Vitamin D deficiency : An Epidemic in India ( A bigger problem than perceived).

Vitamin D deficiency : A bigger problem than perceived in India ... 

Majority of Indian population lives in areas  (tropical region), receiving ample sunlight throughout the year and hence there was a disbelief that Vitamin D deficiency is uncommon in India. However from the data available in

the published literature, VIT. D DEFICIENCY IS VERY

COMMON IN INDIA in all the age groups and both sexes across the country.

It has been estimated that 1 billion people worldwide have Vit. D deficiency or insufficiency. In India nearly 60-90 % people are deficient. If we take into consideration reporting of Vit. D test in our lab, IN OUR AREA, we get nearly 3-5 patients of 'Vitamin D' test daily and on an average of 100 patients/ month and 90-95 of them are found deficient .... Isn't it so alarming with so much of sunshine ??.

CAUSES OF DEFICIENCY....

* Changing food habits, 

* strict vegetarian habits, 

* increasing number of hours spent indoors, 

* increased air pollution hampering the ultraviolet rays to adequately synthesize vit D in the skin, 

* travelling in cars rather than open vehicles like cycles/scooters/bikes etc., 

* more worries for tanning one's skin in sunlight to have good fair looks, 

* highly competitive and busy study schedules in schools and homes for the kids with negligible stress on physical activities in open grounds in sunlight in the schools coupled with least hrs of kid's play in open even at homes.

Ladies with Parda and Burqa.

* Cultural and traditional habits prevalent in certain religions like “burqa” and the “pardah” system in muslims, 

have all contributed to this present dismal scenario.

ROLE OF VITAMIN D IN HUMANS ....

(1). THE BASIC ROLE THIS VITAMIN PLAYS IS ... IT HELPS IN DEPOSITING CALCIUM IN the BONES. So if one has enough Calcium in blood but is deficient in Vit. D, then that calcium is useless as it's not going to be deposited in one's bones. So the role of Vitamin D in the growth of bones and formation of teeth is well known. Severe deficiency of this vitamin leads to brittle bones, a disease known as Rickets in children and Osteomalacia in adults. However, there's more to the 'sunshine vitamin' than bone health.

More Vit. D .... more calcium deposition in bones.

(2). Recently Vit. D has been proved to be a great IMMUNE BOOSTER and its deficiency in winter months (least sun shine), leads to lowered body immunity, inviting so many opportunistic infections in the body during this season, and the most common being flu/viral infections. Therefore, now intelligent physicians do prescribe Vit. D in their ''Flu prescriptions''.

                                       Strong Immunity - Cheers all around !

LIKEWISE, in addition to its role in maintaining calcium and phosphorus balance, Vitamin D maintains maximum muscle strength, inhibits inflammatory activity and prevents many diseases related to the immune system, including Type I diabetes, multiple sclerosis, systemic lupus erythematosus (SLE), rheumatoid arthritis and many common cancers. Low levels of Vitamin D have also been linked to hypertension, cardiovascular disease, Type II diabetes mellitus, infectious diseases, tuberculosis, asthma, psoriasis and even depression.

(3). BESIDES HAVING A MAIN ROLE IN CALCIUM METABOLISM AND IMMUNE SYSTEM REGULATION, VITAMIN D DEFINITELY HAS A ROLE IN REGULATING ONE'S BODY CLOCK. Light is the most potent agent to synchronize your internal body clock that regulates circadian rhythms, which in turn also regulate energy balance. The body's circadian rhythms -- fluctuations in hormone levels and other biological systems depending on the time of day -- are known to play an important role in metabolism and WEIGHT REGULATION. 

Weight Loss
"Vitamin D deficiency is associated with OBESITY and Vitamin D levels in the body at the start of a low-calorie diet predict weight loss success. More or healthier the levels better are the chances to loose weight. Addition of vitamin D to a reduced-calorie diet will lead to better weight loss .... THIS FACT WAS HIGHLIGHTED AND PROPOSED  IN DIFFERENT STUDIES CONDUCTED IN 2009.

Now this has been proved by further studies. The message is that you should get more bright light between 8 a.m. and noon to successfully loose weight. It takes only 20 to 30 minutes of exposure to outdoor morning light to have an impact on your BMI

COMPLAINTS/SYMPTOMS OF VITAMIN D DEFICIENCY ....

Vitamin D deficiency begins slowly before physical signs and symptoms of rickets appear. Common early signs and symptoms of vitamin D deficiency include :

• Nervousness.
• Painful muscle spasms.
• Leg cramps.
• Numbness in extremities.

Ultimately more serious signs and symptoms appear with prolonged vitamin D deficiency. When rickets or osteomalacia signs and symptoms develop, they may include:

• Bone (and skeletal) malformations or deformities. This developing is due to softening of the bones, such as bowed legs, knock-knees, scoliosis (curvature of the spine), protruding breast bone, and/or beading at the ends of the ribs.
• Fragile bones. Children with rickets are more prone to bone fractures.
• Tooth decay and dental problems. These include defects in tooth structure, increased chance of cavities, poor enamel and delayed formation of teeth.
• Bone pain. This includes dull, aching pain or tenderness in the spine (especially the lower spine), pelvis, legs and feet. Pain associated with osteomalacia is usually dull and aching and worsens during physical activity. You might notice that gently pressing on a bone, on your shin, for example, produces severe pain.
• Muscle weakness. Decreased muscle tone may make movement uncomfortable. Osteomalacia can cause weakness or stiffness in your arms and legs, decreased muscle tone and discomfort while moving. Some people with osteomalacia walk with a waddling motion.
• Delayed walking in young children may be associated with rickets.
• Irritability.
• Restlessness.
• Failure to grow normally. Impaired or delayed growth in height or limbs may be a result of rickets.
• Profuse sweating.
• Chronic muscle aches and pains.

