This is a slide presentation delivered at the Webinar "Integrative Medicine in the Prevention and Treatment of Chronic Diseases" organized by Bio Quantum Academy on April 5-6, 2024.

1. THE ROLE OF VITAMIN D
IN
PREVENTION AND TREATMENT
OF
CHRONIC DISEASES
By
Kevin KF Ng, MD, PhD.
Former Associate Professor of Medicine
Division of Clinical Pharmacology
University of Miami, Miami, FL., USA
Email: kevinng68@gmail.com
Presented at the “Integrative Medicine in the Prevention and Treatment of Chronic
Disease” webinar organized by Bio Quantum Academy on April 5-6, 2024

2. Lecture Outline
▪ 400 years history of vitamin D
▪ Nomenclature of Vitamin D
▪ Source of Vitamin D
▪ Conversion of inactive vitamin D to active form
▪ Pharmacology of vitamin D
▪ Chronic diseases associated with deficient vitamin D
▪ Rationale of combining vitamin D3 with K2
▪ Summary

3. Biography of Kevin KF Ng, MD, PhD.
from adrenergic neuron blockade to ACE inhibitor and TRP pain blocker

4. Milestones in discoveries of vitamin D, receptor and gene

5. Number of publications “vitamin D” on PubMed
from 1922 to 2023
https://pubmed.ncbi.nlm.nih.gov/?term=vitamin+D
1937 Vit D receptor
2003 Gene

6. VITAMIN D
● SOURCE
● DIFFERENT FORMS OF VITA D
• PHYSICOCHEMICAL PROPERTIES

7. Origin of Nomenclature of Vitamin D
©DRKKFNG
Vitamin D
4th Vitamin
After vitamin A, B, C
Cod liver oil

8. Different forms of vitamin D
ergocalciferol cholecalciferol Calcidiol Calcitriol
Active
Vitamin D=Vitamin D2

9. Conversion of inactive vitamin D to active vitamin D
Vitamin D receptor
VDR
Active
Biological
responses
Parathyroid gland
Calcium metabolism
• Immune system
• Cardiovascular system
• Metabolic system
• Cancer
©DRKKFNG
Extrarenal tissues

10. Binding of active vitamin D with vitamin D receptor
Vitamin D receptor
VDR
Active
©DRKKFNG
Extrarenal tissues
Calcitriol

11. Biological response to vitamin D transcription complex
©DRKKFNG

12. Targets of active vitamin 1,25 dihydroxy D3 (calcitriol)
©DRKKFNG

13. Time for conversion of inactive vitamin D3 to
active 1,25(OH)2D
©DRKKFNG
3 to 4 weeks
Liver Kidneys & others

14. PHARMACOLOGY OF VITAMIN D3
• PHYSICOCHEMICAL PROPERTIES
• METABOLISM
• PHYSIOLOGICAL ACTIONS

15. Physicochemical characteristics of different forms of Vitamin D
https://gemini.google.com/app/afc5519017e30073

16. Timeline of the absorption of vitamin D to its interaction with VDR
▪ Absorption of Vitamin D3 from the Gut to the Liver:
▪ Absorption of vitamin D3 from the gut typically occurs within a few hours after
ingestion. The process involves the absorption of vitamin D3 in the small intestine and
its transport to the liver via the bloodstream.
▪ Conversion of Vitamin D3 to Calcidiol in the Liver:
▪ The conversion of vitamin D3 to calcidiol (25-hydroxyvitamin D) occurs in the liver. This
process may take several days, and calcidiol is then released into the bloodstream.
▪ Conversion of Calcidiol to Calcitriol in the Kidneys:
▪ The second conversion, where calcidiol is converted to calcitriol (1,25-dihydroxyvitamin
D), takes place primarily in the kidneys. This process usually takes a few hours to a
couple of days.
▪ Interaction of Calcitriol with Vitamin D Receptor (VDR) to Activate
Genes:
▪ Once calcitriol is formed, it can bind to the vitamin D receptor (VDR) in target tissues.
The activation of genes by the calcitriol-VDR complex is a complex process and may
take hours to days, depending on the specific target genes and cellular responses.
https://chat.openai.com/c/45649c18-6547-40b4-9c3a-22669a2dd3db

17. Binding of active vitamin D to VDR (Vitamin D Receptor)
followed by Gene Expression
©DRKKFNG

18. Pharmacological actions of active vitamin D (1,25(OH)2D)
▪ Calcium and bone metabolism
▪ Cellular differentiation and proliferation
▪ Immune system function
▪ Muscle function
▪ Cardiovascular health
▪ Other potential functions:
▪ Diabetes
▪ Mental health
▪ Neurodegenerative diseases
▪ Anti-inflammatory action
▪ Anticancer function

19. Summary of the production and metabolism of vitamin D
https://www.cmaj.ca/content/174/9/1287

20. ● MEASUREMENT OF VITAMIN D 25(OH)D IN BLOOD
● CLASSIFICATION OF VITAMIN D DEFICIENCY
● CHRONIC DISEASES WITH DEFICIENT VITAMIN D
AND TREATMENT

