In Health Tips On 18 October 2018
October is ‘Breast Cancer Awareness’ month and one thing is for sure we do lack awareness. Most of us do not screen ourselves regularly. There are so many questions we do not have answers to. What causes it? What is its prevalence? Therefore, I have gathered as much information as I could to share with you. Prevalence: Breast cancer has become the most common cancer in women now, overtaking cervical cancer. Though the incidence of this disease is lower in India than the Western countries, it is now on a rise, more in the urban population than rural. This is thought to be because of diet and lifestyle differences. The rise of breast cancer has been seen mostly in the younger population than the older (between 25 to 40yrs). One out of 22 women is detected with breast cancer and one out of two who develop this disease dies (https://economictimes.indiatimes.com/magazines/panache/breast-cancer-rates-are-on-the-rise-among-young-women-and-heres-how-you-can-prevent-it/articleshow/62803645.cms). The survival rate of breast cancer patients in the younger age group is lower than the ones in the older age group because the disease is more aggressive in younger patients. Also, the overall survival rate in India is lower than the Western countries due to lack of screening. In India, it is mostly detected at a later stage. Image courtesy of (KEKO64) at FreeDigitalPhotos.net Causes: A lot of research is still going on to understand what are the causes which leads to this disease. A few things have been understood. Genetic factors play a very important role in causing breast cancer, but environmental factors add to it. An early menarche, late menopause, older age at the first birth of a child, no children, can play important roles in causing mammary tumors. High estrogen levels have been related to breast cancer risks. Since most women with high BMI (Basal metabolic index) and obesity show high estrogen levels, obesity is also a risk factor for breast cancer. On the other hand, some studies have shown that obese women are at a lower risk. Though one doesn’t know the exact reason, it is possible that it could be due to diminished ovarian functions, therefore low estrogen levels (https://breast-cancer-research.biomedcentral.com/articles/10.1186/bcr423) Some of the above risk factors are not modifiable, meaning not in our control. But some modifiable risk factors are: Diet, lifestyle and physical activity: Evidence of correlation between fat intake during adult years and cancer is very low. Though it is believed that diet during growing years might be a risk factor. But even then, one needs to take care of their diet and lifestyle because studies have shown a difference in the incidence of this disease in the urban and rural population which is higher in the former and lower in the latter. This has led to the conclusion that the difference in food habits, physical activity and lifestyle might be the reason. The International Agency for Research on Cancer (IARC) and the World Cancer Research Fund (WCRF) have remarked that diet strongly influences cancer prevention, disease development, treatment tolerance and cancer recurrence. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531134/#ref19) Breast feeding too has been found to be related to the incidence of breast cancer. The longer the duration of breast feeding lower is the risk of breast cancer. Image courtesy of (vectorolie) at FreeDigitalPhotos.net One well-established risk factor for breast cancer is alcohol. There are number of studies with convincing evidence that show alcohol consumption is a risk factor for incidence and mortality of breast cancer. Research regarding this disease is still underway, to understand the risk factors better, to understand if it can be prevented and if so, how? There is some evidence based on quite a few observational studies, that a low fat, high fibre diet with a minimum of 5 servings of fruits and vegetables a day and a moderate to high intensity physical activity could be helpful in reducing the risk of breast cancer, its progression and recurrence. So, in conclusion, one can say, A healthy diet, a good amount of physical activity, a limited amount of alcohol consumption, if one cannot completely quit, could be helpful in preventing breast cancer. But once detected, one has to follow stricter rules regarding diet, physical activity and alcohol consumption, so as to slow down progression, tolerate the treatment better and reduce the risk of recurrence after a successful treatment. Other than that regular screening is very important so that if one has developed the disease, it is detected in an earlier stage.
