Vitamin D Metabolism

What May Vitamin D Improve?

-Improved bone health

-Increased absorption of calcium

-Reduced risk of falls and bone fractures

-Reduced coronary artery disease

-Improved muscular function

-Lowering of high blood pressure

-Improved blood sugar tolerance

-Improved nerve function

-Improved kidney function

-Reduced risk of 17 cancers

-Reduced influenza, cold infections, tuberculosis

Vitamin D Deficiency

Low Vitamin D Risks

Increased blood pressure - 2.4 times

High blood sugar - 2.5 times

Metabolic syndrome – 4.0 times

Vitamin D and Bones

Vitamin D is important for people with osteoporosis. Studies show that calcium and vitamin D together can increase bone density in postmenopausal women. Vitamin D also helps with other disorders associated with weak bones, like rickets.

Vitamin D and the Heart

Low levels of vitamin D associated with increased risk of cardiovascular disease and mortality.

One study: Low vitamin D risk increase of

Coronary Artery Disease - 45%

Stroke - 78%

Heart attack - 50%

Death – 77-100%

25-57% USA adults may be deficient

Vitamin D and Critical Illness

For critically ill patients in the hospital, low vitamin D levels have been found to be related to

1.Organ malfunction

2.Length of stay

3.Infection rates

Vitamin D and MSSeveral studies have suggested that maintaining adequate levels of vitamin D may have a protective effect and lower the risk of developing multiple sclerosis (MS). Other studies suggest that for people who already have MS, vitamin D may lessen the frequency and severity of their symptoms. More research is needed to assess these findings.

Is there any proof that vitamin D supplements can prevent MS or keep symptoms of MS from worsening?

•When a person has MS, his or her immune system attacks the coating that protects the nerve cells. Research suggests that a connection between vitamin D and MS could be tied to the positive effects vitamin D has on the immune system.

•The link between vitamin D and MS is strengthened by the association between sunlight and the risk of MS. The farther away from the equator a person lives, the higher the risk of MS. Sunlight is the body's most efficient source for vitamin D — suggesting that exposure to sunlight may offer protection from MS.

Vitamin D and Cancer Cure

1. Inverse correlation between incidence, mortality and or survival rates for many cancers including breast, colorectal, ovarian, and prostate cancers.

2. Emerging evidence that more than 17 cancers are likely to be vitamin D sensitive.

3. 1000 IU/day could reduce cancers 7% for men, 9% for women in US.

4. 25(OH)D level of 52 ng/ml reduced breast cancer by 50%

5. 60-80 ng/ml may be optimal for most individuals

6. 25(OH)D level increase from 29 to 39 reduced cancer risk by 60% after 4 years.

Vitamin D and the Lungs

Asthma: Early studies indicate may reduce severe exacerbations, exercise induced bronchoconstriction

Lower respiratory tract infections are more frequent in those with low 25(OH)D levels.

2000 IU Vitamin D abolished the seasonality of influenza and dramatically reduced the self-reported incidence.

Vitamin D reduces inflammation and viral pathogens.

Vitamin D and Depression

Vitamin D may be primarily associated with cognitive domains other than memory , such as executive cognitive functions, depression, bipolar disorders, and schizophrenia.

Low 25(OH)D may be a risk factor for cognitive impairment (41-60%).

Receptors for Vitamin D are present in brain cells. Increased Vitamin D may improve cognitive function in patients with Alzheimer's

Pros and Cons Vitamin D From the SUN

5-6 times more deaths from internal cancers related to low vitamin D levels than skin cancers

Regular moderate outdoor UV exposure increases survival of melanoma patients

Current Vitamin D Recommendations

Institute of Medicine recommendations:400 IU: infants 0 to 12 months600 IU: age 1 – 70 years800 IU: age above 704000 IU upper limit

Endocrine Society's Clinical guidelines400 IU - 1000 IU: infants 0 to 12 months600 IU – 1000 IU: age 1 – 18 years600 IU – 2000 IU: 19 - 70 years800 IU – 2000 IU: above 701000 IU to 6 mo, 4000 IU over 8 yrs upper limit

Vitamin D Sources

The Sunshine Vitamin

Fortified foods:

Typically supply 150 IU per day, but highly variable

(100 - 400 IU per day).

Supplements:-Over-the-counter usually vitamin D3

Vitamin D3 is more than three times powerful than D2.

Vitamin D Sources

Why Euopeans Need Vitamin D

•70 percent of Europeans suffer from low vitamin D levels---Spanish Foundation for Science and Technology

•In recent years, there have been reports suggesting a high prevalence of low vitamin D intakes and vitamin D deficiency or inadequate vitamin D status in Europe.

•European latitude and Climate resulting in inadequate sun exposure.

Why Euopeans Need Vitamin D

•Lifestyle factors such as longer working hours indoors and less outdoor playtime for children may impact on achieving sufficient sun exposure

•The importance of time spent outdoors was shown in a Swiss population study, where it was a significant predictor of low vitamin D levels in patients aged over 65 years

Vitamin D and sun exposurein Europe

Sunlight is not strong enough to trigger synthesis of vitamin D in the skin from October to March.

Therefore, European population rely on dietary vitamin D and body stores to maintain a healthy vitamin D status, particularly during the winter season

How Much Vitamin D is Needed?

The only way to know how much is needed is to test 25(OH)D.

Everyone should be tested!

Goal: 25(OH)D between 60-80 ng/ml after a consistent intake level

over 2 months.

100 IU of vitamin D raises 25(OH)D about 1 ng/ml.

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