The Sunshine Paradox: Vitamin D in India

Why sun isn't enough

Glass blocks UVB, pollution scatters it, and 10 am–3 pm exposure rarely happens for office workers. Dark skin needs longer exposure.

Midday arms-and-face sun 15–20 min, 3x/week helps — but testing and supplements correct deficiency reliably.

Testing: 25-OH vitamin D, done right

The correct test is 25-hydroxy vitamin D: below 20 ng/mL deficient, 20–30 insufficient, 30–100 sufficient. No fasting needed. Retest 8–12 weeks after a correction course, then yearly — testing monthly wastes money since levels move slowly.

Pair the first test with calcium, and add PTH/alkaline phosphatase when deficiency is severe or bone pain/fractures exist. Normal calcium with low D is typical early; low calcium with tingling needs prompt evaluation.

• Same lab for retests — assays vary between labs
• Note supplements taken in the prior month on the requisition
• Screen the household: spouses and teens often share the deficiency

Correction: the 60K protocol and maintenance

Standard Indian correction is cholecalciferol (D3) 60,000 IU once weekly for 8–12 weeks with a fat-containing meal or milk — D is fat-soluble and absorbs poorly on an empty stomach. Severe deficiency or malabsorption sometimes needs longer courses under supervision.

After correction, maintain with 1,000–2,000 IU daily or 60,000 IU monthly (not weekly forever — indiscriminate mega-dosing causes hypercalcemia with thirst, stones and confusion). Recheck yearly.

Sun: what actually works in Indian cities

UVB synthesis needs direct midday sun (roughly 11 am–2 pm) on arms and face for 15–20 minutes, 3x/week — glass, sunscreen, full covering, pollution and dark skin all reduce it. Office workers behind glass get essentially zero UVB all winter.

Treat sun as maintenance support, not correction therapy: it sustains replete levels but rarely fixes established deficiency alone. Never burn for vitamin D — short, frequent exposures beat weekend marathons.

Calcium pairing and bone basics

Vitamin D without calcium builds nothing: adults need ~1,000 mg calcium/day (ragi, sesame, groundnuts, curd, milk, leafy greens). Postmenopausal women and the elderly need combined assessment — DEXA scans guide osteoporosis treatment, not D levels alone.

Falls prevention completes the picture: strength, balance, vision correction and home safety (lighting, rails, non-slip mats) matter as much as any capsule for fracture prevention.