Researchers and scientists the world over are ringing alarm bells about the newest silent killer — Vitamin D deficiency. In India, 90% of the total population suffers from either deficiency or insufficiency of this vitamin. Rickets, brittle bones, back pain and cardio problems are associated with this deficiency. Doctors talk about serious conditions such as prostate cancer, bone fractures, paralysis and even mental problems that are on the rise due to Vitamin D deficiency. Deebashree Mohanty tells you more about this epidemic
According to Dr Babita Singh, consultant, Bone Health clinic and former medical examiner of PGIMER, in the last six months, around 200 people were tested for Vitamin D levels. “Ninetynine per cent reported to have less than the required Vitamin D levels. A significant number of the entire population, one can say more than 80 per cent of the people, are suffering from vitamin D deficiency. Around 40% of these are young adults in the age group of 15-30 years. Infant skeletal deformities due to this deficiency is also on the rise with more than 10 per cent infants being treated in Delhi alone. Every year, 15-20 patients die indirectly because of this deficiency and the number is set to rise. This is a silent killer, much more lethal than diabetes and other profound conditions because we are not prepared to handle this. It is time to ring the alarm bells,” Dr Singh tells you.
Ankita Chaubey (name changed), a resident of Samachar Apartments, Mayur Vihar, aspired to be a writer well on course when suddenly tragedy struck. A week before her biggest break at a leading book publication, Chaubey came down with a viral and was advised multiple blood tests, including Vitamin D. Much to everyone’s surprise, her Vitamin level was below 20ng/ml but they first wanted to treat the viral. In the next few weeks, Chaubey developed complications like abdomen and back pain, severe headache and constant nausea. She fainted on her first day at the job and was rushed to Apollo Sarita Vihar. The doctors informed her that she suffered from multiple bone deformity in her brain and would require immediate surgery.
“Today, she finds it difficult to talk at length, can seldom finish her own task, needs help to use the washroom and eat food. Chaubey went to work only for one day. After that surgery, she never could recover from the after effects and had to let go of many opportunities. Still she is happy that she is alive,” Dr Shashikant Dubey, orthopaedetrician at Holy Family hospital,says. Dr Dubey has been treating Chaubey ever since the operation and she tells you how the ‘gritty woman’ takes each day as it comes. The doctors at Apollo said dangerously low vitamin D levels should never be neglected as they can indirectly cause a paralysis or even death.
Popular endocrinologist Dr Shashank Joshi from lilavati Hospital in Mumbai has done several studies on both hypertension and Vitamin D deficiency and he feels there is a strong link between the two. According to him, there are over 200 Vitamin D receptors in the body. Previously, doctors thought that Vitamin D only affected skeletal aspects of the body. But that is no longer true. “It is only now that the world is learning that it is connected to the body's entire metabolism. Vitamin D has a link with metabolism of glucose, maintenance of blood pressure as well as acceleration of heart diseases. And hence deficiency and toxicity must be taken very seriously. It is a lethal problem,” Joshi insists.
Scientists and researchers agree that the problem is not easy to solve as deficiency in Vitamin D doesn’t only affect bone health and give rise to complications. It can take a life as well. “There are many implicit problems associated with this deficiency that we are not aware of. Globally, doctors are trying to find out a co-relation between this kind of a deficiency and hypertension. They have also been able to successfully link cardio vascular problems and prostrate cancers to severe deficiency in the Vitamin D level,” Dr Das from SRl Diagnostics centre in New Delhi, says. It may be a global point of concern but the Indian statistics gathered in a recent study by SRl Diagnostics pose a real threat.
According to this study, a total of 37,010 patients screened for serum Vitamin D levels were enrolled. Out of a total of 37,010 patients, there were 13,308 men (35.9%) with the mean age of 46 and 23,702 women (64.04%) with the mean age of 45 who were diagnosed with vitamin deficiency and insufficiency. While 61% of the population in North India had Vitamin D levels dangerously below the normal mark, there were 68% in the south, 67% in the east and a whopping 69% in the west that were suffering from this deficiency.
But, how are people suffering from Vitamin D deficiency in a tropical country like India where there is sunshine in abundanceIJ “Vitamin D is synthesized when the sun’s ultraviolet rays fall on the skin. But the high melanin pigment in the Indian skin deters it. So, even a hot and sunny India has high levels of deficiency. Some studies say, every second Indian is affected, others peg it higher, at eight out of every 10 Indians. The deficiency is worrying as it’s linked to a range of diseases — from bone problems to cancer,” Dr Joshi points out, adding that apart from sunshine even green vegetables are considered a good source for Vitamin D. “However, we are eating all unnaturally grown vegetables and don’t get the benefit of the Vitamin from them,” he tells you.
