Vitamin D deficiency in India

well welcome to this talk we're going to be looking at vitamin d deficiency particularly in india now india is a sunny country so it might surprise you that there's a very high prevalence of vitamin d deficiency in india but indians very often don't spend time in the sun it's not really cultural to spend time in the sun and a lot spend a lot of time indoors and work indoors i've actually uh when i've been in india i've actually cajoled some of my indian friends to do a bit of sunbathing and they might do it to human me but it's really not part of their culture and of course our very often a lot of body surface area is not exposed so there's not a lot of body surface skin exposed to get the vitamin d and we know that 90 of our vitamin d comes from the skin from the synthesis in the skin from the sunlight not from the diet and vitamin d is very important because it's an immunomodulator it will lack of vitamin d definitely in impairs the efficiency of the immune system so we need vitamin d for good immunity and also there's a lack of vitamin d we can get too much inflammation this immunomodulatory effect and of course we know that excess inflammation especially in the second week after initial symptoms and covered can cause this acute respiratory distress syndrome where the fluid collects and the alveoli and the reason this fluid collects in the alveoli is because of inflammation this is an inflammatory process and we know that all the immune cells that we see here have um vitamin d receptors in them they need vitamin d for normal function and uh these are liz gould's graphics from last year are you getting enough vitamin d studies have found many people in northern latitudes are deficient in vitamin d this deficiency is even more pronounced in people northern latitudes with darker skin pigmentation and even in india where it is very sunny so the darker the coloured skin the more you're protected from sunburn that is very good but of course the more slowly you will make vitamin d the lighter the skin the more prone you are to sunburn but the more quickly you will make vitamin d and of course most people in india are darker colored than people in people with european ancestry so making vitamin d more slowly so um important cultural and uh and genetic factors in vitamin d now i want to refer to the evidence here here we've got this paper vitamin d deficiency in india this is from the journal of the family med family medicine in primary care it's written by uh indian clinicians mostly based in delhi mostly from delhi now it's the the figures here are really quite amazing vitamin d is the deficiency is incredibly prevalent in india and this has got to adversely affect a mutant function of people in india and it's a variable that would be so easy to correct and i i know i've talked to a lot of friends in india and that they've all topped up on vitamin d a lot lately so the message is starting to get through but but certainly we needed to get through much more so if you're in india put this on your facebook page you know the simple fact of the matter is that people that are deficient in vitamin d are going to be immunocompromised and more likely to get severe inflammation and therefore many many studies have shown more likely to get sick so do do publicize this it is really important at the moment but it's important anytime now this article i'm reviewing here was actually written in 2018 and the situation i don't believe is any any better so this is a pre-covered article but it just shows how important this is so prevalence of vitamin d deficiency and they looked at about 30 studies range from 40 to 99 i mean these are horrendously high levels most studies clustered around the reporting that uh a prevalence of 80 to 90 percent of people in india are deficient in vitamin d now this is really quite a startling figure very high levels of deficiency in vitamin d therefore it's reasonable to assume that very high levels of immunocompromise simply through lack of vitamin d and of course the population as i said largely vegetarian so not getting a lot of vitamin d from the diet if they're not getting it from the sun prevalent in all age groups and high-risk groups alike and i i know um doing some clinics in india you actually see a lot of children who actually have rickets that they they have bendy bones and they have reduced growth because of the lack of vitamin d and calcium and of course this is very easy to correct you actually see this it is it is around and of course with adults it's harder to detect but these studies show uh that it is there so factors so major source of vitamin d is uh synthesis on the skin due to exposure ultraviolet b uvb radiation wavelength 290 to 320 nanometers not much of a physicist but that's what it is so that this is the higher wavelength so the the ultra the the infrared is at the lower end of the wavelength then we have all the richard of york gay battle in vain red orange yellow green indigo violet and then beyond that we have the ultraviolet this is where this comes in um now um you get it in fish to some extent fortified foods with vitamin d and vitamin d supplements now this is interesting fish um because we have looked on this channel that people in kerala where they eat a lot of fish it was rahul's research that showed this we had rahul on a few times that people in kerala who ate a lot of fish died less in the 1918 1919 pandemic now can we say that that was the the the decreased death rate was as a result of less vitamin d deficiency well we can't say that but it is an interesting correlation so it's certainly and as i say it's a variable