Vitamin D deficiency has been linked to various diseases. It is synthesized in the skin upon sun exposure and is also obtained through dietary sources. A history of vitamin D research is provided dating back to the 17th century. Sources of vitamin D and requirements are outlined. Deficiency can result in nonspecific symptoms and increase risks of various conditions like cancers, cardiovascular disease, respiratory infections, autoimmune diseases, and mortality. Maintaining sufficient levels through diet and sun exposure is recommended.

1. VITAMIN D DEFICIENCY ANDVARIOUS
DISEASES
By
DR SAMIR SALLY,MD
Consultant Medicine & Nephrology,
Mansoura Urology & Nephrology Center,
Mansoura University

2. VITAMIN D
• Vitamin D is a fat-soluble vitamin
• Vitamin D is considered a pro-hormone and not actually a vitamin.
• Vitamins are nutrients that cannot be created by the body
• However, vitamin D can be synthesized by our body when sunlight hits our skin.
• It is transported by blood, activated and act on receptors in target tissues
• Feed back regulation by Plasma ca level and active vitamin D

3. HISTORY OFVITAMIN D
• •In17th-century,the first extensive description of the clinical picture of
rickets,carried out by DanielWhistler and Francis Glisson.
• •At the beginning of the 20th century , the discovery of the dual origin of vitamin D;
dietary vitamin D and the curative effects of UV light.

4. HISTORY OFVITAMIN D
• •In1938,AdolfWindaus earned the Nobel prize due to the chemical
identification and chemical synthesis of vitaminD.
• •In1964-1984,
• Acceptance thatVitamin D was a precursor of a steroid hormone
(1,25(OH)2D3) and the first isolation and characterization of a specific
binding protein (receptor) for1,25(OH)2D3;vitamin D receptor(VDR).

5. HISTORY OFVITAMIN D
• •In 1987–2012, expansion of the vitamin D endocrine system after discovery of
VDR in many tissues.

6. SOURCES OFVITAMIN D
• 90% through skin via UV exposure cholecalciferol- vitamin D3-inactive
• 10% from food Ergocalciferol- vitamin D2 -inactive

8. SOURCES OFVITAMIN D
• Dietary supplements
• Vitamin D2 is manufactured by the UV irradiation of ergosterol in yeast, and
• vitamin D3 is manufactured by the irradiation of 7-dehydrocholesterol from lanolin and
the chemical conversion of cholesterol .

9. SOURCES OFVITAMIN D- SUN EXPOSURE
• Ultraviolet (UV) B radiation penetrates uncovered skin and converts cutaneous
7-dehydrocholesterol to previtamin D3, which in turn becomes vitamin D3
• Season, time of day, length of day, cloud cover, skin melanin content, and
sunscreen are among the factors that affect UV radiation exposure and vitamin
D synthesis .
• Complete cloud cover reduces UV energy by 50%; shade (including that
produced by severe pollution) reduces it by 60% .
• UVB radiation does not penetrate glass, .
• Sunscreens with a sun protection factor block vitamin D-producing UV rays.

10. SOURCES OFVITAMIN D
• Approximately 5–30 minutes of sun exposure between 10 AM and 3 PM at least twice a
week to the face, arms, legs, or back without sunscreen usually lead to sufficient vitamin
D synthesis
• UV radiation is a carcinogen responsible for most of the estimated 1.5 million skin
cancers and the 8,000 deaths due to metastatic melanoma that occur annually in the
United States .

15. VITAMIN D REQUIREMENTS
• One microgram of vitamin D is equal to 40 IU of vitamin D.
• Updated by the U.S. Institutes of Medicine (IOM) in 2010 and are currently set at:
• Infants 0-12 months - 400 IU (10 mcg).
• Children 1-18 years - 600 IU (15 mcg).
• Adults to age 70 - 600 IU (15 mcg).
• Adults over 70 - 800 IU (20 mcg).
• Pregnant or lactating women - 600 IU (15 mcg).

