Vitamin D Deficiency in sun drenched India– Can D-lightful Sunlight Be a Respite? – Sunlight D lemma

  • C V Harinarayan
Keywords: Nutrition


Vitamin D is one of the oldest hormones; 500 million-years old phytoplankton species in Sargasso Sea were found to contain large amount of ergosterol(vitamin D2 precursor). Ergosterol is transferred along the food chain into the sea food, where it is stored and concentrated. Vitamin D was essential for calcium and bone homeostasis to cope with higher gravity in terrestrial animals.  

In humans Vitamin D is synthesized on exposure to mid-day sunlight(UV-B rays 290-315 nm). The widespread vitamin D deficiency[25(OH)D< 20 ng/ml] in India appear to  be due to changes in lifestyle – sun shy attitude, dress code and, lack of dietary calcium.  Experimental studies from India have shown that, Indians can synthesise enough vitamin D on exposure to sunlight.

Vitamin D orchestrates the “Ca-vitamin D-Parathyroid hormone endocrine axis”. Calcitriol, the active form of vitamin D follows either of the two-pathways: Genomic responses – takes anything from few hours to days to become fully manifest(osseous benefits); Chemical messengers that transmits signals and rapid responses(RR) which vary from few seconds to an hour(non-osseous benefits-e.g. insulin secretion, intestinal calcium absorption). Association with vitamin D deficiency has reported hypertension, diabetes, psoriasis, Chron’s disease, multiple sclerosis, prostatic and colonic cancer.

For osseous benefits the vitamin D levels should be above >20ng/ml, while for non-osseous benefit requires 25(OH)D levels>30 ng/ml. Adequate dietary calcium intake of 1gm/day has to be ensured.   


