On 20 Jan, 2024, Seniors today hosted its weekly Health Live Webinar with Dr Dilip Gude, a Senior Consultant Physician, who spoke on and answered questions about Vitamin D deficiency and Care for Seniors.
Dr Dilip Gude is a Senior Consultant Physician at Yashoda Hospitals, Somajiguda, Hyderabad with over 17 years of experience. He has keen interest and expertise in treating metabolic illnesses like diabetes, obesity, hypertension, dengue, complex malaria, typhoid, sepsis and septic shock of various aetiologies, as well as controlling HIV, allergic and immunological and haematological conditions.
Concerns and issues regarding Vit D deficiency have always been there, however we have gained more knowledge about and have become aware of it in the recent times- leading to increase in the diagnosis and treatment of Vit D deficiency.
Bone health and musculoskeletal health is very important to keep us moving, fit and agile. Vit D has an important role to play in the bone health and musculoskeletal health of an individual.
Vit D deficiency/ insufficiency can also lead to worsening of metabolic conditions such as diabetes, hypertension, heart disease, skin diseases, etc.
The newer nano technology of Vit D supplementation is known to give higher bioavailability of Vit D, thereby improving and increasing the pattern in which we are targeting at treating fit D deficiencies in our patients.
Vit D is an important nutrient for the smooth and good functioning of every system of the body, including lungs, preventing breast cancer (with adequate supplementation), increasing your grip strength, bone strength and health.
There are tell tale signs which can be seen in your palm, in case of chronic Vit D deficiency.
Vit D deficiency in the bone can present as osteopenia, osteoporosis, osteoarthritis- it can also lead to exacerbation/ acceleration of these pre existing conditions in the presence of deficiency.
There is an increase in falls in the seniors which is noted in case the individual also has Vit D deficiency.
A study says that almost 85% of Indians have Vit D insufficiency. Ideally, you should have your Vit D levels over 30 to 50 nmol/ l. Values between 20 to 30 nmol/ l means you have insufficient Vit D levels and values less than 20 nmol/ l indicate Vit D deficiency.
The reason for the deficiency of Vit D which is seen in our population can be attributed to
- Diet: ours is not a Vit D fortified diet
- Increased melanin content in our skin
- Inadequate exposure to sunlight- this is the most important cause for Vit D deficiency, especially in the urban population
- Lack of fortified foods
Dietary sources, predominantly non vegetarian sources of diet are known to be rich in Vit D, for vegetarians, mushrooms are a good source of Vit D
Vit D fortified foods are available in the western countries and are also now available in certain parts of our country. We have Vit D fortified milk available in the markets.
Vit D plays a very important role in the metabolism of calcium.
Hydroxylation of Vit D occurs at two sites
- vit
- Kidneys
This helps in maintaining a balance in calcium metabolism and also in maintaining mineral balance and homeostasis
There is UV B related deficiency with advancing age, dark skin, extensive use of sunscreen, seasonal changes, latitude of living/ habitation (people closer to the equator have higher levels of Vit D)
Medical/ physical condition related deficiency such as:
- Fat malabsorption
- Drug induced deficiency
- Chronic liver disease
- Chronic kidney disease
- Obesity- is a vit D deficient condition
Smoking also increases Vit D deficiency
Signs and symptoms of Vit D deficiency can be:
- Proximal muscle weakness which can at a later stage, with progression, present as a waddling gait
- Rib cage tenderness
- Frequent fall resulting in fractures
- Isolated aches and pains
- Myalgia
- Difficulty in squatting and standing
Methods used to access Vit D levels are:
- Blood investigations which include Serum Vit D levels
Beyond musculoskeletal and bone health, Vit D deficiency can also adversely affect hypertension, diabetes, heart disease.
Chronic Vit D deficiency can worsen your hypertension. It can lead to altering the drugs and increasing the dosage required to control your blood pressure, contrary to an otherwise healthy Vit D sufficient hypertensive patient.
Vascular endothelium (the lining that lines the insides of our arteries) will also benefit if you have adequate Vit D levels. Likewise, deficiency of Vit D will lead to vascular endothelium dysfunction.
Patients with chronic Vit D deficiency are also known to have increased insulin resistance which means that the amount of insulin you are prescribed needs to be altered to a higher dose to combat the insulin resistance due to the chronic deficiency as well. Hence, diabetic patients are also adversely affected by Vit D deficiency.
Vit D also plays an important role in immunity and in fighting infections. Having adequate Vit D improves barrier to infection, adaptive immunity and cellular immunity.
Therapeutic measures to treat Vit D deficiency:
- 1000 – 2000 IU everyday capsules are available which can be taken in oral form
- 60,000 IU Vit D capsule is available. It is also available in liquid/ syrup form which can beg taken once a week
- Injections of 1.2 Lakh IU are also available which can be taken once a month
- Parenteral Vit D is also available as a dose of 6 lakh IU is also available
- Nano formulation of supplementation
Compliance with Vit D capsules is strictly advised. After completing your treatment course, it is advised that you continue your maintenance dose, because if stopped, it can lead to demolishing of stores after 3 weeks.
Vit D level toxicity is very rare and is easy to treat with stopping the supplementation.