17. VITAMIN D DEFICIENCY
• Getting sick or infected more often.
• Fatigue.
• Painful bones and back.
• Depressed mood.
• Impaired wound healing.
• Hair loss.
• Muscle pain.

18. VITAMIN D DEFICIENCY
• IfVitamin D deficiency continues for long periods, it can result in:
• obesity
• diabetes
• hypertension
• depression
• fibromyalgia
• chronic fatigue syndrome
• osteoporosis
• neurodegenerative diseases, such as Alzheimer's disease
• Vitamin D deficiency may also contribute to the development of certain cancers, especially breast, prostate, and colon cancers.

19. VITAMIN D
BEYOND BONES AND KIDNEYS
 Neuromuscular stability
 Skeletal muscle power
 Cardiovascular
 Myocardial hypertrophy
 Vascular Smooth Muscle
hypertrophy
 Endothelial cell function
 Proteinuria
 Immune system
 Cancer
 Hematopoiesis
 Diabetes
 Ageing
 Preeclampsia
 All-cause mortality

20. VITAMIN D AND PSYCHATRY
• Commentary on “Future Directions inVitamin D Research in Psychiatry” José Salavert,
MD, PhD
• The Journal of Nervous and Mental Disease •Volume 205, Number 10, October 2017
• To sum up, adequate vitamin D status may play a very important role in appropriate brain
development and function, mainly in specific periods of life, including the prenatal and
neonatal periods.

21. VITAMIN DTREATMENT AND AUTISM
• Link betweenVitamin D treatment and autism prevention
• Summary:
• Giving vitamin D supplements to mice during pregnancy prevents autism traits in their
offspring, researchers have discovered.The discovery provides further evidence of the crucial
role vitamin D plays in brain development.
• Journal Reference:
• StephanieVuillermot,Wei Luan, Urs Meyer, Darryl Eyles. Vitamin D treatment during
pregnancy prevents autism-related phenotypes in a mouse model of maternal
immune activation. Molecular Autism, 2017; 8 (1) DOI: 10.1186/s13229-017-0125-0

22. VITAMIN DTREATMENT AND AUTISM
• Abstract An increasing amount of evidence points to the possibility that gestational and
early childhood vitamin D deficiency [25(OH)D < 40 ng/ml] cause some cases of autism.
• Children who are, or who are destined to become, autistic have lower 25(OH)D levels at
3 months of gestation, at birth and at age 8 compared to their unaffected siblings.
• Rev Endocr Metab Disord (2017) 18:183–193

23. VITAMIN D AND AUTISM
• The vitamin D doses used in these children were 300 IU/KG/day up to a maximum of
5000 IU/day (highest final 25(OH)D level reached was 45 ng/ml).
• In terms of prevention, a recent small study showed vitamin D supplementation during
pregnancy (5000 IU/day) and during infancy and early childhood (1000 IU/day)
significantly reduced the expected incidence of autism in mothers who already had one
autistic child from 20% to 5%.

24. VITAMIN D AND RESPIRATORYTRACT
INFECTION
• Vitamin D supplements can help prevent acute respiratory tract infections, particularly among
people deficient in vitamin D, new study results suggest.
• The results, published in The BMJ, are based on a new analysis of raw data from around 11,000
participants in 25 clinical trials conducted in 14 countries including the UK, USA, Japan, India,
Afghanistan, Belgium, Italy,Australia and Canada. participants aged 0-95.
• BMJ, 2017; i6583 DOI: 10.1136/bmj.i6583

25. VITAMIN D AND COLD
• Individually, these trials yielded conflicting results, with some reporting that vitamin D
protected against respiratory infections, and others showing no effect.
• Vitamin D supplementation is safe and inexpensive, so reductions in acute respiratory
infections brought about by vitamin D supplementation could be highly cost-effective

26. VITAMIN D AND RESPIRATORYTRACT
INFECTION
• After adjusting for potentially influential factors, such as age, sex and study duration, the
researchers found vitamin D supplementation resulted in a 12% reduction in the
proportion of participants experiencing at least one acute respiratory tract infection.

