderful blogs.

=== on skin color issues as they relate to Vitamin D

I hope this doesn't come across as racist, but in the USA, I've seen 
references to the fact that people of darker skins living in the north of 
the USA have more problems with some specific health issues (including 
higher rates of some mental illness etc.) perhaps because of this Vitamin D 
issue.

Basically, skin color is adapted to latitude (distance from the equator). 
The farther north or south you are of the equator, the lighter you skin 
should be to get more Vitamin D (as a tradeoff against increased skin cancer 
risk and sunburn risk if you lived nearer the equator with lighter skin). Of 
course, Vitamin D supplements and sunscreen mean anyone of any skin darkness 
can healthily live anywhere they want to (and I think they should. :-)

But if this Vitamin D issue is not understood, with pregnant mothers *not* 
getting enough Vitamin D (and babies after birth, and the couple before they 
conceive), it may mean lots of needless suffering for dark skinned families 
living in more northern climates. And the problem is getting worse, since 
everyone spends more time indoors now, so presumably the Vitamin D 
deficiency issue is made even worse for people with darker skins with 
continued cultural changes to spend more time indoors and who may have had 
low levels of Vitamin D to begin with.

Clearly, something is known about this scientifically; something from 2006:
   http://jn.nutrition.org/cgi/content/abstract/136/4/1126
"""
Vitamin D insufficiency is more prevalent among African Americans (blacks) 
than other Americans and, in North America, most young, healthy blacks do 
not achieve optimal 25-hydroxyvitamin D [25(OH)D] concentrations at any time 
of year. This is primarily due to the fact that pigmentation reduces vitamin 
D production in the skin. Also, from about puberty and onward, median 
vitamin D intakes of American blacks are below recommended intakes in every 
age group, with or without the inclusion of vitamin D from supplements. 
Despite their low 25(OH)D levels, blacks have lower rates of osteoporotic 
fractures. This may result in part from bone-protective adaptations that 
include an intestinal resistance to the actions of 1,25(OH)2D and a skeletal 
resistance to the actions of parathyroid hormone (PTH). However, these 
mechanisms may not fully mitigate the harmful skeletal effects of low 
25(OH)D and elevated PTH in blacks, at least among older individuals. 
Furthermore, it is becoming increasingly apparent that vitamin D protects 
against other chronic conditions, including cardiovascular disease, 
diabetes, and some cancers, all of which are as prevalent or more prevalent 
among blacks than whites. Clinicians and educators should be encouraged to 
promote improved vitamin D status among blacks (and others) because of the 
low risk and low cost of vitamin D supplementation and its potentially broad 
health benefits."
"""

The place where I saw that first was in reference to minority families in 
the North being blamed for abuse because of broken bones in their children, 
when the problem may really just be rickets (Vitamin D deficiency).
"The debate: Rickets or child abuse?"
http://www.bbc.co.uk/blogs/panorama/johnsweeney/2009/07/the_debate_rickets_or_child_ab.html

Also, is there a possibility of increased H1N1 flu severity related to skin 
color and Vitamin D? See:
"Cases of swine flu higher among city blacks, Hispanics"
http://www.boston.com/news/health/articles/2009/08/18/cases_of_swine_flu_higher_among_bostons_blacks_hispanics/
"""
The new report about swine flu’s variable racial and ethnic impact opens yet 
another window into a novel virus that has killed at least 447 across the 
country. But disease specialists cautioned that the preliminary data from 
Boston provide clues but no definitive answer.
   “It’s definitely a very important observation that we need to track,’’ 
said Dr. Alfred DeMaria, top disease tracker at the state Department of 
Public Health. “But we don’t want to overinterpret it until we have more and 
better information.’’ ...
   The Boston disease specialists found that of the 71 city residents 
hospitalized with swine flu, 49 percent were African-American, and 28 
percent were Hispanic. In both cases, the hospitalization rates were double 
each group’s overall presence in Boston’s population. ...
   The city investigators said the higher rates may also be a legacy of 
poverty and the demands of low-wage work. Parents in such jobs, Barry said, 
find themselves unable to stay home to care for ailing children because a 
day away from work means a day without pay. As a result, ill children are 
sometimes sent to school.
"""

But isn't this fascinating? The public health people say they do not have a 
clue about why there would be any difference, and here we are with one 
possible obvious answer. So, a simple thing like Vitamin D deficiency might 
be leading to all sorts of racially related issues which are otherwise 
linked to other explanations.

