Vitamin D
Deficiency in Scotland
80%
of Scottish Population
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
Vitamin D
deficient
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,
up- and down regulation of genes
insulin production
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
adequate
blood level
Normal Outdoor
workers
UK
old guidelines
Most
vitamin D experts
Compromise
WHO 2003,
US Institute of Medicine
2010
120 nmol/l
25 nmol/l
100 nmol/l
50 nmol/l
as Edinburgh
Royal Infirmary
Scotland’s levels?
.
7437 participants, aged 45
<40 nmol/L
Hyppönen et al 2007
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 % < 50 nmol/l
(of 350 people tested by May 2011)
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 1,25dihydroxyvitamin D3 in gastric cancer cells.
Bao A, Li Y, Tong Y, Zheng H, Wu W, Wei C.
Abstract
It has been previously demonstrated that 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 1,25dihydroxyvitamin 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 1,25dihydroxyvitamin 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: crosssectional 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
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
Umhau, 2013:
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 and lung function in British
adults.
British Journal of Nutrition
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