In Health Tips On 12 October 2017
Many of you, who might have had a look at health check-up packages, might have seen that almost all such packages have tests for Vitamin D and Vitamin B12. I already written about vitamin D in a previous article. Here I am going to focus on Vitamin B12. What is Vitamin B12 It is a water- soluble vitamin, also known as cobalamin or cyanocobalamin, and is very important for normal functioning of brain and the central nervous system. It works closely with folic acid and helps in the formation of red blood cells. Folic acid and B12 also work together to form a compound which is involved in immune function and mood. It also helps in the production of DNA and RNA, body's genetic material. Vitamin B12 along with Folic acid and vitamin B6, control the levels of homocysteine, which in high levels can cause heart diseases. Therefore it is a vital nutrient, the deficiency of which will invite a lot of diseases. Since Vitamin B12 also assists in the metabolism of protein and fat, it has been found to be important for body building. Bodybuilding requires the amino acids resulting from protein metabolism to repair and build muscles, and fat for energy. But if the person is not deficient in Vitamin B12, then taking extra doses than recommended will not improve the energy levels or the workouts. Deficiency Vitamin B12 deficiency is a fairly common condition but is usually undiagnosed due to lack of enough classic symptoms but yet there are some signs and symptoms which one can look out for. Depression, Psychosis, Dementia, Obsessive Compulsive Disorder (OCD), memory loss, tremors, shaky movements, unsteady gait. As mentioned above, it is involved in the functioning of the brain and Central Nervous System, therefore its deficiency can lead to the above symptoms. Pernicious Anemia, Fatigue, Shortness of breath. Anemia is a classic symptom of B12 deficiency. Severe anemia can lead to fatigue and shortness of breath. These symptoms are also related to congestive heart failure, along with ankle edema, breathing difficulty and frequent urination at night. Loss of balance, tingling in the arms and legs are some other signs of deficiency. Reasons of Deficiency In India, one of the main reasons is thought to be dietary habits. Due to religious, spiritual, and socioeconomic conditions, our country is largely vegetarian and since B12 is mainly found in animal food sources, it may contribute to deficiency of this vitamin. Also, there is a high prevalence of Helicobacter pylori infection. H.pylori is a bacteria which causes stomach infection which then leads to low secretion of stomach acids and something called an intrinsic factor which helps in the absorption of vitamin B12. People with Celiac disease, Crohn's Disease may not absorb Vitamin b12 well. People over 50 lose the ability to absorb Vitamin B12 from food. If an individual has undergone any gastrointestinal surgery or weight loss surgery, he or she may not be able to absorb vitamin B12. Some others who are at risk are individuals with diabetes and HIV. Consistent intake of antacid. Heavy drinking Food Sources of Vitamin B12 Image courtesy of (Lamb: James Barker; Fish: Dan; Eggs: amenic181; Museli and fruit: joephotostudio; Milk: John Kasawa) at freedigitalphotos.net Organ meat particularly liver and kidney Fish Shellfish Meat Poultry Eggs Dairy Fortified breakfast cereals In case one is detected with deficiency, supplementation will be required along with food sources. For certain cases which are not diet related deficiency, vitamin B12 injections may be given. Please follow the doctor's advice for supplementation. Do not self-diagnose or self-medicate. Side Effects Recent research from Ohio State University, suggests that long term use of high doses of vitamin B6 and B12 is related to higher risk of lung cancer in men relative to non-users. This risk was higher in male smokers than non- smokers. More research is underway to see if the results can be replicated. https://cancer.osu.edu/news-and-media/news/long-term-high-dose-vitamin-b6-b12-use-associated-with-increased-lung-cancer-risk-among-men Remember that this is only for high doses and long-term use. Do not panic the moment you are given this supplement by your physician. Because deficiency will require supplementation along with the right kind of food.
