On a hot summer afternoon this year, Delhi-based Shanta Gosain came home early from office to find her house in a mess, her full-time househelp, Aparna, sleeping in a corner and her three-year-old son glued to the TV all alone. Her first instinct was to blow her head off at Aparna. At a calmer moment later, she asked Aparna, who had been with her family for almost two years now, what was wrong. Aparna complained of drowsiness that wouldn’t leave her all day, fatigue and persisting body ache. That same evening, Gosain took her to a doctor, who said that the 21-year-old was suffering from Vitamin D deficiency. The blood reports confirmed it. Three months of supplements, milk and healthy food, and Aparna was up and about. From a poor village in West Bengal, Aparna’s family could never afford a healthy diet for her. But that was not the only thing that made her vitamin D deficient. She hardly goes outdoors as she takes care of Gosain’s child when the latter is out to work and, therefore, her exposure to sunlight is minimal.
Ranchi-based Javed Akhtar, 55, often felt lethargic and tired, but never really noticed it. In his choc-a-bloc schedule, which started at 6 am and ended only about 8 in the evening, he had little time to waste over such “trivial matters”. “I realised something is wrong when I started getting infections almost every week. I was often down with a cold or a stomach infection and had become very irritable,” says Akhtar, who is a senior official in a government bank.
Cases of vitamin D deficiency are on the rise in India, across all classes. According to a research paper authored by Ritu G and Ajay Gupta, and published by MDPI, titled ‘Vitamin D Deficiency in India: Prevalence, Causalities and Interventions’ in Febriuary 2014, “Vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70-100% in the general population.” Another study by SRL Diagnostics, cited by various newspaper reports in March, found 84% of the Indian population having vitamin D deficiency.
The range of vitamin D levels in blood should be between 30 ng/ml and 100 ng/ml to be labelled as sufficient. Readings of 0 to 20 are deficient and 20 to 30 are insufficient. Above 100 is toxic.
The deficiency, at the stage when it has not led to any disease, is almost an epidemic, say doctors. “Vitamin D deficiency is pandemic, yet it is the most under-diagnosed and under-treated nutritional deficiency in the world,” according to the MDPI report. Though common symptoms include what Aparna and Akhtar felt, there are cases where the patients show no symptoms at all. “Vitamin D deficiency may be silent. Common symptoms are vague body pains, fatigue, general lethargy, joint pains etc. Bones and muscles are often found tender in such patients,” says Dr JP Manocha, senior consultant and head, orthopaedics, Sitaram Bhartia Hospital.
The deficiency can have devastating effects on our body. It can cause frequent infections, can aggravate certain conditions like diabetes, tuberoculosis and depression, and can even cause certain types of cancer, besides causing rickets among children. “Vitamin D deficiency can result in flattening\softening of bones, which in turn can cause deformities in children. This is most common among toddlers, who are in the process of learning to walk, are in the midst of rapid growth and need to exert a lot of pressure on their limbs,” says Dr Malik, adding that whole lot of new research has changed the way doctors have started paying attention to this aspect.
Two to three years back, the dosage was not as much as what the children are given now. “We now follow international standards and prescribe supplements from infancy,” says Dr Malik. When Seema (name changed), mother of six-year-old Mahi (name changed), saw her daughter sitting aloof even as kids of her age were creating a ruckus in the neighbourhood park, she dismissed it as Mahi’s introvert nature. She didn’t even notice Mahi had developed knock knees, which she thought certain kids naturally had, until a friend advised her to consult a doctor. She discovered later that Mahi was severely deficient and knock knees were a sign of the deficiency reaching an advanced stage.
Our sedentary life is a primary reason why we lose out on the sunshine vitamin, which is now being seen more than just that and as part of our general well-being. A typical day for a city dweller looks like this: home to car, car to office, office to car and back home or to a restaurant or mall. “To maintain the right vitamin D levels, our skin needs to be exposed to the sun for 30-45 minutes every day,” says Dr Malik. Applying copious amounts of sunscreen or wearing clothes that cover your body would nullify the effects of the sun, however. So, those too concerned about their skin tone have really something else to worry about.
That we are a dark-skinned race is also one of the reasons that India has such a high percentage of the population suffering from this deficiency. The high level of pigmentation in our skins doesn’t allow optimum vitamin absorption even when we are exposed to the sun. “Fair-skinned people are able to absorb vitamin D quickly as compared with dark skinned people. In India, therefore, even prolonged exposure to sunlight may not be enough,” says Dr Monica Mahajan, senior consultant, internal medicine, Max Healthcare.
By default, women are more prone, owing to frequent hormonal changes that they undergo. “For example, during menopause, the body ends up losing a lot of minerals. This deficiency is very common post-menopause,” says Dr Mahajan. Varanasi-based Neelam Shrivastava, 65, came all the way to Delhi to consult an orthopaedician because she is a patient of severe osteoporosis. She doesn’t remember since when has she been vitamin D deficient, but now she has an ever-present back pain, also the pain in her left ankle that broke a couple of years back is persistent even now. “Osteoporosis and osteopenia are bone diseases, and is common among older women,” says Dr Havind Tandon, senior consultant, orthopaedics, Apollo Hospitals.
Regular physical exercise is very important for the health of bones. “A morning walk, for example, will give you exercise as well as the requisite amount of sunlight,” he says. A healthy diet, including green leafy vegetables, egg yolk, fatty fish like salmon, is a must for patients. While sunlight exposure is a major factor, being predominantly vegetarian, Indians don’t even take the right food; even non-vegetarians do not eat meat more than twice a week, on an average. Dr Tandon feels the government needs to fortify dairy products with vitamin D like it did for iodine in salt.
While Gosain got her entire family checked for vitamin D levels, Seema has learnt never to take chance, and Akhtar never forgets to take time off to lounge in the sun on the weekends.