The Ontario government is considering an end to provincial health payments for routine vitamin D tests, even while examining a report that 5 per cent of the population is so deficient as to be at risk of bone disease.
Like other provinces, Ontario is grappling with an incredible surge in vitamin D testing, following a flurry of studies suggesting that low blood levels of the sunshine vitamin could be a contributing factor in many common cancers, adult onset diabetes, heart disease and other chronic conditions.
The provocative reports have prompted doctors and patients to clamour for the tests, which have soared in Ontario to an estimated 732,000 last year, more than 10 times the number conducted as recently as 2005. Typical vitamin D blood checks done in private laboratories cost the province about $52 each, while hospitals perform them for $32.
In response to the escalation, the Ministry of Health asked its medical advisory committee to assess the vitamin D status of Canadians, and whether the government should continue funding the tests, which cost about five times as much as a cholesterol reading. The group, known as the Ontario Health Technology Advisory Committee, issued a draft report last month recommending against paying for routine testing in otherwise health people – although it found that a significant number either have outright vitamin D deficiency or low levels.
The report estimated that 5 per cent of Canadians are so deficient as to be at risk of bone diseases such as rickets. Another 10 to 25 per cent were considered to have insufficiencies leading to elevated parathyroid hormone readings. Such readings may indicate that a person's metabolic system, unable to get enough calcium from food, has to scavenge it from bones to meet the body's need.
In another finding, the report concluded that non-whites appear to be at a greater risk of vitamin D insufficiency than Canadians of European heritage. This is one of the first times any governmental body has reacted to scientific evidence on vitamin D blood levels to conclude that Canada needs racially based guidelines for the nutrient.
Being non-white “is a risk factor” for having low vitamin D level, agreed Reinhold Vieth, professor in the department of nutritional sciences at the University of Toronto, who has conducted much of the research showing that levels of the nutrient in Canadians varies by racial origin.
Vitamin D has been nicknamed the sunshine vitamin because people make most of what circulates in their bodies themselves when cholesterol in bare skin is exposed to strong, summertime ultraviolet light. Blacks, Asians, and other non-whites have more skin pigmentation, a natural sunscreen that reduces the speed at which their bodies can make the vitamin.
Canadians can't produce vitamin D at all in fall and winter because the sun doesn't get high enough in the sky, a factor that contributes to the low levels among those who aren't taking supplements, or getting the nutrient from diet, where it is found in such foods as fortified milk and oily coldwater fish such as salmon.
The Ontario report didn't offer a strong opinion on whether, as many doctors believe, low levels of vitamin D might be linked to cancer, multiple sclerosis and other diseases. The evidence “is inconsistent,” it said.
But an Ontario doctor who encourages her patients to have their vitamin D levels checked said it is a worthwhile expenditure. “I think it would be a mistake” to end payments for the tests, said Linda Rapson, a Toronto doctor who treats people with chronic pain. She says she has ordered tests for several thousand people since 2004, and has found deficiencies are widespread.
“The doctors who start doing the testing all come back and are just shocked by how everybody is low,” she said.
The committee's draft report was open to a public comment period that ended last week. The group plans to meet later this month to consider revisions to its recommendations, which will then be used by the Minister of Health to decide whether to end routine testing.
