Vitamin D deficiency

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Vitamin D3:

Higher Doses Reduce Risk of Common Health Concerns

By D. Meletis, ND

Vitamin D3 is one of the most useful nutritional tools we have at our disposal

for improving overall health. This nutrient is unique in that even though it is

a vitamin it has hormone-like actions and controls phosphorus, calcium, and bone

metabolism and neuromuscular function. Vitamin D3 is the only vitamin the body

can manufacture from sunlight. Yet, with today’s indoor living and the use of

sunscreens due to concern about skin cancer, we are now a society with millions

of individuals deficient in life-sustaining vitamin D3.

For more than a century, scientists have recognized that vitamin D3 is involved

in bone health. Research has continued to accumulate that it can reduce the risk

of fractures to a significant degree. The latest research, however, shows that

Vitamin D3 deficiency is linked to a surprising number of other health

conditions such as depression, back pain, cancer, insulin resistance and

pre-eclampsia in pregnancy, impaired immunity and macular degeneration.

At the same time it’s becoming clear that vitamin D3 may play a wide role in

overall health, it’s becoming equally clear that a large percentage of

individuals are deficient in this important nutrient. The fear of skin cancer

has stopped many individuals from obtaining beneficial amounts of sunlight,

which the skin converts into vitamin D3. Even individuals who venture out into

the sun often use suntan lotion and may be deficient in vitamin D3. Furthermore,

as we age, we are less equipped to produce sufficient quantities of this vital

nutrient. One study found that age-related declines in kidney function may

require older people to ingest more vitamin D to maintain the same blood levels

as younger people.1

The Recommended Daily Intake (RDI) is set so low that individuals who consume

this small amount are still likely to be deficient. In fact, researchers have

discovered that the RDI, which was considered adequate to prevent osteomalacia

(a painful bone disease) or rickets, is nowhere near high enough to protect

against the majority of diseases linked to vitamin D3 deficiency. For example,

an analysis of the medical literature found that at least 1,000 to 2,000 IU of

vitamin D3 per day is necessary to reduce the risk of colorectal cancer and that

a low dose of vitamin D3 did not have the same protective effect.2

Researchers Call for Higher Doses

In an editorial in the March 2007 edition of the American Journal of Clinical

Nutrition, a prominent group of researchers from leading institutions such as

the University of Toronto, Brigham and Women’s Hospital, Tufts University and

University Hospital in Zurich, Switzerland, lashed out at the conventional media

for its inaccurate reporting of vitamin D supplementation.3

The researchers wrote, “Almost every time the public media report that vitamin D

nutrition status is too low, or that higher vitamin D intakes may improve

measures of health, the advice that accompanies the report is outdated and thus

misleading. Media reports to the public are typically accompanied by a paragraph

that approximates the following: ‘Current recommendations from the Institute of

Medicine call for 200 IU/day from birth through age 50 years, 400 IU for those

aged 51–70 years, and 600 IU for those aged >70 years. Some experts say that

optimal amounts are closer to 1,000 IU daily. Until more is known, it is wise

not to overdo it.’ The only conclusion that the public can draw from this is to

do nothing different from what they have done in the past.â€

The researchers point out that supplemental intake of 400 IU per day barely

raises blood concentrations of 25(OH)D, which is the circulating vitamin D

metabolite that serves as the major indicator of vitamin D status. To raise

25(OH)D from 50 to 80 nmol/L requires an additional intake of 1,700 IU vitamin D

per day.

The researchers went on to write that, “The balance of the evidence leads to the

conclusion that the public health is best served by a recommendation of higher

daily intakes of vitamin D. Relatively simple and low-cost changes, such as

increased food fortification or increasing the amount of vitamin D in vitamin

supplement products, may very well bring about rapid and important reductions in

the morbidity associated with low vitamin D status.â€

One of the challenges is the outdated acceptable upper limit for vitamin D3

consumption, which was set at 2,000 IU. However, researchers point out that more

recent studies have shown that 10,000 IU is the safe upper limit.4

Dr. Vieth, one of the foremost authorities on vitamin D3 supplementation who has

extensively studied the nutrient, lamented the low requirements for vitamin D3

in a recent issue of the Journal of Nutrition: “Inappropriately low UL [upper

limit] values, or guidance values, for vitamin D have hindered objective

clinical research on vitamin D nutrition, they have hindered our understanding

of its role in disease prevention, and restricted the amount of vitamin D in

multivitamins and foods to doses too low to benefit public health.â€5

When examining the medical literature, it becomes clear that vitamin D3 affects

the health in an astonishing number of ways and that not obtaining enough of

this important nutrient can leave the door open to developing a number of health

conditions.