In Health Tips On 28 August 2017
Polycystic Ovaries Syndrome (PCOS) is a hormonal condition that occurs in 5-10% of women between late adolescence and menopause. It is one of the most common hormonal related problems in women during their reproductive years. Not only is PCOS a leading cause of infertility it can also be a risk factor for other health problems. The diagnostic criteria of PCOS has been a topic of debate. Merely the presence of polycystic ovaries ( enlarged ovaries with small cysts on the outer edges) does not qualify for the condition to be called a syndrome. In November 2015, the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE), and Androgen Excess and PCOS Society (AES) released new guidelines in the evaluation and treatment of PCOS and it was mentioned that the diagnostic criteria for PCOS should include two of the following three conditions: Chronic anovulation ( chronic absence of ovulation), hyperandrogenism (excess of male hormones which can be clinical/biologic), and polycystic ovaries. Signs and symptoms The major features of PCOS include menstrual dysfunction, anovulation, and signs of hyperandrogenism. Other signs and symptoms of PCOS may include the following: Hirsutism Infertility Obesity Metabolic syndrome ( a cluster of conditions such as high blood sugar, abnormal lipid levels, high blood pressure, obesity) Diabetes Obstructive sleep apnea Most PCOS patients are overweight or obese ( except a small percentage who are not markedly overweight). One of the most common metabolic abnormality associated with PCOS is insulin resistance. In this condition the cells fail to react to insulin which leads to abnormal glucose metabolism and high blood sugar. To compensate this condition, the body produces more insulin, thereby increasing the insulin levels in the blood and causing a condition called hyperinsulinemia. This then further leads to Type 2 diabetes. The mechanisms by which insulin resistance leads to PCOS and Type 2 diabetes are different. The details of which I shall not discuss in this article. PCOS has also been related to Type 1 diabetes. Insulin resistance has also been related to dyslipidemia ( abnormal lipid levels) and risk of cardiovascular disease. A lot of research still needs to be done on PCOS. Research to gain a clearer understanding of the mechanisms linking each condition is required. Nevertheless, there are enough studies which have shown that even a moderate weight loss of about 5-10% helps in restoring functions of the ovaries which leads to normal hormone production. This then results in improvement in symptoms of PCOS. Since PCOS is related to so many metabolic abnormalities, many studies have shown that apart from the required drug therapy, diet and lifestyle changes is the first line treatment. Diet for PCOS PCOS diet is very individualistic. Since the symptoms will vary from woman to woman. But there are a few basic guidelines 1. Foods with low GI (Glycemic index ): These are foods which release the sugar slowly to the blood stream, therefore there is a steady rise in blood sugar and insulin, as opposed to high GI foods which are broken down and absorbed quickly by the body leading to a rapid rise in blood sugar levels. Image courtesy of (Grains: rakratchada torsap; fruits and vegetables: Suat Eman; Almonds: phasinphoto) at freedigitalphotos.net List of low GI foods Whole wheat ( chapati, bread) Multigrain bread Oat bran Rolled oats Natural Museli Whole wheat pasta Brown rice Buckwheat ( kuttu ) Kidney beans (Rajmah) Black eyed kidney beans ( Rongi/ Lobia) Lentils Chickpea Almost all vegetables except beetroot which is a medium GI, potatoes, pumpkin and parsnips which are high GI. Cherries, Plums, Grapefruit, Peaches, Apples, Pears, Dried Apricots, Grapes, Coconut, Coconut Milk, Kiwi Fruit, Oranges, Strawberries, Prunes, Nuts and seeds such as walnuts, peanuts, almonds, chia seeds, ground flaxseeds. 2. Less than 30 % of the daily calories should be from fat: This should comprise of mostly unsaturated fats and only a very low amount of saturated fat (<10%). So how does one translate this to normal day to day life. The basic idea is to cook the food in very less oil. Stir fry vegetables and let them steam cook. If you are in the habit of adding a bit of ghee ( clarified butter) to your chapatis, it's completely ok since ghee is one of the good fats, but reduce the amount and the number of times you have it in a week. The amount and restrictions will also depend upon the metabolic conditions of the individual. 3. Dairy: The effect of dairy on PCOS has some conflicting views. Studies have shown that regular consumption of dairy increases insulin production. It is also believed to increase androgen production (except cheese). At the same time whole milk and whole milk products have been related to increased fertility. There are very few studies relating dairy to PCOS. So the effect of dairy will probably vary from person to person. Therefore an individual with PCOS can avoid dairy for a certain period of time and observe if there are any changes in the way they feel. As for the calcium, there are other sources such as broccoli, okra ( bhindi), kidney beans, chickpeas, sweet potato, to name a few which are easily available in our country . Also since cheese is said to have a lesser effect on insulin production, one can try having cheese in moderation. Apart from this, one should take a good calcium supplement and a multivitamin, which is recommended by their physician. 4. For non vegetarians, organic good quality chicken and fish are the best options. Foods to avoid: White rice, White bread, Maida, White pasta, Bagel, Potatoes, Refined sugar, Processed packaged foods, Red meat. A person with PCOS has a very fragile system. Therefore as much as possible have organic products. Keep yourself as much chemical free as possible. In smaller cities the availability of organic products might be a bit difficult. But all is not lost. There are a lot of products that you can find online. Living with PCOS is not easy but a few changes in your diet and some form of regular exercise of about 30 mins will help you deal with it.
