Vitamin D (Calciferol) deficiency in Africans: Symptoms and Causes

 

By: Victoria Iyeduala (Freelance Health and Wellness Writer). Medically reviewed by the DLHA Team.

 

African couple holding a container of vitamin D supplements.

 

 

Introduction

 

Vitamin D, or calciferol, is a vitamin your body needs to maintain healthy calcium and phosphorus levels. The level of need varies with your age.

 

Vitamin D helps your body absorb generous amounts of calcium and phosphorus from what you eat and reabsorb excess from your kidneys.

 

Calcium and phosphorus are chemical substances that are available naturally in the soil and many food products. You need them to maintain healthy bones and teeth.

 

Your nerves, muscles and immune system also need vitamin D to work well. It also aids magnesium from food, energy production and cell growth.

 

Magnesium is another naturally occurring mineral substance found in high quantity in leafy green vegetables like spinach, nuts and seeds, legumes like beans and whole grains.

 

Sunlight is the most abundant source for the natural production of vitamin D in the body. Because the body can produce vitamin D from sunlight, it's nicknamed "sunshine vitamin."

 

Vitamin D is naturally available  in a few foods, mainly animal products – fatty fish like sardine and salmon, fish liver oils, liver meat, egg yolks and cheese.

 

Because vitamin D is a fat-soluble vitamin, it's not easily removed from the body through urine, and your body stores it for a long time – about 30 to 60 days.

 

Read on to discover what causes vitamin D deficiency, who is at risk of having it and how to know if you have the condition.

 

 

What is vitamin D deficiency?

 

Vitamin D deficiency is when your body has an unhealthy low amount of vitamin D. It's a common condition that affects about a billion ^[1] of the world's population.  

 

Several studies published in 2019  and 2021 show that vitamin D deficiency is common in many African countries.

 

To confirm whether you are vitamin D deficient or not, your doctors will likely request for a check of your vitamin D level in blood.  

 

 

Who is at risk of vitamin D deficiency?

 

Africans with a high risk of vitamin D deficiency include:

• Dark-skinned people

• Elderly people

• Exclusively breastfed infants

• People who mostly stay indoors

• People with obesity

• Patients with chronic liver or kidney disease

• People with intestinal absorption  problems (malabsorption)

• Women with decrease in bone mass and density (osteoporosis)

• People who eat less vitamin D-fortified foods and don't take supplements but have a diet that excludes animal products

 

 

What are the signs of vitamin D deficiency?

 

Most vitamin D-deficient patients don't have any symptoms. Symptoms that may start to show up when it goes unnoticed for a long time and gets worse include:

• Feeling pain in your bones, joints and muscles

• Having muscle cramps

• Feeling fatigue and weakness

• Frequently falling and having bone fractures

 

Children also experience;

• Crankiness

• Lethargy

• Bone changes

• Developmental delays

 

 

What causes vitamin D deficiency in Africans?

 

Factors that cause vitamin D deficiency include:

• A diet low in vitamin D
• Malabsorption syndrome
• Inadequate sun exposure
• Reduced production of vitamin D to its active form
• Medications
• Obesity

 

• A diet low in vitamin D

 

Although you may not get enough vitamin D from foods because few foods naturally contain it, adding natural vitamin D-rich foods and fortified foods to your diet helps increase your supply.

 

So, when your diet contains less vitamin D-abundant foods, whether natural or fortified, you may develop vitamin D deficiency in the long run.

 

People who may have a low vitamin D-rich diet include vegans, vegetarians, older adults and exclusively breastfed infants.

 

• Malabsorption Syndrome

 

Medical conditions that reduce fat – you need fat to absorb vitamin D – and poor vitamin D absorption can cause vitamin D deficiency.

 

Examples are:

• Coeliac disease

• Short bowel syndrome

• Gastric bypass (a weight loss surgery)

• Inflammatory bowel diseases like Crohn's disease and Ulcerative colitis

• Chronic pancreatic insufficiency

• Cystic fibrosis

 

• Inadequate sun exposure

 

The major source for the production of natural vitamin D is sunlight. Your skin produces about 50% to 90% of your body's vitamin D when exposed to sunlight's ultraviolet beta (UVB) rays. So, less than adequate exposure to sunlight causes vitamin D deficiency.

 

People who may be at risk of developing vitamin deficiency because of limited skin exposure to sunlight include:

• Dark-skinned people: Dark-skinned people may not produce adequate amounts of vitamin D from the sun because they have abundant melanin (a substance in the skin that protects you from sunlight). The darker your skin, the more melanin you'll have.

• Older adults: Skin production of vitamin D decreases with age.

• People who spend most of their time indoors: Examples of people who spend the majority of their time indoors are long-term hospitalised patients and older people living in care homes or who can't go out and are given prolonged care inside their homes.

• People who wear protective skin covering frequently: These include people who always wear clothing that covers almost all their skin, possibly for religious or other reasons and people who often use sunscreen.

