Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Vitamin D

1,656 views

Published on

Vitamin D at a glance, Vitamin D and its significance in various diseases

Published in: Health & Medicine
  • Don't fear hair loss - fight it! Try Profollica� natural two-step hair loss system for visible results you'll see and love! ■■■ https://tinyurl.com/y49r9d8j
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • How can I improve my memory book? How can I improve my memory recall? visit to learn...♣♣♣ https://tinyurl.com/brainpill101
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Discover How to Cure Acne At Any Age, Even If You�ve Tried Everything And Nothing Has Ever Worked For You Before Click Here ●●● https://bit.ly/2SaU9sk
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Real Money Streams ~ Create multiple streams of wealth from your home! ★★★ https://tinyurl.com/y4urott2
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • I recovered from bulimia. You can too! learn more... ➤➤ http://ishbv.com/bulimiarec/pdf
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Vitamin D

  1. 1. Dr. Manjeeta Gupta08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 1
  2. 2. Sun (UVB) on skin turns cholesterol into vitamin D We can also get Vitamin D from food & supplements Synthesis 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 2
  3. 3. Vitamin D Receptor(VDR) 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 3
  4. 4. Protein Ribosome Messenger RNA makes a copy of DNA Goes out of nucleus to ‘production’ factory (ribosomes) mRNA runs through ribosome like a tape, giving instructions on protein to make DNA is blue print 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 4 Transcription
  5. 5. Genes don’t want to be making proteins continuously – they need to be turned on & off – Regulators Vitamin D  major regulator in humans Over 230 VDRs in nucleus of most tissues found Vitamin D affects gene expression  It turns genes on & off What does Vitamin D do to make such a difference in health? 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 5
  6. 6. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 6 VDR is present in: Kidneys; Parathyroid glands; Osteoclasts & osteoblasts Intestines; Macrophages Nuclei of islets of pancreas; Brain  Neurons, Substantia nigra, Limbic system, Cortex, Cerebellum May stimulate Neurotrophins (regulate neuronal development)….
  7. 7. Adams & Hewison (2008). Nature Clinical Practice Endocrinology & Metabolism, Volume 4, 80-90. TLR = Toll-like receptor allows immune system to recognize microbes by looking at molecular patterns CYP27B1: a gene that encodes an enzyme to convert inactive vitamin D to active vitamin D Active vitamin D VDR = Vitamin D Receptor Active vitamin D binds to VDR 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 8 Vitamin D Signaling Pathway Pathogen invades cell Toll-like receptor signaling activated ↑ Expression of VDR & CYP27B1 genes Active vitamin D binds to VDR Production of cAMP ↑ (fight microbes) Vitamin D & VDR go to nucleus, binds to vitamin D response element (VDRE) Innate Adaptive VDRE
  8. 8. The literature on Vitamin D has exploded in recent years 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 9
  9. 9. No Dodging Prostate Cancer With Vitamin D Vitamin D May Help Curb Breast Cancer, Study Finds Vitamin D Deficiency Worsens Breast Cancer? Study backs Vitamin D in cancer fight ‘Sunshine vitamin’ may ward off breast cancer Vitamin D in preventive medicine: are we ignoring evidence? 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 10
  10. 10. What does vitamin D do? This is one vitamin we ALL need to understand & take from an early age! 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 11
  11. 11. Does sun exposure matter? Further from equator  Less UVB throughout year  Higher incidence of various diseases 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 12
  12. 12. Cancer 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 13
  13. 13. Recent publicity on melanoma - has reduced our sun exposure – so we are getting less vitamin D 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 14
  14. 14. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 15
  15. 15. Vitamin D and Bones 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 16
  16. 16. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 17
  17. 17. 18 Osteoporotic BoneNormal Bone Osteoporosis disease in which bones lose minerals & bone density Bones become thin, fragile & easily broken Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis http://www.surgeongeneral.gov/library/bonehealth Myth  Osteoporosis is only a problem for older women Osteoporosis can occur at any age & in anyone 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade
  18. 18. Parathyroid hormone (PTH) 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 19 Calcium sensing organ
  19. 19. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 20 Vitamin D  inhibits parathyroid gene  supresses proliferation of glands & stimulates cellular differentiation of promyelocytes Renal osteodystrophy (prevent hypertrophy of gland & inhibit secretion of PTH) Calbindin
  20. 20. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 21 Vitamin D in pregnancy
  21. 21. Osteopenia of Prematurity Staging: 1. Hypodensity of bones 2. Abnormalities of metaphyses Fraying and cupping Dense line (healing) 3. Fractures Courtesy of Steve Abrams MD
  22. 22. Vitamin D: Essential for our immune system When ‘Foreign’ protein enters body Helper T cells  turn into Killer T cells An army of specific killer cells attack & kill 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 23
  23. 23. Research from Copenhagen – May 2011 “Without vitamin D the white cells lie dormant!” 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 24
  24. 24. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 25 Researchers at Queen Mary at University of London decided to test out old treatment with modern day antibiotics. What they discovered was that when coupled together, antibiotics & high doses of vitamin D - which is created in body when it is exposed sun - helped people recover faster from tuberculosis." "Before antibiotics were readily available, doctors would to send their patients to receive heliotherapy - basically prescribed sunbathing. Practice was stopped since more effective antibiotics were invented, but physicians have often wondered why sunshine treatment seemed to somewhat work.” 'Sunshine Vitamin' Helps Treat Respiratory infections “272 adults attending emergency department with community-acquired pneumonia were examined for disease severity & outcomes. Over half (53 %) of patients were vitamin D deficient, of which 24 % had severe deficiency. http://www.erscongress2012.org/ http://www.gponline.com/News/article/1148164/vitamin-d-testing-could-slash- pneumonia-deaths/ It has long been thought that by inducing muscle weakness (especially of diaphragm & intercostal muscles), vitamin D deficiency gives rise to difficulties in eliminating respiratory secretions, facilitating development of infections Several epidemiological studies have suggested that vitamin D deficiency is associated with an increased incidence of asthma & allergy symptoms.