that's easy to correct vegetables and grains which are actually the main source of food in india i mean in india in in the south of india especially in poor communities basically you eat rice and rice and lentils rice and dal and in northern india you tend to eat a lot of uh chapati or roti that that's like the flat bread and and dal and these foods basically don't contain well essentially no vitamin d actually and combine that with not getting it in the uh not getting it from the sunshine and the deficiency is inevitable um so other factors latitude so even though it's fairly far south we looked at those behavioral issues solar zenith angle so basically the sun needs to be higher than 45 degrees in the sky to make any vitamin d so um where i live in the north of england uh just just in the past week or two uh towards the end of april that the sun's been more than 45 degrees in the sky and we actually make some vitamin d so we're only really making vitamin d for six months of the year in in scotland and northern england and uh even though there's so much sunshine in india a lot of it is not being used to make human vitamin d in human skin uh atmospheric pollution huge factor in india um it's getting better now but the cities in india i mean new delhi and mumbai terribly polluted ozone layer we looked at mat in new zealand who can make vitamin d much quicker because they've got a depleted ozone layer unfortunately and of course melanin melon in pigmentation as we saw on that uh on that graphic from liz now the thing i like about this study is it defines the levels um pretty straightforward but um always worth remembering ourselves threshold level um serum vitamin d so that's the vitamin d in the blood the 25 vitamin d in the blood uh required to optimize effects may vary in various target organs now what this is saying is the the levels of vitamin d in the blood uh the normal levels were very often dictated by the levels which were needed that the levels were high enough so that people didn't get rickets but it could be that other organs which need vitamin d need higher levels so the heart might like one particular level the the brain might like another level the immune system might like another level so we have to have it high enough to cover these levels not just to stop rickets is the is the important thing so they're defects saying deficiency is less than 20 nanograms per meal which is 50 nanomoles per liter insufficiency they're saying is 21 to 29 nanograms per mil sufficiency is more than 30 and toxicity is more than 150 so very high toxicity threshold for vitamin d and desirable and safe range of serum vitamin d levels would be they say 30 to 100. nanograms per ml which is 7259 moles per liter so that's what they're saying is desirable and deficiency which they've said is so common is is actually very low so when they're quoting these deficiency figures the deficiency of vitamin d these are people with really very low levels less than 20 nanograms per mill and that is what is very prevalent so this study is saying that this is the optimum range so uh ideally everyone in the world will get their vitamin d levels tested uh and uh by their doctors and then it will be titrated accordingly but unfortunately that doesn't always well that very rarely happens um all right metabolism vitamin d's need to facilitate calcium absorption from the gut so if you're low in vitamin d you're not going to absorb calcium so vitamin d encourages the transport of calcium from inside the gut from foods that we've eaten it in into the blood the vitamin d is necessary for gastrointestinal absorption and parathyroid hormone is secreted in response to low blood serum calcium so these parathyroid glands that there's four parathyroid glands they're embedded in the back of the uh the thyroid gland and um what they actually do is when when the blood levels of calcium are low para thormone will be released so parathyroidis is secreted in response to low blood serum calcium and what the parathyroid hormone will do is we'll take calcium from the bones and put it into the blood because you need to maintain the calcium in the blood because it's an electrolyte but of course that's going to deplete the calcium in the bones and that's going to that's going to cause rickets in children and potentially osteoporosis and bone thing in thinning in adults whereas the vitamin d will make sure you're producing you're absorbing plenty of calcium so you don't need to produce the parathorma so that maintains serum calcium levels by moving calcium from the bones to the blood therefore the bones can become demineralized at less than 20 nanograms per ml of serum vitamin d parathyroid is elevated to maintain cerium calcium from bony reserves so when you're deficient the parathyroid hormone is released that takes the calcium from the bones to maintain the amount in the blood which is necessary at serum vitamin d levels uh of uh inter intestinal calcium absorption reaches its peak now now one of the reason i'm hesitating there is i've left that out so at that serum levels of 30. so so when serum levels reach 30 nanograms per ml when same levels reach 39 grams per mil in most people that the parathormone will not be produced and therefore the bones will not be demineralized that's why they're saying that 30 is the necessary amount and that's consistent with what they're saying here so that's so uh sufficiency is more than 30. so if it's less than 30 you will produce parathyroid hormone which will essentially be transporting the calcium from the bones into the blood so that's a very good physiological rationale for saying that uh below 30 nanograms