VITAMIN D THE SUNSHINE VITAMIN

Basic Description• Vitamin D refers to a group of fat-soluble secosteroids.• Most important compounds in this group are • Vitamin d3 - cholecalciferol• Vitamin D2 - ergocalciferol

• Synthesis of vitamin D in the skin is the major natural source of the vitamin• Vitamin D from the diet or dermal synthesis

from sunlight is biologically inactive; activation requires enzymatic conversion (hydroxylation) in the liver and kidney.

• Vitamin D has a significant role in calcium homeostasis and metabolism.• Its discovery was due to effort to find the dietary substance

lacking in rickets• In the liver, cholecalciferol (vitamin D3) is converted

to calcidiol, which is also known as calcifediol• Part of the calcidiol is converted by the kidneys to calcitriol,

the biologically active form of vitamin D.• Ergocalciferol (vitamin D2) is converted in the liver to 25-

hydroxyergocalciferol • Vitamin D deficiency and insufficiency is now a global

public-health problem affecting an estimated 1 billion people worldwide.

TYPES

1. Vitamin D1

2. Vitamin D2 – Ergocalciferol

3. Vitamin D3 – Cholecalciferol

4. Vitamin D4 - 22-dihydroergocalciferol

5. Vitamin D5 - Sitocalciferol

DeficiencySigns and symptoms• Rickets• Osteomalacia• Osteoporosis• Muscle aches and weakness• Muscle twitching (Fasciculation)• Light-headedness• Too little vitamin D can pose health risks. Low blood levels

of the vitamin have been associated with the following:• Increased risk of death from cardiovascular disease• Cognitive impairment in older adults• Severe asthma in children• Cancer

Causes of Vitamin D Deficiency

1. Not consuming the recommended levels of the vitamin over time.

2. Exposure to sunlight is limited

3. Having dark skin

4. Kidneys cannot convert vitamin d to its active form

5. Digestive tract cannot adequately absorb vitamin d

6. Obese

The most accurate way to measure how much vitamin D is in your body is the 25-hydroxy vitamin D blood test. A level of 20 ng/milliliter to 50 ng/mL is considered adequate for healthy people. A level less than 12 ng/mL indicates vitamin D deficiency.

Skeletal disease• Anyone taking calcium needs to take it with vitamin D.• Adequate vitamin D levels can prevent bones from

becoming thin, brittle, or malformed. It is linked with the prevention of osteomalacia, osteopenia, and osteoporosis• Fall prevention is a public-health goal for the elderly.• Each year, one in three people 65 years and older

experiences at least one fall, with 5.6% resulting in a fracture• There are vitamin D receptors in human muscle that

have a direct effect on muscle strength. A severe vitamin D deficiency can cause myopathy, which can cause muscle weakness and pain.

Rickets• Rickets is defective mineralization

or calcification of bones before epiphyseal closure in immature mammals due to deficiency or impaired metabolism of vitamin D

• Cause• Vitamin D deficiency• In the absence of vitamin D, dietary

calcium is not properly absorbed, resulting in hypocalcaemia

www.medicinenet.com

• Bone tenderness• Dental problems• Muscle weakness • Increased tendency for fractures (greenstick fractures)• Skeletal deformity

• Toddlers: genu varum• Older children: genu valgum• Cranial deformity (skull bossing or delayed fontanelle closure)• Pelvic deformity• Spinal deformity (kyphoscoliosis or lumbar lordosis)• Pigeon chest

• Growth disturbance• Hypocalcaemia• Tetany• Craniotabes (soft skull)• Widening of wrist www.webmd.boots articles.mercola.com

SIGNS AND SYMPTOMS

Treatment and prevention• Diet and sunlight• Treatment involves increasing dietary intake of calcium,

phosphates and vitamin D. Exposure to ultraviolet B light (most easily obtained when the sun is highest in the sky), cod liver oil, halibut-liver oil, and viosterol are all sources of vitamin D.

