Sixth-Year medical student in Shanghai Medical College (China), Intern at WHO, Farawaniyah Hospital (Kuwait), and Zhongshan Hospital (China).

Sunlight is a source of abundance. especially in Kuwait, with periods of March-September being a glaring killer. Exposure to sunlight allows us to get the crucial vitamin D but despite it being easily attainable, billions still suffer from vitamin D deficiency and insufficiency.

Though it may seem like an insignificant part of the alphabetical list of vitamins, the vitamin D is fundamental for the body to carry out day to day processes.

Contrary to popular belief due to the name, vitamin D is actually a hormone or at least the “activated” form is because of its importance in regulating bodily functions.

Normally, when the sunlight hits the skin, the ultraviolet light helps convert a chemical into vitamin D which is stored inactively in the body. When needed, the inactive vitamin D goes through a series of conversions in the liver followed by the kidney to become active in order to be used.

Through dietary sources, vitamin D does not need to go through a change with the help of ultraviolet light, it directly goes from liver to kidney to become activated.

If this vitamin is so vital and easily attainable, why are one billion people deficient for it (the reasons listed are in no particular order).

Decreased sun exposure

More than 50% of the vitamin D acquired goes through the sun to skin channel. Spending 30 minutes a day with sufficient skin exposure to the sun, is enough to get the required vitamin D to avoid deficiency. Especially during the COVID-19 pandemic era, more people are staying indoors, limiting the time spent outside that would allow sun to bless them with its abundant resource. In Kuwait, during the peak summer times the sunlight is too easily accessible but just due to the pure overwhelming strength of it, people avoid spending time outside.

Even if there is sufficient sunlight exposure, other factors play a part. The latitude of the location being one of the factors, with higher latitude countries such as the UK making their population prone in struggling to achieve the vitamin D levels required. The color of skin also plays a role, with dark-skinned people having a higher concentration of a pigment called melanin. This pigment prevents the ability of synthesis of vitamin D through sunlight. People, especially women, would wear more skin covering that would decrease the available exposure for the sunlight to hit the skin.

Theoretically, sunscreen inhibits the penetration of ultraviolet lights, which inevitably should decrease the ability of the body to create the inactive vitamin D, but often people do not put enough sunscreen to block out all the ultraviolet lights.

Dietary intake

Simply put, Healthary requirement of vitamin D obtained through foods and/or supplements are not achieved. Most vitamin D rich sources include fatty fish like salmon, egg yolks, orange juice, and milk. In terms of non-meat/non-animal product foods, mushrooms are the vitamin D rich plant/fungi based foods. So naturally vegetarians and vegans are more prone to be deficient in vitamin D compared to the general population.

Underlying health issue

There can be low vitamin D levels even if there is sufficient sun exposure and dietary consumption. Some diseases such as celiac disease, inflammatory bowel disease, cystic fibrosis all lead to decreased absorption of vitamin D within the intestines.

Obesity causes overall health deterioration, with a higher prevalence of vitamin D deficiency in obese individuals being well-documented. Ironically, weight loss surgeries also are at a higher risk of vitamin D deficiency, due to the nature of the surgery. The reduction of the size of the stomach or intestine decreases area of absorption but also causes the individual to not be able to consume the required amount of foods to reach the sufficient level.

As the process of activation of vitamin D needs to go through the liver and kidney, diseases that impact the function of these two organs inevitably lead to a decreased level of activated and usable vitamin D.

The pesky part about vitamin D deficiency is that for the majority it is asymptomatic or brushed off as another issue. The symptoms it causes in the beginning are quite generalized such as lethargy and fatigue. But gradually as it becomes more severe, other prominent issues start to arise like joint and bone pain, muscle pain, twitching, and it can also contribute to depressive symptoms.

A major area that is often overlooked by the general population is the importance of vitamin D for bone health. Since birth we have been told that calcium is important for strong bones, and though it is true, vitamin D is equally important. Vitamin D helps with absorption of calcium in the intestine, kidneys so even if there is sufficient calcium intake, unless vitamin D is there to stimulate those organs to start absorbing calcium, the bones will get weak.

In children, vitamin D deficiency leads to a disease called rickets, while in teenagers and adults it would first cause bone pain then contribute to fragility of bones leading to easy fractures. In women who have hit menopause vitamin D is extremely important, as they have decreased bone density due to drops in hormone estrogen- which helps maintain bone density.

Now the best way to combat the deficiency is to go outside and accept the sunlight and/or with an intake through dietary sources whether those are supplements or foods. Supplements taken orally or through an injection form both are good, but there is a higher level of absorption with the injection.

Of course if the problems still persist, it is best to see a physician to investigate if there is another reason that is either the root of the symptoms or is leading to the decreased vitamin D levels.

Go out, get some sunlight, and renew the energy in your body with vitamin D.

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