Adverse effects of Vitamin D deficiency
Recent studies have revealed that more than 80 per cent people
in India suffer from Vitamin D deficiency. S Nandita, an ex-brand manager
and a freelance writer, gives an idea about the cascading effects of it and
how it can be overcome
it technology, economy or research, India is shining, but is it really? India
is located between 8.4 and 37.61N latitude, which ensures seven hours of sunshine
during the summer months and three to four hours during winters and is known
as the sunny country. Despite having plenty of sunshine, Vitamin D deficiency
is widely prevalent here. Vitamin D is produced from cholesterol when the skin
is exposed to sunlight.
However, recent studies have estimated that more than 80
per cent Indians have low 25 (OH) D levels and Vitamin D deficiency is prevalent
in most parts of the country, irrespective of people's age, socio-economic conditions
and education status1.
In rural areas, Vitamin D levels are better due to exposure to sun but dietary
calcium levels are poor, whereas in urban areas dietary calcium is better but
there is a deficiency of Vitamin D because a majority of people are working
from dawn to dusk in air conditioned offices and even during outdoor excursions,
pollution laden clouds and the use of sunscreens limit their exposure to the
Other contributing factors are consumption of foods rich in phytates such as
chapattis and legumes and less outdoor activity. Genetics and skin tone also
have a role to play in Vitamin D absorption too. Presence of increased 25 (OH)D-
24 - hydroxylase degrades 25 (OH ) D to inactive metabolises2. In addition,
social and religious customs that require people to wear concealing clothing,
veils and traditional attire, such as the burqa, salvar kameez significantly
prevents exposure to sun rays.
The large pool of data gathered from across India demonstrates
that Vitamin D deficiency is not restricted to the elderly or to the confined
but can strike individuals in the prime of their life and affect the quality
of life and the productivity 3,4.
When it comes to bone health, Vitamin D and calcium go hand in hand. In the
early stage of Vitamin D deficiency, human body adapts by increasing the parathyroid
hormone in the blood, which helps in maintaining the normal calcium levels and,
hence, the deficiency is not easily detectable. But in the long run, Vitamin
D deficit leads to bone resorption, a condition where the bone breaks down to
release of calcium in the blood. Vitamin D deficiency leads to lowered absorption
of calcium thereby leading to brittle bones, osteomalacia, rickets and persistent
non-specific muscular pain and speedy onset of osteoporosis and osteoarthritis.
It has always been known that Vitamin D is required for healthy bones. Over
90 per cent of fractures occur after a fall and fall rates increase with age
and poor muscle strength or function. Thus, the benefit of Vitamin D on both
fall and fracture prevention is of significant clinical importance. However,
this is just the tip of the iceberg. Vitamin D receptor is expressed in more
than 30 tissues and has a crucial role to play in transcription of several genes.
Vitamin D deficiency has also been shown to lead to immune disorders and may
be the precursor to malignancy. It is also said to play a role in wheezing disorders,
multiple sclerosis and mental problems.
It has been proven that a daily intake of 1200 mg of calcium and 800 IU of Vitamin
D can reduce the risk of diabetes. It improves insulin secretion and production
by the B-cells of pancreas and also affects secretion by increasing the intracellular
Increasing evidence points that it reduces the risk of heart disease by modulating
the heart's muscle shape and function. Vitamin D deficiency increases blood
vessel contraction and hypertension, as well as causes inflammation in arteries
leading to blockages.
A study conducted in 2006 mentions that Vitamin D deficiency was common in Indian
school children and when remedied medically, it led to significant increment
in height, bone mineral density and weight.
Vitamin D-rich diets include liver, eggs, oily fish, and fortified food, which
is not so far prevalent in India. Another study conducted in November 2011 has
reported Vitamin D deficiency in healthy Indians above 50 years in northern
part of the country5.
Another study has reported requirement of 60,000 to 1,20,000 IU per month to
achieve Vitamin D level > 30 ng/ml; the level is considered to be sufficient.
When the crisis is so widespread and a cascade of problems has been predicted,
it is time for the government to 'see the light' and take drastic measures.
As in countries like the US, Vitamin D fortification should be undertaken on
a large scale, on the lines of salt iodinisation.
Opportunity for the pharma industry
Vitamin D has important implications in the therapeutic aspects of disease processes.
Vitamin D supplementation may be the route to defeat not only bone problems
but a host of other anomalies. While food fortification is one way, supplementation,
whenever necessary, is definitely called for. This opens up a great new opportunity
for the pharma industry too.
The vitamins, minerals market is increasingly throwing up these new opportunities.
From a generalised supplementation for debility, condition specific uses are
emerging. And with prevention becoming as important as treatment, the industry
is certainly looking forward to it.
1. J Assoc Physicians India 2009;57:40-48.
2. Clin Endocrinol Metab 1998;83: 169-173.
3. Indian J Med Res 2008;127:239-244.
4. Osteoporos Int 2005;16:397-402.
5. J Assoc Physicians India 2011;59: 703-707.