Introduction

Vitamin D is an essential factor, not only for homeostasis of calcium and phosphorus but also for cell proliferation, differentiation and apoptosis, immune and hormonal regulation as well as other body processes.

Vitamin D also known as the sunshine vitamin as it is produced by the body in response to sunlight. It occurs naturally in a few foods including some fish, fish liver oils, and egg yolks and in fortified dairy and grain products.

Where to get vitamin D

The principal source of vitamin D is forming our own skin. A chemical compound called 7-dehydrocholesterol, naturally present in the superficial layers of the skin, is converted, on exposure to ultra violet B (UV-B) radiation, to a compound called pre vitamin D, which spontaneously changes in to cholecalciferol (vitamin D3). Small quantity of vitamin Dis also available in food, but unlike the other vitamins most foods do not contain appreciable amount of this micronutrient,.

There are two forms of vitamin D, known as D2 and D3

Vitamin D2, also known as ergocalciferol, comes from fortified foods, plant food, and supplements.

Vitamin D3 also known as cholecalciferol comes from fortified foods, animal foods (fish eggs and liver) and can be made internally when skin is exposed to ultraviolet radiation from the sun.

Vitamin D deficiency is common in India more than 90%of apparently healthy Indians have sub-normal vitamin D levels. The prevalence of vitamin D deficiency or insufficiency is very high in iron deficient women. this means that it is stored in our fat cells and is constantly being used for calcium metabolism and bone remodelling .if your exposure to sun is less suffer from milk allergies or adhere to a strict vegetarian diet you may be at risk for vitamin D deficiency .

Vitamin D deficiency & its prevention from tracking to treatment, prevention and relief.

What is active vitamin D?

The body converts vitamin D, whether taken orally or synthesized in the skin, to a compound called 25-hydroxyvitamin-D (0Hd). The body converts up to 100mg of 25(oh)d each day in to a further compound called calcitriol, which is the active form of vitamin D that help the body to signal the decoding of dna blueprints for over 200 human genes.

Health maintenance and vitamin D

Vitamin D promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentration to enable normal mineralization of bone and to prevent hypocacemic tetany. It is needed for bone growth and bone remodelling by osteoblasta and osteoclast .

Vitamin D sufficiency prevents rickets in children and osteomalasia in adult. Together with calcium, vitamin D also helps to protect older adults from osteoporosis.

Causes

• Latitude, culture dress habits, season, sun avoidance, and sunscreen protection all limit vitamin D production
•  Gastrointestinal hepatic and renal disease may be related to low vitamin D levels
•  Hypo vitaminosis D results from lack of UVB exposure.
•  Dark skin as the pigment melanin reduces the skin ability to make vitamin D in response to sunlight exposure.
•  Certain medical problems including crohn s disease, cystic fibrosis, and celiac disease, can affect intestines ability to absorb vitamin D form the food.
•  obesity

Recovery time

Recovery from this deficiency may take about few months it mainly depends on the type of the treatment and lifestyle of the individual

Diagnosis

Diagnosis is done mainly by 25-hydroxy vitamin D blood test
Medicines are available in the form of oral tablets, injections and sachets.

Symptoms

There is no clear pattern of symptoms. Many people have no symptoms despite low levels. The common symptoms include:

• Fatigue
•  Chronic pain
•  Weight gain
•  General muscle pain, weakness and cramps
•  Joint pain
•  Sleep disturbances
•  Poor concentration
•  Headache
•  Bladder problems
•  Diarrhoea or constipation
• High blood pressure

Severe vitamin D insufficiency may cause rickets in children and osteomalascia and osteoporosis in adult.

To do

To increase vitamin D level in the body stay around 15-30 minutes a day in the summer sun without sunscreen.

Take a vitamin D3 supplement if you are in a low sunlight region.

Women over 40 if deficient in vitamin D are at increased risk of osteoporosis, and should take vitamin D supplement if found deficient

Vitamin D and general health

Beside treating and preventing A range of disease, vitamin D has been applied in managing minor abnormalities so as to improve quality of life .

