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Vitamin D deficiency in Nepal

Vitamin D deficiency in nepal

Posted on : February 14, 2020 by Clinic One on Uncategorized


Vitamin D deficiency simply means a deficiency of vitamin D in your body. Vitamin D is produced by a human body by using sunlight. It is an essential vitamin that the body required for strong bones. Deficiency in Vitamin D is the main cause of body pain, especially among youngsters. Vitamin D is related to calcium absorption by the body and its deficiency leads to rickets and many other problems.

Vitamin D helps absorption in calcium and magnesium and prevents many diseases. About 90% of Vitamin D is produced by the sunlight whereas the remaining 10% is produced from other foods and supplements such as egg yolk, seafood, fortified dairy products, etc. It is very hard to get enough from your diet alone. Active people in the sun produce most of the vitamin D that they need from their skin. The two major forms of vitamin D are:

  • Vitamin D2(ergocalciferol): this is produced by UV irradiation of ergosterol which occurs in yeast, molds and higher-order plants.
  • Vitamin D3 (cholecalciferol): this is photosynthesized in the skin of vertebrates by the action of solar ultraviolet. Vitamin D3 is only found in animal source foods.

There are basically three ways a body can get vitamins that are from the skin, supplements, and from your diet. Unlike other vitamins, vitamin D functions like a hormone and every single cell in your body has a receptor for it. The accurate measure of vitamin D in your body is

If it is less than 20ng = Deficient

If it is between 20 – 29 ng = Insufficient

If it is between 30 – 100 ng = Normal

Data about Vitamin D deficiency in Nepal and World

In Nepal, 60% of people have been suffering from Vitamin D deficiency. The exact data of the people who are affected by vitamin D deficiency is unavailable but the risk of the people who are living in the Kathmandu valley is at a very high risk of Vitamin D deficiency which leads to a host of medical compilation. According to some research done in Pokhara in 2014-2015 about 75% of the people who were admitted to the hospital were found to be low in Vitamin D.

As people adopt an urban lifestyle they tend to stay at homes a lot, do not work or stay under the sun. Not only in Nepal Vitamin D deficiency is one of the worldwide problems and this has made an impact on billions of people. 30% of the men population and 46% of the female population are affected by vitamin D deficiency.

Vitamin D deficiency is common in all age groups. As their in low sunlight in the middle east and the southern part there are more chances of vitamin D deficiency. It was found out that the females are more affected by Vitamin D than that of the male population. Child birthing women or those women that have given birth to a child, and other religious practices that are being done by the people by which the women have to cover the whole parts of their body when they go anywhere or when they are at home have the most chances if Vitamin D deficiency.

Signs and Symptoms of vitamin D deficiency

Autoimmune Disease:

 It includes type 1Diabeties, Multiple sclerosis, lupus, Autoimmune thyroid disease, etc. These are the risks that are associated with a deficiency in Vitamin D in the body.

  • Type 1 Diabetes is a condition when your immune system destroys insulin-making cells in your pancreas which is also called beta cells. This disease is usually seen in children and young people this is why it is also called juvenile diabetes. As research has shown that children who have type 1 diabetes have a higher chance of Vitamin D deficiency in the body.
  • Multiple sclerosis is a potential disability disease of the brain and spinal cord, optical nerve in your eyes (mainly the central nervous system). It causes a problem in vision, balance, and other basic functions. According to the research done the people who have a deficiency of Vitamin D are at the risk of developing Multiple Sclerosis. There is also a higher possibility of Multiple sclerosis in the geographical areas that are away from the equator. The symptoms start with people from the age of 20 and 40. According to doctor people with certain genes may have a greater chance of getting it and also the people who do smoking have a higher risk.
  • Lupus is a systemic autoimmune disease that occurs when your immune system attacks your own tissues and organs which causes swelling. It may affect the various parts of the human body such as Skin, Kidney, Blood cells, Brain, Heart, etc. People who are suffering from lupus often have a reaction from the ultraviolent rays causing rashes, etc. which causes a lack of exposure to the sunlight, which causes Vitamin D deficiency. Women are at a higher risk of lupus than the male. Lupus can have various symptoms and it differs from person to person.
  • Rheumatoid arthritis is also an autoimmune disease that mostly affects the joints, hands, feet, elbows, knees, etc. It is a long term, flexible and disabling disease. It usually affects the same joint on both sides of the body. The causes of rheumatoid arthritis are not known. Research has found that people with low Vitamin D have higher chances of suffering from rheumatoid arthritis than the people who have high Vitamin D.
  • Cancer:

            Cancer is a disease when the cell divides uncontrollably and spread into surrounding tissues. It is caused by changes to DNA. There are different types of cancer Breast cancer, skin cancer, lung cancer, etc. People who have Vitamin D deficiency have a higher risk of facing cancer that other people. According to the research done, it was found that people who took vitamin D supplements had a 13% lower risk of dying from cancer than those who did not.

