Get Your Vitamin D on!

Why should you get your vitamin D on?

Vitamin D is very important to our bodies for many reasons. Known as the “sunshine” vitamin, it promotes bone health, regulates insulin levels, supports lung and cardiovascular health, and is essential to our immune system, Our ability to properly mineralize bone depends on vitamin D to help absorb and retain calcium and phosphorus.

Over half of the general population and most infants are deficient in vitamin D, making it one of the most common medical conditions in the world. Symptoms of low vitamin D levels include bone pain and muscle weakness, increased pain sensitivity, mood issues, depression, frequent infections, sleepiness, and decreased endurance may mean that you have a deficiency. Stress fractures can also occur with low vitamin D levels. Learning disorders in children may be related to low vitamin D levels, as this hormone is important to brain development.

Actually a pro-hormone and not a vitamin, vitamin D has both anti-microbial and anti-inflammatory properties. While only about 10% of our vitamin D comes from food sources, it is fat-soluble and found in foods such as fatty fish, dairy products, and eggs. Vitamin D is primarily sourced from synthesis by the human skin when exposed to sunlight to form cholecalciferol, otherwise known as vitamin D3.

In the liver, vitamin D is hydroxylated to 25(OH)D, the main circulating vitamin D metabolite that is measured to assess vitamin D status. It is easy to get your vitamin D checked. It is a simple blood spot test that can be collected and sent from your home to a lab, or a serum blood test that can be collected by a lab. Standard reference ranges for vitamin D levels are 20-40 ng/ml, but functional practitioners generally regard 40-70 ng/ml as an optimal range.

Who should be tested? Well, everyone could benefit from testing, but some individuals should more than others, especially those individuals with vitamin D-related diseases (such as cancer, hypertension, diabetes, Parkinson’s, epilepsy, Alzheimer’s Disease (AD), Multiple Sclerosis (MS), Systemic Lupus Erythematosus), osteoporosis, elderly, overweight (BMI>25), lacking energy, having depression, supplementing with over 2000 IUs/day, living in northern latitudes, or having persistent, non-specific musculoskeletal pain. For children, a poor diet, and infants being exclusively breastfed are additional considerations. Individuals with medium to dark complexions, who do not get 20 minutes of direct sunlight per day may be at higher risk of vitamin D deficiency.

Through a better understanding of vitamin D and when to supplement, we can provide a very cost-effective strategy to improve health, reduce disease, and live longer. Why? Those who have vitamin D deficiency have twice the rate of death and double the risk for many diseases, such as cancer, cardiovascular disease, diabetes, asthma, and autoimmune diseases such as multiple sclerosis.

Immune System:

Lower levels of vitamin D may even play a role in the development of acute middle ear infections. A study demonstrated that supplementation may be beneficial in the presence of middle ear infections. [i]

Vitamin D has also been studied in asthma and has been found to offer some protection against severe asthma attacks in adults with mild to moderate asthma, although more research is needed before definitive clinical recommendations can be made.[ii]

Newer research is showing a correlation between vitamin D levels, hospitalization, and recovery from viral infection.

Pregnancy:

For pregnancy, small for gestational age babies were associated with low maternal vitamin D levels. [iii] Low maternal vitamin D levels were also associated with an increased risk of gestational diabetes. [iv]

Chronic Disease:

There is a strong inverse (opposite) correlation between vitamin D with a higher risk for many types of cancer: bladder, breast, cervical, colon, endometrial, esophageal, gastric, lung, ovarian, pancreatic, rectal, renal, and vulvar cancer; and Hodgkin’s and non-Hodgkin’s lymphoma. Weaker evidence exists for nine other types of cancer: brain, gallbladder, laryngeal, oral/pharyngeal, prostate, and thyroid cancer; leukemia; melanoma; and multiple myeloma.[v] A high level of circulating 25(OH)D (vitamin D) is also associated with a decreased thyroid cancer risk.[vi] Other studies have supported that vitamin D levels are inversely correlated with the risk of lung cancer.[vii] There are also recent findings that a highly significant linear dose-response relationship between vitamin D levels and overall survival in patients with breast cancer.[viii]

