Vitamin D and Sunlight are we getting enough?
By Dr Brighton Chireka
Vitamin D is important for good health and lack of it is very common. Vitamin D is mostly made in the skin by exposure to sunlight. We take the sunlight for granted because it’s free and easily available. We sometimes complain about it being too much . Our capital city in Zimbabwe is called sunshine city because we are bound to get a good dose of sunshine. For black people the sunshine is good for our health and others with “white” skin may be too much.
The world is now a global village people are relocating to different parts of the world . Many black people have found themselves in cold countries without sunlight. Black people are likely to need more time in sunlight if they live in the northern hemisphere or very far from the Equator – like South Africa, Canada , Europe or the US. The challenge is that in some of these countries there is not enough sunlight.
Allow me to digress a bit
Sunlight is not only needed for light but does play an important role in our food. At high school we used to brag about being learned by talking about “photosynthesis ” and “phototropism” These two processes have something to do with sunlight.
Photosynthesis is the process by which plants, some bacteria and some protistans use the energy from sunlight to produce glucose from carbon dioxide and water.
Phototropism is the orientation of a plant or other organism in response to light, either towards the source of light ( positive phototropism ) or away from it ( negative phototropism ).
Back to our discussion about Vitamin D
Vitamin D is a fat soluble pro-hormone. It is obtained through the action of sunlight on skin and from dietary sources. The action of sunlight (ultraviolet radiation of wavelength 290–310 nm) on skin converts cholesterol in the skin into vitamin D. To get the final active form of vitamin D, the liver and kidney are involved in processing the vitamin D from skin. The dietary form of vitamin D also has to pass through the liver and kidney to be processed into the active form. Most foods contain no or very lite vitamin D naturally .
Food that contain vitamin D include:
– Oily fish ( such as sardines, pilchards , herring , trout, tuna and mackerel)
– Fortified foods ( added vitamin D ) such as margarine and some cereals. Cereals are not without their problems as there are over processed and have high sugar content.
– Infant formula milk has added Vitamin D so babies who are being bottle-fed may not need extra vitamin D.
– cod liver oil is another source of vitamin D
– There is little or no vitamin D in UK milk or dairy products. Egg York, liver and wild mushrooms contain only small quantiles of vitamin D.
This shows that the only answer to getting enough Vitamin D is sunlight or taking supplements.
Vitamin D and Sunlight
We need the sunlight to make vitamin D and for a fair-skinned person (white ) , it is estimated that around 20-30 mins of sunlight on the face and forearms around the middle of the day 2-3 times a week is sufficient to make enough vitamin D in the summer months in the UK.
People with darker skin ( Asians and Africans etc) and the elderly need more time exposed to sunlight to make enough vitamin D. This is not possible in countries like the United Kingdom(UK).
For six months of the year ( October to April) much of the Western Europe ( including 90% of UK) lies too far north to have enough ultraviolet B in sunlight necessary to make Vitamin D in the skin. This means that many people in UK are at risk of not getting enough vitamin D.
Why do we need vitamin D ?
Main action is to help the absorption from the gut of calcium and phosphorus. Calcium and phosphorus are needed to keep bones healthy and strong.
Vitamin D is also important for muscles and general health . There is evidence that vitamin D help to prevent other diseases such as cancer, diabetes and heart disease.
A low vitamin D status has been implicated in a range of diseases including osteoporosis, several forms of cancer, cardiovascular disease, tuberculosis, multiple sclerosis and type I diabetes. Osteomalacia and osteoporosis both increase the risk of fracture.
How common is Vitamin D deficiency?
The National Diet and Nutrition Survey, demonstrates that up to a quarter ( 25%) of people in the UK have low levels of vitamin D in their blood, which means they are at risk of the clinical consequences of vitamin D deficiency. The Health Survey for England (NHS Information Centre for Health and Social Care 2010) found that 35% of adults in London had low status compared to the national average of 24%. This may reflect the higher number of people from the minority ethnic groups at risk of vitamin D deficiency living in London, compared to other parts of England. In winter and spring about 1 in 6 people in the UK have severe deficiency. It is estimated that about 9 in 10 (90%) adults in UK of South Asian origin may be vitamin D-deficient.
Other evidence highlights a greater risk of vitamin D deficiency in population subgroups, particularly infants from black and ethnic minority groups. Cases of rickets and hypocalcaemia in UK children, predominantly of Afro- Caribbean or South Asian origin, are widely reported .
Recently we witnessed a tragedy in our UK Zimbabwean community where a couple lost a baby due to malnutrition and rickets . The couple is sadly in prison as I write this article. They were charged with neglect of their child and ignorance is no defence.
It is my conclusion that over 90% of black people in the UK may be vitamin D-deficient. This is the main reason why I have compiled this article. Most people affected may not have symptoms yet or they have just vague symptoms such as tiredness , aches and pains and are unaware of the problem. I hope this article will add value to those people’s lives as they will say that after reading this article they took action about their vitamin D.
Who gets vitamin D deficiency?
Vitamin D deficiency means that there is not enough vitamin D in one’s body. This can occur in three situations:
1-The body has an increased need for vitamin D
2-The body is unable to make enough vitamin D
3-The body is not getting enough Vitamin D in diet
1-Increased need for vitamin D
Pregnant women , growing children and breast-feeding women all need extra vitamin D. There is increased need for Vitamin D if the gap between pregnancies is short. This is because there is little time to build up vitamin D stores before another pregnancy. Since breast feeding mothers lack enough vitamin D , this means that breast-fed babies will need extra vitamin. Please do not get me wrong , there are significant advantages to breast-feeding . No mother should stop breast-feeding due to concerns about vitamin D levels . The baby can simply have vitamin D supplements as drops by mouth.
