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Vitamin D supplements To the editor: In their statement on vitamin D supplements (Can Med AsSoc J 112: 1216, 1975) the nutrition committee of the Canadian Paediatric Society urged pediatricians to be on the lookout for rickets among two particular groups of children - those with a limited capacity to ingest vitamin-Dfortified formulas and those receiving long-term anticonvulsant therapy. They reported that Nutrition Canada showed that among nine nutrients, vitamin D outranked all for "inadequate intake" in young children and adolescents but that abnormal serum calcium values were not found. In conclusion, the authors exhorted physicians to be vigilant about vitamin D nutrition and to "watch for evidence of unusual forms of deficiency". This sole concern of the statement, of vitamin D deficiency causing only rickets, and the mild reservation that unusual consequences of chronic vitamin D deficiency may exist, move me to mention a contrasting statement made in "Calcium and Phosphorus Metabolism", by James T. Irving,1 and to summarize the reasons for this statement. The statement is that calcium may be more important as a free ion normalizing varied cellular function than as part of a solid chemical compound giving rigidity to the skeleton. In the section of his book devoted to the cellular extrusion processes the author states that "evidence accumulated during recent years indicates that calcium ions are essential in practically all instances where cellular secretion takes place". Evidence is given showing the requirement of ionized calcium for secretion of (a) catecholamines by the chromaffin cells of the adrenal medulla, (b) vasopressin and oxytocin by the Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and should not exceed 1½ pages in length.
neurohypophysis, (c) adrenocorticotropic hormone by the adenohypophysis, (d) thyrocalcitonin by the thyroid and parathyroid hormone by the parathyroid glands, (e) insulin by the p-cells of the pancreas, (f) amylase by the pancreas, (g) protein by the polymorphonuclear leukocytes, (h) hydrochloric acid by cells of the gastric mucosa, (i) histamine by mast cells and (j) serotonin by thrombocytes. Over the past 21 years I have given megadoses of natural vitamin D3 and natural vitamin A and only moderate doses of bone meal to over 10 000 patients, the majority of whom had chronic asthma or arthritis, without ever inciting a toxic reaction. The resolution of the distress in these diseases attained by this therapy, particularly in chronic asthma, far exceeded that attained by conventional therapy. Megavitamin therapy with vitamins A and D, discovered in 1954, was the product of an analysis, performed during the previous 4 years, of every disease, complaint and obscure symptom of patients seen in practice during this period. The resolution of chronic asthma and other complaints and symptoms, including fatigue, anxiety, headaches, leg cramping and indigestion, provided clinical evidence of the abovementioned widespread cellular requirement for ionic calcium. Study of the lifestyle and dietary habits of these patients with asthma and other conditions revealed that a possible ionic deficiency state had developed because of chronic deficiencies of dietary calcium or dietary or solar-generated vitamin D, intestinal malabsorption of these nutrients, or a combination of these factors. Considering the amount of demineralized "junk food" eaten and beverages other than milk drunk, especially by mothers giving birth to several children over a few years, and considering the widespread neglect of dietary supplementation with natural vitamin D3 and
668 CMA JOURNAL/APRIL 17, 1976/VOL. 114
natural bone minerals and lack of exposure to sunshine, I urge practitioners to consider that some "unusual forms of deficiency" of vitamin D and calcium may explain the various unsolved complaints he or she may currently be treating unsuccessfully with drugs in adults and, particularly, their offspring. This is particularly true in cases in which there is spasm or lack of contractibility of smooth or skeletal muscle. It is my experience that ionic calcium deficiency of muscle is one of the most prevalent and serious factors responsible for symptoms and overt disease of tissues and organs other than bone. CARL J. RRICH, MD
205A Medical Centre Calgary, AB
Reference 1. iRVING JT: Calcium and Phosphorus Metabolism, New York, Acad Pr, 1973
To the editor: The statement of the nutrition committee of the Canadian Paediatric Society addressed itself solely to two groups of children in whom vitamin D deficiency might be especially liable to develop - the low birthweight infant and the child receiving long-term treatment with anticonvulsants. The statement mentioned that a low serum calcium value was an early manifestation of vitamin D deficiency. As Dr. Reich points out, calcium has many physiologic functions; the effects of hypocalcemia are described in many texts and are well known by physicians. Our statement also made passing mention of the Nutrition Canada report. A full account of the committee's findings on this aspect of the Nutrition Canada data will be published shortly in CMAJ. In brief, the committee found that an apparent deficiency of dietary intake of calcium and vitamin D in some groups of children was not reflected in any abnormality of serum values of calcium, phosphorus and alkaline phosphatase, which indicated