Depression

Vitamin D3 deficiency is common in older adults and has been implicated in

psychiatric and neurologic disorders. For example, in one study of 80 older

adults (40 with mild Alzheimer disease and 40 nondemented persons), vitamin D3

deficiency was associated with low mood and with impairment on two of four

measures of cognitive performance.6

Back Pain

Musculoskeletal disorders have been linked to Vitamin D3 deficiency in a number

of studies. One of the newest studies explored the role that low vitamin D3

levels play in the development of chronic low back pain in women. Sixty female

patients in Egypt complaining of low back pain lasting more than three months

were studied. Researchers measured levels of vitamin D3 in the women with low

back pain and compared those levels to those of 20 matched healthy controls.

The study revealed that patients with low back pain had significantly lower

vitamin D3 levels than controls. Low vitamin D3 levels (25 OHD < 40 ng/ml) were

found in 49/60 patients (81 percent) and 12/20 (60 percent) of controls.7

Bone Health

One of the most well-known and long-established benefits of vitamin D3 is its

ability to improve bone health and the health of the musculoskeletal system.

Vitamin D3 deficiency causes osteopenia, precipitates and exacerbates

osteoporosis, causes a painful bone disease known as osteomalacia, and increases

muscle weakness, which worsens the risk of falls and fractures. Vitamin D3

insufficiency may alter the regulatory mechanisms of parathyroid hormone and may

cause a secondary hyperparathyroidism that increases the risk of osteoporosis

and fractures.8

Cognitive Enhancement

Scientists are developing a greater appreciation for vitamin D3’s ability to

improve cognition. In a recent study, vitamin D3 deficient subjects scored worse

on mental function tests compared to individuals who had higher levels of the

vitamin.9 The researchers wrote, “In conclusion, the positive, significant

correlation between serum 25(OH)D concentration and MMSE [mental state

examination scores] in these patients suggests a potential role for vitamin D in

cognitive function of older adults.â€

Cancer

One researcher first noted the connection between vitamin D3 and protection from

cancer in the 1940s, when he discovered that individuals at sunny latitudes had

a reduced rate of deaths from cancer. He suggested that sunlight provided “a

relative cancer immunity.â€

Since then, a number of studies have strongly suggested that vitamin D3

deficiency is associated with an increased risk of developing many forms of

cancer including breast, ovarian, prostate and colon cancer.10 In one of the

newest clinical trials, researchers studied 1,179 healthy, postmenopausal women

(all 55 years or older and free of known cancers for at least 10 years prior to

entering the study) who were taking large amounts of vitamin D3 with calcium.

The subjects were randomly assigned to take daily dosages of 1,400-1,500 mg

supplemental calcium, 1,400-1,500 mg supplemental calcium plus 1,100 IU of

vitamin D3, or placebos. Over the four-year trial, women in the calcium/vitamin

D3 group experienced a 60 percent or greater reduced risk of cancer than their

peers who were not consuming these supplements.

Because there was the chance that some women may have had undiagnosed cancers at

the study’s start, researchers threw out the first-year results and then

analyzed the results from the last three years of the trial. These later years

resulted in even more dramatic decrease, with the calcium/vitamin D3 group

experiencing a 77 percent reduction in cancer risk.

There was no statistically significant difference in cancer incidence between

participants taking placebos and subjects consuming only calcium supplements.11

Another interesting study demonstrated that in vitro vitamin D3 may cause tumor

cells to be more sensitive to chemotherapy drugs, increasing the efficacy of the

cancer treatment.12

Immunity

Scientists have linked various aspects of immune health to a vitamin D3

deficiency. Vitamin D3 regulates T cells, which are important to the functioning

of a strong immune system. Vitamin D3 acts as an immune system modulator,

preventing excessive expression of inflammatory cytokines and increasing the

killing efficiency of macrophages. In addition, it dramatically stimulates the

expression of potent anti-microbial peptides, which exist in immune system cells

such as neutrophils, monocytes, natural killer cells, and in cells lining the

respiratory tract. These vitamin-D3-stimulated peptides play a major role in

protecting the lung from infection.13

In addition, vitamin D3 deficiency may influence development and progression of

various autoimmune diseases.14

Multi-Talented Nutrient

Vitamin D3 deficiency has been linked to a host of other conditions such as high

blood pressure, fibromyalgia, diabetes, multiple sclerosis, rheumatoid

arthritis, and an increased risk of pre-eclampsia and insulin resistance during

pregnancy.11,15-16 Most recently, low vitamin D3 levels have been linked to an

increased prevalence of early age-related macular degeneration.17

Proper Dosage

In many of my patients, even after consuming 2,000 to 4,000 IU of vitamin D3 per

day, their test results indicate that their vitamin D3 levels have barely

budged. These patients needed to consume 8,000 IU of vitamin D3 per day to

achieve proper blood levels of the vitamin. Patients should therefore have their

physicians test their vitamin D3 levels to determine the proper level of

supplementation. Testing also is important due to the fact that, in a small

number of patients, vitamin D3 supplementation can raise calcium levels to an

excessively high level. I have found this to be especially true in African

American patients. Testing for vitamin D3 and calcium blood levels should

therefore become a part of a patient’s regular blood work.

