Vitamin D, also called the Sunshine vitamin, as the name suggests is photosynthesized in the skin on exposure to sun rays.
Due to the understanding of this fact, it was thought that Vitamin D deficiency occurs in areas where there are short days and severe winters. It was thought that in a tropical country like India, it would be less likely that people will have the deficiency of this Vitamin. But countrywide studies have reported Vitamin D deficiency all over India across north-south regions and eastern and western regions as more than 70%.
Cultural and social norms dictating lifestyle patterns such as clothing limiting the exposure of bare skin to sunlight; high rise apartment buildings, offices in urban areas providing very little natural sunlight exposure are some of the causes for inadequate vitamin D levels. People with darker skin complexion also require more exposure to sunlight for adequate vitamin D synthesis.
Increasing air pollution, lack of adequate outdoor places for children to play are limiting people wanting to get outdoors and are not helping the matter. More and more people wanting to have a fairer skin, covering the normally exposed areas like face and hands, which is the trend in urban areas now, are all limiting the adequacy of vitamin D in Indians.
Vitamin D deficiency is widespread throughout the nation, irrespective of diverse social and dietary practices.
The most well-known function of Vitamin D is the regulation of calcium and phosphorus metabolism. Without adequate 1,25(OH)2 D in the bloodstream, dietary calcium cannot be absorbed and this causes decreased bone density. In the long term, this leads to brittle bones (osteoporosis) that break easily. Vitamin D deficiency also leads to muscle weakness and increased risk of falls.
Vitamin D and other medical conditions
Vitamin D deficiency is associated with many chronic medical conditions including but not limited to Cardiovascular Disease, Type I and type II Diabetes, certain Cancers and increased risk of infections like Upper Respiratory Infections and Tuberculosis.
Vitamin D deficiency is often clinically silent with no symptoms. Symptoms can be generalized muscle aches. Diagnosis is made with measurement of serum 25 (OH) D which is the most reliable marker of vitamin D. It is measured as nanomoles per liter or nanograms per ml. Vitamin D deficiency is defined as having 25 (OH) D lesser than 20 ng/ml, insufficiency is defined as 20-29 ng/ml, sufficiency as more than or equal to 30 ng/ ml.
Replacement of vitamin D
Exposure to bright sunlight with at least face and upper extremities not covered for 45 minutes a day will help in synthesis of Vitamin D. Milk fortified with Vitamin D is a good source of Vitamin D.
Pressure cooking with short cooking times, baking in place of stovetop cooking can help preserve Vitamin D. Fatty fish, mushrooms and eggs, almonds and spinach (palak) are some dietary sources of vitamin D
Vitamin D supplements
Vitamin D supplementation is given to people who are deficient.
60000 IU of Vitamin D3 is advised by physicians, usually one sachet in a glass of water or 1 tablet every week for a short duration, for 4 to 6 weeks. It is important to take this with only doctor’s prescription to avoid Vitamin D toxicity.
For regular maintenance, multivitamin formulations are available in the market that contains Vit D 400 IU that can be taken with doctors’ advice. Calcium supplementation is generally recommended with Vitamin D supplementation.
All lactating mothers need to take the recommended daily allowance of vitamin D to prevent deficiency in exclusively breastfed infants.
Measures that can be taken
More Indians take a vegetarian diet which is poor in vitamin D. Food fortification is a practical and economically viable option for a country like India. Fortification of wheat flour, rice, lentils, and cereals with tightly regulated costs by the government is needed for India to prevent Vitamin D deficiency in Indian population.