Emmaus Family message from P G vargis
PG&Lilly Vargis
A letter from a minister of the Lord Jesus Christ.
For any one doing any kind of ministry in the body of Christ and who wants to improve and excel.
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(Part-1)
This week I share with you a devotional from a dear friend, Terry Priestap, who was promoted to glory on May first of this year. He recorded a number of his thoughts during his latter months. He being physically dead is still speaking.... Refresh your spirit in his inspiration!
"I would like to share a quote from F. B. Meyer in speaking of Elijah, 'Acquiring spiritual power is impossible unless we hide from others in some deep ravine where we may absorb the power of the eternal God'.....Are we willing to get alone with God and spend time in His Presence, away from the frantic activity of the world? If God has sidelined you for a time, are you drawing upon His Person for refreshment? We mistake activity for fruitfulness and must learn that the branches draw all their sustenance from the Vine. 'No branch can bear fruit by itself; it must remain in the Vine' (John 15:4)... All the fruits of the Spirit can be produced on a sickbed or in isolation. God desires inward fruit first; then He will produce outward fruit."
(The bold highlight is mine)
Be encouraged and deepened in your walk with God this week! You are needed!
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Part II -
More than 80% of healthy Indians are vitamin D deficient: Diabetes Foundation of India
We might live in a country full of sunshine but Indians are still deprived of the sunshine vitamin.
| TNN | May 5, 2013, 07.35 PM IST
We might live in a country full of sunshine but Indians are still deprived of the sunshine vitamin.
MUMBAI: We might live in a country full of sunshine but Indians are still deprived of the sunshine vitamin.
Vitamin D which is wrongly called so is a pro-hormone that influences the expression of more than 200 genes in the human body. Nearly every tissue in the human body has receptors of vitamin D, be it the brain, heart, skin, kidney, pancreas etc. Any deficiency of vitamin D in the human body is bound to affect normal functioning of all organs having Vitamin D receptors.
Vitamin D deficiency is fast becoming a global and national health concern. It is estimated that around 80% of the Indian population has Vitamin D levels less than normal. However, the bigger concern is that the population at large is not even aware of Vitamin D deficiency and its consequences.
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One of India's leading diabetologists, Dr Banshi Saboo, founder of Diabetes Foundation of India, said, "Earlier, vitamin D was thought to be responsible for maintaining calcium homeostasis to prevent osteoporosis and maintain bone health. But, in the past decade, research has established the strong association of vitamin D deficiency in diabetes, immunity, asthma, TB, high blood pressure, neuro-muscular function, etc. Dr Saboo further added, "Low level of vitamin D is associated with higher incidence of type 2 diabetes and correcting Vitamin D deficiency improves insulin sensitivity and helps in better management of hyperglycaemia. Also vitamin D deficiency has been associated with high incidence of type 1 diabetes."
As the mother is the sole source of vitamin D substrate for her developing foetus, vitamin D status is very important during pregnancy. Maternal deficiency of vitamin D is linked with abnormal foetal growth and gestational diabetes. Sunscreen lotions, staying indoors, clothing habits, pollution and minimal exposure to direct sunlight (during the period of 10am to 3pm) are the major reasons of such widespread deficiency in the Indian population.
An eminent endocrinologist from Mumbai, Dr Manoj Chadha said that vitamin D deficiency has no defined signs or symptoms. "People who complain of back pains, unexplained muscle pains, general fatigue are the most likely to be vitamin D deficient. Vitamin D deficiency can be easily corrected by Vitamin D supplementation or some lifestyle changes. In a vitamin D deficient person, oral 60,000 IU per week for 8 weeks followed by maintenance dose of 60,000 IU per month is a reasonably safe method to correct the deficiency."
Vitamin D status in pregnant women and their new born
Studies from northern India have shown vitamin D deficiency (< 20 ng/ml) in pregnant women and their new born.49-52 One of the studies52 has shown pregnant women in winter had higher 25(OH)D levels than in summer. Studies from south India, Tirupati also show a similar trend.
Toddlers have shown to have low vitamin D status.53,54 In one study54 it was clearly shown that a small group of toddlers had higher vitamin D status compared to their counter parts with low dietary calcium and poor exposure to sunlight living in the location and environment. Higher vitamin D status in this group was attributed to education on nutrition and sunlight exposure in this community.
Vitamin D status in children and adolescence
It is important to know the vitamin D status of this age group as the bone accrual is taking place and the peak bone mass is achieved during this period. There are numerous studies in this category from north and south India.55-60 These studies clearly bring forth the fact that approximately 75 to 85% of the groups studied have varying degrees of vitamin D deficiency or insufficiency (hypovitaminosis D). Another important fact drawn out in these studies is the fact that nutritional status and sunlight exposure has a positive impact on the vitamin D status on the population. One of the studies has shown a positive impact on dietary calcium supplementation to a group of children.