21. Adequate and deficiency values of 25(OH)D3 (Calcidiol) in
different countries

22. Distribution of 25-hydroxyvitamin D (25(OH)D) levels among
9548 adults aged 50–75 years from Saarland, Germany. (2020)
https://www.mdpi.com/2072-6643/12/8/2488

23. Classification of vitamin D deficiency based on
Calcidiol 25(OH)D
https://www.secondopinionphysician.com/shop/normal-vitamin-d-levels-calcifediol/
Blood
test

24. Chronic diseases associated with vitamin D deficiency
Muscular
skeletal
disorders
Muscular skeltal
•Osteoarthritis
•Osteoporosis
•Sarcopenia
Metabolic
disorders
•Obesity
•Type 2
diabetes
•Fatty liver
disease
Cardiovascular
disease
•Hypertension
•Cardiovascular
disease
•Atherosclerosis
•Stroke
Neurodegenerative
disease
•Alzheimer’s
disease
•Parkinson’s
disease
Cancer
•Lung
•Gastric
•Liver
•Pancreas
•Colon
•Rectal
•Prostate
•Breast
•Uterus
•Cervix
Autoimmune
disease
•Rheumatoid
arthritis
•Lupus
•Systemic
sclerosis
•Inflammatory
disease
•Sjogren’s
syndrome
•Psoriatic
arthritis
•Ankylosing
arthritis
©DRKKFNG

25. Treatment of Vitamin D Deficiency
https://goodopemk.live/product_details/19209144.html

26. Summary of reported benefits of vitamin D in
non-communicable chronic diseases (2023)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9132394/#:~:text=However%2C%20a
%20meta%2Danalysis%20of,chronic%20inflammation%20in%20adipose%20tissue.
●

27. Summary of reported benefits of vitamin D in
acute diseases (2023)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9132394/#:~:text=However%2C%20a
%20meta%2Danalysis%20of,chronic%20inflammation%20in%20adipose%20tissue.

28. Summary of meta-analysis of effects of vitamin D supplementation on
medical conditions with deficient vitamin D (2019-2023)
©DRKKFNG

29. Doses of vitamin D recommended or administered in interventions
studies with reported benefits in chronic diseases (2023)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9132394/#:~:text=However%2C%20a%20
meta%2Danalysis%20of,chronic%20inflammation%20in%20adipose%20tissue.

30. SYNERGISTIC ACTIONS OF VIT D3 + VIT K2

31. Synergistic effects of vitamin D3 and vitamin K2 on
bone health and cardiovascular health
©DRKKFNG

32. Sources of different forms of vitamin K?
Vitamin K
Vitamin K1
Phylloquinone
green vegetables
Vitamin K2
Menaquinone
gut bacteria
Vitamin K3
Menadione
synthetic
©DRKKFNG

33. Conversion of vitamin K1 and K2 to Hydroquinone

34. Modification of inactive VKDP (vitamin K-dependent proteins)
to functional peptides
Clotting Bone health
Cardiovascular health

35. Comparison of functions of
vitamin D3 and vitamin K subtypes
Vitamin D3
Calcitriol
• Calcium
absorption
• Immuno-
modulation
• Cell differentiation
K1
• Blood clotting +++
• Bone health +
K2
MK-4
• Blood clotting ++
• Bone health +
K2
MK-7
• Blood clotting +
• Bone health +++
• Cardiovascular
health +++
©DRKKFNG

36. Diseases associated with vitamin K deficiency (2023)
https://www.researchgate.net/publication/368288767_Clinical_Medicine_The_Pleiotro
pic_Role_of_Vitamin_K_in_Multimorbidity_of_Chronic_Obstructive_Pulmonary_Disease
New concept

37. The rationale for combining vitamin D3 with vitamin K2
https://goodrwov.live/product_details/12931072.html
▪ Vitamin D3 helps the body absorb calcium
▪ Vitamin K2 helps to activate protein that directs
calcium from the blood vessels to the bones

38. The combination of vitamin K and vitamin D increases the total BMD:
a meta-analysis of seven randomized controlled trials (2020)
https://pubs.rsc.org/en/content/articlelanding/2020/fo/c9fo03063h/unauth
Favors Placebo Favors vit K + vit D

39. Summary of clinical trials of combined vitamin D and K
supplementation on cardiovascular health and disease:
mixed results (2017)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613455/#:~:text=Taken%20together%
2C%20animal%20and%20human,cellular%2C%20and%20some%20human%20studies.

40. Examples of some commercial vitamin D3 + vitamin K2 products

41. Range of dosage of vitamin D3 and K2 in dietary supplements

42. Summary

43. at
Kevin KF Ng, MD, PhD.
Email: kevinng68@gmail.com
Other topics on Food as Medicine are available at
https://www.slideshare.net/ssusera9ba27
Do you have any questions?
If so, please feel free to contact me