Vitamin D

Deficiency in Scotland

80% of Scottish Population Vitamin D deficient Many diseases linked to low vitamin D

Rickets - osteomalacia - muscle weakness depression - dementia - infections - multiple sclerosis - osteoporosis - fractures - cancer prevention - cancer progression - diabetes cardio-vascular disease - falls - tuberculosis inflammatory bowel disease

Right to be informed

Helga Rhein GP Sighthill Health Centre Edinburgh February 2013

1. Vitamin D’s function 2. Deficiency 3. Scottish average levels 4. Linked diseases 5. Solutions

What is vitamin D?

Nutrient

produced in skin exposed to sun fish, supplements

Modern findings - last decade:

• transformation in the body in several steps into a powerful hormone (this is different from all other vitamins) • in addition to bone health:

immune system

insulin production , up- and down regulation of genes influence on cancer cells...

• vitamin D receptor in every organ • organs only in best running order if sufficient vitamin D • optimal levels around

4 times as much

or above

Normal natural blood levels of outdoor workers: around 120 nmol/l Barger-Lux, US, 120 nmol/l, 2002. Binkley, Hawaian surfers, 80 nmol/l 2007, Aydin, Turkish children, 180 nmol/l, 2010. Rajasree, Indian fishermen 270 nmol/l, 1999. Luxwolda, traditional living populations East Africa, 115 nmol/l 2012 Maximal calcium absorption: above 80-90 nmol/l Heaney, 2005

Normal Outdoor workers UK old guidelines

adequate blood level

120 nmol/l 25 nmol/l Most vitamin D experts Compromise WHO 2003, US Institute of Medicine 2010 100 nmol/l

50 nmol/l

as Edinburgh Royal Infirmary

Scotland’s levels?

7437 participants, aged 45 .

Hyppönen et al 2007 <40 nmol/L

Edinburgh University study:

84%

< 50 nmol/l

(Zgaga, 2011, - 2230 participants, Scotland-wide, aged 21-80)

Aberdeen

100%

< 50 nmol/l

(Macdonald et al, 2009, 338 post-menopausal women)

My practice:

70 %

(of 350 people tested by May 2011)

< 50 nmol/l

Scottish Problems:

Northern latitude 55º - 60º Clouds, Wind Clothes

INDOOR LIVING + WORKING

Sunscreen Avoidance of midday sun

Diseases linked to low levels

1. Rickets 2. Infections, pre-eclampsia, pre-term birth 3. MS, autism, schizophrenia....

Pooled analysis of observed/expected births in people with multiple sclerosis in Canadian, British, Danish, and Swedish studies (n=42 045) with 95% confidence intervals. MS Willer C J et al. BMJ 2005;330:120 ©2005 by British Medical Journal Publishing Group

MS Staples, 2010, BMJ Australia 1524 patients with MS born in Australia from a total population of 2,648,779

“Thus, there are now

innumerable

,

experimental, epidemiological, immunological, genetic and clinical

arguments in support of the notion that vitamin D insufficiency is one of the risk factors for MS.....” Pierrot-Deseilligny C, Souberbielle JC. Contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis published online 23 January 2013 Therapeutic Advances in Neurological Disorders

Many diseases linked to low vitamin D

Rickets - osteomalacia - muscle weakness depression - dementia - infections - multiple sclerosis - osteoporosis - fractures - cancer prevention - cancer progression - diabetes cardio-vascular disease - falls - tuberculosis inflammatory bowel disease ???

CVD

Vacec 2011, 10,899 patients normal (≥75 nmol/l) or deficient (<75 nmol/l).

“In conclusion, vitamin D deficiency was associated with a significant risk of cardiovascular disease and reduced survival.

Vitamin D supplementation was significantly associated with better survival, specifically in patients with documented deficiency.”

Cancer

Jenar et al. BMJ 2010: 520 000 participants from 10 western European countries 1248 cases of incident colorectal cancer and 1248 controls

“.....patients in the highest quintile had a 40% lower risk of colorectal cancer than did those in the lowest quintile”

Cancer

Lappe 2009: approx 1000 white women, good baseline vit D levels, supplemented with either a modest amount of vit D, or Calcium + same amount Vit D, or placebo Kaplan –Meier survival curves (ie, free of cancer) for the3 random treatment groups in the cohort of women free of cancerat 1 year of intervention (N 1/4 1,085). Sample sizes are 266 for placebo,416 for calcium only, and 403 for calcium plus vitamin D. The survivalat the end of study for the Ca+D group is significantly higher than thatfor placebo, by logistic regression. (Copyright Robert P. Heaney, 2006)

Cancer

Hepatogastroenterology.

2013 Jan 9;60(126). doi: 10.5754/hge121003. [Epub ahead of print]

Tumor-suppressive effects of 1,25 dihydroxyvitamin D3 in gastric cancer cells.

