The Prophet (SAW) has emphasised the importance of expressing gratitude towards good health and this is discussed in several ahadith. One of my own personal favourites is the following hadith reported by Ubaidullah ibn Mihsan (RA): The Prophet (SAW) said, “Whoever among you wakes up secure in his property, healthy in his body and he has his food for the day, it is as if he were given the entire world.” [Sunan At-Tirmidhi, Book of Asceticism, Number 2346, Hasan]
I believe that one way in which we can express our appreciation for the health that Allah (SWT) has blessed us with is to be proactive and make healthy lifestyle choices. The purpose of this article is not only to capture the growing public health problem of vitamin D deficiency, which affects individuals of all races, ages and religion, but also to recommend how we can all proactively prevent and treat it.
The ‘sunshine vitamin’
Vitamin D, also known as the ‘sunshine vitamin’, plays a vital role in maintaining optimum levels of calcium and phosphate in our bloodstream, both of which are crucial in maintaining healthy teeth and bones. It also plays a vital role in modulating our immune system, therefore making us less susceptible to a whole host of diseases.
It is referred to as the ‘sunshine vitamin’ because as much as 90% of the vitamin D in our bodies comes from sunlight exposure. As the sunlight penetrates our skin, it converts cholesterol, which is naturally found in our skin, to an inactive form of vitamin D, which is then converted into its active form in the kidneys.
The remainder comes from food sources, namely cod liver oil and oily fish such as sardines, mackerel and salmon. Egg yolk, dairy products and liver also contain small amounts although they are negligible. In addition, there are also a wide range of cereals and margarines available in food stores, which are fortified with additional vitamin D.
What is the big deal about vitamin D?
Vitamin D deficiency is now a worldwide endemic and is the commonest nutritional deficiency, with more than 40% of adults over the age of 50 and reports of up to one-third of healthy young adults being affected across the globe. More recent statistics have also revealed that up to 90% of adults of South Asian origin in the UK are vitamin D deficient.
In children, low vitamin D levels can lead to rickets, a condition caused by inadequate bone mineralisation leading to soft bones and skeletal deformities and, in some severe cases, a failure to thrive.
In adults, it can lead to a similar condition called osteomalacia (the literal translation into English being ‘soft bones’), which commonly presents with generalised bone pain, muscle weakness and, in some severe and more advanced cases, fractures. It may also manifest itself as difficulty walking up stairs and standing from a squatting position.
There is also a growing body of evidence to suggest that vitamin D deficiency leads to a whole host of serious chronic conditions including certain cancers (especially bowel, breast and prostate), type 2 diabetes, multiple sclerosis, tuberculosis, osteoarthritis, heart disease and hypertension.
Could you be at risk of vitamin D deficiency?
There are four main causes of vitamin D deficiency:
1) Higher vitamin D requirement than others
All pregnant and breastfeeding women fall under this category because they are building stores for their foetus and constantly replenishing their stores when breastfeeding. Although Islamic and medical literature provides strong evidence in support of breastfeeding, breastfed infants are at higher risk of a vitamin D deficiency because human milk contains very low levels of vitamin D.
2) A lack of sun exposure
Since sun exposure is an integral component in the production of vitamin D, people living in northern latitude countries, such as the UK, where there is little sunshine available are at increased risk of deficiency.
Furthermore, individuals who spend little time outdoors soaking up the sun, such as those who are less mobile due to chronic health problems or their chosen line of work, are also at a higher risk.
Vitamin D deficiency has also sparked off a religious debate about hijab and niqab. Although there is evidence that ‘covering up’ can result in vitamin D deficiency, in a society where there is an abundance of anti-hijab sentiment, this unfortunately adds further fuel to the fire and allows people to jump on the anti-hijab/niqab bandwagon.
3) Inability to produce or absorb it efficiently
Darker skinned individuals, such as those from an African-Caribbean or South Asian background, produce less vitamin D from sunlight due to an increased level of melanin (pigment) in the skin. Besides darker skinned people, the elderly are also unable to produce vitamin D from sunlight as efficiently as younger people because they have poorer skin integrity.
There are also medical conditions resulting in liver and/or renal failure or inflammation of the bowel, which result in defective production and reduced absorption of vitamin D. Medications, especially those commonly used in the treatment of epilepsy, are also associated with reduced levels of vitamin D.
4) Inadequate nutritional intake or high intake of foods which inhibit the production or absorption
Foodstuffs which are naturally high in phytic acid, such as chapattis (traditional South East Asian flatbread), are known to leach vitamin D and prevent its absorption. However, as it is part of the staple South Asian diet, many food companies have clocked on and are now producing vitamin D fortified chapatti flour.
Prevention is better than cure
Prevention is always better than cure and for this reason the DoH (Department of Health, UK) has recommended that around 20-30 minutes of sun exposure to the face and hands three times a week during summer months (April-October) is sufficient. However this guidance is based on individuals who are fair skinned and, for darker skinned individuals, longer more regular periods of sun exposure are advised. If you wear niqab then finding a secluded area outdoors is one possible prevention strategy, but such an ideal spot can be difficult to come across. The problem arises during the winter for countries that lie in the northern hemisphere because there is insufficient sunlight available to produce the optimum level of vitamin D.
Keeping an eye on your nutritional intake by maintaining a healthy balanced diet including plenty of oily fish, cod liver oil and fortified food products and restricting foods high in phytic acid can also help optimise your vitamin D levels.
With a significant proportion of our population being at high risk of vitamin D deficiency, the DoH have also advised the following groups to take vitamin D supplements: all pregnant and breastfeeding mothers, people aged over 65, breastfed babies, infants and children up to 5 years of age and those who do not get much sun exposure.
How is it diagnosed and treated?
Vitamin D deficiency is diagnosed by a simple blood test, which can be done by your GP. Treatment comes in the form of injections, tablets, liquids and drops. Although injections may seem a more convenient option because they can last up to six months and oral preparations are taken on a daily basis, the latter have been found to be more effective.
Even after a course of treatment, it is important that your vitamin D levels are monitored and that you continue with supplements on a maintenance dose. Please note that although vitamin D supplements can be purchased over the counter, it is important to seek expert medical advice before taking them as they can interact with other medications and if taken incorrectly may result in harm.
Soak up the sun!
So sisters, I hope you have found this article informative and that it has inspired you to take care of your health, starting off with simple steps towards preventing and treating vitamin D deficiency. After all, making the most of sunshine can only be a good thing and may just be another excuse for a holiday!
• Lissaeur and Clayton. An illustrated textbook of paediatrics. Third edition. 2007
• Scientfic advisory committee on nutrition (SACN). An update on vitamin D. 2007. Available online at: www.sacn.gov.uk/pdfs/sacn_positionvitamin_d_2007_05_07.pdf
• Patient.co.uk. Vitamin D deficiency including osteomalacia and rickets. Available online at: www.patient.co.uk/health/vitamin-d-deficiency-including-