 

• Reduced production of vitamin D to its active form

 

Your liver and kidneys process vitamin D into its active form. Your liver processes it into calcidiol (also called calcifediol). Your kidneys then convert calcidiol into calcitriol (the usable form of vitamin D).

 

one or both organs fail to do process vitamin D properly because of conditions like chronic liver and kidney diseases, your body won't have sufficient vitamin D to stay healthy. Magnesium deficiency is another health problem that hinders the activation of vitamin D.

 

• Medications

 

Some medications increase the destruction of vitamin D in the liver. Examples are:

• Phenobarbital – an anti-seizure medicine for epilepsy patients and a sedative drug.

• Carbamazepine – a medication for controlling seizures in epilepsy patients and for reducing nerve pain.

• Dexamethasone – a drug used to reduce inflammation and treat some types of arthritis and cancer, asthma, severe allergies and disorders of the blood, skin, eyes, kidney, intestine and thyroid gland.

• Nifedipine – an antihypertensive and chest pain medicine.

• Spironolactone – a drug for treating heart failure, potassium deficiency, high blood pressure, Oedema or edema (swelling caused by excess fluid accumulating in your body) and hyperaldosteronism (too much aldosterone production by your body).

• Clotrimazole – an antifungal medicine for treating skin infections.

• Rifampin – an antibiotic medicine for treating tuberculosis (TB) and a bacteria that causes meningitis (Neisseria meningitidis).

 

• Obesity

 

People with obesity have excess body fat. This excess fat hides away the bulk of the vitamin D that goes into your body and leaves little for you to use. You'll become deficient if you can't take in enough vitamin D to make up for the one lost to fat.

 

 

Takeaway

 

Vitamin D is important for overall health because your bones, teeth and several other body tissues need it to function properly. Less skin exposure to sunlight, a diet lacking vitamin D-rich foods, impaired vitamin D activation, malabsorption problems, certain drugs and obesity are factors that can cause vitamin D deficiency.

 

Click here to discover the health problems vitamin D deficiency can cause and how to prevent it.

 

 

Resources:

• Sizar, O., Khare, S., Goyal, A. & Givler, A. (2023, July 17). Vitamin D Deficiency. StatPearls - NCBI Bookshelf. Retrieved October 19, 2023.

• NIH Office of Dietary Supplements. Vitamin D. Retrieved October 19, 2023.

• Vitamin D. (2021, November 19). nhs.uk. Retrieved October 19, 2023.

• Mogire, R. M., Mutua, A., Kimita, W., Kamau, A., Bejon, P., Pettifor, J. M., Adeyemo, A., Williams, T. N., & Atkinson, S. H. (2020, January). Prevalence of vitamin D deficiency in Africa: a systematic review and meta-analysis. The Lancet Global Health, 8(1), e134–e142. Retrieved October 19, 2023.

• Mogire, R. M., Morovat, A., Muriuki, J. M., Mentzer, A. J., Webb, E. L., Kimita, W., Ndungu, F. M., Macharia, A. W., Cutland, C. L., Sirima, S. B., Diarra, A., Tiono, A. B., Lule, S. A., Madhi, S. A., Sandhu, M. S., Prentice, A. M., Bejon, P., Pettifor, J. M., Elliott, A. M., Adeyemo, A., Williams, T. N. & Atkinson, S. H. (2021, May 20). Prevalence and predictors of vitamin D deficiency in young African children. BMC Medicine, 19(1), 115. Retrieved October 19, 2023.

• Uwitonze, A. M., & Razzaque, M. S. (2018). Role of Magnesium in Vitamin D Activation and Function. The Journal of the American Osteopathic Association, 118(3), 181–189.doi: 10.7556/jaoa.2018.037.

• NIH Office of Dietary Supplements. Calcium. Retrieved October 20, 2023.

• Zimmerman, L. & McKeon, B. (2022, April 28). Osteomalacia. StatPearls - NCBI Bookshelf. Retrieved October 20, 2023.

• Rickets and Osteomalacia. (2021, November 19). nhs.uk. Retrieved October 20, 2023.

• Vitamin D Deficiency in Children. NUH. Retrieved October 19, 2023.

• Osteoporosis. (2023, September 25). NIAMS. Retrieved October 20, 2023.

• Office of Dietary Supplements. Phosphorus. Retrieved October 20, 2023.

• Jagtap, V., Sarathi, V., Lila, A., Bandgar, T., Menon, P., & Shah, N. (2012). Hypophosphatemic rickets. Indian Journal of Endocrinology and Metabolism, 16(2), 177. Retrieved October 20, 2023, from PMC.

• WHO. Radiation: The Known Health Effects of Ultraviolet Radiation. 2017, Oct. 16. Retrieved October 19, 2023

 

Related:

Folate (Vitamin B9) Deficiency in Africa: Symptoms and Treatment

Vitamin B12 (Cobalamin) deficiency: What Africans Need To Know

Vitamin D (Calciferol) deficiency in Africans: Diagnosis, Treatment and Prevention

 

 

 

Published: Novenber 7, 2023

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