The HEART Women and Girls Project, in conjunction with Altmuslimah, is committed to empowering women and girls from faith-based communities by teaching them to connect a healthy mind, body, and soul to achieve an overall sense of well-being. In the first installment of a new monthly column, HEART Director Ayesha Akhtar explores the issue of Vitamin D deficiency in Muslim women.
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).
This was a very interesting and enlightening article. I did not realize that Vitamin D deficiency is also linked to headaches, fatigue, and depression. Taking Vitamin D supplements (something I now do) is an easy preventative measure to help your physical and mental health.
It’s really interesting to see how Vitamin D deficiency has been attributed to many Muslim women across the globe. Women who completely cover must really take this issue seriously and supplement their diet with more D.
I wonder how this played out in earlier times, when such scientific knowledge was not as readily available and women were still covering head to toe?
asma-i had to take a course in dairy at my job. in short, nearly 75% of the world is lactose intolerant. the closer you get to the equator, the stronger the sun is, giving anyone their adequate dose of daily vitamin d (nutrtionists say 15 minutes a day in the sun). folks who lived further away (such as northern europe)relied on fish and greens like kale to get their vitamin d. at one time, animal milk was rarely given to children for survival. most children were breast fed or had a wet nurse, or relied on goat or camel’s milk if their mother had passed away (both goat and camel’s milk have much lower levels of lactose than cattle’s milk).
another interesting tidbit of information is the fact that calcium and vitamin d occur naturally in many fruits, vegetables, and sea foods. i would assume that “earlier” women didn’t suffer as greatly because they weren’t being bombarded with processed foods, movement restrictions, and an obscene beauty industry.
Thank you for that – very helpful! I guess ‘earlier’ can be defined at various points, and I’m wondering if there was a point post-industrialization but pre-advanced knowledge of V3 where there was a widespread phenomenon of covered women suffering from inadequate V3. It’s hard to reconcile a universal, non-time-bound dictate like hijab with its time-bound health risks.
some questions for the author – how exactly does Vitamin D from sunlight get absorbed by the body? i’m asking because UVA/UVB rays can be absorbed by the body even through layers of clothing. different types of fabrics have different “SPFs”, natural fabrics like cotton having the lowest and dense synthetics like polyester having the highest. so part of the problem may be that the traditional burka and niqab worn by women in the middle east and beyond is made of dense, black polyester. this protects from uva/uvb, which makes sense when discussing issues like skin cancer, but can also prevent the body from getting what’s good from sunrays, like vitamin D. if women were to wear lighter clothing made of more natural fibers, i wonder if that will help them get more vitamin D.
lastly, i’m a little confused as to what is considered enough skin coverage to prevent proper vitamin D absorption. are we talking about a woman who covers everything but her hands and face? or do you include even a woman who doesn’t wear a headscarf but whose skin exposure never exceeds wearing short sleeves? the latter example would obviously apply to significantly more muslim women who may not wear a headscarf but still dress modestly, making this issue relevant for them in addition to hijabi women.
@Muqarnas, I know your questions were for the author, but I wanted to at least share with you this link:
http://en.wikipedia.org/wiki/Vitamin_D
@Asma, I’m thinking that folks during that time may not have known that they were suffering from lack of vitamin d, but may have recognized certain traits like getting some extra sunshine to ward off the sadness or eating certain herbs to cure fatigue.
I’m also wondering if the changes in the fabric also have something to do with vitamin D absorption as Muqarnas has pointed out. Or if it’s due to something else entirely.
And lastly, many women from muslim majority countries also suffer from high rates of obesity, high blood pressure, cardio vascular diseases, and diabetes…
thanks for the info katseye. well the questions were really for anyone who could help answer them 🙂
i was reading through some of the blurbs in wiki which say that vitamin d is produced when the skin absorbs uvb radiation. so if the skin can absorb uvb through light clothing, then it can produce vit. D. but nonetheless, the amount of uvb absorption seems to be significantly reduced when skin is covered by clothing.
of course the debate among physicians is how to achieve balanced exposure that provides enough vit. D yet doesn’t cause skin cancer… another wiki entry states this: “not all physicians agree with the assertion that there is an optimal level of sun exposure, with some arguing that it is better to minimize sun exposure at all times and to obtain vitamin D from other sources” (taken from the skin cancer foundation website).
if we go by these physicians who err on the side of caution with regard to the risks of sun exposure, then muslim women aren’t at a disadvantage and are in fact at an advantage, provided they get enough vitamin D from other sources.
another interesting excerpt from the skin cancer foundation website:
“One study of elderly patients, who generally synthesize less vitamin D from the sun due to thinning epidermis, showed that exposing just five percent of their skin surface to the sun (less than the surface area of the face and backs of the hands) yielded vitamin D levels well above deficient ranges.”
If this is true, even burka-clad women are getting enough sun exposure. but in the end, different doctors have different opinions, based on different studies, so some will argue that muslim women aren’t getting enough sun, and others will argue that they are. it’s hard to say which opinion to go by. but nonetheless, what seems to be consistent is that everyone should make sure they get enough vitamin D from food, vitamins, etc and not just depend on the sun.
i also have to admit that when i first heard about this controversy of muslim women and vitamin d a while back, i was a little suspicious of it.
people keep painting it is such a clear-cut issue, even though it’s becoming clear to me that it’s more complex, and opinions vary. I’m surprised to see that even this article doesn’t address the issue of too much vs. too little sun exposure, which is an important point to address. instead it only takes one point of view and just goes with it.
i can’t help but wonder how much of this controversy is fueled by the many socio-political controversies of muslim women’s dress in general. given the tendency of the media to oversimplify everything about muslim women, i wouldn’t be surprised if people are taking the vitamin D issue and jumping to conclusions that the muslim dress code must be harmful, without taking into account other factors – such as katseye’s comment about all the other health problems that many muslim women have. perhaps we’re dealing with a more general lack of health-consciousness, rather than something so directly and exclusively linked to how much skin muslim women cover. just a thought…
Thank you everyone for your insightful comments. I will do my best to address them here generically, rather by person.