27. VITAMIN D AND COLD
• Vitamin D protects against colds and flu, finds major global study
• Date: February 16, 2017
• Source: University of Queen Mary London
• Summary:
• Vitamin D supplements protect against acute respiratory infections including colds and
flu, according to a study..

28. VITAMIN D AND COLD
• Vitamin D -- is thought to protect against respiratory infections by boosting levels of
antimicrobial peptides --- in the lungs.
• Results of the study fit with the observation that colds and 'flu are commonest in winter
and spring, when levels of vitamin D are at their lowest.
• They may also explain why vitamin D protects against asthma attacks, which are
commonly triggered by respiratory viruses.

29. VITAMIN D AND COLD
• Daily or weekly supplementation halved the risk of acute respiratory infection in people
with the lowest baseline vitamin D levels, below 25 nanomoles per litre (nmol/L).
• Overall, the reduction in risk of acute respiratory infection induced by vitamin D was on
a par with the protective effect of injectable 'flu vaccine against 'flu-like illnesses.

30. VITAMIN D AND MORTALITY
• Vitamin D reduces early mortality
• Journal Reference:
• Eirik Degerud, Ottar Nygård, Stefan deVogel, Rune Hoff, Gard Frodahl Tveitevåg Svingen, Eva Ringdal
Pedersen, DennisWinstonTrygve Nilsen, Jan Erik Nordrehaug, Øivind Midttun, Per Magne Ueland, Jutta
Dierkes. Plasma 25-hydroxyvitamin D and mortality in patients with suspected stable angina
pectoris. The Journal of Clinical Endocrinology & Metabolism, 2018; DOI: 10.1210/jc.2017-02328
• Summary:
• The study concludes that people who have suffered from cardiovascular disease, and have a normal
intake of vitamin D, reduce their risk of morality as a consequence of the disease by 30 per cent

31. VITAMIN D AND MORTALITY
• The study followed as many as 4,000 patients with cardiovascular diseases from year
2000, for a period of 12 years.The average age of the participants was 62 years old at the
start of the study.
• Difficult recommendations
• It is difficult to give general a recommendation of how much vitamin D supplementation
one should take.
• "The optimal amount of vitamin D-supplement varies from one person to another. It
depends where you live, and what kind of diet you have,".

32. VITAMIN D AND MORTALITY
• For example, the Nordic countries recommend an intake of 10 microgram per day from
all vitamin D-sources, USA and Germany recommends 15 micrograms .
• "Even if Norwegians receive less sun then the Germans, the Norwegians have more fish
in their diet. Fish and cod liver oil are important sources to vitamin D during the winter, i

33. VITAMIN D AND MORTALITY
• Should measure levels
• Dierkes advices all who have experienced cardiovascular diseases to measure their levels of
vitamin D, so that these can be better regulated, and the need for supplements assessed.
• "It is, however, important to take in account that the levels vary seasonally
• A recent systematic review and meta-analysis of randomized controlled trials (RCTs),2017
found that vitamin D supplementation is associated with decreased all-cause mortality risk
among critically ill adults

35. VITAMIN D3 AND CARDIOVASCULAR DISEASES
• Date: January 30, 2018, published in the International Journal of Nanomedicine.
• Summary:
• A new study shows thatVitamin D3 could help restore damage to the cardiovascular
system caused by diseases like hypertension and diabetes

36. VITAMIN D3 AND CARDIOVASCULAR
DISEASES
• A new study conducted by Ohio University scientists suggests that a little more sunlight
might help restore damage to your cardiovascular system.
• In recent years, in clinical settings people recognize that many patients who have a heart
attack will have a deficiency of D3.
• It doesn't mean that the deficiency caused the heart attack, but it increased the risk of
heart attack,".

