Vitamin Information Center

Vitamin D is known as the “sunshine vitamin” because the human body naturally produces vitamin D when exposed to sunlight. A report in the Archives of General Psychiatry gives new meaning to the term. New research has shown that your risk for depression could be high if your blood is low in vitamin D and high in serum parathyroid hormones, says a report in . (Arch Gen Psychiatry. 2008;65[5]:508-512.)

More specifically, poor vitamin D consumption can cause an increase in serum parathyroid levels, which are frequently accompanied by symptoms of depression. And considering that nearly 15% of older individuals suffer from the blues this could be the relief that they’ve been seeking.

The findings may be important to patients because both low blood vitamin D levels and high parathyroid hormone levels can be treated with higher dietary intake of vitamin D or calcium and increased sunlight exposure. “Moreover, the clinical relevance of the present study is underscored by our finding that 38.8% of men and 56.9% of women in our community-based cohort had an insufficient vitamin D status,” researchers conclude. Additional studies are needed to determine whether changes in levels of vitamin D and parathyroid hormone precede depression or follow it.

The Anti-Aging Bottom Line: Almost 15% of older Americans suffer from depression, which can substantially decrease your quality of life. if you feel like you may be depressed, get your vitamin D levels checked. Recent research has found that vitamin D deficiency is much more common that was previously thought, and that most people need higher amounts of D than the current government mandated recommendations. Vitamin D supplementation has been proven very effective at correcting deficiency. Make sure you are getting at least 1,000 IU of supplemental vitamin D daily.

By Skowron, Jared M

Myth 1: Vitamin D is a vitamin. The Truth: Vitamin D is a hormone. It’s derived from cholesterol. It activates cellular processes and does not do so as a co-factor. Vitamin D receptors nave direct effects on the following cells: adipose, adrenal, bone, brain, breast, cancer, cartilage, colon, endothelium, epididymis, ganglion, hair follicle, intestine, kidney, liver, lung, muscle, osteoblasts, ovary, pancreatic B, parathyroid, parotid, pituitary, placenta, prostate, skin, stomach, testis, thymus, thyroid and uterus.

Myth 2: Normal activity provides us enough vitamin D from sun exposure.

The truth: Most people do not get enough sunshine to maintain adequate vitamin D levels. Our ancestors spent most of the day in the sun, farming, fishing and hunting. Our bodies physiologically developed to need that much vitamin D. Today’s indoor society of office workers, television watchers and hermits gets much less sun exposure and vitamin D production. Add on clothing and sunscreen, which also inhibit vitamin D production, and you understand the problem.

Myth 3: Supplemented vitamin D in foods is adequate.

The truth: Vitamin D^sub 2^ is one-third as effective in the body as naturally occurring vitamin D^sub 3^. Most foods have D^sub 2^ added. A study that analyzed vitamin D^sub 2^ levels in milk off supermarket shelves showed almost 50 percent had less than the label claim of 400 IU of D^sub 2^. A support scientist from the USDA believes no food-label claims are accurate and these labels cannot be trusted.

Myth 4:1,25(OH)D3 is the best analysis for vitamin D levels.

The truth: Vitamin D is mostly stored in adipose and should not be routinely measured. It then converts to 25(OH) D3, which has a long half-life and is the best analysis of vitamin D levels. It then converts to bi-hydroxy forms such as 1,25(OH)D3, 24,25(OH) D3 and other forms, which have the actual action of the cell receptors. However, this form has a short half-life and is not a good measurement.

Myth 5: The reference range for vitamin D levels is accurate.

The truth: The reference range for 25(OH)D3 is horribly inaccurate and is maintaining our vitamin D deficiency in this country. The current reference range of 20-100 is too low. Levels <25 are disease level. Levels between 25 and 75 are suboptimal. Levels between 75 and 200 are optimal.

Myth 6: Vitamin D supplementation is nontoxic.

The truth: The major consequence of vitamin D toxicity is hypercalcemia, which should be monitored periodically while under therapy. Changes in cardiac rhythms or lithiasis are common concerns. Urine calcium monitoring is not accurate. Serum calcium .should be monitored monthly to check vitamin D toxicity, which normally occurs at 40,000 IU/day. Right now, 10,000 IU/day is being proposed as the safe upper limit.

Myth 7: The RDA for vitamin D is accurate.

