Motherhood Clinic

Hi,

I am Dr. Vimal Kumar, Orthopedist. Aaj hum baat karenge ki Indian population mein Vitamin D deficiency itni jyada kyu hai. Aap dekh rahein honge ki aap kea as pass ke bahut se log Vitamin D deficient hain. Bahut se ilakon mein 70-80% long Vitamin D deficiency se pidit hain. Sike kayi karan hain jaise modern lifestyle, like sun exposure na hona, khane ki chizen proper nahi hain. Aap dekhenege ki bachon mein rickets ki bimari hoti hai, bone soft hoti hai aur elderly mein bones weak ho jaati hain jise osteoporosis bolte hain. Kuch tarike ke cancers bhi hai jo Vitamin D deficiency karte hain. Ye disease pure world mein faili hui hai. Bahut sare Indians vegetarian hain. Under privilege ya fir under nutrition vale log bahut hain. Vitamin-D rich foods thode costly hote hain. Bahut sare tarike hote hain jis se aap pata laga pate hain ki aap ko Vitamin D deficiency hai. Normally, log tests karate hain. Normal aa dekhenge toh ise alag alag tarike se dekha jata hai. Humare pass instruments hote hain check karne ke liya ki body mein kahin calcium ki kami toh nahi ho rahi hai. Jaise hi ye level 20 se 39 mm aata hai toh ye marker thik hone shuru ho jaate hain. 30-40 ke upar jaate jaate ye marker thik hote hain. But still humein jarurat hoti hai vitamin-D ko long term mein lene ke liya.

Normally vitamin D humari skin mein hi banta hai. Agar sun ka exposure hota hai toh ultraviolet rays humare body ke cholesterol ko use kar ke body ke andar hi vitamin-D ko synthesis karti hai. Aur bhi dusre sources hain like milk, meat, fish, cod liver oil, yeast, mushroom se bhi hum vitamin-D lete hain. Jab vitamin D body mein banta hai toh usmein body ka ek part active hota hai liver mein aur dusra part kidney mein jake active hota hai. Inki importance hai ki agar kisi ko liver disease hai toh usko agar hum aisa form denge jo liver mein jaake change hoga aur fir kidney mein jayega toh vitamin D use kam nahi aayega. Humein aisa karna padega jo direct kidney ke level pe vitamin-D jaaye aur vo kaam kare. Similarly, agar kisi ko kidney disease hai aur hum use kidney mein form karne ke liya dein toh us se bhi koi fayada nahi hoga. Use aisa form den hoga jo kidney ke function ko bypass karte hue direct utilise ho. Dusri baat ki depend karta hai ki vitamin D kab and kise lena hai kyuki aaj kal koi bhi supplements le raha hai bina soche samajhe. Raat ko vitamin-D lene se skin ka melanin badh jata hai jis se sleep disturb hoti hai.

Agar vitamin-D aap ki body mein badh gaya toh fat cells mein deposit ho jata hai aura ap ki need ke hisab se body mein release hota hai. Sath hi sath agar ye toxic mein convert ho jata hai toh ye aap ko harm bhi kar sakta hai. Isliya vitamin-C lein kyuki ye aap ko vitamin-D ke absorption mein help karta hai. Fish oil bhi aap ko kab khana hai aur kise khana hai. Isliye jaruri hai ki aap Dr se salah leke hi vitamin-D lein. Bachon mein vitamin-D ki kami se rickets hota hai. Agar chronic vitamin-D ki deficiency hoti hai toh bone mein softness aa jaati hai jise osteomalacia bolte hain. Bone mein agar weakness aa jaaye to use osteoporosis bolte hain. Bones ke sath sath ye muscles mein bhi weakness karta hai. Iska asar diabetes pe padta hai, cancer pe padta hai. Agar kisi ko otitis media ka issue hota hai toh vo bhi vitamin-D ki kami se hota hai. Respiratory disease hone ka karan bhi yahi hota hai kayi cases mein. Diabetes 1 autoimmune disease hai. Body ki immunity hi pancreatic cells ko khatam kar deti hai jis se insulin banta hai. Agar aap optimum amount mein vitamin-D le rahein hain toh 30% diabetes 1 kam ho jata hai. Similarly, type 2 diabetes mein insulin bahut jyada hota hai jise body utilise nahi kar paati hai. Toh uski vajah se kayi sari bimariyan agar sath mein jod jaati hain toh obesity, hypertension, lipid disorder hone ke chances badh jaate hain and inhein hum metabolic disorder bolte hain.