37. VITAMIN D3 AND CARDIOVASCULAR
DISEASES
• A major discovery from these studies is that vitamin D3 is a powerful stimulator of nitric
oxide (NO), which is a major signaling molecule in the regulation of blood flow and the
prevention of the formation of clots in the cardiovasculature.
• Additionally, vitamin D3 significantly reduced the level of oxidative stress in the
cardiovascular system.

38. VITAMIN D3 AND CARDIOVASCULAR
DISEASES
• Studies, performed at Ohio University, are the first to identify the molecular mechanism
of vitamin D3-triggered restoration of the function of damaged endothelium in the
cardiovasculature.
• This suggestion is strongly supported by several clinical studies which indicate that
vitamin D3 at doses higher than those currently used for the treatment of bone diseases,
may be highly beneficial for the treatment of the dysfunctional cardiovascular system.

39. VITAMIN D AND AF
• With this knowledge, atrial fibrillation and vitamin D deficiency are associated with worse
prognosis in patient with heart failure.
• If atrial fibrillation occurs in patients with heart failure, especially in the first 6 months
after diagnosis, vitamin D deficiency should be considered.
• Letter to the editor J Cardiovasc Med 2017, 18:121
• Bermuda triangle; heart failure, atrial fibrillation, and vitamin D deficiency

40. VITAMIN D LEVELS IN CARDIOVASCULAR DISEAS
• Peripheral arterial disease:
• RR of peripheral arterial disease 1.8 in those with 25 -OH
levels <17.8 ng/ml compared to those with levels > 29.2
mg/ml.
4,839 participantes in NHANES

41. VITAMIN D AND PREGNANCY
VDD is associated with
• Preeclampsia
• Insulin resistance & gestational diabetes mellitus
• Immune modulation
• Preterm delivery
• LBW
• An increased risk for caesarean section delivery
• Impaired neonatal immunity

42. VITAMIN D AND PREGNANCY
• Insufficient evidence to guide recommendations on vitamin D in pregnancy
• 'Coordinated effort' and 'large new trials' still needed to address unanswered questions
about effects of prenatal vitamin D supplementation, say researchers
• Date: November 30, 2017 Source: BMJ
• Summary:
• There is currently insufficient evidence to guide recommendations on the use of vitamin
D supplements in pregnancy, conclude researchers in a new report

43. VITAMIN D AND PREGNANCY
• WHO does not advise healthy women to take vitamin D supplements during pregnancy.
• They analysed results from 43 randomised controlled trials involving 8,406 women, to
estimate the effects of taking vitamin D supplements during pregnancy on 11 maternal
and 27 child outcomes.
• The results show that taking supplements during pregnancy increased vitamin D levels in
both the mother's bloodstream and umbilical cord blood, but the researchers did not
consistently find that higher doses of vitamin D led to healthier women and babies.

44. VITAMIN D AND PREGNANCY
• Overall, vitamin D increased average birth weight by 58g and reduced the risk of having a
small baby.
• There was a lack of evidence of benefits of vitamin D supplements for maternal health
conditions related to pregnancy, no effect on other birth outcomes of public health
importance, such as premature birth, and scant evidence on safety outcomes.
• There was strong evidence that vitamin D reduced the risk of wheeze in offspring by 3
years of age..

45. VITAMIN D AND PREGNANCY
• They concluded that "there is currently insufficient evidence to guide prenatal vitamin
supplementation recommendations.“
• Journal Reference:
• Daniel E Roth, Michael Leung, Elnathan Mesfin, Huma Qamar, JessicaWatterworth, Eszter
Papp. Vitamin D supplementation during pregnancy: state of the evidence
from a systematic review of randomised trials. BMJ, 2017; j5237 DOI:
10.1136/bmj.j5237

49. VITAMIN D AND OBESITY IN CHILDREN
• Pregnant women deficient in vitamin D may give birth to obese children
• Vitamin D supplements during pregnancy might help stem childhood obesity.
• Date: February 13, 2018, journal Pediatric Obesity
• "It's possible that children of mothers with low vitamin D have higher body mass index
and body fat because vitamin D appears to disrupt the formation of fat cells," Chatzi said.

