Vitamin D - The super enhancer from the sun

Vitamin D is delivered via the sun and is imperative to overall good health and a fully functioning human system. UVB rays from the sun strike our skin and set off a chemical cascade that is naturally pre-programmed in our DNA. There is a chemical in our skin (7-dehydro-cholesterol) that reacts to the suns rays. This cholesterol based chemical is transformed by the UV into the chemical called Vitamin D3 or cholecalciferol. D3 is then circulated through the bloodstream into the liver where it is hydroxylated into 25(OH)D or calcidiol - this is the variant of Vitamin D that is measured in blood serum levels. Calcidiol is then released from the kidney and converted into another form called Calcitriol or I,25(OH)2D. This variant is used to regulate calcium absorption in the body amongst other things. If we have low Vitamin D our body's immune system can't manufacture it's own antibodies.

Until around a decade ago it was thought that calcitriol was only created by the kidneys for the purpose of the skeletal system. Since then it has been discovered that most organs in the body have the ability to generate calcitriol for their own unique purposes. So the brain, the heart, gut, and lungs all generate it. Unlike most vitamins Vit D (more like a super pro hormone) has built in reception areas throughout the body (these are known as Vit D receptors or VDR). These "docking bays" have now been mapped to more than 3000 genes. Our entire system depends on Vit D to function optimally. So please get into the sun for small amounts of time on a daily basis to remain topped up. During the winter supplementation might be required. Please have a read of my notes below so you can be informed about the importance of this incredible vitamin/hormone/super agent. 

Ideal Vit D Level     Deficient Level

125-200 nmol/L     <50 nmol/L

50-80 ng/ml            <20 ng/ml

*50ng/ml is the natural blood level of Vit D often found in people that have worked outside over summer. 

Alzheimers

"We hypothesize that good Vit D levels might prevent or mitigate the disease" Associate Prof of Geriatrics Robert Przybelski 2007

Neurons in the brain have Vit D receptors so Vit D could enhance important protective brain chemicals. It has been noted in a study by Maya Soni (Vit D and cognitive function, Soni et al, Scandinavian Journal of Clinical and Laboratory Investigation, April 2012, Vol. 72, No. S243:79-82) that the risk of cognitive impairment was 4 X greater in people with Vit D levels below 25nmol/L when compared to those with adequate levels of 75nmol/L

Autistic Spectrum Disorders

25 years ago the chance of giving birth to a child on the spectrum was around 1 in 1800. Today it's as low as 1 in 60. Many people have incorrectly blamed the MMR vaccination. Cannells research has linked low Vit D with poor brain development. "Children with Vit D defeficient rickets have several autistic markers that apparently disappear with high-dose Vit D treatment."(Autism and vitamin D, Cannell J, Med Hypotheses. 2008;70(4):750-9. Epub 2007 Oct 24). Vit D deficiency is a risk for neurodevelopmental disorders due to the facts that Vit D functions as a neurosteroid, is an upregulator of nerve growth factor, is found in a wide variety of brain tissue early in a babies development, and gives neuroprotection with control of the brains immune system. 

Asthma and Allergies

Dr. Carlos Camargo Jr's research showed that NZ babies that were born with deficient levels of Vit D were 2.4 times more likely to have suffered an infection before 3 months when compared with babies in the highest group (levels in excess of 75nmol/L). It was concluded in the study that improving Vit D status while pregnant may provide a simple, inexpensive method to reduce respiratory infections that cause most asthma exacerbation. More research later on in kids (particularly males) lives showed that with inadequate Vit D are at increased risk of developing allergic sensitivity and subsequently bronchial hyper-responsiveness and asthma. 

Cancer (breast)

"High Vit D levels at early breast cancer diagnosis correlates with lower tumor size and better overall survival" Published in Carcinogenesis 2012

A massive study was released in the journal Carcinogenesis in May 2012. It measured the blood serum Vit D levels of 1800 women when they were initially diagnosed with breast cancer. The women with the highest levels of Vit D (>75nmol/L) when first diagnosed cut their risk of dying within 5 years by 50% compared to women who had levels below 30ng/ml. Study after study with varying designs in both human populations and the lab have demonstrated that Vit D reduces the risk of breast cancer. 

