This document discusses possible links between vitamin D deficiency and various geriatric syndromes and common comorbidities. It begins by outlining how vitamin D receptors are present in many tissues beyond the musculoskeletal system. It then examines potential associations between vitamin D deficiency and increased risks of frailty, urinary incontinence, dementia/cognitive impairment, and depression in elderly populations. While evidence is limited and relationships are not clearly causal, several observational studies have found correlations between low vitamin D levels and higher rates of these conditions. More research is still needed, but maintaining adequate vitamin D status may help reduce risks of age-related diseases and functional decline.
Bill Faloon's presentation for Age Reversal webinar on Jan 23rd 2021maximuspeto
Bill Faloon presented an age reversal update on a webinar hosted by the Coalition for Radical Life Extension on January 23rd, 2021. These are his presentation slides.
Bill Faloon gives update about human age-reversal clinical studiesmaximuspeto
In this presentation, Bill Faloon gives an update on clinical studies aimed and reversing age-related degeneration in humans at the DaVinci 50 Masters Conference in Key Largo, Florida on April 29th, 2021.
Bill Faloon's presentation for Age Reversal webinar on Jan 23rd 2021maximuspeto
Bill Faloon presented an age reversal update on a webinar hosted by the Coalition for Radical Life Extension on January 23rd, 2021. These are his presentation slides.
Bill Faloon gives update about human age-reversal clinical studiesmaximuspeto
In this presentation, Bill Faloon gives an update on clinical studies aimed and reversing age-related degeneration in humans at the DaVinci 50 Masters Conference in Key Largo, Florida on April 29th, 2021.
Review by Louis B. Cady, MD (Cady Wellness Institute) of need for vitamin and mineral supplements, current evidence for loss of minerals and nutrients in soils. Reasonable strategies for identifying supplement needs. Understand how declining nutrients, inadequate intake of recommended servings of fruits and vegetables all contribute to chronic health conditions.
A link between premenopausal iron deficiency and breast cancer malignancyEnrique Moreno Gonzalez
Young breast cancer (BC) patients less than 45 years old are at higher risk of dying from the disease when compared to their older counterparts. However, specific risk factors leading to this poorer outcome have not been identified.
Webinar 5: Designing Your Future: WHAT'S COMING NEXT?Louis Cady, MD
In this capstone webinar presentation, closing out Dr. Cady's series on dealing with COVID 19, he turns his attention to a nunmber of interesting thems:
- what's the REAL case fatality rate of COVID 19
- How is it likely that society will reopen?
- What's going to happen in education and medicine?
- What's going to happen when the robots and AI arrive?
- What's the future going to be out 500 years?
Bill Faloon Age Reversal Update at DaVinci 50 Masters Conference 2021maximuspeto
In this presentation, Bill Faloon gives an update on the prospects for human age reversal medicine at the DaVinci 50 Masters Conference in Key Largo, Florida on April 29th, 2021.
Hormones, Cognition, and Mood Changes in Older AdultsLouis Cady, MD
HORMONES, COGNITION AND MOOD CHANGES IN OLDER ADULTS. This is Dr. Cady's lecture from the Age Management Medical Group meeting in las Vegas, NV, PRESENTED 12 2 2012.
Bill Faloon at Healthy Masters Conference 2020maximuspeto
Bill Faloon explores the recent hyperbaric oxygen study published in the journal Aging, in which the researchers reported a 20% increase in average telomere length in the human study volunteers.
Bill Faloon at DaVinci 50 about stroke risk and blood pressuremaximuspeto
In this presentation on Thursday April 29th, 2021 at the DaVinci 50 Mastermind Conference in Key Largo, Florida, Bill Faloon discusses how to optimize blood pressure to reduce stroke risk.
Age Reversal Update from Bill Faloon on December 15th 2020maximuspeto
Bill Faloon of LifeExtension reviews several recent age-reversal topics including the remarkable effects of hyperbaric oxygen on telomere length and senescence in humans and clinical studies designed to assess age-reversal potential of multiple interventions.
2019.12.08 Bill Faloon at Confidential Cures Summit Dec 8 2019.maximuspeto
Bill Faloon presents some remarkable advancements in human age-reversal medicine at the Confidential Cures Summit in Palm Beach Florida on December 8th, 2019.
2019.12.08 Bill Faloon Healthy Masters Portugalmaximuspeto
Bill Faloon presents on current topics related to human age-reversal, including rapamycin, senolytics, metformin, NAD+, and human clinical trials of some of these compounds.
Review by Louis B. Cady, MD (Cady Wellness Institute) of need for vitamin and mineral supplements, current evidence for loss of minerals and nutrients in soils. Reasonable strategies for identifying supplement needs. Understand how declining nutrients, inadequate intake of recommended servings of fruits and vegetables all contribute to chronic health conditions.
