Antoaneta Sawyer, Ph.D.
The importance of vit D supplementation is without doubt obtaining the global media attention in the latest times. One of the reason for this huge media attention is the already discovered ‘vit D pandemic deficiency’ common not only for the Nordic latitudes, but also in California where the daily sunshine is a constant factor. The state of hyperparathyroidism is recently found to be secondary to Vitamin D3 deficiency.
Is vit D deficiency a common phenomena?
Vitamin D deficiencies are common among those with chronic degenerative diseases, bulimia or anorexia nervosa, alcoholism, people who have resection or operation of their thyroid glands, overactive parathyroid glands, vegetarians, people with chronic degenerative disease and general nutritional deficiencies. There seems to be overwhelming evidence that shows vit D3 deficiency, and research is now working to prove how much of vit D3 additional supplementation actually works to prevent osteoporosis. It is already proven that an 8th week of daily supplementation may resolve any vit D 3 deficiency. The only correct and reasonable way to supplement with vit D is a serum and urine tests that are both useful in learning more about all of the individual vit D body levels. The parathyroid gland is responsible for maintaining well balanced calcium levels, which is vital for proper functioning of the muscular and nervous systems. One latest study found that insufficient levels of immune cells were produced in the thymus glands of laboratory animals with vitamin D deficiencies.
What is the correct vit D form?
Vitamin D refers to two separate precursors-D3 (cholecalciferol), and D2 (ergocalciferol). The vit D, produced in the skin on exposure to UVB radiation (290 to 320 nm), is known to be more bioactive. Both D3 and D2 precursors are hydroxylated in the liver and kidneys to form 25- hydroxyvitamin D (25[OH] D)-the non-active 'storage' form, and 1,25-dihydroxyvitamin D (1,25[OH]2D)-the biologically active form that is tightly controlled by the body. Vitamin D that is mostly manufactured in the kidneys is called 1, 25-dihydroxyvitamin D, while the other vit D known as 25-hydrovitamin D is manufactured in the liver. The parathyroid hormone produced by the parathyroid glands localized just around the thyroid gland may affect the 1,25 - dihydroxyvitamin D status also. As multiple studies suggest that Vit.D3 (cholecalciferol) is more effective than Vitamin D2 (ergocalciferol) one must look for supplements clearly labeled as Vit.D3 - cholecalciferol.
Is vit. D a vitamin or a hormone?
Vitamin D is actually a type of neurohormone that circulates in blood and signals to the human cells through a specific receptor. It is produced in large amounts as a result of sun exposure, and is available in much smaller amounts from dietary sources. In chronic inflammation, vitamin D also balances immune response to avoid a dangerous pro-inflammatory response. Scientists are now claiming that genes activated by vitamin D have been part of the now-human genome for sixty million years. If all proven in the future, it will mean the vitamin D genes are absolutely crucial for our survival.
Chemistry
The vitamin D that is mostly manufactured in the kidneys is called 1, 25-dihydroxyvitamin D, while the 25-hydrovitamin D form is manufactured in the liver. 25-Hydroxyvitamin D3 (25 [OH] D3) is produced in the liver by 25-hydroxylation of cholecalciferol (Vit D3), although other tissues (intestine, kidney) might perform the same hydroxylation also. This hormonally regulated steroid stimulates the intestinal absorption of both calcium and phosphorus and it also stimulates bone resorption and mineralization thereby preventing the development of rickets in children and osteomalacia in elderly.
Optimum Dose
There is quite of a controversy surrounding the optimum levels of Vit D3 supplementation. Latest studies suggest that the current RDA/DV of vitamin D (200 IU for individuals under age 50, 400 IU for those between the ages of 50 and 70, and 600 IU for those over the age of 70) may not be adequate. In fact, optimal levels are between 2,000 and 4,000 IU per day and many scientists are now questioning this level and calling for the upper limit to be increased to levels as high as 10,000 IU. Despite, most of the authors suggest the use of vit D3 of 1000 IU-2000 IU on a daily basis. I consider this dose on the safer side, as vit D3 can be also toxic.
