Monday, July 05, 2010

Vitamin D confusion for pregnant women as new study suggests daily dose IS best after all

Vitamin D deficiency has historically been a real problem in cloudy Britain so anybody in Britain who doesn't get out much and doesn't eat much fish might well take low dose supplementation as a precaution, particularly in winter. High doses can be toxic, of course. The EU recommends a daily intake of 5 micrograms for 12 to 70-year-olds. In Britain, margarine is compulsorily fortified with vitamin D so those who regularly use margarine on their sandwiches probably have little need for concern

Pregnant women were left in confusion today after doctors issued conflicting advice on vitamin pills. A team of experts at the University College London Institute of Child Health said expectant mothers should routinely take vitamin D supplements to protect babies from life-threatening conditions.

But the advice clashes with the official NHS guidelines and recommendations from the Royal College of Obstetricians and Gynaecologists which say there is no need for every pregnant women to take the supplement.

Who to believe? Should expectant mothers read the official NHS advice or the new guidelines from University College London Institute of Child Health

The mixed signals follow a report in the British Journal of Nutrition which says there is a 'strong case' for a daily dose of vitamin D. The paper says there is growing evidence linking vitamin D deficiency to health problems for pregnant women and newborn babies.

Yet the UK is the only one of 31 European countries that doesn't have a set vitamin D recommendation for women of reproductive age.

Dr Elina Hyppönen, an author of the study, said: 'The incidence of vitamin D deficiency in pregnant women in Britain is unacceptably high, especially during winter and spring. 'This is compounded by a lack of exposure to sunlight and the limitations of an average diet to meet the optimal need.

'In the most severe cases, maternal vitamin D deficiency can be life threatening to a newborn. We believe that the routine provision of a daily supplement throughout pregnancy would significantly decrease the number of mothers who are clearly vitamin D deficient, reducing related serious risks to their babies.'

Vitamin D is essential for healthy bones and teeth. The vitamin is produced in the skin when it is exposed to sunlight and is found in oily fish, liver and eggs. Deficiency can cause the bone disease rickets and infantile hypcalcaemia - a condition also known as Williams syndrome which affects development.

Around one in 10 women are thought to be vitamin D deficient. During pregnancy, the number rises to one in four during winter and spring, while 90 per cent have levels 'considered insufficient', Dr Hypponen said.

'This risk of vitamin D deficiency is largely being overlooked by our health professionals,' she said. 'Under a current government scheme, pregnant women who are on a low income are entitled to receive supplements free of charge, but there is no strong evidence to suggest that this group are at greater risk.

'What’s needed is a unified approach that will ensure that all expectant mothers, regardless of their economic status, are informed of the benefits of taking a regular supplement throughout pregnancy.'

However, their advice conflicts with official guidance. The Department of Health advises pregnant women to ensure they receive a certain level of vitamin D - 10 micrograms per day. The researchers say this in effect endorses use of supplements, because diet and the sun provide too little.

But the National Institute of health and Clinical Excellence (NICE) does not support supplements. Instead, it says women should simply 'be informed' about the importance of having adequate vitamin D levels during their pregnancy and while breastfeeding - adding that some women may choose to do this via supplements.

And the Royal College of Obstetricians and Gynaecologists recommends only women at risk of vitamin D deficiency should take a supplement.

Patrick O'Brien, a spokesman for the college, said: 'There is gradually accumulating evidence that universal vitamin D supplementation in the UK might be beneficial for the whole population. 'But more research is needed on the balance of risks and benefits in women at low risk of vitamin D deficiency, and on the correct dosage to use.'


Genetic testing decides who gets breakthrough drug

Good to see an intelligent approach

A NOVEL cancer drug is set to propel Australian health authorities headlong into a new era of personalised medicine, in which the results of genetic testing determine which patients have access to powerful therapies. The drug, Erbitux, has no chance of working in 40 per cent of bowel cancer patients. Their tumours feature a gene mutation that prevents the molecule from blocking its target cancer growth pathway.

But for the other 60 per cent whose cancer has the "wild type" version of the KRAS (pronounced kay-raz) gene it offers a decent if usually temporary chance of slowing the cancer. For some it can even shrink tumours enough to make them amenable to surgery - holding out a modest prospect of a cure.

If the Pharmaceutical Benefits Advisory Committee this week recommends a subsidy for Erbitux, manufactured by Merck Serono, it will for the first time bring cancer gene testing into the mainstream for a common cancer that affects both men and women, specialists say.

They are calling on the federal government to streamline an ad hoc patchwork of gene testing in public hospitals and the private sector, to prepare for an expected deluge of drugs that work only in the presence or absence of a particular genetic signature.

Nick Pavlakis, the head of medical oncology at Royal North Shore Hospital, said: "This is the start of the queue of a number of drugs in Australia that are married to having a test … What transpires with this may well apply to other targeted therapies. "We need a universal test that's reliable and … sensitive," said Dr Pavlakis, who has worked as a paid adviser to Merck.

The federal health department is understood to be discussing how to bring gene tests within its fold. The talks, centred on how tests might be approved and reimbursed under Medicare, are understood to have intensified in recent weeks.

A breast cancer drug, Herceptin, also requires a gene test, but it was originally subsidised outside usual health department mechanisms after intense lobbying.

Graeme Suthers, the chairman of the genetics advisory committee of the Royal College of Pathologists of Australasia, said: "There is a need for a national policy on genetic testing … This is going to get bigger in terms of numbers and different types of situations."

John Stubbs, the executive director of the advocacy group Cancer Voices Australia, said he supported a standardised regime because it would steer patients towards treatments more likely to benefit them.

Nicholas Wilcken, the director of medical oncology at Westmead Hospital, said it was important to know a patient's KRAS status - even if they could not afford Erbitux, which is only available privately at present - because this might influence how other therapies were offered. But Associate Professor Wilcken said the cost of a genetic test, about $200, was prohibitive for some.

For people who respond well, the total treatment cost typically exceeds $20,000.


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