Angela Kremmyda

Senior Clinical Scientist

Dept of Clinical Biochemistry

Royal Shrewsbury Hospital

Mytton Oak Road

Shrewsbury

SY3 8XQ

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From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Roger Ekins
Sent: 27 November 2009 11:55
To: [log in to unmask]
Subject: Re: Assessment of vitamin D status

I understand Gareth Jones's criticism that Oliver Gillie is simply a free lance  medical  researcher, though such a comment may,  without further amplification,  lead readers to underestimate Dr Gillie's qualifications for writing an article regarding vitamin D.  The facts are that he was the medical correspondent of The Sunday Times, before becoming  medical editor and later special correspondent of The Independent. He has a BSc and PhD degrees from Edinburgh University where he studied genetics and developmental biology under Professor C.H. Waddington at the Institute of Animal Genetics, Edinburgh. He also carried out  research at the National Institute for Medical Research, Mill Hill, under Sir Peter Medawar.

In other words, he seems to me to be at least as well qualified as many members of the ACB to write a review article on vitamin D, and the article contains a large number of references (234) that I considered might be useful to ACB members with interest in this particular field.

Furthermore  - although it may be true that the article has not been formerly peer reviewed - the following comments cannot be brushed aside as irrelevant, biased or  even  fraudulent.

Comments on 'Sunlight Robbery' from health and nutrition experts round the world:

"A well-written, comprehensive review of vitamin D, outlining the widespread concerns about insufficiency in the UK."
Sue Fairweather-Tait, Head, Nutrition Division, Institute of Food Research, Norwich

"Impressively detailed and reads convincingly."Richard Strange, professor of clinical biochemistry, Keele University, Staffordshire.

"I think the document is excellent. I like it and I believe it." Dr Reinhold Vieth, Mount Sinai Hospital, Toronto, Canada

"The paper is excellent. You know your subject extremely well and you have documented the basis for every statement."

Dr Gregory Plotnikoff , associate professor of medicine and pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota

"This document should force the dermatologists away from their 'tunnel vision' thinking with respect to solar exposure."

Bruce W. Hollis, professor of pediatrics, biochemistry and molecular biology, Medical University of South Carolina, Charleston

"This report compiles an impressive array of data linking low vitamin D and adverse health outcomes. It should serve as a 'wake up' call to the public health community. To make health recommendations without acknowledging these data would be negligent."

John McGrath MD, PhD, FRANZCP, professor of psychiatry, University of QueensLand, Australia

Of course this is not to claim that Dr Gillie's views are necessarily correct.

But it seems to me that vitamin D presents us with something of a problem. Clearly humans can exist with low levels of the vitamin, yet there is a clear biological advantage in their acquiring  adequate  supplies either by synthesis in their skins, or by eating certain foods.  Otherwise the entire human race would be dark skinned.

The central message of the Scientific American article to which I drew attention in an earlier discussion  on this topic in June of this year, is that Vitamin D plays a much wider role in the maintenance of human health than the building of bones, the prevention of rickets , and as a treatment for TB.  To quote Scientific American's Editors, Vitamin D is "actually active throughout the human body, powerfully influencing immune system responses and cell defenses...  Measures of Vitamin D levels..show that many people have too little of it in their blood to protect health."

I am reminded of a somewhat similar situation that relates to the  biological role of the unsaturated fat, Omega 3.  Clearly humans can exist with relatively low levels of Omega 3 as compared with the other unsaturated fats, Omega 6, and Omega 9 (oleic acid).  Note that the typical ratio of Omega6/Omega 3 found in individuals  exposed to typical western diets is 20:1.

OK - we nevertheless all survive in reasonable health. But the Omega 6/3 ratio  found amongst Eskimos, and other populations that rely on high proportions of fish and other marine animals (such as seals and whales) in their diets is closer to 1:1. This is also true of populations in certain Mediterranean countries  (such as Crete) whose members  traditionally eat far less meat than is characteristic of typical western diets, and rely  more on 'vegetables' such as purslane or foods of vegetable origin, such as walnut oil  containing high levels of  Omega 3.  (Purslane grows like a weed in the 'garden' of  my Italian wife's house in Sardinia.)    Note that  Omega 3 and Omega 6 compete for certain enzymes in the body, so that consuming the occasional fish containing  Omega 3 (in accordance with current advice in the UK)  will do little to restore the balance, and negate the competitive advantage of Omega 6.

Studies of primitive peoples indicate that the human species developed over millions of years in circumstances such that their dietary intake  of Omega 3 and Omega 6 was approximately 1:1.

So what? Well populations exposed to diets leading to high levels of Omega 6 as compared with Omega 3 suffer far higher rates of heart disease, despite all the advice they receive to avoid saturated fats.  In, contrast, Eskimos - in their traditional way of life - eat huge quantities of fat but suffer negligibly low rates of heart disease. But they rapidly fall into line with the experience  in this regard of  most western societies when they migrate elsewhere, and adopt western life styles and diets.

Regrettably the health authorities of only two countries in the world (Denmark and Japan as far as I can recall)  have issued dietary guidelines relating to the desirable balance in food between Omega 3 and Omega 6.)  

What has this got to do with Vitamin D and Dr Gillies? Well the best review on this subject is a book written by a science journalist,(Susan Allpot) , entitled "The Queen of Fats: Why Omega 3s Were Removed from the Western Diet and What We Can  Do to Replace Them",  published in 2006 as part (no 15) of a series ('California Studies in Food and Culture') published by Univerity of Californiapress.

Has the book  been peer reviewed? Not to to my knowledge.  Is it written by a professional scientist?  No. Does it contain a large number of relevant references in the scientific literature? Yes.

It is not unlike Dr Gillie's review in all these respects. 

Note that in a comment in an American journal on Susan Allport's book, it is reported that " a recent study conducted by Dariush Mozaffarian, MD, of the Harvard School of Public Health, found that the absence of these fatty acids in our diet is responsible annually for up to 96,000 premature deaths in this country [i.e the US]. Scientists, however, are learning that fixing this nutritional deficiency is a bit more complicated than simply telling people to eat more fish".

So don't be snooty Gareth. Even science writers  and free lance  medical researchers may have something to teach you

Roger Ekins

Prof Roger Ekins,  PhD DSc FRS

Molecular Endocrinology

Windeyer Institute

University College London
London W1T 4JF


Phone +44 20 7679 9410
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