CONTENT:

• Intro
• Vitamin D and its use:
• Deficiency:
• How much is required
• Vitamin D Food Sources:
• Sunlight comes to the rescue:
• Fortification:

Intro

Vitamin D is said to be “Sunshine Vitamin”. Since our interaction with sunlight has reduced very much due to COVID 19 lockdown and work from home, I decided to study about what should be done get enough Vitamin D. On reading, I found many (pre covid) studies speaking about Vitamin D deficiency spread across India (a study goes to extent of calling vitamin D difficiency to be “silent epidemic”). So I decided to share what I learnt from reading about vitamin D.

Vitamin D and its use:

• Vitamins are essential micronutrients required by the body in small amounts for proper functioning of the body. Vitamin D is a fat soluble vitamin (meaning it dissolves in fat). Vitamin D helps in absorbing calcium and phosphorous. Therefore, It is necessary for maintaining strong bones.

• An article by Harvard T.H. Chan School of Public Health says “Also, laboratory studies show that vitamin D can reduce cancer cell growth, help control infections and reduce inflammation. Many of the body’s organs and tissues have receptors for vitamin D, which suggest important roles beyond bone health, and scientists are actively investigating other possible functions.”

Deficiency:

• A 2014 Study says that “Vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70%–100% in the general population”.
• It also goes on to say, “vitamin D deficiency is highly prevalent in both urban and rural settings, and across all socioeconomic and geographic strata. Vitamin D deficiency is likely to play an important role in the very high prevalence of rickets, osteoporosis, cardiovascular diseases, diabetes, cancer and infections such as tuberculosis in India.”.
• If you are interested, take a look at Table 1 found in point 8 “Vitamin D Status of Ostensibly Healthy Indians” of the mentioned study, which lists data from various other studies on vitamin deficiency in India.

How much is required

Since I couldn’t find a recommendation by Indian government, I am listing down the details from recommendation of USA’s National Institute of health, Average daily recommended amounts are listed below in micrograms (mcg) and International Units (IU):

Vitamin D Food Sources:

Very few foods naturally have vitamin D. Sources include:

• Oily fish – such as salmon, sardines, herring and mackerel
• Cod liver oil
• Tuna fish
• Smaller amounts are found in egg yolks, cheese, and beef liver.
• Foods fortified (fortified meaning - process of adding micronutrients to food) with vitamin D

Sunlight comes to the rescue:

• Vitamin D production in the skin is the primary natural source of vitamin D. Vitamin D can be produced from cholesterol in your skin when it’s exposed to ultraviolet B (UVB) rays from the sun. But several factors affect how much vitamin D a person’s body can make from exposure to the sun, such as time of day, geographical location, skin color, and wearing sunscreen. So there is no fixed sunlight exposure time, required to produce enough Vitamin D for the day, it varies for everyone.

• In general, WHO website says, “There is no doubt that a little sunlight is good for you! But 5 to 15 minutes of casual sun exposure of hands, face and arms two to three times a week during the summer months is sufficient to keep your vitamin D levels high”

• A study done in Pune(India), concludes “western Indian men living in an urban setting at 18.5° N, with a dark skin (Fitzpatrick Type 5), over 1 h of casual sunlight exposure of the face, forearms, and hands (15% skin surface area) was required (between 11 AM and 3 PM, or scaled equivalent time), to get a minimum 1 SED-UVB dose and to maintain serum 25(OH)D concentrations above 50 nmol/L.” (the study considers having 25(OH)D concentrations above 50 nmol/L to be having sufficient level of vitamin D ).

• The study says one hour of sunlight is required, but do note that if more skin surface (i.e if more than face, forearms, and hands) is exposed, then probably less exposure time is sufficient. Also keep in mind that 11am to 3pm is said to be best time for sunlight exposure, because during the time period, UVB rays from sunlight is maximum. So if you are exposed to sunlight, other than this time period, then probably you might need more exposure time.

• Although applying sunscreen is considered essential during extended exposure to sunlight, it will block the UV rays and hamper the Vitamin D production. So in order to get enough vitamin D, it is better to apply sun screen after you have got the necessary sunlight exposure

• Catching the sun’s rays in a sunny office or driving in a car unfortunately won’t help to obtain vitamin D as window glass completely blocks UVB ultraviolet light.

• After reading this don’t be under sunlight longer than needed, because ultraviolet rays can cause skin cancer, it is important to avoid excessive sun exposure. So it is best to stay outdoors only for a limited time.

Fortification:

In absence of sunlight, either due to geographical location or due to winter season, you can rely on Vitamin D fortified foods (if available in your location). This world bank blog post explains the status of fortification in India,

• “India lags in adopting food fortification as a scalable public health intervention.”. “To fill that gap, NDDB partnered in 2017 with the South Asia Food and Nutrition Security Initiative (SAFANSI), the World Bank, and The India Nutrition Initiative, Tata Trusts to explore the possibilities of large-scale milk fortification in India. “

• “Over the last twelve months, this collaboration has enabled ten milk federations, dairy producer companies, and milk unions across the country to pilot milk fortification for their consumers. Fifteen others have initiated the process.

• A quick search in amazon shows only one brand, Nestle, offering Vitamin D fortified product, with 1 liter toned milk costing Rs 78 (at the time of writing). At this cost not everyone is going to buy the fortified milk. Although FAQ in FSSAI’s wesbite says “Fortification of milk is relatively inexpensive and affordable and costs less than 2 paise per litre.”, India seems to have a long way to go before it produces affordable Vitamin D fortified food.

• In absence of all the above vitamin D sources, one can opt for Vitamin D supplements after getting proper medical advise

Note: I have no medical background. Although I have done my best to provide you correct details as much as possible, Please do your own research and get proper medical advice before taking any decision regarding your health. This article is written only to create awareness regarding Vitamin D deficiency.

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