from www.HolisticHealthResearch.ca
Payment for vitamin D testing in Ontario to be restricted
Up to September 27th 2010 the Ministry of Health and Long-term Care (MOHLTC) is inviting Ontarians to make comments on their current proposal to delist Vitamin D testing as an OHIP insured service for all Ontarians. Exceptions will be made for those with osteoporosis, malabsorption syndromes and individuals who are taking medications that can interfere with vitamin D in the liver.
Are Ontarians vitamin D deficient?
As justification for this action, the Ministry cites a recent review on vitamin D by Ontario’s Health Technology Advisory Committee (OHTAC). That review concluded that vitamin D deficiency is uncommon in Ontario. Using blood levels of 25-hydroxyD of less than 25 nmol/L to indicate deficiency, they estimated that only 5% of Canadians were likely to be Vitamin D deficient, with an additional 10-25% possibly having low Vitamin D levels (blood levels in the 30-40 nmol/L range).
That OHTAC’s definition of deficiency is completely outdated is clear from the fact that all Canadian laboratories now use a reference range which begins at 75 nmol/L. Levels below this are therefore considered insufficient for good health and disease resistance.
A recent Statistics Canada survey showed that 64.6% of individuals in a large survey of Canadians had blood levels below 75 nMol/L[i]. The data are from the 2007 to 2009 Canadian Health Measures Survey, which collected blood samples from 5,306 individuals aged 6 to 79 years, representing 28.2 million Canadians from all regions, by age group, sex, racial background, month of blood collection, and frequency of milk consumption.
What are the health implications of poor vitamin D status?
Vitamin D levels below 75 nmol/L, the lower limit of normal puts people at increased risk not only for bone disease (osteoporosis; osteopenia), but also for early mortality from a broad range of health conditions, including diabetes, heart disease and cancer.[ii]
OHTAC’s report claims there is no credible scientific evidence that vitamin D deficiency has implications for health other than for bone health and the prevention of osteoporosis. However, their opinion is in direct contrast to the many other reviews and scientific studies2 that demonstrate that vitamin D deficiency is an important risk factor for
· Cancer (especially breast, colorectal and prostate)[iii]
· Cardiovascular disease [iv]
· Autoimmune diseases (multiple sclerosis, type 1 diabetes, rheumatoid arthritis) [v]
· Increased risk of death from any cause [vi]
Why is testing important?
There is no way an individual or their doctor can know if someone is vitamin D deficient without taking a blood test (25-hydroxy D). This is because circulating blood levels of vitamin D vary from one individual to another depending on season of the year, latitude, skin colour, body weight and genes. The darker your skin the longer you have to be in the sun to make the same amount of vitamin D as someone with lighter skin, even if you live in a year-round sunny climate.[vii] Weight also affects vitamin D levels – the more overweight you are the lower your vitamin D.[viii] But the most important factor that affects vitamin D levels is genes.
One recent study from the University of Toronto tested people taking no vitamin D. Most had blood levels below the mandatory 75 nmol/L. However, some had very low vitamin D levels, and these had variations (polymorphisms) in the vitamin D binding protein (VDBP). The researchers then found that those with this common genetic defect required 4000 IU of vitamin D to raise their blood levels into the protective range, whereas those with higher (although still inadequate) starting blood levels could manage on lower intakes.[ix]
What does this ruling mean for most Ontarians?
If this new ruling is implemented, OHIP will continue to pay for vitamin D testing for
conditions relating to bone health, including Rickets, Osteoporosis, and Osteopenia. They will also pay for testing for Ontarians who are on medications that affect Vitamin D metabolism. OHIP will not pay for vitamin D testing as part of an annual physical, or for those with darker skin, obesity, cancer or cardiovascular disease risk factors, or autoimmune diseases, as they consider testing under these conditions to be “not medically necessary”.[x]
Anyone can still request vitamin D testing, but they will have to pay for it unless they are in one of the exclusion catagories. The cost of this testing is not clear at present.
What can you do?
If you feel strongly about this change in the Health Insurance Act, either as a medical practitioner or a patient, you can make comments to the Ministry until 27th September 2010 at http://www.ontariocanada.com/registry/view.do?postingId=3902&language=en and scroll down to the bottom of their memo. Click on Comment on this proposal by email
http://www.ontariocanada.com/registry/view.do?postingId=3902&language=en
[i] Health Reports, Vol. 21, no. 1, March 2010 • Statistics Canada, Catalogue no. 82-003-XPE Vitamin D status of Canadians • Research article http://www.statcan.gc.ca/pub/82-003-x/2010001/article/11131-eng.pdf
[ii] APAMLA Welcome Trust (2010, August 24). Vitamin D found to influence over 200 genes, highlighting links to disease. ScienceDaily. Retrieved September 12, 2010, from http://www.sciencedaily.com /releases/2010/08/100823172327.htm
[iii] Lappe JM, et al. Vitamin D and Calcium Supplementation Reduces Cancer Risk: Results of a RCT. Am J Nutr 2007; 85:1586 – 1591
[iv] Giovannuci E, et al. A Prospective Study of 25OHD and Risk of Myocardial Infarction in Men. Arch Intern Med 2008168, 1174 – 1180.
[v] Holick MF. Sunlight and Vitamin D for Bone Health and Prevention of Autoimmune Diseases, Cancers, and Cardiovascular Disease. Am J Clin Nutr 2004;80: 1678S – 1688S
[vi] Dobnig H, et al. Independent Association of Low Serum 25OHD and 1,25(OH)2D levels with All-Cause and Cardiovascular Mortality. Arch Int Med 2008; 168(12): 1340-1349
[vii] Unger MD et al. Vitamin D status in a sunny country: Where has the sun gone? Clin Nutr. 2010 Jul 14. [Epub ahead of print]
[viii]Lagunova Z et al. The dependency of vitamin D status on body mass index, gender, age and season. Anticancer Res. 2009 Sep;29(9):3713-20
[ix] Fu L et al .Common genetic variants of the vitamin D binding protein (DBP) predict differences in response of serum 25-hydroxyvitamin D to vitamin D supplementation. Clin Biochem. 2009;42(10-11):1174-7
[x] http://www.ontariocanada.com/registry/view.do?postingId=3902&language=
For more info on this campaign, contact:
Keren Brown
Founding Executive Director
Holistic Health Research Foundation of Canada
80 Carlton Street
Toronto, ON
M5B 1L6
Ph: 866-778-4443/416-778-4443
Fax: 416-778-5438
kbrown(at)holistichealthresearch.ca