Blood tests
Vitamin D tests are used to determine if osteomalacia, osteoporosis, or bone malformation is occurring as a result of a deficiency or excess of vitamin D. They are also used to determine effectiveness of treatment when vitamin D, calcium, phosphorus, and/or magnesium supplementation is prescribed. Since vitamin D is a fat-soluble vitamin and is absorbed from the intestine like a fat, vitamin D tests are sometimes used to monitor individuals with diseases that interfere with fat absorption, such as cystic fibrosis and Crohn’s disease, to assure that they have adequate amounts of vit D.
The standard blood test is called "serum 25-hydroxy vitamin D3", or 24(OH) D for short. The above test assesses blood levels of vit D3. Another- urinary test calculates the ratio of urinary calcium to urinary creatinine, and that ratio should be less than 0.37. Ratios that are consistently above 0.37 indicate excess urinary calcium. The only correct and reasonable way to supplement with vit D is through a serum and urine tests that are both useful in learning more about all of the individual vit D body levels.
You must also know that most of the MDs measure 25-hydroxyvitamin D, as it exists for much longer (T1/2) period of time (a pharmacokinetic parameter) in the bloodstream. According to me it will be a smart idea to have a complete and accurate picture of both (25-hydroxyvitamin D and 1.25-dihydroxyviramin D) levels studied. The parathyroid hormone produced by your parathyroid glands localized just around the thyroid gland may affect your 1, 25- dihydroxy vitamin D status.
What is the best way to supplement vit D?
The best and maybe the safest way to supplement with vit D3 is through whole body exposure for at approximately 15-20 minutes to the sun at peak sun times during the summer (between 10AM-4PM). In this amount of time at peak sun, skin is able to produce approximately 10,000 IU of Vit D3. No additional Vit D3 is produced in longer exposure. The amount of vit D3 corresponding of 10,000 IU is produced prior to any sunburn pinkness. In the Nordic latitudes, even 15-20 minutes of peak sun exposure may be difficult to be obtained on a daily basis, so supplementation may be the only way to cope with the problem. It seems likely that physiological vitamin D intakes will result in a higher relative risk for kidney stones for people on modern American diets (low potassium, low magnesium, high refined carbohydrates, high sodas, and a high acid residue). You may lower your risk of kidney stones by remaining vitamin D deficient, but then you raise your risk of dying from many other diseases.
What is vit D3 used for?
The versatility of vit D3 can be explained with the following:
1. Vit D3 works for healthy bones and teeth. It is necessary for the maintenance of healthy calcium and phosphorous levels in the body. Calcium, the main structural element in bones and teeth, can only be absorbed by the body when vitamin D is present.Vit D also assists the body in the transport of calcium through the bloodstream, and assists in calcium absorption.
2. Vit D3 is responsible for muscle vigor and strength protection. It’s also believed that vit D3 may contribute to increased muscle strength, by improving body balance and reducing risk of falls among elderly. 2 separate studies found that low vitamin D may be deadly for older adults as fractures are a frequent reason for mortality especially in older women.
3. Vit D3 is a powerful “immune modulator”. Several clinical studies suggested the importance of Vit D3 in improving immunity response and mainly its effects as “immune modulator”. We already know that several vitamins have important immunomodulating effects, by reducing the pro-inflammatory cytokines while increasing levels of anti-inflammatory cytokines. Recently-published research data revealed that vit D can stimulate the innate immune system and to prevent of influenza virus A (H1N1) by turning on antimicrobial peptides, known as “cathelicidins” (LL-37) that have been found to have broad spectrum antimicrobial activity. New studies suggested that despite bacteria are developing resistance by creating “beta-lactamases” and “cephalosporinases” (enzymes) towards the broad spectrum antibiotics (penicillin’s and cephalosporin’s)-it is quite unusual for them to develop resistance to the above mentioned peptides throughout producing specific proteases. The main effect of vit D 3 is to help to prevent immune system from overreacting in case if pathologically stimulated and to be stimulated in case if naturally inhibited. This is the definition of an immune modulator.
4. Vit D3 may help in cancer prevention. Recent studies suggest Vit D3 supplementation may promote up to a 77% reduction of cancer incidence and to prevent from more than 18 types of cancers, even the most deadly ones as colon, ovarian and pancreatic cancer.
5. Vit D3 may play a role in autoimmune disease prevention. Supplementation with vit D 3 may be contraindicated in certain diseases including sarcoidosis, lupus, polymyositis and other autoimmune diseases. Symptoms of rosacea may be also overly stimulated. Thus a consultation with health provider is an absolute must especially in case of autoimmune disease.
