Benefits And Requirements Of Vitamin D For Optimal Health .
Vitamin DReviewBenefits and Requirements of Vitamin Dfor Optimal Health: A ReviewWilliam B. Grant, PhD, and Michael F. Holick, PhD, MDAbstractVitamin D sufficiency is required for optimalhealth. The conditions with strong evidence for aprotective effect of vitamin D include several bonediseases, muscle weakness, more than a dozentypes of internal cancers, multiple sclerosis,and type 1 diabetes mellitus. There is alsoweaker evidence for several other diseases andconditions. There are good reasons that vitaminD sufficiency be maintained during all stages oflife, from fetal development to old age. Adequatecalcium intake is also recommended. The currentvitamin D requirements in the United States arebased on protection against bone diseases.These guidelines are being revised upward inlight of new findings, especially for soft-tissuehealth. The consensus of scientific understandingappears to be that vitamin D deficiency is reachedfor serum 25-hydroxyvitamin D (25(OH)D) levelsless than 20 ng/mL (50 nmol/L), insufficiency inthe range from 20-32 ng/mL, and sufficiency inthe range from 33-80 ng/mL, with normal in sunnycountries 54-90 ng/mL, and excess greater than100 ng/mL. Solar ultraviolet-B (UVB) irradiation isthe primary source of vitamin D for most people.In general, the health benefits accruing frommoderate UV irradiation, without erythema orexcess tanning, greatly outweigh the health risks,with skin pigmentation (melanin) providing muchof the protection. In the absence of adequatesolar UVB irradiation due to season, latitude,or lifestyle, vitamin D can be obtained fromfortified food, oily fish, vitamin D supplements,and artificial sources of UVB radiation.(Altern Med Rev 2005;10(2):94-111)Page 94IntroductionThere is a growing awareness that vitamin Dsufficiency is required for optimal health. The role ofvitamin D in calcium absorption and metabolism forbone health is well known.1 Research during the pasttwo decades has illustrated the importance of vitaminD in reducing the risk of cancer,2-4 multiple sclerosis,5,6and type 1 diabetes mellitus.7 A number of reviewson the role of vitamin D and prevention of diseaseand maintenance of optimal health have appeared inthe past 2-3 years,8-21 and several recent conferenceshave been devoted solely to exploring the role of vitamin D in health and disease prevention.22-24 Finally,organizations in Australia and New Zealand have recognized a sufficiently high prevalence of vitamin Ddeficiency, even in these sunny lands, to have issuedguidelines for solar UVB irradiation.25,26This article discusses the importance of vitamin D sufficiency at various stages of life as a guideto health practitioners, policy makers, and interestedindividuals.Pre- and Postnatal Vitamin D BenefitsOne of the primary roles of vitamin D is theregulation of calcium and phosphorus absorption andmetabolism for bone health. This role is especiallyimportant during pregnancy and lactation becausebones develop rapidly during this period. WomenWilliam B. Grant, PhD – Sunlight, Nutrition and Health Research Center(SUNARC)Correspondence address: 2107 Van Ness Ave., Ste. 403B, San Francisco, CA94109 Email: wgrant@sunarc.orgMichael F. Holick, PhD, MD – Vitamin D, Skin and Bone Research Laboratory,Section of Endocrinology, Diabetes, and Nutrition Department of Medicine,Boston University Medical Center, Boston University School of MedicineAlternative Medicine Review Volume 10, Number 2 2005Copyright 2005 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Vitamin DReviewhave less skin pigmentation than men, a finding attributed to womenʼs greater need for vitamin D during pregnancy and lactation.27 Insufficient vitaminD intake during infancy can result in biochemicaldisturbances, reduced bone mineralization, slowergrowth, bone deformities, and increased risk of fracture – the hallmarks of rickets.28 Indeed, rickets hasbeen reported among breast-fed African-Americaninfants in several southern states.29,30The relationship between maternal vitaminD/calcium and fetal bone development was reviewedby Specker.31 Most of the papers reviewed reportedan effect of maternal vitamin D status on both maternal and infant calcium homeostasis, but did not reportwhether infant bone mineral density (BMD) was affected.Low birth weight (LBW) appears to be a consequence of vitamin D insufficiency during pregnancy.The topic was reviewed by Fuller, who hypothesizedthat insufficient serum 25(OH)D levels disruptedcalcium homeostasis, leading to intrauterine