The Middle East’s sunshine paradox

With more than 300 days of sunshine in the Middle East, you would expect that we would have ample amounts of the Sun vitamin in our system!

Surprisingly, the region registers some of the highest rates of vitamin D insufficiency and deficiency worldwide.

Today, the prevalence of hypovitaminosis D ranges between 20-80% in several countries in the MENA region.

Is there any science behind this paradox?

According to research, people in the Middle East don’t get enough sun, which is hard to believe with it being so readily available. The reasons vary from cultural practices that call to cover up, limited outdoor activities due to a hot climate, and to the lack of government regulations for vitamin D fortification of food.

Additionally, naturally dark skin color, common in the Middle East, makes producing vitamin D harder for some. Other common practices such as prolonged breast-feeding without vitamin D supplementation, obesity, and frequent tea and coffee consumption are all factors that contribute to the deficiency.

So what’s the big deal with vitamin D?

A whole lot! We all know that vitamin D promotes calcium absorption and maintains its levels in the blood. Even if you are consuming enough calcium in your diet, without vitamin D your body will not be able to absorb it and it won’t be taken up by your bones. Its absence causes bones to become thin and fragile, which puts you at a higher risk of fractures and osteoporosis in the future

But that’s not all. Evidence suggests that vitamin D is an essential hormone that has preventative effects over a broad range of diseases ranging from different types of cancers to diabetes, Crohn’s disease, heart attacks, hip fractures, obesity, Alzheimer’s, and multiple sclerosis. It has also been associated with less serious but not much less aggravating disorders such as chronic fatigue, weakness, muscle cramps, muscle weakness, chronic colds and flu.

Its deficiency can also get to your psychology. Seasonal Affective Disorder (SAD), a mood disorder featuring depressive symptoms, usually occurs in winter when there is relatively little sunshine, and coincides with the sudden drop in vitamin D levels in the body. Researchers have suggested that the symptoms of SAD may be due to changing levels of vitamin D, which may affect the secretion of serotonin, the happy hormone. Although researchers are still unsure of how vitamin D is linked with depression, findings such as this continue to support this relationship.

Brittle bones, disease, depression; and yes, it can make you fat. In many studies vitamin D has been found to be inversely associated with BMI, waist circumference, and body fat and positively associated with lean body mass. Who would’ve thought that a deficiency in this vitamin can be standing in the way of your weight loss efforts?

As a result, all these factors contribute to classify vitamin D deficiency as a major public health burden in many parts of the world including ours; hence, yes, it is a pretty big deal.

Worried?

Vitamin D status can be easily identified by a simple blood test for 25-hydroxyvitamin D plasma concentration. The optimal levels for vitamin D have not been clearly defined however, but the most commonly used cut off point by most experts is a normal value of ≥30ng/ml. Anything below that categorizes you as either insufficient or deficient in vitamin D.

First and foremost, your vitamin D status depends on two factors:

1. Vitamin D production in the skin under the influence of ultraviolet radiation from sun, which naturally initiates the conversion of cholesterol in the skin to vitamin D.

2. Vitamin D intake through the diet from naturally containing food, fortified food, or vitamin supplements.

Traditionally the human vitamin D system begins in the skin, not in the mouth. Unlike dietary or supplementary vitamin D, when you get your ‘D’ from sunshine your body takes what it needs, and de-metabolizes any extra. So what fits your day better than having to spend some time outside while enjoying the sun?

Keep in mind however that 90% of a person’s daily requirement comes from the sunlight. For this reason, if sun exposure is not readily accessible, vitamin D supplementation should be considered.

Of course, here the concern for skin cancer must be raised, especially that the action spectrum for vitamin D photosynthesis is basically the same as the spectrum that damages DNA and causes skin cancer. However, many experts will urge you to get a little sun exposure. Around 10 to 15 minutes a day in the summer sun without sunscreen while exposing 40% of your body is enough to top up vitamin D levels for most people. But remember to avoid overexposure during peak UV radiation hours, mainly from 10 am to 3 pm.

In order to meet the rest of your needs, go for natural dietary sources of vitamin D. These include fatty fish such as sardines, tuna, and salmon as well as egg yolk, beef liver and fortified foods and beverages such as cereal, milk, and orange juice.

Too much vitamin D?

You can't get too much vitamin D from being in the sun or from food, but it is possible to take too much in the form of vitamin supplements which may result in toxic levels in the blood. Always consult a doctor to see if you really need these supplements and in what amounts.

_________
Racha Adib is a Beirut-based licensed dietitian who offers nutrition and wellness counseling to individuals and corporations. She graduated from the American University of Beirut with a Bachelor of Science degree in Nutrition and Dietetics followed by a certificate in Essentials of Business. She is a member of the Lebanese Academy for Nutrition and Dietetics and the Lebanese League for Women in Business. She has also been frequently featured in media on MTV's “The Doctors,” LBC's “Mission Fashion,” and Orbit's “Ayoun Beirut” among others, and hosts a weekly radio program on the latest nutrition news and science breakthroughs. She can be found on Twitter: @rachaadib