Demystifying Vitamin D Presented by Daniel Roytas
Presented by Daniel Roytas www.humanley.com [email protected] About the Presenter D a n i e l R o y t a s M H S c ( N u t ) , B H S c (Nat) Dip.RM, MANTA
• Naturopath, Nutritionist & Remedial Massage Therapist
• 12 yrs clinical & 9 yrs lecturing experience
• Published author & public speaker
• Special interest in traditional naturopathy
Presented by Daniel Roytas www.humanley.com [email protected] Vitamin D Setting the Stage
• Despite living on the sunniest continent1, more than 25% of all Australians
are thought to be vitamin D deficient (<25 nmol/L)2
• >40% of Australians are insufficient (<50 – 75 nmol/L)3
• A 128x increase in vitamin D testing from 2000 - 2014, with a cost to
Medicare increasing from $1.02 million to $151 million by 20124
• To put things in perspective, government funding to the Cancer Council in
2012 was just $12.7 million4
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Presented by Daniel Roytas www.humanley.com [email protected] Vitamin D Supplement Industry It’s Big Business!
• An ABS report in 2011, 5% of Australians report taking a vitamin D
supplement daily1
• As of 2010, there were 89 vitamin D manufacturers, selling 195
different vitamin D products in Australia2
• Approximately 60 million vitamin D products were sold that year,
totaling $89.3m2
• Is supplementation having a beneficial effect on health?
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Presented by Daniel Roytas www.humanley.com [email protected] What is Vitamin D? Introduction
• Discovered by Elmer V. McCollum in 19221
• Historically considered a fat soluble essential vitamin2,3
• Actually a fat soluble secosteroid pro-hormone & hormone2,3
2,3 • Present in two forms, D2 (calcidiol) & D3 (calcitriol)
• Thought to be the substance responsible for many biological functions, primarily
involved in calcium & phosphorous homeostasis2,3
• Possesses autocrine, paracrine and endocrine activates4
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Presented by Daniel Roytas www.humanley.com [email protected] Vitamin D Metabolism An Overview
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Presented by Daniel Roytas www.humanley.com [email protected] Biological Mechanism of Vitamin D How Does it Work?
References1
Presented by Daniel Roytas www.humanley.com [email protected] Causes of Vitamin D Deficiency More than Insufficient Sun Exposure
Causes
• Insufficient sun exposure1 • Infection5,9
• Obesity2,3,4 • Kidney disease10,11
• Inflammation5,6 • Liver disease12
• Chronic disease6,7 • COPD13
• Deteriorating health7 • Diabetes14
• Ageing8 • Skin colour15
Presented by Daniel Roytas www.humanley.com [email protected] Vitamin D & Health Exploring the Relationship
• Inverse relationship between vitamin D status & numerous
markers of health & disease prevalence is well established1,2
• Relationship established from epidemiological studies1,2
• Therefore supplementation must protect individuals
against disease, right?
Presented by Daniel Roytas www.humanley.com [email protected] Vitamin D & MSK Health What’s the Evidence?
• Evidence shows an inverse relationship between vitamin D status, risk of falls, fracture, bone & muscle
function1,2
• Many systematic reviews show that vitamin D supplementation (VDS) alone does not significantly reduce
osteopenia, osteoporosis or fracture risk3,4,5
• Evidence suggests an increased risk of falls (15%) & fracture (26%) from high dose VDS6,7,8,9
• Long term, high dose VDS may reduce bone mineral density10
• Calcium plus vitamin D MAY reduce fracture risk11, but increases risk of kidney stones3
Presented by Daniel Roytas www.humanley.com [email protected] Vitamin D & Cardiovascular Health What’s the Evidence?
• Vitamin D status has an inverse relationship with cardiovascular disease (CVD)1,2
• Supplementation is not associated with a reduced risk of CVD3,4
• A meta-analysis of 21 RCTs found supplementation did not reduce incidence of stroke or heart attack5
• Vitamin D alone or in combination with calcium may increase risk of heart attack by 25%6
Presented by Daniel Roytas www.humanley.com [email protected] Vitamin D & Cardiovascular Health Cont’d What’s the Evidence?
• Increased vitamin D status through sunlight is associated with significantly reduced TC, LDL and
HDL whereas VDS is associated with increased TC & HDL1
• Sunlight provides beneficial effects on the CVS above & beyond vitamin D including increased
nitric oxide synthesis2, RAAS regulation3, reduced cortisol4 & dyslipidemia5
Presented by Daniel Roytas www.humanley.com [email protected] Vitamin D & Stroke A Deeper Look
• Vitamin D deficiency is associated with an increased risk of stroke1 & below average sun exposure
increases risk by 60%2
• Preliminary evidence suggests that vitamin D supplementation may increase the risk of stroke by 15-20%3,4
• Deficiency is associated with worse post-stroke outcomes5, however new evidence suggests deficiency is
actually a consequence, not a cause of stroke6
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Presented by Daniel Roytas www.humanley.com [email protected] Vitamin D & Cancer What’s the Evidence?
• Evidence suggests that vitamin D supplementation does not reduce the incidence of cancer1,2 including prostate2,
breast3, or colorectal cancer4
• Vitamin D deficiency is associated with a increased risk of colorectal cancer (31%)4, a two-fold increased risk of
prostate cancer5 & a 7.5 fold increase in breast cancer6
• Inverse relationship between sun exposure & breast (50%)7, colorectal8 & prostate cancer risk9
• Sun exposure protects against cancer independently of vitamin D, probably through regulating nocturnal
melatonin peaks, which has an antiproliferative effect10
Presented by Daniel Roytas www.humanley.com [email protected] Vitamin D & Multiple Sclerosis What’s the Evidence?
