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Vitamin D, Iodine, and Selenium

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Vitamin D, Iodine, and Selenium AAddaappttiivvee IInnnnoovvaattiioonnss iinn MMeeddiicciinnee:: VViittaammiinn DD,, IIooddiinnee,, aanndd SSeelleenniiuumm Donald W. Miller, Jr., M.D. Professor of Surgery, Division of Cardiothoracic Surgery University of Washington School of Medicine 65th Annual Meeting Association of American Physicians and Surgeons Phoenix, Arizona September 12, 2008 Christensen CM, Bohmer R, Kenagy J. Will Disruptive Innovations Cure Health Care? Harvard Business Review 2000;78(Sept-Oct):106-112. Christensen CM, Bohmer R, Kenagy J. Will Disruptive Innovations Cure Health Care? Harvard Business Review 2000;78(Sept-Oct):106-112. VViittaammiinn DD Recommended Dietary Allowance (RDA) for Vitamin D: 440000 IIUU//ddaayy TToo pprreevveenntt rriicckkeettss iinn cchhiillddrreenn aanndd oosstteeoommaallaacciiaa iinn aadduullttss VViittaammiinn DD DDeeffiicciieennccyy Rickets, Osteomalacia Influenza, Tuberculosis MS, RA, SLE, Type I diabetes Hypertension, CAD, PVD, CHF Syndrome X, Type 2 Diabetes Chronic Fatigue, SAD, Depression Cataracts, Infertility Osteoporosis Cancer VViittaammiinn DD 2255((OOHH))DD 11,,2255((OOHH))DD 26 + cells throughout the body UVB 7-dehydrocholesterol photons NNuucclleeaarr RReecceeppttoorrss SSyysstteemm aanndd TTiissssuuee DDiissttrriibbuuttiioonn ooff NNuucclleeaarr VViittaammiinn DD RReecceeppttoorrss ((VVDDRR)) System Tissue Immune Thymus, bone marrow, macrophages, B cells, T cells Gastrointestinal Esophagus, stomach, small intestine, colon, rectum Cardiovascular Endothelial cells, smooth muscle cells, myocytes Respiratory Lung alveolar cells Hepatic Liver parenchyma cells Renal Proximal and distal tubules, collecting duct Endocrine Parathyroid, thyroid, pancreatic beta cells Exocrine Parotid gland, sebaceous gland CNS Brain neurons, astrocytes, microglia Epidermis/appendage Skin, breast, hair follicles Musculoskeletal Osteoblasts, osteocytes, chondrocytes, striated muscle Connective Tissue Fibroblasts, stroma Reproductive Testis, ovary, placenta, uterus, endometrium, yolk sac NNuuttrriiggeennoommiiccss VViittaammiinn DD Confirmatory PCR for 1,25-dihydroxyvitamin D-regulated genes found by Affymetrix GeneChip transcriptional profiling Wood RJ, Tchack L, Angelo G, etal. DNA Microarray Analysis of Vitamin D- induced Gene Expression in a Human Colon Carcinoma Cell Line. Physiological Genomics 2004;17:122-129. HHuummaann MMiiggrraattiioonn OOuutt ooff AAffrriiccaa 35°N 35° S Lamson Rl, etal. SLC24A5, a putative cation exchanger, affects pigmentation in zebrafish and humans. Science 2005;310:1782-1786. IInnddiiggeennoouuss HHuummaann SSkkiinn CCoolloorr bbyy LLaattiittuuddee 35° N 35° S Jablonski NG, Chaplin G. The evolution of human skin coloration. J Hum Evol 2000;39:57-106 SSeeaassoonnaall VVaarriiaattiioonn iinn 2255--hhyyddrrooxxyyvviittaammiinn DD LLeevveellss iinn PPeeooppllee aatt LLaattiittuuddee 4488°°NN Cannell JJ, etal. Epidemic influenza and vitamin D. Epidemiol Infect 2006;134:1129-1140. Cannell JJ, etal. Epidemic influenza and vitamin D. Epidemiol Infect 2006;134:1129-1140 NNoonnccaallcceemmiicc FFuunnccttiioonnss ooff 