[SUBMITTED] Where The Sun Don't Shine

[Frieden-und Freudenland]

OK, I'll be honest, I got this idea after recommending that Singapore no2 should write an issue on the harmful effects of solar radiation. This is the reverse, if you like.

Lol, by the way, I hope the title is OK. I was looking at the idioms that contain the word sun in a dictionary when I came across this one. I found it funny, but I hope it is not too inappropriate.

DRAFT 3

[description]A recent report by the Ministry of Health has shown that about half of @@NAME@@'s citizens suffer from vitamin D deficiency at some point in their lives. Experts have linked this to insufficient exposure to sunlight, a natural consequence of the habitually bad weather conditions in @@NAME@@.

[validity]bad weather, no enforced nudity

1. [option]"This is a public health crisis!" yells @@RANDOMNAME@@, your Health Minister, yanking apart the curtains of your office to let a feeble ray of sun shine in. "Look, I know we can't change the weather, but we can help our people get more sunlight by promoting an outdoor culture. Why should we be cooped up in enclosed spaces like offices and schools? I say we should make people work and study in open-air public spaces!"
[effect]umbrellas are the standard accessories of all @@DEMONYMADJECTIVE@@ students and workers

2. [option]"If you go out, you are more likely to be exposed to a chilling wind than actual sunlight," snarls @@RANDOMNAME@@, the owner of a local tanning salon, handing you a brochure with pictures of perfectly tanned top models. "If you gave some funding to us, however, we could make our sunbeds available to our people for much lower prices, allowing them to enjoy the benefits of the wholesome sun rays, even if it is raining outside. Trust markets, forget the rickets; as I always say."
[effect]@@DEMONYMADJECTIVE@@ citizens sport their solarium-kissed skin all year round

3. [option]"Do you have any idea how complex and time-consuming the chemical process is by which your body synthesizes Vitamin D?" asks @@RANDOMNAME@@, the owner of Pestle Food Company, tapping @@HIS@@ pointing stick on a complicated-looking flowchart. "We don't have time for that! The easiest solution is to have more Vitamin D in our daily food intake. We should fortify all our bread products and breakfast cereals with Vitamin D, and all we need for this is a nice, generous government subsidy."
[effect]a recent health report showed that @@DEMONYMADJECTIVE@@ people have the strongest bones in @@REGION@@

4. [option]"Nothing new under the sun, huh?" butts in @@RANDOMNAME@@, your old nudist neighbour, proudly exposing @@HIS@@ sagging body to your guests. "There is plenty of sunlight outside if you ask me, the problem is that the light cannot pass through this barrier of clothes that we wrap around our bodies like a straitjacket! I say tell people to toss their clothes and let their bodies luxuriate in the sun! You'll see how it will help people get more sunlight!"
[effect]naked people can be daily seen trembling in the cold

5. [option]"Are you trying to kill us?" snaps your cousin who is a downright hypochondriac, carrying a parasol. "Everybody knows that a high intake of fat-soluble vitamins can cause hypervitaminosis! And keep in mind that UV lights can cause skin cancer! You should require all our citizens to carry parasols with them whenever they are out, and also discourage them from consuming foods that contain high levels of Vitamin D!"
[effect]@@NAME@@ has been nicknamed the Vampire-State of @@REGION@@

Draft 2

[description]A recent report by the Ministry of Health has shown that about half of @@NAME@@'s citizens suffer from vitamin D deficiency at some point in their lives. Experts have linked this to insufficient exposure to sunlight, a natural consequence of the habitually bad weather conditions in @@NAME@@.

[validity]bad weather

1. [option]"This is a public health crisis!" yells @@RANDOMNAME@@, your Health Minister, yanking apart the curtains of your office to let a feeble ray of sun shine in. "Look, I know we can't change the weather, but we can help our people get more sunlight by promoting an outdoor culture. Why should we be cooped up in enclosed spaces like offices and schools? I say we should make people work and study in open-air public spaces!"
[effect]umbrellas are the standard accessories of all @@DEMONYMADJECTIVE@@ students and workers

2. [option]"If you go out, you are more likely to be exposed to a chilling wind than actual sunlight," snarls @@RANDOMNAME@@, the owner of a local tanning salon, handing you a brochure with pictures of perfectly tanned top models. "If you gave some funding to us, however, we could make our sunbeds available to our people for much lower prices, allowing them to enjoy the benefits of the wholesome sun rays, even if it is raining outside. Trust markets, forget the rickets; as I always say."
[effect]@@DEMONYMADJECTIVE@@ citizens sport their solarium-kissed skin all year round