The truth: People taking only the RDA of vitamin D will lower their 25(OH) D3 levels. The RDA is too low. When treating with vitamin D supplementation, three months of daily dosing is sufficient to max out 25(OH)D3 levels. Five thousand IU/day for three months should elevate 25(OH) D3 by 80 nmol/L, and 10,000 IU/ day for three months should elevate 25(OH) D3 by 120 nmol/L. People on 1,000 IU/day will elevate their levels by only 10 nmol/L.

Myth 8: Different forms of vitamin D are all the same.

The truth: Vitamin D^sub 3^ is the preferred form. Avoid D^sub 2^ at all costs. D^sub 3^ is derived either from plant sources or from lanolin. Lanolin-derived D^sub 3^ is more active and absorbable. I take the 10,000 IU capsules of D^su 3^.

Myth 9: Vitamin D only treats osteoporosis and rickets.

The truth: The therapeutic benefits of vitamin D are still being discovered. Benefits relative to cancer, cardiac, immune-boosting, diabetes and neurological (such as multiple sclerosis) therapies, as well as low bone density, are just the tip of the iceberg. I test all of my patients for vitamin D deficiency and supplement regularly up to the 75-200 reference range of 25(OH)D3.

Myth 10: Vitamin D should be avoided in pregnancy and breastfeeding.

The truth: Pregnant women should receive 4,000 IU of daily vitamin D supplementation. Breast-feeding women should receive 6,000 IU of daily vitamin D supplementation. Vitamin D, not 25(OH)D3, crosses into the breast milk, and daily doses are preferred over weekly doses. Avoid supplementing the infant and instead supplement the breast-feeding mother directly. If the infant is bottle-fed, supplement with 400-800 IU/day.

By Jared M. Skowron, ND

Bio

Dr. Jared M. Skowron is in private practice in Hamden, Conn., where he specializes in pediatrics and treating autistic spectrum disorders in children. He is the senior naturopathic physician with Metabolic Maintenance and an adjunct professor at the University of Bridgeport, teaching pediatrics, CPD and EENT.

New knowledge of the biological and clinical importance of the steroid hormone 1alpha,25-dihydroxyvitamin D3 [1alpha,25(OH)2D3] and its receptor, the vitamin D receptor (VDR), has resulted in significant contributions to good bone health.

However, worldwide reports have highlighted a variety of vitamin D insufficiency and deficiency diseases. Despite many publications and scientific meetings reporting advances in vitamin D science, a disturbing realization is growing that the newer scientific and clinical knowledge is not being translated into better human health.

Over the past several decades, the biological sphere of influence of vitamin D3, as defined by the tissue distribution of the VDR, has broadened at least 9-fold from the target organs required for calcium homeostasis (intestine, bone, kidney, and parathyroid). Now, research has shown that the pluripotent steroid hormone 1alpha,25(OH)2D3 initiates the physiologic responses of 36 or more cell types that possess the VDR.

In addition to the kidney’s endocrine production of circulating 1alpha,25(OH)2D3, researchers have found a paracrine production of this steroid hormone in 10 or more extrarenal organs.

This article identifies the fundamentals of the vitamin D endocrine system, including its potential for contributions to good health in 5 physiologic arenas in which investigators have clearly documented new biological actions of 1alpha,25(OH)2D3 through the VDR.

As a consequence, the nutritional guidelines for vitamin D3 intake (defined by serum hydroxyvitamin D3 concentrations) should be reevaluated, taking into account the contributions to good health that all 36 VDR target organs can provide.

Source: American Journal of Clinical Nutrition, Aug 2008. 88(2), 491S-499S. PMID: 18689389, by Norman, AW. Department of Biochemistry and Division of Biomedical Sciences, University of California, Riverside, California, USA. [E-mail: anthony.norman@ucr.edu]

Low levels of vitamin D may put older people at a higher risk of depression, a study has found.

Researchers also estimated that 13 per cent of all people aged over 65 could be depressed.

The study, carried out by scientists in Amsterdam and published in Science Daily, found that a deficiency in vitamin D causes high blood levels of the parathyroid hormone, which has been linked to depression.

Of the 1,282 older people aged between 65 and 95 studied, 169 had a minor depressive illness and 26 were majorly depressed. Those with depression were found to have 14 per cent lesser vitamin D in their blood levels.

Over half of the women and 38.8 per cent of the men studied had insufficient vitamin D levels.

The authors of the study write: “Decreased vitamin intake may be secondary to depression, but depression may also be the consequence of poor vitamin D status.”

Decreased outdoor activity and different housing or clothing habits were all believed to decrease vitamin D.

