VITAMIN D DEFICIENCY

 

For all those who love to fall in the trap of whole body check-up that is offered by corporate hospitals, and all those who have an insurance policy that takes care of a bunch of pathology investigations, whether you need them or not, finding low levels of Vitamin D in your system is one of the commonest finding in urban India. This is true, there is a very good chance that we don't get all the Vitamin D we need. Just to soothe your nerves let me tell you that  about 42% of American adults are deficient in this vitamin too. So, what is going on? And, why should we be concerned?

 

Being deficient in vitamin D is associated with a number of health concerns including risk for Alzheimer's disease, diabetes, osteoporosis and heart disease.  Add to that, if you have been diagnosed with breast or prostate cancer, your chances of survival may be lower than someone with normal levels of vitamin D. This may sound alarming, though it shouldn't come as a surprise. After all, vitamin D isn't found in too many foods - with the exception of salmon and fortified milk and yogurt. The only other way to get the nutrient, is to expose your bare skin to the sun. But if you work indoors all day, this is highly unlikely. 

 

Why is Vitamin D important?

Vitamin D plays a crucial role in maintaining the balance of calcium in our blood and bones and in building and maintaining bones. More specifically, we need vitamin D so our body can use calcium and phosphorus to build bones and support healthy tissues.

With chronic and/or severe vitamin D deficiency, a decline in calcium and phosphorus absorption by our intestines leads to hypocalcemia (low calcium levels in our blood). This leads to secondary hyperparathyroidism (overactive parathyroid glands attempting to keep blood calcium levels normal). Both hypocalcemia and hyperparathyroidism, if severe, can cause symptoms, including muscle weakness and cramps, fatigue and depression.

To try to balance calcium levels in your blood (via secondary hyperparathyroidism), our body takes calcium from our bones, which leads to accelerated bone demineralization (when a bone breaks down faster than it can reform). This can further result in osteomalacia (soft bones) in adults and rickets in children. Osteomalacia and osteoporosis put you at an increased risk for bone fractures. Rickets is the same as osteomalacia, but it only affects children. Since a child’s bones are still growing, demineralization causes bowed or bent bones.

 

Who are at risk of Vitamin D Deficiency?

The best way to discover whether you are deficient in vitamin D is to take a blood test. Your levels should be between 45 to 50 µg/mL. So, who all should get tested for Vitamin D levels in blood? This is something you may want to consider if you form part of these groups:   

1. You are over 55. As we age, we tend to become less mobile, making it difficult to spend time outdoors, which would result in getting less vitamin D. In addition, ageing skin cannot synthesize vitamin D as efficiently. In fact in hospitalized adults with hip fractures often have have low levels of vitamin D in their blood. So, you're likely falling short on the nutrient unless you are taking a daily supplement. 

2. You work indoors, in an office. Working a 9 to 5 job would mean that you don't get much sun. Urban people with occupations that limit sun exposure are unlikely to obtain adequate vitamin D from sunlight. This makes supplementation and a smart diet key to staying healthy. Rural people who work in farms and fields get their share of Vitamin D and may not require supplementation.

3. You have dark skin. There are lower levels of vitamin D in those who are dark in complexion. This is because darker skin makes it more challenging for the body to produce vitamin D from sunlight. If you're darker skinned, you should rely on dietary sources of the nutrient, rather than sunlight to reach your daily vitamin D mark. So, you may not require Vitamin D if you are a Kashmiri, but will surely require if you are from the southern states.

4. You suffer from inflammatory bowel disease.  Vitamin D is a fat-soluble vitamin, this means its absorption depends on the gut's ability to take in fat. Fat malabsorption is associated with inflammatory bowel disease (IBD) - this includes conditions like Crohn's disease and ulcerative colitis. In fact, it has been shown that up to 70% of people with IBD have insufficient vitamin D levels, according to a Journal of Gastroenterology and Hepatology report. If you suffer from IBD, speak to your doctor and check whether you are getting enough vitamin D. 

5. You have a high body fat percentage. If your body mass index (BMI) is over 30 or you have a high body fat percentage, it may be more challenging for vitamin D to circulate throughout your body. Nevertheless, this doesn't mean that you will always be deficient. Be sure to speak to your doctor and find out just how much vitamin D you will need.

6. You are taking certain medications. Steroids such as prednisone, as well as weight-loss drugs like orlistat, and the cholesterol-lowering drug cholestyramine can impair vitamin D metabolism. Similarly laxatives, anti-epileptic drugs – Phenobarbital and phenitoin, and anti-tubercular drug Rifampicin also cause Vitamin D deficiency. If you take any one of these drugs, be sure to check in with your doctor to find out the best way for you to get the right dose. 

7. You suffer from depression. Did you know that people with low levels of vitamin D in their blood are more than twice as likely to be diagnosed with depression, than those with higher levels? Medical experts aren't sure why this is the case, however one hypothesis is that the vitamin may alter hormones and areas of the brain that affect and regulate mood. 

8. You suffer from chronic headaches. If you suffer from regular headaches, low blood levels of vitamin D may be to blame. The specific link between headaches and vitamin D remains unclear, researchers believe the nutrient may help combat the inflammation that causes migraines and headaches.

9. Weight loss Surgery. Those undergoing bariatric surgery are doing to suffer from a surgery induced malabsorption to reduce calorie intake. Vitamin D supplementation becomes vital in such situations.

 

How do we treat Vitamin D deficiency?

The goals of treatment and prevention for vitamin D deficiency are the same: to reach and then maintain an adequate vitamin D level in your body. While you might consider eating more foods containing vitamin D and getting more sunlight, your healthcare provider will likely recommend taking vitamin D supplements.

Vitamin D comes in two forms: D2 and D3. D2 (ergocalciferol) comes from plants. D3 (cholecalciferol) comes from animals. You need a prescription to get D2. D3, however, is available over the counter. Your body more easily absorbs D3 than D2.

Work with your doctor to find out if you need a vitamin supplement and how much to take, if needed. Exposure to sunlight is vital. But be careful about being in the sun for too long without sunscreen. Excessive sun exposure puts you at an increased risk for skin cancer.

The amount of vitamin D you need each day depends on your age. The average daily recommended amounts are listed below in micrograms (mcg) and International Units (IU).

Age / Life Stage	Recommended Amount
Infants up to 12 months old	10 mcg (400 IU)
People 1 to 70 years old	15 mcg (600 IU)
Adults 71 years and older	20 mcg (800 IU)
Pregnant and breastfeeding people	15 mcg (600 IU)

 

Source of Vitamin D

There are a few foods that naturally have some vitamin D, including:

• Fatty fish. such as salmon (Rawas), tuna (Kera) and mackerel (Aila / Bangada) and sardines (Tarli)
• Mushrooms.
• Egg yolks.
• Cod liver oil.

You can also get vitamin D from fortified foods. Be sure to check the nutrition labels to find out if a food has vitamin D. Foods that often have added vitamin D include:

• Cow’s milk and soy, almond and oat milk.
• Breakfast cereals.
• Orange juice.
• Other dairy products, such as yogurt.

Vitamin D is in many multivitamins. There are also vitamin D supplements.

 

Vitamin D is a nutrient we need for good health. It helps our body absorb calcium, one of the main building blocks for strong bones. Together with calcium, vitamin D helps protect us from developing osteoporosis, a disease that thins and weakens the bones and makes them more likely to break. Our body needs vitamin D for other functions too. Our muscles need it to move, and our nerves need it to carry messages between our brain and our body. Our immune system needs vitamin D to fight off invading bacteria and viruses. So, knowledge about this vitamin and awareness about its insufficiency and how to manage it becomes vital.