In Health Tips On 28 August 2017
I have been hearing for a while that many people are going gluten- free and that it is healthy. Many believe that it would definitely lead to weight loss. But before we generalize anything let us understand a little more about gluten. Gluten is the general name which is used to describe a mixture of proteins found in grains such as wheat, barley and rye. The protein groups are divided into two groups Prolamines and Glutelins. Different grains have different amounts of these proteins. So... is gluten bad? No gluten is not bad for everyone but only for certain people. Image courtesy of (rolling dough: lemonade; wheat: KEKO64; bread basket: amenic 181) at freedigitalphotos.net Gluten related disorders 1. Autoimmune reactions: i. Celiac Disease: This is probably the most widely studied gluten related disorder wherein gluten triggers an autoimmune response and causes inflammation of the intestines. The Western countries have given it a lot of importance and rightly so, because if it goes undetected then it leads to a lot of other complications. But it is a myth if one thinks that it occurs only in the west because studies conducted in India shows the existence of this disease here too. But the only problem is lack of awareness. It was observed that it occurred mostly in northern India than the southern part of the country obviously because wheat is the staple grain in the north. ii. Dermatitis herpetiformis or Duhring Brocq disease. This is a chronic autoimmune skin blistering condition. iii. Gluten Ataxia which is a neurological condition consisting of lack of voluntary condition of muscle movements and includes gait abnormality. 2. The other form of gluten sensitivity is Non celiac gluten sensitivity (NCGS): There is no specific test for this condition. This is understood after celiac disease and the other known conditions are ruled out. NCGS is under much debate. There are many studies which support the existence and many which don't. Therefore, one needs to rule out other conditions such as the ones mentioned above and others such as irritable bowel syndrome, wheat allergy, to finally come to the conclusion the it is gluten sensitivity just by itself. Many studies on gluten sensitivity have been not very conclusive because some of the test subjects reacted even to other food components such as milk proteins, eggs, tomatoes. 3. Sometimes the individual might be allergic to just wheat but can tolerate other grains: This is simply called wheat allergy. The symptoms of wheat allergy are similar to Celiac disease and NCGS but the difference is in the onset. Wheat allergy has a fast onset. Some patients with wheat allergy can tolerate other grains such barley, oats. While others maybe advised to completely give up gluten. So if one feels discomfort after consuming gluten containing products, should get themselves tested. The symptoms of Celiac disease are different for infants and young children, for teenagers and adults. Infant and young children: Diarrhea, constipation, growth problems, difficulty in gaining weight, irritability, fatigue, vomiting, abdominal bloating and pain. Teenagers: For teenagers with Celiac disease symptoms may not occur unless triggered by some stressful situation. Symptoms are; diarrhea, vomiting, weight loss, delayed puberty, irritability, depression, abdominal pain and bloating, mouth sores, skin rashes Adults: Iron deficiency, joint pains, arthritis, osteoporosis, depression or anxiety, seizures, irregular menstruation, mouth sores, skin rashes, tingling numbness in hands and feet. Even if someone has just a few of these symptoms should consult a physician. It has been observed that the number of people being affected by gluten is rising. So the question which arises is why? Is it a real situation or is there too much awareness? I think it is a bit of both. Of course there is awareness. Just as there is awareness about a whole lot of other things but it is also real. The food that we have now is far more different than what our ancestors would have. The kind of wheat that is available is said to be different than what it used to be. Excessive use of antibiotics might have destroyed a lot of the gut flora leading to inability to digest a lot of things including gluten. Even environmental factors may be responsible. Pesticides, hybrid variety of food products. The exact reason behind why it is increasing could be anything. But what we need is awareness and with awareness the understanding that not everyone needs to go gluten-free. There are some who believe that it is better to give up grains completely. But in a country like India where our diet primarily consists of grains, it is not practical. If you have been experiencing digestive problems or other symptoms mentioned above, it could be gluten, just wheat, milk, eggs, fish (few of the common allergens) or many other factors. So please consult a health professional to understand the exact cause. But if the tests turn out to be inconclusive and you feel better with a gluten-free diet, then by all means go ahead. At the end of the day we just want to feel good and healthy.