50. VITAMIN D AND OBESITY IN CHILDREN
• Advice to moms: Take prenatal vitamins
• Most American doctors recommend that women start taking prenatal vitamins before
trying to conceive to make sure folic acid, iron, calcium and other nutritional levels are
adequate to prevent birth defects.
• Most prenatal vitamins contain 400 international units (IU) (10 micrograms) of vitamin D
per tablet.

51. VITAMIN D AND OBESITY IN CHILDREN
• The Institute of Medicine ofThe National Academies recommends that females 1 to 70
years old consume 600 IU (15 micrograms) of vitamin D daily, regardless of their
pregnancy status.
• The group sets tolerable maximum levels at 4,000 IU (100 micrograms) for pregnant and
non-pregnant women who are 19 and older.
• "It's too early for researchers to recommend increasing the standard amount of vitamin
D contained in prenatal vitamins,"

53. VITAMIN D AND CANCER
• They analysed data from the Japan Public Health Center-based Prospective (JPHC) Study,
involving 33,736 male and female participants aged between 40 to 69 years.
• Vitamin D levels varied depending on the time of year the sample was taken.
• Participants were then monitored for an average of 16 years, during which time 3,301
new cases of cancer were recorded
• The researchers found that a higher level of vitamin D was associated with a lower
(around 20%) relative risk of overall cancer in both men and women

54. VITAMIN D AND CANCER
• Higher vitamin D levels were also associated with a lower (30-50%) relative risk of liver
cancer, and the association was more evident in men than in women.
• No association was found for lung or prostate cancer, and the authors note that none of
the cancers examined showed an increased risk associated with higher vitamin D levels.

55. VITAMIN D AND CANCER
• The authors say their findings support the theory that vitamin D may protect against the
risk of cancer, but that there may be a ceiling effect, which may suggest that there are no
additional benefits beyond a certain level of vitamin D.
• Emerging epidemiologic data suggest that vitamin D may have a protective effect against
colon cancer, but the data are variable for cancers at other sites.
• A recent review found an increased risk of pancreatic cancer associated with high levels
of serum 25(OH)D (≥100 nmol/L or ≥40 ng/mL).

56. VITAMIN D AND CANCER
• However, theWomen’s Health Initiative, in which 36,282 postmenopausal women of
various races and ethnicities were randomly assigned to receive 400 IU vitamin D plus
1,000 mg calcium daily or a placebo, found no significant differences between the groups
in the incidence of colorectal cancers over 7 years.
• A large observational study with participants from 10 western European countries also
found a strong inverse association between prediagnostic 25(OH)D concentrations and
risk of colorectal cancer .

57. VITAMIN D AND MUSCLOSKELETAL PAIN
• A recent study published in the International Journal of Rheumatic Diseases discovered that
vitamin D replacement therapy improved musculoskeletal symptoms, depression and
quality of life among patients with chronic widespread pain.
• Chronic widespread pain (CWP) is defined as pain persisting for at least three months. It
differs from localized pain by both its distribution throughout the body and by the
heightened pain intensity.

58. VITAMIN D AND MUSCLOSKELETAL PAIN
• Patients with CWP are more likely to experience depression, anxiety and a lower quality
of life.
• CWP is very common, affecting approximately one in five people.
• The most severe form of CWP is formally known as fibromyalgia.

59. VITAMIN D AND MUSCLOSKELETAL PAIN
• Vitamin D helps maintain muscle strength, while reducing inflammation.
• This combination led researchers to conduct a randomized controlled trial in which they
discovered vitamin D supplementation significantly reduced musculoskeletal pain.
• Furthermore, several randomized controlled trials have concluded that vitamin D is
an effective antidepressant.

