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VITAMIN D AND
VITAMIN D
TOXICITY

+ VITAMIN D
Fat

soluble secosteroid.

Responsible

for the Intestinal


absorption of calcium and phosphate
in the form of ions
Humans:

Vit. D is unique due to


ingestion as cholecalciferol (Vit D3) or
ergocalciferol (Vit D2) & can be
synthesized by the body.
SUNSHINE

VITAMIN
Secosteroid

+ VITAMIN D
Vitamin
Although it is called a vitamin, it is
actually not essential.
Food contain very low levels of Vitamin
D.
The normal amount of Vitamin D
intake should be 15g (600IU) per day.
The suggested Tolerable Uppper Intake
Level (UL) is safe up till 250g
(10,000IU) per day for healthy adults.

+ VITAMIN D
Stored in the body as calcidiollarge
volume of distribution and a 25-29 day
half-life.
Liver: Vitamin Dcalcidiolmeasured
in serum.
Kidneys:
Calcidiolcalcitriolbiologically active
form of Vitamin D

+ VITAMIN D
Calcitriol circulates in the blood as a
hormoneregulates the concentration
of calcium and phosphate in the
bloodstream and promoting the
healthy growth and remodeling of
bone.
Outside Kidneys: Calcidiolcalcitriol
proliferation, differentiation and
apoptosis of cells and neuromuscular
function and inflammation.

+ VITAMIN D

Calcitriol cancer cell death.


Vit D was discovered rickets, the
childhood form of osteomalacia.

+ VITAMIN D

CHEMICAL
vs.
NATURAL

+ VITAMIN D
CHEMICAL vs. NATURAL
Excessive exposure to sunlightno
risk in Vitamin D toxicity
cholecalciferolregulates Vitamin D
production.
This Process depends on the amount
of melanin in a persons skin.
Melanin hinders the synthesis of
vitamin D.
An endogenous production is
tantamount to and oral dosage of
250g~625g per day.

Oral supplements and the Endogenous


+
VITAMIN
D different
synthesis
of Vitamin D have
effects on the transport form of
Vitamin D (plasma calciferdiol)
concentrations.
Endogenous synthesisVitamin
D3 travels with Vitamin D
binding proteins (DBP)slow
hepatic delivery of vitamin D
and low availability in the
plasma.
Orally administeredfater
hepatic delivery of vitamin D
and increase in plasma
calcifediol.

+ VITAMIN D
Because the amount of melanin differs
per person and annual UV varies from
each day of the year due to climate,
weather, disasters, etc., the IOM has
not yet defined a specific RDA of
Vitamin D.

+ DEFICIENCY
Osteomalacia or Rickets
Low calcium and phosphorus levels
Low serum vitamin D levels
Low bone mineral density
Ricketsbabies
Those who eat meat, fish and eggs
and low intake of cereals are more
prone to this.

+ DEFICIENCY
Cardiovascular Disease
25-hydroxyvitaminD(calcidiol) and
1,25-hydroxyvitaminD(calcitriol) are 2
important factors in Vitamin D levels in
the body.
Low levels renal disease, or kidney
disease.
Low calcidioldiabetes and
hypertensionelevated mortality
Lower calcidiol levels CV disease and
myocardial infarctionsheart attack.

+ DEFICIENCY
Heart attack is caused by a blockage of
the coronary artery(ies)bring blood
and 0xygen to the heart.
Vitamin D regulates the reninangiotensin aldosterone system and
exerts cardioprotection through this
action.
Ex. Against left ventricular
hypertrophyActivated vitamin D
therapy prevents the progression of
cardiac hypertrophythickening of
ventricular walls caused by
hypertension.

+ DEFICIENCY
How can it be counteracted?
Vitamin Dproduced by the skin when
it is exposed to UV light.
Vitamin Dstaple foods1,25-(OH)2D.
Supplementation with vitamin D and
calcium bone density.
Adequate amounts of Vitamin D to
reduce the effects of cancer,
osteomalacia, osteoporosis, heart
disease and many more.

+ FOOD RICH IN
VITAMIN D

+ FOOD RICH IN
VITAMIN D

+ FOOD RICH IN
VITAMIN D

+ FOOD RICH IN
VITAMIN D

Others include cod liver oil, tuna


canned in water, sardines canned in
oil, milk or yoghurt, beef or calf liver,
Egg Yolks, Cheese.

