D

Vitamin
Miracle
Hormone
Than
ks
MMA

Dr. Arvind Ghongane

MD, FICP, FGSI

Story Time
1650 - F. Glisson -Described Rickets
1824 - D. Scheutte
Rickets Treatment - Cod Liver oil
Cause of Rickets

Elusive until 1928

1928 - Adolf Windaus - Nobel prizeDiscovered - D1, D2, D3

Rickets England Disease

Happy
Alert
Even
Teeth

Broad
Chest
Strong,
Straight
Legs

Treating options

Dr. Michael Holick

Father of Vitamin
D

THAN
KS
World Vitamin D Day - November 2, 2014

International Conference
on Vitamin D and
Health Outcomes was
held in the Emirates
Towers, Dubai on
November 21st 2014

India, being a Tropical

country,
is
blessed with plenty of
Sunshine

We have 2856 hours of sunlight per

year with, an average of 7.8 hours of
sunlight per day

Absence of vitamin-D
deficiency in the Indians
was probably due to their
exposure to sunshine
The
Lancet, 1973

197
3

200
3

We know that
TNN | Apr 16,
2010
Vitamin D3 is produced in the skin of
vertebrates after exposure to
ultraviolet B light from the sun!!!
Then,

Vitamin D paradox in plenty

Are Indians prone to have
sunshine India
An
emerging
hypovitaminosis D???
threat
8

Sunshine Vitamin
Vitamin D is a fat-soluble vitamin
Only vitamin produced in our body
Vit D is Stored in the fatty tissue
Every cell and Tissue has Vit D
Receptors
Active Vit D - A pre-hormone
60-80% Adults are Vit D deficient

The Sunshine way

10-15 minutes of sunshine 3
times a wk
Best time 11 am to 2 pm
Not in winter, not with pollution
To use sunscreen after a few
minutes
Skin pigment is a natural
sunscreen

Metabolism of Vitamin D

Functions of Vitamin D

Vit D and Calcium

What is New? - Vit D is a

Hormone

Steroid Hormone - 1,25(OH)2D

Made by skin from sun exposure
Activation by converting Enzyme
Acts on multiple parts of the body
Binds to specific receptor - 36 VDR
Affects other hormones directly

http://ajcn.nutrition.org/content/88/2/491S.l

Why Low Vit D - At risk

population
Breastfed infants need supplements
Older produce 1/3rd Vit D
Limited sun exposure, Sun screens
Darker skin pigments, Dress code
Malabsorption syndrome
Obese produce 50% Vit D

Seasonal variation of 25(OH)D

Need
Supplemen
ts

Cannell JJ, Vieth R, Umhau JC,et al. Epidemiol

Dietary Sources of Vitamin D

%
0
1
t
s
u
J

Dietary content of Vitamin D

Dietary
sources
Cod liver
oil

Servin
IU / serving
g
250 ml

100g
Mushrooms
Beef Liver
100g
Egg yolk
6g
Pink
100g
Salmon
Sardines
100g
Soy milk 250ml
F
Sun Light 15 min

For Total
Needs
400 ml
500 gm
4000 gm
75 Yolks

1,360
400
46
25

500 gm

530

1000 gm

231

5 lit
4 days a week

100
10 to

Fatty Fish for Vit D

Mackerel
Salmon

Cod

Tuna

You want it Vegetarian?

Shiitake
Mushroom
Oysters

Fortified Foods.

Only Possibility..

11 am to
2pm

Disease of Neglect

Holick, M. F., BMJ 2008; 336: 1318-1319

Vit D Deficiency iceberg

Rickets,
Osteomalacia
Influenza,
Tuberculosis,

T1DM, T2DM, Hypertension,

CAD, PVD, CHF Syndrome X,
Chronic Fatigue,
SAD, Depression, Cataracts,
Infertility, Eclampsia
Osteoporosis, Cancer,
Auto-immune - MS, RA, SLE,

25(OH)Vit D Levels (ng/ml)

Diabetes, Osteoporosis, HT, CVD
Cancer - Colon, Breast, Multiple
Sclerosis

Osteomalac
iaRickets

Deficient Insufficien Acceptabl

t
e
0

1
0
4
6
0Desired
0

2
0
8
0

Headache,
N/V

1. J Steroid Biochem Mol Biol. 2004 May;89-90(1-

3
0

Ideal

4
0

10
15
Exces
Intoxication
0
0
s
Nephrocalcinosis,
Pancreatitis

Rickets in Childhood

Delayed milestones
Delayed closure of ant.
fontanels
Delayed dentition
Deformities of bones
Decreased serum calcium

Osteoporosis

All Bones affected

Thin cortical bone, large
medullary cavity
Pains without trauma
HP Normal Bone with
Normal mineral to organic
bony elements
Generalized radiolucency
Normal Ca, P, Alk Po4

Osteomalacia

Spine, pelvis, lower Limbs

Adults, after closure of
epiphyseal plates
Fracture, bending of bones,
due to Increased softness
HP - Mineralization of
osteoid matrix is Impaired
Diffuse radiolucency
Low Ca, P, High Alk Po4

Non-Skeletal Manifestations

Muscular weakness, falls,

myalgias
Rheumatoid Arthritis, Crohns
Disease
Diabetes, Hypertension, CVD
Infections Tuberculosis, Flu
Cancers Breast, Colon,
Prostate
Psoriasis, Multiple sclerosis

Vitamin D and Diabetes

Metabolic syndrome association
Type 1 Diabetes, reduced by 80%
Vit D Deficiency Risk of T2DM
Type 2 Diabetes, reduced by 50%
Complications reduced with D3
Neuropathy pains reduced by Vit D
Arterial wall thickness Improved

Thus,
Vitamin D is considered
as Modifier for
Diabetes Risk
Vitamin D
Insufficiency is
suspected as a risk
factor for T2DM

Vit D & CVD

Vitamin D Deficiency
Insulin resistance
+
Beta Cell Dysfunction

Diabetes &
Metabolic
Syndrome

PTH

RAAS

Inflammation

Hypertension &
Hypertrophy

Atherosclerosis

Cardiovascular Events
J Am Coll Cardiol. 2008;52:19491956.

