![]() ![]() What does vitamin D deficiency cause? Clinically, it weakens the bones and in children causes rickets and in adults, osteomalacia. So let’s approach this problem from another angle. And while air pollution and sedentary work have increased and exposure to sunlight has reduced as compared to 100 years ago, are these enough to push virtually everyone into suddenly becoming vitamin D deficient? Those who believe that there is a vitamin D deficiency pandemic quote reasons ranging from lack of sunlight, exposure to poor sunlight, our dark skins, changing dietary patterns, poor nutrition in low income groups, etc. To assume that more than 70-80% of the country or the world is vitamin D deficient just doesn’t make sense, especially in a sun-drenched country like India. Many of the so-called “insufficient” would also likely just be at the lower limit of normal of a bell-curve (10-20 ng/ml). ![]() ![]() If the cut-off for normality were to be changed to 20 ng/ml instead of 30, then all those 30.5% of patients (one third) supposed to have insufficiency, would be classified as normal, while just 10.4% of patients would be classified as deficient with values less than 10 ng/ml. a study done at CMC Vellore showed that 44% of their patients in one year had vitamin D deficiency when defined as a value < 20 ng/ml, while 30.5% had insufficiency (20-30 ng/ml). ![]() The moment the normal cut-off becomes 30 rather than 20, a large number suddenly becomes insufficient – all those between 20 and 30 ng/ml, who would be considered normal as per the National Academy and Institute of Medicine Guidelines, would be considered insufficient as per the Endocrine Society guidelines. The National Institutes of Heath (NIH) on the other hand, mentions a normal cut-off of 20 ng/ml, 12-20 being insufficient and 20 ng/ml, with insufficiency at 12-20 and deficiency, < 12. Most laboratories in India use a cut-off value of 30 ng/ml as normal, based on the 2011 recommendations of the Endocrine Society, which defines a normal vitamin D level to be above 30 ng/ml, insufficiency as 21-29 ng/ml and deficiency as less than 20 ng/ml. Like with vitamin B12, the devil lies in the details. Multiple studies have described a prevalence of 20-90% of vitamin D deficiency, with most experts agreeing that at least 50% of Indians are likely to have insufficient or deficient levels of vitamin D. Most international bodies including the United States Preventive Services Task Force (USPSTF) say that there is currently no justification for routine vitamin D supplementation in people living in the United States… nor is routine testing justified…and there is no reason why this is not true of India, too. Many people in India these days are routinely advised to get vitamin D levels done, including during so-called whole body health check-ups, or as part of a routine work-up for most diseases. The vast majority of participants including the placebo group had adequate vitamin D levels (vitamin D replete) on testing done later in the trial, suggesting that vitamin D supplementation in those who have otherwise adequate levels may not be justified or be of use. There was a mild increase in cancer mortality in those who received vitamin D, but it was not clear whether this was true or a statistical aberration. The researchers found that vitamin D supplementation did not reduce all-cause mortality, or deaths from cancer or cardiovascular disease. those in whom no testing for vitamin D levels is done) is of use. A recent study, the D-Health from Australia, looked at 21310 individuals above the age of 60 years (10645 placebo and 10,660 receiving 60,000 IU of vitamin D each month for five years) to understand whether routine vitamin D supplementation in an unscreened population (i.e. ![]()
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