Vitamin D supplements To the editor: In their statement on vitamin D supplements (Can Med AsSoc J 112: 1216, 1975) the nutrition committee of the Canadian Paediatric Society urged pediatricians to be on the lookout for rickets among two particular groups of children - those with a limited capacity to ingest vitamin-Dfortified formulas and those receiving long-term anticonvulsant therapy. They reported that Nutrition Canada showed that among nine nutrients, vitamin D outranked all for "inadequate intake" in young children and adolescents but that abnormal serum calcium values were not found. In conclusion, the authors exhorted physicians to be vigilant about vitamin D nutrition and to "watch for evidence of unusual forms of deficiency". This sole concern of the statement, of vitamin D deficiency causing only rickets, and the mild reservation that unusual consequences of chronic vitamin D deficiency may exist, move me to mention a contrasting statement made in "Calcium and Phosphorus Metabolism", by James T. Irving,1 and to summarize the reasons for this statement. The statement is that calcium may be more important as a free ion normalizing varied cellular function than as part of a solid chemical compound giving rigidity to the skeleton. In the section of his book devoted to the cellular extrusion processes the author states that "evidence accumulated during recent years indicates that calcium ions are essential in practically all instances where cellular secretion takes place". Evidence is given showing the requirement of ionized calcium for secretion of (a) catecholamines by the chromaffin cells of the adrenal medulla, (b) vasopressin and oxytocin by the Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and should not exceed 1½ pages in length.
neurohypophysis, (c) adrenocorticotropic hormone by the adenohypophysis, (d) thyrocalcitonin by the thyroid and parathyroid hormone by the parathyroid glands, (e) insulin by the p-cells of the pancreas, (f) amylase by the pancreas, (g) protein by the polymorphonuclear leukocytes, (h) hydrochloric acid by cells of the gastric mucosa, (i) histamine by mast cells and (j) serotonin by thrombocytes. Over the past 21 years I have given megadoses of natural vitamin D3 and natural vitamin A and only moderate doses of bone meal to over 10 000 patients, the majority of whom had chronic asthma or arthritis, without ever inciting a toxic reaction. The resolution of the distress in these diseases attained by this therapy, particularly in chronic asthma, far exceeded that attained by conventional therapy. Megavitamin therapy with vitamins A and D, discovered in 1954, was the product of an analysis, performed during the previous 4 years, of every disease, complaint and obscure symptom of patients seen in practice during this period. The resolution of chronic asthma and other complaints and symptoms, including fatigue, anxiety, headaches, leg cramping and indigestion, provided clinical evidence of the abovementioned widespread cellular requirement for ionic calcium. Study of the lifestyle and dietary habits of these patients with asthma and other conditions revealed that a possible ionic deficiency state had developed because of chronic deficiencies of dietary calcium or dietary or solar-generated vitamin D, intestinal malabsorption of these nutrients, or a combination of these factors. Considering the amount of demineralized "junk food" eaten and beverages other than milk drunk, especially by mothers giving birth to several children over a few years, and considering the widespread neglect of dietary supplementation with natural vitamin D3 and
668 CMA JOURNAL/APRIL 17, 1976/VOL. 114
natural bone minerals and lack of exposure to sunshine, I urge practitioners to consider that some "unusual forms of deficiency" of vitamin D and calcium may explain the various unsolved complaints he or she may currently be treating unsuccessfully with drugs in adults and, particularly, their offspring. This is particularly true in cases in which there is spasm or lack of contractibility of smooth or skeletal muscle. It is my experience that ionic calcium deficiency of muscle is one of the most prevalent and serious factors responsible for symptoms and overt disease of tissues and organs other than bone. CARL J. RRICH, MD
205A Medical Centre Calgary, AB
Reference 1. iRVING JT: Calcium and Phosphorus Metabolism, New York, Acad Pr, 1973
To the editor: The statement of the nutrition committee of the Canadian Paediatric Society addressed itself solely to two groups of children in whom vitamin D deficiency might be especially liable to develop - the low birthweight infant and the child receiving long-term treatment with anticonvulsants. The statement mentioned that a low serum calcium value was an early manifestation of vitamin D deficiency. As Dr. Reich points out, calcium has many physiologic functions; the effects of hypocalcemia are described in many texts and are well known by physicians. Our statement also made passing mention of the Nutrition Canada report. A full account of the committee's findings on this aspect of the Nutrition Canada data will be published shortly in CMAJ. In brief, the committee found that an apparent deficiency of dietary intake of calcium and vitamin D in some groups of children was not reflected in any abnormality of serum values of calcium, phosphorus and alkaline phosphatase, which indicated