A link between premenopausal iron deficiency and breast cancer malignancyEnrique Moreno Gonzalez
Young breast cancer (BC) patients less than 45 years old are at higher risk of dying from the disease when compared to their older counterparts. However, specific risk factors leading to this poorer outcome have not been identified.
Webinar 5: Designing Your Future: WHAT'S COMING NEXT?Louis Cady, MD
In this capstone webinar presentation, closing out Dr. Cady's series on dealing with COVID 19, he turns his attention to a nunmber of interesting thems:
- what's the REAL case fatality rate of COVID 19
- How is it likely that society will reopen?
- What's going to happen in education and medicine?
- What's going to happen when the robots and AI arrive?
- What's the future going to be out 500 years?
Bill Faloon Age Reversal Update at DaVinci 50 Masters Conference 2021maximuspeto
In this presentation, Bill Faloon gives an update on the prospects for human age reversal medicine at the DaVinci 50 Masters Conference in Key Largo, Florida on April 29th, 2021.
Hormones, Cognition, and Mood Changes in Older AdultsLouis Cady, MD
HORMONES, COGNITION AND MOOD CHANGES IN OLDER ADULTS. This is Dr. Cady's lecture from the Age Management Medical Group meeting in las Vegas, NV, PRESENTED 12 2 2012.
Bill Faloon at Healthy Masters Conference 2020maximuspeto
Bill Faloon explores the recent hyperbaric oxygen study published in the journal Aging, in which the researchers reported a 20% increase in average telomere length in the human study volunteers.
Bill Faloon at DaVinci 50 about stroke risk and blood pressuremaximuspeto
In this presentation on Thursday April 29th, 2021 at the DaVinci 50 Mastermind Conference in Key Largo, Florida, Bill Faloon discusses how to optimize blood pressure to reduce stroke risk.
Age Reversal Update from Bill Faloon on December 15th 2020maximuspeto
Bill Faloon of LifeExtension reviews several recent age-reversal topics including the remarkable effects of hyperbaric oxygen on telomere length and senescence in humans and clinical studies designed to assess age-reversal potential of multiple interventions.
2019.12.08 Bill Faloon at Confidential Cures Summit Dec 8 2019.maximuspeto
Bill Faloon presents some remarkable advancements in human age-reversal medicine at the Confidential Cures Summit in Palm Beach Florida on December 8th, 2019.
2019.12.08 Bill Faloon Healthy Masters Portugalmaximuspeto
Bill Faloon presents on current topics related to human age-reversal, including rapamycin, senolytics, metformin, NAD+, and human clinical trials of some of these compounds.
This presentation given to the International Society for Enzymology in Corfu details the extent of vitamin D deficiency in the largest state of Australia, NSW. It highlights the over=testing phenomenon that has occurred and how to correct the problem.
D is for Debacle - The Sun, Vitamin D, 25(OH)D and HealthIvor Cummins
The Story of Vitamin D, and the Debacle of Human Health Impact that has unfolded over the past 50 years, as we allowed the population necessary levels to collapse. For individuals, parents, families, mothers - don't miss this understanding - this is probably the most important single factor for your health and longevity.
This presentation will give a brief idea on proximal myopathy, causes, clinical presentation, history and physical examination, investigations to diagnose the disease easily.
It will be more helpful to medical students.
Vitamin D Deficiency is linked to bone disorders. However, there is insufficient data for establishing guidelines for "adequate levels". Its been close to a century since it was first discovered. But how much do we actually know about it?
Overview of the Health Benefits of Vitamin C by Prof Margreet VissersKiwifruit Symposium
Prof Margreet Vissers, Research Professor at University of Otago, New Zealand: http://www.kiwifruitsymposium.org/presentations/overview-of-the-many-health-benefits-of-vitamin-c/
Presented at 1st International Symposium on Kiwifruit and Health.
Vitamin C is essential for life, and humans obtain this nutrient exclusively through the diet. It functions inside the cells in our bodies, where it plays an important role in supporting many essential processes. One kiwifruit a day gives the daily requirement of vitamin C.
—Chronic patients of spinal cord injury has been detected severe reduction of bone density. Patients with SCI show mostly osteopenia or osteoporosis of the hip and spine. Vitamin D deficiency may contribute to development of osteoporosis in SCI. So a study was conducted on 100 chronic SCI patients to find out status of correlation of Vitamine D and bone mineral density (BMD). Blood samples were collected and investigated routine biochemistry with serum 25(OH)D. DXA scan of hip and spine was also done. This study observed that 55% patients had suboptimal vitamin D. Positive correlation was found between vitamin D & bone mineral density. It is concluded from this study that monitoring of Serum 25(OH)D levels and annual surveillance of bone mineral density is crucial among persons with chronic SCI to reduce progression of osteoporosis and minimize the risk for further fractures. Keywords: 25(OH)D: 25 Hydroxy Vitamin D, DXA: Dual Energy X-Ray Absorptiometry, BMD: Bone Mineral Density.