Conclusion

A growing number of researchers who have widely studied vitamin D3 are almost

begging the general public to consume more of this important nutrient. Due to

vitamin D3’s high safety profile in doses up to 10,000 IU per day and due to the

wide role it plays in our health, consuming 2,000 to 4,000 IU per day of this

nutrient at times of the year when sunlight is scarce is a prudent way to

improve overall health.

References

1. Vieth R, Ladak Y, Walfish PG. Age-related changes in the 25-hydroxyvitamin D

versus parathyroid hormone relationship suggest a different reason why older

adults require more vitamin D. J Clin Endocrinol Metab. 2003 Jan;88(1):185-91.

2. Gorham ED, Garland CF, Garland FC, Grant WB, Mohr SB, Lipkin M, Newmark HL,

Giovannucci E, Wei M, Holick MF. Optimal vitamin D status for colorectal cancer

prevention: a quantitative meta analysis. Am J Prev Med. 2007 Mar;32(3):210-6.

3. Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson- B, Garland CF, Heaney

RP, Holick MF, Hollis BW, Lamberg-Allardt C, McGrath JJ, Norman AW, Scragg R,

Whiting SJ, Willett WC, Zittermann A. The urgent need to recommend an intake of

vitamin D that is effective. American Journal of Clinical Nutrition. March

2007;85(3):649-650.

4. Hathcock JN, Shao A, Vieth R, Heaney R. Risk assessment for vitamin D. Am J

Clin Nutr. 2007 Jan;85(1):6-18.

5. Vieth R. Critique of the considerations for establishing the tolerable upper

intake level for vitamin D: critical need for revision upwards. J Nutr. 2006

Apr;136(4):1117-22.

6. Wilkins CH, Sheline YI, Roe CM, Birge SJ, JC. Vitamin D deficiency is

associated with low mood and worse cognitive performance in older adults. Am J

Geriatr Psychiatry. 2006 Dec;14(12):1032-40.

7. Lotfi A, Abdel-Nasser AM, Hamdy A, Omran AA, El-Rehany MA. Hypovitaminosis D

in female patients with chronic low back pain. Clin Rheumatol. 2007 Mar 22;

[Epub ahead of print].

8. Pérez-López FR. Vitamin D and its implications for musculoskeletal health in

women: An update. Maturitas. 2007 Jun 28; [Epub ahead of print].

9. Przybelski RJ, Binkley NC. Is vitamin D important for preserving cognition? A

positive correlation of serum 25-hydroxyvitamin D concentration with cognitive

function. Arch Biochem Biophys. 2007 Apr 15;460(2):202-5.

10. Grant WB. An estimate of premature cancer mortality in the U.S. due to

inadequate doses of solar ultraviolet-B radiation. Cancer. 2002 Mar

15;94(6):1867-75.

11. Lappe J, Travers-Gustafson D, Davies K, Recker R, Heaney R. Vitamin D and

calcium supplementation reduces cancer risk: results of a randomized trial.

American Journal of Clinical Nutrition. June 8;85(6):1586-1591.

12. Ma Y, et al. Study presented at the 2007 centennial meeting of the American

Association for Cancer Research (AACR), April 14 to 18, 2007, Los Angeles.

13. Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF,

Giovannucci E. Epidemic influenza and vitamin D. Epidemiol Infect. 2006

Dec;134(6):1129-40.

14. Kurylowicz A, Bednarczuk T, Nauman J. [The influence of vitamin D deficiency

on cancers and autoimmune diseases development.] [Article in Polish] Endokrynol

Pol. 2007;58(2):140-152.

15. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, JM. Maternal

vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol

Metab. 2007 May 29; [Epub ahead of print].

16. Maghbooli Z, Hossein-Nezhad A, Karimi F, Shafaei AR, Larijani B. Correlation

between vitamin D(3) deficiency and insulin resistance in pregnancy. Diabetes

Metab Res Rev. 2007 Jul 2; [Epub ahead of print].

17. Parekh N, Chappell RJ, Millen AE, Albert DM, Mares JA. Association Between

Vitamin D and Age-Related Macular Degeneration in the Third National Health and

Nutrition Examination Survey, 1988 Through 1994. Arch Ophthalmol. May 2007;125:

661-669.

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