Al­though there’s no short­age of sun­light in the re­gion, more than 90 per cent of peo­ple in the UAE suf­fer from vi­ta­min D de­fi­ciency. Anand Raj OK meets ex­perts who throw light on this alarm­ing find­ing and sug­gest what needs to be done

Friday - - Editor’s Letter - PHOTO BY STE­FAN LIN­D­EQUE

In spite of all the sun­light in the UAE, did you know over 90 per cent of us have a vi­ta­min D de­fi­ciency? Find out how it’s dam­ag­ing our health.

Nishitha Sharma felt a wave of ex­haus­tion wash over her. Grip­ping the arm­rests of her of­fice chair, she tried to stand up but felt faint. The 30-year-old strug­gled to keep her eyes open, then slowly felt her­self crum­pling down. ‘That was the last thing I could re­mem­ber,’ says the In­dian ex­pat who worked for a com­puter ac­ces­sories com­pany in Dubai. Luck­ily for Nishitha, a cou­ple of col­leagues who were close by saw her col­lapse and rushed her to hos­pi­tal.

‘I came to quickly,’ she says. ‘In fact be­fore I even reached hos­pi­tal.’

There she was asked to take a bat­tery of tests – in­clud­ing ones for thy­roid and hy­per­ten­sion. ‘All of them turned out neg­a­tive,’ she says.

‘How­ever, I’d been put­ting on weight de­spite be­ing care­ful about my diet so since I was in hos­pi­tal I de­cided to con­sult a nu­tri­tion­ist to find out if there was a rea­son be­hind my weight gain.’

In hind­sight, that was a good thing. The nu­tri­tion­ist sug­gested she take a blood test to check her vi­ta­min D lev­els.

‘I did, and was shocked when the re­sults ar­rived,’ she says.

While the re­quired level of vi­ta­min D is around 30ng/ml, Nishitha’s was an abysmal 5ng/ml. A read­ing of 20ng/ml or be­low is con­sid­ered de­fi­cient and cause for con­cern.

Nishitha was im­me­di­ately di­rected to a doc­tor who pre­scribed vi­ta­min D tablets for her. ‘I was also told to spend more time out in the sun.’ Now, two months later, she says she feels a lot bet­ter. ‘I don’t feel as tired and drowsy like I used to ear­lier. I also feel a lot more pos­i­tive.

‘I didn’t know much about vi­ta­min D de­fi­ciency at the time and never for a mo­ment thought I could have it.’

Nishitha is not alone. Ac­cord­ing to the In­ter­na­tional Os­teo­poro­sis Foun­da­tion, de­spite am­ple sun­shine, Hy­povi­ta­minosis D – vi­ta­min D de­fi­ciency – is very com­mon in the Mid­dle East and Africa. Ac­cord­ing to one re­port, more than 90 per cent of peo­ple in the UAE suf­fer from vi­ta­min D de­fi­ciency. The Foun­da­tion’s study also found that close to 70 per cent of preg­nant women in the re­gion are vi­ta­min D de­fi­cient – a con­di­tion some ex­perts be­lieve could lead to chil­dren hav­ing autism, al­though this has not been con­firmed con­clu­sively.

‘Vi­ta­min D de­fi­ciency is of­ten clin­i­cally silent,’ says Dr Zee­shan Khan, in­ter­nal medicines spe­cial­ist at Medeor 24x7 Hos­pi­tal in Dubai. ‘This is a rea­son it of­ten goes un­de­tected or is de­tected late.’

The hu­man body ob­tains vi­ta­min D from ex­po­sure to sun­light or through sup­ple­ments. In­suf­fi­cient ex­po­sure to di­rect sun­light can con­trib­ute to de­fi­ciency.

‘In the short term, vi­ta­min D de­fi­ciency can lead to weight gain, fa­tigue, joint pain es­pe­cially in the back and knees, low cal­cium lev­els, re­duced im­mu­nity, weak mus­cles and blood sugar dis­crep­an­cies.’

In the long term, the de­fi­ciency can con­trib­ute to se­vere health is­sues.

