THE D-LIGHTFUL VITAMIN AND THESILENT GLOBAL EPIDEMIC

DR.RISHIKESAN K.V MD

VENNIYIL MEDICAL CENTRE

SHARJAH

GLOBAL EPIDEMIC - an estimated 1billion people

MOST AMERICANS ARE LACKING VIT.DArchives of Int.Med. April2007

THREE QUARTERS OF U.S TEENS AND ADULTS ARE DEFICIENT IN VITAMIN D THE SO CALLED SUNSHINE VITAMIN

THE LACK OF VITAMIN D IS LINKED TO RICKETS THE SOFT AND WEAK BONES AND THINNING OF BONES IN ELDERLY - OSTEOMALACIA

BUT SCIENTIST ALSO BELIEVE IT MAY PLAY A ROLE IN HEART DISEASE,CANCERS AND DIABETES

UAE SCENARIO

DESPITE THE YEAR-

ROUND SUNLIGHT 78%

OF RESIDENTS HAVE VITAMIN D DEFICIENCY BECAUSE OF INDOOR LIFE STYLE,CLOTHING HABITS AND ABSENCE OF A CLEAR

FORTIFICATION POLICY.

HIGH PREVALENT IN

EMIRATI WOMEN

POOR IGNORANCE

WE ARE GOING THROUGH A PUBLIC HEALTH CRISIS OF EPIDEMIC PROPORTION BECAUSE OF POOR IGNORANCE & MISINFORMATI-ON

VITAMIN D

VITAMIN D IS A VITAMIN AS WELL AS A POTENT REPAIR AND MAINTENANCE STEROID HORMONE

VITAMIN D RECEPTOR IS PRESENT IN ALMOST ALL ORGANS ,TISSUES AND CELLS

HUMAN GENOME PROJECT……..

APPROXIMATELY 30000 GENES DIFFERENTIATE US FROM LOWER ANIMALS.

AMONG THESE 30000 GENES VITAMIN D REGULATES AND INFLUENCES MORE THAN 2000 GENES.

MORE THAN 160 METABOLIC PATHWAYS ARE INFLUENCED BY VIT D SUPPLEMENTATION

THAT IS WHY THIS UNIQUE MOLECULE IS SO VITAL AND CRUCIAL FOR SO MANY DISEASES AND MORBIDITIES

DRIVES THE GENES

Vitamin D deficiency: *Inadequate exposure to sunlight *Adults in nursing homes *Vitamin D malabsorption problems - *People who have undergone resection of the small intestine are at risk for this condition *Celiac sprue, short bowel syndrome, and cystic fibrosis. *Minimal amounts of vitamin D in human breast milk .* Some medications Dilantin, phenobarbital, and rifampin can induce hepatic p450 enzymes to accelerate the catabolism of vitamin D

DEVOLUTION?????

Throughout evolution, humans have depended on the sun for their vitamin D requirement. Indeed, a likely reason that

melanin devolved was to permit humans who migrated north and south of the equator to make enough vitamin D in their skin to satisfy their requirement

CAUSES &CONSEQUENCES

UVB AND D VITAMIN…..

FROM MASAAI……

SYNTHESIS

The production of vitamin D3 in the skin involves a series of reactions initiating with 7DHC.Upon exposure to ultraviolet B (UVB) radiation between the wavelengths of 290-315 nm, 7DHC is converted to pre vitamin D3, which is then converted to vitamin D3 .

From the skin, newly formed vitamin D3 enters the circulation by binding to DBP. In order to become active, Vitamin D is hydroxylated in the 25 position by the hepatic microsomal and/or mitochondrial enzyme vitamin D 25-hydroxylase. The second hydroxylation occurs in the kidney and is performed by the P450 enzyme 25-hydroxyvitamin D-1 alpha-hydroxylase. Upon entering the cell, the 1,25(OH)2 D hormone binds to VDR. The bound vitamin D receptor then forms a heterodimer with the retinoic acid X receptor (RXR). This heterodimer then goes to the nucleus to bind

deoxyribonucleic acid (DNA) and increases transcription of vitamin D–related genes

SYNTHESIS OF VITAMIN D

Sensible sun exposure, between the hours

of 10:00 am & 3:00 pm produces vitamin D in the skin that may last twice as long in the blood compared with ingested vitamin D.If sun exposure produces slight pinkness, the amount of vitamin D produced in response to exposure of the full body is equivalent to ingesting

10,000-25,000 IU.A variety of factors reduce the skin’s vitamin D-3 production:

Increased skin pigmentation, aging,& the topical application of a sunscreen.

RECOMMENDATION……

Foods with high amounts of vitamin D3#Oily fish: salmon, mackerel, &blue fish, as well as fortified milk and other dairy products.#A single serving (3.5 oz) of wild-caught salmon has 988 ± 524 IU of vitamin D3; decreases by 50% if the salmon is fried in vegetable oil.#Farm-raised salmon has only 25% of the vitamin D3 content found in the flesh of wild salmon. Blue fish and mackerel have vit.D3 levels of 280 ± 68 IU and 24 IU, respectively.#Fortified milk may contain less than the stated amount of vit.D3 on the product .#Vegetables are not a good source for vitamin D.