per mill is an insufficiency but that's actually saying frank deficiency is less than 20 nanograms per ml so that makes physiological sense so you will want to avoid the release of the parathyroid hormone which essentially is the emergency level for keeping calcium up and the parathyroid hormone will go down as the vitamin d goes from 20 up to 30 till we get to 30 then the parathyroid hormones will be low and that means you're maintaining the calcium in the bones so that that's quite a useful physiological indicator but of course other other tissues may need higher levels of vitamin d but the tissues need higher levels of vitamin d that's why their sense efficiency is more than more than 30. and they're saying toxicity is not occurring to 150 and serum levels would ideally be 30 to 100 so that actually makes quite a lot of physiological sense right so yeah that's what we've said so by the time you get to 30 the parathyroid hormone level shouldn't be raised maintaining the calcium in the bones because the vitamin d is making sure you're absorbing all of the calcium you need from your gastrointestinal tract as long as there is some in the diet of course consequences of vitamin d rickets of course we know about the bendy bones in children muscle strength reduction lack of vitamin d reduces muscle strength reduction but lack of vitamin d is also associated with autoimmune disease where the immune system attacks the body's own tissues cardiovascular disease psychological depression which can lead to suicide parkinson's disease cancers infections tuberculosis which of course is a chronic infection it's an associate associated with obesity and diabetes mellitus type 2. so all of these things are associated with and may well be caused by lack of vitamin d so quite profound um things there now we know there's an association between obesity and vitamin d but is that causal um are people that are low in vitamin d more likely to be obese it's an interesting association but certainly the the there is suggests very strong suggestions and and data that points towards the fact that vitamin d deficiency can cause all of these conditions and with severe vitamin d deficiency i think a lot of people would agree that these can be caused so increasing vitamin d levels it's just a variable to eliminate for possible spectrum of diseases vitamin d is important for immune function regulation of inflammation and cellular proliferation and differentiation and of course we know that cancer is a disease of excess cellular proliferation so this paper really is very concerned and you'll see this is this is a pre-copied paper but you know it's definitely saying that vitamin d is necessary for immuno protection immune function and the prevalence in india is most that is indicate 80 to 90 percent of people are deficient so ironic in such a sunny country so what the heck to do about this um the authors want to do the following create awareness amongst the public and health care providers about the importance of vitamin d so you can do that you can share this information there is a pressing need in india at the moment and indeed in other countries so publicize the consequences of deficiency indian diet generally fails to satisfy the daily requirements of vitamin d for normal adults therefore they are advising that indian manufacturers need to fortify various foods with vitamin d through national programs but of course we also know that vitamin d supplements we know that vitamin d supplements will increase serum vitamin d levels in the blood and until the until it wasn't cut down on my vitamin d now because i've been out on the sun but before then i was taking 4 000 units a day which is 100 micrograms of vitamin d a day this silent epidemic should be addressed appropriately with concrete public health action the paper advises direct quotes we can imagine the burden this silent pandemic will cause the development of the country so strong words silent epidemic and probably a silent pandemic of vitamin d deficiency so the amounts of supplements that are being recommended in the uk at the moment many think are low i've told you what i'm taking you'll have to look at the evidence and decide what's appropriate for you go to your own doctor get your blood tested titrate your vitamin d levels accordingly is the ideal way to do that but given that this isn't really an option for many poor people in india this paper is advising uh fortification of foods with vitamin d in in india because really things are bad and we need to do something and this is a variable that could be could actually be relatively easily uh eliminated now we're going to do some more vitamin uh on vitamin d on india shortly uh so so hang hang five fat because i am i am quite um well i'm sure many of us are quite quite distressed by the situation in india so um but that's information on vitamin d look at the paper yourself it's it's actually it's it's although it's in a medical journal um and it's written by clinicians in india it's actually quite an accessible article so click on the link take you straight to it read it for yourself follow the evidence wherever it leads but don't take my word for the evidence always check it out and look it up for yourself okay thank you for watching sorry that was a bit longer than i meant it to be

Channel: Dr. John Campbell

Views: 284,260

Keywords: physiology, nursing, NCLEX, health, disease, biology, medicine, nurse education, medical education, pathophysiology, campbell, human biology, human body

Id: 1Q_mhJRFtxg

Length: 19min 43sec (1183 seconds)

Published: Mon Apr 26 2021

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