Vitamin D and Health “Sunshine and Smiles Cost Nothing” (and if that doesn’t work Vitamin D3 supplements cost pennies)
What Is Vitamin D? •
Vitamin D is … not really a Vitamin - it is a steroidal hormone – it acts on over 200 genes in the human body.
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The majority of our Vitamin D is made in our skin when UVb rays convert a form of cholesterol into “Vitamin D”.
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Vitamin D regulates your immune system and other body systems in many ways.
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Vitamin D deficiency is involved in Cancer, Diabetes types I & II, Heart Disease, Autoimmune Diseases (Arthritis, MS, etc), Allergies, Autism, Viral infections (hence the “flu season” in late winter when Vitamin D blood levels are lowest), SAD (Seasonal affective disorder), Schizophrenia and depression.
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People of colour need more sun exposure to achieve healthy levels.
What’s the big issue? • There is an “endemic” deficiency of “Vitamin D” in countries with modern living conditions - and this deficiency is worse the further from the equator you live. • Up to 90% of British people of colour and 70% of white British people are clinically short of “Vitamin D” Sources: various studies.
The Enclosure Movement And Slavery • “The enclosure movement probably peaked from 1760 to 1832; by the latter date it had essentially completed the destruction of the medieval peasant community …” • “The Slave Trade Act was passed by the British Parliament on 25 March 1807, making the slave trade illegal throughout the British Empire, Wilberforce also campaigned for abolition of slavery in British Empire, which he lived to see in the Slavery Abolition Act 1833.” Source: Wikipedia
(The Problem of) Modern Living
“Revealed: the pill that prevents cancer” – The Independent (OLD NEWS !!!!) “A daily dose of vitamin D could cut the risk of cancers of the breast, colon and ovary by up to a half, a 40-year review of research has found. The evidence for the protective effect of the "sunshine vitamin" is so overwhelming that urgent action must be taken by public health authorities to boost blood levels, say cancer specialists.” • Source: Independent Newspaper, By Jeremy Laurance, Health Editor, Wednesday, 28 December 2005
What your Doctor knows • “Ask your doctor what a Normal Vitamin D Level is and, likely, he won’t even know the right name of the Vitamin D blood test to look up to find the answer”. • Source: http://www.easy-immune-health.com
“…We had been using a wrong statistical approach for defining ‘normal (Vitamin D) levels’.” •
There has been a poor consensus in defining normal levels of (Vitamin D).
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Serum levels above 18-20 ng/ml are usually considered normal
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A more functional classification has recently been proposed defining serum 25(OH)D levels > 40 ng/ml or > 100 nmol/l as "desirable“
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These new cut-off levels, suggest that, in the past, we had been using a wrong statistical approach for defining "normal serum 25(OH)D levels".
Source: “Review of the concept of vitamin D "sufficiency and insufficiency" Nefrologia. 2003;23 Suppl 2:73-7. (Spanish)
Public Health is best served by a recommendation of higher daily intakes of vitamin D. • • • • • •
Supplemental intake of 400 IU vitamin D/d has only a modest effect on blood concentrations of 25(OH)D, raising them by 7–12 nmol/L, depending on the starting point. To raise 25(OH)D from 50 to 80 nmol/L requires an additional intake of {approx}1700 IU vitamin D. Safety is the first priority when giving advice to increase supplementation or fortification with any nutrient. A recent review in this Journal (concluded that) the UL for vitamin D consumption by adults should be 10 000 IU/d. This indicates that the margin of safety for vitamin D consumption for adults is >10 times any current recommended intakes. The balance of the evidence leads to the conclusion that the public health is best served by a recommendation of higher daily intakes of vitamin D.
