The Indian emergency of Vitamin D
If you write about the interface between food and health as I often do, there is something you learn very quickly: by the time most public health scares have been understood by the general public, the medical wisdom has usually been turned on its head. And when there are genuine public concerns, they often go unnoticed.
Let’s take one example of a scare where doctors have kept changing their minds though the general public has not always realised this. In the 1960s, as we worried about heart disease, doctors identified cholesterol as a key factor in its onset.
The role of cholesterol in causing heart attacks is still the subject of research, but most doctors will tell you – quite correctly – that patients with higher levels of cholesterol in the blood are more at risk of suffering from heart conditions.
This is uncontroversial enough. But the problem comes when this anti-cholesterol mindset is applied to food. American doctors recommended that we restricted our cholesterol consumption to 300 mg of dietary cholesterol. This meant that many foods which contained cholesterol were put on the banned list: eggs, butter, desi ghee, coconut oil, red meat, dairy products, lobster and even avocado.
The key assumption in this recommendation was that dietary cholesterol would be converted into serum (blood) cholesterol in the body. But there simply wasn’t the scientific evidence to back that up.
In 2015, the US government admitted that we had got this wrong. The Dietary Guidelines Advisory Committee (DGAC) of the US government wrote in its report that year: “Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 grams a day. The 2015 DGAC will not bring forward that recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and blood cholesterol. Cholesterol is not a nutrient of concern for over consumption.”
Not surprisingly, some of our doctors have not read the report, so you keep getting the same outdated warnings about butter and red meat. Few doctors will tell you that of the total cholesterol in the body, around 85 per cent is produced internally. Only 12 to 15 per cent comes from outside sources. So it is unlikely that another slice of buttered toast will kill you.
All over the world, a basic problem is that doctors read research coming out of the US and then don’t always bother to do any follow up. There is also the role of Big Pharma, which likes health scares because they lead to the sale of more drugs. (There has been a huge controversy in the US in recent year about Big Pharma and the cholesterol-reducing drugs it pushes.)
When a health crisis erupts spontaneously in India with few precedents in the West, many of our doctors are caught unawares. Forget for a moment about the overhyped dangers of dietary cholesterol and think about a real public health crisis in India: the Vitamin D deficiency problem.
The thing about Vitamin D is that it should be almost too easy to produce. It is needed mostly by brown people like us (and Hispanics) who have large amounts of the pigment melanin in our skin (White people don’t need it as much as we do). But this should not be a problem because the body naturally synthesises Vitamin D from sunlight. And as we live in sunny countries, we should be making a lot of Vitamin D every day.
Because this is not a condition that greatly concerns the American medical establishment, there is not as much literature about it as there is on, say, cholesterol. Until a couple of decades ago, even the pathology labs in big cities did not offer tests for it.
We only realised what was going on and how bad the problem had got when a handful of doctors began asking questions. Ambrish Mithal is quite well-known now (he is head of the department of endocrinology at Medanta) but a few decades ago when he was a little known professor at a medical college in Lucknow, he would get on his bike and drive to nearby villages to check out poor patients.
Dr. Mithal found massive amounts of bone malformation in children for which there was no clear explanation. Eventually, his research convinced him that the water in those villages had high level of fluoride and the fluoride was causing the bone damage.
As he continued checking on cases of malformed bones, he became convinced that there had to be another reason. We all know that calcium is one obvious contributor to bone health, but Mithal began to wonder if there was also a Vitamin D deficiency. It is Vitamin D that helps transport calcium all over the body.
At first, the idea seemed ridiculous. How could Indians who live and work in the sun be short of a vitamin that is produced naturally by the body from sunlight? But as he began testing for Vitamin D levels in the blood, Mithal was convinced he had it right.
For instance, women from communities that either did not let them go out much or only let them go out if they were covered from head to toe had severe bone problems and yes, low levels of Vitamin D.
Mithal began to look at tests in the cities. He found that Vitamin D levels were far below normal and that they fell further in winter.
His hypothesis – now accepted by most doctors I know – was that while our ancestors spent a long time in the sun, today’s Indians shun direct sunlight. We travel in covered vehicles. We remain indoors more often. We spend less time out on playing fields.
But even if we do go out, there are other factors. Your body won’t pick up many UV rays from the sun if you go jogging in the morning or if you play a game of tennis in the early evening. The best time for the UV rays is between noon to 3pm when the sun’s rays are at their highest. And that’s exactly the time when no one wants to go out in the sun.
In recent years, there is a new factor. The smoggy cloud of pollution that covers most of our cities (especially in the winter) prevents UV rays from reaching the ground. So even if you are out in the sun at say, 1pm, you may not get the level of sunlight required to create Vitamin D.
So, what should you do?
I asked Dr. Mithal. He told me that while most labs can now test for Vitamin D, it is not really necessary to take a test. If you have any of the following symptoms – muscle weakness, fatigue, pains while climbing stairs, your legs hurt all the time – then it is worth adding a Vitamin D supplement to your diet. If these symptoms don’t go away, then you can go and see a doctor and take your tests.
The logic is simple: tests are expensive. Supplements are largely harmless and cheap.
But this individual approach will meet with only limited success, so Dr. Mithal has been lobbying and petitioning government bodies to add Vitamin D to milk and other foods. This is not expensive and in many countries abroad, foods are routinely fortified with Vitamin D.
But there is also a flip side. Now that doctors and labs are aware of the Vitamin D crisis, misinformation is being spread. Doctors will tell you that a level of 20 nanograms of Vitamin D in your blood is normal. (Don’t get really worried until it drops to under 12 nanograms.) But labs will claim in their reports that 30 nanograms is normal and tell you that you have Vitamin D deficiency.
A doctor will then prescribe a supplement that you may not need and which you could have bought yourself anyway. Big Pharma has seen the opportunity, so many doctors will push you to have high dose Vitamin D injections, which are unnecessary for most of us.
So, when it comes to Vitamin D, take a simple do-it-yourself approach. Add an inexpensive supplement to your diet if you have any of the symptoms. There probably will be no need to ever involve doctors or labs.
With a bit of luck, in a few years’ time, food will be fortified with Vitamin D and you won’t even need to take a supplement.
Till that happens, worry about Vitamin D in the way in which doctors make you worry about cholesterol. The dietary cholesterol scare may be overstated and outdated.
But the Vitamin D emergency is real and the time to do something about it is now.
From HT Brunch, May 12, 2019
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