In this presentation, Dr. Cady builds on previous lectures dealing with anti-oxidants and vitamin, mineral, and soil depletion to add discussions of vinpocetine and Bacopa monieri, as well as a discussion of the Medhya Rasayana approach from centuries old Aryuvedic practice in India. There is an emphasis on obtaining solid multivitamin, multi-mineral, and antioxidant support. References for two supplements lines (Physiologics and Metagenics) are given.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
1. SAMIA AHMED ABDUL-RAHMAN
Assistant Professor of Geriatrics and Gerontology
Faculty of Medicine
Ain Shams University
2014
Vitamin D, Geriatric Syndromes
& Common Comorbidities:
Possible Links
2. *The autocrine/paracrine functions of
vitamin D are becoming increasingly
widely recognized.
*Several organs possess the enzymatic
machinery to convert 25-hydroxyvitamin
D, to the active form,
1,25dihydroxyvitamin D, has provided
new insights into the function of this
vitamin.
- Holick MF 2004 Vitamin D: Importance in the prevention of cancers, type 1 diabetes, heart disease and osteoporosis. Am
J Clin Nutr 79:362–371.
- Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT, Schauber J, Wu K, Meinken C, Kamen DL, Wagner M,
Bals R, Steinmeyer A, Zugel U, Gallo RL, Eisnberg D, Hewison M, Hollis BW, Adams JS, Bloom JR, Modlin RL 2006 Toll-like
receptor triggering of a vitamin D-mediated human antimicrobial response. Science 311:170–173.
10. *
*Yes.
*In fact, it controls over 200 genes,
including genes responsible for the
regulation of:
*cellular proliferation,
*differentiation,
*apoptosis, and
*angiogenesis.
Iida-Klein A, Guo J, Xie LY et al. Truncation of the carboxyl-terminal region of the rat parathyroid
hormone (PTH)/PTH-related peptide receptor enhances PTH stimulation of adenylyl cyclase but not
phospholipase C. J Biol Chem 1995; 270: 8458–8465.
11. Although there is no consensus on optimal
levels of 25-hydroxyvitamin D as measured
in serum, most experts defined the
different vitamin D status as :
Holick MF. High prevalence of vitamin D inadequacy and implications for
health. Mayo Clin Proc 2006;81:353-73.
20. 25-hydroxyvitamin D deficiency is
associated with debilitating chronic
diseases and age-related conditions
that may influence physical
functioning and hence relation to
frailty was considered in research.
Wilhelm-Leen ER, Hall YN, deBoer IH, Chertow GM. Vitamin D deficiency and frailty in older Americans. J Intern
Med 2010; 268: 171–180.
21. The largest of these studies was that of
Wilhelm-Leen and colleagues (2010). Using
data from the 3rd National Health and
Nutrition Survey (NHANES III), 25-
Hydroxyvitamin D deficiency, defined as a
serum concentration <15 ng/mL), was
associated with a 3.7-fold increase in the
odds of frailty amongst whites and a 4-fold
increase in the odds of frailty amongst non-
whites.
- Wilhelm-Leen ER, Hall YN, deBoer IH, Chertow GM. VitaminDdeficiency and frailty in older Americans. J Intern Med
2010; 268:171–180.
22. *A cross-sectional study on a total of 1,504
community-dwelling men aged 60-79 years-
using multinomial logistic regression- found
lower levels of 25(OH)D were associated
with being pre-frail and frail even after
adjustment for confounders.
*Among the five frailty phenotypes (FP)
criteria, only sarcopenia was not associated
with 25(OH)D levels.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke
G, McBurnie MA; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a
phenotype. J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56.
weight loss, muscle weakness, poor endurance, slow motor performance and reduced physical activity
23. *Its relation to sarcopenia was examined again in
the cross-sectional study of Dupuy and colleagues
using data from the EPIDOS study. The results again
showed no association between low muscle mass
and low dietary intakes of vitamin D.
*Longitudinal studies are needed to examine if
giving vitamin D supplementation or vitamin D rich
diet to vitamin D deficient frail persons with
sarcopenia has any effect.
Charlotte Dupuy, V. Lauwers-Cances, G. Abellan Van Kan, S. Gillette, A. -M. Schott, O. Beauchet, C.
