With this review, we aim to summarize the existing literature on Vitamin D status in India and understand the enormity of the problem. The prevalence of Vitamin D deficiency ranged from 40% to 99%, with most of the studies reporting a prevalence of 80%–90%.
Urban India is shunning the sunlight and in the process, grappling with an epidemic — a deficiency of Vitamin D. With or without symptoms, doctors are diagnosing almost every urban Indian with the deficiency of a vitamin that is manufactured in the body when the skin is exposed to sunlight. Vitamin D helps in the absorption of calcium and its deficiency can lead to bone diseases such as osteoporosis along with other muscle and nerve-related diseases. It also increases the chances of developing diabetes. Vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70%–100% in the general population. In India, widely consumed food items such as dairy products are rarely fortified with vitamin D. Indian socio-religious and cultural practices do not facilitate adequate sun exposure, thereby negating the potential benefits of plentiful sunshine. Consequently, subclinical 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. Fortification of staple foods with vitamin D is the most viable population-based strategy to achieve vitamin D sufficiency. Unfortunately, even in advanced countries like the USA and Canada, food fortification strategies with vitamin D have been only partially effective and have largely failed to attain vitamin D sufficiency. This article reviews the status of vitamin D nutrition in the Indian subcontinent and also the underlying causes for this epidemic. Implementation of population-based educational and interventional strategies to combat this scourge requires recognition of vitamin D deficiency as a public health problem by the governing bodies so that healthcare funds can be allocated appropriately.
A 2019 pan-India study found that 70-90 percent of Indians are deficient in the sunshine vitamin, and the deficiency can have adverse consequences for skeletal development in babies and children, and bone health in adults. The study was authored by diabetologist PG Talwalkar, and Vaishali Deshmukh, MC Deepak, and Dinesh Agrawal. It noted that the deficiency is linked to chronic diseases, including diabetes, hypertension, and cardiovascular disease. The study found that 84.2 percent of Type II diabetes patients were Vitamin D deficient, 82.6 percent of hypertension patients. It noted that there is no significant variation in deficiency levels across North, South, East, or West regions, with each reporting deficiency prevalence of 88 percent, 90 percent, 93 percent, and 91 percent respectively.
Dr. Sushila Kataria, Senior Director of Internal Medicine at Medanta The Medicity, Gurugram, agrees that vitamin D deficiency has been a long-prevalent issue in India anyway and that we should be vigilant about these levels throughout the year, lockdown or not. Dr. Kataria explains that in certain amounts of UV light, cholesterol in the blood gets converted into vitamin D, adding, “It acts like a hormone, helping in calcium homeostasis and, in turn, bone and muscle strength, as well as optimizing the nervous system.” There are two sub-sects of vitamin D: D2 (found in plants) and D3 (found in fatty animal sources). But Dr. Kataria says that it is difficult to find abundant sources of both in India, hence the need for fortified foods.
Mumbai-based Tanvi Dalal, the founder of WellNest Nutrition, recommends her clients to take multivitamin supplements, adding, “Many people, without testing their levels, assume they are eating a lot of vitamin D-rich foods, such as one piece of salmon for dinner or a whole bowl of cereal which is fortified with vitamin D. These portions are not enough; matching up to 800 IU is very tough. A can of tuna can claim to have 500 IU, but you will not eat the whole can, only two tablespoons most likely. For people, up to 70 years of age, between 600 to 800 IU of vitamin D is required, and the multivitamin covers this exactly, without going over or under.” Tanvi says it’s best to spend between 30 minutes and an hour on the balcony or terrace, between 11 am and 2 pm when the sun is at its nexus. The big key here is to not wear any SPF. Sunscreen-lovers may balk at such a suggestion, but Tanvi affirms that SPF will filter out your sunlight exposure and stop vitamin D production. If you are prone to sunburn, opt for shorter bursts through this period.
Both vitamin D and B12 deficiencies are related to depression and anxiety, especially at this time. Medically, before prescribing an anti-anxiety tablet, your doctor may check these levels, and prescribe a supplement along with psychotherapy. Spending at least half an hour in sunlight with exposure of face and arms is the minimum requirement to fight the deficiency apart from taking supplements that are mostly harmless. Infants should get exposed to the sun, at least 10 to 15 mins a day, which generates 10 to 20,000 Vitamin D units. Along with that, experts also suggest Vitamin D supplements until the age of 1 year depending on the condition to combat the deficiency. Zeljko Serdar, CCRES