In Health Tips On 28 August 2017
These two categories are very important in our diet. Without a doubt, they consist of necessary ingredients for most of our cooking. But these are the two categories which can cause havoc in the body if one doesn't practice moderation. Sugars Sometime ago when the West was struggling with the epidemic of obesity, researchers came to the conclusion, that reducing fat in the diet would help, especially saturated fat. This is not entirely a wrong conclusion but there was another food group which was not given enough attention and that was 'sugars'. As health care professionals started recommending low fat diets, the processed food industry was quick to bring out products of the low-fat variety. But to make these products tasty, they started adding sugar to it. Some of the common ones are corn syrup, dextrose, fructose, invert sugar, sucrose. Most packaged products had and still do have hidden sugar in them. So, although people were consuming low fat products, obesity couldn't be controlled. Newer research then revealed that sugar is a bigger culprit than fat for a lot of conditions. Today obesity and various other related disease is not just a problem of the Western countries . It is something which is spreading all over the world. In 2015, a new WHO guideline recommends adults and children to reduce their daily sugar intake to less than 10% of their total calorie intake. A further reduction to below 5% per day would provide additional health benefits. So, if a person is consuming 2000 Kcal per day, then 5% of 2000kcal would be 100kcal which is about 25grams (6 teaspoons) of sugar. These specifications are for free sugars such as table sugar, sugar added by the manufacturer, sugars naturally present in honey, syrups, store bought fruit juices and fruit juice concentrates. These guidelines do not refer to fresh fruits, vegetables, and sugars naturally present in milk. Now whatever little free sugars that is recommended, we should try and look for healthier options which are available in the market. 1. Jaggery 2. Honey 3. Unrefined raw sugar. 4. Coconut sugar. They are all considered heathier since they have far more minerals and vitamins than refined chemically treated sugar. Even better if we can find organic products. But as mentioned above even though they are healthy options, they should be had in limited amounts. Specially for clinical conditions like diabetes, PCOS, even these options need to be taken in limited amounts or as the health care professional advises. Image courtesy of ( Honey dipper: phasinphoto; Brown and white sugar:nuchylee; Oil: Janpietruszka) at freedigitalphotos.net. Fats The recommended dietary intake of fat is not more than 30% of the total calories per day. This should include more of unsaturated fat, less than 10% of saturated fat and almost no industrial trans-fat ( The nutritional facts section of the package mentions the presence or absence of trans fats. Vanaspati ghee which is still very popular in some parts of our country has been found to contain high amount of trans fats). To simplify this, I would say ,cook in as minimal oil as possible. It is thought to be better if we use different oils in our diet. For example, certain stir fried vegetables can be made in olive oil, some in mustard oil, some in coconut oil, others in groundnut oil. Sometimes a bit of ghee can be added to your dal or chapatti. This would, of course, also depend on the flavour preference and to which region of the country one belongs to. Some healthy options of fat are: 1. Mustard oil 2. Groundnut oil 3. Sesame oil 4. Olive oil 5. Desi ghee (clarified butter) 6. Coconut oil It would be even better, if one can get organic cold pressed or expeller pressed versions of these oils. Since refined oils are highly processed, using various methods, they lose almost all their healthy properties and addition of chemicals make them less safe. Cold pressed oils have been around in the world for a very long time. It's just that we forgot about this process. In India, this system of cold pressing, is known by different names such as 'ghani', 'kolhu', 'chekku'. Though I must say that it is not very easily available. Not in our usual supermarkets. If you do really wish to use cold pressed and expeller pressed oils, there are a few online sites. While buying these oils, buy smaller amounts because it shouldn't be stored for too long as it can lose its properties. Authentic cold pressed oils are sold in opaque or tinted containers/bottles while expeller pressed ones are sold in transparent containers. Although these are healthier options of cooking fats, they need to be used in moderation.For certain clinical conditions such as heart diseases, as the health care professional advises.