VIT.D2 AND D3

VITAMIN D STATUS

BAROMETER

Vitamin D deficiency is often a silent disease. In adults, results in osteomalacia which presents as a poorly mineralized skeletal matrix. Can experience chronic muscle aches and pains.Can reveal periosteal bone pain. Best detected using firm pressure on the sternal bone or tibia. Vitamin D deficiency is the most common cause of nutritional rickets; bowing in the legs. By definition, rickets occurs in children whose growth plates have not fused. They are often found to have started walking late or prefer to sit down for prolonged periods.

VIT.D and AUTISMSeveral findings suggest that low Vit.D levels (in mothers during pregnancy and in infants) may affect the risk of autism.

The risk of autism could be lowered significantly by women using vit. D supplements before conception, during pregnancy, and after birth.

Research suggests that pregnant and nursing women require 6000 IU (150 mcg)/day of vitamin D3 (cholecalciferol) during pregnancy and lactation for best pregnancy outcomes and in order to give the infant sufficient vitamin D3 during nursing.

BREAST AND BOTTLE

MOMS AND BABIES

LIKE MOMS…LIKE BABIES

MUMMY AND ME

CANCERS & VIT.D

In the 80s and 90s, several observations suggested that living at higher latitudes increased the risk of developing and dying of colon, prostate, breast, and several other cancers. A meta-analysis showed that increasing intake of vitamin D3 to 1000 IU/d would be associated with a decreased risk of colorectal and breast cancer of as much as 50%

VIT.D INHIBITS CANCER

UPREGULATES:DIFFERENTIATION,

APOPTOSIS

DOWNREGULATES:PROLIFERATION, INVASIVENESS,

METASTATIC POTENTIAL,

ANGIOGENESIS, and INFLAMMATION

CANCER IN WOMEN

Postmenopaus-al women who received 1100 IU vitamin D3 and 1000 mg Ca daily for 4yrs. reduced their risk of developing cancer by 60%.

Conclusions: Vit.D status, which is amenable to intervention by safely increasing sun exposure or vit.D supplementation, was associated inversely with BP in a large sample representative of the US population.

CONCLUSIONS: Vitamin D deficiency is associated with incident cardiovascular disease

CONCLUSIONS: Low 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels are independently associated with all-cause and cardiovascular mortality.

LOW VIT.D & ANOVULATION

Low vit.D levels may negatively affect ovulation :Dr. Lubna Pal.

She found a significant link between low vitamin D and ovary disturbance. While the preliminary results are interesting, more research is needed to confirm a link. A level of 50 nanomoles per liter and above is sufficient for most people, according to the National Institutes of Health Office of Dietary Supplements.

Vitamin D is positively associated with sperm motility and increases intracellular ca++ in human spermatozoaMETHODS: Cross-sectional association study of semen quality and VD serum level in 300 men from the general population, and in vitro studies on spermatozoa from 40 men to investigate the effects of VD on intracellular calcium, sperm motility and acrosome reaction

CONCLUSIONS: 1,25(OH)(2)D(3) increased intracellular ca++ concentration, sperm motility and induced the acrosome reaction in mature spermatozoa, and VD serum levels were positively associated with sperm motility, suggesting a role for VD in human sperm function. Hum Reprod. 2011 Jun;26(6):1307-17.

LOW VIT.D LEVELS LINKED TO COLD Archives of Int.Med.2009 Feb

Conclusion:

Serum 25(OH)D levels have an independent, inverse association with recent URTI.

25(OH)D levels less than 30 ng/mL and URTI were higher in the winter season.

Individuals with respiratory tract diseases, such as asthma, who have low serum 25(OH)D levels may be even more susceptible to RTI.

Vitamin D supplementation may reduce the incidence of URTI and exacerbations of respiratory tract diseases.

DAILY VIT.D FOR COLD

Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis-

Conclusions:

Low serum vit. D levels are associated with higher risk of active TB. It is more likely that low body vitamin D levels increase the risk of active tuberculosis.

Dietary vit. D supplementation is associated with reduced risk of type1diabetes. Adequate vit.D supplementation for infants could help to reverse the increasing trend in the incidence of type1 diabetes.

TYPE 2 DM

Conclusion: vitamin D insufficiency is under recognized and may be a significant contributor to neuropathic pain in type 2 diabetes. Vitamin D supplementation may be an effective “analgesic” in relieving neuropathic pain.

Low serum 25(OH)D, a stable marker of vitamin D status, are associated with increased prevalence of cognitive dysfunction, AD and all-cause dementia , raising the possibility that vitamin D plays a role in the aetiology of cognitive dysfunction and dementia

TAKE HOME MESSAGE & CONCLUSION

TAKE VITAMIN D ….. LIVE LONGER

THE TRUTH……

ALL TRUTH GOES

THROUGH 3 STAGES:AT FIRST IT IS RIDICULEDSECOND, IT IS VIOLENTLY OPPOSEDFINALLY IT IS ACCEPTED AS SELF

EVIDENT

THANK YOU VERY MUCH