6. Vit D3 is an insulin secretion modifier. I have done 15 years of research on metabolic syndrome and found that Vit D3 is the Hollywood-star in "metabolic syndrome" prevention and healing. It is also helpful in obesity, diabetes prevention and treatment according several studies.
7. Vit D3 has general anti-inflammatory effect. Vitamin D3 has been implicated to be the vitamin "immune modulator". It is playing an important role in various inflammatory and autoimmune diseases like: diabetes, multiple sclerosis, rheumatoid arthritis, hypertension, and cardiovascular disease. Vitamin D prevents all the natural immune response from over-reacting to an antigen as well as reduces general chronic inflammation. It appears to suppress the immune response in cases when pathologically elevated or to increase it when naturally inhibited by an illness. This way vit D is one of the most popular natural immune modulators known in practice.
8. Vit D 3 can participate in skin treatment. Several clinical studies suggest that Vit D3 plays an important role in skin treatment. Latest clinical trial of oral and topical Vitamin D3 in acne, eczema and atopic dermatitis are showing positive results of vit D3 in various skin diseases. Vitamin D was also proven to improve melanoma survival and general survival.
9. Vit D3 is needed for vision support. Few studies suggest that Vitamin D3 also plays an important role in antimicrobial protection of the eyes and their surrounding muscles and tissues.
10. Vit D3 is good for heart disease protection help and blood pressure regulation. An article published in Progress Biophysics Molecular Biology (2006) indicated that vitamin D can help maintain healthy blood pressure, blood sugar and overall cellular health. Vitamin D deficiency in younger women has been found with an increased risk of hypertonia (elevated blood pressure).
11. Vit D3 is a good brain optimizer. Several clinical studies in adults have found significant associations between higher vitamin D levels and better intellectual functioning and short memory improvement. At the same moment, a recent report found high incidence of vitamin D deficiency among younger individuals with intellectual disabilities.
12. Vitamin D3 is the wonder vitamin that is working as a pro-metabolic hormone and immunomodulator, despite it is officially termed a vitamin. I have always believed and stated in most of my previous articles that if there is a vitamin that must be used by older adults that is Vit D3. I also call it the “anti-metabolic” vitamin as there are multiple studies that are showing weight loss and strong metabolic improvement in case of chronic use. In a recent systematic review and meta-analysis, middle aged and elderly people who had high levels of vitamin D3 cut their risk of developing heart disease or elevated blood sugar nearly in 50 percent (Parker et al., 2010). Researchers from the University of Warwick evaluated 28 separate studies involving almost 100,000 men and women across different ethnic groups. The data revealed a significant association between high levels of vitamin D and dramatically decreased risk of both cardiac and metabolic syndrome and its consequences- hypertonia, obesity, gout, kidney failure, Alzheimer disease, etc. Compared to those with low levels, men and women who had high levels of vitamin D had a reduced risk of developing cardiovascular disease by about 33%, elevated blood sugar by 55% and metabolic syndrome by over 50%. Cardiovascular disease is currently the leading cause of death, worldwide. But according to lead author Dr. Oscar Franco, "Targeting vitamin D deficiency in adult populations could potentially slow the current epidemics of cardiometabolic disorders." I suggest that most adults check their vit D levels and to add it in case if deficient. Generally a dose between 1,000-2,000 is completely safe but you must proceed checking up your levels and to even add a dose of 4,000 IU if needed. I personally take 2,000 during the winter and do not use any in the summer, but I do have always optimal blood levels of this vital nutrient. Note* Please note that the road between vit D deficiency and Vit D intoxication is quite narrow and must be recognized as eventual possibility what requests a proper blood test follow up. People with kidney failure or with other chronic degerenerative diseases as well as the advance aged must be very careful while supplementing with this vitamin.
Enjoy the YouTube lecture of Michael Holick, MD, PhD at the University of California San Diego on vit D:
http://www.youtube.com/watch?v=Cq1t9WqOD-0&feature=player_embedded
If you would like to learn more on the above topic, please call and require a personal consultation: (715) 392-7591; (218) 213-6167; or (218) 213-7087
References:
Parker, J., Hashmi, O., Dutton, D., Mavrodaris, A., Stranges, S, Kandala, N. B. et al. (2010). Levels of vitamin D and cardiometabolic disorders: Systematic review and meta-analysis. Maturitas, 65, 225-36.
