Vitamin D deficiency

While the world is talking about obesity, diabetes and other chronic problems, there has been a silent rise of nutritional deficiencies in the overall population.  

Malnutrition has two faces.  One side resulting from over nutrition like obesity due to excess calories and low physical activity.  The other side is under-nutrition especially micro-nutrient deficiency triggering other health problems.

Earlier malnutrition was equated with lack of food availability and poverty.  Of late malnutrition is more due to lack of quality than quantity.  Food is readily available but the quality has dwindled of late which may be due to the following factors:

• Substandard quality of fruits and vegetables available
• Improper food choices leading to imbalance of macro and micro nutrition
• Lack of nutritional knowledge

Deficiency of Vitamin D

Vitamin D, also called as the Sunshine vitamin since body synthesises it in presence of sunlight, is a fat soluble vitamin which is required for a number of functions in the body.

Deficiency of Vitamin D (VDD) has become quite common now with more than 75% population of varied age group suffering from it.  

Function of Vitamin D

• Help in skeletal development and bone health
• Required for absorption of calcium in the body
• Required for neuro-muscular development.
• For hormonal health
• Help in building immunity of the body (Mol Nutr Food Res. 2011 Jan;55(1):96-108.)
• Cancer prevention - Studies suggest the protective effect of Vitamin D and lower incidence of cancer. (American Journal of Public Health (AJPH)  February 2006)

Since many of the symptoms of VDD is often similar to those seen in other diseases, its prevalence is sometimes overlooked and the deficiency goes undetected.  Some of the common symptoms seen are:

• Low immunity - cold, flu, respiratory infections occur more often.
• Fatigue - severe low levels of Vitamin D in blood can lead to tiredness and a negative effect on the energy levels.
• Back pain and pain in the legs, ribs, joints - since Vitamin D is responsible for calcium absorption and bone health, its deficiency can lead to low calcium levels leading to back pain.
• Poor wound healing - its been found that people with VDD have poor wound healing with high susceptibility of having inflammation and infection.
• Rickets characterised by soft bones in children with VDD.
• Hairfall - severe hair fall is very common among women with VDD.

Complications of VDD

• Osteomalacia - Softening of bones making a person prone to fractures.  If the deficiency is not corrected then in the long run, it can cause osteoporosis where bone density decreases leading to fractures especially those of hip and wrist.
• Diabetes - VDD has been linked to retinopathy in type 2 diabetics. (Nutrients. 2017 Mar; 9(3): 307)
• Cardiovascular diseases - studies have shown the association between VDD and inflammation in the body which can lead to cardiovascular diseases.
• Chronic Kidney disease (CKD) - VDD is especially seen in patients with CKD.  It has been characterised by the presence of low grade inflammation which has been an important factor in progression of CKD. (Pediatr Nephrol. 2013 Apr;28(4):605-10)
• Neurocognitive degeneration - recent studies have found an association between dementia, cognitive impairment and VDD.

• Geographic location - People living at high latitude and away from the equator will have less exposure to the sun all year around.  They are prone to VDD.
• Skin tone - dark skin tone has more melanin pigment in them which acts as a natural sunscreen inhibiting the synthesis of Vitamin D in the skin.  This is the reason why more percentage of African americans have VDD.
• Age - The ability to make Vitamin D decreases with age and hence elderly population have low Vitamin D levels.
• Obesity - the bioavailability of Vitamin D decreases in obese people making them susceptible to VDD (The American Journal of Clinical Nutrition, Volume 72, Issue 3, 1 September 2000, Pages 690–693)
• Lifestyle - Spending less time outdoors, covering up completely with clothing while going out and judicious application of sunscreen even while going out for a short duration prevents the synthesis of Vitamin D by the skin.
• Diet - eating food restricted in dairy, fish, fortified milk and cereals can lead to deficiency.

Including Vitamin D rich food and exposing to the sunlight are some of the ways to prevent or manage the deficiency.

Sunlight

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 required for adequate synthesis of vitamin D.

Diet - the dietary sources are both from vegetarian and nonvegetarian sources:

• Fatty fish, like tuna, mackerel, and salmon
• Foods fortified with vitamin D, like some dairy products, orange juice, soy milk, and cereals
• Beef liver
• Cheese
• Egg yolks

Supplements - many supplements with a combination of calcium and vitamin D3 are available and can be taken in chronic deficiency.

The bottom line is, say no to processed foods and yes to home cooked food.  Including fresh produce with whole grains with the required exposure to the sunlight, keeps the nutritional deficiencies at bay and helps you to lead a happy and healthy life!