3. [option]"Do you have any idea how complex and time-consuming the chemical process is by which your body synthesizes Vitamin D from a provitamin by exposure to UV light?" asks @@RANDOMNAME@@, the owner of Pestle Food Company, authoritatively setting @@HIS@@ wire-rimmed glasses on the tip of @@HIS@@ nose. "We don't have time for that! The easiest solution is to have more Vitamin D in our daily food intake. We should fortify all our bread products and breakfast cereals with Vitamin D, and all we need for this is a nice, generous government subsidy."
[effect]a recent health report showed that @@DEMONYMADJECTIVE@@ people have the strongest bones in @@REGION@@

or maybe

3. [option]"Do you have any idea how complex and time-consuming the chemical process is by which your body synthesizes Vitamin D from a provitamin by exposure to UV light?" asks @@RANDOMNAME@@, the owner of a pharmaceutical company, authoritatively setting @@HIS@@ wire-rimmed glasses on the tip of @@HIS@@ nose. "We don't have time for that! The easiest solution is to prescribe Vitamin D pills to all citizens! As I always say, two D-pills a day, keep the rickets away!"
[effect]a recent health report showed that @@DEMONYMADJECTIVE@@ people have the strongest bones in @@REGION@@

4. [option validity=no enforced nudity]
[option]"Nothing new under the sun, huh?" asks @@RANDOMNAME@@, your old nudist neighbour, proudly exposing @@HIS@@ sagging body to your guests. "There is plenty of sunlight outside if you ask me, the problem is that the light cannot pass through this barrier of clothes that we wrap around our bodies like a straitjacket! I say tell people to toss their clothes and let their bodies luxuriate in the sun! You'll see how it will help people get more sunlight!"
[effect]naked people can be daily seen trembling in the cold

[description]A recent report by the Ministry of Health has shown that about half of @@NAME@@'s citizens suffer from vitamin D deficiency at some point in their lives. Experts have linked this to insufficient exposure to sunlight, a natural consequence of the habitually bad weather conditions in @@NAME@@.

[validity]bad weather, no enforced nudity

1. [option]"This is a public health crisis!" yells @@RANDOMNAME@@, your Health Minister, yanking apart the curtains of your office to let a feeble ray of sun shine in. "Look, I know we can't change the weather, but we can help our people get more sunlight by promoting an outdoor culture. Why should we be cooped up in enclosed spaces like offices and schools? I say we should make people work and study in open-air public spaces!"
[effect]umbrellas are the standard accessories of all @@DEMONYMADJECTIVE@@ students and workers

2. [option]"If you go out, you are more likely to be exposed to a chilling wind than actual sunlight," snarls @@RANDOMNAME@@, the owner of a local tanning salon, handing you a brochure with pictures of perfectly tanned top models. "If you gave some funding to us, however, we could make our sunbeds available to our people for much lower prices, allowing them to enjoy the benefits of the wholesome sun rays, even if it is raining outside. Trust markets, forget the rickets; as I always say."
[effect]there has been a suspicious increase in the skin cancer rates in @@NAME@@

3. [option]"Hah, this is just a big baloney," objects @@RANDOMNAME@@, your physician, who is also a hobby cheese producer. "As I always tell you, you are what you eat. It is foolish to depend on the sun or a tanning booth for your Vitamin D, and it is a lengthy process, you know. You first need to have the precursor of Vitamin D which we call a provitamin, and the ultraviolet light from the sun has to trigger a complex chemical reaction to convert it into actual Vitamin D. Boring, if you ask me. Why not subsidize the cheese industry and help people get their vitamins directly from the dairy products?"
[effect]the windows in @@NAME@@'s offices are constantly open as a measure against flatulence

4. [option]"Nothing new under the sun, huh?" asks @@RANDOMNAME@@, your old nudist neighbour, proudly exposing @@HIS@@ sagging body to your guests. "There is plenty of sunlight outside if you ask me, the problem is that the light cannot pass through this barrier of clothes that we wrap around our bodies like a straitjacket! I say tell people to toss their clothes and let their bodies luxuriate in the sun! You'll see how it will help people get more sunlight!"
[effect]naked people can be daily seen trembling in the cold

OK, I am not quite happy with Option 3, I think it can be deleted altogether, if you also think it is kind of unnecessary.

Also, as it stands at the moment, option 4 seems to introduce enforced nudity for nations that do not have it. I know we already have an option in an issue that does the same, so I am open to other suggestions with respect to this option.

Thank you!

[Trotterdam]

[box][description]A recent report by the Ministry of Health has shown that about half of @@NAME@@'s citizens suffer from vitamin D deficiency at some point in their lives. Experts have linked this to insufficient exposure to sunlight, a natural consequence of the habitually bad weather conditions in @@NAME@@.

