Risks of vitamin D deficiency Explained by Doctor

What makes vitamin D a hormone?

Dr. Burnstein: A hormone is a substance that the body makes. A hormone travels in the bloodstream, and it affects targets such as organs and tissues. Vitamin D is a hormone because we can actually make it in our body. It’s made by a series of chemical reactions that start when the sunlight hits our skin, which converts a pre-form of vitamin D into another form that becomes further converted in the liver and kidneys to what we call the “active form of vitamin D.”

How can we get vitamin D?

Dr. Burnstein: In addition to sunlight, we can get it from our diet. There are certain sources that are rich in vitamin D, such as oily fish. For instance, cod liver oil is a great source of vitamin D. You can get some from fortified milk. One cup of milk is about a quarter of the recommended daily allowance.

Can you take vitamin D in supplement form?

Dr. Burnstein: Yes. You can take it as a nutritional supplement.

How much vitamin D should we get each day?

Dr. Burnstein: The recommended amount for people under age 70 is 400 international units, and the recommended amount for people over age 70 is 600 international units. But there are a lot of experts in the field who think that those numbers should be higher.

What does 400 international units translate into?

Dr. Burnstein: It’s about 10 micrograms. It would be four cups of skim milk.

Does sunlight contribute to fulfilling the RDA of vitamin D?

Dr. Burnstein: Actually, no. You can get vitamin D from sunlight, but the problem is that people at northern latitudes or the elderly housebound don’t always get enough sun. Also, elderly skin is not quite as good as younger skin at making vitamin D. Because of the inconsistencies vitamin D derived from sunlight is not figured into the RDA.

What are the risks when you don’t get this recommended allowance every day?

Dr. Burnstein: The best recognized affect of vitamin D is maintaining a healthy skeleton. When vitamin D is deficient, children develop a disease called rickets, which we’ve known about for over a century. Rickets is inadequate bone formation that can result in deformities. Adults get a similar disease called osteomalacia, which means softening of the bones, and they can also get osteoporosis. But now we realize that vitamin D affects a variety of other tissues and organs. Vitamin D deficiency may put people at risk for several different diseases.

What are these other diseases?

Dr. Burnstein: Two that were just published were multiple sclerosis and rheumatoid arthritis. The finding was that vitamin D appears to be protective against those diseases.

If you get enough vitamin D is the thought that it will prevent rheumatoid arthritis and MS?

Dr. Burnstein: These experiments started when it was noted that there are a variety of diseases for which a north/south gradient exists. What that means is that people who reside at northern latitudes seem to be at increased risks for certain diseases compared to people in the south. The correlation is that people in the north have less sunlight, and people in the south have more exposure to sunlight. The thought was that vitamin D may be protective.

We also know that vitamin D affects many things besides the skeleton, and one of the systems that vitamin D affects is the immune system. Immune cells can be regulated by vitamin D, and since there appears to be an immune component to diseases such as multiple sclerosis and rheumatoid arthritis the thought is that again maybe vitamin D can protect.

What are some of the findings that have come out for arthritis?

Dr. Burnstein: The arthritis study showed that women, and I believe that it was elderly women, who were taking vitamin D supplements had decreased incidence of rheumatoid arthritis. Now the fact is, vitamin D can affect immune cells and can lead to an anti-inflammatory type of setting. It’s thought that perhaps that’s how vitamin D may be working, by decreasing inflammatory cells that are contributing to this auto-immune disease.

What is it about vitamin D that is protective?

Dr. Burnstein: Having adequate vitamin D correlates with a decreased risk for the disease, and we don’t exactly know how that happens. It may be through actions in other cells, such as immune cells.

Why is vitamin D so beneficial? What is there about it that makes it so useful?

Dr. Burnstein: We really don’t know for sure. But we do know vitamin D can inhibit the proliferation of abnormal cell growth. The other thing that vitamin D does is helps cells to mature and specialize, which can be especially helpful in cancers. Vitamin D deficiency actually seems to put people at risk for the three major types of cancer — prostrate, breast and colon cancer.

Do you think that cancer is the next sort of big area for vitamin D research and development?

Dr. Burnstein: We don’t really believe that vitamin D is a “magic bullet” to cure cancer, but it might be a helpful addition to other therapies. It may be a chemotherapy preventative agent, meaning that it will protect against the development of disease and also help therapeutically.

There’s something very interesting about prostate cancer: The three major risk groups for prostate cancer are also the three major risk groups for vitamin D deficiency. So, we know that prostrate cancer is more prevalent among African Americans, and we know that African Americans have a tendency to be vitamin D deficient because black skin is not as good at forming vitamin D. Also elderly men get prostate cancer at a much higher rate than younger men, and the elderly tend to be vitamin D deficient We think elderly people are vitamin D deficient because their older skin is not quite as good at forming vitamin D or that they’re not getting outside as much. And the third group that seems to have higher rates of prostate cancer are people who reside at northern latitudes, who also get less sun.

Any other diseases that vitamin D could possibly help?

Dr. Burnstein: I know vitamin D is used for psoriasis or any type of hyperproliferative disorder where cells are growing uncontrollably.

There are also other diseases for which vitamin D deficiency can put people at risk, such as hypertension and type 1 diabetes. There are arrays of diseases that seem to have a lower incidence when adequate vitamin D is adequate.

How much vitamin D is too much?

Dr. Burnstein: It’s too much when calcium rises. Too much calcium in the body can be detrimental. It can affect the neuromuscular system, gastrointestinal system, and it can even lead to cardiac arrest.

Would doubling the recommended dosages lead to too much vitamin D?

Dr. Burnstein: No. The thought is that 50,000 international units might do that, but it really depends on the person and how they respond to vitamin D. It’s dictated by the presence of the receptors for vitamin D, which is what allows vitamin D to have its actions. This is like all hormones.

What would you recommend to people in light of the recent findings from the MS study, the arthritis study, and the work with prostrate cancer?

Dr. Burnstein: I think it’s very important that people get adequate vitamin D. It’s not as easy to get it from the diet as one would think. As I mentioned, it comes from oily fish and milk. I would recommend getting a little bit of sunlight, and it doesn’t take much to form vitamin D. The thought is that it really takes only about 15 minutes of sun, nothing near what it would take to give you a sunburn. Or take a vitamin supplement.

What would your recommendation be to someone who lives in the north who can’t walk outside for as many months of the year?

Dr. Burnstein: I would recommend that they take at least the 400 international units of vitamin D a day, and through supplements is fine. The MS study and the rheumatoid arthritis studies actually showed women who were taking the vitamin D as supplements were the ones with the decreased risk.

What are your personal thoughts on vitamin D in light of all this research?

Dr. Burnstein: Vitamin D is important. It’s not a magic cure-all but vitamin D deficiency is probably more rampant in this world than we recognize. It’s sort of been scoffed at scientifically, but now it’s coming into its own because of some of these studies. You should make sure you have enough.

Is it your hope that vitamin D can be used as a preventative?

Dr. Burnstein: That’s actually what I’m very excited about.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.