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Vitamin D: The Benefits and

risks
Madeline Daugherty, Jenna Shumar, Madison Schwerzler,
Madison DeBone, Samantha McKee, Abby Sekulich, Morgan
Ferguson
What do You Know About Vitamin D?
Take a minute and try the pretest to see what you know about
Vitamin D.

● What is it?
● Risks?
● Benefits?
● Sources?
What is vItamin D?
● Prohormone
● Referred to as calciferol,
the sunshine vitamin
● Required for musculoskeletal
health
● Two forms
○ D2- ergocalciferol
■ Man-made
○ D3- cholecalciferol
■ Synthesized in skin after
sunlight exposure, also
found in diet
Mechanisms of Vitamin D in the Body
● Vitamin D is obtained in two ways:
○ Sunlight
■ If in UVB range, will be absorbed
through skin
● Limitations
■ Triggers the conversion of 7-
dehydrocholesterol to Vitamin D3
■ Then absorbed into capillaries
■ Coupled with VDBP
○ Diet
■ Obtained as D2 or D3
■ Simple diffusion
■ Coupled in intestines with VDBP and
lipoproteins
Mechanism cont…
● After being obtained by either route:
○ Vitamin D is converted to Prohormone
25 (OH)D in liver
■ Circulating form of Vitamin D
that is bound to DBP
○ Distributed to placenta, kidney, or
into breast milk
○ After going to kidney..
■ Converted to calcitriol, active
metabolite
● Regulated by parathyroid
hormone
○ Once in active form, regulates
calcium and phosphorous levels
Vitamin D recommended intake
Where is the vitamin d in sunny d?
Sun intake
● UVB rays cause body to
produce Vitamin D3
Sulfate
■ Water soluble,
requires no carrier
● Limitations
○ Sunblock
○ Location
○ Clothing
● Tanning Beds
○ Do emit UVB light
○ Low pressure bed
○ Electronic ballast bed
Supplementation WITH D3
● Cholecalciferol
○ chemically similar to active form of
vitamin D in body
○ Isolated from cod liver oil and sheep
wool
■ Sheep wool is used more commonly
because of Vitamin A toxicity caused
by taking cod liver oil
○ Ingredients
■ Calcium carbonate, cellulose gel,
maltodextrin, stearic acid, acacia,
sugar, corn starch, magnesium
stearate
Supplementation with d2
● Ergocalciferol
● Isolated from yeast or
mushrooms after being
exposed to UV radiation
○ Ideal for vegans, as this is
plant based
● 10-24 hours before
metabolized by body
○ Differs from D3 in a double
bond and a methyl group
Centrum
Vitamin D Deficiency
● Symptoms
● What does it cause?
● For most adults this isn’t a concern,
however, people commonly at risk are people
who have inadequate sun exposure, limited
oral intake, or impaired intestinal
absorption.
Rickets
Causes:

● Vitamin D Deficiency
○ Sunlight
○ Food Sources
● Poor absorption of vitamin D
○ Celiac Disease
○ Inflammatory Bowel Disease
○ Cystic Fibrosis
○ Kidney Problems
Rickets
Risk Factors:

● Dark skin
● Vitamin D deficiency in pregnancy
● Northern areas (less sunlight)
● Premature birth
● Medications
○ Antiseizure and antiretroviral medications alter body’s ability to
use vitamin D
● Exclusive Breast Feeding
Rickets
Symptoms:

● Skeletal deformities
○ Bowed legs or knock knees
○ Thickened wrist and ankle
bones
○ Breastbone projection
● Spine, pelvis, and leg
pain
● Muscle weakness
● Delayed growth
Rickets
Treatment

● Vitamin D or calcium supplementation


● Bone deformity can be treated with bracing but severe cases may
require surgical repair