Annweiler, B. Vellas, Y. Rolland. Dietary vitamin D intake and muscle mass in older women. Results
from a cross-sectional analysis of the EPIDOS study. The journal of nutrition, health & aging 2013, 17(2),
119-124.
25. *
Urinary continence
requires coordinated
muscle function with
relaxation of the bladder
detrusor allowing the
bladder to fill, followed by
detrusor contraction with
concomitant sphincter
relaxation at a time
controlled by the
individual.
26. Since bladder musculature possesses
vitamin D receptors and responds to
vitamin D analogues, vitamin D deficiency
perhaps could influence bladder/pelvic
floor dysfunction.
- Crescioli C, Morelli A, Adorini L, Ferruzzi P, Luconi M, Vannelli GB, Marini M, Gelmini S, Fibbi B, Donati S, Villari
D, Forti G, Colli E, Andersson KE, Maggi M 2005 Human bladder as a novel target for vitamin D receptor ligands.
J Clin Endocrinol Metab 90:962–972.
- Schroder A, Colli E, Maggi M, Andersson KE 2006 Effects of a vitamin D3 analogue in a rat model of bladder
outlet obstruction. BJU Int 98:637–642.
27. Pelvic floor dysfunction in
females is common, and its
prevalence increases with age.
The prevalence of UI varies by
definition but has been
reported to range between 13-
49%.
• Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, Whitehead WE, Wu J, Brody DJ (2008)
Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300 (11):1311–1316
• Sung VW, Hampton BS (2009) Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin N Am 36:421–443
• Melville JL, Katon W, Delaney K et al. (2005) Urinary incontinence in US women: a population-based study. Arch
Intern Med 165(5):537–42
• Dooley Y, Kenton K, Cao G et al. (2009) Urinary incontinence prevalence: results from the National Health and
Nutritional Examination Survey. J Urol 179(2):656–61
• Irwin DE, Milsom I, Hunskaar S et al. (2006) Population-based survey of urinary incontinence, overactive bladder,
and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 50(6):1306–14
28. Previously; research suggested a
relation between osteoporosis and
pelvic floor muscles function exists
and so the idea to study its relation
to vitamin D deficiency seems
rational.
Holick MF, Chen TC, Lu Z, Sauter E. Vitamin D and skin physiology: a D-lightful story. J Bone Miner Res
2007;22(suppl 2):V28–33.
29. Prospective cohort or randomized
studies investigating the relationship
between vitamin D nutritional status
and PFD symptoms are lacking but
observational studies show a possible
link.
30. *One study including more than 1800
adult women showed that as many
as 82% of the participants had low
levels of vitamin D.
*However those who had pelvic floor
disorders and/or incontinence had
levels significantly lower than those
of the rest of the group.
Badalian, S. and Rosenbaum PF.Vitamin D and Pelvic Floor Disorders in Women: Results From the National Health and
Nutrition Examination Survey Obstetrics & Gynecology, April 2010; vol 115: pp 795-803.
31. *This is not limited to women with UI.
*Studies on males with UI showed significantly
lower levels of vitamin D as well.
*A cross-sectional study on 2387 men with lower
urinary tract symptoms including UI. Although it
included all age groups starting from 20 yet 85%
had vitamin D levels below 30ng/ml and 55% of
them had levels below 20 ng/ml.
*Results showed an association between vitamin D
deficiency and moderate/severe UI.
Vaughan CP1, Johnson TM 2nd, Goode PS, Redden DT, Burgio KL, Markland AD. Vitamin D and lower
urinary tract symptoms among US men: results from the 2005-2006 National Health and Nutrition
Examination Survey. Urology. 2011 Dec;78(6):1292-7.
32. *
*Still, 2 case studies are available; the first was a
78-year-old woman with UUI symptoms who had
vitamin D deficiency [25(OH) D010 ng/ml] who
claims her UI resolved with vitamin D
supplementation.
*The second reported case was a 59-year-old
woman with stress urinary incontinence symptoms
who had a 25(OH)D level of 13 ng/ml. These
symptoms resolved even before normalization of
her serum vitamin D level.
Gau JT. Urinary incontinence resolved after adequate vitamin D supplementation: a report
of two cases.J Am Geriatr Soc. 2010 Dec;58(12):2438-9.
33. *In a small cohort study of patients with
fecal incontinence, it was shown that all
patients had hypovitaminosis D (60% had
vitamin deficiency and 40% with relative
vitamin D insufficiency). The mean
vitamin D level in patients with fecal
incontinence was 17 ng per milliliter
(range 5.4–22.2 ng per milliliter) wither
significantly higher prevalence than the
general population.
