vitamin D deficiency
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Being born and raised in India, since the college days we read vitamin D deficiency is rare in tropical countries as we get it enough from sunlight. Yes, it was an issue for elderly who hardly go out in the sun or, for those who live in countries far from the equator. But who knows within the next 15 years vitamin D deficiency will become like an epidemic even in India and other southeast Asian countries? Everyone in affected – infants, kids, adults, old people.
Have you checked your vitamin D level recently? Most of the time it is not diagnosed or remain untreated. Do you know vitamin D deficiency may lead to obesity, diabetes, hypertension, chronic fatigue, osteoporosis, depression, Alzheimer, etc? It may influence all sort of health hazards that you can think of today.

Vitamin D deficiency is “an ignored epidemic”

About 1 billion people worldwide are suffering from vitamin D deficiencies.

50% of the world population have vitamin D insufficiency.

India and other southeast Asian countries are in an alarming situation.

In India, 90% of infant, 80% of adults and 96% of elderly people are suffering from Vitamin D deficiency.

So you are NOT alone. It’s an ignored epidemic situation which needs more attention rather than just popping supplements. (1,2)

Common signs and symptoms of vitamin D deficiency –

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Hair Loss –

Good bouncy hair is a dream for most of us. Before spending a fat amount on regular hair spa, treatment, expensive hair products or hair extension, check your vitamin D level. Studies have linked vitamin D deficiency with hair loss for female and also for the development of alopecia areata. (3,4,5)

Tiredness –

You may feel tired for multiple reasons. Studies show that a very low level of vitamin D can cause fatigue and extreme tiredness.(6,7)

Muscle pain –

As per the study, 71% of people with chronic pain found to have vitamin D deficiency. Studies suggest supplementation with a high dosage of vitamin D relieve various types of pain among people. (8,9,10)

Back pain –

People with a low level of vitamin D, experience lower back pain and pain in their legs, joints, ribs, etc. So if you often complain about bone pain it’s better to check your vitamin D level immediately. (11,12,13)

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Recurrent infection –

The lower level of vitamin D leads to compromise your immunity to a larger extent. The deficiency has been linked with recurrent cough and cold, lung infection, bronchitis, pneumonia, etc. Many studies have found that situation gets much better with supplementation.(14,15,16)

Delayed wound healing –

If it takes too long to heal the wound, you may think of checking your blood sugar level. Studies have linked vitamin D deficiency with delayed wound healing.(17)

Bone loss –

Do you know that vitamin D plays a major role in calcium absorption and bone metabolism? Yes, so instead of taking calcium supplements for improving your bone mineral density, first check your vitamin D level. (18)

Depression –

Studies have linked depression with vitamin D deficiency and some studies have shown that supplement helps to improve the mood. ( 23, 24)

Are you at risk of vitamin D deficiency?

Low level of vitamin D is common in all the age groups. The conditions where the chances get increased are-

  • if you mostly stay indoor (less exposure to sunlight prevent the synthesis of vitamin D in the skin)
  • if you don’t get much sunlight in your region (less exposure to sunlight prevent the synthesis of vitamin D in the skin)
  • if you always use sunscreen (it blocks UV rays to synthesize vitamin D in the skin)
  • if you are dark-skinned (melanin-the pigment in skin restrict the access of UV rays)
  • if you are overweight or obese (19)
  • if you don’t eat a balanced diet (if diet lack in dairy products, fortified cereal, fish, egg yolk, etc)

These conditions include 90% of us under the “at-risk” category. Thinking why? Let’s take a brief on absorption and metabolism process of vitamin D to understand what’s going wrong for you.

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How vitamin D deficiency is developed?

Vitamin D is also called the sunshine vitamin. It’s a fat-soluble vitamin which acts as a hormone. It regulates the function of 200 genes and essential for our growth and development.

The status of vitamin D in our body depends on the amount –

  • synthesized in the skin (usually, 50-90% of total pool come from the skin)
  • coming from dietary sources or supplements

There are two major forms of vitamin D –

1. Vitamin D2 (Ergocalciferol)- we get it from a plant source

2. Vitamin D3 (Cholecalciferol)- we get this from animal sources

Beside this, our skin contains 7-dehydrocholesterol in its thin outer layer (epidermis layer) which is a form of provitamin D3.

Note that none of these are the active forms of vitamin D which can perform the usual functions of vitamin D.

The active form of vitamin D is 1,25 dihydroxycholecalciferol.

There are few body parts/organs which are involved in absorption and converting the inactive vitamin D into its active form.

Involved body part What happen
Absorption of vitamin D3
Skin The ultraviolet (UV) rays of sunlight converts 7-dehydrocholesterol (pro-vitamin) to pre-vitamin D3. This pre- vitamin converts to vitamin D3 in next 2-3 days by further reactions.
Mid part of Intestine (Jejunum) Vitamin D3 from the dietary sources is absorbed in jejunum with the help of bile salt and release into blood
Metabolism of vitamin D3 to active vitamin D3 (1,25 dihydroxycholecalciferol)
Liver Vitamin D3 converted to 25 hydroxy vitamin D3. The circulating level of 25 hydroxy vitamin D3 – is the indicator of vitamin D nutritional status
Kidney 25 hydroxy vitamin D3 further converted to 1,25 dihydroxycholecalciferol. 1,25 dihydroxycholecalciferol which is the active hormonal form of vitamin D3.

Therefore to maintain the normal range of vitamin D in the blood, one needs to maintain –

  • sufficient exposure to the sun
  • a balanced diet
  • good gut health (intestinal health)
  • optimal liver and kidney functions
vitamin D deficiency 9

Test for vitamin D level

If you haven’t checked your Vitamin D level yet, you must consider checking –

25 hydroxy vitamin D blood test.