Is this a thing? I'd think mere cloudy skies would be less problematic than simply staying indoors all day, particularly since windows, while transparent to visible light, might block the ultraviolet light that's necessary for the synthesis.

I'd focus more on technological advancement leading to an increasingly white-collar-oriented economy where few people need to work outdoors, rather than what the weather's like.

[validity]bad weather, no enforced nudity

By the same token, if people are indoors for too long then it also doesn't matter much what they're wearing. Only the last option actually talks about clothes, so I don't think you need it as a validity for the whole issue.

Speaking of validities, the cheese option might want to watch out for compulsory veganism...

[effect]there has been a suspicious increase in the skin cancer rates in @@NAME@@

This is kind of unfair. Why would artificial sunlight sufficient to generate a certain amount of vitamin-D cause more skin cancer risk than natural sunlight sufficient to generate a certain amount of vitamin-D?

You could have people overusing the technology more than they actually need, of course, but if anything it'd be easier to regulate your intake so ensure you're getting exactly the right amount than if you're just spending a lot of time outdoors.

"Why not subsidize the cheese industry and help people get their vitamins directly from the dairy products?"

Ha, I was thinking of nutrient supplements, but that's certainly a more amusing approach to the same idea!

Also, as it stands at the moment, option 4 seems to introduce enforced nudity for nations that do not have it. I know we already have an option in an issue that does the same, so I am open to other suggestions with respect to this option.

Others might disagree with me, but I am in principle for multiple issues setting the same flag if it can reasonably fit the narrative, especially if there are followup issues (so that it's easier to end up qualifying for those issues).

Question is if you'd actually get more sunlight from being nude indoors than from being clothed outdoors.

[Candlewhisper Archive]

It is indeed a thing. Though even in gloomy countries, Vitamin D Deficiency isn't "most people", as it's incidence is less than 50%.

Though not by much!

http://bestpractice.bmj.com/best-practi ... ology.html

The realistic solutions, which you may or may not want to consider, include:

1) Increase screening, then prescribe vitamin D to deficient populations. Perhaps focus screening on high risk groups (like darker skintones and older people) for maximum cost-efficiency.
2) Public health approach with Vit D fortification. Oblige it to be added to bread and cereals. https://en.wikipedia.org/wiki/Food_fortification
3) Address the knock on complications of low vitamin D through aiming at other factors with a stronger ration of cost to health benefit. For example, promote exercise and healthy eating, and subsidise gyms and the like, combat obesity. This in turn leads to higher bone strength, and prevents osteoporotic fractures, which is the primary downside of low Vit D.

Having said that, IRL, many governments do ALL of the above to some degree, and actually an issue presented with those options would be dull as hell.

The writing talent here would be to present an issue that has verisimilitude in its suggested solutions, but has a story that will appeal to people other than epidemiology-loving health economists.

[Trotterdam]

Should've figured you'd know something about this.

Though...

http://bestpractice.bmj.com/best-practice/monograph/641/basics/epidemiology.html

You have tried to access content that requires a subscription to BMJ Best Practice.

[Candlewhisper Archive]

You don't have a subscription?

Doh, I forget that not everyone lives in the same internet as me.

Here's the text:

Epidemiology

Vitamin D deficiency is the most common nutritional deficiency worldwide in both children and adults. [1] [4] [8] [9] [10] [11] In the US and Europe, >40% of the adult population >50 years of age is vitamin D-deficient. [1] Levels of serum 25-hydroxyvitamin D consistent with vitamin D deficiency (<50 nanomol/L [<20 nanograms/mL]) have been reported in 48% of pre-teen white girls, 52% of adolescent Hispanic and black American boys and girls, and 32% of healthy young adults. [12] [13] [14] [15] In Tibet and Mongolia, vitamin D deficiency leading to clinical rickets is described in 60% of infants. [16] In the Middle East, a high prevalence of rickets and osteomalacia has been described in Muslim women and their infants, perhaps due to increased clothing coverage of the skin. [17] Fortification of foods with vitamin D and use of vitamin supplements have greatly reduced the incidence of clinically significant vitamin D deficiency in developed countries. Despite this, vitamin D deficiency still occurs with the consumption of unfortified foods, especially in the setting of limited sunlight exposure.