Cancer (Colon)

In 2007 a review of published medical studies (called a meta analysis) found that blood levels of Vit D of 33 ng/ml (83 nmol/L) were associated with a 50% lower risk of colon cancer (Optimal Vit D status for colorectal cancer prevention: a quantitative meta analysis, Gorham et al, American Journal of Preventative Medicine 2007;32(3):210-16)

Heart Disease

"Researchers found those with the lowest vit D levels were 3 X more likely to die of heart disease, and 2.5 X more likely to die of any cause."  Results of NHANES III study

Heart disease is the world's biggest killer. In 2012 a major study of metabolic syndrome heart patients in Europe tracking patients for 8 years found that people with the highest levels of Vit D reduced their risk of sudden death by a huge 85%! There isn't a drug out there that gives that amount of improvement. Unfortuantly there isn't as much profit for promoting a vitamin that is delivered from the sun. Another study published in the American Journal of Cardiology (Vit D deficiency and supplementation and relation to cardiovascular health, Vacek et al, American Journal of Cardiology, 2012; 109:359-363) followed almost 11,000 patients enrolled in a University of Kansas CV programme between 2004-2009. It found that people with Vit D above 30ng/ml (75 nmol/L) reduced their mortality risk by 61% compared to people with a lower Vit D value. 

Infections/Pandemics

"Whether Vit D should be implemented as a mandatory Vitamin to prevent pandemic influenza is the question."Journal of Medical Hypotheses 2010

There is a little known essential extract from a South African geranium - umckaloaba or more commonly know as Kabola that has unique anti-bacterial and anti-viral properties to help with colds, influenza, pneumonia and bronchitis. What Kabola does is stimulate the bodies immune system into responding more effectively to incoming infections - that is what Vit D appears to also do. A randomised controlled trail completed in 2007 tested 3 groups for a year (Group 1 - 2000IU/day Vit D, Group 2 - 800IU/day, Group 3 - placebo) Nearly all the Group 3 had a cold or the flu and only one from Group 1 reported a cold (Epidemic influenza and Vit D, Aloia &Li-Ng, Epidemiol Infect 2007; 135:1095-1096). Vit D is known to stimulate the immune system into producing natural antibiotics. The active form of Vit D (I,25-OH2D or Calcitriol) increases the production of endogenous (means "self-made" naturally) antibiotics. These are named antimicrobial peptides (AMP). Examples of these are defensin and cathelicidin have many actions to protect us from microorganisms, including bacteria, fungi, and viruses. One of the defecsins named retocyclin-2 inhibits influenza virus infections. So our bodies are designed to interact with sunlight to create antibiotics and antivirals. Further studys found people with low Vit D levels were 500% more likely to contract tuberculosis(Vit D deficiency and Tuberculosis progression, Talat et al, Emerging Infectious Diseases, Vol. 16, No. 5 May 2010), and having good Vit D levels can also protect you against superbugs (Vit D's potential to reduce the risk of hospital acquired infections, Youssef et al, Dermato-Endocrinology VOl.4, issue 2, April-June 2012).

Mental Illness

"Vit D deficiency and insufficiency are both highly prevalent in adolescents with severe mental illness." BMC Journal of Psychiatry, 2012

Research lead by David Menkes at the Waikato Clinical school showed that 91% of the 102 psychiatric inpatients (mainly schizophrenics and in particular darker sinned Maori patients) had sup-optimal (below 30ng/ml) Vit D levels. 20% had less than 10ng/ml (25nmol/L). Another American study showed that adolescents with psychotic behaviour were 3.5 times more likely to be in the lowest Vit D range. Of course they could be confounding factors but these findings deserve more research. 

Multiple Sclerosis

"There is strong evidence that Vit D concentrations during late adolescence and young adult hood have a major effect in determining MS risk" Lancet neurology 2010

One US study found that service personal with high levels of Vit D (above 99 nmol/L or 39 ng/ml) reduced their risk of MS by 62% (Serum 25-Hydroxyvitamin D levels and risk of Multiple Sclerosis, Munger et al, journal of the American Medical Association, JAMA. 2006;296 (23):2832-2838.) Another study out of Oxford in June 2012 found a leading cause of MS could be a gene that causes Vit D deficiency. 

Crohn's Disease

There appears to be an inverse relationship between Vit D status and risk of Crohn's or it's other form ulcerative colitis. A study in the US showed that women over 40 years of age with the highest levels of Vit D (>32 ng/ml or 80 nmol/L) decreased their chance of suffering Crohn's be 62% (higher Predicted Vit D status is associated with reduced risk of Crohn's disease, Ananthakrishna et al, Gastroenterology, Vol 142, issue 3, March 2012, Pg 482-489). Another study in 2010 gave 94 people either 1200IU of D3 daily or a placebo for a year. All were in a remission phase. 30% of the placebo group relapsed within a year and only 13% of the Vit D group experienced a relapse. This effectively showed a risk reduction of more than 2/3's

Type 1 Diabetes

"Women with low Vit D levels while pregnant have double the risk of giving birth to a diabetic child when compared with mothers whose Vit D levels were high."Diabetes 2012

Another autoimmune disorder linked with low Vit D is Type 1 diabetes. Like Crohn's, and MS Type 1 diabetes likewise shows geographical and seasonal distribution patterns. As you get further away from the equator incidence increases. One study in the Lancet found parents who reularly gave their kids 2000IU of Vit D decreased the prospect of Type 1 diabetes by 78% (Intake of Vit D and risk of type 1 Diabetes: a birth-cohort study, Hypponen et al, Lancet 2001;358:1500-1503). It must be remembered that the causes of type 1 diabetes are essentially unknown, but as all the other conditions mentioned here having adequate Vit D levels could be a protective factor. 