Source: see next slide
Source: American Journal of Clinical Nutrition, Vol. 85, No. 3, 649-650, March 2007 •
From the Departments of Nutritional Sciences and of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada (RV); the Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada (RV); the Department of Nutrition, Harvard School of Public Health, Boston, MA (HB-F and WCW); the Department of Rheumatology and the Institute of Physical Medicine, University Hospital Zurich, Zurich, Switzerland (HB-F); the Department of Epidemiology and the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA (WCW); the Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (BD-H); the School of Population Health, University of Auckland, Auckland, New Zealand (RS); the Vitamin D Laboratory, Section of Endocrinology, Nutrition and Diabetes, Department of Medicine, Boston University School of Medicine, Boston, MA (MFH); the Departments of Pediatrics, Biochemistry, and Molecular Biology, Medical University of South Carolina, Charleston, SC (BWH); the Department of Family and Preventive Medicine, University of California and the San Diego Naval Health Research Center, San Diego, CA (CFG); Creighton University, Omaha, NE (RPH); the Division of Biomedical Sciences, Department of Biochemistry, University of California–Riverside, CA (AWN); the College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada (SJW); the Department of Cardio-Thoracic Surgery, Heart Center North-Rhine Westfalia, Ruhr University of Bochum, Bad Oeynhausen, Germany (AZ); The Centre for Diabetes and Metabolic Medicine, Queen Mary School of Medicine and Dentistry, University of London, London, United Kingdom (BJB); the Queensland Centre for Schizophrenia Research, The Park Centre for Mental Health, Brisbane, Australia (JJM); the Department of Psychiatry, The University of Queensland, Brisbane, Australia (JJM); and the Department of Applied Chemistry and Microbiology, University of Helsinki, Helsinki, Finland (CL-A)
Vitamin D Status – No Need To Guess • "Vigilance of one’s vitamin D status by the yearly measurement of vitamin d 25 hydroxy level should be part of an annual physical examination." Source: Michael F. Holick, 'The Vitamin D Epidemic and its Health Consequences'
Joel M. Kauffman, Ph. D., professor of chemistry, University of the Sciences in Philadelphia •
Recommendations for optimum levels of serum 25-hydroxyvitamin D vary, but are generally rising as the lack of toxicity of vitamin D becomes more apparent and more studies are published.
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Areas beyond 50° N or S will often have a 6-month Vitamin D “winter.”
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Recommendations should be individualized and the results checked by 25hydroxyvitamin D assays. One size does not fit all.
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Optimum vitamin D levels are usually seen only in people exposed to intense sunlight on their bare skin,which leads to a serum 25hydroxyvitaminD level of 50-70 ng/mL.
Source: Journal of American Physicians and Surgeons Vol14 No 2
So Where Are We?
We are ALL above 50 degrees North of the Equator
What Can You Do? • • •
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See your doctor and request a 25(OH)D serum Vitamin D blood test. Find out where you are starting from. In the spring and summer ideally get regular exposure to the sun without sunscreen, building a natural tan whilst avoiding burning. This is the healthiest way to get “Vitamin D”. In the dark months to maintain a healthy level of “Vitamin D” or if you can not get sun exposure you will need to take a supplement. It will take time and a number of blood tests to establish what level of supplement you need, on a year round basis. The idea of a “Healthy” 25(OH)D level is changing rapidly as science catches up. Most expert opinions range around 60ng/ml or 150 nmol/L Your doctor may say your level is sufficient if it is > 20 ng/ml. This level stops bone disease but is far below the levels needed to gain the benefits of cancer reduction shown by the latest research. To gain this benefit a level > 40ng/ml is needed and 50 – 70 is optimal.
Summary • There is an endemic deficiency of Vitamin D in the UK and most “modern countries”. • This is worse for people of colour as skin pigmentation reduces Vitamin D production. • Year round steady and optimal Vitamin D levels are essential for good health. • These levels are around 50 – 70 ng/ml. • Your doctor probably knows less about Vitamin D than you today.
A note on measurements: ng/ml and nmol/L • If you have a 25(OH)D blood test the results may be reported in nmol/L. • Most scientific research and the optimal levels of circulating 25 Hydroxy-vitamin D now being proposed use measures of ng/ml. • To convert from ng/ml TO nmol/L x 2.5 • To convert from nmol/L to ng/ml x 0.4