By Dr. Mercola
Child abuse is a terrible thing. But as evidenced by the work of a select few, including Dr. David Ayoub, thousands of child abuse cases may in fact be misdiagnosed cases of rickets, caused by either vitamin D deficiency or aluminum adjuvants in vaccines, or both.
Vitamin D deficiency is a hidden problem that can actually cause bones to appear as if they've been broken on an x-ray, which is a sure diagnosis of abuse to the inexperienced eye.
This is the other side of the child abuse drama, and I believe it is critical for this information to become more widely known. Being better informed about how infantile rickets mimics cases of child abuse can help prevent traumatic injustice to parents who really have done nothing wrong, besides listening to and trusting conventional medical advice, which still does not place sufficient weight on the importance of vitamin D.
Dr. Ayoub is a practicing radiologist in Springfield, Illinois, working for one of the largest radiology groups in the country. He's also a volunteer faculty member at the Southern Illinois University School of Medicine, where he instructs medical students and radiology residents.
He's been involved in hundreds of misdiagnosed rickets cases over the past six years, testifying on innocent parents' behalf. He also consults and reviews cases for other experts.
Dr. Ayoub has compiled a robust body of evidence to support his position, some of which was recently published in the peer-reviewed American Journal of Roentgenology.1 The paper was co-authored by Dr. Chuck Hyman, a child abuse pediatrician, and Marvin Miller, a pediatric bone specialist and geneticist at Dayton Children's Hospital.
Based on this work, they're also submitting a second paper that addresses the risk factors in pregnancy that set up the baby with rickets, such as low vitamin D, poor calcium status, heavy antacid use, excess body weight, and other factors which I'll list further below.
"The last interview I did for you was really the link to my current work in infantile rickets," he says. "I was looking closely at aluminum adjuvants in vaccines and their association with diseases in early infancy. One of the classic diseases that aluminum is linked to is rickets.
It's also plausible that aluminum is anticoagulant. In other words, it can induce bleeding conditions. What comes to mind is fractures and bleeding (what do you think of) in infants – shaken baby syndrome (SBS).
The other link was my good friend, Dr. Ed Yazbak, who's been on your program before... We have worked together, writing a paper on the influence of vaccine in pregnancy. Ed called me one day and asked me to look at some of his cases. He goes, 'I know these kids weren't abused. They have bleeds in their brain. But some of them have fractures, and I can't figure it out. You're a radiologist. Would you look at these bones? Let me know what you see.'"
Is It Child Abuse, or Rickets?
Since that fateful phone call, Dr. Ayoub has reviewed upwards of 3,000 pieces of medical literature, ultimately revealing to him that a great number of child abuse cases may in fact be instances of misdiagnosed metabolic dysfunction.
Healing rickets can show up on an x-ray as what looks like a fracture, which immediately casts suspicion on the parents. But upon further analysis, it's not actually an injury to the child's growth plate at all.
In his estimation, there may be literally tens of thousands of misdiagnosed cases of child abuse around the country. The trend of misdiagnosis goes back at least 25 years or more.
As Dr. Ayoub points out, modern textbooks simply do not cover rickets as textbooks of the past did, and flawed research has been used as the basis to perpetuate the misdiagnosis of healing rickets as an inflicted injury.
"There's over a 95 percent reduction in our textbooks from what was in the textbooks 50 years ago," he says. "Radiologists and clinicians today do not know the full range of what you see in a radiograph in rickets.
The cases we're seeing are 100 percent healing-phase rickets. I believe it's the healing phase that makes these bones more susceptible to fractures. [It's] not the active phase but the recovery that is the state of susceptibility."
Radiologists Kathy Keller and Patrick Barnes have published a four-case series in the Pediatric Radiology journal, describing what Dr. Ayoub is seeing as well. The bulk of the information can be found in older radiology literature, however. Interestingly, it's not the rickets most modern doctors are familiar with.
"There's no fraying," he explains. "You probably remember in med school what rickets looked like; it's a classic they teach to medical students—the end of the bones looks like the end of a broom or a brush.
