Why your Vitamin D levels may be low despite sun exposure

Dear doctor,

My mum is currently admitted in hospital, and from her test results, she was told that she has low Vitamin D levels. How is this possible in a country like ours that has sun every day? How is Vitamin D deficiency treated?

Moses

Dear Moses,

Vitamin D is essential for bones, teeth and immune system. It is made in the body when the cholesterol in the skin cells is exposed to sun. Dietary sources of Vitamin-D include fatty fish, egg yolk, fish liver, fish oils and fortified foods. A lack of Vitamin D can lead to weakening/softening of the bones, causing bone pain, muscle cramps, problems with the teeth; muscle weakness; and fractures. Additional symptoms of Vitamin D deficiency include poor wound healing; hair loss; recurrent infections; fatigue and low mood.

There is an increased risk of developing Vitamin D deficiency if the individual does not get enough sun exposure or if they always wear sunscreen. Inadequate dietary Vitamin D intake can also lead to low vitamin D levels such as as a result of strict vegan diets; or problems with Vitamin D absorption and processing. There is also a higher risk of Vitamin D deficiency if you are elderly or obese, or if you have darker skin because skin pigmentation affects the body’s capability to absorb ultraviolet B rays. Gastric bypass surgery can also lead to vitamin D deficiency due to reduced absorption.

The deficiency can be prevented by getting sun exposure on the skin. This is about 10 to 30 minutes of sun-exposure daily. Small amounts of Vitamin D can be found in foods. Vitamin D deficiency is treated with Vitamin-D supplements, in addition to sun-exposure and diet.

Dear doctor,

I am 28 years old and was diagnosed with polycystic ovary syndrome (PCOS) several years ago. I get my periods three to four times a year. I have been told that this is not good, and I need medication. What’s the danger of getting infrequent periods, especially since I am not planning to get pregnant any time soon?

Hellen

Dear Hellen,

PCOS is a hormonal disorder, where there are problems with functioning of the ovaries, increased levels or androgen hormones, and there may be cysts on the ovaries. There are also problems with how the body processes and deals with the main nutrients such as fats, carbohydrates and proteins.

In a normal menstrual cycle, there is menstrual bleeding every 21 to 42 days. In the first half of the cycle, oestrogen is produced by the ovaries and causes the uterine lining to thicken. In the second half of the cycle, after ovulation, progesterone is also produced, causing further thickening of the lining in preparation for a pregnancy. If there is no pregnancy, the hormone levels drop and the uterine lining is shed off, which is menstruation. With PCOS, failure of ovulation and no production of progesterone leads to continued oestrogen production and further thickening of the uterine lining. This causes irregular periods, both in frequency and amount of bleeding. The continuous endometrial stimulation by estrogen leads to excessively thickened endometrium, which can result in endometrial hyperplasia (non-cancerous thickening of the endometrial lining), and in a few people it can lead to endometrial cancer.

To protect the endometrial lining from hyperplasia and risk of endometrial cancer, some treatments may be given such as combined oral contraceptives, progesterone-only medications, or use of an intra-uterine device that has medication in it. If you have less than four periods in a year, it is advisable to use medication every three months to trigger bleeding. It is also advisable to be on regular follow-up by a gynaecologist to check on the health of the uterine lining and any other complications associated with PCOS.

Dear doctor,

My younger sister is 13, and she was recently given eye glasses to help with her eyesight. She was also told she has astigmatism. What does this mean? Is it treatable?

Jasmine

Dear Jasmine,

Astigmatism is a condition that causes blurring of vision because of an uneven curvature on the surface of the cornea and/or the lens of the eye. The cornea is the outermost layer of the eye, and it is clear in colour. It helps in bending light for the light rays to converge at a point, making the image clear. The lens is a clear structure within the eye that absorbs and bends light. Both the cornea and the pupil bend the light to make it focus on the retina so that the image can be seen, and seen clearly. With astigmatism, when one or both of them are abnormally curved, then the light rays converge in front of, or behind the retina, which leads to blurring of both near and far vision. In addition to blurred vision, the individual may experience recurrent headaches, problems with night vision and persistent squinting.

Someone may be born with astigmatism, or develop it after injury or illness. It is advisable for the individual to be followed up by an eye specialist. There are several eye tests that may be carried out to diagnose it. Astigmatism can be managed by using eye glasses or contact lenses. Corrective surgery may also be utilised to correct the abnormal curvature.

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