Demystifying 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] 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 ()

• 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 & 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

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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 • insufficiency7,8

• Sunscreen use3,4,5 • insufficiency7,8

• Alcohol consumption6 • 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]