  • Bone and Back Pain:

              Vitamin D is one of the major sources by which you can maintain your bones. It helps your body to absorb calcium by which your bones can stay strong especially for the people above the age of 40 because as they are growing old their bones start to get weaker. Research has shown that people with Vitamin D deficiency have a higher chance to get back pain. Studies have shown that calcium and Vitamin D together can build stronger bones by which back pain also can be reduced. Low blood levels of Vitamin D may be a cause or contribution factor to bone pain and lower back pain.

  • Impaired Wound Healing:

                     Impaired wound healing simply means the wounds take time to heal after some type of injury that you face when this happens it is a clear indication that your body is lacking Vitamin D. When skin is injured higher amount of Vitamin D intake will help in healing and better outcomes. Thus poor in Vitamin D leads to a higher risk of infection in the wounds.

What are the risks of Vitamin D deficiency?

      Vitamin D deficiency has a higher risk than you can expect deficiency in vitamin D not only can cause several kinds of unwanted diseases it also can cause the death of some people if it remains untreated. Various factors can increase the risk of deficiency

  • Diet

     Proper diet is essential people who do not consume enough foods rich in vitamin D have a higher chance of vitamin D deficiency. Foods such as dairy products, seafood, egg yolk, etc. must be consumed by the people to reduce any symptoms of disease caused by vitamin D deficiency. 

  • Lifestyle Factors

     The Lifestyle of people also has a role some people spend less time outdoors due to work, illness, or lack of space. These people have higher chances of facing Vitamin D deficiency as they cannot get the main Source of vitamin D.It also includes cultural or religious factors.

  • Pollution

     Pollution is one of the major problems as it blocks the rays of the sun from reaching the skin. People who are living in polluted areas have a higher chance of vitamin D deficiency because they do not like to stay outside of their homes and food alone cannot fulfill the Vitamin D deficiency.

  • Pregnancy

    Need for Vitamin D increases during pregnancy. Supplements are not a good idea during pregnancy as it reduces the risk of preeclampsia, gestational diabetes, low birth weight, and severe bleeding during delivery.

  • Critical illness

Vitamin D deficiency is associated with increased mortality and critical illness. People who take vitamin D before are likely to live more than those who take supplements after some severe cases. Additionally, vitamin D levels decline during the stay in intensive care.

  • Geographical factors

   People who live in certain parts of the world have less access to the sun such as the people who live in northern Canada, etc. Vitamin D deficiency is not only faced by the people where there is less sun but also by the people where there is more sun as the temperature rises the people living there try to avoid it by staying inside their homes.

  • Obesity

People who have Obesity are at a major risk of facing vitamin D deficiency as their body fat binds the vitamin D that they get from the sun or their food and prevents it from getting into their blood. So, no matter how much vitamin D they get the fat will not let the vitamin D to be used by their body.

  • Skin

  What kind of skin you have is also a way to find out how much vitamin D can you take from the sunlight. Research suggests that people who have dark skin are at a higher risk of vitamin D deficiency that the people who have white skin. As the people who have dark skin they contain a pigment (melanin) does not absorb as much absorb the UV radiations.

Why do women have more Vitamin D deficiency in Nepal?

Women are more likely to have Vitamin d deficiency in Nepal than that of the Male. As in Nepal because of the cultural and traditional believes child birthing women or those women who have already given birth to a child have higher chances of getting vitamin D deficiency as they are not allowed out of their homes or they should cover their whole body with clothing by which sunlight cannot touch their body. According to the doctors, only the foods cannot satisfy the vitamin D that is needed in a human body only 20% can be covered by the supplementary and food but the rest 80% is covered by the sun. As Nepal is a developing country, houses are constructed in such a way that they leave no way for the sunlight to pass which leads to Vitamin D deficiency. Women are usually found to be suffering after menopause due to lack of estrogen hormone which causes weakening of bones. Females are greatly affected by Vitamin D deficiency as there is very low intake of nutrition in them. Females are lacking in vitamin D because of the hormones the female body needs more vitamin D for cell production or regeneration compared to that of the male. Doctors have suggested sitting under the sun in order to minimize the risk of vitamin D. People are consuming tablets for gaining vitamin D which is not good for the health.  

How can we prevent Vitamin D deficiency (lifestyle and home remedies)?

