Should Scotland introduce a Vitamin D supplementation programme?
When Ryan McLaughlin was 14 he found himself displaying symptoms of Multiple Sclerosis. Acutely aware of the condition as a result of his mother’s diagnosis two years previously, he was referred to Yorkhill hospital for tests. Hoping to learn of a cure, he sought answers on the internet and came across research from Oxford University, highlighting the link between Vitamin D deficiency and MS.
“To be honest with you, I kind of discounted it at first, thinking it was a wee bit too simple,” says dad, Alan. “He went back upstairs and had another good read of the research and came back down and said would it not be just as easy to put the vitamins straight into the milk and then every child has protection. We thought that was a brilliant idea and that is really when we took notice.” With the help of the MS Society Scotland, Ryan, whose suffering turned out to be stress causing his body to mimic the symptoms of his mother’s condition, formed the Shine on Scotland campaign and took his proposals to the Scottish Parliament. His petition attracted over 1500 signatures and since then the Scottish Government has agreed to run an awareness campaign highlighting the links between Vitamin D, the so-called sunshine vitamin, and MS.
However, his long-term aim remains that Vitamin D supplements be offered to every child and pregnant women.
This goal was given a significant boost last week following the publication of an article in the Lancet Neurology journal.
In addition to casting a spotlight on Scotland, the article also references the Shine on Scotland campaign and argues that as Vitamin D is an inexpensive supplement, the potential cost savings of such a programme are enormous.
It continues: “In Europe, if the predicted effects of raising serum Vitamin D concentrations to 100 nmol/L are realised, the potential savings have been estimated to be €187 billion [c £160bn] per year from the direct and indirect burden of disease, set against an expenditure of €10 billion on testing and public education.” While it makes clear that trials are still needed to address questions about dosage levels and long-term implications, it nevertheless argues that given the high prevalence and incidence of MS in Scotland, as well as other diseases related to Vitamin D deficiency such as many types of cancer, cardiovascular disease and diabetes, “the benefits of supplementation are likely to outweigh any potential side-effects” and so should not be seen as an impediment to beginning a supplementation programme in the near future.
The McLaughlin family are understandably delighted with the news and argue that a supplementation programme should be introduced without delay.
“I think there has got to be some movement on it, one way or another now,” says Alan.
“To go to a cohort study will take five years.
To go to a randomised control study will probably be a ten-year process and we would be looking at probably another 15 years on top before we see a result and get proper data from it and that is too long. Children are suffering. The numbers are growing for MS for children vastly and obviously, people are being diagnosed a lot younger and that means folk are suffering now. So we can’t wait 15 to 20 years to get a result and then take action.” He continues: “A large study would cost between £10-25m. Whereas the Government literally could say we go and allow fortification for certain products at a higher dosage and share some of the burden and cost of that with the food industry and what you will have is healthier kids with a built up immune system at very little cost to the Government to implement it and hopefully, you will see an instant improvement in people’s health.” Certainly, the food industry is not waiting on the Government to make up its mind, he argues.
“There are plans afoot already by several brands on the market to start putting Vitamin D into all sorts of foods. We’ve already seen it with powdered milk - SMA and Cow & Gate have already started putting it in. Nestle have started putting it into some of their products abroad but not in the UK. They have already brought out Vitamin D in Australia in Kit Kat bars. That will happen here as well, with the right encouragement.” There is growing international recognition of the issue, says Alan, pointing out that US President Barack Obama has recently launched a task force to look at Vitamin D deficiency and Ryan has already written to First Lady Michelle Obama, who is spearheading the ‘Let’s move’ campaign to end childhood obesity to tell her about his campaign in Scotland.
“American groups are up in arms,” Alan says, “they really want it. North America, especially.
Australia started campaigning last week.
Germany kicks one off in a week’s time.
“So it has caught on and the research is there to prove the theory.
“I think we are way by the point where people don’t believe it anymore, it is now just about taking action and seeing how much it will help.” And there is a sense that Scotland is leading the field on this issue, argues Craig Wilkie, head of policy and communications, MS Society Scotland.
“Partly that is because some of the most significant research has been done in the UK and has been taken up in a Scottish context throughout this campaign,” he says, “and from our perspective, the Scottish Government has been very receptive to looking at that, considering that and working with us to see what some of the implications might be.” There is certainly much to consider. In March a group of international experts, health professionals, politicians and patient representatives met in Brussels to call for action to address widespread deficiency of Vitamin D in Europe.
“Most of the experts and health professionals there were very much of the view that this is quite a significant challenge and it was described by one of the participants as the low-lying fruit of public health - the next stage that governments could and should consider,” explains Wilkie, who attended the meeting.
Unfortunately, the meeting tended to be a little bit focused on the academic research itself rather than some of the policies that politicians and governments might look at, he says. However, he is hopeful that the summit that is being hosted by MS Society Scotland with support from the Scottish Government later this year will provide a forum for such debate.
The summit, which had been scheduled for April but was postponed due to the volcanic ash cloud, will now be held in Scotland in September.
“It is quite exciting for us to be able to bring these people into the same room to look at a potentially important issue,” he says.
“One of the things that is interesting, at least to me, about Vitamin D is that even though the research and the evidence is still emerging, and some of it is still at a reasonably early stage, I think, especially in the current climate, that it is important that the options we are looking at are relatively low cost. And even if the benefit as yet is not absolutely definitive, the potential benefit is actually quite big and at the same time, the risks seem to be very low.
“So the combination of all those factors make it potentially quite a significant area to look at in relation to public health and one that might bring a lot of benefit for not very much investment.” Backing the Lancet article’s calls for action now on supplementation, Wilkie says he would like to see the Government giving serious consideration to a programme of supplementation for at-risk groups, such as young children, pregnant women, and certain ethnic minority groups who may tend to cover up and so do not receive the same exposure to the sun.
However, alongside this he would also like to see more co-ordination of public health messages around how to boost levels of Vitamin D naturally.
“By and large, the message on sunscreen and so on has been quite a successful one in public health terms. But one of the implications of that in a country like Scotland is that people are actually denying themselves the opportunity to get Vitamin D from the sun, which is the most obvious and plentiful source of it. Even ten, 15 minutes in the sun prior to putting on sunscreen can make a difference. So one of the things that we’ve been talking about with the Government is how you can try and coordinate some of those messages and look at some of the unintended consequences of certain health messages around sunscreen, for example.” While he says there is still a long way to go, he says it is remarkable what the Shine on Scotland campaign has managed to achieve in a relatively short time, which he credits in no small part to Ryan’s unstinting “enthusiasm and commitment”.
“He is always looking for new opportunities to expand the campaign or add different dimensions to it. He is quite an extraordinary young man. So it is no surprise that he is getting things done,” Wilkie says.
Alan is also proud of what his son has achieved. “He’s done a fantastic job with it.
He’s got his own wee style in the way he speaks to the Government and to manage to get the whole government on side, he has done really well.
“For the last year he has just been stuck in his room, apart from when he is doing his Taekwondo, researching and annoying politicians until they give in.” And he has been right to do so, Alan says.
“It is not as if they are giving in for any reason other than that he’s right. The research is 40 years old now. It was only last year that Oxford University found that specific gene which proved the theory, but the Vitamin D hypothesis has been there for nearly going on 40 years. So it is about time something is done about it.”
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