Great questions! Yes how does Vit D (which is fat-soluble) get absorbed into the body and why did I not address sun exposure at all in my article? As you may know by the link @Katseye posted or otherwise, vit d is absorbed in your skin, unprotected. this goes without saying that one should not sit outside all day long to reap benefits of D sans sunscreen. @muqarnas – I could have taken many angles on this article, especially in the direction of sun, but that is not entirely relevant to my conclusion, hence I left it out.
What I want to expose is that for Muslim women who cover / dress modestly (yes great point would also include Muslim women who do not wear hijab but otherwise cover arms/legs), there is a consequence of our dress. That is not to say we should create controversy on Muslim dress at all – not the point. But rather, consider the mere correlation between lack of skin exposed to the sun for x minutes per day and depressed levels of vitamin D. There are at least 10-15 studies that I have found which have made these correlations on which I am basing my conclusion which is that Muslim women who know they aren’t getting enough sun, or enough D3 in their diets should be tested for D3 deficiency GIVEN the presence of listed symptoms.
As far as what is considered ‘enough skin coverage’, is also controversial. I have read differing opinions, ranging from stomach, arms and back to hands and face. We will never really know!
There is an interesting counter-argument to my conclusion over at the NYT blog. If you are curious, here is the link: http://www.nytimes.com/2010/02/02/health/02well.html
Thank you for all your insightful and productive comments. It is greatly appreciated!
-Ayesha
Below is a very interesting article I came across a few years ago. My take, after reading it is: fair-skinned ppl (esp. pregnant ones) should, perhaps, be the ones in burqas when in the tropics to preserve their folate supplies. Dark polyester is best at blocking UV rays. As for darker ppl living above 50 degrees latitude—wear clothing that allows UV penetration (like light colored cottons) to ensure adequate vitamin D absorption. (I was just being silly re: burqa comment.)
Here’s a portion of the article:
(See entire article at: http://www.pbs.org/wgbh/evolution/library/07/3/text_pop/l_073_04.html)
“…During her preparation for the lecture in Australia, Jablonski found a 1978 study that examined the effects of ultraviolet light on folate, a member of the vitamin B complex. An hour of intense sunlight, the study showed, is enough to cut folate levels in half if your skin is light. Jablonski made the next, crucial connection only a few weeks later. At a seminar on embryonic development, she heard that low folate levels are correlated with neural-tube defects such as spina bifida and anencephaly, in which infants are born without a full brain or spinal cord.
Jablonski later came across three documented cases in which children’s neural-tube defects were linked to their mothers’ visits to tanning studios during early pregnancy. Moreover, she found that folate is crucial to sperm development—so much so that a folate inhibitor was developed as a male contraceptive. (“It never got anywhere,” Jablonski says. “It was so effective that it knocked out all folate in the body.”) She now had some intriguing evidence that folate might be the driving force behind the evolution of darker skin. But why do some people have light skin?
As far back as the 1960s, the biochemist W. Farnsworth Loomis had suggested that skin color is determined by the body’s need for vitamin D. The vitamin helps the body absorb calcium and deposit it in bones, an essential function, particularly in fast-growing embryos. (The need for vitamin D during pregnancy may explain why women around the globe tend to have lighter skin than men.) Unlike folate, vitamin D depends on ultraviolet light for its production in the body. Loomis believed that people who live in the north, where daylight is weakest, evolved fair skin to help absorb more ultraviolet light and that people in the tropics evolved dark skin to block the light, keeping the body from overdosing on vitamin D, which can be toxic at high concentrations.
By the time Jablonski did her research, Loomis’s hypothesis had been partially disproved. “You can never overdose on natural amounts of vitamin D,” Jablonski says. “There are only rare cases where people take too many cod-liver supplements.” But Loomis’s insight about fair skin held up, and it made a perfect complement for Jablonski’s insight about folate and dark skin. The next step was to find some hard data correlating skin color to light levels.
Until the 1980s, researchers could only estimate how much ultraviolet radiation reaches Earth’s surface. But in 1978, NASA launched the Total Ozone Mapping Spectrometer. Three years ago, Jablonski and Chaplin took the spectrometer’s global ultraviolet measurements and compared them with published data on skin color in indigenous populations from more than 50 countries. To their delight, there was an unmistakable correlation: The weaker the ultraviolet light, the fairer the skin. Jablonski went on to show that people living above 50 degrees latitude have the highest risk of vitamin D deficiency. “This was one of the last barriers in the history of human settlement,” Jablonski says. “Only after humans learned fishing, and therefore had access to food rich in vitamin D, could they settle these regions.”
Humans have spent most of their history moving around. To do that, they’ve had to adapt their tools, clothes, housing, and eating habits to each new climate and landscape. But Jablonski’s work indicates that our adaptations go much further. People in the tropics have developed dark skin to block out the sun and protect their body’s folate reserves. People far from the equator have developed fair skin to drink in the sun and produce adequate amounts of vitamin D during the long winter months.
Jablonski hopes that her research will alert people to the importance of vitamin D and folate in their diet. It’s already known, for example, that dark-skinned people who move to cloudy climes can develop conditions such as rickets from vitamin D deficiencies. More important, Jablonski hopes her work will begin to change the way people think about skin color. “We can take a topic that has caused so much disagreement, so much suffering, and so much misunderstanding,” she says, “and completely disarm it.”“