As the amount of vitamin D that a human body needs at a normal level is 25 hydroxyvitamin D not only that it also depends upon your skin color, sun exposure, medical conditions, balanced diet, etc. The goal of treating a vitamin D deficiency is to reach and keep an adequate level of vitamin D in your body. As vitamin D helps a body to function properly by keeping the bones strong, muscles strong, etc. So we can prevent it by

  • Eating more foods containing vitamin D:

As Vitamin D is quite important to keep the human body strong, a balanced diet is also important for a healthy body. Without a proper diet, the body will not be able to function. Vitamin D sources include

  1. Eggs: Eggs are one of the main protein that contains high in Vitamin D not only in Vitamin D they have almost all the vitamin that a human body needs.
  2. Dairy Products: Dairy Products are also another main source of Vitamin D. Dairy products such as milk not only contains Vitamin D but they are rich in calcium which helps to keep the bones strong and also most dairy products are cheaper comparing them with others.  
  3. Fish: Fatty fish such as tuna, salmon is a great source of Vitamin D. Oily fish, as well as oils from fish, have some of the highest quantities of Vitamin D in food source which might also include cod liver oil, herring, swordfish, etc.
  4. Mushroom: Mushroom is also high in Vitamin D. If a person does not like fish or they are vegetarian it is a great option for securing vitamin D. All the mushrooms are not the same. Especially button mushrooms are high in vitamin D and thus are a good option for Vegans.

Getting Exposure to Sun Light:

        Sunlight is one of the major sources of Vitamin D. Every person should get exposure to sunlight each day. As people do not have the same lifestyle so about 10 to 20 mins each day 3 to 4 times a week should be enough. But different age people need a different amount

Age 12mnths  =  400 IU

Age 1-70years = 600 IU

Age 70+ years = 800 IU

Lifestyle plays a vital role in Vitamin D deficiency some people are willing to change and help themselves in removing the deficiency whereas some may not. Also, people who use sunscreen and people who sit in the sun behind the window cannot get Vitamin D properly as the window is blocking the UV rays to enter your body. But too much of sitting in the sun might cause skin burn or skin cancer. As all the people are unable to expose their skin to the sun due to lack of sunlight those people should take those supplements all year long so as to maintain the vitamin D level in their body.

Treatment of Vitamin D deficiency

Sometimes intake in Vitamin D is not sufficient so supplements are required. Vitamin D2 and Vitamin D3 are recommended by doctors. The doctors recommend  daily  intakes must be taken by patients to prevent Vitamin D deficiency  and maximize bone strength

  • Children age 0-1: Doctors recommend  400 IU -1000 IU must be taken daily by the patients to achieve 30 ng/ml.
  • Children age 1-18: Doctors recommend 600 IU -1000 IU must be taken daily by the patients to achieve 30ng/ml.
  • Adult age 17-70: Doctors recommend 600 IU – (1500-2000) IU must be taken daily by the patients to achieve 30ng/ml.
  • Adult older than 70: Doctors recommend 800 IU – (1500-2000)IU must be taken daily by the patients to achieve 30ng/ml.

Daily Supplements with Vitamin D at a dose of  1000-2000 IU is typically needed. If the patients are suffering from any other kinds of diseases or factors such as obesity, malabsorption, and certain ethnicities, etc. higher doses are required in order to fulfill the requirement of the body. Not only with diseased people Transplant patients and older individuals also require higher doses of Vitamin D supplements in order to fulfill their daily requirements.

When to visit a doctor?

Most people do not need a Vitamin D test. NICE recommends that people should not normally go and test their Vitamin D levels. The test should only be performed if there is any indications or symptoms in their body to do so

  • Osteomalacia: It is a disease characterized by the softening of the bones caused by impaired bone metabolism which is caused due to insufficient calcium, Vitamin D, etc. It includes body pain, muscle aches and weakness, impaired physical functions, waddling gait, symmetric lower back pain, etc.
  • Chronic widespread pain: It is characterized by long-lasting pain in multiple body regions such as fatigue, concentration problems, psychological distress, etc.
  • Hypocalcemia: It simply means a low calcium level in blood serum. The normal range is 2.1-2.6 mmol if it is below that it is known as hypocalcemia. It includes muscle cramps, numbness, etc.
  • Bone Disease that may be improved by Vitamin D treatment

    In children:
  • Rickets: It is the skeletal disorder that is caused by a lack of calcium and vitamin D which may lead to bending of bones. People with rickets have soft bones, stunted growth, skeletal deformities, etc.
  • Muscular weakness
  • A chronic disease that may lead to a deficiency in Vitamin D.

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