Brief Answer:
further information needed

Detailed Answer:
Dear
Thanks for contacting with your health concern and after reviewing your history I'm of the following opinion:

1. please let me know about the value of Vit. D since only then I can interpret/ comment about the existing pathology.

PS. here in XXXXXXX we take the value in nmol/L and is between 50- 250nmol/L, and it could be that your value must have been taken in ng/ml [if proved otherwise], whatever may be the case kindly let me know about the value and also the reference range Or it will be nice if you can kindly upload the report.

2. In all probability you are deficient in vitamin D and is/are at high risk of developing bone disease, thus do let me know whether are there any aggravating factors for the same or not like:

. underexposure or poor exposure to sunlight
. any dietary deficiency?
. any hepatic/kidney disease
. any digestive issues?
. on medications [if any]?

3. Are there any symptoms because of low vit. D [osteomalacia] like:

. unusual fatigue
. bone/muscle pains?
. depression/hair loss-fall?

PS. Studies conducted do show relationship between people having low blood levels of vitamin D with greater risk of a heart attack, heart failure, stroke, diabetes or high blood pressure later in life, and if you are unmarried then remember that during pregnancy low vitamin D levels are linked to pre-eclampsia, gestational diabetes and adverse pregnancy outcomes, so having adequate vitamin D levels is important.

4. For Vitamin D; sunlight is the best source, apart from that you can take carrot, beetroot, spinach, radish, tomato, coriander, mint, amla rasayan, soybean, cucumber, cabbage, vitamin D fortified: pineapple-yogurt-milk, dry mushroom, banana, cod liver oil.

5. If interested I can send you the herbal medicines [prepared by me] which will
naturally increase the vitamin.

Dr. Munish sood
Consultant Physician
Naimittika

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Brief Answer:
Further necessary information

Detailed Answer:

Hi,

Thanks for getting back

1. as there is inadequate exposure to sunlight thus you have to make certian lifestyle modifications like taking sunbath during:

early morning ( sunrise) and late evening (hour before sunset) and avoid during peak hours or if not possible apply a good aunscreen with SPF 50+++ and is sweat/water resistant

2. If unusual fatigue/hair loss is there so (in your age) do check with hemoglobin and Thyroid values.

PS. do check with your Serum Calcium level since Vit.D is required for absorption of calcium and if it is normal there is no need to take vitamin D combined calcium tablets.

3. Cost of the medicine including sunscreen will be around 7000-8000/- INR (excluding courier charges), if you are comfortable I can share my bank details.

Dr. Munish

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Brief Answer:
further guidance

Detailed Answer:

Hi,

Thanks for getting back

1. After going through your reports I’m of the following opinion:

i. Calcium is in normal range, so no need to take calcium added vit. D tablets, instead go for plain vitamin D [cholecalciferol] XXXXXXX twice weekly with lukewarm milk/water, do not use very hot or cold liquid Or you can take soft gelatin capsule of Vit. D [twice weekly].
PS. can be taken with or without meals.

ii. Thyroid function test is in normal range and although TSH is normal but on the lower side [ repeat again]

iii.     Vit. B12 is good

iv.     Vitamin D is expressed in ng/ml which means we have to multiply your value by 2.5 to get it into nmol/L, thus 4.88 X 2.5 = 12.2 nmol/L which means you are severely deficient, thus mainstay of treatment has two options:

a. Self-care: increased exposure to sunlight
b. Medicine: in form of Vitamin D capsules, sachets, Intramuscular injections, herbal supplements.

2. Certain risk factors which can be concluded are:
. Inadequate exposure to sunlight
. Lives in a highly polluted environment [let me know is your living environment in XXXXXXX clean or polluted]?
. Darker Skin, weight [being overweight]?

PS. while taking Vit. D [sachet/powder] monitor phosphate and calcium level

3. Herbal supplements have to be included as an important part of your Dietary regime and management.

Dr. Munish

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