Agar body mein calcium and vitamin-D ka balance acha hai toh in sab disease ke chances kam ho jaate hain. Agar vitamin-D ki test report mein ye 20 mm se kam hota hai toh body ka metabolic system disturb hota hai. Body ka calcium hi imbalance hoga. Toh aap ko lab test ka bhi dhayan rakhna hai ki koi test mein problem na ho. Kyuki different labs mein test ke different tarike hain. Agar costly investigation hai toh sabhi logo ko advise nahi kiya ja sakta hai. Dekha gaya hai ki vitamin-D ki jyada requirement pregnant and lactating women mein jyada hoti hai. Agar unhein nahi milta hai toh infants mein bhi vitamin-D ki kami aa jaati hai. Ab diet ki baat hai ki hum kya khayein ki humara vitamin-D thik ho jaaye. Humnein dekha hai ki bangal or east region mein non-veg and fish bahut khate hain tab bhi vitamin-D ki kami hoti hai. Humnein dekha hai bahut sare soldiers and farmers bhi sun mein rehte hain but still unmein bhi vitamin-D ki kami hoti hai. Kyuki koi ek reason nahi hai jis se hum is deficiency ko khatam kar dein.

Even aap Drs mein bhi vitamin-D deficiency utni hi prevalent dekhenege ki jitni aur kisi mein hoti hai. So, hum parathyroid hormones ka bhi test karate hain deficiency check karne ke liya. Ek aur test hota hai dexa scan jo immediate is deficiency ko indicate nahi karta hai. India mein jin logon ka color dark hai uska reason hai high melanin pigment ka hona. Agar aap apni body 45 mins ke liya sunlight mein expose karte hain toh aap ko vitamin-D mil pata hai. Indians are very sensitive to color so log ise practice bhi nahi karte hain. Pollution badhne se ultraviolet rays itne ache se nahi aati hai ki vitamin-D ban paaye. Indians ka diet jayadatar vegetarian hai. Animal diet mein bhi fish itna common source nahi hai. 100 ml milk mein kewal 2 international unit hota hai. Agar hum daily requirement ki baat karein toh kam se kam 10l milk chaiye hoga. Indians ki diet mein sodium jyada hota hai jiski vajah se urine se calcium ka excretion jyada hota hai. Indians milk bhi tea or coffee ke form mein lete hain jis se essential milk ke components body ko nahi mil paate hain.

Jayada der tak milk boil karne se bhi Vitamin-D destroy ho jata hai. Kafi southern and eat ke Indian ko lactose intolerance ki problem hoti hai jiski vajaha se milk products von ahi lete hain. Soldiers ki diet mein wheat hota hai but usmein high phytate hone hone ki vajaha se vitamin-D deficiency rehti hai exercises and sun exposure ke baad bhi and same with farmers. Food ko deep fry karne se bhi vitamin-D destroy hota hai. Pressure cooker mein agar aap low flame pe khana bnate hain toh usmein vitamin-D thoda preserve ho jaata hai. Normally, 60k international unit ka packet aata hai vitamin-D ka jo powder, tablet, capsule and liquid form mein hota hai jo aap ko Dr ki consultation ke baad hi lena hai. Course pura hone ke baad bhi Dr se aap ko further puchna hai ki aap ko kya karna hai. Otherwise, aap ko vitamin-D ki kami fir se ho sakti hai. Self-medications na karein and Dr se consult kar ke hi medicines lein. Agar aise hi aap vitamin-D bina consultation ke lenege to toxic level body mein badhega toh dusre serious consequences bhi ho sakte hain.

Thank You!