It is now recognised that vitamin D deficiency increases the risk of many chronic diseases, including cancer, autoimmune diseases, type 2 diabetes, heart disease and hypertension, and infectious diseases (including upper respiratory tract infections and tuberculosis), as well as osteoarthritis. [1] [4] [18]

A strong association of vitamin D deficiency with an increased risk of prostate, colon, breast, ovarian, and pancreatic cancers, among many others, has been reported. [19] [20] It has been estimated that increasing vitamin D intake to 1000 IU of vitamin D a day reduces the risk of colorectal cancer by 50%. [21] In addition, one study noted that women with higher serum levels of 25-hydroxyvitamin D (on average 120 nanomol/L [48 nanograms/mL]) had a 50% reduced risk of developing breast cancer. [22] In another study, the risk of developing breast cancer was reduced by >60% in women in Canada exposed to sunlight as teenagers and young adults (resulting in cutaneous vitamin D production). [23]

A study in Finland found that infants who had received 2000 IU of vitamin D a day for the first year of life reduced their risk of type 1 diabetes by 78% 31 years later. [24] Furthermore, it has been shown that women with a high intake of vitamin D reduce their risk of developing multiple sclerosis and rheumatoid arthritis by >40%. [25] [26] A study in juvenile-onset SLE patients suggested that vitamin D3 supplementation for 24 weeks was effective in decreasing disease activity and improving fatigue. [27]

Results from the Third National Health and Nutrition Examination Survey (NHANES 3) revealed that, for adults who had the highest levels of serum 25-hydroxyvitamin D, the relative risk of developing type 2 diabetes was reduced by 33%. [28] [29] For post-menopausal women who had received 2000 IU of vitamin D a day for 1 year, the risk of developing upper respiratory tract infections was reduced by 90%. This is consistent with the observation from NHANES 3 demonstrating that children and adults with the highest serum levels of 25-hydroxyvitamin D were less likely to develop respiratory tract infections throughout the year. [18] [29] [30] School children in Mongolia who ingested milk fortified with 300 IU of vitamin D3 reduced their risk of having an acute respiratory infection by approximately 50%. [31] Furthermore, a study showed that children in Japan who received 1200 IU vitamin D3 from December to the end of March demonstrated a reduced risk for influenza infection of almost 50%. [32]

Vitamin D deficiency has been linked with increased risk of hypertension and heart disease. [33] [34] One study looking at the vitamin D status in Framingham Offspring Study participants without prior CVD demonstrated a 50% increased risk of developing a myocardial infarction if the patient was vitamin D-deficient. It has also been suggested that patients with CVD who are vitamin D-deficient have a greater mortality risk. [35] [B Evidence] In addition, it has been shown that adults with a serum level of 25-hydroxyvitamin D of >72 nanomol/L (>29 nanograms/mL) have an 80% reduced risk of developing peripheral vascular disease. [36] Two studies have shown that vitamin D deficiency may be considered a risk factor for sudden cardiac death and fatal strokes. [37] [38] Large epidemiological studies consistently report that vitamin D deficiency confers increased risk of mortality, cardiovascular disease, and cancer (especially colorectal cancer). [39] [40] Patients in the Framingham heart study who were vitamin D-deficient were found to have an increased risk of developing osteoarthritis. [41] However, some studies have raised questions about the value and effectiveness of vitamin supplementation for preventing cancers, cardiovascular events, and cognitive decline [42] [43] [44] and treating hypertension. [45]

It has also been observed that vitamin D deficiency is linked to pre-eclampsia, low birth weight and preterm birth, and an increased risk of having a caesarean section. [46] [47] [48] [49] Vitamin D3 supplementation during the third trimester enhanced postnatal linear growth. [50] A meta-analysis revealed on the basis of available evidence that there was an association with vitamin D status and several outcomes in children including birth weight and dental caries. [51]

Furthermore, it has been suggested that many of the health disparities in black Americans are due to vitamin D deficiency. [52] Black Americans have a higher risk of developing hypertension and type 2 diabetes than white Americans. They also have a higher incidence of prostate, colon, and breast cancer that tends to be more aggressive. In addition, black Americans are at higher risk for contracting tuberculosis, particularly more aggressive disease, which is thought to be in part due to their vitamin D deficiency. [53]

Vitamin D deficiency has also been linked to an increased incidence of schizophrenia, Parkinson's disease, cognitive dysfunction, Alzheimer's disease, dementia, and depression, although further research is needed in this regard. [50] [51] [54] Furthermore, high intake of vitamin D has been shown to decrease the incidence of acute respiratory infections, asthma, and wheezing illness. [1] [55] [56]

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[Trotterdam]

1) Increase screening, then prescribe vitamin D to deficient populations. Perhaps focus screening on high risk groups (like darker skintones and older people) for maximum cost-efficiency.

What does screening entail? Can it be done without icky blood samples?

