Despite having plenty of sunshine, Pakistan is facing a major nutritional problem of vitamin D deficiency. This seems contradictory because the body can make vitamin D when the skin is exposed to ultraviolet B radiation from sunlight.

The figure commonly quoted is “70%+ Pakistanis are vitamin D deficient,” but this needs to be treated carefully. It is more accurate to state that the prevalence of vitamin D deficiency has been reported to be very high in Pakistani populations, with some studies reporting prevalence around or above 70% in certain groups. This should not be considered as an exact national figure for every Pakistani.

The problem is affected by lifestyle, clothing, indoor living, air pollution, skin pigmentation, diet and other health factors.

Vitamin D contributes to calcium absorption, bone mineralization, muscle function and many other physiological functions.

Why Doesn't Pakistan's Abundant Sunlight Prevent Deficiency?

There is sunlight availability and then there is proper vitamin D production.

A person may live in a sunny city, but spend most of the day in an office, school, shop or home. Clothes can cover most of the skin, even when outside the house.

Also production of vitamin D is affected by:

• Skin pigmentation

• Time of day

• Season

• Amount of skin exposed

• Age

• Sunscreen use

• Air pollution

• Geographic location

• Duration of exposure

So just saying “Pakistan has enough sunlight” does not tell us if an individual is getting enough vitamin D.

Why Does Skin Tone Matter?

Melanin is the pigment that gives skin its colour, and it reduces the skin’s ability to make vitamin D from UVB exposure.

So people with darker skin may need more UV exposure to make the same amount of vitamin D as someone with lighter skin.”

That’s not to say you should intentionally get too much sun. Sun exposure should still be sensible and appropriate as ultraviolet radiation can harm the skin.

Can Pakistani Clothing Contribute to Low Vitamin D?

Yes it can.

Clothing that covers most of the body decreases the amount of skin exposed to UVB radiation. This is especially true for people who do not spend much time outdoors.

This does not make traditional dress unhealthy. That just means that clothing is one of many things that can affect vitamin D production.”

What Are the Symptoms of Vitamin D Deficiency?

Vitamin D deficiency can be difficult to detect, as there may be few obvious signs or symptoms of mild deficiency.

Possible symptoms include

• Muscle weakness

• Bone or muscle discomfort

• Tiredness

• Reduced physical performance

• Poor bone health

• Increased risk of fractures in severe cases

Nevertheless, vitamin D deficiency is not always to blame for tiredness.

Other issues such as iron deficiency, thyroid problems, lack of sleep, stress and other nutritional problems can have similar symptoms.

How Does Vitamin D Support the Body?

Vitamin D has a wide range of important functions.

Its most famous job is helping the body absorb calcium and keep bones healthy. It also plays a role in normal muscle and nerve function and helps support the immune system.

Vitamin D deficiency can lead to rickets in children and osteomalacia in adults. Long-term deficiency of vitamin D and calcium can also cause poor bone health.

What Foods Contain Vitamin D?

Dietary sources of vitamin D are relatively sparse.

Useful sources:

• Fatty fish

• Egg yolks

• Fortified milk

• Fortified cereals

• Some mushrooms

• Certain fortified foods

Diet alone might not be enough vitamin D for many people.

How Is Vitamin D Deficiency Diagnosed?

A healthcare professional may use a 25-hydroxyvitamin D [25(OH)D] blood test to evaluate vitamin D status.

Testing can be especially helpful for someone who has symptoms, risk factors or a medical condition that is associated with vitamin D deficiency.

Testing also prevents you from taking high dose supplements blindly.

Can Vitamin D Supplements Help?

Yes, supplementation may be appropriate when dietary intake is insufficient or a deficiency has been identified.

Herbiotics Calfint-D Vitamin D3 in 5,000 IU and 10,000 IU strengths The 5,000 IU product is listed as containing 5,000 IU vitamin D3 per tablet. The 10,000 IU version contains 10,000 IU per tablet.

But these are fairly high strength products, considering the general recommended daily intake of 600 IU for adults 19-70 and 800 IU for adults over 70.

And that’s a significant difference. A high strength supplement should be used according to professional advice rather than assuming that a higher dose is automatically better.

What Happens If You Take Too Much Vitamin D?

Vitamin D is fat soluble so it can build up too much.

Excessively high vitamin D levels can increase calcium levels, resulting in nausea, weakness, excessive thirst, frequent urination and kidney problems.

Hence the need to supplement according to actual needs, not just assuming that everyone needs a high dose.

Why Should Pakistanis Pay More Attention to Vitamin D?

Vitamin D deficiency can be silent for a long time.

You may blame work, stress or a hectic schedule for tiredness or muscle weakness, but not realize that you could also be suffering from nutritional deficiencies.

For those at higher risk, it’s more helpful to get proper testing and medical advice than to guess.

FAQs

1. Is more than 70% of Pakistan vitamin D deficient?

High deficiency rates have been reported in Pakistani studies including in populations where the prevalence approaches or exceeds 70%. But this is not to be taken as a definite percentage for the whole country.

2. Is there enough sun in Pakistan for me to get enough vitamin D?

So it may be. Depends on exposure of skin, lifestyle, clothing, season, time of day, and many other factors.

3. What is the best test to check for vitamin D deficiency?

Serum 25-hydroxyvitamin D (25(OH)D) is the standard blood marker for vitamin D status.

4. Is tiredness due to vitamin D deficiency?

Fatigue, muscle weakness can be associated with it but fatigue can be due to many causes.

5. Should everyone take high-dose vitamin D supplements?

No. High potency vitamin D should be taken as needed for individual nutrition and professional advice.

Conclusion

Despite the ample sunlight, vitamin D deficiency is a major nutritional problem in Pakistan. Indoor living, limited skin exposure, clothing, pigmentation, dietary patterns, and other factors can all play a role.

The wise way is not to expose too much to the sun or to supplement indiscriminately in high doses. Instead, know your risk, think about testing where appropriate and use vitamin D supplements wisely.

References & External Resources:

• MedlinePlus — consumer-friendly medical information from the U.S. National Library of Medicine
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