‘It can lead to rick­ets in chil­dren and os­teo­ma­la­cia – or soft bone dis­ease – where the bones eas­ily bend or break in adults,’ says the doc­tor. ‘If left un­treated vi­ta­min D de­fi­ciency in the long run can con­trib­ute to the on­set of os­teo­poro­sis.’

The ini­tial symp­toms of vi­ta­min D de­fi­ciency are non-spe­cific and as Dr Khan

The body ob­tains vi­ta­min D from ex­po­sure to SUN­LIGHT or through SUP­PLE­MENTS. IN­SUF­FI­CIENT ex­po­sure to di­rect sun­light can con­trib­ute to DE­FI­CIENCY

says, clin­i­cally silent.

‘In chil­dren, the warn­ing signs are when their walk­ing is delayed or if they pre­fer to sit down for pro­longed pe­ri­ods of time. In adults it causes chronic mus­cle aches and pain, and fa­tigue.’

Some peo­ple may have bone pain, mus­cle aches and weak­ness, low mood or de­pres­sion.

So, is a lack of ad­e­quate ex­po­sure to sun­light the only cause of vi­ta­min D de­fi­ciency?

‘Not re­ally,’ says Dr Khan. ‘There are sev­eral rea­sons that can cause low

vi­ta­min D and place you in the ‘at risk’ cat­e­gory.’

He lists lifestyle as a ma­jor rea­son. ‘Peo­ple who spend less time out­doors, or who cover up when they are out­doors get less sun ex­po­sure. Ergo, their body makes less vi­ta­min D,’ he says. ‘Other causative fac­tors in­clude sun­screen use, skin tone and age – the skin’s abil­ity to make vi­ta­min D drops as we age. Cer­tain health con­di­tions such as os­teo­poro­sis and chronic kid­ney dis­eases too could re­sult in poor vi­ta­min D ab­sorp­tion by the body.’


bu Dhabi-based Dr Melissa Li-Ng lists a few more at-risk cat­e­gories. ‘Peo­ple who are over­weight, who fol­low a ve­gan diet (be­cause most nat­u­ral sources of the vi­ta­min are an­i­mal-based and found in liver, fish, eggs and milk) and those who live in the very south­ern and north­ern latitudes – could be at risk,’ says the staff physi­cian at the Medical Sub­spe­cial­ties In­sti­tute in Abu Dhabi’s Cleve­land Clinic.

Skin tone, it ap­pears, is a cru­cial fac­tor when it comes to the body’s abil­ity to pro­duce vi­ta­min D.

Ac­cord­ing to ex­perts, peo­ple who have a darker skin tone have more melanin in their skin. This pig­ment is a ‘nat­u­ral sun­screen’ that slows down pro­duc­tion of vi­ta­min D. This means those with fair com­plex­ions need to spend less time in the sun to get their daily re­quire­ment of vi­ta­min D com­pared to those with darker skin tones.

‘If you were to ask de­mo­graph­ics, I’d say peo­ple from Asian and African back­grounds are more at risk,’ says Dr Khan.

Dubai-based Ban­dana Peters matched that pro­file. She never used to shy away from the sun while in her home­town of New Delhi. ‘But that changed when I ar­rived here,’ says Ban­dana who moved to the UAE four years ago. A hec­tic job meant she had lit­tle time to be out­doors dur­ing much of the day. Then two years ago, she be­gan ex­pe­ri­enc­ing se­vere pain in the joints of her legs. ‘I also used to feel drowsy and weak all day,’ she says.

Ini­tially she put it down to be­ing on her feet for a large part of her work­ing day. ‘But when the symp­toms be­gan to get re­ally se­vere, I de­cided to un­dergo a complete check-up,’ she says.

‘The doc­tor at Medeor did a se­ries of tests in­clud­ing to check vi­ta­min D.’ That last test re­vealed the cause of her prob­lems – vi­ta­min D de­fi­ciency.

In Ban­dana’s case it was an alarm­ing 10 ng/ml. Like Nishitha, she too, never ex­pected to be suf­fer­ing from the con­di­tion.

So what could be the rea­son for the high rate of vi­ta­min D de­fi­ciency in the UAE?

