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Vitamin D in the UAE - Are we getting enough?

Updated: May 15

What does vitamin D do?

The main role of Vitamin D is to allow your body to absorb and use calcium and phosphate. This calcium and phosphate are essential for healthy bones, teeth, and muscles. Even if you eat plenty of calcium, you will not absorb it properly without sufficient vitamin D.

Vitamin D has many other roles in the body. Research suggests that it also plays a key role in the proper functioning of our immune and nervous systems. Low vitamin D levels can therefore cause an increased risk of many health problems such as infections, autoimmune conditions such as type 1 diabetes, multiple sclerosis possibly even some cancers.

By far the best natural source of vitamin D is our own bodies – it is made in our skin when it is exposed to sunlight. People who do not get much sun exposure are therefore at risk of low vitamin D levels.

What does vitamin D do?

What are the consequences of not getting enough vitamin D?

Vitamin D has multiple roles in the body; because of this, deficiency can cause multiple problems. Babies born with low vitamin D stores (especially if they are not getting enough from breast milk), are at risk of seizures and rickets – a condition where the bones are weak and softened. Older children can also suffer from rickets if they do not have enough vitamin D. Adults who don’t get enough vitamin D are at risk of osteomalacia, which causes softer bones, leading to weakened bones, bone pain and muscle weakness.

Research has shown that symptoms of low vitamin D levels (bone pain) are more frequently found in females; and fatigue was associated with low vitamin D and younger participants.

Do you get enough vitamin D if you live in the UAE?

A recent paper had shown that, in the UAE, 30-50% of people have vitamin D deficiency. There are lots of reasons for this, many of which are common around the world –

  • Many people work indoors during the day.

  • Avoiding sun exposure due to extreme heat.

  • Use of clothing that covers most of the skin.

  • Lack of exercise

  • Low dietary intakes

  • Less clear food fortification policies

Sunscreen use probably does not affect vitamin D production much, and of course it is very important to protect your skin from the harmful effects of the sun’s rays. More recent studies have found that people who wear sunscreen daily can maintain their vitamin D levels.

Research has also shown that the people in Abu Dhabi who have higher vitamin D levels are those who wear clothes that leave their arms and legs uncovered, regularly perform daily outside physical activity and also those who consumed extra servings of high vitamin D containing foods such as cod liver oil, tuna, salmon, and eggs.

Populations at risk of low vitamin D

There are several groups of people who are at more risk of low vitamin D levels –

  • Breast fed babies

  • People who get very little sun exposure

  • Pregnant and breast-feeding women

  • People who are obese

  • People with darker skin pigmentation

  • Older people – especially those over 65

Those with certain medical conditions or medications - if unsure ask your doctor.

What can I do to help increase my vitamin D levels?

It can be difficult to meet vitamin D requirements from diet alone as there are relatively few rich dietary sources. Oily fish are some of the best foods - salmon, pilchards, trout, sardines, herring, and kippers for example. Eggs, milk, and liver (but you should avoid liver if pregnant due to its high vitamin A content), also contain some vitamin D. Some foods have extra vitamin D added to them, such as margarine, some breakfast cereals, infant formula milk, some yoghurts, and some bread.

Skin exposure to the sun is important but in very hot countries like the UAE it is particularly important to balance this with sun safety - there is a balance to be struck between safe sun exposure to produce sufficient vitamin D, and the known risk of getting skin cancer with excessive sun. It is difficult to give a recommended amount of time to spend in the sun, as there are several factors to consider (including your skin pigmentation, the time of day when you go out in the sun, the time of year, and your age). In the summer months, when the sun is at its most intense, some recommend a regular short 15-minute exposure between 9.30 and 10.30am or 2.30 and 3.30pm. In the winter when the temperature is more bearable there is a suggested window between 9.30am and midday.

Sunscreen, in theory, can reduce vitamin D production in the skin. In practice it probably doesn’t have much effect for most people as not enough sunscreen is used. Studies looking at the effects of sunscreen produce conflicting results partly because of factors such as how well the sunscreen is applied, the SPF, and if the sunscreen is reapplied as recommended.

Who should take a vitamin D supplement?

In less sunny areas of the world is it probably a good idea for everyone to have some sort of supplementation. The UK official recommendations are –

  • All babies under 1 year should be given 10mcg (4000IU) vitamin D daily unless they have more than 500mls of infant formula a day.

  • Everyone over the age of one year should consider taking 10mcg a day of vitamin D each day, especially in the winter months

  • High risk groups should take 10mcg vitamin D daily all year round.

In the UAE although it is sunnier all year round, this does not mean we need less supplemental vitamin D. As I have written above, vitamin D deficiency is still a problem in very hot countries. In 2018, suggested guidelines were published for vitamin D supplementation in UAE and Gulf populations (Afrozul Hag, et al. 2018) –

  • Breastfed infants – 10mcg (4000IU/d) a day up to one year of age

  • Children and adolescents – 15 to 25mcg (600 to 1000IU) a day depending on body weight

  • Adults – 25-50mcg (1000-2000IU) a day depending on body weight

  • Pregnant and breastfeeding women – 50mcg a day from the first trimester of pregnancy

  • Individuals with darker skin pigmentation and for nightshift workers – 25 to 50mcg (1000-2000IU) a day depending on body weight

  • People who are obese and those with metabolic syndrome – 50mcg (2000IU) a day.

So, although recommendations around the world vary, it seems clear that most of us need at least 10mcg a day. You may need more if you are in one of the higher risk groups.

Vitamin D supplements

Supplements are widely available in pharmacies, supermarkets and online. It is important to always check the label to see how much vitamin D the supplement contains. It is surprising how little or how much vitamin D some supplements have in them. It is also important to avoid high doses, which in the long term can be harmful. Pregnant women need to avoid supplements which are high in vitamin A (as this is potentially harmful to the growing baby).

It is therefore best to choose a supplement specifically tailored to your age group or condition. If you are taking cod liver oil, you do not need an additional vitamin D supplement. Pregnant women should not take cod liver oil due to its high vitamin A content.

For most people, a supplement only needs to contain 10mcg of vitamin D. If you are in one of the at-risk groups and do not get much exposure to the sun, then I would suggest taking a higher dose supplement as per the UAE guidelines above. If you have an actual vitamin D deficiency, your doctor can prescribe a supplement which has a higher dose than those available over the counter. If in doubt you should always discuss this with your doctor.

Ultimately we all need enough vitamin D – and it can be from a combination of diet, safe sun exposure, and supplements – as long as you get enough!

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