Vit D & Vascular Protection

Glucose Metabolism

Nephroprotection

Increased insulin secretion

Decreased inflammation

Increased insulin sensitivity

Antiproteinuric effect

Increased glucose uptake

Suppression of renin, AT II, AT 1R

Expression of insulin receptor

Decreased NF-B activation

Endothelial & CV Protection

Suppression of Renin Angiotensin System

Control of inflammation

Inhibition of smooth muscle cell Proliferation

Improves Lipid Profiles

Vitamin D and Cancer

Prevention
Roles in prevention of Cancers
Cancers, all combined, reduced by
75%
Breast Cancer, reduced by 50%
Ovarian Cancer, reduced by 25%
Colon Cancer, reduced by 67%
Non-Hodgkins, reduced by 30%
Kidney Cancer, reduced by 67%
Endometrial Cancer, reduced by 35%

How it prevents Cancer?

Promotes cellular differentiation

Decreases cancer cell growth
Stimulates cell deaths
http://www.vitamindsociety.org/benefits.php

Vitamin D Is Better than ANY Vaccine

Vitamin D increases
immune function 3
to 5 times Rx Viral
Diseases
Vitamin D Stimulate
production of
200potent antimicrobial peptides
Vitamin D Regulates
3,000 genes and
body functions

Vitamin D and Pregnancy

Vit D Improve Fertility
Reduces Vaginitis in first trimester
Reduces Risk of GDM, Preterm birth
Vitamin D receptors found in the
placenta
Pre-eclampsia reduced by 50%
Cesarean Section, reduced by 75%
De-Regil LM et al, Vitamin D supplementation for women during pregnancy.
Cochrane Database of Systematic Reviews, 2012, (2): CD008873. DOI:
10.1002/14651858.CD008873.pub2.

Possible Correlation with Vit D

Acute LRTI

Anaphylaxis

Anemia

Anxiety

Arthritis

Asthma

Atherosclerosis

Autism

Autoimmune dis

Bipolar dis

Brain damage

Breast-density

Chr. Fatigue

Chronic pain

Cognitive

Colds

Craniotabes

CRP levels

Crohns disease

Cystic fibrosis

Dental caries

Depression

Diabetes

Dyslexia

Eczema

Epilepsy

Falls

Fibromyalgia

Flu

Fractures

Headache

Hearing loss

Heart disease

High cholesterol

HIV/AIDS

Hypertension

Immune dysf

Infertility

Inflammation

IBD

Insomnia

Int. claudication

Kidney disease

Leprosy

Leukemia

Low back pain

Low birth weight

Lupus

Macular dege.

Melanoma

Meningitis

Metabolic
syndrome

Migraines

Myeloma

Myopathy

Myopia

Necrotizing
fasciitis

Neuroblastoma

Neuropathy

Muscle pain

Nursing risk

Obesity

Osteomalacia

Osteoporosis

Parasites

Parkinsons

PAD

Pneumonia

PCOD

Pre-eclampsia

Psoriasis

Retinoblastoma

Rickets

Schizophrenia

SAD

Septicemia

Stroke

Tuberculosis

Multiple sclerosis Muscle strength

How to Prescribe Vit D?

Clinical Suspicion or Blood
Report
Urgency of Correction
Select Tablet / Granules
Check the Dose of Vit D3
Additional Calcium need
Loading and Maintainance

D3 Better than D2
D3 is approximately 87% more
potent
D3 Produce 2 to 3 fold greater
storage
D3 is converted 500% faster
D2 has a shorter shelf life
D2 metabolites bind poorly with
proteins

Recommended Daily Allowance

Age

Infants

RDA of D3

400 1000
IU
Children 600 1000
IU
Adults
1500 2000
IU
Pregnan
2000
IOA and1500
Endocrine
Guidelines
t PracticeIU
Recommendations
Lactati
1500
ng
2000 IU

Indian

Safe
Limit

500 IU
500 IU 2000
IU
400 IU
4000
1000
IU
IU
10000
1000
IU
Indian Guidelines
IU
10000
JAPI Dr. Shashank
JoshiIU
10000
IU

Vit D3 Suppliments
Calcitriol & Alfacalcidol - More prone to
Hypercalcaemia

Vitamin
D Status

< 25 ng/ml

Cholecalciferol
60000 IU / wk
For 12 wks

Calcium +
Vit D3
1000-2000/d

25 50
ng/ml

Cholecalciferol
20000 IU / 2
wk For 12 wks

Calcium +
Vit D3
1000-2000/d

> 50 ng/ml

No
Supplements

Injectable Cholecalciferol Only for Malabsorption cases

Carry Home Messages..

Sunlight, 30 minutes/day
Good dietary calcium intake
Preventive use of sun screens
Fortification of infant foods
Supplement to lactating mothers
Outdoor activities for the elderly
Physical training to children
Avoid Caffeine, Cola, Alcohol
J Assoc Physicians India 2009 Jan;5740-48

Carry Home Lessons

Vitamin D is an essential
Hormone
Vitamin D Deficiency is very
common
Sunlight and Diet are not
sufficient
Supplementation is a Necessity
Supplementation is Success
Let us not miss this easy
approach

Thanks
All of You..