2) Public health approach with Vit D fortification. Oblige it to be added to bread and cereals. http://en.wikipedia.org/wiki/Food_fortification

Is there such a thing as vitamin D overdose?

You don't have a subscription?

Not to a medical journal, no

Here's the text:

I'm not seeing anything in that article that specifically links deficiency to weather conditions, though. Incidence in the Middle East (which has lots of sunny deserts) is said to be greater than in many rainier regions, though it doesn't say exactly how much. (These numbers would give infuriate any statistician, since the measured populations differ in everything from location to age to gender to skin color, rather than breaking things down into one at a time with proper control groups. Sure, that data probably exists, but this article's numbers are going for shock value rather than information.)

[Australian rePublic]

People who work underground may have something to do with it

[Candlewhisper Archive]

A non-gated article:

http://www.jarcp.com/703-the-global-epi ... tatus.html

Note that the physiology of it is such that it's entirely expected (and shown) that the sunnier your location, the higher vitamin D levels are. However, it's also relative to skin colour, so you're much more likely to be Vitamin D deficient in Glasgow if you're a black guy than if you're pale skinned and ginger.

Of course, the flipside issue is skin cancers, especially melanomas. The black guy is way better adapted to the sunlight of the Australian Outback, for example.

[Frieden-und Freudenland]

[box][description]A recent report by the Ministry of Health has shown that about half of @@NAME@@'s citizens suffer from vitamin D deficiency at some point in their lives. Experts have linked this to insufficient exposure to sunlight, a natural consequence of the habitually bad weather conditions in @@NAME@@.

Is this a thing? I'd think mere cloudy skies would be less problematic than simply staying indoors all day, particularly since windows, while transparent to visible light, might block the ultraviolet light that's necessary for the synthesis.

I'd focus more on technological advancement leading to an increasingly white-collar-oriented economy where few people need to work outdoors, rather than what the weather's like.

Yeah, this might be the primary reason, but as CWA explained above, the amount of sunlight that a country gets also plays a role.

[validity]bad weather, no enforced nudity

By the same token, if people are indoors for too long then it also doesn't matter much what they're wearing. Only the last option actually talks about clothes, so I don't think you need it as a validity for the whole issue.

Speaking of validities, the cheese option might want to watch out for compulsory veganism...

I took note of that. Maybe the doctor should instead suggest compulsory Vitamin D supplements? I can also mention that he is a shareholder in a pharmaceutical company that produces these supplements.

[effect]there has been a suspicious increase in the skin cancer rates in @@NAME@@

This is kind of unfair. Why would artificial sunlight sufficient to generate a certain amount of vitamin-D cause more skin cancer risk than natural sunlight sufficient to generate a certain amount of vitamin-D?

You could have people overusing the technology more than they actually need, of course, but if anything it'd be easier to regulate your intake so ensure you're getting exactly the right amount than if you're just spending a lot of time outdoors.

You are right. But the idea is that people may be more prone to overuse tanning beds, because they can underestimate the risk.

The article to which I provide a link below contains the following statement:

Modern tanning lamps now use around 5% UVB, so they can both tan and burn the skin more quickly, but on the plus side it means people generally stay underneath them for a much shorter time. Put simply, the new tanning lamps are about as strong as the Mediterranean sun, while older sunbeds are more similar to a day out in Blackpool.

https://www.theguardian.com/science/200 ... equestions

So I imagine people could be deceived into thinking lying in a sunbed for 1 hour is the same as lying in the natural sun for 1 hour, but it isn't.

"Why not subsidize the cheese industry and help people get their vitamins directly from the dairy products?"

Ha, I was thinking of nutrient supplements, but that's certainly a more amusing approach to the same idea!

This might go away, as I am thinking of vitamin D supplements at the moment.

Also, as it stands at the moment, option 4 seems to introduce enforced nudity for nations that do not have it. I know we already have an option in an issue that does the same, so I am open to other suggestions with respect to this option.

Others might disagree with me, but I am in principle for multiple issues setting the same flag if it can reasonably fit the narrative, especially if there are followup issues (so that it's easier to end up qualifying for those issues).

Question is if you'd actually get more sunlight from being nude indoors than from being clothed outdoors.

I think there is no difference between being fully naked or wearing a burqa indoors in that respect, because the windows usually block the ultraviolet wavelength of the sunlight.

The difference, I imagine, would be detected once you are out. When you are wearing clothes, only some exposed parts of your skin will be exposed to sunlight while you are walking to the supermarket to buy groceries, for instance. If you are naked, this walk will help you get more sunlight.

Any ideas on the option, though? Is it OK to have a new enforced-nudity option in the game? Or do you have other suggestions?

