The Sunshine Hormone

This page is intended for informational purposes ony. It is not my intent to make any type of recommendations. I am sharing information with colleagues which I learned from a conference on Vitamin D presented primarily for physicians. Vitamin D is actually a steroid hormone, it is important that supplementation is monitored by a physician. A simple blood test can identify Vitman D levels and supplementation can be done accordingly.

My interest in vitamin D comes from working with folks with osteoporosis and the association between vitamin D deficiency and low bone mass. It is speculated that some people diagnosed with osteoporosis actually have osteomalacia and taking osteoporosis drugs may be to the detriment of the patient as these drugs do not treat the root cause. Osteomalacia - better known as adult rickets - is caused by vitamin D deficiency and in these patients what is needed is vitamin D supplementation.The dexa scan used to diagnose osteoporosis cannot differentiate between osteomalacia and osteoporosis.

A vast majority of our cells have vitamin D receptors which has a significant impact on what physical therapists are trying to achieve when helping a patient regain strength and functional mobility. The following two diagrams show a remarkable improvement in function achieved by supplementation with vitamin D alone:


Timed sit to stand test
Bischoff-Ferrari, H. American Journal of Clinical Nutrition, September 2004; vol 80: pp 752-758


Timed 8 foot walk test
Bischoff-Ferrari, H. American Journal of Clinical Nutrition, September 2004; vol 80: pp 752-758

Full article here: Am J Clin Nutr 2004;80:752– 8.

Notes from Vit. D conference
90% of all individuals are Vit. D deficient - all ages

Vitamin D is actually a hormone - or more accurately a prohormone

the upper limit of 2,000 IU is erroneous.

A single MED of UVB radiation (about 10 minutes exposed to a midsummer noon day sun) to a light skinned individual will release approximately 10,000 IU Vitamin D3 into the circulation within 24 hours. Dark skin may require 10 times amount of exposure.

D2 - ergocalciferol is less potent(about 30% as effective) than D3 - cholecalciferol.
Your body cannot make too much Vitamin D by sun exposure, there is a built in control mechanism.

Head, neck and arm exposure not enough. Trunk and leg exposure more effective.

Need at least 80nmol/L serum 25(oh)D. Which is at the low end of normal. Optimum levels are 125 nmol/L or 50ng/ml - (55ng/ml for cancer prevention)

1000 IU daily increases serum 25-OH vitamin D by about 10 ng/ml
Armas LA, Hollis BW, Heaney RP. J Clin Endocrinol Metab. 2004;89:5387-91.

No case of hypercalcemia with doses of <10,000 IU daily
Tolerable Upper Intake Level (UL) for vitamin D3 revised to 10,000 (250 ugm) IU daily
Hathcock JN, Shao A, Vieth R, Heaney R. Am J Clin Nutr. 2007;85:6-18

The exact long-term safe dose of vitamin D is not entirely known; all known cases of vitamin D toxicity with hypercalcemia have involved intake of or over 1,000 micrograms (40,000 IU)/day
Vieth R (1999). Am J Clin Nutr 69 (5): 842-56.

Increase in Vitamin D deficient disorders coincides with recommendation to avoid sun exposure. Sun exposure has no relation to lethal cancer incidence. There is a direct correlation between sun exposure and prevention of lethal cancers. As distance from the equator increases, cancer incidence rises. An inverse correlation between cancer death rates and sunlight exposure has been found for the following cancers: breast, colon, rectum, prostate, stomach, bladder, non-hodgkins lymphoma, ovary, lung, pancreas, uterus, kidney, esophagus, multiple myeloma.
This has been known from early studies: 1941 Apperly - Cancer mortality higher in northern than in southern states. 1989 Garland - Colon cancer mortality higher in northeastern US than in southern states.
Greater than 500 genes have VDRE's(Vitamin D Response Element) - maintenance of "normal" serum levels of 25(oh)D will reduce risk of malignant transformation in tissues that use this system.

Further research needs to be done to substantiate the correlation between the below listed disorders/disease. Some have a very strong correlation due to the amount of research others are not conclusive.


Vitamin D deficiency related to:
Childhood disorders- autism, asthma, diabetes
influenza - evidence shows high levels of Vit. D can even kill the TB virus as well
osteoporosis
osteomalacia
autoimmune illness
chronic pain
depression
diabetes
heart disease
hyperparathyroidism
hypertension
myopathy
fibromyalgia
chronic fatigue
seasonal affective disorder
muscle weakness
muscle pain
cancer - such as breast, prostate, colon, kidney, lung, stomach, non-Hodgkin's lymphoma and other internal cancers.
multiple sclerosis
crohns disease
schizophrenia
depression

Higher 25(OH)D levels are associated with better lower extremity function in ambulatory women.
Timed sit to stand test used as a measure by Bischoff HA, et al. J Bone Miner Res. 2003; 18:343-351

216 patients 65 and older with previous stroke followed for 2 years. No falls if 25(OH)D >20 ng/ml, incidence of hip fractures increased as serum levels of 25(OH)D decreased. Sato Y et al. Stroke 2001;3261673-7

Study showed increase in dental health with 4,000 IU/day.