So, how does this move from the blogosphere to public health people 
considering it? How can people in public health be missing stuff like this? 
Maybe the focus on vaccination instead of nutrition or other wellness 
aspects (like sunlight exposure) has clouded and narrowed their perceptions?

Although, now that I look, I see this:
"Despite Anti-Vitamin D Bias, CDC Stumbles on Deficiency Link to H1N1 Deaths"
http://articles.mercola.com/sites/articles/archive/2009/09/22/Low-Vitamin-D-Increases-Flu-Death-Risk-in-Kids.aspx
"""
So far, Swine flu, H1N1, has killed thirty-six children in U.S. and analysis 
of CDC data indicates Vitamin D deficient children at higher risk of death. 
The CDC did not realize they discovered this. However, anyone familiar with 
the Vitamin D literature will recognize it. Almost two-thirds of the dead 
children had epilepsy, cerebral palsy, or other neurodevelopmental 
conditions like mental retardation. All of these neurological conditions are 
associated with childhood Vitamin D deficiency. Exacerbating the problem 
further, many of these kids take anticonvulsant drugs, which lower Vitamin D 
levels. 58 million American children are Vitamin D deficient; 7.6 million 
are severely deficient. When researchers looked at more than 6,000 American 
kids (age one to 21) who were carefully selected to be representative of the 
average American child. 9 percent of the kids had 25(OH)D levels less than 
15 ng/mL and 70 percent had levels less than 30 ng/mL.
"""

Maybe this skin color issue is another too big kettle of worms, like arguing 
over the science and cost-effectiveness and risk of vaccines? :-)

But clearly, the skin color issue just makes this more extreme. Everyone is 
effected. And pediatricians can be clueless. When our child was an infant, I 
asked my pediatrician if we should give extra Vitamin D because it was 
winter and we live in the North, and she said not to. How much was my child 
limited by that "advice" by a health care professional?

Anyway, here is a historic related example of possible political correctness 
perhaps preventing the understanding of Vitamin D issues (assuming this is 
true):
http://www.vitamindcouncil.org/newsletter/vitamin-d-and-schizophrenia.shtml
"""
Schizophrenia more common in those with dark skin
   Before I describe the remarkable paper from Harvard, I want to compliment 
researchers at the Saint Barthomew's Hospital in England for almost saying 
what most psychiatrists already know; the incidence of schizophrenia is much 
higher in people with dark skin. In the 1970s and 80s, that was an accepted 
fact, until charges of racism were leveled against the American Psychiatric 
Association (APA). The spineless APA promptly did retrospective chart 
analyses and announced the incidence of schizophrenia is exactly — precisely 
— the same for Blacks as it is for Whites. The ethnicity question is 
important as the Vitamin D theory is not tenable unless darker skin means a 
higher incidence.
   Actually, in 2007, a group at Columbia University appears to be the first 
to break with the APA's political correctness. Dr. Michaeline Bresnahan and 
her colleagues followed 12,000 children for up to 28 years after birth. 
African Americans were 3 (three) times more likely to develop schizophrenia 
than whites and socioeconomic factors could not explain away their findings.
"""

Also mentioned here:
  http://www.schizophrenia.com/sznews/archives/005560.html
"The International Journal of Epidemiology states in the study published in 
a recent issue, that: "The data indicate substantially elevated rates of 
schizophrenia among African Americans in comparison with whites in this 
birth cohort"."

From:
   http://mentalhealth.samhsa.gov/cre/fact1.asp
"African Americans are over-represented in high-need populations that are 
particularly at risk for mental illnesses: ..."

Now, granted, as with any study, there can be reasons of bias in the 
results. But, let's assume there is not for the moment, and there is a 
genuine difference for some reason.

In the more distant past, genetic reasons were blamed for racial 
differences, which was claimed to justify eugenics and racism. Thus the 
emphasis to show no disparities in something like schizophrenia, even to the 
point of redoing data or analysis, as suggested above. Still, this is an odd 
conclusion because if you look around, there are plenty of countries run for 
a long time by people with darker skins than most US Americans, and often 
doing a better job of it. :-)

Now people see the issues as more social related to ongoing discrimination, 
and as a legacy of slavery and poverty. For example, who would not get 
depressed more often if you had to deal with driving-while-black?
   http://en.wikipedia.org/wiki/Driving_While_Black

It will be controversial to suggest Vitamin D is a big factor in any 
differences, because, first it means admitting differences (which has become 
politically incorrect), and then suggesting some of the differences are 
related to a physical cause will mean other arguments over other social 
spending being curtailed as if everything was solved with some vitamins. 
There will also be arguments over whether, due to a Vitamin D deficiency, 
people of darker skins in the USA may be more at risk of mental issues 
leading to anti-social behavior, and whether that would justify racial 
profiling. That would be potentially an explosive issue. That's an issue 
which would be a very hard to discuss socially for all sorts of reasons 
(including whether political correctness stopped an examination of this 
issue that might have decades earlier led to improvements in the health of 
people with dark skins). There are all sorts of ironic twists there, and all 
sorts of potential for racism and so on.

