Twenty-five-year-old Rhea from Bengaluru was unable to comprehend why her hairline fractures were taking way longer to heal than the usual six to eight weeks. Even her open wounds were taking more than a month to recover, affecting her mobility. It was only later that Rhea learned from her doctor that the cause of the prolonged recovery was vitamin D deficiency in her body.
About 80 to 90 per cent of people in India and a major chunk of people across the globe are found to be deficient for vitamin D, informs Dr Pradip Shah, General Physician, Fortis Hospital, Mumbai.
Rhea told Happiest Health that she met with an accident in November 2021 and sustained a few open wounds and two hairline fractures – one on her left wrist and another on her cheekbone. “My open wounds were not healing despite taking all the prescribed medication. My doctor also asked me to expose it to the sun for better healing. As it was winter, it wasn’t possible to get enough sunlight, and I assumed the wounds took longer to heal due to the weather,” she said.
However, when Rhea visited an orthopaedic in January 2022 to check on her fracture, she learnt that her wound should have been ideally cured within two months. “It was only after my doctor asked me to take a few blood tests to check for vitamin D and calcium deficiency, I was diagnosed to have an extreme low level of vitamin D, with 3.5 nmol/L, while 30 should have been the optimal count for me. Even my calcium level was below 5 mg/dL, while the ideal reading in my case should have been above 8.5 mg/dL,” she said.
The presentation of vitamin D deficiency in children, adults and older adults could vary in range, points out Dr Prashant Bafna, Consultant Rheumatologist, SPARSH Hospital, Bengaluru.
Some of the common symptoms among children are body pain, muscle weakness and pain after indulging in playing/physical activities. “In the case of leg deformities such as knocked knees or bow knees in children, parents should watch out whether the kids are lacking in vitamin D,” says Dr Bafna.
Dr Shah highlights some commonly prevalent signs of vitamin D deficiency among patients:
- Bone, joint pain and fractures: Vitamin D deficit leads to a lack of calcium absorption, resulting in weakness in bones and joint pain. Among elders, it leads to fragile fractures.
- Frequent illness and infections: A dearth of this fat-soluble vitamin could also cause protein synthesis to decrease, and as protein is responsible for immunity, immunity becomes weak and makes people more prone to infections.
- Low sex drive: Vitamin D deficiency also leads to low levels of oestrogen among women and testosterone among men, which leads to low sex drive.
- Slow recovery of wounds: Those who lack an optimal level of vitamin D in their body could also experience a slowing down of the immune mechanism, which results in slow recovery of wounds.
- Depression: Vitamin D affects serotonin function, a molecule that manages our mood and cognition. A dip in the serotonin levels could result in people feeling depressed and anxious.
Dr Shah feels that if any of the above-mentioned signs linger for a prolonged period, then one should consult a doctor and check if vitamin D supplements should be administered.
Role of vitamin D and calcium in bone strengthening
Dr Shah says that both vitamin D, which is a hormone, and calcium, a mineral, are essential for keeping bones healthy. A dearth of vitamin D results in excessive synthesis of a hormone called parathyroid in the body, which is responsible for absorption of calcium from the bones into the blood.
“If vitamin D count is high in the body, parathyroid hormone will be low and vice versa. If parathyroid hormone is high due to vitamin D deficiency, it will absorb more calcium from the bone, and over a period of time, the hormone will extract majority of calcium. This leaves the bone in a weak state as the bone’s strength is dependent on calcium,” he said.
He added that parathyroid hormone is also responsible for absorption of calcium from the intestine. “Vitamin D is indirectly needed in absorption of calcium from the intestine and reabsorption of calcium from renal filtrate,” explained the doctor.
Rhea said that her fractures healed as soon as her vitamin D deficiency was taken care of, and it also automatically normalised her calcium count.
Calcium and vitamin D work in tandem
Dr Shah says that if you are consuming 1,000 unit of calcium through food, normally 60-70 per cent of it is absorbed, which is adequate for the body. “If vitamin D is not adequate, then out of 1,000, only 20-30 per cent will be absorbed, while the remaining will be filtered out of the body through stools. Calcium is needed for many essential activities in our body such as optimal heart function, muscle contraction and nerve conduction. It also stabilises bone density and bone strength,” he elaborates.
When are vitamin D supplements prescribed?
Dr Shah shares that vitamin D supplements are commonly prescribed when a person is suffering from causes of vitamin D calcium deficiency, has weakness, fatigues, muscle cramps, etc.
Vitamin D tablets are also prescribed for people with musculoskeletal symptoms, says Dr Bafna. He says that in children, it could be rickets (skeletal disorder) and in adults, it could be osteomalacia (softening of bones) and in elderly people with osteoporosis (a condition where bone strength weakens and is susceptible to fracture).
Dr Bafna says that conditions where they prescribe supplements are chronic kidney disease, hepatic dysfunction (liver disease) and in cases of malabsorption. “The other conditions are during pregnancy and lactation, for older adults with history of falls or non-traumatic fractures, obese children and adults, and some people who are on medications/steroids, people taking HIV medicine or those who are taking seizure medications,” he adds.
How to get sunshine vitamin?
Walks are the easiest and the most effective way of getting some this vitamin into the body naturally, says Dr Shah. He says that people suffering from the deficiency are advised by treating doctors to take oral supplements or injections, eat food that provides vitamin D and get enough sunlight. “When soaking in some sunlight becomes difficult during the monsoon or winter seasons, relying on some food sources such as fish, egg yolk, mushroom, soy milk, cow milk, cheese, etc., could help you get your fill of vitamin D deficiency treatment,” he says.
According to Dr Bafna, the major chunk of vitamin D an adult obtains is from the UVB light (ultraviolet B therapy); that makes it 80 to 90 per cent of the vitamin D absorption from UVB therapy (direct sunlight) and the remaining 10 to 20 per cent from dietary sources.
He says, “If you get exposed to the sun for 10 to 15 minutes, especially from 10 am to 3 pm, the time when the UVB radiation is high, you get 1,000 international units of this vitamin. However, one has to be cautious about overexposure. If you get exposed to the sun for a long period of time, you may get sunburns. Sunburn risks increase after 10 minutes of exposure. If, however, you limit your sun exposure to 10 minutes, the 1,000 units you get is sufficient.”
Dr Bafna adds that the remaining 10 to 20 per cent can be obtained from nutrition.
Is there anything such as excessive vitamin D in the body?
Dr Bafna says that a higher dose of vitamin D can lead to vitamin D intoxication and higher calcium value, leading to hypercalcemia (elevated calcium level). The excess calcium is then passed in urine, resulting in kidney stone.
I have been suffering with bones and joints pain from a very long time. I can relate to this. I will try to intake vitamin D rich food sources. Thank you for this information.
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