India's silent epidemic, let's address it

India's silent epidemic, let's address it

By Trisha Malhotra

What do mood changes, bone pain, fatigue, and muscle cramps have in common? They’re all symptoms of a Vitamin D deficiency. This particular Vitamin is necessary to keep teeth, muscles, and bones healthy. It's also implicated as a major protective factor for certain cancers, and even mood-related complications like depression. In the past decade, community-based studies across India have shown a prevalence of large-scale Vitamin D deficiency affecting anywhere between 50% to 94% of the population. 

The studies included a variety of age groups, income brackets, and locations to really hone in the fact that India has a chronic Vitamin D deficiency transcending age, socioeconomic class, and weather conditions. Some go as far as to call this India’s silent epidemic. On the surface, this seems like a counterintuitive finding. India has adequate amounts of UV-rich sunshine, almost all year round. Additionally, the majority of the population lives in areas with adequate amounts of sunlight. So what’s going on? Why are we observing an epidemic-sized Vitamin D deficiency across the nation?

Why is India deficient in vitamin D?

  • Among the urban population, a more sedentary and indoor lifestyle has prevented adequate exposure to sunlight, thereby contributing to a Vitamin D deficiency. 
  • Lack of access to fortified foods, such as fortified milk, bread, cereals, curd, butter, and more also play a major role. 
  • Pollutants in the air also hamper Vitamin D synthesis from UV rays. 
  • Dietary habits can also result in low dietary calcium which is needed to synthesize Vitamin D. A fiber-rich vegetarian diet consisting of more phytates and phosphates can prevent calcium from being absorbed in the intestines. 
  • Cultural practices such as wearing a burqa and following the purdah system also result in reduced exposure to UV rays.
  • Pregnancies that are badly planned or ill-spaced in women with nutritional deficiencies can exacerbate a pre-existing Vitamin D deficiency in both the mother and her child. 

What does Vitamin D deficiency look like?

While severe Vitamin D deficiency can show up as rickets, children who undergo it will likely show deformities in joints, weakness in muscles, incorrect growth patterns, and pain in bones. Signs of this deficiency in adults include:

  • Bone pain
  • Muscle aches
  • Mood changes, like depression
  • Fatigue

Lowered blood levels of this vitamin have also been associated with the following:

  • Cognitive impairment in older individuals
  • Severe asthma in younger populations
  • Increased risk of cardiovascular disease
  • Cancer

How to treat India’s silent epidemic?

Although this sounds challenging at first glance, India has a strong enough UV index all year round, making undoing a chronic Vitamin D deficiency much easier. According to researchers, the lack of fortified foods is the easiest cause to target. It has been shown that foods fortified with Vitamin D do not hamper its bioavailability to a significant level. This means it can be absorbed in the body with relative ease. Fortification is possible in most foods, starting off with all grades of milk. 

Additionally, other milk and oil-based products like ghee, butter, yogurt, curd, and infant formulas can be fortified with Vitamin D. Food items that are widely consumed like atta, rice flour, and maida can be made Vitamin D rich. Even the economic feasibility of fortification of foods across the country is very encouraging. Not only is this a relatively easy thing to target, but it will also have a resounding impact on the health of the general public. 

The next and equally important target should be creating awareness through educational programs since this particular deficiency is the most underdiagnosed and undertreated one across the globe. Implications of a chronic deficiency should be made available to both physicians and the general public. Targeted educational campaigns toward school children, adults, and underdeveloped segments of the population about why Vitamin D is important can have a huge impact on people’s awareness. Adequate amounts of effort, time, and money will be needed to launch educational campaigns, but the payoff is expected to be worth the investment.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060930/

https://economictimes.indiatimes.com/magazines/panache/give-me-some-sunshine-most-indians-have-vitamin-d-deficiency/articleshow/70890677.cms?from=mdr

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179178/#__sec9title

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