Vitamin D and B12 deficiencies: A growing public health concern in India

Urban lifestyles, dietary habits, and lack of awareness are fuelling a crisis doctors say is vastly underestimated

A viral social media post recently mentioned that India needs a polio-like drive to tackle Vitamin B12 and Vitamin D deficiencies among adults. The appeal struck a chord with many, with users calling it a “silent epidemic” and urging the Health Ministry to step in.

 

According to a study by the Indian Council for Research on International Economic Relations (ICRIER), published earlier this year, one in five Indians is Vitamin D deficient, with 46 per cent of children (aged 0–10 years) suffering from rickets.

 

Separately, a 2022 study in The Egyptian Journal of Internal Medicine reported that around 75 per cent of India’s population, over 650 million people suffer from Vitamin B12 deficiency, largely due to differences in diet, demography, and religion.

 

 

“Vitamin D deficiency affects 70–90 per cent of Indians, even among urban, middle-class adults. Vitamin B12 deficiency is prevalent in 50–70 per cent of vegetarians and 40–50 per cent of the rest of the population,” said Dr Amyn Rajani, consultant knee, shoulder, hip surgeon and founder, OAKS Clinic, Mumbai.

 

Who is most at risk?

 

Health experts point out that urban office-goers, women, the elderly, and pregnant women are especially vulnerable to Vitamin D and B12 deficiencies.

 

Vitamin B12 deficiency is commonly seen in vegetarians, as the primary dietary source of B12 is animal-based protein. Those with malabsorption syndromes or individuals on long-term medications such as metformin or antacids are also at increased risk.

 

Meanwhile, people living in cities are particularly prone to Vitamin D deficiency due to limited exposure to sunlight, as many spend most of their time indoors.

   

What’s behind India’s vitamin crisis? 

“Some medicines, such as steroids, anti-seizure drugs, and drugs that decrease cholesterol, can make it difficult for the body to digest Vitamin D3. A diet low in fat or having a poor stomach (such IBS or coeliac disease) can also make it tougher for the body to digest nutrients. Eating a lot of foods that are high in fibre or phytic acid, like uncooked bran, may also make it difficult for the body to get the nutrients it needs,” said Dr R Nanda Kumar, senior consultant for general medicine with SRM Global Hospitals, Chennai.

 

“Vegetarian diet is one of the major reasons for widespread B12 deficiency in India. This vitamin is naturally found in meat, eggs, and dairy which many Indians do not take. This puts vegetarians at higher risk of deficiency,” said Dr Shweta Mendiratta, associate clinical director & head of obstetrics & gynaecology, Marengo Asia Hospitals, Faridabad.

   

Health effects one shouldn’t ignore

 

Experts share some possible symptoms for Vitamin D deficiency:

 

• Muscle and bone pain
• Increased sensitivity to pain
• Tingly, ‘pins-and-needles’ sensation in the hands or feet
• Muscle weakness with twitches, spasms or tremors
• History of broken bones
• Bowed legs (when the deficiency is severe)

 

“If not treated, Vitamin D deficiency will gradually weaken bones and muscles, causing premature osteopenia, osteoporosis, bone pain, increased fracture risk, tiredness, and in children, rickets. It is also associated with an increased risk of metabolic disorders, cardiovascular disease, and certain autoimmune diseases,” said Dr Lipika Parulekar, internal medicine at Lilavati Hospital Mumbai.

   

Symptoms of vitamin B12 deficiency include:

 

• Feeling exhausted or weak
• Experiencing nausea, vomiting or diarrhoea
• Appetite and weight loss
• Sore mouth or tongue
• Yellowish skin
• Numbness or tingling in your hands and feet
• Vision problems
• Having a hard time remembering things or getting confused easily
• Difficult time walking or speaking like you usually do
• Feeling depressed and irritable
• Change in the way you feel and behave

 

“If vitamin B12 deficiency goes untreated, neurological symptoms including numbness, tingling, and cognitive impairment can set in, where the symptoms could prove to be irreversible, and cause permanent nerve damage in the worst instances," said Dr Anirban Chattopadhyay, critical care specialist with CMRI Kolkata (The Calcutta Medical Research Institute).