2-Body unable to make enough vitamin D
There are various reasons why the body may be unable to make enough Vitamin D. The best source of Vitamin D is sunlight so people who get little of it are at high risk of deficiency. This is more of a problem in more northerly parts of the world where there is less sun especially the United Kingdom. This is worse in people who stay inside a lot. Those in hospital for a long time or are housebound.
People who cover up a lot of their body when outside especially those who wear veils such as the niqab or burqa.
I know there is need to protect the skin from harmful effect of the sun rays but there is a need for a balance. Sunscreen use lead to vitamin D deficiency , particularly if high sun protector factor (SPF) creams factor 15 or above are used.
People who have darker skin for example , people of African , African-Caribbean and South Asian origin are not able to make much Vitamin D in countries with less sun. This has been explained in detailed above.
Vitamin D deficiency can also occur in people taking certain medicines. For example Epileptic people on carbamazepine, phenytoin and people on some anti HIV medicines ( efavirenz).
One study showed that initiating two efavirenz-based antiretroviral regimens had a significant early decline in their vitamin D levels when compared to those initiating an atazanavir-based regimen.
3-,Not enough dietary Vitamin D
We all know that diet is not the best source but we must not shun away from foods with some vitamin D. People who follow a strict vegetarian or vegan diet or a non fish diet are at high risk of deficiency.
Symptoms of Vitamin D deficiency
Many people may have no symptoms of may complain of tiredness or general aches. Because of this the diagnosis of vitamin D is often missed.
Symptoms in babes and children
Vitamin D deficiency leads to low calcium which will result in muscle cramps , seizures and breathing difficulties. This may need urgent hospital treatment as it may be dangerous.
Severe deficiency may result in soft skull or leg bones. The legs may look curved ( bow-legged). This condition is known as rickets and children may also complain of leg pain and muscle pains or weakness.
Poor growth can result due to the deficiency
There is delay in teething
Children can be easily irritable
Children may be more prone to infections
Extreme low vitamin D level can cause weakness of the heart muscle ( cardiomyopathy)
Symptoms in Adults
Common symptoms which are ignored by many of us are general tiredness, vague aches and pains and a general sense of not being well.
Severe deficiency ( osteomalacia) there may be severe pain and also weakness. People can find themselves unable to get up from the floor or low chair. It can also cause difficulties in climbing stairs and can lead to the person walking with a waddling pattern ( clumsy swaying motion )
Bones can feel painful to moderate pressure especially in the ribs or shin bones)
Sometimes people have hairline fractures in bones and also bone pain in lower back, hips , pelvis , thighs and feet.
Treatment of Vitamin deficiency
Treatment varies depending on the level of deficiency and associated symptoms or disease. Please speak to your doctor for the appropriate dose for you .
According to Dr Kem
If you are deficient you’d need at least 10,000 IU per day till your levels normalise then you’d maintain on 2000IU per day.
— If you have insufficient levels you’d need at least 2000IU per day, normalise then maintain on 1000IU per day. You’d still have to increase back to 2000IU per day in winter months though.
You may want to read her 10 pillars of a healthy lifestyle
All UK Health Departments recommend:
* All pregnant and breastfeeding women should take a daily supplement containing 10μg of vitamin D, to ensure the mother’s requirements for vitamin D are met and to build adequate fetal stores for early infancy.
* All infants and young children aged 6 months to 5 years should take a daily supplement containing vitamin D in the form of vitamin drops, to help them meet the requirement set for this age group of 7-8.5 micrograms of vitamin D per day. However, those infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products are fortified with vitamin D. Breastfed infants may need to receive drops containing vitamin D from one month of age if their mother has not taken vitamin D supplements throughout pregnancy.
* People aged 65 years and over and people who are not exposed to much sun should also take a daily supplement containing 10 micrograms of vitamin D.
* People who have darker skin, for example people of African, African-Caribbean and South Asian origin, because their bodies are not able to make as much vitamin D. These will need supplements containing 10 micrograms of vitamins per day.
Take note of the units – 1 micrograms is equivalent to 40 international units (IU) . This means the 10 micrograms recommended is similar to 400IU.
Here are just a few tips on increasing your sun exposure by by Eden Chiuslekuda.
Eden is an ECCT Natural Health Contributor.
Just expose your bare arms and or legs while you are out and about and simultaneously get more exercise by opting to walk to work or run your errands by foot.
Exercise outdoors instead of at the gym.
Do not wear sunblock which reduces our skin’s ability to make vitamin D from sunlight by as much as 95%.
If you are concerned about sun damage – get your exposure in the early to mid morning time frame, or late afternoon to early evening when the sun is not so intense in the sky.
Use a very mildly protecting natural oil like shea butter to prevent sun damage or eat a diet very high in antioxidants. A lot of our wild indigenous fruits (like tsubvu) have high levels of phytonutrients that add a protecting quality against sun damage to the skin.
What is the take away home message ?
We know our lifestyles, we know that we are always indoors and we know that there is not enough sunlight. We know we are not feeling well, we ache all over and also feel tired. We are prone to more infections , diabetes , cancer you name it. Could it be related to lack of vitamin D deficiency? Probably yes ! So what are you waiting for ? See your doctor for further discussion.
I will leave you with my quote :
“Remember when it comes to taking action about your health , do not procrastinate or say I will start tomorrow. There may be no tomorrow or tomorrow can be a disease”, says Dr Chireka
This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: firstname.lastname@example.org and can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.