There is a silent epidemic among Muslim women that is especially problematic because it involves the way in which Muslim women dress. This only complicates the issue as it devolves from a mere health issue to one of culture and religion. The issue in question is vitamin D deficiency (specifically D3) and how a person’s exposure to sunlight, or rather her lack of exposure, can lead to a host of other more serious syndromes.

Case study: A hijab-wearing Muslim woman walks into her internist’s office, armed with a list of symptoms including chronic headaches, irritability, and fatigue. To some, this may resemble the characteristics of a new mom, or even a bad week. However, after answering questions on personal fitness, diet, nutrition, and ‘could it be depression?’ a simple blood test reveals that this 20-something woman is severely vitamin D3 deficient. Moreover, she will need more than 10 times the weekly requirement as a supplement in order to ‘bring her back to life.’ This deficiency, caused by low levels of sunlight (best source of D) certainly comes as a shock to her as it flies in the face of her personal beliefs of modesty.

Let’s revisit vitamin D and find out why, when taken on a regular basis, it is now reported to protect you from the flu, regenerate cells, clear your skin, and free your mind from depression. What do you think of when you hear about Vitamin D? Fortified milk? Sunlight? Healthy bones? Children are encouraged to drink milk fortified with vitamin D3 (it helps our bodies absorb calcium). We were told that milk with vitamin D is like ‘liquid sunshine,’ given that nature’s best way to obtain vitamin D3 is to soak up some rays at least 15 minutes daily. In nearly 100% of the lay magazines I perused while writing this article there was a reference to Vitamin D3 with regards to a deficiency or as a new form of healthy living. What is behind this new ideology?

Recent interest groups and stakeholders are pushing for better prospective studies to show the efficacy of higher doses of vitamin D3. One such organization is the American Medical Association (AMA) which recognizes the positive relationship between increasing the current recommended dosage of vitamin D and the prevention of cancer, diabetes and other morbidities. The current ‘recommendations’ by the Food & Drug Administration is a Recommended Daily Allowance (RDA) between 400 and 600 IU. If you are not getting enough from your diet, or from at least 15 minutes of adequate sunlight daily, chances are you are already vitamin D deficient. And as the above mentioned case suggests, modestly-dressed Muslim women are not getting their dose of liquid sunshine.

The push for increased vitamin D is timely in light of recent reports related to incidences of H1N1 deaths and seasonal flu cases which correspond with low levels of vitamin D3, according to Dr. John Cannell MD, an expert at the Vitamin D Council. He reaffirms this wonder drug to be a powerful nutrient that stimulates the production of “antibacterial peptides and boots the innate immunity system.”

Scientists and physicians are beginning to refer to vitamin D3 (Cholecalficerol) as a hormone, moving away from the vitamin classification. It has an important function as a ‘precursor’ hormone which works with Calcitrol (a steroid hormone). So, we’ve migrated from the belief that vitamin D is traditionally intended to fortify strong bones and promote white teeth to the increasingly popular approach that vitamin D is actually a misnomer, i.e., not a vitamin, but rather a hard-working hormone and/ or nutrient, and if supplemented in greater than recommended doses, one that can help ward off the flu and an assortment of morbidities, not to mention, lift modestly-dressed Muslim women out of the gloom of constant fatigue, mood swings, headaches and poor sleep.

To confirm my assertion of the above paradigm shift, I checked in with an endocrinologist, and was pleasantly surprised. Dr. Kashuf Munir, MD, Chief of the Endocrinology Section at the Baltimore Washington Medical Center, in Baltimore, MD, asserts that “vitamin D has now been discovered to be an important hormone with effects throughout the body. Studies have shown [that] deficiency in vitamin D is associated with osteoporosis, heart disease, autoimmune diseases, malignancies, and hypertension.” Further confirming my suspicion and the motivation for me to pen this article with Muslim women in mind was his comment that “more than half of Americans are vitamin D insufficient or deficient and up to a billion people worldwide.” Immediately I remember all the women who have recently told me they got diagnosed as vitamin D deficient. Many of them got them checked after the November Health + Wellness Workshop. These women are lucky because while there are many who are deficient and present the right symptoms, they are misdiagnosed as having depression and / or other morbidities.

Next steps? How can I increase my daily intake?

Diet. Select whole foods that are dense in nutrients. If your diet currently does not include vitamin D rich foods, such as oily fish, cod liver oil, eggs and fortified drinks, chances are that you are deficient.

Sunlight. If your lifestyle doesn’t encourage you to seek sun daily, you are missing the best source vitamin D. (That said, don’t forget the sunblock!) Again this issue has been overlooked in the Muslim community, and as a result, traditionally covered Muslim women as compared to non-Muslim women are at high risk of deficiency. In fact, studies from Middle-Eastern countries have reported case after case of women who had low levels of D3, when presented with a variety of symptoms of deficiency.

Supplement. If the body produced vitamin D itself (by exposing skin to sunlight), it would produce 3,000 to 10,000 IU daily! The Food and Drug Administration (FDA) recommendation of a daily allowance (RDA) of only 400 to 600 IU is clearly deficient. Select a supplement of D3, but first consult with your physician to determine the additional amount your body requires. Dr. Munir states that many people may require supplements in addition to their diet and sun exposure. Vitamin D can be taken safely in large doses (up to 10,000 international units daily) without any untoward side effects.

Recommendations

Know the symptoms. Muscle pain; weakness; headaches; low-energy/fatigue; sleep irregularities; mood swings; symptoms of depression.

Get tested. Testing for deficiency is a simple blood test at your internist’s office. The physician will order a 25-hydroxyvitamin D test, also called a 25(OH)D. Dark-skinned and covered women who may experience some of the symptoms should consider testing for vitamin D deficiency.

References and Resources

http://www.womentowomen.com/healthynutrition/vitamind.aspx
http://www.vitamindcouncil.org

(Photo: D Sharon Pruitt)

Ayesha Akhtar is Director of Policy & Research at HEART Women and Girls Project. HEART empowers women through: Health Education (increasing access to accurate information and resources about one’s body and health issues), Advocacy (advocating for culturally-sensitive health care services & education for faith based communities), Research (conducting research to generate data and information about the status of women and girls from faith based communities), and Training (training women and girls to become leaders of wellness in their communities).