Can Fortified Milk Fight Vitamin D deficiency?
"Most milk products available in the UAE are not sufficiently fortified with Vitamin D3 but having said that, consumption of fortified milk alone cannot cure deficiency for sure," said Dr Afrozul Haq, Senior Clinical Scientist, Sheikh Khalifa Medical City (SKMC).
Dr Haq said the problem of Vitamin D3 deficiency in the UAE is too pressing to ignore. An extensive study he conducted with over 100,000 patients at SKMC has revealed that over 65 per cent of women and 60 per cent of men in the country suffer from Vitamin D3 deficiency, down from 80 per cent in 2006 when the tests began. Worse, patients were found to be 90 per cent deficient on their first visit.
The alarming figures have raised serious concerns about how the Vitamin D3 deficiency problem is being tackled, even as lack of awareness and regulations on fortification have resulted in growing misconceptions about where and by how much the sunshine vitamin should be sourced. Dr Haq said Vitamin D3 is a steroidal hormone and is the only vitamin that the body can produce on its own with direct exposure to the sun. Where insufficient exposure exists, Vitamin D3 is sourced through supplements and fortification.
As nutrient fact labels on milk bottles in the UAE reveal, most dairies - Al Amarai, Al Rawabi, Marmum and Al Ain - add 400 International Units of Vitamin D3 in a litre of milk, which is the recommended daily allowance, according to bodies like the GCC Standardisation Organisation in Saudi Arabia and Institute of Medicine in Canada.
But Dr Haq said: "Researchers don't agree with this because the dose is very low, especially since such a high percentage of the UAE population is suffering from vitamin D3 deficiency. We need a minimum of 800 International Units per day. And by that yardstick, we should be drinking two litres of milk which is not practical."
A spokesperson for Al Ain Dairy said as things stand, it is up to the individual dairy manufacturer to fortify their products or not. "We think it is an essential addition to our milk products for the long term health benefits of our consumers. We only add the RDA amount and our products are regulated by the Food Control Authority."
According to Dr Haq, the optimum level of Vitamin D3 in the blood of an adult should be at 75-200 nmol/litre in order to maintain good bone health and guard against non-skeletal diseases. He said when the level falls below 75, it can contribute to osteoporosis, mutliple sclerosis, cardiovascular and neurological disorders, autoimmune disease, Alzeimers, tuberculosis, even diabetes and cancer.
Similarly, when the level crosses 200, it can lead to toxicity and a number of problems. The symptoms include hypercalcimia, high blood pressure, headaches, fatigue, loss of appetite, excessive thirst and polyurea, severe itching, vomiting, diarrhea, constipation, kidney damage and joint and muscle pain.
"Therefore, it is important to establish an individual's baseline through a simple laboratory test and make necessary corrections."
Dr Haq said the main source for Vitamin D3 is direct exposure to the sun, failing which supplements should be taken. Consumption of fortified milk can only be an added bonus.
"If a person is severely deficient in Vitamin D3 (less than 10 nmol/litre), he would need 2,000 International Units of supplements per day. If the level is 25-50 nmol/litre, which is the average in the UAE, the requirement would be 1,000 International Units per day."
He said patients should be aware that there are two types of Vitamin D - D2 and D3. In some severe cases of deficiency, doctors prescribe around 50,000 International Units of D2 per week. "But always go for D3 because it is a natural vitamin and more potent than D2."
He said Vitamin D3 levels are particularly low during summer as people avoid the direct sun. "But what they forget is that by spending just 10 to 20 minutes under the direct sun, they can get 10,000 to 25,000 International Units of Vitamin D3 released into their blood stream. And the vitamin sourced directly from the sun can never lead to toxicity."
He said the ideal time to get the benefits of direct sunlight are between 11 am and 2 pm everyday as UVB rays, the source of Vitamin D3, are the strongest during these hours.
The researcher said lack of exposure to the sun is the main cause for the Vitamin D3 deficiency epidemic in the UAE. "Factors contributing to this include hot climate, poor outdoor activity, dark skin colour, pollution, dress code (women covered in abayas and burqas) and lack of awareness and authoritative regulation on fortification," he noted.
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