Complications if left untreated

● Abnormally curved spine, skeletal deformity, dental defects,


seizures
Rickets case study
● 9 month old presents to local
Boston hospital after a
seizure and days of nasal
congestion and diarrhea and
on exam had a bulging soft
spot.
● Why?
Osteomalacia
● A metabolic bone disorder distinguished by a
decrease in mineralization of newly formed osteoid
at sites of bone turnover
● Symptoms: generalized “bone” pain, muscle
weakness/decreased muscle tone, and gait
disturbances
● Higher frequency of fractures
● Not to be confused with osteoporosis
Osteomalacia
● Causes:
○ Vitamin D deficiency
○ Surgeries
○ Celiac disease
○ Kidney or liver disorders
○ Medications
● Treatment for osteomalacia generally involves the
replenishment of low levels of Vitamin D, as well as
treating the underlying disorder that caused said
deficiency.
Osteomalacia
Osteomalacia
● Patient- 34 y/o Japanese female
● Physical exam:
○ Relatively normal HR,
○ Temp
○ BP
○ RRR
○ Patient had generalized bone tenderness with indirect pain/referred
pain, bilateral symmetric proximal muscular weakness and a waddling
gait.
Osteomalacia
● Testing:
○ Lab work
○ Bone Mineral Density
○ Bone reabsorption, formation, and urinary type
● Diagnosis and Treatment:
○ The patient was diagnosed with Vitamin D deficiency,
○ The patient was treated with oral active Vitamin D (0.75 ug/day) and
calcium (1 g/day)
● Outcome:
○ After 12 months of treatment, the patient was pain free, with no
other associated symptoms.
WHAT IS THE DIFFERENCE? RICKETS VS. OSTEOMALACIA
● Rickets is generally a disease in
children, whereas osteomalacia
affects adults.
○ In children this occurs before the
epiphyseal plate closes; in adults this is
after.
Vitamin D Deficiency may also lead to:
● Dementia
● Prostate Cancer
● Erectile Dysfunction
● Schizophrenia
● Heart Disease
Dementia
● A 2014 study has shown that moderate to severe Vitamin D
Deficiency may double that risk for some forms of
Dementia- specifically Alzheimer’s disease
● Researchers believe that the Vitamin D received from
direct sunlight may help clear the plaques in the brain
that are linked to Dementia
● There are many Vitamin D receptors in brain tissue- when
they are activated this stimulates nerve growth in the
brain
Dementia: Preventions with the help of Vitamin D
● There is a threshold of circulating Vitamin D in which an
individual should receive a minimum of 50 nmol/L Vitamin
D in order to obtain healthy brain activity
● Sun Exposure
● Take supplements of Vitamin D3, rather than synthetic
Vitamin D2 in conjunction with Vitamin K2
Prostate Cancer
● A 2014 study has shown a link between low levels of
Vitamin D and higher risks of Prostate Cancer
● There are Vitamin D receptors found on the surface of a
cell, when Vitamin D binds to the receptors the chemical
signals that are released tell the cell to either divide
or terminate itself
● Increased levels of Vitamin D may cause a down regulation
of receptors which would limit the chances of a cancerous
cell binding to one of the receptors in the prostate
gland
Prostate Cancer: Preventions with the help of Vitamin D

● More sun exposure

● Vitamin D3 Supplementation
Erectile Dysfunction
● 2014 study (Journal of Sexual Medicine) found men with
severe erectile dysfunction (ED) had significantly lower
vitamin D levels than men with mild ED
● Men with Vitamin D deficiency have 30% greater prevalence
of ED and 80% greater prevalence of severe ED compared to
men with optimal levels of Vitamin D (Erin D. Michos, MD,
of Johns Hopkins University School of Medicine)
○ Case study measuring 25(OH)D levels
○ Serum levels lower among men with ED than without
Erectile Dysfunction: Possible Correlation to Deficiency
● Several mechanisms related to relationship between
vitamin D deficiency and ED
○ Mediated glucose metabolism
○ Reduced synthesis of nitric oxide
Schizophrenia
● Those who are vitamin D deficient are twice as likely to
be diagnosed with schizophrenia than those with
sufficient vitamin D levels
● Unsure of exact mechanism correlated between
Schizophrenia and Vitamin D deficiency
○ Vitamin D’s action on regulation of inflammatory immunological
processes
Schizophrenia: Possible Correlation to Deficiency
● Season of birth
○ Winter months
○ Exposed to lower levels of UV rays in prenatal periods
● Latitude
○ Higher latitude, increased rate of schizophrenia
● Skin pigmentation
○ Darker skinned, more melanin

