Desert countries can be deficient in Vitamin D, Magnesium and Iron (Saudi Arabia in this case)
The Co-occurrence of Iron and vitamin D deficiency in the middle east: A regional review with a focus on Saudi Arabia as a case study for integrated public health strategies
J Steroid Biochem Mol Biol . 2026 Sep: doi: 10.1016/j.jsbmb.2026.107040 PDF behind paywall
Khaled Essawi 1
Iron deficiency (ID) and vitamin D deficiency (VDD) often occur together in Saudi Arabia and across the Middle East, influenced by shared cultural, dietary, and environmental factors. This narrative review compiles evidence on this dual issue, exploring epidemiology, mechanisms, clinical effects, and public health strategies.
Data confirm significant overlap:
- VDD affects 60-88% of Saudi adults and 60-81% of children, while
- ID impacts 23-36% of adults and 20-49% of children.
Throughout this review, vitamin D deficiency (VDD) is defined per original study criteria, most commonly as 25-hydroxyvitamin D [25(OH)D] < 20 ng/mL (<50 nmol/L), consistent with pre-2024 Endocrine Society guidelines. We acknowledge the 2024 Endocrine Society revised guideline, which defines deficiency as < 12 ng/mL (<30 nmol/L) and eliminates the 'insufficiency' category; prevalence estimates would be substantially lower under this newer threshold. Their co-occurrence may be linked through common inflammatory pathways affecting hepcidin regulation and vitamin D activation, although human data are inconsistent. Combined deficiencies worsen health outcomes, including impaired growth, neurocognitive issues, immune problems, and adverse effects on maternal and child health. Diagnosis is difficult due to nonspecific symptoms and biomarker limitations during inflammation. Current interventions such as food fortification and supplementation, are hampered by isolated approaches and a lack of nationally representative combined prevalence data. The top priority is conducting a national survey to measure the prevalence of concurrent ID and VDD. Once this data is available, integrated strategies such as dual fortification, combined supplementation protocols, and culturally-sensitive public health campaigns can be effectively implemented. This framework offers an evidence-based approach to translating epidemiological and mechanistic insights into measurable public health improvements in Saudi Arabia and the wider Middle East.
Snippits
- This challenge is not unique to Saudi Arabia. Evidence from across the Middle East, including Morocco, Jordan, Bahrain, Qatar, Kuwait, and the United Arab Emirates (UAE), reveals that co-occurring ID and VDD represent a regional phenomenon driven by shared cultural, climatic, and dietary factors [35], [34], [31], [36], [33], [32]. While Saudi Arabia serves as the primary case study, this review synthesizes regional evidence, with implications for integrated nutrition policies across the Arab world [39], [37], [38].
Desalinated water lacks magnesium and restricts Iron uptake by plants
People in hot countries can now avoid the sun by using air conditioning
- Hypothesis – China air conditioning disease is the result of less vitamin D
- Air Conditioning probably has decreased vitamin D
Related in Vitamin D Life
- Magnesium deficiency is now widespread — health consequences and best supplement forms
- Calcium-Magnesium Balance and How it Relates to Vitamin D - Sunil video Dec 2025
- Diseases at high risk if just low Vitamin D, low (D and Mg), low (D and Omega-3) – Perplexity AI
Saudi Arabia
- Low Vitamin D is associated with risk of Depression 5X, Stress 4.8 X, and Anxiety 3.9 X (Saudi Arabia college students)
- Low vitamin D is big problem during pregnancies (Saudi Arabia in this case)
- Many fertilization and pregnancy problems associated with low vitamin D in Saudi Arabia
- Painful to be a female Saudi teacher (very low vitamin D)
Desalination reduces Magnesium (needed by Vitamin D)
- Water produced by reverse osmosis removes Magnesium and causes health problems if not supplemented
- Desalination in ~50 countries - Saudi has the higest % consumption of desalinated water) (Wikipedia)
- An estimated 4,000 Israelis are already dying each year due to inadequate levels magnesium in their bodies due to desalination– nearly 10 times the number of deaths from road accidents
Iron, Anemia