In focus Vitamin D deficiency is emerging as a more common menace than we thought. Why do we need to be in good D company?
Renuka, in her late twenties, suffered a fracture in her leg during a trip to Philippines. She returned home to Hyderabad with a cast on her leg and, during a medical check-up, was detected with vitamin D deficiency. “My physician advised me to spend some time in the sun every day. He said the healing process would be faster if my vitamin levels improved,” she recalls. Vitamin D supplements and the golden rays of sunshine has helped her get back on her feet.
This isn’t an isolated case. Men, women and children are increasingly being diagnosed with and treated for acute vitamin D deficiency and associated problems such as obesity, chronic pains, sleep disturbance and even depression. From teens to elders in their 70s, no one is spared.
“There was a reason our ancestors started the day with prayers and suryanamaskars facing the sun, outdoors,” says Dr. Bakhtiar Choudhary, Senior Consultant Sports Medicine, Ergonomics and Obesity.
“We spend the best part of the day in enclosed spaces both at home and work.” Chronic D deficiency, he says, hasn’t happened overnight. “What we see today is the result of lifestyle changes over the last 30 to 40 years. I feel it’s a medical blunder that the importance of vitamin D has been ignored for so long,” he adds.
Most Indians are also at a genetic disadvantage with regard to vitamin D, points out Dr. M. Rajiv, physician. “Dark skin, with its melanin pigments, prevents sunlight and UV light from converting pro-vitamin D to vitamin D3 (cholecalciferol) in the skin.”
The pitfalls to this are manifold. “Vitamin D deficiency can cause rickets in children and osteomalacia in adults, leading to deformed bones in children and increased risk of fractures among the elderly.
Nearly every tissue or organ in the body has receptors for vitamin D: immunity, cardiovascular health, depression, diabetes prevention and cancer prevention are some of the potential areas of benefit,” he says.
To treat deficiency, physicians recommend Vit D granules, tablets and injections along with a daily intake of calcium-Vit D3 supplements.
What’s flummoxed the medical fraternity is the growing incidence of deficiency in a tropical country like ours where ample sunlight is available throughout the year. “Colder countries seem to be faring better with regular intake of supplements and foods fortified with Vitamin D,” Dr. Choudhary points out.
The deficiency isn’t specific to gender or age. Having come across around 3800 individuals with vitamin D deficiency in the last seven years, he says, “The deficiency occurs in all levels of society. At least 60 per cent of patients have below 5 nanograms of vitamin D (the normal range in most labs is between 30 and 100).
Further, the levels don’t rise rapidly. On discontinuing all supplements after three to six months, individuals tend to revert to deficiency syndromes.”
Lack of vitamin D manifests itself through acute pain in the feet, shoulders, neck and joints in some individuals.
Research has also shown link between vitamin D and low immunity levels, obesity and diabetes.
The next time you suffer prolonged throbbing pain or find yourself easily susceptible to common flu, give vitamin D a thought. It pays to be in good D company.
SANGEETHA DEVI DUNDOO
How much do we need?
Dr. Rajiv says: The Recommended Dietary Allowance for children 1 to 18 years and adults through age 70 years is 600 IU or international units (15 mcg) and increases to 800 IU (20 mcg) after age 71. Pregnant and lactating mothers require at least 600 IU (15 mcg). However, some studies suggest that higher intakes may be necessary to maintain normal levels during pregnancy and lactation.
Infants exclusively breast-fed may require supplements because the vitamin D content of human milk is low. One Paediatric Endocrine Society recommends supplementation with 400 IU daily beginning within days of birth for infants exclusively breast-fed. Most infant formulas contain at least 400 units/L of vitamin D, so formula-fed infants will also require supplementation to meet this goal unless they consume at least 1000 mL daily of formula.
Foods rich in vitamin D
Egg yolks, fatty fish, liver, unsalted white butter, and to a smaller extent milk and ghee. Vegetarian food has inadequate doses of vitamins B1, B6 and B12 in addition to vitamin D. Compensate this with supplements prescribed by the physician.
Time in the sun
Fair-skinned individuals require only 20 minute exposure to direct sunlight three to four times a week for the skin to make adequate vitamin D. Darker-skinned individuals with more melanin pigments require 30 to 40 minute exposure three to four times a week. However, even short exposures of 5 to 10 minutes are beneficial. “The best source of vitamin D is UV-B radiation from the sun,” says Dr. Rajiv. “UV radiation levels vary depending on location, season, time of day, cloud coverage and the environment. UV-B levels are most intense during the mid-day, but longer exposures in early morning or late evening can be adequate.”
“Spend a few minutes in the sun without applying sunscreen,” Dr. Choudhary suggests. “Only the exposed parts of the skin help in manufacturing vitamin D. Keep moving while out in the sun. Being stationary will make you prone to sunburns.”
Sangeetha Devi Dundoo