Amer A. Alkhatib • Ashok K. Tuteja. High Prevalence of Vitamin D Deficiency Among Patients with
Fecal Incontinence Dig Dis Sci (2010) 55:3632–3633
35. *Research in the last 10 years has yielded
a large amount of knowledge regarding
vitamin D and its previously unknown role
in brain development and function.
*For example, the distribution of the
vitamin D receptor (VDR) has been
mapped in human brain.
D.W. Eyles, S. Smith, R. Kinobe et al.Distribution of the vitamin D receptor and 1 alpha-
hydroxylase in human brain Journal Of Chemical Neuroanatomy, 29 (2005), pp. 21–30
36.
37. *Hypovitaminosis D has been associated
with cognitive decline in the elderly,
Parkinson’s disease and Alzheimer’s
disease patients.
• Evatt ML, DeLong MR, Khazai N, et al. Prevalence of vitamin D insufficiency in patients with Parkinson disease
and Alzheimer disease. Archives of Neurology; 65: 1348–1352, 2008.
• Jorde R, Sneve M, Figenschau Y et al. Effects of vitamin D supplementation on symptoms of depression in
overweight and obese subjects: randomized double blind trial. Journal of Internal Medicine; 264: 599–609,
2008.
• Llewellyn DJ, Lang IA, Langa KM, et al. Vitamin D and risk of cognitive decline in elderly persons. Archives of
Internal Medicine; 170: 1135–1141, 2010.
• May HT, Bair TL, Lappe DL, et al. Association of vitamin D levels with incident depression among a general
cardiovascular population. American Heart Journal; 159: 1037–1043, 2010.
38. *Direct evidence for an association of
vitamin D deficiency with Alzheimer’s
disease (AD) is limited.
*However, low vitamin D levels have been
frequently associated with cognitive
impairment in the elderly and
prospectively with cognitive decline.
• J.S. Buell, B. Dawson-Hughes, T.M. Scott, D.E. Weiner, G.E. Dallal, W.Q. Qui, P. Bergethon, I.H. Rosenberg, M.F.
Folstein, S. Patz, R.A. Bhadelia, K.L. Tucker, 25-Hydroxyvitamin D, dementia, and cerebrovascular pathology in elders
receiving home services, Neurology 74 (2010) 18–26.
• M.L. Evatt, M.R. Delong, N. Khazai, A. Rosen, S. Triche, V. Tangpricha, Prevalence of vitamin D insufficiency in patients
with Parkinson disease and Alzheimer disease, Arch. Neurol. 65 (2008) 1348–1352.
• E. Pogge, Vitamin D and Alzheimer’s disease: is there a link? Consult. Pharm. 25 (2010) 440–450.
• J.W. Miller, Vitamin D and cognitive function in older adults: are we concerned about vitamin D-mentia? Neurology 74
(2010) 13–15.
• D.J. Llewellyn, I.A. Lang, K.M. Langa, G. Muniz-Terrera, C.L. Phillips, A. Cherubini, L. Ferrucci, D. Melzer, Vitamin D
and risk of cognitive decline in elderly persons,Arch. Intern. Med. 170 (2010) 1135–1141.
39. *Results of 2 large cross-sectional studies
(one on 6,257 and one on 498 subjects)
showed an association between cognitive
decline and vitamin D deficiency.
*4 year follow up of these cohort revealed
the same finding.
Slinin Y, Paudel M, Taylor BC, et al. Association Between Serum 25(OH) Vitamin D and the Risk of Cognitive
Decline in Older Women. J Gerontol A Biol Sci Med Sci ; 67 (10): 1092-1098, 2012.
Annweiler C, Rolland Y, Schott AM, et al. Higher Vitamin D Dietary Intake Is Associated With Lower Risk of
Alzheimer’s Disease: A 7-Year Follow-up. J Gerontol A Biol Sci Med Sci; 67 (11): 1205-1211, 2012.
40. *Another large prospective study showed
that cognitive decline and the rate of
decline were increased in subjects
deficient in 25(OH)D (<25 nM).
Llewellyn DJ, Lang IA, Langa KM, et al. Vitamin D and risk of cognitive decline in elderly
persons. Archives of Internal Medicine; 170: 1135–1141, 2010.
41. *However, it is unclear if associations
between hypovitaminosis D and dementia
are causative or circumstantial, but there
is some evidence for symptom
improvements with vitamin D
supplementation.
Jorde R, Sneve M, Figenschau Y et al. Effects of vitamin D supplementation on symptoms of
depression in overweight and obese subjects: randomized double blind trial. Journal of Internal
Medicine; 264: 599–609, 2008.
43. *Vitamin D has also been linked to depression
which is one of the most common mental
disorders in elderly populations.