Is vit D deficiency a common phenomena?
Vitamin D deficiencies are common among those with chronic degenerative diseases, bulimia or anorexia nervosa, alcoholism, people who have resection or operation of their thyroid glands, overactive parathyroid glands, vegetarians, people with chronic degenerative disease and general nutritional deficiencies. There seems to be overwhelming evidence that shows vit D3 deficiency, and research is now working to prove how much of vit D3 additional supplementation actually works to prevent osteoporosis. It is already proven that an 8th week of daily supplementation may resolve any vit D 3 deficiency. The only correct and reasonable way to supplement with vit D is a serum and urine tests that are both useful in learning more about all of the individual vit D body levels. The parathyroid gland is responsible for maintaining well balanced calcium levels, which is vital for proper functioning of the muscular and nervous systems. One latest study found that insufficient levels of immune cells were produced in the thymus glands of laboratory animals with vitamin D deficiencies.
What is the correct vit D form?
Vitamin D refers to two separate precursors-D3 (cholecalciferol), and D2 (ergocalciferol). The vit D, produced in the skin on exposure to UVB radiation (290 to 320 nm), is known to be more bioactive. Both D3 and D2 precursors are hydroxylated in the liver and kidneys to form 25- hydroxyvitamin D (25[OH] D)-the non-active 'storage' form, and 1,25-dihydroxyvitamin D (1,25[OH]2D)-the biologically active form that is tightly controlled by the body. Vitamin D that is mostly manufactured in the kidneys is called 1, 25-dihydroxyvitamin D, while the other vit D known as 25-hydrovitamin D is manufactured in the liver. The parathyroid hormone produced by the parathyroid glands localized just around the thyroid gland may affect the 1,25 - dihydroxyvitamin D status also. As multiple studies suggest that Vit.D3 (cholecalciferol) is more effective than Vitamin D2 (ergocalciferol) one must look for supplements clearly labeled as Vit.D3 - cholecalciferol.
Is vit. D a vitamin or a hormone?
Vitamin D is actually a type of neurohormone that circulates in blood and signals to the human cells through a specific receptor. It is produced in large amounts as a result of sun exposure, and is available in much smaller amounts from dietary sources. In chronic inflammation, vitamin D also balances immune response to avoid a dangerous pro-inflammatory response. Scientists are now claiming that genes activated by vitamin D have been part of the now-human genome for sixty million years. If all proven in the future, it will mean the vitamin D genes are absolutely crucial for our survival.
Chemistry
The vitamin D that is mostly manufactured in the kidneys is called 1, 25-dihydroxyvitamin D, while the 25-hydrovitamin D form is manufactured in the liver. 25-Hydroxyvitamin D3 (25 [OH] D3) is produced in the liver by 25-hydroxylation of cholecalciferol (Vit D3), although other tissues (intestine, kidney) might perform the same hydroxylation also. This hormonally regulated steroid stimulates the intestinal absorption of both calcium and phosphorus and it also stimulates bone resorption and mineralization thereby preventing the development of rickets in children and osteomalacia in elderly.
Optimum Dose
There is quite of a controversy surrounding the optimum levels of Vit D3 supplementation. Latest studies suggest that the current RDA/DV of vitamin D (200 IU for individuals under age 50, 400 IU for those between the ages of 50 and 70, and 600 IU for those over the age of 70) may not be adequate. In fact, optimal levels are between 2,000 and 4,000 IU per day and many scientists are now questioning this level and calling for the upper limit to be increased to levels as high as 10,000 IU. Despite, most of the authors suggest the use of vit D3 of 1000 IU-2000 IU on a daily basis. I consider this dose on the safer side, as vit D3 can be also toxic.
Blood tests
Vitamin D tests are used to determine if osteomalacia, osteoporosis, or bone malformation is occurring as a result of a deficiency or excess of vitamin D. They are also used to determine effectiveness of treatment when vitamin D, calcium, phosphorus, and/or magnesium supplementation is prescribed. Since vitamin D is a fat-soluble vitamin and is absorbed from the intestine like a fat, vitamin D tests are sometimes used to monitor individuals with diseases that interfere with fat absorption, such as cystic fibrosis and Crohn’s disease, to assure that they have adequate amounts of vit D.
