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    Vitamin D3

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    Ambreen Amir
    Vitamin D3 deficiency is a global epidemic affecting over 50% of the population. Recent evidence shows health benefits occur at serum levels of 50 ng/mL or higher, indicating over 90% of people have insufficient levels. Vitamin D3 is produced in the skin upon sun exposure and plays an important role in calcium absorption and bone health. Deficiency can lead to musculoskeletal pain, increased fracture risk, and other chronic diseases. Pregnant women are also at high risk of deficiency, which can impact birth outcomes and infant health. Supplementation of 1000-4000 IU per day is generally safe and effective at improving vitamin D3 status.

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    Vitamin D3

    Uploaded by

    Ambreen Amir
    180 views29 pages
    Vitamin D3 deficiency is a global epidemic affecting over 50% of the population. Recent evidence shows health benefits occur at serum levels of 50 ng/mL or higher, indicating over 90% of people have insufficient levels. Vitamin D3 is produced in the skin upon sun exposure and plays an important role in calcium absorption and bone health. Deficiency can lead to musculoskeletal pain, increased fracture risk, and other chronic diseases. Pregnant women are also at high risk of deficiency, which can impact birth outcomes and infant health. Supplementation of 1000-4000 IU per day is generally safe and effective at improving vitamin D3 status.

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    Vitamin D3 deficiency is a global epidemic affecting over 50% of the population. Recent evidence shows health benefits occur at serum levels of 50 ng/mL or higher, indicating over 90% of people have insufficient levels. Vitamin D3 is produced in the skin upon sun exposure and plays an important role in calcium absorption and bone health. Deficiency can lead to musculoskeletal pain, increased fracture risk, and other chronic diseases. Pregnant women are also at high risk of deficiency, which can impact birth outcomes and infant health. Supplementation of 1000-4000 IU per day is generally safe and effective at improving vitamin D3 status.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    180 views29 pages

    Vitamin D3

    Uploaded by

    Ambreen Amir
    Vitamin D3 deficiency is a global epidemic affecting over 50% of the population. Recent evidence shows health benefits occur at serum levels of 50 ng/mL or higher, indicating over 90% of people have insufficient levels. Vitamin D3 is produced in the skin upon sun exposure and plays an important role in calcium absorption and bone health. Deficiency can lead to musculoskeletal pain, increased fracture risk, and other chronic diseases. Pregnant women are also at high risk of deficiency, which can impact birth outcomes and infant health. Supplementation of 1000-4000 IU per day is generally safe and effective at improving vitamin D3 status.

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    Vitamin D3

    Super Sun Vitamin

    Super Sun Vitamin

    Vitamin D3, a Silent Epidemic

    Vitamin D3, a Silent Epidemic


    Vitamin D3 deficiency is a world-wide epidemic, with recent estimates indicating greater than 50% of the global population at risk. Recent evidence reveals beneficial effects of vitamin D3 at serum levels around 50 ng/mL (125 nmol/L) or higher - effects not seen at levels below 40 ng/mL (120 nmol/L), indicating a need for upward revision of the deficiency reference threshold. The percentage of the population determined to be deficient(less than 50 ng/mL) would most-likely be closer to 90% or greater.

    What is Vitamin D3?


    Fat-soluble vitamin and serves as a hormone in the body.1 The only vitamin, human body makes itself. Vitamin D3 is naturally present in few selective foods, such as oily fish & in very low amount in cow's milk.

    Curr Opin Endocrinol Diabetes Obes. 2008;15:489494.

    Types of Vitamin D
    Vitamin D3 (Cholecalciferol) Produced in skin with direct sunlight UVB Preferred form of supplementation Vitamin D2 (Ergocalciferol) Found in plants Supplements

    Vitamin D3 Metabolism

    (Calcitriol: Active form of Vit D3)

    What affects vitamin D3 level?


