Are we aware of the severity of vitamin D deficiency in Bangladesh?

If half of the population of Bangladesh and up to 70 percent of children are deficient in vitamin D, then it must be a major cause for concern for us. Despite having the natural advantage of abundant sunshine all year round allowing vitamin D synthesis, why are we having this phenomenon in our population?

The high prevalence of vitamin D deficiency in Bangladesh can be explained by people's limited exposure to sunlight especially in the urban areas, use of traditional clothing, limited outdoor activity by women and children, and low consumption of vitamin D-rich food including sea fish.

In fact, vitamin D deficiency is not a problem only in Bangladesh; it is a neglected public health issue globally. Almost one billion people in the world suffer from this deficiency. It is prevalent in both the western countries and the tropical countries with abundant sunshine. In South Asia, about 80 percent of the apparently healthy population is deficient in vitamin D ((20 ng/mL) and up to 40 percent of the population is severely deficient ((10 ng/mL).

Vitamin D has been given high importance for its role in calcium homeostasis and bone health since its identification in 1921. Since then, medical practitioners know that vitamin D deficiency leads to bone diseases like rickets and osteomalacia (softening of bones), and other illnesses such as diabetes, different types of cancer, autoimmune diseases, backache, myalgia, muscle weakness, rheumatoid arthritis, gout, chronic ulcers, cardiovascular diseases, hypertension, dental problem, pre-eclampsia and psychological disorders like depression.

I have developed an interest in this regard after my own suffering caused by vitamin D deficiency. I am sharing my personal experience below with the hope that it will help raise awareness of the severity of the problem.

In the early morning of April 10, 2020, I was unable to get out of bed due to severe back pain. I had no previous experience of such pain and so got very nervous. I thought I should not visit any doctor given the Covid-19 situation. So I spoke with two friends who I knew had suffered back pain in recent months. All that they suggested was that I take complete bed rest for a week and I should be fine.

However, after a couple of days, since I could not tolerate the pain, I consulted a doctor over phone. He suggested some medicines which I took for a week. This did not help. I consulted another doctor the following week, and started taking medicine as prescribed, for another two weeks. However, the pain continued and in fact increased more. I could not sleep the whole night due to extreme pain. I was still not prepared to see any doctor due to the worsening Covid-19 situation in the country.

Two months passed by without any improvement in my physical condition. I finally decided to visit a doctor. When I met him, the doctor asked me to do a number of tests. On the basis of the test reports, he prescribed me medicines and advised me to see a physiotherapist. Accordingly, I went to a physiotherapist who I have known for several years, a young man in his mid-thirties. He carefully went through all my medical reports, looked at the X-ray and MRI plates, and came to the conclusion that I was severely vitamin D deficient, and the only thing I needed to do is either take vitamin D tablets or sit under the sun for 15-20 minutes every day for the next six months.

The next day, I pulled a chair and sat down near the window from where sunlight was pouring in. I felt much better after sitting for only 15 minutes. The next day, I sat again for 15 minutes. And, I could not believe myself as I was soon completely free from pain. Along with the back pain, my knee pain and muscle pain—which I had been suffering from for the last ten years—were also totally gone. I realised the value of vitamin D; I never thought it would work so fast.

I believe we should undergo lifestyle modification in order to reduce vitamin D deficiency. We should expose ourselves to sunshine at least two to three times a week to naturally minimise vitamin D deficiency. Among various micronutrients, vitamin D is an important one for our body which we can easily get from sunlight. Vitamin D plays a crucial role in bone mineralisation and other metabolic processes in the human body, such as calcium and phosphate needed for skeletal growth. Due to the deficiency of vitamin D, millions of children suffer from rickets which leads to skeletal abnormalities, growth retardation and stunting. Vitamin D deficiency in adults leads to osteomalacia, osteopenia, osteoporosis and subsequent risks of fractures.

According to the World Health Organization, getting anywhere from 5 to 15 minutes of sunlight on the arms, hands, and face 2-3 times a week is enough to get the required vitamin D for ourselves. To be effective, the sunrays must penetrate the skin. Wearing sunscreen or heavy clothing will not result in vitamin D production. However, we have to remember that overexposure to sunrays might cause harm to our health. Skin cancer is associated with too much exposure to sunrays. There have been numerous studies linking cancer to sunrays but it is well-established by now that limited exposure is not a risk; rather it is immensely beneficial to health.

Due to the current lockdown-like situation imposed by Covid-19, many people are still spending most of their time indoors. Others are spending long hours in offices and their respective workplaces. It is important that they regularly expose themselves to sunshine, if possible during the week days, or at least during the weekends.

Dr Nawshad Ahmed is an economist and urban planner. He is engaged in research activities after retiring from the United Nations.