  25. 25. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 26 Vitamin D has been shown to influence microarray gene expression in bronchial smooth muscle cells, with consequent effects on remodeling, cell growth & survival Functions of vitamin D also depend on individual VDR variability Lower vitamin D levels are associated with ↑ airway responsiveness, higher eosinophil counts & IgE levels, while higher vitamin D levels associated with a lower likelihood of hospitalization for asthma exacerbations
  26. 26. Whenever there is a risk of infection, make sure Vitamin D levels are optimal Is it a coincidence that flu & infections are higher in winter months? Vitamin D switches on production of over 200 antimicrobial peptides – Most important CATHELICIDIN (naturally occurring broad-spectrum antibiotic) 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 27
  27. 27. A study demonstrated that vitamin D supplementation improved muscular power in healthy overweight & obese individuals within 4 weeks. Elevated vitamin D status was associated with greater losses in waist circumference, with no additional benefits in lean mass accumulation, muscular strength, or glucose tolerance during participation in a 12-week resistance exercise training program. Another study, supports previous findings that indicate a relationship between vitamin D status & waist circumference rather than fat mass. Inverse relationship with waist circumference is particularly important as abdominal fat has been implicated as an important factor in development of Type 2 diabetes. Waist circumference is also an independent risk factor for cardiovascular disease. Therefore, greater decrease in waist circumference associated with higher vitamin D intake represents a potential reduction in risk for metabolic disease & cardiovascular risk. http://www.clinicalnutritionjournal.com/article/S0261-5614(12)00181-1/abstract Vitamin D and waist circumference 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 28
  28. 28. Diabetes in Children under 14 in Finland 1965 -2009 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 29
  29. 29. Vitamin D seems to do all the right things for the heart VDR  Present in artery walls, heart muscle 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 30
  30. 30. Vitamin D in cancer Switches apoptosis back on – programmed cell death 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 31
  31. 31. Vitamin D tells cells when to divide, stop dividing & also when to die (apoptosis) With low vitamin D levels: Cells continue to divide out of control! 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 32 Major vitamin D catabolizing enzyme, CYP24A1 (24- hydroxylase), is often amplified & over expressed in tumor cells
  32. 32. Slows down multiplication & spread of cancer cells 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 33
  33. 33. Reduces growth of new blood vessels to feed cancer cells & ↓ spread 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 34
  34. 34. "Vitamin D3 plays a key role in immune regulation & may protect against aging process. Age-related changes  In outer retina, there is high metabolic demand resulting in a gradual ↑ in extracellular deposition, inflammation, & cell loss  rise to visual decline. Vitamin D3 administration for only 6 weeks in aged mice has a significant impact on this aging process... Recently, vitamin D3 has been linked epidemiologically to protect against age-related macular degeneration." In a study, supplemention with vitamin D3  helps rejuvenate aging eyes by reducing inflammation & amyloid beta (risk factor for age-related macular degeneration  leading cause of blindness) Vitamin D in Eye http://www.neurobiologyofaging.org/article/S0197-4580(11)00519-7/abstract 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 35
  35. 35. “A cohort study included women over age of 75 years to study risk factors for hip fractures over 4 years. Dietary factors & midday sun exposure habits were examined. Presence of Alzheimer’s disease & other dementias was assessed 7 years after enrolment.” Vitamin D and Alzheimer’s http://www.ncbi.nlm.nih.gov/pubmed/22503994 http://blog.vitamindcouncil.org/2012/04/23/dietary-vitamin-d-intake-and-sun- exposure-linked-to-lower-risk-of-alzheimers-in-france/ 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 36 Those in highest 5th of vitamin D intake had ¼ incidence rate of Alzheimer's disease... In addition, those in highest 5th of sun exposure had 50 % less incidence of Alzheimer's..."