    Time spent outdoors

    Age - 70 y/o produces 4 x less than 20 y/o


    Amount of skin exposed Skin color

    Clothing - Cultural Practices


    Body fat Latitude - > 37 in winter, Early and late hours

    Season and time of day


    Drugs - Anticonvulsants, corticosteroids, rifampicin

    Vitamin D3 Physiology
    Vitamin D3 (cholecalciferol) is formed in the skin from exposure to sunlight. Then it is converted in the liver to 25hydroxy-vitamin D (calcidiol, 25(OH)D3) by the enzyme vitamin D-25-hydroxylase. 25(OH)D3 then is transformed in the kidney to 1,25-dihydroxyvitamin D (calcitriol) by 25hydroxy-vitamin D3-1alpha-hydroxylase (1OHase).

    Vitamin D3 Status

    Vitamin D3 insufficiency, 25(OH)D levels <30ng/ml is prevalent, worldwide, especially in Middle East and South Asia.2

    J Am Coll Cardiol. 2008;52:19491956. Osteoporos Int. 2010 Jul;21(7):1151-4.

    Signs and symptoms of Vitamin D3 deficiency


    Musculoskeletal disorders

    Low back pain, joint pain


    Fatigue and Muscular Weakness Increased susceptibility to infections It thus adversely effects Quality of Life

    Vitamin D3 Deficiency Affects Quality of Life


    Immediate Quality of Life Future Quality of Life

    Muscle pain and weakness


    Osteomalacia (Adults)

    Osteoporosis & Fractures Other Chronic Disorders


    Diabetes type 1 & 2 Recurrent infections CVD & HTN

    Rickets (Children)

    Autoimmune Diseases
    Cancers

    RDA
    Calcium Life Stage Group Estimated Average Requirement (mg/day)
    * *

    Vitamin D3 Recommended Dietary Allowance (mg/day)


    1000 1500

    Upper Level Intake (mg/day)


    * *

    Estimated Average Requirem ent (IU/day)


    ** **

    Upper Level Intake (IU/day)


    ** **

    Recommended Dietary Allowance (IU/day)


    1000 1500

    Infants 0-6 months Infants 6-12 months

    1-3 years
    4-8 years 9-13 years 14-18 years 19-30 years 3150 years

    500
    800 1100 1100 800 800

    700
    1000 1300 1300 1000 1000

    2500
    2500 3000 3000 2500 2500

    400
    400 400 400 400 400

    600
    600 600 600 600 600

    2500
    3000 4000 4000 4000 4000

    5170 year, males


    5170 year, females >70 years 1418 years, pregnant/lactating 1950 years, pregnant/lactating

    800
    1,000 1,000 1,100 800

    1000
    1200 1200 1300 1000

    2000
    2000 2000 3000 2500

    400
    400 400 400 400

    600
    600 800 600 600

    4000
    4000 4000 4000 4000

    *For infants, Adequate Intake is 200 mg/day for 0 to 6 months of age and 260 mg/day for 6 to 12 months of age.

    **For infants, Adequate Intake is 400 IU/day for 0 to 6 months of age and 400 IU/day for 6 to 12 months of age.

    Functions of Vitamin D3

    Ca & Vitamin D3 Deficiency Causes Fractures

    Osteomalacia

    Osteoporosis

    Muscle Weakness

    Increases risk & Rate of Fall

    Increases risk of Fracture

    Over 90% of Fractures occur after fall and fall rate increases due to poor muscle strength and function.1 Adequate dose of Vitamin D found to be useful in reduction of persistent non specific pain & Fractures
    Medicographia. 2010;32(4):384-390

    Vitamin D3 Deficiency : Summary


    Vitamin D deficiency Calcium in the serum

    Muscle weakness

    Osteomalacia

    PTH Risk of falls Osteoblastic activity Osteoclastic activity

    calcium efflux from bone


    Risk of Fracture

    OSTEOPOROSIS

    Vitamin D3 supplementation in deficiency state


    Vitamin D Calcium in the serum Osteomalacia

    Muscle Strengthens

    PTH
    Risk of falls Osteoblastic activity Osteoclastic activity

    calcium efflux from bone Risk of Fracture

    OSTEOPOROSIS

    How Much Vitamin D3

    Supplementation?

