The Sunshine Paradox: Plenty of Sun, Little Vitamin D
Pakistan is blessed with abundant sunshine. From the long summers of Punjab and Sindh to the bright winters of Balochistan, most cities get hundreds of hours of direct sunlight every year. Yet vitamin D deficiency is one of the country's most common nutritional problems — a true paradox.
How can people living under such strong sun run short of the "sunshine vitamin"? Because vitamin D status depends on far more than sunshine alone: how much skin is exposed, for how long, how dark the skin is, how clean the air is, and what we eat. When those pieces don't line up, deficiency becomes widespread — even in a sunny country.
How Widespread Is Vitamin D Deficiency in Pakistan?
This is not just a guess. A 2024 systematic review and meta-analysis by Mahar and colleagues, published in the Journal of Diabetology, pooled 37 studies covering 19,338 people across Pakistan and found an overall pooled prevalence of vitamin D deficiency of 78% — roughly three out of every four people [1].
It was even more pronounced in some groups: 84% among children and adolescents, and 84% in Punjab — the highest province-level figure. The authors concluded that public-health interventions — dietary improvement, sensible sun exposure, and awareness campaigns — are essential [1].
These numbers don't mean everyone should panic — but they confirm that low vitamin D is genuinely common in Pakistan, not rare, and worth understanding.
Why Does This Happen in a Sunny Country?
Several everyday factors reduce how much vitamin D our bodies make, even when the sun shines. None of this is anyone's fault:
Most of the day is spent indoors. Vitamin D is made when ultraviolet B (UVB) rays from sunlight strike the skin [2]. Time spent indoors — even near a sunny window — doesn't count, because UVB radiation does not penetrate glass [2].
Clothing covers most of the skin. Normal, modest dress — completely appropriate and culturally valued — means less skin is directly exposed to sunlight. Since vitamin D is produced in exposed skin, covering more of the body naturally reduces production [1].
Darker skin needs more sun to make the same amount. This is simple biology, not a flaw. The pigment melanin, which gives skin its darker color, reduces the skin's ability to produce vitamin D from sunlight — so people with darker skin generally need longer exposure than lighter-skinned people [2].
Air pollution blocks UV rays. Season, time of day, cloud cover, and smog all affect how much UV radiation reaches the skin and how much vitamin D is synthesized [2]. In cities with heavy smog seasons — Lahore's winter smog being the most well-known example — less UVB gets through.
Food contributes only a small share. Vitamin D is naturally present in only a few foods, and Pakistani staples — roti, rice, daal, sabzi — contain virtually none. Fortified foods, which provide most of the dietary vitamin D in some Western countries [2], are not widely available here.
| Risk factor | How it reduces vitamin D |
|---|---|
| Indoor lifestyle | Less direct sun on skin during peak UVB hours |
| Modest clothing norms | Less exposed skin for vitamin D synthesis |
| Darker skin tone | Melanin reduces vitamin D made per minute of sun |
| Smog and air pollution | Filters out UVB before it reaches the skin |
| Few fortified foods | Little dietary backup when sun exposure is low |
| Winter season | Shorter days, weaker UVB, especially up north |
Signs That May Be Associated With Low Vitamin D
One reason vitamin D deficiency goes unnoticed is that its signs can be vague and easy to blame on a busy life. These may be associated with low vitamin D — but none can diagnose it, and each has many other possible causes:
- Persistent tiredness or low energy that doesn't improve with rest
- Bone pain or aching, especially in the back, legs, or ribs
- Muscle weakness or cramps, such as difficulty climbing stairs
- Frequent illness, since vitamin D plays a role in immune function [2]
- Low mood in darker months (research on this link is still developing)
In children, severe deficiency can lead to rickets — soft, weakened bones — while in adults it can contribute to osteomalacia, a softening of the bones [2]. These are the classic, well-established consequences of prolonged deficiency.
Feeling tired or achy does not mean you are vitamin D deficient — only a blood test can tell. If you recognize several of these signs, consider it a reason to get checked, not a diagnosis.
Because vitamin D also supports immune function [2], keeping your levels healthy is one more reason to eat well overall. For the bigger picture, read about foods that support your immune system and the proven benefits of healthy eating.