  36. 36. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 37 A link between lack of exposure to sunlight, consequent lack of vitamin D production & development of MS Whether low levels of vitamin D affect number of relapses & disease course? There is some evidence that lower levels of vitamin D are associated with higher relapse rates & greater disability One study also found that people with progressive forms of MS had lower levels than those with relapsing remitting MS Whether lack of vitamin D contributes to risk of developing Multiple Sclerosis? http://www.mstrust.org.uk/news/article.jsp?id=5503
  37. 37. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 38 Vitamin D Improves Seizure Control in Epilepsy Pilot study included 13 subjects between ages of 19 - 60, who had had epilepsy anywhere between 10-42 years. All subjects were given a one-time mega-dose of vitamin D3, ranging from 40,000 IU to 200,000 IU, followed by a daily dose of 2,000-2,600 IU for 3 months, in an effort to correct each individual's vitamin D status & bring them up to at least 30 ng/ml. At 90-day follow-up, median vitamin D level for group was 38 ng/ml (23.3 to 45 ng/ml). They then tallied number of seizures experienced during 3-month long treatment period, compared to 3 months prior to treatment. 10 out of 13 had a decrease in number of seizures; 5 of which experienced more than 50 % reduction. 2 participants had more seizures, while 1 experienced no change at all. Overall, group had 40 % reduction in number of seizures. http://www.ncbi.nlm.nih.gov/pubmed?term=Correction%20of%20vitamin%20D%20deficiency%20improves%20seizure%20control%20in%20epilepsy%3A%20A%20pilot%20study
  38. 38. Vitamin D and Depression: Where is all the Sunshine? 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 39
  39. 39. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 40 Role of Vitamin D in skin VDR present on keratinocytes Vitamin D induce differentiation of keratinocytes & inhibit their proliferation Effective in psoriasis vulgaris (hyperproliferative disease), actinic keratitis
  40. 40. Role of vitamin D in hair growth Researchers at Cairo University found - women with hair loss problems also had lower levels of iron & vitamin D Hair loss only got worse as levels dropped “It might regulate expression of genes that promote normal hair follicle growth” 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 41 Some studies have shown that vitamin D when applied topically to scalp can ↓ chance of cancer patients developing hair loss after being given certain types of chemotherapy
  41. 41. Arctic Circle EquatorGeographic Location SeasideElevation Mountains Sun-seeking Behaviors Always outsideNever outside DeepSkin Pigmentation Light Mostly uncoveredCultural Dress Mostly covered Never Owned AnySunscreen Use Applies to any exposed skin SUNLIGHT EXPOSURE FACTORS Assessment of Vitamin D Stores Diet No milk, No fish Vit D fortified Milk, Salmon 3 X a week Present Diseases assoc. with Vit D Deficiency Not present Supplements No supplements 400 IU Vit D per day DIETARY FACTORS
  42. 42. 43 Need more vitamin D with age Age Daily vitamin D (IU) 600 IU 200 IU 400 IU 0 100 200 300 400 500 600 up to 50 51-70 over 70 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade
  43. 43. How much vitamin D should we take? **Some cancers can raise blood calcium level, so in cancer patients ask for calcium levels to be checked before starting & after being on high dose of vitamin D 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 44
  44. 44. UVA UVB Middle hours of day (between 10 am & 2 pm) With low sun, good UVB rays are filtered out & UVA gets through
  45. 45. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 46
  46. 46. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 47
  47. 47. Vitamin D2 (Ergocalciferol) or Vitamin D3 (Calcitriol) Calcitriol analouges – Calcipotriol (topical), Doxercalciferol (1α hydroxy D2) & paricalcitol Adults treated with vitamin D2 showed ↑ total blood levels of 25(OH)D & maintained total blood levels of 1,25(OH)2D same as adults who received same dose of vitamin D3 Recent meta-analysis indicated that vitamin D3 is more efficacious at ↑ serum 25(OH)D concentrations than vitamin D2 11-week course of treatment with 1000 IU vitamin D2, 1000 IU vitamin D3, or combination of 500 IU vitamin D2 & 500 IU of vitamin D3 daily  equivalent ↑ in serum total 25(OH)D levels Type of Vitamin D Supplementation Mayo Clinic Proceedings Volume 88, Issue 7, Pages 720 - 755, July 2013 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 48
  48. 48. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 49
  49. 49. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 50
