Dr Irengbam Mohendra Singh
This is my Last Article. 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 article is dedicated to my loving kid sister Naorem’ORupobati Irengbam.
This article is about vitamin D related health problems in old people. Vitamin D insufficiency is present in old people worldwide. It causes unsteadiness in walking (ferefere haiba in Manipuri); falls (tuganba), cognitive impairment (kaoganba); vertigo (fukhougatpada koknagouringauritouba); hip fracture (feigalgee sarumakoktekpa) after falls; lack of wellbeing (hakchanginnungnungaitaba); low mood (nungaiphamikhangkhangdaba); hair fall (koktagi sham kenba); muscle, bone and joint pains (saru-saranginanaba); breathing difficulties (sorhonbadanungaitaba) and low spirit (pukninghanthaba).
Research also increasingly suggests that Vitamin D might have protective benefits against heart attacks(thamoi-laiyum gee singlee da e famba), Strokes (kokkisingleeda e phamba, natragasingleepokhaiba)), diabetes, cancer, chest infections (neumonia), hair loss (kokkee sham kenba); andautoimmune diseases (leinamakhalkhara; madugee hourakfam:eikhoi ishabu atei leinasingdagee kannanaba, ishageemanungda leibasel kanglupkharana, 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 an old man,I do suffer from most of the above symptoms and find vitamin D3 to be my sunshine, only in the last few months since I have been taking it. 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 alsonormal, I was advised to take Vitamin D3 1,000 IU daily, because of UK national guidelines. I looked up the recent research findings, and having been convinced I began to take one tablet a day from August 2017. Lo and behold! My light-headedness on moving my head suddenly in bed or getting out of it quickly, and looking up at the ceiling, 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 naturally contain vitamin D. 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 somelocal, 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 is 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 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 25 to 200 µg (1000-4000 IU) 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 (International Units) equivalent to 25-100 mcg, in tablet, capsule or liquidforms, 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 and not D2, as it is three times as powerful as D2, in raising the level of 25-hydroxycholecalciferol – the chemical name for Vitamin D3. Vitamin D2 is cheaper to produce and so certain food, such as cereals or orange juice, contain vitamin D2.
Every cell in your body has a receptor for vitamin D (there are many receptors doing different functions, such as taking glucose from digested food in to the cells). This vitamin is involved in many processes, including bone and teeth health, immune system function and protection against cancer. We all know 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 within the body. In this form, it’s circulated in the bloodstream to help in the absorption of calcium and phosphorous that is received from digested food sources.It performs many vital processes in daily cell metabolism in our body, bringing benefits to our overall health and wellbeing, including mood elevation and function of our immune system. It also plays a role in the process of cell division. It’s deficiency in elderly people, causes unsteadiness on standing and walking, leading to frequent falls.
Imbalance and falls in the elderly are 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 much research, due to the existence of low level of vitamin D (cf. Jansen, Samson: vitamin D deficiency, muscle function, and falls in the elderly (Am J ClinNutr. 2002).
Having seen so many publications in favour, it seems 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.
According to many studies, light headedness or dizziness in the elderly, is posture-related, known as benign paroxysmal positional vertigo (BPPV), which is due to deficient vitamin D in the body. They base their hypothesis on the existence of a link between otolithmembrane (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 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 (alarming 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 equilibrium in the elderly via an improvement of attentioncapacities, independent of any muscular action (DhesiSurindaret al, 2004). It also improves walking performance, muscle strength and functional mobility in older women (Milano, 2000).
In conclusion: this article reviews reliable evidence of disorders related to Vitamin D deficiency leading to poor general health in senior citizens.
The writer is based in the UK Email:firstname.lastname@example.org Website: drimsingh.co.uk