The Arabian paradox: Epidemic vitamin D deficiency in the land of perpetual sunshine

Prof. Dr. Justin Thomas | United Arab Emirates | 24.01.2018

In the Gulf States, for much of the year we avoid the sun. It seems like it’s just too hot. When the cool weather returns, however, so too do the smiles and the outdoor activities.

 

The eight or nine months of sun avoidance, however, are not without consequences. The exposure of skin to the sun is our primary source of vitamin D—sometimes called the sunshine vitamin. Unsurprisingly, the rates of vitamin D deficiency are alarmingly high in some Arabian Gulf nations.

 

In one recent study, published in the International Journal of Medicine and Medical Sciences, the rate of vitamin D deficiency among indoor workers in the UAE was 92.3 percent. Furthermore, 63.2 percent were classed as severely deficient. Studies undertaken in the neighbouring Gulf States of Oman, Kuwait, and KSA report equally alarming rates.

 

But so what? What if vitamin D is a little on the low side? This attitude is common, but on further exploration of the emerging research, you begin to appreciate just how vital vitamin D is for health and well-being. Low levels of the sunshine vitamin are associated with a host of physical and mental health problems.

 

It has long been known that vitamin D is essential for the maintenance of healthy bones. However, the recent discovery that almost all cells in the body express vitamin D receptors has unveiled a host of other vitamin D functions. This growing body of research suggests a protective role for the sunshine vitamin in the case of osteoporosis (bone disease), diabetes, rheumatoid arthritis, cardiovascular diseases, hypertension, multiple sclerosis, some common forms of cancer, and certain life-threatening bacterial infections like tuberculosis. If this is not enough to encourage us to get out in the sun more, then there is also substantial evidence linking low levels of vitamin D with depression.

 

In one of our studies, published in the International Journal of Mental Health Promotion, we followed a group of Emirati university students, measuring their levels of vitamin D and depressive symptoms in the winter and the summer months. As expected, depression peaked in the summer at about the same time as vitamin D levels dropped. Even in the winter when depression symptoms were lowest, and vitamin D levels were highest, the vast majority of our sample was still classed as vitamin D deficient or severely deficient.

 

The typical response to the issue of vitamin D deficiency has been to throw pills at it. In other words, treat the deficiency with supplements, typically in the form of pills. The problem with this is that we are just treating the symptom, not the cause. Once you stop taking the supplements what will happen? Exactly. If avoiding the sun is the cause, then to truly treat vitamin D deficiency we need to alter this sun avoidant behaviour.

 

To address this issue, we developed a behavioural intervention. We termed our new treatment: sun-enhanced behavioural activation, or SEBA for short. SEBA is a six-session group-based intervention, encouraging individuals to engage in routine and pleasurable activities, with a particular emphasis on activities that will increase exposure to the sun. This can include minimal changes such as parking the car a little further from the mall entrance and walking in the sunshine or taking breakfast outside in the garden. The cultivation of such habits is intended to result in lasting changes to vitamin D levels over time.

 

We tested the effectiveness of this intervention on students with high levels of depressive symptoms and extremely low levels of vitamin D. The results were published in the journal Community Mental Health in December 2017. The main finding suggested that, compared to a control group, those participating in the SEBA program demonstrated clinically significant improvements in both depressive symptoms and vitamin D levels. It worked!

 

Maintaining these improvements, however, will mean braving the Gulf’s summer sun, too. The ancestors of the students in our SEBA study had confronted the Gulf’s summer sun for millennia, long before AC existed, and when outdoor chores were a must. It is doable.

 

Getting closer to our more traditional lifestyles is associated with improved vitamin D levels. One study undertaken among semi-nomadic tribesmen of East Africa (the pastoral Maasai and the Hadzabe hunter-gatherers), published in the British Journal of Nutrition in 2012, found healthy levels of vitamin D all round.

 

Sensible levels of sun exposure taken consistently can have a substantial positive impact on our quality of life. Winter in the Gulf is a great time to try to introduce small, sustainable lifestyle changes that will help ensure we have good, year-round levels of vitamin D.  

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