Vitamin D3 Your Sunshine Vitamin
So is another year. Another year is gone & one gets older the time moves faster. This is my swansong. I’ve been a columnist for the Sangai Express for the last 10 years. It’s time to stop and give my space to some young writers. This last article is dedicated to my loving younger sister Rupobati, as she reminds me of an old, but all-time favourite American song, which was very popular in early 1950s.
You are my sunshine, my only sunshine
You make me happy when skies are grey
You’ll never know dear, how much I love you
Please don’t take my sunshine away
This article is also about vitamin D-related health problems in elderly people. Vitamin D insufficiency is present in old people worldwide. It causes unsteadiness in walking (fere fere haiba in Manipuri); falls (tuganba), cognitive impairment (kaoganba); dizziness (fuk hougatpada kok nagouri ngauri touba); hip fracture (feigalgee saru makok tekpa) after falls; lack of wellbeing (hakchang innung nungaitaba); low mood (nungaipham ikhang khangdaba); hair fall (koktagi sham kenba); muscle, bone and joint pains (saru-sarang ina naba); breathing difficulties (sor honbada nungaitaba) and low spirit (pukning hanthaba).
Research also increasingly suggests that vitamin D might have protective benefits against heart attacks
(thamoi-laiyum gee singleeda e famba), Strokes (kokki singleeda e phamba, nattraga singlee pokhaiba)), diabetes, cancer, chest infections (neumonia), and autoimmune diseases (laina makhal khara; madugee hourakfamdi: eikhoi ishabu atei lainasingdagee kannanaba, ishagee manungda leiba sel kanglup kharana, lanna khalladuna ishamaktada landarakpa). There is also now strong evidence for its benefit against bowel cancers.
Though there are not many old people in Manipur, yet there are a few above 70, who will experience some or all of these symptoms. As I am getting on a bit, I do suffer from one or two of the above symptoms. And I find vitamin D3 to be my sunshine, since I started taking it in August 2018.
I usually have a full routine blood test every year in July. Last year, I had it done in August. My doctor rang me saying that everything was normal. Although my vitamin D value was also normal, I was advised to take Vitamin D3, one tablet of 1,000 IU (international units) daily, because of UK national guidelines following the publication of recent research evidence.
My dizziness on moving my head suddenly in bed or getting out of it quickly, and looking up at the ceiling due to BPPV (see below) for which I have been taking betahistine tablets on and off, had disappeared only after a month. More excitingly, I’ve just noticed (January 2019) that the massive hair fall like autumn leaves, from my head, has stopped. Seeing is believing.
Vitamin D is currently a hot potato with a raft of research, despite the fact that treatment with vitamin D and calcium to strengthen thinning bone in menopausal women, has been a failure. Supporting bone, brain and digestive health, is the main task of vitamin D. The problem is, very few food sources contain natural vitamin D3. As a result, the general population does not have enough vitamin D.
Vitamin D deficiency is in epidemic proportions all over India, despite the abundant sunshine (Ritu & Gupta, PMID, 2014). It’s more than 50% in the UK and more than 40% in the US. Normally, large amounts of vitamin D3 is made in our skin when it’s exposed to UV-rays from sunlight. Hence its nickname the ‘Sunshine Vitamin’. Vitamin D2 is produced by plants like mushroom. D3 is found in oily fish, fortified milk, egg yolks and cheese. In Manipur, the best oily fish are imported raw and hilsa, as well as some local, found in fresh water, such as pengba (carp) and ngatol (trout) and khajing (shrimps). They are rich in omega 3. But they are only seasonal. The best supplement available was cod liver oil. I remember my mother taking it.
Any excess vitamin D is stored in your body fat for later use. Normal value of vitamin D in the body is the measure of 25- hydroxyl vitamin D. A level of 20-50ng/mL is normal. A level less than 12ng/mL indicates its
deficiency. Leading experts however, recommend that 25-Hydroxyvitamin D concentrations should be at least 30-32 ng/mL. The daily doses of vitamin D3 that are found in common multivitamins and calcium supplements are not sufficient. The safety of daily doses ranging from 1,000 -4,000 IU (25 to 200 µg) has well been documented. Within these limit, there are no side effects.