Child with Rickets ( Bow Legs)

Adult Osteomalacia.

To conclude, the main complaints of Vit. D deficiency would be ...

* Body aches, 

* Back ache, 

* Muscle spasm/Leg cramps,

* Joint pains, 

* Lethargic nature, 

are the main symptoms of this deficiency and in the longer run it also makes bones fragile and prone to fractures and other joint problems as well.

Recent study ( July, 2013) ...

Epidemic of Vitamin D shortage puts Indians at high blood pressure risk ....

Runny noses and stomach flu aren't the only ills associated with overcast skies. The absence of sunlight hits production of Vitamin D in the body, adversely affecting blood pressure. A recent study in London by an Indian-born researcher has proved beyond doubt that the lower the vitamin level, the higher the BP.

SOURCES OF VITAMIN D ....

First and foremost to remember is  ''No vegetarian diet contains Vit. D''

SUN SHINE ( 90 % source of Vit. D in humans )

Though this vitamin is naturally present in very few foods, and almost no vegetarian diet contains this sunshine vitamin, therefore it is added to foods (dairy products) through fortification in developed countries.  
Rich food sources include fish, fish oils, ghee, butter and egg yolk. Compared to fish-liver oil, which is the best dietary source of Vitamin D, other foods are quite low in this vitamin.

Fortified Dairy products, Eggs, Fish.

Ideally, a diet that includes dairy products (fortified with Vit. D), fish and egg yolk ( fish-liver oil being the BEST) coupled with adequate exposure to sunshine, should prevent Vitamin D deficiency. 

Thirty minutes of exposure of the skin over the arms and face to sunlight, without application of sunscreen, preferably between 10 am to 2 pm (as maximum ultraviolet B rays are transmitted during this time) daily is adequate to avoid Vit D deficiency.

Two Interesting Facts ..... 
(1). Vitamin D deficiency plagues doctors too ....

 There’s a common belief among the general public that doctors are healthy beings. This myth was dispelled by a pan-India study conducted by Indian Menopause Society, which revealed that about 95% of the gynecologists they studied, suffered from Vitamin D deficiency. About 2,500 gynecologists from across major cities like Delhi, Mumbai, Chennai and Hyderabad were screened for the study and shockingly about 95% of them suffered from lack of Vitamin D. The study has been published in the journal of ''Archives of Osteoporosis'' (February 2013). 
(2). Pregnant women .... 

Meanwhile, yet another study conducted by the Indian Menopause Society, taking into consideration about 1,000 pregnant women from across the major Indian cities (which included Bangalore), have revealed that about 80-90% of them suffered from Vitamin-D deficiency. Expectant mothers lacking Vitamin-D are at higher risk of acquiring hypertension, diabetes and there may be slower growth of their child.

NORMAL DAILY REQUIREMENTS OF VITAMIN D  .... 

A normal adult requires a minimum of 1,500 to 2,000 units of Vitamin-D and about 800 mgs of Calcium every day. Dietary sources of Vit. D in predominant vegetarian Indian public are practically NIL, hence daily exposure to sunlight for a minimum of 1/2 an hour is most important. 
How much, How and When to get Sunshine ? ....

Sitting in the Sun in an area with slow or no breeze with bare arms, face and feet, for a minimum of 30 minutes between 9 am and 3 pm on daily basis is recommended.

TESTS for VITAMIN D DEFICIENCY ....

1. Blood levels of Vit. D ( Serum Vit. D i.e. 25-OH Vit. D)
2. Blood Calcium and Phosphorus levels
3. X-Rays Bones

WHAT TO DO IF FOUND DEFICIENT IN BLOOD VITAMIN D LEVELS ....

(1). Make a routine to sit in the sunlight daily for at least 30 minutes between 9 am to 3 pm with uncovered hands, face and legs facing the sun.

(2). Try to take foods rich in Vit. D as outlined above.

(3). Oral Vit. D (Cholecalciferol) granules available as 1 gm sachets (marketed in India as ''CALCIROL''by Cadila pharma), each gm having 60,000 IU of Vit. D.

Take this 1 gm sachet orally with milk once a fortnight. Intake of 4-6 such sachets or as suggested by your physician would be sufficient to supplement the depleted levels of Vit. D.

HOW MUCH IS TOO MUCH ? .... 

There is an upper limit to how much vitamin D you can safely take. The Institute of Medicine recommendations for adults say that a daily intake of up to 4,000 IU of vitamin D is safe. Taking more than 10,000 IU per day can cause kidney and tissue damage. 

The best approach is to check with your health care provider before taking vitamin D supplements.