Agarwal K S, Mughal M Z, Upadhyay P, Berry J L, Mawer E B
et al. (2012) The impact of atmospheric pollution on
vitamin D status of infants and toddlers in Delhi, India
Arch Dis Child 87 111-113
Amaresh Reddy P, Harinarayan C V, Suresh V, Rajagopal G and
Sachan A (2012) Bone disease in thyrotoxicosis – A review
IJMR 135 277-286
Amaresh Reddy P, Harinarayan C V, Suresh V, Rajagopal G,
Krishna Tilak T, Suchitra M M, Srinivasa Rao P V L N
and Sachan A (2012) Effect of block-replacement regimen
on bone mineral density and biochemical markers in patients
with thyrotoxic bone disease J Clin Sci Res 1 60-70 http:/
Bouillon R and Suda T (2014) Vitamin D: calcium and bone
homeostasis during evolution Bonekey Rep 3 480.
Chen T C, Chimeh F, Lu Z, Mathieu J, Person K S, Zhang A, et
al. (2017) Factors that influence the cutaneous synthesis
and dietary sources of vitamin D Arch Biochem Biophys
460 213-7 PMID:17254541;
Chen T C (1998) Photobiology of vitamin D. In: Holick MF, ed.
Vitamin D physiology, molecular biology, and clinical
applications. Clifton, NJ: Humana Press 17-37
Chittari V Harinarayan, Tirupati Ramalakshmi, Upadrasta V
Prasad, Desineni Sudhakar, Kadainti V S Sarma and
Ethamakula G Tiruvenkata Kumar (2007) High prevalence
of low dietary calcium, high phytate consumption, and
934 C V Harinarayan
R, Aggarwal S, Ganapathy A, Joshi P and Bhatia H (2012)
Skeletal muscle strength in young Asian Indian females
after vitamin D and calcium supplementation: A doubleblind
randomized controlled clinical trial J Clin Endocrinol
Metab 97 4709-16. doi: 10.1210/jc.2012-2340
Harinarayan C V (2014) Multiple roles of Vitamin D NFI Bulletin
35 1-8
Harinarayan C V, Srinivasa P Munigoti, Thennarasu K, Leena
Apicatala and Seema Ismail Inamdar (2015) Vitamin D
supplementation therapy – efficacy of three different
protocols J Clin Sci Res 42 73-80
Harinarayan C V, Appicatlaa L, Nalini A and Joshi S (2012)
Efficacy and Safety of Cholecalciferol Supplementation in
Vitamin D Deficient Subjects Based on Endocrine Society
Clinical Practice Guidelines Endocrinol Metabol Syndrome
S4:004, 2012. doi:10.4172/2161-1017.S 4-004.http://
Harinarayan C V and Joshi S R (2009) Vitamin D status in India
– its implications and remedial measures – A Review JAPI
Harinarayan C V, Ramalakshmi T, Prasad U V and Sudhakar D
(2008) Vitamin D status in Andhra Pradesh: A populationbased
study IJMR 127 211-8
Harinarayan C V, Ramalakshmi T and Venkataprasad U (2004)
High prevalence of low dietary calcium and low vitamin D
status in healthy south Indians Asia Pac J Clin Nutr 13
Harinarayan C V, Sachan A, Reddy PA, Satish K M, Prasad U V
and Srivani P (2011) Vitamin D status and bone mineral
density in women of reproductive and postmenopausal
age groups: A cross-sectional study from south India J
Assoc Physicians India 59 698-704
Harinarayan C V and Ramamalakshmi T (2015) Dietary calcium
intake in south Indian – rural, urban and metro subjects J
Clin Sci Res 4 143-148
Harinarayan C V (2009) Crohn’s disease and osteoimmunology –
Is vitamin D the cross talk coordinator? IJMR 130 108-
Harinarayan C V (2005) Prevalence of vitamin D insufficiency in
postmenopausal south Indian women Osteoporos Int 16
Harinarayan C V (2012) Thyroid Bone disease – Commentary
IJMR 135 9-11
Harinarayan C V (2014) Vitamin D and Diabetes Mellitus
Hormones 13 163-181
Harinarayan C V, Arvind S, Joshi S, Thennarasu K, Vedavyas V
and Baindur A (2014) Improvement in pancreatic â-cell
function with vitamin D and calcium supplementation in
vitamin D-deficient non-diabetic subjects Endocr Pract
20 129-38
Heaney R P, Dowell M S, Hale C A and Bendich A (2003) Calcium
absorption varies within the reference range for serum 25-
hydroxyvitamin D J Am Coll Nutr 22 142-46
Hernigou P, Auregan J C and Dubory A (2018) International
Orthopaedics (SICOT)
Holick M F, Binkley N C, Bischoff-Ferrari H A, Gordon C M,
Hanley D A, et al. (2011) Evaluation, treatment, and
prevention of vitamin D deficiency: An Endocrine Society
clinical practice guideline J Clin Endocrinol Metab 96 1911-
Holick M F (2000) Vitamin D: The underappreciated D-lightful
hormone that is important for skeletal and cellular health
Curr Opin Endocrinol Diabetes 9 87-98
Indian Council of Medical research, Dietary guidelines for Indians.
Available at URL:
guidelinesforIndians-Finaldraft.pdf. Accessed on March
20, 2015.
John E M, Schwartz G G, Dreon D M and Koo J (1999) Vitamin
D and breast cancer risk: The NHANES I epidemiological
follow up study, 1971-1975 to 1992. National Health and
Nutrition Examination survey Cancer Epidemiology,
Biomarkers and Prevention 8 399-406
Johnston C C Jr, Miller J Z, Slemenda C W, Reister T K, Hui S,
Christian J C, et al. (1992) Calcium supplementation and
increases in bone mineral density in children N Engl J Med
327 82-7
Lips P (2001) Vitamin D deficiency and secondary
hyperparathyroidism in the elderly: consequences for bone
loss and fractures and therapeutic implications Endocr
Rev 22 477-501
Luscombe C J, Fryer A A, French M E, Liu S, Saxby M F, Jones
P W and Strange R C (2001) Exposure to ultraviolet
radiation: association with susceptibility and age at
presentation with prostate cancer Lancet 25358 (9282)
Menon B, Harinarayan C V, Raj M N, Vemuri S, Himabindu G
and Afsana T K (2010) Prevalence of low dietary calcium
intake in patients with epilepsy: a study from South India
Neurol India 58 209-12
Menon B and Harinarayan C V (2010) The effect of anti-epileptic
drug therapy on serum 25-hydroxyvitamin D and
parameters of calcium and bone metabolism – A longitudinal
study Seizure 19 153-8
Mithal A, Bonjour J P, Boonen S, Burckhardt P, Degens H, El
Hajj Fuleihan G, Josse R, Lips P, Morales Torres J, Rizzoli
Vitamin D Deficiency in Sun Drenched India 935
R, Yoshimura N, Wahl D A, Cooper C, Dawson-Hughes B
(2013) IOF CSA Nutrition Working Group. Impact of
nutrition on muscle mass, strength, and performance in
older adults Osteoporos Int 24 1555-66 doi: 10.1007/
Peyrin-Biroulet L, Oussalah A and Bigard M A (2009) Crohn’s
disease: The hot hypothesis Med Hypothesis 7 394-6
Rathored J, Sharma S K, Singh B, Banavaliker J N, Sreenivas V,
Srivastava A K, Mohan A, Sachan A, Harinarayan C V and
Goswami R (2012) Risk and outcome of multidrugresistant
tuberculosis: vitamin D receptor polymorphisms
and serum 25(OH)D Int J Tuberc Lung Dis 16 1522-8
Slemenda C W, Peacock M, Hui S, Zhou L and Johnston C C
(1997) Reduced rates of skeletal remodeling are associated
with increased bone mineral density during the development
of peak skeletal mass J Bone Miner Res 12 676-82
Srinivasa P M and Harinarayan C V (2015) Vitamin D Deficiency
In India – Fortify Or Let The Sun Shine In? J Clin Sci Res
4 220-6
Tiwari L, Puliyel J M, Vitamin D level in slum children of Delhi
Indian Pediatr (2004) 41 1076-7
Webb A R and Engelsen O (2006) Calculated ultraviolet exposure
levels for a healthy vitamin D status Photochem Photobiol
82 1697-703
Webb A R, Kline L and Holick M F (1988) Influence of season
and latitude on the cutaneous synthesis of vitamin D3:
exposure to winter sunlight in Boston and Edmonton will
not promote vitamin D3 synthesis in human skin J Clin
Endocrinol Metab 67 373-8PMID:2839537; http://