Treatment of vitamin D deficiency needs an intake of vitamin D3 with a dose between 1,000 – 4,000 IU equivalents to 25-100 mcg, in tablet, capsule or liquid forms, on top of what you get from food. Vitamin D supplements are available to buy in health stores, pharmacies, and online.
Vitamin D comes in two forms: vitamin D2 (ergocalciferol) from food, and vitamin D3 (cholecalciferol), naturally produced in the skin with sunlight. So, the main difference between them is where they come from and how they are made. The benefits of vitamin D is in form of D3. It is three times as powerful as D2. Vitamin D2 is cheaper to produce and so certain food, such as cereals and orange juice, contain vitamin D2.
Every cell in your body has a ‘receptor’ for vitamin D on its wall, which senses vitamin D in the fluid outside the cell and draws it into the cell. There are many receptors eg for glucose, the end-product of our digested food. We all know how vitamin D helps in transporting calcium to our bones and teeth, and is vital for the development of bone mass and growth in children, Lack of calcium causes softening of bone in children (osteomalacia), and in adults, especially menopausal women (osteoporosis), often leading to hipbone fracture with falls. Fall is a common occurrence in elderly people, for which there has been much research to find the cause. Almost 99% of your vitamin D supply is used for regulating the calcium in the body; the remaining part is utilised for strengthening the immune system and maintaining muscle strength.
Vitamin D3 transforms into a steroid hormone like cortisol within the body. In this form, it’s circulated in the bloodstream to help perform many vital processes in daily cell metabolism in our body, bringing benefits to our overall health and wellbeing. It maintains our blood pressure and immune system, and protects against cancer.
It’s deficiency in the elderly, causes the most common imbalance on standing and walking (dizziness), leading to frequent falls. This is due to age-related alterations of ‘postural reactions’ between the individual’s anticipated posture adjustments and external environment. It partly explains why hip fracture is more prevalent after the age of 75 (Mackey & Robinovitch. 2006).
Muscle weakness that is also related to falls in the elderly, has been found, according to research, due to the existence of low level of vitamin D (cf. Jansen, Samson: vitamin D deficiency, muscle function), and (cf. Am J Clin Nutr. Falls in the elderly, 2002). Some research suggests that vitamin D could affect nerve-muscle function and fall risks, in a way which does not involve only the muscle but also the central nervous system.
For years, doctors believed that the most common dizziness in the elderly (70% in the age above 65) ie a sensation of spinning or swaying with a sudden change of your head position, known as ‘benign paroxysmal positional vertigo’ (BPPV), is due to age-related decline in the function of vestibule, a little organ in the inner ear. It’s now believed to be due to deficiency of vitamin D in the body. They base their hypothesis on the existence of a link between otolith membrane (the fibrous membrane in the inner ear) disturbances, osteoporosis and vitamin D deficiency. This fibrous membrane plays a critical role in the brain’s interpretation of equilibrium, by determining if the body or the head is tilted, in addition to the linear acceleration (how fast you are moving) of the body (Von Breven, et al. 2015).
Association of vitamin D with protection from cardiovascular diseases (heart attack, stroke etc), comes from the finding that atherosclerosis (thickening of arteries) is a systemic inflammatory disease related to vitamin D insufficiency (Zittermann 2003).
Cognitive impairment (increasing forgetfulness) in the elderly and vitamin D connection, was evidenced by researchers on elderly rats, and a study of cognitive impairment among 5,596 community-dwelling (living in
old peoples’ homes) healthy older women aged 80.4 years on average. (Remember, many old men don’t live
that long). The study showed a significant association between weekly vitamin D dietary intakes and global cognitive function (Annweiler et al, 2010). Depressive mood, usually associated with less activity like walking
about, as well increasing forgetfulness, is also associated with low vitamin D content (Bjorkman et al, 2010).
Vitamin D supplements appear to stabilise postural unsteadiness in the elderly via an improvement of attention capacities, independent of any muscular action (Dhesi Surindar et al, 2004). It also improves walking performance, muscle strength and functional mobility in older people (Milano, 2000).
Finally, this article reviews reliable evidence of disorders ‘related to Vitamin D deficiency’ in the elderly, and their treatment with vitamin D3 supplements, leading to improvement in general health.
The writer is based in the UK Email:firstname.lastname@example.org