Vitamin D Food Sources in Pakistan
Food alone usually can't fix a deficiency — sunlight does most of the work — but vitamin D–rich foods still help. The best natural sources are fatty fish, fish liver oils, egg yolks, beef liver, and cheese [2]. Here is what that looks like in a Pakistani kitchen:
| Food (typical serving) | Approximate vitamin D | Notes for Pakistan |
|---|---|---|
| Oily fish — surmai (kingfish), mackerel-type fish, tuna (85 g / 3 oz, cooked) | ~570 IU (14 mcg) | Among the best food sources [2] |
| UV-exposed mushrooms (½ cup) | ~366 IU (9 mcg) | Only UV-treated mushrooms reach this level [2] |
| Fortified milk (1 cup / 250 ml) | ~120 IU (3 mcg) | Check the label — not standard in Pakistan |
| Egg yolk (1 large egg / anda) | ~44 IU (1 mcg) | Small, but adds up with daily eating |
| Beef liver / kaleji (85 g / 3 oz, cooked) | ~42 IU (1 mcg) | Traditional food; enjoy in moderation |
| Canned tuna (85 g / 3 oz, drained) | ~40 IU (1 mcg) | Affordable and widely available |
Values are approximate international reference values [2]; exact content varies. 1 mcg vitamin D = 40 IU.
A few practical notes:
- Rohu and other freshwater fish are eaten widely in Pakistan and are excellent protein sources — but as leaner fish they provide less vitamin D than oily marine fish, so don't rely on them as your main source.
- UV-exposed mushrooms are one of the only meaningful plant-based sources, but ordinary mushrooms have very little; check packaging where available. Fortified milk and cereals supply much of the dietary vitamin D in countries like the US [2], but fortification is inconsistent in Pakistan — the label will tell you.
- Vitamin D is fat-soluble, and eating it with some dietary fat aids absorption [2] — the oil in a fish curry or the ghee on an egg paratha is doing you a small favor.
A diet with regular oily fish, eggs, and dairy supports the whole body. A liver-friendly eating pattern built on whole foods pairs naturally with these vitamin D sources, and adding high-fiber foods that aid weight loss keeps the overall diet balanced.
Safe Sun Exposure: A Sensible Approach
Sunlight is the most powerful natural way to raise vitamin D — and in Pakistan, it's free. But it must be balanced against sunburn and skin damage:
- Aim for short, regular periods of midday sun on exposed skin — for example, arms and legs or face and arms — a few times a week. Midday is when UVB is strongest, so shorter exposures are enough.
- People with darker skin need longer exposure than lighter-skinned people to make the same amount of vitamin D [2]. There is no one-size-fits-all number of minutes; it depends on skin tone, season, and time of day.
- Avoid sunburn. Brief exposure is the goal — not tanning or burning. If your skin is turning red, you've had too much.
- Go outside rather than sitting by a window — UVB does not pass through glass, so sunshine through a window doesn't produce vitamin D [2]. And skip sunbeds, which carry their own health risks.
- Sunscreen and shade still matter for long outdoor periods. A brief midday walk for vitamin D and sunscreen for longer outings can easily coexist.
If your routine keeps you indoors most of the day, even a short daily walk in the sun can make a difference.
When to Get Tested and Talk to Your Doctor
The only reliable way to know your vitamin D status is a blood test measuring 25-hydroxyvitamin D [25(OH)D] — the main indicator used by health professionals [2]. Levels below 30 nmol/L (12 ng/mL) are generally associated with deficiency, while levels of 50 nmol/L (20 ng/mL) or more are considered adequate for most people [2].
Consider asking your doctor about testing if you have persistent bone pain or muscle weakness, spend almost all your time indoors, are elderly, pregnant, or breastfeeding, or follow a very restricted diet with no fish, eggs, or dairy.
If a test shows deficiency, your doctor may discuss treatment options — which can include dietary changes, planned sun exposure, and in some cases supplements. Because excessive vitamin D can cause harm (nausea, kidney stones, and calcium buildup in extreme cases [2]), supplements should only be taken on a doctor's advice — never self-prescribed megadoses.
The Bottom Line
Vitamin D deficiency in Pakistan is common — roughly three in four people according to the best available pooled data [1] — but it is also understandable and addressable. The causes are everyday ones: indoor routines, modest dress, darker skin needing more sun, smoggy air, and a diet low in vitamin D–rich foods. None require dramatic life changes to improve.
Start with what's practical: short midday sun on exposed skin, oily fish and eggs on the plate, and a doctor's visit — including a simple blood test — if symptoms or risk factors apply. Small, consistent habits beat occasional big efforts.
For everyday inspiration, explore anti-inflammatory spices like ginger to round out a diet that supports your whole body — bones, immunity, and all.
Disclaimer: This article is for educational purposes only and is not medical advice. Talk to your healthcare provider before making major dietary changes, especially if you have a medical condition or take medication.
References
- Mahar B, Shah T, Sadiq N, Mangi R, Warsi J, Abbas Q. Vitamin D Deficiency Prevalence in Pakistan: Common, Important, and Neglected – A Comprehensive Meta-Analysis. Journal of Diabetology. 2024;15(4):335–348. https://doaj.org/article/9c4d55576bea4949b28148717400af2e
- National Institutes of Health, Office of Dietary Supplements. Vitamin D – Health Professional Fact Sheet. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ (accessed 2026-10-04)