Cancer – garland et al. were the first to propose that vitamin D deficiency may contribute to a higher risk of colon cancer mortality since vitamin D is formed in the skin through solar UV-B radiation. The protective relationship between sufficient vitamin D status and lower risk of cancer has been found in many studies.

It has been reported that breast and colorectal cancer can be reduced by50/ with the concentration of 25ohd

Tuberculosis- recently it was found that low vitamin D status resulting from a vegetarian diet is an independent risk factor for active TB.

One study measuring 192 healthy adult who came in contact with TB, showed that a single oral dose of 2.5mg vitamin D significantly enhanced participant whole blood ability to restrict functional whole blood

Vitamin D has also been found to play an important role in brain development and function

Periodontal disease is a common chronic inflammatory disease characterized by loss of periodontal attachment. A 3 year study showed that supplementation with vitamin D (700IU/d) plus calcium (500mg/d) significantly reduced tooth loss in older people.

Prevention

• Allow yourself limited, unprotected sun exposure
• Eat a diet rich in whole foods
• Take a top quality multivitamin every day
• Take a vitamin D supplement

Discuss adding a vitamin D supplement to your diet with your doctor/healthcare provider

Key massages

• Vitamin D is a vital link for human body to be healthy. Vitamin D is mainly available as D2 and D3
• Vitamin D3 has higher potency and longer duration of action compared with vitamin D2
• Adequate intake of vitamin D is directly linked to
•  Improvement in BMD and is important in preventing osteoporosis and osteopenia
•  Reduction in incidence of type 2 diabetes mellitus
•  Reduction I cancer incidence, cell differentiation, apoptosis and metastasis. Increased vitamin D and calcium intake decreases the risk of developing colon cancer
• Vitamin D intake and exposure to UV_B radiation result in a substantial improvement in BMD and is important in prevention osteoporosis and increase in 25(OH)d concentration and has a positive effect in the management of hypertension in adults
•  Vitamin D is necessary to maintain fertility and reproductive health in women
•  Vitamin D has also been found to play an important role in brain development and function along with prevention of periodontal disease
•  A potential physiological role for vitamin D in regulating normal innate and adaptive immunity has been demonstrated in many studies which prevent RA and MS
•  Epidemiological and clinical studies indicate innumerable benefits of vitamin D. supplementation with vitamin D3 help in maintaining a healthy and disease free body.

Recommendation

• Ideal sun exposure the best time for vitamin D synthesis is between 11 to 2 pm and it should be to the bare skin of as much body as possible e.g. face, neck hands forearms ect. The required duration of time required to turn the skin pink or to have burning sensation.
•  General shift workers should use the lunch hour and Sundays while employees with rotating duties can utilize evening & night shift days to get adequate sun exposure.
• Milk intake through milk is not a great source regular intake of at least 500ml milk /day is recommended particularly for vegetarians
•  People with dark skin elderly smokers having chronic illness like DM, epilepsy are more likely to develop the deficiency .they should follow the recommendation s more mesticusly or they should take supplements on periodic basis.
• Extra care should be taken for females in pregnancy & lactation phases, as there is high chance of developing insufficiency and it may have lasting effects on bone strength of the off springs.
• Sunscreens shall be used very judiciously

Conclusion

Vitamin D deficiency and insufficiency Is very widely prevalent than once thought. It is under diagnosed in most health set ups. The possible reasons of low vitamin D levels are as follows

• Reduced direct sun exposure – largely due to lifestyle changes and preferences for comforts has led to minimal time spent outdoors in the ideal times.
•  Job profile & demands – more and more time being spent inside buildings by most shop floors control room and office workers.
•  The continuous monitoring required in control rooms shop floors leave very less chance of sun exposure for workers
•  Smoking – smoking & use of sunscreens are known to increase the risk of vitamin D deficiency
•  Use of PPEs – as per safety requirements all filed workers have to were mandatory PPEs including full sleeves , gloves helmets goggles leaving minimum skin exposed to direct sun light.