  50. 50. Skepticism grows regarding widespread vitamin D supplementation • Serious questions about safety & efficacy of popular practices of high-dose vitamin D supplementation across population • One of these concerns is that not all of extra calcium absorption promoted by boosting vitamin D goes into bone to prevent fractures • Serum 25-hydroxyvitamin D levels were positively associated with increased calcified atherosclerotic plaque in aorta & carotid arteries • A large prospective randomized trial assessed effects of using calcium supplements on vascular event rates: NNT for 5 years of supplemental calcium in order to cause one additional MI than with placebo was 44. NNT for one stroke was 56 NNT to cause one additional cardiovascular event was 29 In contrast, NNT to prevent one symptomatic fracture was 50 “The question we have to ask is: What does that low serum vitamin D level mean? Is it the thing that predisposes, or is it somehow a byproduct of illness?” (J.Clin.Endo.Metab. Jan. 8, 2010; Epub ahead of print PMID:20061416) 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 51
  51. 51. Too much Vitamin D – Is it toxic? Vitamin D intoxication  hypercalcemia, hypercalciuria, & hyperphosphatemia  responsible for soft-tissue, vascular calcifications & nephrolithiasis (long term use) Serum 25(OH)D levels markedly elevated (>150 ng/mL) Daily doses of vitamin D3 up to 10,000 IU (safe in healthy males) with no evidence of hypercalcemia / hypercalciuria for 5 months Tolerable upper level – 4000 IU (IOM guidelines)08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 52
  52. 52. Drug interactions 1. Drugs that impair vitamin D absorption –  Obesity medication – Orlistat  Bile acid sequestrants – Cholestyramine & Colestipol 2. Drugs that may ↑ vitamin D catabolism –  Anticonvulsants, cimetidine, thiazides 3. Drugs that may ↓ vitamin D absorption –  Olestra (Fat substitutes)  Liquid paraffin 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 53
  53. 53. 54 Putting it all together… 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade
  54. 54. Low Vitamin D levels associated with: Archives of Neurology, March 2011 American Heart Association's (AHA) Annual Scientific Sessions, Chicago, IL November 15, 2010 Journal of Allergy and Clinical Immunology June 8, 2010 Diabetes Care. 2011 March08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 55
  55. 55. Leg artery disease  80% more (NHANES2001-2004) Heart attacks  62% more (Framingham study,Circulation Jan 2008) High BP  300% more (In15 year study of women in Michigan School of public health, AHA BP Conference 2009) Diabetes  57% more (Australian Institute of medicine 2011) Cancer  72% more colorectal cancer (NHANES 2010)* Low Vitamin D levels 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 56
  56. 56. In people taking Vitamin D supplements: Pancreatic cancer 45% reduction in 120,000 in 2006 All cancers reduced by 77% in 1,200 Cancer Epidemiology Biomarkers & Prevention 15 (9): 1688–95. 2006 The American Journal of Clinical Nutrition 85 (6): 1586–91 2007 American Journal of Clinical Nutrition 91 (5): 1324–35. 2010 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 57
  57. 57. Once the diseases have developed, Vitamin D levels still make a difference: Doubles survival in people with colon cancer Hospitalisation due to heart failure & mortality is reduced Lowered heart deaths by 33% in women Vitamin D supplements reduced cancer by up to 60% women British Journal of Cancer September 15, 2009; 101(6):916-23 European Society of Cardiology (ESC) Congress 2010 August 28-September 1, 2010, Stockholm, Sweden 2nd annual conference on Cardiovascular Disease and Epidemiology Prevention in Honolulu, Hawaii. April 23, 200208-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 58
  58. 58. Cancer Hypertension Heart disease Autism Obesity Rheumatoid arthritis Diabetes 1 and 2 Multiple Sclerosis Crohn"s disease Flu Colds Tuberculosis Septicemia Aging Psoriasis Eczema Insomnia Hearing loss Muscle pain Cavities Periodontal disease Athletic performance Macular degeneration Myopia Pre-eclampsia Seizures Fertility Asthma Cystic fibrosis Migraines Depression Alzheimer’s disease Schizophrenia The list of illnesses benefitting from vitamin D grows by the day 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 59
  59. 59. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 60
  60. 60. 1. Goodman Gillman 2. Martindale 3. KD Tripathi 4. KK Sharma 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 61 References
  61. 61. 08-07-2016 Department of Pharmacology MIMER Medical College Talegaon Dhabade 62 • Determine whether vitamin D inadequacy ↑ cancer risk • Whether greater exposure to nutrient is protective • Need to consider metabolism, catabolism, & VDR polymorphisms • Address methodology to measure serum vitamin D level (biomarkers) • Need surrogate markers of vitamin D activity • Determine molecular targets for vitamin D • Explore vitamin D/sun exposure dilemma Further research is needed:

×