60. VITAMIN D AND MUSCLOSKELETAL PAIN
• The clinical trial included 58 CWP patients who were considered vitamin D deficient as
defined by levels less than 25 ng/ml.
• All patients received 50,000 IU of vitamin D3 weekly for three months.
• The researchers concluded
• “A 3-month replacement treatment has provided reductions in musculoskeletal
symptoms, level of depression and an increase in quality of life of patients with
nonspecific CWP and vitamin D deficiency.
• Patients with FM or CWP should be investigated in regard to deficiency of vitamin D.

61. MUSCLE WEAKNESS AND FALLS
• Proximal muscle weakness
• Chronic muscle aches
• Myopathy
• Increase in falls
• Dailly 700 and 800 IU/d in a vitamin D-deficient elderly population can
significantly reduce the incidence of falls.

62. VITAMIN D AND SLEEP QUALITY
• RCT finds vitamin D supplements improve sleep quality
• Posted on: May 29, 2017 by AmberTovey
• A new randomized controlled trial (RCT) published in the journal Nutritional Neuroscience
found that vitamin D supplementation improved sleep quality, increased sleep duration
and decreased the time it takes to fall asleep among 20 to 50-year old adults with sleep
disorders.

63. VITAMIN D ANDTYPE 2 DIABETES
Strong evidence has emerged that vitamin D alters glucose metabolism through its action
on synthesis and transport of insulin and its signalling pathways, and it also has a widespread
role in regulating insulin sensitivity and resistance.
Obese people have been found to have lower stores of vitamin D which predispose them
to inflammation and insulin resistance, leading to alteration in glucose homeostasis and the
development of type 2 diabetes.
Practical Diabetes 2017; 34(1): 19–24

64. VITAMIN D AND OSTEOPOROSIS
• More than 40 million adults in the United States have or are at risk of developing
osteoporosis
• Osteoporosis is most often associated with inadequate calcium intakes, but insufficient
vitamin D contributes to osteoporosis by reducing calcium absorption .
• Adequate storage levels of vitamin D maintain bone strength and might help prevent
osteoporosis in older adults, non-ambulatory individuals who have difficulty exercising,
postmenopausal women, and individuals on chronic steroid therapy

65. VITAMIN D AND OSTEOPOROSIS
• Normal bone is constantly being remodeled. During menopause, the balance between
these processes changes, resulting in more bone being resorbed than rebuilt.
• Several medical groups and professional societies support the use of HRT as an option
for women who are at increased risk of osteoporosis or fractures .

66. VITAMIN D AND OSTEOPOROSIS
• Among postmenopausal women and older men, supplements of both vitamin D and calcium
result in small increases in bone mineral density throughout the skeleton.
• However, a large study of women aged ≥69 years followed for an average of 4.5 years found
both lower (<50 nmol/L [<20 ng/mL]) and higher(≥75 nmol/L [≥30 ng/mL]) 25(OH)D levels
at baseline to be associated with a greater risk of frailty .
• Women should consult their healthcare providers about their needs for vitamin D (and
calcium) as part of an overall plan to prevent or treat osteoporosis.

67. VITAMIN D AND AUTO IMMUNE DISEASES
• Vitamin D and Autoimmune Diseases
• Published: November, 2017
• Shir Azrielant1,2,Yehuda Shoenfeld1,2,3
• 1Sheba Medical Center,The Zabludowicz Center for Autoimmune Diseases,Tel-Hashomer,
Ramat-Gan, 2Sackler Faculty of Medicine,Tel-Aviv University,
• 3Tel-Aviv University, Incumbent of the Laura Schwarz-Kip Chair for Research of Autoimmune
Diseases, Ramat-Aviv,Tel-Aviv, Israel

68. VITAMIN D AND AUTO IMMUNE DISEASES
• The association between vitamin D deficiency and autoimmune diseases has been
supported by epidemiological studies, demonstrating higher prevalence of vitamin D
deficiency among autoimmune patients, in comparison to the general population.
• Vitamin D was also associated to various autoimmune diseases : systemic lupus
erythematosus, type 1 diabetes mellitus, multiple sclerosis and others.