Vitamin D levels are often low in people with inflammatory bowel disease. They have Intestinal flora imbalance, excessive inflammatory response, and injury of the intestinal mucosal barrier. Vitamin D can induce and maintain IBD remission decreasing inflammation, restoring flora balance, and repair of intestinal mucosal barriers. [ix]

While available data shows that vitamin D deficiency may be associated with an increased risk of developing AD and dementia, the association needs to be confirmed by prospective cohort studies. [x]

Vitamin D Supplementation:

Vitamin D is best obtained through the sun. Sun exposure on bare skin (with no sunscreen) for 5-10 minutes 2-3 times per week can provide adequate stores, however, it can break down quickly, especially in winter months.

Vitamin D is a useful treatment for atopic dermatitis due to the low levels in this population and is particularly important in children. [xi] It has also been shown to be a useful treatment for ovarian polycystic disease, as well as to improve mental health, hormonal status, and reduce inflammatory and oxidative stress. [xii]

Recent studies show that vitamin D supplementation may be beneficial for heart failure. [xiii] Beneficial effects of vitamin D supplementation also were found to improve blood sugar control, HDL-cholesterol, and inflammation (CRP) levels among patients with cardiovascular disease, but not triglycerides or total- and LDL-cholesterol levels.[xiv]

Older adults may benefit from vitamin D supplementation to reduce the risk of depression. [xv]Providers of patients with osteoporosis, Alzheimer’s Disease, dementia, and depression should assess vitamin D status and the need for supplementation. One study showed that supplementation with vitamin D₃ reduced overall mortality significantly among older adults; however, before any widespread supplementation, further studies will be required to determine the optimal dose and duration and to reliably establish whether vitamin D₃ affects the mortality risk differently than vitamin D₂.[xvi]

Vitamin D supplementation is often recommended in preparations that include vitamin K to support the absorption of vitamin D as well as prevent toxicity from high doses of vitamin D that can also result in high calcium levels (hypercalcemia). This combination is thought to improve both bone and heart health. Vitamin K activates the MGP (matrix Gla-protein), a protein that helps direct calcium to the bone and lead calcium away from the arteries. The most widely used vitamin K form for supplementation is vitamin K₂ and more specifically menaquinone-4 and menaquinone-7.

Vitamin K primarily functions as a coenzyme to speed up a reaction for the synthesis of proteins involved in blood clotting and bone metabolism. Prothrombin, vital for blood coagulation, is vitamin K dependent.  So, if you have a condition where you need to reduce clotting and are on anticoagulants, such as Warfarin, you must avoid vitamin K supplementation. In addition, some research recommends caution be taken with long-term supplementation of vitamin D and calcium supplementation along with vitamin K deficiency, as this may increase calcification and cardiovascular disease, particularly in vitamin K antagonist users and other high-risk populations. [xvii]

Summary:

In summary, it is very important to make sure that you have adequate vitamin D levels to prevent disease and support your immune system, bone, and cardiovascular health. Keep in mind that your best source is the sun….in moderation…so, make sure you get your vitamin D on!

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[i] Li, HB, Tai, XH, Sang, YH, Jia,JP, Xu,ZM, Cui,XF, Dai,S. Association between vitamin D and development of otitis media. Medicine: October 2016 – Volume 95 – Issue 40 – p e4739. doi: 10.1097/MD.0000000000004739.

[ii] Martineau AR, Cates CJ, Urashima M, Jensen M, Griffiths AP, Nurmatov U, Sheikh A, Griffiths. Vitamin D for the management of asthma. Cochrane Systematic Review – Intervention Version published: 05 September 2016. https://doi.org/10.1002/14651858.CD011511.pub2.

[iii] Hu, Z., Tang, L., & Xu, H. L. (2018). Maternal Vitamin D Deficiency and the Risk of Small for Gestational Age: A Meta-analysis. Iranian journal of public health, 47(12), 1785–1795.

[iv] Amraei, M., Mohamadpour, S., Sayehmiri, K., Mousavi, S. F., Shirzadpour, E., & Moayeri, A. (2018). Effects of Vitamin D Deficiency on Incidence Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis. Frontiers in endocrinology, 9, 7. doi:10.3389/fendo.2018.00007.

