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Times of India
16 April 2010
Mumbai, India

It has traditionally been called the sunshine vitamin. Adequate exposure to sunshine means adequate vitamin D in the body, so went the old fundamental of health.

But vitamin D is now symbolic of a great Indian paradox: India, the land of plenty sunshine, is now home to a growing epidemic of vitamin D deficiency. The reason, say doctors, is the growing pollution across the country. “The pollutants screen the UV rays that are needed to come in contact with the skin to create vitamin D,’’ says endocrinologist Dr H Chandalia. Concurs Dr Shashank Joshi, consultant endocrinologist at Lilavati Hospital, “Not only do the UV rays get filtered out by the pollutants, the melanin on Indian skin further acts as a block against vitamin D.’’

Vitamin D, which is a hormone that controls bones by ensuring absorbtion of calcium, is now increasingly been viewed as the body’s immunomodulator. “If a person has a recurrent infection or even TB, a vitamin D deficiency could wreak havoc,’’ says Dr Joshi. In other words, if such a immuno-compromised person is given vitamin D supplements, his\her ability to fight the disease would be better.

Doctors started noticing the vitamin D paradox well over a decade back. “We would get people complaining of acute backache that would seem to have no particular cause. I started asking such patients to do a vitamin D3 test and sure enough, each of them had a vitamin D deficiency,’’ recalls Dr Chandalia. Now, the vitamin D factor is being analysed in the context of a list of diseases, including cancer and diabetes.

So, what could be the solution? Doctors believe fortified foods would be the only answer. Says Dr Joshi, “All milk in the US is fortified with vitamin D. Breakfast cereals are also similarly fortified.’’ The medical fraternity believes the government should make it mandatory to fortify foods.

Dr Chandalia says there is a need to increase the dosage of vitamin supplements. “The pharma industry seems to be still stuck on the old dosage of 400 units a day, while new recommendations say people need up to 800 units or more a day. Supplements should be prepared accordingly,’’ he adds.

Vitamin D Deficiency
The skin can make vitamin D when exposed to sunlight. But people with dark skin, older adults, obese people or with digestive disorders may not get enough vitamin D

In children, deficiency causes rickets where bones become soft and bend. In adults, it causes bone pain and muscle weakness. Adults who don’t get enough vitamin D and calcium can develop weak and brittle bones (osteoporosis)

Only a few foods have vitamin D. The best source is fatty fish like salmon, tuna, and mackerel. Beef liver, cheese, egg yolks, and mushrooms provide smaller amounts. One can get vitamin D from supplements or fortified food or milk

In adults, vitamin D at doses up to 2,000 IU is safe. In infants, up to 1,000 IU is safe

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