HEALTH SPECIAL ..................Aint no sunshine and you're gone

Aint no sunshine and you're gone   As many studies associate heart disease, dementia and cancer with Vitamin D deficiency, steady sunlight might just be the best precaution Spine surgeon Dr Kedar Deogaonkar's consulting room at P D Hinduja hospital at Mahim is crowded with patients complaining of severe body aches, weakness and depression. He sends them for a blood test and more often than not, his doubts are confirmed -they suffer from Vitamin D deficiency. “Vitamin D is critical for strong bones, right from infancy to old age. If the body isn't producing enough of this vitamin, its deficiency can cause tired bones and depression, both of which are common symptoms among youngsters today. With schedules being so erratic, there is little or sometimes no time to breathe, let alone time to walk out in the mornings,  which is the best way to produce Vitamin D,“ says Deogaonkar. Known as the sunshine vitamin, Vitamin D is a prohormone, which gets converted to Calcitriol in our body, primarily in the kidneys. The main function of this vitamin is to facilitate the absorption of dietary calcium from the intestines. The vitamin is produced by the body when exposed to sunlight. “Few foods are rich in the vitamin, but they are mostly animal sources including a few species of fish, fish liver oils and egg yolks,“ says Dr Sweety Mandot, a dietician at Bhatia Hospital. While fortified grains and cereals too may have Vitamin D, it may or may not meet the daily requirement. “That's also why most vegetarians (especially Jains) are detected with Vitamin D deficiency,“ adds Mandot. Vitamin D deficiency leads to weak bones and muscles, causing osteomalacia and osteoporosis.“This leads to an increased risk of falls and fractures. A person can also become more prone to infections due to a decrease in immunity. Many trials have shown a relationship between vitamin D deficiency and increased risk of cardiovascular diseases, diabetes and certain cancers,“ says consultant physician Dr Sharat Kolke, who specialises in internal medicine and diabetes. TRIO LINK Experts point out that Vitamin D and calcium deficiency are often confused with each other.“While Vitamin D deficiency is associated with calcium deficiency, the two need not co-exist,“ says Kolke. That's why it's imperative to get to the core of the deficiency to prescribe a solution. “First, find out if it is lifestyle-related or dietary-linked and then a treatment should be charted. Sometimes, a vitamin Dd deficiency could be due to low level of calcium or phosphate too,“ says Mandot. DON'T SHUN THE SUN If you suffer from Vitamin D deficiency, improving your dietary intake alone cannot suffice. You have to rely on its major source, the sunlight. Dr Kolke advises, “Exposing yourself -including your face, bare arms and legs -for about 45 minutes from 11 am to noon should do the trick“. But there are several factors to keep in mind before stepping out, warn experts. “Like pollution. Or, the angle at which the skin is exposed to the rays. All these things matter,“ says Deogaonkar. Sunscreen lotions reduce the body's ability to absorb Vitamin D by more than 90 per cent.Moreover, Ultraviolet B (UVB) rays, which help the skin produce vitamin D, are stronger near the equator and weaker at higher  latitudes.“If basking in the sun isn't an option, increase the intake of foods containing or fortified with Vitamin D. Or else, have a doctor prescribe supplements for you,“ says Mandot. Melanin, the pigment that gives our skin, hair, and eyes its colour, also plays a role in Vitamin D absorption. Dark skin means more melanin, less absorption of the sun's rays and, therefore, less production of Vitamin D. In such cases, Deogaonkar suggests relying on food and supplements. Doctors recommend undergoing a simple blood test to check your vitamin D levels. While in India, there are no set guidelines, the Institute of Medicine, USA has set a blood level of 20 nanograms per milliliter (ngmL) as the parameter for good bone health and overall health. Some doctors debate this number, thinking it should be about 30 ngmL to enjoy all the health benefits of Vitamin D.“Supplements can be had for up to three months, post which if the Vitamin D levels increase, the intake must be stopped,“ says Deogaonkar. WHO NEEDS D? Although multiple studies have shown the link between heart diseases, diabetes, dementia and cancers with Vit D deficiency, more robust data is imperative to prove the role of Vit D in prevention of these diseases. “Considering these facts, the only people who may need regular testing for vitamin D deficiency, and supplementation, are those with malabsorption problems like Celiac disease, those who have had bypass surgery, or those who have already had fractures and have been diagnosed with osteoporosis.People taking certain medications, including treatment for tuberculosis, may also need to consider vitamin D pills,“  says Dr Kolke. THE CLEAR WINNER While no trials have been conducted to compare morning or afternoon walks with supplements, most doctors prescribe the former. “Patients who are symptomatic and have been detected with the deficiency can be given Vitamin Supplements of 600 IU to 1000IU day life-long. Healthy individuals without any symptoms and mild insufficiency need not opt these. A healthy diet thats rich in Vit D should suffice. Vit D toxicity, on the other hand, can occur in people taking high doses of 10000 IU or more per day and can lead to increased calcium levels in the blood. Its deposition in various body tissues can cause kidney damage, kidney stones, hypertension and muscle weakness,“ warns Kolke.

         

Nasrin Modak Siddiqi

19OCT15