It is indeed a thing. Though even in gloomy countries, Vitamin D Deficiency isn't "most people", as it's incidence is less than 50%.

Though not by much!

http://bestpractice.bmj.com/best-practi ... ology.html

The realistic solutions, which you may or may not want to consider, include:

1) Increase screening, then prescribe vitamin D to deficient populations. Perhaps focus screening on high risk groups (like darker skintones and older people) for maximum cost-efficiency.
2) Public health approach with Vit D fortification. Oblige it to be added to bread and cereals. https://en.wikipedia.org/wiki/Food_fortification
3) Address the knock on complications of low vitamin D through aiming at other factors with a stronger ration of cost to health benefit. For example, promote exercise and healthy eating, and subsidise gyms and the like, combat obesity. This in turn leads to higher bone strength, and prevents osteoporotic fractures, which is the primary downside of low Vit D.

Having said that, IRL, many governments do ALL of the above to some degree, and actually an issue presented with those options would be dull as hell.

The writing talent here would be to present an issue that has verisimilitude in its suggested solutions, but has a story that will appeal to people other than epidemiology-loving health economists.

These are great suggestions!

I think only the 3rd option you suggest is boring

I could use 1 or 2. Well, maybe food fortification is a better way of forcing people to get Vitamin D than prescribing them compulsory supplements?

Also, the effect line could mention increased rates of hypervitaminosis D as a result, overcalcification of the bones, and increased rates of fractures?

2) Public health approach with Vit D fortification. Oblige it to be added to bread and cereals. http://en.wikipedia.org/wiki/Food_fortification

Is there such a thing as vitamin D overdose?

I presume there is. Hypervitaminosis D.

Of course, CWA could provide better info on this.

People who work underground may have something to do with it

True. But as I said above, there is not much difference between working underground and working in an office that receives sunlight only through the windows.

[Candlewhisper Archive]

You can overdose on vitamin d, but it's mostly a problem for dosing errors in kids of frail elderly folk. You need really, really big doses for an adult to overdose on vitamin D. The most common error is GPs like myself giving the loading dose tablet as a maintenance dose AND prescribing it at above the normal frequency.

However, it's not enough of a problem to need to be considered. Way rarer, for example, than paracetamol overdosing, as you barely need to exceed prescribed doses to run into lethal toxicity for that innocuous drug.

[Frieden-und Freudenland]

You can overdose on vitamin d, but it's mostly a problem for dosing errors in kids of frail elderly folk. You need really, really big doses for an adult to overdose on vitamin D. The most common error is GPs like myself giving the loading dose tablet as a maintenance dose AND prescribing it at above the normal frequency.

However, it's not enough of a problem to need to be considered. Way rarer, for example, than paracetamol overdosing, as you barely need to exceed prescribed doses to run into lethal toxicity for that innocuous drug.

What exactly would be considered an overdose? I mean, can you still be exposed to some detrimental effects (e.g. overcalcification of your bones) without this technically being considered an overdose?

[Candlewhisper Archive]

The medical meaning of "overdose" is no more precise than the colloquial meaning.

[Frieden-und Freudenland]

The medical meaning of "overdose" is no more precise than the colloquial meaning.

Well, OK. Can I then just avoid the technical term hypervitaminosis D, and instead point out that the new government policy (be it prescribing Vitamin D supplements or adding Vitamin D to food) causes overcalcification of bones?

[Candlewhisper Archive]

In what context? Not seeing where referencing something with heavy medical jargon is going to improve the narrative.

[Bears Armed]

You can overdose on vitamin d, but it's mostly a problem for dosing errors in kids of frail elderly folk.

Or a result of eating Polar Bear livers...

[Candlewhisper Archive]

Man, if they weren't so delicious, I'd cut back on my 20-a-day habit.

Fava beans, chianti, etc.

[Trotterdam]

http://www.jarcp.com/703-the-global-epidemiology-of-vitamin-d-status.html

Ah, a much better article. Also means it's kinda longwinded, but let's see what I can pick out.

It can be concluded that vitamin D deficiency is common within Europe, specific at risk groups include non-western immigrants and the institutionalized elderly. The role of latitude in vitamin D status is not completely clear and higher serum levels in some Scandinavian studies may be due to diet or a genetic adaptation.

In terms of interventions, in regions such as Scandinavia, dietary supplements appear to have been effective in reducing the prevalence of deficiency.