    100 I.U./day of Vitamin D3 increases circulating 25(OH)D by 1 ng/ml when taken for 2 months If the typical serum 25 (OH)D level in is 10 ng/ml And if the target serum 25 (OH)D level is 30 ng/ml

    Patients would require about 2000 IU/Day or 60000 IU per month

    50-60% fractures can be reduced at ~30 ng/ml serum Vitamin D.1


    1. Alt Med Rev. 2008;13(1):21-33

    Vitamin D3 epidemic in pregnancy & lactation ?

    Vitamin D3 Epidemic in Pregnant & Lactating Women

    Pregnant women with low serum 25(OH)D levels had 46% higher risk of developing anemia.1

    1. Plos One2010;5(1):e8770

    Impact Vitamin D3 Epidemic on the health of Pregnant women


    Gestational Diabetes
    Presence of diabetes during pregnancy

    Pre-term birth
    More than 2 fold increase in risk of preterm birth

    Preeclampsia
    Development of hypertension in
    Pregancy (PIH) along with excretion of protein in urine (proteinuria).

    Maternal Mortality

    Prevalence of Osteomalacia
    Results in low back pain during pregnancy and post delivery

    1. Am J Obstet Gynecol 2010;202:429.e1-9.

    Impact of Vitamin D3 Epidemic in infants

    1. 2. 3. 4. 5. 6. 7. 8. 9.

    Congenital rickets Low birth weight Poor postnatal growth Neonatal Hypocalcemia Compromised Immunity : recurrent infections Perinatal Mortality Impaired brain development Type 1 diabetes in neonates Asthma

    How Much Vitamin D in Pregnancy & Lactation ?


    1000 IU/day is necessary to achieve 25(OH)D levels more than 20 ng/ml in pregnant women.1, 2

    Safety upper limit in Pregnancy & Lactation: 4000 IU/day

    1. Indian J Med Res. 2011;133:250-252 2. Clinical protocols & guidelines, 2009 3. Vitamin D by Michael H. Holick, II Ed. 2010

    Benefits of Vitamin D3
    The prenatal maternal nutritional requirement for vitamin D, that is, the amount required to elevate circulating 25(OH)D, will be substantially greater in darkly pigmented pregnant women due to limited cutaneous synthesis of vitamin D3.

    High-dose (2,000 or 4,000 IU/day) vitamin D supplementation of pregnant mothers will provide sufficient anti-rachitic activity to prevent hypovitaminosis D in the pregnant mother and her fetus, regardless of ethnicity and sunlight exposure of the subject. Further, this supplementation level will be safe and efficacious without any adverse side effects or health consequences in the mother or fetus.

    Vitamin D3 & Polycystic Ovarian Syndrome


    Small study of 13 PCOS pts
    9 of 13 w/ Vit D deficiency Ca 1500mg/day + Vitamin D3 50,000iu/week 9 of 9 pts with normalization of menses and/or fertility within 3 months
    Thys-Jacobs S. Steroids. 1999;64(6):430.

    Vitamin D3 & Pain


    Study with 150 pts with persistent, nonspecific musculoskeletal pain
    93% had Vit D3 deficiency
    Plotnikoff, Quigley. Mayo Clin Proc. 2003;78(12):1463.

    Children w/ limb pain improved in 3 months Low Back Pain


    83% of 299 LBP pts had Vit D3 def
    5000-10,000iu/day Decrease in pain medication in nearly 100% after 3 months
    Al Faraj, Al Mutairi. Spine 2003;28(2):177.

    Overview
    Vitamin D receptors found in gut, bone, brain, breast, prostate, lymphocytes, placenta, and other tissues Routine screening is appropriate Safe up to 4000iu/d without monitoring Safe up to 10,000iu/d with monitoring Supplementation helpful in:
    DM, metabolic syndrome, CAD, depression, autoimmune diseases, various cancers, HTN, osteoporosis, fall prevention, PCOS, pregnancy & lactation, periodontal disease, URI and influenza, and decreasing all-cause mortality

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