***Estimated that individuals with darker complected skin at


higher latitudes are more likely to develop schizophrenia
Heart Disease
● Vitamin D deficiency linked to more severe cases of heart
disease (American College of Cardiology)
● Men deficient in vitamin D were twice as likely to have a
heart attack than men with adequate levels of vitamin D
(Health Professional Follow-Up Study)

● Low levels associated with higher risk of heart failure,


sudden cardiac death, stroke, and cardiovascular death

● Possible prevention through blood pressure and artery


damage
Heart Disease: Possible Correlation to Deficiency
● Mechanisms for how vitamin D protects individuals from
CVD has not been fully clarified but there are several
proposals:
○ Negatively regulating renin to lower blood pressure
○ Improving vascular compliance
○ Decreasing parathyroid hormone levels
○ Improving glycemic control
Discussion Question!
Break up into small groups and discuss this question:

Do you think that Vitamin D deficiency is the main factor for


these diseases or do you think other aspects in life are the
more prevalent reasons to have these diseases? (Lifestyle,
diet, exercise)
Does Vitamin D ACtually Help To Prevent These Diseases?
According to a study funded by the International Prevention
Research Institute, vitamin D supplements do not necessarily
prevent diseases, but deficiency may be a symptom of these
conditions. (The Lancet Diabetes and Endocrinology)

● Several reasons why the trials found no link between


vitamin D supplementation and disease prevention

http://www.nhs.uk/news/2013/12december/pages/study-questions-role-of-vitamin-d-in-disease.aspx
ADDITIONAL Studies
Vitamin D Supplementation and Total Mortality: A Meta-analysis of Randomized
Controlled Trials.

● Systematic review of 18 independent randomized controlled studies with 57,311


patients
● What is the correlation between vitamin D supplementation and total mortality?
● Intake of ordinary doses of vitamin D supplements seems to be associated with
decreases in total mortality rates.
● “The relationship between baseline vitamin D status, dose of vitamin D supplements,
and total mortality rates remains to be investigated. Population-based, placebo-
controlled randomized trials with total mortality as the main end point should be
organized for confirming these findings.”
What Happens When You Take Too Much
Vitamin D?
● Vitamin D Toxicity
○ Can cause symptoms including: anorexia, weight loss, polyuria, heart
arrhythmias
○ More serious symptoms: raise blood levels of calcium which leads to
vascular and tissue calcification
○ Excessive sun exposure DOES NOT result in toxicity
○ Unlikely for intakes from food to cause toxicity
● Long-term Supplementation
○ Intakes above the UL increase risk of adverse health effects
○ Most suggest toxicity threshold of 10,000 to 40,000 IU/day
■ Greater risk of cancer (pancreas), cardiovascular issues, and
more falls and fractures (elderly)
What Happens When You Take Too Much Vitamin D?
Risk: Vitamin D can interact with Other Medications
● Steroids
○ prednisone
● Weight Loss Drugs
○ orlistat, Xenical, alli
● Cholesterol-lowering Drugs
○ cholestyramine, Questran,
LoCholest, Prevalite
Risk: Vitamin D can interact with Other Medications
● Medications to prevent/control epileptic seizures
○ phenobarbital, phenytoin, Dilantin

● Medications that increase Vitamin D levels in the blood


○ Estrogen (Hormone Replacement Therapy), Isoniazid (treat
tuberculosis), Thiazide (Diuretic)