Dr Hemant Thacker from Jaslok Hospital, Mumbai blames the smog-filled environment in cities for poor Vitamin D levels too. “We don’t get adequate exposure to sunlight because we travel in cars and buses and don’t come out even during weekends. Children watch TV instead of playing football in the ground, but Vitamin D deficiency isn’t only about paucity of sunlight. The quality of sunlight plays an important role. A part of the ultraviolet radiation needed by the body to make Vitamin D, is filtered out by the smog. This is a leading cause for deficiency,” Thacker said.
For some doctors, Vitamin D levels dictate outcomes of ICUs as well. A study done by Thacker showed that patients with lower levels of Vitamin D were more susceptible to infections than patients with normal levels. “We have seen it in many patients with post operative procedures. If they have a sustainable Vitamin D level, they tend to recuperate faster. But many of our patients who have had a successful surgery succumb to a low vitamin level condition. In one out of 20 cases, we are unable to save the patient,” Thacker reveals.
Vitamin D deficiency, however, is not a new phenomenon but its co-relation with other widespread and lethal diseases makes it a silent killer. Researcher Vimal Karani’s work at the University College of london conclusively proves that low Vitamin D levels can send blood pressure soaring. Karani looked at 35 studies, covering 1.5 lakh people across Europe and North America, and found people with high concentrations of 25-hydroxyvitamin D (25(OH)D) had lower blood pressure and, therefore, a reduced risk of hypertension. A prehormone, 25-hydroxyvitamin D or calcidiol, is produced in the liver when Vitamin D3 is synthesised (a blood test to determine its levels is also an indicator of Vit D levels). The study found that for every 10% increase in 25(OH)D concentrations, the risk of developing hypertension decreased by 8.1%.
Talking about India, where every fifth adult suffers from hypertension, the study has severe implications. “The association of lower levels of Vitamin D and high blood pressure can, in part, be associated with increasing number of hypertensives in India,” Delhi-based Dr Anoop Soni pointed out, adding that “we know that salt, smoking, obesity and heredity are the causes for hypertension. We can, at best, consider Vitamin D deficiency as a fifth contributor,” he tells you.
The theories about Vitamin D deficiency and its various implications have gained importance in the past decade. One reason could be easy availability of diagnostic tests. “When we started offering the test about 15 years back, we would get 5 to 10 cases a month but now this has become a regular test in every blood report. It is treated as a compulsory test and proper analysis is done on this part. Several hospitals also offer counselling if the patients vitamin levels are dangerously below the 20ml mark.” Dr Das tells you. His laboratory performs 1,500 tests a month.
Experts say a way of tackling this widespread deficiency would be to chart out a public health policy. “The Government should look at solutions like fortifying milk with Vitamin D as is done in the US and Europe could be a good starting point,” Das concludes.
Foods to take
Point taken
Treatment
Get the right amount of sunlight: According to experts, 20 minutes of good exposure, two to three times a week, with bare arms and face, is enough to achieve healthy Vitamin D.
Overcome obesity: Work out, exercise or simply walk. It is essential to burn those fat cells that absorb the Vitamin and let your body regain the effect of the sun. The right diet and outdoor activity would help you regain the Vitamin D levels in your body.
Pay attention: Consume foods rich in Vitamin D and calcium like salmon, sardines, eggs and meat, breakfast cereals, soy products, dairy products and low-fat spreads in your diet.Say no to sunscreen lotions: It is best to leave one's skin in its natural form. Most sunscreen lotions have chemicals which can harm your skin anyway. So best to avoid.
Make simple lifestyle adjustments: Go for outdoor activities and make it a habit of going to parks regularly. Take a multivitamin every day to fill in any nutritional gaps.
Regular check-ups: If you think you may be suffering from Vitamin D deficiency, get a blood test done.
— Compiled from various sources
Vitamin D is synthesised when the sun's ultraviolet rays fall on the skin. But the high melanin pigment in the Indian skin deters it. So, even a hot and sunny India has high levels of deficiency. Some studies say every second Indian is affected, others peg it higher, at eight out of every 10 Indians