 

“As a gynaecologist, I often see these deficiencies in women of reproductive age, pregnant women, and even post-menopausal women. This is worrying as these two vitamins have a crucial role to play in maintaining hormonal balance, bone health, and fetal development,” added Dr Mendiratta.

   

Is self-supplementation a safe option?

 

In India, over-the-counter Vitamin D and B12 supplements are widely available but that doesn’t mean they should be taken without guidance. Excessive or unmonitored use can do more harm than good.

 

“Self-supplementation with Vitamin D or B12 without proper medical guidance is strongly not recommended. While both nutrients are critically important, misuse can lead to an opposite reaction. A 2016-2019 study published in the Indian Journal of Pharmacology reported that repeated high-dose vitamin D3 injections caused hypercalcemia, renal damage, and even one fatality, with serum D levels above 300 ng/mL. Symptoms related to a deficiency of nutrients can also result from more significant underlying malabsorption and chronic diseases,” said Dr Mukesh Batra, founder and chairman emeritus, Dr Batra’s Healthcare.

 

Adding to the point, Dr Rajani said, “While taking B12 supplements is safer, excessive use may mask underlying issues like pernicious anaemia (an autoimmune condition that prevents your body from absorbing vitamin B12).”

 

What works better?

 

For many, a healthy diet with fortified foods, dairy, leafy greens, and sunlight exposure might help. But in cases of severe deficiency, dietary changes alone may not be enough.

 

“Unfortunately, dietary and lifestyle techniques are rarely sufficient in the case of moderate to severe [Vit-D and B12] deficiencies. In those situations, we need to provide medically supervised supplementation to intervene quickly. Once deficiencies are medically addressed, then we can work to make lifestyle modifications like nutrition, sun exposure, and address malabsorption issues,” said Dr Batra.

 

Dr Parulekar added, “Trace amounts of B12 are present in milk, which may be inadequate to meet the daily needs, especially in strict vegetarians and vegan vegetarians. Enriched and fortified foods can benefit vegetarians as a source of B12, but most of this group requires individual supplements, oral tablets or injections in consultation with a physician.”

 

“The sun is the best way to get Vitamin D. However, those with darker skin have more melanin, which makes it harder for their skin to generate D3,” said Dr Kumar.

 

He explained that people need blood tests to check their vitamin levels once or twice a year, especially after the monsoon or winter season. “People with chronic illnesses, osteoporosis, obesity, or symptoms like fatigue and muscle pain may need to be tested more often than people who are healthy,” he said. 

   

Does India need a national health mission?

 

Some healthcare professionals are now calling for a national campaign to address the concern. With the scale of deficiency being comparable to public health crises of the past, India may need mass screening, awareness drives, and food fortification policies.

 

Adding to the discourse, Dr Chattopadhyay said, “Food fortification is very much a proven and scalable solution for a diverse country like India. Fortification of staples, namely milk, oils, cereals, and flour, with Vitamins D and B12 can facilitate reaching out to the general population, especially in rural and low-income areas, where healthcare access is an issue.”

 

“Given the high prevalence and silent impact, this is a public health concern. Deficiencies of these vitamins impair quality of life, productivity, and increase healthcare burden due to fractures, fatigue, and neuropathy. The awareness is low even among the educated. National campaigns can drive early testing, sun exposure education, and safe supplementation,” said Dr Rajani.

 

Dr Amyn Rajani of OAKS Clinic recommends:

 

• Mandatory fortification of staple foods with Vitamin D and B12
• Mass awareness campaigns, similar to those for polio or anaemia
• Routine screening for pregnant women, the elderly, and vegetarians
• Subsidised supplements through public health programmes
• Training for general physicians to recognise early signs and conduct proactive screening
• Encouraging urban design that allows more sun exposure, such as open spaces in schools and offices.

   

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This report is for informational purposes only and is not a substitute for professional medical advice.