The standard blood test is called "serum 25-hydroxy vitamin D3", or 24(OH) D for short. The above test assesses blood levels of vit D3. Another- urinary test calculates the ratio of urinary calcium to urinary creatinine, and that ratio should be less than 0.37. Ratios that are consistently above 0.37 indicate excess urinary calcium. The only correct and reasonable way to supplement with vit D is through a serum and urine tests that are both useful in learning more about all of the individual vit D body levels.
You must also know that most of the MDs measure 25-hydroxyvitamin D, as it exists for much longer (T1/2) period of time (a pharmacokinetic parameter) in the bloodstream. According to me it will be a smart idea to have a complete and accurate picture of both (25-hydroxyvitamin D and 1.25-dihydroxyviramin D) levels studied. The parathyroid hormone produced by your parathyroid glands localized just around the thyroid gland may affect your 1, 25- dihydroxy vitamin D status.
What is the best way to supplement vit D?
The best and maybe the safest way to supplement with vit D3 is through whole body exposure for at approximately 15-20 minutes to the sun at peak sun times during the summer (between 10AM-4PM). In this amount of time at peak sun, skin is able to produce approximately 10,000 IU of Vit D3. No additional Vit D3 is produced in longer exposure. The amount of vit D3 corresponding of 10,000 IU is produced prior to any sunburn pinkness. In the Nordic latitudes, even 15-20 minutes of peak sun exposure may be difficult to be obtained on a daily basis, so supplementation may be the only way to cope with the problem. It seems likely that physiological vitamin D intakes will result in a higher relative risk for kidney stones for people on modern American diets (low potassium, low magnesium, high refined carbohydrates, high sodas, and a high acid residue). You may lower your risk of kidney stones by remaining vitamin D deficient, but then you raise your risk of dying from many other diseases.
What is vit D3 used for?
The versatility of vit D3 can be explained with the following:
1. Vit D3 works for healthy bones and teeth. It is necessary for the maintenance of healthy calcium and phosphorous levels in the body. Calcium, the main structural element in bones and teeth, can only be absorbed by the body when vitamin D is present.Vit D also assists the body in the transport of calcium through the bloodstream, and assists in calcium absorption.
2. Vit D3 is responsible for muscle vigor and strength protection. It’s also believed that vit D3 may contribute to increased muscle strength, by improving body balance and reducing risk of falls among elderly. 2 separate studies found that low vitamin D may be deadly for older adults as fractures are a frequent reason for mortality especially in older women.
3. Vit D3 is a powerful “immune modulator”. Several clinical studies suggested the importance of Vit D3 in improving immunity response and mainly its effects as “immune modulator”. We already know that several vitamins have important immunomodulating effects, by reducing the pro-inflammatory cytokines while increasing levels of anti-inflammatory cytokines. Recently-published research data revealed that vit D can stimulate the innate immune system and to prevent of influenza virus A (H1N1) by turning on antimicrobial peptides, known as “cathelicidins” (LL-37) that have been found to have broad spectrum antimicrobial activity. New studies suggested that despite bacteria are developing resistance by creating “beta-lactamases” and “cephalosporinases” (enzymes) towards the broad spectrum antibiotics (penicillin’s and cephalosporin’s)-it is quite unusual for them to develop resistance to the above mentioned peptides throughout producing specific proteases. The main effect of vit D 3 is to help to prevent immune system from overreacting in case if pathologically stimulated and to be stimulated in case if naturally inhibited. This is the definition of an immune modulator.
4. Vit D3 may help in cancer prevention. Recent studies suggest Vit D3 supplementation may promote up to a 77% reduction of cancer incidence and to prevent from more than 18 types of cancers, even the most deadly ones as colon, ovarian and pancreatic cancer.
5. Vit D3 may play a role in autoimmune disease prevention. Supplementation with vit D 3 may be contraindicated in certain diseases including sarcoidosis, lupus, polymyositis and other autoimmune diseases. Symptoms of rosacea may be also overly stimulated. Thus a consultation with health provider is an absolute must especially in case of autoimmune disease.