It's a frayed or irregular border. We don't see that. We didn't see that in any of the cases, because rickets in infancy is much, much different from rickets in the classical age group, which is between one and two years of age." [Emphasis mine]
Sadly, once a suspected child abuse case makes it to court, the prosecution usually wants to win at virtually any cost, even if it means sidestepping truth and medical fact. One argument that is frequently made is that vitamin D deficiency is rare. Clearly, that's not true. Another common argument is that vitamin D deficiency is common, but rickets is rare, even though the scientific data tells us this isn't true either.
"I had a horrible case in Ohio in which a young baby with multiple fractures – the typical presentation – had a very, very low vitamin D, and one of the forms of vitamin D, which is 1,25-dihydroxyvitamin D, was remarkably elevated.
If you know anything about these pathways, that form of vitamin D pulls calcium from bones. An elevated form of this vitamin D is bad for bone. It's a marker of calcium deficiency or vitamin D deficiency rickets.
The expert told the court that this [vitamin] D level is the active form. It is high, which means it's healthy for the baby, and the child can't have rickets based on this.
Now, any good endocrinologist, pediatric endocrinologist, who heard the statement would realize that this was absolutely, completely, and utterly false. It means the exact opposite. You could look at any lab manual and realize that that form of vitamin D is detrimental to bone. That woman [the baby's mother] is in prison."
How Metabolic Bone Disease in Infants Gets Confused with Child Abuse
Whenever rickets occurs in the first couple of months of life, it's not really an infantile issue per se; it actually originates in the mother. Therefore, you have to look carefully at the mother's characteristics. According to Dr. Ayoub, mothers of children who end up displaying fractures due to infant rickets have a variety of signs and symptoms in common, including the following:
|Most live in northern latitudes, where the population tends to have lower vitamin D levels. The average vitamin D level in this maternal population was about 18-19 ng/ml, which is a significant deficiency state
||Twin pregnancies are overrepresented, which is another risk factor. The risk of rickets in a twin pregnancy is 25 times higher than in a single pregnancy|
|More often than not, she was pregnant during early spring, when vitamin D levels tend to be at their lowest (March-May)
||Higher than background rates of gestational diabetes and difficult labor|
|80 percent of the mothers Dr. Ayoub reviewed had a body mass index of 30 or greater. Overweight or obesity is yet another risk factor for vitamin D deficiency
||Half of the mothers he reviewed had severe musculoskeletal symptoms that were undiagnosed by their clinicians. Some were even on narcotic drugs because of severe musculoskeletal pain, which is a feature of adult rickets (osteomalacia)|
|About 30 percent smoked cigarettes prior to or during pregnancy
||Debilitating acid reflux was very common in these pregnant women, and about 75 percent of the mothers were taking excessive amounts of TUMS, which is a calcium carbonate-based antacid that binds phosphate and makes bone density MUCH worse|
Oddly enough, a significant percentage of the mothers in these cases are also diagnosed with Ehlers-Danlos syndrome (EDS), a connective tissue disease characterized by hypermobile skin and hypermobile joints. Dr. Ayoub notes that vitamin D deficiency can actually mimic Ehlers-Danlos as well, because it's associated with joint hypermobility.
"We know that collagen requires vitamin D as well. We didn't know that traditionally, but research in the last 10 years has shown it's important for collagen pathways, just like vitamin C is. It may just be a manifestation of vitamin D deficiency, or it may be a comorbidity. But it's useful for the mother to get worked up for metabolic bone disease as well," he says.
Pregnant Women: Beware of Taking TUMS!
I want to make special note of the acid reflux connection here, as this is a MAJOR point that can so easily be overlooked. TUMS, a commonly used over-the-counter antacid, just like many other OTC antacids, contains calcium carbonate to neutralize the acid. What has now been found is that calcium carbonate can actually wreak havoc on both vitamin D levels and your bone density. And, if you're pregnant, may severely weaken the bones of your child.
