Vitamin DNew Openings

Dr.Hisham Abid AldabaghMSc. Internal Medicine

Kingdom of Saudi ArabiaMinistry of HealthDirectorate of Health Affairs in GurayatGurayat General Hospita

In the last 5 years, there has been a remarkable change in our understanding of the health benefits of vitamin D.

The classical actions of vitamin D as a determinant of mineral metabolism and rachitic bone disease have been expanded to include a broader role in skeletal homoeostasis and prevalent bone disorders such as osteoporosis.

The nonskeletal function of vitamin D that has attracted most attention.

Vitamin D and ImmunityMedscape reference, 2015

The new perspective on nonclassical vitamin D function stems from three more recent concepts:

1- The impaired vitamin D status is common to many populations across the globe. 2- The association of vitamin D 'insufficiency' to several chronic health problems including autoimmune and cardiovascular disease, hypertension and common cancers. 3- In addition to another prominent nonclassical action of vitamin D – namely its role as an immunomodulator.

It is suggested that a serum level of 50 nM (20 ng/ml) 25OHD is sufficient to optimize bone mineral density (BMD) as a marker of skeletal health.

However, people with darker skin pigmentation, and those living at more Northerly latitudes may find it harder to meet this target level.

To achieve the 50 nM target level of circulating 25OHD, it is recommended a modest increase in the recommended daily allowance for supplemental vitamin D to 600 IU/day.

Individuals with low serum 25OHD will be less able to support monocyte induction of antibacterial activity and may therefore be at greater risk of infection.

Conversely, supplementation of vitamin D-insufficient individuals in vivo has been shown to improve induction of monocyte cathelicidin. and may therefore help to protect against infection.

Vitamin D and Innate Immunity

1,25(OH)2 D can suppress T helper cell proliferation as well as modulating cytokines production by these cells.

T regulatory cell mediates the immunoregulatory actions of vitamin D

1,25(OH)2D expands circulating T regulatory cell populations.

For example, circulating levels of 25OHD have been shown to correlate with T regulatory cell activity in patients with multiple sclerosis (MS).

Vitamin D and Adaptive Immunity

1,25(OH)2D has direct effects of on B-cell homoeostasis, with notable effects including inhibition of plasma cell and class switched memory cells differentiation.

These effects support for vitamin D's role in B-cell-related autoimmune disorders such as systemic lupus erythematosus (SLE).

Epidemiology has shown that serum levels of 25OHD <75 nM are associated with higher incidence of TB.

Vitamin D reduced the time for sputum smear conversion from acid fast bacteria (AFB) positive to AFB-negative status. 

In other infectious diseases such a sepsis, serum 25OHD levels have been correlated with circulating levels of cathelicidin, and this in turn was associated with increased risk of critical illness. 

Vitamin D Status, Immunomodulation and Human Disease

Lower serum 25OHD has been described for patients with type 1 diabetes at the time of diagnosis

Vitamin D supplementation has been reported to protect against type 1 diabetes.

  Other autoimmune diseases that have

also been linked to low vitamin D status include Crohn's disease, SLE,rheumatoid arthritis,MS and Graves disease.

A new study published in the American Journal of Clinical Nutrition  in 24/July /2015 has discovered that vitamin D status is a modifiable risk factor for miscarriage.

Vitamin D levels less than 20 ng/ml were associated with over two times the risk for miscarriage during the first trimester.

Vitamin D levels were not associated with an increased risk of miscarriage during the second-trimester.

Vitamin D and Miscarriage

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Posted on July 23, 2015 by Vitamin D council A recent meta-analysis published by the

journal Nutrients found that vitamin D supplementation is significantly associated with a reduced risk of developing Parkinson’s disease.

Low vitamin D level was associated with increased risk of PD, which is consistent with the hypothesis that low vitamin D status is a risk factor for PD.

Thus, optimizing vitamin D level may represent a potential avenue for the prevention of PD.

Vitamin D supplementation reduces the risk of Parkinson’s disease

Vitamin D status is a risk factor for knee osteoarthritisPosted on July 23, 2015 by Vitamin D Council

• Low vitamin D levels (less than 15 ng/ml) had more than double the risk of knee osteoarthritis worsening compared to the volunteers with healthy vitamin D levels.

• Low vitamin D and high parathyroid hormone levels had more than three times the risk of their condition worsening than those with healthy levels of both.

Vitamin D supplementation modulates the gut microbiome of the upper gastrointestinal tract, offering a possible explanation for the benefits of vitamin D supplementation on gastrointestinal diseases

Vitamin D supplementation reduced opportunistic pathogens in the gutPosted on July 20, 2015 by Vitamin D Council

Vitamin D deficiency is linked with fatigue and symptom severity in patients with fibromyalgia

Posted on July 30, 2015 by Vitamin D Council

Fatigue was significantly higher among patients with both fibromyalgia and vitamin D deficiency

Vitamin D supplementation is an effective treatment for bacterial vaginosis

Treatment of vitamin D deficiency using 2000 IU/day of vitamin D for 15 wk was an effective way to cure the asymptomatic BVPosted on July 29, 2015 by Vitamin D council

Higher vitamin D levels linked to success of treatment in patients with familial Mediterranean fever

Vitamin D levels are significantly lower in CR FMF patients than in non-CR FMF patients. This may be a factor which has a role in etiopathogenesis of CRPosted on July 10, 2015 by Vitamin D Council.

Vitamin D supplementation in conjunction with standard treatment may improve chronic hives

Posted on July 8, 2015 by  Vitamin D Council

Vitamin D supplementation as “add-on” therapy for the treatment of CU patients showing a greater resolution of CU symptoms.”

Recent study finds mood disorders are linked to a more severe vitamin D deficiency than schizophrenia

Posted on June 26, 2015 by Vitamin D Council

Patients with mood disorders (major depression, bipolar disorders and dysthymia) have more severe hypovitaminosis D than patients with schizophrenia

The relationship between vitamin D and breast cancer

Posted on June 15, 2015 by Vitamin D Council

There is a meaningful evidence for potential preventive effect of vitamin D on breast cancer for Asian population

A link between low vitamin D status and larger lesions after ischemic stroke

Posted on June 1, 2015 by Vitamin D Council

Higher vitamin D status was independently associated with smaller infarct volumes

These observations suggest that despite the major research advances that have been made over the last 5 years, our understanding of the nonclassical actions of vitamin D is far from complete. The next 5 years may turn out to be even more eventful.

Conclusion

Please,• Consider Vitamin D status in chronic

diseases, especially those having immunologic or unknown factors in their pathogenesis.

• Try to add vitamin D in your therapeutic plans for the above diseases, based on dosage guidelines, unless contraindicated.

Professional MessageDear Colleagues,

Waiting for new openings of Vitamin D

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