In Health Tips On 28 August 2017
It is known that about 60% of our body is made up of water. Water is an essential nutrient for almost all forms of life. We all know that it is very important for various functions of the body. It helps in regulating body temperature, digestion and distribution of nutrients, removing waste products from the body, blood circulation, keeps the tissues moist etc. It has been understood that as the body loses water, different functions are affected. At just 1 % loss, thermoregulation is impaired, and as water losses increase, thirst increases and then progressively, dry mouth, discomfort, loss of appetite, decrease in work capacity and therefore productivity. In higher water losses of about 6% there is numbness and tingling sensation in body extremities such as finger tips, toes. Higher losses can lead to a person collapsing and can sometimes be life threatening.( http://www.who.int/water_sanitation_health/dwq/nutwaterrequir.pdf ) So, the most important question which everybody wants to know, is how much water should one have. The answer to that is, there is no specific amount. There is no RDA (Recommended Dietary Allowance) for water. This is because every person has a different weight, dietary practices, lifestyle, age. There is a common practice of recommending 8 glasses of an 8 ounce glass, also known as 8x8 rule. That is, 8 glasses of a glass with a capacity of about 237 ml. But how did this practice start? In an article by Heinz Valtin in the American Journal of physiology ( "Drink at least 8 glasses of water a day." Really? Is there scientific evidence for "8x8"? November 1, 2002 Vol 283 no. 5, R 993-R 1004) it has been mentioned that this might have its origin from 1945 when the Food and Nutrition Board of the National Research Council wrote: A suitable allowance of water for adults is 2.5 liters daily in most instances. An ordinary standard for diverse persons is 1 milliliter for each calorie of food. Most of this quantity is contained in prepared foods. Which means, apart from the water which is consumed, food also provides a certain amount of water. But there is no study which states that one should have 8 glasses of water. Therefore, many believe that one need not drink that much water. But the basic point about water consumption is, it is not the same for everyone. A lot depends upon the environmental conditions, activity level of the individual and the body weight. If one wants to be specific, there are daily water intake calculators online which take under consideration all these factors. In a country like India where the summers are very harsh, one must drink a lot of water. I have come across people who drink as much as 4 liters of water because of extreme climatic conditions. Image courtesy of (winnond) at freedigitalphotos.net Although there is no study to back the 8x8 rule or 8-10 glasses rule, it is not a bad practice. As I mentioned, with the kind of climate that we face in our country (except the winter months when water requirements would be less), can we afford to have less water than this? I would think not. If one cannot bring themselves to drink as much, start with just half a glass at a time and gradually increase the amount. As mentioned above, by the time one feels thirst, the body has already lost 1%. So many experts believe waiting to feel thirsty is not a good way of judging water requirements. Water Toxicity Water toxicity is a condition which happens if a person has too much water in a short amount of time. According to American Chemistry Society, it takes about 6 liters of water to kill a 165 pounds (75 kg) human being. This condition mostly occurs in endurance sports when an athlete consumes too much water while running, water drinking contests or if a person is involved in activities which causes heavy sweating and to replenish that ends up consuming too much water in a short span of time. Too much water causes a drop in sodium levels leading to something called hyponatremia. Under normal circumstances, a person would rarely have water toxicity. So, drinking 8-10 glasses for a moderately active person will be beneficial. For anyone who wants a specific amount try the water intake calculators online. Below is a link to one of the online sites. http://www.medindia.net/patients/calculators/daily-water-requirement.asp
