It isn't just thals who are vitamin D deficient. The majority of people being tested are being found deficient. In addition, the lower range is being revised upwards because it is being learned that vitamin D is far more important than previously realized. Vitamin D, which is actually a hormone, is responsible for fixing over 40 different nutrients in the body and without an adequate supply, insufficient quantities of these other nutrients will be available to the body. A study done a few years ago in the United Arab Emirates, where sunshine is not scarce, found that almost all of the women tested were deficient in vitamin D. In addition, it was found that it was not a simple task to reverse this quickly. Even with monthly doses of 60,000 IU, only 30% of the women raised their levels to normal within the 3 month study period. You can read about this study in our thread at
http://www.thalassemiapatientsandfriends.com/index.php?topic=1184.msg9248#msg9248Singapore has a similar climate and people tend to avoid the hot sun, so once again, exposure is often minimal.
Very few people get the amount of daily sunshine that the human body needs.We no longer walk around with little to no clothing, spending most of our time outdoors hunting and gathering like our ancient ancestors and our bodies do not get anywhere close to the same exposure to the sun as they historically did. In hot climates, people stay indoors and get little sun. In cold climates, there is not enough sun year round to enable us to get adequate sun. Without sunshine, our bodies have a very hard time producing enough vitamin D. This is such a no-brainer that we have to wonder why the medical profession has taken so long to catch onto this fact, but they now have, and are recognizing the value of vitamin D in so many areas of human health, from building bones to preventing many cancers. In addition, people are being advised to avoid a lot of direct sun because of the possibility of skin cancers, which seem to be rising with changes to our atmosphere that have been brought on by humans since the dawn of the industrial age. Our bodies are designed to get regular sunshine to provide us with this most important nutrient but changes in how humans live have greatly reduced how much sun we do get. Unless a person works outdoors or is a sun worshiper, it is almost impossible to get enough sunshine. I live in upstate New York, where we only have a few warm months each year, so during the colder months, our vitamin D production from exposure to the sun drops greatly. This summer, getting much exposure has been difficult due to almost constant rain. I recently had a physical and told my doctor I was supplementing with D. He had my level tested and even though I have been taking 2000 IU daily, I was very deficient and the doctor raised my dose to 3000 IU daily. As I said, deficiency is very common, and the amount needed is actually much higher than previously thought. A look around the vitamin section of any grocery store will show that vitamin D supplements which previously contained no more than 400 IU, now contain up to 2000 IU. Almost every day we hear about some new finding regarding the importance of D to our bodies. Whereas the previous optimal range in the body was considered to be 20-60, that is now being revised upward and it has been found that the low end range needs to be at least 30 for the body to produce the normal level of parathyroid hormone, the important hormone that controls calcium levels in the body.
http://www.clinlabnavigator.com/Tests/VitaminD.htmlA 25-OHD concentration of 20 ng/mL is adequate to prevent rickets and osteomalacia. However, a recent editorial in JAMA (292:1416-18, Sep 22/29, 2004) stated that some individuals with a 25-OHD level of 20 ng/mL already exhibit compensatory increases in PTH and suggested that a 25-OHD level of 30 ng/mL is necessary to maintain normal levels of PTH.
Your question is important and thus the lengthy response. This is not a problem exclusive to thals, but with thal, vitamin D deficiency can exacerbate many other problems.
As far as B vitamins, they are water soluble and wash through the body rapidly, needing frequent replenishing. There is no harm in the dose you will find in B 50 or B 100, and you can easily decide for yourself if they make any impact on your energy levels. If you don't have a diet that includes much unprocessed whole grains, you may not be getting adequate B vitamins. I am not familiar with the brands available in Singapore, so I can't really advise you there, other than to say, look for brands that promote natural ingredients. As far as B 12, use a sublingual variety that is dissolved under the tongue. Please be aware that because L-carnitine is also used by body builders, it sometimes gets and unfairly bad reputation. In fact, in Canada it is only available by prescription due to the ignorance of the Health Authority about its nutritional value. Researchers and doctors are becoming more aware of the importance of L-carntine in preventing pulmonary hypertension (PHT) in thalassemia majors, and over and over we hear from thal minors that they exhibit symptoms that are characteristic of mild PHT. These include breathlessness, poor circulation and numbness in the extremities.