By Staff Writer - February, 16th 2014

Rickets is a bone disease that affects infants and young children. The child’s growing bones fail to develop properly due to a lack of vitamin D. This can result in soft and weakened bones, fractures, bone and muscle pain, and bony deformities. You can help protect your child from the effects of rickets by understanding their risk factors for vitamin D deficiency and taking steps to prevent it. Children with naturally dark skin or inadequate exposure to sunlight are among those most commonly affected. Having a mother with vitamin D deficiency also increases a child’s risk. Other causes may be nutritional deficiencies and disorders of the liver, kidney or small intestine. A similar condition can occur in adults, but this is called osteomalacia.

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. 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's 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.

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 Research (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.

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