Why Indians should take calcium and vitamin D supplements

As per the shocking revelation of a study, vitamin D supplements may not be beneficial for your bones. © Shutterstock

Vitamin D deficiency is on the rise in India with doctors prescribing calcium and vitamin D supplements even to infants, right from birth. Calcium is needed for healthy bones and vitamin D is needed to absorb calcium. According to Dr Ajay K Ajmani, Senior Consultant Endocrinologist, BLK Super Specialty Hospital, New Delhi up to 90% Indians have these deficiencies. Since the crisis is widespread, it is high time you actively decide how you can make up for it through your diet or by using supplements.

Most of your aches and pains are due to severe calcium and vitamin D deficiencies. Even women who get backaches after delivery assume that it is due to an epidural or just the strain of labour, but it may be because they are not taking their vitamin supplements regularly. When you are deficient, you are prone to fractures and conditions such as osteoporosis. Here are 6 signs of vitamin D deficiency

Severe vitamin D deficiency has been linked to diabetes, dementia, depression, infertility cardiovascular problems and even cancer. A recent study found that vitamin D can help manage symptoms of Crohn s disease. Here are 12 health problems caused by vitamin D deficiency

Misdiagnosis

Even though vitamin D deficiency can be easily determined by measuring serum 25-hydroxyvitamin D through a blood test, many people who end up going to a doctor for body ache, may not be accurately diagnosed. Many orthopaedic doctors try to investigate the cause using x-rays and at times MRIs instead of a simple blood test.

First let us understand why we are deficient in these vitamins.

Isn t vitamin D made by the skin through exposure to sunlight? How are Indians deficient despite ample sunlight across India?

Vitamin D is a fat-soluble vitamin, which means it can be stored by the body. Sunlight exposure is a major source of Vitamin D and there are not many dietary sources that can provide the required amount of vitamin D. Most Indians are usually completely clothed and do not get adequate exposure to sunlight. To get some perspective here, a Caucasian (white person) in a bathing suit (bikini type suit for women) can get up to 20000 IU of vitamin D3, which is equal to 1 MED (minimal erythemal dose) after exposure to sunlight for a couple of hours. Dark skinned people and obese people would need more exposure to sunlight to synthesize that much vitamin D.

Other than our skin colour and attire, these factors also contribute to our deficiency:

Limited exposure to sunlight

Indians do not usually sunbathe. Those who do, do it using a sunscreen with SPF 30 or more which affects the production of vitamin D. Our lifestyles have also become less active with fewer outdoor activities.

Inadequate intake of Vitamin D from dietary source

There a few natural, or dietary, sources of vitamin D

Food	Amount of Vitamin D

Cod liver oil	400 1,000 IU/teaspoon vitamin D3
Salmon, fresh wild	600 1,000 IU/3.5 oz vitamin D3
Salmon, canned	300 600 IU/3.5 oz vitamin D3
Sardines, canned	300 IU/3.5 oz vitamin D3
Mackerel, canned	250 IU/3.5 oz vitamin D3
Tuna, canned	236 IU/3.5 oz vitamin D3
Egg yolk	20 IU/yolk vitamin D3 or D2
Mushrooms, fresh	100 IU/3.5 oz vitamin D2
Mushrooms, sun-dried	1,600 IU/3.5 oz vitamin D2

How much vitamin D do we need in a day? Approximately 2000 IU/d for adults and 1000 IU/d for children is essential for most people but this depends on age, weight, etc. So you can see why supplements are needed along with adequate sun exposure.

Lack of food fortification

In countries like the United States many foods, such as milk, are fortified with vitamin D i.e. vitamin D is added to the food and labelled accordingly. In India, such food is not readily available yet.

Inadequate calcium intake

On an average, adults need about 1000 mg of calcium in a day. So you get about 240 mg from a tall glass of milk. There are other sources of calcium that are better than milk. But, getting 1000 mg is still difficult and remember, you need this daily. More when you are pregnant and as you grow older. Find out whether drinking a couple of glasses of milk is enough for calcium.

Myths and Facts

Dr Ajmani addresses all our doubts about taking calcium and vitamin D supplements.

1. Many people believe that even if a pregnant woman does not take supplements, the fetus will get the required amount of calcium from the mother.

This is not true. Intestinal absorption of calcium is doubled during pregnancy from as early as 12 weeks of gestation. Low calcium intake during pregnancy has been associated with:

Reduced bone mineral content in newborns.
Decreased fetal femur length.
Reduced maternal bone mass in pregnant adolescents.

2. Do babies need vitamin D and calcium supplements?

These days, parents don t expose their babies to sunlight and the amount of vitamin D in breast milk is negligible. So it is better for the child s musculoskeletal development to take these supplements. Since kids are not able to express that they have body pain, it is difficult to know that they are deficient unless they exhibit visible signs and symptoms. You may also like to read why your body needs vitamin D.

3. What are the not so well-known symptoms of vitamin D deficiency in kids?

Sometimes the forehead is widened. Sometimes the kids walk they may drag their feet or walk a bit differently.

4. What are the common symptoms in adults?

Myalgia and bone pain are common in adults with vitamin D deficiency.

5. Who should take these supplements without fail?

Doctors could prescribe Vitamin D supplements 1 sachet of 60,000 IU every month — to the elderly in India without even knowing their vitamin D levels. Pregnant and lactating women and children also need to take these supplements.

6. Sometimes calcium supplements make people feel gassy. What types of calcium supplements should we choose to avoid this?

People usually tolerate calcium supplements with citrates and maleates are usually better than calcium carbonate. However, if you are able to tolerate it, any inexpensive calcium supplement will do.

Types of supplements and the level of calcium they contain:

Approximately, 40% of any calcium supplement is the elemental calcium
Calcium Citrate: 21% elemental calcium; best absorbed form of calcium supplement, does not require stomach acidity for absorption (can be given without food)
Calcium Carbonate: 40% Elemental Calcium, requires stomach acid for absorption, has to be given with food

To sum up

Sunlight exposure is the major source (90%)
Influence of diet on vitamin D status is minimal
Vitamin D is important in the maintenance of bone health
Here is how much vitamin D we need:

Age	IU/Day	Maintenance

Infants & Toddlers	2000 IU/Day	400-1000 IU/Day
Children (1-18)	2000 IU/Day or 50,000/ week for 6 week	600-1000 IU/Day
Adults (18 above)	6000 IU/Day or 50,000/ week for 6 week	1500-2000 IU/Day
Obese Pts	6000? 1000 IU/Day or 50,000/ week for 8 week	3000-6000 IU/Day