Rickets in sunny places

© 2011 Nucleus Medical Media, Inc.

A few weeks ago, I wrote about seeing kids here with Rickets, and wondered why they’d have this condition that’s classically linked to low vitamin D, which is a vitamin produced by exposure to sunlight.

Well I wrote my Nutrition final this morning, and we covered it a little more.  So-called African Rickets is common in developing countries, despite the sunniness.  Bone health is a complicated thing that’s not just Vitamin D.  It could be a lack of calcium in the diet, which would increase the release of calcium from bones, weakening them over time.  This makes sense since calcium’s involved in a lot of really important functions, some which are more important than bone strength (e.g. nerve and heart function).  So the bones go in order for more important things to continue to function.

Cow’s milk isn’t too expensive at supermarkets here (at least, not the strange long-shelf-life kind that is imported from Europe and will likely be on this island longer than I am), but the fact that cow’s milk has to be imported from Europe suggests how important it is in the Caribbean diet.

Another thing could be fruits and vegetables.  Surprisingly, they also impact bone health.  Fruits and veggies have a lot of potassium which helps to decrease the acidity of your body.  Without the fruits and veggies, the acidity goes up and bones will tend to “de-mineralize” (i.e. dissolve).  Not sure why there’d be a lack of fruits and veggies in the Caribbean diet.  Maybe it’s just individual kids personal preferences not to eat them, or maybe it’s a greater emphasis on starchy foods when kids are weaning off breast milk.

And that’s that!

Why would a child have rickets in the Caribbean?

Earlier last week Frond and I were studying at the library when we heard a nice ruckus stir up outside.  It was a full piece band with tuba, horns, drums, and crisp white uniforms!  It was Grenadian Thanksgiving and there was a small ceremony being held to commemorate the occasion, as well as remember the 19 US Marines who died when they came to Grenada to oust the group that had overthrown the previous government.

Frond and I, curious, went outside and sat a ways away to spot the Chancellor and other dignitaries.  When we got outside there were a few other people sitting close but not too close like us.  One of them was a woman and a toddler, they both looked Grenadian.  The baby was well dressed and looked healthy but I noticed her classic bow-legs right away.  Rickets!

Bow leg of Rickets. Photo by the Thatcher Family.

Rickets is a childhood bone deformity caused by a lack of Vitamin D.  Vitamin D can be absorbed in the diet but mostly the body creates it’s own vitamin D on exposure to sunlight.  So why would a child have rickets in the Caribbean?

This morning on the drive to school I saw another child with rickets.  He was walking down the side of the road with a grandmotherly figure and another child.  All three looked well dressed and otherwise healthy, at least in my 2 second glimpse.  Leah says it’s really common in developing countries despite being in the tropics.  I’m not sure how much this has been studied but it is a really interesting question, considering that even in a Caribbean medical school, we’re taught that vitamin D deficiencies and rickets is due to lack of sunlight.  There must be more to it than just sunlight.

Emma Morton for The Sun, Nov. 13/10

Maybe a lack of nutrition somehow affects the body’s ability to generate vitamin D?  Perhaps there’s another mineral deficiency going on, calcium or phosphorus. Maybe age-related; I haven’t seen many older kids with rickets, just the two toddler-aged children.  Hmm.