In Health Tips On 28 August 2017
Recently I have come across many individuals with vitamin D deficiency and therefore felt the need to inform people in the simplest way to take necessary action. In recent years, there is renewed interest in this vitamin because new data suggest that its benefits are beyond just healthy bones. It has been linked to the treatment and pathogenesis of various disease such as cancer, hypertension, multiple sclerosis, rheumatoid arthritis, osteoporosis, muscle weakness and diabetes. A lot of research is still under way to understand its link to these conditions. Nevertheless, one needs to be aware. Undoubtedly, various types of cancer and infections will happen even under optimal vitamin D but the risk will be lower. So, in case anyone is diagnosed with deficiency or insufficiency, it should not be taken very lightly. Vitamin D is a fat- soluble vitamin which is very important for various functions of the body and for strong and healthy bones. Most of this vitamin can be synthesized by the body with sufficient exposure to the sun since its precursor is present in our skin. A very small amount also comes from some of the foods that we eat. Vitamin D from food and skin synthesis is in an inactive form. It needs to be further converted to its active form in the liver and kidney. Deficiency Vitamin D deficiency has now been recognized as a pandemic which means it is prevalent all over the world. Earlier vitamin D deficiency was detected because of either rickets in children or osteomalacia in adults. Now it can be detected by a simple blood test. Almost all general overall test packages in most laboratories will include this test. The test then determines whether the patient has vitamin deficiency or insufficiency even though there might be no evidence of any disease. According to available data, some of the reasons for this widespread deficiency or insufficiency could be not enough exposure to the sun, use of sunscreen (which for other health reasons is good but one need not put sunscreen all the time. Certain amount of exposure is important as mentioned below), digestive tract problems such as Celiac disease, Crohn's disease, and improper nutrition. Symptoms of Vitamin D deficiency Some of the signs of vitamin D deficiency are: 1. Children are often found to have walked late or prefer to sit for prolonged periods. 2. Adults can experience chronic muscle pains. In severe deficiency: 1. One can see bowing of legs in children. 2. In adults, periosteal bone pain (Periosteum is the membrane which covers the surface of the bone) which is diagnosed by physical examination. Toxicity Under very rare circumstances vitamin D toxicity can occur. This can only happen due to improper supplementation wherein too much vitamin D has been taken orally. Some of the symptoms are dehydration, vomiting, kidney damage. Some of the good sources of Vitamin D are as follows: Image courtesy of (Fish: markuso; Milk: alex_ugalek; Egg: Photouten; Cheese: Serge Bertasius Photography) at freedigitalphotos.net 1. Fatty fish 2. Foods fortified with Vitamin D such as some brands of milk and some cereals in India. Check the labels while buying. The Food Safety and Standards Authority of India (FSSAI) has set up a panel to draft guidelines on fortification of many other food items so as to address deficiencies and malnutrition problems. 3. Cheese 4. Egg yolk 5. Cod liver oil 6. Wild mushrooms or those treated with UV light. A reasonable amount of exposure to the sun helps in the synthesis of vitamin D in the body. According to studies, the optimal time to absorb sunlight is between 11:00 am- 2:00 pm. For people with light skin about 15-20 mins and for people with dark skin about 30-40 mins in the sun. So, get yourself tested and if you are detected with deficiency or insufficiency then, proper supplementation, a wholesome diet, and a little bit of sunshine would restore the vitamin D levels in the body. Please do not self diagnose and self medicate. Visit a doctor and a dietician/nutritionist for proper guidance.