Many Singaporeans lack vitamin D

Many people in Singapore are deficient vitamin D even though there is abundant sunshine here, doctors have reported.

A normal level of vitamin D is 30 to 100 nanograms (ng) per millilitre (ml). An insufficient level is classified as below 30ng per ml, while 10ng per ml and below is considered deficient. Vitamin D deficiency can lead to osteoporosis, a lower immunity to infections, and a higher risk of autoimmune disease, among other issues.

Commonly called the "sunshine vitamin", vitamin D is mainly produced in the skin when it is exposed to ultraviolet B (UVB) rays of the sun.
The vitamin is involved in calcium absorption, immune function, and protecting bone, muscle and heart health.

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Dr Derek Koh, head of medical health screening at Thomson Wellth Clinic, said about 80 per cent of his clinic's patients between the ages of 30 and 70 have low levels of, or are deficient in, vitamin D. "Most Singaporeans are not exposed much to the sun, as they are largely covered by clothes and shaded by umbrellas in the afternoon," he said.

A study published in 2019 in the International Journal Of Environmental Research And Public Health found the prevalence of vitamin D deficiency among indoor workers here was 32.9 per cent. Dr Charu Malik Narayanan, a family practitioner at International Medical Clinic, said people who spend most of their time working indoors and away from direct sunlight may not expose their skin to ultraviolet rays for the production of vitamin D.
Sitting by a window may not help, as UVB radiation does not penetrate glass, she added.

Symptoms of vitamin D deficiency include fatigue and lethargy, bone pain, muscle pain and falling sick often. Pregnant women also tend to have low levels of vitamin D as the foetus draws its nutrients from the mother. Dr Koh added that haemodilution, which occurs during pregnancy, may also result in low levels of vitamin D.

Haemodilution refers to an increase in blood volume, which can dilute vitamin D levels in the blood and, in turn, the rest of the body. A sufficient amount of vitamin D in pregnant women reduces the risk of complications in pregnancies, such as pre-term birth and low birth weight in infants.

The lack of vitamin D also affects people who have liver or kidney disease, as these organs are unable to adequately convert active vitamin D in the body. Said Dr Koh: "Easily half of my patients are not familiar with the importance of vitamin D."

Those who know (about it) know only of its role in the prevention of osteoporosis." Dr Mishra said the Covid-19 pandemic may have indirectly worsened people's levels of vitamin D, "as they spend more time indoors and may not be exposed to adequate sunlight".

Overall, doctors stressed that the importance of vitamin D cannot be ignored.

Get enough vitamin D

1. Spend more time in the sunlight - Doctors advise people to go out into the sun to increase the absorption of vitamin D in the skin. However, this should be balanced against the sun's effects on skin ageing and cancer.

2. Eat food rich in vitamin D - The daily recommended dietary allowance of vitamin D for those aged 18 and above is 2½ micrograms.

3. Consider taking supplements - He advises patients to take "a more practical approach" by taking a vitamin D supplement daily. 

Source: ST 31/03/2021