• Supplementation

Those at higher risk for developing rickets include• Breast-fed infants whose mothers are not exposed to sunlight• Breast-fed infants who are not exposed to sunlight• Breast-fed babies who are exposed to little sunlight• Any child whose diet does not contain enough vitamin D or

calcium

Osteomalacia• Osteomalacia refers to a softening of your bones, often

caused by a vitamin D deficiency. Soft bones are more likely to bow and fracture• Signs & symptoms• No symptoms in early stage• bone pain and muscle weakness• dull, aching pain in lower back, pelvis, hips, legs and ribs• pain may be worse at night, or when you're putting weight on

affected bones.• Decreased muscle tone and leg weakness- waddling gait

• Treatment• vitamin D supplements • supplements of minerals (calcium or phosphorus)

Osteoporosis• Osteoporosis causes bones to become weak and brittle,

so brittle that a fall or even mild stresses like bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.• white and Asian women especially older women who are

past menopause are at highest risk.• Signs & Symptoms• Back pain, caused by a fractured or collapsed vertebra• Loss of height over time• A stooped posture• A bone fracture that occurs much more easily than expected

www.eurospine.org

Cardiovascular disease

• Vitamin D deficiency is associated with an increased prevalence of• hypertension • hyperlipidaemia• peripheral vascular disease• coronary artery disease• myocardial infarction• heart failure• stroke

Infections• More respiratory infections in the winter

• Observational studies have shown an association between low vitamin d status and an increased risk of both upper and lower respiratory tract infections.

The role of vitamin D in reducing the risk of hospital-acquired infections, such as pneumonia, bacteraemia, urinary tract infections, and surgical site infections is also being investigated

• Multiple sclerosis• Depression• Tuberculosis• Reducing the risk of type 2 diabetes• Decreasing inflammation• Reducing risk of allergies in children and adolescents• Sleep apnea• Decreasing dental cavities• Erectile dysfunction

Other effects of Vitamin D on Health

Dietary Toxicity• The tolerable upper intake level (UL) for vitamin D is

4000 IU for adults. Given that it is a struggle for many people to reach the 400 IU daily value, it appears very difficult to regularly go above the UL from diet alone. Using our top vitamin D food as an example, you'd have to eat just under 2 pounds of salmon per day to be at the UL.• Dietary toxicity of vitamin d and the ul of 4,000 iu in

certain clinical situations, some individuals may need to exceed the dietary ul via vitamin d supplementation in order to promote optimal health.

• Excessive amounts of vitamin D in the body can cause calcium levels in the blood to rise. This can lead to a condition called hypercalcemia, which can cause a variety of symptoms, including:• fatigue• loss of appetite• weight loss• excessive thirst• excessive urination• dehydration• constipation• irritability, nervousness• ringing in the ear (tinnitus)• muscle weakness• nausea, vomiting• dizziness• confusion, disorientation• high blood pressure• heart arrhythmias

Treatment for Vitamin D Deficiency

• Treatment for vitamin D deficiency involves getting more vitamin D -- through diet and supplements. • There is no consensus on vitamin d levels required for

optimal health -- and it likely differs depending on age and health conditions -- a concentration of less than 20 ng per millilitre is generally considered inadequate, requiring treatment.• Guidelines from the institute of medicine increased the

(rda) of vitamin d to 600 (iu) for everyone ages 1-70, and raised it to 800 iu for adults older than age 70 to optimize bone health. The safe upper limit was also raised to 4,000 ius.

Source

Ergocalciferol, comes from fortified foods, plant foods, and supplements.

Cholecalciferol, comes from fortified foods, animal foods (fatty fish, cod liver oil, eggs, and liver), supplements, and can be made internally when your skin is exposed to UV radiation from the sun.

SOURCE per 100 gms

• Cod Liver Oil 10,000IU• Oily Fish (Trout, cooked) 759IU• Mushrooms 446IU• Fortified Cereals (Whole Grain Total) 333IU• Tofu 157IU• Caviar 117IU• Dairy Products 110IU• Pork (Extra Lean Ham) 93IU• Eggs (Hard Boiled) 87IU• Dairy Alternatives (Plain Soy Yogurt) 53IU

Public Health Recommendations

• 0-12 months: 400 IU (10 micrograms of cholecalciferol)

• 1-70 years: 600 IU (15 micrograms of cholecalciferol)

• 70+ years: 800 IU (20 micrograms of cholecalciferol)

• Pregnant women: 600 IU (15 micrograms of cholecalciferol)

• Lactating women: 600 IU (15 micrograms of cholecalciferol)

THANK YOU

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References