Regional differences in EpiPen prescriptions in the United States: The potential role

[Ted Hutchinson]

Regional differences in EpiPen prescriptions in the United States: The potential role of vitamin D. (http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17559916&itool=pubmed_DocSum)

BACKGROUND: The epidemiology of anaphylaxis is uncertain, especially its geographic distribution. OBJECTIVE: To address this deficit, we examined regional rates of EpiPen prescriptions in the United States. METHODS: EpiPen prescriptions in 2004 were obtained for all 50 states and Washington, DC, from NDCHealth, Pharmaceutical Audit Suite (Alpharetta, Ga). Data included the number of total filled prescriptions, including refills, and the actual number of EpiPens prescribed. Several data sets were used to obtain state-specific populations, as well as multiple demographic, health, and weather characteristics. State population was used to calculate the average number of prescriptions written per person. RESULTS: Overall, there were 1,511,534 EpiPen prescriptions filled during 2004. These prescriptions accounted for 2,495,188 EpiPens. On average, there were 5.71 EpiPens prescribed per 1000 persons. Massachusetts had the highest number of prescriptions per 1000 persons (11.8), whereas Hawaii had the lowest (2.7). In addition to state-to-state variation, there was an obvious regional difference: New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine) had the highest values, with 8 to 12 EpiPen prescriptions per 1000 persons, whereas the southern states (between and including California and Mississippi) had only 3 prescriptions per 1000 persons. The New England finding persisted even when controlling for all available factors (eg, population demographic characteristics, number of health care providers, prescriptions for other medications). CONCLUSION: A strong north-south gradient was observed for the prescription of EpiPens in the United States, with the highest rates found in New England. CLINICAL IMPLICATIONS: The regional differences in EpiPen prescribing may provide important etiologic clues (vitamin D status) and merit further investigation.

[StLouis79]

Wow, this is interesting.

[kwms]

As I was reading the statistics and before I got to the bottom of the description, my mind immediately lept to Vitamin D deficiencies in the North due to the less frequent sun exposure. Supplement with cod liver oil. That's what we are doing with our allergic kids.

[Ted Hutchinson]

Although it is possible to buy low vitamin A forms of cod liver oil, it is NOT usually recognised as a good scource of Vitamin D because the level of Vitamin A is normally so high. One teaspoon for a child is fine and 2 for an adult but more than that, (sufficient to actually raise vitamin d status) would risk Vitamin A toxicity. (the problem is that some CLO's contain synthetic not natural vitamin A).

Is the sunshine vitamin the way to beat asthma? (http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=496608&in_page_id=1774)

The problem arises from the womb
Maternal vitamin D intake during pregnancy and early childhood wheezing. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17344509&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17344501&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

The problem arises because the amount of vitamin d in prenatal vitamins is way too low and irrespective of whether or not mothers take prenatal vitamins their children are born vitamin d insufficient or deficient.
In order for babies to be born vitamin d replete and for their mothers breast milk to flow replete with vitamin D3 either we have to persuade them to spend more time in the sunshine or take an EFFECTIVE amount of D3.

Vitamin D in pregnancy: an old problem still to be solved? (http://adc.bmj.com/cgi/content/full/92/9/740)

High prevalence of vitamin D deficiency in newborn infants of high-risk mothers (http://adc.bmj.com/cgi/content/abstract/92/9/750?lookupType=volpage&vol=92&fp=750&view=short)

[kwms]

Although it is possible to buy low vitamin A forms of cod liver oil, it is NOT usually recognised as a good scource of Vitamin D because the level of Vitamin A is normally so high. One teaspoon for a child is fine and 2 for an adult but more than that, (sufficient to actually raise vitamin d status) would risk Vitamin A toxicity. (the problem is that some CLO's contain synthetic not natural vitamin A).

Correct, some CLOs contain synthetic Vitamin A. We take Green Pasture's which does not. We also take it with High Vitamin Butter Oil from Green Pasture's which helps the body absorb the vitamins.

Here is some information about how Vitamin A toxicity has become overblown and about the importance of cod liver oil in one's diet. At the bottom of the article are recommendations on 3 cod liver oils which are completely natural and do not contain any synthetic vitamins:
http://www.westonaprice.org/basicnutrition/cod-liver-oil-menu.html

Katy
"All diseases begin in the gut" - Hypocrates

[Ted Hutchinson]

If you look at NORDIC NATURALS (http://www.nordicnaturals.com/en/General_Public/BUY_NOW!/98/?ProdID=1418#) you will see that their Vit A content is anywhere between 650–1500 IU. Clearly this isn't standardised and will vary naturally, seasonally IHerb listing $22.74 (http://www.iherb.com/ProductDetails.aspx?c=1&pid=2804&at=0)

But they also do Nordic Naturals Arctic-D Cod Liver Oil with Vitamin D Lemon -- 8 fl oz (http://www.vitacost.com/Nordic-Naturals-Arctic-D-Cod-Liver-Oil-with-Vitamin-D) that has no vitamin A at all.
But these are quite low.
Carlson, Norwegian Cod Liver Oil, Lightly Lemon, 1000 mg, 150 Soft Gels $11.28
(http://www.iherb.com/ProductDetails.aspx?c=1&pid=6141&at=0)