growthretardation, premature labor, and hypertension, all ofwhich are risk factors for LBW infants.32 Subsequentpapers seem to support the hypothesis that AfricanAmerican and Asian-Indian mothers have much higher rates of LBW infants in the United States than doEuropean Americans or Hispanic Americans.33-35 Thismay be in part because Hispanic Americans have aslightly higher consumption of vitamin D than African Americans,36 as well as lighter skin. Also, Koreans born in winter tend to have lower BMD thanthose born in summer.37Children born prematurely are likely to haveenamel defects in both primary and permanent teeth.38Maternal vitamin D sufficiency is required for properfetal tooth development,31,39 as well as adequate calcium. An additional benefit of sufficient vitamin Dand calcium during pregnancy is good maternal bonehealth. Studies report 2-4 percent bone density lossesduring pregnancy that are exacerbated by calciumand vitamin D deficiency.31Maternal and infant 25(OH)D sufficiencyalso appears to greatly reduce the risk of type 1 diabetes mellitus (DM). A study of vitamin D supplementation during the first year of life found those receiving the highest amounts in Finland had an oddsratio of 0.2 of developing type 1 DM compared withthose receiving no supplements.7,40 In further supportof this hypothesis, mechanisms were investigated in amouse model,41 and vitamin D receptor (VDR) alleleshave been associated with risk of type 1 DM.42 TheVDR bind 1,25-dihydroxy vitamin D3 (1,25(OH)2D)to its target cells and organs where it performs certain functions. The fact that VDR alleles are associated with a particular disease gives further support tovitamin D having an effect. In addition, there is anexcess summer birth rate for those who develop type1 DM.43 The most likely explanation is that maternal vitamin D insufficiency occurs during the secondtrimester of pregnancy, a time when the pancreas islikely to develop. Risk of type 1 DM related to vitamin D status should be considered when revisingvitamin D guidelines.44Maternal and infant 25(OH)D sufficiency isalso linked to significant reduction of risk for multiple sclerosis (MS). Vitamin D is hypothesized toreduce the risk of MS by strengthening the immunesystem against viral infections, a theoretical etiological factor in MS.45-47 Adequate serum 25(OH)D levelsduring pregnancy appear to reduce the risk of MS,as evidenced by seasonal variations in birth rate forthose who later develop MS, with spring being theseason of greatest birth rate for MS.48,49 A recent paper suggests vitamin D supplementation during pregnancy as a way to reduce the risk of fetal inclinationtoward MS.50A study in England found birth seasonalitywas related to later diagnosis of bipolar disorder,51strongly suggesting that the risk of bipolar disordercan be reduced through sufficient vitamin D intakeduring pregnancy. The same can be said of anxietyneurosis, for which there is a very pronounced springtime excess birth rate; for example, in New SouthWales.52 It is likely several other mental disorders andbirth defects associated with springtime excess birthrates will be linked to maternal vitamin D deficiencyearlier in pregnancy.Vitamin D during Youth andAdolescenceThe primary role of sufficient vitamin D during youth and adolescence is optimization of BMD.For example, serum 25(OH)D levels were found to bestrongly correlated with BMD for peripubertal Finnish girls53 and young Finnish men.54 A study in BostonAlternative Medicine Review Volume 10, Number 2 2005Page 95Copyright 2005 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Vitamin DReviewAnother important roleof vitamin D during youth appears to be in reducing the riskof MS. A study in Tasmaniafound that children ages 6Multiple Sclerosis Case Control Rates (U.S.)15 years reporting the highestand Prevalence Rates (Australia) vs. Latitudeamount of sun exposure, especially in winter, had an odds200ratio of 0.31 (95% confidenceinterval (CI): 0.16-0.59) of de180veloping MS compared with160those experiencing less than140one hour of sun exposure daily.58 It is well known that the120risk of MS increases rapidly100with increasing latitude. Thisfinding has been demonstrated80in Australia,59 Europe,60 and60the United States.61,62 Figure401 shows the latitudinal dependence for U.S. veterans at the20time of entry into World War0II and the Korean Conflict.621520253035404550Wintertime serum 25(OH)Dvalues are much more likelyLatitude (degrees)to follow a simple latitudinaldependence due to the reduced59Multiple sclerosis prevalence rates (age adjusted) for Australianumber of days during which(circles) and case control ratios for veterans of WWII and theKorean Conflict for the United States62 (dots) versus latitude.vitamin D can be producedfrom solar UVB at the higherlatitudes.57 In the winter, littleif any vitamin D can be madein the skin above 37 N latireported that 24 percent of 307 adolescents recruitedtude, and serum 25(OH)D levels reach their nadir induring an annual physical examination were vitaminFebruary or March in the northern hemisphere.57,63 InD deficient (serum 25(OH)D 15 ng/mL), with 14summer, the level of serum 25(OH)D is generally adpercent severely vitamin D deficient (25(OH)D 8equate. Summertime UVB irradiation does not followng/mL);55 the deficiencies were highest among Afria simple latitudinal dependence, due to the higher surcan Americans. A study based on the National Healthface elevation and lower stratospheric ozone layer forand Nutrition Examination Survey (NHANES) IIIstates west of and including the Rocky Mountains.64found adolescents were more likely to be vitaminThe best explanation for this latitudinal variation isD insufficient, rather than deficient, in low-latitude56strengthening of the immune system, especially inwinter and high-latitude summer populations. Therewinter, which can then help prevent viral infectionsare 4-5 months of the year when vitamin D cannotfrom giving rise to MS.11,19,45-47,65-67 For example, vibe produced from solar UVB irradiation in Boston attamin D regulates T-helper 1 (Th1) and dendritic cell42.5 N latitude.57function.MS RateFigure 1. Multiple Sclerosis Case Control Rates (U.S.) and PrevalenceRates (Australia) versus LatitudePage 96Alternative Medicine Review Volume 10, Number 2 2005Copyright 2005 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Vitamin DReviewIn addition to reducing the risk of MS, vitaminD is also beneficial for treating the symptoms of MS.Two papers reported higher numbers of MS lesionsin winter than in summer.68,69 It was suggested thatUVB-induced seasonal variations of serum 25(OH)Daccounted for the near doubling of MS lesions inthe winter versus summer.70 Seasonal variations forsouthern California69 were much lower than in Germany,68 supporting the UVB/vitamin D hypothesis.There is also some evidence that solar UVBirradiation/vitamin D during youth reduces the risk ofcancer. A study in the United Kingdom found childhood UV exposure was associated with a large reduction in the risk of prostate cancer.71,72 For example,those with frequent childhood sunburns had an oddsratio of 0.18 (95% CI: 0.08-0.38).71 A study from Australia reported the risk of developing non-Hodgkinʼslymphoma (NHL) was inversely correlated with sunexposure, with the strongest effects found for womenand children.73,74Vitamin D Benefits in AdulthoodVitamin D levels in adulthood are importantfor maintaining BMD. The primary risk factors forlow BMD, osteoporosis, and osteopenia include vitamin D insufficiency, inadequate calcium intake, lackof exercise, and other dietary factors. Serum 25(OH)Dlevels have been directly related to bone health inmen and women of all ages.75 It was recently reportedthat tanners who had robust levels of 25(OH)D ( 40 ng/mL) had higher bone density.76 Inflammatorybowel diseases (IBD), such as Crohnʼs disease, canreduce the absorption of dietary vitamin D, especiallywith resection of the duodenum and jejunum, sitesof vitamin D absorption.77 The decreased vitamin Dlevels and increased risk of osteoporosis in IBD areassociated not only with poor absorption of vitaminD but also with use of corticosteroids,78,79 which arealso frequently prescribed for the treatment of suchconditions as collagen vascular diseases, bronchialasthma, and skin conditions.80 Other medications,including anticonvulsants, heparin, warfarin, andmethotrexate, also contribute to low BMD.81 Therefore, adequate vitamin D and calcium consumptionand exercise should be maintained to combat bothprimary and secondary risk factors for low BMD during adulthood.Another benefit of vitamin D is maintenanceof optimal muscle strength. Vitamin D deficiency cancause osteomalacia, which is associated with muscleand bone pain.82,83 In one report, of 150 patients ata hospital in Minneapolis presenting with persistent, nonspecific musculoskeletal pain syndromesrefractory to standard therapies, 140 had vitamin Ddeficiencies (mean 25(OH)D level 12.1 ng/mL;95% CI: 11.2-13.0).84 Among different ethnic groups,16 percent of Asians, 24 percent of Anglo Americans,40 percent of Hispanics and Native Americans, and50 