Note, in the table, the anomalously high value listed for Sweden. (Or the worrying fact that a value not far above what the article claims is the healthy minimum looks "anomalously high".)

in Turkish women, who wore three different dress types, serum 25(OH)D levels averaged 56nmol/l in the western dressed group, 31.9 nmol/l in the second group wearing a hijab with uncovered face and hands, and only 9nmol/l in the completed covered group

Women of Maasai and Hadzabe origin had higher 25(OH)D compared to women of Sengerema origin who cover all but their lower arms and faces (78).

This attests to clothing having a pretty huge effect. (Though I do wonder about the Ardawi study in Saudi Arabia finding higher levels in women than in men.)

Vitamin D deficiency is very common in this area of the world [the Middle East] despite high levels of sunshine and UV radiation throughout the year.

Whilst there is a plethora of vitamin D data from elsewhere in the world, the number of studies originating from Africa is limited. However, those that have been completed show much higher baseline levels of serum 25(OH)D compared to the rest of the world although there is significant variation within the continent (31).

It has previously been noted that Asian immigrants to higher latitude countries have a high incidence of vitamin D deficiency. It was thought that this was in part due to their skin not being adapted to cope with low levels of UV radiation. However, studies across different parts of Asia show a widespread prevalence of vitamin D insufficiency within both sexes and all age groups.

Air pollution may play a role, in a study from Delhi infants aged 9-24 months had significantly lower serum 25 (OH)D in areas of high atmospheric pollution compared to infants from [less] polluted part of the study (mean serum 25(OH)D 30.9nmol/l vs 67.6nmol/l).

Weather appears to have some role, though it's kind of unclear and appears to be overshadowed by clothing. Air pollution only causes a factor of slightly more than 2:1, while clothing can cause variations of up to 6:1.

In the Middle East and Africa, children tend to have higher vitamin D levels than adults (51). This may reflect the greater amount of time they spend outside compared to other age groups. Recently, however, it has been shown that these differences are reducing which may be the result of a change in lifestyle in developed countries, with younger people spending a greater amount of time indoors (e.g. watching television and playing computer games) (52).

There are several more mentions of indoors vs outdoors lifestyles, but the article doesn't give numbers.

Regardless of the definition of vitamin D insufficiency it is apparent that sub optimal levels of 25(OH)D are a global problem with very few areas spared. Severe deficiency seems to be most common in the Middle East and South Asia.

So I imagine people could be deceived into thinking lying in a sunbed for 1 hour is the same as lying in the natural sun for 1 hour, but it isn't.

Why would people be making their own decisions? The advantage of sunbeds is that you have professional staff operating them, so they can tell you what a good duration is.

I can see people using the beds for cosmetic reasons ignoring professional advice ("hey, I'm not brown enough yet!"), but not if they're just there for vitamin D, which you can't measure on your own anyway.

This might go away, as I am thinking of vitamin D supplements at the moment.

Well, it's less funny, but it probably does make more sense.

I think there is no difference between being fully naked or wearing a burqa indoors in that respect, because the windows usually block the ultraviolet wavelength of the sunlight.

The difference, I imagine, would be detected once you are out. When you are wearing clothes, only some exposed parts of your skin will be exposed to sunlight while you are walking to the supermarket to buy groceries, for instance. If you are naked, this walk will help you get more sunlight.

It's probably just enforced public nudity anyway. Nations that ban nudity still allow you to get naked in the privacy of your own home, so it should also work the other way around. So we can stop worrying about what happens indoors.

Mind you, there would be little practical difference, in terms of sun exposure, between total nudity and wearing a bikini. Not that that'll stop fanatic nudists.

True. But as I said above, there is not much difference between working underground and working in an office that receives sunlight only through the windows.

Mandatory open-air skylights in buildings?

[Frieden-und Freudenland]

How about draft 2?

Now I have two candidates for option 3. Which one do you think looks better?

Also, any opinions on the nudity option? I am still not too keen on it...

Would it perhaps be better to give people some kind of an opt-out option to avoid dealing with the issue?

Maybe a crazy and very misinformed person who is afraid of hypervitaminosis (hahaha) and thinks that @@LEADER@@ should not try to tackle the problem of Vitamin D deficiency but instead actively discourage people from consuming foods with fat-soluble vitamins? Yeah, I know this is crazy, just a thought...

[Frieden-und Freudenland]

in Turkish women, who wore three different dress types, serum 25(OH)D levels averaged 56nmol/l in the western dressed group, 31.9 nmol/l in the second group wearing a hijab with uncovered face and hands, and only 9nmol/l in the completed covered group

Women of Maasai and Hadzabe origin had higher 25(OH)D compared to women of Sengerema origin who cover all but their lower arms and faces (78).

This attests to clothing having a pretty huge effect. (Though I do wonder about the Ardawi study in Saudi Arabia finding higher levels in women than in men.)