6. Vit D3 is an insulin secretion modifier. I have done 15 years of research on metabolic syndrome and found that Vit D3 is the Hollywood-star in "metabolic syndrome" prevention and healing. It is also helpful in obesity, diabetes prevention and treatment according several studies.
7. Vit D3 has general anti-inflammatory effect. Vitamin D3 has been implicated to be the vitamin "immune modulator". It is playing an important role in various inflammatory and autoimmune diseases like: diabetes, multiple sclerosis, rheumatoid arthritis, hypertension, and cardiovascular disease. Vitamin D prevents all the natural immune response from over-reacting to an antigen as well as reduces general chronic inflammation. It appears to suppress the immune response in cases when pathologically elevated or to increase it when naturally inhibited by an illness. This way vit D is one of the most popular natural immune modulators known in practice.
8. Vit D 3 can participate in skin treatment. Several clinical studies suggest that Vit D3 plays an important role in skin treatment. Latest clinical trial of oral and topical Vitamin D3 in acne, eczema and atopic dermatitis are showing positive results of vit D3 in various skin diseases. Vitamin D was also proven to improve melanoma survival and general survival.
9. Vit D3 is needed for vision support. Few studies suggest that Vitamin D3 also plays an important role in antimicrobial protection of the eyes and their surrounding muscles and tissues.
10. Vit D3 is good for heart disease protection help and blood pressure regulation. An article published in Progress Biophysics Molecular Biology (2006) indicated that vitamin D can help maintain healthy blood pressure, blood sugar and overall cellular health. Vitamin D deficiency in younger women has been found with an increased risk of hypertonia (elevated blood pressure).
11. Vit D3 is a good brain optimizer. Several clinical studies in adults have found significant associations between higher vitamin D levels and better intellectual functioning and short memory improvement. At the same moment, a recent report found high incidence of vitamin D deficiency among younger individuals with intellectual disabilities.
12. Vitamin D3 is the wonder vitamin that is working as a pro-metabolic hormone and immunomodulator, despite it is officially termed a vitamin. I have always believed and stated in most of my previous articles that if there is a vitamin that must be used by older adults that is Vit D3. I also call it the “anti-metabolic” vitamin as there are multiple studies that are showing weight loss and strong metabolic improvement in case of chronic use. In a recent systematic review and meta-analysis, middle aged and elderly people who had high levels of vitamin D3 cut their risk of developing heart disease or elevated blood sugar nearly in 50 percent (Parker et al., 2010). Researchers from the University of Warwick evaluated 28 separate studies involving almost 100,000 men and women across different ethnic groups. The data revealed a significant association between high levels of vitamin D and dramatically decreased risk of both cardiac and metabolic syndrome and its consequences- hypertonia, obesity, gout, kidney failure, Alzheimer disease, etc. Compared to those with low levels, men and women who had high levels of vitamin D had a reduced risk of developing cardiovascular disease by about 33%, elevated blood sugar by 55% and metabolic syndrome by over 50%. Cardiovascular disease is currently the leading cause of death, worldwide. But according to lead author Dr. Oscar Franco, "Targeting vitamin D deficiency in adult populations could potentially slow the current epidemics of cardiometabolic disorders." I suggest that most adults check their vit D levels and to add it in case if deficient. Generally a dose between 1,000-2,000 is completely safe but you must proceed checking up your levels and to even add a dose of 4,000 IU if needed. I personally take 2,000 during the winter and do not use any in the summer, but I do have always optimal blood levels of this vital nutrient. Note* Please note that the road between vit D deficiency and Vit D intoxication is quite narrow and must be recognized as eventual possibility what requests a proper blood test follow up. People with kidney failure or with other chronic degerenerative diseases as well as the advance aged must be very careful while supplementing with this vitamin.
Enjoy the YouTube lecture of Michael Holick, MD, PhD at the University of California San Diego on vit D:
http://www.youtube.com/watch?v=Cq1t9WqOD-0&feature=player_embedded
If you would like to learn more on the above topic, please call and require a personal consultation: (715) 392-7591; (218) 213-6167; or (218) 213-7087
References:
Parker, J., Hashmi, O., Dutton, D., Mavrodaris, A., Stranges, S, Kandala, N. B. et al. (2010). Levels of vitamin D and cardiometabolic disorders: Systematic review and meta-analysis. Maturitas, 65, 225-36.
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