Hi

I am Dr. Vimal Dakour hai. Main Lajpat Nagar, South Delhi mein practice karta hoon. Aaj hum baat karne wale hain Ki kaun sa calcium hamein khana chahiye supplement ke taur pe ya hamein calcium khana chahiye ya nahi khana chahiye. Normally sabhi patients ko lagta hai ki hame koi na koi calcium ki jarurat hai but aisa nahin hai. Agar aap normally aise substances lete hain apni diet ke andar jo aapko calcium provide karate hain to aapko kisi bhi calcium ke supplement ki jarurat nahi hai. Ab aapko dekhna hai ki kya aap green leafy vegetables khaate hain ya nahi khaate hain, milk ko kis form mein lete hain aap kya chai ki form mein lete hain, coffee ki form mein lete hain ya normal milk lete hain, ya dahi lete hain, paneer lete hain ya aisi cheezein bhi khaate hain jinme calcium aur vitamin refortified hota hai, tab aapKo kisi extra calcium supplement ko lene ki jarurat nahi hai kyunki 1 particular amount se jyada agar calcium hota hai body ke andar to ya aapko bahut saari diseases ko cause karta hai. Jaise renal stones hone ke chances hote hain, constipation ek bahut badi problem usse possible hai, cardiovascular diseases kyunki jo blood vessels hoti hai usme extra calcium deposit ho jata hai.

Usi ke saath-saath agar aap ki calcium ki demand poori nahi ho pa rahi hai to bhi aapko bahut saari disease hoti hain to isliye samajhna padega agar calcium nahi hai to osteoporosis, osteomalacia aur bohot saare aur health related issues jo hum discuss karenge wo calcium ki kami se hote hain. To normally body agar calcium supplement ki form main ya tablet ki form mein le rahi hai to tablet ka jo content hai jo amount hai wo ek sath suppose agar normally amount jo hoti hai. 1000 milligrams se 2000 milligram tak ki maximum amount hai calcium ki jo leni chahiye par agar hum ek sath bohot jyada amount lenge to body use absorb nahi karegi aur wo excess amount nikal jayega isliye calcium hamesha divided doses mein lena chahiye. Jaise ki 500 milligram ki ek tablet agar hum le rahe hain to 1 Subah aur aur 1 shaam ko leni chahiye. Is tarike ki market mein kahin tarike ke calcium ke products aate hain. Jaise agar aap dekhenge uske picche product ko padenge to calcium ka gluconate form aata hai, lactate form aata hai, coral calcium aata hai, calcium carbonate aata hai.

To ek-ek karke agar hum baat karen to calcium gluconate aur jo lactate hote hain inke andar basic Jo elemental calcium hota hai wo bohot hi kam hota hai to ye utna effective nahi hai isi tarike se jo coral calcium form aati hain uske andar lead ki position hone ki vajah se, lead ki amount hone ki wajah se wo body ke liye nuksan dayak hai.Calcium ka 1 bohot accha form aata hai, calcium ka citrate form jisme elemental calcium accha 21% se 22% ke kareeb hota hai but uski ek problem hai ki thoda sa mehanga hota hai. Iske sath acchi baatein ye bhi hai ki agar kisi elderly male ya female ko koi acidity ki disease hai to usme main aap is calcium ko lenge to ye aapko digest ho jayega. sabse commonly market mein jo calcium aata hai wo hai calcium carbonate form wo sasta to aata hai par use hamesha aapko kisi na kisi meal ke saath ya khaane ke saath lena padta hai aur usme agar aap antacid kha rahe hain Pan 40 kha rahe hain, Ocid kha rahe hain, Rantac kha rahe hain to uska absorption aapke liye kam ho jata hai. Isi tarike se inke beech ka ek aur substance aata hai calcium ka phosphate joki inke beech product hai ki jo aapka mehanga bhi nahi hai, iske andar elemental calcium bhi theek thaak hai. to ab aapko ye dekhna hai ki aap kis category mein aate hain aur kaun sa calcium aapke liye Jyada suitable hai.