"I was surprised that the antacids were promoted by their obstetrician," Dr. Ayoub says. "I had a couple of people taking hundreds of TUMS over a course of two or three days! It was way above the maximum recommended dose. That was one of the odd things. It was an outlier."
While generally considered safe, calcium carbonate was actually the active ingredient given to rats during research studies in the 1920s-1950s to produce rickets in the mice! Crazy but true—TUMS' active ingredient (calcium carbonate) is a rickets-causing chemical due to its phosphate-binding properties (calcium carbonate is even used in dialysis patients to bind phosphate).
Additionally, the majority of the population is under the mistaken belief that they need to take calcium to prevent osteoporosis. Calcium carbonate is one of the most popular calcium supplements. Tragically, rather than prevent osteoporosis, the carbonate form of calcium actually decreases bone density. Normally, you might think of it as a source of calcium, which would decrease rickets, but as Dr. Ayoub explains, your bones need more than calcium to remineralize.
"It's really the calcium-phosphorus ratio in the diet that optimizes mineralization. It has been known since the '20s that if you have high calcium and low phosphorus, high phosphorus and low calcium, or either of those imbalances from the normal ratio, which is about 2:1 calcium to phosphorus, when you go one way or the other too much, you don't mineralize. In other words, you can absorb the calcium but it's just not going into bone. There's not enough phosphorus to make the matrix, the mineralized matrix, to proceed to the mineralization, which is deficient in rickets."
According to Dr. Ayoub, commercial calcium carbonate products are also contaminated with heavy metals, including lead and aluminum, both of which are known to cause both rickets and bone disease.
Acid Reflux—An Overlooked Sign of Vitamin D Deficiency
Another important point is that acid reflux is actually a sign of vitamin D deficiency. Your upper GI tract, from your pharynx to the lower third of your esophagus, is skeletal muscle. Vitamin D is important for muscle strength. The medical literature Dr. Ayoub reviewed revealed that dyspepsia, bloating, constipation, and reflux symptoms are all quite common among those with vitamin D deficiency because of reduced esophageal motility and sphincter dysfunction.
As stated earlier, in the list above, testing revealed that the mothers in these cases averaged a mere 18-19 ng/ml of vitamin D, which is a severe deficiency state. And babies are born with about 60-70 percent of the mother's vitamin D level.
"We don't have a control group here, but we do have population values," Dr. Ayoub says. "The vitamin D levels in these moms are about 50 percent lower than what's been reported in general populations. That was, I think, the first epiphany that this is a unique population. We actually had more Caucasians than blacks, but the Caucasians were very light-skinned, Fitzpatrick Class I (which is a dermatology term). These are the pale women who avoid sun or use sunblock, which is, of course, a major risk factor for vitamin D deficiency.
The mothers also tended to have really poor diets: a lot of caffeine consumption, a very high prevalence of lactose intolerance, or just disliked dairy. Over 90 percent of the women avoided dairy products. [They] did not meet the minimum requirement of one cup of dairy a day. So you add calcium deficiency, you add vitamin D deficiency, and finally you add calcium carbonate in TUMS in 75 percent of these mothers..."
Tragically, infant rickets perfectly mimics child abuse. Making matters worse, the baby will have virtually no symptoms—until their bones fracture. One symptom, however, reported in the older rickets literature is head-sweating.
"I would be very concerned if a baby is perspiring heavily at night, especially around the face, head, and neck," Dr. Ayoub says. "They're described as soaking their pillows. They had to change the sheets, because they're so wet. That's one of the odd, lesser-known signs of infantile rickets. Upper respiratory tract infections and sinus infections are very prevalent in this group of babies as well."
Vitamin D Is Critical During Pregnancy
If you're pregnant, or planning to become pregnant, it's absolutely vital to make sure you're getting enough vitamin D. Everything Dr. Ayoub is describing is virtually 100 percent preventable from the implementation of one simple measure, which is to optimize your vitamin D levels during pregnancy. Everyone should have normal vitamin D levels, but one of the most at-risk populations is a pregnant woman. To me, it's reprehensible medical malpractice not to test an expectant woman's vitamin D level.
