News reports continue to quote dermatology leaders suggesting that sun exposure isn’t necessary to maintain recommended vitamin D blood levels. But can dermatology’s lobbying groups really be trusted on this topic?
“Dermatology groups generally consider 20 ng/ml an acceptable vitamin D blood level,” Smart Tan Executive Director Joseph Levy said. “The entire vitamin D research community recommends vitamin D levels between 40-60 ng/ml — levels researchers now call ‘natural’ or ‘physiological’ because that’s what you make and maintain naturally in your skin if you work outdoors.”
But even if you consider 20 ng/ml as acceptable, some reports suggest that dermatologists themselves might be woefully short of that.
A 2009 study in the British Journal of Dermatology reported that Australian dermatologists at the end of Australian summer — when vitamin D levels should be their highest — had vitamin D blood levels averaging just 13.8 ng/ml. Such levels are so low as to be borderline for osteomalacia in adults and rickets in children.
In the United States in 2010, NBC News reported that a Washington, D.C., dermatologist was unable to identify her 14-year-old son’s severe vitamin D deficiency even after he complained of constant pain, headaches, exhaustion, body aches and stomach pain — classic signs of severe vitamin D deficiency.
“Because Benjamin’s an active tennis player she (his mother) thought he’d just pulled a muscle or strained something,” NBC-Washington reported after talking with Dr. Marilyn Berzin, Benjamin’s mother. She is a Washington, D.C., dermatologist whose web site states she is considered “to be one of Washington, D.C.’s leading cosmetic dermatologists.” The web site encourages people to always apply sunscreen with at least an SPF15 rating.
Based on video images of Berzin and her son — who both appear pale in the story — it is likely they don’t get a lot of sun.
It was the stomach pain that got Dr. Berzin to take her son to a pediatrician, NBC reported. “Doctors tested him for everything from arthritis to muscular dystrophy to Lyme disease,” the story reported. The tests ultimately showed he was severely deficient in vitamin D and was put on 50,000-international-unit-weekly supplements for an eight-week period.
“Within about two to three weeks he started feeling a lot better — he grew immediately about two inches,” Dr. Berzin said in the NBC-Washington report.
The story did correctly report that 70 percent of children are believed to be vitamin D deficient, and that kids not getting outdoor sunlight like they used to is most likely the cause. But doctors in the report only recommended 400 IU of vitamin D daily.
While the story did not mention Benjamin’s vitamin D level, it is likely that it was below 10 ng/ml, based on the symptoms he reported and the level of vitamin D prescribed to him. The number of children below 10 ng/ml has increased significantly in the past generation, according to government data — levels so low that childhood rickets, virtually eradicated in the mid-20th century, is making a resurgence. Overzealous sun avoidance is believed to be the cause.
“While the dermatology lobby has been advising people they don’t need to get sun exposure to make vitamin D — even though sun is the natural and intended way to make vitamin D and getting full-body summer sun makes more than 100 times the vitamin D supplemented into a glass of milk — here’s an example of a dermatologist who obviously didn’t know enough about vitamin D deficiency and it was hurting her own family,” Smart Tan’s Levy said. “We are glad that Dr. Berzin and her family are in better health. Hopefully dermatology can learn something from this story.”