The pandemic has made everyone realise the importance of maintaining their health. But exercising is not the only thing, one also needs to consume a balanced diet and ensure the body gets its daily dose of the various minerals and vitamins. While a balanced diet takes care of most of the requirements, vitamin D — essential for bone health — is something that the body cannot produce by itself and hence needs to be consumed externally — via the sun and supplements.
What is vitamin D?
Vitamin D is actually not a vitamin but a prohormone. This means that whether vitamin D is taken in the diet or from sunlight, it needs to be first transformed by the liver and kidney into an active form. So, it is not ready to use on consumption right away like other vitamins and minerals.
What is the normal level of vitamin D in the blood?
Levels of 20 nanograms/milliliter (ng/ml) to 50 ng/ml is considered adequate for healthy people while lower than 20ng/ml are a sign of deficiency. According to WebMD, avoiding sunlight, suffering from milk allergies, or adhering to a strict vegan diet, may put one at risk for vitamin D deficiency. Vitamin D is produced by the body in response to skin being exposed to sunlight. It also occurs naturally in a few foods — including some fish, fish liver oils, and egg yolks — and in fortified dairy and grain products, as per the site.
How does vitamin D deficiency manifest?
It manifests in the form of chronic headache, body pains, hair loss, and brittle bones which increases incidence of fractures and lowered immune levels with increase susceptibility to infection, said Dr Ritu Sethi, senior consultant, gynecologist, Cloud Nine Hospital, Gurugram, and Apex Clinic, Gurugram.
Causes of deficiency
The sun rays help in the absorption of vitamin D from the cholesterol underneath the skin, but since Indian skin is a “little darker in shade”, the process remains quite slow, said Dr Rajesh Kumar Verma, director, Orthopaedics and Spine Surgery, Narayana Superspeciality Hospital, Gurugram. “Secondly, majority of the Indian population has thinner skin; hence due to lesser cholesterol beneath the skin, there will be lesser absorption of vitamin D. Another reason is the geographical positioning of our country which doesn’t ensure enough vitamin D absorption, which is the case of many other countries as well,” he remarked.
Conditions
Covid-19
A study published in the Journal of Clinical Endocrinology and Metabolism found that 80 per cent of Covid-19 patients didn’t have adequate levels of vitamin D in their blood. As per the researchers who studied the data of 216 patients in a hospital in Spain, people who had Covid-19 and lower vitamin D levels also had higher inflammatory markers such as ferritin and D-dimer.
“People with vitamin D deficiency had a higher prevalence of hypertension and cardiovascular disease. They also had longer hospital stays for Covid-19,” the study showed, and the study author Dr Hans Konrad Biesalski, a professor at the University of Hohenheim, comorbidities such as hypertension, diabetes, and obesity are associated with low vitamin D status, as per Healthline.com.
Bone health
The commonly known consequences of Vitamin D deficiency are rickets in children and osteomalacia and osteoporosis in adults, as per a National Center for Biotechnology Information study. In children, it causes defective mineralization of bone due to imbalance between calcium and phosphorous in the bone, resulting in rickets and external skeletal deformity. It also causes muscle weakness and bone pain. Whereas in adults, inadequate dietary intake of vitamin D leads to poor absorption of calcium from diet and increased calcium resorption from the bone and kidney and reduces bone mineral density resulting in osteoporosis and osteomalacia, muscle weakness and increased risk of falls.
PCOS
As per Dr Nupur Gupta, director, Obstetrics and Gynaecology, Fortis Memorial Research Institute, Gurgaon, vitamin D helps to improve insulin resistance, reduce blood pressure and lower cholesterol levels in PCOS women.
Notably, fertility issues due to anovulatory cycles or irregular periods showed improvement after three months of Vitamin D supplementation. “Conception rate and IVF success rates were more in women who received vitamin D. The eggs were more healthy, cycles were regular and ovaries produced more mature follicles,” Dr Gupta added.
Vitamin D levels can manifest in conditions like PCOS. (Source: Getty Images/Thinkstock)
“The Institute of Medicine recommends 600 IU of vitamin D daily in women of reproductive age. We know there is no cure for PCOS but one of the most cost-effective measures is to measure your vitamin D levels and ease your PCOS symptoms. Reducing androgen levels, improving insulin sensitivity, regulating hormones, improving fertility, regulating weight and stabilising the inflammatory markers are some of the benefits that we know about vitamin D in women with PCOS,” noted Dr Gupta.
Diagnosis
Vitamin D adequacy is best determined by measurement of the 25-hydroxyvitamin D concentration in the blood. “People, especially women and the elderly, need to regularly screen for vitamin D deficiency through a pathological blood test and bone density test,” said Dr Akta Bajaj, senior consultant and head- Obstetrics and Gynecology, Ujala Cygnus Group of Hospitals.
Treatment
Treatment for vitamin D deficiency involves getting more vitamin D through exposure to the sun, diet, and supplements. “10 minutes exposure to sunlight can help the body make adequate vitamin D for a person’s needs. Also taking a diet rich in sources of vitamin D like fortified cereals, dairy products, mushrooms can help on keeping vitamin D levels in check,” said Dr Sethi.
As per Dr Sethi, a daily supplement of 600 iu is recommended with a maximum limit of uptill 4000 iu daily for vitamin D deficient women. “Keeping a healthy weight is also important for optimum vitamin D levels as obesity aggravates the deficiency,” said Dr Sethi.
Vitamin D is essential for health. (Source: Getty Images/Thinkstock)
Dr Bajaj added mentioned that besides sun exposure for 15-20 minutes 3-4 days a week, foods such as mackerel salmon, cheese mushroom, egg yolks, and fortified foods like breakfast cereals, orange juice, milk, soy drinks and mcgurrin are other sources.
Can you go overboard with vitamin D?
While one cannot go overboard with vitamin D from the sun or diet, overconsumption of vitamin D supplements may cause vitamin D toxicity or hypervitaminosis D. “Diarrhea, nausea, abnormalities in blood, frequent urination can be the symptoms,” said Dr Verma. The main consequence of vitamin D toxicity is a buildup of calcium in the blood (hypercalcemia), which can cause these symptoms.
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While you can take vitamin supplements, doctors advise that spending some early hours of the day under sun, can help your body absorb the vitamin. (Source: Getty/Thinkstock) 
Vitamin D levels can manifest in conditions like PCOS. (Source: Getty Images/Thinkstock)
Vitamin D is essential for health. (Source: Getty Images/Thinkstock)
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