*Stumpf and colleagues first suggested that
vitamin D may contribute to the higher
prevalence of seasonal affective disorders at
high latitudes.
*However to date, the results of small trials of
vitamin D supplements in seasonal affective
disorder have been inconclusive
Stumpf, W.E., Privette, T.H., 1989. Light, vitamin D and psychiatry. Role of 1,25
dihydroxyvitamin D3 (soltriol) in etiology and therapy of seasonal affective disorder and other
mental processes. Psychopharmacology (Berlin) 97, 285–294.
Gloth 3rd, F.M., Alam, W., Hollis, B., 1999. Vitamin D vs broad spectrum phototherapy in the
treatment of seasonal affective disorder. J. Nutr. Health Aging 3, 5–7.
Lansdowne, A.T., Provost, S.C., 1998. Vitamin D3 enhances mood in healthy subjects during
winter. Psychopharmacology (Berlin) 135, 319–323.
44. *Even with large cross-sectional studies
the results are conflicting.
*A number of cross-section studies have
reported an association between low
vitamin D and depression.
*While other cross-sectional studies have
failed to find such an association when
controlled for potential confounding
factors.
Pan, A., Lu, L., Franco, O.H., Yu, Z., Li, H., Lin, X., 2009. Association between depressive symptoms
and 25-hydroxyvitamin D in middle-aged and elderly Chinese. J. Affect. Disord. 118, 240–243.
Nanri, A., Mizoue, T., Matsushita, Y., Poudel-Tandukar, K., Sato, M., Ohta, M., Mishima, N., 2009.
Association between serum 25-hydroxyvitamin D and depressive symptoms in Japanese: analysis by
survey season. Eur. J. Clin. Nutr. 63, 1444–1447.
Zhao, G., Ford, E.S., Li, C., Balluz, L.S., 2010. No associations between serum concentrations of 25-
hydroxyvitamin D and parathyroid hormone and depression among US adults. Brit. J. Nutr. 104, 1696–
1702.
45. *One large, population-based survey
of the elderly (n = 2070
participants, aged 65 years and
older) reported a significant
increased risk of depressive
symptoms in those with vitamin D
deficiency.
Stewart, R., Hirani, V., 2010. Relationship between vitamin D levels and depressive
symptoms in older residents from a national survey population. Psychosom. Med. 72,
608–612
46. *A 6-year prospective study of 954 adults aged
65 years and older examined the association
between low vitamin D at baseline and
subsequent (incident) depression.
*Those with 25(OH)D less than 50 nM at
baseline (compared with those with higher
levels) experienced significantly higher scores
on measures of depression at 3 and 6 year
follow-up even after adjustment for
confounding factors.
Milaneschi, Y., Shardell, M., Corsi, A.M., Vazzana, R., Bandinelli, S., Guralnik, J.M.,
Ferrucci, L., 2010. Serum 25-hydroxyvitamin D and depressive symptoms in older
women and men. J. Clin. Endocrinol. Metab..
47. *A re-analysis of the Women’s Health
Initiative examined the association
between dietary vitamin D intake at
baseline and depression in a very large
sample (n = 81,189).
*Those with the highest dietary intake has
lower scores on depressive symptoms at
the 3 year follow-up, and this persisted
after adjustments for potential
confounding factors.
Bertone-Johnson, E.R., Powers, S.I., et al. 2011. Vitamin D intake from foods and
supplements and depressive symptoms in a diverse population of older women. Am. J.
Clin. Nutr. 94, 1104–1112.
49. *Of great interest is the role it can play in
decreasing the risk of many chronic
illnesses:
*Infectious diseases
*Malignancies
*Cardiovascular disease
52. *The link between vitamin D deficiency and
susceptibility to infection has been suggested
for longer than a century.
*One of the first clinical trials to use vitamin D
for treatment of infections was on patients
with pulmonary TB in the 1950s and it’s
been demonstrated that vitamin D enhanced
bactericidal activity of human macrophages
against Mycobacterium tuberculosis.
• Khajavi A, Amirhakimi GH. The rachitic lung: pulmonary findings in 30 infants and children with malnutritional rickets. Clin Pediatr
(Phila). 1977;16:36-38
• Martineau AR, Honecker FU, Wilkinson RJ, Griffiths CJ. Vitamin D in the treatment of pulmonary tuberculosis. J Steroid Biochem
Mol Biol. 2007;103:793-798.
• Bhalla AK, Amento EP, Clemens TL, Holick MF, Krane SM. Specific high-affinity receptors for 1,25-dihydroxyvi-tamin D3 in human
peripheral blood mononuclear cells: presence in monocytes and induction in T lymphocytes following activation. J Clin Endocrinol
Metab. 1983;57: 1308-1310.