Calcium ke sath-sath kuch aur bhi medications hoti hain jab aap calcium le rahe hain to aap ko dhyan rakhna chahiye ki bisphosphonate nahi lena chahiye. Bisphosphonate ek osteoporosis Ki bimari mein hum dete hain patients ko jo hafte mein ek tablet hoti hai ya mahine mein ek tablet hoti hai taaki aapka calcium body se kam nikale uske saath calcium nahi lena chahiye, uske saath kayin interactions hote hain, isi tarike se blood pressure ki kuch dwaiyan hain jaise calcium channel blockers wo bhi calcium ke saath nahi lene chaahiyen. Kuch antibiotics bhi hoti hain jo ki iske saath mein nahi leni chahiye. Uske alawa agar aap dekhen to jo normal amount jaise humne bola tha ki 1000 mg se 2000 mg as per the requirement ki agar koi pregnant lady ya lactating lady hai jo abhi milk feeding kara rahi hai baby ko to unki demands jyada hoti hai ya old age mein ya post-menopausal women ke andar bhi jyada requirement hoti hai but aapko saath mein ye bhi dekhna hai ki aap bahar se to calcium ke product nahi le rahe hain tab aapko supplement kam rakhne chahiye wo bhi doctor ki Salah ke saath-saath.

To normally calcium ki problem hoti hai to un logo ko sochna chahiye calcium lene ke baare mein extra, ek to wo jo vegetarian diet lete hain dusre wo jinko lactose intolerance ki bimari hai ki jo milk products lete hain or unko difficulty ya koi pareshani ho jaati hai, teesre wo log jo bohot hi high protein diet le rahe hain bohot jyada meat kha rahe hain ya animal proteins khaa rahe hain ya protein ke supplements leh rahe hain ya Indian diet mein sodium ya namak ki matra bohot jyada hoti hai wo bhi calcium ko body se jyada jaldi bahar nikalti hai. Old age mein jo 45 se upar ki women hain aur males so 50-60 se upar wale hain jinko osteoporosis hoti hai unko jarurat hoti hai. Isi ke sath agar aapko Koi intestinal disease hai bowel se judi hui ya koi infection hai aapke intestinal tract mein to aapko calcium ki jarurat hoti hai. Ab jaise humne discuss kiya tha ki kitna calcium lena chahiye, to humne ek term used kiya tha elemental calcium. Elemental calcium ka matlab hai ki agar aap 1250 mg ka calcium carbonate le rahe hain to uska keval 40% hi body absorb Kar payegi yaani ki lagbhag 500 mg ka calcium hi aapko mil raha hai.

To agar aap 1250 mg ki ek tablet din mein ek time kha rahe hain to effectively aapko 500 mg ka calcium mil raha hai. Uske saath ab uski tolerability ki baat aati hai jo log calcium lete hain Khaas taur se carbonate form wala unko gas ki problem jyada hoti hai, constipation ki problem jyada hoti hai aur interaction maine bataya hi tha jaise BP ke drug le rahe hain to usko calcium ke sath nahi lena chahiye, thyroid ke drug ko saath me nahi jena chahiye, bisphosphonate, antibiotics, calcium channel blocker nahi lene chahiye aur agar aap kam dose mein lenge to jyada acchi rahegi aur jaise ki vitamin C agar aap sath le rahe hain calcium ke to ek tarike se to vo achha hai kyunki Vitamin C jo hain calcium ke absorption ko achha ker deta hai aur badiya kar deta hai par dusri taraf agar vitamin B12 aap sath mein le rahe hain supplement ke taur par to uske absorption ko kam karta hai to isliye jab aap usko saath mein le rahe hain vitamin C ko calcium ke saath to apko koi B complex wala vitamin nahi lena chahiye isi tarike se vitamin C ek aur tarike se hamari madad karta hai ye kuch aesi cells banata hai joki apke calcium aur aapki bones banane wale cell ko promote karti hai.