Unfortunately, politics and policy has done a great deal of harm here. In Dr. Ayoub's presentation "Rickets by Policy?," he highlights how fear-mongering has led to dwindling vitamin D levels, as parents are constantly told to cover up their child and avoid sun exposure. Women are also told to use liberal amounts of sunscreen as a general rule, pregnant or not. As a result, studies show that, in northern latitudes, only about 1 in 10 black women, and 1 in 3 white women, have normal vitamin D levels.
Most Infant Formulas Have an Adverse Effect on Baby's Bones
Feeding your child commercial infant formula can also exacerbate the problem. A 2006 study published in the Journal of the American College of Nutrition2 found that palm olein found in the fat blend of infant formulas (a synthetic triglyceride meant to mimic palmitic acid in breast milk) has "unintentional physiological consequences, including diminished intestinal absorption of fat, palmitic acid and calcium and lower bone mass."
Subsequent studies have confirmed these effects3, 4. In fact, virtually every paper that looks at the effects of palm olein-containing infant formulas on bone show osteopenia or diminished mineralization! Yet, palm olein is found in most commercial infant formulas. Interestingly, early research papers from the 1920s implicate formula feeding as a risk factor in rickets.
"They didn't implicate breastfeeding. They said that obviously these patients are artificially fed. Across the board, they recognized that formula feeding was a risk factor. That's been flip-flopped. Why? It's because mothers are now vitamin D deficient, so their milk is D deficient," Dr. Ayoub says.
"My wife breast-fed our last and third baby. For two months, we tested his vitamin D levels. He's 100 percent breastfed, and his vitamin D levels were 55 nanograms per milliliter on breast milk... We supplemented that with the sun. We measured my wife's vitamin D levels. I think she's right at about 74 nanograms per milliliter."
What About Babies with Bleeding in the Brain?
A number of child abuse cases also involve a situation where the child has bleeding in the brain. This is a typical presentation of shaken baby syndrome.
"Obviously, the child abuse pediatricians just say, 'There are fractures, but there are bleeds in the head. This is obviously head injury. You must be wrong that the bleeds indicating a violent attack to the whole body, including the head, can have anything to do with bone disease.'"
"That absolutely turns out to be untrue," Dr. Ayoub says. "There is a link between risks of bleeding in the brain and rickets. It's a little bit more than just bone health. Again, it's not one thing; it's not so straightforward. But the old pathology literature, even pre-1900 in the French literature, [indicate] hemorrhage in the brain, over the convexities of the brain, the subdural compartment. They didn't use [the term] 'subdural hematomas.' They used 'pachymeningitis hemorrhagica interna.' It was the term from the old literature. It was very common in rickets."
Why do you get brain bleeds in children with rickets? Dr. Ayoub points out a number of factors:
- Autopsy studies on babies that died of natural causes in the first few months of life show that about 20 percent of those babies have bleeds in the head – subclinical, undetected bleeds from normal birth trauma. Others can develop bleeds linked to hypoxic events such as seizures or other acute life-threatening events such as choking. In other words, if you diminish perfusion of blood and oxygen delivery to the brain, you can predispose that brain to bleeding. That can occur very acutely, and some hypoxic events are associated with rickets such as laryngospasm.
- During coughing or feeding¸ because of the low calcium state, an airway spasm may be triggered, and the child chokes to death. The hypoxia, diminished oxygenation of the brain, causes hemorrhage.
- Vitamin C deficiency can also play a role. An estimated 90 percent of children with rickets have vitamin C deficiency.
- Vitamin K metabolism occurs through vitamin D pathways as well, and clotting also occurs more exuberantly in cases of vitamin D deficiency. The veins in the head can clot in vitamin D deficiency, which will cause bleeding in the brain.