Vitamin D status in middle age group (20 to 45 years)
It is important to have vitamin D status in this group of population as the peak bone mass is achieved (up to 30 years of age). Apart from the peak bone mass achieved, parity of women and their nutritional status (bone health) determines the pattern of post menopausal bone loss and age related osteoporosis. All the reports uniformly available so far show universal vitamin D deficiency/ hypovitaminosis states in these populations. Rural population have better vitamin D status compared to urban population.58-61 Most of the rural workers in these studies are agriculture laborers who have longer exposure to sunlight. It is pertinent to point out that soldier and subjects of Indian Para military forces who undergo rigorous outdoor exercise in sunlight with high dietary calcium intake had higher vitamin D status.49,62
Vitamin D status in post menopausal women
There are two studies24,63-65 to show the low vitamin D status. It has important implications in interpretations of bone mineral density and therapy of post menopausal osteoporosis.
Vitamin D status and atmospheric pollution
There is a report of toddler in mori gate (Delhi) where the atmospheric pollution is high had lower vitamin D status compared to toddler in Gurgaon(Delhi).53
Vitamin D status and calcium intake
Uniformly all studies have clearly documented dietary calcium intake less than RDA of ICMR. Besides this, it has been shown that the calculated values for all nutrients are significantly higher than the analytical values.65 Hence, a patient with a calculated low intake of calcium with a background diet containing foods high in phytates, may be more calcium deficient than calculated from dietary intake data. The inadequate dietary calcium intake is significant when viewed in the background of high phytate/calcium ratio associated with low 25 (OH)D levels.
The calcium absorptive performance of the gut is a function of a person’s 25(OH)D status.23,27,33 When the 25(OH)D concentrations are low, the effective calcium absorption from the gut is reduced.23,27 This is further amplified by the low dietary calcium intake. It was shown that low dietary calcium converts the 25(OH)D to polar metabolites in the liver and leads to secondary 25(OH)D deficiency.33 The SHPT consequent to inadequate dietary calcium intake and low 25(OH)D concentrations mobilizes mineral and matrix from the skeleton. This increases the risk of fractures, especially in postmenopausal women and elderly patients. These are further amplified by age related changes with calcium supplementation.55,66 High phytate/calcium ratio amplifies the inadequate dietary calcium intake. Also, low calcium intake increases PTH which increases conversion of 25(OH)D to 1,25-dihydroxyvitamin D which, in turn, stimulates the intestinal calcium absorption. In addition, 1,25-dihydroxyvitamin D induces its own destruction by increasing 24-hydroxylase. This is the likely explanation for the low 25(OH)D concentrations in persons on a high-phytate or a low calcium diet.59,60
The RDA for calcium in India recommended by the Indian Council of Medical Research (ICMR) is lower than the recently revised recommendations by the USA and Canada57-72 (Table 2). Recently the RDA has been revised and redefined as the Dietary Reference Intake (DRI), which is a collaborative effort between USA and Canada. There is neither a recommendation for dietary intake of vitamin D nor a monitored food fortification program for the intake of calcium or vitamin D by ICMR.
Vitamin D status in Urban and rural locations
Studies52,55,58-61 have clearly shown the vitamin D status of urban population is lower than the rural population. This is attributable to dress code and occupation, longer duration of exposure to sunlight.
Vitamin D status in higher altitude and latitude
It is known that cloud retain 10% of the rays, snow absorbs 20% and reflects the rest, the UV-B rays increases
MEASURES
Until more data is available to document the low vitamin D status in Indian population in the length and breadth of the country, the following preventive measures could be adopted.
• Direct exposure to sunlight, at least 30 minutes/day.
• Good dietary calcium intake (equivalent to one liter of milk and milk products).
• Supplementation to lactating mothers.
• Artificial fortification of infant food products.
• Making physical training to children in the schools compulsory daily.
• If on supplements, check for optimum dosage.
• Artificial fortification of food product may have to be considered. The major limitation before making a decision on this issue is on economics. Considering the huge cost involved it would be wise to propagate and advocated direct exposure to D – liteful sunlight and fortify the food with calcium.
a. Food fortification through the nutritious mid day meal scheme
b. Supplementation to pregnant and lactating mother
• Preventive use of sun screens with SPF greater than 6
• Outdoor activities of the elderly and aged.
ROLE IN OTHER SYSTEMS
Vitamin D is an old hormone which has been produced by lifeforms since last 750 million years with most plants and animals that are exposed to sunlight have a capacity to make vitamin D. In humans we know know that Vitamin D is critically important for development, growth and maintenance of health at all times during the life cycle from birth till old age. There is now a vast body of evidence to suggest that vitamin D deficiency as a major factor in the pathology of at least 17 varieties of cancer as well as heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis, myopathies, birth defects, periodontal disease, and many more diseases.81
CONCLUSION
In the developing countries, a scientist or medical personnel who think more seriously in terms of continuing importance of deficiency diseases per se are often derogated or relegated to quackery fringe. The result is inattention to the real deficiency diseases masquerading as other disorders that may be simply ignored altogether. We are doing disservice to these group of patients failing to diagnose vitamin D deficiency merely because of lack of proper definition if hypovitaminosis D.
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Your brother in Christ,
P g vargis