Bao A , Li Y , Tong Y , Zh eng H , Wu W , Wei C .

Ab stract

It has been pr eviously demo nstrat ed th at vitamin D acts as a prognostic indicator of gastric cancer and may be correlated with the incidence risk of gastric cancer. However, the effect of 1,25-dihydroxyvitamin D3 on the apoptosis of human gastric cancer cells is unclear. The aim of this study was to determine whether 1,25 dihydroxyvitamin D3 induced the cellular apoptosis of BGC-823 gastric cancer cells and to determine the potential mechanism of action. We demonstrate that 1,25-dihydroxyvitamin D3 induced the apoptosis of gastric cancer cells via the processing of PARP and cleavage of caspase 3. Additionally, an increase in BAX expression and a decrease in ERK1/2 and AKT phosphorylation were associated with 1,25-dihydroxyvitamin D3-induced apoptosis. The mRNA expression levels of VDR, CYP24A1, and p21 were increased significantly following 1,25-dihydroxyvitamin D3 treatment. These findings suggest that 1,25 dihydroxyvitamin D3 exerts tumor-suppressive effects on BGC-823 human gastric cancer cells.

Cancer

Mental Health

May 2010: 7,358 Cardio-vascular patients. Lowest levels, below 37 nmol/l were nearly 3 times more likely to develop

depression

compared to highest levels of above 125 nmol/l.

Mental Health

7,401 participants UK aged 45 5 years later higher vitamin D = less risk of depression

Maddock J et al.Vitamin D and common mental disorders in mid-life: cross sectional and prospective findings.Clinical Nutrition, Jan 2013

Mental Health

Randomised controlled trial:

Jorde 2008: Effects of vitamin D supplementation on symptoms of

depression

in overweight and obese subjects.

In the two groups given vitamin D, but not in the placebo group, there was a

significant improvement

in BDI scores after 1 year.

Systematic review:

Anglin R et al . 2013. Vitamin D deficiency and depression in adults.

Twice as likely to be depressed if vitamin D low.

Mental Health

Umhau, 2013: Of 500

suicides

in US military service members :

those with lowest vit D <37 nmol/l - had highest risk

“It may be that in a young, sometimes aggressive population such as military, impulsivity plays more of a role than depression in risk for suicide...” Suicide rates: US: 12 per 100,000 (2010) England: 11 per 100,000 (2006) Scotland: 19.8 per 100,000 (2006) Scots aged 15-44 double the rate compared to English counterparts

Colds and flu

6789 participants UK 45-year olds July 2011 Berry et al, July 2011. Vitamin D status has a linear association with seasonal infections adults. British Journal of Nutrition and lung function in British

Colds and flu

“...vitamin D significantly reduces the respiratory tract infection ...” 10 mcg/day to 50 mcg/day

1/3 less colds, coughs, flus, pneumonia

Charan,, JC. et al. Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis. J Pharmacol Pharmacother. 2012 Oct-Dec; 3(4): 300 –303.

All cause mortality

Autier 2007 Meta-analysis of 18 randomised placebo controlled trials 57,000 participants 7.5 - 50 mcg daily

7% reduction in mortality

Bjelakovic 2011 Cochrane Systematic Review: 50 randomised placebo controlled trials 94,148 participants

6% reduction in mortality

20 - 30 % of Scottish people

severely deficient and symptomatic:

tired achy legs and back low mood frequent colds wait few months for improvement

•

Country starved of a nutrient.

•

Much greater importance than previously thought

•

Linked to all kinds of diseases Scottish ailments

: •

MS

•

Depression, suicides

•

Cancer incidence and mortality

•

Cardio-vascular disease

•

Total mortality

Vitamin D is

cheap and safe

.

What can we do?

information website: www.scots4vitd

What else can we do?

One day exposed in sunshine: 250 mcg

Ferguson installed tanning booths so United players could top up their Vitamin D levels

PUBLISHED: 08:56, 19 December 2012 | UPDATED: 13:41, 19 December 2012

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, M. Murad H, Weaver CM. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an

Endocrine Society Clinical Practice Guideline .

J Clin Endocrinol Metab, July

2011

, 96(7) 10 mcg to all babies, starting after birth 25 mcg for children aged 1 to 18 50 mcg for all adults over 18 50 mcg for pregnant women (25 mcg for pregnant women aged 14 -18)

‘10 mcg is not enough’ 10 mcg is sufficient for a baby but not for a 20 - 30 times heavier adult

In our practice on prescription to all:

Adults, Teenagers over 12:

weekly 500 mcg (= 20,000 IU)

Children aged 5 - 12:

daily 25 mcg (= 1,000 IU)

Children aged 0 - 5:

daily 10 mcg (= 400 IU)

Pregnant women:

daily 50 mcg (= 2,000 IU)

When living in Scotland:

take vitamin D

50 -100 mcg daily (Adults)

Read up on rare conditions when you should not take vitamin D or check with your doctor