[v]Grant, WB, Ecological Studies of the UVB–Vitamin D–Cancer Hypothesis. AntiCancer Research, 32: 223-236 (2012).

[vi] Hu M-J, Zhang Q, Liang L, Wang S-Y, Zheng X-C, Zhou M-M, Yang Y-W, Zhong Q, Huang F. Association between vitamin D deficiency and risk of thyroid cancer: a case-control study and a meta-analysis. J Endocrinol Invest. 2018 Feb 20. Epub 2018 Feb 20. PMID: 29464660

[vii] Wei, H., Jing, H., Wei, Q., Wei, G., & Heng, Z. (2018). Associations of the risk of lung cancer with serum 25-hydroxyvitamin D level and dietary vitamin D intake: A dose-response PRISMA meta-analysis. Medicine, 97(37), e12282. doi:10.1097/MD.0000000000012282.

[viii] Hu K, Callen DF, Li J, Zheng H. Circulating Vitamin D and Overall Survival in Breast Cancer Patients: A Dose-Response Meta-Analysis of Cohort Studies. Integr Cancer Ther. 2017 May 1:1534735417712007. Epub 2017 May 1. PMID: 28589744.

[ix] Li, J., Chen, N., Wang, D., Zhang, J., & Gong, X. (2018). Efficacy of vitamin D in treatment of inflammatory bowel disease: A meta-analysis. Medicine, 97(46), e12662. doi:10.1097/MD.0000000000012662.

[x] Shen, L., & Ji, H. F. (2015). Vitamin D deficiency is associated with increased risk of Alzheimer’s disease and dementia: evidence from meta-analysis. Nutrition journal, 14, 76. doi:10.1186/s12937-015-0063-7

[xi] Hattangdi-Haridas SR,Susan A Lanham-New SA, Sang Wong WH ²,Kung Ho MH, Darling AL.^, Vitamin D Deficiency and Effects of Vitamin D Supplementation on Disease Severity in Patients with Atopic Dermatitis: A Systematic Review and Meta-Analysis in Adults and Children. Nutrients 2019, 11(8), 1854; https://doi.org/10.3390/nu11081854.

[xii] Ostadmohammadi V, Jamilian M, Bahmani F, Asemi Z. Vitamin D and probiotic co-supplementation affects mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome. J Ovarian Res. 2019 Jan 21 ;12(1):5. Epub 2019 Jan 21. PMID: 30665436

[xiii] Wang C, Wang H, Cai L. Efficacy of Vitamin D on Chronic Heart Failure Among Adults. Int J Vitam Nutr Res. 2019 Apr 16:1-10. Epub 2019 Apr 16. PMID: 30987550

[xiv] Ostadmohammadi V, Milajerdi A, Ghayour-Mobarhan M, Ferns G, Taghizadeh M, Badehnoosh B, Mirzaei H, Asemi Z. The effects of vitamin D supplementation on glycemic control, lipid profiles and C-reactive protein among patients with cardiovascular disease: a systematic review and meta-analysis of randomized controlled trials. Curr Pharm Des. 2019 Mar 8. Epub 2019 Mar 8. PMID: 30854952

[xv] Li H, Sun D, Wang A, Pan H, Feng W, Ng CH, Ungvari GS, Tao L, Li X, Wang W, Tao Y-T Xiang, Guo X. Serum 25-Hydroxyvitamin D Levels and Depression in Older Adults: A Dose-Response Meta-Analysis of Prospective Cohort Studies. Am J Geriatr Psychiatry. 2019 Jun 5. Epub 2019 Jun 5. PMID: 31262683.

[xvi] Chowdhury, R, Kunutsor S, Vitezova A, Oliver-Williams C, Chowdhury, S, Kiefte-de-Jong JC,  Khan, H, Baena CP, Prabhakaran, D, et. al.  Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1903 (Published 01 April 2014).

[xvii] van Ballegooijen, A. J., Pilz, S., Tomaschitz, A., Grübler, M. R., & Verheyen, N. (2017). The Synergistic Interplay between Vitamins D and K for Bone and Cardiovascular Health: A Narrative Review. International journal of endocrinology, 2017, 7454376. doi:10.1155/2017/7454376.

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