● Medications that decrease Vitamin D levels in the blood


○ Antacids, Calcium Channel Blockers (Verapamil), and Mineral oils
Benefits on AutoImmune disease-
● Interesting fact:
○ Tuberculous patients were treated by
exposure to the sun and cod liver oil (high in
Vitamin D)
● VDRs located on the nuclei of all
immune cells
● Innate immune response:
○ Binds TLR (toll like receptors)
○ Cascade produces: cathelicidin and beta
defensin 4
● Vitamin D lower in:
○ multiple sclerosis (MS), rheumatoid
arthritis (RA), diabetes mellitus (DM),
inflammatory bowel disease and systemic
lupus erythematosus (SLE)
Immune system (cont.): mechanisms
● B cell inhibition :
○ Proliferation
○ Cell differentiation
○ Antibody secretions
● T cell inhibition:
○ Proliferation
○ Skew away from inflammatory Th17
● Monocyte inhibition:
○ Inflammatory cytokines

Dendritic Cells inhibition:


● Proliferation and maturity
● Immature DCs maintain self
tolerance
Benefits of Vitamin D on depression-
● Bipolar depression:
○ mitochondrial dysfunction
○ Inflammation
● Effects melatonin production-
○ Seasonal affective disorder
● Brain processes:
○ neuroimmunomodulation

○ Neuroplasticity

○ Receptors in the parts of the brain associated with depression

○ Vitamin D and glucocorticoids receptor interactions

○ Vitamin D promotes serotonin genes


Benefits of Vitamin D on the Skeletal System-
● Involved in regulation of calcium
homeostasis
● Decreased risk of fractures
● Helps non-specific back pains
without diagnosis
● Necessary doses to prevent
falls (with deficiency):
○ between 700 and 1000 IU

● NOTE:
○ No significant decrease in hip
fractures with calcium intake
Benefits of Vitamin D on the CardioVascular System
● Research has linked
Vitamin D supplements
with improved cardiac
function

● Inhibits the rapid


increase of
cardiomyoblasts by
promoting cell-cycle
arrest - reduces cardiac
hypertrophy
Benefits of Vitamin D on Cancer
● Plays a role in the prevention of colon, prostate, and breast
cancer
● Studies shown lower death rates for cancer in southern
latitudes, where there is more exposure to sunlight
● Study on rats suggests that Vitamin D has slowed or prevented
the development of cancer cells and tumors
○ Promotes cell differentiation, decreasing cancer cell
growth, stimulates apoptosis, and reducing tumor
angiogenesis
Vitamin D’s
interaction with
the endocrine
system
Benefits to Women’s Health
● Increase fertility

● Reduce the risk of breast cancer

● Promotes bone health - growth and


development

● Pregnant women are at a higher risk of


being Vitamin D deficient
○ Calcium loss due to the use of it for the
development of the fetus
Additional studies - Safe in pregnancy??
Vitamin D supplementation during pregnancy: Double-blind, randomized clinical
trial of safety and effectiveness

● As vitamin D deficiency is often passed from mother to child, is vitamin D


supplementation to correct this safe?
● “It is concluded that vitamin D supplementation of 4000 IU/d for pregnant women is
safe and most effective in achieving sufficiency in all women and their neonates
regardless of race”
Conclusion: Do the Benefits outweigh the Risks of
Taking a Vitamin D Supplement?
● What do you think?
● Depends on each person
● If you are deficient in Vitamin D, taking a supplement
would benefit the body
● 5-30 minutes of sun exposure twice a week should be
enough for Vitamin D to be synthesized in a healthy human
○ so you might not need a supplement
Video Input
● https://www.youtube.com/watch?v=PyXl50B2p24
What did you Learn about Vitamin D?
Take a minute and try the posttest to see what you have
learned about Vitamin D.
PostTest ANswers
1. D 8. B
2. B
9. C
3. True
10. B
4. True
11. False
5. A
12. D
6. True
13.True
7. D
14. A
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