• Rook GA, Steele J, Fraher L, et al. Vitamin D3, gamma interferon, and control of proliferation of Mycobacterium tuberculosis by
human monocytes. Immunology. 1986;57: 159-163.
• Crowle AJ, Ross EJ, May MH. Inhibition by l,25(OH)2-vitamin D3 of the multiplication of virulent tubercle bacilli in cultured human
macrophages. Infect Immun. 1987;55: 2945-2950.
53. *VDRs are present in cells of the immune system.
*Recent studies have demonstrated that vitamin D
regulates the expression of specific endogenous
antimicrobial peptides in immune cells.
*This action leads to a potential role for vitamin D
in modulating the immune response to various
infectious diseases.
Stumpf WE, Sar M, Reid FA, Tanaka Y, DeLuca HE Target cells for 1,25-dihydroxyvitamin D3 in intestinal
tract, stomach, kidney, skin, pituitary, and parathyroid. Science. 1979;206:1188-1190.
Liu PT, Stenger S, Li H, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial
response. Science. 2006;311:1770-1773.
54. *This induces production of
cathelicidin- which has broad
spectrum antibacterial activity-
from macrophages.
*It also induces the production of
other antimicrobial peptides as β-
defensin that works against
bacteria, fungi, and viruses.
• Ramanathan B, Davis EG, Ross CR, Blecha E Cathelicidins: microbicidal activity, mechanisms of action, and
roles in innate immunity. Microbes Infect. 2002;4: 361-372.
• Wang TT, Nestel FP, Bourdeau V, et al. Cutting edge: 1,25-dihydroxyvitamin D3 is a direct inducer of
antimicrobial peptide gene expression [published correction appears in J Immunol. 2004;173:following
6489]. J Immun. 2004;173:2909-2912.
55. *It has been argued through
observations that the seasonal
variations in vitamin D status could
be a major influence on the flu
season especially that both β-
defensin and cathelicidin play major
role in immune defense of the
respiratory system.
57. *An analysis from the Nurses’ Health
Study cohort (32,826 subjects)
showed that the odds ratios for
colorectal cancer were inversely
associated with median serum levels
of 25(OH)D BUT NOT 1,25(OH)D (the
odds ratio at 16.2 ng/ml was 1.0, and
at 39.9 ng/ml was 0.53; P"0.01).61
- Feskanich D, Ma J, Fuchs CS, et al. Plasma vitamin D metabolites and risk of colorectal
cancer in women. Cancer Epidemiol Biomarkers Prev 2004;13:1502-8.
58. *A prospective study of vitamin D intake
and the risk of colorectal cancer in 1954
men showed a direct relationship (with a
relative risk of 1.0 when vitamin D intake
was 6 to 94 IU per day and a relative risk
of 0.53 when the intake was 233 to 652 IU
per day, P<0.05).
- Gorham ED, Garland CF, Garland FC, et al. Vitamin D and prevention of colorectal cancer. J
Steroid Biochem Mol Biol 2005; 97:179-94.
59. *A study of men with prostate cancer,
the disease developed 3 to 5 years later
in the men who worked outdoors than
in those who worked indoors.
*Also, pooled data for 980 women
showed that the highest vitamin D
intake, as compared with the lowest,
correlated with a 50% lower risk of
breast cancer.
- Luscombe CJ, Fryer AA, French ME, et al. Exposure to ultraviolet radiation: association with
susceptibility and age at presentation with prostate cancer. Lancet 2001;358:641-2.
- Garland CF, Garland FC, Gorham ED, et al. The role of vitamin D in cancer prevention. Am J Public
Health 2006;96:252- 61.
60. *Both prospective and retrospective
epidemiologic studies indicate that levels
of 25(OH)D below 20 ng/ml are
associated with a 30 to 50% increased risk
of incident colon, prostate, and breast
cancer, along with higher mortality from
these cancers.
- Ichikawa S, Guigonis V, Imel EA et al. Novel GALNT3 mutations causing hyperostosis-hyperphosphatemia syndrome
result in low intact FGF23 concentrations. J Clin Endocrinol Metab 2007.
- Ben-Dov IZ, Galitzer H, Lavi-Moshayoff V et al. The parathyroid is a target organ for FGF23 in rats. J Clin Invest 2007;
117: 4003–4008.
- Yamazaki Y, Tamada T, Kasai N et al. Anti-FGF23 neutralizing antibodies show the physiological role and structural
features of FGF23. J Bone Miner Res 2008; 23: 1509–1518.