Ab agar aap poochenge ki agar hum calcium tablet nahi khana chahte hain to aisi kya-kya khaane Ki cheezein ho jo hame calcium ke supplement ke taur par khani chahiye toh jaise yogurt ya dahi ho gayi, mozzarella cheese ho gaya, milk ke kisi bhi form mein chahe wo low fat milk ho, buttermilk ho ya whole milk ho uske alawa tofu aap le sakte hain, cottage cheese le sakte hain, salmon fish agar fish khaate hain to aur ek cabbage le sakte hain aap, uske alawa chocolate pudding aur raw broccoli ke andar bhi acche amount mein calcium milta hai. Calcium khane ke baad agar aap kabhi-kabhi supplement ke baad dekhenge to aapko kuch cheezon ka dhyan rakhna hoga ki aapko uske baad bohot jyada pyaas lag sakti hai, nausea, vomiting, abdomen mein pain hona, body mein phosphate ki kami ya blood pressure ka kam hona, muh ka sukhapan, constipation ka hona, sar mein dard hona, heart thoda sa low feel karna, sinus bradycardia bolte hain, thoda drowsiness. To ye saari agar problem aapko aati hain, muscle mein weakness to aapko apne doctor se consult karna chahiye ki aap jo calcium le rahe hain uski amount ya uska type theek hai kyunki different types ke calcium hote hain maine aapko bataya hai, to usi ke saath calcium ke absorption ko badhane ke liye jaise vitamin C maine discuss kiya tha, vitamin E bhi uski help karta hai uske alawa vitamin K ka K2 form jo hota hai wo bhi help karta hai, magnesium help karta hai, boron help karta hai to isse kya hai ki agar aap kisi aise calcium ke salt ko le rahe hain jisme ye saari bhi thodi-thodi amounts mein mile hue hain to wo calcium jo hai aapke liye jyada better hoga kyunki usse body mein calcium ka absorption aur acche tarike se hoga. Kya cheezein hoti hai jo calcium ke absorption ko kharab karti hain?

Agar aap usko saath mein le rahe hain tablets ko? To corticosteroid agar kisi ka skin disease hai aur 3 se 4 hafte tak wo calcium supplement le raha, prednisolone ya kisi aur steroid ki form main to usko jarurat hoti hai ki wo extra amount of calcium le. Jo log jyada namak use kar rahe hain unko bhi jyada calcium ki jarurat hoti hai, joh log jyada protein kkaate hain unko bhi extra calcium ki jarurat hoti hai. Kuch khaano mein hamare oxalate milla hota hai ek aisa salt ek aisa substance hai jo calcium ke sath windup karta hai. Jo berries aur chocolate mein oxalate kafi matra mein hota hai to wo aapki body mein calcium ke amount ko achche tarike se nahin aane deta. Isi tarike se bohot saare jo aap coca cola lete hain uske andar phosphorus mila hota hai joki aapko calcium ko absorb nahi karne deta hai, so avoid coca cola agar aap calcium ki deficiency se pareshan hain. Isi tarike se jo normal roti khaate hain agar bina chaane aate ki hoti hai to wo jo bran hota hai uska bina chaana hua wo aapke calcium ke absorption ko disturb karta hai. Isi tarike se alcohol lene se kya hota hai ki alcohol jo milk ke andar vitamin D ka form hota hai usko active form mein nahi aane deta kul mila kar aapki calcium ki deficiency karta hai.

Caffeine Hamare India habit mein jyadatar log doodh, chai or coffee Ki form mein lete hain to caffeine bhi urine aur fecal matter ke through calcium ka excretion karata hai jisse kii calcium ki deficiency rehti hai aur sath hi sath smoking, stress ya lack of exercises jo ye cheezein hoti hain ye bhi cheezein apki calcium ko kam karati hai. To ye saari ki saari baatein humne calcium related ki hain. Maine aapko wo cheezein btaayi hain ki diet mein kya cheezein agar aap le sakte hain to aapko supplement ki jarurat nahi hain. Calcium ka bhi alag-alag tablets ke forms ke baare mein maine aapko bataya hai toh in sab cheezon ko agar aap early age se start karenge yaneki childhood se apne bacchon ke liye start karenge to jabh wo adults banege to unki bones ki deficiency nahin ho payegi, agar bohot late shuru karte hain to utna achha effect nahi aa pata hai.

Thank you!