69. VITAMIN D AND AUTO IMMUNE DISEASES
• People with rheumatoid arthritis are frequently deficient in vitamin D.
• Maintaining vitamin D levels could help to prevent inflammatory diseases such as
rheumatoid arthritis.
• But a study led by researchers at the University of Birmingham found vitamin D is less
effective once inflammatory disease has set in, because of increased insensitivity to the
vitamin.
• Researchers concluded if vitamin D is prescribed to patients with rheumatoid arthritis,
they may require higher doses or treatment to correct the insensitivity of immune cells.

70. VITAMIN D ANDVITILIGO
• Theoretically, vitamin D plays roles in vitiligo pathogenesis through the following
mechanisms:
• (a) proliferation and differentiation of the immune cells and modulation of immune
activities;
• (b) association of its decreased serum levels with increased risk of autoimmune diseases;
• (c) increasing size of melanocytes, number and length of their dendrites, levels of
tyrosinase, and melanin synthesis; and
• (d) increasing serum calcium which has role in pathogenesis of vitiligo, per se.

71. VITAMIN D ANDVITILIGO
• The authors prescribed topical tacrolimus as monotherapy for cases with normal serum
vitamin D level and combination of topical tacrolimus and oral vitamin D for subjects
with decreased levels.
• The study showed a statistically significant improvement of vitiligo in cases under
combination therapy.
• The authors concluded that vitamin D could be a useful supplement in combination with
other therapeutic options for treating vitiligo.
• Received: Accepted: 28 July 2017Vitamin D supplementation for vitiligo

72. VITAMIN D ANDTHYROID DISEASES
• International Journal of Molecular Sciences
• The Role ofVitamin D inThyroid Diseases
• Received: 14 July 2017;Accepted: 7 September 2017; Published: 12 September 2017
• Recent evidence has demonstrated an association between low vitamin D status and
autoimmune thyroid diseases such as Hashimoto’s thyroiditis and Graves’ disease

74. WHO SHOULD BE SCREENED ?
• Elderly
• Patients with known or suspected malabsorption
• Patients with osteoporosis or osteopenia
• CKD and chronic liver disease patients
• Patients with nonspecific musculoskeletal pain
• On medications that induce P-450 enzyme activity
• Obese and pregnant women

75. NOVEMBER 2ND ISVITAMIN D DAY!
• Vitamin D Day is a day to recognize vitamin D deficiency as a world problem. to spread
awareness on the vitamin D deficiency pandemic.
• Researchers agree that at least one third of the world is deficient in vitamin D, and some
scientists even think a greater percent of people are deficient in vitamin D.
• Why are so many people deficient, you might ask? It’s simple really.We get vitamin D
from sun exposure.And now, more than ever, the world’s population lives an indoor
lifestyle, avoiding the sun daily.

76. NOVEMBER 2ND ISVITAMIN D DAY!
• Doctors are beginning to discover that vitamin D deficiency is a risk factor for many
diseases, including heart disease and cancer.
• Furthermore, they’re discovering that vitamin D deficiency may make some diseases
more severe, like respiratory diseases and autoimmune diseases like multiple sclerosis
and lupus.And they’re discovering that vitamin D can be an important piece in the
treatment of some illnesses and diseases, including multiple sclerosis, cystic fibrosis,
asthma and many other diseases!

77. CONCLUSIONS
• Vitamin D is both a vitamin and a hormone,.
• While vitamin D has been typically linked to bone health, its receptor is
widely distributed in many other tissues
• This translates into many functions for vitamin D in extra-osseous tissues,
including the cardiovascular, immune and hematopoietic, as well as the
integrity of the cell cycle at large.
• Improvement in the world’s vitamin D status could significantly reduce risk
of many chronic illnesses including cardiovascular diseases, type II diabetes
and many deadly cancers as well as infectious diseases including upper
respiratory tract infections,and influenza.”

78. Thank you
Dr Samir Sally,MD,MUNC