- Krajisnik T, Bjorklund P, Marsell R et al. Fibroblast growth factor-23 regulates parathyroid hormone and 1alpha-
hydroxylase expression in cultured bovine parathyroid cells. J Endocrinol 2007; 195: 125–131.
62. *Vitamin D deficiency increased insulin
resistance, decreased insulin production, and
was associated with the metabolic syndrome in
one study.
*In another; a combined daily intake of 1200 mg
of calcium and 800 IU of vitamin D lowered the
risk of type 2 diabetes by 33% (relative risk,
0.67; 95% CI, 0.49 to 0.90) as compared with a
daily intake of less than 600 mg of calcium and
less than 400 IU of vitamin D.
- Chiu KC, Chu A, Go VLW, Saad MF. Hypovitaminosis D is associated with insulin resistance and !
cell dysfunction. Am J Clin Nutr 2004;79:820-5.
- Pittas AG, Dawson-Hughes B, Li T, et al. Vitamin D and calcium intake in relation to type 2
diabetes in women. Diabetes Care 2006;29:650-6.
64. Laboratory studies indicate that 1,25-
dihydroxyvitamin D suppresses renin
expression and vascular smooth muscle
cell proliferation.
Vitamin D deficiency is associated with
blood levels of inflammatory markers,
including C-reactive protein and
interleukin-10.
65. *Clinical studies demonstrate an inverse association
between ultraviolet radiation exposure and blood
pressure.
*Patients with hypertension were exposed to
ultraviolet B radiation three times a week for 3
months, 25-hydroxyvitamin D levels increased by
approximately 180%, and blood pressure became
normal (both systolic and diastolic blood pressure
reduced by 6 mm Hg).
- Krause R, Buhring M, Hopfenmuller W, Holick MF, Sharma AM. Ultraviolet B and blood pressure. Lancet
1998;352:709- 10.
- Thomas KK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N Engl J Med
1998;338:777- 83.
- Zittermann A, Schleithoff SS, Tenderich G, Berthold HK, Körfre R, Stehle P. Low vitamin D status: a
contributing factor in the pathogenesis of congestive heart failure? J Am Coll Cardiol 2003;41:105-12.
- Zittermann A. Vitamin D and disease prevention with special reference to cardiovascular disease. Prog
Biophys Mol Biol 2006;92:39-48
66. *Other studies on vitamin D
supplementation to patients with
hypertension showed similar results.
68. *Vitamin D supplementation intake
recommendations are controversial based upon
the targeted condition.
*The Institute of Medicine (IOM) published the
“2011 report” on dietary reference intakes for
vitamin D to be:
*600 IU/day for ages 1 to 70 years, and
*800 IU/day for those older than 71 years in
musculoskeletal conditions.
Ross AC, Manson JE, Abrams SA et al. (2011) The 2011 repor on dietary reference intakes for Calium
and Vitamin D from the Institute of medicine: what clinicans need to know. J Clin Endocrinol Metab
96:53–58
69. * Nevertheless, there is ample
evidence that vitamin D doses
above these recommendations are
well tolerated.
Brazier M, Grados F, Kamel S, et al. (2005) Clinical and laboratory safety of one year's use of a
combination calcium + vitamin D tablet in abmulatory elderly women with vitamin D insufficiency:
results of a multicenter, randomized, double-blind, placebo-controlled study. Clin Ther 27:1885–93
Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol)
supplementation on fractures and mortality in men and women living in the community: randomized
double blind controlled trial. BMJ 326:469
70. *Yet, due to the lack of conclusive level
I evidence, the IOM concluded that
recommendations for vitamin D
supplementation to address any other
condition-specific goal must await
larger epidemiologic or randomized
studies.
72. *Several problems are inevitably connected
with the use of plasma 25(OH)D to assess
vitamin D status.
73. *One important problem is that
plasma 25(OH)D level depends on:
*Unchangeable ecological factors
(season, local weather conditions and
latitude),
*Modifiable individual lifestyle factors
(clothing, dietary habits, etc.), and
*Unmodifiable individual factors (race,
pigmentation, skin thickness and age).
Mosekilde, L., Hermann, A.P., Beck-Nielsen, H., Charles, P., Nielsen, S.P. & Sorensen, O.H. (1999) The
Danish Osteoporosis Prevention Study (DOPS): project design and inclusion of 2016 normal
perimenopausal women. Maturitas, 31, 207209
74. So, most guidelines for elderly
population recommend vitamin D
and calcium supplementation for
the elderly without previous
testing of vitamin D status.
Ross AC, Manson JE, Abrams SA et al. (2011) The 2011 repor on dietary reference intakes for Calium and Vitamin D
from the Institute of medicine: what clinicans need to know. J Clin Endocrinol Metab 96:53–58