If I had to venture a guess, I'd say that this might be related to the fact that gender segregation is allowed and actively practised in the Middle Eastern countries.

Even in Turkey, you can find so-called "conservative hotels" in the South where women are allotted a separate part of the beach away from the men's eyes. And though these women can be wearing hijab when they are in the company of men - which is a necessity in city life anyway - they can sunbathe in their bikinis in such places. (Haha, in fact, a couple of years ago the guests of such a hotel had complained about the parachuters jumping from a cliff on a nearby mountain and flying over the beach, because they thought these parachuters - who were mostly male - could be peeping at the bikini-clad devout women and thereby harassing them. Well, yeah, right, I bet this is what those parachuters are primarily interested in. And I bet they can see your body very clearly from an altitude of 1000 meters. )

Anyways, I imagine the same can be happening in Saudi Arabia. People are generally wealthy, too; so a Saudi housewife could perhaps go to a secluded spot for women (maybe an enclosed space within a public park allotted to women? I don't know.), take off her full-body veil and sit there in her Western-style clothes, receiving more sunlight. When she is done and she has to blend into the streets with members of the opposite sex, she might just put on her hijab again.

Men, on the other hand, are more likely to be participating in the workforce, so maybe they stay in the office the whole day...

Such a scenario would explain why Saudi women have higher Vitamin D levels than Saudi men.

[Australian rePublic]

Just curious, how would this work with the Midnight Sun?

Not that you should mention it, it's just an interesting side note

[Frieden-und Freudenland]

Just curious, how would this work with the Midnight Sun?

Not that you should mention it, it's just an interesting side note

Midnight Sun? So I assume we are talking about Nordic countries and suchlike.

OK, first of all, if you mean the places where the Sun is visible 24/7, that happens in summer if you live beyond the Arctic (or the Antarctic) Circle. These places are already not densely populated. The weather is harsh, and obviously not many people would like to live under so extreme conditions.

If you look at more southern places in the Nordic countries, there is still a huge discrepancy between night and daytime, of course. In the winter, you are exposed to the sun for a short time, and in the summer, though you have plenty of sunlight, it is "weak," in the sense that it does not have much UV-B.

The first reason for that is the thickness of the cloud cover. If you have a rainy weather, and the sky is overcast, the clouds will prevent quite a sizable portion of the UV-B from reaching the Earth's surface. But the effect of clouds is rather minimal.

The more important reason why Norway would not be exposed to too much UV-B even in summer has to do with the "angle" with which the sunlight comes to Earth. At higher latitudes, the sunlight will fall on Earth with an oblique angle. This has two immediate consequences. First, the UV light will now be dispersed over a wider area (if the Sun was directly overhead, it would focus on a smaller area and not be as mild as this), and secondly, due to this oblique angle, the sunlight will travel through the atmosphere for a longer time, passing through more ozone and getting filtered. (Imagine cutting a cake into two with a knife first by putting the knife on it in the middle and pushing the knife down vertically. Then imagine putting the knife on the "edge" of the cake sideways and cutting the cake diagonally, going from upper left corner to the lower right corner, for instance. Obviously, in the second case, the knife will have travelled through more cake Lol, I know, probably not the best example, but that's what I could think of in a hurry).

As a result, the countries with the Midnight Sun do not get much UV light, that's true. But I believe this is compensated for by the naturally light skin color of the people who live here & by their diet (which contains fish and dairy products, which are good sources of Vitamin D). I guess this lack of sufficient UV mostly affects the immigrants living there, who come from lower latitudes and have much darker skin colors, and thus they are not good at absorbing the feeble sun rays of Norway, Sweden, etc. And this has already been pointed out as a problem. In the internet you can find many news articles about dark-skinned people in Northern Europe having Vitamin D deficiency, and so on.

[Frieden-und Freudenland]

How about draft 2?

Now I have two candidates for option 3. Which one do you think looks better?

Also, any opinions on the nudity option? I am still not too keen on it...

Would it perhaps be better to give people some kind of an opt-out option to avoid dealing with the issue?

Maybe a crazy and very misinformed person who is afraid of hypervitaminosis (hahaha) and thinks that @@LEADER@@ should not try to tackle the problem of Vitamin D deficiency but instead actively discourage people from consuming foods with fat-soluble vitamins? Yeah, I know this is crazy, just a thought...

Bumpty Dumpty

[Frieden-und Freudenland]

Draft 3 is up.

[Australian rePublic]

This is NationStates, where's the option of "We can change the weather, damn it!"?

[Australian rePublic]

Also, maybe you can take inspiration from Umea. Although, come to think about it, this maybe an issue I could write about in and of itself...