Dr David McGrath

Spine Physician

MB BS (Hons) FAFOM, RACP, FAFMM
Master of Pain Medicine

Vitamin D

Bottom Line
1. Essential for health
2. Daily dosage around 4000 IU all sources (sun and diet)

1. (30-50%) reduction in risk for colorectal, breast, prostate cancer by
1000IU/day or blood levels 25(OH)D3>30ng/ml (Holick MF 11/6/08 Vitamin D and Sunlight :Strategies for cancer prevention and other health benefits.)

2. Skin Immune Function regulated by 1,25 (OH)D3. Less Malignant Melanoma,less infectious and inflammatory skin diseases. (Nurnberg B 2008,Schauber J 2008)

3. Normal range. 25(OH)D3 (plasma) [40 ng/ml=100 nmol/l ]
<10 ng/ml acute deficiency. [25 nmol/l ]
>150 ng/ml toxic [400 nmol/l ]
Summer 15-80
Winter 14-42
Optimal estimated to be around 40 ng/ml or 100 nmol/l

4. Nomemclature
Vitamin D3- chole/calciferol (made in skin from cholesterol or ingested animal sources)
PrevitaminD3-pre/calciferol
25(OH)Cholecalciferol -25(OH)D3 (calcidiol) (made in liver )
Calcitriol-1,25(OH)2 D3(made in multiple tissues, kidney)
Osteocalcin- downstrean bone protein product (BGlaP)
24,25(OH)Cholecalciferol or 24,25(OH)D3 (made in cartilage and GIT)

5.PTH-VitaminD-Ca++/Mg++ Axis.
Dysregulation of this metabolic pathway leads to osteomalacea (bad bones)
Insufficiency leads to osteoporosis

5. D3 Preparations
Vitamin D3
25(OH) vitamin D3
1,25(OH) vitamin D3

6. Sources
1. Sunlight UV-B produces vit B in the skin and is re-absorbed. Coproduces melanin, protects against the harmful effects of UV-B and MSH (Melanocyte Stimulating Hormone )
2. Fatty fish,liver,butter,cheese,milk

7. Interactions
Protective against, high levels of vitamin A. Probable synergistic actions.

Transport
1. Chylomicrons from GIT
2. Special protein DBP (D binding protein)

8. Vitamin D from UV-B
1. Only present miday hours at higher latitudes (10-2pm)
2. 5% penetration through glass
3. No penetration through clouds,smog,fog
4. 24 hour lag before vitD production
5. Cholesterol containing body oils on skin contain VitD production. 60 minutes for re-absorption
6. Oils can be removed by showering or chlorine swimming pools
7. 10-20 minutes sunlight three times a week (Recommended but INADEQUATE) Only provides around 200-400 IU vitD/exposure

Low Vitamin D levels
1. Myopathy (muscle and bone pain, with proximal weakness)
2. Peripheral Neuropathy
3. Auto-immune Diseases
4. Osteoporosis
5. Innate inflammation (non specific system)
6. Decreased specific immunity
7. Infertility
8. Breast,prostate,skin,colon cancer
9. Fibromyalgia, Chronic Fatigue Syndrome
10.Seasonal affective disorder
11.Parkinsons,Alzheimers
12. Congenital Deformities in children born to low D mothers
13. Behavior and learning disorders
14. Senile cataract
15. PCOS polycystic ovary syndrome (hormone dysregulaion)
16. Type I and Type 2 diabetes disposition
17. Poor anti-oxidant capacity (decreased production of anti oxidant enzymes)
18. Decreased Hormone production
19. Poor Magnesium absorption (relative magnesium deficiency)