percent of African Americans demonstrate severe vitamin D deficiency (25(OH)D 8 ng/mL).84An analysis of walking speed and sit-to-stand timesamong individuals 60 years or older reported bestperformance when 25(OH)D levels were at least 30ng/mL.85 Serum 25(OH)D levels less than 20 ng/mLhave been associated with increased body sway, andlevels less than 12 ng/mL with decreased musclestrength.86Sufficient vitamin D levels in adulthood maysignificantly reduce the risk for many types of cancer.The interest in vitamin D as a risk reduction factor forcancer began in 1980 when Cedric and Frank Garlandlooked at maps of cancer mortality rates in the UnitedStates and noticed colon cancer rates were lowest inthe southwest.2 In trying to determine a mechanism,they reasoned that the primary physiological effect ofexposure to sunlight, other than inducing tanning, wasthe production of vitamin D. A few years later theydemonstrated, using sera stored for another purpose,that colon cancer risk was inversely associated withpre-diagnostic serum 25(OH)D levels.3 It was soondemonstrated that breast, ovarian, and prostate canceralso had inverse correlations with solar UVB radiation.87-90 By the late 1990s, the mechanisms wherebyvitamin D reduces the risk of cancer were fairly wellknown91-93 and include facilitation of calcium absorption (colon cancer),93 increased cell differentiationand apoptosis,91 and reduction of both metastasis andangiogenesis.91 Calcium has been shown to decreaseproliferation and induce differentiation in epithelialcells.94 In addition, it was discovered that most organshave VDRs and that various alleles of the gene forVDRs affect the risk of cancer.95-99 Another importantdiscovery was that most organs convert circulating25(OH)D to the active hormone, 1,25(OH)2D.100-103Alternative Medicine Review Volume 10, Number 2 2005Page 97Copyright 2005 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Vitamin DReviewIt is now thought that UVB and vitamin Dreduce the risk of 17 types of cancer.4,104,105 This determination was made using cancer mortality ratedata from the Atlas of Cancer Mortality Rates inthe United States106 and UVB data for July from theTotal Ozone Mapping Spectrometer (TOMS).64 TheTOMS data provide a convenient index for vitamin Dproduction from UVB irradiation, but are somewhatlimited because they cover only one month. BothJuly UVB irradiation and cancer mortality rates havehighly asymmetrical distributions in the United States– UVB levels are highest in the southwest and lowest in the northeast; whereas, the opposite holds formany types of cancer. The reason for the asymmetryin UVB irradiation is that, as the westerly winds prepare to cross the Rocky Mountains, the air massespush up the tropopause west of the Rockies, therebyreducing the thickness of the stratospheric ozone layer. The edge of the ozone absorption band occurs inthe UVB region (290-315 nm); therefore, variationsin ozone column amounts affect the UVB transmission.Statistically significant inverse correlationswere found for bladder, breast, colon, esophageal,gastric, ovarian, prostate, rectal, renal, uterine cancer, and NHL.4 This study was extended by including several additional cancer risk-modifying factors,including degree of urbanization, smoking, alcoholconsumption, Hispanic heritage, and fraction of thepopulation living below the poverty level, with alldata averaged at the state level.104 The additionalcancers found to be vitamin D sensitive are cervical,gall bladder, laryngeal, oral, pancreatic, and Hodgkinʼs lymphoma.104 In most cases the association withUVB irradiation for July is stronger than that for anyother factor. The primary exceptions to this relationare cancers strongly linked to smoking. However, inmulti-country comparisons, the fraction of energy derived from dietary animal products is the primary riskfactor for breast107 and colon108 cancer. The link between diet and cancer risk in such cases appears to bemediated through insulin-like growth factor-1 (IGF1).109,110 Dietary factors do not vary greatly within theUnited States. Vitamin D has been shown to counteract the growth-signaling effects of IGF-1.111,112Presently, the role of UVB and vitamin D inreducing the risk of cancer is considered a scientificPage 98finding that satisfies most, if not all, the criteria forcausality in a biological system given by Hill.113,114The most important criteria appear to be: (1) strengthof association; (2) consistency in results for different populations; (3) generally linear dose-responsegradients; (4) exclusion