For the record, I advocate a basic income for everyone of any age and any 
color, as an economic equalizer: :-)
   http://en.wikipedia.org/wiki/Basic_income
And I think the US prison system has at least ten times too many prisoners 
than should be in there, of whatever colors:
   http://en.wikipedia.org/wiki/Incarceration_in_the_United_States
"The United States has the highest documented incarceration rate,[3][4] and 
total documented prison population in the world.[3][5][6] As of year-end 
2007, a record 7.2 million people were behind bars, on probation or on 
parole. Of the total, 2.3 million were incarcerated.[7] More than 1 in 100 
American adults were incarcerated at the start of 2008. The People's 
Republic of China ranks second with 1.5 million, while having four times the 
population, thus having only about 18% of the US incarceration rate"

Still, what if not *all* the reasons for these health disparities or crime 
disparities were socially caused by discrimination?  What if a significant 
part of it were just such a simple thing as people with darker skins living 
in the USA needing more Vitamin D than they get? If that were true, this 
would be a tremendous ongoing tragedy of miscommunication from political 
correctness and embarrassment and so on. It might even involve a 
tremendously complex discussion of political correctness sometimes harming 
people it was trying to help, by, as above, forcing scientists to ignore 
obvious issues, while at the same time not trying to let them off the hook 
when they justify racism:
   http://www.google.com/#hl=en&source=hp&q=science+and+racism
   http://en.wikipedia.org/wiki/Scientific_racism

Still, even differences related to Vitamin D may well be considered yet 
another continuation of the brutal legacy of slavery, from ripping people 
from their homes and dumping them in another climate they were unfamiliar 
with in order to exploit them. So, even if there were differences in mental 
and physical health, including ones not fixable by getting more Vitamin D 
now, the question of how any differences should be handled is a complex one.

And maybe something too awkward for most to discuss face-to-face? :-)
(I've been editing and re-editing this, and it still no doubt has problems.)

Anyway, I don't want to suggest the USA does not have many social issues 
that need to be resolved; it does, big ones. Though often these days they 
are more problems of class than of race, based on this analysis by a black 
woman:
   "Why Anti-Racism Will Fail, by Thandeka"
   http://archive.uua.org/ga/ga99/238thandeka.html

But, what if Vitamin D were an aspect of all this, anyway?

It's controversial to suggest people with darker skins in the USA are 
statistically suffering more physical and mental issues of specific types 
from birth, because that in turn might become fuel for discrimination, 
including claims of bad genes or bad culture or bad attitude and so on. That 
is of course not my intent, even as I raise the issue of differences. So, 
it's a difficult issue to address, to even admit to any disparities related 
to skin color.

Still, I bring it up anyway despite that risk because I don't want to see 
anyone of any color denied their potential because of such a simple and 
cheap thing like Vitamin D pills if that should prove important (and, if 
this research on Vitamin D is to be believed, it is, very important).

Related:
   http://www.dignitarians.org/
"""
The Dignitarian Foundation is an organization dedicated to promoting and 
protecting the intrinsic right to human dignity - the belief that as a 
person, one is automatically worthy, honorable, and deserving of respect, 
regardless of status, station or stage of life. We believe we can and must 
find alternatives to practices that harm individual dignity, instead of 
continuing to convey the toxic residue of these indignities down the line, 
from those with the most power to those with the least. Our mission is to 
overturn the consensus view that says it is acceptable to treat certain 
people and groups badly because other people are doing it or because you can 
get away with it. We invite you to join us in raising awareness within 
families, schools, workplaces and governments of the enormous personal and 
public costs arising from everyday insults to dignity. Collectively, we can 
dissolve unhealthy power imbalances and begin to create societies that not 
only acknowledge, but also actively celebrate, the inherent dignity in everyone.
"""