Dr Li-Ng at­tributes it to the fact that al­though this re­gion en­joys a lot of sun­shine, ‘most peo­ple who live here seem to avoid the sun. So there is lim­ited sun ex­po­sure.

‘And when they do go out, they are usu­ally well cov­ered.’ To make mat­ters worse as far as vi­ta­min D pro­duc­tion is con­cerned, those who do step out­doors use a lot of sun­block.

‘While cor­rectly-ap­plied sun­screen blocks the harm­ful ul­tra­vi­o­let B rays that cause skin cancer, it also blocks most of the skin’s pro­duc­tion of vi­ta­min D,’ says Dr Khan.

Dr Li-Ng agrees. ‘Any type of sun­screen – be­cause it blocks UVA and UVB rays – is go­ing to be block­ing vi­ta­min D ac­ti­va­tion. So if the rea­son to be out in the sun is to boost your vi­ta­min D then you should be out with­out sun­screen,’ she says. ‘But you should take care to main­tain a bal­ance. If the sun ex­po­sure on the skin is for a long time there is the risk of de­vel­op­ing skin cancer.’ So how much sun is enough? ‘Ten min­utes of full-body ex­po­sure is enough. But be­cause most of us are clothed and pretty much cov­ered up, be­ing out in the sun with your face, arms and legs ex­posed for about 15 or 20 min­utes would be good,’ says Dr Li-Ng.

Ac­cord­ing to ex­perts, peo­ple who have a darker skin tone have more MELANIN in their skin. This pig­ment is a ‘NAT­U­RAL SUN­SCREEN’ that SLOWS down pro­duc­tion of vi­ta­min D

She also says it’s im­por­tant to have di­rect sun ex­po­sure. ‘Go­ing out at 6am or 7am is not good enough be­cause at that time there is not enough UV light to ac­ti­vate the pro­duc­tion of vi­ta­min D.’

Can vi­ta­min D be ‘banked’ – can we stay out more on week­ends and less on week­days to get our re­quired amounts of vi­ta­min from the sun? ‘Yes,’ says Dr Khan. A sin­gle 15-20 min­utes ex­po­sure of di­rect sun­light would be enough for more than a week.

He also sug­gests eat­ing food that con­tains vi­ta­min D. ‘Very few foods have vi­ta­min D, and that too, in small quan­ti­ties. Salmon, mack­erel, tuna and egg yolks do have vi­ta­min D. It’s also in for­ti­fied foods for ba­bies.

‘Vege­tar­i­ans can in­clude mush­rooms, cheese and soya milk in their di­ets,’ he says.

(Re­search pub­lished in Der­ma­toEn­docrinol­ogy has shown mush­rooms can give as much vi­ta­min D as a health sup­ple­ment, but they need to be ex­posed to sun­light for 30-60 min­utes be­fore eat­ing. This is be­cause they can trans­form UV light into vi­ta­min B, just like the hu­man body does.)

Dr Khan ad­mits there’ve been re­ports sug­gest­ing preg­nant women with vi­ta­min D de­fi­ciency at 20 weeks are more prone to have autis­tic ba­bies. ‘But that’s still be­ing de­bated,’ he says. ‘Vi­ta­min D in­suf­fi­ciency data is ex­pand­ing to in­clude ev­i­dence on its role in asthma, al­ler­gic dis­or­ders, and atopic der­mati­tis.’

Ac­cord­ing to Dr Meis Moukayed, vi­ta­min D has been found to act syn­er­gis­ti­cally with chemo­ther­apy agents to com­bat cancer cells and po­ten­ti­ate the ef­fect of chemo­ther­apy drugs. ‘Sev­eral lines of ev­i­dence have sup­ported a strong role for Vi­ta­min D in cancer preven­tion,’ says the Har­vard-trained sci­en­tist who has years of ex­pe­ri­ence in health and sci­ence sec­tors. She wants more re­search done in this field.

While go­ing out in the sun is im­por­tant to get enough vi­ta­min D ex­perts make it clear too much sun too, could cause harm. What’s needed is a com­mon-sense ap­proach.

Nishitha en­sures she spends more time in the sun to get her re­quired dose of vi­ta­min D

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