High doses eliminates colds and flus.

91% reduction in Multiple Sclerosis risk if serum 25(OH)D is > 100nmol/L

Vitamin D more important than calcium! Focus on Vitamin D deficiency - allows calcium supplement to be absorbed. Calcium absorption 65% greater with 25(OH)D values of 32 ng/ml vs 20 ng/ml. PTH values rise at levels below 30 ng/ml and are often above normal at levels <20ng/ml

The brain has Vit. D receptors - seasonal affective disorder - Studies show Vit. D subjects improved in all depression outcome measures.

"Low Mood & Worse Cognitive Performance in the Elderly" - Washington University School of Medicine, Alzheimer's Disease Research Center. Vit. D deficiency was associated with low mood & with impairment on 2 of 4 measures of cognitive performance.
Those with an active mood disorder had significantly lower Vit D concentrations than those without a mood disorder.

D3 enhances mood in healthy subjects - Allen TG, Psychopharmacology (1998) 135:319-323
Anxiety and depression in Fibromyalgia - Patients with Vit. D deficiency had higher HADS (Hospital and Anxiety Depression Score).

Low prenatal Vit. D risk factor for schizophrenia

Increase in Autism rates coincide with recommendations to avoid sun exposure. Vit. D deficiency coincides with risk of autism. http://www.vitamindcouncil.com/health/autism/ for detailed information. This is not valid evidence but suggests that it may play a role at least in some types of autism.

 

Speakers were:
Bruce W. Hollis, PhD - Professor of Pediatrics, Biochemistry and Molecular Biology,
Director of Pediatric Nutritional Sciences, Medical University of South Carolina, Charleston, SC. Considered world expert on Vitamin D, studied Vitamin D for 30 years and has 150 publications on Vitamin D.

Michael McClung, M.D., F.A.C.E., F.A.C.P.
Director of the Oregon Osteoporosis Center, Portland, OR

Neil Buist, M.D. - Professor emeritus, Departments of Pediatrics and Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR

John Cannell, M.D. - Psychiatrist - Atascadero State Hospital, Executive Director of Vitamin D Council, Atascadero, CA

Joan Lappe, R.N., Ph.D., F.A.A.N. Professor of Medicine, endowed Chair in nursing, Creighton University Medical Center, Omaha, NE irst to report the effects of vitamin D on all cancer incidences.

Downloads from the conference as well as a few others:

New article added 237Kb - Diagnosis and Treatment of Vitamin D Deficiency

8.1 Mb - PowerPoint presentation in pdf format by Bruce W. Hollis, PhD - Professor of Pediatrics, Biochemistry and Molecular Biology, Director of Pediatric Nutritional Sciences, Medical University of South Carolina, Charleston, SC. Considered world expert on Vitamin D, studied Vitamin D for 30 years and has 150 publications on Vitamin D

232Kb - Publication by Bruce W. Hollis

1.1Mb - PowerPoint presentation in pdf format by Michael McClung, M.D., F.A.C.E., F.A.C.P. Director of the Oregon Osteoporosis Center, Portland, OR

This is recommended reading unfortunately I cannot post my copy, it must be purchased. Vitamin D Deficiency, Michael F. Holick, M.D., Ph.D. N Engl J Med 2007;357:266-81.

912Kb - Vitamin D deficiency as a cause for increased autism rates by J. Cannell, MD

532Kb - CME The Clinical Importance Of Vitamin D (Cholecalciferol): A Paradigm Shift With Implications For All Healthcare Providers

62Mb - PowerPoint lecture on Rickets by Neil Buist, M.D. - Professor emeritus, Departments of Pediatrics and Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR

2.58 Mb - Vitamin D newsletter for physicians UPDATED 03-13-2008

70Kb - Lecture on nutrition by Cindy Reuter, R.D., N.D., L.Ac.- Registered Dietitian, naturopathic Physician, Providence Integrative Medicine Program, Portland, OR

1.6 Mb Vitamin D Finds Its Place In The Sun; Evidence for Cancer Prevention by Joan Lappe, R.N., Ph.D., F.A.A.N.   Professor of Medicine, endowed Chair in nursing, Creighton University Medical Center, Omaha, NE   First to report the effects of vitamin D on all cancer incidences.

Two Articles regarding Vitamin D and high blood pressure by the American Heart Association:

Vitamin D Intake and Risk of Incident Hypertension: Results From Three Large Prospective Cohort Studies

Plasma 25-Hydroxyvitamin D Levels and Risk of Incident Hypertension