Also related:
   http://en.wikipedia.org/wiki/Rankism

Is this maybe Vitamin D deficiency some well known thing in, say, by most 
African Americans in the USA already?
   http://www.google.com/#hl=en&q="african+american"+vitamin+d

Example from this year, showing how this issue is heating up:
"Your Health: Skin color matters in the vitamin D debate"
http://www.usatoday.com/news/health/painter/2009-04-19-your-health_N.htm
"""
   Can dark skin be a health hazard? It might be — if you are a dark-skinned 
person who lives far from the equator, gets little sun exposure and consumes 
little vitamin D.
   Just how much vitamin D Americans need and how they should get it is 
under debate. Scientists also are debating evidence that vitamin D, best 
known for building bones, can lower the risk of cancer, diabetes, heart 
disease and other ailments.
   And they are asking this intriguing question: Could varying vitamin D 
levels contribute to the health gap between black and white Americans?
   ...
   John Flack, principal investigator at the Center for Urban and African 
American Health at Wayne State University, Detroit, says: "I think it's 
potentially a very important explanation for some of the differences, from 
hypertension to cancer to heart failure. The actual proof is not there, but 
it's plausible."
   But Flack adds that many factors contribute to African Americans' poorer 
health. Studies suggest those factors include reduced access to health care, 
pervasive barriers to healthful living (for example, neighborhoods that lack 
fresh groceries), differences in income and education and the stress of 
racial inequality itself.
   Solving those problems will be difficult, he says. Closing the vitamin D 
gap could be easier.
   It won't be as easy as recommending more sun exposure, however. Though 
someone in Boston with pale skin can get adequate vitamin D by exposing 
their arms and legs to the sun for 10 to 15 minutes twice a week in the 
summer, someone with the darkest skin might need two hours of exposure each 
time, Holick says. "It's impractical," he says, and it also darkens skin, 
which many people find cosmetically unacceptable.
   Dermatologists also warn that sun exposure increases the risk of skin 
cancer and wrinkling, even in dark-skinned people. ...
"""

Anyway, lots of cans of worms here.

And obviously, there are nutritional issues that have nothing to do with 
race but may have everything to do with poverty or culture, like getting 
enough Omega-3 fatty acids or various other nutrients. So, there are all 
sorts of interactions in the USA between race, class, poverty, 
discrimination, and health. So, there is unlikely to be just one issue that 
explains everything, even if this Vitamin D issues may be important.

If there is any truth to too little Vitamin D leading to more physical and 
mental problems, and that this may have affected the African American 
experience in the USA negatively, then African Americans have been the 
"canary in the coal mine" of vitamin D deficiency in the USA? And, maybe 
there will eventually need to be a deep rethinking of many aspects of US 
history? And even, one can wonder what to make of the fact that President 
Obama (who just won a Nobel Peace Prize today) was conceived and raised as a 
young boy in sunny Hawaii? What would the USA have been like if more people 
with dark skins could have reached their potential? How many more "peace 
prizes" would the USA have won?

From:
   http://en.wikipedia.org/wiki/United_Negro_College_Fund
"""
In 1972, the UNCF adopted, as its motto, the maxim, "A mind is a terrible 
thing to waste." This maxim has become one of the most widely recognized 
slogans in advertising history.
"""

Could a few hundred dollars worth of Vitamin D during pregnancy and in 
childhood per dark skinned mother and baby made a bigger difference than 
many thousands of dollars spent later on college? Difficult questions to 
explore? And was political correctness the reason this was not understood 
decades ago?

Still, the first three years (four including pregnancy) are very important 
for any child of any skin color:
   http://www.zerotothree.org/
"We welcome you to ZERO TO THREE’s website. ZERO TO THREE is a national 
nonprofit organization that informs, trains and supports professionals, 
policymakers and parents in their efforts to improve the lives of infants 
and toddlers."

And, it's hard to know if Vitamin D really would make such a big difference 
compared to other things? No doubt, this will be a contentious issue for 
years to come.
   http://www.vitamindcouncil.org/treatment.shtml

Anyway, it seems like almost everyone needs more Vitamin D. As we all spend 
more time indoors in front of screens, it would seem that skin color won't 
matter much, and we will all need to take the same amount of Vitamin D 
supplements, whatever our skin color. :-)

Perhaps this need for Vitamin D supplements will more and more even include 
people with dark skins living near the equator and spending more and more 
time indoors?

Anyway, a big, big can of worms for all sorts of reasons.

--Paul Fernhout
http://www.pdfernhout.net/