11,,2255--ddiihhyyddrrooxxyyvviittaammiinn DD Cytokines Adaptive Innate Immune modulation TTuubbeerrccuulloossiiss TTrreeaatteedd wwiitthh SSuunnsshhiinnee IImmmmuunnoommoodduullaattoorryy EEffffeeccttss ooff 11,,2255--ddiihhyyddrrooxxyyvviittaammiinn DD MMuullttiippllee SScclleerroossiiss iinn WWoorrlldd WWaarr IIII VVeetteerraannss bbyy LLaattiittuuddee aanndd SSttaattee ooff RReessiiddeennccee 220 200 ) s 180 t i n u 160 e v i t a l 140 e r ( e 120 c n e l 100 a v e r 80 P S M 60 40 20 25 30 35 40 45 50 Latitude (degrees N) Wallin MT, etal. Multiple sclerosis in US veterans… Ann Neurol 2004;55:65-71 BBrreeaasstt CCaanncceerr MMoorrttaalliittyy RRaatteess aanndd CCoonnttoouurrss ooff AAnnnnuuaall MMeeaann DDaaiillyy SSoollaarr IIrrrraaddiiaannccee Lappe JM, etal. Vitamin D and calcium supplementation reduces cancer risk: Results of a randomized trial. Am J Clin Nutr 2007;85:1586-1591. 2255--hhyyddrrooxxyyvviittaammiinn DD33 BBlloooodd LLeevveellss Calcium Absorption SSeevveerreellyy ddeeffiicciieenntt << 88 nngg//mmll DDeeffiicciieenntt 88--1199 nngg//mmll 32 ng/ml IInnssuuffffiicciieenntt 2200--2299 nngg//mmll SSuuffffiicciieenntt 3300--4499 nngg//mmll PTH Levels OOppttiimmaall 5500--9999 nngg//mmll EExxcceessssiivvee 110000--115500 nngg//mmll TTooxxiicc >>115500 nngg//mmll (1 ng/ml = 2.5 nmol/L, 1 nmol/L = O.4 ng/ml) PPrreeoopp VViittaammiinn DD33 lleevveellss iinn 7733 VVeetteerraannss UUnnddeerrggooiinngg HHeeaarrtt SSuurrggeerryy aatt tthhee SSeeaattttllee VVAA HHoossppiittaall No. of History of 25-hydroxyvitamin D3 Patients Cancer Level (ng/ml) 7 (9.6 %) 1 (colon) < 8 (severely deficient) 41 (56.2%) 6* 8-19.9 (deficient) 9 (12.3%) 0 20-29.9 (insufficient) 13 (17.8%) 0 30-49.9 (sufficient) 3 (4.1%) 0 50-100 (optimal) * Prostrate cancer – 3; Colon cancer – 1; Tonsillar cancer – 1; Melanoma -- 1 Surgery performed December 2006 ± July 2007 SSoouurrcceess ooff VViittaammiinn DD CChhoolleeccaallcciiffeerrooll ((DD3)) aanndd EErrggooccaallcciiffeerrooll ((DD2)) Dietary Natural Salmon (wild, 3.5 oz) 800 IU D3 Salmon (farmed, 3.5 oz) 150 IU D2 or D3 Cod liver oil (1 tsp) 400-1100 IU D3 Tuna (canned, 3.6 oz) 230 IU D3 Egg yolk 20 IU D 2 or D3 Fortified Foods Milk (8 oz) 100 IU D3 Orange juice (8 oz) 100 IU D3 Skin synthesizes 20,000 IU D3 in 20 minutes Infant formula (8 oz) 100 IU D3 when exposed to sunlight Butter (3.5 oz) 50 IU D3 Breakfast cereals/serving 100 IU D3 Supplements Prescription Ergocalciferol (D2) 50,000 IU/capsule Over the Counter Multivitamins 400 IU D2 or D 3 Cholecalciferol (D3) 400, 800, 1000, 2000, 5000 and 5,000 IU D3 50,000 IU D3 50,000 IU/tablet OTC at vitalady.com, lifespannutrition.com SSeerruumm 2255--hhyyddrrooxxyyvviittaammiinn DD33 LLeevveellss oonn 00,, 11000000,, 55000000,, aanndd 1100,,000000 IIUU ooff VViittaammiinn DD3 aa DDaayy (80 ng/ml) 80 ng/ml 10,000 IU qd 6(06 0n gn/gm/ml l) 5000 IU qd 30(3 n0g n/mg/lml) 1000 IU qd 0 Heany RP, etal. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 2003;77:204-210. BBeenneeffiittss ooff VViittaammiinn DD • Skeletal-muscular ± Strong muscles and bones · Infections ± Prevent influenza, treat tuberculosis · Cancer ± Prevent breast, colon, and prostate cancer ± ? Suppress metastasizes · Autoimmune Diseases ± Prevent multiple sclerosis and type 1 diabetes · Cardiovascular Disease ± Slow progression of atherosclerosis ± Treat hypertension and congestive heart failure · Neuropsychiatric Disorders ± Prevent schizophrenia and relieve depression IIooddiinnee IIooddiinnee iinn SSuurrggeerryy TThhyyrrooiidd--rreellaatteedd IIooddiinnee DDeeffiicciieennccyy PPyyrraammiidd 1-10% Cretinism Worsening Iodine Mental Deficiency Retardation 5-30 % Loss of Energy due to Hypothyroidism 30-70 % IIooddiinnee iinn TThhyyrrooiidd HHoorrmmoonneess Iodine atoms TThhee MMaaiinnssttrreeaamm MMeeddiiccaall VViieeww ooff IIooddiinnee 11)) TThhee tthhyyrrooiidd ggllaanndd iiss tthhee oonnllyy oorrggaann tthhaatt nneeeeddss iiooddiinnee,, iinn mmiiccrrooggrraamm aammoouunnttss,, ffoorr bbiioossyynntthheessiiss ooff tthhyyrrooiidd hhoorrmmoonneess.. RRDDAA ffoorr IIooddiinnee:: 110000--115500 JJ//ddaayy 22)) AA ddaaiillyy iinnttaakkee ooff mmoorree tthhaann 11--22 mmgg//ddaayy ooff iiooddiinnee iiss eexxcceessssiivvee aanndd ppootteennttiiaallllyy hhaarrmmffuull.. EExxttrraatthhyyrrooiiddaall BBeenneeffiittss ooff IIooddiinnee • Formation of the Earth’s Atmosphere ± Role in photosynthesis · Antioxidant ± Prevent lipid peroxidation · Fibrocystic disease of the breast · Cancer ± Trigger apoptosis · Immune system ± Suppress autoimmunity ± Coat external proteins rendering them non-allergic · Mucosal Defense ± Provide antisepsis in mouth, stomach, and vagina · Civil Defense ± Against radioactive fallout TThhee EEaarrtthh''ss 33rd AAttmmoosspphheerree,, ffrroomm 22..22 GGaa Oxygen Level in Atmosphere (Percent) 4.6 3.6 2.6 1.6 0.6 Billion Years Ago Photosynthesis first done by Cyanobacteria: 6CO2 + 6H2O C 6H12 O6 + 6O2 Cyanobacteria are also the first life forms to tolerate and use………………… IIooddiinnee KKiinnggddoommss ooff LLiiffee AAllggaaee Eukaryotic cells 1. Plants 2. Animals 3. Fungi 4. Protista Seaweed: Kelp, etc. Prokaryotic cells 5. Monera Cyanobacteria Blue Green Algae Other Bacteria Archaea IIooddiinnee aass aann AAnnttiiooxxiiddaanntt RReeaaccttiivvee OOxxyyggeenn SSppeecciieess - - II ++ HH2OO2 HHIIOO ++ OOHH - + HHIIOO ++ II ++ HH II2 ++ HH2OO Kupper FC, et al. Iodine uptake in Laminariales involves extracellular, haloperoxidase- mediated oxidation of iodide. Planta 1998;207:163-171. RReeaaccttiivvee OOxxyyggeenn SSppeecciieess IIoonniizziinngg RRaaddiiaattiioonn PPhhoottoossyynntthheessiiss:: Chlorophyll Lane, N. Oxygen: The Molecule that Changed the World London: Sunlight Oxford University Press, 2004. CO2 IIooddiinnee aass aann AAnnttiiooxxiiddaanntt PPrreevveenntt LLiippiidd PPeerrooxxiiddaattiioonn Omega 6 Arachidonic Acid (AA) Iodolactone I- Omega 3 Docosahexaenoic Acid (DHA) FFiibbrrooccyyssttiicc BBrreeaasstt DDiisseeaassee CCyysstt EElleemmeennttaall IIooddiinnee,, II ,, mmoorree FFiibbrroouuss 2 ttiissssuuee eeffffeeccttiivvee tthhaann - IIooddiiddee,, II EEppiitthheelliiaall aanndd aappooccrriinnee hhyyppeerrppllaassiiaa Ghent WR, Eskin BA, Low DA, Hill LP. Iodine replacement in fibrocystic disease of the breast. Can J Surg 1993;36:453-460. DDiiaattoommiicc IIooddiinnee ((II2))TTrreeaattmmeenntt ffoorr FFiibbrrooccyyssttiicc DDiisseeaassee SSppeecciiaall RReeppoorrtt ooff EEffffiiccaaccyy
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