The Clinical Importance Of Vitamin D ( Cholecalciferol ) Last Sunday, I gave a lecture on this topic to a group of doctors and I would like to share some of that information on this forum ! This topic will be useful for those who are not aware of the important role of Vitamin D in our each body system, for those of you, who are aware, please consider this as a revision. We are familiar with the important role of Vitamin D in Calcium absorption and bone metabolism. Now let's go beyond these effects. The widening range of therapeutic applications available for Cholecalciferol have come from the recent research data , as both a Vitamin and a pro-hormone. Recent data highlights the physiological requirement for Vitamin D in adults may be as high as 5000IU/day, which is less than half of the >10000IU that can be produced endogenously with full body sun exposure. Vitamin D receptors are not only seen in the gut and bone, but also in brain, breast, prostrate and lymphocytes and recent research suggests that higher Vitamin D levels provide protection from DM, Osteoporosis, Osteoarthritis, Hypertension, CVD, Metabolic syndrome, Depression, cancers of the breast, prostrate and colon and several autoimmune diseases. We should be assessing the Vitamin D status and treating with oral Vitamin D supplements , as a routine component of clinical and preventive medicine Periodic assessment of Serum 25OH-vitamin D and serum Calcium helps to ensure Vitamin D levels are sufficient and safe for good health and disease prevention. We shall concentrate our attention, more on on the use of Vitamin D in the management of T2DM, osteoporosis, Osteoarthritis, Hypertension, CVD, metabolic syndrome, Multiple sclerosis, PCOD, Musculoskeletal pain,depression, epilepsy, and also in the prevention of cancer and T1DM. Supplementation of vitamin D is a must in all age groups, infants, children, adults and during pregnancy and lactation. CVD Deaths from CVD are more common in winter, more common at higher latitudes and more common at lower altitudes, observations that are consistent with vitamin D insufficiency. The risk of A heart attack is twice as high for those with 25(OH)D levels < 34 ng/ml than for those with vitamin D status above this level. Patients with CCF were recently found to have markedly lower levels of vitamin D than controls. HYPERTENSION It has long been known that BP is higher in winter than in the summer, increases at a greater distances from the equator and is affected by skin pigmentation - all observations consistent with a role of vitamin D in regulating BP. When patients with HT were treated with ultraviolet light three times a week for 6 weeks, their vitamin D levels increased by 162 % and their BP fell significantly. Even small amounts of oral cholecalciferol 800IU for 8 weeks lowered both BP and HR. T2DM Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction in diabetic young adults who are apparently healthy. Healthy adults with higher serum 25( OH)D levels had significantly lower 60 minutes, 90 minutes, and 120 minutes PPBS levels and significantly better insulin sensitivity than those who were vitamin D deficient.. One interesting observation was that Metformin improved insulin sensitivity by 13% and higher vitamin D status correlated with a 60% improvement in insulin sensitivity. OSTEOARTHRITIS We know that vitamin D helps in prevention and treatment of osteoporosis, but few know that the progression of osteoarthritis is lessened by adequate blood levels of vitamin D. Framingham data shows that osteoarthritis of knee progressed more rapidly in those with 25(OH)D levels < 36 ng/ml. MULTIPLE SCLEROSIS This autoimmune/ inflammatory disease is notably rare in sunny equatorial regions and becomes increasingly prevalent among people who live farther from the equator and/or who lack adequate sun exposure .Daily supplementation with approximately 1000mg calcium, 600mg magnesium and 5000 IU vitamin D ( from cod liver oil ) for upto 2 years and found a reduction in number of exacerbations and an absence of adverse effects. PREVENTION OF T1DM This is generally caused by autoimmune/inflammatory destruction of pancreatic beta cells. In a study with >1000 participants, supplementation in infants < 1yr of age and children with 2000 IU of vitamin D reduced the incidence of T1DM by approximately 80%. DEPRESSION Seasonal affective disorder ( SAD ), a subset of depression characterized by the onset or exacerbations of melanocholia during winter months, when bright light, sun exposure and serum 25(OH)D are reduced. A dose of 10000IU of vitamin D was found superior to light therapy in treatment of SAD after 1 month, also in another study supplementation with vitamin D 400 - 800 IU per day improved mood witin five days of treatment. EPILEPSY Seizures can be the presenting manifestation of vitamin D deficiency. Hypovitaminosis D decreases the threshold for and increases the incidence of seizures and several anticonvulsant drugs interfere with the fformation of calcitriol in the kidney and further reduces the calcitriol levels via induction of hepatic clearance. Therefore anticonvulsants may lead to iatrogenic seizures by causing iatrogenic Hypovitaminosis D. Conversely, supplementation with 4000-16000 IU per day of vitamin D helps to reduce seizure frequency, a study finding ! MIGRAINE HEADACHES Calcium clearly plays a role in the maintenance of vascular tone and coagulation, both of which are altered i patients with migraine. In a study, a daily supplementation with 1200 mg of calcium and 1200- 1600 IU of vitamin D in women with vitamin D deficiency showed a reduction in frequency, duration and severity of menstrual migraine headaches. PCOD Surprisingly, this disease is seen only in humans and is classically characterized by polycystic ovaries, amenorrhea, hirsuitism, IR and obesity. Studies have shown that calcium is essential for oocyte activation and maturation. Vitamin D deficiency is highly prevalent in these patients. Thus a supplementation of 1500 mg of calcium per day and 50000 IU of vitamin D on a weekly basis helps in normalization of menstruation and/or fertility. MUSCULOSKELETAL PAINS Patients with non traumatic, persistent Musculoskeletal pain show a significant high prevalence of overt vitamin D deficiency .In a study, patients with non specific low back pain , good results were obtained with supplementation with 5000- 10000 IU of vitamin D per day after 3 months. I hope, after this reading you might be convinced of importance of vitamin D . Let us add vitamin D in treatment, more often !



quite good & informative

My pleasure ! DrNath

Excellent information sir

wonderful information, clear , precise. more posts are welcome. thanks

Thanks for the interest shown, Dr Prakash , Love to share information but Time is the constraint.

Good information i have been used injction form 60 thu.unit once wkly.togeder with supportive treatment in case of primary sterility due to PSOD ., found good result.,she conceive. .

Useful info sir

Very elaborative information, Thnx

Useful information sir

nice information

Thanks, Dr Vinayak !



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