The normal range is – 20-50ng/ml

Deficiency indicates if the value is below 12 ng/ml

How to cure and prevent vitamin D deficiency

Popping supplement is NOT a solution. Self-prescribed medication is most dangerous. Please consider taking vitamin D supplements only after consulting your doctor. Yes, you may need it initially but ultimately you must fix the flaws in your lifestyle to prevent the recurrent deficiency.

Follow the 3 simple steps to improve the condition –

1. Get exposed to sunlight –

Air-conditioned vehicle, house, office has indeed put our selves in such a “cozy” environment that we keep seeking for an excuse not to go out in sun. The dangerous ultraviolet ray, skin cancer, hair damage, premature skin aging, etc are a very convenient excuse to stay indoors as much as possible.

No, I am not saying they are false. But the fact is you need UV rays to some extent at least to allow your skin to synthesize vitamin D.

Therefore you need to strike a balance between the two. A little bit of sun exposure is not an option but necessary for you.

1. Allow your kids to play outside under the sun, the way probably you had played in your childhood.

2. Anytime between 8 am to 4 pm allow yourself to get exposed to sunlight for about 20 mins to 1 hour for at least 3-4 days a week. Few studies recommend midday is the best time to get sunlight. (20)

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3. Do not completely cover yourself. Allow sunlight to touch your skin.

4. If you are dark-skinned then you need to stay more under the sun as skin pigment melanin prevent UV rays to act on the skin.

What are you thinking – more exposure to sunlight means more chances of skin cancer? No. the fact is the skin pigment melanin prevent UV rays to act on the skin for vitamin D synthesis, it also reduces the chance of skin cancer for dark-skinned people. Whereas white-skinned people get vitamin D synthesized fast but for long exposure, they are at the greater risk of developing skin cancer.So strike the balance.

5. Stop being obsessed with sunscreen. It’s great to leave your skin as it is for sometime under the sun. Sunscreen contains chemicals which either block or absorb or scatter sunlight and reduce vitamin D synthesis in the skin.

2. Focus on a balanced diet –

Vitamin D considered more as a pro-hormone than a vitamin. It can be synthesized in the body in adequate amount only by simple exposure to sunlight.

Most of the food has negligible amount of vitamin D. But still diet plays a major role in terms of absorption and metabolism of the vitamin D. Vitamin D get absorbed in jejunum – the middle part of the intestine and metabolized in liver and kidney – so diet which is beneficial for keeping kidney, liver, and gut-healthy should be considered.

vitamin D deficiency 3

Following dietary modifications are must for treatment and prevention of vitamin D –

1. Cod liver oil is one of the best sources of vitamin D. Other than this, butter, egg yolk, cheese, milk, shrimp, liver(lamb) provide some amount of vitamin D. Fortified bread, oil, cereals are considered as good source of vitamin D, however utilization of vitamins from fortified sources sometimes is a debatable issue.

2. Since vitamin D is a fat-soluble vitamin, it’s essential to have good fat in daily diet. Cold-pressed (kachhi ghani) oil, ghee(clarified butter), butter are the best source of good fat. Add little fat in the diet without any hesitation even if you are trying for weight loss. Please note- refined oil, reheated oil offers more damage than benefits.

3. Factors that affect gut health may also impact vitamin D absorption to a large extent. Excessive intake of fast food, ultra-processed food, food loaded with refined sugar, chemicals and preservatives damage the gut health and vitamin D absorption.

vitamin D deficiency 2

4. Homemade food, seasonal food, and fermented foods are best for maintaining gut health. Consume fermented foods like- idli, curd, buttermilk, kanji, panta bhat, sauerkraut, kombucha, homemade sun-treated pickle, etc regularly.

5. Add seasonal fruits and vegetables in daily diet. Consider drinking a glass of vegetable juice and 2 whole fruits a day – one citrus fruit (lemon/orange/musambi/amla etc) and any other seasonal fruit. Snack on fruits/ vegetable juices instead of packaged items. These are the best liver cleanser you can ever have.

6. Drink 3-4 liters of water without fail to keep your entire system clean. Remember plain water is the best detox drink.

7. Keep a balance on your carbohydrate and protein intake. Eat-in moderation. Include whole grains instead of refined flour. Eat a variety of pulses, milk, and milk products, sprouts, nuts and seeds in moderation but every day.

3. Exercise –

vitamin D deficiency1

It is evident that only eating a balanced diet is not enough until you work on associate factors to utilize the nutrients. The study suggests exercise helps to improve vitamin D absorption and metabolism. Therefore not only for weight loss, for avoiding the nutrients deficiency disorder, start doing exercise. Exercise helps to enhance your bone mineral density, strong bone and improve muscle activity. Instead of doing a particular type of exercise every day- bring variety to your routine – brisk walking, running, dancing, aerobics, swimming, yoga, strength training, etc.(21, 22)

Bottom Line

Vitamin D deficiency is a silent and ignored epidemic. But you must take the situation seriously. Taking supplements can help initially. But ultimately you need to work on the prevention aspects. Get exposed to the sun regularly, maybe for 30 minutes. Allow your kids to play outside. Avoid junk and eat a balanced meal. Enjoy outdoor activity rather than spending hours on scrolling phone. Start doing some exercise. Do whatever form you enjoy. Just do it.

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Dr. Soma Chakrabarty is based in Hyderabad. She has 15 yrs of working experience in nutrition. She guides people to modify eating behavior and achieve goals for wellness. She believes in a practical diet that helps people to live rather than survive.

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