of possible confounding factors from explaining the observations; and (5) identification of mechanisms to explain the observations.These criteria are generally satisfied for several cancers in particular and many cancers in general.4To be fully accepted by the health policyestablishment, there would likely have to be doubleblind crossover studies of vitamin D supplementationand cancer outcome. However, given the strength ofthe evidence regarding cancer and the many benefitsof vitamin D, the authors believe the cancer risk-reduction potential should be accepted by public healthbodies, and thereafter guidelines be developed andpromulgated.Tuberculosis (TB) is a disease for which vitamin D can strengthen the immune system by enhancing the macrophage phagocytosis of Mycobacteriumtuberculosis.115 TB is often associated with lower serum 25(OH)D levels among patients and increasedrisk among those with low serum 25(OH)D levels.116A recent Peruvian study found VDR alleles were associated with response to treatment.117The Effect of Vitamin D in the ElderlyPopulationThe elderly have a particularly strong needto maintain vitamin D sufficiency. Not only are theylikely to produce less vitamin D from solar UVB irradiation because they generally spend less time insunlight than do younger people,118,119 but their efficiency of photoproduction is less.119-121 In addition,diseases such as cancer and osteoporotic fractures aremost likely among the elderly. A study from Turkeyreported it was possible to identify risk of vitaminD insufficiency in elderly subjects simply by asking about clothing habits and exposure to sunlight.122In countries where
light of new findings, especially for soft-tissue health. The consensus of scientific understanding appears to be that vitamin D deficiency is reached for serum 25-hydroxyvitamin D (25(OH)D) levels less than 20 ng/mL (50 nmol/L), insufficiency in the range from 20-32 ng/mL, and sufficiency in the range from 33-80 ng/mL, with normal in sunny
Konsumsi asam folat, vitamin B12 dan vitamin C pada ibu hamil tergolong masih rendah, sehingga konsumsi sumber vitamin perlu ditingkatkan untuk mencegah masalah selama kehamilan, seperti anemia, prematur, dan kematian ibu dan anak. Kata kunci: asam folat, ibu hamil, vitamin B12, vitamin C *Korespondensi: Telp: 628129192259, Surel: hardinsyah2010@gmail.com J. Gizi Pangan, Volume 12, Nomor 1 .
Milk Thistle Red Clover Rhodiola St. John’s Wort Soy Bean Tomato Tribulus Terrestris Willow Vitamin B1 Vitamin B2 Vitamin B6 Vitamin B12 Vitamin C Vitamin D3 Vitamin E MISCELLANEOUS Alpha Lipoic Acid Beta Carotene Caffeine Choline Bitartrate Chond. Sulphate Bovine Chond. Sulphate Porcine Ch
Normal vitamin D 36% 9% 55% Vitamin D deficiency* Severe vitamin D deficiency** Normal vitamin D Camargo CA, Jr., Ingham T, Wickens K, et al. Vitamin D status of newborns in New Zealand. Br J Nutr 2010;104:1051 -7. Grant CC, Wall CR, Crengle S, Scragg R. Vitamin D deficiency in early childhood Public Health Nutr. 2009;12(10):1893-1901
VITAMIN A This vitamin helps your body maintain healthy eyes and skin. VITAMIN C This vitamin helps the body heal cuts and wounds and maintain healthy gums. VITAMIN E This vitamin helps maintain healthy cells throughout your body. WATER Water makes up more than half of your body weight. Your
Vitamin A Keeps the skin healthy Helps us see in dim light Helps children to grow Keeps mucous membranes moist and healthy This vitamin is an antioxidant Vitamin D Helps calcium to be absorbed in the body Helps calcium to strengthen the bones and teeth Vitamin E This vitamin is an antioxidant Vitamin K Helps the blood.
25-OH Vitamin D levels* To determine vitamin D status * Only measure if patient is symptomatic and has risk factors for Vitamin D deficiency. Measurement, status and management (see Appendix 1 for flowchart) Vitamin D level Vitamin D status Health effect Management 30 nmol/L Defi
important.1 But the form of the vitamin D in it is. Look for supplements that contain: Vitamin D3, which is superior at optimizing and maintaining vitamin D levels long-term2 3 Or, if you prefer a plant-based option: Vitamin D2, which is derived from yeast or mushrooms For best absorption, take vitamin D with a meal, especially one that .
VITAMIN D3 VITAMIN D2 Ergosterol Not produced in humans 1/3 activity D3 7-dehydrocholesterol Produced by skin by UVB Fully active 16 VITAMIN D3 1,25(OH) 2VITAMIN D 3 VITAMIN D3 Biologically inactive Does not bind to VDR Nutritional substance 1,25(OH) 2 D 3 Steroid hormone Acts through Vitamin D Receptor (VDR) 17
