Meeting A P J was a memorable experience. I had never met him personally, though he was the chief guest at our convocation at the All India Institute of Medical Sciences convocation ceremony in 2013. We were awded our degrees by the then Health minister Mrs Sushma Swaraj. A P J was the President of India and was by defacto the President of the Institute. He was a extremely popular person then as he is now. He delivered his address, the most strking of what I thought was his simplicity. At the same time his zeal, enthusiasm and imagination was very inspiring.

Incidentally he was visiting to our Housing colony to meet his old friend and colleague Shri Vasant Govarikar( Ex Chief of ISRO and Scientific advisor to PM). As expected a large crowd had gathered to greet APJ. My son Ved was 11 years and was very eager to see him. We could only briefly see him and that did not satisfy my son. He qwas very much not happy that he could not talk to him. Any amount of consolation would not satisfy hi. That is when I suggested that we send A P J an email and seek an appointment to meet him.

His  secretary gave a prompt reply and then we forgot about it. A few months down the line, I got a surprise call from A P J’s office in New Delhi. I was invited to see him during this visit to Pune the same day with my family.

We got to see him for a short while though. I found him remarkably fit for his age and his hectic schedule. The moment we entered his room, he got up to greet us, again a mark of a very great human being. My son even asked him for a message and he very readily gave him in his very teacherly manner asking Ved to repeat..

Knowledge Makes you Great.

Vitamin D: A neglected gift from the Sun!

Measuring Vitamin D levels in the blood is gradually becoming a part of many preventive health checkups. With increasing avenues of illnesses where lack of Vitamin D in the body could be a possible culprit, we are coming across more and more reports mentioning deficiency levels. It would be worthwhile knowing more of this vital vitamin.

What is it?

Vitamin D is a unique Vitamin which is produced under your skin with the help of sunlight. Once this is produced, it is further processed in the kidney and the liver after which it has a variety of tasks to perform. Important amongst all is making the bones stronger by helping deposition of calcium in them. Over the years, it also has been found that several other organs also have channels for Vitamin D and it could be playing a significant role in other diseases as well.

What is the reason for the deficiency state?

An obvious cause of Vitamin D deficiency is the lack of exposure to good sunlight, which is the main resource for the body. Long office hours and prolonged indoor stays are affecting the right dosage of sunlight. Dark skin and certain traditional clothing could also affect the Vitamin D production under the skin.

What are the implications?

Rickets and Osteomalacia have been long known to be the effects of vitamin D deficiency. Although this was predominantly noted in the low socio economic strata of the population, urban Vitamin D deficiency effects cannot be neglected. As the possibility of measuring Vitamin D levels is becoming increasingly available, it has been found that Vitamin D deficiency could have a role in diseases like Diabetes, breast Cancer, Prostate cancer, depression and certain autoimmune diseases as well. This could be specifically important in women after their menopause because of the change in the hormonal environment. The most important effect of a deficiency is the weakening of the bones. This weakening causes an increased predisposition to fractures after trivial injuries or falls, which in turn causes a lot of disability.

Assessment of the Status:

Assessing the fracture risk in an individual could be done by two important tests. Viz. 1. Measuring Vitamin D levels in blood and 2. Bone Mineral Densitometry or BMD scan.

Although there is a difference of opinion about the exact level of Vitamin D level which is responsible for disease, a general consensus is that a level of more than 30 ng/ml is a healthy level.

A Bone mineral densitometry is an X ray based study. It can give us the estimate of the calcium mineralization of the bones, which is an indirect reflection of the fracture risk. Usually this test is performed using a technique called DXA or Dual energy X Ray Absorptiometry. This test gives us two important scores viz. the T score and the Z score. T score compares your bones with bones of a young healthy person while Z score compares the bones with those of your age. T score is generally useful for estimating the fracture risk and Z score is used when some specific disease of the bone is suspected in a particular part of the body.

BMD scanners are now being made widely available. Estimating the mineralization of the heel bone by placing your foot on the machine could be used as a screening test. However, with increasing age, there are specific areas like the hip and the vertebral column which are actually more prone to fractures. Hence it makes sense to do an area wise T score estimation with bigger machines to know the area wise fracture risk better.

Artificial replacement: Is it a solution?

Modern medicine advises supplementation of Vitamin D and Calcium for those who are found to have an increased fracture risk. A Calcium supplementation of 500 mg per day is sufficient usually to improve calcium reserves. This has to be taken after consultation with your doctor, as it is to be given carefully in patients with kidney stones and other diseases.

If a low T score is accompanied with low Vitamin D levels, a supplementation with Vitamin D would be helpful. Usually a onetime dose of 50,000 Units for 4 consecutive weeks followed by a maintenance supplementation is recommended. The maintenance supplementation could vary from 200 to 400 IU of Vitamin D3 per day depending on your age.

There are still controversies on whether a supplementation of artificial Vitamin D actually prevents disease. Increasing an intentional healthy exposure of sunlight, especially early in the mornings could be holistically handling all the effects of the Vitamin D deficiency being caused by faulty lifestyles.

The healthy state of the mind has a big role to play with the immune system. And it is a proven fact that a good sunlight exposure is needed for the mind to be in a happy state.

No wonder the diseases associated with the body immunity like diabetes, cancers and auto immune diseases are being seen associated with the deficiency of vitamin D which in fact could be reflecting a lack of good exposure to sunlight.

It would be a good idea for the Industry to provide a 30 minute sunlight tea break at around 11 am on their terraces for their employees every day.

Definitely, the sun has much more to offer us than just Vitamin D!

Author: Dr Pushkar Khair