Dr M.K. Mam
Lot many patients that include children, young adults to elderly present with the complaints of body aches and pains, feeling tired and exhausted, and we know there are lot many causes for that.
When we work them out, get various laboratory tests done, most often we find that the vitamin D level is low. Vitamin D is important for overall health of bones. It helps in absorption of calcium and phosphorus from the small intestine and maintains adequate serum calcium and phosphate concentrations to enable normal mineralization of bone.
Diet and Vitamin D: Some food items like fish especially salmon, cod liver oil, dairy products cheese and yogurt have some amount of vitamin D. It is present in small amounts in meat, milk, egg yolk and vegetables. It has been reported that the amount of vitamin D in the fish decreases by 50% when it is fried, however there is little change if we just bake it. Our dietary sources usually fall short of the requirements of vitamin D, so this has to be taken care of by supplements and the foods like milk and cereals which are fortified with the vitamin D. Malnutrition and under nutrition is one of the major problems in most of the developing countries especially in children as such it is but natural that people will have deficiency of important nutrients which include vitamin D, calcium etc.
Lack of awareness: There is certainly a lack of awareness in the people about vitamin D. Educating the people and making them aware of the importance of vitamin D, having a balanced diet with all the essential nutrients including Vitamin D and calcium.
An epidemic of vitamin D deficiency: It has been observed that vitamin D deficiency prevails in majority of people all over the world, in all strata of people and in all ages and various factors are responsible for it.
Modern life style : With change of life styles to mostly indoors and the overall increase in urbanization and industrialization, we hardly go outdoors. Most of the people in urban areas live and work indoors, so there is very little or no direct exposure to sun. Same is the case with children and the youngsters, who hardly move out or play outdoor games and spend most of their time indoors hooked to mobile phones, iPods and other gadgets.
Sun phobia: Most of the people especially ladies and the children do not like to sit in the sun, as they are simply scared of some of the ill effects of the sun like- losing the fair color of the skin, aging spots and at times getting skin cancer. Whenever they go outside even for a short while, they make sure to apply sun screen with the result whole purpose is lost. Concern about the risk of skin cancer is certainly there and the risk is much more in persons with fair skin as compared to dark skinned people where dark pigmentation protects against skin cancer.
Atmospheric pollution: Air pollution has certainly increased over the years and it does reduce the amount of UVB rays reaching down to us as compared to clean air, so vitamin D formation decreases.
Dietary habits: Our dietary sources usually fall short of the requirements of vitamin D. The children and the youngsters nowadays have preference for all sorts of junk foods, soft drinks etc. and are averse to taking milk and its products, fresh green vegetables and fruits, with the result end up with vitamin D and calcium deficiency.
Excess vitamin D: Vitamin D toxicity is not so common but is a potentially serious condition .It is usually caused by high intakes of vitamin D supplements for several weeks especially when taken as injections and not by diet or excessive sun exposure. Vitamin D toxity can cause non-specific symptoms such as poor appetite, nausea and vomiting, frequent urination, weakness, weight loss and kidney problems. Calcium level in the blood rises and it gets deposited in soft tissues with subsequent damage to the heart, blood vessels and kidneys.
Vitamin D and extraskeletal health: The role of vitamin D in maintaining the bone health is very well established, however lot of research has been going on to know about its role in various physiological functions other than that of the bone. These are evidences that vitamin D is a modulator of immune system and its deficiency can impair immune function, resulting in an increased risk of autoimmune disease. Studies have shown that vitamin D reduces the risk of several infectious diseases- both bacterial and viral e.g. acute respiratory tract infections and influenza. There are reports that suggest that vitamin D does has a beneficial effect on the cardiovascular system and lower vitamin D levels are associated with higher risk of cardiovascular disease. It has also been reported that people with higher vitamin D level have a lower risk of developing type 2 diabetes than those with lower levels of vitamin D. Several studies have also shown that the people with a good level of vitamin D have a lower risk of developing cancer of colon, breast and prostrate. However, most of the evidence for these benefits provided by various studies is inadequate and one cannot determine a cause-effect relationship between vitamin D deficiency and the diseases except in rickets and osteomalacia. There are also studies where the evidence has been mixed or little to support these health benefits. As such, lot of debate and research is going on to further elucidate the role of vitamin D in the extra skeletal health, however well designed large scale controlled clinical trials will certainly offer more definitive answers in near future .
To summarize vitamin D is very important for bone health and its deficiency is very much prevalent all over and in all age groups. Adequate and proper exposure to sun, intake of diet rich in vitamin D with supplements when needed and educating the people about the importance of vitamin D will certainly help in circumventing its deficiency thus improving bone health.
(The author is formerly Vice Principal, Prof. & Head of Orthopaedics, CMC, Ludhiana)