Best sources of Vit D

Food supplies only a limited amount of Vit D. unless your diet is rich in wild caught fatty fish, sun dried Shitake mushrooms or wild reindeer meat you can dismiss "adequate" Vit D intake from diet. To get 2000IU daily from food you would need to eat 50 eggs OR 9kg of cheese OR 2kg of salmon. The only food that comes close to giving you the Vit D hit you need is the mushrooms (Shitake are best or button or flat browns). Like humans they manufacture Vit D when they are in sunlight - it's the D2 variety so isn't stored for as long in the body as D3 (hours/days compared to weeks) and most reports of Vit D toxicity have arisen from this type. By far the best source of Vit D is from the sun. If you sunbathe for 30min in summer you will generate somewhere between 20,000-30,000IU of Vit D. This is the upper limits - but the body will create and store as much as it needs and no more - you can not get an overdose of Vit D from the sun. The stores of Vit D your body builds up over summer and autumn are needed to carry you through winter - most people by mid winter will be running low leaving you open for a variety of "illnesses" which can hit in later winter of spring. What is recommended by NZ health guidelines is grossly inadequate and totally reductionist (Ministry of Health talk about bone health and suggest only 5% of adults are deficient when it's probably closer to 50%. The NZ MOH don't think supplements are necessary) compared to the 2000-6000IU required daily depending on your individual circumstances (occupation, skin colour, sun exposure). Researcher John Cannell states that very few humans obtain enough Vit D even if they take several thousand units a day. He cites a sunbathing study out of Hawaii that shows that 6400IU was inadequate for breastfeeding mothers. It implies virtually everyone has a deficiency in the winter months. 

".....most individuals have chronic Vit D deficiency in the winter. Because of this most have chronic substrate starvation, functional Vit D deficiency, and thus, perhaps higher risk for the diseases of civilisation."John Cannell 

Research suggests that we should be tested twice a year (late summer and early spring) to gauge peak and low levels. In NZ the standard medical prescription is a monthly pill of 50,000IU - equivalent to 30-60min of sunbathing. This averages out to 1500IU/day which compared to 6400IU/day required for a breastfeeding women is simple not enough. At present during the winter and early spring months (4-5months/year) I have a monthly 50,000IU pill plus a spray that delivers 2000IU daily. Over the summer I have the spray but try to top up with 20-30min in the sun without sunscreen (rest of time covering up, staying in the shade or using sunscreen if needed).  Most people who manage to achieve the ideal 50-70 ng/ml of Vit D have done so through relying on UV rays plus high supplementation in the colder months.  The research estimates that a 1000IU daily supplement will boost blood levels by 10ng/ml over 3months, so an average adult taking 2000IU could go up from 10 to 30 ng/ml over that time. Of course sunlight is far superior to oral supplementation. It appears the upper limit from ingesting too much oral Vit D could be around 10,000IU daily.  Some medication raises Vit D levels while others drop them so if you are on any medication please consult your GP before looking at supplementation and you should have blood tests to keep a track on levels. In some parts of the world Vit D levels are so bad that injections delivering  600,000IU to elderly patients raising levels from 2 ng/ml to 27 ng/ml over 6 weeks. One study in the Australian Medical Journal has recommended 600,000IU doses for the elderly each autumn to cover the winter months(Annual intramuscular injection of a megadose of cholecalciferol for treatment of Vit D deficiency: efficacy and safety data, Diamond et al, Med J Aust 2005; 183:10-12)

I have talked about the importance of Vit D in terms of bone health and the immune system in the past. Getting into the sun safely and taking supplements (especially in the winter months) will allow you to keep your levels topped up throughout the entire year giving protection against colds and flu's towards the end of the winter season. As always I do not promote silver bullet fixes, and your stress relief, sleep, relationship quality, and nutrition will all play a part in WELLNESS. As always check with your GP if you are thinking about Vit D supplementation and you are on existing medication. 

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Catching some rays while having a swim at Pilot Bay, Mt. Maunganui, NZ