+ TOXICITY

Excess intake of Vitamin D


abnormally increases
Calciumhypercalcemia.
The symptoms a period of several
days to months.
Blood serum concentrations of
calcidiol Storage form becomes too
high causing adverse effects.
Overdose usually occurs at 1925g per
day (77,000g per day)
Acute overdose occurs at
15,000g~42,000g per day

+ TOXICITY
Intake of Vitamin D raises
calcitriol concentrations
Intake of vitamin D raises
plasma calcifediol
concentrations which exceed the
binding capacity of the DBP, and
free calcifediol enters the cell

+ TOXICITY
Intake of vitamin D raises the
concentration of vitamin D
metabolites which exceed DBP
binding capacity and free
calcitriol enters the cell
All in which affect gene transcription
and overwhelm the vitamin D signal
transduction process, leading to
vitamin D toxicity

+ TOXICITY
What are the diseases associated?
Hyperparathyroidism
Increase in the production of
PTHPhosphorus and Vitamin D levels
in the blood and bone.
hypercalcemia

+ TOXICITY
Hypercalcemia
Over calcification of the bones, soft
tissues, heart and kidneys. May damage
kidney and cause kidney stones.
Causes soft tissue calcificationdeposits
of calcium crystals in the heart, lungs,
and/or kidneys.
Prolonged hypercalcemia leads to
permanent damage.
Anorexia, nausea, vomiting to the point
that it can cause renal failure.

+ TOXICITY
Hypercalcuria
Excess calcium in the urine
Cardiovascular disease
Vitamin D(OD)vascular calcification
Increase in calcitriol dosageaortic
calcification
Hypervitaminosis D-state of vitamin D
toxicity
Symptoms: dehydration, vomiting,
decreased appetite, constipation,
fatigue and muscle weakness.

+ TOXICITY
How can it be counteracted?
Discontinuing the use of vitamin D
Low calcium Intake
Severe toxicitycorticosteroids and
bisphosphonates.
Kidney damage is irreversible.

+ TOXICITY
Sufficient amounts of calcitriol can
prevent hyperparathyroidism
calcificationparathyroid glands in the
neck produce too much parathyroid
hormonecontrols Phosphorus and
Vitamin D levels in the blood and bone.
The Body has a natural way of lowering
excess Vitamin D synthesized by the
body
Supplemental Vitamin D, however,
bypasses the natural metabolism of
vitamin D.

METABOLISM

Must undergo two hydroxylation


reactions to be activated in the body.
2 forms: D2 and D3

Click icon to add


picture

HYDROXYLATION REACTION
Chemical process that introduces a
hydroxyl group to an organic
compound.

Click icon to add


picture

METABOLISM

USES OF VITAMIN D

Messaging

Immunity

Bone formation

Maintenance

Abrorption of Calcium and


Phosphorus

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picture

Click icon to add


picture

METABOLISM

METABOLISM

METABOLISM

+ METABOLISM

http://courses.washington.e
du/bonephys/opvitD.html

+ REFERENCES

http://www.webmd.com/osteoporosis/features/
the-truth-about-vitamin-d-vitamin-d-foodsources
http://www.webmd.com/osteoporosis/features/
the-truth-about-vitamin-d-how-much-vitamind-do-you-need
http://www.webmd.com/osteoporosis/features/
the-truth-about-vitamin-d-can-you-get-toomuch-vitamin-d
http://www.webmd.com/osteoporosis/features/
the-truth-about-vitamin-d-what-kind-ofvitamin-d-is-best
http://www.webmd.com/osteoporosis/features/
the-truth-about-vitamin-d-drug-interactions

+ REFERENCES

Vieth, R.
Vitamin D supplementation, 25-hydroxyvitamin
D concentrations, and safety
. Am J Clin Nutr. 1999 May; 69 (5): 842-56.
Koutkia, P. Chen, T. C. Holick, M. F.
Vitamin D intoxication associated with an ove
r-the-counter supplement
. N Engl J Med. 2001 Jul 5; 345 (1): 66-7.
Los Angeles Times
Supplements guru sues over his own product.
2010/4/29;
Jones, G.
Pharmacokinetics of vitamin D toxicity. Am J
Clin Nutr. 2008 Aug; 88 (2): 582S-586S.
Heaney, R. P.
Vitamin D: criteria for safety and efficacy. Nutr
Rev. 2008 Oct; 66 (10 Suppl 2): S178-81.

+ REFERENCES
NIH Office of Dietary Supplements
Dietary Supplement Fact Sheet: Vitamin D.
2009/11/13;
Deluca, H. F. Prahl, J. M. Plum, L. A.
1,25-Dihydroxyvitamin D is not responsible for
toxicity caused by vitamin D or 25-hydroxyvit
amin D
. Arch Biochem Biophys. 2010 Oct 18;
http://www.news-medical.net/health/VitaminD-Overdose.aspx
http://www.news-medical.net/health/VitaminD-Deficiency.aspx
http://www.fao.org/docrep/004/Y2809E/y2809e
0e.htm

+ REFERENCES
Vieth, R.Vitamin D toxicity, policy, and science
. J Bone Miner Res. 2007 Dec; 22 Suppl 2V648.
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
http://www.webmd.com/osteoporosis/features/
the-truth-about-vitamin-d-how-can-you-getenough-vitamin-d
http://www.webmd.com/osteoporosis/features/
the-truth-about-vitamin-d-vitamin-d-tests
http://www.vitamindcouncil.org/about-vitamind/what-is-vitamin-d/vitamin-d-toxicity/