Low A Cod Liver Oil (http://www.vitaminlife.com/product-exec/PNAME/Low_A_Cod_Liver_Oil/product_id/51204)

I agree with you that it is likely the Vitamin A toxicity issue is probably as overblown as the VIT d toxicity issue. But unless you have invested sufficient time in researching the matter it is difficult to be sure. I suspect there is a difference between natural and synthetic forms. So long as people are aware of the potential for problems with using high vitamin a content CLO and check out their supply is "natural" or "LOW A" there should be able to avoid problems.
I do want people to be sure they are taking sufficient vitamin d and omega 3.
It's great that CLO should be a part of the source of vit D and omega 3 but I think MORE omega 3 than just from CLO needs to be provided and MORE VITAMIN D3 than just from CLO is needed.
An adult needs 4g omega3 daily and a total from all sources of 4000iu/D3/daily
as sunlight is out of the question for those above lat37N at the moment all of the 4000iu/d/d3 has to come from somewhere and great though CLO is no one is going to consume 10tsps of CLO daily irrespective of the VIT A content so people do have to be aware of alternative Vit d3sources.

[kwms]

If you look at NORDIC NATURALS you will see that their Vit A content is anywhere between 650–1500 IU. Clearly this isn't standardised and will vary naturally

Not all cod liver oils are equal. The essential fatty acids in cod liver oil are polyunsaturated, which makes them prone to oxidation. Some companies take poor care of their oils, resulting in a spoiled oil.

Actually I wouldn't recommend Nordic Naturals because the vitamin E it contains is derived from refined soybean oil. When vitamin E is refined ( that's in anything, bleached wheat especially) it becomes a dangerous chemical toxin.

However the fact that there is a range of Vitamin A content means the vitamin has not been standardized (which you acknowledged), but this in my opinion is a good thing. It means that it has not been stripped of its naturally ocurring Vitamin A, only to have a measured amount of synthetic Vitamin A reintroduced. This is what you will get in standardized supplement products. Yes, you can't exactly measure the amount of vitamin A you are getting when your CLO is not standardized, but since you are getting naturally occurring Vitamin A and Vitamin D, then you are not going to risk toxicity. In my mind I feel that it is natural for the vitamin content to vary in a living thing. The people living in northern climes such as Iceland get much less sun than we do, yet God/nature provides healthy fatty fish from these cold waters to provide Vitamin D to these people since they can't get what they need from the sun. The vitamin level is going to vary in this food just as the vitamin level in butter will vary when the cows graze on the fast-growing Spring grasses. Its natural and designed by our maker to work that way, so I don't spend much time worrying about the fact that I can't accurately measure how much NATURAL vitamin A I'm receiving from my cod liver oil.

I agree with you that it is likely the Vitamin A toxicity issue is probably as overblown as the VIT d toxicity issue. But unless you have invested sufficient time in researching the matter it is difficult to be sure.

Yes, but that is what makes communities like this so great. There is an exchange of ideas and someone, or some organization who has researched which CLO brands are the most beneficial can communicate what those are to those who don't have the time to research it, but are very interested in the health implications. To totally disregard CLO because of not having time to research seems to be doing oneself a great disservice (nutritionally speaking), IMHO. CLO has been used for more than a century. I think its time we started looking back at some of our traditional nutrition principles. This is but one example.

Actually The Weston A. Price Foundation (where my link came from) has done much of the research into which CLO brands are non-standardized and contain only natural ingredients and are minimally processed so as not to reduce the nutritional value or introduce harmful chemicals. They also evaluate all sorts of food and supplement products (oils, healthy dairy, grains, nuts, condiments, salts, beverages, sweeteners, etc.) and produce an annual "Shopping Guide" which is updated every year. The shopping guide rates each category of food with "BEST", "GOOD" (compromise if you can't get the items on the BEST list) and "AVOID." If you are a member of the foundation ($40 per year) you receive the shopping guide free (along with other free publications), otherwise the shopping guide is just $1.00 and orderable from their website here: http://www.westonaprice.org/membership/orderform.html

Here is more info about the foundation:

Good health begins w/ plants and animals raised in healthy ways; and with meats, eggs, milk products, fish, grains, legumes, fruits and vegetables that are packaged and processed so that the vitamins and minerals in the foods are preserved or enhanced.

Good health also requires avoiding foods that are devoid of nutrients or that can do us harm, such as refined sugars, white flour, most commercial liquid vegetable oils, partially hydrogenated vegetable oils, modern soy-based imitation foods and additives like MSG, hydrolyzed protein and aspartame.

This booklet (the shopping guide) is designed to serve as a guide for shopping in supermarkets and health food stores. We have also provided phone numbers or when a phone number is not available, internet addresses for items available primarily my mail order. General guidelines and specific brand names are listed for each food category. Use the guidelines to make wise choices from among the brands available to you.

The Weston A. Price Foundation is a nonprofit nutrition education foundation dedicated to providing consumers with accurate information about diet and health. The Foundation has many local chapters to help people find the best quality whole foods available in their area. It also publishes a quarterly journal, "Wise Traditions in Food, Farming and the Healing Arts," which provies up-to-date commentary on a variety of nutrition issues and helps consumers find foods directly from farms through the classified advertising section.

You can contact the Foundation at (202) 363-4394 or www.westonaprice.org

Katy

"All diseases begin in the gut" - Hypocrates