However, a healthy dose of sun exposure can relieve minor feelings of depression.

Newswise — Softening of the skull bones in normal-looking babies might reflect vitamin D deficiency during pregnancy, according to a new study accepted for publication in the Journal of Clinical Endocrinology & Metabolism (JCEM). Furthermore, breast-feeding without vitamin D supplementation could prolong the deficiency, which might lead to a risk of serious health problems later in life, including type 1 diabetes and decreased bone density.

“Craniotabes, the softening of skull bones, in otherwise normal newborns has largely been regarded as a physiological condition without the need for treatment,” said Dr. Tohru Yorifuji, of Kyoto University Hospital in Japan. “Our findings, however, show that this untreated condition may be the result of a potentially dangerous vitamin D deficiency.”

For this study researchers evaluated 1,120 newborns for incidence of craniotabes, and at 5-7 days of age, 246 neonates (22 percent) were found to have craniotabes. Researchers also found the incidence of craniotabes had obvious seasonal variations. This clear seasonal variation strongly suggests that the condition is associated with prenatal vitamin D deficiency and likely reflects the amount of sun exposure of pregnant women.

Most importantly, vitamin D deficiency in neonates, could persist into later life, especially in breast-fed infants who do not receive a formula containing vitamin D supplementation. In this study, more than half of the breast-fed infants with craniotabes showed statistically significant low levels of serum 25-OH vitamin D, the storage form of vitamin D. Some of those infants also had symptoms of an overactive parathyroid gland consistent with vitamin D deficiency.

Vitamin D deficiency has not received as much attention as it once did, however several recent studies have reported a resurgence of the condition, even in developed countries. Vitamin D deficiency classically presents with skeletal manifestations such as rickets in childhood or the softening of bones in adults. In addition, vitamin D deficiency in adults can also lead to increased incidence of immunological diseases such as multiple sclerosis, type 1 diabetes, or even colorectal cancer.

“Until more research is done on the effects of perinatal vitamin D deficiency, we suggest treating breast-fed infants with craniotabes with vitamin D, or preferably, treating all pregnant women with vitamin D,” said Yorifuji.

Other researchers working on the study include Junko Yorifuji, Shizuyo Nagai, Masahiko Kawai, Toru Momoi, and Tatsutoshi Nakahata of Kyoto University Hospital in Japan; Kenji Tachibana and Hiroshi Hatayama of Adachi Hospital in Japan; and Hironori Nagasaka of Chiba Children’s Hospital in Japan.

A rapid release version of this paper has been published on-line and will appear in the May 2008 issue of JCEM, a publication of The Endocrine Society.

Founded in 1916, The Endocrine Society is the world’s oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Today, The Endocrine Society’s membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society, and the field of endocrinology, visit our web site at http://www.endo-society.org.

ISLAMABAD: Vitamin D injections can greatly improve survival for most kidney failure patients on dialysis, according to a new study.

Currently, vitamin D injections are recommended only for dialysis patients with elevated levels of parathyroid hormone — which represents about 50 percent of kidney failure patients. But this Massachusetts General Hospital study found that vitamin D injections may help extend the lives of most kidney dialysis patients.

“We�ve been administering vitamin D injections for decades, but the potential benefit on survival has never been studied. This finding was a surprise and should force us to think more broadly about who should be treated,” study senior author Dr. Ravi Thadhani, director of clinical research in MGH nephrology, said in a prepared statement.

Reporting in the April issue of the Journal of the American Society of Nephrology, Thadhani�s team analyzed data on more than 50,000 U.S. kidney patients who began dialysis between 1996 and 1999 and were tracked until 2002. More than 37,000 of the patients in the study received vitamin D injections.

At the end of the two-year study, 76 percent of the patients receiving vitamin D injections were still alive, compared with 59 percent of patients who didn�t receive vitamin D. That difference was evident across all categories of patients, the researchers said. Even kidney dialysis patients with elevated calcium and phosphorous levels — which often lead to discontinuation of treatment with vitamin D — lived longer if they received the vitamin D injections.

The study authors said their findings must be confirmed by follow-up studies before more precise recommendations for vitamin D therapy can be made.

“While these results need to be verified, we at least need to be more aggressive in treating people that meet the current criteria. Thereafter we need to investigate what is the mechanism conferring this survival benefit. We are actively pursuing that with a focus on the effects of cardiovascular disease,” said Thadhani, who is also an assistant professor of medicine at Harvard Medical School The National Kidney Foundation.