July 28, 2011
The beginning of the emergency room visit looked bad for the 16-month-old infant. He was in full cardiac arrest. His heart had stopped beating (asystole) but the Swiss hospital crew applied advanced cardiac life support and got the infant’s heart beating once again. When the child’s blood work came back, the doctor immediately noted his calcium was about one-third of what it should be (his ionized calcium was .42 instead of between 1.15 – 1.5), and so the doctor administered IV calcium.
While this was occurring, one of the team noted bowing (curving) of the child’s legs and his wrists were swollen, so the doctor included a vitamin D blood test to the additional blood tests. The child’s vitamin D level was 5.7 instead of in the normal range of 30-100 ng/ml.
On more careful exam, the doctor noted frontal bossing (front of head sticks out), a rachitic rosary (beading along the rib where bone and cartilage meet), hypotonia (muscle flabbiness) and wide wrists and ankles. These are the common signs of vitamin D deficient rickets.
The doctor gave the infant 5,000 IU/day of vitamin D for 3 months resulting in a 25(OH)D level of 65 ng/ml (the FNB/IOM committee members would not be happy). This paper, in today’s edition of the Journal of Clinical Endocrinology and Metabolism, has reproductions of the infants wrist x-rays before and after the vitamin D. The before x-rays look like the x-rays of the children whose parents are unjustly arrested for child abuse, but after 3 months of vitamin D, the x-rays looked perfectly normal.
Chehade et al. Acute Life-Threatening Presentation of Vitamin D Deficiency Rickets. J Clin Endo and Metab. July 27, 2011 Current Issue.
After the medical team stabilized the child, the doctor obtained a dietary history from the parents; the only group that would be satisfied is La Leche League. For the first 10 months of his life, the infant got nothing but breast milk and for the last 4 months got nothing but breast milk and a little rice water. His dark skin and lack of sunlight, combined with his mother’s belief that breast milk alone is all children need to thrive, condemned him to severe rickets and a serum calcium low enough to stop his heart from beating.
When I practiced emergency medicine in the 1970s and 80s, I saw similar cases of asystole and can tell you that the few who survive asystole often have brain damage. Not this child; he thrived once his body got what most breast milk does not have (95%) and that is vitamin D. As Professor Bruce Hollis is about to prove to the world, that simply means 95% of lactating women are vitamin D deficient. A few lucky breast-feeding infants have mothers wise enough to take 5,000 IU of vitamin D daily. Those women have plenty of vitamin D in their breast milk, enough to make this Swiss nightmare only a memory of the new FNB dark ages.
If only the recent FNB had the courage to address all the women with levels below the 20 ng/ml (the level the FNB said was adequate). They know the main way to address the 25% of women with such levels is food fortification, but they chose not to make any food fortification recommendations. Rather, they dispensed advice they know most of these women will not follow. May God and the souls of the lost children forgive them.
-John J. Cannell, M.