- There's a condition where water builds up in the brain, called external hydrocephalus. Dr. Ayoub cites a Chinese paper published a few years ago that reported 73 cases of rickets with this condition. It causes enlargement of the head, and about 10 to 20 percent of those children get subdural hemorrhages, just like what we see in shaken baby syndrome.
Widespread Systemic Changes Are Desperately Needed
As you can see, vitamin D deficiency can cause physiological symptoms that cleverly mimic child abuse. The challenge that we have in contemporary society is that an entire industry has been built up around protecting children from child abuse, and it's firmly entrenched in these flawed views. Many times they're operating under insufficient or inadequate information, outdated information, or a combination of all of them.
So, what can be done to change that system, and what can parents do to protect themselves if they or someone they know or love is accused of child abuse when they know that's not the case and it's more likely a result of vitamin D insufficiency? Dr. Ayoub replies:
"I think the legal system is relying heavily on the existing science, which is flawed. Physicians have to be responsible. We have to do research. And it is being done. Number one: we've got to get the papers out that establish what these diagnoses really are. We certainly have to be sensitive of the fact that abuse does occur. We have to be sensitive that when you have a broken bone, you can still abuse a child with rickets.
"There still needs to be a process in which these families are evaluated for mishandling and real child abuse. But in my experience and the cases I've seen, I have not seen any high-risk family. I don't believe any case of fractures I've seen has been a result of real physical child abuse.
"Now, as you know, there's science that links vaccines with autism. Why isn't that science believed? Well, it's attacked. It's marginalized because there are competing papers, generally very flawed papers, which refute their claims. [They] design studies in order to give the answer that they want. That's going to happen when you have an industry this strong. The government is a big industry. Child Protection Services (CPS) is a behemoth, believe me. There's a lot of money generated from the job of protecting children from abuse."
I consider vitamin D education of professionals as one of the successes we've been able to catalyze through our sharing of information. More physicians are aware of it today than ever before. But I still think there's a significant number, especially in the field of obstetrics, who obviously don't get it, or else these tragic cases of infantile rickets would not be occurring. Unfortunately, the American Congress of Obstetricians and Gynecologists (ACOG) has not made any updated recommendations to protect the health of pregnant women and children.
"Their recommendations are abysmal. They basically acknowledge that vitamin D deficiency is prevalent. They acknowledge that vitamin D deficiency is linked to a number of conditions in pregnancy, including gestational diabetes, preeclampsia, hypertension, preterm labor, difficult labors, and increased C-section rates. But they turned around and stated that they needed more randomized studies before they change the recommendations, which is absurd. You don't need randomized study. This isn't a drug trial. Health is at stake. We have to improve these abysmal vitamin D deficiency rates. Their policy makes absolutely no sense whatsoever," Dr. Ayoub says.
What You Can Do to Prevent This Horrible Tragedy
My message to you is that you can significantly make a difference. You can really change someone's life with the information provided by Dr. Ayoub in this interview. The professional organizations are reluctant to have this widely disseminated as the standard of care. Until that happens, we're going to need people who understand the truth to spread this message to save both parents and children from this needless, and absolutely tragic, pain and suffering.
To learn more, you can review the presentation Dr. Ayoub gave at the 2010 American Society for Bone and Mineral Research5 (ASBMR). Last but certainly not least, the following are Dr. Ayoub's general recommendations when he gets a phone call from a defense attorney or is contacted directly by a caregiver or parent:
- Go to your obstetrician and get a vitamin D test immediately, because your baby's vitamin D levels increase dramatically after birth. The vitamin D level in a baby in the first 15 months of life can go up three, four, or five-fold. The vitamin D level your baby presents several months or a year after birth does not reflect what he or she was developing with. A mother's level stays relatively constant unless you're actively trying to optimize it through sun exposure or supplementation. Getting the mother's level will tell you what the baby was born with and what the baby had to work with in the first few weeks of life.
- Seek out a pediatric endocrinologist, because those specialists are the best specialists to assess the clinical circumstances – biochemical assessment, clinical assessment – of vitamin D deficiency metabolic bone disease.