• Vitamin D deficiency is associated with an increased risk of multiple sclerosis1
• Current evidence suggests vitamin D supplementation may have a limited therapeutic effect2,3
or risk reduction effect4, however evidence is inconclusive
• Several studies have shown sun exposure protects against multiple sclerosis via
immunomodulatory mechanisms independent of vitamin D5,6,7
Presented by Daniel Roytas www.humanley.com [email protected] A Proxy Marker (Quotes 1) Barking Up The Wrong Tree?
“The 25(OH)D level is simply a proxy for sun exposure, time outdoors or associated behaviours. Any positive non-vitamin D pathway effects of sun exposure will not be apparent in vitamin D supplementation trials and may explain the discrepancies between observational studies and clinical trials“. 1
“An alternative explanation for the discrepancy between observational and intervention studies is that the risks associated with low 25OHD are not linked, or only partly linked to vitamin D per se, and largely due to an associated exposure (or lack of sun exposure)”.2
Presented by Daniel Roytas www.humanley.com [email protected] A Proxy Marker (Quotes 2) Barking Up The Wrong Tree?
“Vitamin D has long been considered the principal mediator of beneficial effects of sun exposure. However, oral vitamin D supplementation has not been convincingly shown to prevent disease; thus, serum 25(OH)D as an indicator of vitamin D status may be a proxy for and not a mediator of beneficial effects of sun exposure”.1
“Higher vitamin D concentrations (measured as serum 25-hydroxy vitamin D) are considered as a proxy for sun exposure so that their association with health benefits will be taken as indicating a beneficial effect of sunlight but not necessarily a benefit of vitamin D”.1
Presented by Daniel Roytas www.humanley.com [email protected] Effects Beyond Vitamin D Embrace the Sun
Causes
• Nitric oxide synthesis & release1 • Cytochrome oxidase induction4
• β-endorphin synthesis1 • TRPV induction4
• POMC gene expression (HPA axis)2 • CRH release5
• ACTH regulation2 • Melatonin regulation5
• Collagen synthesis / wound healing2 • Acetylcholine regulation5
• Cancer protective effects3 • Serotonin regulation6
Presented by Daniel Roytas www.humanley.com [email protected] Sun Exposure & Vitamin D How Much Do We Need?
• One whole body minimum erythema dose (faint skin redness) generates the
equivalent of 10 – 25000 IU of vitamin D1
• 7 minutes during Summer (outside of 10 am – 3 pm) & 7 – 40 minutes at
midday in Winter with 15% of the skin exposed2
• 25(OH)D reflect sun exposure over the last 5 – 10 years3
• Serum levels from sun exposure plateau at 150 nmol/L4
• 340,000 deaths (US) & 480,000 deaths in Europe per year from insufficient
exposure5 Image source1
Presented by Daniel Roytas www.humanley.com [email protected] Sun Exposure Cause For Concern?
• Sun (UV light) exposure is associated with increased risk of malignant
melanoma
• Incidence of melanoma is greater in vitamin D deficient individuals
(66%) compared to sufficient individuals (15%)1
• Intermittent sun exposure is associated with a higher risk of
melanoma compared to a null or inverse association with regular sun
exposure2,3
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Presented by Daniel Roytas www.humanley.com [email protected] Other Risk Factors For Melanoma More Than Just UV
Causes
• FM radio waves1,2 • Vitamin A insufficiency7,8
• Sunscreen use3,4,5 • Vitamin C insufficiency7,8
• Alcohol consumption6 • Vitamin E insufficiency7,8
• Low dietary antioxidant intake7 • Low beta-carotene7,8
Presented by Daniel Roytas www.humanley.com [email protected] Antioxidants for Sun Protection Supporting Natural Mechanisms
• Beta carotene provides protection against sun induced skin damage
• Dietary carotenoid intake for approximately 10 weeks provides systemic photoprotection1
• Supplemental beta-carotene (>12 mg/d / 7000 IU) provides photoprotection for >7 wks1
• Supplemental vitamin C (2000 mg) + vitamin E (1000 IU) for 8 days increased the minimum erythema dose from
80 - 96.5 mJ/cm2 & decreased from 80 - 68.5 mJ/cm2 in the placebo group2
Presented by Daniel Roytas www.humanley.com [email protected] Vitamin A + Sun Burn
• In 1964, Cluver et al. found vitamin A supplementation + CaCo32- provided 12 hours before sun exposure,
protected 100 fair skinned participants against sunburn in people visiting South African beaches in the
middle of Summer1
• In 1965, Cluver et al. found 25000 IU of vitamin A + CaCo32- protected 11 fair skinned participants against
sunburn from excessive solar radiation2
• In a control group, participants with low serum vitamin A had a higher susceptibility to sunburn compared
to participants with sufficient levels2
Presented by Daniel Roytas www.humanley.com [email protected] Time To Re-Think Our Approach? What’s Happening In Practice?
• Deficiency is a direct consequence of insufficient sun exposure & various diseases
• Can we really provide “sun in a capsule?”
• Is it time for clinicians to reconsider prescribing vitamin D supplements?
• Promote sensible sun exposure & grounding
• Remember our naturopathic principles (tolle causum / naturae)
Presented by Daniel Roytas www.humanley.com [email protected] Check Out Humanley
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Presented by Daniel Roytas www.humanley.com [email protected] Time For Question & Answers THANKYOU!
Presented by Daniel Roytas www.humanley.com [email protected]